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Mental Health > Principles of management in mental health > Flashcards

Principles of management in mental health Flashcards

1
Q

What should a risk assessment include?

A

Self harm , Suicide , Finances, Physical health/neglect, Medications, Nutrition, Mobility and falls, Driving, Fire, Aggression to others, Children/caring responsibilities
History of risk behaviour, insight and pkanning, impact on patient, impact on others, protective factors

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2
Q

3 Ps risk assessment factors

A

Precipitating factors, protective factors, perpetuating factors

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3
Q

1-7 risk assessment ‘history’

A

1-7: 1, demographics – age, sex/ 2, FH/ 3, Mental illness, symptoms, insight. 4, MSE. 5, Alcohol, illicit substances. 6 – Previous behaviour. 7 – recent incidents eg self harm

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4
Q

What does a formulation do?

A

Guides individualised management for patients. Descriptive summary – key features history, MSE, risk. Differential diagnosis. Aetiology, investigations, management (short and long), prognosis

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5
Q

What aspects of aetiology consider in a formulation?

A

Predisposing, perpetuating, precipitating. BPS (3 Ps for each)

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6
Q

What do you include in psychological part of formulation?

A

Temperament, IQ, Self esteem, coping skills, social skills, family relationships, trauma

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7
Q

What do you include in social aspect of for,ulation?

A

Drug effects, peers, family relationships, trauma, family circumstances, school

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8
Q

What do you include in the biological aspects of a formulation?

A

Physical health, disability, genetic vulnerabilities, termperament, IQ, drug effects

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9
Q

Neuroimaging investigations when diagnosing a psychiatric concern Strucutral vs functional?

A

Structural – CT, MRI
Functional – SPECT, PET, DAT

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10
Q

CT head indications?

A

Focal neurological signs, confusion developing after head injury, evidence of raised ICP

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11
Q

EEG indications

A

Differentiating delirium from dementia OR non convulsive status epilepticus OR temporal lobe epilepsy

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12
Q

Lumbar puncture indications

A

Sus meningitis/encephalitis

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13
Q

Aims of treatment of metnal heatlh

A

Treat acute problems, promote recovery and prevent relapse

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14
Q

What to consider when considering medication Regular or PRn

A

Side effects, concordance, safety

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15
Q

What to consider when thinking of physical treatments for psychiatric conditions

A

Treatment of other conditions, review of meds, ECT, drugs and alcohol, prescribed meds, phyiscial illness

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16
Q

3 groups of psychological interventions

A

Investigative eg formulation. Formal therapies – individual and group. Counselling and support incl voluntary sector

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17
Q

Types of psychological therapies

A

CBR, Interperonal therapy incl effective brief therapy, Cognitive analytic therapy, couple therapy, family therapy, DBT, EMDR, Cognitive stimulation therapy, psychoanalytic psychotherapy

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18
Q

Alternative to CBT on NICE

A

Effective brief therapy (type of interpersonal therapy)

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19
Q

When is DBT esp helpful?

A

Personality disorders esp BPD esp if recurrent self harm and female

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20
Q

What therapy can be used to improve dementia?

A

Cognitive stimulation therapy

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21
Q

What happens in psychoanalytic psychotherapy?

A

Reflect on thoughts and feelings, explore how events from past (esp early life) affect current thoughts and feelings, therapist helps patient make connnections

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22
Q

What are the indications for psychoanalytic psychotherapy?

A

BPD, chronic depression, personality difficulties when interpersonal factors prominent

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23
Q

How long does psychoanalytic psychotheraoy continue for?

A

Weekly session for 12-18 months

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24
Q

Types of social interventions

A

Behavioural activation, voluntary work, return to employment, meal provision, carers, support re-mobility, spiritual needs, hobbies + activities, engaging with friends and family

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25
Q

What social prescribing examples would strengthen psychosocial, life and coping skills of individuals?

A

Community education froups, arts/learning/exercise referral, self help groups/resources, CCBT, bibliotherapy

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26
Q

What impact do interventions that aim to strengthen psychosocial, life and coping skills have?

A

Promote self expression, self efficacy, self esteem, opportunities to learn new skills, stress/anger/anxiety management and relaxation

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27
Q

What do interventions that increase social support as a buffer against adverse life events aim to do?

A

Help build social contacts through self help groups, netwirsm collective action and opportunities for new friendships

28
Q

Examples of social interventions aiming for social support

A

Self help groups, group activities eg walking, green gyms, volunteering, time banks

29
Q

What interventions increase access to resources and services which protect mental wellbeing

A

Signposting to information+ advice eg debt, benefit, housing, immigration, violence and crime, Support with seeking help, supported education/employment, time banks

30
Q

What is personality?

A

Personality is a complex set of characteristics that make us who we are – typical behaviours, coping, attitudes towards ourselves and others. Thinking, feeling and behaving patterns.

31
Q

What is an adverse childhood experience?

A

Traumatic events that can have negative, lasting effects on health and wellbeing

32
Q

Types of ACEs

A

Abuse – emotional, physical, sexual. Neglect – emotional, physical. Household challenges – domestic violence, substance abise, mental illness, paretnal separation/divorce, incarcerated parent

33
Q

How much of the population have >4 ACEs?

A

1 in 8

34
Q

How much earlier do people with >6 ACEs die than those with none?

A

20 years

35
Q

How much of the population have at least one ACE?

A

67%

36
Q

How do ACEs lead to earlier death?

A

ACE -> Disrupted neurodevelopment -> social, emotional, cognitive impairment, adoption of health risk behaviours -> disease, disability, social problems -> early death

37
Q

What do ACEs increase the likelihood of?

A

Injury, mental health (depression, anxiety, PTSD, suicide), pregnancy – unintended, complications, foetal death), infectious disease, chronic disease (cancer, diabetes), risky behaciours (alcohol+drug abuse, unsafe sex), opportunities – education, occupation, income.

38
Q

What stress is considered healthy?

A

Stress that helps us respond to temporary challenges in our life – race etc. Stress response activates and quickly returns to baseline

39
Q

When can intense or longer lasting stressors be tolerable?

A

Support systems in our lives to help us cope

40
Q

When is stress considered toxic?

A

Severe or frequent exposure to stress -> toxic on body and brain

41
Q

What systems does stress affect in the brain?

A

HPA axis, emotional processing and regulation in prefrontal cortex and amygdala, evaluation of reward ventral striatum, brain connectivity from amygdala to ventromedial PFC pathway

42
Q

Where is the stress pathway based?

A

HPA axis, hippocampus

43
Q

Affect on the stress pathway in chronic stress?

A

Dysregulated HPA axis and decreased hippocampal volume leading to anxiety, depression and impaired learning and memory

44
Q

What brain changes cause hypervigilance and reduced attentional control in toxic stress?

A

Decreased grey matter in the prefrontal cortex + increased amygdala volume – dysregulated emotional processing

45
Q

What happens to the reward response in toxic stress? Where is it based>?

A

Decrease reward response in ventral striatum leading to anhedonia. Difficulty experiencing joy

46
Q

What biological changes to brain connectivity does toxic stress cause?

A

Disrupted amygdala to ventromedial Prefrontal cortex pathway, decreased activity in the default mode network, increased activity in salience networks

47
Q

What does toxic stress affect on brain connectivity cause?

A

-> difficulty understanding relevance of situations and how to respond

48
Q

Why do some people develop a disorder after experiencing ACEs and others don’t?

A

Work through experience not just exposure – if ACE prevented from causing toxic stress, harm should not occur – presence of resilience

49
Q

Why do some people develop a disorder after experiencing ACEs and others don’t?

A

Work through experience not just exposure – if ACE prevented from causing toxic stress, harm should not occur – presence of resilience

50
Q

What is the significance of resilience in relation to ACEs?

A

Ability to thrive, adapt and cope despite tough and stressful times – counterbalance to ACEs. Evident when childs health and development tips toward positive outcomes, even when heavy load stacked on negative outcome side

51
Q

What is the significance of the attachment theory?

A

It shows the importance of a childs relationship with their primary caregiver in terms of their social, emotional and cognitive development. Important to remember attachment styles are also influenced by other experiences/influences that shape us as we develop

52
Q

What can cause later maladjustment in terms of primary caregiver and child?

A

Early separation

53
Q

What are the severities of personality disorder on ICD 11?

A

Mild, moderate, severe

54
Q

What predominant traits can be assigned to personality disorders on ICD 11?

A

Negative affectivity, detachement, dissociality, disinhibition, anakastia, borderline pattern
Option for personality difficulty

55
Q

What has to be present for the diagnosis of personality disorder?

A

Enduring disturbance from adolescence characterised by problems functioning of aspects of: the self, interperonsal dysfunction, > 2 years, patterns of cognition, emotional experience, emotional expression, beahviour that are maladaptive, range personal and social situations, not developmentally appropriate or better explained by primary social or cultural factors, not due to medicine or substance or another disorder, ass with substantial distress or significant impairment in personal, family, social, educational, occupational or other important areas of functioning

56
Q

What makes a personality disorder severe?

A

Severe disturbances in self function, interpersonal dysfunction seriously affect all relationships/ability + willing to perform expected social and occupational roles. Specific manifestations of personality disturbance are severe and affect most areas of personality functioning, often ass with harm to self or others, ass with severe impairment in nearly all areas of life

57
Q

What areas of life can be impaired in personality disorders?

A

personal, family, social, educational, occupational, and other important areas of functioning.

58
Q

What is the definition of negative affectivity trait in personality disorder?

A

Tendency to experience a broad range of negative emotions with a frequency and intensity out of proportion to the situation

59
Q

What is the definition of detachment trait in personality disorder?

A

A tendency to maintain interpersonal distance (social detachment) and emotional distance (emotional detachment)

60
Q

What is dissociality trait definition?

A

Disregard for rights and feelings for others, encompassing both self-centredness and lack of empathy

61
Q

What is the definition of disinhibition trait?

A

A tendency to act rashly based on immediate external or internal stimuli (ie sensations, emotions, thoughts) without consideration of potential negative consequences

62
Q

What is anakastia trait definition?

A

Narrow focus of ones rigid standard of perfection and of right or wrong, and on controlling ones own and other behaciour and controlling situations to ensure conformity to these stadnards

63
Q

What are the features of negative affectvity?

A

Anxiety, anger, worry, fear, vulnerability, hostility, shame, depression, pessimism, guilt, low self esteem, mistrustfulness

64
Q

What are the features of social detachment?

A

Avoidance of social interactions, lack of friendships, acoidance of intimacy

65
Q

What are the features of emotional detachment?

A

Being reserved, aloofness, limited emotional expression and experience eg individuals seek out employment that does not involve interactions with others

66
Q

What are the features of dissociality trait?

A

Self centredness – entitlement, grandiosity, expectation of others admiration, attention-seeking. Lack of empathy - deceptive, manipulative, exploiting, ruthless, callus, ohysically aggressive, sometimes pleasure in others suffering

67
Q

What are features of disinhibition trait?

A

Impulsivity, distractibility, irresponsibility, recklessness, lack of planning. Often engaged in reckless driving, sports, substance use, gambling, unplanned sexual activity

Mental Health (57 decks)

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