Mental Health Flashcards
What is depression ?
A mood disorder in which the predominant feelings are of sadness.
What is the patient health questionnaire ( PHQ-9 ) ?
A depression assessment tool which scores each of the 9 DSM-IV criteria as 0 to 3.
What are the 9 questions that are asked in the PHQ-9 ?
Over the last 2 weeks how often have to been bothered by any of the following :
. Little interest or pleasure in doing things
. Feeling down, depressed or hopeless
. Trouble falling asleep or staying asleep, or sleeping too much
. Feeling tired or having too little energy
. Poor appetite or overeating
. Feeling bad about yourself
. trouble concentrating
. Moving or speaking slowly that over people have noticed or the opposite
. Thoughts that you would be better off dead
If someone is persistently sad or in a low mood or has a loss of interest or pleasure then what other symptoms should you ask about ?
Disturbed sleep
Decreased or increased appetite or weight
Fatigue or loss of energy
Agitation or slowing of movements
Poor concentration
Feeling of worthlessness
Suicidal thoughts or acts
What features would require an urgent referral to a specialist mental health service ?
Actively suicidal ideas or plans
Psychotic symptoms
Severe agitation
Severe self neglect
What are some symptoms to ask people when you are suspecting depression ?
Sadness
Low self esteem
Guilt
Pessimism
Helplessness
Hopelessness
Loss of interests
Apathy
Loss of concentration
Weight loss
Loss of appetite
Insomnia
What are some non-pharmacological management options for depression ?
Social interventions
- day centres
- self help
- hospital admission
CBT
Counselling
How do antidepressants work for depression ?
Modify the levels of monoaminergic neurotransmitters in the brain. The raphe nucleus in the brain stem contains the cell bodies of these serotonergic and noradrenergic neurones which innervate whide areas of the brain. Synaptic levels of monoamines particularly serotonin are though to be decreased in depression.
What are the classes of drugs used to treat depression ?
Tricyclic antidepressants
SSRI’s
Nonadrenergic and specific serotonergic antidepressants
What is an example of a Tricyclic antidepressants ?
Amitriptyline
What is an example of a SSRI ?
Sertraline
Citalopram
What antidepressant is usually first line for depression in primary care ?
SSRI. As just as effective as tricyclic antidepressants but have less side effects so are most likely to be continued.
How long should someone be kept on antidepressants for ?
6 months after remission - this greatly decreases the risk of relapse.
What is cognitive behavioural therapy ?
CBT uses a range of techniques to challenge the faulty thought process and behaviours we learn. This is the belief that we learn poor attitudes and behaviours to cope with certain life events from past experiences.
What are some indications for CBT ?
Depression
Panic disorder
PTSD
OCD
Psychosis
Chronic fatigue
What are some behavioural methods used in CBT ?
Behavioural experiments used to challenge negative thoughts
Graded exposure to real or imaginary situations
Role playing
Target setting and rewards
What cognitive methods are used for depression in CBT ?
Diary keeping
Patients are trained to recognise and challenge negative thoughts
Rehearsals of coping with feared situations
What is the management plan for someone with less severe depression who does not want treatment ?
.Offer active monitoring with the option to consider treatment when necessary
.Ensure the person has adequate social support
.Arrange an initial review usually within 2 - 4 weeks
What management options are there for people with less severe depression wanting treatment ?
Guided Self help
Don’t offer antidepressants first line
CBT, mindfulness and counselling
Arrange a 2 -4 week follow up
What are management options for more severe depression ?
Offer SSRI
CBT, counselling and group exercise
Follow up at 2 weeks
Use PHQ-9 to monitor
How should i do a follow up after initial management of depression ?
Ask about any ongoing symptoms
How are they responding to treatment
Any thoughts of self harm, suicide or risks of self neglect
Personal, social or environmental factors
Any new symptoms
What is anxiety ?
A normal response to an unusual or stressful event. It is the psychological component of the fight or flight response.
What is generalised anxiety disorder ?
One of a range of anxiety disorders that has a central feature of excessive worry about a number of different events associated with heightened tension.
What are some features of generalised anxiety disorder ?
Sudden onset often reactive to an external stress.
Feeling of fear and loss of control
Sweating
Palpitations
Dry mouth
Chest constriction
Sleep and appetite disturbance
How is a diagnosis of GAD made ?
Using the DSM-IV classification system ( 2 major symptoms occurring more days than not for at least 6 months )
What are some differentials for GAD ?
Schizophrenia
Dementia
Thyrotoxicosis
Parathyroid disease
Angina
What are the drug treatments that can be given foe GAD ?
SSRI first line - Sertraline
If people can’t tolerate SSRI or SNRI then offer pregabalin
Don’t offer benzodiazepine or antipsychotics
Review every 2-4 weeks during the first 3 months
Relapse is high so continue to take the medication
What psychological treatment options are there for GAD ?
Psychotherapy
CBT
What are the main indications for an SSRI ?
Depression
Anxiety
OCD
Why chose a SSRI over tricyclics ?
Less sedative
Cause less Anticholinergic effects
Fewer CVD effects
Less psychomotor effects
Safer in overdose
What are some side effects from using SSRI’s ?
Nausea
Anxiety
Tremor
Postural hypotension
Urinary retention
Rash and pruritus
Vomiting
