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Psychiatry Year 3 Dundee > Mental Health across the lifespan > Flashcards

Mental Health across the lifespan Flashcards

1
Q

A diagnosis of bipolar disorder has what impact on life expectancy?

A

9-20 years reduction

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2
Q

A diagnosis of schizophrenia has what impact on life expectancy?

A

10-20 year reduction

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3
Q

A drug and alcohol misuse disorder has what impact on life expectancy?

A

9-24 year reduction

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4
Q

What is the most common disorder diagnosed children?

A

Disruptive behavioural disorders

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5
Q

What are the two types of behavioural disorders and when is there peak onset?

A

Conduct disorder <12 years

Oppositional defiant disorder >12 years

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6
Q

Why are early conduct disorders so worrying?

A

Very strong indicators of serious antisocial behaviour imprisonment and illicit substance misuse

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7
Q

What is the management for disruptive behavioural disorders in children?

A

Early psychosocial intervention is key

Medication is rarely required.

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8
Q

Why do parents seek a diagnosis if ADHD or ASD in their children?

A

As it allows them to access individual educational and social support.

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9
Q

What is the epidemiology of ASD?

A

1 in 100/200 children

M:F 4:1

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10
Q

Epidemiology of ADHD

A

4-5% of children

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11
Q

What is the management for ADHD

A

In moderate to severe cases medication is required

Social educational and parental intervention

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12
Q

When is separation anxiety normal in your child?

A

7 months to beginning of Preschool

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13
Q

How is Separation anxiety disorder distinguishable?

A

Age inappropriate excessive and disabling anxiety developing into school refusal

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14
Q

How do Trauma and Attachment disorders present?

A 
PTSD symptoms
Anger
Avoidance
Irritabiilty
Anxiety
Oppositional behaviours
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15
Q

What comorbidities do trauma and anxiety disorders have?

A

Substance misuse
Suicide
Psychotic disorders

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16
Q

What groups have a higher incidence of Trauma and Anxiety disorders?

A

Asylum seekers
Refugees
Ethnic minorities
Fostered/Adopted

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17
Q

Children of primary school age may have these benign presentations.

A 
Developmental appropriate anxiety - strangers places 
Hyperactivity and short attention span
Grandiose Ideas and over-talkativeness
Imaginary friends
Intense interests
Non impairing tics
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18
Q

Children of secondary school may present with these that aren’t related to mental illness.

A

Mood swings, sullenness, withdrawal, irritability, sleep changes
Peer pressure influenced thoughts
Rituals and OCD type behaviours
Intrussive thoughts and pseudo hallucinations

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19
Q

What are some common peer pressure influence thoughts that teenagers present with?

A

Superficial self harming

Voicing suicidal thoughts without the features of mental illness

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20
Q

Why is individual psychological therapy less likely to be beneficial to young children?

A

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

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21
Q

What are some common stressors in early adulthood?

A 
Leaving school
Getting a job
Initiating a long term relationship
Buying a house
having children
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22
Q

What are some common stressors in middle adulthood?

A

Maintaining professional and financial security
Managing relationships - diverse reunified families
Dealing with children leaving home

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23
Q

What are some common stressors in late adulthood?

A

Adjustment to retirement and change in social role
Dealing with deteriorating physical health
Managing bereavement

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24
Q

What is puerperium?

A

Period of six weeks post pregnancy where sexual organs return to normal

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25
Q

Why is the puerperium period linked to an increase in new or relapsing mental disorders?

A 
Loss of independence 
Hormonal changes
Unremitting demands
Chronic loss of sleep
Psychotic medication may have been paused
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26
Q

Epidemiology of Puerperal Psychosis?

A

1 in 1000 births

2-4 week onset

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27
Q

What are the major symptoms of puerperal psychosis?

A

Psychosis

Disinhibition and confusion

28
Q

What are some risk factors for developing puerperal psychosis?

A 
Previous thyroid disorders
previous episodes 
Family history
Unmarried
FIrst pregnancy
C-section
Perinatal death
29
Q

Epidemiology of postnatal depression

A

1 in 10 women

1-4 weeks post pregnancy

30
Q

Risk factors for postnatal depression

A 
Family or personal history of depression or anxiety
Complicated or traumatic pregnancy 
Relationship difficulties 
History of abuse or trauma
Lack of support
Financial difficulties
31
Q

What percentage of over 65s have a mental illness?

A

25%

32
Q

Why are older patients less likely to present with depression?

A

More stigma surrounding mental health in that generation

More likely to try and tough it out

33
Q

In old age what is the most important mental disorder to be aware of?

A

DELIRIUM

34
Q

Symptoms of pseudodementia in the elderly

A

Fluctuating loss of memory and vagueness
Good insight into loss of cognition
Prominent slowing of movement and speech
Consistently depressed mood

35
Q

What is the management of Pseudodementia?

A

Medication

ECT

36
Q

Why is it classed as “pseudo” dementia?

A

There is no sign of neurodegeneration

37
Q

What is late onset depression?

A

First occurrence of depression occurs later life

38
Q

What proportion of adolescents have a diagnosable health condition?

A

1 in 10

39
Q

What is the genetic basis of anxiety disorder

Adolescents

A

Overactive limbic system

Abnormal serotonin norepinephren dopamine or GABA

40
Q

What is the behavioural basis of an anxiety disorder?

Adolescents

A

Association of a threatening stimuli with a non threatening stimuli.
Maintenance of fear by avoidance
Observational learning - see others and copy

41
Q

What is the cognitive basis of an anxiety disorder?

Adolescents

A 
Attentional biase - doesn't consider alternatives
Selective attention - focus on negatives
Distorted risk assessment
Selective memory processing 
Perfectionism
42
Q

What is the management plan for mild anxiety disorder?

Adolescents

A

CBT

43
Q

What is the management plan for unresponsive or Moderate to severe anxiety disorders?
Adolescents

A

SSRI’s

Citalopram

44
Q

What SSRIs are considered in anxiety disorders?

Adolescents

A

Setraline
Fluoxetine
Fluvoxamine

45
Q

How long could medication take to have an effect on anxiety disorders?
Adolescents

A

Up to 12 weeks

46
Q

When can BDZ be used in the context of anxiety?

Adolescents

A

If they become very agitated in the acute setting

47
Q

What medication is never used for anxiety in adolescents?

A

Propanolol

48
Q

What proportion of adolescents suffer from depression ?

A

4-8 in 100

49
Q

Which groups are at particular risk of suffering from depression?
Adolescents

A 
Young offenders 
LGBTQIA
Ethnic minorities
Disabled
Homeless
Fostered or adopted
50
Q

What are some risk factors for developing depression in adolescence? Adolescents

A 
Family History
Negative perception of world and self
Stressful environment 
Family conflict
Divorce
Bullying
Social disadvantage
Bereavements
School stress
51
Q

What is the management for an adolescent with mild depression? Adolescents

A

Watch and wait for 2 weeks

Group CBT - non directed support for 2-3 months

52
Q

What is the management for an adolescent with moderate to severe depression?
Adolescents

A

Individual CBT or psychodynamic psychotherapy 4-6 sessions.
Fluoxetine
Setraline
Citalopram

53
Q

What medication is first line for depression?

Adolescents

A

SSRIs

54
Q

If you have had a poor response to at least two SSRIs what is the next step? Depression
Adolescents

A

Low dose antipsychotic.
Olanzapine
Risperidone
Aripiprazole

55
Q

What can be used as an alternative to antipsychotic in the older age group? Depression

A

Venlafaxine SNRIs

Mirtazapine Tetracylcic

56
Q

What is the rule when medicating someone for depression?

Adolescents

A

Start low Go slow

Target symptoms not diagnosis

57
Q

What are some red flags for adolescent depression?

A

Suicidal behaviour
Self harm
Agitation/ Hostility
Altered appetite

58
Q

What proportion of Adolescents self harm?

A

1 in 12-15

59
Q

What are some reasons adolescents self harm?

A 
Coping with emotions 
Communicating stress
Reconnect with oneself
Attempt to end own life
Life saving
60
Q

What is the physiological reasoning behind self harm?

A

Promotes release of endorphins which acts at temporary stress reliever.
Negative reinforcement of action to repeat action as brain wants to avoid stress.

61
Q

Non suicidal adolescent self harm.

A

Periods of optimum and sense of self control
Provides temporary release from unpleasant emotions
Chronic and repetitive

62
Q

Suicidal adolescent self harm

A 
Hopelessness and Helplessness is core dogma
No release from discomfort in life
Tunnel vision 'one way out'
Escape pain
Not repetitive or chronic
63
Q

What are some consequences of self harm?

A

50-100x more likely to commit suicide of history of self harm
Serious long term health consequences e.g. liver transplant

64
Q

What is the management of an adolescent who self harms?

A

Listen and empathise
Refer to specialist
Normalise experience

65
Q

Anterograde amnesia

A

Difficulty acquiring new material

66
Q

Retrograde amnesia

A

Difficulty in remembering information prior to onset

67
Q

What are some typical complaints of someone with memory problems?

A 
Forgetting messade
losing track of conversation 
Forgetting to do routine things
Inability to navigate familiar places
Misplacing items

Psychiatry Year 3 Dundee (21 decks)

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