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psychiatry > primary care management of mental health > Flashcards

primary care management of mental health Flashcards

1
Q

common mental illnesses

A

depression

bipolar disorder

anxiety disorders

insomnia

eating disorders

psychosis

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2
Q

depression risk factors

A

PPH: depression, substance misuse, other mental illness

FH: depression, suicide

PH: domestic violence

SH: unemployment, stressful life events

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3
Q

depression diagnosis

A

“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

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4
Q

depression management

A
  • assessment
  • support
  • psychoeducation
  • lifestyle advice: sleep
  • psychological interventions: CBT
  • active monitoring
  • antidepressant
  • combined interventions: CBT, IPT, BA

consider: fitness to work/drive

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5
Q

suicide risk assessment

A

suicidal thoughts - ideation, intents, plans, previous attempts

homicidal risk

impulsivity/self control

lethal methods

protective factors

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6
Q

bipolar disorder management

A

primary care: refer

secondary care: discuss and start SSRIs

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7
Q

what should ensured before treating bipolar disorder

A

women should be on effective contraception

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8
Q

why should you stop antidepressants

A

patient becomes hypomanic

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9
Q

types of anxiety disorder

A

generalised

panic

social anxiety

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10
Q

generalised anxiety disorder

A

excessive worry about a number of different events

screening tool: GAD-7

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11
Q

generalised anxiety disorder management

A
  1. education
  2. active monitoring of patient’s function & symptoms
    3/4. psychological interventions: CBT, relaxation therapy
  3. drug therapy: SSRI (sertraline/fluoxetine)
  4. specialst CMHT referral
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12
Q

panic disorder

A

recurring unforeseen panic attacks and persistent worry about further attacks

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13
Q

panic attack

A

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
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14
Q

panic disorder management

A
  1. self help
  2. bibliotherapy
  3. support groups
  4. exercise
  5. psychological therapy
  6. drug treatment: SSRI (not fluoxetine)
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15
Q

SSRIs

A 
sertraline
fluoxetine
paroxetine
escitalopram
citalopram
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16
Q

social anxiety disorder

A

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?
17
Q

social anxiety disorder management

A
  1. CBT

2. medication: sertraline, escitalopram (6 months)

18
Q

grief vs depression

A

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

19
Q

what should not be offered for anxiety in primary care

A

antipsychotics

20
Q

OCD

A

obsession or compulsions which must be time consuming or cause significant distress or cause functional impairment

21
Q

OCD management

A

CBT

medication: SSRI, clomipramine

22
Q

insomnia causes

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)

23
Q

insomnia management

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
24
Q

eating disorder management

A

recognise and refer to secondary care

25
Q

emerging psychosis

A

increasing distress and declining function

26
Q

major mental illness management

A

monitor medications

BMI/BP/smoking

blood tests

  • antipsychotics
  • lithium
27
Q

antipsychotics effects

A

CV risk factors for 2nd generation

ECG for QTC prolongation 1st generation

28
Q

lithium effects

A

thyroid / kidney function tests 6 monthly

lithium levels 3 monthly

29
Q

side effects of taking lithium

A

fine tremor

dry mouth, altered taste sensation, increased thirst, mild nausea

urinary frequency

weight gain

psychiatry (23 decks)

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