community psychiatry

Question 1

WHO definition of mental health

Answer 1

• state of health in which the person is able to;
  1. realise his/her potential
  2. cope with normal life stress
  3. work productively and fruitfully and
  4. make a contribution to his/her community

Question 2

percentage of mental health disorders in overall disability world wide

Answer 2

1. mental health disorders (neuropsych disorders) are responsible for about 12-15% of the worlds total disability - more than cardiovascular diseases, and twice as much as cancer
2. their impact on daily life is even more extensive, accounting for more than 30% of all years lived with disability

Question 3

chlorpromazine

Answer 3

• is a phenothiazine, meaning it has tranquilizing properties and potentiates general CNS depression
• moa;
  1. antagonist on different postsynaptic receptors - on dopaminergic receptor (subtypes D1, D2, D3 and D4 - different antipsychotic properties on productive and unproductive symptoms), on serotonergic-receptors (5-HT1, and 5-HT2, with anxiolytic, antidepressive and antiaggressive properties as well as an attentuation of extrapyramidal side-effects but also leading to weight gain, fall in BP, sedation and ejaculation difficulties)
• antagonist on histaminergic receptors (H1 receptors, sedation antiemesis, vertigo, fall in BP and weight gain)
• antagonist on alpha 1/alpha2 receptors (antisympathomimetic properties, lowering of BP, reflex tachycardia, vertigo, sedation, hypersalivation and incontinence as well as sexual dysfunction, but may also attenuate pseudoparkinsonism)
• antagonist on muscarinic (m1 and M2) - anticholinergic side effects like dry mouth, blurred vision, obstipation, difficultuy urinating, sinus tachycardia, ECG changes and loss of memory

Question 4

mental health service ireland components

Answer 4

1. patient and family
2. community network
3. community resources
4. primary care
5. inpatient
6. acute day hospital
7. CMHT (community mental health team) - OPD, community psychiatric nurse, day centre)

Question 5

community resources mental health ireland

Answer 5

1. family and friends
2. school counselors/HR workplace
3. Helplines
4. NOSP (national office for suicide prevention)
5. mental health apps - headspace, calm
6. HSE funded - aware, SOS, headstrong/jigsaw, community bereavement services
7. Pieta house

Question 6

primary care and mental health disorder

Answer 6

-GPs deal with 90% of mental health difficulties
- up to 25% of GP workload
- refer approx 5% to psychiatric services
- AVFC regards GPs and important part of the continuum of community care
- gatekeepers
- they require: adequate training, access to psychological therapies (counselling in primary care), easy access to specialist services (psychiatric nurse triage - assessing severity/risk)

Question 7

When/ who to refer on to specialist services

Answer 7

• as specialist services are scarce and expensive, they should focus on:
  1. assessing and diagnosing complex cases and those requiring an expert second opinion
  2. treating patients with the severest symptoms and accompanying risks
  3. caring for those with the greatest disability from mental illness, needing extra support
  4. and making treatment recommendations for conditions that have proved nonresponsive to initial treatment, homecare team/psychology

Question 8

community mental health team

Answer 8

1. MDT/ local
   - consultant psychiatrist
   - NCHD
   - community psych nurse
   - psychiatric social worker
   - psychologist
   - CBT therapist
   - occupational therapist
   - dietician
   - employement support

others;
1. crisis intervention team
2. early diagnosis and intervention DETECT (diagnosis, treatment advice, CBT for psychosis)
3. Clozapine clinic
4. access to day hosp/day centre/wrap
5. other mental health teams e.g perinatal, eating disorder

Question 9

delivering mental health treatment in the community - advantages and disadvantages

Answer 9

1. advantages
   - treatment is as effective
   - social inclusion
   - cost; similar but more cost effective
   - greater involvement in their treatment
2. disadvantages
   - burden on families/neighbours
   - intensive service; requiring continous funding, organization and provision of services
   - risks; homelessness, noncompliance, drugs, violence

Question 10

when to admit patients to psychiatric hospital

Answer 10

1. severe psychiatric relapses/behavioural disturbances
2. co-morbid medical and psychiatric diagnoses, especially if severe and require urgent medical assessment
3. strong violent/suicidal tendencies
4. acute neuropsychiatric conditions
5. Old age
6. treatment requiring inpatient stay e.g clozapine initiation

Question 11

hospital admissions

Answer 11

1. may need to be involuntary
2. should be promptly arranged
3. as brief as possible
4. treatment involves community team and discharge planning