Psychsomatic Disorders - Hill Flashcards
what are the two assumptions of psychosomatic medicine?
- unity of mind and body
2. psychological factors must be considered in all disease states
a medical condition separate from the mental disorder is present
psychological factors adversely affect the general medical condition in one of the following ways:
- factors influence the course of the general medical condition
- factors interfere with treatment of the general medical condition
- factors constitute additional health risks for the individual
- stress-related physiological responses precipitate or exacerbate symptoms of the general medical condition
psychological factors affecting medical conditions
depression has independent risk factors for what?
- incident of coronary heart disease
- increased risk of subsequent stroke
- number of depressive sx related to the number of diabetic sx
anxiety is a risk factor for what?
- coronary artery disease
- asthma
- specific phobias
a circumstance that disturbs, or is likely to disturb, the normal physiological or psychological functioning of a person
stress
what are the neurotransmitter responses to stress?
- noradrenergic: release catecholamines
- serotogenic: increased 5HT turnover
- dopaminergic: increase DA neurotransmission
medical sx: fever, photosensitivity, butterfly rash, joint pains, headache
psychiatric sx: depression, mood disturbances, psychosis, delusions, hallucinations
systemic lupus erythematosus (SLE)
- supportive psychotherapy can help patients acquire knowledge and maturity to cope and promote positive interactions
medical sx: transient motor/sensory disturbances, impaired vision, diffuse neurological signs with remission and exacerbations, slurred speech, incontinence
psychiatric symptoms: anxiety, euphoria, mania
multiple sclerosis (MS)
medical sx: sensory distortions, violence, belligerence
psychiatric sx: confusion, psychosis, dissociative states, catatonic state, bizarre behavior
seizure disorder
tx: mood stabilizer!!!
depression, anxiety, type A behavior, hostility, anger, acute mental stress have been evaluated as risk factors for the development and expression of what?
coronary disease
- 2x risk of incident of MI and CAD-related mortality
- cardiac arrhythmias and sudden cardiac death (autonomic cardiac modulation is profoundly sensitive to emotional stress)
30% of asthmatics meet criteria for what?
panic disorder or agoraphobia
- fear of dyspnea can trigger asthma attacks and high levels of anxiety
NOTE: anxiety and panic disorder prevalence also high in COPD pts
what benzo did Hill say he gives to COPD patients?
alprazolam
medical sx: heat intolerance, excessive sweating, diarrhea, wt loss, tachycardia, palpitations, vomiting, fine tremor
psychiatric sx: nervousness, excitability, irritability, pressured speech, insomnia, psychosis, visual hallucinations
hyperthyroidism
medical sx: cold intolerance, dry skin, constipation, wt gain
psychiatric sx: lethargy, depressed, personality change, paranoia
hypothyroidism
med sx: paroxysmal HTN, headache, diaphoresis, tremor
psychiatric sx: anxiety, apprehension, feeling of impending doom, panic
pheochromocytoma
medical sx: excessive thirst, polydipsia, stupor, coma, seizures
psychiatric sx: confusion, lethargy, personality changes
hyponatremia
which vitamin deficiency:
med sx: neuropathy, cardiomyopathy, Wernicke-Korsakoff syndrome, malaise, common in alcoholics
psychiatric sx: poor concentration, confusion, confabulation
thiamine
which vitamin deficiency:
med sx: pallor, dizziness, peripheral neuropathy, dorsal column signs, ataxia
psychiatric sx: irritability, inattentiveness, psychosis, dementia
cobalamin (vit B12)
toxic levels of which vitamins cause confusion?
vitamin A, D and iron
toxic levels of what causes psychosis?
copper
toxic levels of what affect peripheral nerve function?
B6 and 12
toxic levels of what cause cognitive dysfunction?
lead
what are the most common side effects of antidepressants?
GI symptoms (N/V)
- SSRI’s have highest rate of GI disturbance d/t 5HT in the GI tract
- TCA side effects due to anticholinergic effects: constipation, dry mouth
weight loss, abdominal pain, depression, lethargy, anhedonia, apathy, decreased energy
pancreatic carcinoma
med sx: abdominal pain, fever, nausea, vomiting, constipation, peripheral neuropathy, paralysis
psychiatric sx: acute depression, agitation, paranoia, visual hallucinations
acute intermittent porphyria (AIP)
med sx: asterixis, hyperreflexia, spider angioma, palmar erythema, ecchymosis, liver enlargement/atrophy
psychiatric sx: euphoria, disinhibition, psychosis, depression
hepatic encephalopathy
mood changes, irritability, facetiousness, impaired judgement, impaired memory, delirium, loss of speech, loss of smell
frontal lobe tumor
what are the treatments for stress management?
- self observation (daily diary)
- cognitive restructuring (CBT)
- relaxation exercises
- mindfulness (mental state achieved by focusing one’s awareness on the present moment, while calmly acknowledging and accepting one’s feelings/thoughts/sensations)
the study, practice, and teaching of the relation between medical and psychiatric disorders
consultation-liaison psychiatry
what are some common consultation-liaison problems?
- suicide attempt or threat
- depression
- agitation (dementia)
- hallucinations (DT most common cause hallucinations)
- sleep disorder/deprivation/sleep apnea
- confusion (delirium most common among hospitalized pts)
reversible, acute onset of impaired cognition, attention, consciousness, perception, sleep patterns, or emotional states that fluctuate over the course of the day
- often misdiagnosed or unrecognized and inappropriately treated
delirium
AVOID BENZO’S IN ELDERLY HOSPITALIZED PTS
med sx: elevated BP, tachycardia, nystagmus, muscular rigidity, vomiting
psychiatric sx: agitation with blank stare, anxiety, stupor, aggression, panic, bizarre behavior
PCP-induced organic mental disorder
med sx: elevated BP, tachycardia, mydriasis, diaphoresis, tremor
psychiatric sx: agitation with persecutory delusions or euphoria with irritability
amphetamine/cocaine
overuse of what substance can cause mania and psychosis (hallucinations)
corticosteroids
overuse of what substance can cause sedation, paradoxical agitation
- should be avoided in elderly pts with delirium
benzodiazepines
overuse of what substance can cause mania (bipolar pt), anxiety, insomnia
antidepressants
