Management of Mental Illness Flashcards
Factors in the biopsychosocial model
-Genetic predisposition
-Biological vulnerability
-Biological alterations in brain functioning
=Symptoms and signs
-Early adverse experiences
-Personality/ temperament
-Traumatic/ adverse life events
-Social circumstances
-Alcohol/ substance misuse
-Physical illness
What levels can interventions be made at?
-Biological:
=Aetiology – contributory biological factors can include physical conditions, prescription medications, substance misuse etc…
=Management – usually refers to pharmacological treatments
-Psychological:
=Aetiology – contributory psychological factors can include psychiatric conditions, trauma, learned behaviours, personality etc…
=Management – spectrum from relaxation, mindfulness, counselling, range of psycho / exposure / behavioural therapies
-Social:
=Aetiology – contributory social factors can include poor social support, role models, finance, occupation, housing, relationships, substance misuse etc…
=Management – many social issues can be managed through 3rd sector agencies
Examples of 3rd sector agencies
-Citizens advice for debt and many other things
-Drugs and alcohol: turning point, recovery hub, AA/CA/NA, Al Anon
-Gambling: GA
-Self-harm: Penumbra
-Relationship counselling: Relationships-Scotland
-Accommodation: Access Point
-Studies: personal tutor, university counselling
-https://edspace.org.uk/
What is formulation and what does it include?
-Term used by psychiatrists to describe the integrated summary that helps explain a particular patient’s problems in context
=Description of patient
=Differential diagnosis
=Aetiology
=Management
=Prognosis
Describe description of patient
-Usually in the form of a case summary:
=Identifying information
=Main features of PC
=Relevant background (psychiatric Hx, PMH and FH)
=Positive findings in examinations(MSE and physical)
Describe differential diagnosis
- Schizophrenia
-For: symptoms present for more than 1 month, ICD-10 and first-rank symptoms of delusions of control or passivity (thought insertion): delusional perception; and third person running commentary, hallucination, clear and marked deterioration in social and work functioning - Schizoaffective disorder
-For: typical symptoms of schizophrenia
-Against: no prominent mood symptoms - Mood disorder (manic or depressive episode) with psychotic features
-Against: on MSE, mood mainly suspicious secondary to delusional beliefs, no other prominent features of mania or depression, mood-incongruent delusions and hallucinations - Substance-induced psychotic
-Against: long duration of symptoms, no evidence of illicit substance or alcohol use - Psychotic disorder secondary to medical condition
-Against: no signs of medical illness or abnormalities on physical examination
Describe aetiology
-Predisposing factors
=What made the patient prone to this problem?
=Biological: FHx schizophrenia
-Precipitating
=What made this problem start now?
=Biological: peak of onset for schizophrenia men 18-25
=Social: break up of relationship, recently started college
-Perpetuating
=What is maintaining this problem?
=Biological: poor concordance with medication due to lack of insight
=Psychological: high expressed emotion family
=Social: lack of social support
Describe management
-Immediate to short-term
=Biological: antipsychotic medication, with benzodiazepines if necessary
=Psychological: establish therapeutic relationship, support for family (carers)
=Social: admission to hospital, allocation of care coordinator (care programme approach), help with financial, accommodation and social problems
-Medium to long term
=Biological: review progress in out-patient clinic, consider another antipsychotic then clozapine for non-response, consider depot medication for concordance problems
=Psychological: relapse prevention work, consider CBT and family therapy
=Social: regular review under care programme approach, consider day hospital, vocational training
Describe prognosis
Depends on:
-Natural course of condition (predicted based on patient studies)
-Individual patient factors (social support, compliance, comorbid disease or substance misuse)
Describe Step 1 in stepped care model
Prevention and promotion
-Support that can be utilised before approaching health or social services:
=friends and family;
=self-help, spiritual advice;
=self-help groups;
=occupational advice;
=national and local mental health organisations;
=telephone helplines;
=advice agencies;
=welfare rights;
=housing;
=employment;
=leisure services;
=carer support.
Describe step 2 of the stepped care model
-Recognition in Primary care
‘Watchful waiting’…with further assessment; self-help; guided self-help; expert advice; short-term (distress) brief interventions; signposting to /mobilising resources outlined in Step 1
Describe step 3 of stepped care model
-Assessment/ Primary care intervention
Mental Health Assessment; short term psychological interventions; physical health checks; medicine review; computerised CBT; social prescribing; signposting to / mobilising resources outlined in Step 1
Describe step 4 of stepped care model
-Secondary/ Specialist services
=Comprehensive specialist assessment (General Adult, Addictions, Liaison, ID,CAMHS, Older Adult, Forensic, Psychotherapy); specialist services based in the community or outpatient clinics – e.g. crisis/home treatment, early intervention, assertive outreach, eating disorder services, ADHD, perinatal, rehabilitation; formal measures under the Mental Health (Scotland) Act (e.g. patients on community-based orders); more complex care coordination (possibly using the Care Program Approach); supervision of risk/relapse management plans; crisis accommodation.
Describe step 5 of the stepped care model
-Specialist services
=Range of assessment and treatment in-patient services working with high risk, complex patients requiring specialist interventions; use of powers under the Mental Health (Scotland) Act & Adults with Incapacity Act; high level of care coordination/risk relapse management (may be possible in some crisis / home treatment teams)
Describe the role of the primary care service in mental health
-95% of mental illness is managed by Primary Care alone.
-The most common disorders are mild-moderate mood and anxiety disorders, and alcohol misuse.
-Note, around 50% of all mental illnesses can go undetected in primary care due to patients only describing the physical symptoms (reluctant to discuss emotional issues – stigma, embarrassment)
-Primary Care Liaison Teams are available in some areas to act as a single point of contact for a GP to refer to if they feel secondary services may be required – referrals are assessed and referred on to psychiatric, psychological, Community Mental Health Team (CMHT), Occupational Therapy (OT), or Social Work services as appropriate
