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
