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Questions and Answers
What does the bio-psycho-social model, central to psychiatry, primarily aim to explain?
What does the bio-psycho-social model, central to psychiatry, primarily aim to explain?
- Social determinants of mental health, undermining biological and psychological influences.
- The biological basis of all mental illnesses, disregarding psychological and social factors.
- The superiority of psychological interventions over biological treatments.
- Human behavior by integrating biological, psychological, and social factors. (correct)
Which statement accurately describes the relationship between the mind and body in psychosomatic medicine?
Which statement accurately describes the relationship between the mind and body in psychosomatic medicine?
- The mind and body have a unidirectional relationship where mental states dictate physical health.
- The body primarily affects the mind, with minimal impact in the reverse direction.
- The mind and body have a bidirectional relationship, where each influences the other's state of health. (correct)
- The mind and body are independent entities that do not significantly influence each other.
What crucial diagnostic step differentiates psychiatric symptoms due to a medical condition from primary psychiatric disorders?
What crucial diagnostic step differentiates psychiatric symptoms due to a medical condition from primary psychiatric disorders?
- Identifying a direct physiological consequence of a medical condition that explains the psychiatric symptoms. (correct)
- Excluding the possibility of any psychological stressors in the patient's life.
- Confirming the absence of any past psychiatric history in the patient or their family.
- Relying solely on the patient's self-reported symptoms without objective measures.
What is an important consideration when a patient presents with new-onset psychiatric symptoms?
What is an important consideration when a patient presents with new-onset psychiatric symptoms?
Which clinical feature is most suggestive of a medical, rather than a primary psychiatric, origin of mental health symptoms?
Which clinical feature is most suggestive of a medical, rather than a primary psychiatric, origin of mental health symptoms?
In a patient presenting with psychiatric symptoms, which historical detail would most strongly suggest an underlying medical etiology?
In a patient presenting with psychiatric symptoms, which historical detail would most strongly suggest an underlying medical etiology?
When evaluating a patient with suspected delirium, what is the significance of identifying a 'direct physiological consequence' related to their symptoms?
When evaluating a patient with suspected delirium, what is the significance of identifying a 'direct physiological consequence' related to their symptoms?
Which of the following is the most critical initial assessment in differentiating dementia from delirium?
Which of the following is the most critical initial assessment in differentiating dementia from delirium?
What clinical feature most strongly suggests a diagnosis of delirium over a primary psychotic disorder?
What clinical feature most strongly suggests a diagnosis of delirium over a primary psychotic disorder?
Which assessment strategy is most critical in evaluating a patient presenting with acute delirium?
Which assessment strategy is most critical in evaluating a patient presenting with acute delirium?
What distinguishes depression caused by a general medical condition from a primary depressive disorder?
What distinguishes depression caused by a general medical condition from a primary depressive disorder?
A patient being treated for hepatitis C with interferon alpha begins to exhibit symptoms of major depression. What is the most appropriate course of action?
A patient being treated for hepatitis C with interferon alpha begins to exhibit symptoms of major depression. What is the most appropriate course of action?
A patient with no prior psychiatric history develops prominent olfactory hallucinations. What underlying condition should the clinician suspect?
A patient with no prior psychiatric history develops prominent olfactory hallucinations. What underlying condition should the clinician suspect?
What key factor differentiates anxiety disorder due to a general medical condition from primary anxiety disorders?
What key factor differentiates anxiety disorder due to a general medical condition from primary anxiety disorders?
Which of the following is the MOST critical first step in evaluating a patient presenting with new-onset psychiatric symptoms?
Which of the following is the MOST critical first step in evaluating a patient presenting with new-onset psychiatric symptoms?
What is a common feature of both delirium and dementia?
What is a common feature of both delirium and dementia?
A 68-year-old patient with no prior history of mental illness presents with new-onset depression characterized by psychomotor retardation, anhedonia, and significant weight loss. The patient's spouse reports that these symptoms began shortly after the patient was diagnosed with pancreatic cancer. Which of the following is the MOST likely diagnosis?
A 68-year-old patient with no prior history of mental illness presents with new-onset depression characterized by psychomotor retardation, anhedonia, and significant weight loss. The patient's spouse reports that these symptoms began shortly after the patient was diagnosed with pancreatic cancer. Which of the following is the MOST likely diagnosis?
What is the defining characteristic of a somatic symptom disorder?
What is the defining characteristic of a somatic symptom disorder?
What condition represents a medical complication of psychiatric treatment?
What condition represents a medical complication of psychiatric treatment?
What is it called when a psychiatric condition co-occurs with a medical issue?
What is it called when a psychiatric condition co-occurs with a medical issue?
A patient is brought to the emergency department with acute onset of confusion, disorientation, and fluctuating levels of consciousness. The family reports that the patient has a history of well-controlled type 2 diabetes and has recently started taking a new medication for insomnia. Physical examination reveals mild tremor and tachycardia, but no focal neurological deficits. What is the MOST appropriate initial step in managing this patient?
A patient is brought to the emergency department with acute onset of confusion, disorientation, and fluctuating levels of consciousness. The family reports that the patient has a history of well-controlled type 2 diabetes and has recently started taking a new medication for insomnia. Physical examination reveals mild tremor and tachycardia, but no focal neurological deficits. What is the MOST appropriate initial step in managing this patient?
Which of the following is MOST suggestive of delirium rather than dementia?
Which of the following is MOST suggestive of delirium rather than dementia?
A 55-year-old patient with a history of hypertension and hyperlipidemia presents with new-onset depressive symptoms, including anhedonia, fatigue, and difficulty concentrating. The patient reports no prior history of mental illness and denies any recent psychosocial stressors. Medical workup reveals evidence of previously undiagnosed subclinical hypothyroidism. Which of the following is the MOST appropriate initial treatment approach?
A 55-year-old patient with a history of hypertension and hyperlipidemia presents with new-onset depressive symptoms, including anhedonia, fatigue, and difficulty concentrating. The patient reports no prior history of mental illness and denies any recent psychosocial stressors. Medical workup reveals evidence of previously undiagnosed subclinical hypothyroidism. Which of the following is the MOST appropriate initial treatment approach?
A patient with metastatic breast cancer undergoing chemotherapy develops new-onset anxiety symptoms, including panic attacks and anticipatory anxiety. What is the most crucial step in differentiating anxiety disorder due to cancer treatment from a primary anxiety disorder?
A patient with metastatic breast cancer undergoing chemotherapy develops new-onset anxiety symptoms, including panic attacks and anticipatory anxiety. What is the most crucial step in differentiating anxiety disorder due to cancer treatment from a primary anxiety disorder?
A 40-year-old patient with no prior psychiatric history presents with acute onset of paranoia, disorganized thinking, and auditory hallucinations. Medical workup reveals that the patient has recently been diagnosed with systemic lupus erythematosus (SLE) and started on high-dose corticosteroids. Which of the following is the MOST likely cause of the patient's psychotic symptoms?
A 40-year-old patient with no prior psychiatric history presents with acute onset of paranoia, disorganized thinking, and auditory hallucinations. Medical workup reveals that the patient has recently been diagnosed with systemic lupus erythematosus (SLE) and started on high-dose corticosteroids. Which of the following is the MOST likely cause of the patient's psychotic symptoms?
Which of the following medical conditions is MOST closely associated with symptoms of anxiety?
Which of the following medical conditions is MOST closely associated with symptoms of anxiety?
During an evaluation of a patient, the decision is made to recommend a neurology consult. What is the MAIN reason?
During an evaluation of a patient, the decision is made to recommend a neurology consult. What is the MAIN reason?
When approaching mental disorders, what needs to be determined before other things are considered?
When approaching mental disorders, what needs to be determined before other things are considered?
For patients with mental disorders caused by medical conditions, which patient population requires the greatest research?
For patients with mental disorders caused by medical conditions, which patient population requires the greatest research?
Which approach is most necessary towards improving patients with mental disorders caused by medical conditions?
Which approach is most necessary towards improving patients with mental disorders caused by medical conditions?
When should patients be given emergent medications for conditions that are caused by other factors?
When should patients be given emergent medications for conditions that are caused by other factors?
Flashcards
What is psychiatry?
What is psychiatry?
A medical discipline focused on the diagnosis, treatment, and prevention of mental, emotional, and behavioral disorders. Deals with and treats brain disorders.
What is the biopsychosocial model?
What is the biopsychosocial model?
Biological, psychological, and social factors interplay. Used to explain human behavior and differentiate normal and abnormal patterns.
Psychosomatic medicine
Psychosomatic medicine
A specific area of focus in medicine for more than 50 years. It refers to how the mind affects the body and how the body affects the mind.
Delirium
Delirium
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Dementia
Dementia
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Secondary psychiatric symptoms
Secondary psychiatric symptoms
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Major Depressive Episode criteria
Major Depressive Episode criteria
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Depressive Disorder Due to Medical Condition
Depressive Disorder Due to Medical Condition
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Depression and Medical Condition
Depression and Medical Condition
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Sensory modality
Sensory modality
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Anxiety Disorder
Anxiety Disorder
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Mental Disorders Due to a General Medical Condition
Mental Disorders Due to a General Medical Condition
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Psychiatric and medical disorders
Psychiatric and medical disorders
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Study Notes
- Psychiatry is a medical discipline that deals with and treats brain disorders
- Psyche means "soul" in Greek
- Psychiatry uses a bio-psycho-social model, and tries to explain human behavior based on this
- Psychiatry also tries to differentiate between normal and abnormal behavioral patterns in order to treat the person effectively
Psychosomatic Medicine
- It focuses on how the mind affects the body and how the body affects the mind
- Has been an area of focus for over 50 years
Bidirectional Relationship
- There is a bidirectional relationship between the mind and the body
Psychiatric Symptoms Due to Medical Origin
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These illnesses can come about gradually and be present after the age of 50
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Features of a medical origin presents itself in:
- Late onset of initial presentation
- Known underlying medical condition
- Atypical presentation of a specific psychiatric diagnosis
- Absence of personal and family history of psychiatric illnesses
- Illicit substance abuse
- Medication use
- Treatment resistance or unusual response to treatment
- Sudden onset of symptoms
- Abnormal vital signs
- Waxing and waning mental status
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Medical conditions that can cause psychiatric symptoms:
- Absence of family history
- Abnormal medical results
- HIV treatments
- Changes in mental status
- Vital sign problems
- Catatonia
- Trouble with delirium
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Dementia and delirium need an underlying medical cause
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It's important to perform a medical evaluation so you can properly diagnose
Type of Clinical Problems in Psychosomatic Medicine
- Psychiatric symptoms can be secondary to a medical condition
- This includes delirium and dementia
- The cognitive alteration can not be explained by a pre-existing neurocognitive disorder
- These can be distinguished from a psychotic disorder due to a general medical condition in the presence of; confusion or significant intellectual deficits
- Symptoms usually develop over a short period of time
- Delirium has a disturbance of attention or awareness accompanied by a change in baseline condition
- There is a reduced ability to direct, focus and shift attention
- Symptoms tends to fluctuate
- There is evidence from history, an examination, or lab findings that the disturbance is a direct physiological consequence of another medical condition
Causes of Delirium
- This can be caused by: Infectious abscess, drug or alcohol Withdrawal, Acute metabolic disturbances, Trauma, CNS disease, Hypoxia, Deficiencies, Environmental factors, Acute vascular issues, Toxins, and Heavy metals (Use the I WATCH DEATH mnemonic)
Dementia
- There is evidence of significant cognitive decline from a previous level of performance
- Decline affects one or more cognitive domains like attention, executive function or social cognition
- This includes Alzheimer’s disease, Frontotemporal lobar degeneration, Lewy body disease, and vascular disease
Medical Complications
- Psychiatric symptoms can be secondary to medical treatments like anxiety related to chemotherapy or depression
- Depression can also be related to obesity
- Psychiatric issues can be complications from medical conditions and treatments like depression
- Depression can be secondary to interferon treatment
- Psychological factors can contribute to medical symptoms
- A common example is Somatic symptom disorder
Other Medical Complications
- Medical complications can be a result of psychiatric conditions or treatment
- Lithium intoxication and Neuroleptic malignant syndrome, and acute withdrawal from alcohol
- There can be co-occuring medical and psychiatric conditions such as End stage renal disease
Major Depressive Episode Criteria
- Depressed mood
- Loss of interest or pleasure
- Significant weight loss or weight gain (5%)
- Insomnia and/or hypersomnia
- Psychomotor agitation or retardation
- Fatigue, loss of energy
- Feelings of worthlessness and/or excessive guilt
- Diminished ability to think or concentrate
- Recurring thoughts of death and/or suicidality
- Must have 5 of 9 symptoms for 2 weeks
- Symptoms must cause clinically significant distress or impairment in social area
- The episode is not attributable to psychological effects of a substance or to another medical condition
Depressive Disorder
- Depressed mood or markedly diminished interest or pleasure
- The disorder cannot be explained by another mental disorder
- Symptoms cause clinically significant distress or impairment in social or occupational areas
- There is evidence from the history, physical examination, or lab findings that the disturbance is the direct pathophysiological consequence of another medical condition
- The disturbance does not occur exclusively during the course of a delirium
Depression and General Medical Condition
- Depression must begin, worsen, or improve in parallel with a medical condition
- Depression should include Atypical symptoms
- Practitioners best judgement is important for diagnosis
Medical conditions related to depression
- Neuroanatomical correlates of depression and MC
- Stroke
- Huntington's disease
- Parkinson's disease
- Traumatic brain injury
- Neuroendocrine conditions
- Cushing’s disease
- Hypothyroidism
Medications that can induce depression:
- Steroids
- Alpha interferon
Psychotic Disorder Due to Another Medical Condition
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Characterized by Prominent hallucinations or delusions
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The disorder is not better explained by another mental disorder
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There is evidence from history, physical examination, or laboratory findings that the disturbance is the direct pathophysiological consequence of another medical condition
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There is not a disturbance occurring exclusively during the course of a delirium
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In these cases Hallucinations can occur in any sensory modality
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Temporal lobe epilepsy results in Olfactory hallucinations
Medical Conditions Related to Psychosis
- Systemic lupus erythematosus
- NMDA receptor autoimmune encephalitis
- Temporal lobe epilepsy
- Multiple sclerosis, Huntington's disease
- Endocrine conditions (hyper/hypo thyroidism, hypo/hyperparathyroidism)
- Metabolic conditions (hypoxia, hypercarbia etc.)
Anxiety Disorder Due to Another Medical Condition
- The clinical picture includes Panic attacks or anxiety
- There is evidence from the history, physical examination, or laboratory findings that the disturbance is the direct pathophysiological consequence of another medical condition
- Anxiety is not better explained by another mental disorder
- The disturbance does not occur exclusively during the course of a delirium
- There is clinically significant distress or impairment in social or occupational areas
Medical Conditions Related to Anxiety
- Endocrine disease (hyperthyroidism, pheochromocytoma, hypoglycemia, hyperadrenocortisolism)
- Cardiovascular disease (congestive heart failure, pulmonary embolism, atrial fibrillation)
- Metabolic disturbances (vit B 12 deficiency, porphyria)
- Neurological illness (neoplasms, vestibular dysfunction, encephalitis, seizure disorders)
Approach for Mental Disorders
- Mental disorders can result as a part of primary disorder or a medical condition
Approach for Mental Disorders Due to a General Medical Condition
- Review the history and physical examination results
- Review laboratory tests/imaging studies
- Determine if mental symptoms are most likely a consequence of medical condition or better accounted for by a primary mental disorder
- See if there is evidence for presence of a general medical condition that could plausibly cause the mental symptoms in question
- If mental disorder is a result of medical condition, whether emergent symptomatic treatment is needed
Conclusion
- Psychiatric and medical disorders either predispose or worsen each other
- Drug-drug interaction and side-effect profile of medications has to be taken care of while prescribing in these illnesses
- Close attention to the patient's symptomatology will help reduce their suffering
- It is important for physicians and psychiatrists to have good understanding of both psychiatric and physical illness
- The concomittant presence of both disorders leads to increased morbidity and mortality
- Psychiatric disorders in medical illness pose a unique challenge considering their diagnosis and management
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