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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
Q

Define OCD

A

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

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26
Q

Define Obsession

A

Unwanted intrusive thoughts/images/urges that repeatedly enter the persons mind

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27
Q

Define Compulsion

A

Repetitive behaviours/mental acts that a person feels driven to perform

28
Q

Describe three contributing aetiologies of OCD

A

Genetic
Developmental factors (eg neglect, bullying)
Stress (eg Pregnancy)

29
Q

Often OCD patients won’t volunteer information easily, therefore state four questions that you could ask

A

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
Q

How would you manage OCD in adults?

A

Step up depending on severity

1) CBT
2) CBT or SSRI
3) High Intensity Psychological therapy and SSRI

31
Q

How would you manage OCD in children?

A

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
Q

Pharmacological management of OCD can sometimes cause worsening symptoms, state a non pharmacological management of OCD

A

Deep Brain Stimulation

33
Q

Define Type 1 Bipolar Disorder

A

Manic episodes interspersed with major depressive episodes

Severe and impair function

34
Q

Define Type 2 Bipolar Disorder

A

Hypomania (no psychotic symptoms such as hallucinations) interspersed with depression

35
Q

Describe 5 features of the ‘Manic Phase’ of BPD

A 
Elevated mood
Grandoise ideas
Pressure of Speech
Delusions
Hallucinations
36
Q

When would you refer a BPD patient to a Mental Health Team?

A

Severe Depression
Self Danger
Poor response/adherence to treatment
Pregnancy

37
Q

What pharmacology could you use in an ACUTE episode of BPD (ie in depressive phase and mania phase respectively)?

A

Depressive - Fluoxetine with Olanzepine
Manic - Haloperidol
Mixed - ALWAYS use antimania NOT antidepressants

38
Q

What long term medication can you give BPD patients?

A

Lithium (+/- Sodium Valproate)

39
Q

What two organs require monitoring if Lithium is prescribed?

A

Thyroid

Kidney

40
Q

Define Anorexia Nervosa

A

Preoccupation with weight as a result of either a fear of fatness or pursuit of thinness

41
Q

Give 5 risk factors for Anorexia Nervosa

A 
Female
Age
Western Society
Occupation
Personal Characteristics (perfectionism etc)
42
Q

Describe four presentations of Anorexia Nervosa

A

BMI<17.5kg/m2 (in adults)
Dieting/Restrictive eating practices
Dread of gaining weight
Denial of problem

43
Q

Describe three possible physical manifestations of Anorexia Nervosa

A

Amenorrhoea
GI Symptoms
Fainting

44
Q

State four investgations that should be done if you suspect the patient is Anorexic

A

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
Q

State four features of SEVERE Anorexia

A

BMI<13
Weight loss >0.5kg a week
HR<40
Unable to get up from sitting without using arms for leverage

46
Q

CBT is the mainstay of Anorexia treatment, what two other managements could you carry out?

A

Anorexia Nervosa Focused Family Therapy

Managing any electrolyte imbalances

47
Q

Define Bulimia Nervosa

A

Repeated episodes of uncontrolled eating followed by compensatory behaviours (such as vomiting/fasting/intensive exercise/laxatives)

48
Q

Describe 5 presentations of Bulimia

A 
Regular binge eating (occurring once weekly for atleast 3 months)
BMI>17.5kg/m2
Heartburn
Sore Throat
Dental Problems
49
Q

Give 3 examination features of Bulimic Patients

A

Swollen Parotid (chronic vomit exposure)
Erosion of Dental Enamel
Russel’s Sign (Calluses on the back of the hand)

50
Q

Give four managements of Bulimia

A

CBT
Regular U&Es
Dental Reviews
Osteoporosis Screen

51
Q

Define ‘Binge Drinking’

A

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
Q

What is the recommended alcohol allowance?

A

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
Q

Give four features of Alcohol Dependence

A

Overwhelming desire for alcohol
Need for increasing amounts
Withdrawal Symptoms
Out of Control

54
Q

How is Alcohol Dependence assessed?

A

SADQ (Severity of Alcohol Dependence Questionnaire)

55
Q

Describe three conservative managements of Alcohol Dependence

A

CBT
Education
Weaning (spacing drinks, watering them down)

56
Q

Name a drug used in the management of Mild-Mod Alcohol Dependence as a last resort. How does it work?

A

Acamprosate

Blocks GABA and NMDA receptors reducing excitation and craving

57
Q

When do alcohol dependent patients require detoxification?

A

If they’re drinking more than 15 units daily

58
Q

During the ‘ Alcohol Detox’ phase, describe two medications that can be used

A

Benzodiazepines (reduce tremors and agitation)

IV Pabrinex for the first few days followed by oral Thiamine (to prevent Wernicke’s Encephalopathy)

59
Q

What is the triad of Wernicke’s Encephalopathy?

A

Opthalmoplegia
Ataxia
Confusion

60
Q

What medication is given post Alcohol Detox?

A

Disulfiram (Aldehyde Dehydrogenase Inhibitor)

61
Q

State one natural and one synthetic Opioid

A

Natural - Heroin

Synthetic - Methadone

62
Q

State 4 acute Opioid withdrawal symptoms

A

Sweating
Rinorrhoea
Insomnia
N&V&D

63
Q

What would you give to patients to reverse Opioid Intoxication acutely?

A

Naloxone
Pure Opioid receptor antagonist
Infuse slowly and monitor (rapid onset but short half life)

64
Q

What medication can you prescribe to aid a patient who wants to detox from Opioids?

A

Methadone

Reduce dose by 5mg every 1-2 weeks

65
Q

What is Buprenorphine Naloxone combination used for?

A

Naloxone has a higher bioavailability if crushed and injected causing withdrawal (compared to oral intake)

Year 3 GP (6 decks)

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