Mental Health

Question 1

Questions to ask someone presenting with self harm

Answer 1

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

Question 1

What underlying conditions may be present with self harm?

Answer 1

BPD
Anxiety, Depression
Eating disorders
Early psychosis
Substance abuse
Gender dysphoria
PTSD
Bullying
Chronic physical illness
Traumatic brain injury

Question 2

Name 3 common drug treatment for bipolar

Answer 2

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)

Question 3

Features of ADHD

Answer 3

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

Question 4

Differential diagnoses for adult ADHD

Answer 4

Substance misuse
Learning disability
PTSD, anxiety, depression, EUPD
Hearing and vision problems
Hyperthyroidism
Sleep apnoea
Chronic insomnia

Question 5

Define mania

Answer 5

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.

Question 6

OCD management

Answer 6

Education, self help
CBT
Fluoxetine/sertraline

Question 7

Define OCD

Answer 7

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

Question 8

Management anxiety

Answer 8

Counselling, self help, silvercloud
Breathing exercises
Exercise, avoiding caffeine, smoking, alcohol
CBT
Sertraline 50mg, fluoxetine 20mg if younger/OCD
Propranolol for physical symptoms

Question 9

What 11 underlying conditions/issues might cause anxiety symptoms?

Answer 9

Depression.
Hyperthyroidism, Phaeochromocytoma
Arrhythmia, Angina
COPD
Menopause
Domestic abuse
Side-effects of medications.
Substance misuse
Caffeine

Question 10

What 7 common mental health disorders come under the heading of ‘anxiety’?

Answer 10

Generalised anxiety disorder (GAD)
PTSD
OCD
Panic disorder
Body dysmorphic disorder
Social anxiety disorder
Specific phobias, e.g. spiders, flying

Question 11

Common side effects of ADHD medication

Answer 11

High BP, arrhythmia
Irritability, aggression, tearfulness, and social withdrawal
Headaches and abdominal pain
Appetite suppression and weight loss.
Sleep problems
Appearance of new tic

Question 12

3 screening questions for depression

Answer 12

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?

Question 13

Risk factors for suicide

Answer 13

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

Question 14

Qs to ask in depression hx

Answer 14

Alcohol, smoking, drugs
Suicidal ideation
Self harm
Mania
Psychosis
Functional impairment/occupation/concentratin/agitation
Support network
Sleep/appetite/energy

Question 15

Referral criteria depression

Answer 15

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.

Question 16

Common side effects SSRIs

Answer 16

Hyponatramia (esp if low BMI, poor renal function, low baseline Na)
Sexual dysfunction
QT prolongation with citalopram
Mild incr bleeding risk

Question 17

Risk factors for delirium

Answer 17

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

Question 18

Components of 4AT

Answer 18

Screen for delirium
Alertness
AMT4 (age, DOB, place, year)
Attention (months year backwards)
Fluctuating course

Question 19

Definition of dementia

Answer 19

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

Question 20

Red flags for eating disorders

Answer 20

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

Question 21

Features of anorexia nervosa

Answer 21

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

Question 22

Features of bulemia

Answer 22

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

Question 23

Features of binge eating disorder

Answer 23

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

Question 24

What is refeeding syndrome

Answer 24

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.

Question 25

Features of PTSD

Answer 25

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

Question 26

Management PTSD

Answer 26

Reassurance, advice
Self refer to:
Veterans Wales
CAVDAS
New Pathways if sexual abuse
CBT
EMDR
Sertraline/fluoxetine/mirtazapine

Question 27

Qs to ask perinatal mental health

Answer 27

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

Question 28

Features of puerperal psychosis

Answer 28

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

Question 29

Name 3 positive psychotic symptoms

Answer 29

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.

Question 30

Name 5 negative psychotic symptoms

Answer 30

Lack of energy and motivation
Social withdrawal
Poor personal care or self-neglect
Lack of emotion
Reduced speech output

Question 31

Qs to ask re psychosis

Answer 31

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.

Question 32

Management psychosis

Answer 32

If risk to self or others: crisis/999
Think about safeguarding/dependents
If prodrome, consider bloods and urgent ref

Question 33

Baseline Ix for starting antipsychotics

Answer 33

BP+ pulse
Weight, BMI, Waist circumference
FBC, U+E, urine ACR, LFT, TFTs, CK
Prolactin, HbA1C, Lipids
CVD risk, QRISK3
ECG

Question 34

Name 4 extra-pyramidal side effects

Answer 34

Tremor (“pill rolling”) and stiffness
Dystonia
Restlessness – akathisia
Abnormal movements – tardive dyskinesia