18-09-23 - Opening up to mental health Flashcards
Learning outcomes
- Be able to start talking to a patient about their mental health
- Be able to sign post to sources of support / mental health resources
- Be able to recognise common presentations of mental health problems
- Be able to consider how to conduct an initial mental health assessment
- To be able to consider self-care
How common are mental health problems?
- How common are mental health problems?
- Major health challenge
- 1 in 4 affected by a mental health problem each year (England, mind)
- 40% of GP appointments involve mental health (mind)
- Most common mental health disorder in England is mixed anxiety and depression (mind)
- 753 probable suicides registered in Scotland in 2021 (PHS)
- See Scottish Health Survey 2021: chapter 2 mental health and wellbeing
Principles of talking about mental health.
What are the 13 Dos?
- Principles of talking about mental health.
- 13 Dos:
1) Begin the dialogue and seem comfortable with it
2) Active listening and open questions
3) Be sensitive and encouraging, build relationship of trust
4) Non-judgmental
5) Acknowledge how they are feeling, validate
6) Good time and place to talk, not rushed
7) Confidentiality, dignity and respect
8) Take care of yourself to take care of your patient
9) Provide information appropriate to level of understanding
10) Avoid clinical language without adequate explanation
11) Provide written information where necessary
12) Use interpreters where necessary
13) Establish consent
Principles of talking about mental health.
What are the 6 Don’ts?
- Principles of talking about mental health
- 6 Don’ts:
1) Make dismissive comments like ‘snap out of it’, ‘cheer up’, ‘forget about it’, ‘pull yourself together”
2) Say ‘you know how they feel’ if you don’t
3) Point out that others are worse off
4) Blame the individual
5) Think of mental illness as a personal weakness or failing
6) Use words that stigmatise
What are 7 flags for potential mental health problems?
- 7 flags for potential mental health problems:
1) Unexplained chronic pain or fatigue
2) Recurrent presentations
3) Changes in eating or sleeping patterns
4) Signs of impairment in work, school or home life
5) Signs of past or present use of alcohol or drugs
6) Previous mental health problem
7) Chronic physical health problem
What are 13 questions to consider regarding mental health?
- 13 questions to consider regarding mental health:
1) Take a full history (PC, HPC, PMH, DH, FH, SH, SE)
2) Identify if a trigger
3) Duration of symptoms, recurrent or isolated episode
4) Consider own/family history
5) Dependents
6) Level of social support/isolation
7) Drugs, alcohol, cigarettes
8) Employment history
9) Forensic history
10) Childhood and development
11) Evidence of other mental health problems
12) Response to previous treatments (if relevant)
13) Evidence of vulnerability or neglect
Examination: Describe the Brief Mental Status Exam (MSE) form (in picture)
How does signposting help the patient?
What is the key objective of sign posting?
What are 2 sources of support for mental health problems?
- Signposting helps the patient understand the direction the consultation is going in and why, and allows doctors to share their thoughts and needs with the patient
- The key objective of Care Navigation and Active Signposting is to help patients access the right care at the earliest opportunity
- Sources of support for mental health problems:
1) Advise and inform re:
* Self-help groups
* Support groups
* Other local and national resources
* Consider support for family/dependents/carers
2) Signpost to various websites/organisations
* e.g., www.moodcafe.co.uk
* Samaritans.org
* Breathing space
* Own GP
* Out Of Hours (OOH) Service: 111
* A+E / 999
* Many other sources of support, for example:
* Free and confidential mental health support for LGBTQ+ people (16+) in Scotland: https://www.lgbthealth.org.uk/services-support/mental-health/
* Carers
* Children
What are 2 questions we ask during screening for depression?
- Questions we ask during screening for depression:
1) During the last month, have you often been bothered by feeling down, depressed or hopeless?
2) 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
NICE Guideline “Depression in adults: recognition and management”
- NICE Guideline “Depression in adults: recognition and management”
- “Conduct a comprehensive assessment that does not rely simply on a symptom count when assessing a person who may have depression, but also takes into account severity of symptoms, previous history, duration and course of illness. Also, take into account both the degree of functional impairment and/or disability associated with the possible depression and the length of the episode.”
Depression in adults: the matched care model (in picture)
What are 4 key symptoms of Generalised Anxiety Disorder (GAD)?
What are 6 associated symptoms of GAD?
What else should we ask about in GAD?
- 4 key symptoms of Generalised Anxiety Disorder (GAD):
1) Excessive anxiety and worry about a number of events or activities
2) Difficulty controlling the worrying
3) Occurs on a majority of days for at least 6 months
4) Not in keeping with another anxiety disorder
- 6 associated symptoms of GAD:
1) Restlessness
2) Being easily fatigued
3) Difficulty concentrating
4) Irritability
5) Muscle tension
6) Disturbed sleep - We should also ask about duration, distress, impairment of functioning and past history of anxiety and mood disorders.
What care model do we use in the management of GAD?
Describe the 4 steps in the stepped care model
- We use the Stepped care model in the management of GAD
- 4 steps in the stepped care model:
1) Step 1
* Identification and assessment; education about GAD and treatment options; active monitoring
2) Step 2
* Low-intensity psychological interventions; individual non-facilitated self-help; individual guided self-help and psychoeducational groups 27 Management of GAD continued
3) Step 3
* Choice of a high-intensity psychological intervention (CBT/applied relaxation) or a drug treatment
4) 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
What are the 3 lines of drug treatment of GAD?
When can benzodiazepine be offered?
- 3 lines of drug treatment of GAD:
1) 1st line - SSRI e.g. sertraline
2) 2nd line - alternative SSRI or SNRI
3) 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.
What is psychosis?
When can psychosis occur?
How can it affect someone’s ability to function?
What are 3 symptoms of psychosis?
How might it also present?
- Psychosis refers to a collection of symptoms that affect the mind, where there has been some loss of contact with reality
- Psychosis can occur in a number of mental health conditions e.g. schizophrenia, depression, bipolar disorder, puerperal psychosis
- Examples of other causes/associations: some neurological conditions, alcohol and drugs
- Psychosis can interfere significantly with ability to function
- 3 symptoms of psychosis:
1) Delusions
2) Hallucinations
3) Disorganised thinking and speech - Psychosis may present through concerns of others
