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NMSP Exam 1 > Psychsomatic Disorders - Hill > Flashcards

Psychsomatic Disorders - Hill Flashcards

1
Q

what are the two assumptions of psychosomatic medicine?

A
  1. unity of mind and body

2. psychological factors must be considered in all disease states

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2
Q

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
A

psychological factors affecting medical conditions

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3
Q

depression has independent risk factors for what?

A
  • incident of coronary heart disease
  • increased risk of subsequent stroke
  • number of depressive sx related to the number of diabetic sx
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4
Q

anxiety is a risk factor for what?

A
  • coronary artery disease
  • asthma
  • specific phobias
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5
Q

a circumstance that disturbs, or is likely to disturb, the normal physiological or psychological functioning of a person

A

stress

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6
Q

what are the neurotransmitter responses to stress?

A
  • noradrenergic: release catecholamines
  • serotogenic: increased 5HT turnover
  • dopaminergic: increase DA neurotransmission
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7
Q

medical sx: fever, photosensitivity, butterfly rash, joint pains, headache
psychiatric sx: depression, mood disturbances, psychosis, delusions, hallucinations

A

systemic lupus erythematosus (SLE)

- supportive psychotherapy can help patients acquire knowledge and maturity to cope and promote positive interactions

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8
Q

medical sx: transient motor/sensory disturbances, impaired vision, diffuse neurological signs with remission and exacerbations, slurred speech, incontinence
psychiatric symptoms: anxiety, euphoria, mania

A

multiple sclerosis (MS)

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9
Q

medical sx: sensory distortions, violence, belligerence

psychiatric sx: confusion, psychosis, dissociative states, catatonic state, bizarre behavior

A

seizure disorder

tx: mood stabilizer!!!

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10
Q

depression, anxiety, type A behavior, hostility, anger, acute mental stress have been evaluated as risk factors for the development and expression of what?

A

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)
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11
Q

30% of asthmatics meet criteria for what?

A

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

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12
Q

what benzo did Hill say he gives to COPD patients?

A

alprazolam

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13
Q

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

A

hyperthyroidism

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14
Q

medical sx: cold intolerance, dry skin, constipation, wt gain
psychiatric sx: lethargy, depressed, personality change, paranoia

A

hypothyroidism

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15
Q

med sx: paroxysmal HTN, headache, diaphoresis, tremor

psychiatric sx: anxiety, apprehension, feeling of impending doom, panic

A

pheochromocytoma

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16
Q

medical sx: excessive thirst, polydipsia, stupor, coma, seizures
psychiatric sx: confusion, lethargy, personality changes

A

hyponatremia

17
Q

which vitamin deficiency:
med sx: neuropathy, cardiomyopathy, Wernicke-Korsakoff syndrome, malaise, common in alcoholics
psychiatric sx: poor concentration, confusion, confabulation

A

thiamine

18
Q

which vitamin deficiency:
med sx: pallor, dizziness, peripheral neuropathy, dorsal column signs, ataxia
psychiatric sx: irritability, inattentiveness, psychosis, dementia

A

cobalamin (vit B12)

19
Q

toxic levels of which vitamins cause confusion?

A

vitamin A, D and iron

20
Q

toxic levels of what causes psychosis?

A

copper

21
Q

toxic levels of what affect peripheral nerve function?

A

B6 and 12

22
Q

toxic levels of what cause cognitive dysfunction?

A

lead

23
Q

what are the most common side effects of antidepressants?

A

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
24
Q

weight loss, abdominal pain, depression, lethargy, anhedonia, apathy, decreased energy

A

pancreatic carcinoma

25
Q

med sx: abdominal pain, fever, nausea, vomiting, constipation, peripheral neuropathy, paralysis
psychiatric sx: acute depression, agitation, paranoia, visual hallucinations

A

acute intermittent porphyria (AIP)

26
Q

med sx: asterixis, hyperreflexia, spider angioma, palmar erythema, ecchymosis, liver enlargement/atrophy
psychiatric sx: euphoria, disinhibition, psychosis, depression

A

hepatic encephalopathy

27
Q

mood changes, irritability, facetiousness, impaired judgement, impaired memory, delirium, loss of speech, loss of smell

A

frontal lobe tumor

28
Q

what are the treatments for stress management?

A
  • 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)
29
Q

the study, practice, and teaching of the relation between medical and psychiatric disorders

A

consultation-liaison psychiatry

30
Q

what are some common consultation-liaison problems?

A
  • 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)
31
Q

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

A

delirium

AVOID BENZO’S IN ELDERLY HOSPITALIZED PTS

32
Q

med sx: elevated BP, tachycardia, nystagmus, muscular rigidity, vomiting
psychiatric sx: agitation with blank stare, anxiety, stupor, aggression, panic, bizarre behavior

A

PCP-induced organic mental disorder

33
Q

med sx: elevated BP, tachycardia, mydriasis, diaphoresis, tremor
psychiatric sx: agitation with persecutory delusions or euphoria with irritability

A

amphetamine/cocaine

34
Q

overuse of what substance can cause mania and psychosis (hallucinations)

A

corticosteroids

35
Q

overuse of what substance can cause sedation, paradoxical agitation
- should be avoided in elderly pts with delirium

A

benzodiazepines

36
Q

overuse of what substance can cause mania (bipolar pt), anxiety, insomnia

A

antidepressants

NMSP Exam 1 (19 decks)

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