Psychiatry Flashcards
How common is mental illness?
1) 1 in 3 will have mental health disorder in lifetime
2) 1 in 3 GP consultations have mental health component
3) Most people fully recover
How do people with mental illnesses feel stigmatised?
1) 3 in 4 people feel stigmatised
2) Many people scared to discuss illness
3) Only 10% of NHS funding
4) Real-term cut in funding
6) Six weeks in most undergraduate courses
What treatments are available for mental illness?
A range of treatment options are available, with an excellent evidence base, such as:
> Psychotherapies
> Social therapies
> Medication
What are the differences between mental illness and physical illness?
1) People often do not perceive themselves to be ill
> No “therapeutic contract”
> Reluctance to accept treatment
> Use of Mental Health Act (50,000 detentions per year)
2) No scientific basis to diagnosis
> Similar to 18th Century medicine
> Diagnose by symptom cluster - not aetiology or pathology
> Uncertainty about diagnosis
> Dispute about existence of mental illness
3) Perceived lack of treatment
4) Agents of social control
What are the symptoms of periods of intense anxiety?
1) Sudden fear
2) Heart racing
3) Shaking
4) Dry mouth
5 Last 10-15 minutes then subside
What are the symptoms of obsessional thought?
1) Ruminating on germs
2) Knowing they’re senseless thoughts
3) Being their own thoughts
4) Trying and failing to resist thoughts
What is pathogical anxiety and what are its symptoms?
This is a feeling of fear or dread, that is part of normal life. It becomes pathological when it begins to affect daily life, to the extent that i5 becomes disabling. It is characterised by physical symptoms in a positive feed back loop, including:
1) Palpitations
2) Sweating
3) Dry mouth
4) Splanchnic vasoconstriction (butterflies)
5) Tremor
6) Paraesthesia (pins & needles)
7) Depersonalisation
8) Syncope
What are compulsions?
These are motor response to obsessional thoughts and are often ritualistic, stereotyped and precise. Examples of compulsions include:
•Handwashing
•Counting
•Arranging and symmetry
•Checking door locks
The entire process usually starts again if interrupted or in case of doubt.
What are obsessions?
These are ego-dystonic thoughts, meaning one’s own thoughts that make them uncomfortable. These are usually repetitive, circular ruminations that may be bizarre and sound delusional. Insight is maintained, so one does not accept obsessions as a fact. Obsessions are unbidden and resisted, but resistance leads to anxiety.
How is anxiety classified?
Anxiety can be classified as: •Generalised anxiety disorder •Panic disorder •Agoraphobia (fear of going out) •Simple phobia (e.g. snakes, spiders, thunder) •Social phobia
Some disorders that used to be classified as anxiety, but no longer are, include:
•Obsessive Compulsive disorder
•Post traumatic stress disorder
Why are anxiety disorders important?
1) While they represent a comparatively heterogenous set of conditions, with a considerable ‘clinical iceberg’, under-diagnosis and under-treatment is common.
2) Anxiety disorders are believed to be increasing in prevalence.
3) Anxiety can be the beginning of a trajectory associated with eating disorders and self-harm – both of which are strongly associated with parasuicide and suicide.
4) Globally it is difficult to quantify the burden of anxiety due to varying diagnostic criteria and cultural contexts.
What are the inequalities of anxiety disorders in the UK?
1) Diagnosed more commonly among women than men.
2) 60% of LGBT community report anxiety in last 12 months.
3) Slightly higher prevalence among ethnic minorities in UK.
4) Prevalence of mixed anxiety and depression as high as 60% among social care users.
What is anxiety?
Anxiety is normal (and useful!)! it is only a ‘disorder’ if it is excessive, so impacts on life or out of context. It is the most common cause of mental disorder with estimates of lifetime prevalence of between 14 and 33%. It is more common in females (2:1) and has a median onset age of 11.
How can anxiety be managed?
1) Course of cognitive behavior therapy (CBT), either in a group, individually or online. A trained therapist, not psychiatrist, usually a psychologist or nurse or allied health professional, delivers the treatment over a period of weeks (~12-16 weeks). The patient sets the goal as to what they want to get out of the therapy.
2) Clomipramine, an ancient antidepressant but with good evidence base for OCD.
Why do psychiatrists do home visits?
1) It’s more efficient, they are more likely to see the patient. Up to 50% of patients don’t turn up to psychiatric clinics in hospitals.
2) The patient does not have to travel, or go to a psychiatric hospital,with all the stigma attached to that.
3) The patient can be observed in their own environment, which gives away a huge number of clues.
What are the symptoms of depression?
1) Core features:
> Pervasive low mood/sadness
> Loss of energy (anergia)
> Loss of enjoyment (anhedonia)
2) Physical symptoms:
> Loss of appetite
> Weight loss
> Diurnal variation of mood
> Poor sleep
> Loss of libido
> Constipation
> Psychomotor slowing or agitation
3) Psychological symptoms:
> Poor concentration
> Feelings of guilt
> Feelings of hopelessness
> Low self-esteem
> Indecisive
> Suicidal ideation
> DelusionsWhy is depression important?
Depression is important because:
1) In the NHS it consumes a huge proportion of resource: whether directly through mental health support and pharmaceuticals, but more so in affecting resilience and likelihood to self-care for a range of other conditions.
2) Globally it is the leading cause of disability and is increasing in diagnosed prevalence: largely driven by greater awareness and more timely diagnosis.
What are the inequalities of depression in the UK?
1) Surprisingly, the prevalence of depression is fairly consistent across deprivation deciles.
2) Women are twice as likely to be diagnosed than men.
3) 50% of LGBT community report depression in last 12 months.
4) Depression is much more common in the north of England than in London and the south.
5) People with depression are less likely to self-care and very likely to become socially isolated as they fall out of
Outline the prevalence of suicide
1) There are over 6000 suicides in UK annually, making it a significant public health burden.
2) It is the single most common cause of death in young men aged 18-25 and rates are only rising in young and middle aged men.
3) The male to female ratio of suicide being 3:1, but 3x as many women attempt suicide and self harm than men.
4) Hanging is most common method of suicide.
5) Suicide is most commonly associated with drug/alcohol use disorders and depression.
How is depression treated?
1) Medication: Antidepressants (e.g. Venlafaxine)
> Response after 2-3 weeks, sometimes up to 6 weeks before patients get back to an even keel
2) Psychological therapies
> 12 session cognitive behavioural therapy
3) Social prescribing
> Exercise, company
- 90% of patients make a full recovery
What is bipolar disorder?
This affects 1% of the population, who flip between depression and being manic. The periods of depression are indistinguishable from those suffering from pure depression, they may even recover and have several years of normal function, but then get another episode of depression or mania.
What are the symptoms of mania?
1) Elated mood
2) Irritability
3) Over-energized
4) Grandiose
5) Little need for sleep
6) Poor concentration
7) Poor judgement
8) Over-spending
9) Rapid speech
What are the symptoms of schizophrenia?
1) Hallucination: hearing, seeing or feeling things that are not there.
2) Delusion: fixed false beliefs not shared by others in the person’s culture and that are firmly held even when there is evidence to the contrary.
> Passivity
> Thought alienation
3) Abnormal Behaviour: disorganised behavior such as wandering aimlessly, mumbling or laughing to self, strange appearance, self-neglect or appearing unkempt
4) Disorganised speech; incoherent or irrelevant speech, neologisms and formal thought disorder
5) Disturbances of emotions: marked apathy or disconnect between reported emotion and what is observed such as facial expression or body language
