General Adult

Question 1

How would you structure a station about giving weight loss advice regarding antipsychotics

Answer 1

Brief history to check if symptomatic with MH, degree of weight loss, diagnosed medical conditions including diabetes or high cholesterol

Explain why weight gain happens & the risk (cardiovascular and metabolic —> MI, CVA, T2DM, high cholesterol —> poor physical health & death)

Pharmacological & non-pharmacological

• Non-pharmacological:
  —> Diet - low GI index, more protein to maintain satiety
  —> smaller portions, smaller plates, link to a dietician
  —> set goals for weight loss

—> Group CBT for diet & appetite - psychoeducation explaining where overeating can arise from (thoughts and feelings - boredom / stress) & strategies to manage these experiences

—> physical exercise (20 mins a day / sports)

Pharmacological:
—> Can we try Aripiprazole
—> Can we reduce the dose of Olanzapine
—> If not metformin - individuals lose on average 3kg with this - monitor for renal function and B12

How to monitor:
- Weight circumference, height, weight and BMI
- Bloods - HbA1c and Cholesterol

Question 2

What questions would be helpful to inquire about social anxiety?

Answer 2

Do any particular situations make you anxious?

Do you tend to get anxious when meting people?
What about speaking in front of an audience?
What about eating or drinking in front of other people?

Duration, effect and coping:
- How long have you been feeling this way?
- What do you think might caused this?
- How is it affecting you life?
- How does it interfere with your activities?
- How do you manage to cope? - drug and alcohol misuse

Do you tend to avoid situations because you get anxious?
Do you make effort to avoid, situations, places or people because you feel you will get more embarrassed?
What would you do? How does it make you feel?

Elicit anxiety symptoms:
- Other times you been frightened or anxious?
- Sense something terrible might happen
- panic attacks? - times in your life - heart ponded, felt sweaty, dizzy?
- Do you get anxious in certain situations - travelling/in crowds

Rule out co-morbidity - depression, psychosis, anxious PD

Question 3

What are the aetiological factors that may cause anxiety?

Answer 3

Genetic - limited evidence
- Predisposing factors - shy individuals. anxious and avoidant with low self-esteem

• Parental separation, over controlling maternal upbringing, childhood sexual abuse
• Classical conditioning - environmentally determined fear response which is conditioned to the situation the anxiety first occurs