mental health Flashcards
gender dysphoria - ddx
eating disorder borderline personality disorder body dysmoprhic disorder transvestic disorder asperger's syndrome
gender dysphoria - dx criteria, (2/5 for 6months)
- significant difference between their own experienced gender and their secondary sexual characteristics
- strong desire to be rid of or prevent development of secondary sexual characteristics
- wanting secondary sexual characteristics of the opposite gender
- wanting to be treated as the opposite gender
- strong belief that they have the feelings/reactions of the opposite gender
gender dysphoria - key hx questions
duration of symptoms suicidal ideation social supports drug abuse sexual abuse psychological distress
gender dysphoria - mx
screen for and tx depression/mental illness
establish desire to physically transition
psychological counselling - refer to a psychologist or a psychiatrist for a gender assessment
provide letter for changing sex on their legal documents
refer to specialist endocrinologist for initiation of hormone therapy
surgical reassignment therapy - refer as needed
suicide RF
access to lethal means fhx suicide PMHx suicide attempts feelings of hopelessness/unable to id protective factors hx substance use definite ideation, plan and access to means current psychosis recent major loss social isolation male gender significant/chronic illness recent major loss/relationship breakdown
BPAD dx criteria
DIGFAST
distinct period of abnormal + persistently elevated, expansive or irritable mood (Mania => 7 days, hypomania => 4 days < 7 days) Distractiblilty Indiscretion + disinhibited Grandiosity Flight of ideas Activities and energy increased Sleep deficit Talkativeness (pressured speech)
Features of bipolar depression
melancholic psychomotor retardation hypersomia +/or increased appetite diurnal mood variation delusions + hallucinations lability of mood onset of 1st depression < 25yrs old FHx BPAD multiple prior depressive episodes
Acute Mania - Mx
medical emergency:
1st line - 2nd gen antipsychotic:
olanzepine 5-10mg po nocte, titrate up to 30mg
respiredone 0.5-1mg po nocte - titrate up to 2mg
2nd line - quetiapine 50mg po bd titrate up by 50mg bd until response seen
Hypomania dx criteria distinct period of elevated or irritable mood, lasting 4/7 < with 3=< of the following symptoms
Inflated self esteem/grandiosity
Decreased need for sleep
Racing thoughts/flight of ideas
Increased talkativeness
Excessive participation in pleasurable activities with a high potential for painful consequences
Marked distractibility
Increase in goal directed activity or agitation
Generalised anxiety disorder dx criteria
Excessive anxiety or worry, most days, for 6 months. Associated with 3/6=< Muscle tension Fatigue Concentration problems Restlessness, feeling on edge Irritability Sleep problems
Panic attack symptoms
Heart - palps, chest pain, nausea
Breathlessness - sob, choking sensation, dizziness, parasthesia, chills or hot flushes
Fear - of dying, of going crazy, shaking, sweating, derealisation or depersonalisation
Postnatal depression risk factors
PMHx mental illness, childhood abuse FHx mental illness Isolation or low level of supports* for mother, (or father) Numerous stresses* Low education/low socioeconomic Perfectionist personality style
Postnatal depression hx
assess risk factors for PND assess mood symptoms - low, irritability, teariness, short fuse sleep interest/anhedonia guilt/hopelessness/self esteem energy levels/motivation concentration appetite psychomotor agitation/retardation libido
ask about risks of harm to mother and children
SI, plan, intent
neglect, safety of children
Postnatal depression hx
assess risk factors for PND
assess mood symptoms - low, teariness, short fuse, feeeling angry or resentful
sleep
interest/anhedonia
guilt/hopelessness/self esteem - recurring neg thoughts of doing bad job.failure
energy levels/motivation low, unable to cope with daily routine concentration appetite psychomotor agitation/retardation libido
ask about risks of harm to mother and children
SI, plan, intent
neglect, safety of children
thoughts about harming self or your baby
Postnatal depression Mx
do EPDS
identify and explain dx to patient - one in ten women experience depression during pregnancy and one in seven during the year after pregnancy.
Dx is Perinatal depression.
risk assessment mother, children family support, aid support with house stuff refer for mothers group MHCP CBT SSRI and side effects early review/f/up safetynetting, f/up freq
