Mental Health Presentations

Question 1

2 key questions to ask for depression screen?

Answer 1

• During the last month, have you often been bothered by feeling down, depressed or hopeless?
• During the last month, have you often been botheed by having little interest or pleasure in doing things? (anhedonia)

Question 2

Associated symptoms of depression to ask?

Answer 2

• Sleep
• Appetite and weight
• Fatigue/loss of energy
• Agitation/slowing of movements or thoughts
• Concentration/indecisiveness
• Feeling worthless/guilt
• Recurrent thoughts of death, suicidal ideas, attempts or specific plans

Question 3

Depression questionaires

Answer 3

• PHQ-9 - patient health questionaire 9
• HADS - hospital anxiety and depression scale
• BDI-II - Beck Depression Inventory II

Question 4

General management of depression

Answer 4

• Signpost - Royal College Psychiatrists website, MIND, Samaritans, SANEline, central access point
• Advice on wellbeing (exercise, alcohol, sleep, diet)
• Social support - family and carers
• Urgent referral to specialist services if high risk of suicide, self harm, risk to others, self neglect or psychotic symptoms
• Address safeguarding

Question 5

Management options depression - specific to less severe (PHQ-9 <16)

Answer 5

• Less severe and does not want treatment, offer active monitoring and f/u in 2-4 weeks
• If less severe and wants treatment offer guided self help first line - not antidepressant
• If want medication SSRIs are first line (eg Sertraline) offer other treatments depending on patient preference/local availability

Question 6

If more severe depression: management

Answer 6

• Offer any treatment first line depending on patient preference
• If want medication, SSRI’s or SNRI’s (eg duloxetine)

Question 7

Other treatments for depression that you can offer

Answer 7

• Guided self help (first line for less severe)
• CBT - group or individual
• Behavioural activation - group or individual
• Group exercise
• Group mindfulness/meditation
• Interpersonal psychotherapy
• SSRIs
• Counselling
• Short term psychodynamic psychotherapy

Question 8

Follow up for those starting SSRIs

Answer 8

• Within 2 weeks normally
• If aged 18-25 within 1 week - can cause initial increased suicidal thoughts/low mood

Question 9

Management options GAD

Answer 9

• Education and monitoring of condition
• Non-facilitated self help
• Guided self help
• Psychoeducational groups
• If still not helped - high intensity psychological intervention eg CBT and SSRI

Question 10

Follow up for those with GAD

Answer 10

• GAD-7 score - see improvement
• F/u within 1 week if starting SSRI and under 30

Question 11

Treatment for symptoms of anxiety eg racing heart, sweating etc

Answer 11

Propanolol

Question 12

Short term option for anxiety for crisis

Answer 12

• Benzodiazepines - but VERY addictive, careful needs only to be short term
• Pregabalin is also sometimes used

Question 13

Tips for coping with anxiety

Answer 13

• Minfulness exercises on youtube
• Square breathing
• Exercise
• Kalms OTC trial?