SCA online - Mental health, addictions Flashcards
Alcohol misuse
Pattern of alcohol that impacts a persons daily living.
AUDIT questionnaire - how often do you drink more than 6 drinks, how much do you drink when you do, anyone come to harm because of your drinking, feel guilt after drinking?
FRAMES principles
- Feedback - inform patient that amount of alcohol intake is too high
- Responsibility - patient’s responsibility
- Advice - discuss benefits of stopping alcohol
- Menu of options - lower percentage alcohol, delay first drink, set clear limits, avoid triggers
- Empathy
- Support
Do not drive - need to inform DVLA
Anorexia nervosa
- eating disorder, where your life is dominated by your meals and thoughts about food, actively trying to lose weight, despite others saying you too slim.
Mx/
risk assess - self harm, suicide, mood
bloods, ecg, BMI, CV examination
CBT, psych/ CAMHS referral
Anxiety
- normally to feel anxious from time to time, but it starts to become a problem when it interferes with our day to day life
GAD7 - assess severity - over the past 2 weeks have you felt nervous, not able to stop worrying, trouble relaxing, irritable.
Mx/
risk assess - self harm, suicide, mood, psychosis
drugs/ alcohol
Exercise, diet
CBT, counselling
Medication - SSRI
Cannabis use
Short term - relax, calm
Long term - anxiety, irritability, low mood, inability to concentrate, schizophrenia/ psychosis
Mx
CBT, motivational enhancement therapy
no medications are useful
Depression
- everyone feels low from time to time, but this becomes a problem when it significantly effects our day to day lives.
Fx/
Low mood
Anhedonia
Sleep - disturbed
Off appetite
Tiredness, poor concentration
Hx/
risk assess - self harm, suicide
psychotic symptoms
Drugs, alcohol
Safeguarding - risk to self, risk to others, are they a carer
Mx/
Lifestyle
Therapies/ counselling
Medication - SSRI
FU within 1-2 weeks
Depression lifestyle Mx
Mindfulness/ stress management
Sleep hygiene
Social support - engage in activities, see friends/ family
Physical exercise - yoga, walking, anything enjoyable
Stop alcohol/ smoking/ drugs
Diabulimia
People with T1DM, reduce or skip insulin on purpose to lose weight.
Danger - high sugars, over prescribing of insulin, effects on heart kidneys eyes nerves.
Mx
Education - importance of insulin
CBT
Dietician - nutritional management
Psych eating disorder clinic - - address relationship with food
Regular FU
Diazepam addiction
Addiction - over time, the body becomes dependant. This means that you need high doses to achieve the same effects, difficulty stopping without side effects. (physical/ psychological dependence, tolerance)
Red flag Hx
risk
other drugs/ alcohol
quality of life
socioeconomic impact
Mx
gradual tapering - Drugs and alcohol team will do this, not us.
lifestyle
CBT/ counselling
medication - SSRI
Domestic abuse
Incidents that involve violent behaviour from a person close to you - can be partner, ex, family member, carer. Violent behaviour includes physical/ psychological/ emotional/ financial abuse amongst other things.
Red flag Hx/
Risk to self or others
mental health
Regular FU
Ensure confidentiality unless risk to life
mx/
Refer IDVA (independent domestic violence advisors)
Safe lives charity
National Domestic abuse helpline
Victim support
Womens aid
Social services
Gambling disorder
Gambling itself is not a disorder, but when this has significant impact on your day to day life then this becomes a problem. This is where the person feels they have lost control, continue to gamble despite negative consequences, prioritizes gambling over other activities (eg spending time with family, going to work, eating/ sleeping)
Qs/
Do you bet more than you can afford
Have you tried winning back money that you have lost (chasing losses)
Gamble with increasingly larger amounts to get the same feeling
Do you feel guilt or feel you have a problem with gambling
Mx/
Self help
Refer for specialist - CBT, medication (naltrexone)
Gamblers anonymous
Health anxiety
fear and preoccupation with the belief that one has, or is in danger of, a serious illness (eg cancer, MND, stroke). The body has numerous sensations which are harmless, but can be interpreted as dangerous by those with health anxiety.
Mx
address concerns
Acknowledging the symptoms, and addressing the anxiety is important
1st - CBT
2nd - SSRI
regular FU
note: further investigations are needed if red flags, but can also worsen health anxiety, so clear safety netting and education is important
Insomnia
Qs/
sleep issues
daytime sleepiness
risk factors - stress, chronic conditions
impact on day to day life
caffeine, drugs, alcohol
Short term Mx
- Address stressors
- manage comorbidities - anxiety/ depression
- Sleep hygiene
- Driving, do not if tired
- CBT
- Zopiclone 3-7 days only
- FU in 2 weeks
Long term Mx
- CBT
- Melatonin can be helpful
- do not use benzo/ z drugs long term
- regular FU
OCD
person has repetitive unwanted thoughts (obsessions) and feels the need to do certain actions (compulsions) over and over. It’s like having a song in your head, that tapping your foot is needed to get rid of the song. Common condition.
Hx/
do these thoughts and/ or actions disrupt your everyday life?
Mx/
Risk
1st - CBT
2nd - SSRI
3rd - Refer to psych
Postpartum psychosis
serious mental health condition usually within the first few weeks after childbirth.
Fx/
auditory/ visual hallucinations
delusions
mood swing
risk assessment, support
Mx/
Urgent referral to psychiatry - Mother and Baby specialist unit
Post traumatic stress disorder
Anxiety disorder caused by a stressful event.
Fx/
nightmares
flashbacks
irritability
guilt
difficulty sleeping
Mx/
Treat co-morbid depression - SSRI
CBT
assess social needs
Refer to psych - EMDR - eye movement desensitization and reprocessing
