Mental health Flashcards
Depression
Both negative affect (low mood) and/or absence of positive affect (loss of interest and pleasure in most activities).
C: Risk factors - past history, significant physical illness, other mental health problems, psychosocial problems, abuse, lack of security.
S: 1 of persistent low mood or loss of interest. 3-4 of fatigue, worthlessness, suicidal thoughts, inability to concentrate, psychomotor retardation, insomnia/hypersomnia, change in appetite.
D: Questionnaires, mental state examination, past psychiatric history, patient risk and risk to others, blood tests (FBC, TFTs, LFTs, U&Es, Ca), MRI/CT.
T: Watchful waiting for 2 weeks, CBT, physical activity programmes, counselling, SSRI (e.g. citalopram, fluoxetine, paroxetine, or sertraline), review regularly. Make an urgent psychiatric referral if the patient has active suicidal ideas or plans, is putting themself or others at immediate risk of harm, is psychotic, severely agitated or self-neglecting.
Anxiety
A syndrome of ongoing anxiety and worry about many events or thoughts that the patient generally recognises as excessive and inappropriate.
C: Risk factors - 35-45 years old, divorce, living alone, female.
S: Excessive anxiety and worry, difficulty controlling worry, restlessness, difficulty concentrating, irritability, sleep disturbance, fatigue, sweating, palpitations, chest pain, dry mouth.
D: Exclude physical disorder, OCD, PTSD, phobia.
T: CBT. Anxiety management treatment involving education, relaxation training, and exposure. Medication - sedative antihistamines, benzodiazepines (not beyond 4 weeks), SSRI or
Serotonin and norepinephrine reuptake inhibitors (SNRIs), such as duloxetine or venlafaxine. Self-help. Therapist. Review regularly.
Tobacco/Nicotine Dependence
Occurs when you need nicotine and can’t stop using it.
C: Risk factors - Starting smoking at a young age, genetics, parents and peers, depression or other mental illness, substance misuse.
S: One or more serious, but unsuccessful, attempts to stop. Withdrawal symptoms - strong cravings, anxiety, irritability, restlessness, difficulty concentrating, depressed mood, frustration, anger, increased hunger, insomnia, constipation or diarrhoea.
D: Patient questionnaire
T: Nicotine replacement therapy - nictoine gums, patches, inhalators, tablets/lozenges, nasal spray, mouth spray. Use for at least 8-12 weeks. Set a date to start. May need counselling.
Alcohol dependence
Psychiatric diagnosis in which an individual is physically or psychologically dependent upon alcohol.
C: Risk factors - male, binge drinking, parents with alcohol problems, mental health disorder, peer pressure, self-esteem issues, stress.
S: Overwhelming desire for alcohol, out of control drinking, a need for increasing amounts of alcohol, withdrawal symptoms, little interest in leisure activities, continuing to drink even when harm is clear.
D: ‘CAGE’ questions (Cut down, Annoyed, Guilty, Eye-opener), Alcohol Use Disorders Identification Test (AUDIT), Severity of Alcohol Dependence Questionnaire (SADQ).
T: Advice leaflets, local help groups, psychological therapies (may have acamprosate or oral naltrexone in combination). Detox - daily supervision, Vitamin B complex - IV Pabrinex as an inpatient, then oral thiamine and multivitamins, Benzodiazepines (diazepam or chlordiazepoxide), continuing support.
Acute stress reaction
A psychological condition that can develop after exposure, and as a response, to a stressful event.
C: Traumatic events, usually life-threatening. Examples may include, serious accidents, natural disasters, violent assaults, sexual abuse, terrorist incidents, domestic violence.
S: Usually one month after event - disorientation, agitation, over-activity, tachycardia, sweating, flushing, partial or complete amnesia, recurrent dreams and/or flashbacks, reckless or aggressive behaviour, low mood, sleep disturbance.
D: Mental state examination, psychiatric assessment.
T: May resolve on its own. Trauma-focused cognitive behavioural therapy. Eye movement desensitisation and reprocessing (EMDR). Sleep advice. Medication - benzodiazepines are indicated for the short-term, b-blocker for symptomatic relief.
Bereavement
A distressing but common experience of losing someone we love.
C: Losing a loved one.
S: Shock, emotional numbness, denial, difficulty relaxing, sleeping or concentrating, anger, guilt, sadness, withdrawal.
D: Mental state examination.
T: Support from family and friends, practical help, bereavement counsellor, sleep medication, if the depression continues to deepen, affecting appetite, energy and sleep, antidepressants may be helpful.
Dysthymic disorder
AKA persistent depressive disorder, a chronic depression.
C: Chemical imbalance, family history, other mental health conditions, stressful or traumatic life events, chronic physical illness, physical brain trauma.
S: Persistent feelings of sadness and hopelessness, sleep problems, low energy, change in appetite, difficulty concentrating, lack of interest in daily activities, poor self-esteem.
Symptoms may come and go over several years, and the severity of them may vary over time.
D: Bloods, mental state examination.
For adults - depressed mood most of the day, nearly every day, for two or more years. For children - depressed mood or irritability most of the day, nearly every day, for at least one year.
T: SSRIs such as fluoxetine and sertraline, Tricyclic antidepressants such as amitriptyline and amoxapine,
Serotonin and norepinephrine reuptake inhibitors (SNRIs), such as desvenlafaxine and duloxetine, talking therapy.
Bipolar disorder
A chronic episodic illness characterised by episodes of mania (or hypomania) and depression.
Type I is manic episodes, Type II is hypomanic, both interspersed with depression.
C: Chemical imbalance of neurotransmitters, genetics, stressful circumstances.
S: Mania - elevated mood, grandiose ideas, pressure or speech, flights of ideas, overactivity, little sleep, increased appetite, disinhibition, hallucinations, delusions.
Hyomania - lesser degree of mania, elevated mood and increased activity and energy but without hallucinations or delusions.
Depression - Low mood, reduced energy, no pleasure in daily activities, low self-esteem, tearful, reduced appetite, disturbed sleep.
D: Mental state examination
T: Education, self-help groups, psychological therapy, telephone support, CBT.
Medication - antipsychotic (commonly used haloperidol, olanzapine, quetiapine and risperidone), lamotrigine on its own, consider adding lithium (or valproate if inappropriate). Combine antipsychotic with antidepressant such as fluoxetine. Review regularly - Regular questioning about side-effects and suicidal ideation should occur. ECT if all else has failed.
Phobia
Strong fear or dread of a thing or event, which is out of proportion to the reality of the situation.
C: Can be linked to an early negative childhood experience, or “learnt” from an early age, anxious parents, genetics, brain chemistry.
Commonly social anxiety disorder, agoraphobia, or specific phobias of a thing or a place.
S: Sweating, trembling, hot flushes or chills, SOB, choking sensation, tachycardia, chest pain.
D: History-taking, psychiatric assessment.
T: CBT and mindfulness, desensitisation or exposure therapy, medication is not usually recommended but antidepressants (escitalopram, sertraline, paroxetine) or Venlafaxine may be prescribed. Clomipramine is a TCA. Benzodiazepines like diazepam for short-term. Beta-blockers like propranolol.
PTSD
Develops following a stressful event or situation of an exceptionally threatening or catastrophic nature.
C: Risk factors - serious accidents, hostage taking, natural disasters, terrorist incidents and violent assault, refugees, first-responders, military with little support, history of previous psychiatric disorders.
S: Non-specific anxiety, depression, insomnia or hypochondria with frequent attendance. May experience flashbacks, common and repetitive nightmares, suppression of memories, hypervigilance, difficulty concentrating, sleep disturbance, detachment from others.
D: Mental state examination, psychiatric assessment.
T: Watchful waiting, trauma-focused CBT, eye movement desensitisation and reprocessing (EMDR) and stress management. Paroxetine and mirtazepine may be considered. Stellate ganglion block to reduce adrenaline.
Hypnotics may be considered to help insomnia but they should not be used for more than a month.
Anorexia Nervosa
Maintain a low body weight as a result of a preoccupation with weight, construed as either a fear of fatness or a pursuit of thinness.
C: Risk factors - female, young, Western society, family history, sexual abuse, dieting behaviour within family, preoccupation with slimness, perfectionism, low self-esteem, obsessional traits.
S: Weight below 85% of predicted, dieting or restrictive eating, over-evaluation of size, denial, lack of desire for intervention, social withdrawal, over-exercise, diuretics, laxatives and self-induced vomiting, amenorrhoea, fatigue, fainting, dizziness and intolerance of cold, hair loss.
D: FBC, ESR, U&Es, creatinine, glucose, LFTs and TFTs. Dual-energy X-ray absorptiometry (DXA) scan. ECG (prolonged QT interval).
T: Under 18s - Anorexia-nervosa-focused family therapy or Individual cognitive behavioural therapy.
Adults - Individual eating-disorder-focused cognitive behavioural therapy, Maudsley Anorexia Nervosa Treatment for Adults (MANTRA). Monitor U&Es and ECG. Dietary advice. Multivitamin-and-mineral supplements.
Admission required for electrolyte imbalance or hypoglycaemia, severe malnutrition/dehydration, bradycardia, prolonged QT interval, suicide risk.
Bulimia Nervosa
An eating disorder characterised by repeated episodes of uncontrolled overeating (binges) followed by compensatory weight loss behaviours.
C: Family history, family culture of dieting, severe life stresses, parental problems, such as high expectations, low care and overprotection, recreational pressure, early menarche, perfectionism, anxiety, obsessional traits, low self-esteem.
S: Regular binge eating with loss of control, attempts to counteract the binges - eg, vomiting, using laxatives, diuretics, dietary restriction and excessive exercise, preoccupation with weight, body shape and body image, abdo pain, reflux, bloating, anxiety, low self-esteem, erosion of dental enamel.
D: Low serum K, renal function and electrolytes should be checked.
T: First-line - bulimia-focused guided self-help programme, second-line - eating-disorder-focused cognitive behavioural therapy. No pharmacological recommendations. Fluid and electrolyte balance assessed frequently. Regular dental checks.
Drug abuse
Drug abuse or substance abuse refers to the use of certain chemicals for the purpose of creating pleasurable effects on the brain.
C: Genetics, lack of parental involvement, abuse/neglect, peer pressure, stress, other mental health conditions, age at which you start taking them, the types of drugs - cocaine, heroin, and methamphetamines more addictive.
S: Loss of Interest, blood shot eyes, dilated pupils, injection sites, puffy face, unusual skin colour, rapid mood swings, erratic behaviour, reclusive and private behaviour, defensiveness.
D: History-taking, toxin screen, testing for blood-borne infections (hepatitis A, B and C and HIV).
T: Psychosocial assessment and support, counselling, CBT, support groups. If motivated to change, Methadone and buprenorphine as maintenance. Detoxification programmes should include a complete package including drug treatment and preparatory and post-detoxification support.
Domestic abuse
Any incident of threatening behaviour, violence or abuse between adults who are or have been intimate partners or family members, regardless of gender or sexuality.
C: Risk factors - Female, young, pregnancy, chronic illness, cultural factors, language barriers, stalking, mental health problems.
S: Unexplained symptoms/nonspecific symptoms, depression, chronic pain, genital injuries, self-harm, frequent attendance, delay between injury and presentation, injuries inconsistent with the explanation.
D: History-taking.
T: Risk assessment, liaise with local multi-agency risk assessment conference, provide a safety plan, and details of available resources, initiate child protection or adult safeguarding procedures.
Self-harm
Self-harm refers to an intentional act of self-poisoning or self-injury, irrespective of the motivation or apparent purpose of the act. It is an expression of emotional distress.
C: Genetics, family history, imbalances of neurotransmitters, abuse, trauma, instability, addiction, mental health problems.
S: Spending a lot of time alone, withdrawal, difficulty in relationships, helplessness, hopelessness, scars, cuts, broken bones, patches of hair missing, mood swings, anxiety, guilt, shame, disgust.
D: History-taking, mental state examination.
T: Risk assessment, identify suicidal intent, activated charcoal in case of drug overdose, iIntegrated and comprehensive psychosocial assessment, psychological intervention, care plans in place.
