Psychiatry Flashcards
4 members of the mental health team in primary care
GP: 1st point of contact, refer
Health visitor: child development and postnatal depression
Practise counsellor: mild/moderate health problems
Primary care mental health worker: Assesses and signposts
6 members of the mental health team in the community
Psychiatrist: Assess, diagnose, prescribe, manage and section
Clinical psychologist: psychological assessment and therapies
Community psychiatry nurse: Visits patients at home, support with injections
Registered mental health nurse: hospital based
OT: Assess ADL
Social worker: money and housing problems
Who is the key worker
Usually a nurse or social worker
Waiting time for consultant led mental health services on the NHS
18 weeks
Risk factors for depression (9)
Female FHx Bereavement Physical illness Dementia Asian/Afro-Caribbean Social isolation Unemployment Unmarried
Lifetime risk of depression and bipolar disorder
Male depression: 10%
Female depression: 20%
Male and Female Bipolar: 1%
Management of depression
Often GP
Cultural differences to depression
Higher disengagement Language differences Physical Sx (nerves, headaches) Stigmatised Relgision
Largest single cause of disability in the UK
Depression
3 key facts about depression in primary care
1/3 GP appointments contain mental health
2/3 suicide victims see a GP before they die
50% GPs at risk of burnout
When can you treat without consent
When patient lacks capacity to consent
Relative or approved social worker must apply for individual to be forcibly kept in hospital and 2 doctors must assess their condition
4 reasons why you can be sectioned
urgently treated for mental health
health would be at serious risk of worsening if no treatment
your safety or others would be at serious risk
doctor believes you need treating in hospital
Human rights and detaining
Cannot detain without reason or against will unless sectioned
Person must be given a reason why they are detained and given the opportunity to challenge it
What is the mental health act?
A law that allows people with a mental disorder who do not give their consent to be admitted to hospital, investigated and treated for their own safety and that of others
Section 2
28
Admission, assessment and treatment of a person with a mental health disorder
AMP and 2 approved clinicians (one section 12 approved)
Section 3
6 months
Treatment of a mental disorder
Can be renewed
Patients can appeal
AMP and 2 approved clinicians (one section 12 approved)
Section 5(2)
A holding order completed by any doctor used for the emergency detention of inpatients on any ward for assessment of a suspected mental health problem
72 hours
Can be made by one doctor with the approval of a mental health professional
Not renewable so patient needs to be assessed quickly
Section 5(4)
Urgent detention of inpatients recieving treatment for a mental disorder for 6 hours
Registered mental health nurse
Section 135
Allows a police officer to enter someones house and take them to a place of safety if they are thought to be suffering from a mental health disorder
Section 136
Allows a police officer to reovoe someone who seems to be suffering from a mental disorder from a pubic place and take them to a place of safety for assessment
Community treatment orders
When discharged from section 3
Supervised treatment when you leave the hospital
If you break it, you must return to the hospital for 72 hours
Everyone detained under the mental health act is entitled to an independent mental health advocate who can help and support the patient
What is their role (5)
Listen to views and concerns
Explore options and rights (without advising)
Help them contact people
Accompany them to meetings/appointments
Ensure patients opinions and ideas are articulated and taken seriously
What questionnaire can assess cognitive representations of illness.
illness perception questionnaire from Leventhal’s self-regulatory models of illness behaviour
Anxiety and depression in people with other medical problems
Twice as common
2 good coping strategies for physical illness
Problem focussed: seeing information and practical support, participate in treatment and develop new interests
Emotion focused: sharing feelings and concerns, emotional support, give up unrealistic thoughts
Poor strategies for physical illness
Denial
Preoccupation with health
Seeking blame
Hoping the condition will go away
Personal factors which impact how an individual responds to illness
Stress response
Family
Primary care approach to mental health and wellbeing
Exercise, healthy diet and sleep patterns
Mindfulness/relaxation techniques
Self-help and education
Psychological/psychotherapeutic interventions
NHS 5 year forward plan for mental health
7 day 24hr NHS service
Integrate physical and mental health
Creating a culture (end the stigma)
Elderly and depression
More likely to be depressed
For consent to be valid (3)
Voluntary, informed and the patient must have capacity
4 ways consent can be given
Verbally, non-verbally, written, implied
How can you make consent informed
Give basic overview of condition, outcome of decision and treatment options (including a second option)
When is consent not required
Emergency treatment
Mental health
Risk to public health (e.g. rabies)
Severely ill and living in unhygienic conditions
To have capacity
Understand the information
Retain the information
Weigh up the information
Communicate the decision
If someone lacks capacity
Someone else can make the decision for them
Whether this be a lasting power of attorney or advance decision
If someone lacks capacity
Someone else can make the decision for them
Whether this be a lasting power of attorney or advance decision
5 key principles of Mental Capacity Act
Presumption of capacity
Being supported to make their own decisions
People have the right to make unwise decisions
Anyone who lacks mental capacity must be acted on in their best interest
Decisions should be made in the least restrictive option
Assessment of capacity
- is there an impairment of or disturbance in the functioning of a persons mind or brain?
- is the impairment or disturbance sufficient that the person lacks the capacity to make a particular decision
When is an advanced decision not legally binding
If the person is held under the mental health act
Is consent always needed for sharing information
No, it can be breached if demanded by court, patient lacks capacity and disclosure is in their best interest or it is necessary to prevent harm
Effect of dementia on carers
Worry about patient discomfort Overwhelmed Frustration over no treatment Hurt by personality change Angry with their behaviour Guilt at resenting care Sadness over the loss of the person Fatigued, poor sleep Financial, emotional and health burdens Less time looking after themselves Lack of practical support e.g. lifting
4 tests for dementia
MMSE (lengthy but good for monitoring)
6-CIT (short and easy)
AMTS (short and simple)
Addenbrooks (very long)
How can social services help carers
Physical help e.g. gardening or laundry
Breaks
Direct payments
Assess to determine care
What does the care act 2014 state
Carers have a right to an assessment of their own needs and the same rights as those they care for
4 methods of financial support for carers
Carers allowance
Disability living allowance
Attendance allowance
Carers special grant: funding for respite
Dementia nursing care is free but the care home might not be
Role of admiral nurses
Support emotionally and practical guidance for dementia
Community residential and respite services for dementia
Community: Primary care, support with daily living
Residential/nursing care: Housing with intensive support, sheltered accommodation
Respite: day centres to allow carers rest, care at home
Focuses that CAMHS can provide
Art therapy
Psychotherapy
CBT
Family therapy
Medications in CAMHS
Clozapine Fluoxetine! Lithium Lorazepam Propanolol
Common conditions in childhood
Anxiety ADHD Mania self-harm depression personality disorder
Prevention of child mental health problems
Parenting programmes Home visiting programmes Anxiety and depression programmes Youth offending programmes School based programmes
Role of the: School Health visitor Social services Educational psychologists
School: ensure equal access to learning, contact parents, manage behaviour and support
Health visitor: offer advice and refer parents
Social services: assess and report to mental health services, ensure child is not disadvantaged
Educational psychologists: support schools and families, tackle learning difficulties, work with individual children
3 methods to treat ‘not wanting to go to school’
CBT
Systemic desensitisation
Exposure therapy
If a child disclosed information to you
Stay calm
Do not promise confidentiality
Say it was not their fault
Involve them in a plan
Contact child protection lead, social services or police within 48 hours and document everything!
Role of the family in emotional, social and cognitive development
Values: right and wrong
Skills: motor, language, emotional
Socialisation: trust and friendships
Security: emotion and physical
Which act assesses whether a child is at need
The children and family act 2014 and Children act 1989
Difficulty accessing support for individuals with sensory impairments
Deaf/visually impaired excluded from outreach and mass media –> reduced understanding
Communication barriers - don’t go to the GP
Risk of social eclusion
Access to counselling reduced
Impact of addiction on the family
Family ashamed and stigmatised causing arguments
Child neglect and poor safety
Children placed in care
Higher chance children will go onto become addicts
Impact of addiction on the individual
Affect them financially and socially
Withdrawal
Health problems and death
Impact of addiction on society
Loss of productivity at work Resources of child in care Domestic violence Cost of rehab Higher rates of crime
Individual and societal factors that maintain drug taking
Individual: genetic, influence of family and friends, socioeconomic status, occupation, personality type, physiology of addiction
Society: availability, economics, lawa
Mechanism of addiction
Salience Compulsion Tolerance Withdrawal upon abstinence Narrowing of repertoire Reinstatement upon abstinence
Health promotion strategies to prevent harm from alcohol
Primary: educate, increase alcohol tax, advertise, reduce availability, drink free areas, fines
Secondary: Screen for problem drinkers (CAGE, AUDIT), target high risk groups
Tertiary: Treat alcohol related problems, fortify food with vitamins, support groups and counselling
Health promotion strategies and prevention of harm from drugs
Primary: education, identify at risk groups (including children)
Secondary: immunise Hep B, condoms, needle exchange
Tertiary: Better access to treatment centres, self-help groups, relapse prevention schemes
Problems caused by excessive alcohol drinkers
Acute: accidents, poisoning, violence, suicide
Chronic: organ damage, dependence/addiction, resource consumption
3 types of drinkers
Hazardous: drink above limit but not harmed
Harmful: drink above limit and experiencing harm
Dependent: drink above limit and experience harm and sx of dependence (cage)
Alcohol harm reduction strategy for england
Better communication with public
Prevent and tackle alcohols harms to health
Reduce alcohol related crime and disorder
Work with the alcohol industry
Long term effects of drugs
Amphetamine: paranoia, hallucinations, aggression, convulsions, resp problems, obsession, loss of coordination
Cocaine: nasal damage
Cannabis: psychosis
General: organ dysfunction, depression/anxiety, paranoia, withdrawal from society
Explain the cycle of change
Pre-contemplation: Not currently considering change (validate)
Contemplation: Sitting on fence, no plan in the next month (encouragement)
Preparation: Experience with change, trying to change, planning in next month (identify problems, support)
Action: Practise new behaviour for 3-6 months (reiterate benefits)
Maintenance: Continued commitment to new behaviour (6m-5 years) (plan follow-up, discuss relapse)
Relapse: Resumption of old behaviours (evaluate trigger, plan for coping strategies)
