Primary Care Management

Question 1

How would you diagnose common mental illness in primary care?

Answer 1

Diagnosis is done via ICD10 classification or DSM IV criteria
Can use PHQ-9 questionnaire for depression, GAD-7 for assessing anxiety

Question 2

How is a suicide risk assessment performed?

Answer 2

Ask about suicidal thoughts 
Ideation/intent/plans
Previous attempts/lethality/access
Homicidal risk
Impulsivity/control 
Stressors 
Support/protective factors 
Arrange help to level of risk 
Advise to seek help if situation decreases

Question 3

How is management of common mental illness initiated at primary care level?

Answer 3

Depression
Stepped care model: 1 - recognise, assess, manage. 2 - recognised depression = sleep hygiene, active monitoring. No pharma. 3 - antidepressant (SSRI), high intensity psychological intervention. 4 - risk to life, severe = refer

Anxiety
1 - identify and assess. Offer education and monitoring. 2 - Low intensity psychological interventions eg self help. 3 - high intensity psychological interventions eg CBT. Drug therapy. 4 - specialist referral

OCD
1 - CBT. 2 - drug therapy eg SSRI. 3 - medications eg clomipramine. 4 - busprione + SSRI.

Panic disorder
Mild, moderate - self help. Moderate, severe - psychological therapy eg CBT, drug therapy eg SSRI. No response - refer.

Question 4

When would you refer to secondary care for a mental illness?

Answer 4

If there is risk to life or severity of symptoms increases, or no response to Tm