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4th yr- CMS- Medicine > Common mental health problems > Flashcards

Common mental health problems Flashcards

1
Q

How many people suffer from mental or behaviour disorders

A

450 milllion

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2
Q

How many people commit suicide every year

A

1 million

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3
Q

What do we aim to find out when taking a history and exam of a psychiatry patient

A
  1. Appearance
  2. Behaviour
  3. Speech
  4. Mood or affect
  5. Thoughts
  6. Cognition insight
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4
Q

What do we want to record about a patients appearance when taking a mental state examination

A
  1. Features
  2. Level of grooming
  3. Gait
  4. posture
  5. Clothing
  6. Evidence of self harm
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5
Q

What do we want to record about a patients behaviour when taking a mental state examination

A
  1. Eye contact
  2. Facial expression
  3. Body language
  4. Rapport and energy levels
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6
Q

What do we want to record about a patients speech when taking a mental state examination

A
  1. Cadence
  2. Amount of verbalisation
  3. Tone
  4. Volume
  5. Rhythm
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7
Q

What do we want to record about a patients thought when taking a mental state examination

A
  1. Form
  2. Content
  3. Possesion
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8
Q

What is schizophrenia

A

A psychotic illness involving delusions, hallucinations and disorder of the form of thought

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9
Q

What are delusions

A

Thought insertions/ withdrawals

Thought broadcasting

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10
Q

What are hallucinations

A

Can be auditory or visual in the form of voices telling them to do something or intrusive thought

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11
Q

What is a disorder of the form of thought

A

Thinking of themselves in the third person

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12
Q

What are the different subtypes of schizophrenia

A
  1. Paranoid
  2. Hebephrenic
  3. Catatonic
  4. Delusional
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13
Q

How common is schizophrenia

A

15-20 per 100,000

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14
Q

At what age does schizophrenia mostly present in

A

Late 20s early 30s

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15
Q

How can we treat schizophrenia

A
  1. Neuroleptics (medications)
  2. Rehabilitation
  3. Social care
  4. Psychological treatments
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16
Q

What does the term affect with in psychiatry

A

Mood

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17
Q

What are disorders of affect

A

Mood disorders

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18
Q

Name the most common disorder of affect

A

Depression

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19
Q

When does depression become pathological

A

When there is a pervasive persistence to the thoughts and feelings associated with it e.g.:

  1. Persistent low mood
  2. Anhedonia (loss of ability to experience pleasure) • Thoughts of self-harm or suicide
  3. Early morning wakening
  4. Sleep disturbances
  5. Slowing of speech/monotonous speech
  6. Failure to make eye contact
  7. Psychosexual dysfunction
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20
Q

How common is depression

A

Affects 3-4% of the population

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21
Q

Name the different theories of aetiology for depression

A
  1. Genetic predilection
  2. Biochemical imbalanced in the brain
  3. Psychological theories
  4. Sociological theories
  5. Life event triggers
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22
Q

How can we treat depression

A
  1. Psychological
  2. Pharmacological
  3. Social care
  4. ECT
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23
Q

When can anxiety be problematic

A

When there is a misplacement of feeling associated thoughts that leads to it becoming pathological

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24
Q

What is anxiety a collection of

A 
Disorders including;
1. Phobias
2. Panic disorders
3General anxiety disorder
4. PTSD
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25
Q

What can make anxiety worse

A

Drugs and alcohol

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26
Q

How can we treat anxiety

A
  1. Psychological therapies
  2. Antidepressants
  3. Antipsychotics
  4. Antimanics/ mood stablisers
  5. Anxiolytics/sedatives
  6. ECT
  7. Psychosurgery
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27
Q

Give examples of psychological therapies

A 
1. Cognitive behavioural therapies (CBT)
2Interpersonal therapy 
3. Behaviour therapy 
4. Psychodynamic psychotherapy
5. Couples/ family therapy 
6. Couples intervention
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28
Q

How common is dementia

A

5% Of the population have dementia

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29
Q

What is dementia

A

It is an umbrella term for brain disease causing problems with memory, thinking, problems solving and/ or languages

30
Q

Describe what can happen to patients with untreated dementia

A

It is usually progressive and is frequently a terminal condition contributing directly to the cause of death

31
Q

Name the different types of dementia

A
  1. Vascular
  2. Alzheimers
  3. Lewy body dementia
  4. Frontotemporal dementia
  5. Others
32
Q

Name the most common type of dementia

A

Alzheimers

33
Q

How common is vascular dementia

A

15-25% of total dementia cases

34
Q

What causes the symptoms seen in vascular dementia

A

It is due to atherosclerotic disease in the arteries supplying the brain leading to death of brain cells and concomitant loss of function

35
Q

How common is Alzheimers

A

40-70% of total dementia cases

36
Q

What causes the symptoms seen in Alzheimer’s

A

This is due to shrinkage (atrophy) of the brain with loss of synaptic connections between brain cells due to beta-amyloid ‘plaques’ and neurofibrillary ‘tangles’ developing

37
Q

How common is LEWY BODY dementia

A

2-20% of all dementia cases

38
Q

What causes the symptoms seen in LEWY BODY dementia

A

Often misdiagnosed as Alzheimer’s.
Involved deposition of Lewy Bodies in the cortex which are deposition of alpha synuclein, another protein. They are also responsible for Parkinson’s disease.

39
Q

How common is frontotemporal dementia

A

2-4% of all dementia cases

40
Q

What causes the symptoms seen in frontotemporal dementia

A

is due to death of neurones in the frontal and/or temporal lobes of the brain with a decline in functional neurotransmitter levels - resulting in brain death and shrinkage.
Personality and behavioural changes are very prominent here due to the anatomical location of the disease process.

41
Q

In whom is frontotemporal dementia more common in

A

Is much more common in younger patients than any other form of dementia i.e. in the 45-65 year old bracket.

42
Q

What is another name for frontotemporal dementia

A

Picks disease

43
Q

Give some general symptoms of dementia

A
  1. Memory loss
  2. Slowed speed of thinking
  3. Blunting of mental sharpness/reaction time
  4. Trouble finding or understanding info given
  5. Mood disturbances
  6. Movement disorders
  7. Difficulty carrying out the actives of daily living
44
Q

How can dementia affect oral hygiene

A

Patients may lose interest in oral health care practices as their dementia progresses and other health or social issues take precedence. Loss of dentures, poor oral hygiene and undiagnosed toothaches leading to painful abscesses are sadly not uncommon in patients with moderate to severe dementias.

45
Q

What is illness denial

A

When a patient denies that they are ill and will therefore not engage with healthcare services or carry out their own self-care prac

46
Q

What is illness affirmation

A

When a patient over estimates their degree of ill health and in worst case scenarios leads to malingering

47
Q

What can contribute to abnormal illness behaviour

A

Sociological, psychological and psychiatric factors

48
Q

Who do we assume has capacity

A

All adults are assumed to have capacity unless demonstrated otherwise

49
Q

What requirements must a person furfil to be deemed capacitant

A
  1. Retain information given to them
  2. Weigh that information
  3. Understand the consequences of that action and lack of action
  4. Communicate their decision to you
50
Q

What does IMCA stand fro

A

Indépendant mental capacity advocates

51
Q

What do Independent Mental Capacity Advocates do

A

They are appointed people who support those who are ruled to lack capacity to make certain decisions

52
Q

How many people in England and Wales lack mental capacity

53
Q

What is detention defined as by the mental health act 1983

A

Detention means treating a patient who has not agreed voluntarily to the proposed treatment

54
Q

What is the aim of detention

A

To prevent harm to the patient and to others

55
Q

Name some common types of medications encountered by patients with mental health problems

A
  1. Anti anxiety drugs
  2. Sedatives/ hypnotics
  3. Antidepressants
  4. Mood stablisers
  5. Antipsychotic agents
  6. Anti-Parkinsonian drugs:
56
Q

Give examples of anti anxiety drugs patients may be taking

A 
antihistamine derivative hydroxyzine 
benzodiazepines including:
1. clonazepam, 
2. diazepam, 
3. lorazepam, 
4. chlordiazepoxide
57
Q

Give examples of Sedatives/ hypnotics drugs patients may be taking

A
  1. benzodiazepines such as temazepam
  2. choral hydrate,
  3. doxepin
  4. zolpidem
58
Q

Give examples of Antidepressants patients may be taking

A
  1. Selective Serotonin Reuptake Inhibitors such as:
    - citalopram, fluoxetine, paroxetine, sertraline
  2. Serotonin and Noradrenaline Reuptake Inhibitors such as: duloxetine, venlafaxine
  3. mirtazapine, trazodone
  4. Tricyclic Antidepressants (TCAs) e.g. amitriptyline, doxepin, imipramine, nortriptyline
  5. MAOIs - MonoAmine
    6, Oxidase Inhibitors such as selegiline, phenelzine
59
Q

Give examples of mood Stabilisers patients may be taking

A
  1. lithium
  2. carbamazepine,
  3. gabapentin,
  4. oxcarbazepine, lamotrigine
  5. sodium valproate
60
Q

Give examples of antipsychotic agents patients may be taking

A
  1. Typical antipsychotics such as chlorpromazine, haloperidol
  2. Atypical antipsychotics including clozapine, aripiprazole, olanzapine, quetiapine, risperidone
61
Q

Give examples of Anti-Parkinsonian drugs patients may be taking

A
  1. Anticholinergics such as benztropine, diphenhydramine, trihexyphenidyl
  2. Other agents such as amantadine or even propranolol
62
Q

What effect can Selective Serotonin Reuptake Inhibitors (SSRIs) have on the oral cavity

A
  1. Xerostomia,
  2. risk of bleeding increased
  3. lowered analgesic effect from opioids
  4. tramadol due to decreased biotransformation to their active metabolites, serotonin syndrome
63
Q

What effect can Serotonin and Noradrenaline Reuptake Inhibitors (SSRIs) have on the oral cavity

A
  1. Xerostomia,
  2. risk of bleeding increased
  3. lowered analgesic effect from opioids
  4. tramadol
  5. increased risk of cardiovascular effects when using adrenaline
64
Q

What effect can Tricyclic Antidepressants have on the oral cavity

A
  1. Anticholinergic effects such as xerostomia,
  2. orthostatic
  3. hypotension,
  4. drowsiness,
  5. cardiac arrhythmias
65
Q

What effect can (MAOIs) MonoAmine Oxidase Inhibitors have on the oral cavity

A
  1. Anticholinergic effects,
  2. hypotension,
  3. may interact with other medications to cause hypertensive crises or serotonin syndrome
66
Q

What effect can lithium have on the oral cavity

A
  1. Xerostomia,
  2. stomatitis,
  3. metallic taste,
    best to avoid NSAIDs in these patients
67
Q

What effect can Serotonin and Noradrenaline Reuptake Inhibitors (SSRIs) have on the oral cavity

A

Increased risk of bleeding (anti-platelet activity) especially if give NSAIDs

68
Q

What effect can Valproate have on the oral cavity

A
  1. Anticholinergic effects,
  2. orthostatic hypotension,
  3. erythema multiforme/Steven Johnsons syndrome,
  4. aplastic anaemia, agranulocytosis,
  5. multiple reactions with other drugs e.g azole antifungals etc
69
Q

What effect can Antipsychotics have on the oral cavity

A
  1. Anticholinergic effects,
  2. orthostatic hypotension,
  3. extrapyramidal side effects (jaw/neck stiffness, motor restlessness),
  4. tardive dyskinesia
70
Q

What effect can Anti-Parkinsonian drugs have on the oral cavity

A

Anticholinergic effects

71
Q

Give examples of anticholinergic effects

A
  1. Xerostomia
  2. Tachycardia
  3. Blurred vision
  4. Dry eyes
  5. Constipation
  6. Urinary retention
  7. Dizziness due to postural hypotension
  8. Cardiac arrhythmias
  9. Cognitive impairment
  10. Hallucinations
72
Q

What causes anticholinergic effects

A

When an agent competitively inhibit the binding of the neurotransmitter acetylcholine

4th yr- CMS- Medicine (14 decks)

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