primary care management of mental health Flashcards
common mental illnesses
depression
bipolar disorder
anxiety disorders
insomnia
eating disorders
psychosis
depression risk factors
PPH: depression, substance misuse, other mental illness
FH: depression, suicide
PH: domestic violence
SH: unemployment, stressful life events
depression diagnosis
“during the last month, have you often been botheredby feeling down, depressed or hopeless?”
“during the last month, have you been botheredby having little interest or pleasure in doing things?”
ICD-10
DSM IV
PHQ-9
depression management
- assessment
- support
- psychoeducation
- lifestyle advice: sleep
- psychological interventions: CBT
- active monitoring
- antidepressant
- combined interventions: CBT, IPT, BA
consider: fitness to work/drive
suicide risk assessment
suicidal thoughts - ideation, intents, plans, previous attempts
homicidal risk
impulsivity/self control
lethal methods
protective factors
bipolar disorder management
primary care: refer
secondary care: discuss and start SSRIs
what should ensured before treating bipolar disorder
women should be on effective contraception
why should you stop antidepressants
patient becomes hypomanic
types of anxiety disorder
generalised
panic
social anxiety
generalised anxiety disorder
excessive worry about a number of different events
screening tool: GAD-7
generalised anxiety disorder management
- education
- active monitoring of patient’s function & symptoms
3/4. psychological interventions: CBT, relaxation therapy - drug therapy: SSRI (sertraline/fluoxetine)
- specialst CMHT referral
panic disorder
recurring unforeseen panic attacks and persistent worry about further attacks
panic attack
abrupt surge of intense fear or physical discomfort, reaching a peak within a few minutes, in which at least of the four symptoms are present:
- palpitations, pounding ♡, tachycardia
- chest pain, SOB
- muscle trembling, shaking, numbness
- nausea, abdominal distress
- sweating, faint, dizzy
- fear of losing control
panic disorder management
- self help
- bibliotherapy
- support groups
- exercise
- psychological therapy
- drug treatment: SSRI (not fluoxetine)
SSRIs
sertraline fluoxetine paroxetine escitalopram citalopram
social anxiety disorder
persistent fear of situations in which the person is exposed to unfamiliar people or to possible scrutiny by others
screening questions:
- do you find yourself avoiding social situations or activities?
- are you fearful or embarrassed in social situations?
social anxiety disorder management
- CBT
2. medication: sertraline, escitalopram (6 months)
grief vs depression
grief is longing for the loved one and positive emotions can still be experienced
people want to be with others whereas in depression people want to be alone
what should not be offered for anxiety in primary care
antipsychotics
OCD
obsession or compulsions which must be time consuming or cause significant distress or cause functional impairment
OCD management
CBT
medication: SSRI, clomipramine
insomnia causes
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)
insomnia management
sleep hygiene
sleep diaries - CBT
medications NOT routinely advised
- melatonin > 55 y/o and short term
- hypnotics in severe disabling insomnia causing marked distress
eating disorder management
recognise and refer to secondary care
emerging psychosis
increasing distress and declining function
major mental illness management
monitor medications
BMI/BP/smoking
blood tests
- antipsychotics
- lithium
antipsychotics effects
CV risk factors for 2nd generation
ECG for QTC prolongation 1st generation
lithium effects
thyroid / kidney function tests 6 monthly
lithium levels 3 monthly
side effects of taking lithium
fine tremor
dry mouth, altered taste sensation, increased thirst, mild nausea
urinary frequency
weight gain
