Mental Health Flashcards
State the two core symptoms of Depression
Persistent Sadness/Low Mood almost every day
Loss of interest/pleasure
Describe four other symptoms of Depression
Fatigue Guilt/Worthlessness Psychomotor Agitation Insomnia/Hypersomnia Change in Appetite
Define Depression
Atleast 5 depressive symptoms present for atleast 2 weeks
Should be no physical/organic cause
What is Persistent Depressive Disorder?
Encompasses chronic major depressive disorder and dysthymia (persistent mild depression)
What is Disruptive Mood Dysregulation?
Persistent bad mood/temper/anger in young children/adolescents
Give four risk factors for Depression
Female Gender
Significant physical illness
Other mental problems
Pyschosocial problems (divorce/unemployment)
Describe three assessments used in Depression
PHQ-9
Hospital Anxiety & Depression Scale (HAD Scale)
Becks Depression Inventory
Describe the management of subthreshold/mild/mod Depression
Wait and assess again in 2 weeks
CBT/Counselling
Only consider anti-depressants if other interventions fail or if subthreshold for atleast 2 years
Describe the management of mod/severe Depression
CBT
SSRIs (Sertraline, Citalopram) first line
Mertazepines/TCAs second line
What would you advise patients regarding SSRIs?
Won’t be effective for 2-4 weeks
Can cause weight gain/ increased bleeding
Define Generalised Anxiety Disorder
Excessive anxiety and worry occurring more days than not for atleast 6 months
Associated with restlessness/fatigued/difficulty concentrating/irritability
State 5 physical manifestations of GAD
Autonomic arousal (palpitations/dry mouth) Chest Pain/Difficulty breathing Derealisation/Depersonalisation Hot flushes Difficulty sleeping
Describe the 3 step care management of GAD
1) Indentification/Assessment/Education/Monitoring
2) Low Intensity Psychological Support
3) CBT (16-20 hours)
Give two possible pharmacological managements of GAD
Sedative antihistamines/benzodiazepines
Antidepressants (Escitalopram)
What is Agoraphobia?
Avoidance of exposed situations for fear of panic/inability to escape
Define Panic Disorder
Experiencing recurrent unexpected Panic Attacks, and subsequent anxiety about recurrence
Associated with GABA receptor dysfunction
Define Panic Attack
Discrete episode of intensive subjective fear associated with palpitations/sweating/SOB/nausea/dry mouth
Panic Disorder can be caused by medication, name 3
SSRIs
Benzodiazepine withdrawal
Zopiclone withdrawal
Give 4 conservative measures to aid Panic DIsorder
Exclude alcohol/drugs
CBT
Promote exercise
Diaphragmatic/Abdominal breathing
What pharmacological measure could you use to treat Panic Disorder?
SSRIs (warn patients there may be a brief increase in symptoms)
Define Social Anxiety Disorder
Persistent fear and anxiety about one or more social/performance situations
Can be Generalised Social Anxiety OR Performance Social Anxiey
How might Social Anxiety Disorder present?
Dreading social situations/analysing them after
Fear of being around people
Physical symptoms
What is the screening tool for Social Anxiety Disorder called?
Mini - SPIN
How would you manage Social Anxiety Disorder?
Initially try CBT
SSRI (can then progress to add a second, or an SNRI)
Define OCD
Obsessions and/or compulsions present on most days for at least 2 weeks
Repetitive and unpleasant
At least one obsession is excessive or unreasonable
Patient has tried to resist but been unsuccessful on at least one occasion
Define Obsession
Unwanted intrusive thoughts/images/urges that repeatedly enter the persons mind
Define Compulsion
Repetitive behaviours/mental acts that a person feels driven to perform
Describe three contributing aetiologies of OCD
Genetic
Developmental factors (eg neglect, bullying)
Stress (eg Pregnancy)
Often OCD patients won’t volunteer information easily, therefore state four questions that you could ask
Do you wash/clean a lot?
Do you check things a lot?
Are there thoughts bothering you that you can’t get rid of?
Do normal daily activities take a long time to finish?
How would you manage OCD in adults?
Step up depending on severity
1) CBT
2) CBT or SSRI
3) High Intensity Psychological therapy and SSRI
How would you manage OCD in children?
Step up depending on severity
1) Self help techniques and information for family
2) CAMHS or CBT
3) Sertraline or Fluvoxamine (only if between 8-18)
Pharmacological management of OCD can sometimes cause worsening symptoms, state a non pharmacological management of OCD
Deep Brain Stimulation
Define Type 1 Bipolar Disorder
Manic episodes interspersed with major depressive episodes
Severe and impair function
Define Type 2 Bipolar Disorder
Hypomania (no psychotic symptoms such as hallucinations) interspersed with depression
Describe 5 features of the ‘Manic Phase’ of BPD
Elevated mood Grandoise ideas Pressure of Speech Delusions Hallucinations
When would you refer a BPD patient to a Mental Health Team?
Severe Depression
Self Danger
Poor response/adherence to treatment
Pregnancy
What pharmacology could you use in an ACUTE episode of BPD (ie in depressive phase and mania phase respectively)?
Depressive - Fluoxetine with Olanzepine
Manic - Haloperidol
Mixed - ALWAYS use antimania NOT antidepressants
What long term medication can you give BPD patients?
Lithium (+/- Sodium Valproate)
What two organs require monitoring if Lithium is prescribed?
Thyroid
Kidney
Define Anorexia Nervosa
Preoccupation with weight as a result of either a fear of fatness or pursuit of thinness
Give 5 risk factors for Anorexia Nervosa
Female Age Western Society Occupation Personal Characteristics (perfectionism etc)
Describe four presentations of Anorexia Nervosa
BMI<17.5kg/m2 (in adults)
Dieting/Restrictive eating practices
Dread of gaining weight
Denial of problem
Describe three possible physical manifestations of Anorexia Nervosa
Amenorrhoea
GI Symptoms
Fainting
State four investgations that should be done if you suspect the patient is Anorexic
TFT (lost weight from hyperthyroidism)
U&Es (Vomiting)
DEXA (after 1 year of being underweight in under 18s, or two years in adults)
ECG (long QT from Hypokalaemia)
State four features of SEVERE Anorexia
BMI<13
Weight loss >0.5kg a week
HR<40
Unable to get up from sitting without using arms for leverage
CBT is the mainstay of Anorexia treatment, what two other managements could you carry out?
Anorexia Nervosa Focused Family Therapy
Managing any electrolyte imbalances
Define Bulimia Nervosa
Repeated episodes of uncontrolled eating followed by compensatory behaviours (such as vomiting/fasting/intensive exercise/laxatives)
Describe 5 presentations of Bulimia
Regular binge eating (occurring once weekly for atleast 3 months) BMI>17.5kg/m2 Heartburn Sore Throat Dental Problems
Give 3 examination features of Bulimic Patients
Swollen Parotid (chronic vomit exposure)
Erosion of Dental Enamel
Russel’s Sign (Calluses on the back of the hand)
Give four managements of Bulimia
CBT
Regular U&Es
Dental Reviews
Osteoporosis Screen
Define ‘Binge Drinking’
Drinking more than 8 units on their heaviest day for Men and 6 units for WOmen
(Bottle of wine = 9 units, Beer can = 2 units)
What is the recommended alcohol allowance?
2-3 units daily for Women
3-4 units daily for Men
Don’t drink more than 14 units in a week (spread at least over 3 days)
Give four features of Alcohol Dependence
Overwhelming desire for alcohol
Need for increasing amounts
Withdrawal Symptoms
Out of Control
How is Alcohol Dependence assessed?
SADQ (Severity of Alcohol Dependence Questionnaire)
Describe three conservative managements of Alcohol Dependence
CBT
Education
Weaning (spacing drinks, watering them down)
Name a drug used in the management of Mild-Mod Alcohol Dependence as a last resort. How does it work?
Acamprosate
Blocks GABA and NMDA receptors reducing excitation and craving
When do alcohol dependent patients require detoxification?
If they’re drinking more than 15 units daily
During the ‘ Alcohol Detox’ phase, describe two medications that can be used
Benzodiazepines (reduce tremors and agitation)
IV Pabrinex for the first few days followed by oral Thiamine (to prevent Wernicke’s Encephalopathy)
What is the triad of Wernicke’s Encephalopathy?
Opthalmoplegia
Ataxia
Confusion
What medication is given post Alcohol Detox?
Disulfiram (Aldehyde Dehydrogenase Inhibitor)
State one natural and one synthetic Opioid
Natural - Heroin
Synthetic - Methadone
State 4 acute Opioid withdrawal symptoms
Sweating
Rinorrhoea
Insomnia
N&V&D
What would you give to patients to reverse Opioid Intoxication acutely?
Naloxone
Pure Opioid receptor antagonist
Infuse slowly and monitor (rapid onset but short half life)
What medication can you prescribe to aid a patient who wants to detox from Opioids?
Methadone
Reduce dose by 5mg every 1-2 weeks
What is Buprenorphine Naloxone combination used for?
Naloxone has a higher bioavailability if crushed and injected causing withdrawal (compared to oral intake)
