Mental Health, Awareness, Wellbeing Flashcards
Depression
Low mood is very common; everyone feels sad at times. It is when the low mood is severe and persistent that it is deemed to be clinical depression. The key factor is the impact on functioning and activities of daily living.
Depression is a real illness with real symptoms, and it’s not a sign of weakness or something you can “snap out of” by “pulling yourself together”.
Depression will be the second biggest cause of illness by 2020 – WHO.
Treatments for Depression
For mild depression social prescribing around exercise and changes to lifestyle have been proven to be as effective as antidepressant.
Moderate depression - primary care – IAPT service CBT, mindfulness etc psychological therapies – these may be used in conjunction with antidepressant therapies.
Antidepressants most common SSRI (SNRI) prevents reuptake of serotonin boosting feel good emotions. Medication clearly has its place and is a really important part of some peoples treatment /recovery. They should be taken daily and without alcohol or drugs. They take 4-6 weeks to take effect. They are however over prescribed and often treat the symptoms not the root cause.
Counselling : a safe place to be yourself. Should be with a skilled therapist in a relationship of trust and openness. Informal support via P2P can help but if there is a complex issue that impacts on functioning structured support to reframe thought processes can really help.
Anxiety
Anxiety is a normal feeling but it becomes a symptom or disorder when it causes distress, interferes with normal functioning, goes on for too long, or is too intense.
Types of anxiety disorder
Generalised anxiety (GAD) – persistent feelings of anxiety
Phobic disorders – anxiety provoked by specific situations
Panic disorder – recurrent attacks of severe anxiety.
Post Traumatic Stress Disorder
Signs and symptoms of ASD:
Anxiety
Feeling worried or apprehensive
Irritability, restlessness
Insomnia (often initial insomnia)
Psychogenic symptoms i.e. headache, sweats, feeling that a lump in throat, GI problems.
Memory problems as a result of information not being registered.
Feelings of fear or doom that is out of context
Consequences – avoidance of “trigger” situations.
Stress:
Increased Isolation/preoccupation
Sleep, appetite, mood, irritability, hypervigilance
SOB, restlessness, palpitations, nausea, headaches
Muscle tension, fidgeting
Feelings of hopelessness and helplessness
Automatic negative thinking/impending doom
Significant change in presentation
Lack of protective factors/self soothing
Concern from colleagues/friends/family members
Social concerns such as job loss, relationship, financial or other problems
Depression: Mask symptoms to provide false assurance of wellbeing EG I am ok. Sustained low mood or tearfulness Lack of enjoyment and interest Lack of energy Poor concentration or memory Poor sleep, especially waking early Changes in appetite Lowered libido Feelings of guilt or worthlessness Feelings of hopelessness or suicidal ideation Negative thoughts and ruminations Preoccupation with physical health symptoms Withdrawing from social contacts
Statistics around suicide
Almost 6000 deaths by suicide every year. Likely to be many more due to “narrative and misadventure verdicts”. (This compares to 1713 fatalities in RTA’s)
200,000 self-harm and suicide attempts present in A&E departments.
72% of patients who complete suicide have not had contact with mental health services in the preceding year.
For every suicide an average of 10 people are affected by the trauma for life.
17% of the population regularly have thoughts of suicide but have protective factors around “live love do” principles.
HEE. How to manage and what to say
Acknowledge distress. Understand transference (avoid/manage escalation).
Provide empathy and compassion.
Encourage containment and resilience.
Offer hope and solution focused approaches.
Encourage self help and distraction techniques.
Stay calm and compassionate (eg this must be difficult and I am sorry you feel this way).
Listen attentively.
Focus on what normally helps.
Be personable and focus on achievements /strengths.
If patients are agitated keep calm, de-escalate and “think mindfulness thoughts”.
Keep a note on areas to say and not to say.
Ask for help if things become difficult to manage
Dementia
If the bookcase is full and wobbles the books fall from the top first and then progressively down the bookcase. - this is why they may not recognise family members as they do not look how they remember them to look
Ability to assess visual perception – i.e carpets with patterns may look like holes – chevrons on ambulance may look like a sudden drop – relate ot how MAPA principles will assist in managing these issues.
How you approach – slow down, come from the side, speak clearly and pause regularly to allow people to process information - based on studies that every 4/5th word is missed due to slow down in cognitive processing
Learning Disabilities
Common Conditions in Learning Disability
Increased rates of:
Epilepsy (20 x higher than general population).
50% of Downs Syndrome -congenital heart defects, early onset dementia
Higher levels of Gastrointestinal cancers (Helicobacter Pylori )
Coronary heart disease (second highest cause of death in LD)
Increased hypertension, obesity,
More likely to have tooth decay, Loose teeth, Gum disease, Higher levels untreated extraction
Constipation – profound LD
Anxiety Disorder , Depression , Schizophrenia – 3x more prevalent in LD
Genetic conditions linked to obesity – Downs syndrome, prader-willi syndrome. Underweight – phenylketonuria
RTI caused by Pneumonia or reflux, aspiration - Main cause of death in LD
40% have sight problems & hearing impairments (common to be unrecognised)
Lifestyles factors (e.g. poor diet, lack of exercise).
Poor take up of health screening & health promotion.
Less likely to be immunised
More people treated as emergency cases or with advanced disease.
vulnerable to MH problems through a range of biological, psychological & social factors.
, psychotic symptoms less marked & complex. Difficult to diagnose rely on person being able to communicate internal processes
MH hard to diagnose in severe/profound atypical indicators such as self injury/aggression.
Legislation around Mental Health
Mental health act (MHA): a patient can be “detained” under the MHA and admitted to hospital where there is concern about:
A significant risk to self.
A significant risk to others.
Severe neglect
Refusal of treatment where there is evidence of significant mental illness.
In order for a patient to be detained they must be assessed normally by two doctors and an approved Mental health Practitioner (AMHP). In situations where a patient is detained an AMHP will normally request and ambulance to convey to hospital.
Mental Health Act
Section 2 – up to 28 days - assessment
Section 3 – up to 6 months – treatment
Section 4 – emergency only (requires 1 doctor) valid for 72 hours
Section 135(1) – warrant to search and remove patient to a place of safety for assessment/or care. Section 136 – up to24 hours - police holding power to be taken to place of safety for assessment. New legislation December 2017 highlights police custody as place of safety as a “last resort” and never for child and adolescent services.
