MENTAL HEALTH Flashcards
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
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
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)
anorexia nervosa management
individual eating disorder CBT - CBT-ED
MANTRA
specialist support clinical management (SSCM)
young people - focus family therapy (first line)
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
chronic depressive state more than 2 years duration
doesn’t meet the full criteria for depression
dysthymia
management of dysthymia
antidepressants first line
psychotherapy
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
management of bipolar disorder
antipsychotics = olanzapine, haloperidol, quetiapine or risperidone
lithium may be added, or if unsuitable valproate is added
psychological interventions
in depressive period = SSRI/fluoxetine
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
management of schizophrenia
oral antipsychotics - clozapine (titrate up from low dose)
CBT offered to all patients
associated with CVD - pay close attention to this
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
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
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
attention deficit disorder
10 week wait and watch, refer to 2° care
first line = methylphenidate - alternative, lisdexamfetamine
do baseline ECG
intrusive thoughts (flashbacks and nightmares) dissociation negative mood avoidance arousal <4weeks
acute stress disorder
management of acute stress disorder
- trauma focused CBT
2. benzodiazepines for agitation/sleep disturbance
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
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 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
