Psychiatry and Medicine Trans

8/19/2019 Psychiatry and Medicine Trans

http://slidepdf.com/reader/full/psychiatry-and-medicine-trans 1/5

♠GALANG.E.GARCIA.J.SANTOS.VENTENILLA♠

Main message: Psychiatric disorders and some

psychological symptoms that are not severe enough tosatisfy the diagnostic criteria for a psychiatric disorder

are frequently encountered by primary care physicians.

Therefore, problems should not be missed.

Outline:

1.

Psychiatric and psychological disorders

occurring together by chance

2.

Psychological factors affecting the onset and

course of physical illness

3.

Psychological factors contributing to medically

unexplained symptoms

4.

Psychological and psychiatric consequences of

physical illness

5.

Psychiatric problems with physical

complications

Introduction

In the general population

Physical illness and physical symptoms are associated

with an increase of psychiatric disorder (Wells et al,

1988; Koenkeand Price, 1993

Strong association between somatic symptoms and

psychiatric morbidity in primary care (WHO)

Moderate and severe physical disorder was

associated with psychiatric disorder

The more medically unexplained symptoms, thehigher the association with psychiatric disorder

Medically unexplained symptoms were more

common than those with a physical explanation

Medically and non-medically explained

symptoms often occurred together (Kisely and

Goldberg 1996; Simon et al; Kisely et al 1997;

Simon 2000.)

In general hospital in-patients, outpatients and

emergency rooms more than 25% of patients inmedical wards have a psychiatric disorder

Affective and adjustment disorders more

common in the elderly

Drinking problems more common in younge

men

Psychological problems more frequent in ER as well as

gynecological and medical out-patients.

Primary care physicians often fail to recognize

psychiatric disorder in patients with physical illness

(Goldberg, and Huxley, 1980)

Psychiatric and Physical disorders occurring together by

chance

Psychiatric and Physical disorders often arise

independently of one another and then interact.

Psych do may affect the patient’s response to

physical symptoms and increase the problems of

medical management

Eating disorder and diabetes

Depression and MI

Physical illness may lead to deterioration of

psychiatric do

DM or hypertension and depression

Psychological factors affecting the onset and course ophysical illness

Topic: Psychiatry and Medicine

Lecturer: Dr. Jimenez




Medically unexplained symptoms are extremely

frequent in the general population (Mayou et al 1995;

Simon 2000)

Minor transient symptoms

Persistent symptoms and syndromes, often

associated with psychiatric disorder

Factitious disorder

Factitious disorder by proxy

Malingering

Epidemiology

Common

More frequent in women than in men

Can cause absenteeism, frequent doctor

consults; taking meds and distress (Koenke and

price 1993); von Korff et al 1998)

Etiology: interaction of physiological, pathological and

psychological variables

1. Starts with bodily sensations – awareness of

abnormal heart rate

2.

Mental state (concern and anxiety result in

focusing on the subjective symptoms and make

the perception of the symptom worse-anxiety

leads to panic

Some causes of bodily sensations

Major pathology

Minor pathology

Physiological processes

Sinus tachycardia and benign minor arrhythmias

Effects of fatigue

Hangover

Effects of overeating

Effects of prolonged inactivity

Autonomic effects of anxiety

Lack of sleep

Illness experience which may affect interpretation of

bodily sensations and concern

Childhood illness

Family illness and consultation in childhood

Childhood consultation and school absence

Physical illness in adult life

Experience and satisfaction with medica

consultation

Illness in family and friends

Publicity in television, newspapers, internet

Knowledge of illness and its treatment

Association with psychiatric disorder

Majority are not associated with psychiatric disorder

Persistent are likely to be associated with psychiatricdisorder

Usually anxiety and depression

Assessment

Consider psychological factors from onset

Appropriate physical investigation to exclude

physical cause

Clarify psychological and physical complaints

Clarify previous personality and concerns aboutphysical illness

Understand patient’s beliefs and expectation

Identify depression or other psychiatric disorde

Identify psychosocial problems

General principles of treatment of medically

‘unexplained’ symptoms

Emphasize that symptoms are real and familia

and that medical care is appropriate

Provide physical treatment for any associated

established disease and co-ordinate physica

and other care

Offer explanation and discuss

Allow patients and families to ask questions

Discuss the role of psychological factors in al

medical care




Treat any primary psychiatric disorder

Agree on a treatment plan

Treatments suitable for non-specialist care

Discussion and explanation of etiology

Treatment of any minor underlying physical

problem

Anxiety management

Advice on diary monitoring and graded return

to full activities

Specific self-help programmes

Involvement of relatives and explanation of the

treatment

Chronic Fatigue

Also post-viral fatigue syndrome; neurasthenia;myalgic encephalomyelitis

Case definition of chronic fatigue syndrome

Clinically evaluated, medically unexplained

fatigue of at least 6 months duration that is:

Of new onset

Not result of ongoing exertion

Not substantially alleviated by rest

A substantial reduction in previous level ofactivities

The occurrence of 4 or more of the following

symptoms:

Subjective memory impairment

Sore throat

Tender lymph nodes

Muscle pain

Joint pain

Headache

Unrefreshing sleep

Post-exertional malaise lasting for more than 24

hours

Does not have

Active, unresolved or suspected disease

Psychotic, melancholic, or bipolar depression

Psychotic disorders

Dementia

Anorexia or bulimia nervosa

Alcohol or other substance abuse

Severe obesity

Possible causal factors in chronic fatigue syndrome

Predisposing Precipitating Perpet

Biological Genetic

Previous

depression

Virus HPA

disturb

Inactiv

Psychological Personality

(perfectionism)

Response to

stress

Diseas

attribu

Avoida

coping

Social Stresses Life co

Iatroge

factors

Assessment

Exclude any treatable organic or psychiatric

cause of chronic fatigue

Detailed description of course of symptoms and

their consequences for the patient

Inquire about depression

Acknowledge the reality of the patient’s

symptoms and the disability associated with

them

Provide appropriate information to patient and

family

Encourage return to normal functioning

Provide help with occupational and practica

problems

Irritable Bowel – abdominal pain or discomfort, with o

without an alteration of bowel habits, persisting for

longer than 3 months in the absence of any

demonstrable organic disease




Fibromyalgia- syndrome of generalized muscle aching,

tenderness, stiffness, and fatigue, often accompanied

by poor sleep

Factitious disorder- intentional production of feigning

of physical or psychological symptoms which can be

attributed to a need to assume the sick role

Malingering – fraudulent simulation or exaggeration of

symptoms that is motivated by external incentives

Psychological and psychiatric consequences of physical

illness

Most common response – resilience

Unsual emotional response –anxiety, then

depression

Psychiatric disorder –in up to 30%

Adjustment disorder

Major depression

Anxiety disorder

Somatoform disorder

Substance misuse

Eating disorder

Sleep disorder

Factitious disorder

Sexual disorders

Determinants of the occurrence of psychiatric disorder

among physically ill patients

The physical disease as a cause of:

Symptomatic psychiatric disorder

Threat to normal life

Disability

Pain

Nature of the treatment

Side effects

Mutilation

Demands for self-care

Factors in the patient

Psychological vulnerability

Social circumstances

Other life stresses

Reactions of others

Family

Employers

Doctors

Some organic causes of common psychiatric symptoms

Depression Carcinoma, infections

neurological disorders

including dementias, diabetes

thyroid disorder, Addison’s

disases, Systemic lupuserythematosus

Anxiety Hyperthyroidism,

hyperventilation,

phaeochromocytoma,

hypoglycemia, neurologica

disorders, drug withdrawal

Fatigue Anemia, sleep disorders

chronic infection, diabetes

hypothyroidism, Addison’s

disease, carcinoma, Cushing’s

syndrome, radiotherapy

Wekness Myasthenia gravis, periphera

neuropathy

Episodes of epilepsy Hypoglycemia,

phaeochromocytoma, early

dementia, toxic states

Headache Migraine, giant cell arteritis

space-occupying lesions

Loss of weight Carcinoma, diabetes

tuberculosis, hyperthyroidism

malabsorption

Some drugs with psychological side effects

Drug Side effect

Antiparkisonian agents

Anticholinergic drugs

L-dopa

Disorientation, agitation

confusion, visua

hallucinations

Acute organic syndrome




depression, psychotic

symptoms

Antihypertensives

Methyldopa

Calcium-channel blockers

Clonidine

Sympathetic blockers

Tiredness, weakness,

depression;

Impotence, milddepression

Digitalis Disorientation,

confusion, mood

disturbance

Diuretics Weakness, apathy,

depression

Analgesics

Salicylamide

Phenacetin

Confusion, agitation,

amnesia

Dementia with chronic

abuseAntituberculous therapy

Isoniazid

Cycloserine

steroids

Acute organic syndrome

and mania

Confusion,

schizophrenia-like

syndrome

* FIN *

*Yo! Please don’t rely solely on this trans, this is just the

more readable copy of the handout that was given to us.However, we just made it more highlighter friendly and

printer friendly.

If you guys don’t have the Kaplan book or ebook (that we

think is pretty vital to this course) here’s a link where you can

download it fo sho: www.4shared.com/file/CqtDmSp-

/Kaplan_and_Sadocks_Synopsis_of.html

It’s a chm file. If this link doesn’t work, just read the tr ans and

keep calm.

~Psych trans team OUT~

THAT IN ALL THINGS GOD MAY BE GLORIFIED.

http://www.4shared.com/file/CqtDmSp-/Kaplan_and_Sadocks_Synopsis_of.html





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Psychiatry and Medicine Trans