Mental Health Flashcards
Define generalised anxiety disorder:
Generalized Anxiety Disorder (GAD) constitutes a chronic and pervasive condition characterized by excessive, uncontrollable worry extending across various life domains.
What is the ICD-11 criteria for anxiety disorder?
Excessive worry and apprehension.
Difficulty controlling worry.
Associated symptoms: Restlessness, muscle tension, fatigue.
Duration: At least 6 months.
What is the DSM-V criteria for anxiety disorder?
Excessive anxiety and worry about various domains.
Difficulty controlling worry.
Associated symptoms: Restlessness, muscle tension, fatigue, irritability.
Duration: At least 6 months.
What is the epidemiology of generalised anxiety disorder?
Predominantly affects females.
Affects up to 10% of the general population.
Commonly comorbid with depression, substance misuse, and personality disorder.
An onset beyond the age of 35-40 years is more likely indicative of depressive disorder or organic disease.
Associated risk factors include lower socioeconomic status, unemployment, divorce, renting rather than owning a home, lack of educational qualifications, and urban living.
What are the clinical features of generalised anxiety disorder?
Psychological: Fears, worries, poor concentration, irritability, depersonalization, derealization, insomnia, night terrors
Motor symptoms: Restlessness, fidgeting, a feeling of being on edge
Neuromuscular: Tremor, tension headache, muscle ache, dizziness, tinnitus
Gastrointestinal: Dry mouth, dysphagia, nausea, indigestion, “butterflies” in the stomach, flatulence, frequent or loose bowel movements
Cardiovascular: Chest discomfort, palpitations
Respiratory: Dyspnea, tight/constricted chest
Genitourinary: Urinary frequency, erectile dysfunction, amenorrhea
What is first line management for generalised anxiety disorder?
low-intensity psychological interventions:
Individual non-facilitated self-help - written/electronic materials that the patient can work through over a period of around 6 weeks, with occasional but minimal therapist contact.
Individual guided self-help - written/electronic materials that a patient works through with 5–7 weekly or fortnightly face-to-face or telephone sessions (30 minutes each) with a trained practitioner.
Psychoeducational groups - interactive CBT-guided group sessions consisting of 6 weekly 2-hour sessions
What is second line for generalised anxiety disorder?
Second line: for people with GAD and marked functional impairment, or with GAD that has not improved following the above:
High-intensity psychological intervention such as CBT or applied relaxation
Medical management - SSRIs are preferred i.e. sertraline, and if one does not work an alternative can be trialled e.g. escitalopram, paroxetine, or an SNRI (venlafaxine or duloxetine) can be used
In the first week of treatment there may be increased anxiety, agitation, and sleeping problems, and in people aged under 30 years that in a minority of people aged under 30 years, SSRIs and SNRIs are associated with an increased risk of suicidal thinking and self-harm.
Patients under 30 should therefore have a follow-up appointment within 1 week to monitor progress.
Symptomatic management with propranolol for palpitations can also be used
What are the three steps to generalised anxiety disorder management?
- Step 1- education & monitoring
- Step 2- low intensity psychological intervention
- Step 3- CBT or pharmacology
What is ICD-11 criteria for depression?
Depressive Episode: Depressed mood, loss of interest (anhedonia), and reduced energy (fatigue) persisting for at least two weeks.
This consists of the presence of at least five out of a possible eight defining symptoms, during the same two-week period, where at least one of the symptoms is depressed mood or loss of interest or pleasure
What is the DSM-V criteria for depression?
Major Depressive Disorder (MDD): Presence of a major depressive episode lasting at least two weeks, with specific criteria regarding mood, cognitive, and physical symptoms.
Persistent Depressive Disorder (Dysthymia): A chronic form of depression lasting for at least two years.
This consists of the presence of at least five out of a possible eight defining symptoms, during the same two-week period, where at least one of the symptoms is depressed mood or loss of interest or pleasure
What are the different severities to depression?
Mild: Few, if any, symptoms in excess of those required to make the diagnosis (associated symptoms, see below), and the symptoms result in minor functional impairment.
Moderate: Symptoms or functional impairment between “mild” and “severe.”
Severe: The number of symptoms, intensity, and impairment are all greatly increased.
To diagnose mild depression according to ICD-10, look for a minimum of two key symptoms and additional symptoms for a minimum duration of two weeks.
What are the clinical features of depression?
Depressed mood or irritability for most of the day, indicated by either subjective report (feels sad or empty) or observation by others (appears tearful).
Anhedonia: Decreased interest or pleasure in most activities, most of the day.
Significant weight change (5%) or change in appetite.
Sleep alterations: Insomnia or hypersomnia.
Activity changes: Psychomotor agitation or retardation.
Fatigue or loss of energy.
Guilt or feelings of worthlessness: Excessive or inappropriate guilt or feelings of worthlessness.
Cognitive issues: Diminished ability to think or concentrate, or increased indecisiveness.
Suicidality: Thoughts of death or suicide, or formulation of a suicide plan.
What are some additional features to depression?
Psychotic Features: Delusions (e.g. nihilistic delusions, Cotard’s syndrome) and hallucinations.
Depressive Stupor: Profound immobility, mutism, and refusal to eat or drink, sometimes necessitating electroconvulsive therapy (ECT).
What are the investigations for depressions?
Standard investigations for depression may include Full Blood Count (FBC), Thyroid Function Test (TFT), Urea and Electrolytes (U&E), Liver Function Test (LFT), Glucose, B12/folate levels, cortisol levels, toxicology screen, and imaging of the Central Nervous System (CNS).
These help rule out organic causes (listed above) such as endocrine disorders (e.g. thyroid disorders).
There are several questionnaires that can also be used to help assess depressive symptoms, such as the Hospital Anxiety and Depression (HAD) Scale and Patient Health Questionnaire (PHQ-9).
What are the three steps for treatment for mild-to-moderate depression?
1st line = Low-intensity psychological interventions (individual self-help, computerised CBT).
2nd line = High-intensity psychological interventions (individual CBT, interpersonal therapy)
3rd line = Consider antidepressants
