Opening up to Mental Health Flashcards
What proportion of the UK population experiences a mental health problem each year ?
1 in 4 affected by a mental health problem each year in
UK
What proportion of GP appointments involve mental health ?
• 40% of GP appointments involve mental health
What is the most common mental health disorder in the UK ?
Most common mental health disorder in Britain is mixed anxiety and depression
What is the trend of suicides in Scotland from 2017 to 2018 ? Describe the epidemiology of these suicides.
Suicides increased (to about 800 from about 700 in 2018)
Men at much higher risk, especially between ages of 35 and 44 (cohort that is usually fit and well physically, and that don’t often go to doctor, especially for mental health)
What proportion of Scots take an antidepressant every day.
1 in 8 Scots (12%) take an antidepressant every day
Describe the trend in use of medicines used in the treatment of mental health conditions.
Most increasing, including antidepressants, drugs used in psychoses, dementia, and ADHD.
Only category decreasing is hypnotics and anxiolytics.
List reasons why antidepressant use is increasing.
- Less stigma so patients more likely to present
- Better patient-Dr rapport leading to better exploration of mental health
- Increase in frequency of mental health issues in population
- Possibly less counselling available in some areas (so more prescribing)
- Possible increase in other pathologies where antidepressants may be used, such as conditions with chronic pain
List principles of talking about mental health.
- Begin the dialogue and seem comfortable with it
- Active listening and open questions (UNLESS need to assess suicide risk, by asking closed questions)
- Be sensitive and encouraging, build relationship of trust
- nonjudgmental
- Acknowledge how they are feeling, validate
- Good time and place to talk, not rushed
- Confidentiality, dignity and respect (break confidentiality if person or other people at imminent risk and cannot be managed without informing others)
- Take care of yourself to take care of your patient
- Provide information appropriate to level of understanding
- Avoid clinical language without adequate explanation
- Provide written information where necessary
- Use interpreters where necessary
- Establish consent where necessary
- SIGNPOST if necessary
Identify some DON’Ts of talking about mental health.
- make dismissive comments like ‘snap out of it’, ‘cheer up’, ‘forget about it’, ‘pull yourself together”
- say ‘you know how they feel’ if you don’t
- point out that others are worse off
- blame the individual
- think of mental illness as a personal weakness or failing
- use words that stigmatise
Identify red flags for potential mental health problems.
- Unexplained chronic pain or fatigue
- Recurrent presentations
- Changes in eating or sleeping patterns
- Signs of impairment in work, school or home life
- Signs of past or present use of alcohol or drugs (risk factor, but also possibly bad coping mechanism)
- Previous mental health problem
- Chronic physical health problem
Identify relevant questions for any mental health problem.
- Identify if a trigger
- Duration of symptoms, recurrent or isolated episode
- Consider own/family history
- Dependents
- Level of social support/isolation (to assess support network: living alone, poor friendship and family network, unemployment all increase risk of suicide )
- Drugs, alcohol, cigarettes
- Employment history
- Forensic history (i.e. related to legal issues)
- Childhood and development (any possible traumatic events in childhood)
- Evidence of other mental health problems
- Response to previous treatments (if relevant) (can guide future treatments)
- Evidence of neglect
Identify and describe a tool to assess mental status in more severe mental illness.
Brief Mental Status Exam:
1) Appearance
- casual dress, normal grooming and hygiene
- other (describe)
2) Attitude
- calm and cooperative
- other (describe):
3) Behavior
- no unusual movements or psychomotor changes
- other (describe):
4) Speech
- normal rate/tone/volume w/out pressure
- other (describe):
5) Affect (how they are right now)
- reactive and mood congruent
- labile
- tearful
- blunted
- normal range
- depressed
- constricted
- flat
- other (describe):
6) Mood (sustained emotion that person is describing)
- euthymic
- irritable
- elevated
- anxious
- depressed
- other (describe)
7) Thought process
- goal-directed and logical
- disorganized
- other (describe)
8) Thought content
-Delusions
-Phobias
-Other (describe):
-Obsessions/Compulsions
-Suicide Ideation:
None
Passive
Active
If active, then:
-Intent ?
-Plan ?
-Means ?
9) Perception
- no hallucinations or delusions during interview
- other (describe)
10) Orientation
- Oriented wrt time
- Oriented wrt place
- Oriented wrt person
- Oriented wrt self
- Other (describe)
11) Memory/Concentration
- short term intact
- other (describe):
- long term intact
- distractable/ inattentive
12) Insight Judgement
- good
- fair
- poor
Identify a mental health condition where speech may be changed.
In schizophrenia, pressure of speech (constant rush of words)
Identify a mental health condition where thought process is disorganised.
Psychotic disorder that is not fully controlled
Identify sources of support for mental health problems.
– Self help groups
– Support groups (childline)
– Other local and national resources (e.g. moodcafé in Fife, Samaritans, Mind infoline, own GP, out of hours service, A+E)
– Consider support for family/dependents/carers
Must SIGNPOST if necessary
Identify questions asked to screen for depression. Can they be used for diagnosis ?
- During the last month, have you often been bothered by feeling down, depressed or hopeless?
- During the last month, have you often been bothered by having little interest or pleasure in doing things?
If yes to either of these questions needs a mental health assessment (these NOT enough for diagnosis)
Describe NICE guidelines for assessment of possible depression in an adult.
When assessing a person who may have depression, conduct a comprehensive assessment that does not rely simply on a symptom count. Take into account both the degree of functional impairment and/or disability associated with the possible depression and the duration of the episode.
Give an example of anxiety disorder.
Generalised Anxiety Disorder (GAD).
Identify key, and associated symptoms of GAD.
KEY
– excessive anxiety and worry about a number of events or activities
– difficulty controlling the worrying
– occurs on a majority of days for at least 6 months
– not in keeping with another anxiety disorder
ASSOCIATED • restlessness • being easily fatigued • difficulty concentrating • irritability • muscle tension • disturbed sleep
Describe management of GAD.
- Stepped care model
- Step 1: Identification and assessment; education about GAD and treatment options; active monitoring
- Step 2: Low-intensity psychological interventions; individual non-facilitated self-help; individual guided self-help and psychoeducational groups
- Step 3: Choice of a high-intensity psychological intervention (CBT/applied relaxation) or a drug treatment
- Step 4: Highly specialist treatment, such as complex drug and/or psychological treatment regimens; input from multi-agency teams, crisis services, day hospitals or inpatient care
Describe drug treatment of GAD.
- SSRI e.g. sertraline
- 2nd line alternative SSRI or SNRI
- 3rd line consider offering pregabalin
Do not offer a benzodiazepine for the treatment of GAD in primary or secondary care except as a short-term measure during crises.
What is psychosis ? Identify symptoms.
- NOT a diagnosis in itself. Occurs in a number of serious mental illnesses e.g. schizophrenia, depression, bipolar, puerperal psychosis, some neurological conditions, alcohol and drugs
- Interferes with ability to function – can be very disabling
- Symptoms include delusions and hallucinations
How do patients with psychosis usually present ?
• Often present through concerns of others
Define delusions.
A false, fixed, strange, or irrational belief that is firmly held. The belief is not normally accepted by other members of the same culture or group.
• Certainty, incorrigibility, impossibility
• Consider in cultural context
Give examples of delusions.
Delusions of grandeur
Delusions of paranoia Somatic delusions
Define hallucinations.
Sensory perception without an appropriate stimulus
Give examples of hallucinations.
Seeing – visual Hearing – auditory Feeling - tactile Smelling – olfactory Taste – gustatory Posture – proprioceptive
Identify questions to consider in assessment of psychosis.
- What is the nature of the hallucination or delusion? (are they telling them to hurt themselves? others?)
- Timing?
- Is there a recurring theme?
- Insight?
- Have there been any recent major life events?
- Is there a history of substance abuse?
- Vulnerability?
- Family history of mental illness?
Describe treatment of psychosis.
- Specialist led
- Dependent on cause
- Early intervention in psychosis services
- Usually a combination of anti psychotic medications, psychological therapies, social support, occupational and educational interventions
What is the prevalence of common mental health disorders among UK doctors.
Between 17% and 52%
Briefly state how to boost mental well being.
How to boost mental well being (evidence based 5 steps) • Connect • Be active • Keep learning • Give to others • Be mindful
Identify support sources in St. Andrews.
ASC
Student Services
Identify a mental health condition where appearance may be changed.
Psychosis, patient may be dressed extravagantly
