Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Psychiatry > Primary Care Management of mental health > Flashcards

Primary Care Management of mental health Flashcards

1
Q

What are the components of the Stepped Care model?

A

The least intrusive intervention to be provided first/

If that intervention is ineffective, or declined, offer an appropriate intervention for the next step.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Step One of the stepped care model in the context of depression

A

Recognition, assessment and initial management
- All known and suspected presentations of depression
Intervention options
- assessment
- support
- psychoeducation
- lifestyle advice
- advice monitoring and referral for further assessment and interventions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Step two of the stepped care model in the context of depression

A

Recognised depression - persistent threshold depressive symptoms or mild to moderate depression
Offer advice on sleep hygiene
Offer advice monitoring
Low intensity psychological and psychosocial interventions
DO NOT routinely use antidepressants

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

DO NOT routinely use antidepressants in the step two of the stepped care model unless….

A

Past history of moderate - severe depression
They present with subthreshold symptoms that have been present for 2 years or more
They have subthreshold symptoms for < 2 yrs but they dont respond to other interventions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Examples of advice monitoring

A

Discuss concerns
provide info about depression
reassess within 2 weeks
contact the person if they do not attend the follow up appointment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Step 3 of the stepped care model in the context of depression

A 
Inadequate response to initial interventions, and moderate to severe depression 
An antidepressants (SSRI)
High intensity psychological intervention 
- CBT, IPT, behavioural activation, couples therapy 
Combined treatments of medication and high intensity psychological preferred for moderate to severe depression
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Things to consider in primary care management of mental health

A

Fitness to work

Fitness to drive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

In the context of severe depression or anxiety, when is a patient not allowed to drive?

A

Significant memory or concentration problems
Agitation
Behavioural disturbance
Suicidal thoughts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Follow up after appointment

A

see people 2 weeks after starting, at intervals of every 2 to 4 weeks for 3 months and then longer intervals if response is good

In patients < 30 or high risk then see after one week and then as frequently thereafter as appropriate until risk considered no longer clinically important

Encourage to take for at least 6 months after remission and for up to 2 years if at risk of relapse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is done If response is absent or minimal after 3-4 weeks therapeutic dose?

A

Increase level of support

Increase dose OR switch to another antidepressant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Switching antidepressants

A

SSRI to
a different SSRI to
another class e.g. TCA, venlafaxine to
combination and augmentation (primary care and psychiatrist) to
- combining with lithium, an antiphyscotic or another antidepressant e.g. mirtazapine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Step 4 of the stepped care model

A

Severe and complex depression, risk to life, severe self neglect
Intervention options
- refer to multiprofessional and possible inpatient care for people with depression who are at significant risk or have psychotic symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Bipolar disorder and issues with the mediation

A

2ndry care medication only

women must be on effective contraception and signed agreement between prescriber and patient

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is panic disorder?

A

Recurrent panic attacks and persistent worry about further attacks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is social anxiety disorder?

A

Persistent fear of, or anxiety about, one or more social or performance situations that is out of proportion to the actual threat posed by the situation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Step 1 of the stepped care approach in the context of anxiety

A

if depression or other anxiety disorder present, treat the primary disorder first e.g. co morbid depression / anxiety - treat the depression first
Treat the co morbid substance misuse disorder first

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Step 2 of the stepped care approach in the context of anxiety

A

For those whome active monitoring is insuffient
Offer; low intensity psychological interventions
- self help
- psychoeducational groups

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Step 3 of the stepped care approach in the context of anxiety

A

For those with marked functional impairment OR for those who have not improved with step 2 treatments
Offer; high intensity psychological therapy or drug therapy
- CBT
- applied relaxation
- SSRI then
- Alternative SSRI or SNRI then
- Pregabalin
See patients every 2-4 weeks in first 3 months then continue therapy for 12 months after initiation to reduce rate of relapse

19
Q

What SHOULD NOT be offered for anxiety in primary care

A

Antipsychotics

20
Q

Step 4 of the stepped care approach in the context of anxiety

A

Specialist (CMHT) referral
if self harm / suicide risk, significant comorbidity, self neglect or failure to respond to step 3 interventions
Combined therapies

21
Q

Presentation of panic attacks

A 
Abrupt surge of intense fear or physical discomfort, reaching peak within a few minutes 
Palpitations/pounding heart
tachycardia
muscle trembling/shaking
sweating
SOB 
sensations of smothering 
Choking sensations
chest pain / discomfort
nausea
abdo distress
dizzy/light headed 
instability 
derealisation / depersonalisation 
fears of losing control or going crazy
fear of dying
numbness, tingling sensations
chills, hot flushes
22
Q

Treatment of mild - moderate panic disorder

A

Self help

23
Q

Treatment of mod - severe panic disorder

A

Psychological therapy
Drug treatment
- SSRI (NOT FLUOXETINE)
- imipramine or clomipramine

24
Q

What drugs to avoid in panic disorder

A

Benzodiazpeines
sedating antihistamines
antipsychotics

25
Q

Treatment for social anxiety disorder

A

1st line ; CBT
2nd line ; medication
- sertraline or escitalopram
- continue for 6 months after become effective

26
Q

Acute grief is characterised by…..

A

feelings of disbelief and comprehending difficulties
Bitterness/anger/guilt/blame
Impaired functioning
Intense yearning / sadness
emotional and psychical pain
mental fogginess
difficulty concentrating
forgetfulness
loss of sense of self or sense of life purpose
feeling disconnected
difficulty engaging and making plans for future

27
Q

Grief features that can help differentiate from depression

A

Longing/yearning from loved one
positive emotions can still be experienced
symptoms worse when thinking about deceased person
people often want to be with others, whereas people with depression tend to want to be alone

28
Q

Features of prolonged grief disorder

A

Marked distress and disability caused by the grief reaction
AND
persistence of the distress and disability MORE THAN 6 MONTHS after bereavement

29
Q

How long is grief for when it turns into prolonged grief disorder?

A

More than 6 months

30
Q

Treatment options of prolonged grief disorder

A

counselling
antidepressants for comorbid depression
behavioural/cognitive/exposure therapies
Refer if significant impairent in functioning

31
Q

Definition of obsessions

A

Unwanted intrusive thoughts, images or urges. tend to be repugnant and inconsistent with a persons values

32
Q

Definition of compulsions

A

Repetitive behaviours or mental acts the person feels driven to perform
Can be overt (checking theyve locked the door) or convert (mentally repeated a phrase in their head)

33
Q

To warrant a diagnosis of OCD, what must be present?

A

Obsessions and compulsions must be time consuming > 1 hr OR cause significant distress OR functional impairment

34
Q

OCD treatment

A

1st line; CBT including exposure and response prevention
2nd line; medication
- SSRIs
3rd line; clomipramine

35
Q

Possible causes of insomnia

A

Anxiety / depression
Physical health problems (e.g. pain, dyspnoea)
Obstructive sleep apnoea
Excess alcohol or ilicit drugs
Parasomnias (restless legs, sleep walking etc)
Circadian rhythm disorder (especially in shift workers)

36
Q

Treatment of insomnia

A 
Sleep hygiene 
Sleep diaries - CBT 
Medications NOT routinely advised 
- melatonin > 55 y/o and short term 
- hypnotics in severe disabling insomnia causing marked distress
37
Q

Features of sleep hygiene

A

avoid stimulating activities before bed
avoiding alcohol/caffeine/smoking before bed
Avoiding heavy meals or strenuous activities before bed
regular day time exercise
same bedtime each day
ensure bedroom environment promotes sleep
relaxation

38
Q

What is a GP’s role in an eating disorder?

A

Recognise and refer to secondary care

39
Q

Which medications require tests to monitor their effects?

A

Antipsychotics
- CV risk factors for 2nd generation
- ECG for QTC prolongation 1st generation
Lithium
- thyroid / kidney function tests 6 monthly
- lithium levels 3 monthly

40
Q

What does taking lithium put you at risk of?

A

Lithium toxicity
- fine tremor vs coarse tremor
avoid nephrotoxic drugs

41
Q

Expected side effects of taking lithium

A 
Fine tremor
dry mouth 
altered taste sensation 
increased thirst
urinary frequency 
mild nausea
weight gain
42
Q

Symptoms of lithium toxicity

A 
Vomiting
diarrhoea
coarse tremor (larger movements, especially of hands)
muscle weakness
lack of coordination including ataxia
slurred speech 
blurred vision 
lethargy 
confusion 
seizures
43
Q

Suicide Risk assessment

A

Must always ask about suicidal thoughts
Will not “plant the idea of suicide” in patient
Ideation/Intent/Plans - vague, fleeting / recurring, detailed, specific, already in motion
Previous attempts
Impulsivity/self control
Current stressors / triggers or sense of hopelessness
Protective factors vs risk factors
Assess whether the person has adequate social support and aware of sources of help
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 the situation deteriorates

Psychiatry (63 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions