Date post: | 14-Jan-2017 |
Category: |
Health & Medicine |
Upload: | dr-riaz-ahmad-bhutta |
View: | 39 times |
Download: | 0 times |
MENTAL AND BEHAVIORAL DISORDERS DUE TO GENERAL MEDICAL
CONDITIONS
Learning Objectives Identify Psychiatric symptoms in
the following: Thyroid diseases (thyrotoxicosis, myxodema) Hyperadrenalism (cushing’s syndrome), Hypoadrenalism (Addison’s disease) Hyperglycemia and hypoglycemia
Learning Objectives
Renal failure and electrolyte disturbance
Hepatic encephalopathy Vitamin B deficiency Cerebral hypoxia
Acute(organic) brain syndrome/Delirium
This condition is the consequence of both medical and surgical disorders
Etiology consists of intracranial as well as extracranial causes
Clinical feature are diverse and according to underlying physical ailment
Management is that of cause and symptoms
Hyperthyroidism/Thyrotoxicosis
The symptoms are: Symptoms of anxiety Restlessness Over activity Lability of mood Other symptoms of increased thyroid activity Mental symptoms may precede or may be
the only indication of hyperthyroidism
Hyperthyroidism/Thyrotoxicosis
Hyperthyroidism should be differentiated from primary anxiety state, depressive illness and schizophreniform psychosis.
Hypothyroidism/Myxoedema
It usually manifests at middle aged or elderly ladies but no age or sex is exempt.
The psychiatric symptoms may be:1. Mental lethargy2. Loss of spontaneity3. Dulling of comprehension4. Mild memory impairment5. Frequently a depressed mood6. May present as delirium
Hypothyroidism/Myxoedema
Typically the voice is husky and skin is coarse. Deafness is common. Deep tendon
Reflexes are slow and there is delayed relaxation of muscles.
A combination of myxoedema coma and hyperthyroidism may leads to death
Sheehan’s Syndrome
It results from post partum necrosis of anterior pituitary.
The picture is usually of intensely pale middle aged women with a fine and prematurely wrinkled skin sitting drowsily by the fire on a warm summer day
Sheehan’s Syndrome
The clinical picture is:1. Lack of initiative2. Increased susceptibility to cold3. Increased desire for rest and sleep4. Depression of mood.5. Emaciation6. Impotence in males and
amenorrhoea in females
Addison’s Disease
May be caused bilateral primary atrophy of the glands or infection of the adrenal glands or necrosis due to hemorrhagic shock. The symptoms are:
1. Apathy2. Hypotension3. Pigmentation of exposed part of skin4. Depression5. Episodes of delirium may occur
Cushing’s Syndrome
It can be caused by tumors of pituitary gland or may be the result of primary hyperplasia of adrenals and thus prolonged excessive secretion of steroid hormones. The physical features are:
1. Red moon shaped face2. Hirsutism3. Obesity4. Buffalo-hump
Cushing’s Syndrome The mental symptoms are:
1. Depression of mood is the commonest but rarely elation may be seen
2. Episodes of disturbed behaviour like excitement or anxiety can be present
3. Auditory hallucinations and paranoid delusions may be observed
Diabetes Mellitus
Two main psychiatric syndromes:1. Delirium2. Diabetic cerebral arteriopath.
“INSULINOMA”: Major features are intermittent
bizarre behaviour occurring after exercise in the late morning or before break fast in the early morning.
There is pallor, sweating, anxiety, unsteadiness and depersonalization.
Very frequently physical symptoms are the sole features.
METABOLIC DISORDERS
Renal Failure and Electrolyte Disturbance
In this condition mental state of a patient changes as the uremia increases
Early changes include undue fatigue, drossiness and impaired concentration. Slowing of thought process and memory disturbances then follow
Renal Failure and Electrolyte Disturbance
Subsequently tremors, muscle twitching, neuropathy and epileptic fits start occurring.
This picture can also be seen in patient with chronic renal failure who are being treated be dialysis. Anxiety and depression are other common psychiatric symptoms in patient on dialysis.
Hepatic Encephalopathy
This state can be seen in viral hepatitis or in association with an established case of cirrhosis
Prodromal symptoms include anergia, headache, disturbed sleep leading to confuional state and coma.
Hepatic Encephalopathy
Chronic encepthalopathy occurs in all types of cirrhosis
There are reversible episodes of altered consciousness leading to stupor
This state is also associated with increased sleep. Other features are hepatic foetor, flapping tremers and splenomegaly
Vitamin B Deficiency
1. Thiamine. (B-1) Deficiency Deficiency of thiamine is the cause
of Wernicke’s encephalopathy which may terminate in a transient or permanent memory impairment and Korsakoff’s psychosis.
Vitamin B Deficiency
2. Nicotinic Acid Deficiency The features are dermatitis,
dysphagia, dierrhoea, delirium and dementia.
Other symptoms are weakness of muscles, paraesthesias, depression and confusional state
Vitamin B Deficiency3. Vitamin B12 Deficiency. Major causes are gastrectomy and
defective diet. The symptoms are pernicious
anaemia, sub acute combined degeneration of the cord and psychiatric squellae like depression, anxiety, irritability and poor memory.
In some cases mental symptoms may precede the neurological and haematological abnormalities.
Cerebral Hypoxia
The causes are CO poisoning exposure to high altitude, respiratory diseases and congestive cardiac failure.
The mental sequellae are more marked in the elderly with co-existing disease of the cerebral vessels.
The symptoms are that of fluctuating delirium with associated behavioural symptoms.