Mental Health Flashcards
Depression
Feelings of severe despondency, dejection, feelings of inadequacy and guilt. Accompanied by lack of energy and disturbance of appetite and sleep
How common is Depression
Mid 30s HIgher rates in older people Leading cause of disability and premature death F:M 2:1 Low social class and unemployment
Pathophysiology of Depression
Abnormal concentrations of neurotransmitters
Dysregulation of the HPA axis
Risk Factors for Depression
Age 65+ Post-natal status FHx of depression and suicide Corticosteorid, interferon or propranolol use OCP
Symptoms of Depression
Depressed mood (for 2 weeks) Anhedonia (for 2 weeks) Thoughts of death or suicide Restlessness Irregular sleep Decreased evergy Changes in mood Insomnia Indecisiveness Appetite and weight loss Tearfulness Psychomotor retardation Constipation Amnorrhoea Loss of libido
Negative Cognitive Triad
Self: Worthless
Future: Hopeless
World: Critical, guilt
Screening Tools for Depression
Clinical History
PHQ-9
Geriatric Depression Scale (GDS)
Hospital Anxiety and Depression Scale (HAD)
Patient Health Questionnaire (PHQ-9)
'Over the last 2 weeks, how often have you been bothered by any of the following problems?' Each item rated 0-3 Total Score Depression Severity 0-4 None 5-9 Mild depression 10-14 Moderate depression 15-19 Mod Severe depression 20-27 Severe depression
ICD- 10 Core Symptoms of Depression
Low or Depressed Mood
Loss of interest and enjoyment
Loss of energy
Duration: more that 2 weeks
Differentials for Depression
Bipolar Disorder Dementia Anxiety Disorders Alcohol Abuse Hypothyroidism Cushing's Disease
Biological Treatment for Depression
SSRI e.g. fluoxetine, citalopram, sertraline
Tricyclics e.g. amitriptyline, nortriptyline, lofepramine
NaSSA e.g. mirtazapine
SNRI e.g. venlafaxine, duloxetine
Continue antidepressant medication for at least 6 months after remission of depression- reduces risk of relapse
Psychological treatment for Depression
(For Low-intensity psychosocial interventions)
Improving Access to Psychological Therapies (IAPT) in Primary Care
Problem focussed, counselling
Cognitive Behavioural Therapy (CBT)
Computerised Cognitive Behavioural Therapy (CCBT)
Anxiety
Generalised Anxiety Disorder is 6 months of excessive worry about everyday issues that is disproportionate to any risk, causing distress or impairment
How common is Anxiety
More common in females
Prevalence increases in those with chronic diseases
Increases risk during pregnancy and in the post-natal period
Depression and Anxiety often co-occurs
Symptoms of Anxiety
Restlessness, easily fatigued, poor concentration, irritability, muscle tension, sleep disturbance, sweating, light-headedness, palpitations, dizziness, epigastric discomfort
Treating Anxiety: Psychological
IAPT in primary care
Relaxation, mindfullness, problem focussed counselling, graded exposure
CBT
When NOT to prescribe Benzodiazepines
for Panic Disorders
for GAD in primary and secondary care unless short-term measure during crises
When NOT to prescribe Antipsychotics
for Panic Disorders
for GAD in primary care
Alcohol Dependence
Increased tolerance to the effects of alcohol, presence of withdrawal signs and impaired control over the quantity and frequency of drinking
Pathophysiology of Alcohol Dependence
The pleasurable and stimulant effects of alcohol are mediated by dopaminergic pathway. Repeated, excessive alcohol ingestion sensitises this pathway and leads to dependence. Long term exposure causes:
Down-regulation of inhibitor neuronal GABA receptors
Up-regulation of excitatory glutamate receptors
Increased noradrenaline activity
Discontinuation of alcohol ingestion leaves this excitatory state unopposed resulting in the nervous system hyperactivity and dysfunction that characterises withdrawal
Risk Factors for Alcohol Dependence
FHx of alcoholism
Anti-social behaviour
High trait anxiety level
Symptoms and signs of Alcohol Dependence
Withdrawal: agitation, nercousness, sizsures, delirium
Jaundice, ascites, nausea and vomiting, abdominal pain, haematemesis, gastritis, peripheral neuropathy, HTN
urticarial reactions, flushing, pruritis, broad-based gait
Investigations for Alcohol-dependence
Diagnostic Interview Alcohol Breath Carbohydrate-Deficient transferrin (CDT) increased Gamma-GT, ALT, AST increased Low platelets
Treatment for Alcohol-dependence
Detoxification and supportive medical care
Psychosocial interventions with aim to promote abstinence
Pharmacotherapy
Treatment for Alcohol-dependence
Detoxification and supportive medical care
Psychosocial interventions eg CBT, social network
aim to promote abstinence
Pharmacotherapy
What is the SADQ and LDQ
The Severity of Alcohol Dependence Questionnaire measure the severity of alcohol dependence.
The Leeds Dependence Questionnaire is an indicator of how addicted a person is and therefore how difficult it will be to achieve a positive outcome
Complications of Alcohol Dependence
Mallory-Weiss Tear Delirium tremens Seizures Alcohol Liver Disease Liver Cirrhosis Nutritional Disorders Wernicke encephalopathy and Korsakoff psychosis-t thiamine deficiency
Self-harm
An intentional act of self-poisoning or self-injury, irrespective of the motivation or purpose and is an expression of emotional distress
How common is Self-harm
More common in adolescent and young adults
15-19 in females
20-24 in males
F>M
