Module Eight PSYCHIATRIC SYMPTOMS AND PHYSICAL DISEASES

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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

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Lesson 1

• TREATMENT OF PHYSICAL DISEASES AND ADAPTING TO
  THEM

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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.

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Step 2 Slide projection

• Slide 8.1.1 Patients behaviour
• This may comport
•      visit to the doctor,
•      take medication,
•      stay in bed,
•      absence from work,
•     take advice from relatives and friends,
•     give up some activities.

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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.

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Step 4 Questions and comments

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Lesson 2

• MENTAL DISORDERS CAUSED BY A PHYSICAL DISEASE

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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.

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Step 2 Slide projection

• Slide 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

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Step 3 Theory presentation

• Acute 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.

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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.

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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.

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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
  Schizophrenias, Manias or Depressions.
• 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.

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Step 4 Slide projection

• Slide 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

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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

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Step 5 (continued)

• Depression
• Brain tumors, Epilepsy, Deficiency B12,
  Cushings 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

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Step 5 (continued)

• Manic symptoms
• Brain tumors, B1 deficiency, Cushing syndrome,
  Medication and other substances, Syphilis, Aids,
  Multiple sclerosis, Acute intermittent porphyria

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Step 5 (Continued)

• Anxiety Symptoms
• Cushing syndrome, Hyperthyroidism,
  Pheochromocytoma, Aids

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Step 7 Questions and comments (5?)

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Lesson 3

• EPILEPSY

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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.

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Step 1 (continued)

• From these that have Epilepsy
• 70-80 have no episodes after the therapy
• 20 is difficult to treat
• 80 take medication

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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?      

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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.

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Step 3 Slide projection

• Slide 8.3.2 Cause of epilepsy
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• Unknown 70
• (some cases might be hereditary)
•  
• Rest 30
• Brain lesion
• Metabolic causes

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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.

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Step 4 (continued)

• Partial seizures
• Simple
• Complex
• Generalized seizures
• With tonic clonic spasms (known in the past as
  grand mal)
• Muscle contractions
• Drop attacks
• Reductions (known as petit mal)
• Muscle spasms
• Secondary Generalized seizures

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Step 5 Discussion

• In 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.

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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?

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Step 7 Theory presentation and Slide projection

• Slide 8.3.5 Tests ??et?se?? 
• Physical and psychiatric diagnosis
• EEG (Electroencephalograph )
• Cranial Imaging (CAT, MRI)
• Psychological research
• Detailed History
• Seizures observation

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Step 7 (continued)

• EEG - (electroencephalograph )
• Records images of electric clearing evacuation
  from brains 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.

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Step 7 (continued)

• Cranial Imaging Techniques
• Computed Tomography (CT) fit for brain
  structure anomalies.
• Magnetic Tomography (MRI) eases the
  differential diagnosis

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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.

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Step 8 Slide projection

• Slide 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.

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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.

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Step 8 (continued)

• Slide 8.3.7 Antiepileptic medication
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• Valproic Acid (Depakine)
• First rateprimary-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

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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

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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.

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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.

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Step 8 Questions and comments (5?)