Mental Health Flashcards

1
Q

What is alcohol dependence?

A

Characterised by 3 or more of:

  • Withdrawal on cessation of alcohol
  • Tolerance
  • Compulsion to drink, difficulty controlling termination or the levels of use
  • Persistent desire to cut down or control use
  • Time is spent obtaining, using, or recovering from alcohol
  • Neglect of other interests (social, occupational or recreational)
  • Continues use despite physical and psychological problems
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2
Q

What is the aetiology of alcohol dependence?

A
  • Genetic factors suggests by twin studies and family history
  • Environmental factors include cultural, parental and peer group influences, availability of alcohol, occupation (e.g. increased risk in publicans, doctors, lawyers)
  • Pts with depressive and anxiety states are at risk
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3
Q

What is alcohol withdrawal?

A
  • Alcohol enhances inhibitory GABA inactivity and inhibits excitatory glutamate neurotransmission
  • Chronic alcohol exposure results in a compensatory reduction in GABA receptor function and upregulation of the glutamate NMDA receptors
  • Abrupt alcohol cessation leads to overactivation of the excitatory NMDA system relative to the GABA system
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4
Q

What is the epidemiology of alcohol dependence?

A

The prevalence of alcohol dependence in primary care populations in the United States was reported as 2–9 % in 2004.

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5
Q

What should be noted when taking an alcohol history?

A

Record how much, what, when and with whom alcohol is taken

- Evaluate for associated comorbidities including smoking, other substance abuse, depression, anxiety and panic attacks

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6
Q

What are the CAGE screening questions for alcohol dependence?

A
  • Cut down: ‘…felt that you should cut down on intake?’
  • Annoyed: ‘…felt annoyed by criticism of your drinking
  • Guilt: ‘…felt guilty about how much you drink?’
  • Eye-opener: ‘… feel that you need a drink when you wake up?’
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7
Q

What are the presenting symptoms of acute alcohol intoxication?

A
  • Amnesia
  • Ataxia
  • Dysarthria
  • Disorientation
  • Palpitations
  • Flushing
  • Coa
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8
Q

What are the symptoms of alcohol withdrawal?

A
  • Nausea
  • Sweating and tremor
  • Restlessness
  • Agitation
  • Visual hallucination
  • Confusion
  • Seizures
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9
Q

What are the signs of alcohol dependence on examination?

A
  • Signs suggestive of chronic alcohol misuse: Dupuytren’s contracture, palmar erythema, bruising, spider naevi, telangiectasia, facial mooning, bilateral parotid enlargement, gynaeocomastia, smell of alcohol
  • Signs of complications
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10
Q

What are the investigations for alcohol dependence?

A
  • Blood: Raised MCV, GGT, Transaminases. Raised uric acids and triglycerides or markers of end organ damage (e.g. bilirubin, albumin, PT in liver)
  • Acute overdose: Blood alcohol, glucose, ABG (risk of ketoacidosis or lactic acidosis), U&E, toxic screen (e.g. barbiturates, paracetamol)
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11
Q

What is a generalised anxiety disorder?

A
  • Common condition defined as chronic, excessive worry for at least 6 months that causes distress or impairment
  • At least 3 key symptoms required to make diagnosis: nervousness/restlessness, easy fatiguability, poor concentration, irritability, muscle tension or sleep disturbance
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12
Q

What is a social anxiety disorder?

A
  • Excess fear of social and performance situations where individual is afraid of being embarrassed or negatively evaluated by others
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13
Q

What is the epidemiology of anxiety disorders?

A
  • Common

- 4-6% of primary care pts

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14
Q

What is the aetiology of anxiety disorder?

A
  • Increased in minor life stressors, presence of physical or emotional trauma and genetic factors
  • Risk factors: Having another mental disorder, female, FHx
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15
Q

What are the signs of symptoms of anxiety disorders?

A

Nervousness/restlessness, easy fatiguability, poor concentration, irritability, muscle tension or sleep disturbance

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16
Q

What are the investigations for anxiety disorders?

A

Clinical diagnosis

17
Q

What is a depressive disorder?

A

Chronic depression in which depressive symptoms are present for more than a 2 year period

18
Q

What is the aetiology of a depressive disorder?

A

Risk factors: Having another mental disorder, female, FHx

19
Q

What are the presenting symptoms of a depressive disorder?

A
  • Presence of risk factors
  • Depressed mood
  • Anhedonia
  • Functional impairment
  • Weight change
  • Libido changes
  • Sleep disturbance
  • Psychomotor problems
  • Low energy
  • Excessive guilt
  • Poor concentration
  • Suicidal idealation
20
Q

What are the investigations for a depressive disorder?

A
  • Clinical diagnosis: DSM-5 diagnostic criteria depending on the depressive subcategory
  • Metabolic panel: normal
  • FBC: normal
  • TFTs: normal