module eight psychiatric symptoms and physical diseases lesson 1: treatment of physical diseases and...
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Module Eight PSYCHIATRIC SYMPTOMS AND PHYSICAL DISEASES
Lesson 1: treatment of physical diseases and adapting to them
Lesson 2: Mental Disorders caused by a physical disease
Lesson 3: Epilepsy
Step 1: Introduction
Some mental disorders are a result of physical disease or damage which is either generalized or concerns only the brain.
The psychiatric consequences of physical diseases can be separated in two categories:
Problems that derive from the treatment of physical disease or damage.
Mental disorders that derive directly from the physical disease or damage.
Step 2: Slide projectionSlide 8.1.1: Patient’s behaviourThis may comport: visit to the doctor, take medication, stay in bed, absence from work, take advice from relatives and friends, give up some activities.
Step 3 (continued)
Slide 8.1.2: Coping and adaptation
The psychological procedures that derive from short stressful events (which may include an illness) are known with the term coping, which practically means the way of getting along.
Step 1: Introduction Many physical disorders can cause psychiatric
symptoms similar to those characterizing mental disorders.
There are exterior natural factors, like medication (therapeutic or illegal) and other chemical substances that can too cause psychiatric symptoms.
The physical diseases related to the manifestation of psychiatric symptoms can be separated in brain disorders and general or systematic Disorders even though in reality these two categories overlap.
Step 2: Slide projectionSlide 8.2.1: Brain disorders with psychiatric
symptoms
Acute confusional state Delirium Chronic brain syndromes Dementias Focal disorders Tumors, Vascular events Brain disorders that cause symptoms of other
psychiatric disorders. Epilepsy
Step 3: Theory presentationAcute confusional state (delirium) Common in pathological and surgical units (5 –
15%) and in Intensive treatment units (20-30%). The person is disorientated, cannot remember some
things and is uneasy and shows hyperactivity, irritability, fear or aggression, even delusions or hallucinations and ideas of persecution.
There are many causal factors: Medication, General infections, Brain infections,
Kidney failure, Hepatic failure, Brain tumors, Cerebrovascular episodes, Cerebral injury Epilepsy.
Step 3 (continued)
Chronic brain syndromes It is about dementias, which are already
described. Dementias do not appear only to elders, some of them can also appear to people of other ages.
The causes of dementias include many factors that cause deliriums.
Step 3 (continued)
Focal Disorders The disorder or injury is found in a section
of the brain and the symptoms depend on the principal functions of this section.
The disorders related to a particular brain section are more common after brain injury, cerebrovascular injuries, or tumors.
Step 3 (continued)Brain disorders that cause symptoms of other
mental disorders. The symptoms of delirium or dementia focus on
orientation and memory. Other disorders, though, cause psychiatric symptoms similar to Schizophrenia’s, Mania’s or Depression’s.
The most common of these disorders is Epilepsy. Apart from confusional symptoms that appear during generalized seizures, it can cause delusions. Epilepsy of temporal lobe can lead to escape behaviour, like in Conversion Disorders.
Step 4: Slide projectionSlide 8.2.2: General diseases with psychiatric symptoms Diseases from vitamins deficiency (pellagra, deficiency
B1, deficiency B12) Endocrine disorders (Cushing's syndrome,
hyperthyroidism and hypothyroïdism , Addison disease, pheochromocytoma , hyper and hypoparathyroidism, hypopituitarism)
Drugs and toxic substances Infections (Syphilis, Aids, Malta fever, glandular fever,
HIV infection) Metabolism disorders ( hepatic insufficiency, electrolyte
disorders, uraemia) Acute intermittent porphyria Multiple sclerosis Lupus erythematosus
Step 5: Slide projection and Discussion
Slide 8.2.3: Psychiatric symptoms of physical disorders
Schizophrenic Symptoms:
Delirium, Dementias, Brain tumors, Cerebrovascular episodes, Brain lesions, Epilepsy, Cushing syndrome, Hyperthyroidism, Hypothyroïdism, hypoparathyroidism, Medication and toxic substances, Syphilis, Aids, multiple sclerosis, Hepatic insufficiency, Hypoglycaemia, electrolyte disorders, uraemia, acute intermittent porphyria, lupus erythematosus
Step 5 (continued)
Depression:
Brain tumors, Epilepsy, Deficiency B12, Cushing’s syndrome, Hypothiroïdisme, Addison disease, Hyper parathiroïdisme, Hypopituitarism, Medication and toxic substances, Syphilis, Aids, Malta fever, monocytic angina, hepatitis, multiple sclerosis, Electrolyte disorders, Uraemia, Acute intermittent porphyria
Step 5 (continued)
Manic symptoms:
Brain tumors, B1 deficiency, Cushing syndrome, Medication and other substances, Syphilis, Aids, Multiple sclerosis, Acute intermittent porphyria
Step 1: Slide projection
Slide 8.3.1: What is Epilepsy? Epilepsy is a chronic or recurrent disorder,
which is related to the state of consciousness and depends on the electrical excitations activity of the brain.
Step 1 (continued)
From these that have Epilepsy: 70-80% have no episodes after the therapy 20% is difficult to treat 80% take medication
Step 2: Discussion 1 in 3 persons that suffer from Epilepsy appear some
psychiatric problems. This correlation is even higher for temporal lobe Epilepsy.
Why is the occurrence of psychiatric symptoms in persons with Epilepsy so high?
What is the connection between mental disorders and Epilepsy?
Step 2 (continued) People who suffer from epilepsy face difficulties
to join into society because of their state. The medication they are on aggravate these
difficulties. The appearance of psychotic episodes people
with temporal lobe epilepsy is common and it is considered in these cases that both are caused by the same physical problem.
Epileptics appear more often high rate of mental retardation and personality disorders, which are again attributed to the same physical problem and to medication.
Step 3: Slide projection
Slide 8.3.2: Cause of epilepsy
Unknown : 70%(some cases might be hereditary)
Rest : 30%Brain lesion
Metabolic causes
Step 4: Theory presentation and slide projection
There are different types of epileptic seizures. A person that suffers from Epilepsy might show more than one type of epileptic seizures but usually there is a standard and particular type for this person.
The type of seizures depends on the brain section that is injured. According to International classification of Seizures, the seizures can be classified as Partial and Generalized.
Step 4 (continued)
Partial seizures Simple ComplexGeneralized seizures With tonic clonic spasms (known in the past as
grand mal) Muscle contractions Drop attacks Reductions (known as petit mal) Muscle spasmsSecondary Generalized seizures
Step 5: DiscussionIn most epileptic persons the seizures are not
predictable but there might be dissolute factors.What are the most frequent dissolute factors? Psychological: Stress, fatigue, anxiety, boredom,
agitation, sadness. Physical: bad health, hormonal changes,
constipation, nutrition changes. Environmental: flashing lights, television,
images with geometric shapes, sounds, intense heat or cold.
Step 6: Slide projection
Slide 8.3.4: Seizures’ description Is there any warning sign before the
seizure? What has happened before the seizure? What happens when the seizure is finished? How exactly is the seizure?
Step 7: Theory presentation and Slide projection
Slide 8.3.5: Tests Εξετάσεις Physical and psychiatric diagnosis EEG (Electroencephalograph ) Cranial Imaging (CAT, MRI) Psychological research Detailed History Seizures observation
Step 7 (continued)EEG - (electroencephalograph ) Records images of electric clearing evacuation
from brain’s nervous cells. It is used as means for neurologic disorders’
diagnosis. A common EEG usually lasts for about 25
minutes. The person is asked to open and close its eyes and
take deep breath or look in flashing lights. It can help to differentiation from other disorders
and to the classification of the Epileptic type. A normal EEG can never totally exclude
Epilepsy.
Step 7 (continued)
Cranial Imaging Techniques Computed Tomography (CT) – fit for
brain structure anomalies. Magnetic Tomography (MRI) – eases the
differential diagnosis
Step 7 (continued)
Psychological research
It is done with neuropsychological tests and psychometric Tests. The EEG, and simultaneous psychometric tests, can contribute to identification of the epileptic centre and of its effects to cognitive functions.
Step 8: Slide projectionSlide 8.3.6: Treating an epileptic seizure You have to : Loosen his/ her clothes. Lift up his/ her head – even by putting his/ her
hands under it if there is no other way. Turn the person to its side after the seizure – this
helps breathing. Move any furniture or objects that may injure the
person.
Step 8 (continued)
You must not: Move the person during the seizure, except if
there is danger. Put any object between his/ her teeth. Restrain his/ her movements. Abandon the person until he / she is perfectly
well. Give something to drink or eat until is perfectly
well.
Step 8 (continued)Slide 8.3.7: Antiepileptic medication Valproic Acid (Depakine) First rate:primary-reductions, muscle spams, tonic spasms, Second rate: Focal, All Carbamazepine (Tegretol) First rate: Focal Second rate: tonic spasms Phenitoin sodium (Epanutin)First rate: Focal, origin tonic spasms
Step 8 (continued) Phenobarbital (Gardenal)Secondary rate: Focal, Generalized tonic spasms Primidone (Mysoline)Secondary rate: Focal, Tonic spasms Clonazepam (Rivotril)Secondary rate: Reductions, Muscle spasms, All Gabapentin (Neurontin) Lamotrigine (Lamictal)Secondary rate: Resistant, Focal, Generalized
Step 8 (continued)
Side effects of antiepileptic medication. The eventual severe side effects are
depression, ataxia, and hematological disorders.
The milder social side effects of these medication are hypertrichosis, obesity, oedema of the gums and hardness of facial characteristics.
Step 8 (continued)
The efficiency of the medication depends on the levels of the medication in the blood, not by the way it is taken. It is possible to measure the medication level in the blood.
Many people need to take antiepileptic medication for all their life, the doctor can decide to stop it if the person is free of seizures for two years. The general rule for every change or stop of the medication is “ the slightest change possible within the longest possible time period”.