Mental health core conditions Flashcards
What are the symptoms of depression? 11
Fatigue/ loss of energy worthlessness inappropriate/excessive guilt recurrent thoughts of death/ suicidal thoughts/attempts diminished ability to think lack of concentration indecisiveness anorexia weight loss insomnia/ hypersomnia
What are the symptoms of atypical depression? 5
reactive mood increased appetite weight gain hypersomnia sensitivity to rejection
What are the 2 core depression questions?
During the last month have you been bothered by feeling down. depressed or hopeless?
Do you have little interest or pleasure in doing things
What are the questions to ask when assessing the risk of suicide?
Do you ever feel that life is hopeless and not worth living?
Do you ever think about suicide?
Have you made any plans for ending your life?
Do you have the means to do this?
what has kept you from acting on these thoughts?
What are the risk factors for suicide? 12
M>F <30 but also old age single or living alone prior attempts history of substance/ alcohol abuse recently started on antidepressants Showing signs of: hopelessness, psychosis, anxiety, agitation, severe depression concurrent physical illness
For a first episode of depression what antidepressants can you give?
SSRI Citalopram fluoextine paroxetine sertraline
Which antidepressant should you prescribe id they have co-current physical health problems?
sertraline as it has the lowest risk of drug interactions
How long after recovery should people continue taking antidepressants for?
at least 6 months
what is generalised anxiety disorder (GAD)
a range of anxiety disorders including acute stress disorder, OCD, panic disorder, PTSD, social phobia and specific phobias
Is GAD more common in M or F?
F
What are the core symptoms of GAD? 2
excessive anxiety and worry occurring more days than not for at least 6 months
difficulty controlling the worry or feelings of anxiety
What are the somatic symptoms of GAD? 7
restlessness increased fatigability irritability heightened muscle tension (including chronic headache) difficulty concentrating sleep disturbances palpitations
What investigations can you do in GAD?
anxiety questionaires
GAD2 and GAD7
What are the questions in GAD7?
Over the last 2 weeks how often have you been bothered by any of the following:
Feeling nervous or on edge (GAD2)
Not being able to stop or control worrying? (GAD2)
Worrying too much over different things?
Trouble relaxing
Being so restless that it’s hard to sit still?
becoming easily annoyed or irritable?
Rank it 0-3: 3 being happens every day 0= not at all
Score 5= mild
10= moderate
15= severe
What are the differential diagnoses for GAD?
anaemia
hyperthryoidism
phaeochromocytoma
^mimic the symptoms
Panic disorders
social anxiety disorders
substance missuse
^ can co-exist
If CBT doesn’t help/ isn’t right what antidepressant can be offered for a first episode of GAD?
SSRI- sertroline
can also give SSRIs escitalopram or paroxetine
If symptoms of GAD don’t improve after 2 months of being on an SSRI then what do you try?
Another SSRI
or switch to a serotonin-noradrenaline reuptake inhibitor e.g. duloxetine, venlafaxine
If the person has severe anxiety which is causing them significant distress, what can you consider?
A short term treatment with a benzodiazepine e.g. diazepam
for no more than 2-4weeks
What is the advised alcohol consumption for men and for women?
M 4units/ day
F 3 units/ day
Is alcohol dependence more common in M or F?
M
What are the criteria for alcohol dependence diagnosis?
Strong desire/ compulsion to drink
Difficulty controlling drinking
Physiological withdrawal state when stopping drinking
Evidence of tolerance
Progressive neglect of other interests
Persistent consumption despite awareness of overtly harmful consequences
What are the potential incidental findings of alcohol dependence that a GP might pick up? 6
Abnormal blood: raised gamma-glutamyl transferase and MCV Dilated facial capillaries bloodshot eyes hand tremor numerous unexplained accidents numerous sick notes- warning signs
What are the two questionnaire used to measure alcohol dependence?
AUDIT- alcohol use disorders identification test
SADQ- severity of alcohol dependence questionaire
When should prophylactic oral thiamine be offered to dependent drinkers?
They are malnourished, or at risk of it
They have a decompensated liver
They are in acute withdrawal
Medically assisted withdrawal is planned
If really badly malnourished consider IM or IV thiamine
What are the withdrawal symptoms? When is the onset? And how long does it normally last?
tremor nausea vomiting sweating generalised convulsions Delrium tremens
3-6 hours after last drink
lasts 5-7 days
What are delirium tremens? And what are its complications?6
Occur in 3% of alcohol withdrawals rapid onset of confusion Complications: seizures hyperthermia dehydration electrolyte imbalance shock chest infection
Wernicke’s encephalopathy is a complication of alcohol dependence, what are its symptoms? 8 and how is it treated?
confusion ataxia opthalmoplegia nystagmus memory disturbances hypothermia hypotension coma
Treat urgently with parenteral thiamine
What ages in M and F does self harm peak at?
F: 15-19
M;20-24
Is self harm more common in M or F?
F
According to NICE guidelines what should happen to young people or children that have presented with self harm?
They should be referred to A&E and be admitted to a paediatric ward over night
According to NICE guidelines how should over 65s who have presented with self harm be managed?
Referred to A&E and presumed to have suicidal thoughts until proven otherwise
What are the risk factors for somatisation?
IBS and chronic pain
PTSD
antisocial personality disorder
history of sexual or physical abuse
When does somatisation usually begin?
Before 30
Is somatisation more common in M or F?
F
What are the typical features of somatisation?
Multiple symptoms, often occurring in different organ systems
symptoms that are vague or exceed objective findings
chronic course
presence of psychiatric disorder
history of extensive diagnostic testing
rejection of previous physicians
What are the precipitating factors for delirium? 16
Infection- e.g. UTI
Metabolic disturbances- e.g. hypoglycaemia, electrolytes, dehydration
CV disorder- e.g. MI
respiratory disorder- e.g. PE or COPD exacerbation
Neurological disorders- e.g. stroke, enecephalitis, SAH
Endocrine disorders- e.g. thyroid or Cushing’s
Urinary retention
GI disorders- e.g. hepatic failure, constipation, malnutrition
Severe uncontrolled pain
Depression sleep deprivation visual or hearing impairment emotional stress change in environment
alcohol intoxication
Medication
Which drugs precipitate delirium? 13
opioids benzodiazepines amoldipine antihistamines anti-parkisonian meds tricyclic antidepressants lithium antipsychotics anticonvulsants antiarrhythmics antihypertensives corticosteroids NSAIDs
What are the risk factors for delirium? 12
>65 cognitive impairment e.g. dementia Multiple co-morbidities significant injuries catherisation polypharmacy surgery alcohol excess sensory impairment poor nutrition lack of stimulation terminal phase of illness
How long do the symptoms of delirium develop over?
hours to days
They tend to fluctuate
What are warning signs of delirium?
falling and loss of appetite
What are the features of hyperactive delirium? 4
inappropriate behaviour
hallucinations
restlessness
wandering
What are the features of hypoactive delirium? 4
lethargy
reduced concentration
reduced appetite
may appear quiet and withdrawn
What are the CAM (short confusion assessment
method) criteria for delirium? 4
Confusion that has developed suddenly and fluctuates
Inattention
disorganised thinking
altered level of consciousness
What investigations should be done in delirium? 14
urinalysis- hyperglycaemia sputum culture- chest infection FBC- infection or anaemia Folate and B12 Urea and electrolytes- AKI, hyponatremia/kalaemia HbA1c Ca LFTs ESR CRP drug levels TFTs CXR ECG
What are the causes of dementia? 4, 12
Alzheimer’s (50-75%)
Vascular dementia (20%)
Dementia with Lewy bodies (5%)
Frontotemperal dementia (2%)
rarer: Parkinson's disease dementia progressive supranuclear palsy Huntington's CJD Normal pressure hydrocephalus chronic subdural haematoma benign tumours Hypocalcaemia recurrent hypoglycaemia Vitamin B12 and thiamine def HIV Syphillis
What are the risk factors for dementia? 11
Age mild cognitive impairment Learning difficulties esp. Down's Genetics CV risk factors for vascular dementia- DM, smoking, HTN low physical activity stroke depression alcohol low educational attainment low social engagement and support
What causes young onset dementia?
mutation in the amyloid precursos protein (APP)
or presebillin genes: PSEN1, PSEN2
What must a person have for a diagnosis of dementia to be made?
Impairment of at least 2 cognitive domains (see below) leading to significant functional decline that cannot be explained by another disorder or medication
memory
language
behaviour
visuspatial or executive function
What are the behavioural and psychological symptoms of dementia? 8
agitation/ emotional labillity depression apathy repetitive questioning psychosis aggression sleep problems wandering
What are the cognitive impairment problems in dementia? 5
memory problems
receptive or expressive dysphagia
difficulty carrying out coordinated movements e.g. dressing
Disorientation and unawareness of time and place
impairment of executive function e.g. planning or problem solving
What are the signs of Alzheimer’s disease?
early impairment of episodic memory- loss of memory of recent events, repeated questioning, difficulty learning new info
What are the signs for vascular dementia?
stepwise increase in severity of symptoms
focal neurological signs e.g. hemiparesis or visual field defects may be present
what are the signs for Lewy body dementia? 7
repeated falls syncope severe sensitivity to antipsychotics delusions hallucinations Memory impairment may not be apparent in early sarges Parkinsonian motor features
what are the signs for frontotemporal dementia?
Personality changes and behavioural disturbances e.g. apathy, sexual disinhibition
Other cognitive functions e.g. memory and perception may be preserved
What medications are available for Alzheimer’s?
Acetylcholinesterase inhibitors- donepezil, galantamine and rivastigmine
Memantidine
