Mental Health Flashcards
1
Q
Outline the main diagnostic categories used by ICD-10
A
- F00-09: organic mental disorders (dementia).
- F10-19: psychoactive substance (alcohol, opioids).
- F20-29: schizophrenia, delusional disorder, schizoaffective.
- F30-39 affective disorders (mania, bipolar, depression).
- F40-48: anxiety disorders.
- F50-59: eating disorders, insomnia.
- F60-69: personality disorders.
- F70-79: learning disabilities.
- F80-89: developmental disorders.
- F90-98: CAMS.
- F99: unspecified mental disorder.
2
Q
Describe the strengths and limitations of diagnostic categories such as ICD-10 and DSM
A
- Strengths: standardisation of diagnostic criteria, allows epidemiological studies, geographical comparisons of prevalence/incidence, alphanumerical format allows quick referral and easy addition of categories.
- Limitations: two different criteria’s confusing on which one to use; schizophrenia diagnosis relies on many psychotic symptoms, which are a common final pathway in other diseases; just groups commonly co-existing symptom pattern, without understanding of underlying cause.
3
Q
Outline approaches to the management of patients who may be potentially violent
A
- De-escalation techniques.
- Least restrictive option.
- Maintain dignity and human rights.
- Work in partnership with patient and carers.
- Ensure safety and both patients and staff.
- Detain under MHA if needed.
- Check if patient has advance decisions or advance statements about use of restrictive interventions.
4
Q
Define advocacy and stigma in relation to mental health difficulties
A
- Advocacy: patient with a mental disorder receiving support from another person (advocate) to help them express their views and wishes, and promote their human rights. It reduces stigmata and discrimination.
- Stigma: any physical or behavioural attribute which is negatively valued and leads a person to be regarded as unacceptable or inferior. Negative or unfair beliefs about an individual/group of people.
- The labels of ‘schizophrenia’ and ‘psychosis’ elicit stereotypical attributes of dangerousness and fear. Leads to social withdrawal and isolation of the person being stigmatised.
5
Q
What are the 5 processes of stigma?
A
- Labelling.
- Stereotyping: when labels are attributed to characteristics.
- Othering: social mechanism for distinguishing normal and abnormal.
- Stigmatisation: marked and identified and devalued.
- Discrimination: when stigmatisation is reinforced through legislation.
6
Q
List the members of community mental health teams (CMHT) and their roles
A
- Psychiatrist: prescribe medication, may be involved in administering psychotherapy.
- Community psychiatric nurse (CPN): visit patient at home, see patient in out-patient departments. Can help co-ordinate the care for a patient, they can administer medications & monitor effects.
- Social worker: allow patient to talk through their needs & consider social care implications. Includes insuring patient rights under MHA are considered.
- Occupational therapist (OT): help to improve ADLs; identify what patient can’t do, what support they need etc. to allow them to become independent & regain skills etc.
- Clinical psychologist: person giving psychotherapies. (counselling can be given by counsellors with less training).
- Primary mental health worker: assess & sign-post patient, can also provide them with short-term therapy (not-trained).
- Team manager: usually a senior nurse or social worker, don’t see patient themselves, are responsible for running team.
- Care coordinator: responsible for organising and monitoring the care of the patient under the care programme approach (CPA). Can be nurses, social workers, CPN or OTs.
- Approved mental health professional (AMHP): trained to use mental health act, can be psychologist, nurse, social worker or OT. Can detain patient under MHA along with 2 doctors.
7
Q
Outline how mental health services are organised in the UK
A
- Most mental health services require a referral from a GP.
- 95% of mental health (mainly anxiety & depression) managed by GPs.
- Patients are referred to secondary care if they have a severe mental illness, if they’re at risk to themselves/others, if there’s uncertainty regarding diagnosis or if specialist treatment is required.
- Community mental health teams (CMHT).
- Out-patient clinics.
- Day hospitals: non-residential units, require patient to have supportive home environment to return to. Can also be used to slowly discharge patient back to community.
- Assertive outreach teams: effectively high level CMHTs for challenging patient (pose real threat of harm & does not want to engage with mental health services)
- In-patient units: admitted when high risk (to self or others), grossly disturbed behaviour, or period of assessment needed (diagnosis/treatment efficacy) for severe psychiatric disorder.
- Early intervention services: works with young people over the age of 14 (< 35) to deal with first episode of psychosis as evidence earlier treatment improves prognosis. More intensive input than CMHT.
- Crisis resolution & home team (CRHT): team available 24/7 that can support you at home during a mental health crisis e.g. suicidal ideations, mania, psychotic episodes, severe panic attacks.
- Child & adolescent mental health services (CAMHS).
8
Q
Outline the epidemiology of depression in the UK
A
- UK prevalence = 4.5%
- Female:male ratio = 2:1
- Risk factors: FHx, personality traits (neuroticism), chronic illness, HPA axis, substance misuse, traumatic life events (including childhood trauma), abuse, low SES, unemployment, homeless.
9
Q
Outline the relationships between socio-cultural factors and depression
A
- Ethnicity: Afro-Caribbean present less frequently to GP; Japanese depression seen as a ‘black mark’, shameful & can stop marriages; Chinese depression may be seen as normal/some people expected to experience difficulties.
- Migration: due to language barrier & social isolation.
- Cultures: some cultures think grieving is disrespectful, other cultures believe mourn for a long time, some cultures may not accept western theory for depression & therefore not accept treatment.
10
Q
Outline healthy and unhealthy adjustment responses to physical symptoms
A
- Unhealthy: ruminating about the problem, avoidance of the issue, unhelpful behaviours, maladaptive coping mechanisms, safety behaviours, asking for reassurance.
- Healthy: talking, making changes, positive thinking.
11
Q
Describe primary health promotion strategies for mental health and well-being
A
- Improving QoL by reducing stressors that can cause mental illness, such as: minimum wage, better housing, improved working hours and good physical health.
- Educating population on how to maintain mental well-being, such as: media campaigns to increase awareness, stress techniques.
- Perinatal and postnatal visits by nurses and community workers to mothers to prevent post-natal depression, child abuse, improve parenting skills (attachment).
- Education in schools about bullying prevention, promotion of body size acceptance and bad health behaviours such as smoking and alcohol consumption.
- Tackling social and economic inequalities as that is a risk factor for mental illness.
12
Q
Outline the effects of the normal ageing process and physical illness on mental health, taking into account the social and family consequences
A
- Normal ageing process —> forgetfulness —> cognitive decline and behaviour change —> dementia.
- Effects on patient: changes in identity, behaviour change, isolation, loss of confidence, loss of independence.
13
Q
Describe the community, residential and nursing home support available for patients suffering from psychiatric disorders of old age
A
- Community: district nurse/health visitor (nursing care/advice at home), CPN and outpatient services (care for mentally ill at home), primary care (assessment, support and treatment), day centres (socialising, activities and respite for carers), sheltered housing (semi-independent living).
- Residential: short-term or permanent residential care (social services, local health authority, voluntary organisations). Provide accommodation, meals and personal care. Generally don’t provide nursing care. Minimum age for admission is 65.
- Nursing home: provide accommodation, meals, personal care and have qualified nurses. May provide specialist dementia care, such as: safe independence, stimulating activities, layout helps with orientation.
- Inpatient unit: elderly patient with mental illness.
14
Q
Give examples of the effects of dementia on carers, and models of support available
A
- Carer: someone who looks after a partner, relative or friend in need of support because of age, physical or mental disability or illness. Care is unpaid and is formal/informal.
- Initial impact: fear, anger or grief, which is determined by understanding, patient reaction and nature of relationship.
- Long-term impact for spouse/partner: relationship becomes skewed as one partner is less able to contribute: practically (chores), companion (lonely), emotionally (depression), sexually and financially (extra costs of caring, loss of earnings from partner).
- Long-term impact for child: role reversal, conflict between family members, if child is young can reduce opportunities for socialising and education.
- General long-term impacts: social isolation, physically taxing, stressful caring for someone 24/7, emotionally straining if patient develops personality change, grief reaction for loss of patient, poor sleep, burnout/can’t have a break, neglect own care.
- Models for support: Carers Act 1995 (carers have a right to assessment of own needs, flexibility around employment, education, training and leisure, Carer’s allowance >= 35 hrs per week, 16-65, not in full time education or certain income —> entitled to £61.35pw). Work & Families Act 2006 (carers allowed to request flexible working hours). Bedroom Tax (one room allowed for one carer).
15
Q
What is included in a care plan for a CPA?
A
Outlines the support for the patient including medicines, financial help, housing advice, support at home and social support.
16
Q
Describe the importance of prevention in child mental health, including normalising of professional or parental anxiety when appropriate
A
- Education of teachers about noticing issue in children & importance of schools to prevent bullying etc.
- School curriculums that teach resilience, life skills, that are pro-social.
- Promotion of body size acceptance, reducing stigma about cultural / ethnical differences etc.
- Education about bad health behaviours: smoking, alcohol consumption etc.
- Perinatal and postnatal visits by nurses and community workers to mothers in order to prevent: poor child care (via education), child abuse, postnatal depression, improve child-parent attachment and advise good parenting skills.
17
Q
Outline the role of the school, health visitor, social services and educational psychologist in managing child mental health
A
- School: facilitate development via learning opportunities, help recognise a mental health condition, attempt strategies to manage child behaviour in classroom.
- Health visitor: qualified nurse with specialist training who educates, offers support to parents and sign-posts to other services e.g. social services and educational psychologists.
- Social services: can provide initial assessment in certain circumstances (severe behavioural or emotional disturbances, risk of danger, communication problems, parents fabricating illness), provide assessment/treatment, provide a range of psychiatric/psychological assessments.
- Educational psychologist: tackle learning difficulties and social/emotional problems, enhance learning, write child reports for allocation of special educational places, observe/assess/counsel child, facilitate group work in schools e.g. anger management.
18
Q
Give examples of the problems that people with sensory impairments may have accessing mental health services
A
- Many deaf people feel socially excluded and isolated, which can impact on mental health and also the accessibility of mental health services.
- May also impact their ability to communicate how they’re feeling leading to both missed & mis-diagnosis.
- E.g. schizophrenia - deaf people might experience auditory hallucinations differently and blind people might not experience visual hallucinations affecting diagnosis.
- High levels of unemployment which is known to affect psychological wellbeing of the patient.
19
Q
Outline the impact of addiction on society, the family and individuals across all age groups
A
- Physical: alcohol can cause liver cirrhosis, pancreatitis and cancers, blood borne viruses in IVDU, psychological effects e.g. depression, schizophrenia (cannabis).
- Society: higher crime rates (violence/robbery/damage), increase absence in workplace/higher unemployment rates, drain healthcare resources/cost to NHS, homelessness.
- Family: arguments/conflict, break down in relationships, violence, debt (job loss, expense of addiction), promiscuity, child neglect/abuse.
20
Q
Describe the individual and societal factors at work in the genesis and maintenance of drug taking, including risk factors
A
- FHx of drug abuse/addiction.
- Exposure at a young age.
- Mental health conditions (e.g. depression, ADHD, PTSD) - coping mechanism.
- Peer pressure at young age.
- Drug availability.
- Lack of social support (maintenance).
- Unemployment, homelessness, low SES (maintenance).
- Low self-efficacy (maintenance).
21
Q
Describe how health promotion can impact upon alcohol intake and drug misuse
A
ALCOHOL
- Primary: education in schools, mass media campaigns about risk (daily allowance, effects of alcohol), government policies include law for minimum age, increasing tax on alcohol, earlier bar closing times.
- Secondary: screening in problem drinkers, identifying high risk populations for advice.
- Tertiary: physical and psychological treatment.
DRUGS
- Primary: education in schools, making drugs illegal, identify at risk populations, mass media campaigns about risk.
- Secondary: immunisation for Hep B, provide condoms and needles, supervised drug centres.
- Tertiary: reduce stigma about getting help, self-help groups, relapse prevention schemes, court-enforced drug testing.
22
Q
Recognise that patients may be at different places in the cycle of change (motivational interviewing) and that interventions offered should be tailored accordingly
A
- Cycle of change: pre-contemplation, contemplation, preparation, action, maintenance, relapse.
- Motivational interviewing: collaborative conversation style aiming to strengthen a patient’s motivation and commitment to change. Guides the patient by both listening to the patient and using their own expertise. Example use: weight and alcohol problems, smoking.
23
Q
What is the cost of alcohol to society?
A
£21 billion, including £3.5 billion cost to NHS.
24
Q
Outline how effective co-working with other NHS specialties and non-NHS agencies maintains high quality patient care
A
- Introduction of specialist psychiatric liaison teams into ED.
- Improving capacity of ambulance service to meet mental health needs.
- Privately funded in-patient units relieve burden on NHS for number of beds.
- Police involvement in mental health - section 136 & 135.
25
Q
Outline the epidemiology of deliberate self-harm (DSH) and suicide
A
SUICIDE
- Rates generally stable.
- Males > females.
- Increase risk with age, peak incidence 60-75.
- Greatest incidence in: divorced/widows, low SES, unemployed, university students, doctors, lawyers, police, 90% have psychiatric illness (depression most common), social isolation, previous DSH or suicide attempt, FHx mental illness, recent loss (job, family/friend), chronic physical illness, discrimination, trauma/abuse, lack of social support.
DSH
- More common in young and women (until 50, then equal).
- Increase incidence in low SES.
- 15-20% in those with psychiatric illness.
- Major life events: breakdown of interpersonal relationships, broken homes, criminal records, child abuse, social isolation, anxiety over job/housing.
- Following crisis —> cry for help, escape from intolerable situation, relief.
26
Q
Outline the physiological, sociological and developmental theories put forward for the aetiology of eating disorders
A
- Physiological: female, young age, obsessive personality/perfectionist, BPD, low self-esteem (increases risk of over-evaluation of body), FHx mental illness, fear of fatness.
- Sociological: previous criticism of eating habits, bullying about weight, increased pressure to be slim, body shaming on social media.
- Developmental: Hx sexual abuse, childhood trauma.
27
Q
Describe the impact of mental health in primary care
A
- Mental health condition reduces QoL.
- Infereres with other health conditions.
- Often misdiagnosed or under detected.
- Large economic burden.
28
Q
Outline actions taken to reduce health inequalities and improve health outcomes in mental health
A
- Understand local population need.
- Address the social determinants of poor health.
- Build stronger communities and social connections (reducing social isolation).
- Early detection and intervention for physical health risks (smoking cessation alcohol use).
- Social support.
29
Q
List some protective factors from suicide
A
- Strong personal relationships.
- Social support.
- Coping strategies.
- Job.
- Religious or spiritual beliefs.
30
Q
Outline the social inequalities experienced by patients with mental health conditions
A
- Poverty.
- Homelessness.
- Incarceration.
- Social isolation.
- Unemployment.
31
Q
Outline the physical health inequalities in people with severe mental illness
A
- Obesity. *
- Asthma.
- Diabetes. *
- COPD. *
- CVD.
- HF.
32
Q
Describe the role of EIP (early intervention in psychosis)
A
- Service that aims to assess and treat patients after their first episode of psychosis in order to prevent relapse.
- Consists of MDT of psychiatrists, psychologists, CPN, social workers and support workers.
- Decrease treatment resistance and improve long-term prognosis.
- Works closely and intensively with patient and their families.
