SLA 15 - Mental Health (B) Flashcards
What is the mini mental state examination (MMSE)?
A commonly used set of questions for screening cognitive function. It is not suitable for making a diagnosis, but can be used to indicate the presence of cognitive impairment.
Interpret the following scores for MMSE:
a) 25-30
b) 21-24
c) 10-20
d) 0-9
a) normal cognitive function
b) mild cognitive impairment
c) moderate cognitive impairment
d) severe cognitive impairment
What is the general practitioner assessment of cognition (GPCOG)
A screening tool to test for dementia, by assessing the following components:
- time orientation
- visuospatial functioning
- information
- recall
What is the purpose of a suicide risk assessment?
- establish patient’s intent
- assess the seriousness and perceived seriousness of their attempt
- assess how they feel about the attempt at the time of assessment
What are some risk factors for suicide?
- previous suicide attempt / self harm
- male gender
- unemployment
- physical health problems (e.g. chronic pain)
- living alone
- unmarried
- alcohol dependence
- active mental illness
Note risk factors for suicide are more common in the prison population, therefore this group of people are at higher risk.
List some protective factors for suicide.
- strong religious faith
- family support
- children at home
- sense of responsibility (e.g. work, caring)
- problem-solving skills
Suggest three mental health disorders where suicide risk is heightened.
- depression
- schizophrenia
- personality disorder
What are the ‘red flag’ symptoms of suicidal intent?
- sense of hopelessness
- feeling of entrapment
- well formed plans
- perception of no social support
- significant pain / physical chronic illness
What are the aims of a care plan in reference to suicide risk?
- prevent self-harm or suicide attempts
- reduce level or injury
- improve quality of life
- improve social / occupational functioning
- improve mental health conditions
- improve physical symptoms
Why is the use of SSRIs controversial in the treatment of suicidal ideation?
Some SSRIs and anti-depressant medication can increase suicidal ideation, especially when first introduced.
What is the definitive management of a patient at high-risk of suicide?
Ensure safety with 24-hour support through the crisis team
Consider grounds for psychiatric evaluation and detention under the Mental Health Act (1983) if the patient refuses.
What telephone helplines are available to patients displaying suicidal ideation?
- Shout
- Samaritans
- CALM helpline (prevents male suicides specifically)
Suggest some ways in which self-harm can be inflicted.
- self-cutting
- ingesting a substance in excess of the prescribed or generally recognised therapeutic dose
- ingesting a recreational or illicit drug with the intent to cause harm
- ingesting a non-ingestible substance or object
Give the prevalence of self-harm within the UK.
At least 5% lifetime prevalence.
Note self-harm is often performed privately and discretely, so true number may be much greater.
How should self-poisoning be managed in primary care?
In most circumstances, patients who have self-poisoned should be referred urgently to the nearest emergency apartment.
What is obsessive-compulsive disorder (OCD)?
Characterised by the presence of obsessions or compulsions but commonly both.
Define ‘obsession’ in relation to OCD.
Unwanted intrusive thoughts, images or urges that repeatedly enter the person’s mind.
Define ‘compulsion’ in relation to OCD.
Repetitive behaviours or mental acts that the person feels driven to perform.
They can be overt (e.g. checking a door is locked), or they can be covert (e.g. repeating a certain phrase in one’s mind).
What is the cause of OCD?
Not known, but seems to be multifactoral:
- genetic
- developmental factors (e.g. abuse, neglect, bullying)
- psychological factors
- stress (e.g. pregnancy, post-natal period)
- neurological conditions (e.g. tumour, frontotemporal dementia)
What are the diagnostic criteria for OCD?
- obsessions / compulsions on most days for at least 2 weeks
- repetitive and unpleasant
- subject tries to resist thoughts (unsuccessfully)
- carrying out obsessive thought or compulsive act is not in itself pleasurable
Suggest some questions you can ask to identify OCD.
- do you wash or clean a lot?
- do you check things a lot?
- is there any thought that keeps bothering you, that you would like to get rid of but cannot?
- do your daily activities take a long time to finish?
- are you concerned about putting things in a special order?
Outline the management of OCD.
- cognitive behavioural therapy (CBT)
- exposure and response prevention (ERP)
- SSRI
What are the types of eating disorder?
- anorexia nervosa
- bulimia nervosa
- binge eating disorder
What is anorexia nervosa?
The significantly low body weight for the individuals height, age and developmental stage that is not due to another health condition or to the unavailability of food.
What are the risk factors for anorexia nervosa?
- female sex
- age
- living in Western society
- family history of eating disorders or depression
- sexual abuse
- dieting behaviour within the family
- anxiety
Presentation of anorexia nervosa.
- refusal to maintain a normal body weight
- weight below 85% of predicted
- dieting or restrictive eating practices
- rapid weight loss
- have a dread of gaining weight
- social withdrawal
Note in women, amenorrhoea for three months or longer is a common symptom.
What is bulimia nervosa?
An eating disorder characterised by repeated episodes of uncontrolled overeating (binging) followed by compensatory weight loss behaviours (e.g. self-induced vomiting, fasting, intensive exercise, abuse of laxatives / diuretics).
Give some risk factors for bulimia nervosa.
- parental and childhood obesity
- family dieting
- early menarche
Presentation of bulimia nervosa.
- regular binge eating
- attempts to counteract the binges
- BMI maintained above 17.5kg/m2
- preoccupation with weight, body shape, and body image
- preoccupation with food and diet
