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