Primary Care Management of Common Mental Health Disorders Flashcards
When should depression be considered in primary care?
PMH depression
Significant illness
Other mental health issues
What are the key questions for depression?
“are you feeling down/hopeless?”
“are you no longer having interest/pleasure in things?”
What scoring system is used for depression in primary care?
PHQ-9
What are the guidelines for management of depression?
Intervention first - lifestyle, assessment, active monitoring
What non-pharmacological options are used for depression in primary care?
Advice on sleep hygiene
Active monitoring
Low-intensity psychological interventions
When should antidepressants be offered in mild-moderate depression?
PMH of mod-severe depression
>2yrs
No response to other management
What is the management of moderate-severe depression?
Antidepressants
High intensity psychological intervention
What else should be considered in a depressed patient?
Fitness to work (Med 3)
Fitness to drive
Follow-up (esp. <30y)
How should you treat non-response to antidepressants?
Switch or combine
How do you take a patient off antidepressants?
Over 4 weeks, gradually reducing the dose
How should suicide risk be assessed?
ALWAYS ASK Ideation/plans Previous attempts Homicidal risk Arrange help if a problem arises Social support Risk assess
How is Generalised anxiety disorder managed?
Treat comorbid subtance misuse
Treat primary mental health condition
Education and active monitoring
What scoring system is used for Generalised anxiety disorder?
GAD-7
Mild (5-9)
Moderate (10-14)
Severe (>15)
How is Generalised anxiety disorder managed for those whom active monitoring is insufficient?
Non-facilitated self-help
Individual guided self-help
Psychoeducation
How is Generalised anxiety disorder managed in those whom self-help is insufficient?
Psychological intervention (high-intensity) Drug therapy (SSRI)
When is specialist referral indicated in Generalised anxiety disorder?
Functional impairment and:
- Risk of self-harm
- Significant comorbidity
- Self-neglect
- Failure to respond to intervention or SSRI
What management is indicated in panic disorder?
Bibliotherapy (CBT)
Support groups
Exercise
Review
What drug therapy is indicated in panic disorder that cannot be otherwise managed?
SSRI (NOT fluoxetine)
Imipramine or clomiramine
Avoid sedatives
What are the screening questions for social anxiety disorder?
Do you find yourself avoiding social situations?
Fearful or embarrassed in social situations?
What is the management of social anxiety disorder?
1st line: CBT
2nd line: Medication
Sertraline or Escitalopram
How does Prolonged Grief Disorder present?
Distress and disability caused by grief
Persistence after 6months
What are the treatment options for Prolonged Grief Disorder ?
Counselling
Antidepressants
Behavioural therapies
(Refer)
What are the screening questions for obsessive compulsive disorder?
Do you wash/clean alot?
Check things?
Daily activities take a lot of time?
Putting things in a special order?
How is OCD diagnosed?
Obsessions (unwanted, intrusive urges) Compulsions (repetitive behaviours) Must be time consuming OR Cause distress OR Cause functional impairment
How is OCD treated?
1st: CBT
2nd: SSRI
3rd: Clomipramine
4th: Buspirone + SSRI
How is Insomnia managed?
Screen for secondary causes
What are common secondary causes of insomnia?
Anxiety/depression Physical health issues Sleep apnoea Excess alcohol/drugs Parasomnias Night shift workers
How is insomnia managed?
Sleep hygiene
Sleep diaries
Melatonin >55yrs
Hypnotics if disabling
What tests are needed with Lithium prescription?
Thyroid function tests
Kidney function
3 monthly lithium
Avoid nephrotoxic drugs
What are 4 signs of lithium toxicity?
Vomiting/diarrhoea Coarse tremor Muscle weakness Lack of coordination Slurred speech Lethargy Seizures
