Life Expectancy Flashcards
Why is it important to consider life expectancy as it relates to mental health?
Disease prevention
Allows better understanding of aetiology
More accurate diagnosis and formulation
Early intervention and age-tailored treatments
Allows for service planning and development
Better prognosis comes with early treatment
What is the average reduction in life expectancy for some mental health disorders?
Bipolar disorder = 9-20 years
Drug/alcohol abuse = 9-24 years
Schizophrenia = 10-20 years
Recurrent depression = 7-11 years
How common are mental illnesses in older people?
25% of people aged >65 will have mental illness
What is mental illness onset associated with?
Periods of stress and lack of supportive mechanisms to manage this
What are the systemic influences on mental illness onset?
Family, school, neighbourhood, work, church, social networks, health services
What are some developmental and transitional influences on mental illness onset?
Birth, separating from parent, nursery to primary then secondary school, developing adult thinking, adult life development, adult life transitions, ageing and dying
In what age groups can it be difficult to identify prodromal schizophrenia symptoms?
Extremes of age = very young or very old
In what age groups is it rare for schizophrenia to occur?
Very early/early and late onset are rare
Some reluctance to diagnose in children
How do risk factors for schizophrenia vary in different age groups?
Young people = high THC cannabis and drug induced psychoses
Elderly = dementia and associated psychosis
When do most patients experience their first depressive episode?
About 50% of depressed adult patients claimed their first depressive episode occurred before age 20
What is the gender distribution of depression?
Equal prepubertal incidence but sudden increase in female cases during adolescence
What are some risk factors for depression in the elderly?
Physical illness and loneliness
Why is it rare for CAMHS to diagnose bipolar disorder?
Assume mood is labile during adolescence and due to fear of medicalising normal adolescence
What is onset of bipolar disorder in old age associated with?
Negative outcomes, cognitive deficits, increased suicide risk and overall mortality
At what age are personality disorders diagnosed?
Technically only after age 18
May be diagnosed earlier when symptoms are clear, persistent and impair functioning
When is the peak incidence of frequency of symptoms for personality disorder?
At age 14 = also when there is first access to services
What are some mental illnesses that are mainly seen in children?
Behavioural disorders, ADHD and ASD, separation anxiety, attachment disorders
What is the most common mental disorder of childhood?
Behavioural disorders = around 6%
Why do most mental health services not cater for behavioural disorders?
Behavioural disorders aren’t considered a mental illness
What age group is oppositional defiant disorder diagnosed in?
Under 12s = primary school age
What age group is conduct disorder diagnosed in?
Over 12s = secondary school age
What are early conduct disorder behaviours predictors of?
One of the most robust predictors of serious antisocial behaviour, criminality and substance misuse in later life
What is key in managing behavioural disorders?
Early intervention by parenting and social intervention
Is medication usually given to treat behaviour disorders?
No = rarely given unless very severe
What are some features of autism spectrum disorder?
4 times more common in boys
Huge range of impairments
Some comorbidities are depression, anxiety and psychosis
How is autism spectrum disorder treated?
Mainly through education and social interventions
Medication only indicated to treat comorbidities
How common is ADHD?
Occurs in 4-5% of children
How is ADHD treated?
Medical treatment key in moderate to severe cases = should be accompanied by social, educational and parenting interventions
In what age group is separation anxiety normal?
From age 7 months through preschool years
What distinguishes separation anxiety?
Age inappropriate, excessive and disabling anxiety
What does separation anxiety lead to?
School refusal = mostly seen during main transitions
Marked increase in social anxiety and perfectionism during adolescence
What are some common mental illnesses in adults aged 18-65?
Puerperal psychosis and postnatal depression
What are some mental illnesses of old age?
Dementia, delirium, pseudo-dementia, late onset depression
What is attachment disorder most commonly linked to?
Maltreatment and abuse in early childhood
What is the presentation of attachment disorder?
PTSD type symptoms, general irritability, anxiety, oppositional behaviours, quasi-psychotic symptoms
What are some comorbidities of attachment disorder?
High comorbidity with other mental illness = substance misuse, psychotic disorders, mood disorders, anxiety disorders, suicide attempts
What are some groups at increased risk of attachment disorder?
Asylum seekers, refugees, looked after children
What are some presentations in primary school age children that shouldn’t be mistaken for mental illness?
Developmentally appropriate anxiety, hyperactivity and short attention span, grandiose ideas and overtalkativeness, imaginary friends, intense interests, onset of non-impairing tics
What are some presentations in secondary school age children that shouldn’t be mistaken for mental illness?
Mood swings, sullenness, withdrawl, irritability, sleep changes, peer pressure influencing behaviour, rituals and OCD-type behaviours, intrusive thoughts and pseudohallucinations
Why are mental disorders in young children difficult to detect and treat?
Young children less likely to manage individual psychological therapy and lack verbal abilities to talk about emotions
Why are children with medical disorders difficult to detect and manage?
May have less insight into difficulties and may not engage
Medications commonly unlicensed for under 16s
Tend to have less predictable response and more side effects
What is delirium linked to?
The ageing brain
What characterises delirium?
Acute onset = lasts hours-weeks, fluctuates and is worse at night, attention decreased or hyperalert
What are some causes of delirium?
Infection, alcohol withdrawl, dehydration, drugs, tumour, stroke, hypoxia, trauma
What are some of the challenges of early adulthood?
Leaving school, getting a job, buying a house, having children, establishing long term relationships
What are some of the challenges of middle adulthood?
Maintaining financial/professional security, managing relationship difficulties, dealing with children leaving home
What are some of the challenges of late adulthood?
Preparing for retirement and change of role, dealing with deteriorating physical health, managing bereavement
What are disorders of puerperium?
Typical of adulthood = puerperium is period of increased risk of new mental illness and relapse of existing illness
What are disorders of puerperium linked to?
Loos of independence, hormonal changes, unremitting demands, chronic sleep loss, stopping psychotropic medication
What is puerperal psychosis characterised by?
Acute sudden onset of psychotic symptoms, manic symptoms/disinhibition and confusion = emergency due to safeguarding risk
What are some features of puerperal psychosis?
Every 1 in 1000 births
Presents between 2-4 weeks postpartum
Increased risk of previous mental illness but 50% have no previous condition
What are some risk factors for puerperal psychosis?
Previous thyroid disorder, previous episode, positive history, being unmarried, first pregnancy, c-section, perinatal death
What are some features of postnatal depression?
Occurs in 1 in 10 women
Usually presents 1-4 weeks postpartum
What are some risk factors for postnatal depression?
Family/personal history of depression or anxiety, complicated pregnancy, traumatic birth, relationship difficulties, history of abuse, lack of support, financial difficulties
What are some features of dementia?
Symbolic of ageing brain
70% due to Alzheimer’s, 17% due to vascular dementia and 13% due to other dementias
Age is biggest risk factor
What are the features of pseudodementia?
Fluctuating loss of memory and vagueness Good insight into memory loss Prominent slowing of movement and reduced speech Consistently depressed mood Lack of neurodegenerative dementia
How is pseudodementia treated?
Responds to medication and ECT
Condition is non-progressive
What is late onset depression?
Depression occurring for first time in later life = estimated prevalence of about 2% in people aged >65, poorer prognosis than early onset type
What are the risk factors for late onset depression?
Genetic susceptibility, life events, loneliness, financial issues, poor physical health
What are the features of late onset depression?
Structural changes in brain Higher rates of vascular risk factors More cognitive/neurological issues Lack of insight Greater comorbid physical illness Express somatic rather than depressive symptoms Highest risk for suicide
