14&16 - Mental Health

Question 1

What is a common side effect of SSRIs in the elderly?

Answer 1

SSRIs in Elderly

- Hyponatraemia

Question 2

What are common SSRIs and SNRIs in depression?

Answer 2

SSRI:

• Sertraline 50-200mg
• Citalopram 20-40mg
• Fluoxetine 20-60mg

SNRI:

• Duloxetine 60mg
• Venlafaxine 75-375mg

Question 3

Depression pharmaceuticals that are not SSRI or SNRI?

Answer 3

1. Alpha 2 antagonist
   Mirtazapine 15-45mg
2. Serotonin receptor modulator
   Vortioxetine 10-20mg

Question 4

What are the features of a MMSE?

Answer 4

MMSE (24/30)

1. Year (season, date, day, month)
2. Place (state, county, town, setting, floor)
3. Three objects repeated until learnt
4. Count backwards in 7s from 100
5. Recall three things
6. Name two simple objects shown
7. Repeat phrase ‘No ifs, ands, or buts’
8. ‘Take the paper in your right hand, fold it in half, and put it on the floor’
9. Please read this and do what it says: ‘close your eyes’
10. Make up and write a sentence about anything
11. Please copy this picture (intersecting pentagons)

Question 5

GAD criteria?

Answer 5

GAD criteria:

1. Two major symptoms (excessive anxiety/worry)
2. Six symptoms for 6/12 (restless/fatigued/muscle tension/sleep disturbance,irritable)

3. GAD-7 
	Nervous/on edge
	Unable to stop worrying
	Too much about different things
	Trouble relaxing
	Hard to sit still
	Easily annoyed or irritable
	Afraid

Question 6

GAD lifestyle management options?

Answer 6

1. Education
2. Breathing
3. Distraction

Question 7

GAD pharmaceutical management?

Answer 7

1. SSRI
	Escitalopram 10-20mg
SNRI
	Duloxetine 30-120mg
	Venlafaxine 37.5-225mg

2. Tricyclic
   Imipramine 25-300mg
   Quetiapine 25-200mg
   (Amitryptiline not recommended due to overdose fatality risk)

Question 8

GAD review?

Answer 8

1. 1 Week review of any SSRI/SNRI

2. 2-4 week review for 12 weeks

Question 9

What are five alarms for suicide risk?

Answer 9

1. Age:
   DSH
   W 16-24
   M 25-34

Suicide:
45-49

2. Socio-economic
3. Life events + bereavement by suicide
4. PMH
   Mental health
   Physical health
   Addiction
5. Criminal justice

Question 10

What are three important considerations for a MH risk assessment?

Answer 10

1. Place
   Quiet
   Undisturbed
2. Questions
   “Has it every felt so difficult you thought about not wanting to be here?”
   “Have you ever told anyone about or made any plans?”
3. Harm to self and others?
   eg. Children/Dependants

Question 11

What two groups are useful for child mental health?

Answer 11

1. Health visitors
   <5/10yo
2. CAMHS
   Children and adolecent MH services
   Crisis Team

Question 12

Adult Suicide Team?

Answer 12

Crisis team

1. Two consultants
2. Registrars
3. Several nurses

Bradgate Unit for Inpatient treatment

Question 13

AMTS

- AMT10

Answer 13

Abbreviated Mental Test Score

1. Age
2. Hour
3. 42 West St
4. Year
5. Current address
6. Recognise two persons
7. Date of birth
8. WW1 start
9. Monarch/PM
10. 20-1

Repeat address

Question 14

Depression

- Assessment tool

Answer 14

Depression assessment
- PHQ 9
(patient health questionnaire)

1. Interest/pleasure
2. Down/depressed
3. Sleeping
4. Low energy
5. Appetite
6. Failure
7. Concentration
8. Slow/restless
9. Suicidal
10. Difficulty working

Question 15

Mild Depression

- Mx

Answer 15

Mild Depression Mx

1. Supportive intervention
   - Self-help/exercise
   - Relaxation/light therapy
2. Psychotherapy
   - CBT
   - IPT (interpersonal)
   12 weeks for response

3. Antidepressant
SSRI
 - Citalopram
 - Sertraline
 - Fluoxetine
SNRI
 - Duloxetine
Atypical
 - Mirtazapine
 - Bupropion

4. Computer based CBT
5. Alternative anti-depressant
6. St John’s Wort

Question 16

Moderate Depression

- Mx

Answer 16

Moderate depression mx

1 .Antidepressant

2. Psychotherapy
3. Alternative antidepressant

Question 17

Severe Acute Depression

- Mx

Answer 17

Severe depression mx

1. Psychiatric referral
   +hospitalisation
   + antidepressant
2. Benzodiazapine prn
   - lorazapam
   - clonazepam

3 Antipsychotic prn

• risperidone AAP
• olanzapine AAP
• quetiapine AAP
• fluphenazine Typical
• trazodone SARI

3. ECT under GA
   - 2/3 per week; total 6-12
   - 2 deaths/100,000
   - Rapid, short-term

Question 18

Anxiety

- Mx

Answer 18

Anxiety Management

1. CBT
2. Medication
   - SSRI
   - SNRI
   - Atypical
   - Anxiolytic
   Buspirone (5HT agonist)
3. Further medication
   - Tricyclic
   Imipramine
   - Antipscyotic
   quetiapine
   - Benzodiazapine
   clonazepam
   - Pregabalin

Question 19

MMSE

- Components

Answer 19

MMSE

1. Time (5)
2. Place (5)
3. Registration (3)
   - Repeating
4. Attention/calculation
   - 7s and World
5. Recall (3)
6. Language (2)
   - Name objects
7. Repetition (1)
8. Complex commands
   - Drawing figures

Question 20

GPCog

- Components

Answer 20

GPCog

Patient

1. Date (1)
2. Clock drawing (2)
   - Hours
   - 11:10
3. Recent news
4. Recall (5)

Informant

5. Recent happenings
6. Recent conversations
7. Using wrong words
8. Money management
9. Medication management
10. Transport assistance

Question 21

Safety Plan

- Components

Answer 21

Safety Plan

1. Getting through now
2. Making situation safer
3. Things to lift or calm
4. Things to distract
5. People who support
6. List who can talk
7. Emergency professionals