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Year 3 GP > Mental Health > Flashcards

Mental Health Flashcards

1
Q

State the two core symptoms of Depression

A

Persistent Sadness/Low Mood almost every day

Loss of interest/pleasure

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2
Q

Describe four other symptoms of Depression

A 
Fatigue
Guilt/Worthlessness
Psychomotor Agitation
Insomnia/Hypersomnia
Change in Appetite
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3
Q

Define Depression

A

Atleast 5 depressive symptoms present for atleast 2 weeks

Should be no physical/organic cause

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4
Q

What is Persistent Depressive Disorder?

A

Encompasses chronic major depressive disorder and dysthymia (persistent mild depression)

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5
Q

What is Disruptive Mood Dysregulation?

A

Persistent bad mood/temper/anger in young children/adolescents

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6
Q

Give four risk factors for Depression

A

Female Gender
Significant physical illness
Other mental problems
Pyschosocial problems (divorce/unemployment)

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7
Q

Describe three assessments used in Depression

A

PHQ-9
Hospital Anxiety & Depression Scale (HAD Scale)
Becks Depression Inventory

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8
Q

Describe the management of subthreshold/mild/mod Depression

A

Wait and assess again in 2 weeks
CBT/Counselling
Only consider anti-depressants if other interventions fail or if subthreshold for atleast 2 years

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9
Q

Describe the management of mod/severe Depression

A

CBT
SSRIs (Sertraline, Citalopram) first line
Mertazepines/TCAs second line

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10
Q

What would you advise patients regarding SSRIs?

A

Won’t be effective for 2-4 weeks

Can cause weight gain/ increased bleeding

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11
Q

Define Generalised Anxiety Disorder

A

Excessive anxiety and worry occurring more days than not for atleast 6 months
Associated with restlessness/fatigued/difficulty concentrating/irritability

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12
Q

State 5 physical manifestations of GAD

A 
Autonomic arousal (palpitations/dry mouth)
Chest Pain/Difficulty breathing
Derealisation/Depersonalisation
Hot flushes
Difficulty sleeping
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13
Q

Describe the 3 step care management of GAD

A

1) Indentification/Assessment/Education/Monitoring
2) Low Intensity Psychological Support
3) CBT (16-20 hours)

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14
Q

Give two possible pharmacological managements of GAD

A

Sedative antihistamines/benzodiazepines

Antidepressants (Escitalopram)

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15
Q

What is Agoraphobia?

A

Avoidance of exposed situations for fear of panic/inability to escape

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16
Q

Define Panic Disorder

A

Experiencing recurrent unexpected Panic Attacks, and subsequent anxiety about recurrence
Associated with GABA receptor dysfunction

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17
Q

Define Panic Attack

A

Discrete episode of intensive subjective fear associated with palpitations/sweating/SOB/nausea/dry mouth

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18
Q

Panic Disorder can be caused by medication, name 3

A

SSRIs
Benzodiazepine withdrawal
Zopiclone withdrawal

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19
Q

Give 4 conservative measures to aid Panic DIsorder

A

Exclude alcohol/drugs
CBT
Promote exercise
Diaphragmatic/Abdominal breathing

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20
Q

What pharmacological measure could you use to treat Panic Disorder?

A

SSRIs (warn patients there may be a brief increase in symptoms)

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21
Q

Define Social Anxiety Disorder

A

Persistent fear and anxiety about one or more social/performance situations
Can be Generalised Social Anxiety OR Performance Social Anxiey

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22
Q

How might Social Anxiety Disorder present?

A

Dreading social situations/analysing them after
Fear of being around people
Physical symptoms

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23
Q

What is the screening tool for Social Anxiety Disorder called?

A

Mini - SPIN

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24
Q

How would you manage Social Anxiety Disorder?

A

Initially try CBT

SSRI (can then progress to add a second, or an SNRI)

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25
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
26
Define Obsession
Unwanted intrusive thoughts/images/urges that repeatedly enter the persons mind
27
Define Compulsion
Repetitive behaviours/mental acts that a person feels driven to perform
28
Describe three contributing aetiologies of OCD
Genetic Developmental factors (eg neglect, bullying) Stress (eg Pregnancy)
29
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?
30
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
31
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)
32
Pharmacological management of OCD can sometimes cause worsening symptoms, state a non pharmacological management of OCD
Deep Brain Stimulation
33
Define Type 1 Bipolar Disorder
Manic episodes interspersed with major depressive episodes | Severe and impair function
34
Define Type 2 Bipolar Disorder
Hypomania (no psychotic symptoms such as hallucinations) interspersed with depression
35
Describe 5 features of the 'Manic Phase' of BPD
``` Elevated mood Grandoise ideas Pressure of Speech Delusions Hallucinations ```
36
When would you refer a BPD patient to a Mental Health Team?
Severe Depression Self Danger Poor response/adherence to treatment Pregnancy
37
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
38
What long term medication can you give BPD patients?
Lithium (+/- Sodium Valproate)
39
What two organs require monitoring if Lithium is prescribed?
Thyroid | Kidney
40
Define Anorexia Nervosa
Preoccupation with weight as a result of either a fear of fatness or pursuit of thinness
41
Give 5 risk factors for Anorexia Nervosa
``` Female Age Western Society Occupation Personal Characteristics (perfectionism etc) ```
42
Describe four presentations of Anorexia Nervosa
BMI<17.5kg/m2 (in adults) Dieting/Restrictive eating practices Dread of gaining weight Denial of problem
43
Describe three possible physical manifestations of Anorexia Nervosa
Amenorrhoea GI Symptoms Fainting
44
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)
45
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
46
CBT is the mainstay of Anorexia treatment, what two other managements could you carry out?
Anorexia Nervosa Focused Family Therapy | Managing any electrolyte imbalances
47
Define Bulimia Nervosa
Repeated episodes of uncontrolled eating followed by compensatory behaviours (such as vomiting/fasting/intensive exercise/laxatives)
48
Describe 5 presentations of Bulimia
``` Regular binge eating (occurring once weekly for atleast 3 months) BMI>17.5kg/m2 Heartburn Sore Throat Dental Problems ```
49
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)
50
Give four managements of Bulimia
CBT Regular U&Es Dental Reviews Osteoporosis Screen
51
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)
52
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)
53
Give four features of Alcohol Dependence
Overwhelming desire for alcohol Need for increasing amounts Withdrawal Symptoms Out of Control
54
How is Alcohol Dependence assessed?
SADQ (Severity of Alcohol Dependence Questionnaire)
55
Describe three conservative managements of Alcohol Dependence
CBT Education Weaning (spacing drinks, watering them down)
56
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
57
When do alcohol dependent patients require detoxification?
If they're drinking more than 15 units daily
58
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)
59
What is the triad of Wernicke's Encephalopathy?
Opthalmoplegia Ataxia Confusion
60
What medication is given post Alcohol Detox?
Disulfiram (Aldehyde Dehydrogenase Inhibitor)
61
State one natural and one synthetic Opioid
Natural - Heroin | Synthetic - Methadone
62
State 4 acute Opioid withdrawal symptoms
Sweating Rinorrhoea Insomnia N&V&D
63
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)
64
What medication can you prescribe to aid a patient who wants to detox from Opioids?
Methadone | Reduce dose by 5mg every 1-2 weeks
65
What is Buprenorphine Naloxone combination used for?
Naloxone has a higher bioavailability if crushed and injected causing withdrawal (compared to oral intake)

Year 3 GP (6 decks)

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