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HYMS phase II H&S > Block 33 > Flashcards

Block 33 Flashcards

1
Q

State 3 strengths of the ICD-10/ DSM.

A

1) Standardisation of diagnostic criteria.
2) Allow for epidemiological studies and geographical comparisons of prevalence and incidence.
3) Alphanumerical format allows for quick referral and easy addition of categories.

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2
Q

State 3 limitations of the ICD-10/ DSM.

A

1) There are 2 different sets of criteria, so who uses what?
2) Schizophrenia diagnosis relies on many psychotic symptoms which are a common final pathway in other disease as well.
3) Just groups together commonly co-existing symptoms patterns without an understanding of an underlying cause/ nature.

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3
Q

What is advocacy?

A

This means getting support from another person to help you express your views and wishes and to help you to stand up for your rights. There are 3 types of advocacy; self-advocacy, individual advocacy and systems advocacy.

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4
Q

What is statutory advocacy?

A

This means that a person is legally entitled to an advocate because of their circumstances.

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5
Q

What are the three types of professional advocate?

A

1) An independent mental health advocate (IMHA): Support people who are being assessed or receiving treatment under the MHA 1983.
2) An independent mental capacity advocate (IMCA): Support people who lack capacity to make certain decisions and are provided under the MCA 2005.
3) A social care advocate: Support people under the care act of 2014.

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6
Q

What is self-advocacy?

A

The action of representing oneself or one’s views or interests.

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7
Q

Describe 3 potential roles of an advocate.

A

1) Listen to views and concerns of the patient.
2) Help to explore options and rights without advising.
3) Give information to help patient to make informed decision.
4) Help patient to contact people or contact people themselves on your behalf.
5) Accompany and support patient in meetings or appointments.

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8
Q

Describe the epidemiology of suicide and deliberate self-harm. State 5 factors.

A
  • DSH F>M
  • Suicide M>F
  • Suicide is one of the top 10 causes of death in every country.
  • Previous attempts of suicide increase the risk of a successful attempt by 40x.
  • Men aged 30-44 years are the group where suicide is most common.
  • Suicide is second only to RTAs as a cause of death in males aged 15-24.
  • DSH/ suicide are more common on evenings, weekends, in spring and in autumn.
  • Rates are increasing fastest in Western countries.
  • Eastern Europe (former USSR) has the highest rates.
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9
Q

Give 5 sociodemographic risk factors for DSH and/ or suicide.

A
  • Male
  • Elderly
  • Lower SES
  • Lower educational status
  • Social isolation: elderly, unmarried, separated, divorced, widowed.
  • Unemployed or insecure employments.
  • Students, prisoners, immigrants, refugees.
  • Farmers, sailors, female doctors.
  • Lack of social support.
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10
Q

Give 5 clinical risk factors for DSH and/ or suicide.

A
  • FHx mental health disorder.
  • Chronic physical illness
  • Previous attempts at suicide or DSH.
  • Access to lethal methods (vets, pharmacists, dentists, doctors, farmers).
  • Recent post-discharge period.
  • Specific mental illnesses have a higher rate: anorexia. severe depression, psychosis, BAD, PD, substance misuse.
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11
Q

State 5 risk factors for the development of depression.

A
  • FHx depression/ BPAD
  • Adverse childhood experiences (abuse, relentless criticism, parental loss, perceived lack of affection).
  • Unemployment
  • Lower SES
  • Social isolation
  • Life events
  • Physical illness
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12
Q

Describe the epidemiology of depression.

A
  • Female predominance
  • Increased risk if recent bereavement (see Holmes-Rache social adjustment scale)
  • More common in patients with chronic illness
  • Increasingly common in the elderly.
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13
Q

Name 5 professionals involved in a mental health team.

A 
GP
CPN
Psychiatrists
OT
Pharmacists
Social workers
Key workers
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14
Q

Briefly describe the roles of the following professionals with regards to mental health care:

1) GP
2) CPN
3) Psychiatrists
4) Occupational therapists
5) Pharmacists
6) Social workers
7) Key workers

A

1) Diagnosis and community management.
2) Talk through problems, offer advice and support, give medications and monitor patient.
3) Diagnosis, primary assessment and prescribe medication.
4) Teach skills, help to increase confidence and independence.
5) Dispense medications, give expert advice to doctors/ nurses.
6) Money, housing and childcare.
7) Manage cases

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15
Q

Describe the impact of race, ethnicity, culture and age on schizophrenia.

A
  • Rates higher in young men than women.
  • Higher rates in BAME groups
  • Higher rates in socially disadvantaged groups.
  • Incidence has been stable over time (any increase could be explained by ethnic make up of the study population).
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16
Q

Describe the impact of race, ethnicity, culture and age on affective psychoses.

A
  • Rates are equal in males and females.
  • No evidence for geographical or neighbourhood effects on incidence.
  • Higher rates in social disadvantaged groups.
  • Higher rates in BAME groups
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17
Q

Describe the principles underpinning the organisation of UK mental health services (4).

A
  • Built around individual’s needs and views of users/ carers
  • Rapidly accessible
  • A range of services functioning as a system
  • Sensitive to local needs, resources and culture
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18
Q

How does the current organisation of mental health services in the UK differ from the past?

A

Presently, mental health services are mainly community based where as formerly psychiatrists were. based at centres and patients routinely underwent long inpatient stays.

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19
Q

Give 5 examples of key teams which work within mental health in the UK.

A 
CAMHS
Addiction clinic
Learning disability service
Liaison psychiatry teams
Assertive outreach team
Early intervention for psychosis teams
Forensic teams
Memory assessment
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20
Q

Describe what each of the following mental health teams in the UK do:

1) CAMHS
2) Addiction clinic
3) Learning disability service
4) Liasion psychiatry teams
5) Assertive outreach team
6) Early intervention for psychosis team
7) Forensic teams
8) Memory assessment team

A

1) Look after children and adolescents. Usually have an eating disorder team.
2) Substance misuse specialists and community clinics
3) For both adults and young people
4) Mainly work in general hospitals and primary care. Aim to bridge gap between physical and psychological symptoms.
5) Community outreach team caring for severe disorders and personality disorders.
6) Deal with 18-35 year olds with their first episode fo psychosis. Offer follow-up for years after.
7) Work with those who have committed serious crimes.
8) Old age psychiatry and treatment/ advice about dementia care.

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21
Q

Name and describe 3 primary health promotion strategies for mental health wellbeing.

A

1) Parenting programmes - for those with children with conduct disorder with the aim to prevent PD.
2) Health visitor interventions - for women at increased risk of postnatal depression.
3) School based programmes - preventing violence, bullying, offending and re-offending.
4) Screening and brief intervention - alcohol CAGE questions, brief advice
5) Debt advice
6) Physical activity campaigns
7) Anti-stigma campaigns
8) Promote wellbeing and early depression detection at work.

22
Q

What are the most common mental illnesses seen in primary care?

A

Depression = most common.
Other mood/ affective disorders (dysthymia)
Anxiety (GAD, OCD, panic disorder)

**Mental illnesses that present more acutely tend to present to secondary care.

23
Q

Name 3 ways that community support can be given for patients with psychiatric disorders in old age.

A

1) CPN and care assistants: visit patients to allow them to stay in their own homes (private or social services funding)
2) Day centres: available for socialising, providing food and to provide a place of contact with MH practitioners.
3) Respite care: gives carers a break.

24
Q

Aside from community support, what other 3 levels of support are there for patients with psychiatric disorders old age?

A

1) Sheltered housing: semi-independent living in apartment complexes with a warden. Often group activities and healthcare worker visits.
2) Residential homes: 24 hour staffing using with HCAs who help with ADLs and provide meals. Not suitable for those with a high level of medical needs. Semi-dependent.
3) Nursing home: highly dependent residents who are unable to care for themselves. There are regular doctor visits and higher levels of nursing staff.

25
Q

Describe the epidemiology of workers in the UK.

A
  • Women > men
  • 50-64 year old age bracket has the highest proportion of carers.
  • Exist in younger generations which might impact on early opportunities.
  • Highest proportion in more economically deprived areas due to poorer health.
  • People of Pakistani/ Bangladeshi heritage are more likely to be carers.
26
Q

State 3 effects of being a carer on health.

A
  • Carers are 2x more likely to report physical or mental health problems.
  • Relationship breakdowns
  • Difficult to establish causal relationship between caring and ill health.
  • Greatest impact on emotional and psychiatric health.
  • Carers have less time to look after their own health (they put others before themselves).
  • Carers often neglect physical symptoms so prevent late with disease.
27
Q

Describe the policies/ legislation available to support carers.

A

1) Carers have the right to assessment of their own needs despite refusal by the recipient of care. Carers must be made aware of this.
2) Carers special grant: offers funding for respite/ short breaks.

28
Q

Describe what financial support is available for carers.

A

Carer’s allowance: £61.35 per week.

29
Q

What criteria must be met in order for a carer to be eligible for carer’s allowance? (4)

A

1) Care recipient in middle/ higher rate of disability living allowance AND

2) Caring for at least 35 hours per week.
3) Over 16
4) Studying <21 hours per week

**Carer’s allowance is difficult for students and employed people to get.

30
Q

What is the bedroom tax?

A

This means that carers and care recipients will receive less housing benefit if they live in a house with one or more spare bedrooms (-14% per ‘spare’ room in the house).

31
Q

What is the bedroom tax based on?

A

A couple, 2 same sex under 16s or 2 mixed sex under 10s per room.

32
Q

What are the problems with the bedroom tax?

A

1) The couple must sleep in the same room even if this is made difficult by the care recipient’s condition.
2) Can be difficult for disabled children who might find it difficult to share rooms with a sibling.
3) Cannot use a spare room for storage of large equipment.

33
Q

What employment support might carers be able to receive?

A

The work and families act of 2006 states that carers of adults can request flexible working hours.

34
Q

Name 3 types of practical support that carers can receive.

A

1) Moving and handling training.
2) Education on specific disease (S+S, natural Hx, prognosis)
3) Respite (recipient of care in home or hospice to allow carer a break)
4) Social services/ community nursing (cleaning/ personal care)

35
Q

What types of emotional support can be available for carers?

A

Counselling and support groups.

36
Q

State 2 ways that attempts can be made to try and reduce incidence of child mental health problems.

A

1) Promote self esteem and self efficacy through secure and supportive personal relationships.
2) Identify risk factors (unstable home, lack of secure attachment relationships, stressful early life events, abuse, low self-esteem, learning difficulty).

37
Q

List 4 protective factors for children which can help individuals to cope and reduce development of mental illnesses.

A
  • Secure attachment relationships
  • Higher intelligence
  • Good communication skills
  • Religious faith
  • Clear, firm and consistent discipline from parents
  • Wide supportive network of friends and families.
38
Q

Describe 2 roles of schools in managing child mental health.

A

1) Must train school staff to recognise the onset of psychiatric difficulty (decreased performance, withdrawal, quietness), teach interpersonal skills and intervene where necessary.
2) Provide a report or assessment of behaviour to medical/ social services.

39
Q

Describe 2 roles of health visitors in managing child mental health.

A

1) Monitor and identify problems at an early stage through visiting home and observing interactions with parents.
2) Help parents to cope with a child’s mental illness (educate and advise).

40
Q

Describe 2 roles of educational psychologists in managing child mental health.

A

1) Assess educational levels and suggest interventions to help increase learning ability.
2) Observe child’s behaviour in class and report.

41
Q

Give 2 impacts of addiction on society.

A

1) Addiction closely follows levels of criminal activity.

2) Clinics and provision of medical therapy cost billions each year.

42
Q

Name and briefly describe 4 alcohol related harms which could occur.

A

1) Deaths and hospital admissions: comes conditions are wholly attributable to alcohol (E.G. Alcoholic liver disease) and some are partially attributable (E.G. colon cancer).
2) Crime and disorder: alcohol has been particularly implicated in violent crimes (assault, domestic violence, robbery and criminal damage).
3) Workplace: There is an impact of drunkenness and hangovers on productivity and absence or leave for alcohol related reasons.
4) Family: 2.5 million adults drinking at harmful levels which has an impact on the wider family. Associated with child abuse/ neglect, arguments, violence, debt and relationship problems.

43
Q

How is the causal impact of alcohol estimated?

A

From epidemiological studies and expressed as alcohol attributable fractions which are applied to deaths and hospital admissions.

44
Q

Name and briefly describe 4 origins of addiction.

A

1) Genetics: inherent susceptibility to drugs differs between individuals (drug metabolism and effects differ).
2) Social: peer pressures, family influence (learned acceptable behaviours).
3) Occupation: higher rates in unskilled workers.
4) Social stressors: debt, stressful life events.

45
Q

Name 4 factors which can maintain addiction.

A

1) Conditioning: taking a drug removes the negative side effects of withdrawal (negative reinforcement).
2) Physiological: development of tolerance means increased levels of drug needed for same effect.
3) Psychological crutch: drug becomes a habitual method of dealing with stress (negative coping mechanism).
4) Social: seeing peers and socialising besoms drug-orientated.

46
Q

How do origins and maintenance factors for addiction influence the healthcare response? (3).

A

Pharmacology: to counteract the physiological impact.
Psychological: CBT, counselling
Social: employment, housing, support groups

47
Q

Name 5 health promotion strategies for decreasing use of alcohol and drugs.

A

1) Education
2) Policy
3) Mass media campaigns
4) Support and info.
5) Healthcare worker roles

48
Q

Describe the use of education to reduce use of alcohol and drugs. (4).

A
  • Less effective method
  • PSHCE in schools (dangers and consequences of alcohol and drug abuse)
  • TV/ radio advertisements (highlighting dangers)
  • Provision of information in GP surgeries, online and in 2o and 3o care.
49
Q

Describe the use of policies to reduce use of alcohol and drugs. (6)

A
  • More effective
  • Minimum unit pricing and taxation
  • Restrict availability (i.e. not for sale after 10pm)
  • Restrictions on promotion and placement on shop floor.
  • Stricter licensing laws (decreased hours for sale of alcohol)
  • Restrict advertising
  • Decrease pressure from big money on politics and politicians.
50
Q

Describe the use of mass media campaigns to reduce use of alcohol and drugs. (2)

A
  • Less effective
  • Drink aware campaign (largest campaign in UK) focussing on responsible drinking.

**Drink aware is run and funded by breweries.

51
Q

Describe what ‘FRANK’ is.

A

A government education programme offering a confidential advice phone line or web chat.
Available 24 hours a day.
FRANK website is a good source of information.

52
Q

Describe 3 aspects of a healthcare workers role in helping to reduce use of alcohol and drugs.

A

1) Identification of problems and brief advice (e.g. CAGE questions).
2) Hospital alcohol health workers: nurse/ specialist worker can implement screening, detoxification, brief interventions, referrals and can support other staff.
3) Specialist treatment: CBT, etc.

** It is thought that hospital or ED admissions are ‘teachable moments’.

HYMS phase II H&S (12 decks)

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