* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Download Psychiatric manifestations of medical problems in adults with
Spectrum disorder wikipedia , lookup
Conversion disorder wikipedia , lookup
Schizoaffective disorder wikipedia , lookup
Autism spectrum wikipedia , lookup
Intellectual disability wikipedia , lookup
Psychiatric and mental health nursing wikipedia , lookup
Mental disorder wikipedia , lookup
Sluggish schizophrenia wikipedia , lookup
Political abuse of psychiatry wikipedia , lookup
Child psychopathology wikipedia , lookup
History of psychiatry wikipedia , lookup
Anti-psychiatry wikipedia , lookup
Dissociative identity disorder wikipedia , lookup
Psychiatric rehabilitation wikipedia , lookup
Abnormal psychology wikipedia , lookup
History of psychiatric institutions wikipedia , lookup
Cases of political abuse of psychiatry in the Soviet Union wikipedia , lookup
Factitious disorder imposed on another wikipedia , lookup
Asperger syndrome wikipedia , lookup
Classification of mental disorders wikipedia , lookup
History of mental disorders wikipedia , lookup
Political abuse of psychiatry in Russia wikipedia , lookup
Mental status examination wikipedia , lookup
Diagnostic and Statistical Manual of Mental Disorders wikipedia , lookup
Psychiatric hospital wikipedia , lookup
Glossary of psychiatry wikipedia , lookup
Emergency psychiatry wikipedia , lookup
Psychiatric manifestations of Medical Problems in Adults with Intellectual Disability Shirley Portuguese MD MHA BINA Clinic, Beer Yaakov Psychiatric center Content BINA Clinic Psychiatric Comorbidities in ID Physical Comorbidities in ID Psychiatric Manifestations of medical problems – case studies How to Prepare for the Psychiatrist ? BINA Clinic Beer Yaakov outpatient clinic Multidisciplinary model by a joining psychiatrist References including: Welfare municipal Units, service suppliers, child and adolescent psychiatric clinics, special Education facilities, etc. ID Psychiatric Comorbidities Up to 2/3 of ID adults have comorbid psychiatric disorder Prevalent - Mood disorders, Autism, ADHD, Schizophrenia and Conduct disorder The more severe the disability the higher the rate of psychiatric disorders. Common Medical Manifestations in ID Physical maintenance Hygiene, vision, hearing, dental problems Genetically related Down syndrome - heart, ear, eye, thyroid, blood, GI etc Tuberous sclerosis - brain, kidney, etc Fragile X - ear, sinus, eye, seizures, ADHD etc Common Medical Manifestations in ID Stress related - Peptic ulcer, Myocardial infarction etc Sedentary Lifestyle - metabolic syndrome, sleep apnea etc Iatrogenic – including medication side effects : - Antipsychotic (eg Risperidone) akathisia, dystonia etc - Benzodiazepine (eg Clonex) drowsiness, coordination etc Abstract Up to two thirds of adults with intellectual disability have a comorbid psychiatric disorder, including mood disorders, autism, ADHD, schizophrenia and conduct disorder. The more severe the disability the higher the rate of psychiatric disorders. The presentation of medical problems can mimic psychiatric signs and symptoms thus hinder proper diagnosis and treatment. Medical causes can include medication side effects (such as antipsychotic medications causing dystonia or akathisia), metabolic deficits (such as diabetes and vitamin deficiencies), sleep disorders (such as sleep apnea syndrome) and many more. Medical problems might be masked by language and communication thus not addressed by the general practitioner. A psychiatrist specializing in adults inflicted by intellectual disability should be aware of possible physical diseases that might mimic psychiatric disorders allow for a better medical care. Patient A 50 y female with ID (moderate) from hostel Primary Complaint- Anxiety 3 months not improved by SSRI History- Picky eater, vegetarian, severe menstruation Interview – Anxious, irritable, fatigue, refuses to work Physical examination – warm clothes, pale, pulse 90/min Patient A Diagnosis - Anemia Treatment- Food supplements (iron, B12), stop bleeding Patient B 42 y female ID (severe) from hostel Primary Complaint- Eating problems 1 mo, food cut for her Interview - Slowness, back aches, Odd gait Physical- muscles spasms of lower back and jaw Patient B Diagnosis –Dystonia Risperidone started 1 mo due to behavioral disturbances Antipsychotic side effects include Dystonia Treatment- stop Risperidone if possible Try Anticholinergic medications Patient C 35y Male with Down’s syndrome Complains- Cognitive decline inc. memory and concentration Family crisis 3 years ago -> depressive symptoms and behavioral disorders. Received SSRI -> Zyprexa. Gained 20 kg in 2 years. Interview- sleepiness, low concentration Mother says he snores Patient C diagnosis - Sleep Apnea syndrome Obstruction of larynx causing decline in oxygen delivery to the brain Results- sleepiness, decline of concentration & attention, depression, anxiety etc Childhood – Large Adenoids, Adulthood – Obesity Treatment – CPAP (mask during sleep) Patient D 27y Female with ID Complains- Irritability, Anger outbursts, preoccupation with toilet, wet herself for 2 weeks Received Benzo -> worsening of wetting. Interview- has an new boyfriend in hostel, abdominal pain especially during urination Patient D diagnosis Urine sample- Urinary Tract infection Symptoms – persistent urge to urinate, burning sensation while urinating, frequent urination, pelvic/ rectal pain Treatment- Oral antibiotics Medical issues to address Before attending a Psychiatrist Vision & Hearing Pain and discomfort (inc. teeth, ears, abdomen) Blood pressure, pulse Blood Tests – blood count, liver and kidney function, TSH, B12, Folic acid, Glucose Complete medical history including medications and family history, preferably GP visit QUESTIONS?