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Year 3 > mental health > Flashcards

mental health Flashcards

1
Q

define generalised anxiety disorder

A

worry that is:

  • disproportionate
  • pervasive
  • uncontrollable
  • widespread

range of somatic, cognitive, and behavioural symptoms

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2
Q

aetiology of GAD

A

multifactorial

environmental

genetic

chronic illness

substance abuse

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3
Q

management of GAD step 1

A

assess severity using GAD-7 questionnaire

ask about comorbidities and environmental stressors

written material about GAD and treatment options

active monitoring of symptoms, functioning, and response to treatment

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4
Q

managemet of GAD step 2

A

if no improvement following step 1 management

low intensity psychological interventions

psychoeducational groups

self-help, non-facilitated and guided

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5
Q

when to escalate management of GAD to step 3

A

if marked functional impairment or no improvement following step 2 interventions

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6
Q

management of GAD step 3

A

individual high-intensity psychological intervention, eg. CBT

drug treatment: SSRI, SNRI, pregabalin if SSRI/SNRI contraindicated

  • review effectiveness every 2-4 weeks in first 3 months, then every 3 months
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7
Q

do not offer what medications for GAD

A

benzodiazepines (antipsychotic) in primary care except as short term measure during crises

antipsychotics in primary care

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8
Q

cautions for SSRI/SNRIs

A

<30yrs: increased risk of suicidal thinking and self-harm

monitor weekly for first month

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9
Q

when to escalate management of GAD to step 4 (referral for specialist treatment)

A

severe anxiety

marked functional impairment

no improvement following step 3

self harm

self neglect

signifcant comorbidity

suicide

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10
Q

define dementia

A

chronic and progressive deterioration in coginitive ability due to organic brain disease

  • irreversible
  • no impaired consciousness
  • all types present with progressive memory loss + impaired cognition
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11
Q

Types of dementia

A
  • Alzheimers (70%)
  • Vascular (25%)
  • Lewy body
  • Frontotemporal dementia- affects frontal/temporal brain lobes
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12
Q

pathophysiology of Alzheimer’s

A
  • degeneration of neurons in cerebral cortex
  • beta amyloid plaques deposit outsde neurons and tau tangles develop in neurons
  • causes brain atrophy (narrow gyri, wide sulchi, larger ventricles)
  • affects ACh neurons => reduced ACh release
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13
Q

risk factors for Alzheimer’s

A
  • increasing age
  • genetic susceptibility
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14
Q

risk factors for dementia

A
  • older age
  • learning disability
  • genetics
  • CVD
  • Cerebrovascular
  • Parkinson’s

Modifiable

  • higher levels of education
  • hearing impairment (less cognitive stimulation)
  • obesity
  • hypertension
  • depression
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15
Q

pathophysiology of vascular dementia

A

brain damage due to repeated attacks of cerebrovascular disease (strokes/TIAs)

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16
Q

pathophysiology of lewy body dementia

A
  • deposition of lewy bodies (abnormal proteins) in brainstem
  • has parkinsonian symptoms
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17
Q

general presenting symptoms of dementia

A

Cognitive impairment

  • memory loss (can’t learn new info, forget recent events)
  • can’t make decisions
  • poor communication
  • poor coordination (can’t dress themselves)
  • disorientation
  • poor planning/judgement

Behavioural

  • psychosis (hallucinations/ delusions)
  • depression/anxiety
  • withdrawal
  • agitation/ mood swings
  • motor disturbance - wandering, pacing, restlessness, repetitive activity
  • affects activities of daily living
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18
Q

presenting symptoms of Alzheimer’s

A
  • Insidious onset (episodic memory loss- repeated questionning, forgets recent events, can’t learn new info)
  1. short term memory loss
  2. motor skills affected- apraxia (can’t do familiar movements)
  3. language affected- aphasia (can’t communicate)
  4. long term memory affected
  5. disorientated
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19
Q

presenting symptoms of Vascular dementia

A
  • step-wise deterioration
  • gait problems
  • attention problems
  • personality change
  • focal neurological problems (visual field defects)
20
Q

presenting symptoms of Lewy body dementia

A
  • visual hallucinations
  • fluctuating cognition
  • Parkinsonian features- bradykinesia, rest tremor, or rigidity
  • memory loss usually later
21
Q

presenting symptoms of Frontotemporal dementia

A
  • personality/behaviour change
  • poor hygiene
  • aphasia
  • memory usually preserved
22
Q

History taking for dementia

A
  • onset (acute => infection/delerium, chronic => dementia)
  • ask about recent head traum
  • PMHx - parkinson’s, stroke, depression, epilepsy
  • DHx- anticholinergics, benzodiazepine, opioids (cause confusion)
  • FHx- dementia
  • Safety - Activities of daily living, support at home, drive
  • SHx - smoking, alcohol
  • Collaborative history
23
Q

Examinations for dementia

A

Neuro exam

  • gait
  • sensory- neuropathy
  • motor- tremor, rigidity, bradykinesia (parkinsonian features)
  • visual
24
Q

Investigations for dementia

A

Bloods: (exclude other causes)

  • FBC (WCC-infection)
  • ESR/CRP
  • TFTs (hypothyroidism)
  • serum B12/folate
  • Calcium (hypercalcemia-pschycic groans)
  • HbA1c (hypoglycaemia)
  • LFTs

Assess cognition

25
Q

How to assess congition in dementia

A

10- cognition score

  • 3 temporal orientation questions (year, month, date)
  • 3-word recall
  • 4 point scaled animal naming task

*score = 8 is normal (<8= probably cognitive impairment)

26
Q

Management of dementia

A
  • acetylecholinesterase inhibitors (donepezil)
27
Q

differentials for dementia (memory loss/confusion)

A
  • delerium
  • hypothyroidism- TFTs
  • infection
  • low B12/folate
  • hydrocephaleus
  • expanding brain lesion (tumours)- CT scan
  • medication (anticholinergics, benzodiazepine)
28
Q

define delirium

A

reversible acute confusional state usually in susceptible individuals (elderly/multiple comorbidities) caused by a precipitating factor

29
Q

predisposing factors for delirium

A
  • older age
  • multiple comorbidities/ frail
  • immobility
  • XS alcohol consumption
  • dementia
  • sensory impairment - visual/hearing
30
Q

precipitating factors that trigger delirium

A
  • infection- UTI, pneumonia
  • CO-MORBIDITIES: CVD/MI, stroke, thyroid dysfunction, COPD, Cushing’s, hypo/perglycaemia
  • alcohol withdrawal
  • medication- benzodiazepine, opioids, CCBs
  • depression
  • change in environment
  • poor sleep
  • PAIN
  • malnutrition
  • Constipation
31
Q

History taking for delirium (confusion/behaviour change)

A
  • onset of symptoms (acute
  • PMHx- cormorbidities (dementia), recent hospital admission, falls
  • DHx- medicine compliance
  • SHx- alcohol intake, food/fluid intake, PAIN, recent changes in environment
  • safety - care packages, who’s at home- support
  • GP cognition assessement score
32
Q

presenting symptoms of delirium

A

acute behavious change (hours-days)

  • impaired cognition (memory loss/ confusion/ disorientation)
  • disorganised thoughts (rambling speech)
  • inattention
  • hallucinations/delusions
  • impaired consciousness
33
Q

types of delirium behaviour

A
  • hyperactive- agitated, restlessness, wandering, sleep disturbance
  • hypoactive (most common) - withdrawn, reduced appetite, lethargic, reduced movement, anhedonia
  • mixed
34
Q

investigations for delirium

A

Identify cause:

Bedside:

  • urinalysis- UTI
  • sputum culture- chest infection
  • ECG- arrythmias

Bloods:

  • FBC- WCC (infection), anaemia
  • ESR/CRP (infection/inflammation)
  • TFTs - hypothyroidism
  • Calcium (hypercalcemia)
  • U&Es- AKI, dehydration
  • B12/folate
  • drug toxicity
  • HbA1c- hypoglycaemia

Imaging

  • CXR- chest infection
35
Q

What criteria are used to diagnose delirium?

A
  • short-CAM/confusion assessment method - confusion, inattention, disorganised thinking, altered consciousness
  • DSM-5 -
  • 4 A’s- ACUTE, alertness, attention, cognition (memory loss/confusion)
36
Q

management for delerium

A

treat cause

  • antibiotics for infection
  • analgesia for PAIN
  • fluids for dehydration
  • correct electrolyte imbalances
  • reduce/replace dosage of drugs (avoid WITHDRAWAL)
  • treat constipation (laxatives)
  • treat sensory impairments (remove wax, glasses)
  1. reorientate patient (date, clocks, calendars)
  2. advise carers to support (reorientate, maintain mobility -avoid restraints), place in low stimulation environment
  3. avoid giving anti-psychotics
37
Q

define depression

A

persisitent low mood/ loss of interest in activities (anhedonia) for >2 weeks which affects functioning

  • diagnosed with DSM-5 criteria (5/9)
38
Q

risk factors for depression (in the history)

A
  • FEMALE
  • older age

PMHx:

  • Hx of depression
  • chronic comorbidites (PAIN/ disability/ CVD/ diabetes)
  • other mental health problems (dementia)

FHx of depression

​DHx: corticosteroids

SHx:

  • Adverse childhood experiences (poor parent-chid relationship, abuse)
  • Recent psychosocial trauma - divorce, unemployment, poverty, homeless
  • recent childbirth (port-partum depression)
39
Q

DSM-5 criteria for diagnosis of depression

A

>1 CORE + 5/9 needed

  • CORE (2): low mood, anhedonia
  • PHYSICAL: low appetite, anergia (low energy/ fatigue/lethargy), distubed sleep, slowed movements
  • PSYCHOLOGICAL: suicidal thoughts, guilt/feelings of worthlessness, poor concentration
40
Q

How to classify depression

A
  • subthreshold depression- <5 symptoms
  • mild- >5 symptoms + minor functional impairment
  • moderate- >5 symptoms + some impaired function
  • severe- most symptoms + severe impaired function +/- psychotic symptoms
  • seasonal affective disorder - symptoms occur around same time of the year
41
Q

How to assess for depression?

A
  • patient health questionnaire/PHQ-9 (GP)
  • Hospital anxiety and depression scale (HAD)
42
Q

Investigations for depression

A

Not routinly done for depression but can exclude other causes/ differentials

Bloods:

  • FBC- infection (high WCC)
  • TFTs - hypothyroidism (low T4/TSH)
  • Calcium - hypercalcemia
  • U&Es, creatinine
  • ESR-inflammation
  • low glucose - hypoglycaemia

Imaging:

  • CT/MRI - head injury (hypopituitarism)
43
Q

differentials for depression

A
  • Grief reaction (loss)
  • anxiety disorders
  • bipolar disorder
  • neurological conditions (Parkinson’s)
  • Obstructive sleep apnoea
  • Hypothyroidism
  • Substance misuse / CO poisoning
44
Q

Management of depression

A
  1. manage suicide risk
  2. safeguarding for children
  3. advise patient about medication side effects/withdrawal, hive leaflets for self-help and numbers to contact
  4. routine follow-up/ monitoring

mild/moderate

  • low intensity psychosocial intervention (guided self-help)
  • CBT

moderate/severe

  • anti-depressants (SSRIs- sertraline, citalopram, fluoxetine)
  • high intensity pschycologial intervention (individual CBT)

*Mirtazapine (SNRI)- depression/anxiety + sleep problems

45
Q

What antidepressants should be given for people taking

  1. NSAIDs
  2. anticoagulants (Warfarin/ heparin)
  3. antiplatelet (aspirin)
  4. anti-epileptics
  5. had a previous overdose
A
  1. Mirtazapine (avoid SSRIs)
  2. Mirtazapine (avoid TCAs, SSRIs, SNRIs)
  3. Mirtazapine (avoid SSRIs, SNRIs)
  4. SSRIs
  5. avoid TCAs
46
Q

complications of depression

A
  • SUICIDE
  • increased risk of substance use
  • pain exacerbation
  • increased morbidity/mortality in comorbid conditions
  • lower quality of life
  • medication side effects: SSRIs=>suicide risk, hyponatremia, agitation, weight gain
  • medication withdrawal effects: mania

Year 3 (27 decks)

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