common psychiatric disorders Flashcards
intergrating mental health w other non communicable disease:
- Cardiovascular diseases, diabetes, cancer and respiratory diseases commonly co-occur with —-
- Common mental disorders- include —–
- Risk factors for NCDs common to both and cluster in people with mental illness
- Risk factors include :
common mental disorder and severe mental illness
depression n anxiety
tobacco, unhealthy diet, physical inactivity and harmful alcohol use, environmental risk factors (including adverse childhood experiences)
- —- evidence supports integration of mental health treatment into primary care
- —- of mental illness and— illness comorbidity at secondary care level – improves —- , reduces —
- Professionalism – multidisciplinary team work
- Inclusion in medical curriculum at an early stage as —
collabortive care
awareness
physical illness
improves outcomes
reduces costs
spirlling
-common mental disorders as —- and —- are managed primarly by —-
-these are relevant to condition like —-
- —– in a primary care consultation
- Referred to secondary care (psychiatric services) – not responding to —- or —
depression and anxiety
primary care ( mild n stable )
anemia inflammation sepsis
recognition
initial treatment or complex
—- is the most common psychotic illnesses
it includes:
- —- loss of contact of reality
- it affects —-
- —– symptoms (addition) includes hallucinations, delusions, disorganized thinking (manifests in speech), altered behaviour
- —– symptoms (reduction/absence) includes loss of motivation, loss of drive, apathy, impoverished thinking (manifests in speech), loss of enjoyment, loss of social contact
- —- symptoms as impairments in memory, attention, concentration
- mood changes as – lability, depressed mood, elevated mood, blunting
schizophrenia
psychosis
thinking aka cognitive disorder
positive
negative
cognition
-prevalence of schizophrenia is — of the population and it affects — more than —-
- neurochemistry: — and — excess and — over activity
- —- aetiology as – genetics, birth complications, neurodevelopmental associated with substances including cannabis and stimulants, organic – TLE, ABI
0.5 - 1%
males more than females
glutamate and dopamine
serotonin
multifactorial
How might Schizophrenia or other psychoses present?
we can take help from —- , —- . and —– which depends on level of —- and —– impairment
primary care police emergency department
behavioural and functional
( read:
GP: gradual onset, acute onset but mild impairment
Teenager in bedroom, refusing to come out, parents worried, loss of friends, altered academic performance, may or may not be aware of hearing voices or expressing strange beliefs
ED: person may self-present to ED with strange beliefs, may be brought to ED with bizarre behaviour (? organic- always investigate)
Police: If behaviour very aggressive or bizarre, or the person is acting on their strange beliefs, they may be picked up by the police/arrested)
Snapshot of a patient’s thoughts, emotions and behaviour at the time of observation is known as —-
helps identify the —, —- , and —- of any mental condition
its a —- format when written down down but done during the interview while the patient is talking
mental state examination
presence severity and risk to self n others
structured format
( mental state examination includes:
Appearance
Behaviour
Speech
Mood ( what patient thinks) and Affect ( what I think )
Thought form ( structure of the thought )
Thought content ( what it contains ) as delusions is content of thought
Perception
Cognition∞
Insight & Judgment∞
Risk assessment
Comorbidity between BPAD and other illnesses include:
( make sure to watch the video on slide 24 for BPAD )
Substance abuse (male > female)
Migraines, obesity, thyroid disease (female> male)
Anxiety
Renal disease (nephrotoxicity from lithium)
biopsychosocial approach include : ( complex interplay of condition )
Physical environment
Social environment
Psychological factors
impact of environment/system on mental and physical health:
We, and our patients, live in a system
Mental and physical illness can be predisposed to, precipitated, orperpetuated by the system we live in
Environmental: socio-economic deprivation, poverty,poor sanitation, toxins, varies globally
Family: adverse life experiences, abuse,neglect, supportive, resilient, genetics of family of origin, epigenetics, substance abuse, smoking
Current living situation – supportive, resilient,abuse, neglect,epigenetics, substance abuse, smoking
Loneliness, isolation
Prevailing cultural context
MDT approach and teamwork :
1-GP surgery: primarycare: when to refer for secondary care and when to manage in primary care – medical, nursing, primary care psychologist
2-Multimorbidity
3-Secondary and tertiary services: physiotherapist, nursing, occupational therapist, social worker, psychologist, liaison psychiatrist
4-Professionalism: know when and how to collaborate with other team members – good to familiarise self with roles of MDT
global mental illness:
From addiction to dementia to schizophrenia, almost 1 billion people worldwide suffer from a mental disorder
Lost productivity as a result of two of the most common mental disorders, anxiety and depression, costs the global economy US$ 1 trillion each year
In total, poor mental health was estimated to cost the world economy approximately $2·5 trillion per year in poor health and reduced productivity in 2010, a cost projected to rise to $6 trillion by 2030
burden of disease WHO:
14 -19% of people in employment in UK reported mental disorder
Milder illness, less impact on ability to work
More severe illness or more severe disorder – bigger impact on gaining employment, keeping employment, functioning at work (presenteeism)
Reported that 60% people with BPAD (severe and enduring) are unemployed
80% people with Schizophrenia (severe and enduring) are unemployed
Illnesses with onset at a formative stage of life – late adolescence, early 20s – school, education, college, getting first job
Stigma
check slide 17 for MSE
Mention mood congruent and incongruent delusions
Comorbidity between Schizophrenia and other illnesses:
1- On average, people with schizophrenia die —- earlierthan people without majormental illness.
2- Common risk factors:
3-At least10% of patients prescribed long-termantipsychotic medications will develop —- , morethan twice the rate in the general population
4- Neurodevelopmental – certain genetic conditions associated with higher likelihood of psychotic illness e.g. Chromosome 22q11 deletion syndrome (Di George/velo-cardio-facial syndrome)
5-Death due to suicide is a contributing factor, BUT approximately two-thirds of this premature mortality are attributable to cardiovascular disease, smoking-related lung disease and type II diabetes. There may also be a shared genetic vulnerability between psychosis and risk of diabetes. There is an increased risk of some cancers and a decreased risk of others but overall increased mortality due to delayed recognition and treatment
15-20
sedentary lifestyle, smoking (70% v 20%), obesity
type II diabetes
