Primary care psychiatry

Question 1

What are the risk factors for depression?

Answer 1

PMH of depression
Significant illness causing disability
Other mental health problems e.g. dementia

Question 2

What are the key features of depression?

Answer 2

Persistent low mood
Anhedonia
Fatigue

Question 3

What are the associated features of depression?

Answer 3

Disturbed sleep
Poor concentration or indecisiveness 
Low self confidence
Poor or increased appetite
Suicidal thoughts or acts
Agitation or psychomotor retardation
Guilt or self blame

Question 4

What is the treatment of sub threshold to mild depression?

Answer 4

Sleep hygiene
Active monitoring
Low intensity psychological and psychosocial iterventions
Antidepressant IF
-PMH of moderate to severe depression
->2 years sub threshold symptoms
-not responding to other interventions

Question 5

What is the treatment of moderate to severe depression?

Answer 5

Antidepressant- usually SSRI
High intensity psychological intervention
-CBT, IPT, behavioural activation, couples therapy

Question 6

What is the treatment of severe and complex depression?

Answer 6

Refer on

Question 7

What is the treatment of depression in non responders?

Answer 7

1. Increase dose SSRI
2. Switch antidepressant
   a. to another SSRI
   b. to SNRI
   c. To TCA or MAOI or augment in consultation with psychiatrist

Question 8

What is the primary care management of bipolar?

Answer 8

Refer

Question 9

What is generalised anxiety?

Answer 9

Excessive anxiety and worry, occurring more days than not for at least 6 months, about a number of events and activities

Question 10

What symptoms is generalised anxiety associated with?

Answer 10

Restlessness
FAtigue
Difficulty concentrating 
Irritability
Muscle tension
Sleep disturbance

Question 11

What are the steps of treatment of generalised anxiety?

Answer 11

1. active monitoring
2. psychological interventions
3. SSRI
4. switch to another SSRI or SNRI
5. refer

Question 12

What is panic disorder?

Answer 12

Recurrent unforeseen panic attacks, followed by at least a month of persistent worry about another attack or its consequences, or a significant change in behaviour in relation to the panic attacks

Question 13

What is the treatment of mild to moderate panic disorder?

Answer 13

self help

Question 14

What is the treatment of moderate to severe panic disorder?

Answer 14

1. Psychological
2. SSRI- not fluoxetine
3. Imipramine or clomipramine

Question 15

What is social anxiety disorder?

Answer 15

persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or possible scrutiny

Question 16

What is the treatment of social anxiety disorder?

Answer 16

1. CBT

2. SSRI

Question 17

What is prolonged grief disorder?

Answer 17

Marked distress and disability caused by a grief reaction for >6 months

Question 18

What is the treatment of prolonged grief disorder?

Answer 18

Counselling
CBT
Antidepressants for co-morbid depression

Question 19

What is OCD?

Answer 19

Obsessions and compulsions that impair function, consuming >1 hour to causing significant distress or functional impairment

Question 20

What is the Treatment of OCD?

Answer 20

1. CBT
2. SSRI- normally higher dose
3. CLomipramine

Question 21

What are the possible secondary causes of insomnia?

Answer 21

Anxiety
Depression
Psychical health problems
Sleep apnoea
Excess alcohol or illicit drugs
Parasomnias
Carcadian rhythm disorder

Question 22

What is the treatment of insomnia?

Answer 22

Sleep hygiene
Sleep diaries
CBT
Medication- not routinely advised

Question 23

What is the treatment of ED in primary care?

Answer 23

Refer

Question 24

What is the indication to contact DVLA re fitness to drive?

Answer 24

Significant memory or concentration problems
Agitation
Behavioural disturbance
Suicidal thoughts