Theme C Flashcards
Criteria for sectioning
3 people must agree:
- You are suffering from a mental disorder
- You need to be detained for assessment and treatment
- It is in the patient’s best interests or protects the safety of patients or others
Section 2 Mental health act 1983
Detained in hospital for ASSESSMENT and treatment
Up to 28 days
Can’t renew but can transfer to section 3
Patient CANNOT refuse treatment
Section 3 Mental Health Act 1983
Detained in hospital for TREAMENT
Up to 6 months
Can be renewed - 6m-6m-12m
Patient cannot refuse treatment
Section 4 Mental Health Act 1983
Emergency situations Detained for ASSESSMENT Only needs recommendation of one doctor Up to 72 hours Patient can refuse treatment
Section 5(2) Mental Health Act 1983
Doctors holding power Detained from leaving hospital Must already be in hospital for treatment Up to 72 hours, not renewable Patients can refuse treatment
Section 5(4) Mental Health Act 1983
Nurses holding power Detained from leaving hospital Must already be in hospital for treatment Up to 6hours, not renewable Patients can refuse treatment
Human rights that conflict with mental health act
Article 2 - right to life (authorities must make every protection to protect your life, if death under section = coroner’s report)
Article 3 - Prohibition of torture and inhumane or degrading treatment
If patient disagrees with treatment, independent psychiatrist agrees then not breaking article 3. Restraint is not torture unless done other than for protection
Article 5 - right to liberty and security. Limited liberty if section
Right to education - if a child is detained, they must get education
Common Law regarding detainment
it is used until the mental health can be put into place
- Right to detain a person if the person is at right to self or others
- Right to restrain with reasonable force (no more than necessary)
- If patient cannot consent: done in best interests
- Treatment must be body recommeded
Leventhal’s self-regulatory model of illness behaviour
Representation of a health threat depends on
- Patient interpretation: symptom perception, social messages
- Coping - mechanisms
- Appraisal: is coping effective
These all determine the emotional response to a health threat
5 areas of illness representations
- Identity - symptoms, signs, labels and diagnosis
- Cause: perceived causes
- Consequences: perceived physical, social, economical etc
- Timeline: perceived timescale
- Control or cure
Patient may not match the clinician
Method of quantifying patient belief on disease
Illness perception questionnaire
Coping strategies and groupings
Problem focused - seeking new information, practical support, learning new skills, new interests, actively participating in treatment
Emotion focused: sharing feelings, expressing anger in appropriate ways, acknowledging loss, emotional support
Unhelpful: denial, reoccupation with minor issues, blaming
Ways in which patients with learning disabilities are vulnerable
BIOLOGICAL
- Genetic vulnerability
- Brain damage
- Physical disability
- Sensory impairment
SOCIAL
- small circle of friends
- limited opportunities for social interaction
- decreased finance, employment
- decrease support
- at risk of exploitation
- poor housing
- limited choices
PSYCHOLOGICAL
- coping strategies
- low self-esteem
- lack of assertiveness
- feeling helpless
Family support available for those with learning difficulties
Access to family advocacy Family support and info groups Disability support groups Skills training and emotional support Respite care Formal carers assessment
Role of FHx in breast cancer
BRCA gene
Calculate carrier probability using BOADICEA or Manchester scoring system
Refer for screening if
- 1 first degree under 40
- 1 male relative
- 1 first degree with bilateral
- 2 first degree or 3 second degree at any age
- 1 first or second degree with both breast and ovarian
Only do genetic screening if mutation risk 10-20%
Preventing cancer in BRCA gene positive women
Risk reducing mastectomy
Risk reducing oophorectomy
Chemoprevention - tamoxifen or raloxifene
Impact of caring for a mental health patient
Stress and worry
Social isolation
Guilty for taking time for self
Financial stresses
Physical health problems - demanding role
Depression - feeling hopeless
Frustration and anger - may not have had a choice about being a carer
Low self-esteem
Emotion strain - especially if patient attempts suicide
Patients with mental health are unpredictable and therefore challenging to care for
Stigma from others on behalf of patient - many try to cope alone
Reduced specialist mental health respite
Epidemiology of suicide
Increase in men
men choose more lethal methods - hanging, guns
Women tend to choose poisoning and self-cutting
Males have higher success rate
4500 per year
Incidence 19 per 100,000 men and 5 per 100,00 women
Increased in whites and Asians
highest in 15-44 years, although elderly also at risk
RFs Previous self harm Single/widow/divorced/separated Prisoners Vets/doctors/pharmacists/farmers Immigrants/refugees Recent life crisis Victim of abuse Mental illness Chronic physical illness
Epidemiology of self harm
Increased in females 1-4% of adults 10% of 15-16 year old girls Highest in adolescents and college students Increased in South Asians
RFs Borderline personality disorder (70% self harm) MH - depression, bipolar, schizophrenia, drug and alcohol misuse Domestic violence Eating disorder Armed force veterans Prisoners Asylum seekers Victim of abuse Gay/lesbian/bisexual
Members of community mental health team and their roles
Community psychiatric nurse (CPN) - facilitates treatment plan and monitors progress
Social worker - housing and benefits, make the most of available services
Clinical psychologist - delivers CBT
Psychiatrist - diagnoses and develops care plan
OT - maintain own skills and develop new ones. Back to work. Keep up motivation
Pharmacist - advice on meds
Admin staff - first point of call, arrange appointments
Counsellor - taking treatment and developing coping strategies.
Barriers to rapid diagnosis and treatment of MI
Symptoms - large variation between patient’s
Patient decision time
- Shorter in men than women (women tend to be atypical)
- STEMI has shorter time as more severe presentation
- ** increase education to decrease time
Symptom recognition - men more likely to realise MI
More likely to use ambulance if
- educated about MI
- Increase symptoms severity
- STEMI
- Increased age
- Increased distance to hospital
- Prehospital ECG, and meds decreases time to treat
- Incorrect level of triage
- Busy EF
- Further from hospital / increases time to treatment
- No access to phone
- Minimal education
Outcome indicator
Describes the effects of healthcare on the status of the population e.g. proportion with surgical site infection
Process indicator
Measures what is actually done in the giving and receiving of care.
e.g. number of patients receiving the correct antibiotics
Advantages of publically available performance indicators
Patient choice
Patient’s want the information
Increased transparency and openness
Managers more likely to focus on quality than cost
Ensures accountability of staff/ providers of care
Identify areas for concern and improvements
Disadvantages of publically available performance indicators
Only focussing on measured activity
Lose sight of long term outcomes
Avoiding new approaches in fear of worse outcome
Altering behaviour tot gain advantage
- Decreased access to care in high risk patients
- e.g. number treatment with antibiotics in first hour will cause overtreatment of non-cases
Cost of producing information - resource demanding
Patients may not use info
Epidemiology of CHD
1/5 men and 1/7 women will die from CHD More common in males Increase South Asians. Increased in northern England Increased with age
RFs Smoking Lower socioeconomic group Poor diet - high LDL Alcohol Physical wellbeing: work stress, decreased social support, depression and anxiety Hypertension Diabetes Hypercholesterolaemia FHx - 1st degree relative in men under 55 in women under 65 Obesity
RFs for CVD from highest to lowest importance
Apo-B/Apo-A1 protein (genetic) Current smoker Psychosocial e/g stresses Abdominal obesity Hypertension Daily fruit and veg intake Exercise Diabetes Alcohol
High risk hypertension patients
Patients at a high risk of complications from hypertension
- older age, men over 55, women over 65
- Diabetes
- Renal disease/proteinuria
- LV hypertrophy
- Established vascular disease
- CHD
- Stroke
- Peripheral vascular disease
For high risk patients aim for 130/80
Others aim for 140/90
Lifestyle changes to reduce CV risk
Cardioprotective diet - 5 a day - reduced refined sugars - 2 portions of fish a week - wholegrain carbs Physical activity - 150 minutes of moderate or 75 minutes of high intensity Lose weight Reduce alcohol consumption Smoking cessation Decreased salt consumption
Health benefits of smoking cessation
Decreased lung and other cancers Decreased CVD risk Decreased risk of COPD and respiratory symptoms Decreased risk of infertility Increased life span
20 minutes: decreased HR and BP 12 hours: CO levels drop to normal 2-12 weeks: increase circulation and lung function 1-9 months: decreased cough and SOB 1 year: half risk of CHD 5 years: risk of stroke that of non-smoker 10 years: half risk of lung cancer 15 years: risk of CHD that of non-smoker
Epidemiology of breast cancer
15% of total cancer paitents 31% of female cancer patients Most common cancer in the UK Increased in women Increases with age Highest in Caucasians - western Europe FHx - BRCA gene defect Most common cause of cancer in 15-49 years Most are detected in stage I or II Incidence has been increasing
RFs (separate flashcard)
RFs for breast cancer
COCP Alcohol Increased adult height Ionising radiation HRT Raised BMI post-menopause (protective pre-menopause) Decreased breast density History of Hodgkin's lymphoma, melanoma, lung, bowel, uterus Ca Increased breast density Benign breast disease Digoxin Diabetes Smoking increased birth weight Increased dietary fat Increased bone mineral density Decreased age at menarche Decreased parity Increased age at menopause Increased age at first giving birth
Protective factors for breast cancer
Breastfeeding Hysterectomy / oophorectomy pre-menopause Physical activity Regular aspirin / NSAIDs Osteoporosis Coeliac disease
Principles of screening
- Condition should be an important health problem
- Recognisable latent or early symptomatic stage
- Natural history of condition should be understood
- Accepted treatment for patients with recognised disease
- Suitable test or examination with high level of accuracy
- Test should be acceptable to population
- Agreed policy on who to treat
- Facilities for diagnosis and treatment should be available
- Cost of screening should be balanced
- Screening should be a continuing process
Define sensitivity
Effectiveness of a test to detect disease in all of those with disease
True positives / true positives + false negatives
Define specificity
The extent to which a test gives negative results in those without disease
True negative / true negatives + false positives
Define positive predictive value
Extent in which a person with disease in those that test positive
True positive / true positive and false positive
Define negative predictive value
Extent to which a person without disease in those with a negative test result
True negative / true negative + false negative
What needs to be agreed in order for screening program to happen?
Frequency of screening Ages at which it should be performed Defined mechanisms for referral and treatment Information systems that can: - Send out invitations - Recall for repeat screening - Follow patients with abnormality - Monitor and evaluate the program
Breast cancer screening
50-70 (trial extension from 47 to 73)
Every 3 years
Mammography
Benefits of breast cancer screening
Allows for less aggressive treatment
Increases prognosis
Decreased mortality
Pain Radiation Anxiety (false positives) Does not detect 20% of cancers Over diagnosis and over treatment
Over diagnosis
A cancer or disease that is picked up by screening that would not otherwise have come to attention in that person’s lifetime
Over treatment
Unnecessary medical interventions
- Either due to over diagnosis
- OR extensive treatment for a disease which only requires limited treatment.
Psychological impact of a cancer diagnosis
Employment and income
- financial hardship
- may have to give up work due to illness/ appointments
Social engagement
- harder to participate in social events and maintain friendships
- decreased energy and mobility
Change in family dynamics
Emotional distress
Uncertain about unwanted changes to self and life
Feelings - shock, disbelief, fear, anxiety, guilt, sadness
Depression and anxiety
Fertility - can cause infertility
Change in relationships with family and friends
Inability to perform social roles
Changes to sex drive
Changes to body image
Feelings of guilt and self-blame
Factors associated with delayed presentation of breast cancer
Older age Lower educational level Non-white ethnicity Non-recognition of symptom seriousness Decreased social support Presentation type - no breast lump No pain Presence of co-existing morbidity Fear of cancer diagnosis Competing life priorities Embarrassment around breast exam
Effect of culture on psychological response to diagnosis and treatment (breast cancer)
Members of ethnic minorities can often delay in help seeking
Blacks and Hispanics have more advanced breast cancer when detected and have poorer survival rates
Less likely to have mammogram if single, decreased education and unemployed
Increased set backs - unemployment, trouble returning to work, struggle with interpersonal relationships
Differences in knowledge and beliefs regarding cause, symptoms, curability and consequences
Differences in trust in physicians
Some cultures RE male examination worries.
Some cultures stress importance towards families and putting others first
FHx in breast cancer
BRCA1 and 2 gene
Can calculate carrier probability using:
BOADICEA or Manchester Scoring system
Refer if:
- 1 1st degree under 40
- 1 1st degree male
- 1 1st degree with bilateral cancer
- 3 2nd degree or 2 1st degree with breast cancer at any age
- 1 1st or 2nd degree with breast and ovarian cancer
Prevention of breast cancer in BRCA +
Risk reducing mastectomy
Risk reducing oophorectomy
Chemoprevention- tamoxifen or raloxifene
Role of a post mortem
Examination of a patient after death
Carried out by a pathologist to establish the cause of death or determine effects of treatment
Who is the coroner
Independent official with legal responsibility for the medical-legal investigation of certain deaths including: sudden, unexplained, unnatural or violent in nature
What deaths are reportable to the coroner?
Sudden deaths from unknown causes
Any case where cause of death unknown
Any vehicle, boat, train or plane accident
Any suspicious circumstances
Suicide
If not been seen or treated in last 14 days
Any death within 24 hours of admission
Due to possible negligence, misconduct or malpractice
Any death caused by a treatment or anaesthesia
Any infant death or still birth
Death due a crime
Detained under Mental Health Act 1983 or under police custody
Death linked with occupational hazard e.g. mesothelioma, bladder cancer
Due to fall or fracture
Reasons for retaining tissue after post-mortem
Controlled by Human Tissue Authority
- Examined with microscope
- Complex abnormality requiring detailed examination
- Sample may need preparation prior to examination
- Preparation can take weeks
Benefits of post mortem
Provides valuable information on cause of death
Provides vital info for future treatment/research
Gives relatives information which may impact on their health
Data can improve and assess medical care and research - cause and prevention of disease
Assists in education of doctors and students
Provides accurate mortality and morbidity stats to improve public health
Confirmation of death
- Full extensive attempts at reversible causes of cardiorespiratory arrest
Body temp, endocrine, metabolic and biochemical abnormalities
One of the following criteria is met:
- Meets criteria for not attempting CPR
- Attempts of CPR failed
- Life sustaining treatment has been withdrawn
Observe individual for minimum 5 minutes
Primary care
- No mechanical cardiac function: absent central pulse on palpation, absent heart sounds on auscultation
Hospital: one of
- Asystole on ECG
- Absence of pulsatile flow on arterial monitoring
- Absence of contractile activity using echo
Check reflexes to light, corneal reflexes, and motor response to supra orbital pressure
Who can confirm death?
Doctors
Nurses
Suitably trained ambulance clinicians
A doctor’s legal duty is to notify the cause of death, not the fact the death has taken place
Defining death in primary care
Unresponsive patient with temperature over 35 degrees with no drug or alcohol use
- No spontaneous movement
- No respiratory effort
- No heart sounds or palpable pulse
- Absence of corneal reflexes
- Pupils fixed and dilated
Role of death certificate
Allows relatives to register the death
Provides a permanent legal record of death
Allows relatives to arrange a funeral and settle estate
Provides national statistics regarding cause of death and trends in disease
Given to the next of kin to deliver to the Registrar of Births, deaths and marriages within 5 days who decides if it needs reporting to the coroner
Reasons that cannot be used as cause of death on death certificate
Old age Organ failure e.g. renal/heart/liver Mode of dying e.g. cardiac arrest or shock Diabetes Any abbreviations
Epidemiology of lung cancer (not RFs)
3rd most common cancer in the UK
2nd most common cancer in males and females in the UK
13% of total cancer cases
Increases with age
Increased in males
Higher in Caucasians
FHx - yes
87% non small cell lung cancer
13% small cell lung cancer
Most diagnosed in stage 4
RFs for lung cancer
Smoking Low BMI Past cancer (breast, Hodgkin's lymphoma) Asbestos Radon Silica dust HIV Air pollution Ionising radiation Hx of pneumonia, TB, silicosis, COPD Production of coal/coke Organ transplant recipients Diet high in red meet or total fats
Medical conditions that decrease the risk of lung cancer
MS
Coeliac
Parkinson’s
Role of MDT
Bring together staff with necessary knowledge and skills to ensure high quality diagnosis, treatment and care
- Considers patients as whole, not just disease
- Takes into account patients views, preferences and circumstances
- Makes recommendations not decisions
- Final decision is patient and clinician
Effective MDT should result in:
- Treatment and care considered by field experts
- Offered opportunity to enter clinical trials
- Continuity of care
- Good communication between 1y, 2y and 3y care
- Good data collection
- Improved equality
- Better adherence to local and national guidelines
- Promotion of good working relationships between staff
- Optimisation of resources
Psychological effects of stoma
Shock Depression or anxiety esp if due to prolonged recovery, long lasting disability Alteration in body image - scar Alterations in body function - stoma Change in daily routine Problems with self care and ADLs Impact on relationships Feelings of embarrassment - sex life Rejection from partner Altered sleep habits due to fear or leakage, pain or discomfort Self- conscious Modification of diet Employability and insurance issues
Physical side effects of chemotherapy
Fatigue 2y cancer Weight gain Diabetes Ulcers in mouth Anaemia Memory loss Decreased libido Decreased hair Infertility Neuropathy Osteoporosis Renal, liver, lung, cardiac damage Pain Premature aging Early menopause
Psychological effects of chemotherapy
Fear of recurrence Grief Loss of libido Loss of physical dependence Loss of fertility Depression Body image and self-esteem (hair loss) Relationship strain Worry of outside world (increased infection risk) Decreased energy Anxiety Fear of losing job - missing for illness and medical appointments Requiring assistance with ADLs Emotional stresses Financial stresses - decreased work, cost of travelling Feelings of isolation
Reducing cardiovascular disease in community
- Policy approaches: global, national and local
- Healthcare delivery: access to care, quality of care, drugs and technologies
- Heath communication: media
- Determinants: cultural and social norms, health inequalities,
- Identify groups that are high risk
- Assess levels of major preventable causes of CVD
Focus on
- Education
- Schools
- Work
- Environmental change
- Policy change
In what ways can education lower CVD?
- Media emphasising importance of lifestyle behaviours and risk factors
- Public education campaigns to make aware of guidelines for primary and secondary prevention
- Ongoing education of public in CPR
- Guide for prevention, diagnosis and treatment made available
- Limit food advertising to youth
- TV shows for children should promote physical activity
- Teaching in schools
- Compulsory physical education in schools
- healthy school meals
- CPR teaching
What ways can change in environmental factors lower CVD?
- Supermarkets selling fruit and veg at reasonable price
- restaurants offering dishes which meet nutritional guidelines
- Low fat/calorie snacks
- healthy food at check outs
- Support of physical education programmes
- Smoke free areas
In what ways can a change in policy lower CVD?
- Increase unit price for tobacco
- Removal of tobacco advertising
- NHS treatment for smoking cessation
- 5 a day
- 30 mins exercise per day
- Change for life
- No smoking indoors
- Alcohol recommended limits
Levels of evidence
1a - meta-analysis of RCTs
1b - evidence from at least one RCT
2a - evidence from at least one well designed controlled study
2b - evidence from at least 1 other type of well designed studies
3 - well designed non-experimental descriptive studies
4 - evidence from expert committee reports or opinions
Evidence behind dermatological treatments
High levels of evidence for
- PUVA + UVB in psoriasis but is associated with increased cancer risk
- Systemic steroids in eczema (no evidence as to which is the best steroid)
- Little evidence for methotrexate used in psoriasis
- Ciclosporin is the best systemic drug for psoriasis
Dangers of excessive sun exposure
Increased risk of skin cancer
Skin burn - cells and blood vessels are damaged
Heat exhaustion - core temp > 40, sickness, headaches, excessive sweating, feeling faint
Heat stroke - core temp > 40, body cells begin to break down and body functions stop working, organ failure
Vomiting, confusion, hyperventilation, decreased consciousness
Repeated damage leads to premature skin ageing
- Decreased elasticity, dry wrinkled and discoloured
Damage to eyes
UK Mental health services
GP Community mental health team (CMHT) Early intervention service (EIS) Crisis resolution team Home based treatment (HBT) Assertive outreach team (AOT) Day hospitals In patient units Improving Access to Psychological therapies (IAPT) Support groups and charities - Mind, Rethink, SANE, AA, The Samaritans
Role of GP in mental health services
Bulk of treatment done by GP
If referral required usually to community mental health team
Can refer to early intervention service for psychosis
Some patients can present to A&E instead
They will be assessed by a psychiatrist and then referred
Screen and diagnose MH problems
Role of Community Mental Health Team in mental health services
MDT: psychiatrist, mental health social workers, CPNs, psychologists
Co-ordinates patient care
Monitors patients in the community
Initial assessment by psychiatrist then holistic care plan
Role of Early Intervention Service in mental health services
Used to improve short and long term outcomes of schizophrenia and other psychotic disorders
Exclusively PSYCHOSIS at first presentation
- Preventative measures
- Earlier detection of untreated cases
- Intensive treatment and support in early stages of disease
Role of crisis resolution team in mental health services
24/7
Acts as gateway to various psychiatric services e.g. admission
Most common referrals comes form GP, A&E and CMHT
Rapid assessment to determine if admission of home based therapy (HBT)
Role of Home Based Treatment team in mental health services
Short term intensive home based care
MDT as per CMHT
Visits up to 3x per day with gradual decreased
Role of Assertive outreach team in mental health services
For revolving door patients
Reluctant to seek help therefore present at times of crisis
Often have most complex mental health and social problems
Specialist MDT dedicated to engaging them in treatment and providing support.
Role of day hospitals or in patient units in mental health services
If they cannot be safely managed in community
- Patient is danger to self or others
- Requires specialist care or supervised treatment
- Patient lacking social structure
- Carer can no longer cope / needs respite
Most are involuntary / informal
Role of key worker in mental health services
Usually a CPN or social worker
Co-ordinates and administers treatments
Has knowledge of local services and encourages and allows access
Liase with GP and other agencies
Assists with planning and monitoring of care
Specialist mental health services
General adult Old age Child and adolescent Liaison Substance abuse Forensic Learning disability
Psychiatry
Social and cultural factors contributing to depression
Social support - those with more are less likely to get depression
- Helps to know they are not alone
- Someone pushing them towards getting better
Strong family network
Decreased socioeconomic group have decreased stability and increased risk of depression
High stress job or environment can worsen depression
Ethnic minorities are at higher risk of depression - immigration status, decreased income and education level
Different populations talk about depression differently and have different help seeking behaviour
Services may not be available in native language
Less likely to seek help for depression if: elderly, young adult, ethnic minority or decreased social support
Financial implications may be barrier to treatment- child care, transport
Stigma is different in different populations
Different groups have different beliefs and preferences RE treatment e.g. CBT/medication
Primary health promotion strategies to increased mental health
- Health visitors for all at risk of post natal depression
- School based prevention of violence, bullying, offending or re-offending
- Screening and brief interventions for alcohol abuse
- Promotion of well being at work
- Supported employment for those recovering from mental health problems
- CBT for those with medically unexplained symptoms
- Suicide prevention
- Early intervention service
- Debt advice
- Anti-stigma campaigns
- Increased focus or social support
- Tackle social and economic inequalities
Political action regarding mental health problems
Public Health White Paper
- Tackle substance addiction through minimum alcohol pricing policy
- Promote public health interventions to prevent future inequalities
- Ensure suicide prevention strategy
- Prioritise mental health within smoking cessation
- attended to discrimination and stigma around MH (time to change)
- Target public mental health interventions for high risk people: cared for children, unemployed and homeless
- Promote importance of MH and well being
RFs for chronic liver disease
Hepatitis
- Travel to high risk areas
- IVDU
- Male homosexuality
- Healthcare worker
- Tattoos and piercings
- Blood transfusions
Alcohol Medications FHx Obesity Metabolic syndromes Heart failure
Methods for prevention of chronic liver disease
In high risk areas - wash hands, no salad or ice
IVDU - needle exchange programmes
Condoms
PPE at work.
Tattoos and piercings only though registered practices
National screening of blood transfusions
Recommended alcohol limits: 14/ weeks, 2 free days
Promote MH to decrease Paracetamol OD
Drs aware of drug interactions
Obesity: national health eating, change for life. increase exercise programmes
In metabolic syndromes: control diabetes and weight
Physical problems associated with dialysis
Not treated daily so can feel tired and nauseous between treatments
Gain fluid weight between sessions
Must limit fluid intake and diet strictly
Pain and discomfort
Additional for PD:
- Increased risk of peritonitis
- Problems with sleep and rest
Psychosocial issues associated with dialysis
Difficulty arranging transport
Difficulty managing a fixed schedule around other plans
Difficulties with going on holiday - need treatment while there
Alteration in marital, social and family relationships - may develop carer role
Feelings of loss of personal control
Increased anxiety and depression
Uncertain future, large demands of illness
Dependence on machinery, medication and healthcare
Loss of freedom (less with PD)
Feelings of frustration
Decreased quality of life
Impaired self and body image
Impact on sexual activity
Feeling like a burden
Impact of mental health on primary care
COMMON
Large range of conditions seen by GP: adjustment reactions, anxiety, depression, schizophrenia, bipolar disorder, addiction
90% of MH problems are managed by GPs
GPs only receive 10% of MH funding
30% of GP visits have a mental health component
30% will have sick leave due to MH problems
Patients with MH problems have more consultations regarding physical problems Increased use of services Increased cost Decreased appointments available In 10 minute appointments: - Difficult to spot a problem - Run late if more than 1 problem or brought up last - patient dissatisfied if rushed
National Framework for Mental Health 1999
Primary care to care for common mental health problems
Primary care to contribute to health promotion
Lack of clarity regarding management of complex, chronic and disabling non-psychotic problems
- GPs require good understanding of healthcare needs in these patients
Types of living organ donation
Directed donation
Direct altruistic donation
Non directed altruistic donation
Donor chain
Describe a directed organ donation
Living organ donation
Health person donates organ to a specific person where there is a relationship between them
Describe a directed altruistic organ donation
Living organ donation
Donation to specific individual but no evidence of genetic or emotional relationship between donor and recipient
Describe a non directed altruistic organ donation
Living organ donation
Health person donates organ to unknown recipient matched by NHSBT
Describe donor chains in organ donation
Living organ donation
Non directed altruistic donors can donate into paired or pooled scheme
Match 2+ donors to recipients and the organ at the end of the chain goes to best matched NHSBT patient on list
- Occurs when donor can’t donate to friend/relative as they are not a match
- Enter a pool, when friend gets a kidney, they donate theirs
