Mental Health Flashcards
Types of depressive disorder
Major: >= 5 symptoms
Minor: 2-4 symptoms
Persistent: 2 years of symptoms
Epidemiology and depression
Leading cause of disability and premature death in 18-44o
2:1 F:M ratio
20% of adults will require medical intervention at some point in their life
2-3x more likely to become depressed if a first degree relative has it
First onset most common in 18-24yo and >65
Pathophysiology of depression
Abdnormal levels of neurotransmitter + dysregulation of HPA + abnormalities of secondary messengers
Methods for screening depression
PHQ-2 which may lead to PHQ-9
Risk factors for depression
Aged >65 Postnatal Female Coritcosteroid use Propranolol use 1st degree relative affected Poor lifestyle Oral contraception Co-existing medical conditions which may make you sad
Clinical presentation of someone with depression
Low mood Weight change Libido change Anhedonia Functional impairment Sleep disturbance Low energy Excessive guilt Suicidal thoughts
Investigations to consider in depression
Bloods: TFTs, FBC, U+E
PHQ2/9 + other questionnaires
Management of depression
If severe: hospitalise + refer + 2nd or 3rd get antidepressants i.e. SSRIs or SNRIs
Definition of general anxiety disorder
> =6 months of excessive worry about everyday issues that are disproportionate to any inherent risk
Symptoms for anxiety disorder
Excessive worry Muscle tension Sleep disturbance Fatigue Restlessness Poor concentration Irritability Anxiety not confined to any other condition or substance
Investigations to consider in anxiety
Usually made from clinical picture
TFTs
FBC
Urine drug screen
Management of anxiety disorder
1st: Pharmacotherapy w/ SSRI / SNRI or tricyclic if others are CI
2nd: CBT
3rd: Augmented treatments
What is alcohol use disorder
Chronic relapsing condition resulting from multifactorial components, characterised by increased tolerance to the effects of alcohol and impaired control over consumption
Epidemiology of alcohol use disorder
Common
7-12% prev. in west
M:F 2:1
3.2% of global deaths due to alcoholism
Pathophysiology of alcohol use disorder
Increased use of alcohol sensitises dopaminergic pathway = dependance
Long term exposure increases excitatory receptors and noradrenaline activity
Withdrawal of alcohol leaves excitatory receptors unposed = symptoms of withdrawal
Risk factors for alcohol use disorder
\+ve FHx Anxiety Lack of facial flushing on consumption of alcohol Antisocial behaviour Low response to effects of alcohol
Clinical presentation of someone with alcohol use disorder
Withdrawal symptoms Tolerance established Change in liver size Jaundice Acsites Nictoine dependance Hyper tension and tachycardia Broad gait Social/pysch problems Impaired nutritional status Nausea and vomiting
Investigations to consider in alcohol use disroder
Diagnostic interview with DSM-5
Alcohol level blood test
Withdrawal assessment
Management of an acute presentation of alcohol use with severe withdrawal
Detox
Supportive medical care
Inpatient speciality treatment
Management of a problematic alcohol abuse with mild dependance
Physician advice + brief interventions
Moderate to severe dependance on alcohol: management
Psychological intervention + medication to prevent relapse and support abstinence i.e. Naltrexone
What is alzheimers?
A chronic, neurodegenerative disease, with insidious onset and progressively slow decline.
Which is the most common form of dementia?
Alzheimers
What are some epidemiological facts RE AD
Common
6% >65yo
30% > 90yo
Occurs more commonly in women and blacks
Aetiology of AD
Amyloid theory currently prevails
Excess amyloid peptide = formation of plaques = inflammation = synaptic and neuritic injury and cell death
Pathophysiology of AD
Cortical atrophy apparent in the temp., frontal and parietal areas only
Plaques and neurofib. tangles found on autopsy
Screening method for AD
MMSE
Risk factors for AD
Increased age \+ve FHx Genetics (presenelin 1/2) Downs CVD Hyperlipidemia
Clinical presentation of AD
Memory loss disorientation misplacing items getting lost dysphasia apathy personality change mood change dyspraxia
Investigations in AD
Bedside cognitive testing FBC to rule out anaemia Metabolic panel to rule out metabolic dementia B12 CT/MRI
Management of AD
- support
- environmental control
- cholinesterase inhibitors
What is vascular dementia
Chronic progressive disorder of the brain, brining about cognitive impairment, where cognitive function is affected more than memory
Epidemiology of vascular dementia
2-% of all dementias
Men more affected than women
Asians/Blacks > Whites
Causes of vascular dementia
Often multifactorial
- infarction
- disease of the white matter
- haemorrhage
- AD
Risk factors for vascular dementia
Age >60
Obesoty
HTN
Smoker
Investigations in vascular dementia
FBC ESR Glucose LFTs Renal Syph. serology B12 Folate Thyroid CT/MRI ECG
Clinical presentation of vascular dementia
Inability to solve problems Loss of interest Slower processing Poor attention Memory retrieval difficulty
Management of vascular dementia
Treat any underlying cause or predisposing factors
Clinical presentation of Lewy Body Dementia
Visible hallucinations Extrapyrmaidal signs Depression cognitive impairment Antipsychotic sensitivity
Management of Lewy Body dementia
Cholinesterase inhibitors
Causes of Delerium
DELIRIUMS
Drugs Eyes/ears and other sensory deficits Low O2 Infection Retention Ictal Under hydration/nutrition Metabolic Subdural haemorrhage
management of delirium
Correct the initial cause
What is delirium?
Acute, fluctuating change in mental status with inattention, disorganised thinking, and levels of consciousness
Clinical presentation of delirium
Disorentiation to time, place and person Reversal of sleep wake cycle Labile mood Illusions, delusions and hallucinations Cognitive impairment
