Introduction to Psychiatry

Question 1

What is the ratio of people with mental health disorders in their lifetime?

Answer 1

1 in 3 will have mental health disorders in their lifetime.

Question 2

What is the ratio for the effects of mental health on GP consultations?

Answer 2

1 in 3 GP consultations will have a mental health component.

Question 3

What is the ratio of people who feel stigmatised about mental health?

Answer 3

3 in 4 people feel stigmatised or are too scared to discuss their illness.

Question 4

How much of NHS funding is allocated towards mental health services?

Answer 4

10% of NHS funding.

Question 5

What is a stigma?

Answer 5

Fundamental mindset which attaches blame and lack of acceptance/understanding of that disorder.

Question 6

What are the range of treatment options available for mental health disorders?

Answer 6

Psychotherapies

Social therapies

Medication

Question 7

How are mental illnesses diagnosed? How does this compare to general medicine?

Answer 7

We don’t have scientific basis to diagnose as we diagnose by symptom cluster.

General medicine is diagnosed by aetiology or pathology.

Question 8

When is the Mental Health Act used?

Answer 8

When those who need urgent treatment are unwilling to receive it or are a threat to themselves/others, they are detained under the Mental Health Act.

Question 9

Everyone experience symptoms of anxiety at some point as it is normal and part of the human condition, so when does anxiety symptoms become abnormal?

Answer 9

When the degree of anxiety and degree of physical symptoms becomes disabling.

Only a ‘disorder’ if it is excessive, impacts on life or out of context.

Question 10

What are some symptoms of anxiety?

Answer 10

Psychic anxiety: Feeling of fear or dread.

Physical symptoms:

• Palpitations
• Sweating
• Dry Mouth
• Splanchnic Vasoconstriction (Butterflies).
• Tremor
• Paraesthesia (Pins and needles)
• Depersonalisation (Feeling disconnected from world around you)
• Syncope (Fainting)

Physical symptoms vary from person to person.

Question 11

What role does adrenaline play in anxiety?

Answer 11

Adrenaline = body’s fight or flight response.

Someone with anxiety has an abnormal psychological response to adrenaline.

Question 12

How does adrenaline work in a positive feedback loop in anxiety?

Answer 12

Positive feedback loop:

Adrenaline released in response to stimuli.

Heart beats faster.

You become aware that your heart is beating faster, think its a heart attack maybe.

More adrenaline released.

Causes more physical symptoms.

Physical symptoms picked up and more adrenaline released.

Question 13

What are the some symptoms of Obsessive Compulsive Disorder (OCD)?

Answer 13

Obsessions

Compulsions

Question 14

What are Obsessions?

Answer 14

• Ego-dystonic thoughts = thoughts that make you feel uncomfortable, but they are your own thoughts.
• Repetitive, circular ruminations.
• May be bizarre and sound delusional.
• Insight maintained.
• Unbidded and resisted.
• Resistance leads to anxiety.

Question 15

What are the differences between obsessions and delusions?

Answer 15

Obsessions are not accepted as fact by the patient, whereas delusions are.

• E.g. woman comes in saying she has thoughts about stabbing her own baby.
• If these are obsessions, then she’s not going to entertain it, knows it’s a horrible thought, but it just keeps popping into her mind.
• If delusions, could be because she thinks the baby is not her baby or just other reasons which lead her to want to stab the baby (postpartum psychosis possibly) and this is very high risk to the baby.

Might obviously still have concerns about sending the baby home, but obsessions are far less risky than delusions.

Question 16

What are Compulsions?

Answer 16

Motor responses to obessional thoughts

Often ritualistic, stereotyped, precise.

Patients start again if interrupted.

E.g. handwashing, counting, arranging, symmetry, checking door locks.

Question 17

What are the different classifications of anxiety?

N.B. Take a modicum of circumspection about these because we don’t know the underlying causes of these, but useful for communicating with other clinicians.

Answer 17

• Generalised anxiety disorder.
• Panic disorder.
• Agoraphobia.
• Simple phobia.
• Social phobia.

Question 18

What is Generalised Anxiety Disorder?

Answer 18

Generalised anxiety disorder is where you feel anxious most of the time.

Symptoms vary from person to person, but include:

• Constant worrying
• Sense of dread
• Difficulty concentrating.

Question 19

What is Panic Disorder?

Answer 19

Opposite to generalised anxiety disorder.

Panic disorder is where you regularly have sudden attacks of panic or fear.

Very disabling.

Question 20

What is Agoraphobia?

Answer 20

Agoraphobia is fear of being in situations where escape might be difficult or that help wouldn’t be available if things go wrong, e.g. leaving home, travelling on public transport, open spaces.

Question 21

What are Simple Phobias?

Answer 21

Most common.

Centre around a particular object, animal, situation or activity.

Normal to have fears like spiders, but simple phobia is when you can’t be in a room with a dead spider 5 metres away.

Question 22

What is Social Phobia?

Answer 22

An overwhelming fear of social situations like meeting or speaking to people.

Also known as Social Anxiety Disorder.

Question 23

Why is anxiety considered a ‘clinical iceberg’?

Answer 23

Very under-diagnosed due to vast number of barriers:

People not seeking help.

Even if they seek help, their symptoms are considered physical rather than psychological.

Even if perceived as psychological, still are not formally diagnosed with anxiety.

Question 24

What is iAPT?

Answer 24

improving Access to Psychological Therapies.

Largest open access talking therapies programme in the world.

Delivers cognitive behavioural therapy.