PHA 535 Lecture 2 Medical Condition Summary PDF

Lecture 2 Medical Condition Summary PHA 535 Human Behavior and Psychiatry Created by: Dr. Renee Levy 1  1.Infections (e.g., Sepsis, Urinary Tract Infections, or Pneumonia) The five most Infections, especially in older adults, can lead to...

Lecture 2 Medical Condition Summary PHA 535 Human Behavior and Psychiatry Created by: Dr. Renee Levy 1  1.Infections (e.g., Sepsis, Urinary Tract Infections, or Pneumonia) The five most Infections, especially in older adults, can lead to systemic inflammation and cause delirium. Urinary tract infections and pneumonia are common frequently associated with acute mental status changes. 2.Metabolic Imbalances medical Hypoglycemia or Hyperglycemia: Fluctuations in blood sugar can cause confusion or loss of consciousness. conditions that Electrolyte Imbalances: Sodium abnormalities (e.g., hyponatremia or hypernatremia), hypercalcemia, or severe hypokalemia can affect brain function. can cause Hypoxia: Low oxygen levels from respiratory or cardiac issues can impair cognition. confusion, 3.Neurological Conditions Stroke: Sudden confusion, especially with other focal delirium, and neurological deficits, may indicate a cerebrovascular event. Traumatic Brain Injury (TBI): Even mild head trauma can cause disorientation disorientation, particularly in older adults. Dementia or Acute Exacerbations: While typically a chronic are: condition, acute confusion can result from overlapping conditions like infections. 2  4.Substance-Related Causes The five most Intoxication or Withdrawal: Alcohol, sedatives, opioids, or recreational drugs can lead to common confusion. Withdrawal syndromes, particularly delirium tremens from alcohol, are common. medical Medication Side Effects or Toxicity: Polypharmacy, especially in older adults, can conditions that predispose patients to delirium due to drug interactions or inappropriate dosing. can cause 5.Psychiatric Conditions Delirium Tremens (DTs): A severe form of confusion, withdrawal delirium. Acute Psychosis: Conditions like schizophrenia delirium, and or bipolar disorder can sometimes present with disorientation confusion. Severe Depression or Mania: Mood disorders are: may lead to cognitive slowing or confusion. 3 The five most 1. Dementia (Neurocognitive Disorders) common Alzheimer's Disease: The most common cause of progressive cognitive decline, often associated medical with memory loss, disorientation, and changes in personality or behavior. conditions that Vascular Dementia: Cognitive deficits and cause cognitive behavioral changes due to small strokes or chronic vascular insufficiency. impairment Frontotemporal Dementia: Behavioral disinhibition, loss of empathy, and executive and behavioral dysfunction are common features. instability are: 4  2. Delirium Often due to acute medical conditions like The five most infections (e.g., sepsis, UTIs), metabolic disturbances, or drug toxicity. common Characterized by fluctuating levels of attention, medical confusion, and inappropriate or unstable behavior. 3. Psychiatric Disorders conditions that Bipolar Disorder: Mania or mixed states often cause cognitive include impulsivity, poor judgment, and emotional instability. impairment Schizophrenia: Cognitive deficits such as impaired executive functioning, memory, and attention can and behavioral occur alongside hallucinations and behavioral disturbances. instability are: 5 The five most common 4. Substance Use Disorders medical Alcohol-Related Disorders: Chronic alcohol use can cause cognitive impairment (e.g., Wernicke- conditions that Korsakoff syndrome), and withdrawal may lead to behavioral instability. cause cognitive Drug Intoxication/Withdrawal: Substances such as opioids, stimulants, or benzodiazepines can lead to impairment acute changes in behavior and cognitive function. and behavioral instability are: 6 The five most common 5. Traumatic Brain Injury (TBI) medical Acute and Chronic Effects: Cognitive impairment (memory, attention deficits) and behavioral conditions that changes (irritability, aggression) are common after head trauma. cause cognitive Chronic Traumatic Encephalopathy (CTE) in repetitive head injury can also lead to progressive impairment cognitive decline and mood instability. and behavioral instability are: 7 The five most 1. Hypothyroidism Underactive thyroid function leads to low energy common levels, fatigue, and mood changes, often mimicking symptoms of major depressive disorder. medical Easily diagnosed with thyroid function tests (e.g., TSH, free T4). conditions 2. Chronic Pain Conditions that can cause Fibromyalgia, Arthritis, or Migraines: Persistent pain can lead to physical and emotional or contribute exhaustion, resulting in depression. Depression is both a response to the pain and a to depression potential exacerbating factor. are: 8  3. Neurological Disorders The five most Parkinson's Disease: Affects dopamine pathways critical for mood regulation. Depression often precedes motor common symptoms. Stroke: Particularly strokes affecting the frontal lobe or medical left hemisphere, which are associated with post-stroke depression. conditions Multiple Sclerosis: Chronic inflammation and neurodegeneration can lead to depression that can cause 4. Cardiovascular Disease Coronary Artery Disease (CAD): Depression is common or contribute after heart attacks or in chronic heart disease, possibly due to inflammatory and hormonal changes. to depression The bidirectional relationship means depression may also increase the risk of developing heart disease. are: 9 The five most common 5. Diabetes Mellitus medical Both Type 1 and Type 2 Diabetes are associated conditions with depression due to the chronic burden of managing the disease, fluctuations in blood sugar, and systemic inflammation. that can cause Depression can also negatively affect glucose or contribute control. to depression are: 10 The five most 1. Bipolar Disorder The most well-known psychiatric condition common associated with mania and euphoria. Mania involves elevated mood, increased energy, medical grandiosity, decreased need for sleep, impulsivity, and sometimes psychosis. conditions 2. Hyperthyroidism (Thyrotoxicosis) that can cause Overactive thyroid can cause mood elevation, restlessness, hyperactivity, and irritability that may euphoria or resemble mania. Often accompanied by physical symptoms like mania weight loss, heat intolerance, and tachycardia. include: 11 The five most common 3. Substance Use or Abuse Stimulants: Cocaine, amphetamines, or medical methamphetamines can produce euphoria and manic-like behaviors. conditions Steroids: High-dose anabolic steroids or corticosteroids can induce mood elevation or that can cause manic symptoms. euphoria or Hallucinogens or Recreational Drugs: Substances like ecstasy (MDMA) or LSD may cause temporary euphoria. mania include: 12 The five most common 4. Neurological Conditions Frontal Lobe Lesions: Tumors, strokes, or traumatic medical injuries affecting the frontal lobe can lead to inappropriate euphoria or disinhibited behavior. conditions Multiple Sclerosis (MS): Some patients experience that can cause euphoria as part of the neuropsychiatric manifestations of the disease. euphoria or Temporal Lobe Epilepsy: Rarely, seizures may cause transient euphoria or mania mania include: 13 The five most common 5. Delirium or Dementia medical Conditions like frontotemporal dementia (FTD) conditions can cause behavioral disinhibition, inappropriate euphoria, and manic-like symptoms. that can cause Euphoria may also appear transiently in delirium due to infections, metabolic imbalances, or other euphoria or acute triggers. mania include: 14 The five most common medical causes of insomnia include: 1. Chronic Pain Conditions Examples: Arthritis, fibromyalgia, migraines, or back pain. Pain disrupts sleep onset and maintenance, leading to fragmented or insufficient sleep. 2. Psychiatric Disorders Anxiety Disorders: Excessive worry or hyperarousal makes it difficult to fall asleep or stay asleep. Depression: Insomnia is a hallmark symptom, particularly early- morning awakenings or difficulty maintaining sleep. 15 The five most common medical causes of insomnia include: 3. Sleep-Related Breathing Disorders Obstructive Sleep Apnea (OSA): Recurrent airway obstructions during sleep lead to fragmented, poor-quality sleep and insomnia-like symptoms. Symptoms include snoring, gasping, or choking episodes, and excessive daytime sleepiness. 4. Endocrine Disorders Hyperthyroidism: Overactive thyroid function increases metabolic rate, leading to restlessness, racing thoughts, and difficulty sleeping. Diabetes Mellitus: Nocturia (frequent nighttime urination) and fluctuating blood sugar levels can interrupt sleep. 16 The five most common medical causes of insomnia include: 5. Gastroesophageal Reflux Disease (GERD) Acid reflux symptoms are often worse when lying down, causing discomfort and awakening during the night. This is particularly disruptive in individuals with untreated or poorly managed GERD. 17 The five most common medical conditions that can cause irritability include: 1. Psychiatric Disorders Anxiety Disorders: Chronic worry and hyperarousal can lead to irritability as a key symptom. Depression: Particularly in children and adolescents, irritability can be a prominent manifestation of mood disorders. Bipolar Disorder: Mania or hypomania often includes irritability, restlessness, and impulsivity. 2. Thyroid Disorders Hyperthyroidism: Overactive thyroid function increases metabolic activity, leading to restlessness, nervousness, and irritability. Hypothyroidism: Low thyroid hormone levels can also contribute to mood changes, including irritability and fatigue. 18 The five most common medical conditions that can cause irritability include: 3. Chronic Pain Conditions Conditions like fibromyalgia, arthritis, or migraines can lead to persistent discomfort, resulting in irritability due to frustration and fatigue from the pain. 4. Neurological Conditions Traumatic Brain Injury (TBI): Damage to the brain, especially the frontal lobes, can result in personality changes and increased irritability. Dementias (e.g., Alzheimer's Disease, Frontotemporal Dementia): Behavioral changes, including irritability, are common as cognitive function declines. 19 The five most common medical conditions that can cause irritability include: 5. Hypoglycemia Low blood sugar levels, often seen in diabetes mellitus or prolonged fasting, can cause mood swings, anxiety, and irritability. Symptoms resolve once blood sugar levels are normalized. 20 The five most common medical causes of memory impairment include: 1. Neurodegenerative Diseases Alzheimer’s Disease: The most common cause of progressive memory loss, starting with short-term memory impairment and eventually affecting long- term memory and other cognitive functions. Other Dementias (e.g., Vascular Dementia, Frontotemporal Dementia): These conditions can cause memory impairment along with changes in behavior and executive function. 2. Stroke or Cerebrovascular Disease Stroke: Brain damage from a stroke, particularly in areas responsible for memory (e.g., hippocampus or frontal lobes), can lead to short- or long- term memory impairment. Chronic Vascular Dementia: Ongoing, small strokes or poor circulation in the brain can impair memory over time. 21 The five most common medical causes of memory impairment include: 3. Vitamin Deficiencies Vitamin B12 Deficiency: Lack of vitamin B12 can lead to cognitive deficits, memory problems, and neuropathy. Thiamine Deficiency: Often seen in chronic alcoholism, this can cause memory loss and confusion, known as Wernicke-Korsakoff syndrome. 4. Thyroid Disorders Hypothyroidism: Low thyroid hormone levels can cause sluggish thinking, memory problems, and cognitive fog. It is often reversible with appropriate thyroid hormone replacement. Hyperthyroidism: Though less common, overactive thyroid can lead to anxiety, restlessness, and impaired memory. 22 The five most common medical causes of memory impairment include: 5. Traumatic Brain Injury (TBI) Concussions or More Severe TBIs: Damage to the brain from accidents, falls, or blows to the head can impair memory function, often affecting both short- and long-term recall. Post-Concussion Syndrome: Even after the brain has healed from an injury, some individuals experience persistent memory and cognitive difficulties. 23 The five most common medical causes of personality change include: 1. Traumatic Brain Injury (TBI) Frontal Lobe Damage: Injuries affecting the frontal lobe, often from accidents or falls, can lead to significant personality changes, including impulsivity, disinhibition, or emotional instability. Chronic effects may include irritability, apathy, or inappropriate behavior. 2. Dementias Alzheimer’s Disease: Early stages often involve subtle personality changes, such as withdrawal, irritability, or decreased social engagement. Frontotemporal Dementia (FTD): Specifically associated with profound personality changes, including apathy, disinhibition, loss of empathy, and socially inappropriate behaviors. 24 The five most common medical causes of personality change include: 3. Neurological Conditions Stroke: Personality changes may occur following strokes, especially those affecting the frontal lobe or limbic system. Emotional lability, apathy, or irritability are common. Epilepsy: Temporal lobe epilepsy, in particular, can cause mood and personality changes during or between seizures. 4. Psychiatric Disorders Depression: May present as irritability, withdrawal, or a lack of motivation, which can mimic personality changes. Bipolar Disorder: Manic or depressive episodes can dramatically alter behavior and mood, giving the appearance of a changed personality. Schizophrenia: Onset often involves changes in social behavior, emotional expression, or thought patterns. 25 The five most common medical causes of personality change include: 5. Substance Use or Medication Side Effects Substance Abuse: Long-term use of alcohol, stimulants, or other recreational drugs can alter mood, behavior, and decision-making, leading to personality shifts. Medication Effects: Corticosteroids, certain antiepileptics, and psychotropic drugs can induce mood swings, aggression, or apathy. 26 The five most common medical causes of psychosis (e.g., hallucinations, delusions) include: 1. Primary Psychiatric Disorders Schizophrenia Spectrum Disorders: The most common cause of persistent psychosis, often presenting with auditory hallucinations, delusions, and disorganized thinking. Bipolar Disorder: Psychotic symptoms can occur during manic or depressive episodes, often with mood-congruent delusions. 2. Substance Use or Withdrawal Substance-Induced Psychosis: Drugs such as cocaine, methamphetamine, LSD, PCP, or cannabis can trigger psychosis, particularly at high doses. Alcohol Withdrawal (Delirium Tremens): Severe alcohol withdrawal can cause hallucinations and agitation. Medications: Corticosteroids, anticholinergics, or dopaminergic drugs (e.g., for Parkinson’s disease) may induce psychosis. 27 The five most common medical causes of psychosis (e.g., hallucinations, delusions) include: 3. Neurological Disorders Dementias (e.g., Alzheimer’s Disease, Lewy Body Dementia): These conditions frequently cause hallucinations and paranoia, especially in advanced stages. Epilepsy: Temporal lobe epilepsy can cause transient psychosis, often with complex visual or auditory hallucinations. Brain Tumors or Lesions: Masses affecting areas like the temporal or frontal lobes may lead to psychotic symptoms. 28 The five most common medical causes of psychosis (e.g., hallucinations, delusions) include: 4. Metabolic or Endocrine Disorders Delirium from Metabolic Disturbances: Severe imbalances such as hypoglycemia, hypercalcemia, or electrolyte derangements can cause confusion and psychosis. Thyroid Disorders: Hyperthyroidism or hypothyroidism may rarely present with psychotic symptoms. Vitamin Deficiencies: Deficiency in vitamin B12 or thiamine (e.g., Wernicke-Korsakoff syndrome) can cause psychotic features. 29 The five most common medical causes of psychosis (e.g., hallucinations, delusions) include: 5. Infections Central Nervous System Infections: Encephalitis (e.g., viral, autoimmune, or paraneoplastic), meningitis, or HIV-related brain disease can cause psychosis. Delirium Secondary to Systemic Infections: Infections like urinary tract infections or pneumonia can trigger psychosis in vulnerable populations (e.g., the elderly). 30