Mental Health Flashcards
What’s the core symptoms of depression in an adult?
At least two weeks of experiencing:
-low mood
-Anhedonia (lack of pleasure or interest in activities)
What are some emotional symptoms of depression?
Anxiety
Irritability
Low self-esteem
Guilt
Hopelessness about the future
What are some cognitive symptoms of depression?
Poor concentration
Slow thoughts
Poor memory
What are some physical symptoms of depression?
Low energy (tired all the time)
Abnormal sleep (particularly early morning waking)
Poor appetite or overeating
Slow movements
How can you differentiate low mood from depression
may feel tired, lacking confidence, frustrated, angry and worried. But a low mood will often pass after a couple of days or weeks
still feeling down or no longer get pleasure from things for most of each day and this lasts for several weeks, you may be experiencing depression
What risk assessment should be done in consultations about mental health?
Self-neglect
Self-harm
Harm to others
Suicide
How should you manage someone who’s been diagnosed with depression in primary care?
Provide advice on the nature and course of depression, recovery, and sources of information and support including self-help materials, support groups, and peer support
Provide advice on activities to improve sense of wellbeing
Refer if severe depression or risk of self-harm or suicide
Discuss the options for treatment of depression and develop a treatment plan
How can you manage less severe depression initially?
guided self-help
Do not routinely offer an antidepressant as first-line treatment BUT if pt wants drug treatment offer SSRI
Arrange an initial review usually 2–4 weeks after starting treatment
What management can be offered to someone experiencing more severe depression?
SSRI if they wish
Arrange an initial review usually 2–4 weeks after starting treatment, and ensure follow-up if the person does not attend
CBT, counselling
Advise the person they must not drive and must notify the Driver and Vehicle Licensing Agency (DVLA) if they have significant memory or concentration problems, agitation, behavioural disturbance, or suicidal thoughts
What is the PHQ-9 questionnaire?
not a screening tool for depression but it is used to monitor the severity of depression and response to treatment
nine questions about how often the patient is experiencing symptoms in the past two weeks
What do the PHQ-9 scores mean?
5-9 indicates mild depression
10-14 indicates moderate depression
15-19 indicates moderately severe depression
20-27 indicates severe depression
What are the typical emotional and cognitive presenting features of generalised anxiety disorder in adults?
-Excessive worrying
-Unable to control the worrying
-Restlessness
-Difficulty relaxing
-Easily tired
-Difficulty concentrating
What are some physical symptoms of anxiety and what are they caused by?
caused by overactivity of the sympathetic nervous system
-Muscle tension
-Palpitations (e.g., a feeling of their heart racing)
-Sweating
-Tremor
-Gastrointestinal symptoms (e.g., abdominal pain and diarrhoea)
-Headaches
-Sleep disturbance
What is generalised anxiety disorder?
is a mental health condition that causes excessive and disproportional anxiety and worry that negatively impacts the person’s everyday activity, unidentifiable cause
Symptoms persistent, occurring most days for at least six months
What are the key symptoms required for a diagnosis of GAD?
restlessness or nervousness, being easily fatigued, poor concentration, irritability, muscle tension, and/or sleep disturbance
3/6 required
Whats some differences between stress and anxiety?
Stress is short term, anxiety lingers
Stress usually has a recognised trigger
What is the GAD7 questionnaire?
Generalised Anxiety Disorder Questionnaire
assess the severity
5-9 indicates mild anxiety
10-14 indicates moderate anxiety
15-21 indicates severe anxiety
How can mild anxiety be managed?
Active monitoring
Self-help advice - sleep, diet, exercise and avoiding alcohol, caffeine and drugs
How can moderate to severe anxiety be managed?
Self help advice
CBT
Medication - SSRI (sertraline) 1st line
Propranolol for physical symptoms
SNRIs
Pregabalin
What is the mini mental state examination (MMSE)?
commonly used set of questions for screening cognitive function
not suitable for making a diagnosis but can be used to indicate the presence of cognitive impairment, such as in a person with suspected dementia or following a head injury
What does the MMSE check?
checks 6 areas of mental ability:
-knowing where you are — the date and place
-attention and concentration
-short-term memory (recall)
-language skills
-visual and spatial relationships between objects
-ability to understand and follow instructions
What are the limitations of the MMSE?
A low score does not always mean that you have dementia. Low scores can also be caused by:
-physical problems
-intellectual disability
-language or speech problems
-education level
-cultural differences
A high MMSE score does not always mean that you have a normal mental ability. You may still have signs of cognitive impairment.
How should MMSE scores be interpreted?
Out of 30
Score of 25 or higher is normal
Score of 24 or below could mean cognitive impairment
Limitations should be taken into account
What is GPCOG?
General practitioner assessment of cognition
screening tool for cognitive impairment. It has been designed for general practitioners
What are the components of GPCOG?
a cognitive assessment conducted with the patient
an informant questionnaire (only considered necessary if the results of the cognitive section are equivocal, ie score 5-8 inclusive)
How should GPCOG results be interpreted?
-results >8 assumed to be cognitively intact
-results < 5 assumed to be cognitively impaired
-if patient scores 5-8, more information required -> informant questionnaire:
-for patients requiring a informant questionnaire, scores of 3 or less out of 6 in this section indicates cognitive impairment
What are some risk factors specific to depression that increase the risk of suicide?
Family history of mental disorder
History of previous suicide attempts (or self harm)
Severe depression
Anxiety
Feelings of hopelessness
Personality disorder
Alcohol abuse and/or drug abuse
Male gender
What is self-harm
intentional self-injury without suicidal intent. Cutting is the most common method of self-harm
What is the cycle of self-harm?
1)Emotional suffering
2)Emotional overload
3)Panic
4)Self-harming
5)Temporary relief
6)Shame and guilt
What are some protective factors that may reduce the risk of suicide?
Social support and community
Sense of responsibility to others (e.g., children or family)
Resilience, coping and problem-solving skills
Access to mental health support
What are some other risk factors for suicide?
Family history of suicide or self-harm
Physical illness (especially if chronic)
Exposure to suicidal behaviour of others
Recent discharge from psychiatric inpatient care
Access to potentially lethal means of self-harm/suicide
How do you conduct a suicide assessment risk?
Conduct in quiet room
Sensitively ask about suicidal ideas
Explore other areas of concern
Establish if they have support
Safety net, provide with crisis lines
Document
How do you manage a patient at risk of suicide or self-harm?
Safety-netting, a safety plan and follow-up are important aspects of management
Consider safeguarding issues
may require immediate referral to A&E after a suicide attempt or for physical injuries, overdoses or safety concerns
Empathy, supportive communication and building rapport
Identifying triggers for episodes
Separating the means of self-harm (e.g., removing blades or medications from the environment)
Discussing strategies for avoiding further episodes (e.g., distractions, alternative coping strategies and getting help)
Providing details for support services in a crisis (e.g., mental health services, Samaritans and Shout)
Treating underlying mental health conditions (e.g., depression and anxiety)
Cognitive behavioural therapy
