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Year 3 psych (JK) > Primary care management of common mental health conditions > Flashcards

Primary care management of common mental health conditions Flashcards

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1
Q

Mental health and primary care stats

A

40% gp consultations
most handled exclusively by gp
1 in 4 people

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2
Q

Major mental illness and death

A

women - 12 yrs earlier

men - 16 years earlier

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3
Q

Be alert to depression especially if…

A

PMH
significant illness - disability
other mental health problem eg dementia

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4
Q

2 key questions for depression

A

During the last month - feeling down, depressed or hopeless?

During last month - little interest or pleasure?

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5
Q

Recognising and diagnosing depression

A

ICD-10
DSM-5
PHQ-9

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6
Q

Suicide risk assessment

A 
suicidal thoughts 
ideation 
intent 
plans 
previous attempts
social support 
level of risk 
immediate risk - refer 
further help
also homicidal risk
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7
Q

Stepped care model

A

Least intrusive intervention provided first
Ineffective/declined
offer appropriate intervention from next step

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8
Q

Stepped care model step 1

A

recognise, assess, initial management

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9
Q

step 1 - options

A 
assessment 
support 
psycho-education 
lifestyle advice 
active monitoring
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10
Q

Step 2

A

sleep hygiene
active monitoring
CBT
(medication)

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11
Q

step 3

A

antidepressant - SSRI

CBT, IPT, behavioural activation

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12
Q

Follow up

A

see patients 2 weeks after starting
2-4 weeks interval for 3 months
under 30 at great risk - 1/week
6 months after remission take meds and up to 2 years if relapse risk

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13
Q

Do NOT routinely use anti-depressants unless

A

PMH of mod-severe depression
subthreshold symptoms for 2+years
Subthreshold for <2yrs but not respond to other interventions

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14
Q

Fitness for work

A

Med 3 forms

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15
Q

Fitness to drive - must not drive

A

significant memory or concentration problems, agitation, behaviour or suicidal thoughts

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16
Q

Non responders to anti-depressants

A

absent/minimal after 4 week
increase level of support and dose
OR switch to other

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17
Q

Switching anti-depressant

A

Switch to other SSRI
another class eg TCA
combine and augment
Lithium, antipsychotic or mirtazapine

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18
Q

Stopping or reducing anti-depressants

A

advise risk - discontinuation symptoms and gradually reduce dose over 4 weeks

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19
Q

Step 4

A

severe and complex depression
risk to life
severe self-neglect

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20
Q

Step 4 - interventions

A

multiprofessional - inpatient
self harm
psychotic symptoms

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21
Q

Antidepressants in bipolar

A

do not start SSRI in depressed phase

stop if become hypomanic

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22
Q

Panic disorder

A

Recurrent panic attacks and persistent worry about further attacks

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23
Q

Social anxiety disorder

A

Persistent fear of 1 or more social performance situations out of proportion to actual posed threat

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24
Q

GAD - DSM 5

A

excessive anxiety and worry for atleast 6 months
difficult to control worry
6 symptoms

25
Q

6 part C symptoms in GAD DSM-5

A 
restlessness
easily fatigued 
difficult concentrating 
irritability 
muscle tension 
sleep disturbance
26
Q

Step 1- GAD

A

education

active monitoring

27
Q

Step 2 - GAD

A

CBT
guided self help
psychoeducational groups

28
Q

Step 3 - GAD

A

CBT and applied relaxation
SSRI eg sertraline
SNRI
(pregabalin)

29
Q

GAD - BZD

A

only in short term crisis

30
Q

GBD - pregabalin

A

beware abuse potential

31
Q

GBD - antipsychotics

A

do not offer for anxiety disorders

32
Q

Step 4 - GAD

A

specialist referral
self harm, suicide
co-morbid eg substance misuse
self neglect

33
Q

CMT review

A

assessment of problem and risks

impact on family and care plan

34
Q

Step 4 - GAD treatment

A

drug and psychological

augmentation or anti-depressants

35
Q

Symptoms of panic attacks

A 
palpitations 
sweating 
shaking 
choking sensation 
chest pain 
nausea
light headed 
fear of dying 
numbness
36
Q

Panic disorder (mild-mod)

A

self help

37
Q

mod-severe panic disorder

A

psychological therapy

drug treatment

38
Q

Self help

A

bibliotherapy based on CBT
support groups
exercise benefits

39
Q

Psychological interventions of panic disorder

A

CBT
self-completed questionnaires
alternative therapy if this fails

40
Q

Panic disorder - drug treatment

A

citalopram, sertraline
NOT fluoxetine
clomipramine (no response to SSRI after 12wks)
avoid BZD, anti-psychotics

41
Q

Screening questions in social anxiety

A

avoiding social situations?

fearful or embarrassed in social situations?

42
Q

Treating social anxiety disorder

A

1st line = CBT

2nd line = sertraline/citalopram

43
Q

Normal grief

A 
disbelief 
anger/guilt/blame
impaired functioning
yearning and sadness
difficult concentrating
loss of purpose
44
Q

Differentiating grief from depression

A

Grief - longing/yearning
+ve emotions still experienced
worst symptoms when thinking of person
want to be with others

45
Q

Prolonged grief disorder

A

distress and disability

persistence - more than 6m

46
Q

Prolonged grief disorder - treatment

A

counselling
anti depressant
CBT
refer if significant

47
Q

Screening for OCD

A

do you wash or clean a lot?
do you check things a lot?
special order? upset by mess?
do these problems trouble you?

48
Q

OCD diagnosis

A

obsessions and compulsions
obsession - intrusive thoughts, images
Compulsions - repetitive behaviour
>1hr or distress or functional impairment

49
Q

overt behaviour - OCD

A

checking the locked door

50
Q

Covert behaviour - OCD

A

mentally repeating a phrase in their head

51
Q

OCD treatment

A

CBT - exposure+response
SSRI - up to 12 weeks to see a response
clomipramine

52
Q

Insomnia - 2ry causes

A

anxiety/depression
obstructive sleep apnoea
excess alcohol/drugs
parasomnia eg restless legs, teeth grinding
circadian rhythm disorder (shift workers)

53
Q

Insomnia treatments

A

sleep hygiene
sleep diaries - CBT
melatonin >55yrs
hypnotics if disabling

54
Q

Sleep hygiene

A 
avoid stimulating activities
avoid alcohol/caffeine before bed 
avoid heavy meals 
regular day time exercise
relaxation
55
Q

Eating disorders - 1 care

A

recognise and refer

56
Q

Shared care for major mental illness

A 
medication monitoring 
BMI/Bp/smoking
blood tests 
- antipsychotics (ECG)
- lithium (thyroid/kidney every 6 months)
- lithium levels 3 monthly
57
Q

3rd sector

A

voluntary +community organisations
ACIS counselling
bereavement counselling
alcohol and drugs action

58
Q

Lithium toxicity

A 
vomit and diarrhoea
course tremor 
muscle weakness
lethargy 
confusion 
seizures 
slurred speech 
confusion
59
Q

Expected side effects of lithium

A 
Fine tremor 
dry mouth 
altered taste sensation 
urinary frequency 
weight gain

Year 3 psych (JK) (20 decks)

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