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GP block > Mental health > Flashcards

Mental health Flashcards

1
Q

What is the presentation of depression?

A
  • Presence of RF
  • Depressed mood and anhedonia, worthlessness, guilt
  • Suicidal thoughts or acts of self harm
  • Functional impairment
  • Weight and libido changes
  • Problem with sleep or low energy
  • Slowing of movements
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2
Q

What is the difference between low mood and depression?

A

Low mood normally coincides w major life changes or events and will pass after a couple of days or weeks. Depression isn’t associated w life events and there are symptoms for at least 2 weeks.
Small changes can normally improve mood, this wouldn’t be the case in depression..

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3
Q

What is used to help diagnose depression?

A

PHQ 9 questionnaire

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4
Q

What are the features of mild mod and severe depression?

A

Severe - psychotic, suicidal, pyschomotor slowing, catatonia
Mod - severe sx and impairment but no psychosis or suicidal thoughts
Mild - low sx, partial impairment, no psychosis or suicidal thoughts

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5
Q

How do you ix depression?

A

Is a clinical diagnosis and most investigations are to rule out things that mimic depression:

  • Metabolic panel eg. Ca2+
  • FBC
  • TFTs
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6
Q

Define anhedonia and psychomotor retardation

A

Anhedonia - inability to feel pleasure

Psychomotor retardation - slowing thinking or body movements

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7
Q

What is the initial management of depression?

A
  • Assess risk of suicide - crisis team
  • Manage comorbidities
  • Recommend self referral talk therapy
  • CBT
  • Antidepressants for mod/severe
  • Offer sleep hygiene advice
  • Follow up needs arranging
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8
Q

What qs do you ask when assessing risk of suicide?

A

Do you have thoughts about harming yourself?
Have you actioned these thoughts or do you have a method you’ve thought about?
Any access to materials and any prep?
What keeps you from harming yourself?
RF - history, FH, male, unemployed, chronic disease, substance abuse

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9
Q

What are the comorbid conditions associated w depression?

A
  • Substance abuse
  • Anxiety
  • Psychosis and schizophrenia
  • Eating disorders
  • Dementia
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10
Q

What antidepressants should you prescribe?

A

1st episode - an SSRI eg. citalopram, fluoxetine, sertraline

Recurrent episodes - base on pt preference, what has worked or not worked for them in the past

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11
Q

What is the presentation of GAD in adults?

A
  • Physical sx - muscle tension, nausea, palpitations, SOB, headaches
  • Excessive worry for at least 6 months, not due to any meds or substances
  • Poor concentration
  • Irritability
  • Sleep disturbance
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12
Q

What is the difference between stress and GAD?

A

Stress has a clear reason whilst people with GAD worry for no identifiable reason. People w GAD have low self esteem and self worth.

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13
Q

What is used to help diagnose GAD?

A

GAD 7 questionnaire

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14
Q

What are some RF of GAD?

A
  • Female
  • FH
  • Hx of physical oremotional trauma
  • Chronic pain or disease
  • Hx of substance abuse
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15
Q

How do you manage GAD?

A
  • CBT based self help if no functional impairment
  • High intensity CBT
  • Psychological interventions
  • Drug treatment - SSRI eg. sertraline then SNRI eg. duloxetine/venlafaxine
  • Offer pregabalin if SSRIs and SNRIs are contraindication/not tolerated
  • Review every 4 weeks then every 3 months
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16
Q

Name some differentials for GAD

A
  • Situation anxiety
  • Adjustment disorder
  • Depression
  • Panic disorder
  • Social phobia
  • OCD/PTSD
  • Hyperthyroidism
  • Anaemia
  • IBS
17
Q

What is a MMSE and GPCOG?

A
  • Mini mental state examination - eg. date, what season, where pt is
  • General practitioner assessment of cognition
  • Both are normally used to assess a patients memory
18
Q

What factors are associated with an increased risk of suicide?

A
  • FH mental disorder, suicide or self harm
  • Previous suicide attempts and self harm
  • Mental disorder - depression, anxiety, personality disorder
  • Substance/alcohol abuse
  • Male
  • Physical illness
  • Exposure to suicidal behaviour of others
  • Recent discharge from inpatient care
19
Q

What are some protective factors against suicide?

A
  • Social support - family, friends, community, social institutions
  • Religious belief
  • Responsible for children, esp young
  • Life skills eg. copying and problem solving
  • Sense of purpose
  • Good self esteem
20
Q

How do you conduct a suicide risk assessment?

A
  • Thoughts of death/suicide, life not worth living? previous suicide attempts? FH suicide attempts?
  • If yes: method? access to materials? any preparations?
  • Ask about protective factors and RF
  • If there is risk do they have any social support? any treatable RF?, arrange help and give further information
21
Q

Self harm vs suicide

A
  • Self harm is harming oneself purposefully without the intent of killing oneself
  • Those who self harm are more likely to die from suicide
  • Self-harm is more freq than suicide attempts
  • Methods of self harm are less severe than attempted suicide
  • It is normally done to appease suicidal impulses
22
Q

What resources are there for patients experiencing suicidal thoughts?

A
  • If have seriously harmed yourself or feel you might than call 999 or go to A+E
  • Can call the GP and ask for an emergency appointment
  • Call 111
  • If pt have a mental health crisis team call them
  • Telephone helplines - Samaritans, CALM, Childline, Silence of Suicide (SOS)
  • Text helpline - Shout crisis text line, YoungMinds crisis messenger
23
Q

What are the RF associated with self harm?

A
  • Young people
  • Prisoners, asylum seekers, veterans
  • LGBTQ+ population
  • Exposure to others who self harm
  • Physical, emotional and sexual abuse/childhood trauma
  • Depression, low self esteem, feeling isolated
24
Q

How do you manage a person presenting following an act of self harm?

A
  • Examine physical injuries, may need wound management
  • Assess emotional and mental state, esp suicidal intent
  • Assess for any mental health disorders
  • Assess safeguarding concerns
  • Any protective factors and RF
  • May need referral to A+E if severe injuries or acute mental state is risky and arrange follow up, can enforce Mental Health Act and section patients if needed
  • Attempt treatment for any mental health disorders
  • Can suggest alternatives to self harm
25
Q

What is the long term management of a person who self harms?

A
  • Referral to CAMHs in children
  • Community mental health teams and liasion psychiatry teams and more involved in long term management
  • Harm minimisation techniques
  • Copying strategies and resources for support and advise
  • CBT, problem solving interventions, individual care plan, crisis plan
  • Manage any underlying mental health problems

GP block (14 decks)

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