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Mental Health Flashcards

1
Q

DEPRESSION: How common is it?

A

2.6-15% prevalence. 1.6/100 new cases per year

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2
Q

DEPRESSION: Risk factors

A

Elderly
Mid 30s (if recurrent)
F:M 2:1
Low social class & unemployment

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3
Q

DEPRESSION: Presentation

A 
Biological:
Loss of interest or pleasure
Lack of emotional reactivity
Loss of energy, fatigue
Insomnia, with early morning wakening (or hypersomnia)
Diurnal mood variation
Psychomotor retardation
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4
Q

DEPRESSION: Signs on examination

A 
Somatic symptoms:
Loss of appetite (or increased)
Weight loss
Constipation
Amenorrhoea
Loss of libido
Psychomotor agitation

Psychological symptoms:
Poor concentration, indecisiveness
Pessimistic thoughts - Negative cognitive triad: Self = Worthless, World = Critical, guilt, Future = Hopelessness
Poor self esteem/confidence
Guilt & worthlessness
Hopelessness & thoughts of self harm/suicide

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5
Q

DEPRESSION: Investigations

A

MSE: Psychotic features, suicidal thoughts
Screen for risk - 3 main domains: Risk to SELF, Risk to OTHERS, SUICIDE & SELF-HARM
PHQ-9
Geriatric Depression Scale (GDS)
Hospital Anxiety & Depression Scale
ICD-10 Core symptoms

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6
Q

DEPRESSION: ICD-10 Core Symptoms

A 
Low or depressed mood
Loss of interest & enjoyment
Loss of energy
Duration more than 2 weeks
Each symptom present at sufficient severity for most of every day
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7
Q

DEPRESSION: Treatment

A

Bio-psycho-social: CBT + Manage underlying physical cause/behaviour (eg drug misuse)
Antidepressants (for 6 months after remission):
- SSRIs - fluoxetine, citalopram, sertraline
- Tricyclics - Amitriptyline, lofepramine
- NaSSA - Mirtazapine
- SNRI - Venlafaxine
Not for mild depression! (unless symptoms present for long time)
Improve social circumstances!

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8
Q

Conditions that would present similarly to DEPRESSION

A

PTSD, anxiety & other neurotic disorders, somatisation

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9
Q

ANXIETY: How common is it?

A

25% lifetime risk

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10
Q

ANXIETY: Causes

A

Normal emotion, but can become out of proportion & interfere with daily life

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11
Q

ANXIETY: Risk Factors

A

GAD Risk Factors:

  • Environmental stressors - eg domestic violence, unemployment, separation, child abuse, low SE status
  • Genetic factors - 5 fold increase if 1st degree relative
  • Substance dependence
  • Cognitive styles of negative thinking
  • Chronic illness
  • Neurophysiological factors
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12
Q

ANXIETY: Presentation

A
  • Psychological - worry, apprehension, poor concentration, persistent nervousness, irritability
  • Arousal - Hypervigilance, restlessness, increased startle response
  • Fears: patient or relative will become ill, fear of losing control, unrealistic ideas of danger, fear of dying, can’t cope
  • Motor - Muscle tension, headaches, trembling, purposeless activity, weakness
  • Autonomic - CVS (palpitations, tightness etc), RESP (over breathing, difficulty inhaling), GI (dry mouth, dysphagia etc), GUS (freq micturition), Neuro (blurred vision, light headed, tingling)
  • Sweating, sleep disturbance, derealisation, depersonalisation, flushing
  • Obsessions - Repetitive intrusive involuntary anxiety provoking thoughts - recognised as own
  • Compulsions - Patient has insight
  • PTSD - flashbacks, emotional blunting, anhedonia, avoidance of activities
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13
Q

ANXIETY: Investigations

A

GAD screening questions - see history

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14
Q

ANXIETY: Treatment

A

Manage underlying physical disorders
CBT
Antidepressants - SSRIs, NaSSAs, SNRI, pregabalin, trazadone, buspirone, BENZODIAZEPINES - PRN only (NOT FOR GAD OR PANIC DISORDERS)

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15
Q

Conditions that present similarly to ANXIETY

A

Physical Disorders - Heart Disease (IHD, AF, heart failure, PE), Diabetes, Under/overactive thyroid, Asthma/COPD, IBS, Tumours (eg phaeochromocytoma)
Drug & alcohol abuse or withdrawal
Depression
Psychosis

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16
Q

ALCOHOL DEPENDENCE: How common is it?

A

6% M, 2% F

Prevalence: 0.69-0.1% (Mild-Severe)

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17
Q

ALCOHOL DEPENDENCE: Who does it effect?

A

Adults from most minority ethnic groups are LESS likely to drink than the general population

18
Q

ALCOHOL DEPENDENCE: Cause

A

AD = Classified as a score as 20+ in the AUDIT (Alcohol Use Disorders ID Test) questionnaire.
Confirm using ICD-10

19
Q

ALCOHOL DEPENDENCE: ICD-10 criteria

A

If 3+ have been present during the previous year:

  • Strong desire/compulsion to drink
  • Difficulty in controlling drinking onset/termination/level
  • Physiological withdrawal state - eg tremor, sweating, tachycardia, anxiety, insomnia, disorientation
20
Q

ALCOHOL DEPENDENCE: Treatment

A

Advise reducing alcohol consumption, advise to not operate heavy machinery, AA groups
Don’t prescribe NSAIDS/Warfarin if hepatic varices
Parenteral thiamine if Wernicke’s encephalopathy
Prophylactic oral thiamine to harmful drinkers IF: malnourished/decompensated liver disease/acute withdrawal
PSYCHOLOGICAL: CBT, social network

21
Q

SELF HARM: How common is it?

A

Prevalence 0.5% (low self- reporting?)

22
Q

SELF HARM: Who does it effect?

A

15-19y/o F, 20-24y/o M

15-16y/0 - 10% girls, 3% boys

23
Q

SELF HARM: Risk Factors

A 
SE disadvantage, asylum seeker
Socially isolated, single, divorce, living alone, sexual minority
Stressful life events
Mental health problems
Chronic physical health problems
Alcohol/drug misuse
Involvement in criminal justice system
Child maltreatment, domestic violence
24
Q

SELF HARM: Signs on examination

A

Take a very detailed history and risk assessment (physical, psychological, to self and others, SAFEGUARDING)

25
SELF HARM: Treatment
Follow up within 48hours | Manage any psychosocial needs & remove access to any means of self harm
26
DELIRIUM: How common is it?
Prevalence 0.4%
27
DELIRIUM: Who does it effect?
65+y/o, living in long term care = 10-40% Up to 50% of elderly in hospital Complicates 17-61% of surgery
28
DELIRIUM: Causes
MULTIFACTORIAL - if predisposing factors already present, it only takes a precipitating factor to result in delirium Precipitating factors: Infection (eg UTI), metabolic disturbances, CV disorders, Resp disorders, Neuro, Endocrine, Urological, medication (benzopdiazepines, opioids) Predisposing factors - See Risk factors
29
DELIRIUM: Risk factors
.65y/o, cognitive impairment, frailty/multiple comorbidities, significant injuries, functional impairment, iatrogenic events, sensory impairment, poor nutrition, lack of stimulation, terminal phase of illness
30
DELIRIUM: Presentation
Acute behavioural changes (hours-days) - underlying precipitating factor Lucid intervals, worst disturbances at night - Altered cognitive function, inattention, disorganised thinking, altered perception, altered level of consciousness, falling, loss of appetite HYPERACTIVE DELIRIUM: Increased sensitivity to surroundings, agitation/restlessness HYPOACTIVE DELIRIUM (more common): Clouding consciousness, reduced awareness MIXED
31
DELIRIUM: Investigations
History from someone who knows patient well
32
DELIRIUM: Treatment
Treat underlying condition | Low dose haloperidol for LESS than a week
33
Conditions that present similarly to DELIRIUM
Depression, dementia, mental illness, anxiety Thyroid disease Non-convulsive epilepsy/temporal lobe epilepsy Charles bonnet syndrome: visual hallucinations in those with severe visual impairment
34
DEMENTIA: How common is it?
835,000 in UK 2014 - 62% F, 38% M
35
DEMENTIA: Who does it effect?
Prevalence: 7.1% in 65+y/o
36
DEMENTIA: Causes
Alzheimer's (50-75%): Atrophy of cerebral cortex & formation of amyloid plaques & neurofibrillary tangles. Acetylcholine production in affected neurons is reduced. Vascular (20%): Result of reduced blood supply to brain, caused by cerebrovascular disorders - eg infarcts Lewy Bodies (10-15%): Cortical & subcortical Lewy bodies, similar features to Parkinson's Other Causes: Frontotemporal dementia, Parkinson's, Progressive supranuclear palsy, Huntington's, Prion disease, Chronic subdural haematoma, Benign tumours, metabolic & endocrine disorders, vitamin deficiencies
37
DEMENTIA: Risk Factors
Age, mild cognitive impairment, learning difficulties, genetics (86% have mutation in amyloid precursor protein gene), APOE4 for Alzheimer's, Cardiovascular disease RF, Parkinson's disease, Stroke, Depression, Heavy alcohol consumption, low educational attainment, low social engagement & support
38
DEMENTIA: Presentation
Cognitive impairment, inc: memory problems, difficulty learning/recalling new info, vague with dates, receptive/expressive dysphagia, difficulty in coordinating movements, disorientation in time & place, Difficulty with daily living activities Behavioural & psychological symptoms of dementia (BPSD) tend to fluctuate (6months or more): Psychosis, agitation, emotional liability, depression & anxiety, withdrawal or apathy, disinhibition, motor disturbance, sleep disturbance, tendency to repeat phrases & questions
39
DEMENTIA: Investigations
Assess capacity for each decision | MRI or CT to exclude non-dementia cerebral pathology - eg normal pressure hydrocephalus
40
DEMENTIA: Treatment
ACEi (donepezil, galantamine) for mild to moderate Alzheimer's (Memantine for severe) Antipsychotics are bad & don't work
41
Conditions that present similarly to DEMENTIA
``` Normal-age related memory changes Mild cognitive impairment Depression Delirium Vitamin Deficiency Hypothyroidism Adverse drug effects (eg benzodiazepines, analgesics, anticholinergics, antipsychotics, anti-convulsants & corticosteroids) Normal pressure hydrocephalus Sensory deficits ```

Core Conditions (2 decks)

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