Mental Health Flashcards
Depression-
Need to explore the behavioural, social, cognitive and insight of the pt. Diagnose with (DSM-5) the pt presenting with at least3 of the signs for more than 2yrs or depressive syndrome for >2yrs.
This can be quantified with PHQ-9 score, where rate each statement from 0-4, 0- don’t experience. 4-daily.
PHQ-9
- Little interest or pleasure in doing things
- Feeling down, depressed, hopeless
- Trouble falling or staying asleep or sleeping too much
- Feeling tired or having little energy
- Poor appetite or overeating
- Feeling bad about yourself- or that you are a failure or have let yourself or family down
- Trouble concentrating on things such as reading newspaper
- Moving or speaking so slowly people have noticed or the opposite- fidgety and restless
- Thoughts that you would be better off dead or hurting yourself
Depression differentials-
Schizophrenia- Hear voices, people out to get you etc.
Bipolar- features of mania- feel really high
Cushing’s syndrome
Low mood
Suicide Risk-
Example q’s to ask- When people feel like this they start thinking about ways to end their life.. have you had these thoughts? Have you made preparations to end your life/ harm yourself etc?
High risk- Male, unemployed, previous attempts, FHx of mental health, personal mental health disorders etc.
Manage- By assessing the pt and their social support network. Contact Crisis Resolution and Home Treatment for urgent assessment. Either voluntary or forced admittance. Review regularly in GP.
Depression types-
Mild- 5+ a few symptoms with mild functional impairment.
Moderate- Functional impairment between mild and severe.
Severe- Majority of the symptoms + severe functional impairment.
Subthreshold (minor) depression- 2-3 symptoms, lasting >2 wks. If this is persistent treat with good sleep advice, no drugs, CBT/counselling.
Persistent depressive disorder- 2yrs of 3-4 symptoms for more days than not.
SSRIs-
Citalopram, sertraline, fluoxetine. Stops reuptake of serotonin at cleft therefore more available for transmission- improves mood.
ADR- GI upset, GI bleeding (if used with NSAIDs/Aspirin therefore use PPI also), hypersensitivity, citalopram- long QT.
Interactions- NSAIDs/Aspirin, Antipsychotics- long QT, don’t use with warfarin.
Review after 2wks unless <30yrs then 1 week. If no improvement in 4wks then change dose/meds.
Don’ stop suddenly- mood changes, stomach upset etc.
Commit for 6 months to see changes and reduce relapse.
PTSD Characteristics-
DDx of GAD
H- Hyperarousal; persistent heightened perception of current threat.
A- Avoidance of situations/events.
R- Re-experiencing the traumatic events, reliving them.
D- Distress when reexperiencing especially.
GAD-
At least 6 months of symptoms including; fatigue, irritability, muscle tension, restless, irritability, poor concentration, increased HR, SoB.
Tests- TFTs, urine dip (substance abuse), 24hr urine metanephrine- along with HTN and/or tachycardia may suggest pheochromocytoma.
GAD-7;
For the last 2wks how much have you been bothered by-
- Feeling afraid, as if something awful might happen
- Becoming easily annoyed or irritable
- Being so restless that it is hard to sit still
- Trouble relaxing
- Worrying too much about different things
- Not being able to stop or control worrying
- Feeling nervous, anxious, or on edge
GAD-
Management
1) Education on their anxiety.
2) Low intensity psychological interventions i.e. group/self activities.
3) CBT or Drugs- SSRIs, if contraindicated then SNRIs (duloxetine) otherwise pregabalin. Not benzodiazepines as build tolerance and addiction.
4) Specialist.
May also give BB for symptomatic control; avoid in asthmatics, heart block etc.
MMSE-
30 points
Assess if a pt has cognitive impairment i.e. post head injury or dementia.
GP-COG-
Dementia screening tool.
Cognitive assessment portion:
- Name and address for subsequent recall
- Time orientation
- Clock drawing- visuospatial functioning
- Information- eg tell me something in the news in the past week
- Recall- ask what was the name and address I asked you to remember
Informative quiz about:
- Trouble remembering things happening recently
- Trouble recalling conversations from a few days ago
- Ability to manage money and financial affairs
- Ability to take own medications
- Need for assistance with transport
- Any difficulty in finding the right word or using the wrong words in conversation
Borderline personality disorder-
- Repeated self harm
- Repeated suicide attempts
- Chronic unwavering feelings of hopelessness
- Persistent suicidal thoughts
- Drug use
Treat with sign-posting and referral.
