Psychiatry and physical health

Question 1

What is adjustment disorder?

Answer 1

Maladaptive response to a stressor or significant life event

Question 2

What are differentials for adjustment disorder? (4)

Answer 2

-Recent psychosocial stressors
-Mood swings and preoccupation on stressors
-Typically resolves after 6 months
-Psychotic symptoms usually rare

Question 3

What is psychotic depression?

Answer 3

Experience symptoms of both severe depression and psychosis

Question 4

What are differentials for psychotic depression? (5)

Answer 4

-Recent psychological stressors
-Older age and chronic medical conditions
-No other core features of depression/ biological symptoms
-Paranoid psychosis rare
-Visual hallucinations uncommon

Question 5

What are the differentials for behavioural and psychological symptoms of dementia?

Answer 5

-Known history of recent vascular insult to the brain
-Delusions and hallucinations seen
-Ongoing vascular risk factors and advancing age
-Affected MoCA
-Cognitive impairment
-Feature of a more advanced disease

Question 6

What is the most common cause of post stroke psychosis?

Answer 6

Right sided middle cerebral artery lesions affecting frontal and temporal lobes

Question 7

What are common symptoms of post stroke psychosis?

Answer 7

-Delusions
-Auditory and visual hallucinations

Question 8

What is a potential management of post stroke psychosis?

Answer 8

Antipsychotic medication

Question 9

What is contraindication of using antipsychotics in a patient with dementia?

Answer 9

Increased risk of stroke

Question 10

What are examples of interplay between long term medical conditions and psychological problems?

Answer 10

-Cardiovascular disease and depression/anxiety
-MSK disorders and depression
-Diabetes and depression
-COPD and panic disorder

Question 11

Which physical illnesses cause discrete mental illness?

Answer 11

-Hyperthyroidism → anxiety, mania
-Hypothyroidism → depression, cognitive impairment
-Cushing’s syndrome → depression
-Infections → psychosis, dementia
-Systemic lupus erythematosus → depression
-Cancer → depression
-Parkinson’s disease → depression, anxiety, dementia, psychosis
-Phaeochromocytoma → anxiety

Question 12

What medications cause discrete mental illness?

Answer 12

-Dopamine agonists → psychosis
-L dopa → psychosis, delirium, anxiety, depression
-Steroids → depression, mania, psychosis, anxiety
-Isoniazid → mania, psychosis
-Anticholinergics → delirium, anxiety, psychosis
-Isoretinoin → depression
-Digoxin → depression, psychosis
-Interferon alpha → depression, mania, psychosis

Question 13

What is delirium?

Answer 13

Acute brain failure

Question 14

What are the 3 types of delirium?

Answer 14

-Hyperactive
-Hypoactive
-Mixed

Question 15

What are symptoms of hyperactive delirium?

Answer 15

-Agitation
-Hallucinations
-Inappropriate behaviour

Question 16

What are symptoms of hypoactive delirium?

Answer 16

-Lethargy
-Reduced concentration
-Reduced alertness
-Reduced oral intake

Question 17

What are risk factors for delirium?

Answer 17

-Advancing age
-Cognitive impairment, sensory impairment
-Poor nutrition
-Polypharmacy/alcohol misuse
-Fraility

Question 18

What are some causes of delirium?

Answer 18

-Physical illness
-Physical injury

Question 19

How do we manage delirium?

Answer 19

-Anticipate and address any modifiable risk factors
-Optimise treatment of underlying comorbidities
-Treat underlying causes
-Re orientation strategies
-Normalise sleep wake cycles
-Maintain safe mobility to avoid falls