Primary Care + Hospital Psychiatry

Question 1

What is step one of management of depression in primary care?

Answer 1

• Recognition,
• Assessment,
• Support,
• Psycho-education,
• Lifestyle advice,
• Active Monitoring

Question 2

What is step two of management of depression in primary care?

Answer 2

• Offer advice on sleep hygiene
• Offer active monitoring
• Low-intensity psychological andpsychosocial interventions

Question 3

In what situations may you use antidepressants in step two of management?

Answer 3

• Past history of moderate–severe depression
• Present with subthreshold symptoms that have been present for 2y or more OR
• They have subthreshold symptoms for <2y but they don’t respond to other interventions

Question 4

What is step three of management of depression in primary care?

Answer 4

• An antidepressant (Usually SSRI)

- High intensity psychological intervention

Question 5

How often should follow-up be for antidepressants in primary care?

Answer 5

• 2 weeks after starting, at intervals of every 2 to 4 weeks for 3 months and then at longer intervals if the response is good
• In patients aged under 30, or considered at greater risk, see after one week and as frequently thereafter until clinical risk unimportant
• Encourage to take for at least 6 months after remission, and for up to 2 years if they are at risk of relapse

Question 6

What is step four of management of depression in primary care?

Answer 6

For severe and complex depression - refer for multiprofessional care

Question 7

What is considered in a suicide risk assessment?

Answer 7

• Must always ask about suicidal thoughts
• Ideation/Intent/Plans
• Previous attempts
• Also homicidal risk
• Impulsivity/self control
• Access to lethal methods
• Current stressors/sense of hopelessness
• Protective factors
• Adequate social support?
• Arrange help appropriate to the level of risk
• If considerable immediate risk to themselves or others, refer urgently to specialist mental health services
• Advise the person to seek further help if deteriorates

Question 8

What is the recommended treatment for Mild-Moderate Panic Disorder?

Answer 8

Self Help

Question 9

What is the recommended treatment for Moderate-Severe Panic Disorder?

Answer 9

Psychological therapy

Drug treatment

Question 10

What is the recommended treatment for Social Anxiety Disorder?

Answer 10

1st Line - CBT

2nd Line - Sertraline or escitalopram

Question 11

List some examples of functional disorders?

Answer 11

• Functional Neurological Disorder
• Non-epileptic attack disorder
• Persistent postural-perceptual dizziness
• Irritable Bowel Syndrome
• Cyclical vomiting syndrome
• Functional dyspepsia
• Fibromyalgia
• Benign hypermobility syndrome
• Chronic fatigue syndrome
• Temporomandibular Joint Dysfunction
• Atypical Facial Pain
• Loin Pain Haematuria Syndrome
• Chronic Pelvic Pain
• Atypical chest pain
• Chronic Hyperventilation

Question 12

What treatment options are available for functional disorders?

Answer 12

-Explanantion of FND
-Medications for co-morbid mental health problems
-Psychological therapies
(CBT, IPT, Psychodynamic therapies)
-Other therapies for comorbid disorders