Mental Health + Contraception Flashcards
Define generalised anxiety disorder
Disproportionate, pervasive, uncontrollable and widespread worry and range of somatic, cognitive and behavioural symptoms that occur on a continuum of severity
ICD-10 criteria for generalised anxiety disorder
Symptoms of anxiety to be present for most days for several months
- apprehension
- motor tension
- autonomic overactivity
Risk factors for generalised anxiety disorder
Female sex FH of psychiatric disorders Childhood adversity - maltreatment - parental problems - exposure to overprotective or overly harsh parenting style - bullying or peer victimisation Environmental stressors - physical or emotional trauma - domestic violence - unemployment - low socioeconomic status Substance dependence Chronic/painful illnesses
Complications of anxiety
Serious disability and impaired quality of life Impaired social and occupational functioning Comorbidities - depression - social anxiety disorder - alcohol and drug misuse - chronic pain - asthma - COPD - IBD Suicidal ideation and attempts
Differential diagnosis of GAD
Situational anxiety Adjustment disorder Depression Panic disorder Social phobia OCD PTSD Medication induced anxiety Cardiac disease Pulmonary disease Hyperthyroidism Anaemia Infection IBS Pheochromocytoma
Stages of suicide risk assessment
Do you ever think about suicide
Have you made plans for ending your life
Do you have the means for doing this available
What has kept you from acting on these thoughts
Protective factors
- what keeps you
- anything that makes your life worth living
Risk factors for suicide risk
Previous attempts at suicide or self-harm Feelings of hopelessness Male gender Age < 30 Advanced age Single/living alone History of substance or alcohol abuse FH of suicide Recent initiation of antidepressant treatment Psychosis Anxiety, agitation, panic attacks Severe depression
Management of GAD
Individual non-facilitated or guided self-help
Psychoeducational groups
Psychological intervention - CBT or applied relaxation
Drug treatment
- SSRI - sertraline or pregabalin
Define depression
Persistent low mood and/or loss of pleasure in most activities and range of associated emotional, cognitive, physical and behavioural symptoms
Risk factors for depression
Chronic comorbidities Medicines Female Older age Recent childbirth Psychosocial issues - divorce, unemployment, poverty, homelessness PMH Genetic and FH Adverse childhood experiences Past head injury
Complications of depression
Exacerbation of pain, disability or distress Reduced QoL Increased morbidity and mortality Impaired ability to function normally Increased risk of substance abuse
Complications of antidepressants
Risk of self-injurious behaviour Sexual adverse effects Undesired weight gain Hyponatraemia Agitation or excessive activation Risk of suicide
Diagnosis of depression
At least one of the two core symptoms present most days, most of the days for at least 2 weeks
- bothered by feeling down, depressed or hopeless
- little interest/pleasure in doing things
Associated symptoms of depression
Disturbed sleep
Decreased or increased appetite and/or weight
Fatigue/loss of energy
Agitation or slowing of movements
Poor concentration or indecisiveness
Feelings of worthlessness or excessive/inappropriate guilt
Suicidal thoughts/acts
Stages of depression
Subthreshold - 2-5 symptoms
Mild - more than 5 but minor functional impairment
Moderate - symptoms or functional impairment are mild-severe
Severe - most symptoms and marked interference with functioning
Differential diagnosis of depression
Grief reaction Anxiety disorders Bipolar disorder Premenstrual dysphoric disorder Neurological conditions - Parkinson's - MS - dementia Substance and adverse drug effects - CO poisoning - substance misuse Hypothyroidism Obstructive sleep apnoea syndrome
Management of depression
Low-intensity psychosocial intervention
Group based CBT
Antidepressant
High-intensity psychosocial intervention
Consider starting an anti-depressent if
History of moderate or severe depression
Subthreshold depressive symptoms that have persisted for a long period - 2 years
Mild depression that persists despite other interventions
Mild depression complicating care of chronic physical health problem
Causes of fatigue
Physiological - pregnancy - breastfeeding - inadequate rest/sleep - excessive exercise Physical - anemia - DM - glandular fever - malignancy Psychological - depression - anxiety - loss - stress Chronic fatigue
Risk factors for chronic fatigue
Female
Higher BMI
Lower educational attainment
Clinical features of chronic fatigue syndrome
Fatigue - persistent (4 months) or recurrent - new or specific onset - unexplained by other conditions - resulted in substantial reduction in activity level - characterised by post-exertional malaise / fatigue Other features - difficulty sleeping - muscle or joint pain without inflammation - headaches - painful lymph nodes without enlargement - sore throat - cognitive dysfunction - worsening symptoms on exertion - general malaise/flu-like symptoms - dizziness/nausea - palpitations
Investigations for fatigue
FBC - anaemia - polycythaemia - haematological malignancy ESR and CRP - infection - inflammation - autoimmunity LFTs U&Es - kidney disease - electrolyte imbalance Thyroid function tests - hypo - hyper HbA1c - DM IgA tissue transglutaminase - coeliac
Method of action of COCP
Inhibit ovulation
- no LH and FSH surge
Oestrogen - endometrium proliferation and growth
Progesterone - prevents hyperplasia of endometrium
When to start COCP
Postpartum - breastfeeding = 6 weeks to 6 months - not breastfeeding = 21 days No regular contraception - day 1 of menstrual cycle
Advantages of COCP
More effective than barrier methods
Sexual intercourse not interrupted
Menstrual bleeding usually regular, lighter and less painful
Reduced risk (50%) of ovarian and endometrial cancer
Reduced risk of colorectal cancer
Reduced severity of acne
Normal fertility returns immediately after stopping
Disadvantages of COCP
Temporary adverse effects when start
Does not protect against STIs
Less effective than long-acting reversible methods
Risks/adverse effects of COCP
Nausea and abdo pain Headache Breast pain/tenderness Menstrual irregularities Hypertension Changes in lipid metabolism MI and stroke VTE Breast cancer Cervical cancer Mood changes
Drug interactions to be aware of with COCP
Liver enzyme-inducing drugs
- antibiotic - rifampicin
- antiepileptics - carbamazepine, phenytoin
- antiretrovirals - ritonavir
- St John’s wort
