1. Opening up to mental health

Question 1

Red flags for potential mental problems?

Answer 1

• Unexplained chronic pain or fatigue
• Recurrent presentations
• Changes in eating or sleeping patterns
• Signs of impairment in work, school or home life
• Signs of past or present use of alcohol or drugs
• Previous mental health problem
• Chronic physical health problem

Question 2

Relavent q’s for mental health problem

Answer 2

• Identify ifatrigger
• Duration of symptoms, recurrent or isolated episode
• Consider own /family history
• Dependents
• Level of social support/ isolation
• Drugs, alcohol, cigarettes
• Employment history
• Forensic history
• Evidence of other mental health problems
• Response to previous treatments (if relevant) • Neglect
• Evidence of psychosis

Question 3

Sources of support for mental health problems

Answer 3

Advise and inform re:
– Self help groups
– Support groups
– Other local and national resources
– Consider support for family/dependents/carers

Person centred care

Question 4

Screening q’s for depression

Answer 4

• During the last month, have you often been bothered by feeling down, depressed or hopeless?
• During the last month, have you often been bothered by having little interest or pleasure in doing things?
If yes to either of these questions needs a mental health assessment

Question 5

How to assess for despression?

Answer 5

Using DSM-IV (Diagnostic and Statistical Manual of Mental Disorders,)

Key symptoms:
• persistent sadness or low mood; and/or • marked loss of interests or pleasure
At least one of these, most days, most of the time for at least 2 weeks.

Question 6

Associated symptoms to depression?

Answer 6

• disturbed sleep (decreased or increased compared to usual)
• decreased or increased appetite and/or weight
• fatigue or loss of energy
• agitation or slowing of movements
• poor concentration or indecisiveness
• feelings of worthlessness or excessive or inappropriate guilt
• suicidal thoughts or acts.

Question 7

What are the 4 severities of depression?

Answer 7

1. Subthreshold depressive symptoms: – Fewer than 5 symptoms.
2. Mild depression:
   – Few, if any, symptoms in excess of the 5 required to make the diagnosis, and symptoms result in only minor functional impairment.
3. Moderate depression:
   – Symptoms or functional impairment are between ‘mild’
   and ‘severe”
4. Severe depression:
   – Most symptoms, and the symptoms markedly interfere with functioning

Question 8

Treatment options for depression?

Answer 8

• Depends on nature and severity
• Lifestyle measures
• Self help/ guided self help
• Computerised Cognitive Behavioural Therapy (CCBT)
• Talking therapies
• Drug treatments
• Alternative/ complimentary therapies
• Group physical activity programmes

Question 9

Treatment options for more severe depression?

Answer 9

• Referral to specialist mental health services
• Combined treatments
• Multi professional and in patient care
• Crisis service
• Electroconvulsive therapy (rarely used with few indications - severe depression, resistant mania, catatonia)

Question 10

LIfestyle measures that can treat depression?

Answer 10

• Eat well
• Drink less
• Exercise more
• Get involved
• Quit smoking
• Sexual health
• Sleep hygiene
• Manage physical conditions

Question 11

Different forms of talking therapy for depression?

Answer 11

• Cognitive behavioural therapy
• Interpersonal therapy
• Counselling
• Listening services
• Psychodynamic psychotherapy
• Group therapy
• Bereavement counselling
• Relationship counselling/ couples therapy
• Family therapy
• Mindfulness based therapies

Question 12

Name the 5 main types of antidepressants?

Answer 12

1. Selective serotonin re-uptake inhibitors 9ssRIs) e.g. citalopram
2. Tricyclic and related antidepressants e.g. amitriptyline
3. Serotonin and noradrenaline reuptake inhibits (SNRIs) e.g. venlafaxine
4. Mirtazapine (presynaptic alpha2-adrenoreceptor antagonist)
5. Monoamine-oxidase inhibitors

Question 13

Why must you `‘safety net” when prescribing anti depressants?

Answer 13

NOTE: Some people too depressed to commit suicide. If on medication and improve mental state, may have drive to commit suicide. Make sure to safety net

Question 14

What is GAD?

Answer 14

Generalised anxiety disorder

Question 15

Key symptoms of GAD?

Answer 15

– excessive anxiety and worry about a number of events or activities
– difficulty controlling the worrying
– occurs on a majority of days for at least 6 months
– not in keeping with another anxiety disorder

Question 16

Associated symptoms of GAD?

Answer 16

• restlessness
• being easily fatigued
• difficulty concentrating • irritability
• muscle tension
• disturbed sleep

Question 17

Management of GAD?

Answer 17

• Stepped care model
• Step 1: Identification and assessment; education about GAD and treatment options; active monitoring
• Step 2: Low-intensity psychological interventions; individual non-facilitated self-help; individual guided self-help and psychoeducational groups
• Step 3: Choice of a high-intensity psychological intervention (CBT/applied relaxation) or a drug treatment
• Step 4: Highly specialist treatment, such as complex drug and/or psychological treatment regimens; input from multi-agency teams, crisis services, day hospitals or inpatient care

Question 18

Drug treatment options for GAD?

Answer 18

• SSRI e.g. sertraline
• 2nd line alternative SSRI or SNRI
• 3rd line consider offering pregabalin
Do not offer a benzodiazepine for the treatment of GAD in primary or secondary care except as a short-term measure during crises.

Question 19

Name 4 mental illnesses in which psychosis occurs/

Answer 19

Schizophrenia, depression, bipolar, puerperal psychosis and some neurological conditions

Also alcohol and drugs

Question 20

Main symptoms of psychosis?

Answer 20

Delusions and hallucinations

Question 21

What is a delusion?
Characteristics?
Examples?

Answer 21

A false, fixed, strange, or irrational belief that is firmly held. The belief is not normally accepted by other members of the same culture or group.

Characteristics: Certainty, incorrigibility, impossibility

Examples: Delusions of grandeur
Delusions of paranoia Somatic delusions

Question 22

What is a hallucination?

Examples?

Answer 22

Sensory perception without an appropriate stimulus
E.g.
Seeing – visual
Hearing – auditory Feeling - tactile
Smelling – olfactory Taste – gustatory Posture – proprioceptive

Question 23

Considerations when assessing psychosis?

Answer 23

• What is the nature of the hallucination or delusion?
• Timing?
• Is there are curringt heme?
• Insight?
• Have there been any recent major life events?
• Is there a history of substance abuse?
• Vulnerability?
• Family history of mental illness?

Question 24

What is an MSE form?

Answer 24

Mental state exam used for psychosis

Question 25

How do you treat psychosis?

Answer 25

• Specialist led
• Dependent on cause
• Early intervention in psychosis services
• Usually a combination of anti psychotic medications, psychological therapies, social support, occupational and educational interventions