Psychsomatic Disorders - Hill

Question 1

what are the two assumptions of psychosomatic medicine?

Answer 1

1. unity of mind and body

2. psychological factors must be considered in all disease states

Question 2

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

Answer 2

psychological factors affecting medical conditions

Question 3

depression has independent risk factors for what?

Answer 3

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

Question 4

anxiety is a risk factor for what?

Answer 4

• coronary artery disease
• asthma
• specific phobias

Question 5

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

Answer 5

stress

Question 6

what are the neurotransmitter responses to stress?

Answer 6

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

Question 7

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

Answer 7

systemic lupus erythematosus (SLE)

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

Question 8

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

Answer 8

multiple sclerosis (MS)

Question 9

medical sx: sensory distortions, violence, belligerence

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

Answer 9

seizure disorder

tx: mood stabilizer!!!

Question 10

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

Answer 10

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)

Question 11

30% of asthmatics meet criteria for what?

Answer 11

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

Question 12

what benzo did Hill say he gives to COPD patients?

Answer 12

alprazolam

Question 13

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

Answer 13

hyperthyroidism

Question 14

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

Answer 14

hypothyroidism

Question 15

med sx: paroxysmal HTN, headache, diaphoresis, tremor

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

Answer 15

pheochromocytoma

Question 16

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

Answer 16

hyponatremia

Question 17

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

Answer 17

thiamine

Question 18

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

Answer 18

cobalamin (vit B12)

Question 19

toxic levels of which vitamins cause confusion?

Answer 19

vitamin A, D and iron

Question 20

toxic levels of what causes psychosis?

Answer 20

copper

Question 21

toxic levels of what affect peripheral nerve function?

Answer 21

B6 and 12

Question 22

toxic levels of what cause cognitive dysfunction?

Answer 22

lead

Question 23

what are the most common side effects of antidepressants?

Answer 23

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

Question 24

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

Answer 24

pancreatic carcinoma

Question 25

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

Answer 25

**acute intermittent porphyria (AIP)**

Question 26

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

Answer 26

hepatic encephalopathy

Question 27

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

Answer 27

**frontal lobe tumor**

Question 28

what are the treatments for stress management?

Answer 28

- 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)

Question 29

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

Answer 29

consultation-liaison psychiatry

Question 30

what are some common consultation-liaison problems?

Answer 30

- 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)

Question 31

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

Answer 31

delirium | **AVOID BENZO'S IN ELDERLY HOSPITALIZED PTS**

Question 32

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

Answer 32

PCP-induced organic mental disorder

Question 33

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

Answer 33

amphetamine/cocaine

Question 34

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

Answer 34

corticosteroids

Question 35

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

Answer 35

benzodiazepines

Question 36

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

Answer 36

antidepressants