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Psychiatry andMedicine

Dr Jon LaugharneUniversity of Western Australia

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Organic causes of Psychiatric

SymptomsDepression carcinoma, infections,diabetes, thyroid disorder, SLE, beta

blockers Anxiety hyperthyroidism,hypoglycaemia, drug withdrawal,phaeochromocytomaFatigue anaemia, chronic infection,diabetes, carcinoma, Addisons disease

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Diabetes

Depression and anxiety

Hyperglycaemia can cause delirium

Early dementia

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Steroids

DepressionMania

Paranoia

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Maternity Blues

2-3 days post-partumLabile mood

50-60% mothers (partic primigravida)Often some anxiety/depression in finaltrimester

Resolves spontaneously

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Postnatal depression Rx

Supportive psychotherapyProblem solving

Relaxation advicePractical supports

Anti-depressants

amitriptyline/imipramine

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Postpartum Psychosis

1-2 weeks post partum

Delirium (sepsis) AffectiveSchizophreniform

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Postpartum psychosis

Attitude to baby? Risks to baby or self?

Treat the clinical syndrome Antidepressants Antipsychotics

ValiumECT

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Psychiatric drugs &

breastfeeding Avoid if possible Antidepressants OK

Antipsychotics OKCarbamazepine OKMonitor baby

Can mother use formula alternative?

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Pregnancy & psychiatric drugs

Avoid if possible in 1 st trimester Avoid carbamazepine

Haloperidol rather than chlorpromazine Antidepressants OKClinical decision risks vs benefits

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Causes of delirium (brain)

Infections - meningitis, encephalitis,malaria.

SOLs tumour, haemorrhage

Injury/trauma

Epilepsy postictal, status

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Treating delirium

FIND and TREAT CAUSESedate chlorpromazine 100mg 8hrly or

diazepam 2-5mg 6hrlyNurse in unstimulating environment darkened room

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Unexplained medical

symptomsInterpretation of physical sensationsPersonality

Mental stateKnowledgeBeliefs/cultural factors

Symptoms/behavioural change/disability

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Principles of management

Do not overinvestigateExplain and discuss your diagnosis

Explain symptoms are real and takenseriouslyTreat any associated psychiatric orphysical disorderInvolve relatives/supports if possible

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