Psychosomatic medicine Flashcards
psychological factors affecting medical conditions
- mental disorder
- psychological sx’s
- personality traits or coping style
- maladaptive health behaviors
- stress-related physiological response
- other psychological factors
Stress theory
- a circumstance that disturbs the normal physiological or psychological fxning of a person
- stim of SNS- tachycardia, HTN, inc CO- stress!!
Responses to stress
- inc serotonin turnover
- inhibition of immune fxning
Musculoskeletal system- what presents w psychiatric illness/sx’s?
- SLE
- MS
- seizure disorder
SLE
- fever, photosensitivity, butterfly rash, joint pains, HA
- depression, psychosis, delusions, halucinations
MS
- motor/sensory disturbances..etc
- anxiety, euphoria, mania
seziure disorder
-confusion, psychosis, dissociative states, catatonic like state, bizzare behavior
CV system- affected by? affected how?
- depression, anxiety, type A behavior, acute mental stress- risk for coronary dz!!!
- cardiac arrhythmias and sudden cardiac death
- HTN
- heart transplantation response
Resp system- what presents w psychiatric illness/sx’s?
- Asthma
- COPD
Asthma
-30% have panic disorder!!
Fear of dyspnea can trigger anxiety
COPD
-anxiety disorder, panic disorder
Endocrine system- what presents w psychiatric illness/sx’s?
- Hyperthyroidism
- hypothyroidism
- diabetes mellitus
- hyponatremia
- vit def- thiamine (B1), B12
Hyperthyroidism
-nervousness, excitability, irritability, pressured speech, insomnia, psychosis, visual hallucinations
(anxiety)
Hypothyroidism
-lethargy, depressed, personality change, paranoia
depression
diabetes mellitus
depression!!!!
hyponatremia
-confusion, lethargy, personality changes
Thiamine def
(in alcoholics)
-poor concentration, confusion, confabulation (cant remember things!!)
cobalamin (vit B12) def
-irritability, inattentiveness
GI- what presents w psychiatric illness/sx’s?
- peptic ulcer dz
- UC
- CD
peptic ulcer dz
-assoc w stress
ulcerative coliits
-inc prevalence of dependent personalities
crohn’s dz
-high rates of panic disorder
GI- drug SE’s
Antidepressants!!!
- SSRIs- nausea, diarrhea
- TCAs- anticholinergic effects- constipation, dry mouth
Hepatic/Pancreatic system- what presents w psychiatric illness/sx’s?
- pancreatic carcinoma
- acute intermittent porphyria
- hepatic encephalopathy
Pancreatic carcinoma
-depression!!!
acute intermittent porphyria
abd pain + psychosis!
Skin- what presents w psychiatric illness/sx’s?
- atopic dermatitis
- psoriasis
- urticaria
atopic dermatitis
-anxiety, depression
psoriasis
-anxiety, depression
Tumors- what presents w psychiatric illness/sx’s?
- brain neoplasms
- frontal lobe tumor
- occipital lobe tumor
brain neoplasms
-personality changes!
frontal lobe tumor
-mood changes, irritability, facetiousness, impaired judgement, impaired memory, delirium, loss of speech, loss of smell
occipital lobe tumor
-aura, visual hallucinations
Head trauma- sx’s
-confusion, personality changes, memory impairment
aggressive, impulsive
Treatments- stress management
- self-observation (diary- stressors)
- cognitive restructuring
- relaxation exercises
- hypnosis
Consultation-liason psychiatry
-relation b/w medical and psychiatric disorders
Common consultation-liason problems
- suicide attempt/threat- risk factors: men, >45yo, no social support, alcohol dependence, prev suicide attempt, incapacitating medical illness
- depression
- agitation- dementia (#2!)
- hallucinations- DT is most common cause!
- sleep disorder
- confusion- delirium is most common cause! (#!)
delirium
- in elderly, surgical, ICU pts
- educate pt and family PRIOR to hospitalization/surgery!!
- reversible, acute onset of impaired cognition, attention, consciousness, perception, sleep patterns that fluctuate over course of day
Delirium- interventions to mitigate risk factors
-orientation protocols (use of clocks, calendars, windows)
-cognitive stimulation
-facilitate physio sleep
AVOID BENZODIAZEPINES IN ELDERLY HOSPITALIZED PTS (makes them more confuseD)
Substance-induced mental disorders
- PCP
- amphetamine/cocaine
- LSD
- corticosteroids
- benzodiazepines
- anti-parksinson’s meds
- antidepressants
PCP
- elevated BP, tachycardia, nystagmus, muscular rigidity, vomiting
- agitation w blank stare, anxiety, stupor, aggression, panic, bizarre behavior
Amphetamine/cocaine
- inc BP, tachycardia, mydriasis, diaphoresis, tremor
- agitation, delusions, euphoria
LSD
- sympathetic excess
- hallucinations!!
corticosteroids
-mania, psychosis (hallucinations!!)
benzodiazepines
-avoid use in elderly w delirium!!!!
antidepressants
- mania (in bipolar pts)
- insomnia
