Psychiatry 精神病学 Wang Keqin Jining Medical College Jinig Medical College
Prefrontal- Hypothalamus cortex Amygdala Locus ceruleus 11.Psychological aspects of Cytok physical illness Increased Jining
11.1 Psychological reactions to physical illness and its treatment Worry and uncertainty ■Anxiety ■Loss of control ■Sense of failure ■Stigma ■Fear ■Secretiveness ■Isolation Jining Medi
11.2.Psychiatric illness following physical illness or its treatment Depressive disorders Drug treatment can Anxiety states and panic cause: disorder Depressive disorders Conditioned responses ■Acute confusion ■Body image problems ■Psychosis ■Sexual problems ■Alcohol problem Post-traumatic stress disorder Jining Medical College
Depression in medical patients Depressive illness is an important cause of morbidity and disability in physically ill patients All patients with depression should be examined for suicidal ideation Depression is treatable in physically ill patients Jining Medical College
Pathways to depression Multiple stressors of illness Personality ------- -------Life stage Social support Prior experiences of mastery Personal meaning Anxiety Sadness Somatic distress (Normative response) Social support ----- ---Genetic loading Medical complications Coping strategies Persistent subthreshold symptoms Depressive disorders
Physical symptoms that may be due to depression "Memory loss Malaise Insomnia Fatigue and tiredness Headache ☑Painful joints and back Chest pain Nausea Weight loss vomiting,and constipation Disrupted menses
Anxiety in medical patients Medical conditions mimicking or directly resulting in anxiety Poor pain control-Such as ischaemic.Anaemia heart disease,malignant infiltration Hypoglycaemia Hypoxia-May be episodic in both.Hyperkalaemia asthma and pulmonary embolus Alcohol or drug withdrawal ●Hypocapnia--May be due to occult●Vertigo bronchial hyperreactivity ●Thyrotoxicosis Central nervous system disorders ●Hypercapnia (structural or epileptic) ●Hyponatraemia Jining Medical College
11.3 Psychiatric disorder resulting in physical illness ■Alcohol ■Drug abuse ■Deliberate self--ham ■Schizophrenia 。Hypomania ■Eating disorders Jining Medical College
11.4 Management of acute behavioral disturbance Causes of delirium due to underlying medical conditions Intoxication with drugs-Many drugs implicated especially anticholinergic agents,anticonvulsants,anti-parkinsonism agents, steroids,cimetidine,opiates,sedative hypnotics.Don't forget alcohol and illicit drugs Withdrawal syndromes-Alcohol,sedative hypnotics,barbiturates Metabolic causes Hypoxia,hypoglycaemia,hepatic,renal or pulmonary insufficiency Endocrinopathies(such as hypothyroidism,hyperthyroidism, hypopituitarism,hypoparathyroidism or hyperparathyroidism) Disorders of fluid and electrolyte balance Rare causes(such as porphyria,carcinoid syndrome) Infections ● Head trauma ● Epilepsy-Ictal,interictal,or postictal Neoplastic disease Vascular disorders Cerebrovascular (such as transient ischaemic attacks,thrombosis, embolism,migraine) Cardiovascular (such as myocardial infarction,cardiac failure)