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8/13/2019 Psychiatry and Medicine
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Psychiatry andMedicine
Dr Jon LaugharneUniversity of Western Australia
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Organic causes of Psychiatric
SymptomsDepression carcinoma, infections,diabetes, thyroid disorder, SLE, beta
blockers Anxiety hyperthyroidism,hypoglycaemia, drug withdrawal,phaeochromocytomaFatigue anaemia, chronic infection,diabetes, carcinoma, Addisons disease
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Diabetes
Depression and anxiety
Hyperglycaemia can cause delirium
Early dementia
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Steroids
DepressionMania
Paranoia
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Maternity Blues
2-3 days post-partumLabile mood
50-60% mothers (partic primigravida)Often some anxiety/depression in finaltrimester
Resolves spontaneously
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Postnatal depression Rx
Supportive psychotherapyProblem solving
Relaxation advicePractical supports
Anti-depressants
amitriptyline/imipramine
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Postpartum Psychosis
1-2 weeks post partum
Delirium (sepsis) AffectiveSchizophreniform
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Postpartum psychosis
Attitude to baby? Risks to baby or self?
Treat the clinical syndrome Antidepressants Antipsychotics
ValiumECT
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Psychiatric drugs &
breastfeeding Avoid if possible Antidepressants OK
Antipsychotics OKCarbamazepine OKMonitor baby
Can mother use formula alternative?
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Pregnancy & psychiatric drugs
Avoid if possible in 1 st trimester Avoid carbamazepine
Haloperidol rather than chlorpromazine Antidepressants OKClinical decision risks vs benefits
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Causes of delirium (brain)
Infections - meningitis, encephalitis,malaria.
SOLs tumour, haemorrhage
Injury/trauma
Epilepsy postictal, status
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Treating delirium
FIND and TREAT CAUSESedate chlorpromazine 100mg 8hrly or
diazepam 2-5mg 6hrlyNurse in unstimulating environment darkened room
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Unexplained medical
symptomsInterpretation of physical sensationsPersonality
Mental stateKnowledgeBeliefs/cultural factors
Symptoms/behavioural change/disability
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Principles of management
Do not overinvestigateExplain and discuss your diagnosis
Explain symptoms are real and takenseriouslyTreat any associated psychiatric orphysical disorderInvolve relatives/supports if possible
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