mental health Flashcards
who gets depression?
mid 30s if recurrent
can occur any age
F>M
lower social class and unemployment
risk factors for depression
history of depression or mental health/physical comorbidities
poor interpersonal relationships
poor living conditions
social isolation
presentation of depression
lack of interest or pleasure lack of emotional reactivity loss of energy, fatigue insomnia, early morning wakening (hypersomnia) diurnal variation in mood psychomotor retardation
signs on examination of depression
somatic symptoms - back pain, headache, loss of apetite, wt loss, constipation, amenorrhoea, loss of libido, psychomotor agitation
psychological symptoms - poor conc or attention, indecisiveness pessimistic (negative cognitive triad), poor self esteem and low confidence, guilt and worthlessness, hoplessness and thoughts of self har or suicide
negative cognitive triad
self: worthless
world: critical, guilt
future: hopelessness
investigations for depression
mental state examination - psychotic features, suicidal thoughts, risk screen (self harm/suicide, risk to self, risk to others)
PHQ-9 questionnaire
geriatric depression scale (GDS), hospital anxiety and depression scale (HAD)
ICD-10 core symptoms of depression
low or depressed mood
loss f interest and enjoyment
loss of energy
duration (more than 2 weeks - shorter can just be reactive to ife events and each symptom should present at sufficient severity for most of everyday)
treatment of depression
bio-psycho-social = CBT _manage underlying physical disorders/alcohol and drug missuse
for biological causes, use antidepressants - carry on for 6 months after remission - SSRIs, tricyclics, NaSSA, SNRI
- only if severe depression or for a long time or treatment resistive
investigate improving social circumstances
who gets anxiety?
25% lifetime risk
F>M
types of anxiety
disabling - agoraphobia
life damaging - OCD
potentially life threatening - PTSD
what is anxiety?
normal emotional feeling, part of flight or fight repsonse
becomes a problem if:
- interferes with daily life
- response is out of proportion to threat
- more prolonged
- occurs without a threat and if focus is on physiological repsosne
risk factors for anxiety
aetiology is multifactorial
- environmental stressors
- genetic factors (5x if first degree relative has it)
- substance dependent
- cognitive styles of negative thinking
- chronic illness or painful disorders such as arthritis
presentation of anxiety
psychological
- free floating anxiety, worry, apprehension, persistent nervousness, poor concentration, irritability
arousal
- hypervigilance, restlessness, increased startle response
fears
- fear of losing control, impeding danger, unrealistic ideas of danger, cant cope, fear of dying
motor
- muscle tension, headaches, trembling
autonomic symptoms
obessessions
- repeitive intrusive involuntary anxiety provoking thoughts, recognised by patient as own
compulsions
PTSD
who gets alcohol dependence?
M>W
less likely in ethnic minority groups who are less likely to drink
classification of alcohol dependence
score of >20 in AUDIT questionnaire (alcohol use disorders identification test)
confirm diagnosis using ICD-10 criteria for alcohol dependence
ICD-10 for alcohol dependence
3 or more of following present during previous year
- strong desire or sense or compulsion to drink alcohol
- difficulty controlling drinking in terms of onset, termination or level of se
- physiological withdrawal state - tremor sweating, tachycardia, anxiety, insomnia, less commonly seizures, disorientation, hallucinations
presentation of alcohol dependence
wernickes encephalopathy - presence of neurological symptoms caused by biochemical lesions of the CNS after exhaustion of vitamin B reserves (particularly thiamine)
triad of symptoms: mental confusion, ataxia, opthalmoplegia
ataxia
Ataxia is a term for a group of disorders that affect co-ordination, balance and speech.
treatment of alcohol dependence
reduce alcohol consumption
adivse about driving restircitons, heavy machinery etc
involve friends, family and carers
AA involvement
if suspect wernickes encephalopathy, admit urgently to hospital with parenteral thiamine
off prophylactic thiamine to harmful or dependent drinker if: malnourished, decompensated liver disease, acute withdrawal is planned)
refer to psychological treatments such as CBT
who self harms?
adolescents and young adults peak 15-19 in females and 20-24 in males
5.6% in lifetime
risk factors of self harm
socio-economic disadvantage social isolation stressful life events mental health problems chronic physical health problems alcohol and drug missuse invovlement in crimincal justice system child maltreatment or domestic violence
signs on examination of self harm
detailed history
risk assessment - physical risks, risk of further harm or suicide (explore hopelessness, suicidal intent, understanding of their own self harm, emotional distress, mental state)
assess safeguarding concerns in children, young peiple or vulnerable adults
treatment of self harm
ensure follow up within 48hrs or soner
manage psychoscial needs that you can
remove access to means of self harm where possible
offer written or verbal info to person or family, carers or significant others
info about local or natonal sources of support
arrnage for review and follow up
manage underlying conditions
what is somatisation
extreme focus on physical symptoms sych as pain or fatigue that causes major emotional distress and problems functioning
may not be diagnosed with condition associated with these symptoms but reaction to symptoms is not normal
often think worset of symptoms and frequently seek medical care
health concenrs are cnetral focus of life and hard to function- can lead to disability
cuases of somatisation
genetic and biological factors - increased sensitivity to pain
family influence - genetic, environmental
personality trait of negativity
decreased awareness of or problems processing emotions
learned behaviour - gained attention from illness
risk factors of somatisation
anxiety or depression
medical condition or recovering from one
being at risk of devleoping a medical condition - strong family history
experiencing stressful life events, trauma or violence
having past trauma
lower level of education and socio-economic status
presentation of somatisation
specific sensations or general symptoms- pain, SOB, fatigue, weakness
unrelated to any medical cause or more significatn than usually expected
excessive thoughts, feelings or behaviours which cause significant problems
investigations for somatisation
physical examination to determine if any health conditons that need treating
psychosocial evaluation and talk about symptoms, fears or concerns
fill out psychological self assessment or questionaire
ask about alcohol or substance use
DSM-5 (diagnostic and statistical manual of mental disorders)
DSM-5 criteria for diagnosis of somatisation
one or more somatic symptoms that are distressing or cause problems in dialy life
excessive and persistent tohughts aobut seriousness of symptoms
continue to have symptoms for more than 6 months even though symptoms my vary
treatment of somatisation
prevention - seek help in anxiety and depression, recognise when stressed and how it affects body, stick to treatment plan
improve symptoms and ability to function in dialy life - psyhotherapy/talk therapy CBT, family therapy to examine family relationships
medications - antidepressatns can reduce symptoms associated with depression
who gets delirium
prevalence in >65yo in long term care is 10-40%
up to 50% of older people in hospital
30% older people in emergency department
complicates 17-61% major surgery
causes of delirium
multifactoral
PINCH ME
pain infection nutrition constipation hydration
medication
enviornment change/electrolytes
presentation of delirium
acute behaviour changes - hours to days
clinical evidence of udnerlying preciptating factors
lucid intevrals occur during day
disorientation, memory and language impairment, worsened conc, slow repsonses, confusion, may not recall details of current illness
altered perception
2 catagories of delirium
hyperactive = increased sensitvity to surroundings, agitation and restlessness
hypoactive = clouding of consciousness and reduced awareness
investigations of delirium
take history froms omeone that knows patient well so can assess how they have changed and what time frame
treatment of delirium
always treat underlying condition
low dose haloperidol short term <7days or low dose lorazepam
drug treatment no very effective
who gets dementia
very common
W>M
>65
1/3-1/2 of those in care homes
types of dementia
alzheimers
vascular dementia
dementia with lewy bodies
+many others
cause of alzheimers dementia
atrophy of cerebral cortex
formation of amyloid plaques and enurofibriliary tangles
acetylcholine production ina affected neurons is reduced
vascular dementia cause
reduced blood supply to brain
caused by cerbrovascular disorders - large or multiple small infarcts, cerebral amyloid angiopathy etc
dementia with lewy bodies causes
2nd most common degenrative type
cortical and subcortical lewy bodies
similar features to parkinson disease in dementia
risk factors of dementia
age mild cognitive impairment genetics (e.g. APOE4 for alzheimers) cardiovascular disease risk factors parkinson disease stroke depression heavy alcohol consumption low social engagement and support
presentation of dementia
cognitive impairment including memory problems, difficulty retaining info, receptive or expressive dysphagia, difficulty with coordinated movements, disorientation
behavioural and psychological symptoms fluctuate may last for 6 months or more: psyhosis, agitation, emotionbal labiliy, depression and anxiety, motor disturbance, disinhibition, insomnia, repeat phrases or questions
investigations for dementia
assess capacity for each decision
MRI or CT for structural imaging to excluyde non-dementia cerbral pathology such as normal pressure hydrocephalus
identify type of dementia from history
treatment of dementia
antiphsychotics - dont work very well. only in severely distressed patients at risk of harm to themselves or others
acetylcholinesterase inhibitors - donezepil galantamine and rivastigmine
