Mental Health Flashcards
1
Q
Define anhedonia.
A
Loss of pleasure in day to day activities
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
3
Q
What is the duration of symptoms required for the diagnosis of major depression?
A
- Nearly every day for at least 2 weeks
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?
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?
6
Q
What aspects are important in a social history for depression?
A
- Occupation
- Living situation
- Care for anyone?
- Alcohol, drugs
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
8
Q
What is ‘anxiety neurosis’?
A
Maladaptive psychological symptoms without organic cause or psychosis.
Generally due to stress
9
Q
How is General Anxiety Disorder defined?
A
Anxiety + 3 somatic symptoms for greater than 6 months
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
11
Q
How can general anxiety disorder be managed?
A
- Symptom control
- Regular exercise
- Meditation
- CBT
- Drugs: Diazepam, SSRIs, B-blockers
- Hypnosis
12
Q
What is the name given to the mental illness that causes the patient to experience different unexplained bodily symptoms?
A
- Somatisation
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
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
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
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
What type of dementia is associated with a step wise progression, and has a sudden onset?
Vascular
26
What type of dementia is associated with hallucinations and Parkinsonism?
Lewy body
27
What type of dementia can be associated with behavioural and personality changes?
Fronto-temporal
28
What are clinical features of dementia?
- Agitated, aggressive, hallucinations
- Slow repetitive speech
- Apathy, mood disturbances
- Depression
29
What investigations should be carried out in suspected dementia?
- FBC, U&Es, ESR, Ca, TSH, B12/Folate, LFTs, glucose, Syphilis
- CT/MRI/ECG/MSU
30
What is the pathology of Alzheimers?
- Cerebral atrophy
- M. Temporal lobe atrophy
- Senile plaques: extra cellular, B-amyloid
- Amyloid deposition in blood vessels
- Intracellular neuro-fibrillary tangles
- Reduced ACh
31
What are risk factors for Alzheimers?
- First degree relative
- Vascular RF
- ApoE4
- Reduced cognitive activity, loneliness
- Down's syndrome
- Depression
32
What is the definition of Alzheimer's?
- 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
How is memory generally affected in Alzheimer's?
- Problems of learning of new information
| - Recall of previous information may also be affected
34
Where is the best place to assess for dementia?
- Patient's home
| - Be aware of environment etc
35
What are the 5 A's of Alzheimers?
```
Amnesia - memory
Aphasia - speech
Agnosia - recognition
Apraxia - doing
Associated behaviours
```
36
What behavioural symptoms can occur in Alzheimer's?
- Aggression
- Wandering
- Restlessness/agitated
- Crying/screaming
- Apathy
- Repetitive questioning
- Hoarding
37
What are psychological symptoms of Alzheimer's?
- Delusions
- Hallucinations
- Depressed
- Insomnia
- Anxiety
- Misidentifications
38
What is the management of Alzheimer's?
- Specialist memory services
- Acetylcholinesterase inhibitors
- BP Control
