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Core Conditions AJL (minus renal and respiratory) > Mental Health > Flashcards

Mental Health Flashcards

1
Q

Who does depression affect?

A

F:M
2:1

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2
Q

What causes depression?

A

Combination of biopsycosocial causes throughout pts life

Cause not known fully

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3
Q

What are the risk factors for depression?

A 
Genetics
Childhood experience
Personality traits (neuroticism, anxiety, impulsivity, obessionality) 
Social circumstances
- marital status
- adverse life events
Physical illness
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4
Q

What are the symptoms for depression?

A

Present for at least 2 weeks
Not secondary to drugs/alcohol/medication/bereavement

Core symptoms:

  • depressed mood (most of the day, nearly every day)
  • anhedonia
  • weight change
  • disturbed sleep
  • fatigue/loss of energy
  • reduced libido
  • feelings of worthlessness
  • diminished concentration
  • suicidal thoughts (may/may not been acted on)
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5
Q

What are the signs of depression on examination?

A

Psychomotor agitation/retardation

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6
Q

What are the differential diagnoses of depression?

A 
Other psychiatric disorders
Neurological disorders
Endocrine disorders
Metabolic disorders
Anaemia
SLE
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7
Q

What are the treatments for depression?

A

Mild-moderate

  • watch wait
  • CBT

Moderate- severe

  • antidepressants + CBT
  • ECT
  • psychiatric referral
  • exercise

Pharmacological

  • tricyclic antidepressants - amytriptyline
  • monoamine oxidase inhibitors (MAOIs) - Isocarboxazid
  • selective serotonin reuptake inhibitors (SSRIs) - citalopram, fluoxetine
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8
Q

How common is anxiety?

A

Prevalence 2.5-6%

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9
Q

Who does anxiety affect?

A

F>M
Single
Unemployed

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10
Q

What are the causes of anxiety?

A

Genetics 30%

Neurobiological

  • ANS responsiveness
  • loss of control of cortisol
  • abnormal behaviour inhibition system
  • neurotransmitter abnormalities (⬇️ GABA, ⬇️5-HT)

Psychological

  • experience of unexpected negative events (rape, war, loss of parent)
  • chronic stressors (family, marriage)
  • parental issues (overprotective, unresponsive, not-loving)
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11
Q

What are the risk factors for anxiety?

A 
Stressful event
Other anxiety disorders
Depression, dysthymia
Alcohol/drug issues
Physical problems ➡️ IBS, atypical chest pain
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12
Q

What are the symptoms of anxiety?

A

Must be present every day for more than 6 months

DSM-IV ➡️ at least 3 of:

  • restlessness/feeling on edge
  • easy fatigability
  • concentration difficulty/mind blanking
  • irritability
  • muscle tension
  • sleep disturbance

ICD-10 ➡️ at least 4 of:

  • autonomic arousal - palpitations, tachycardia, sweating, trembling, shaking, dry mouth
  • physical - breathing difficulties, choking sensation, chest pain/discomfort, nausea/abdo distress
  • mental state - dizzy, unsteady, faint/lightheaded, derealisation/depersonalisation, fear of losing control/passing out/dying
  • general - hot flushes, cold chills, numbness/tingling
  • tension - muscle aches/pains, muscle tension, inability to relax
  • other - exaggerated response to minor surprise
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13
Q

What are the differential diagnoses of anxiety?

A

Normal worries
Depression (mixed with anxiety)
Drug/alcohol misuse
Medical condition (arrhythmias, HF, asthma, COPD, hyperthyroidism)
Drug side effects (anti hypertensives, anti arrythmics, bronchodilators, anticonvulsants, anticholinergics)

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14
Q

What are the treatment options for anxiety?

A

Psychological - CBT

Behavioural - treat avoidance with exposure, relaxation methods, controlling hyperventilating

Pharmacological -
Buspirone
Benzodiazepines
Tricyclic antidepressants
Beta blockers
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15
Q

How common is alcohol dependence?

A

~180,000 prescriptions for alcohol dependence in primary care

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16
Q

Who does alcohol dependence affect?

A

M>F

Young

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17
Q

What are the causes of alcohol dependence?

A

Genetics - 2x risk if 1st degree relative

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18
Q

What are the risk factors for alcohol dependence?

A

Lower socioeconomic groups
Lower educational levels
Occupation (industry workers, travelling salesman, doctors)

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19
Q

What are the signs of alcohol dependence?

A

An overwhelming desire for alcohol
Drinking out of control
A need for increasing amounts of alcohol
Withdrawal symptoms experienced
Having little interest in other activities
Continuing to drink even when the harm being done is made clear

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20
Q

What investigations are necessary to diagnose alcohol dependence?

A

CAGE questionnaire

  • ever felt you should Cut back?
  • anyone Annoyed you by criticising your drinking?
  • ever felt Guilty about your drinking?
  • ever needed a drink first thing as an Eye-opener

2+ then ask ➡️

  • what’s the most alcohol you’ve drunk in a day?
  • what’s the most you’ve drunk in a week?

Alcohol Use Disorders Identification Test (AUDIT)

  • breath testing - blood alcohol conc correlated with breathalyser results
  • gives recent alcohol consumption

Bloods - ⬆️ MCV, carbohydrate-deficient transferrin (CDT) = markers for excessive alcohol consumption
- FBC, LFT

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21
Q

What are the complications of alcohol dependence?

A 
Hepatitis
Liver cirrhosis
Anaemia
Cardiomyopathy
Coma
Hypoglycaemia
AKI
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22
Q

What are the treatments options for alcohol dependence?

A

Harmful/mildly dependent drinking:

  • brief intervention
  • CBT

Detoxification

  • inpatient - if suicide risk, no social support, history of severe withdrawal
  • community - daily supervision to detect complications

Pharmacological:

  • benzodiazepines - long acting for tremor/agitation, short acting for seizures, can lead to dependence
  • vitamin B complex - IV pabrinex then oral thiamine- treats wernicke-korsakoff syndrome
23
Q

How common is self-harm?

A

Common- annual prevalence approx 0.5%

24
Q

Who does self harm affect?

A

F>M

15-16years - >10% of girls >3% of boys

25
Q

What are the causes of self-harm?

A

Often an attempt at control during a highly stressful time

26
Q

What are the risk factors for self-harm?

A

Psychiatric disorders:

  • borderline personality disorders
  • depression
  • bipolar disorder
  • schizophrenia
  • drug/alcohol misuse
Victims of domestic violence
Socio-economic disadvantages
Eating disorders
South Asian women
Stressful life events
Chronic health problems
27
Q

What are the symptoms of self-harm?

A

Definition ➡️ an act with a nonfatal outcome in which an individual deliberately did:

  • a behaviour intended to cause self harm
  • ingesting a substance in excess of the prescribed or generally recognised therapeutic dose
  • ingrsting a recreations or illicit drug use that was an act that the person regarded as self-harm
  • ingesting a non-ingestible substance or object
28
Q

What investigations are necessary in suspected self-harm?

A

Needs assessment

  • social, psychological, and motivational factors specific to the act of self harm
  • full mental health and social needs assessment

Risk assessment
- psychological characteristics associated with risk (depression, hopelessness, and continuing suicidal intent)

29
Q

What are the treatment options for self-harm?

A

Initial management
-treat harm caused to self

Further management:

  • psychological intervention
  • psychosocial intervention
30
Q

What is somatisation?

A

When physical symptoms are caused by psychological or emotional factors

31
Q

What are the causes of somatisation?

A

Associated with childhood illness
History of parental anxiety about illness
Associated with childhood sexual abuse

32
Q

What are the risk factors of somatisation?

A

Family history - 1st degree relative ⬆️ risk

33
Q

What are the symptoms of somatisation?

A

Occur in any system
Non-specific
Atypical
Multiple, atypical and inconsistent medically unexplained symptoms

34
Q

What are the signs of somatisation?

A

Pts life revolves around illness
Excessive use of medical services
Iatrogenic substance dependence
Other psychiatric disorders

35
Q

What are the possible differential diagnoses of somatisation?

A

Variable multi system presentation disorder (AIDS, SLE, MS)

Psychiatric disorder

Other somatoform disorders:
- hypochondriasis- firm belief in disorder
- somatoform pain disorder- pain main symptom
- conversion disorder - functional loss without multi system symptoms
Fictitious disorder- deliberate feigning of physical symptoms to assume sick role

36
Q

What is the treatment for somatisation?

A

Initial:
communicate diagnosis
Emphasise negative investigations
Educate family

Ongoing:
CBT

37
Q

How common is dementia?

A

Prevalence 800,000 in UK

38
Q

Who does dementia affect?

A

Early onset dementia M

Vascular and mixed M>F

39
Q

What are the causes of dementia?

A

Alzheimer’s (50%)
Vascular dementia (25%)
Dementia with Lewy bodies (15%)
Frontotemporal dementia (

40
Q

What are the risk factors for dementia?

A 
Mild cognitive impairment
Cerebrovascular disease
Learning disorders
Cardiovascular risk factors- smoking, alcohol, obesity, diabetes, hypertension, hypercholesterolaemia
Severe psychiatric issues
Genetics
41
Q

What are the symptoms of dementia?

A

Triad of:
Cognitive dysfunction ➡️ problems with memory, language, attention, thinking, orientation, calculation and problem solving

Psychiatric and behavioural problems ➡️ personality changes, emotional control, social behaviour, depression, agitation, hallucinations, and delusions, depression or anxiety

Difficulties with activities of daily living ➡️ driving, shopping , eating, dressing

42
Q

What are the signs of dementia on examination?

A

Head turning sign - ask a simple question and they immediately turn to partner to help them answer

Neurological signs - gait disturbances, apraxia

Neglecting hygiene or self-care

Sundowner syndrome - as evening approaches, increase in confusion and falls

43
Q

What are the differential diagnoses of dementia?

A 
Delirium
Depression
Amnestic disorders
Learning disabilities 
Psychotic disorders
Normal ageing decline in cognition
44
Q

What investigations are needed to diagnose dementia?

A

Bloods - FBC, LFT, U&Es, glucose, ESR, TSH, Ca, Mg, Phos, vitB12/folate, cultures

Lumbar puncture

EEG

ECG

CXR

CT/MRI

45
Q

What are the treatment options of dementia?

A

Cognitive enhancements - acetylcholine esterase inhibitors (tacrine, donepezil, rivastigimine)

Antipsychotics - for psychosis/agitation

Treat depression/insomnia - SSRIs, hypnotics

Functional management

46
Q

How common is delirium?

A

Inpatients 10-20%

47
Q

Who does delirium affect?

A 
Elderly
Pre existing dementia
Blind/deaf
Post operative
Burn victims
Alcohol and benzodiazepines dependent
Serious illness
48
Q

What causes delirium?

A

Usually multifactorial:

  • infective ➡️ UTI, LRTI, wound abscess, cellulitis
  • metabolic ➡️ anaemia, electrolyte disturbance, hepatic encephalopathy
  • intracranial ➡️ CVA, trauma, encephalitis, primary/met tumour, ⬆️ICP
  • endocrine ➡️ pituitary/thyroid/parathyroid/adrenal disease, hypoglycaemia, diabetes
  • substance abuse/withdrawal
  • hypoxia
49
Q

What are the symptoms of delirium?

A

Disturbance in sleep-wake cycle

Symptoms worsen at night

Hallucinations, perceptual distortions illusions,

Paranoid delusions

50
Q

What are the signs of delirium?

A

Rapid onset
Fluctuating impaired level of consciousness
Disorientation and impairment of cognition
Impairment of recent memory/abstract thinking
Psychomotor agitation

51
Q

What investigations are necessary to diagnose delirium?

A 
History - collateral history and cognition testing (MMSE/AMTS)
Exam - look for sources of infection
Bloods
Urine - dipstick and microscopy
ECG
52
Q

What are the treatment options for delirium?

A

Supportive:

  • clear communication
  • reorientation

Environmental:

  • avoid sensory extremes
  • adequate space and sleep
  • control noise, lighting, temperature

Medical:
- antipsychotics - haloperidol, lorazepam

53
Q

How common is depression?

A

2-5% prevalence in general population

5-10% of pts seem in primary care

Core Conditions AJL (minus renal and respiratory) (10 decks)

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