W01 - PSYCH: Primary Care Management of Common Mental Health Disorders; Psychedelics Flashcards
Be able to diagnose common mental illnesses.
- significant PMH, poor social support, recent adverse/difficult life event, severe illness causing disability, other MH problem =dementia
“During the last month, have you often been botheredby feeling down, depressed or hopeless?”
“During the last month, have you been botheredby having little interest or pleasure in doing things?”
core triad = MOOD, ENERGY, ANHEDONIA
Be able to perform suicide risk assessment.
Consider 5Ps:
Presenting complaint
PREDISPOSING FACTORS
PRECIPITATING FACTORS
PERPETUATING FACTORS
PROTECTIVE FACTORS
*alcohol, head injury (sig. suicide risk)
Be able to initiate management at primary care level
> psycho-education, lifestyle, active monitoring
(2) recognised depression, persistent subthreshold or mild to moderate
> sleep hygiene support, active monitoring 2w reassessment
> low intensity psychosocial intervention: CBT, group physical activity programme
!avoid routine antidepressant prescription unless
* PMH of mod-severe
* subthreshold symptoms for 2y+
* or subthreshold and dont respond to psychotx interventions
(3) persistent subthreshold, mild-mod with inadequeate response, mod-severe
> SSRI
high intensity psychological intervention
combined rx.
To recognize when secondary care referral is required.
- mdt or inpatient care with significant risk of self-harm, psychotic symptoms, severe self-neglect
- eating disorders
Dx of Severity of Depression
2 +2
2 +3
3 +4 /+psychotic symptom
Considerations for depression
Fitness to drive = memory symptoms
Fitness for work
Follow up = 2w, at risk = 1w.
Bipolar disorder considerations @ primary care
- do not start SSRI in depressed phase
= refer! - stop antideprr. if patients become hypomanic
Assessment of anxiety
GAD-7 Anxiety Form
Significance and mgmt of co-morbid substance misuse disorder alongside depression/anxiety
> treat substance misuse first: education, active monitoring, discourage OTCs.
> CBT principles for 6w, self-help, psychoeducational groups
> high intensity CBT
SSRI: sertaline / fluoxetine
-> SSRI/SNRI
-> pregabalin
review pt every 2-4w in first 3mos
Panic disorder mgmt
> SSRI: citalopram, sertaline NOT. fluoxetine
> imipramine (TCA) or. clomipramine
> benzodiazepines
> alternatives or referral
Social Anxiety mgmt
> CBT
> Sertaline or escitalopram
-continue for 6mos of treatment once tx has become effective
Dx and mgmt of OCD
- obsessions or compulsions that are
- time consuming
- sig. distress
- or functional impairment
> CBT +xposure/response
> SSRI: sertaline/fluoxetine, high dose for longer duration
> clomipramine (TCA)
Sleep disorder, insomnia tx
> sleep hygiene
sleep diaries
> melatonin for <13w use
hypnotics: only in disabling insomnia, addictive, and disruptive
Significance for monitoring
antipsyc.
- cardiovascular risk factors
- ECG and QTC prolongation
lithium: bipolar or adjunct in deppr.
- thyrod / kidney /6mos
- lithium levels for tox /3mos
- fine tremor Vs coarse tremor (toxic symptoms!)
- avoid nephrotoxic. drugs
Discuss the use and adverse effects of psychedelic drugs
illicit class of hallucinogenic drugs, triggering non-ordinary states of consciousness. Psilocybin active component in magic mushrooms.
- Ketamine
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