Psychiatric problems in the general hospital Flashcards
What is liaison psychiatry?
Subspecialty of psychiatry that works with patients in general hospitals
Liaison psychiatrists provide specialist psychiatric care to medical patients. These include those attending A&E, general hospital in and out patients, and increasingly patients being seen in community and primary care medical services.
See patients with a range of problems including self harm, adjustment to illness, and physical and psychological co-morbidities
Name some common mental health problems seen in the general hospital (7)
Self-harm
Affective and adjustment disorders (depression, anxiety)
Organic brain syndromes (delirium, dementia, amnesic syndromes)
Personality disorders
Psychiatric disorders associated with substance misuse
Eating disorders
Functional disorders
Self-harm: causes, prognosis etc
15-20% of patients will repeat within one year and approximately 1% of patients will go on to complete suicide within one year.
Paracetamol commonest drug taken in overdose.
May be associated with significant mental illness and/or personality disorder (but often is not).
Substance misuse common (alcohol, drugs). And it is often associated with multiple social problems
Self-harm assessment: what do you want to find out from the patient?
Risk factors for further self-harm, completed suicide
Identify mental disorder and need for further psychiatric treatment
Identify psychosocial stressors and patient’s way of coping
Identify appropriate help, even in absence of mental disorder
Environmental and supportive measures in management of delirium (4)
Education of relatives, medical and nursing staff
Make environment safe
Ensure hearing aids are working, glasses available, aim for regular mobilisation
Ensure adequate diet and fluids, reduce stress
Orientation - remind them where they are, avoid bed moves etc
Factors contributing to delirium that need to be corrected (11)
Disorientation Dehydration Constipation Hypoxia Immobility/limited mobility Infection Multiple medications Pain Poor nutrition Sensory impairment Sleep disturbance
What Medication treatment (as required) is used for delirium?
Anti-psychotics - risperidone, quetiapine
Benzodiazepines - lorazepam - use in withdrawal states
Promethazine
What medication should you avoid whilst treating delirium?
Avoid sedation - unless severely agitated or required to facilitate investigation or treatment
Avoid antipsychotics in alcohol/drug withdrawal states unless patient well covered with benzodiazepines due to lowering of seizure threshold
How might Substance misuse/dependence present in general hospital?
physical complications intoxication Withdrawal (including delirium) ARBD trauma/accident drug-induced psychosis (e.g. novel psychoactive substances) feigned illness in order to obtain drugs
What are functional disorders?
An umbrella term used to describe real physical symptoms that are not caused by a structural lesion or abnormality but rather the functioning of bodily systems i.e dissociative disorders or somatoform disorders - an emotional trauma is manifesting as a physical symptom
They present to all specialties
This is different to factitious disorders such as munchausen syndrome
Treatment of Functional neurological disorders
Explanation of FND
Medications for co-morbid mental health problems
Psychological therapies
CBT, Others including IPT and psychodynamic therapies
Other therapies for co-morbid disorders
i.e. OT for agoraphobia
What is functional neurological disorder?
Functional neurological symptoms are neurological symptoms that are genuine, but not due to a disease of the nervous system.
