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*Psychiatry > Primary Care Management of Common Mental Health Disorders > Flashcards

Primary Care Management of Common Mental Health Disorders Flashcards

1
Q

When should depression be considered in primary care?

A

PMH depression
Significant illness
Other mental health issues

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2
Q

What are the key questions for depression?

A

“are you feeling down/hopeless?”

“are you no longer having interest/pleasure in things?”

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3
Q

What scoring system is used for depression in primary care?

A

PHQ-9

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4
Q

What are the guidelines for management of depression?

A

Intervention first - lifestyle, assessment, active monitoring

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5
Q

What non-pharmacological options are used for depression in primary care?

A

Advice on sleep hygiene
Active monitoring
Low-intensity psychological interventions

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6
Q

When should antidepressants be offered in mild-moderate depression?

A

PMH of mod-severe depression
>2yrs
No response to other management

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7
Q

What is the management of moderate-severe depression?

A

Antidepressants

High intensity psychological intervention

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8
Q

What else should be considered in a depressed patient?

A

Fitness to work (Med 3)
Fitness to drive
Follow-up (esp. <30y)

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9
Q

How should you treat non-response to antidepressants?

A

Switch or combine

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10
Q

How do you take a patient off antidepressants?

A

Over 4 weeks, gradually reducing the dose

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11
Q

How should suicide risk be assessed?

A 
ALWAYS ASK 
Ideation/plans
Previous attempts
Homicidal risk
Arrange help if a problem arises 
Social support
Risk assess
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12
Q

How is Generalised anxiety disorder managed?

A

Treat comorbid subtance misuse
Treat primary mental health condition
Education and active monitoring

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13
Q

What scoring system is used for Generalised anxiety disorder?

A

GAD-7
Mild (5-9)
Moderate (10-14)
Severe (>15)

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14
Q

How is Generalised anxiety disorder managed for those whom active monitoring is insufficient?

A

Non-facilitated self-help
Individual guided self-help
Psychoeducation

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15
Q

How is Generalised anxiety disorder managed in those whom self-help is insufficient?

A 
Psychological intervention (high-intensity) 
Drug therapy (SSRI)
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16
Q

When is specialist referral indicated in Generalised anxiety disorder?

A

Functional impairment and:

  • Risk of self-harm
  • Significant comorbidity
  • Self-neglect
  • Failure to respond to intervention or SSRI
17
Q

What management is indicated in panic disorder?

A

Bibliotherapy (CBT)
Support groups
Exercise
Review

18
Q

What drug therapy is indicated in panic disorder that cannot be otherwise managed?

A

SSRI (NOT fluoxetine)
Imipramine or clomiramine
Avoid sedatives

19
Q

What are the screening questions for social anxiety disorder?

A

Do you find yourself avoiding social situations?

Fearful or embarrassed in social situations?

20
Q

What is the management of social anxiety disorder?

A

1st line: CBT
2nd line: Medication
Sertraline or Escitalopram

21
Q

How does Prolonged Grief Disorder present?

A

Distress and disability caused by grief

Persistence after 6months

22
Q

What are the treatment options for Prolonged Grief Disorder ?

A

Counselling
Antidepressants
Behavioural therapies
(Refer)

23
Q

What are the screening questions for obsessive compulsive disorder?

A

Do you wash/clean alot?
Check things?
Daily activities take a lot of time?
Putting things in a special order?

24
Q

How is OCD diagnosed?

A 
Obsessions (unwanted, intrusive urges)
Compulsions (repetitive behaviours)
Must be time consuming
OR
Cause distress
OR
Cause functional impairment
25
Q

How is OCD treated?

A

1st: CBT
2nd: SSRI
3rd: Clomipramine
4th: Buspirone + SSRI

26
Q

How is Insomnia managed?

A

Screen for secondary causes

27
Q

What are common secondary causes of insomnia?

A 
Anxiety/depression
Physical health issues
Sleep apnoea
Excess alcohol/drugs 
Parasomnias
Night shift workers
28
Q

How is insomnia managed?

A

Sleep hygiene
Sleep diaries
Melatonin >55yrs
Hypnotics if disabling

29
Q

What tests are needed with Lithium prescription?

A

Thyroid function tests
Kidney function
3 monthly lithium
Avoid nephrotoxic drugs

30
Q

What are 4 signs of lithium toxicity?

A 
Vomiting/diarrhoea
Coarse tremor
Muscle weakness
Lack of coordination
Slurred speech
Lethargy
Seizures

*Psychiatry (18 decks)

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