GP

Question 1

Overview of MH in GP

Answer 1

1 in 4 suffer MH
40% of consultations have a MH component
MH is mostly managed in GP’s

Question 2

What do patients complain of in GP?

Answer 2

Feeling low
No energy
TATT
Struggling to cope
Cant stop crying
Cant sleep
Loss of enjoyment
Cant work

Question 3

What are the screening questions for depression?

Answer 3

Last month feeling down or hopeless?

Having little interest in doing things?

Question 4

What is the PHQ-9 and its scores?

Answer 4

For depression
5-9 = mild
10-14 = moderate
15-19 = moderately severe
20-27 = severe

Question 5

Other things to consider with depression?

Answer 5

MED 3 forms

Fitness to drive

Question 6

What is the treatment for depression?

Answer 6

1 = support and advice and monitoring
2 = sleep hygiene, monitoring, psychological interventions
3 = Antidepressant, high psychological intervention, combined treatment
4 = refer

Question 7

Depression follow-up in the GP?

Answer 7

2 weeks after starting
2-4 weeks for 3 months
6 months after remission

Question 8

What is the treatment for bipolar?

Answer 8

Dont start SSRIs in depressed phase
Stop antidepressants if manic
Beware of sodium valoprate in pregnancy

Question 9

What anxiety disorders present to the GP

Answer 9

GAD = anxiety and worry in more days than not for 6 months, cant control
Panic = unforeseen attacks
SAD = CBT then medication

Question 10

What is the GAD 7 and what do its scores mean?

Answer 10

For anxiety
5-9 = mild
10-14 = moderate
>15 = severe

Question 11

What are the questions in OCD screening?

Answer 11

Clean a lot?
Wash a lot?
Thoughts that bother you?
Anything trouble you?

Obsessions = unwanted intrusive thoughts, images or urges
Compulsions = repetative behaviours or mental acts the person feels driven to perform

Question 12

What is OCD treatment?

Answer 12

1 = CBT
2 = medication (SSRI's)
3 = Different medication
4 = buspirone + SSRI

Question 13

What is Insomnia treatments?

Answer 13

Sleep hygine
Sleep diaries (CBT-I)
Medication not advised (Hypnotics)

Question 14

What can the GP do for MH and Care for patients?

Answer 14

Med monitoring
BMI / BP / Smoking
Blood tests
-Antipsychotics 
-Monitoring ECG for QTC prolongation
-Lithium (TFT 6 months and levels every 3 months)

Question 15

What happens in lithium toxicity?

Answer 15

Expected SE
-Fine tremor, dry mouth, altered taste, thirst, urinary, nausea and weight gain

Signs of toxicity
-Vomiting and diarrhoea, coarse tremor, muscle weakness, lack of coordination, speech and vision problems, lethargy and confusion and seizures