MENTAL HEALTH Flashcards by Majayda Islam

recurrent episodes of binge eating
lack of control during an eating episode
recurrent inappropriate compensatory behaviour to prevent weight gain

binge eating with purgative behaviour at least once a week for 3 months

bulimia nervosa

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restriction of energy intake relative to requirements
intense fear of gaining weight. becoming fat
disturbance to one’s body weight/shape is experiences

anorexia nervosa

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bulimia nervosa management

refer to specialist care

bulimia-nervosa guided self-help for adults - or CBT-ED
children should be offered focused family therapy (FT-BN)

pharmacological tx = trial of high dose SSRI (fluoxetine)

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anorexia nervosa management

individual eating disorder CBT - CBT-ED

MANTRA

specialist support clinical management (SSCM)

young people - focus family therapy (first line)

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low mood 
lack of interest in activities 
significant changes to weight/appetite
changes to amount of sleep 
inappropriate feeling of guilt 
indecisive/inability to concentrate/think
recurrent suicidal ideation

mild to moderate depression = sleep hygiene, low intensity psychosocial interventions, computerised CBT and group physical activity programmes

moderate-severe depression = SSRI initiation, high intensity psychosocial interventions, individual CBT

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chronic depressive state more than 2 years duration

doesn’t meet the full criteria for depression

dysthymia

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management of dysthymia

antidepressants first line

psychotherapy

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elevated mood, irritable, agitated or aggressive
high levels of energy and very little sleep
pressure of speech or incomprehensible speech
racing thoughts
distracted
poor concentration
increased libido
extravagant/improactile plans

bipolar disorder

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management of bipolar disorder

mx of mania/hypomania = consider cessation of antidepressants, initiate antipsychotic
= olanzapine or haloperidol

mx of depression
talking therapies
fluoxetine

psychological interventions specifically for BPD
lithium - mood stabilizer

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auditory hallucinations - voices, thought echo
though disorders = insertion, withdrawal or broadcasting
delusions
disorganised speech, behaviour and thoughts
loss of motivation
social withdrawal
self neglect

schizophrenia

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management of schizophrenia

oral antipsychotics -
risperidone or olanzapine
if trialled 2 diff antipsychotics use
clozapine (titrate up from low dose)

CBT offered to all patients

associated with CVD - pay close attention to this

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impaired social interaction/communication
playing alone
unable to regulate interactions with non-verbal cues
unable to form and maintain appropriate relationships
Problems in obtaining or sustaining employment or education.
A history of a neurodevelopmental/mental condition

autistic spectrum disorder

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management of autistic spectrum disorder

early educational/behavioral interventions

pharmacological - SSRIs, antipsychotics, methylphenidate for ADHD
family support and counselling
parent education on how to interact with the child

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cannot follow instructions
reluctant to engage, distracted
forgetful/loses things
difficulty organising and sustaining tasks
talks excessively, plays noisily
interruptive/intrusive
run and climbs in inappropriate situations

attention deficit disorder

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attention deficit disorder mx

10 week wait and watch, refer to 2° care

first line = methylphenidate - alternative, lisdexamfetamine
do baseline ECG

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intrusive thoughts (flashbacks and nightmares)
dissociation 
negative mood 
avoidance 
arousal 
<4weeks

acute stress disorder

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management of acute stress disorder

trauma focused CBT

2. benzodiazepines for agitation/sleep disturbance

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usually occurs over 5 stages
initially denial = feeling numb, pseudohallucinations of the deceased
anger = against family/medical professionals
bargaining
depression
acceptance

not same for all

uncomplicated bereavement

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use of OTC drugs (overdose)
use of illicit drugs 
ingesting household substances and plant material 
or 
episodes of cutting

deliberate self harm

management of deliberate self harm

assess for ant physical, psychological or safeguarding risks/concerns

if at physical/psychological risk = emergency referral
minor self-injury = primary care

referral to CAHMs if within that age group

symptoms start at 6-12 hours: tremor, sweating, tachycardia, anxiety
peak incidence of seizures at 36 hours
peak incidence of delirium tremens is at 48-72 hours: coarse tremor, confusion, delusions, auditory and visual hallucinations, fever, tachycardia

alcohol withdrawal

alcohol withdrawal management

admit and monitor till the patient stabilises

first-line = long-acting benzo such as chlordiazoepoxide /diazepam

if hepatic failure lorazepam is preferred

chronic alcoholics may need thiamine to prevent wernicke’s encephalopathy
rehydration important

6months of excessive uncontrollable worry about everyday issues 
restlessness/nervousness 
poor concentration, sleep disturbance 
easily fatigued irritable 
muscle tension 
can experience abdo discomfort

generalised anxiety disorder

management of GAD

education and active monitoring
low intensity psychological interventions
high intensity psychological interventions + drug Tx firstline = sertraline
or duloxetine/venlafaxine), pregabalin last

under 30yrs = weekly follow up for the first month
benzodiazepines in acute crises

``` frequently complain of pain sleep disturbance chest pain & SOB tachycardia hypertension tremors sweating ```

panic disorder

management of panic disorder

CBT or drug treatment - SSRI first line | if unresponsive after 12 weeks = imipramine or clomipramine offered

feared situation makes patient anxious and distressed tachycardia sweaty tremor/trembling response is usually out of proportion to the reality of the situation

phobia

management of social phobia

CBT + medication (SSRI)

management of agoraphobia

psychological therapy (systemic desensitisation) & SSRIs

management of simple phobias

systematic desensitisation

re-experiencing through nightmares, flashbacks avoidance of people/places/things which resemble the traumatic event hyperarousal/vigilance and exaggerated startle response emotional numbing/feeling detached

post-traumatic stress disorder

management of post-traumatic stress disorder

mild cases = watchful waiting for 4 weeks severe cases = trauma-focused CBT, eye movement desensitisation and reprocessing drugs Tx not routinely used but usually venlafaxine pr SSRI severe cases = risperidone

unwanted intrusive thoughts, urges or images that com repeated to mind repetitive behaviours or mental acts that a person feels driven to perform - either overtly or covertly

obsessive-compulsive disorder

management of OCD

mild cases = CBT or ERP (can offer SSRI course if insufficient) moderate cases = offer SSRI/intensive CBT severe functional impairment - combined SSRI + CBT if SSRI effective = continue use for 12months

``` unstable mood or emotional dysregulation - daily or hourly mood changes may present with overdose/self-harm pseudohallucinations angry outbursts chronic feeling of emptiness dissociation impulsivity ```

Borderline/emotionally unstable PD

management of borderline PD

psychotherapy antipsychotic can be given - usually quetiapine

deception, repeatedly lying impulsiveness, failure to plan ahead irritable, aggressive reckless, disregard of personal and other's safety consistent irresponsibility and lack of remorse men>women

antisocial PD

unwarranted tendency to question the loyalty of friends reluctance to confide in others preoccupation with conspirationa beliefs/hidden meanings unwarranted tendency to perceive attacks on their character

paranoid PD

inappropriate sexual seductiveness needs to be centre of attention rapidly shifting & shallow expressions of emotion self dramatisation relationships considered more intimate than reality

histrionic PD

``` gardoise sense of self importance preoccupied in fantasies - unlimited power, success or beauty sense of entitlement lack of empathy chronic envy arrogant, hauty attitude excessive need for admiration ```

narcissistic PD

``` indifference to praise or criticism prefers solitary activities lack of interest in sexual relations/interactions lack of desire for companionship emotional coldness few friends/confidants ```

schizoid PD

``` Odd beliefs, magical thinking unusual perceptual disturbance paranoid ideation, suspiciousness lack of close friends odd but clear speech eccentric behaviours ```

schizotypal PD

mental health condition that causes an individual to experience physical bodily symptoms in response to psychological distress. these could include pain, weakness, dizziness, fainting and digestive symptoms also

somatoform disorder

somatoform disorder management

CBT and SSRI

somnolence pupillary constriction/pin-point pupils decreased repsiration track marks on the arms

opiate intoxication/overdose

treatment for opiate intoxication/overdose

naloxone injection (opiate reversal agent) may get aggressive/vomit substance abuse counselling needed