psychosomatic medicine Flashcards
Describe the Stress theory
- A circumstance that disturbs, or is likely to disturb, the normal physiological or psychological functioning of a person
- Stimulation of autonomic nervous system particularly the SYMPATHETIC
Describe the neurotransmitter responses to stress
- -Activate Noradrenergic systems: release Catecholamines
- Activate Serotonergic systems: increased Serotonin Turnover
- Glucocorticoids enhance serotonin function
- increased dopaminergic neurotransmission
Describe endocrine responses to stress
- CRH (hypothalamus) triggers release of ACTH
- promotes energy used, increasing cardiovascular activity, and inhibiting functions such as growth, reproduction, and immunity
describe immune responses to stress
-inhibition of immune functioning
what are the musculoskeletal diseases that can present with psychiatric symptoms
- SLE
- MS
Medical symptoms of SLE?
Psychiatric symptoms?
- Fever, photosensitivity, butterfly rash, joint pains, headaches
- Depression, mood disturbances, psychosis, delusions, hallucinations
what are the medical symptoms of MS?
psychiatric symptoms?
- Transient motor/sensory disturbances, impaired vision, diffuse neurological signs with remissions and exacerbations, slurred speech, incontinence
- Anxiety, euphoria, mania
what psychiatric disorders have been evaluated as risk factors for the development and expression of coronary disease?
- Depression
- anxiety
- type A behavior
- hostility
- anger
- acute mental stress
KNow the hyperthyroid and hypothyroid symptoms
Slide 16
What is the correlation b/t DM and psychiatric symptoms
depression
hyponatremia medical symptoms?
Psychiatric symptoms?
- Excessive thirst, polydipsia, stupor, coma, seizures
- Confusion, lethargy, personality changes
Thiamine deficiency medical symptoms?
Psychiatric symptoms?
- Neuropathy, cardiomyopathy, Wenicke-Korsakoff syndrome, malaise, common in alcholics
- Poor concentration, confusion, confabulation
Cobalamin (vitamin B12) deficiency medical symptoms?
Psychiatric symptoms?
- Pallor, dizziness, peripheral neuropathy, dorsal column signs, ataxia
- irritability, inattentiveness, psychosis, dementia
UC shows increased prevalence in what personality disorder
dependent
Crohn’s has high rate of what preexisting disorder
panic
what medications have highest rate of GI disturbances?
- SSRI due to serotonin in GI tract
- N/V
main TCA side effects
- anticholinergic
- constipation, dry mouth
Pancreatic Carcinoma and Psychiatry?
- weight loss
- abdominal pain
- depression
- lethargy
- anhedonia (inability to find pleasure in things that are usually enjoyable)
- apathy
- low energy
Acute Intermittent Porphyria medical symptoms?
Psychiatric symptoms?
- Abdominal pain, fever, nausea, vomiting, constipation, peripheral neuropathy, paralysis
- Acute depression, agitation, paranoia, visual hallucinations
Hepatic encephalopathy medical symptoms?
Psychiatric symptoms?
- Asterixis, hyperreflexia, spider angiomata, palmar erythema, ecchymoses, liver enlargement/atrophy
- Euphoria, disinhibition, psychosis, depression
symptoms of a frontal lobe tumor
- mood changes
- irritability
- Facetiousness
- impaired judgment
- impaired memory
- delirium
- loss of speech
- loss of smell
what is the most common cause of confusion or disorientation among hospitalized patients in general hospitals
Delirium
Bullet points for delirium
- common in elderly, surgical and ICU pts (ICU psychosis)
- educate pts and family PRIOR to hospitalization/surgery
- Reversible, acute onset of impaired cognition, attention, consciousness, perception, sleep patterns (day/night reversal), or emotional states that fluctuate over the course of the day
- often misdiagnosed or unrecognized and thus inappropriately treated or untreated
What are the interventions to mitigate risk factors for Delirium?
- orientation protocols: used of clocks, calendars, windows, verbal reorientation
- Cognitive stimulation: visits from family, friends, but avoid at night
- Facilitate physio sleep: procedures/meds avoided (when possible) during sleeping hours. reduce night time noise
What should be avoid in elderly hospitalized pts
Benzodiazepines
Phencyclidine (PCP) medial symptoms?
psychiatric symptoms?
- elevated BP, tachycardia, NYSTAGMUS, muscular rigidity, vomiting
- Agitation with blank stare, anxiety, stupor, aggression, panic, bizarre behavior
Corticosteroids and psychiatry?
- mania
- psychosis (hallucinations)
- maybe COPD treatment
Avoid what in elderly with delirium
Benzos
An antidepressant can induce what in a bipolar patient
mania
