Primary Care and Learning Disability Flashcards
Key symptoms of Depression
Persistent sadness/low mood
Anhedonia
Fatigue/low energy
Associated symptoms of depression
Disturbed sleep Poor concentration Low self-confidence Poor or increased appetite Suicidal thoughts or acts Agitation or slowing of movements Guild or self-blame
Which criteria is required for mild depression
4 symptoms
Least 2 key
Which criteria is required for moderate depression Dx
5-6 symptoms
least 2 key
Which criteria is required for severe depression dx
Seven or more (all 3 key)
What must you ALWAYS ask a patient in a psychiatric history
suicidal thoughts
What should you ask regarding suicide in a history
How far have they gone to plan it?
Previous attempts
Homicidal risk
if patient presents with considerable immediate risk to themselves or other what is the management
Refer urgently to specialise mental health services
Which criteria is often used by GPs to diagnose depression
DSM
Which is the 1st line anti-depressant
SSRI
Which psychological therapy should you use for depression
CBT
Rules for switching anti-depressant
initially switch to a different SSRI or SNRI Subsequently to another class which may be less well tolerated
Who should prescribe MAOI
Specialist care only
Define prolonged grief disorder
Marked distress and disability caused by the grief reaction.
AND the persistence of this distress and disability more than 6m after a bereavement.
What are the treatment options for prolonged grief disorder
Counselling
Antidepressant for co-morbid depression
Behavioural/cognitive/exposure Refer if significant impairment in functioning
1st line Rx for OCD
CBT including exposure and response prevention
2nd line Rx for OCD
SSRI
3r line Rx for OCD
Clomipramine
Examples of SSRIs
Sertraline
Citalopram
Fluoxetine
Paroxetine
2ndry causes of insomnia
Anxiety/depression Physical health problem Obstructive sleep apnoea Excess alcohol or illicit drugs Parasomnias Circadian rhythm
Primary care for eating diroders
Recognise and refer to 2ndry care
Expected SE of lithium treatment
Fine tremor Dry mouth Altered taste sensation Increased thirst Urinary frequency Mild nausea Weight gain
Toxicity symptoms of lithium
Vomiting and Diarrhoea Coarse tremor Muscle weakness Lack of co-ordination including ataxia Slurred speech Blurred vision Lethargy Confusion Seizures
How often do lithium levels need to be checked
3/12
What should you not start Rx in the depressed phase
Refer/discussed with 2yr care
What is GAD?
Generalised Anxiety Disorder (GAD)
Excessive worry about a number of different events
What is panic disorder
Recurrent panic attacks
Persistent worry about
further attacks
What is social anxiety disorders
persistent fear of, or anxiety about one or more social or performance situations that is out of proportion to the actual health posed by the situation
ICD 10 definition of learning disability
• ‘A condition of arrested or incomplete development of the mind, which is especially characterised by impairment of skills manifested during the developmental period, which contribute to the overall level of intelligence i.e. cognitive, language, motor and social abilities’
Criteria for LD
1.Intellectual impairment (IQ < 70) (Wechsler)
2.Social or adaptive dysfunction (Vineland Scale)
a. Deficits/Impairments in 2 or more of following adaptive skills: communication,
self-care,
home living,
social skills,
community use,
self direction,
health and safety, functional academics,
leisure & work
3.Onset in the developmental period (age 18)
IQ of mid learning disability
50-59
IQ of moderate LD
35-49
IQ of severe learning disability
20-34
IQ of profound LD
<20
Genetic aetiology of LD
Single gene: Fragile X, PKU, Retts Syndrome
Microdeletion/duplication: DiGeorge Syndrome, Prader-Willi, Angelman syndrome
Chromosomal abnormality: Down Syndrome
Infective aetiology of LD
Ante-natal e.g rubella, Zika virus
Post-natal e.g meningitis, encephalitis
Toxic aetiology of LD
Fetal alcohol syndrome
What is the main aetiology of LD
unknown for most individuals
Trauma aetiology of LD
Birth asphyxia
Head injury
Which neuro condition is more common in LD
Epilepsy
Which sensory impairments are more common in LD
Hearing
Vision
Which GI problems are more common in LD
Swallowing problems Reflux oesophagitis Helicobacter pylorii
Constipation
Which respiratory problems are more common in LD
Chest infections
Aspiration
Pneumonia
Is cerebral palsy more or less common in LD
more common
Which orthopaedic problems are more common in LD
Joint contractures
Osteopororsis
How many of those with LD have autism
2/3
Is ADHD higher or lower incidence in LD
Much higher
