Mental Health

Question 1

Depression:
Definition
Epidemiology
Pathogenesis
Presentation
Investigations
Differentials
Risk Factors
Treatment

Answer 1

Definition - mental state characterised by persistent low mood, loss of interest + enjoyment in everyday activities
Epidemiology - F2:M1, age>30
Pathogenesis - abnormal concentration of neurotransmitters, dysregulation of HPAacis, abnormalities of second messenger systems
Presentation - depressed mood, diminished interest/pleasure in activities, low energy, libido changes, sleep disturbances
Investigations - mental state examination, FBC, TFT, metabolic panel, PHQ 9 + PHQ 2 - positive result screens for depression
Differentials - adjustment disorder, bipolar, grief reaction
Risk Factors - >65, postnatal status, steroids
Treatment - antidepressants: citalopram/agomelatine, in severe cases psychiatric treatment + hospitalisation

Question 2

Anxiety:
Definition
Epidemiology
Pathogenesis
Presentation
Investigations
Differentials
Risk Factors
Treatment

Answer 2

Definition - 6 months of excessive worry about everyday issues that disproportionate to any inherent risk
Epidemiology - usually occurs with other mental illness, anyone of any age
Pathogenesis - multiple neurotransmitter involvement, abnormalities in brain corticotropin releasing factor secretion in HPA axis
Presentation - excessive worry, muscle tension, sleep disturbance, fatigue, restlessness, irritability, poor concentration
Investigations - DSM-S criteria: restlessness, nervousness, easily fatigued, poor concentration, irritability, muscle tension, sleep disturbances
Differentials - OCD, panic disorder, social phobia, PTSD
Risk Factors - Fx, physical or emotional stress, emotional trauma, female
Treatment - 1st line: CBT, SSRIs - citalopram
2nd line: tricyclic antidepressant - imipramine

Question 3

Alcohol Dependence:
Definition
Epidemiology
Pathogenesis
Presentation
Investigations
Differentials
Risk Factors
Treatment

Answer 3

Definition - alcohol use disorder
Epidemiology - 7-10% in most western countries
Pathogenesis - ICD-10 criteria for alcohol dependence 3 or more of:
1. Strong desire or sense compulsion to drink alcohol
2. difficulty in controlling drinking in terms of its onset
3. A physiological withdrawal state when drinking has ceased or reduced
Presentation - of alcohol excess use - increased liver size, jaundice, ascites
Investigations - diagnostic interview, alcohol bloods, CDT
Differentials - other psychiatric disorders
Risk Factors - Fx, antisocial behaviour, high trait anxiety level
Treatment - significant alcohol withdrawal, physician advice

Question 4

Self Harm:
Definition
Epidemiology
Pathogenesis
Presentation
Investigations
Differentials
Risk Factors
Treatment

Answer 4

Definition - self inflicted injury that is not associated with an inpatient or explicit intent to die
Epidemiology - 0.5% prevalence relies on self reporting
Pathogenesis - genetics, social factors, behavioural, situational
Presentation - current suicide plan, access to lethal means, psychiatric disease
Investigations - risk assessment, mental state examination
Differentials - depression, anxiety, schizophrenia
Risk Factors - current suicidal plans, Hx of abuse/neglect
Treatment - follow up, management of psychosocial needs

Question 5

Somatisation:
Definition
Epidemiology
Pathogenesis
Presentation
Investigations
Differentials
Risk Factors
Treatment

Answer 5

Definition - group of psychiatric conditions that fall under somatic symptoms and related disorders
Epidemiology - strong female predominance
Pathogenesis - generalised sensory amplification of bodily symptoms
Presentation - emotional processing problems, false sensory findings, distinctive symptoms
Investigations - hoovers sign: inducing extension of pseudo paralysed leg when unaffected leg is flexing against resistance, speech and swallowing disturbances, FBC, U&E, LFT, ECG
Differentials - bipolar, schizoaffective disorder, panic disorder, anxiety
Risk Factors - Hx of abuse, female, neuroticism, alexithymia
Treatment - electric psychotherapy, antidepressant, psychotherapy

Question 6

Delirium:
Definition
Epidemiology
Pathogenesis
Presentation
Investigations
Differentials
Risk Factors
Treatment

Answer 6

Definition - acute fluctuating change in mental status with inattention disorganised thinking and altered levels of consciousness
Epidemiology - 0.4% of population, 65+
Pathogenesis - multifactorial with predisposing factors
Presentation - lucid intervals during the day, worse episodes at night, altered cognitive function, inattention, disorganised thinking, altered perception/social behaviour
Investigations - 4 At score - over 4 = delirium, LFT, FBC, PSA, WCC, CRP, ESR, Calcium, Vitamin D, TPTs
Differentials - dementia, pain, stroke, MI, thyroid disease
Risk Factors - >65, cognitive impairment, frailty, iatrogenic events
Treatment - treat underlying condition, low dose haloperidol for short term use

Question 7

Alzheimers Dementia:
Definition
Epidemiology
Pathogenesis
Presentation
Investigations
Differentials
Risk Factors
Treatment

Answer 7

Definition - chronic neurodegenerative disease with insidious onset and progressive decline
Epidemiology - 29 million people, elderly
Pathogenesis - cortical atrophy in temporal, frontal and parietal lobe
Presentation - memory loss, disorientation, decline in activities of daily living
Investigations - cognitive test, TFTs, FBC, metabolic panel, serum TSH, B12, CT/MRI
Differentials - delirium, depression, vascular dementia, dementia with Lewy body
Risk Factors - >age, genetics, Down syndrome, cerebrovascular disease, hyperlipidaemia, lifestyle
Treatment - supportive treatment, cholinesterase inhibitor: doneoexil orgalantermine, antidepressant, antipsychotic