Mental Health Flashcards
Insomnia
Management depends on the cause and duration, age and co-morbidities, of the patient. Exclude secondary causes before initiating treatment.
✓ Good sleep hygiene is very important and should be discussed with patients.
✓ CBT-I is first line in management of chronic insomnia in adults of any age.
✓ Stimulus control therapy: Learn to associate bedroom and sleep, establish consistent sleep/wake pattern.
✓ Sleep restriction therapy: Restricting sleep to create deprivation and more efficient sleep then increasing duration.
✓ Relaxation training: Minimise intrusive thoughts that might affect sleep.
✓ Paradoxical intention: Staying passively awake.
✓ Biofeedback: Visual or auditory feedback to help control physiologic parameters.
✓ Short term medication can be used if daytime impairment is severe whilst awaiting behavioural therapy.
✓ Referral to sleep clinic can be considered if unsure of diagnosis, primary sleep disorder is suspected or in long term insomnia that has not responded to treatment in primary care.
✓ Ensure patients are aware they should not drive if sleepy, no need to inform DVLA unless primary sleep disorder is the cause of insomnia.
Diagnosing Depression - Questionnaires
✓ PHQ-9 is a nine-item, self-administered scale, which scores severity using DSM-V (Diagnostic and Statistical Manual of Mental Disorders, fifth edition) criteria. The maximum score is 27. Those scoring less than 16 may be diagnosed as Less severe depression, and those scoring 16 or more are diagnosed as More severe depression.
✓ HADS is a self-administered scale, with 14 items in total (seven covering depression and seven covering anxiety). The maximum score for each subscale is 21.
✓ BDI-II - 21-item, self-administered scale that uses DSM-IV criteria. The maximum score is 63.
✓ 3 minute depression test is a self-assessment test which is not recommended for use in primary care.
✓ GAD-7 scale is used in Generalised anxiety Disorder.
Mental Health Act 1983 (amended 2007)
✓ Section 2 - compulsory admission for assessment, or for assessment f/b medical treatment, for a duration of up to 28 days.
✓ Section 3 - compulsory detention for treatment for up to 6 months in patients with known mental health conditions.
✓ Section 4 - emergency detainment for assessment for a duration of up to 72 hours.
✓ In Section 5(4) a registered mental nurse must record the time detention started, indicate a doctor was not available to immediately implement section 5(2) and also document that the patient is a potential danger to themselves or others.
✓ Section 5(2) allows the compulsory detention of a patient already receiving inpatient treatment for a duration of up to 72 hours by the doctor in charge of the case. They must have a mental health disorder and be a potential danger to himself or to others.
