Psychiatric Disease & Substance Abuse PDF

Psychiatric Disease & Substance Abuse Health Assessment Psychiatric Disease 10% of men, 20% of women have major depression Minor depression is difficult to quantify Mood and cognitive symptoms of psych diseases are common OCD, panic disorders, anxiety disorders, phobias, and bipolar disease Psychose...

Psychiatric Disease & Substance Abuse Health Assessment Psychiatric Disease 10% of men, 20% of women have major depression Minor depression is difficult to quantify Mood and cognitive symptoms of psych diseases are common OCD, panic disorders, anxiety disorders, phobias, and bipolar disease Psychoses like schizophrenia Medical Problems leading to Psych Hypothyroidism Cushing syndrome AIDS Seizure disorders Brain tumors Encephalitis Nutritional deficiency Toxic substance poisoning Psych Assessment Determining if patient is legally able to give consent Determining medical versus non-medical power of attorney Psych diseases are only managed, not cured Understanding how long and what treatments are effective is key Psych Drugs SSRIs Continued perioperative Potent inhibitors of CYP4502D6 (think opioids) TCAs Can slow cardiac conduction (ECG) Exaggerated responses to pressors MAOIs Coming back; produce serotonin syndrome Hypertension, coma, and death Continued perioperative Serotonin Syndrome Symptoms Psych Drugs Atypical Antidepressants Increased risk of seizures (lower threshold) Also used for chronic pain treatment Anticonvulsants Effective mood stabilizers and chronic pain Induce CYP450 system Continues perioperative (Acute discontinuation can cause seizures) Impact NDNMB Specific Psych Questions Past experience with anesthesia Use of recreational drugs What happens when…. Compliance with meds (has anything been discontinued) Bottom line: take your psych meds and prepare for the end first Substance Abuse Alcohol > Prescription Drugs > Marijuana > Cocaine Identified by the WHO as a pandemic in nature Both a social and public health problem Substance abuse is almost NEVER seen in isolation Usually has (or needs) a psych diagnosis Alcohol Medical implications impact ALL organ systems CNS → atrophy, tremor CV → dilated cardiomyopathy, HTN, PVD GI → gastritis, esophageal varices, ulcers, pancreatitis, hepatitis, and cirrhosis Preoperative workup includes ECG, coags, CBC, and consider need for blood products ACUTE v. CHRONIC alcohol use Marijuana Acute intoxication and anesthesia interactions are rare Chronic use impacts ANS (tachycardia & increased CO) Synergy with other sedatives Acute intoxication CAN lead to direct myocardial depression Avoid use 1 week prior to anesthesia Cocaine Never perform an elective anesthetic on someone acutely intoxicated on cocaine Direct and profound depression on LV function Slowing of cardiac conduction AT LEAST 1 week of no cocaine; some recommend 30 days Avoid ketamine Heroin Rapidly converted to morphine in the plasma As with other chronic opioid users, be mindful on the last dose and compliance with treatment Avoid elective anesthesia when acutely intoxicated on heroin Preoperative assessment focused on treatment of heroin addiction