Mental Health Flashcards
Why can a diagnosis of depression be difficult to achieve?
The patient may not be honest about their feelings because of the stigma attached to it
What does it mean if depressed patients “Somatosise” their condition?
They have physical symptoms as a manifestation of their mental health condition.
Which examination is appropriate with a mental health patient?
Mental State examination
How might a patients’ appearance be different if they are suffering from depression?
Can be normal May appear self-neglected - Unkempt, dirty clothes etc May be tearful May avoid eye contact May appear anxious and fidgety
How might a patients’ speech be different if they are suffering from depression?
Monotonic
Slow/hesitant
May appear distracted
May lose their train of speech
How might a patients’ mood be different if they are suffering from depression?
Subjectively and Objectively low
If a patient has severe depression, what features may they have?
Features of psychosis with loss of insight
What are some key questions to ask in a depression history (many to ask)?
What do they mean by “depressed”?
Has something triggered these feelings?
How long have they felt this way?
Has their sleep/appetite changed?
Do they no longer enjoy things they used to?
Is their concentration/memory affected?
Do they feel lethargic or fatigued?
Do they have any physical symptoms?
How is this impacting their life?
Who is at home with them?
Have they had any thoughts of self-harm/ideation?
Have they had depression before? If so, how was it treated?
Do they have any other psychiatric illnesses?
Are they on any medication, drugs or alcohol?
Do they have any family history of depression?
What are some key safeguarding questions to ask in a depression history?
Have they had any suicidal thoughts?
If so, have they made any plans for suicide?
If they have, what would stop them from committing suicide?
What investigations are important in a depressed patient and why?
FBC, TFTs - to exclude any medical conditions that can cause depression
Which scoring system can be used to assess depression?
PHQ - 9
What are some key features of a depression history?
Pervasive Low Mood
Loss of interest and enjoyment - Anhedonia
What are some additional features that may be found in a depression history?
Disturbed sleep Change in appetite Reduced energy/fatigue Poor concentration Sense of worthlessness or guilt Feeling of hopelessness Ideas/Acts of DSH
What are the Five Stages of Grief?
- Denial
- Anger
- Bargaining
- Depression
- Acceptance
What happens in the Denial stage of Grief?
Feel shocked or “Numb”. Cannot believe what has happened
What happens in the Anger stage of Grief?
Feel anger directed towards medical professionals, family and friends, or even the person who has died.
What happens in the Bargaining stage of Grief?
May occur during an illness, or after a death. Attempt to “Make Deals” to change whats happened
What happens in the Depression stage of Grief?
All the typical features of the bereavement process
What happens in the Acceptance stage of Grief?
Begin to think about other things, and goals for the future
What PHQ-9 score suggests mild depression?
5-9
What treatment is recommended for mild depression?
Active monitoring
Low intensity psychosocial intervention - CBT
No pharmacological intervention
What PHQ-9 score suggests moderate depression?
10-14
What treatment is recommended for moderate depression?
Low intensity psychosocial intervention - CBT
Pharmacological intervention
Consider high intensity psychosocial intervention - Individual CBT, Psychotherapy
What PHQ-9 score suggests severe depression?
> 14
What is the recommended treatment for severe depression?
High intensity psychosocial intervention
Pharmacological intervention
Consider referral to secondary care
Consider urgent referral if risk of suicide, harm or neglect
Electroconvulsive therapy may be considered if symptoms do not improve
What can be offered to all depressed patients that is proven to improve symptoms?
Physical activity - 30 mins a day helps with mental state
Which illnesses are encompassed by the term “Anxiety Disorders”?
Panic Disorder
Generalised Anxiety Disorder
What is a Panic Attack?
A presentation of acute overwhelming anxiety
What is Panic Disorder?
A condition where the patient experiences regular panic attacks without any obvious precipitant, in the absense of any other psychiatric illness
What is Generalised Anxiety Disorder?
A condition where patients have persistent anxiety symptoms without panic attacks, agoraphobia or other marked phobic symptoms
How does Generalised Anxiety Disorder often present?
Apprehensive expectations
Hypervigilance
Poor Sleep
Muscle tension
How can Panic Disorder present?
Severe overwhelming anxiety Fear of dying Breathlessness Palpitations Sweating Tremor Nausea Depersonalisation
What other condition can often be confused with anxiety?
Stress
How can stress present?
Tiredness Poor concentration Irritability Headache Insomnia Palpitations Heartburn Indigestion
What are important things to consider in an anxiety history?
Their ideas, concerns and expectations Obvious precipitating factors Personal and Medication history Have they attended ED? Do they have a FHx of anxiety? How is this impacting their social functioning?
If a patient has anxiety and depression, which should be managed first?
Depression
What are some management steps for anxiety disorders?
CBT
Pharmacological management - SSRIs
Self Help - Literature, self-help groups
If a patient is acutely at risk of self harm/suicide, who can they be referred to?
CRISIS
