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* year 3 core conditions (detailed) > mental health > Flashcards

mental health Flashcards

1
Q

depression:

  • which age group highest in?
  • which gender higher in?
  • risk factors? 10
A
  • elderly
  • female (2:1)
  • stressful life events (esp multiple)
  • personality (low self-esteem, very self-critical)
  • family history
  • PMH of depression
  • giving birth
  • loneliness
  • alcohol abuse
  • substance abuse
  • hypothyroidism
  • chronic medical problems

(and many more)

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2
Q

depression symptoms:

- physical? 9

A
  • fatigue
  • insomnia, w early morning wakening (or hypersomnia)
  • loss (or gain) of appetite
  • loss (or gain) of weight
  • constipation
  • amenorrhoea
  • psychomotor retardation (slow speech, slow movement, slow thinking)
  • loss of libido
  • unexplained aches + pains (often present w head/back ache)
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3
Q

depression symptoms:

- psychological? 10

A
  • loss of interest or pleasure
  • lack of emotional reactivity
  • diurnal variation in mood
  • pessimistic thoughts
  • poor concentration/attentiveness
  • indecisiveness
  • no motivation/being reclusive
  • guilt + worthlessness (low self-esteem)
  • anxiety feelings
  • thoughts of self-harm/suicide
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4
Q

what is the negative cognitive triad in depression?

A

self: worthlessness
world: critical, guilt
future: hopelessness

the cycle of pessimistic thoughts seen in depression

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5
Q

depression:

clinical examinations? 3

A
  • mental state examination
  • PHQ-9
  • screen for risk (see below)
= suicide + self-harm
- past attempts
- current thinking/plans
- acute stressors
= risk to self
- able to cope at home
- basic living skills
- intoxication
= risk to others
- forensic history
- impulsivity
- any dependents
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6
Q

depression:

- non-pharm treatment? 5

A
  • CBT (or other talking therapy)
  • manage underlying physical conditions
  • manage alcohol/drug missuse
  • exercise
  • good sleep hygiene + diet
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7
Q

depression:
- pharm treatment? 4

describe when use different types (and examples of drug names)

A 
SSRIs
= 1st line (same efficacy as tricyclics but fewer side effects)
- fluoxetine (best for younger people)
- citalopram
- sertraline
Tricyclics
= sometimes used, also for nerve pain, migraines, fibromyalgia + other things (bit of a marmite drug)
- amitriptyline
- nortriptyline
- lofepramine

NaSSA
= often used as also has an anti-histamine effect which helps with insomnia
- mirtazapine

SNRIs
= often used by psychiatrists when SSRIs haven’t worked
- venlafaxine
- duloxetine

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8
Q

differential diagnoses for depression:

  • psychiatric? 6
  • CNS? 4
  • endocrine? 3
  • drug-induced? 3
  • infectious? 2
  • other? 3
A
  • bipolar disorder
  • dysthymia
  • PTSD
  • eating disorders
    (nb above, plus anxiety, are often co-morbid w depression)
  • chronic fatigue syndrome (CFS/ME)
  • dementia
  • post-concussion syndrome
  • MS
  • parkinsons
  • brain tumours
    (nb depression does not produce focal neurological signs, if found should look for other causes of low mood)
  • hypothyroidism
  • hypoparathyroidism
  • cushings syndrome
  • OCP (particularly progesterone only)
  • anti-epileptic drugs
  • interferons
    (and many others)
  • syphilis
  • toxoplasmosis
  • SLE
  • anaemia
  • folate deficiency

nb insomnia + sleep apnoea can also mimic depression

nb also grief

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9
Q

anxiety:

- types? 7 (+ differences between them)

A

generalised anxiety disorder (GAD)
- consistent feelings of excessive, unrealistic worry + tension with little/no reason

social phobia
- feel overwhelming worry + self-conciousness about everyday social situs, fixate about other judging you/beng embarrassed or ridiculed

panic disorder

  • acute terror that strikes at random
  • manifests as panic attacks (+ fear of getting panic attacks)

agoraphobia

  • fear of open spaces/public transport/leving home etc
  • but more complex than that

phobias

  • intense fear of a specific object or situation disproportionate to risk of object/situ
  • go to great lengths to avoid it

PTSD (EMDR or DBT)

OCD (CBT)

  • obsession (thought based) is an unwanted + unpleasant thought/image or urge that enters your mind
  • compulsion (behaviour based) is a repetitive behaviour or mental act that you feel you need to carry out to try to temporarily relive the unpleasant feelings brought on by the obsessive thought
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10
Q

anxiety:

- risk factors? 5

A
  • environmental stressors/trauma (sexual assault, violence, bullying)
  • FH
  • substance dependence or abuse
  • cognitive styles of negative thinking
  • chronic illness

nb anxiety is a normal feeling/emotion in response to a stimulus but when it occurs without stimulus or after that has disappeared then this is a medical condition

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11
Q

anxiety:
- psychological symptoms general to all forms? 2
physical symptoms general to all forms? 10
- symptoms specific to PTSD? 4

A
  • panic, fear, uneasiness
  • not being able to stay calm + still
  • sleep problems
  • cold, sweaty, numb or tingling hands/feet
  • dry mouth
  • tense muscles
  • SOB
  • palpitations
  • chest pain/tightness
  • nausea
  • dizziness
  • headaches
  • re-experiencing (flashbacks/nightmares/physical sensations on remembering)
  • avoidance
  • emotional numbing
  • hyperarousal
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12
Q

treatment:

  • GAD? 4
  • social phobia? 4
  • panic disorder? 3
  • agoraphobia? 3
  • other phobias? 3
  • PTSD? 3
  • OCD? 2
A

GAD

  • group/online therapy
  • CBT
  • mindfullness/applied relaxation
  • antidepressants (if above not effective)

social phobia

  • online CBT/self help
  • CBT
  • psychotherapy
  • antidepressants (if above don’t work)

panic disorder

  • CBT
  • antidepressants
  • propranolol (used like a blue inhaler in asthma)

agoraphobia

  • self help + lifestyle changes
  • CBT
  • medication (rarely)
other phobias
- self help
- CBT
- mindfullness
(rarely meds)

PTSD

  • CBT (or psychotherapy)
  • EMDR (eye movement desensitisation + reprocessing)
  • antidepressants

OCD

  • CBT
  • antidepresssants
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13
Q

differential diagnoses for anxiety

  • psychiatric? 2
  • medications? 2
  • cardiac? 2
  • endocrine? 2
  • respiratory? 2

nb this is not an exhaustive list!! (it also excludes the different types of anxiety)

A
  • schizophrenia/psychosis
  • mania
  • withdrawal from alcohol (+ benzodiazepines, cocaine, marijuana + SSRIs)
  • certain stimulants (amphetamines, asthma meds, caffeine)
  • AF (or other arrhythmia)
  • angina
  • pheochromocytoma
  • hyperthyroidism
  • asthma
  • COPD

loads of other things as well!!!

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14
Q

alcohol dependence:

- what are the 4 CAGE questions?

A

C - ever felt you ought to Cut down on your drinking?
A - have people Annoyed you by criticising your drinking?
G - ever felt bad or Guilty about your drinking (e.g. if it lead you to neglecting your responsibilities or relationships)
E - ever had an Eye-opener to steady nerves in the morning? (drinking to relieve withdrawal symptoms is telling sign)

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15
Q

alcohol dependence:

  • risk factors? 6
  • symptoms? 12
A
  • male
  • high alcohol intake
  • FH of alcoholism
  • PMH of mental health problems
  • low self-esteem
  • stress
  • drinking ALONE
  • drinking in the MORNING
  • having high alcohol TOLERANCE
  • becoming VIOLENT/ANGRY when asked about drinking habits (i.e. denial)
  • not EATING/eating poorly
  • neglecting personal HYGIENE
  • MISSING works/school dt drinking
  • making EXCUSES to drink
  • CONTINUING to drink when legal/social Econ problems develop
  • alcohol CRAVINGS
  • WITHDRAWAL symptoms when not drinking (shaking, nausea, vomitting, sweating, anxiety)
  • BLACK OUTS after a night of drinking
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16
Q

alcohol dependence:

- clinical signs?

A
  • palmar erythema
    (- hypertension)
  • liver flap
  • tremor
  • smell on breath
  • hair loss
  • bruising
  • itching
  • gynacomastia
  • jaundice (+ in sclera)
  • spider naevi
  • hepatomegaly
    (- caput medusa)
  • ascites

nb these are mainly just symptoms of liver cirrhosis/failure and won’t be present in early stages

17
Q

alcohol dependence, what can it put you at risk of/lead to:

  • GI tract? 3
  • other GI? 2
  • neuro effects? 4
  • other effects? 3
A
  • oesophageal varices
  • peptic ulcers
  • GI cancers
  • liver cirrhosis
  • pancreatitis
  • dementia
  • depression
  • nerve damage
  • wernickes encephalopathy
  • high blood pressure
  • macroytic anaemia
  • impotence

(if in pregnancy: foetal alcohol syndrome)

18
Q

wernicke’s encephalopathy:

  • what is it specifically due to?
  • main symptoms? 3
  • what’s can it co-occur with?
A

thiamine (B1) deficiency

  • confusion
  • ataxia
  • ophthalmoplegia

nb this is partially reversible with thiamine supplements

Korsakoff’s syndrome
- inability to create new memories
- confabulation of memories
lack of insight + apathy

nb this is more irreversible than Wernicke’s

19
Q

alcoholism:

  • withdrawal symptoms/signs? 6
  • non-pharm treatments? 2
  • pharm treatment to prevent complications?
  • pharm treatment to use for medically-induced withdrawal?
  • pharm treatment which causes bad reaction to alcohol?
A
  • increased pulse
  • low BP
  • tremor
  • confusion
  • fits
  • hallucinations (delirium tremens)
  • group therapy (e.g. AA)
  • CBT/psychotherapy
  • oral (or IV) thiamine to protect against/treat Wernickes/Korsakoffs
  • benzodiazepines (norm chlordiazepoxide) - slowly taper off, a GABA agonist (similar effect to alcohol)

disulfarim
- causes acetaldehyde build up (like metronidazole) -> nausea, headaches, palpitations etc

nb lots of relapse, especially if underlying psychological + social issues not

nb don’t prescribe NSAIDs or anticoagulants to patients with/high risk of oesophageal varies as increases bleeding risk!

20
Q

self-harm:

  • who most at risk?
  • other risk factors? 9
A

adolescents + young adults
(women more than men)

  • low socio-economic background
  • socially isolated
  • single or divorced
  • sexual minority
  • asylum seeker/refugee
  • stressful life events
  • mental health conditions (depression, schizophrenia etc)
  • alcohol or drug missuse
  • child abuse/sexual abuse/domestic violence
21
Q

self harm:

- methods of self harm (incl signs)? 6

A

cutting or burning skin

  • unexplained cuts/bruises/cigarette burns, norm on wrist/arms/thighs/chest
  • keeping themselves covered, even in hot weather

punching or hitting themselves

poisoning themselves with tablets (e.g. paracetamol) or chemicals
- overdose

misusing alcohol or drugs

deliberately starving themselves (anorexia nervosa or binge eating (bulimia nervosa)
- change in eating habits, being secretive about eating, any unusual weight gain or loss

excessively exercising

  • signs of depression
  • self-loathing
  • becoming withdrawn
  • low self-esteem
  • signs of pulling hair out
  • signs of drug/alcohol missuse
22
Q

self-harm:

- treatment?

A
  • treat damage done (stop bleeding, treat OD etc)
  • don’t discharge until seen psychiatric nurse etc
  • start CBT
  • identify triggers
  • remove instruments
  • counselling to address underlying problems (e.g. coming to terms w sexuality, bullying, bereavement)
  • treatment of underlying mental health condition

nb though self-harm can be intended suicide, often it is not intended to be fatal and is more of a cry for help

23
Q

delirium:

  • underlying causes? 10
  • largest risk factor (bar above)?
  • other risk factors? 8
A
  • SYSTEMIC INFECTION (pneumonia, UTI, malaria)
  • INTRACRANIAL INFECTION (meningitis, encephalitis)
  • DRUGS (opiates, anti epileptics, levodopa, sedatives, post-GA)
  • ALCOHOL WITHDRAWAL (2-5 days post-admission)
  • METABOLIC (uraemia, liver failure, Na or glucose high or low)
  • HYPOXIA (resp or cardiac failure)
  • VASCULAR (stroke or MI)
  • HEAD INJURY (raised ICP, space occupying lesions/haematomas)
  • EPILEPSY (non-convulsive status epilepticus, post-octal states)
  • NUTRITIONAL (thiamine, nicotinic acid, B12 deficiency)

AGE OVER 65!!!

  • cognitive impairment (e.g. dementia)
  • frailty
  • multiple comorbidities
  • functional impairment (immobility)
  • iatrogenic events (catheterisation, polypharmacy or surgery)
  • PMH or current alcohol excess
  • poor nutrition
  • terminal phase of illness
24
Q

delirium:

  • signs of delerium? (incl acronym)
  • what is the timescale and pattern of these signs and what different types are there?
A

DELERIUM

D - DISORDERED THINKING (slow, irrational, rambling, jumbled up, incoherent ideas)
E - EUPHORIC, FEARFUL, DEPRESSED OR ANGRY (labile mood)
L - LANGUAGE IMPAIRED (speech is reduced or gambling, repetitive + disruptive)
I - ILLUSIONS/DELUSIONS/HALLUCINATIONS (tactile or visual - auditory suggests psychosis)
R - REVERSAL OF SLEEP/WAKE CYCLE (may be drowsy in day + hyper vigilant at night)
I - INATTENTION (focusing, sustaining or shifting attention is poor, no real dialogue)
U - UNAWARE/DISORIENTATED (doesn’t know it’s evening or his own namer location)
M - MEMORY DEFICITS (often marked - later may be amnesic for episode)

basically globally impaired cognition + impaired awareness/consciousness

  • behavioural changes develop ACUTELY (hours to days)
  • normally clinical evidence of underlying illness/drug reaction etc

hyperactive delirium
= increased sensitivity to their surroundings, agitation + restlessness

hypoactive delirium (more common)
= clouding of conciousness + reduced awareness

mixed
= have features of both

25
Q

delirium:

  • main three types of investigations? 2
  • three different forms of management?
A
  • identify whether person have features of delirium (mental state exam, AMTS etc)
  • identify the norm/timescale (normally by taking a collateral history from relative etc to understand whether this is acute or long-term)
  • identify the underlying illness, deficiency etc that is resulting in this
    1) support and make environment comfortable, put in side room, get fam to sit with, try not to change staff, make sure have hearing aids/glasses, remove catheters if poss
    2) treat underlying condition/review and remove unnecessary drugs
    3) treat with low dose sedatives (e.g. haloperidol) to calm but try and avoid if poss
26
Q

differential diagnoses for delirium? 6

A
  • anxiety (may be acute, e.g. prior to surgery, phobia of hospitals)
  • depression
  • schizophrenia
  • dementia
  • thyroid disease
  • non-convulsive epilepsy

history and timescale is very important to differentiate
- nb delirium may persist beyond the duration of the underlying illness so don’t try to diagnose dementia until a month or so later

27
Q

dementia:

  • 3 commonest types of dementia? (incl pathogenesis)
  • other causes of dementia? 9
A 
Alzheimers disease (50-75%)
- formation of amyloid plaques + neurofibrillary tangles, ACh production in affected neutrons is reduced
Vascular dementia (20%)
- result of reduced blood supply to brain, can be multiple mini infarcts or larger ones

Dementia with Lewy bodies (10-15%)

  • cortical + subcortical lewy bodies
  • nb may have similar features to Parkinson’s
  • frontotemporal (picks) dementia
  • Parkinson’s disease dementia
  • progressive supra nuclear palsy (PSP)
  • huntingtons disease
  • prion disease
  • normal pressure hydrocephalus
  • chronic subdural haematoma
  • metabolic + endocrine disorders (prolonged hypocalcaemia or hypoglycaemia)
  • vitamin deficiencies (B12, thiamine)
28
Q

dementia:

  • main risk factor?
  • genetic risk factors? 2
  • other risk factors? 9
A

AGE

  • mutation in amyloid precursor protein gene (esp in young-onset)
  • APOE4 subtype (for alzheimers
  • mild cognitive impairment
  • learning difficulties
  • CVD risk factors (diabetes, smoking, high cholesterol etc)
  • heavy alcohol consumption
  • stroke
  • parkinsons disease
  • depression
  • low educational attainment
  • low social engagement + support
29
Q

dementia:

- symptoms? 7

A
  • memory loss (esp recent memories)
  • difficulty concentrating
  • difficulty with ADLs
  • struggling to follow a convo or find the right word
  • being confused re time + place
  • mood changes
  • weight loss + changes in sleep patterns

and many others!

30
Q

dementia:

  • bloods? 9
  • imaging? 1
  • other investigations? 2
A
  • FBC
  • ESR
  • U + E
  • Ca2+
  • LFT
  • TFTs
  • autoantibodies
  • B12/folate
  • syphillis serology (HIV if indicated)

CT or MRI of head

other tests if suspicion

  • collateral history from relatives etc (timescale is especially useful)
  • structured cognitive testing
31
Q

dementia:

- important aspects to consider when managing patients with dementia? 9

A
  • treat any underlying cause (e.g. reduce vascular risks, give B12 etc)
  • get a care coordinator
  • assess capacity
  • develop routines (helps with confusion)
  • plan ahead (look to move into care home before needed so not rush)
  • organise activities during day to keep up stimulation
  • who will care for carers?
  • screen for depression (common) + treat w SSRI
  • ensure calorie intake is sufficient
  • avoid drugs that impair cognition (tricyclics, sedatives etc)
32
Q

dd for dementia:

  • psych/neuro? 4
  • drugs? 6
  • other? 2
A
  • normal age-related memory changes
  • mild cognitive impairment
  • depression (weeks to months)
  • delirium (hours to days)
  • benzodiazepines
  • analgesics
  • anticholinergics
  • antipsychotics
  • anticonvulsants
  • corticosteroids
  • vitmin deficiency
  • hypothyroidism
33
Q

what is somatisation?

A

when mental or psychological distress causes physical symptoms

nb this is an ‘in depth’ core condition

* year 3 core conditions (detailed) (12 decks)

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