Mental Disorder d/t General Medical Condition Mood Disorder

Cognitive fx is still intact no cognitive impairment Causes of 2nd mood disorder Drug intoxication Alcohol or sedative hypnotics Antipsychotics Antidepressants Metoclopramine, H2 R blockers AntiHPT Sex steroid Glucocorticoid Levodopa Bromocriptine Tumour 1o cerebral Systemic neoplasm Drug withdrawal Nicotine, caffeine, cocaine, amphetamine Trauma Cerebral contusion Subdural hematoma Infxn Cerebral (meningitis, encephalitis, HIV, syphilis) Systemic (sepsis, UTI, pneumonia) Cardiac & vascular Cerebrovascular (infarct, h/rage, vasculitis) CVS ( output state, CCF, shock) Physiological or Hypoxaemia metabolic Electrolyte imbalance Renal or hepatic failure Hypo/hyperglycaemia Postical state Endocrine Thyroid disturbance Glucocorticoid disturbn Nutrition Vit B12 def Folate def Demyelinating Multiple sclerosis Neurodegenerative Parkinsons dz Huntingtons dz Tx anT depressant TCA MOAi SSRI

DSM for Mood disorder d/t Medical Condition A Prominent & persistent disturbance in mood predominates in clinical picture & characterized by either (or both) of following : - Depressed mood or markedly diminished pleasure in all or almost all activities - Elevated, expansive or irritable mood B There is evidence from hx, PE, or lab findings that d disturbance is direct physiological consequences of GMC C D disturbance is x better accounted for by another mental disorder D D disturbance does x occur exclusively during course of delirium E D symptoms cause clinical significant distress or impairment in social, occupation, or other important areas of functioning Specify : Wif depressive feature :If prominent mood is depressed but, d full criteria r not meet for MDD Wif major depressive like episode : if ALL criteria of MDD r met, except, clearly for d critetion that d symptoms r not d/t physiological effect of substance or GMC Wif manic features : if predominant mood is elevated, euphoric, or irritable Wif mixed features : if symptoms of mania & depression r present but NEITHER predominant

ECT Treat underlying medical cond Psychotherapy

nha 0813 source : kaplan synopsis of psychiatry

Psychotic d/o d/t GMC

Must exclude syndromes in which psychotic symptoms may B present in a/w cognitive impairment (e:g delirium & dementia of Alzheimers type) Etiology Any cerebral or systemic dz that affect brain fx psychotic symptoms Degenerative d/o (Alzheimers/Huntington) initial phase of dz can present with psychosis wif minimal cognitive impairment DSM A Prominent hallucination or delusion B There is evidence from hx, PE, or lab findings that d disturbance is direct physiological consequences of GMC C D disturbance is x better accounted for by another mental disorder D D disturbance does x occur exclusively during course of delirium Specify : With delusion:if delusions r d predominant symptoms Wif hallucination:if hallucination r d predominant symptoms
Psychotic symptoms a/w Abnorm of Specific Brain Regions

Step in dx 1. Determine px is x delirious as evidenced by stable level of consciousns 2. Full mental status assessment to exclude significant cognitive impairment 3. Search systemic or cerebral disease that may related with psychosis 4. Systemic PE & CNS PE 5. Any new onset of psychosis irrespective of any age do MRI DDX 1. Delirium-related psychosis acute & fluctuating a/w disturbance in conciousns 2. Stimulant intoxication psychosis involve formication 3. Temporal lobe epilepsy olfactory hallucination & religious delusion 4. Rt parietal lobe lesions contraL neglect state of delusional nature in which individual disown part of their bodies 5. Occipital lesions visual hallucination

Symptoms 1st rank symp: Thoughts spoken aloud Voices commenting 3rd person voices arguing Made actions Made feeling Thought withdrawal Thought diffusion Delusional perception Complex delusion Anton syndrome Anosognosia Misidentification syn

Site Temporal lobe

Laterality Dominant hemisphere

Subcortical or limbic Occipital Bilateral lobe, optic tract Parietal lobe Nondominant hemisphere Parietal, Nondominant temporal, hemisphere, frontal lobes bilateral

nha 0813 source : kaplan synopsis of psychiatry

Anxiety d/o d/t GMC

- Anxiety dz d/t GMC individual experiences anxiety antxiety that causes clinically significant distress or impairment in functioning - Substance induced anxiety d/o : anxiety symptoms r d product of a prescribed medication or stem from intoxication or withdrawal from a nonprescribed substance typically drug of abuse Etiology Substance related - Intoxication w caffeine, cocaine, state amphetamine, etc, - Withdrawal from nicotine, sedative-hypnotics, alcohol Endocrinopathies - Pheochromocytoma - Hyperthyroidism - Hypercortisolemic state - Hyperparathyroidism Metabolic - Hypoxemia derangement - Hypercalcemia - Hypoglycaemia Neurological d/o DDX 1. 2. 3. 4. 5. Delirium Psychosis Depression Dementia Adjustment disorder

Sleep d/o d/t GMC

Sleep d/o manifest in 4 ways : 1. Excs sleep (hypersomnia) 2. Deficiency in sleep (insomnia) 3. Abnorm behavior or actvt during sleep (parasomnia) 4. Disturbance in timing of sleep (circadian rhythm sleep d/o) DSM A Predominant disturbance in sleep that is sufficiently severe to warrant independent clinical attention B There is evidence from hx, PE, or lab findings that d disturbance is direct physiological consequences of GMC C D disturbance is x better accounted for by another mental disorder D D disturbance does x occur exclusively during course of delirium E Disturbance does not meet criteria for breathingrelated sleep d/o or narcolepsy F D symptoms cause clinical significant distress or impairment in social, occupation, or other important areas of functioning Specify : Insomnia type : if predominant sleep disturbance is insomnia Hypersomnia type : if predominant sleep disturbance is hypersomnia Parasomnia type : if predominant sleep disturbance is parasomnia Mixed type : if > 1 sleep disturbance is present & non predominate of comparable sexual dysfx that was not substance-induced Medical condition commonly a/w 2o sleep d/o Condition Sleep symptoms Parkinsonism - Frequent awakening - Disturbance or circadian rhythm Dementia - Sundowning - Frequent awakening Epilepsy - Difficulty in initiating sleep - Frequent awakening Huntingtons dz Frequent awakening Klein-Levin syn Hypersomnia Uremia - Restless leg - Nocturnal myoclonus

DSM A Prominent anxiety, panic attacks or obsession or compulsion predominant in clinical picture B There is evidence from hx, PE, or lab findings that d disturbance is direct physiological consequences of GMC C D disturbance is x better accounted for by another mental disorder D D disturbance does x occur exclusively during course of delirium E D symptoms cause clinical significant distress or impairment in social, occupation, or other important areas of functioning Specify : Wif generalized anxiety : if xcss anxiety or worry about a number of events or activities predominate in clinical presentation Wif panic attacks : if panic attack predominate in clinical presentation Wif O-C symptoms : if obsession or compulsion predominate in clinical presentation
nha 0813 source : kaplan synopsis of psychiatry

Sexual dysfx d/t GMC

Subsumes multiple forms of medically induced sexual disturbance include: - Erectile dysfx - Pain during sexual intercourse - Low sexual desire - Orgasmic d/o Causes of 20 sexual dysfx Medications - Cardiac drugs anTHPT - H2R blocker - Carbonic anhydrase inhibitor - Anticholinergic - Anticonvulsant - Antipsychotic - Antidepressant - Sedative-hypnotic Substance of abuse - Alcohol - Opiods - Stimulants - Cannabis - Sedative hypnotic Local dz procs that - Congenital abnorm or affect 10 & 20 sexual malformations organs - Trauma - Tumour - Infx - Postsurgical or postirradiation local neurological & vascular pathology Systemic dz procs - Neuro : CNS (stroke, MS) PNS (peripheral neuropathy) - Vascular : atherosclerosis, vasculitis - Endocrine : DM. alteration in fx o thyroid, adrenal cortex, gonadotrophin, gonadal hormones

DSM A Clinically significant sexual dysfx that result in marked distress or interpersonal difficulty predominate in clinical picture B There is evidence from hx, PE, or lab findings that d disturbance is direct physiological consequences of GMC C D disturbance is x better accounted for by another mental disorder Select code & term based on predominant sexual dysfx Female hypoactive sexual desire d/o d/t . : if deficient or absent sexual desire is prominent feature Male hypoactive sexual desire d/o d/t . : if deficient or absent sexual desire is prominent feature Male erectile d/o d/t : if male erectile dysfx is prominent feature Female dyspareunia d/t : if pain a/w sexual intercourse is prominent feature Male dyspareunia d/t : if pain a/w sexual intercourse is prominent feature Other female sexual dysfx d/t : if some other feature is predominant or if no feature is predominate Other male sexual dysfx d/t : if some other feature is predominant or if no feature is predominate

nha 0813 source : kaplan synopsis of psychiatry

Personality Change d/t GMC

Etiology Any dz that affect frontal lobes & subcortical structure manifest personality change - Head trauma - Frontal lobes tumor (meningiomas or gliomas) Progressive dementia syndrome especially those wif subcortical pattern of degeneration can cause personality change - AIDS dementia comples - Huntingtons dz - Progressive supranuclear palsy Exposure to toxin significant personality change disproportionate to cognitive or motor impairment DSM A Persistent personality disturbance that represent a from individuals prev characteristic perconality pattern. (in children, disturbance involve a marked deviation from a norm dvlpmnt or a significant in d childs usual behavior patterns lastind at least 1 yr) B There is evidence from hx, PE, or lab findings that d disturbance is direct physiological consequences of GMC C D disturbance is x better accounted for by another mental disorder D D disturbance does x occur exclusively during course of delirium E D symptoms cause clinical significant distress or impairment in social, occupation, or other important areas of functioning Specify type : Labile type : if predominant feature is affective lability Disinhibited type : if predominant feature is poor impulse control as evidence by sexual indiscretions, etc Aggressive type : if predominant feature Is aggressive behavior Paranoid type : if predominant feature is suspiciousns or paranoid ideation Other type : if d presentation is not characterized by any of above subtypes Combined type : if > 1 feature predominate in clinical picture Unspecified type

nha 0813 source : kaplan synopsis of psychiatry