[10.16] Psychiatric Disorders Secondary to A General Medical Condition V2 - Google Docs.pdf

Psychosis, depression, anxiety, sleep disturbances, and sexual complaints

What are five psychiatric or mental symptoms commonly seen in disorders secondary to a general medical condition?

Underestimated

How is the frequency of psychiatric disorders secondary to general medical conditions currently viewed in clinical practice?

General medical conditions (GMCs) and substances

Aside from a primary psychiatric disorder, what two major differentials should always be considered when a patient presents with psychiatric symptoms?

Organic

What was the outdated term used to classify psychiatric disorders caused by general medical conditions or substances?

Non-organic, functional, or primary

What were the three outdated terms used for psychiatric disorders not related to general medical conditions or substances?

History, physical examination, and laboratory findings

From which three sources must evidence be gathered to show a psychiatric disturbance is a direct physiological consequence of a GMC?

Etiological relationship via a physiological mechanism

What type of relationship must exist between the GMC and the psychiatric disorder to fulfill diagnostic criteria?

Not its sole etiology

How can a GMC be related to a psychiatric disturbance even if it is part of it?

Delirium

A psychiatric disorder cannot be diagnosed as secondary to a GMC if it occurs exclusively during the course of what?

Major Depressive Disorder due to Hypothyroidism

What is the specific diagnosis for a 30-year-old female with psychomotor retardation and cold intolerance who has elevated TSH and low FT4?

Depressed affect, lethargy, difficulty in concentration, and psychomotor retardation

What are four psychiatric symptoms mentioned in the clinical correlation of hypothyroidism?

Cold intolerance, dry skin, constipation, weight gain, and brittle hair

What are five medical signs of hypothyroidism mentioned in the source?

Temporal association

What is the term for the relationship between the onset, exacerbation, or remission of a GMC and a mental disorder?

Parathyroid adenoma

In what condition might anxiety symptoms resolve after surgical excision of a mass and restoration of normal calcium levels?

Epilepsy

In what condition might a psychiatric disorder emerge several years after the onset of the medical problem?

Personality changes

What usually precedes the appearance of psychosis in patients with epilepsy?

Huntington's disease

In what neurodegenerative disease might depression precede choreiform movements?

Pancreatic cancer

Depression can appear before the detection of what specific type of malignancy?

Amenable to symptomatic treatment while the GMC remains active

What is the treatment status of a psychiatric disorder due to a GMC while the underlying condition is still being treated?

Late teens or early adulthood

What is the characteristic age of onset for primary schizophrenia?

Organic pathology

If a 75-year-old patient presents with acute schizophrenic-like symptoms, what should always be considered despite the symptoms?

Auditory

What is the most common type of hallucination in primary schizophrenia and psychotic depression?

Visual or tactile

The presence of which two types of hallucinations should increase suspicion of an organic cause?

The more primitive the sensory hallucination

What factor regarding hallucinations increases the index of suspicion for an organic cause?

50-pound weight loss in a mildly depressed individual

What example is given for a feature disproportionately more severe than expected in a psychiatric presentation?

Stroke acting as a psychosocial stressor

What is an example of a coincidental relationship where a stroke leads to MDD but not via direct physiological effects?

Cognitive impairment

Psychotic disorders secondary to a GMC exclude syndromes where symptoms are associated with what?

Delirium, dementia, and amnestic disorder

What are the three most common syndromes involving cognitive impairment that must be excluded from secondary psychosis?

Stable level of consciousness

Unlike delirium and dementia, what is the status of the sensorium in psychosis due to a GMC?

Cortical and temporal lobe masses

What specific locations of cerebral neoplasms can cause hallucinations?

Tumors, subdural masses, and brain abscesses

What are three examples of intracranial masses associated with psychosis?

Head injury

What is the example provided for the trauma category of psychosis etiology?

Parkinson's, Huntington's, Pick's disease, ALS, and Wilson's disease

What are five neurodegenerative disorders associated with psychosis?

Creutzfeldt-Jakob disease, AIDS, viral encephalitis, neurosyphilis, and meningitis

What are five infections associated with psychosis?

Vitamin B1 or thiamine deficiency

Wernicke-Korsakoff syndrome is caused by a deficiency in what?

Vitamin B12 (cobalamin), Vitamin B9 (folate), and Vitamin B3 (niacin/pellagra)

Aside from thiamine, what other three vitamin deficiencies are associated with psychosis?

Renal insufficiency, hepatic insufficiency, and parathyroid disease

Aside from thyroid issues and Cushing's, what are three metabolic causes of psychosis?

Systemic lupus erythematosus (SLE), multiple sclerosis, and Whipple's disease

What are three chronic inflammatory disorders associated with psychosis?

Alcohol, amphetamines, cocaine, phencyclidine, hallucinogens, sedative-hypnotics, and cannabis

What are seven substances associated with psychosis?

Brain tumor

In the show The Good Doctor, what did a homeless patient's suspected schizophrenia turn out to be?

Etiology

On what does the prognosis of secondary psychotic symptoms largely depend?

Irreversible CNS tissue damage

Why might psychotic symptoms from an infectious process not improve despite treating the infection?

Rapid identification and treatment of the underlying cause

What is the first basic principle of treatment for all psychiatric disorders secondary to GMCs?

Antipsychotics

What class of medications is used for the symptomatic relief of secondary psychosis?

Haloperidol and trifluoperazine

What are two examples of first-generation antipsychotics mentioned as no longer commonly used?

Extrapyramidal symptoms

Why are first-generation antipsychotics less commonly used today?

Olanzapine, risperidone, and sulpiride

What are three examples of second-generation or atypical antipsychotics with fewer side effects?

Depression and bipolar disorder

What are the two most common examples of mood disorders?

Cyclothymia and dysthymic disorder

What are the two milder forms of mood disorders mentioned?

More than two years

What is the duration required to characterize dysthymic disorder?

Depressed mood or elevated, expansive, or irritable mood

Mood disorders are characterized by either of which two main features?

Higher in men

What is the epidemiology of depression in the medically ill compared to primary MDD?

Primary MDD

In which condition is the incidence of depression higher in women?

Males use more violent methods

How does the method of suicide generally differ between genders?

Shooting oneself in the head or jumping from a building

What are two examples of violent suicide methods mentioned for males?

Strokes, Parkinson's, Huntington's, HIV, and multiple sclerosis

What are five illnesses where depressive episodes are particularly common?

Manic symptoms

Which is less prevalent in neurological diseases: depressive symptoms or manic symptoms?

Girl Interrupted, Gone Girl, The Crush, and Fatal Attraction

What four films are listed as demonstrating typical signs of Borderline Personality Disorder?

Decrease interest in activities, poor sleep/appetite, lethargy, and psychomotor changes

Aside from mood and guilt, what are four symptoms of depression?

Anhedonia

What is the term for the lack of interest or pleasure in life experiences?

Difficulty with sleeping and decreased appetite

What are the two typical accessory symptoms of depression?

Prolonged/excessive sleeping and increased appetite

What are two atypical accessory symptoms of depression?

Feeling worthless and feeling hopeless

Aside from sadness, what are two emotional symptoms of depression?

Brain fog, difficulty focusing, and indecisiveness

What are three cognitive symptoms of depression?

Pseudodementia

What is the term for cognitive symptoms of depression that mimic dementia?

Truly demented patients will not ask if they are getting dementia

How does the reaction of a depressed patient regarding memory loss differ from a truly demented patient?

Thoughts of death

What is considered a passive suicidal thought?

Suicidal ideations

What is considered an active suicidal thought?

Elevated, expansive, or irritable

Manic mood is persistently one of which three states?

Inflated self-esteem, decreased sleep, racing thoughts, and distractibility

What are four manic symptoms?

Flight of ideas

What is the term for thoughts moving rapidly from one idea to another in mania?

Greater aggression

What manic symptom can lead to potentially assaultive behavior like road rage?

Bipolar Disorder

What occurs when there is a mix of both depressive and manic symptoms?

Unipolar depression

Which is more common: unipolar depression or bipolar disorder?

Metoclopramide and H2 blockers

Aside from antipsychotics and antihypertensives, what are two medications listed under drug intoxication causing mood disorders?

Sex steroids and corticosteroids

What two types of steroids can cause secondary mood disorders?

Nicotine, caffeine, cocaine, and amphetamines

Aside from alcohol/sedatives, what are four substances whose withdrawal can cause mood disorders?

Cerebral contusion and subdural hematoma

What are two types of trauma that can cause secondary mood disorders?

Sepsis, UTI, and peripheral neuropathy

What are three systemic infections that can cause secondary mood disorders?

Low-output states and CHF

What are two cardiovascular conditions that can cause secondary mood disorders?

Hypoxemia, electrolyte disturbances, and postictal states

What are three physiologic/metabolic causes of secondary mood disorders?

SSRIs, SNRIs, and NDRIs

What are the three main classes of medications for MDD?

Norepinephrine-Dopamine Reuptake Inhibitor

What does the acronym NDRI stand for?

NDRIs

Which class of antidepressant is noted as being unavailable in the Philippines?

Serotonin

Which neurotransmitter is the main one implicated in MDD?

Bipolar depressed patients

To which group of patients should you never give SSRIs or SNRIs?

It can induce mania

Why is giving SSRIs or SNRIs to bipolar patients contraindicated?

Secondary depressive disorders

Which generally has a poorer prognosis: primary depression or secondary depressive disorders?

Remissions, recurrences, and continuous illness

What are three characteristics of the chronic course of secondary depression?

Hypothyroidism

Depression secondary to which condition has a better outcome than depression from pancreatic carcinoma?

Tricyclic antidepressants and MAOIs

Aside from SSRIs/SNRIs, what are two other standard medication classes for mood disorders?

Psychostimulants like methylphenidate

What class of medication is given to depressed patients who are vegetative or unable to get out of bed?

Generalized anxiety, panic attacks, OCD symptoms, and phobias

What are the four key manifestations of anxiety symptoms?

Caffeine, amphetamines, cocaine, and sympathomimetic agents

What are four substances of intoxication causing anxiety?

Pheochromocytoma

What specific endocrinopathy involves adrenal dysfunction and anxiety?

Hypercalcemia and hypoglycemia

Aside from hypoxemia, what are two metabolic derangements causing anxiety?

Subarachnoid hemorrhage and migraine

Aside from cerebrovascular disease, what are two vascular neurologic disorders causing anxiety?

Cardiac arrhythmia and pulmonary insufficiency

What are two systemic conditions causing hypoxia-related anxiety?

100 to 150 mg

How much caffeine is in one cup of coffee?

Consumption of more than 250 mg in one sitting

What defines caffeine intoxication?