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Psychiatry > Primary care management of mental health > Flashcards

Primary care management of mental health Flashcards

1
Q

What are common psychiatric complaints in primary care?

A 
Feeling low
No energy
Tired all the time
Struggling with motivation
Can't stop crying
Struggling with sleep
Not enjoying things
Struggling to get to work
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2
Q

What are risk factors for depression to consider in primary care?

A

PMH of depression

Significant illnesses causing disability

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3
Q

What questionnaire can be used to assess severity of depression?

A

PHQ-9

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4
Q

How is depression treated in primary care?

A

Stepped care model
Step one - recognition and assessment, intervention - psycho-education, lifestyle advice
Step two - Recognised subthreshold symptoms/mild-moderate depression - sleep hygiene, active monitoring, low-intensity psych interventions
Step 3 - unresponsive to initial interventions - Antidepressant or high intensity psych intervention
Step 4 - severe and complex - referral

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5
Q

What is the first line antidepressant used?

A

SSRI

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6
Q

What needs to be considered about the patient’s life and safety with depression?

A

Fitness to work

Fitness to drive

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7
Q

What should be done when switching antidepressants?

A 
Initially switch to a different SSRI
Subsequently to another class that may be less well tolerated ie tricyclic, MAOI
Combining
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8
Q

How should antidepressants be stopped?

A

Gradually reduce dose over 4 weeks

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9
Q

What are risk factors for suicide?

A 
Suicidal ideation - vague, detailed, specific
Previous attempts
Impulsivity
Access to lethal methods
Current stressors
Protective factors
Assess social support
Alcohol/drug misuse
Physical illness
Relationship breakdown
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10
Q

What is used to assess severity of generalised anxiety disorder?

A

Level of distress
Functional impairment
Number, severity, and duration of symptoms

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11
Q

What factors can affect development, source, and severity of anxiety state?

A 
Other anxiety disorder in addition
Depression
Substance misuse
Physical health problems
History of mental health problems
Past experience and response to treatments
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12
Q

What is first line pharmacological treatment for generalised anxiety disorder?

A

SSRI

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13
Q

When should referral be considered in generalised anxiety disorder?

A

Risk of self-harm or suicide
Significant comorbidity
Self-neglect

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14
Q

What are features of panic attacks?

A 
Palpitations/tachycardia
Sweating
Muscle trembling
Shortness of breath
Choking sensations
Chest pain
Nausea
Dizziness
Fear of dying
Numbness
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15
Q

What are psychological interventions for panic disorder?

A

CBT

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16
Q

What pharmacological treatment should be used for panic disorder?

A

SSRI - citalopram but NOT fluoxetine

17
Q

What is 1st line treatment for social anxiety disorder?

A

CBT

18
Q

How is acute grief characterised?

A 
Feelings of disbelief and difficulty comprehending loss
Bitterness/anger/guilt/blame
Impaired functioning
Intense yearning and sadness
Mental fogginess
Loss of sense of self
Feeling disconnected from other people
Difficulty engaging in activities
19
Q

How does grief differ from depression?

A

Grief includes longing/yearning for the loved one
Positive emotions can still be experienced
Symptoms worsen when thinking of deceased person
Grief typically wants to be with others, depression wants to be alone

20
Q

What is prolonged grief disorder?

A

Marked distress and disability caused by grief reaction

Persistence for more than 6 months after bereavement

21
Q

How is prolonged grief disorder treated?

A

Counselling
Antidepressants
Behavioural/cognitive/exposure therapies
Referral if significant impairment in function

22
Q

What is 1st line treatment for OCD?

A

CBT

23
Q

What is 1st line pharmacological treatment for OCD?

A

SSRIs

24
Q

What are secondary causes of insomnia?

A 
Anxiety/depression
Physical health problems
Obstructive sleep apnoea
Excess alcohol or illicit drugs
Parasomnias
Circadian rhythm disorder
25
Q

How can sleep hygiene be improved?

A

Avoid stimulating activities before bed
Avoid alcohol, caffeine, smoking before bed
Avoid heavy meals or strenuous exercise before bed
Regular day time exercise
Same bedtime each day
Ensure bedroom environment promotes sleep
Relaxation

26
Q

What are potential side effects of lithium?

A 
Fine tremor
Dry mouth
Altered taste sensation
Increased thirst
Urinary frequency
Mild nausea
Weight gain
27
Q

What are symptoms of lithium toxicity?

A 
Vomiting and diarrhoea
Coarse tremor
Muscle weakness
Lack of coordination including ataxia
Slurred speech
Blurred vision
Lethargy
Confusion
Seizures

Psychiatry (18 decks)

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