Mental Health across the lifespan Flashcards
A diagnosis of bipolar disorder has what impact on life expectancy?
9-20 years reduction
A diagnosis of schizophrenia has what impact on life expectancy?
10-20 year reduction
A drug and alcohol misuse disorder has what impact on life expectancy?
9-24 year reduction
What is the most common disorder diagnosed children?
Disruptive behavioural disorders
What are the two types of behavioural disorders and when is there peak onset?
Conduct disorder <12 years
Oppositional defiant disorder >12 years
Why are early conduct disorders so worrying?
Very strong indicators of serious antisocial behaviour imprisonment and illicit substance misuse
What is the management for disruptive behavioural disorders in children?
Early psychosocial intervention is key
Medication is rarely required.
Why do parents seek a diagnosis if ADHD or ASD in their children?
As it allows them to access individual educational and social support.
What is the epidemiology of ASD?
1 in 100/200 children
M:F 4:1
Epidemiology of ADHD
4-5% of children
What is the management for ADHD
In moderate to severe cases medication is required
Social educational and parental intervention
When is separation anxiety normal in your child?
7 months to beginning of Preschool
How is Separation anxiety disorder distinguishable?
Age inappropriate excessive and disabling anxiety developing into school refusal
How do Trauma and Attachment disorders present?
PTSD symptoms Anger Avoidance Irritabiilty Anxiety Oppositional behaviours
What comorbidities do trauma and anxiety disorders have?
Substance misuse
Suicide
Psychotic disorders
What groups have a higher incidence of Trauma and Anxiety disorders?
Asylum seekers
Refugees
Ethnic minorities
Fostered/Adopted
Children of primary school age may have these benign presentations.
Developmental appropriate anxiety - strangers places Hyperactivity and short attention span Grandiose Ideas and over-talkativeness Imaginary friends Intense interests Non impairing tics
Children of secondary school may present with these that aren’t related to mental illness.
Mood swings, sullenness, withdrawal, irritability, sleep changes
Peer pressure influenced thoughts
Rituals and OCD type behaviours
Intrussive thoughts and pseudo hallucinations
What are some common peer pressure influence thoughts that teenagers present with?
Superficial self harming
Voicing suicidal thoughts without the features of mental illness
Why is individual psychological therapy less likely to be beneficial to young children?
As they aren’t able to properly vocalise their issues and emotions
Less insight into their own issues
Working as a group can help increase emotional intelligence and social skills
What are some common stressors in early adulthood?
Leaving school Getting a job Initiating a long term relationship Buying a house having children
What are some common stressors in middle adulthood?
Maintaining professional and financial security
Managing relationships - diverse reunified families
Dealing with children leaving home
What are some common stressors in late adulthood?
Adjustment to retirement and change in social role
Dealing with deteriorating physical health
Managing bereavement
What is puerperium?
Period of six weeks post pregnancy where sexual organs return to normal
Why is the puerperium period linked to an increase in new or relapsing mental disorders?
Loss of independence Hormonal changes Unremitting demands Chronic loss of sleep Psychotic medication may have been paused
Epidemiology of Puerperal Psychosis?
1 in 1000 births
2-4 week onset
What are the major symptoms of puerperal psychosis?
Psychosis
Disinhibition and confusion
What are some risk factors for developing puerperal psychosis?
Previous thyroid disorders previous episodes Family history Unmarried FIrst pregnancy C-section Perinatal death
Epidemiology of postnatal depression
1 in 10 women
1-4 weeks post pregnancy
Risk factors for postnatal depression
Family or personal history of depression or anxiety Complicated or traumatic pregnancy Relationship difficulties History of abuse or trauma Lack of support Financial difficulties
What percentage of over 65s have a mental illness?
25%
Why are older patients less likely to present with depression?
More stigma surrounding mental health in that generation
More likely to try and tough it out
In old age what is the most important mental disorder to be aware of?
DELIRIUM
Symptoms of pseudodementia in the elderly
Fluctuating loss of memory and vagueness
Good insight into loss of cognition
Prominent slowing of movement and speech
Consistently depressed mood
What is the management of Pseudodementia?
Medication
ECT
Why is it classed as “pseudo” dementia?
There is no sign of neurodegeneration
What is late onset depression?
First occurrence of depression occurs later life
What proportion of adolescents have a diagnosable health condition?
1 in 10
What is the genetic basis of anxiety disorder
Adolescents
Overactive limbic system
Abnormal serotonin norepinephren dopamine or GABA
What is the behavioural basis of an anxiety disorder?
Adolescents
Association of a threatening stimuli with a non threatening stimuli.
Maintenance of fear by avoidance
Observational learning - see others and copy
What is the cognitive basis of an anxiety disorder?
Adolescents
Attentional biase - doesn't consider alternatives Selective attention - focus on negatives Distorted risk assessment Selective memory processing Perfectionism
What is the management plan for mild anxiety disorder?
Adolescents
CBT
What is the management plan for unresponsive or Moderate to severe anxiety disorders?
Adolescents
SSRI’s
Citalopram
What SSRIs are considered in anxiety disorders?
Adolescents
Setraline
Fluoxetine
Fluvoxamine
How long could medication take to have an effect on anxiety disorders?
Adolescents
Up to 12 weeks
When can BDZ be used in the context of anxiety?
Adolescents
If they become very agitated in the acute setting
What medication is never used for anxiety in adolescents?
Propanolol
What proportion of adolescents suffer from depression ?
4-8 in 100
Which groups are at particular risk of suffering from depression?
Adolescents
Young offenders LGBTQIA Ethnic minorities Disabled Homeless Fostered or adopted
What are some risk factors for developing depression in adolescence? Adolescents
Family History Negative perception of world and self Stressful environment Family conflict Divorce Bullying Social disadvantage Bereavements School stress
What is the management for an adolescent with mild depression? Adolescents
Watch and wait for 2 weeks
Group CBT - non directed support for 2-3 months
What is the management for an adolescent with moderate to severe depression?
Adolescents
Individual CBT or psychodynamic psychotherapy 4-6 sessions.
Fluoxetine
Setraline
Citalopram
What medication is first line for depression?
Adolescents
SSRIs
If you have had a poor response to at least two SSRIs what is the next step? Depression
Adolescents
Low dose antipsychotic.
Olanzapine
Risperidone
Aripiprazole
What can be used as an alternative to antipsychotic in the older age group? Depression
Venlafaxine SNRIs
Mirtazapine Tetracylcic
What is the rule when medicating someone for depression?
Adolescents
Start low Go slow
Target symptoms not diagnosis
What are some red flags for adolescent depression?
Suicidal behaviour
Self harm
Agitation/ Hostility
Altered appetite
What proportion of Adolescents self harm?
1 in 12-15
What are some reasons adolescents self harm?
Coping with emotions Communicating stress Reconnect with oneself Attempt to end own life Life saving
What is the physiological reasoning behind self harm?
Promotes release of endorphins which acts at temporary stress reliever.
Negative reinforcement of action to repeat action as brain wants to avoid stress.
Non suicidal adolescent self harm.
Periods of optimum and sense of self control
Provides temporary release from unpleasant emotions
Chronic and repetitive
Suicidal adolescent self harm
Hopelessness and Helplessness is core dogma No release from discomfort in life Tunnel vision 'one way out' Escape pain Not repetitive or chronic
What are some consequences of self harm?
50-100x more likely to commit suicide of history of self harm
Serious long term health consequences e.g. liver transplant
What is the management of an adolescent who self harms?
Listen and empathise
Refer to specialist
Normalise experience
Anterograde amnesia
Difficulty acquiring new material
Retrograde amnesia
Difficulty in remembering information prior to onset
What are some typical complaints of someone with memory problems?
Forgetting messade losing track of conversation Forgetting to do routine things Inability to navigate familiar places Misplacing items
