Mental Health Flashcards
Which class of antidepressants is most associated with risk of hyponatraemia?
SSRIs
Peak age of onset of bipolar disorder?
age 15-19 years
Antidepressant of choice in patients with bipolar disorder and depression?
Fluoxetine
1st line drugs for social anxiety disorder?
Sertraline or Escitalopram
Computerised CBT good for high recovery rates
What blood test monitoring is required for patients on sodium valproate?
LFTs at start of tx and within the 1st 6 months, then annually
FBC at start of tx and before surgery
plasma valproate only needed if e/o ineffectiveness, poor adherence or toxicity
Which drugs are used in the treatment of PTSD?
SSRIs and venlafaxine
Minimum duration of drug treatment if effective for GAD?
1 year
note for panic disorder minimum duration is 6 months from when optimal dose reached
Lithium monitoring?
Lithium levels 12hr post last dose, done weekly until stable, then 3 monthly for 1st year then 6 monthly, if high risk-over 65, poor renal/thyroid function, poor sx control, drugs interact with lithium, then every 3 months
U+Es, calcium and TFTs every 6 months
Difference between acute stress disorder and PTSD?
acute stress disorder is an acute stress reaction occurring within the 1st 4 weeks after a traumatic event and lasts less than 4 weeks (usually a few days), PTSD is diagnosed after 4 weeks
1st line tx of acute stress disorder?
trauma-focused CBT
Examples of low intensity psychosocial interventions used in the management of depression?
- computerised CBT
- individual guided self help based on principles of CBT
- a structured group physical activity programme
When should drug tx be offered for patients with subthreshold depressive sx or mild depression?
- persistent sx after other interventions
- initial presentation of subthreshold depressive sx that have been present a long time (at least 2 yrs)
- a past hx of moderate or severe depression
Psychological interventions for relapse prevention in patients with depression?
- individual CBT for those who have relapsed despite antidepressant medication, and for those with a significant hx of depression and residual sx despite tx
- mindfulness based cognitive therapy for patients who are currently well but have experienced 3 or more previous episodes of depression
How long can you be detained under section 3 of the MHA?
6 months
note can renew or extend this
What is a section 5 (2) MHA?
applies if person is a voluntary patient or inpatient (not for a mental health condition)
this is an application by a Dr or other approved clinician to keep the person in hospital
can be detained for up to 72hrs
What is a section 5 (4) MHA?
applies if you are a voluntary patient receiving tx for a mental disorder as an inpatient
a nurse can detain the patient for up to 6 hours if MH problem serious enough that pt needs to be kept in hospital immediately
What is a section 4 MHA?
Person with a mental health problem can be detained for up to 72hrs if urgently necessary for the person to be admitted to hospital and detained and waiting for a 2nd doctor to confirm the need to admit under a section 2 would cause undesirable delay.
What is a section 135 MHA?
police officer (plus doctor and AMHP) are authorised to enter patients’ premises and take patient to a place of safety as concern patient being ill treated or neglected or unable to care for themselves and lives alone.
When should active monitoring be offered in the tx of depression?
if person, on the judgement of the practitioner, may recover with no formal intervention OR
people with mild depression who don’t want tx OR
subthreshold depressive sx (<5 DSM-IV) and person requests tx
further assessment should be done within 2 weeks
Tx of moderate or severe depression?
PHQ9 of 10 or more-10-14 moderate, 15-19 moderately severe, 20-27 severe
combination of drug tx and high intensity psychological intervention (CBT or IPT)
Management of pt if no response to an antidepressant after 3-4 weeks?
increase level of support and consider:
- increasing the dose if no significant side effects OR
- switching to another antidepressant if side effects or person prefers
How long should sx be present for to make a diagnosis of GAD?
6 months
Low intensity psychological interventions for GAD?
- Individual non-facilitated self help
- Individual guided self help
- Psychoeducational groups
When should high intensity psychological interventions be offered in management of GAD?
CBT or applied relaxation should be offered if marked functional impairment or inadequate sx response to step 2 (low intensity) interventions
Could also offer drug treatment at this stage as alternative-Sertraline-if ineffective offer alternative SSRI or SNRI
What drug tx can be offered for GAD if person cannot tolerate SSRIs or SNRIs?
pregabalin
How should risk of suicide be monitored in patients under the age of 30 started on an SSRI?
Pt should be seen within 1 week of first prescribing and then reviewed weekly for the 1st 1 month of treatment
if patient over the age of 30 is started on an SSRI and is assessed at being at risk of suicide then should also be reviewed at 1 week, everyone else at 2 weeks
When should a high intensity psychological intervention be considered to be added to drug treatment in management of GAD?
if person has had a partial response to drug treatment
After recognition and diagnosis what treatment should be offered in primary care for mild to moderate panic disorder?
offer or refer for low intensity psychological intervention:
individual non-facilitated or facilitated self help
if moderate to severe, consider referral for CBT or anti-depressant if CBT not effective or pt does not want psychological therapy
Which anti-depressants can be offered for management of moderate to severe panic disorder?
SSRIs, SNRIs and TCAs
if an SSRI is not suitable or pt not improving with SSRI then imipramine or clomipramine (TCAs) may be considered
Alternative to SSRI as 1st line tx of depression if pt cannot take SSRI due to drug interaction e.g. on warfarin?
mirtazapine
Psychological therapy for borderline PD (EUPD)?
mentalisation based therapy (previously known as psychodynamic therapy)
or dialectical behaviour therapy
Most common type of eating disorder?
atypical eating disorders
followed by binge eating and bulimia, then anorexia
Duration of sx for diagnosis of bulimia nervosa?
patients must have recurrent (at least once a week for 3 months) episodes of uncontrolled eating of an abnormally large amount of food over a short time period, followed by compensatory behaviour
Mental health disorder with the highest mortality rate?
anorexia nervosa
Weight loss amount in eating disorders indicative of high risk?
more than 1kg per week
Specialist tx for bulimia nervosa?
- Bulimia nervosa focused guided self help programmes
- if unacceptable, CI or ineffective after 4 weeks can consider individual eating disorder focused CBT (CBT-ED-1st line for anorexia nervosa in adults)
- Focused family therapy may be considered in children and young people
Specialist tx for binge eating disorder?
- Evidence based self help programmes with brief supportive sessions
- If not acceptable/CI/ineffective, consider group based eating disorder focused CBT
Guidance on how to switch from an SSRI to a TCA in managing depression?
cross tapering of SSRI and TCA-current SSRI reduced slowly whilst TCA slowly increased
NOT if taking fluoxetine-should be stopped before starting TCA
leave at least 4-7 days after stopping fluoxetine before starting another antidepressant
Mental health disorder with the highest lifetime risk for suicide attempts and completion?
bipolar disorder
What are patients at risk of if they take St Johns Wort aswell as an SSRI?
serotonin syndrome
Exposure to which parasite has been shown to increase the risk of schizophrenia?
toxoplasma gondii
In the assessment of psychosis in primary care how should a patient judged to be at high risk of harm to self or others be managed?
same-day specialist mental health assessment by early intervention in psychosis service (if available)
if not, or level of risk deemed to exceed management capacity of this service then refer to crisis resolution and home treatment team
people with psychosis MUST tell the DVLA about their illness and cannot drive in an acute episode
Secondary care management of a psychotic disorder?
PO antipsychotic in conjunction with any or all of:
- family intervention
- individual CBT-at least 16 planned sessions
- arts therapy-particularly good for negative symptoms
Secondary care management of a patient without a clear diagnosis of a psychotic disorder?
monitoring for up to 3 years, note patients can have a prodromal phase for up to 18 months prior to an acute psychotic episode
Clozapine monitoring?
-weekly FBC for 1st 18 weeks, then 2 weekly for up to 1 year, then monthly.
note risk of hypotension and convulsions during initiation
-blood lipids and weight at baseline and every 3 months for 1st year, then yearly. Other antipsychotics-baselines, 3 months then yearly.
-fasting blood glucose at baseline, after 1 month then every 4-6 months. Other antipsychotics-baseline, at 4-6 months then yearly.
Monitoring for all antipsychotics?
- weight at baseline, weekly for 1st 6 weeks, at 3 months then yearly.
- fasting blood glucose, HbA1c and lipids at baseline, 3 months, 1 year then yearly.
- ECG may be needed at baseline
- BP at baseline, 3 months, 1 year then yearly.
- FBC, U+Es and LFTs at baseline and yearly.
- prolactin at baseline, 6 months then yearly.
Blood tests at annual review of patients with schizophrenia/psychosis?
FBC U+Es LFTs fasting glucose, HbA1c lipid profile prolactin-not required if person taking olanzapine, aripiprazole, clozapine or quetiapine.
attempt to make contact with those who do not attend a review appointment (within 14 days), if not possible inform persons care coordinator
Which personality disorder displays the negative sx of schizophrenia?
schizoid personality disorder
