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Mental health conditions Flashcards

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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
Q

How does mental illness impact social isolation?

A

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

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26
Q

How does mental illness impact housing?

A

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

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27
Q

What is depression?

A

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

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28
Q

What is the prevalence of depression in people with diabetes?

A

30% of people with diabetes are estimated to be affected by depression
this is set against 36% who experience diabetic distress

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29
Q

What is the economic cost of treating people with diabetes and depression?

A

£1.8 billion of additional costs can be attributed to poor mental health

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30
Q

What is the prevalence of depression in people with cancer?

A

ranges from 4-49% depending on the type of cancer

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31
Q

What is the economic cost of treating people with cancer and depression?

A

£7.6 billion a year due to premature deaths and time off work
service costs are increasing to £13 billion by 2020-21

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32
Q

What is the prevalence of depression in people with COPD?

A

varies depending on the severity of the condition

estimated to be as high as 27%

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33
Q

What is the economic cost of treating people with COPD and depression?

A

£3 billion and £1.9 billion respectively

in total, all lung conditions (including lung cancer) directly cost the NHS £11 billion annually

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34
Q

What is the prevalence of depression in people with CVA?

A

post-stroke depression is estimated to be 30%

varies from 29-36%

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35
Q

What is the economic cost of treating people with CVA and depression?

A

3-5% of all healthcare expenditure

England, Wales and Northern Ireland was £3.60 billion in the first five years after admission

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36
Q

What is the prevalence of depression in people with arthritis?

A

varies depending on the type of arthritis from 5-51%

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37
Q

What is the economic cost of treating people with arthritis and depression?

A

healthcare costs of osteoarthritis and rheumatoid arthritis will reach £118.6 billion over the next decade

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38
Q

What are the four levels of depression (NICE, 2009)?

A

subthreshold depressive symptoms
mild depression
moderate depression
severe depression

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39
Q

What are subthreshold depressive symptoms (NICE, 2009)?

A

fewer than 5 symptoms of depression

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40
Q

What is mild depression (NICE, 2009)?

A

few, if any, symptoms in excess of the 5 required to make the diagnosis
symptoms result in only minor functional impairment

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41
Q

What is moderate depression (NICE, 2009)?

A

symptoms or functional impairment are between ‘mild’ and ‘severe’

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42
Q

What is severe depression (NICE, 2009)?

A

most symptoms and the symptoms markedly interfere with functioning
can occur with or without psychotic symptoms

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43
Q

What are the key symptoms of depression (NICE, 2009)?

A

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

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44
Q

If any of the key symptoms are present, what are the following associated symptoms that should then be discussed?

A

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

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45
Q

What are the criteria for general advice and active monitoring?

A

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

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46
Q

What are the criteria for active treatment in primary care?

A 
five or more symptoms with associated disability
persistent or long-standing symptoms
personal or family history of depression
low social support
occasional suicidal thoughts
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47
Q

What are the criteria for referral to mental health professionals?

A

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

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48
Q

What are the criteria for referral to specialist mental health services?

A

actively suicidal ideas or plans
psychotic symptoms
severe agitation accompanying severe symptoms
severe self-neglect

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49
Q

What are some non-pharmacological interventions for persistent subthreshold depressive symptoms or mild to moderate depression?

A 
individual guided self-help based on the principles of CBT? 
computerised CBT (CCBT)
a structured group physical activity programme
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50
Q

What are the two alternatives if an individual does not benefit from first-line non-pharmacological treatment?

A 
an antidepressant (normally an SSRI) OR
a high-intensity psychological intervention
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51
Q

What are four types of high-intensity psychological interventions?

A 
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)
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52
Q

What is the recommended treatment for moderate to severe depression?

A

antidepressant medication AND

a high-intensity psychological intervention (CBT or IPT)

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53
Q

What factors should influence the choice of intervention for moderate to severe depression?

A

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

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54
Q

In what cases should antidepressant medication be considered?

A

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

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55
Q

List some examples of SSRIs.

A

sertraline, citalopram, fluoxetine

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56
Q

What are some adverse effects of SSRIs?

A

increased risk of bleeding, risk of suicidal ideation

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57
Q

List some examples of TCAs.

A

amitriptyline, imipramine, lofepramine

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58
Q

What is an adverse effect of TCAs?

A

increased risk of overdose (except lofepramine)

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59
Q

What is the McGurk effect?

A

an illusion that results from conflicting information coming from different senses, namely sight and hearing

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60
Q

What is solution-focused brief therapy?

A

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

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61
Q

What are the four steps of solution-focused brief therapy?

A

(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?

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62
Q

What are the three principles of solution-focused brief therapy?

A

(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

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63
Q

What is the ‘miracle question’?

A

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?

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64
Q

What are the assumptions to solution-focused brief therapy?

A

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

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65
Q

What is a ‘scaling question’?

A

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)?

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66
Q

What are the exceptions to solution-focused brief therapy (Wand, 2010)?

A

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

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67
Q

What is cognitive behavioural therapy (CBT)?

A

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

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68
Q

What are the three key elements of CBT?

A

thoughts, feelings, behaviours

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69
Q

What is meant by ‘thoughts’?

A

negative automatic thoughts are the cognitive cause of distress
they are automatic, involuntary, plausible, distorted and unhelpful

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70
Q

What is meant by ‘feelings’?

A

emotions - one word such as anger, depression, fear, guilt

physical sensations - sweating, crying, lack of appetite, sleep difficulty

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71
Q

What is meant by ‘behaviours’?

A

what people do - includes what people avoid and what they do to make themselves feel better (can be safety behaviours)

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72
Q

What are the key characteristics of CBT?

A

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

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73
Q

What is a case formulation?

A

outlines the relationship between thoughts, emotions, behaviours, physical reactions and environment
models of case formulation range from simple to complex

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74
Q

What are the two basic assumptions of a case formulation (Grant et al., 2010)?

A

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

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75
Q

What are the three key elements of a case formulation?

A

core beliefs, assumptions, triggers

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76
Q

What is meant by ‘core beliefs’?

A

negative automatic thoughts about self, others and the world

the lens through which people see the world

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77
Q

What is meant by ‘assumptions’?

A

rules for living

“If… then…”

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78
Q

What is meant by ‘triggers’?

A

incidents that set off the symptoms or cause changes to one or more of the elements of psychological distress

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79
Q

What percentage of the UK population suffer from bipolar affective disorder?

A

2%

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80
Q

How is bipolar affective disorder classified?

A

DSMCI - bipolar I and bipolar II

ICD-10 - bipolar affective disorder and bipolar affective disorder in remission

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81
Q

How is bipolar affective disorder characterised?

A

episodes of depressed and elated mood

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82
Q

How is bipolar affective disorder diagnosed?

A

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)

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83
Q

What is the risk of recurrence following an episode of bipolar affective disorder (BMJ, 2018)?

A

within 12 months - 50% (especially high when compared to other psychiatric disorders)
within four years - 75%

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84
Q

What factors can improve the prognosis for people with bipolar affective disorder?

A

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)

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85
Q

What is psychosis?

A

encompasses a number of symptoms associated with significant alternations to a person’s perception, thoughts, mood, and behaviour

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86
Q

What are the two types of symptoms associated with psychosis?

A

positive symptoms and negative symptoms

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87
Q

What are positive symptoms of psychosis?

A

disorganised behaviour
speech, and/or thoughts (thought disturbance) delusions (fixed or falsely-held beliefs)
hallucinations (perceptions in the absence of stimuli)

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88
Q

What are negative symptoms of psychosis?

A 
emotional blunting
reduced speech
loss of motivation
self-neglect
social withdrawal
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89
Q

What are psychotic symptoms?

A

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

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90
Q

What is the aim of treatment for psychosis?

A

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

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91
Q

What is the role of a care coordinator (NHS, 2015)?

A

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

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92
Q

According to the NHS (2015) guidelines for psychosis, how quickly should someone with suspected first episode of psychosis be seen for a specialist assessment?

A

within two weeks of referral

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93
Q

List three benefits to early intervention in psychosis.

A

decreased service use
better health and economic outcomes in both the short- and long-term
reduced risk of premature death

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94
Q

Is voice hearing only associated with psychosis?

A

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

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95
Q

List six risk factors for drug misuse (PHE, 2017).

A

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

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96
Q

What is the estimated cost of alcohol abuse in the UK (PHE, 2017)?

A

£21 billion

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97
Q

What is the estimated cost of drug abuse in the UK (PHE, 2017)?

A

£15 billion

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98
Q

What is the estimated cost of lost productivity due to alcohol in the UK (PHE, 2017)?

A

£7.3 billion

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99
Q

How many working days are lost each year in the UK due to alcohol misuse alone (PHE, 2017)?

A

17 million

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100
Q

What percentage of substance abusers are in full-time employment (PHE, 2017)?

A

70%

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101
Q

What is drug dependence?

A

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

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102
Q

What is drug abuse?

A

recurrent or continued use of drugs in doses or ways that result in adverse consequences

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103
Q

What is drug tolerance?

A

(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

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104
Q

What is drug withdrawal?

A

(1) the characteristic withdrawal syndrome from the substance
(2) the same (or closely related) substance being taken to relieve or avoid withdrawal symptoms

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105
Q

What is substance dependence according to the DSM-IV?

A

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

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106
Q

What is the first criteria for substance dependence according to the DSM-IV?

A

tolerance

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107
Q

What is the second criteria for substance dependence according to the DSM-IV?

A

withdrawal

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108
Q

What is the third criteria for substance dependence according to the DSM-IV?

A

the substance is often taken in larger amounts or over a longer period than intended

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109
Q

What is the fourth criteria for substance dependence according to the DSM-IV?

A

there is a persistent desire or unsuccessful efforts to cut down or control substance use

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110
Q

What is the fifth criteria for substance dependence according to the DSM-IV?

A

a great deal of time is spent in activities necessary to obtain the substance, to use the substance, or to recover from its effects

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111
Q

What is the sixth criteria for substance dependence according to the DSM-IV?

A

important social, occupational, or recreational activities are given up or reduced because of substance use

112
Q

What is the seventh criteria for substance dependence according to the DSM-IV?

A

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
Q

What is substance abuse according to the DSM-IV?

A

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
Q

What is the first criteria for substance abuse according to the DSM-IV?

A

recurrent substance use resulting in a failure to fulfil major role obligations at work, school or home

115
Q

What is the second criteria for substance abuse according to the DSM-IV?

A

recurrent substance use in situations in which it is physically hazardous

116
Q

What is the third criteria for substance abuse according to the DSM-IV?

A

recurrent substance related legal problems

117
Q

What is the fourth criteria for substance abuse according to the DSM-IV?

A

continued substance abuse despite having persistent or recurrent social interpersonal problems caused or exacerbated by the effects of the substance

118
Q

What are the two types of dependence?

A

physical and psychological

119
Q

What is physical dependence?

A

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
Q

How long does it taken to develop physical dependence to a drug?

A

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
Q

What is abstinence syndrome?

A

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
Q

What is psychological dependence?

A

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
Q

What is meant by the phrase: ‘Context-specific tolerance is an integral part of psychological dependence’?

A

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
Q

List some examples of psychological dependence.

A 
enhances mood or performance
copes better with adverse or stressful situations
to help socialise
to conform
expansion of experimental awareness
125
Q

What is secondary psychological dependence?

A

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
Q

What is involved in the mechanism of reinforcement action?

A

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
Q

How does religion impact on dependence?

A

the more religious, the less the problem with drug abuse/dependence, especially if the religion bans the substance

128
Q

How do sociological factors impact on dependence?

A 
drug availability
significant others labelling the person as a deviant
peer influence
early childhood deviance
poor school adjustment
weak family influence
129
Q

What personality traits correlate with dependence?

A

sensation or novelty seeking traits

history of antisocial behaviour (e.g. nonconformity, acting out, and impulsivity)

130
Q

What is comorbidity in relation to substance dependence?

A

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
Q

What are the general factors involved in treatment for substance dependence?

A

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
Q

Why is treatment for substance dependence difficult?

A

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
Q

What is the ‘cycle of change’?

A 
pre-contemplation
contemplation
determination
action
maintenance
re(lapse)
lasting change
134
Q

What is the physical treatment for substance dependence?

A

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
Q

What factors may help to prevent relapse of substance dependence?

A

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
Q

What is the psychological treatment for substance dependence?

A

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
Q

What factors make psychological treatment for substance dependence more difficult?

A 
poor self-image
sees themselves as a drug user
history of deviance
poor socioeconomic background
few education-related skills
138
Q

How is medication used in the treatment of substance dependence?

A

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
Q

What would be the ideal characteristics of a medication used in the treatment of substance dependence?

A 
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
Q

What are the key factors of a substance use assessment?

A 
thorough assessment
under detection
assessment process
nurse’s attitude
confidentiality
adaptable assessment process
time
needs change
141
Q

Why is the assessment process important?

A

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
Q

What are psychotherapeutic processes?

A

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
Q

Why does the assessment process need to be adaptable?

A

the assessment could be done in a variety of different settings
people are at different stages of being ready to change

144
Q

What is the current legislative framework?

A

MHRA - Medicines Act 1968
Home Office - Misuse of Drugs Act 1971 - recreational psychoactive drugs
regulated sales - alcohol/tobacco/solvents
unregulated sales - khat/coffee

145
Q

Emerging clinical research has provided evidence to support the claim that cannabis-based treatments can have therapeutic effects for which conditions?

A 
childhood epilepsy
Alzheimer's disease
cancer
chronic pain
multiple sclerosis
146
Q

Which countries have legalised medical cannabis?

A 
Germany
Israel
Australia
Portugal
Canada is set to become the first G7 nation to legalise recreational use
147
Q

What did the World Health Organisation (WHO) (2017) state regarding the legalisation of cannabis?

A

publicly endorsed the medicinal qualities of cannabis

recommended to review their approach to the scheduling of Cannabidiol (CBD) oil

148
Q

What did the Medicines and Healthcare Products Regulatory Agency (MHRA) (2016) state regarding the legalisation of cannabis?

A

“products containing Cannabidiol (CBD) used for medical purposes are a medicine”

149
Q

Following recent high-profile campaigns by the parents of childhood epilepsy sufferers, what did Home Secretary Sajid Javid commission in 2018?

A

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
Q

What happened on the 26th July 2018?

A

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
Q

What must patients demonstrate, with the support of a specialist clinician, before a license for cannabis-based prescriptions may be granted (Home Office, 2018)?

A

‘exceptional clinical circumstances’ to an expert panel

152
Q

What did the Government’s 2017 ‘Drug Strategy’ report state?

A

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
Q

What are the health benefits of cannabis-based treatments?

A

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
Q

How do cannabis-based treatments reduce pain?

A

cannabis binds to CB1 receptors while reducing swelling

155
Q

How do cannabis-based treatments prevent neurodegenerative disorders like Alzheimer’s disease?

A

cannabis helps to remove plaques that block neuron-signalling

156
Q

How do cannabis-based treatments reduce tobacco addiction?

A

cannabis modulates the rewarding effects of nicotine

157
Q

How do cannabis-based treatments help to clear acne?

A

cannabis inhibits lipid synthesis on the skin

158
Q

How do cannabis-based treatments provide relief for IBD?

A

cannabis has anti-inflammatory effects

159
Q

What are the patterns of substance use?

A

substance use is on a continuum
occasional/experimental
recreational binge dependency - psychological or physiological

160
Q

What information is used in an assessment to detect substance use?

A

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
Q

What are the key components of a comprehensive substance use assessment?

A 
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
Q

How can you assess current and recent substance use?

A 
What? When? How? Where? With whom?
details
diary
withdrawal
funding
observational assessment
health education
163
Q

Why is a diary useful?

A

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
Q

What is involved in an observational assessment?

A 
inspect injection site - is it safe?
physical appearance (e.g. underweight, disshelved/ unkempt, agitated, anxious)
non-verbal communication
intoxication or withdrawal
any injuries
165
Q

What is health education?

A

client consents to getting information from other sources

166
Q

How can you obtain a substance use history?

A 
when substance use began
what prompted use
how use developed over time
impact on life
periods of abstinence
previous treatment
timeline
167
Q

What is important to remember when obtaining a substance use history?

A

think carefully about the language you use
be sensitive and adaptable
some people find the verb ‘use’ offensive

168
Q

What are the physical effects of alcohol use?

A 
nutritional deficiency
withdrawal seizures
delirium tremens
cognitive impairment
transient memory loss
ulcers
Korsakoff’s syndrome
hypertension
engaging in unsafe sex
169
Q

What are the physical effects of stimulant use?

A

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
Q

What are the physical effects of opiate use?

A 
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
Q

What are the physical effects of benzodiazepine use?

A

risks associated with crushing and injecting pills

172
Q

What are the physical effects of cannabis use?

A

respiratory problems if smoking

173
Q

What are the general factors to consider regarding the physical effects of substance use?

A

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
Q

What tests can be completed to detect physical effects of substance use?

A

urinalysis
breathalyser
blood tests for liver function

175
Q

What are some of the potential mental health effects of substance use?

A

suicide
deliberate self-harm
self-neglect
depression

176
Q

How is sustance use related to suicide?

A

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

177
Q

How is sustance use related to deliberate self-harm?

A

alcohol use often precursor
reduces inhibitions
numbs pain

178
Q

How is sustance use related to self-neglect?

A

not eating
neglecting personal hygiene
lack of basic amenities in accommodation/no accommodation

179
Q

How is substance use related to depression?

A

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
Q

Why is it important to gain insight into the client’s perceptions of their situation, their reasons for substance use and readiness to change?

A

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
Q

Why is a decision matrix useful?

A

it enables people to explore their reasons for using substances and identify the disadvantages of substance use

182
Q

What is motivational interviewing?

A

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
Q

Why was motivational interviewing developed?

A

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

184
Q

What are the key concepts emplyed in the motivational interviewing style?

A

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
Q

What proportion of adults with mental health problems are supported in primary care?

A

9 in 10

186
Q

What is generalised anxiety disorder (GAD)?

A

estimated to affect 5% of the UK population
slightly more women are affected than men
more common in people aged 35-59 years

187
Q

What are personality disorders?

A

a group of personality traits that interfere with a person’s ADLs
they are strongly associated with adverse childhood experiences

188
Q

What diagnostic information is provided by the ICD-10 (2019) Classification of Mental and Behavioural Disorders for personality disorders?

A

“…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.”

189
Q

What proportion of people in the UK have a personality disorder?

A

1 in 20

190
Q

In which settings is the prevalence of personality disorders much higher?

A

criminal justice system

inpatient mental health services

191
Q

What are the key features of cluster A personality disorders?

A

odd and eccentric

difficulty relating to others

192
Q

What are the three cluster A personality disorders?

A

paranoid
schizoid
schizotypal

193
Q

What are the key features of cluster B personality disorders?

A

difficulty controlling emotions

impulsive

194
Q

What are the four cluster B personality disorders?

A

antisocial
borderline
histrionic
narcissistic

195
Q

What are the key features of cluster C personality disorders?

A

anxious and fearful

perfectionist

196
Q

What are the two cluster C personality disorders?

A

avoidant

dependent

197
Q

What are the two most common personality disorders?

A

borderline personality disorder and dissocial personality disorder

198
Q

Why is the diagnosis of a personality disorder seen as controversial?

A

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
Q

According to NICE (2015), what treatments are recommended for borderline and antisocial personality disorders?

A

psychological therapies
pharmacological interventions - antipsychotic or sedative medication for short-term crisis management or treatment of comorbid conditions

200
Q

What is delirium?

A

a common clinical syndrome characterised by disturbed consciousness, cognitive function or perception, which has an acute onset and fluctuating course.
it usually develops over 1-2days
a serious condition associated with poor outcomes
it can be prevented and treated if dealt with urgently (NICE, 2010)

201
Q

What are some of the common risk factors for delirium?

A 
old age
severe illness
dementia
physical frailty
admission with infection or dehydration
polypharmacy
surgery
202
Q

What signs and symptoms indicate delirium?

A

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
Q

What are the three types of delirium?

A

hyperactive, hypoactive, mixed

204
Q

What is hyperactive delirium?

A

abnormally alert, restless, agitated, maybe aggressive could experience hallucinations or delusions

205
Q

What is hypoactive delirium?

A

symptoms could include abnormal sleepiness and withdrawal

could be unresponsive

206
Q

What is mixed delirium?

A

alternate between hypoactive and hyperactive delirium

207
Q

What are the differences between delirium and dementia?

A

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
Q

What are the two types of assessment used to diagnose delirium?

A

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

209
Q

What is feature 1 of the CAM?

A

acute onset and fluctuating course

210
Q

How is feature 1 usually obtained and shown?

A

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
Q

What is feature 2 of the CAM?

A

inattention

212
Q

How is feature 2 usually obtained and shown?

A

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
Q

What is feature 3 of the CAM?

A

disorganised thinking

214
Q

How is feature 3 usually obtained and shown?

A

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
Q

What is feature 4 of the CDM?

A

altered level of consciousness

216
Q

How is feature 4 usually obtained and shown?

A 
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
Q

What is the first stage of the 4AT delirium assessment tool?

A

alertness
normal (fully alert, but not agitated) 0
mild sleepiness for <10 secs after waking, then normal 0
clearly abnormal 4

218
Q

What is the second stage of the 4AT delirium assessment tool?

A

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
Q

What is the third stage of the 4AT delirium assessment tool?

A

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
Q

What is the fourth stage of the 4AT delirium assessment tool?

A

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
Q

What does the total score of the 4AT suggest?

A

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
Q

According to NICE (2010), what should nurses do to prevent sleep disturbance in patients with delirium?

A

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
Q

According to NICE (2010), what should nurses do to prevent dehydration and constipation in patients with delirium?

A

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
Q

According to NICE (2010), what should nurses do to prevent cognitive impairment/disorientation in patients with delirium?

A

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
Q

How can nurses support the family members of patients with delirium?

A

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
Q

What is dementia?

A

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
Q

What is young-onset dementia (YOD)?

A

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
Q

How many people are estimated to be living with YOD in the UK (Dementia UK)?

A

42,000

229
Q

How many people are estimated to be living with dementia in the UK (PHE, 2018)?

A

850,000

230
Q

By 2025, how many people could have dementia in the UK (PHE, 2018)?

A

over 1 million

231
Q

By 2050, how many people could have dementia in the UK (PHE, 2018)?

A

over 2 million

232
Q

What is the cost of dementia to the UK (PHE, 2018)?

A 
£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
Q

What is the Prime Minister’s challenge on dementia 2020 (Department of Health, 2015)?

A

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
Q

What are the most common causes of dementia?

A

Alzheimer’s disease - 50-70% of cases
vascular dementia - 20%
dementia with Lewy bodies - 15%
frontotemporal dementia - 5%

235
Q

What are the NICE (2018) guidelines on dementia?

A

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
Q

The NICE (2018) guideline includes recommendations on which areas?

A

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
Q

What is Alzheimer’s disease?

A

pathology - amyloid plaques and neurofibrillary tangles

symptoms - impairment in memory (particularly STM), language, and functional ability

238
Q

What is vascular dementia?

A

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

239
Q

What is dementia with Lewy bodies?

A

pathology - abnormal protein deposits in neurons

symptoms - hallucinations and disorientiation; short-term memory loss; slowed movements; attention and alertness

240
Q

What is frontotemporal dementia?

A

pathology - degeneration of frontal and temporal lobes

symptoms - socially inappropriate behaviour; personality changes; obsessional behaviour

241
Q

Where are memories made and stored in the brain?

A

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
Q

What medications are used in the management of Alzheimer’s disease?

A

acetylcholinesterase inhibitors
mild to moderate - donepezil (Aricept), galantamine (Reminyl), rivastigmine (Exelon)
moderate to severe - memantine (Ebixa)

243
Q

What are the principal goals for dementia care?

A

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
Q

What are the four essential elements of the person-centred care VIPS model?

A

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

245
Q

What is meant by the ‘values’ component of the VIPS model?

A

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
Q

What is meant by the ‘individuals’ component of the VIPS model?

A

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
Q

Why is life story work a good way to incorporate the VIPS model into dementia care?

A

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
Q

What is important to remember when communicating with people who have dementia?

A

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
Q

List some of the most prevalent communication difficulties for people with dementia which arise from severe short-term memory loss.

A

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
Q

What does the VERA model stand for?

A

Validate, Emotion, Reassure, Activity

251
Q

What is meant by the ‘validate’ component on the VERA model?

A

accepting that the behaviour exhibited has a value to the person and is not just a symptom of dementia

252
Q

What is meant by the ‘emotion’ component on the VERA model?

A

paying attention to the emotional content of what the person is saying

253
Q

What is meant by the ‘reassure’ component on the VERA model?

A

this can be as simple as saying “It’ll be okay” and smiling, holding their hand

254
Q

What is meant by the ‘activity’ component on the VERA model?

A

people with dementia need to feel occupied and active

see if you can engage them in some related activity

255
Q

How many families in the UK are estimated to be caring for people with dementia (RSAS, 2016)?

A

700,000

256
Q

What percentage of family carers of people with dementia provide in excess of 100 hrs of care per week (RSAS, 2016)?

A

36%

257
Q

What is the financial value of the care provided by unpaid carers?

A

£13.9 billion

258
Q

How can nurses support the carers of people with dementia?

A

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
Q

In 2016, how many suicides were recorded in Great Britain (ONS, 2017)?

A

5,688

260
Q

Of the suicides recorded in Great Britain in 2016, what percentage were males in comparison to females (ONS, 2017)?

A

males - 75%

females - 25%

261
Q

What are some of the questions we should ask to assess suicidal ideation?

A

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
Q

What are the red flag warning signs around suicidal ideation?

A

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
Q

How do we have discussions around suicidal ideation?

A

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
Q

What key services can we signpost people to who have been bereaved by suicide?

A 
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
Q

What tools can mental health specialists use to manage suicidal ideation?

A

psychiatric observation levels
personal safety plans
inpatient hospitalisation
distraction techniques

266
Q

What steps should you take if you suspect someone has suicidal ideation?

A

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
Q

Why is it essential to assess for suicidal ideation in patients who have self-harmed?

A

around 1 in 50 people die from suicide after presenting to A&E with self-harm

268
Q

What characteristics of self-harm increase the risk of suicide?

A 
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
Q

What characteristics of the person increase the risk of self-harm?

A 
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
Q

What circumstances of the person increase the risk of self-harm?

A

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
Q

What are some of the questions we should ask to assess self-harm ideation?

A

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
Q

How should you assess safety in patients who have self-harmed?

A

assess and reduce any immediate physical risks (environmental risks and risks to physical health)
assess and reduce safeguarding risks
assess for suicidal ideation

273
Q

How should you communicate with patients who have self-harmed?

A

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
Q

What tools can mental health specialists use to manage self-harm ideation?

A

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
Q

What does Sullivan (2017) believe about self-harm in hospital settings?

A

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

Therapeutic Nursing (16 decks)

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