Mental health Flashcards
What is the presentation of depression?
- 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
What is the difference between low mood and depression?
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..
What is used to help diagnose depression?
PHQ 9 questionnaire
What are the features of mild mod and severe depression?
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
How do you ix depression?
Is a clinical diagnosis and most investigations are to rule out things that mimic depression:
- Metabolic panel eg. Ca2+
- FBC
- TFTs
Define anhedonia and psychomotor retardation
Anhedonia - inability to feel pleasure
Psychomotor retardation - slowing thinking or body movements
What is the initial management of depression?
- 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
What qs do you ask when assessing risk of suicide?
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
What are the comorbid conditions associated w depression?
- Substance abuse
- Anxiety
- Psychosis and schizophrenia
- Eating disorders
- Dementia
What antidepressants should you prescribe?
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
What is the presentation of GAD in adults?
- 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
What is the difference between stress and GAD?
Stress has a clear reason whilst people with GAD worry for no identifiable reason. People w GAD have low self esteem and self worth.
What is used to help diagnose GAD?
GAD 7 questionnaire
What are some RF of GAD?
- Female
- FH
- Hx of physical oremotional trauma
- Chronic pain or disease
- Hx of substance abuse
How do you manage GAD?
- 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
Name some differentials for GAD
- Situation anxiety
- Adjustment disorder
- Depression
- Panic disorder
- Social phobia
- OCD/PTSD
- Hyperthyroidism
- Anaemia
- IBS
What is a MMSE and GPCOG?
- 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
What factors are associated with an increased risk of suicide?
- 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
What are some protective factors against suicide?
- 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
How do you conduct a suicide risk assessment?
- 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
Self harm vs suicide
- 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
What resources are there for patients experiencing suicidal thoughts?
- 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
What are the RF associated with self harm?
- 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
How do you manage a person presenting following an act of self harm?
- 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
What is the long term management of a person who self harms?
- 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
