Lifespan of Mental Health

Question 1

Describe the difference in prevalence of mental and physical conditions across a patients life span?

Answer 1

Teen- young adult = high prevalence of mental disorders and low prevalence of physical health problems

Old age = high prevalence of physical health problems and lower rates of mental problems

Question 2

What mental disorders can decrease a patient’s life expectancy and by how much?

Answer 2

Bipolar (9-20yrs)
Schizophrenia (10-20yrs)
Alcohol/drugs (9-24yrs)
Recurrent Depression (7-11yrs)

Question 3

Why does mental health vary across the lifespan?

Answer 3

Onset often associated with periods of stress/ lack of supportive mechanisms

Question 4

What protective mechanisms can offer support to patients who are struggling with their mental health?

Answer 4

Family/Friends
Neighbourhood
School/Work
Church
Health services inc. care services

Question 5

What developments/ transitions in a patients life can be stressful and cause changes in their mental health?

Answer 5

• Birth
• Separating from parent
• Nursery-Primary-Secondary transition
• Developing adult thinking/ transitioning to being an adult
• Ageing and dying

Question 6

What age do most mental disorders begin to present and when are most diagnosed?

Answer 6

Most are diagnosed in 20-30s but in hindsight patients recall episodes in their teens that probably stemmed from their mental illness

Question 7

In what age groups is schizophrenia rarely diagnosed and why?

Answer 7

Early and late onset Schizophrenia are rare

• There is reluctance to diagnose children with schizophrenia
• increasing rates of dementia and psychosis in the elderly make diagnosis difficult

Question 8

WHy is depression rarely diagnosed in the elderly?

Answer 8

• can be overlooked due to physical illness and loneliness

- Older patients also have “pride and stigma” stopping them from accessing services

Question 9

Why is Bipolar Disorder rarely diagnosed in CAMHS?

Answer 9

• Rare due to assumptions that mood is labile in adolescence

- fear of medicalising normal adolescence

Question 10

A diagnosis of Bipolar Affective Disorder in the elderly population is associated with what negative outcomes?

Answer 10

cognitive deficits

increased suicide risk and overall mortality

Question 11

Personality disorders are usually diagnosed after what age?

Answer 11

18 (but earlier when symptoms are clear, persistent and impair functioning)

Question 12

What presentations to mental health services are mainly seen in Children and Adolescents (0 – 18 years) ?

Answer 12

Disruptive/Behavioural Disorders
ADHD and Autism Spectrum Disorder
Separation anxiety (SAD) and school refusal
Trauma and Attachment Disorders

Question 13

What disruptive/behaviour disorders usually present to CAMHS?

Answer 13

Oppositional defiant disorder (ODD) <12 yrs

Conduct disorder (CD) > 12yrs

Question 14

Why do disruptive/behaviour disorders exist?

Answer 14

Children often cant articulate why they feel down

=> act out to show they are struggling

Question 15

How are disruptive/behaviour disorders treated?

Answer 15

• Early intervention by parenting/social interventions is key
• Medication rarely required but can be consider in severe cases

Question 16

What gender is more affected by Autism Spectrum disorder?

Answer 16

M:F = 4:1

Question 17

How are the impairments of Autism Spectrum Disorder treated?

Answer 17

• through education and social interventions

- Medication rarely required other than to treat main comorbidities (depression, anxiety, psychosis)

Question 18

How is ADHD treated?

Answer 18

• Medical treatment is key in moderate to severe cases

- MUST be accompanied by social, educational and parenting interventions

Question 19

What is separation anxiety and when does it normally present?

Answer 19

• SAD and other anxiety disorders lead to school refusal (mostly seen during main transitions)
• Present normally from age 7 months through preschool years

Question 20

What can occur during childhood to precipitate a trauma and attachment disorder?

Answer 20

• maltreatment and abuse during early childhood

Question 21

What symptoms are seen in a trauma and attachment disorder?

Answer 21

• PTSD symptoms (anger, avoidance)
• General irritability, anxiety
• Oppositional behaviours

Question 22

What developmental stages of young children appear similar to presentations of mental illness?

Answer 22

Hyperactivity and short attention span
Strangers, separation, specific phobias
overtalkativeness
Imaginary friends
Intense interests

Question 23

What normal symptoms of secondary school age children may present like a mental disorder?

Answer 23

Mood swings
Sleep changes
Peer pressure influencing thoughts and behaviours
Rituals and OCD type behaviours

Question 24

What differences are there between the treatment of child and adult mental disorders?

Answer 24

• Medications are commonly unlicenced for under 16s
• Children tend to have less predictable medication responses
• Young children less likely to talk about emotions in psychotherapy

Question 25

What challenges present in early adulthood causing distress?

Answer 25

Leaving school
Getting a job
Establishing long-term relationships
Buying a house, having children

Question 26

What challenges normally present in Middle Adulthood?

Answer 26

Maintaining professional/financial security
Managing relationships difficulties (divorce, separation, re-unified families)
Children leaving the home

Question 27

What are the main challenges of late adulthood?

Answer 27

Preparing for retirement and change of role
Dealing with deteriorating physical health
Managing bereavements (death of parents)

Question 28

What is the Puerperium period and why do new mental health diagnoses and existing relapses occur?

Answer 28

(after birth of a baby)
Loss of independence/role
Hormonal changes
Unremitting demands
Chronic loss of sleep
May have stopped psychotropic meds

Question 29

What is Puerperium Psychosis?

Answer 29

• Acute onset of psychotic symptoms, mania/disinhibition, confusion
• psychiatric emergency due to safeguarding risks
• presents between 2-4 weeks postpartum

Question 30

What are the risk factors for developing Puerperium Psychosis?

Answer 30

previous thyroid disorder
previous episode
family history
being unmarried
first pregnancy
c-section
perinatal death

Question 31

When does Postnatal Depression usually present?

Answer 31

onset 1-4 weeks postpartum

Question 32

What are the risk factors for developing Post-Natal Depression?

Answer 32

• family or personal history of depression or anxiety
• complicated pregnancy
• traumatic birth
• relationship difficulties
• history of abuse or trauma
• lack of support
• financial difficulties

Question 33

What mental health problems do the elderly usually have when in hospital?

Answer 33

Dementia

Delirium

Question 34

What is meant by Pseudo-Dementia?

Answer 34

Fluctuating loss of memory, and vagueness 
insight into loss of memory 
Prominent slowing 
depressed mood 
improves with psych treatment

Question 35

Above what age is depression considered late onset?

Answer 35

65

Question 36

What risk factors are there for late onset depression?

Answer 36

• genetics
• life events (loss of spouse)
• social factors (i.e. Loneliness, financial hardship)
• poor physical health (e.g. vascular disease)