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Mental Health Flashcards

1
Q

What is defined as excessive anxiety and worry occurring more days than not for at least 6 months, about a number of events or activities, disproportionate to any risk?

A

Generalised Anxiety Disorder

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2
Q

What needs to be present for most of the time to diagnose generalised anxiety disorder?

A

At least 3 of:
-Restlessness or nervousness
-Being easily fatigued
-Poor concentration
-Irritability
-Muscle tension
-Sleep disturbance

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3
Q

Is generalised anxiety disorder multifactoral?

A

Yes

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4
Q

What broad categories of factors play a role in anxiety disorders?

A

Genetic factors and environmental factors

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5
Q

In which sex is generalised anxiety disorder more common?

A

Female - twice as common as in men

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6
Q

What other conditions increase the risk of developing generalised anxiety disorder?

A

Panic disorder
Social phobia
OCD

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7
Q

What childhood factors can increase risk of generalised anxiety disorder?

A

Childhood adversity e.g. maltreatment, family disruption, domestic violence, parental mental health problems, bullying

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8
Q

Which group of psychiatric disorders is most common?

A

Anxiety disorders

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9
Q

When does prevalence of generalised anxiety disorder peak?

A

In middle age (between 35 and 55 years)

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10
Q

Are GAD and depression frequently comorbid?

A

Yes - around 62% of those with GAD have at least one major episode of depression in their lifetime

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11
Q

How does generalised anxiety disorder affect social and occupational functioning?

A

Reduced work productivity and increased days of missed work

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12
Q

Are suicidal ideation and attempts more common in those affected by generalised anxiety disorder?

A

Yes

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13
Q

In which secondary care specialism do patients with generalised anxiety disorder present to most ommonly?

A

Gastroenterology

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14
Q

In addition to those who present with typical anxiety symptoms, who should we consider GAD in?

A

Those who attend primary care frequently with a chronic physical health problem, those seeking reassurrance for somatic symptoms, or those presenting with wide ranging issues.

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15
Q

Can generalised anxiety disorder present with solely physical symptoms?

A

Yes

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16
Q

What physical symptoms can generalised anxiety disorder present with?

A

-Headaches
-Muscle tension
-Motor restlessness
-GI symptoms
-Back pain
-Insomnia

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17
Q

Why is it important to check medication history (prescribed, herbal, and OTC) in a presentation of suspected anxiety?

A

Anxiety can be a side effect of some medications

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18
Q

Which medications can cause side effects mimicking anxiety?

A

Salbutamol
Theophylline
Beta blockers
St John Wart
Ma huang
Ginseng
Guarana
Belladonna
Corticosteroids

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19
Q

Which screening/assessment tools can be used when assessing a patient with suspected anxiety?

A

GAD-2 or GAD-7

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20
Q

What physical symptoms may be seen in clinic when a patient presents with generalised anxiety disorder?

A

Increased heart rate
Shortness of breath
Trembling
Exaggerated startle response

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21
Q

How many questions are in the GAD-7?

A

7

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22
Q

How is GAD-7 scored?

A

Each of 7 questions is assigned a score between 0 and 3 depending on how frequently they experience the symptoms

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23
Q

What is situational anxiety?

A

Controllable anxiety that is not generally associated with pathological symptoms and relates to particular life events

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24
Q

What is adjustment disorder?

A

Temporary anxiety that has occurred in response to a life stressor and persists for no longer than 6 months after the stressor ends

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25
What is panic disorder?
Recurrent episodes of sudden onset anxiety in absence of multi-themed worry, with physical symptoms during each attack, and often accompanied by avoidance behaviours.
26
What is step 1 in management of generalised anxiety disorder?
-Communication and explanation of disorder -Active monitoring -Treat any comorbid conditions
27
What is step 2 in management of generalised anxiety disorder?
-Individual non-facilitated self-help -Individual guided self-help -Psychoeducational groups
28
What is step 3 in management of generalised anxiety disorder?
-Individual high-intensity psychological intervention such as CBT or applied relaxation -Drug therapy
29
Which drug treatment should be offered in step 3 of generalised anxiety disorder management?
SSRIs - sertraline first line
30
After sertraline is offered for anxiety, what other drugs are offered if it is ineffective?
Other SSRIs e.g. paroxetine or escitalopram SNRIs e.g. duloxetine or venlafaxine
31
If a patient with generalised anxiety cannot tolerate any SSRIs or SNRIs, what can we consider offering in terms of medication?
Pregabalin
32
What initial adverse effects should a patient be counselled on when starting an SSRI/SNRI for anxiety?
Increased anxiety, agitation, sleep problems for a couple of weeks Potential especially in under 30s of increased risk of suicidal thinking/self harm
33
How frequently should drug treatment efficacy be reviewed in generalised anxiety disorder?
Every 2-4 weeks in first 3 months, then 3 monthly thereafter.
34
What should step 3 management of generalised anxiety disorder be when managing a pregnant woman?
-Ideally high intensity psychological therapy -Can discuss medication -If already on medication, discuss tapering down and switch to psychological therapy while pregnant
35
What does SSRI or SNRI treatment at or after 20 weeks of pregnancy increase risk of?
Persistent pulmonary hypertension of newborn Neonatal withdrawal
36
What is step 4 of management of generalised anxiety disorder?
-Referral for specialist assessment -Ensure steps 1-3 have been offered if not trialled or accepted
37
What lifestyle modifications should be suggested to those with generalised anxiety disorder?
Sleep hygiene Regular exercise
38
If a medication is effective for generalised anxiety disorder, how long should a patient take it for to minimise risk of relapse?
1 year
39
Which of sertraline, paroxetine, and escitalopram does the evidence suggest is the most effective for generalised anxiety disorder?
None of them - the evidence says they are all equally effective
40
Is sertraline licenced for treatment of GAD?
No although it is most commonly used - informed consent should be obtained and documented
41
What are the clinical advantages of sertraline in managing GAD over paroxetine?
Fewer drug interactions Lower risk of symptoms of discontinuation
42
What are the clinical advantages of sertraline in managing GAD over escitalopram?
Lack of associated ECG changes
43
After what time period do most patients see maximal benefit once commenced on drug treatment for anxiety?
6 weeks
44
When should SSRIs not be prescribed?
-Manic pahse of bipolar disorder -Taking MOAIs or recently stopped MOAIs -Taking pimozide -Poorly controlled epilepsy or new onset seizures
45
What ECG changes can escitalopram cause?
QT interval prolongation Torsade de Pointes
46
In whom should SSRIs be prescribed with caution?
-History of bleeding disorders especially GI tract -FHx of QT prolongations -Daiebets -Mania -Epilepsy -Those susceptible to angle-closure glaucoma
47
What common CNS side effects can SSRIs cause?
Dizziness Headache Tremor
48
What common GI side effects can SSRIs cause?
Nausea Vomiting Abdominal Pain Dyspepsia Constipation Diarrhoea
49
What other common side effects can SSRIs cause?
-Hot flushes -Palpitations -Sexual dysfunction -Visual disturbance -Yawning
50
What biochemical abnormality can occur due to SSRIs?
Hyponatraemia
51
What is characterised by absence of a positive affect, low mood, and associated range of emotional, cognitive, physical and behavioural symptoms?
Depression
52
How does DSM-5 define depression?
Presence of at least 5/8 possible defining symptoms during same 2-week period, where at least one symptom is depressed mood or loss of interest/pleasure
53
What assessment tool can be used to screen for and assess the severity of depression?
PHQ-9 scale
54
What score on PHQ-9 scale separates less severe and more severe depression?
16 - less severe if less than this, more severe if equal to or more than.
55
Over what time period does chronic depression span over?
2 years or more
56
What condition is defined as episodes of depression which recur annually at the same time each year with remission in between?
Seasonal affective disorder
57
What are some of the risk factors for depression?
-Female sex -Older age -Personal or family Hx of depression -Personal/social/environmental factors -Post-partum -Chronic health conditions -History of other mental health conditions
58
What risk factors are there for relapse of depression?
-Older age of onset -Hx of recurrent episodes -Incomplete response to previous treatment -Unhelpful coping mechanisms -Chronic physical/mental health conditions
59
How much higher is the risk of suicide in those being treated for a mental health condition than the general population?
10 times higher
60
How might depression present in an older patient?
Physical symptoms and cognitive decline are more common in older population
61
What are the two key features of depression that can be used to identify when a patient has depression?
-Feeling low/down/depressed/hopeless -Little interest or pleasure doing things
62
Other than the 2 key symptoms, what associated symptoms might a patient report with depression?
-Disturbed sleep -Change to appetite and/or weight -Fatigue -Agitation or slowing down of thoughts/movements -Poor concentration/indecisiveness -Feeling worthless or inappropriate guilt -Recurrent thoughts of death
63
What lifestyle questions should be asked when screening for depression?
-Diet -Physical activity -Sleep -Alcohol -Substance misuse -Any forensic history
64
What is the maximum score in the PHQ-9 scale?
27
65
What is the HADS?
Hospital Anxiety and Depression Scale
66
What is the BDI-II?
Beck depression Inventory II
67
Can depressive symptoms be present when a person is in a state of bereavement?
Yes, usually transiently
68
https://cks.nice.org.uk/topics/depression/management/
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