Opening up to mental health Flashcards
how common are mental health problems
1 in 4 each year
40% GP appointments
what is the most common mental health disorder in Britain
mixed anxiety and depression
how many scots take an antidepressant every day
1 in 8
why is there a rise in antidepressants being prescribed
more presenting
more diagnosis
more prescriptions
do men or women commit suicide more
men present later
people in at risk groups are not as likely to go to GP
need to reduce barriers to seeking medical advice
what are the principles of talking about mental health
DOs
be comfortable with beginning a convo
active listening
open questions
sensitive, encouraging
non-judgemental
acknowledge, validate feelings
good time, place
confidentiality, respect
take care of yourself makes you take care of your patients
provide appropriate info
avoid jargon
written info if needed
interpreters
consent
LANGUAGE LINE- interpreting service over the phone
what are the principles of mental health
DON’Ts
make dismissive comments
‘i know how you feel’
say others are worse
blame them
see it as a personal weakness/ failing
stigmatising words
what are red flags for potential mental health problems
unexplained chronic pain/fatigue
recurrent presentations
eating/sleeping changes- SLEEPING PILLS?
impairment in work, school, home- SICK NOTES
alcohol/drug use/ history (AS A MASK)
previous mental health problem
chronic physical health problem
what are relevant questions for a mental health problem
identify if a trigger- exacerbations, things that make it better
duration of symptoms, recurrent, isolated episode
family history
dependents
social support/ isolation
drugs, alcohol, cigs
employment history
forensic history
childhood and normal development milestones?
evidence of other mental health problems
response to treatment
evidence of neglect of them or those dependent on them
what are some sources of support
self help groups
support groups
other local and national resources
support for family/dependents/carers
PERSON centred care
how do you screen for depression NOT DIAGNOSIS
during last month
-bothered by feeling down, depressed, hopeless
-bothered by having little interest/ pleasure
if YES –> need a mental health assessment
what is a general “examination” of mental health- inspecting and listening
Brief Mental Status Exam MSE
1. appearance
2. attitude
3. behaviour
4. speech
5. affect (current emotional state)- weather
6. mood (sustained subjective emotional state over a period of time)- season, climate
7. thought processes- goal directed/ disorganised
8. thought content- suicidal (passive, active), compulsion, delusions, phobias
9. perception- hallucinations/delusions during interview
10. orientation
11. memory/ concentration
12. insight/judgement- aware of illness
what are delusions
fixed false, strange, irrational belief firmly held, maybe a feature of psychosis
belief not normally accepted by other members of culture or group
certainty, impossibility
delusions of grandeur
delusions of paranoia
somatic delusions
what are hallucinations
what are different types
sensory perception without an appropriate stimulus
where you hear, see, smell, taste or feel things that appear to be real but only exist in your mind.
visual
auditory
tactile (feeling)
olfactory
gustatory (taste)
proprioceptive
what are some signposts
moodcafe (fife)
samaritans (24 hour, crisis, risk of suicide, but broader)
mind infoline
GP
out of hours:111
A&E
what are the key symptoms of Generalised Anxiety Disorder
excessive anxiety/ worry about a number of events/activities
difficulty controlling the worrying
majority of dats for at least 6MONTHS
not in keeping with another anxiety disorder
what are associated symptoms of GAD
restlessness
being easily fatigued
difficulty concentrating
irritability
muscle tension
disturbed sleep
what is the management of GAD
stepped care model
step 1: identification and assessment, GAD education, treatment option, active monitoring
step 2: low intensity psychological interventions, individual non-facilitated self help, individual guided self-help, psychoeducational groups
step 3: high-intensity psychological intervention (CBT/ applied relaxation) or drug
step 4: highly specialist treatment, complex drug/ psychological treatment regimens, multi-agency teams, crisis services, day hospitals, inpatient care
drugs of GAD
SSRI- sertraline
2nd line alternative SSRI or SNRI
3rd line consider PREGABALIN
DONT OFFER benzodiazepine for the treatment of GAD in primary or secondary care, except short term crisis
what is psychosis
delusions, hallucinations,
when people lose some contact with reality. This might involve seeing or hearing things that other people cannot see or hear (hallucinations) and believing things that are not actually true (delusions)
present through concerns of others
occur in schizophrenia, depression, bipolar, puerperal psychosis, neurological conditions, alcohol drugs
what should you consider when assessing psychosis (speciality led)
nature of delusions, hallucinations
timing
recurring?
insight?
major life evets recently?
substance abuse?
vulnerability?
fam history?
what is the treatment of psychosis
specialist led
dependent on cause
early intervention in psychosis services
anti-psychotic meds, psychological therapies, social support, occupational and educational interventions
how to protect/boost out mental health
evidence based 5 steps
connect
be active
keep learning
give to others
be mindful
coping mechanisms, reducing stigma, acknowledging and seeking help, ensuring safety for all
what are delusions of grandeur
when you believe that you have more power, wealth, smarts, or other grand traits than is true.
delusions of paranoia
reflect profound fear and anxiety along with the loss of the ability to tell what’s real and what’s not real.
somatic delusions
individual believes something is wrong with part or all of their body,
