Mental health conditions Flashcards

1
Q

What proportion of people will have experienced a common mental health disorder in the past week?

A

1 in 6

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2
Q

How many adults in England are affected by severe mental illness (SMI) such as schizophrenia or bipolar disorder?

A

500,000

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3
Q

Why do people with SMI have an increased mortality rate and reduced life expectancy (15-20 yrs) compared with the general population?

A

multifactorial
iatrogenic harm from psychiatric medication
lifestyle
reduced access to health services and leisure facilities

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4
Q

What percentage of mental health problems are established by the age of 14?

A

50%

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5
Q

What percentage of mental health problems are established by the age of 24?

A

75%

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6
Q

How many children aged 5-16 experience a mental health issue at any one time?

A
1 in 10
conduct disorder (6%)
anxiety disorder (3%)
attention deficit hyperactivity disorder (ADHD) (2%)
depression (2%)
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7
Q

Almost how many young people contacted Childline with suicidal thoughts between 2014/2015?

A

20,000

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8
Q

In an average group of 30 15-year-olds, how many are likely to have been bullied?

A

7

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9
Q

In an average group of 30 15-year-olds, how many could have experienced the death of a parent?

A

1

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10
Q

In an average group of 30 15-year-olds, how many are likely to have watched their parents separate?

A

10

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11
Q

In an average group of 30 15-year-olds, how many may be self-harming?

A

6

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12
Q

What proportion of mothers suffer from depression, anxiety or, in some cases, psychosis during pregnancy or in the first year after childbirth?

A

1 in 5

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13
Q

People with long-term physical health conditions suffer more complications if they also develop mental health problems. On average, this increases the cost of care by what percentage?

A

45%

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14
Q

What proportion of older people in the community are affected by depression?

A

1 in 5

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15
Q

What percentage of older people living in care homes suffer with depression?

A

40%

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16
Q

What percentage of veterans of the armed forces who experience mental health problems like post-traumatic stress disorder (PTSD) seek help from the NHS?

A

50%

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17
Q

What proportion of prisoners have a mental health, drug or alcohol problem?

A

up to 9 in 10

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18
Q

In London from 2018-2019, what percentage of people seen sleeping rough had no alcohol, drug or mental health support needs?

A

20%

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19
Q

In London from 2018-2019, what percentage of people seen sleeping rough had alcohol misuse needs?

A

42%

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20
Q

In London from 2018-2019, what percentage of people seen sleeping rough had mental health needs?

A

50%

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21
Q

In London from 2018-2019, what percentage of people seen sleeping rough had drug misuse needs?

A

41%

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22
Q

What is the stress vulnerability model proposed by Zubin and Spring (1977)?

A

proposes that an individual has unique biological, psychological and social elements
these elements include strengths and vulnerabilities for dealing with stress
vulnerability is a scale where resilience can reduce the impact of this predisposition and stressors

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23
Q

How does mental illness impact employment?

A

for those in contact with secondary mental health services, the employment rate was 67.4 percentage points lower than the overall rate

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24
Q

How does mental illness impact benefit claims?

A

50.9% of Employment Support Allowance Claimants have a primary condition of a mental and behavioural problem

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25
How does mental illness impact social isolation?
psychotic disorder is more common in people living alone evidence suggests links between mental illness, social isolation, and the challenges that people with psychotic disorder may face with maintaining relationships
26
How does mental illness impact housing?
54% of adults (age 18-69) receiving secondary mental health services on the Care Programme Approach were recorded as living independently, with or without support
27
What is depression?
a persistent low mood that can be either mild or severe | it will have varying degrees of impact upon the person, and their engagement in personal and social activities
28
What is the prevalence of depression in people with diabetes?
30% of people with diabetes are estimated to be affected by depression this is set against 36% who experience diabetic distress
29
What is the economic cost of treating people with diabetes and depression?
£1.8 billion of additional costs can be attributed to poor mental health
30
What is the prevalence of depression in people with cancer?
ranges from 4-49% depending on the type of cancer
31
What is the economic cost of treating people with cancer and depression?
£7.6 billion a year due to premature deaths and time off work service costs are increasing to £13 billion by 2020-21
32
What is the prevalence of depression in people with COPD?
varies depending on the severity of the condition | estimated to be as high as 27%
33
What is the economic cost of treating people with COPD and depression?
£3 billion and £1.9 billion respectively | in total, all lung conditions (including lung cancer) directly cost the NHS £11 billion annually
34
What is the prevalence of depression in people with CVA?
post-stroke depression is estimated to be 30% | varies from 29-36%
35
What is the economic cost of treating people with CVA and depression?
3-5% of all healthcare expenditure | England, Wales and Northern Ireland was £3.60 billion in the first five years after admission
36
What is the prevalence of depression in people with arthritis?
varies depending on the type of arthritis from 5-51%
37
What is the economic cost of treating people with arthritis and depression?
healthcare costs of osteoarthritis and rheumatoid arthritis will reach £118.6 billion over the next decade
38
What are the four levels of depression (NICE, 2009)?
subthreshold depressive symptoms mild depression moderate depression severe depression
39
What are subthreshold depressive symptoms (NICE, 2009)?
fewer than 5 symptoms of depression
40
What is mild depression (NICE, 2009)?
few, if any, symptoms in excess of the 5 required to make the diagnosis symptoms result in only minor functional impairment
41
What is moderate depression (NICE, 2009)?
symptoms or functional impairment are between 'mild' and 'severe'
42
What is severe depression (NICE, 2009)?
most symptoms and the symptoms markedly interfere with functioning can occur with or without psychotic symptoms
43
What are the key symptoms of depression (NICE, 2009)?
persistent sadness or low mood, and/or marked loss of interests or pleasure at least one of these, most days, most of the time for at least 2 weeks
44
If any of the key symptoms are present, what are the following associated symptoms that should then be discussed?
disturbed sleep (decreased or increased compared to usual) decreased or increased appetite and/or weight fatigue or loss of energy agitation or slowing of movements poor concentration or indecisiveness feelings of worthlessness or excessive or inappropriate guilt suicidal thoughts or acts
45
What are the criteria for general advice and active monitoring?
four or fewer of the above symptoms with little associated disability symptoms intermittent, or less than 2 weeks' duration recent onset with identified stressor no past or family history of depression social support available lack of suicidal thoughts
46
What are the criteria for active treatment in primary care?
``` five or more symptoms with associated disability persistent or long-standing symptoms personal or family history of depression low social support occasional suicidal thoughts ```
47
What are the criteria for referral to mental health professionals?
inadequate or incomplete response to two or more interventions recurrent episode within 1 year of last one history suggestive of bipolar disorder the person with depression or relatives request referral more persistent suicidal thoughts self-neglect
48
What are the criteria for referral to specialist mental health services?
actively suicidal ideas or plans psychotic symptoms severe agitation accompanying severe symptoms severe self-neglect
49
What are some non-pharmacological interventions for persistent subthreshold depressive symptoms or mild to moderate depression?
``` individual guided self-help based on the principles of CBT? computerised CBT (CCBT) a structured group physical activity programme ```
50
What are the two alternatives if an individual does not benefit from first-line non-pharmacological treatment?
``` an antidepressant (normally an SSRI) OR a high-intensity psychological intervention ```
51
What are four types of high-intensity psychological interventions?
``` CBT interpersonal therapy (IPT) behavioural activation (evidence is less robust than for CBT or IPT) behavioural couples therapy (for people who have a regular partner and where the relationship may contribute to the development or maintenance of depression, or where involving the partner is considered to be of potential therapeutic benefit) ```
52
What is the recommended treatment for moderate to severe depression?
antidepressant medication AND | a high-intensity psychological intervention (CBT or IPT)
53
What factors should influence the choice of intervention for moderate to severe depression?
duration of the episode of depression and the trajectory of symptoms previous course of depression and response to treatment likelihood of adherence to treatment and any potential adverse effects person's treatment preference and priorities
54
In what cases should antidepressant medication be considered?
past history of moderate or severe depression OR initial presentation of sub-threshold depressive symptoms that have been present for a long period (typically at least 2 years) OR sub-threshold depressive symptoms or mild depression that persist(s) after other interventions
55
List some examples of SSRIs.
sertraline, citalopram, fluoxetine
56
What are some adverse effects of SSRIs?
increased risk of bleeding, risk of suicidal ideation
57
List some examples of TCAs.
amitriptyline, imipramine, lofepramine
58
What is an adverse effect of TCAs?
increased risk of overdose (except lofepramine)
59
What is the McGurk effect?
an illusion that results from conflicting information coming from different senses, namely sight and hearing
60
What is solution-focused brief therapy?
developed in the 1980s by Steve de Shazer and Insoo Kim Berg in Milwaukee, USA assumptions - the client will choose the goals for therapy and has the resources to make changes detailed history not necessary average length of treatment 3-5 sessions
61
What are the four steps of solution-focused brief therapy?
(1) What do you want? (2) How will you know when you have it? (3) What are you doing already to get there? (4) What would be happening if you were a little closer to what you want?
62
What are the three principles of solution-focused brief therapy?
(1) If it ain’t broke, don’t’ fix it (2) Once you know what works, do more of it (3) If it doesn’t work, don’t do it again: do something different
63
What is the 'miracle question'?
You go to bed tonight and while you are asleep a miracle happens. But you are asleep and don’t know that it has happened. What will be the first thing you notice? And then what? And then what? And what next? Who will notice that this miracle has happened? How will you know they have noticed?
64
What are the assumptions to solution-focused brief therapy?
goals for therapy are chosen by the client clients have resources which they use to make changes descriptions are promoted in specific, small, positive steps and favour the presence of solutions rather than the absence of problems a detailed history is not required but if a story has never been told it may need to be heard prior to continuing (safety assessment if the client or others are at risk) information comes from the client and language matching is used to stay connected to the client and their experience focus on thoughts not feelings
65
What is a 'scaling question'?
Imagine a scale from 0-10 where ten indicates everything you described in the Miracle Day is happening now and zero indicates none of that is happening. What number would indicate where you are at now? What would make it a …..(increased number)?
66
What are the exceptions to solution-focused brief therapy (Wand, 2010)?
information from the exceptions help the client to devise strategies to solve or reduce the problem clients are supported to reflect on and describe in detail what was different when the problem did not occur or what they did differently exceptions are gleaned for potential solutions this helps clients to develop a more optimistic view of themselves by being reminded of current and past successes
67
What is cognitive behavioural therapy (CBT)?
developed in the 1960s by psychiatrist Dr Aaron Beck hypothesis - negative interpretation and behavioural response to an event causes psychological distress detailed history taken average length of treatment 6-9 months
68
What are the three key elements of CBT?
thoughts, feelings, behaviours
69
What is meant by 'thoughts'?
negative automatic thoughts are the cognitive cause of distress they are automatic, involuntary, plausible, distorted and unhelpful
70
What is meant by 'feelings'?
emotions - one word such as anger, depression, fear, guilt | physical sensations - sweating, crying, lack of appetite, sleep difficulty
71
What is meant by 'behaviours'?
what people do - includes what people avoid and what they do to make themselves feel better (can be safety behaviours)
72
What are the key characteristics of CBT?
active therapeutic relationship psychological formulation of the problem collaborative relationship structure to sessions and to therapy collaborative development of goals examines and questions unhelpful thinking use of a range of aids and techniques (e.g. questionnaires for change monitoring) teaching the client to become their own therapist use of “homework” or assignments time-limited audio recorded sessions
73
What is a case formulation?
outlines the relationship between thoughts, emotions, behaviours, physical reactions and environment models of case formulation range from simple to complex
74
What are the two basic assumptions of a case formulation (Grant et al., 2010)?
emotional disorders arise from an individual’s interpretation of events the way in which an individual behaves in relation to how they interpret events plays an important role in the maintenance of their problems
75
What are the three key elements of a case formulation?
core beliefs, assumptions, triggers
76
What is meant by 'core beliefs'?
negative automatic thoughts about self, others and the world | the lens through which people see the world
77
What is meant by 'assumptions'?
rules for living | “If... then…”
78
What is meant by 'triggers'?
incidents that set off the symptoms or cause changes to one or more of the elements of psychological distress
79
What percentage of the UK population suffer from bipolar affective disorder?
2%
80
How is bipolar affective disorder classified?
DSMCI - bipolar I and bipolar II | ICD-10 - bipolar affective disorder and bipolar affective disorder in remission
81
How is bipolar affective disorder characterised?
episodes of depressed and elated mood
82
How is bipolar affective disorder diagnosed?
after a full medical history and mental state examination | this is to rule out other differential diagnoses (e.g. substance abuse, Cushing's disease, frontal lobe dementia)
83
What is the risk of recurrence following an episode of bipolar affective disorder (BMJ, 2018)?
within 12 months - 50% (especially high when compared to other psychiatric disorders) within four years - 75%
84
What factors can improve the prognosis for people with bipolar affective disorder?
healthcare support received in a quick and timely manner a mixture of interventions needed to ensure that people have early access to person-centred treatment involvement of healthcare professionals working closely with an individual to create a profile of early warning signs (Walker and Kelly, 2011)
85
What is psychosis?
encompasses a number of symptoms associated with significant alternations to a person's perception, thoughts, mood, and behaviour
86
What are the two types of symptoms associated with psychosis?
positive symptoms and negative symptoms
87
What are positive symptoms of psychosis?
disorganised behaviour speech, and/or thoughts (thought disturbance) delusions (fixed or falsely-held beliefs) hallucinations (perceptions in the absence of stimuli)
88
What are negative symptoms of psychosis?
``` emotional blunting reduced speech loss of motivation self-neglect social withdrawal ```
89
What are psychotic symptoms?
cardinal features of psychotic disorders (the most common of which is schizophrenia) may also be caused acutely by certain medicines, substance misuse, and certain medical conditions (e.g. sepsis) with treatment, psychotic symptoms as a feature of a psychotic disorder may resolve fully, recur intermittently with periods of remission between, or persist
90
What is the aim of treatment for psychosis?
treatment is based on reducing any distressing symptoms, both positive and negative early intervention is important in psychosis as long periods of untreated psychosis is associated with poorer health outcomes
91
What is the role of a care coordinator (NHS, 2015)?
a care coordinator supports the individual throughout their time in the service this includes helping them with self-management skills, social care issues (e.g. housing or debt management) and relapse prevention work
92
According to the NHS (2015) guidelines for psychosis, how quickly should someone with suspected first episode of psychosis be seen for a specialist assessment?
within two weeks of referral
93
List three benefits to early intervention in psychosis.
decreased service use better health and economic outcomes in both the short- and long-term reduced risk of premature death
94
Is voice hearing only associated with psychosis?
no many people in the general population experience voice hearing voice hearing is likely to be a spectrum which includes people who experience voice hearing as a trauma response
95
List six risk factors for drug misuse (PHE, 2017).
family history of addiction socioeconomic deprivation homelessness unemployment, poor working conditions and job insecurity men are more likely to use illegal drugs poor mental health is linked to drug misuse and vice versa
96
What is the estimated cost of alcohol abuse in the UK (PHE, 2017)?
£21 billion
97
What is the estimated cost of drug abuse in the UK (PHE, 2017)?
£15 billion
98
What is the estimated cost of lost productivity due to alcohol in the UK (PHE, 2017)?
£7.3 billion
99
How many working days are lost each year in the UK due to alcohol misuse alone (PHE, 2017)?
17 million
100
What percentage of substance abusers are in full-time employment (PHE, 2017)?
70%
101
What is drug dependence?
when a person’s drug use results in: experiencing uncontrollable & unpleasant mood states or withdrawal symptoms when the drug is not taken, AND use of the drug compulsively despite obvious adverse reactions
102
What is drug abuse?
recurrent or continued use of drugs in doses or ways that result in adverse consequences
103
What is drug tolerance?
(1) need for markedly increased amounts of the substance to achieve intoxication or desired effect (2) markedly diminished effect of continued use of the same amount of the substance
104
What is drug withdrawal?
(1) the characteristic withdrawal syndrome from the substance (2) the same (or closely related) substance being taken to relieve or avoid withdrawal symptoms
105
What is substance dependence according to the DSM-IV?
a maladaptive pattern of substance use, leading to clinically significant impairment or distress, as manifested by 3 (or more) of the following, occurring at any time in the same 12-month period
106
What is the first criteria for substance dependence according to the DSM-IV?
tolerance
107
What is the second criteria for substance dependence according to the DSM-IV?
withdrawal
108
What is the third criteria for substance dependence according to the DSM-IV?
the substance is often taken in larger amounts or over a longer period than intended
109
What is the fourth criteria for substance dependence according to the DSM-IV?
there is a persistent desire or unsuccessful efforts to cut down or control substance use
110
What is the fifth criteria for substance dependence according to the DSM-IV?
a great deal of time is spent in activities necessary to obtain the substance, to use the substance, or to recover from its effects
111
What is the sixth criteria for substance dependence according to the DSM-IV?
important social, occupational, or recreational activities are given up or reduced because of substance use
112
What is the seventh criteria for substance dependence according to the DSM-IV?
the substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance
113
What is substance abuse according to the DSM-IV?
a maladaptive pattern of substance use, leading to clinically significant impairment or distress, as manifested by 1 (or more) of the following occurring within a 12-month period the symptoms never met the DSM criteria for substance dependence
114
What is the first criteria for substance abuse according to the DSM-IV?
recurrent substance use resulting in a failure to fulfil major role obligations at work, school or home
115
What is the second criteria for substance abuse according to the DSM-IV?
recurrent substance use in situations in which it is physically hazardous
116
What is the third criteria for substance abuse according to the DSM-IV?
recurrent substance related legal problems
117
What is the fourth criteria for substance abuse according to the DSM-IV?
continued substance abuse despite having persistent or recurrent social interpersonal problems caused or exacerbated by the effects of the substance
118
What are the two types of dependence?
physical and psychological
119
What is physical dependence?
refers to the presence of physical symptoms during withdrawal (e.g. chills, aches, seizures, sleep disturbance) these effects are usually the opposite of the direct effects induced by the drug
120
How long does it taken to develop physical dependence to a drug?
it usually takes several exposures to the drug within a relatively short period to produce dependence (e.g. taken daily for several days or weeks at relatively high doses) however, dependence can occur in one dose if it is sufficiently large
121
What is abstinence syndrome?
refers to the physical symptoms associated with drug withdrawal varies greatly in intensity and duration universally unpleasant also occurs with prescription drugs (e.g. some anti-depressants, painkillers, benzodiazepines) can be minimised/avoided by tapering off the drug administration of a drug antagonist will cause immediate abstinence syndrome
122
What is psychological dependence?
refers to psychological symptoms during withdrawal (e.g. craving, depression, anxiety) drug use often produces pleasure or reduces psychic discomfort, absence of drug produces the opposite (displeasure and no reduction in psychic discomfort)
123
What is meant by the phrase: 'Context-specific tolerance is an integral part of psychological dependence'?
substance dependence is primarily a result of having learning and memory (e.g. positive reinforcement, discriminative effects, aversive effects, and stimulus associations with drug use)
124
List some examples of psychological dependence.
``` enhances mood or performance copes better with adverse or stressful situations to help socialise to conform expansion of experimental awareness ```
125
What is secondary psychological dependence?
following physical dependence, craving may develop based on the fear of developing abstinence symptoms if the drug is not taken (instrumental conditioning involving negative reinforcement) cues associated with taking the drug may elicit the drug, or the compensatory response would feel like an abstinence syndrome (classical conditioning) you can have tolerance without dependence, but if you have dependence then tolerance will have developed
126
What is involved in the mechanism of reinforcement action?
mesolimbic system has received most attention the release of dopamine appears to be a necessary but insufficient condition for positive reinforcement to take place endogenous opioids may be involved in reinforcement glutamate appears to play a critical role in drug cravings elicited by conditional stimuli
127
How does religion impact on dependence?
the more religious, the less the problem with drug abuse/dependence, especially if the religion bans the substance
128
How do sociological factors impact on dependence?
``` drug availability significant others labelling the person as a deviant peer influence early childhood deviance poor school adjustment weak family influence ```
129
What personality traits correlate with dependence?
sensation or novelty seeking traits | history of antisocial behaviour (e.g. nonconformity, acting out, and impulsivity)
130
What is comorbidity in relation to substance dependence?
the presence of substance abuse and another psychological disorder drug use is often a form of self-medication among alcohol abusers, 78% of men and 86% of women have at least one other psychiatric disorder high levels of depression pre-existing motivation factors interact with physiological and psychological conditioning factors once drug taking begin
131
What are the general factors involved in treatment for substance dependence?
the first step is to recognise the problem (realise that dependency has occurred and is causing detrimental consequences) the second step is for the user to have the motivation to change
132
Why is treatment for substance dependence difficult?
denial - a defence mechanism whereby users do not consciously recognise that they have a problem enabling - when significant others do things that actually encourage the person’s drug use (sometimes this means helping them avoid the harmful consequences of drug use)
133
What is the 'cycle of change'?
``` pre-contemplation contemplation determination action maintenance re(lapse) lasting change ```
134
What is the physical treatment for substance dependence?
if the person is dependent on a legitimate prescription drug, they can be weaned off the drug slowly (assuming they recognise the problem and wish to stop)
135
What factors may help to prevent relapse of substance dependence?
the person is under compulsory supervision or experiences a consistent aversive reaction the person finds a substitute dependency to compete with drug abuse the person obtains new social supports the person becomes a member of an inspirational group
136
What is the psychological treatment for substance dependence?
recognise predisposing psychological and/or sociological factors which led to drug-taking remove user from drug-associated environmental stimuli extinguish the conscious/unconscious association by exposing the user to the cues in the absence of the unconscious, repeatedly
137
What factors make psychological treatment for substance dependence more difficult?
``` poor self-image sees themselves as a drug user history of deviance poor socioeconomic background few education-related skills ```
138
How is medication used in the treatment of substance dependence?
substance replacement (e.g. diazepam instead of alcohol) replacement drugs may reduce negative affectivity that caused drug abuse (e.g. antidepressants) other drugs may serve as antagonists (acamprosate/Campral used to treat alcohol dependence; thought to stabilise the chemical balance in the brain that would be disrupted by alcoholism) others drugs cause aversive body states when they are taken with the abused substance (e.g. disulfiram/Antabuse for alcohol)
139
What would be the ideal characteristics of a medication used in the treatment of substance dependence?
``` less toxic, with fewer side-effects decrease craving for the abused drug provide an insurmountable blockade of the effects of the abused drug block the effects of all drugs of abuse long-lasting able to take orally ```
140
What are the key factors of a substance use assessment?
``` thorough assessment under detection assessment process nurse’s attitude confidentiality adaptable assessment process time needs change ```
141
Why is the assessment process important?
to engage and develop a therapeutic relationship with the client to gain an understanding of the person and their circumstances to identify goals to decide on the most appropriate treatment interventions
142
What are psychotherapeutic processes?
the patterns of conscious and unconscious thoughts, feelings and behaviour that occur in psychotherapy, in and between the therapist and client, that mediate, enable or prevent change
143
Why does the assessment process need to be adaptable?
the assessment could be done in a variety of different settings people are at different stages of being ready to change
144
What is the current legislative framework?
MHRA - Medicines Act 1968 Home Office - Misuse of Drugs Act 1971 - recreational psychoactive drugs regulated sales - alcohol/tobacco/solvents unregulated sales - khat/coffee
145
Emerging clinical research has provided evidence to support the claim that cannabis-based treatments can have therapeutic effects for which conditions?
``` childhood epilepsy Alzheimer's disease cancer chronic pain multiple sclerosis ```
146
Which countries have legalised medical cannabis?
``` Germany Israel Australia Portugal Canada is set to become the first G7 nation to legalise recreational use ```
147
What did the World Health Organisation (WHO) (2017) state regarding the legalisation of cannabis?
publicly endorsed the medicinal qualities of cannabis | recommended to review their approach to the scheduling of Cannabidiol (CBD) oil
148
What did the Medicines and Healthcare Products Regulatory Agency (MHRA) (2016) state regarding the legalisation of cannabis?
“products containing Cannabidiol (CBD) used for medical purposes are a medicine”
149
Following recent high-profile campaigns by the parents of childhood epilepsy sufferers, what did Home Secretary Sajid Javid commission in 2018?
a review into the scheduling of cannabis-based treatments | cannabis will remain an illegal Class B substance under the Misuse of Drugs Act 1971 following the review
150
What happened on the 26th July 2018?
the Home Office announced that cannabis-derived medicinal products should be placed in schedule 2 of the Misuse of Drugs Regulation 2001 the effect would be to formally acknowledge their therapeutic effects and enable clinicians to prescribe related cannabis-derived medicines
151
What must patients demonstrate, with the support of a specialist clinician, before a license for cannabis-based prescriptions may be granted (Home Office, 2018)?
'exceptional clinical circumstances' to an expert panel
152
What did the Government's 2017 'Drug Strategy' report state?
cannabis is the most widely recorded illicit drug used by 16-59 year olds curbing recreational use has been the Government’s primary policy since 2010
153
What are the health benefits of cannabis-based treatments?
reduce pain reduce social anxiety, cognitive impairment and discomfort in patients diagnosed with generalized social anxiety disorder (SAD) prevent Alzheimer's disease reduce tobacco addiction improve sleep quality and restore respiratory stability in sleep apnoea clear acne regulate blood glucose and lowers insulin resistance provide relief for IBD prevent obesity
154
How do cannabis-based treatments reduce pain?
cannabis binds to CB1 receptors while reducing swelling
155
How do cannabis-based treatments prevent neurodegenerative disorders like Alzheimer's disease?
cannabis helps to remove plaques that block neuron-signalling
156
How do cannabis-based treatments reduce tobacco addiction?
cannabis modulates the rewarding effects of nicotine
157
How do cannabis-based treatments help to clear acne?
cannabis inhibits lipid synthesis on the skin
158
How do cannabis-based treatments provide relief for IBD?
cannabis has anti-inflammatory effects
159
What are the patterns of substance use?
substance use is on a continuum occasional/experimental recreational binge dependency - psychological or physiological
160
What information is used in an assessment to detect substance use?
observational skills self-report tools (e.g. DALI or semi-structured) interviews urinalysis information from family/carers past notes other agencies involved (e.g. GP, midwife, probation officer, housing association)
161
What are the key components of a comprehensive substance use assessment?
``` current and recent use past use physical health (including sexual health) mental health social situation legal situation personal and family history risk assessment client’s perception ```
162
How can you assess current and recent substance use?
``` What? When? How? Where? With whom? details diary withdrawal funding observational assessment health education ```
163
Why is a diary useful?
baseline data about consumption insight into motivations/triggers direct feedback to client about quantifiable data regarding consumption change according to client needs (e.g. amount, mood)
164
What is involved in an observational assessment?
``` inspect injection site - is it safe? physical appearance (e.g. underweight, disshelved/ unkempt, agitated, anxious) non-verbal communication intoxication or withdrawal any injuries ```
165
What is health education?
client consents to getting information from other sources
166
How can you obtain a substance use history?
``` when substance use began what prompted use how use developed over time impact on life periods of abstinence previous treatment timeline ```
167
What is important to remember when obtaining a substance use history?
think carefully about the language you use be sensitive and adaptable some people find the verb ‘use’ offensive
168
What are the physical effects of alcohol use?
``` nutritional deficiency withdrawal seizures delirium tremens cognitive impairment transient memory loss ulcers Korsakoff’s syndrome hypertension engaging in unsafe sex ```
169
What are the physical effects of stimulant use?
injecting risks blood borne diseases when sharing crack pipes respiratory problems risk of fits and seizures cardiovascular problems associated with cocaine use prolonged periods without sleep or food
170
What are the physical effects of opiate use?
``` injecting risks infections (local and systemic) vein damage deep vein thrombosis blood borne diseases (Hep B, Hep C, HIV) by sharing equipment (spoons, filters, water) and inadequately cleaning surfaces on which injection is prepared respiratory problems if smoking ```
171
What are the physical effects of benzodiazepine use?
risks associated with crushing and injecting pills
172
What are the physical effects of cannabis use?
respiratory problems if smoking
173
What are the general factors to consider regarding the physical effects of substance use?
may be registered with a GP or engaged with health services opiates mask pain (e.g. stomach cancer and irregular eating) sexually transmitted diseases if exchanging drugs for sex and not using condoms
174
What tests can be completed to detect physical effects of substance use?
urinalysis breathalyser blood tests for liver function
175
What are some of the potential mental health effects of substance use?
suicide deliberate self-harm self-neglect depression
176
How is sustance use related to suicide?
alcohol reduces inhibitions alcohol increases risk of suicide when combined with other CNS depressants lifestyle factors may contribute (e.g. lack of social support, financial problems, difficulties with police and courts, problems in relationships with close friends/relatives, feelings of hopelessness and helplessness) factors associated with life experiences (e.g. sexual abuse, domestic violence) people misusing drugs have access to substances which are lethal in overdose
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How is sustance use related to deliberate self-harm?
alcohol use often precursor reduces inhibitions numbs pain
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How is sustance use related to self-neglect?
not eating neglecting personal hygiene lack of basic amenities in accommodation/no accommodation
179
How is substance use related to depression?
alcohol and drugs can trigger/exacerbate depression depression is common, independent or secondary to alcohol use alcohol (alcoholic hallucinosis/delirium tremens), stimulants and cannabis may trigger psychotic symptoms low mood/depression are associated with coming down from stimulants
180
Why is it important to gain insight into the client’s perceptions of their situation, their reasons for substance use and readiness to change?
to complement the more specific information that is obtained during assessment to inform care planning and treatment interventions alongside other information information obtained in the assessment will place the person on the circle of change
181
Why is a decision matrix useful?
it enables people to explore their reasons for using substances and identify the disadvantages of substance use
182
What is motivational interviewing?
a form of collaborative conversation for strengthening a person's own motivation and commitment to change a person-centred counselling style to address the common problem of ambivalence about change by paying particular attention to the language of change designed to strengthen a person's motivation for and movement toward a specific goal by eliciting and exploring the person's own reasons for change within an atmosphere of acceptance and compassion
183
Why was motivational interviewing developed?
as an intervention style for facilitating behavioural and cognitive change with substance users (Miller, 1983;1995) particular value with clients who are ambivalent about change and at the “contemplation” stage of the change process
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What are the key concepts emplyed in the motivational interviewing style?
resolving ambivalence is a key to change therapist style is a powerful determinant of client resistance and change client motivation can be increased through a variety of therapeutic strategies change efforts are not started before the client is committed to particular goals and change strategies goals and treatment strategies are negotiated with the client
185
What proportion of adults with mental health problems are supported in primary care?
9 in 10
186
What is generalised anxiety disorder (GAD)?
estimated to affect 5% of the UK population slightly more women are affected than men more common in people aged 35-59 years
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What are personality disorders?
a group of personality traits that interfere with a person's ADLs they are strongly associated with adverse childhood experiences
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What diagnostic information is provided by the ICD-10 (2019) Classification of Mental and Behavioural Disorders for personality disorders?
"...comprise deeply ingrained and enduring behaviour patterns, manifesting themselves as inflexible responses to a broad range of personal and social situations. They represent either extreme or significant deviations from the way the average individual in a given culture perceives, thinks, feels, and particularly relates to others. Such behaviour patterns tend to be stable and to encompass multiple domains of behaviour and psychological functioning. They are frequently, but not always, associated with various degrees of subjective distress and problems in social functioning and performance."
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What proportion of people in the UK have a personality disorder?
1 in 20
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In which settings is the prevalence of personality disorders much higher?
criminal justice system | inpatient mental health services
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What are the key features of cluster A personality disorders?
odd and eccentric | difficulty relating to others
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What are the three cluster A personality disorders?
paranoid schizoid schizotypal
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What are the key features of cluster B personality disorders?
difficulty controlling emotions | impulsive
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What are the four cluster B personality disorders?
antisocial borderline histrionic narcissistic
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What are the key features of cluster C personality disorders?
anxious and fearful | perfectionist
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What are the two cluster C personality disorders?
avoidant | dependent
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What are the two most common personality disorders?
borderline personality disorder and dissocial personality disorder
198
Why is the diagnosis of a personality disorder seen as controversial?
some people argue that a diagnosis provides: a way to understand their experiences, a peer community, and access to services that would otherwise not be available to them some people argue it is a diagnosis of exclusion and the stigma associated with personality disorders is highly damaging
199
According to NICE (2015), what treatments are recommended for borderline and antisocial personality disorders?
psychological therapies pharmacological interventions - antipsychotic or sedative medication for short-term crisis management or treatment of comorbid conditions
200
What is delirium?
a common clinical syndrome characterised by disturbed consciousness, cognitive function or perception, which has an acute onset and fluctuating course. it usually develops over 1-2 days a serious condition associated with poor outcomes it can be prevented and treated if dealt with urgently (NICE, 2010)
201
What are some of the common risk factors for delirium?
``` old age severe illness dementia physical frailty admission with infection or dehydration polypharmacy surgery ```
202
What signs and symptoms indicate delirium?
an acute confusional state a change in perception (e.g. visual or auditory hallucinations) a change in physical function (e.g. reduced mobility, agitation, sleep disturbance) a change in social behaviour (e.g. withdrawal, lack of co-operation for reasonable requests, alterations in mood, change in communication/attitude)
203
What are the three types of delirium?
hyperactive, hypoactive, mixed
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What is hyperactive delirium?
abnormally alert, restless, agitated, maybe aggressive could experience hallucinations or delusions
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What is hypoactive delirium?
symptoms could include abnormal sleepiness and withdrawal | could be unresponsive
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What is mixed delirium?
alternate between hypoactive and hyperactive delirium
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What are the differences between delirium and dementia?
delirium - treatable and reversible; sudden onset dementia - no treatment and usually irreversible; progressive, usually over many months and years a person can have both delirium and dementia simultaneously which makes it hard to distinguish between them
208
What are the two types of assessment used to diagnose delirium?
Confusion Assessment Method (CAM) - requires the presence of features 1 and 2 and either 3 or 4 4AT - a screening instrument designed for rapid initial assessment of delirium and cognitive impairment; designed for 65+ years
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What is feature 1 of the CAM?
acute onset and fluctuating course
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How is feature 1 usually obtained and shown?
from a family member or nurse shown by positive responses to the following questions: 1. Is there evidence of an acute change in mental status from the patient’s baseline? 2. Did the (abnormal) behaviour fluctuate during the day, that is, tend to come and go, or increase or decrease in severity?
211
What is feature 2 of the CAM?
inattention
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How is feature 2 usually obtained and shown?
by interacting with the patient, or reported by family members or staff shown by a positive response to the following question: 3. Did the patient have difficulty focusing attention, for example being easily distractible or having difficulty keeping track of what was being said?
213
What is feature 3 of the CAM?
disorganised thinking
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How is feature 3 usually obtained and shown?
by interacting with the patient, or reported by family members or staff shown by a positive response to the following question: 4. Was the patient’s thinking disorganised or incoherent, such as: rambling or irrelevant conversation, unclear or illogical flow of ideas, or unpredictable switching from subject to subject?
215
What is feature 4 of the CDM?
altered level of consciousness
216
How is feature 4 usually obtained and shown?
``` by observing the patient shown by any answer other than ‘alert’ to the following question: 5. Overall, how would you rate this patient’s level of consciousness? alert (normal) vigilant (hyperalert) lethargic (drowsy, easily aroused) stupor (difficult to arouse) coma (unarousable) ```
217
What is the first stage of the 4AT delirium assessment tool?
alertness normal (fully alert, but not agitated) 0 mild sleepiness for <10 secs after waking, then normal 0 clearly abnormal 4
218
What is the second stage of the 4AT delirium assessment tool?
AMT4 - ask your patient the following: age, date of birth, name of hospital/building, current year no mistakes 0 1 mistake 1 2 or more mistakes or untestable 2
219
What is the third stage of the 4AT delirium assessment tool?
attention - ask your patient to list the months of the year backwards 7 months or more correctly 0 starts, but scores <7 months/refuses to start 1 untestable (cannot start because unwell, drowsy) 2
220
What is the fourth stage of the 4AT delirium assessment tool?
acute change or fluctuating course - evidence of significant change or fluctuation in alertness, cognition, other mental function arising over the last 2 weeks and still evident in last 24 hrs no 0 yes 4
221
What does the total score of the 4AT suggest?
4 or above - possible delirium (use the delirium pathway) 1-3 - possible cognitive impairment 0 - delirium or severe cognitive impairment unlikely (bu delirium still possible if stage 4 information incomplete)
222
According to NICE (2010), what should nurses do to prevent sleep disturbance in patients with delirium?
avoid nursing/medical procedures during sleeping hours, if possible schedule medication rounds to avoid disturbing sleep reduce noise to a minimum during sleep periods avoid sedatives
223
According to NICE (2010), what should nurses do to prevent dehydration and constipation in patients with delirium?
ensure adequate fluid intake - encourage to drink and eat monitor dietary intake - be aware of aspiration needs if applicable ensure dentures fit properly, if applicable
224
According to NICE (2010), what should nurses do to prevent cognitive impairment/disorientation in patients with delirium?
provide appropriate lighting and clear signage - a clock (consider providing a 24-hour clock) and a calendar should be easily visible to the patient talk to the patient to reorientate them by explaining where they are, who they are, and what your role is introduce cognitively stimulating activities (e.g. reminiscence) facilitate regular visits from family and friends
225
How can nurses support the family members of patients with delirium?
ensure family are given information about delirium (including causes, reversibility, and the best way to interact with their relative) encourage family to visit and bring familiar objects from home nurses should work within the interdisciplinary team to ensure a planned, sensitive and timely approach to informing the patient's family about delirium and its implications for their relative, recognising the family carer's role and likely distress (Toye et al. 2014)
226
What is dementia?
a syndrome in which there is deterioration in memory, thinking, behaviour and the ability to perform everyday activities the biggest risk factor is age, but it is not a normal part of ageing (WHO, 2017) a major cause of disability and dependency among older people worldwide physical, psychological, social, and economical impact on carers, families and society
227
What is young-onset dementia (YOD)?
dementia diagnosed under the age of 65 younger people are more likely to still be working when they are diagnosed many will have significant financial commitments they often have children to care for and dependent parents too their lives tend to be more active and they have hopes, dreams and ambitions to fulfill, up to and beyond their retirement
228
How many people are estimated to be living with YOD in the UK (Dementia UK)?
42,000
229
How many people are estimated to be living with dementia in the UK (PHE, 2018)?
850,000
230
By 2025, how many people could have dementia in the UK (PHE, 2018)?
over 1 million
231
By 2050, how many people could have dementia in the UK (PHE, 2018)?
over 2 million
232
What is the cost of dementia to the UK (PHE, 2018)?
``` £11.6 billion on unpaid care £5.8 billion on individual social care £4.5 billion on state social care £4.3 billion on health care £100 million on other costs ```
233
What is the Prime Minister's challenge on dementia 2020 (Department of Health, 2015)?
sets out what this Government wants to see in place by 2020 for England to be: (1) the best country in the world for dementia care and support and for people with dementia, their carers and families to live (2) the best place in the world to undertake research into dementia and other neurodegenerative diseases it also highlights the progress to date on improving dementia care, support and research
234
What are the most common causes of dementia?
Alzheimer's disease - 50-70% of cases vascular dementia - 20% dementia with Lewy bodies - 15% frontotemporal dementia - 5%
235
What are the NICE (2018) guidelines on dementia?
this guideline makes specific recommendations on Alzheimer's disease, dementia with Lewy bodies (DLB), frontotemporal dementia, vascular dementia and mixed dementias, as well as recommendations that apply to all types of dementia
236
The NICE (2018) guideline includes recommendations on which areas?
involving people living with dementia in decisions about their care assessment and diagnosis interventions to promote cognition, independence and wellbeing pharmacological interventions managing non-cognitive symptoms supporting carers staff training and education
237
What is Alzheimer's disease?
pathology - amyloid plaques and neurofibrillary tangles | symptoms - impairment in memory (particularly STM), language, and functional ability
238
What is vascular dementia?
pathology - mpeded oxygen supply to the brain caused by infarcts symptoms - cognitive decline with reduced ability to concentrate and communicate; weakness in limbs; loss of coordination
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What is dementia with Lewy bodies?
pathology - abnormal protein deposits in neurons | symptoms - hallucinations and disorientiation; short-term memory loss; slowed movements; attention and alertness
240
What is frontotemporal dementia?
pathology - degeneration of frontal and temporal lobes | symptoms - socially inappropriate behaviour; personality changes; obsessional behaviour
241
Where are memories made and stored in the brain?
hippocampus is underneath the cortex and involved in making new memories short-term memories are stored in the cortex long-term memories are stored deep in the brain
242
What medications are used in the management of Alzheimer's disease?
acetylcholinesterase inhibitors mild to moderate - donepezil (Aricept), galantamine (Reminyl), rivastigmine (Exelon) moderate to severe - memantine (Ebixa)
243
What are the principal goals for dementia care?
early diagnosis in order to promote early and optimal management optimising physical health, cognition, activity, and wellbeing identifying and treating accompanying physical illness detecting and treating challenging behavioural and psychological symptoms providing information and long-term support to carers
244
What are the four essential elements of the person-centred care VIPS model?
valuing - people with dementia and those that care for them individuals - people are individuals and have a unique history perspectives - look at the world from their perspective social - people need to live in a social environment
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What is meant by the 'values' component of the VIPS model?
start from a position of inclusion and respect people with dementia have periods of lucidity and insight people with dementia still experience feelings and emotions and these are still complex and deeply held.
246
What is meant by the 'individuals' component of the VIPS model?
knowing a person's background is important in providing care to provide quality of care you must think about the person with dementia as a unique individual to do this you need to understand the person’s life (e.g. their choices, talents, past experiences, the people and things that are important to them)
247
Why is life story work a good way to incorporate the VIPS model into dementia care?
provides information to use in conversations gives you clues as to how a person might express their needs and emotions you can be sensitive to past loses easier to provide support
248
What is important to remember when communicating with people who have dementia?
make sure the person can see you speak slightly slower and in a calm, positive manner use simple sentences yes-no questions listen ask people to say things in a different way if they have problems finding the right words use body language and read their body language do not stand too close use appropriate physical contact to demonstrate care use visual clues consider the physical environment
249
List some of the most prevalent communication difficulties for people with dementia which arise from severe short-term memory loss.
limited attention span impaired ability to think logically confusion about past and present, including muddling generations impossibility of focusing on more than one thought at a time losing their train of thought repeating thoughts or words over and over given all the above, an unsurprising inability to maintain a conversational topic
250
What does the VERA model stand for?
Validate, Emotion, Reassure, Activity
251
What is meant by the 'validate' component on the VERA model?
accepting that the behaviour exhibited has a value to the person and is not just a symptom of dementia
252
What is meant by the 'emotion' component on the VERA model?
paying attention to the emotional content of what the person is saying
253
What is meant by the 'reassure' component on the VERA model?
this can be as simple as saying "It’ll be okay" and smiling, holding their hand
254
What is meant by the 'activity' component on the VERA model?
people with dementia need to feel occupied and active | see if you can engage them in some related activity
255
How many families in the UK are estimated to be caring for people with dementia (RSAS, 2016)?
700,000
256
What percentage of family carers of people with dementia provide in excess of 100 hrs of care per week (RSAS, 2016)?
36%
257
What is the financial value of the care provided by unpaid carers?
£13.9 billion
258
How can nurses support the carers of people with dementia?
help carers to identify what is positive help carers to express and verbalise what is difficult identify practical solutions that can help maximise opportunities to enjoy and live in the moment encourage the use of validation approaches which acknowledge the feeling being expressed even where the overall message is incomprehensible
259
In 2016, how many suicides were recorded in Great Britain (ONS, 2017)?
5,688
260
Of the suicides recorded in Great Britain in 2016, what percentage were males in comparison to females (ONS, 2017)?
males - 75% | females - 25%
261
What are some of the questions we should ask to assess suicidal ideation?
Do you have thoughts about death or suicide? Do you feel that life is not worth living? Have you made a previous suicide attempt? Is there a family history of suicide? (NICE, 2020)
262
What are the red flag warning signs around suicidal ideation?
increased frequency and or intrusiveness of suicidal ideation feelings of hopelessness about the future, feelings of guilt sudden euphoria following low mood can be an indication that someone is planning to commit suicide and needs to be treated as a serious clinical indicator for further assessment having a definite plan and acting on this plan (engaging in final acts such as writing a letter, collecting tablets, etc.)
263
How do we have discussions around suicidal ideation?
there is no evidence that asking about suicide increases the risk of suicide. try and use open questions to get as much information as possible beware of leading questions which invite a particular response questions may include techniques like normalising which makes it easier for a disclosure. “Sometimes when people are depressed, they quite commonly experience feelings of not wanting to be alive; is this something you can relate to?”
264
What key services can we signpost people to who have been bereaved by suicide?
``` Samaritans Survivors of Bereavement by Suicide (SOBS) Cruse Bereavement Care If U Care Share Foundation Child Bereavement UK Winston’s Wish Muslim Bereavement Support Services ```
265
What tools can mental health specialists use to manage suicidal ideation?
psychiatric observation levels personal safety plans inpatient hospitalisation distraction techniques
266
What steps should you take if you suspect someone has suicidal ideation?
assess listen none judgmentally support the individual to get access to help (e.g. GP, primary MH workers, psychiatric liaison services, secondary MH services, places of safety, or police (in very specific circumstances) you must inform colleagues and contact specialist MH workers seek supervision and support after supporting someone through this situation
267
Why is it essential to assess for suicidal ideation in patients who have self-harmed?
around 1 in 50 people die from suicide after presenting to A&E with self-harm
268
What characteristics of self-harm increase the risk of suicide?
``` serious intent medical seriousness potential use of violent methods evidence of planning (e.g. suicide note or changes to will) precautions taken to prevent rescue ```
269
What characteristics of the person increase the risk of self-harm?
``` older age male gender ongoing hopelessness and intent physical health problems mental health problems other risk-taking or destructive behaviours (e.g. unprotected sexual activity, alcohol or drug use) ```
270
What circumstances of the person increase the risk of self-harm?
lower social class high-risk employment unemployment recent bereavement social isolation harmful relationships (e.g. neglect, abuse, domestic violence) access to the means to self-harm (e.g. supply of medications)
271
What are some of the questions we should ask to assess self-harm ideation?
Can you explain to me your thoughts before you self-harmed? How did you feel after you had self-harmed? Have you self-harmed before? Do you have thoughts about death or suicide? Do you feel that life is not worth living? Is there a family history of self-harm or mental illness?
272
How should you assess safety in patients who have self-harmed?
assess and reduce any immediate physical risks (environmental risks and risks to physical health) assess and reduce safeguarding risks assess for suicidal ideation
273
How should you communicate with patients who have self-harmed?
use positive listening to none judgmentally build a picture of the individual's self-harm this may include the frequency, items used, severity, triggers, time between impulse and self-harm, and self-harm journey over time
274
What tools can mental health specialists use to manage self-harm ideation?
work with individual to minimise risks (e.g. infection minimisation, safety plans, ensuring the individual knows when and how to seek further support) distraction techniques, alternatives, support boxes, positive affirmation cards CBT and other evidence-based talking therapies
275
What does Sullivan (2017) believe about self-harm in hospital settings?
there should be some occasions where a person-centred approach calls for harm minimisation that allows people to self-harm in hospital this would only be allowed after careful MDT discussions, a full assessment of individual needs, and a person-centred care plan