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CCs > Mental Health > Flashcards

Mental Health Flashcards

1
Q

Define anhedonia.

A

Loss of pleasure in day to day activities

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2
Q

What symptoms are diagnosing features of major depression?

A
  • Poor appetite with weight loss
  • Early waking and diurnal variation
  • Sluggish
  • Reduced libido
  • Reduced concentration
  • Feeling worthlessness and guilt
  • Death and suicidal thoughts
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3
Q

What is the duration of symptoms required for the diagnosis of major depression?

A
  • Nearly every day for at least 2 weeks
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4
Q

What screening questions should you start with in a suspected depression history?

A
  • Have you been experiencing feelings of worthlessness, hopelessness or guilt?
  • Have you been bothered by having little interest or pleasure in your daily activities?
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5
Q

What other things should you screen for in a depression history?

A
  • Alcohol use
  • Psychosis: have you been experiencing any hallucinations or hearing any voices in your head?
  • Suicide: have you ever felt life is not worth living? Have you thought about ending it all? Plans?
  • Anxiety: is there anything you are feeling anxious about or that is worrying you?
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6
Q

What aspects are important in a social history for depression?

A
  • Occupation
  • Living situation
  • Care for anyone?
  • Alcohol, drugs
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7
Q

What are the 7 markers of severe suicide risk?

A 
Suicide attempt/ Self harm
Unexplained worthless/guilt
Inability to function 
Concentration impaired
Impaired appetite 
Decreased sleeping 
Energy low
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8
Q

What is ‘anxiety neurosis’?

A

Maladaptive psychological symptoms without organic cause or psychosis.
Generally due to stress

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9
Q

How is General Anxiety Disorder defined?

A

Anxiety + 3 somatic symptoms for greater than 6 months

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10
Q

What symptoms occur in General Anxiety Disorder?

A
  • Agitation, butterflies, palpitations, sweating, shaking
  • Impending doom
  • Reduced concentration
  • Headache
  • Trouble sleeping
  • Reduced appetite & nausea
  • Hyperventilating
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11
Q

How can general anxiety disorder be managed?

A
  • Symptom control
  • Regular exercise
  • Meditation
  • CBT
  • Drugs: Diazepam, SSRIs, B-blockers
  • Hypnosis
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12
Q

What is the name given to the mental illness that causes the patient to experience different unexplained bodily symptoms?

A
  • Somatisation
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13
Q

What can be associated with somatisation?

A
  • IBS/chronic pain
  • PTSD
  • Antisocial personality disorder
  • Attention of sick role
  • family influence
  • Negative personality trait
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14
Q

How can somatisation present?

A
  • Specific symptoms ie pain, shortness of breath
  • General symptoms ie fatigue and weakness
  • Symptoms may be unrelated or more significant than cause
  • Associated anxiety
  • Thinking normal is abnormal
  • Obsessive checking
  • Unresponsive to medication/have bad experiences of side effects
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15
Q

What can cause delirium?

A
  • Systemic infection
  • Head injury - raised ICP, space occuping lesion
  • Epilepsy
  • Hypoxia
  • Vascular - stroke/MI
  • Metabolic - uraemia, liver failure, glucose, low Hb
  • Malnutrition - low thiamine, B12 & nicotinic acid
  • Alcohol/drug withdrawal
  • Drugs: opiates, anticonvulsants, sedatives, illicit
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16
Q

What are the 8 signs of delirium?

A 
Disordered thinking 
Euphoric, fearful, depressed, angry
Language impaired, reduced speech, gabbling, repeat
Inattention 
Reversal of sleep awake cycle
Illusions, delusions, hallucinations
Unaware/disorientated
Memory deficits 
RAPID ONSET
17
Q

Investigations for delirium?

A

Find cause:

  • Septic screen (lactate, CXR)
  • FBC, U&E, CRP, blood glucose
  • Urine dip
  • ECG
  • ABG
  • Malaria
  • LP
  • CT/MRI
18
Q

Management of a delirious patient?

A
  • Identify and treat underlying cause
  • Reduce distress to patient
  • Lit quiet room
  • Same staff working with them
  • Reassure and augment self care
  • Minimise medications
  • 3 Ms for agitation: music, massage and muscle relaxation
19
Q

What are the four screening questions for alcoholism?

A
  • Have you ever felt the need to cut down on your drinking?
  • Have you ever felt annoyed by someone criticising your drinking?
  • Have you ever felt guilty about drinking?
  • Have you ever felt the need for a drink in the morning?
20
Q

What questions are used in an alcohol history to investigate dependence?

A
  • Do you feel a need to drink?
  • Does alcohol take priority over other activities?
  • Have you ever experienced withdrawal symptoms - shakes, flu like, from not drinking?
  • Do you find yourself having to drink more in order for it to have the same effect?
  • Do you think alcohol is making your situation worse, do you drink anyway?
21
Q

What are the features of alcohol withdrawal?

A
  • Occur 10-72 hours post last drink
  • Pulse increases, blood pressure drops
  • Tremor
  • Confusion, fits
  • Hallucinations = delirium tremens
22
Q

What are the effects of chronic alcohol intake on the body?

A
  • Liver: fatty, cirrhosis, hepatitis
  • CNS: memory impairment, cortical atrophy, fits, falls, wide based gait, Korsakoffs, Wernicke’s encephalopathy
  • Gut: obesity, D&V, ulcers, varices, erosion, pancreatitis, cancer, oesophageal rupture
  • Blood: Raised MCV anaemia, bone marrow depression, folate deficiency, haemolysis, sideroblastic anaemia
  • Heart: arrhythmia, hypertension, cardiomyopathy, sudden death
23
Q

How is alcohol dependency managed?

A
  • Group therapy/self help
  • Encourage will to change
  • Disulfuram: causes acetaldehyde to build up - SE when drink alcohol
24
Q

How is severe alcohol withdrawal managed?

A
  • Admit
  • Chlordiaz epoxide
  • Vitamins and thiamine
25
Q

What type of dementia is associated with a step wise progression, and has a sudden onset?

A

Vascular

26
Q

What type of dementia is associated with hallucinations and Parkinsonism?

A

Lewy body

27
Q

What type of dementia can be associated with behavioural and personality changes?

A

Fronto-temporal

28
Q

What are clinical features of dementia?

A
  • Agitated, aggressive, hallucinations
  • Slow repetitive speech
  • Apathy, mood disturbances
  • Depression
29
Q

What investigations should be carried out in suspected dementia?

A
  • FBC, U&Es, ESR, Ca, TSH, B12/Folate, LFTs, glucose, Syphilis
  • CT/MRI/ECG/MSU
30
Q

What is the pathology of Alzheimers?

A
  • Cerebral atrophy
  • M. Temporal lobe atrophy
  • Senile plaques: extra cellular, B-amyloid
  • Amyloid deposition in blood vessels
  • Intracellular neuro-fibrillary tangles
  • Reduced ACh
31
Q

What are risk factors for Alzheimers?

A
  • First degree relative
  • Vascular RF
  • ApoE4
  • Reduced cognitive activity, loneliness
  • Down’s syndrome
  • Depression
32
Q

What is the definition of Alzheimer’s?

A
  • A chronic/progressive syndrome that causes disturbances of multiple higher cortical functions. Consciousness is not affected. Accompanied by deterioration in emotional control, social behaviour or motivation.
33
Q

How is memory generally affected in Alzheimer’s?

A
  • Problems of learning of new information

- Recall of previous information may also be affected

34
Q

Where is the best place to assess for dementia?

A
  • Patient’s home

- Be aware of environment etc

35
Q

What are the 5 A’s of Alzheimers?

A 
Amnesia - memory
Aphasia - speech
Agnosia - recognition
Apraxia - doing
Associated behaviours
36
Q

What behavioural symptoms can occur in Alzheimer’s?

A
  • Aggression
  • Wandering
  • Restlessness/agitated
  • Crying/screaming
  • Apathy
  • Repetitive questioning
  • Hoarding
37
Q

What are psychological symptoms of Alzheimer’s?

A
  • Delusions
  • Hallucinations
  • Depressed
  • Insomnia
  • Anxiety
  • Misidentifications
38
Q

What is the management of Alzheimer’s?

A
  • Specialist memory services
  • Acetylcholinesterase inhibitors
  • BP Control

CCs (12 decks)

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