General Hospital Flashcards
What are common mental health disorders in the general hospital?
Affective disorders Self-harm Delirium Substance misuse disorders Medically unexplained symptoms Personality disorders Dementia Eating disorders
What are functional disorders?
“medically unexplained symptoms”
Dissociative disorders
Somatoform disorders
How many symptoms are required for mild/moderate/severe depression?
Mild; four
Moderate; five-six
Severe; seven or more
Describe the stepped care model for depression in primary care
Step One; recognition, assessment and initial management
Step Two; advice on sleep hygiene, active monitoring, low intensity psychological interventions
Step Three; antidepressant (usually SSRI) or high intensity psychological intervention
When are people seen by GP for depression follow-up?
Normally 2 weeks after starting and then every 2-4weeks for three months
How to treat non-responders for depression
Increase level support and dose or switch antidepressant
Switching
- initially switch to a different SSRI
- subsequently to another class e.g. TCA, venlafaxine, MAOI (MAOI by specialist only)
Consider combining or augmenting with lithium , an antipsychotic or another antidepressant
Describe suicide risk assessment
Ask about suicidal thoughts
Ideation/Intent/Plans; vague, detailed, specific?
Previous attempts
Homicidal risk
Impulsivity/self-control, access to lethal methods
Current stressors, protective factors, social support
What is GAD7?
Anxiety assessment score
Treatment in anxiety
try psychological therapies first
Drug therapy if functional impairment or no improvement
- SSRI first line
- if ineffective swap to SNRI
Social anxiety disorder treatment
first line CBT
Second line medication; sertraline or escitalopram
OCD treatment
First line CBT
Second line SSRIs
Third line Clomipramine (most SSRI like of tricyclics)
Fourth line; buspirone + SSRI
What to monitor in antipsychotic use?
Cardiovascular risk factors in second generation
Monitoring ECG for QTC prolongation first generation
What to monitor in lithium use?
Thyroid/KFTs 6monthly
Lithium levels 3monthly; risk of lithium toxicity
Symptoms of lithium toxicity
Vomiting and Diarrhoea Coarse tremor Muscle weakness Lack coordination including ataxia Slurred speech Blurred vision Lethargy Confusion Seizures
Expected lithium SEs
Fine tremor Dry mouth Altered taste sensation Increased thirst Urinary frequency Mild nausea Weight gain
