Mental Health Flashcards
1
Q
Define alcohol dependence
A
- Characterised by THREE OR MORE of the following:
(o Withdrawal on cessation of alcohol
o Tolerance
o Compulsion to drink, difficulty controlling termination or levels of use
o Persistent desire to cut down or control use
o Time is spent obtaining, using or recovering from alcohol
o Neglect of other interests (social, occupations or recreational)
o Continued use despite physical and psychological problems ) - Recommended weekly amount < 14 units/week (1 unit = 8 g of alcohol)
2
Q
Explain the aetiology/risk factors of alcohol dependence
A
- Genetic factors
- Environmental factors (upbringing)
- Patients with depressive and anxiety states are at increased risk
- Alcohol Withdrawal Pathophysiology
(o Alcohol:
(* Enhances inhibitory GABA activity - Inhibits excitatory glutamate neurotransmission )
o Chronic alcohol exposure leads to a compensatory reduction in GABA receptor function and upregulation of excitatory glutamate receptors
o Abrupt alcohol cessation leads to overactivation of these excitatory receptors)
3
Q
Summarise the epidemiology of alcohol dependence
A
- US prevalence: 2-9%
4
Q
Recognise the presenting symptoms of alcohol dependence
A
- History of heavy drinking
- CAGE Questions
(o Have you felt like you should Cut down on drinking?
o Have you felt Annoyed by people telling you to stop drinking?
o Have you ever felt Guilty about how much you drink?
o Do you feel like you need a drink to wake you up (Eye-opener)? ) - Check for other comorbidities/risk factors (e.g. smoking, depression)
* Symptoms of Withdrawal (o Nausea o Sweating o Tremor o Restlessness o Agitation o Visual hallucinations o Confusion o Seizures)
5
Q
Recognise the signs of alcohol dependence on physical examination
A
* Signs of chronic alcohol misuse (o Dupuytren's contracture o Palmar erythema o Bruising o Spider naevi o Telangiectasia o Facial mooning o Bilateral parotid enlargement o Gynaecomastia o Smell of alcohol ) * Signs of complications (e.g. alcoholic hepatitis, liver failure)
6
Q
Identify appropriate investigations for alcohol dependence
A
* Bloods (o Macrocytic anaemia o High GGT o High AST/ALT o Others: high uric acid, high triglycerides, markers of organ damage (e.g. long PT) ) * Acute Overdose (o Blood alcohol o Glucose o ABG o U&Es o Toxic screen (check for drug overdose e.g. barbiturates, paracetamol))
7
Q
Define anxiety disorder
A
- A group of mental disorders characterised by feelings of anxiety or fear.
8
Q
Explain the aetiology/risk factors of anxiety disorder
A
- It is a syndrome of ongoing anxiety and worry about many events or thoughts that the patient generally recognises as excessive and inappropriate
- Risk Factors
(o Being aged 35-54
o Being divorced or separated
o Living alone or as a single parent )
9
Q
Summarise the epidemiology of anxiety disorder
A
- Lifetime prevalence of about 5%
* More common in WOMEN
10
Q
Recognise the presenting symptoms and signs of anxiety disorder
A
* Diagnostic criteria for anxiety disorder: (o Excessive anxiety and worry occurring more days than not for at least 6 months o Patient finds it difficult to control the worry o Anxiety and worry are associated with 3 or more of the following symptoms: (* Restlessness * Easily fatigued * Difficulty concentrating * Irritability * Muscle tension * Sleep disturbance )) * Autonomic arousal symptoms: (o Palpitations o Sweating o Trembling o Dry mouth ) * Chest and abdomen symptoms: (o Difficulty breathing o Feeling of choking o Chest pain or discomfort o Nausea/abdominal pain ) * Symptoms involving mental state: (o Dizziness/light-headedness o Feeling of losing control o Fear of dying ) * General symptoms: (o Hot flushes and cold chills o Numbness and tingling sensation o Muscle tensions or aches and pains o Restlessness o Globus )
11
Q
Identify appropriate investigations for anxiety disorder
A
- It is a CLINICAL diagnosis
12
Q
Define depressive disorders
A
- A mood disorder that causes a persistent feeling of sadness and loss of interest.
13
Q
Explain the aetiology/risk factors of depressive disorders
A
- NICE recommends the use of DSM-IV classification to diagnose depression
- Major depression requires at least one of the core symptoms:
(o Persistent sadness or low mood nearly every day
o Loss of interests or pleasure in most activities ) - Along with some of the following symptoms:
(o Fatigue or loss of energy
o Worthlessness, excessive or inappropriate guilt
o Suicidal thoughts
o Diminished ability to think or concentrate
o Psychomotor agitation and retardation
o Insomnia
o Changes in appetite and/or weight loss ) - Symptoms should have persisted for at least 2 weeks
- Risk Factors
(o Being FEMALE
o Past history of depression
o Significant physical illness causing disability or pain
o Other mental health problems (e.g. dementia)
o Being part of a refugee community )
14
Q
Summarise the epidemiology of depressive disorders
A
- 5% of adults will have a depressive episode every year
* 1/4 women will develop depression severe enough to require treatment at some point in their lives
15
Q
Recognise the presenting symptoms and signs of depressive disorders
A
- Look above at the aetiology learning objectives
- Somatisation (physical symptoms resulting from psychiatric illness) is a very important signs and must not be missed
- Elderly people may present with depressive pseudodementia (altered memory and behaviour that mimics dementia)
- Assessment Tools
(o Patient Health Questionnaire (PHQ-9)
o Hospital Anxiety and Depression (HAD) Scale
o Beck’s Depression Inventory )
