w7 Flashcards
___________ – d/o that present with psychiatric symptoms directly resulting from an underlying medical condition
- The cause of psychiatric symptoms is medical illness
_____________ – attributing symptoms of a physical illness to a mental illness
Medical mimics
Diagnostic overshadowing
Medical illnesses with psychiatric symptoms
- Mind and body are intertwined
- Holistic entity
- New medical dx or illness is stressful and life changing
- Pts being treated for medical/surgical problems may display behaviors of aggression, depression, anxiety, anger, suspicion, or psychosis
- Identification of medical condition can be challenging, especially if individual has an existing psychiatric condition
- Over 100 d/o mimic mental illnesses (have psychiatric manifestations)
- Misdiagnosing can result in unnecessary or harmful treatment, delay in treatment, increased hospital stays/costs
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Medical mimics associated with mood disorders
d/o that presents with psychiatric symptoms (mood disorder) directly resulting from an underlying medical condition
Medical illnesses with psychotic symptoms
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Psychotic disorder due to ____________
Symptoms include
- Hallucinations
- Delusions
- Disorganized speech and thought patterns
- Symptoms of a medical condition not associated with mental disorders that may cause psychosis (ex: schizophrenia spectrum d/o)
Symptoms may be temporary or long term/persisting after the associated medical condition has been resolved
another medical condition/insert medical condition here
Medical mimics associated with anxiety disorders
d/o that present with psychiatric symptoms (anxiety disorders) directly resulting from an underlying medical condition
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_________ side effects (PSEs) from _________ treatment
- PSEs often resemble spontaneous psychiatric syndromes
- Can occur with usual doses, intoxication, or withdrawal of treatment
- Ranges from short-lasting anxiety to severe confusion
- Suicide
Psychiatric side effects (PSEs) from pharmacological treatment
Risk factors for ______________
- Polypharmacy
- High doses
- Route of admin
- Faster admin (any route)
- Narrow therapeutic index
- Metabolic conditions – hepatic insufficiency, slow metabolizer
- Augmented permeability of BBB
- Very young or old
- Post partum or other stressful situations – ICU
Psychiatric side effects (PSEs) from pharmacological treatment
Common meds with PSEs
- Antiepileptic agents – delirium, psychosis, irritability
- Beta blockers - delirium, psychosis, depression
- steroids – mood changes, psychosis
- interferon – depression
- benzo (withdrawal) – anxiety, agitation
- fluroquinolones – restlessness, irritability
- isoniazid, sulfonamide abx, anticholinergics – delirium
- acyclovir/ganciclovir – hallucinations
- psychostimulants, dopaminergic agents (anti-parkinson) – psychosis, agitation, irritability
- OTC cough and cold prep - delirium, confusion, hallucinations
- Opioids – anxiety, irritability
- Stimulants (cocaine, amphetamine) – paranoia, depression, psychosis, hallucinations
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Meds with induction of a psychoactive state
- Antihypertensives
- Oral contraceptives
- Steroids
- Cancer chemotherapy agents
- Benzo
- Barbiturates
- Histamine 2 blockers
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Commonly abused substances
- Alcohol
- Opioids
- Amphetamines – ecstasy, meth
- Cocaine
- Benzo
- Barbiturates
- Steroids
- LSD
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Hallmark risk factors of a medical mimic (d/o that present with psychiatric symptoms directly resulting from an underlying medical condition)
- Normal functioning ______ to sudden onset of mental symptoms
- ______ onset of initial presentation
- Known underlying _______ condition
- _______ presentation of a specific psychiatric diagnosis
- Disturbance of ______, balance, or both
- Hallucinations
- Recent substance use
- Normal functioning prior to sudden onset of mental symptoms
- Late onset of initial presentation
- Known underlying medical condition
- Atypical presentation of a specific psychiatric diagnosis
- Disturbance of gait, balance, or both
- Hallucinations
- Recent substance use
Other high risk features of a medical mimic (d/o that presents with psychiatric symptoms directly resulting from an underlying medical condition)
- Absence of personal and family hx of _______ illnesses
- Family concern – “this is not her usual behavior”
- Medication use – new meds, dose change, overuse
- Abnormal vitals - fever, tachy
- Significant abnormalities on exam – pupil change, nystagmus, signs of physical trauma
- mental status - Waxing and waning, abnormal findings
- disorientation with _____ consciousness
- recent memory loss
- history of ____ injury
- treatment - resistance or unusual response, worse after antipsychotic or anxiolytic
- Absence of personal and family hx of psychiatric illnesses
- Family concern – “this is not her usual behavior”
- Medication use – new meds, dose change, overuse
- Abnormal vitals - fever, tachy
- Significant abnormalities on exam – pupil change, nystagmus, signs of physical trauma
- mental status - Waxing and waning, abnormal findings
- disorientation with clouded consciousness
- recent memory loss
- history of head injury
- treatment - resistance or unusual response, worse after antipsychotic or anxiolytic
high risk individuals for a medical mimic
- age?
- hx of ?
- no hx of ?
- preexisting medical illness
- ________ socioeconomic status
- elderly
- hx of substance abuse
- no hx of psychiatric illness
- preexisting medical illness
- lower socioeconomic status
lab and metabolic assessment
- pulse ox
- CMP, CBC
- Therapeutic drug levels
- Urine analysis
- Thyroid function testing
- Erythrocyte sedimentation rate
- C-reactive protein
- Screen for syphilis, Lyme disease, lupus and demyelinating d/o
- AIDS/HIV screening
- CT
- Lumbar puncture
- Blood culture
- B12 and thiamine deficiency testing
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Medical illnesses with psychiatric symptoms: Nursing implications
- Holistic entity
- Be aware of medical mimics – common psychiatric symptoms can arise from medical illnesses
- Emotional dimensions may be overlooked
- Provide reassurance and support
- Be sensitive to emotional experience of client with medical illness
Medical illnesses with psychiatric symptoms: Nursing interventions
- History and physical
- Ask everyone about substance use
- Review current prescriptions, OTC meds, alternative meds, and recent changes
- Monitor labs
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