Mental Health Flashcards
Questions to ask someone presenting with self harm
Recent relationship breakdown or rejection by a significant person.
Changes to employment or in financial and occupational status.
Support network.
Planned or impulsive episode.
Other risky or impulsive behaviour.
Sexual, physical, or emotional abuse
What underlying conditions may be present with self harm?
BPD
Anxiety, Depression
Eating disorders
Early psychosis
Substance abuse
Gender dysphoria
PTSD
Bullying
Chronic physical illness
Traumatic brain injury
Name 3 common drug treatment for bipolar
Lamotrigine (only helps avoid depression, risk steven johnson syndrome)
Sodium valproate (teratogenic for men and women)
Lithium (not in pregnancy, measure trough levels 5 days after dose change and 3-6 monthly alongside U+E TFT calcium + weight)
Features of ADHD
Inattention- easily distracted, difficulty sustaining attention on tasks, not listening if spoken to directly, losing or forgetting things, difficulty getting organised, difficulty finishing a task
Hyperactivity -inner restlessness, talking excessively
Impulsivity- blurting out answers before you finish a question, difficulty waiting for their turn, interrupting or intruding on others
Differential diagnoses for adult ADHD
Substance misuse
Learning disability
PTSD, anxiety, depression, EUPD
Hearing and vision problems
Hyperthyroidism
Sleep apnoea
Chronic insomnia
Define mania
elevated or expansive mood, accelerated speech and flight of ideas, irritability and increase in energy.
Increased sexual drive or behaviour, decreased requirement for sleep, reckless spending and a flavour of grandiosity throughout.
OCD management
Education, self help
CBT
Fluoxetine/sertraline
Define OCD
Anxiety disorder
Obsessions- Recurrent and persistent intrusive ideas, thoughts, impulses, or images that are usually resisted by the patient, and are recognised as the product of their own mind.
Compulsions- Repetitive, stereotyped behaviours in response to an obsession, to prevent discomfort or some dreaded event with which it is not connected in a realistic way.
frequent washing and cleaning.
frequent checking behaviours.
putting things in a special order
Management anxiety
Counselling, self help, silvercloud
Breathing exercises
Exercise, avoiding caffeine, smoking, alcohol
CBT
Sertraline 50mg, fluoxetine 20mg if younger/OCD
Propranolol for physical symptoms
What 11 underlying conditions/issues might cause anxiety symptoms?
Depression.
Hyperthyroidism, Phaeochromocytoma
Arrhythmia, Angina
COPD
Menopause
Domestic abuse
Side-effects of medications.
Substance misuse
Caffeine
What 7 common mental health disorders come under the heading of ‘anxiety’?
Generalised anxiety disorder (GAD)
PTSD
OCD
Panic disorder
Body dysmorphic disorder
Social anxiety disorder
Specific phobias, e.g. spiders, flying
Common side effects of ADHD medication
High BP, arrhythmia
Irritability, aggression, tearfulness, and social withdrawal
Headaches and abdominal pain
Appetite suppression and weight loss.
Sleep problems
Appearance of new tic
3 screening questions for depression
During the past month, have you often felt down, depressed, or hopeless?
During the past month, have you had little interest or pleasure in doing things?
Is this something with which you would like help?
Risk factors for suicide
Male
Previous suicide attempts
Depression, substance abuse, schizophrenia, victims of abuse, personality disorder
Young person
Elderly, especially if male, recent bereavement, poor health, living alone, isolated, or self‑neglect
Recent loss, isolation
Recent suicide of a close friend or family member
Impulsiveness while intoxicated
Deliberate self-harm
Qs to ask in depression hx
Alcohol, smoking, drugs
Suicidal ideation
Self harm
Mania
Psychosis
Functional impairment/occupation/concentratin/agitation
Support network
Sleep/appetite/energy
Referral criteria depression
Crisis team:
serious suicidal intent.
significant psychotic symptoms.
mental health severely impacting on ability to perform basic self‑care tasks (self‑neglect).
significant risk to self or others.
psychotic depression.
Common side effects SSRIs
Hyponatramia (esp if low BMI, poor renal function, low baseline Na)
Sexual dysfunction
QT prolongation with citalopram
Mild incr bleeding risk
Risk factors for delirium
Dementia
Acute illness or infection, recent change in environment
Age>70
Visual or hearing impairment
Depression
Abnormal serum sodium/calcium
Indwelling catheter/constipation
Polypharmacy
Alcohol
Benzodiazepine
Dehydration + poor nutrition
Sleep deprivation
Pain
Immobility
Previous delirium
Components of 4AT
Screen for delirium
Alertness
AMT4 (age, DOB, place, year)
Attention (months year backwards)
Fluctuating course
Definition of dementia
Progressive impairment 2+ cognitive domains (memory, language, behaviour, or visuospatial or executive function) leading to significant functional decline (enough to affect ADLs) that cannot be explained by another disorder or adverse effects of medication
Red flags for eating disorders
Recent loss of weight of ≥1kg/week for 2 weeks (consecutive) in an undernourished patient
Rapid weight loss at any weight
Over 18: BMI <13
HR<40 when awake
Standing systolic BP <90, associated with recurrent syncope and postural drop in systolic BP of >20mmHg or increase in HR of over 30bpm
Fluid refusal/Severe dehydration: reduced urine output, dry mouth,
decreased skin turgor, sunken eyes, tachypnoea, tachycardia
<35.5°C tympanic
Unable to sit up from lying flat, or to get up from squat at all or only by using upper limbs to help
Long QTc or other ECG abnormalities
Low phosphate, K<2.5, albumin, glucose<3, sodium, calcium
Transaminases >3x normal range
Low WCC, Hb<100
Acute food refusal or estimated calorie intake <500kcal/day for 2+ days
Features of anorexia nervosa
Low body weight, or rapid weight loss
Body image distortion
Obsessive fear of fatness and gaining weight
Restrictive type – very low calorie intake
Purging type – calorie restriction plus purging (self‑induced vomiting, laxatives, overexercising)
Anaemia, osteoporosis, amenorrhoea
Features of bulemia
May be normal weight or fluctuant
Cyclical pattern of calorie restriction followed by binge eating, then purging (self‑induced vomiting, laxatives, over-exercising)
Dental decay, mallory weiss tears, GORD
Features of binge eating disorder
Very large volumes of food rapidly ingested in discrete time frames (binges) with associated guilt, remorse, and self-disgust afterwards
the patient is unable to control the length and frequency of binges
the binges are used as a way to manage stress or psychological distress
What is refeeding syndrome
Severe electrolyte and fluid shifts as a result of rapid introduction of nutrition after a period of inadequate nutritional intake.
Advise the patient and family not to suddenly increase the calorie intake and to present urgently if the patient has any peripheral oedema.
Features of PTSD
Significant adverse response to a major traumatic event that involves actual or threatened death, serious injury or sexual violence.
Nightmares or flashbacks
Avoiding reminders
Increased sense of threat (hypervigilance and increased startle reaction)
Affective dysregulation (numbing, dissociation)
Negative self‑concept
Disturbed relationships
Management PTSD
Reassurance, advice
Self refer to:
Veterans Wales
CAVDAS
New Pathways if sexual abuse
CBT
EMDR
Sertraline/fluoxetine/mirtazapine
Qs to ask perinatal mental health
Pervasive mood disturbance
Sleep or appetite disturbance
Memory and concentration problems
Excessive worry or anxiety, panic attacks
Strange beliefs and behaviour, or perceptual disturbance
Disorganised thoughts
Thoughts of worthlessness, hopelessness, guilt, or self blame
Difficulty bonding with the baby
Thoughts of harm to self or baby
Impact on relationships and functioning
Impact on quality of parenting
Features of puerperal psychosis
sleeplessness, hyperactivity, or stupor.
intermittent lucid periods.
anxiety, disorientation and confusion.
rapid mood swings.
hallucinations.
delusional beliefs.
thoughts of harm to baby.
Medical emergency, needs admission
Name 3 positive psychotic symptoms
Delusions – false, fixed, or irrational beliefs which are firmly held and are not shared by other people of similar cultural backgrounds (e.g. paranoia, grandeur).
Hallucinations – sensory perceptions which occur without external stimulus. Voices are most common, but can occur in any sensory modality.
Thought disorder – disorganised thought patterns, may make speech difficult to follow.
Name 5 negative psychotic symptoms
Lack of energy and motivation
Social withdrawal
Poor personal care or self-neglect
Lack of emotion
Reduced speech output
Qs to ask re psychosis
have you been having any thoughts that people might be trying to harm you?
do you feel unsafe at home or in your day-to-day life.=?
Do you hear voices when no one else is around?
Do you find that content of media or world events relate specifically to you?
Ask if they think people have been able to:
read their mind.
take thoughts out of their mind.
insert thoughts into their mind.
control their body’s actions.
Management psychosis
If risk to self or others: crisis/999
Think about safeguarding/dependents
If prodrome, consider bloods and urgent ref
Baseline Ix for starting antipsychotics
BP+ pulse
Weight, BMI, Waist circumference
FBC, U+E, urine ACR, LFT, TFTs, CK
Prolactin, HbA1C, Lipids
CVD risk, QRISK3
ECG
Name 4 extra-pyramidal side effects
Tremor (“pill rolling”) and stiffness
Dystonia
Restlessness – akathisia
Abnormal movements – tardive dyskinesia
