mental health Flashcards
depression:
- which age group highest in?
- which gender higher in?
- risk factors? 10
- 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)
depression symptoms:
- physical? 9
- 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)
depression symptoms:
- psychological? 10
- 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
what is the negative cognitive triad in depression?
self: worthlessness
world: critical, guilt
future: hopelessness
the cycle of pessimistic thoughts seen in depression
depression:
clinical examinations? 3
- 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
depression:
- non-pharm treatment? 5
- CBT (or other talking therapy)
- manage underlying physical conditions
- manage alcohol/drug missuse
- exercise
- good sleep hygiene + diet
depression:
- pharm treatment? 4
describe when use different types (and examples of drug names)
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
differential diagnoses for depression:
- psychiatric? 6
- CNS? 4
- endocrine? 3
- drug-induced? 3
- infectious? 2
- other? 3
- 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
anxiety:
- types? 7 (+ differences between them)
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
anxiety:
- risk factors? 5
- 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
anxiety:
- psychological symptoms general to all forms? 2
physical symptoms general to all forms? 10
- symptoms specific to PTSD? 4
- 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
treatment:
- GAD? 4
- social phobia? 4
- panic disorder? 3
- agoraphobia? 3
- other phobias? 3
- PTSD? 3
- OCD? 2
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
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)
- 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!!!
alcohol dependence:
- what are the 4 CAGE questions?
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)
alcohol dependence:
- risk factors? 6
- symptoms? 12
- 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
alcohol dependence:
- clinical signs?
- 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
alcohol dependence, what can it put you at risk of/lead to:
- GI tract? 3
- other GI? 2
- neuro effects? 4
- other effects? 3
- 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)
wernicke’s encephalopathy:
- what is it specifically due to?
- main symptoms? 3
- what’s can it co-occur with?
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
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?
- 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!
self-harm:
- who most at risk?
- other risk factors? 9
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
self harm:
- methods of self harm (incl signs)? 6
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
self-harm:
- treatment?
- 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
delirium:
- underlying causes? 10
- largest risk factor (bar above)?
- other risk factors? 8
- 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
delirium:
- signs of delerium? (incl acronym)
- what is the timescale and pattern of these signs and what different types are there?
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
