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Y3 GP > Mental health > Flashcards

Mental health Flashcards

1
Q

What are some symptoms suggestive of mania?

A

Abnormally elevated mood, extreme irritability, and sometimes
aggression. Increased energy or activity, restlessness, and a decreased
need for sleep. Pressure of speech or incomprehensible speech. Flight of
ideas or racing thoughts. Distractibility, poor concentration. Increased
libido, disinhibition, and sexual indiscretions. Extravagant or impractical
plans. Psychotic symptoms: delusions (usually grandiose) or
hallucinations (usually voices).

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2
Q

Which questionnaires can be used in primary care to help monitor depression?

A

There are many- some common ones - PHQ-9 (Patient Health
Questionnaire-9), HADS (Hospital Anxiety and Depression Scale), BDI-II (Beck Depression Inventory-II).

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3
Q

What is the definition of delirium?

A

Delirium is an acute, fluctuating encephalopathic syndrome of
inattention, impaired level of consciousness, and disturbed cognition.

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4
Q

What are some medications someone can be started on with generalised anxiety?

A
  • Sertraline
  • Paroxetine
  • Escitalopram
  • SNRI-Venlaxafine
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5
Q

What is it important to warn people about with generalised anxiety who are about to start SSRIs and SNRIs?

A

In the first week of treatment, there may be increased sleeping problems, increased anxiety, agitation and suicidal ideation.

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6
Q

What is a phone number/people they can contact with depression in Leicester 24/7?

A

Central access
For adults and children

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7
Q

What is a characteristic feature of depression?

A

Early morning wakening.

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8
Q

What is a medication you can give short-term for anxiety?

A

Benzodiazepines- Diazepam, doctors worried as you can become easily addicted.

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9
Q

What are some medications that you can use for anxiety?

A

Bospirone
Propanolol
Pregabalin

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10
Q

What practical advice/small snippets can you give to help with anxiety?

A
  • Square breathing (increasing vagal tone), reducing stress response. Gives you something to think about.
  • Positive affirmations
  • Limit triggers
  • Challenge negative thoughts
  • Progressive muscle relaxation
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11
Q

What is the first line for Schizophrenia?

A

Risperidone or Fluoxetine

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12
Q

What are some risk factors of suicide for people with depression?

A
  • Have a family history of mental health disorders
  • Have a history of previous suicide attempts (including self-harm)
  • Have severe depression, anxiety, feelings of hopelessness
  • Have personality disorder
  • Have alcohol &/or drug abuse
  • Are male
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13
Q

What are some general risk factors for suicide?

A
  • People with depression
  • Family history of suicide or self-harm
  • Previous self-harm
  • Physical illness
  • Exposure to suicidal behaviour of others
  • Access to potentially lethal means of self-harm/suicide
  • ACEis (rape, trauma)
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14
Q

What are some protective factors for suicide?

A
  • Religious belief
  • Being responsible for young children
  • Social support
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15
Q

What is the most common thought you will hear in consultations about suicide/depression?

A

I don’t want to be here anymore

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16
Q

What are some helplines for suicide you can give to patients?

A

Samaritans
Campaign against living miserably
Papyrus
Mental health central access point

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17
Q

What do you do in a GP consultation if a patient says they have plans to kill themselves?

A

Refer them onto the crisis team
They will monitor the patient- home treatment where they call in on the patient everyday

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18
Q

What are some questions you should ask

A
19
Q

What are the four categories for symptoms of self-harm?

A
  • Physical
  • Cognitive
  • Behavioural
  • Psychosocial
20
Q

Complications of self-harm

A
  • Broken bones
  • Unintentional death
  • Infection
  • Multi-organ damage
  • Permanent scarring
  • Social isolation
21
Q

What is the difference in treatment of suicide and self-harm?

A

Suicide
- Crisis intervention
- Risk assessment
- Long term therapy

Self-harm
- Underlying emotional issues
- Developing healthier coping strategies
- Building resilience

22
Q

How long after an admission to hospital after a person has self-harmed do you need to have a follow up appointment?

A

48 hours

23
Q

What specific cultural factors may contribute to disparities in mental health access among ethnic minorities in the UK?

A
  • Stigma surrounding mental illness, such as the belief that mental health issues are a sign of personal weakness or spiritual failing within some ethnic communities.
  • Mistrust of mental health services due to historical experiences of discrimination or mistreatment, such as the Tuskegee syphilis study.
  • Cultural beliefs about mental health, such as the preference for traditional healing methods over Western psychiatric treatment among certain cultural groups.
24
Q

How is depression diagnosed?

A

Depression is diagnosed using the diagnostic and statistical manual of mental health disorders, firth edition

(DMS-5)

25
Q

What are the two core symptoms of depression?

A

During the last month have you been bothered by feeling down, depressed or hopeless?

Do you have little interest or pleasure in doing things?

If either of the two core symptoms have been present most days, most of the time, for at least 2 weeks: ask about

26
Q

If either of the two core symptoms have been present most days, most of the time, for at least 2 weeks: what should you ask about?

A
  • Fatigue
  • Excessive guilt
  • Recurrent thoughts of death, suicidal thoughts
  • Lack of concentration
  • Psychomotor agitation
  • Insomnia/hypersomnia
  • Significant appetite and/or weight loss.
27
Q

Describe the typical presenting features of depression in adults.

A

Key Points:
Persistent sadness
Loss of interest or pleasure
Fatigue and decreased energy
Changes in sleep patterns
Changes in appetite or weight
Difficulty concentrating
Feelings of worthlessness or guilt
Psychomotor agitation or retardation
Suicidal thoughts or behaviours
Physical symptoms such as headaches or digestive problems

28
Q

Differentiate between low mood and depression in adults.

A

Key Points:
Low Mood:
Transient feelings of sadness or unhappiness.
Often triggered by specific events or circumstances.
Typically resolves without intervention or persists for a short duration.
Mild impact on daily functioning and quality of life.
Depression:
Persistent and pervasive feelings of sadness, emptiness, or hopelessness.
Not necessarily triggered by specific events and may persist for weeks or months.
Interferes significantly with daily functioning, including work, relationships, and self-care.
Accompanied by additional symptoms such as loss of interest or pleasure, changes in sleep or appetite, fatigue, and thoughts of worthlessness or suicidal ideation.

29
Q

Use a PHQ 9 questionnaire with a patient and interpret the score generated.

A

NICE updated its depression guidelines in 2022. It now favours a simple classification of depression severity
‘less severe’ depression: encompasses what was previously termed subthreshold and mild depression
a PHQ-9 score of < 16
‘more severe’ depression: encompasses what was previously termed moderate and severe depression
a PHQ-9 score of ≥ 16

30
Q

What are the key components of suicidal risk assessment and monitoring?

A

All patients assessed for suicide risk, comorbid conditions, and other risk factors.
Patients monitored for suicidal ideation, especially in early weeks of treatment.
Treatment decisions not withheld based solely on suicide risk; toxicity in overdose considered if prescribing antidepressants.
Patients and families advised to be vigilant for mood changes, especially during high-stress periods or treatment changes.

31
Q

When should a regular review be scheduled after starting a medication?

A

Regular reviews scheduled 2 to 4 weeks after treatment initiation.

32
Q

Indications for reviewing patients after 2 weeks of starting medication?

A

Patients on antidepressants reviewed within 2 weeks, especially those at risk of suicide or aged 18 to 25.

33
Q

When should patients be reassessed (risk of relapse)

A

The risk of relapse should be reassessed on completion of psychological therapy, and at least every 6 months for those who continue on antidepressant treatment.

For patients under the age of 25 years or at increased risk of suicide should be reviewed after 1 week.

34
Q

How do tricyclic antidepressants cause urinary retention?

A

Tricyclic antidepressants (TCAs) can cause urinary retention by blocking acetylcholine receptors in the bladder, leading to impaired muscle contraction and difficulty emptying the bladder. Additionally, TCAs can block alpha-adrenergic receptors in the bladder neck and urethra, interfering with the relaxation of these structures during urination.

35
Q

What is the first line treatment for less severe depression?

A

Guided self help

36
Q

What is the main difference between depression and a normal grief reaction?

A

Normal grief reaction lasts less than 6 months

37
Q

What are the 5 stages of a grief reaction?

A

Denial: this may include a feeling of numbness and also pseudohallucinations of the deceased, both auditory and visual. Occasionally people may focus on physical objects that remind them of their loved one or even prepare meals for them
Anger: this is commonly directed against other family members and medical professionals
Bargaining
Depression
Acceptance

38
Q

Why is Sertraline preferred in general practice for mental health?

A

SSRIs such as sertraline are first line treatment in general practice. Tricyclics such as imipramine are more dangerous in overdose, so generally reserved for refractory cases.

39
Q

What do a crisis team do in risk of suicide?

A

The Crisis Team assess people to see if they need admission to a Psychiatric Ward. Often they are able to manage them at home, with intense support. A Mental Health Act Assessment may become necessary if she refuses a hospital admission which is felt to be needed.

40
Q

What type of mood congruent delusions can people develop with severe depression?

A

One type of delusion seen in depression is the nihilistic delusion, which concerns the absence of something; often part of the patient’s own body.
Delusional perception is a delusional belief resulting from a normal perception.

Somatic passivity is the belief that external forces are making you feel bodily sensations.

Hypochondriasis is an overvalued idea that you have a particular serious illness, despite reassurance to the contrary.

41
Q

What should the normal course be for benzodiazepines?

A

2-4 weeks

42
Q

What are examples where benzodiazepines are best used?

A

Very short-term anxious situations that will end
Blood tests, plane flights

43
Q

After long term use of benzodiazepines, how should they be withdrawn?

A

Reduce the dose in steps of 1/8 of the daily dose every fortnight

Y3 GP (13 decks)

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