Mental heath Core Conditions Flashcards
Prevalence of depression?
5-10%
Who gets depression?
2/3 adults experience depressed mood
More common in people with backgrounds of asylum seeking, refugees
Causes of depression?
Stress/traumatic event Physical/chronic illness Low self-esteem Postnatal 1st degree relative affected Alcohol/drugs abuse Progesterone contraceptives CNS depressants Centrally active anti-HTN Lipid soluble B blockers Benzos
Risk factors for depression?
Female Hx Chronic illness/disability Other metal illness Social stresses Lack of social support/loneliness
Symptoms of depression?
Low mood Hopeless/helpless Tearful Guilty Irritable No motivation/interest (anhedonism) Anxious Suicidal/self harm Slowed movement/speech Appetite/weight changes Constipation Aches Loss of energy and libido Menstrual changes Sleep disturbances
Differentials for depression?
Bipolar affective disorder Schizophrenia Dementia SAD Bereavement Amphetamine withdrawal Organic causes (hypothyroidism, Cushing's, corticosteroid treatment)
Investigations for depression?
PHQ-9 Hospital anxiety and depression scale Beck depression inventory MMSE Bloods Brain imaging
Treatment for depression?
Watchful waiting Exercise Diet SSRIs ECT as last line
% of population affected by anxiety?
4-6%
Causes of anxiety?
Stressful event
NA/serotonin imbalances
Genetics, environments and biological processes
Risk factors for anxiety?
35-54 Divorced Loneliness FHx YA for GAD/social anxiety Female Low income Social support of avoidance Adolescents who smoke Girls who began puberty early
DSM symptoms of anxiety?
Excessive anxiety for more days than not over 6 months PLUS 3 or more of these symptoms: Restlessness Easily fatigued Difficulty focusing Muscle tension Sleep disturbances PLUS at least 4 from: Palpitations Sweating Shaking Dry mouth SOB Choking Chest pain Nausea Dizzy Unsteady Derealisation Depersonalisation ETC ETC
Differentials for anxiety?
Panic disorder OCD PTSD Phobias Social anxiety Acute stress disorder Schizphrenia Dementia Anxiety with depression Alcoholims Thyrothoxicosis Phaechromocytoma Hypoglycaemia
Investigations for anxiety?
HR, BP, tremor MSE TFTs, ECG Urinalysis for phaechromocytoma EEG Pulmonary function test
Treatment for anxiety?
CBT/applied relaxation SSRIs SNRIs Pregabalin Propanolol
Who self harms?
F>M
Adolescents and YAs
5% done by >65
Causes of self harm?
Coping with suicidal thoughts Release of emotions Social factors Trauma Emotional distress Low self esteem Mental illness Dissociation Hearing voices BPD
Risk factors for self-harm?
Psychiatric conditions Drug/alcohol abuse Domestic violence Low SEC Young age South Asian Women
Symptoms of self harm?
Unexplained cuts/bruises/burns Covering skin at all times Low mood Tearful Lack of motivation Appetite/weight changes Pulling hair out Drug/alcohol misuse Feelings of shame/guilt
Differentials for self harm?
Attempted suicide Undiagnosed brittle bones disease Accidental Haemophilia Other clotting disorders Sexual/physical abuse
Investigations for self-harm?
Screen for anxiety, depression, personality disorders
Examine injuries
Treatment for self-harm?
Activated charcoal within 1 hour of overdose Support Risk assessment Psychological intervention Treat underlying mental illness
Who is more likely to develop somatisation?
F>M
<30y/o
Causes of somatisation?
IBS Chronic pain Antisocial personality disorder Mood disorder Childhood trauma Misuse of prescription drugs Seeking attention/care/monetary reward Sexual or physical abuse
Risk factors for somatisation?
Genetics Difficulties expressing emotions as a child Maladaptive/anxious styles Poor coping mechanisms Anger Disengagment Avoidance Internalising High familial pressure on children Trauma Abuse Family secrets School stressors
Symptoms of somatisation?
Multiple, vague symptoms that span organ systems Rejection of previous doctors Stress worsens symptoms SOB Palpitations Chest pain D+V/abdo pain Muscle/joint pain Headaches Dizziness Amnesia Vision changes Impotence
Differentials for somatisation?
ARDS Alcoholism Adjustment disorders Amphetamine related Androgen excess Eating disorders AF ADHD Autism Delirium Munchasen's Fibromyalgia IBS Insomnia Meningitis Sleep apnoea Premenstrual dysphoric disorder
Investigations for somatisation?
Thorough history and exam
Psych eval
Diagnosis by exclusion
Treatment for somatisation?
BATHE techniques Goal setting Physical exercise Relaxation Psychotherapy
What is the BATHE technique?
Background Affect Trouble Handle Empathy
Who gets delirium?
Elderly
Pre-existing cognitive impairment
Malignancy
HIV
Causes of delirium?
Systemic infection Renal/hepatic failure Dehydration/electrolyte imbalance Hypoxia Vit def Hypothyrid Cushing's IC truma/tumour/abscess SAH Epilepsy Drugs Post-op stress Terminal illness
Risk factors for delirium?
>65 Male Pre-existing cog impairment Burns AIDS # Low albumin Infeciton Dehydration Benzos Alcohol abuse Hyper/hypothermia Poor mobility Social isolation Stress ICU High serum urea
Symptoms of delirium?
Acute/subacute Impaired cognition Poor concentration/short term memory Abnormal sleep-wake cycle Hallucinations Agitation Emotional lability Psychotic ideas Unsteady gait, tremor Hypo/hyperactive Mixed Drug induced
Differentials for delirium?
Dementia (Lewy body) Depression Bipolar Fucntional psychoses Stroke/TIA MI Infection Hypoglycaemia Meningitis Brain tumour Post-tictal state
Investigations for delirium?
Full Hx and cognition assessment Lymphadenopathy FBC, U+E, creatinine, BM, Ca, Mg, LFTs, TFTs, cardiac enzymes, B12, syphillis serology, autoAb test, PSA Urinalysis and microscopy Blood cultures ECG Imaging (inc EEG)
Treatment for delirium?
Clear communication and reminders Staff consistency Relaxation Familiar objects around Avoid sensory extremes Haloperidol Lorazepam Delirium tremens - diazepam oe chlorodiazepoxide Mianserin helps with non-cog symptoms
What % of >80’s are affected by dementia?
20%
Causes of dementia?
Degenerative Vascular Metabolic Meningiomas, gliomas, mets Alcohol/solvent abuse Brain injury SOL Prion disease Neurosyph MS Pseudodementia
Risk factors for dementia?
Age FHx Down syndrome Alcohol Atherosclerosis HTN Hyperlipidaemia Depression DM High oestrogens Smoking Elevated serum homocysteine
Symptoms of Alzheimer’s?
Progressive loss of ability to learn new information Decline in language abilities Apraxia BVR change Loss of insight Loss of gait Motor/sensory impairment Seizures later
Symptoms of Lewy Body?
Fluctuating cognition Memory loss Depression Sleep disorders Visual hallucinations Parkinsonism
Vascular dementia symptoms?
Slow thinking Memory loss Depression Personality changes Confusion Incontinence Stroke like symptoms
Frontotemporal dementia symptoms?
Progressive deterioration of social bvr Disinhibition OCD Aggressive Problems planning Lack of interest in personal hygiene Childlike bvr Easily distracted
Differentials for dementia?
Delirium Depression Normal aging Mild cog impairment Parkinsonism Chronic SDH Mets Uraemia Chronic hepatic encephalopathy
Investigations for dementia?
Full bloods CXR CTH+MRI MMSE SMTS Genetics EEG Dalton's brief praxis test
Treatment for dementia?
Supportive, individualised care Address ADL Treat fever, pain etc Oral feeding for as long as possible then move to PEG if appropriate Benzos, anticonvulsants NMDA antagonists
