W03 - PSYCH: Organic Disorders; General Hospital Psych & Functional Disorders Flashcards
To be able to discuss the common organic conditions, their classification and basic management
organic conditions: due to distinct demonstrable change in brain ie. physical.
- acquired in nature rather than developmental
but many mental disorders present with a mixture of mental and physical features. two-way street.
- acute Vs chronic
Common features of organic disorders
Cognitive
|Memory
Intellect
Learning
Sensorium
|Consciousness
Attention
Mood
Psychotic
+personality and behavioural disturbance
*Most tend to start in adult or later life
Relationship between Physical and Mental Health
- organic disorder
- emotional reaction to illness/trauma/treatment
=> emotional symptoms manifestation
Delirium
Impairment of consciousness and attention
Global disturbance of cognition
Psychomotor disturbances
Disturbance of sleep-wake cycle
Emotional disturbance
*dt central cholinergic def.? or neurotoxic effects of inflamm.
* marker of subsequent dementia
> risk-reduction: aids - ORIENTATE, mobility, support.
optimise physiology, promote brain recovery
Delirium Dx and stratification
4AT
overall a cliinical dx.
Delirium - Tranquilisation
- combat acute and quick deterioration to reduce severe agitation
(1)
> lorazepam (if antipsych already)
> olanzapine
- risperidone (existing neuro)
(2) IM administration
> lorazepam
or
> aripiprazole
*start low dose
Dementia
A syndrome which characterised by global cognitive impairment which is chronic in nature.
a
a
Amnesic Syndrome and aetiology
Immediate recall preserved but impaired recent and remote memory
* new learning impaired.
*diencephalic dmg:
korsaakoffs
3rd ventricle tumour or cyst
bilaateral thalamic infarction
post-subarachnoid haem.
*hippocamnpal dmg:
HSV enceophalitis
arterila occlusion
head injury
“Wernicke-Korsakoff Syndrome”
Alcohol Amnestic Disorder
Wernickes:
Acute Confusional State
Ataxia
Ophthalmoplegia
Korsakoff’s psychosis
-impaired anterograde mem., disdturbed time sense
> High potency parenteral B1 replacement
3-7 days
Oral thiamine
Depression linked to physical illness.
- structural or metabolic
May be initial presenting feature of the pathology
Suspect if:
First presentation in middle-age or later
No family history of psychiatric illness
No convincing psychosocial precipitant
*thyroid
*head injury/malignancy
* cardiac
*MS, dementia, neurodegenration
and tx that may cause deppr.
- corticosteroids
- digoxin, BB, levodopa
- benzos
Nuances of depression in medically unwell
Staff may regard depressive symptoms as a normal reaction
Somatic symptoms of depression may be due to the medical illness
Patients usually develop ways of coping if given appropriate support and time to adjust
Is distress very severe?
Is mood change persistent?
Is there evidence of failure to adjust to the illness?
Are there suicidal ideas?
Is physical function poorer than expected?
Is there poor social interaction?
Disorders linked with high-rates of deppr.
Neurological disorders
Life-threatening disorders
Chronic, painful, disabling illness
Unpleasant treatments
Chronic illness in older age
> mgmt of present condition(s)
psychosocial interventions: CBT etc.
antideppr.
Common mental health problems in the general hospital
affective
delirium
substance misuse
functional disorder
dementia
eating disorders
Liaison Psychiatry
Subspecialty of psychiatry that works with patients in general hospitals
Work with medical and surgical colleagues in the management of mental health problems in their patients
