Mental Health (B) Pre-work Flashcards
Tools to assess cognitive function in primary care
- MMSE - Mini mental state examination
- GPCOG - GP assessment of cognition
How to complete MMSE - components
- Orientation - date, year, month, season, day, country, county, city, hopsital etc
- Registration - examiner names 3 objects and patient repeats back
- Attention and calculation - spell WORLD backwards and forwards, keep subtracting 7 from 100
- Recall - ask for 3 objects named earlier
- Language - name a pencil and a watch, repeat no ifs,ands or buts, 3 stage command (right hand finger on nose and then left ear), read and obey written command, write a sentence
- Copying - copy intersecting pentagons
What is involved in GPCOG?
- Give name and address - for recall later on
- Time orientation - what is the date
- Clock drawing - please draw all the numbers on the clock, mark hands to show 10 past 11
- Information - can you tell me something that happened in the news recently?
- Recall - what was the name and address I asked you to remember?
Suicide - factors that can contribute
- Prexisting psychiatric disorder –> psychological distress/hopelessness –> thoughts of self harm/suicide –> suicide or self harm
- FH, negative events, psychological factors, exposure to self harm/suicide and availability of methods all contribute to outcome
RF for suicide which are linked to depression
- FH of mental health disorder
- Previous suicide attempts (inc self harm)
- Severe depression
- Anxiety
- Feeling hopelessness
- Personality disorder
- Alcohol +/- drug abuse
- Male gender
Other RF for suicide
- FH of suicide/self harm
- Physical illness - esp if recent diagnosis and is chronic and painful
- Exposure to suicidal thoughts of others eg on internet
- Recent psychiatric patient discharge
- Access to lethal means of self harm/suicide
Protective factors from suicide
- Religious beliefs
- Social support
- Being responsible for children (esp young)
Assessing someone’s suicide risk
- Quiet room, chances of being disturbed are minimal
- Meet with patient alone but then with family friends after
- Open questioning
- Face to face recommended
- Sometimes when people are very low they have thoughts that life isn’t worth living, have you ever had these thoughts?
- Plans?
- Anticipations of death - eg affairs in order etc
- Means for suicide?
- Support?
- Do you have a mental image of what suicide might involve - strong link of visual imagery influencing behaviour
Involve family in mental health discussions
- Recommended to involve others where possible and with consent
How to manage risk of suicide?
- Document clearly in notes
- Share awareness with other team members
- Open and honest about your concern with the patient and prompt f/u because of this
- Advise on how to contact if emergency arises - worsening thoughts or need to act on thoughts
- Who to contact in OOH
- Prescribe limited doses of medication?
- Accessing pro-suicide websites?
- Exposure to behaviour in family?
- Manage underlying depression
- Crisis teams/referral to psychiatric secondary care services
Does enquiring about suicide increase patients risk?
No - no evidence of this
Usually relieved to talk about these
Do antidepressants increase risk of suicide?
- Slight increase in those under 25
- Closer monitoring needed
- Active treatment overall though is associated with decreased risk
Rating scales to quantify suicide risk?
- None are very effective for individuals
- Reliant on self reporting
- Do not take into account suicidal ideation
- Depression scales may be useful
What if patient does not want to inform family of suicidal thoughts?
- Unless imminent risk cannot inform family/friends
- Worth exploring why they are reluctant and offering to be present when they inform them for support
Chronic suicidal ideation - when to be more concerned than usual?
If notice something that could lead to sudden change in stability
Eg losing support network, drug/alcohol abuse, physical illness, relationship breakdown
Should you tell patients you are concerened about them in terms of suicide risk?
Collaborative approach is advised - patient often feels understood and listened to if concerns are expressed
Agree plan to try and keep them safe
Resources for patients at risk of suicide
- Samaritans
- NHS 111
- NHS - depression and suicide pages
- MIND - how to cope with suicidal thoughts
- Beyond blue - depression
- Papyrus - for young people
Factors associated with self harm
- Depressed
- Low self esteem
- Physical or sexual abuse
- Relationship problems
- Unemployed or difficulties at work
When are you more likely to self harm?
- Hopeless
- Isolated/alone
- People don’t understand
- No power/control over life
Relationship to self harm and suicide
If you harm yourself you are more likely to attempt suicide than others
Short term management self harm - primary care
- Provide information on self harm - why people do it, how to manage injuries, emergency contacts
- Refer to mental health services for psychosocial assessment
- Discuss removing means of self harm
- Regular appts
- Medicines review
- Do not use risk assessment tools - focus on persons needs and immediate and then long term support
- Establish severity of injury, current mental state
- Do not use criminal justice approaches
