W19 68 anxiety depression psychoses and eating disorders

Question 1

How do you examine mental state?

Answer 1

Difficult to assess
Appearance and behaviour - what they’re wearing, clean and looking after themselves, things in hands, agitated?, aggressive?
Speech - fast? Slow? Slurred?, abnormal or normal
Mood - happy or sad, no mood at all
Thoughts - assessed by what people say and how they act
Perceptions - hallucinations? Uncommon
Cognition - level of functioning and understanding in general
Insight - do they understand whether they’re unwell or not

Question 2

Risk assessment of people with mental health conditions?

Answer 2

Risk to self/suicide
Risk to others
Risk to self-neglect (eg teeth!)
Risk of exploitation
Risk of deterioration in mental/physical health
Risk of non-compliance with treatment - people might not want to get better/not believe they’re unwell/forget or cannot be bothered to take medications

Question 3

What are the 5 key principles of the mental capacity act?

Answer 3

Assume patient has capacity
Support patients to make own decisions
Respect right to make unwise decisions
Act in patients best interest
Use the lead restrictive option

Question 4

What is capacity?

Answer 4

The ability to make the decision for ones self.

Question 5

What is the 2 stage process to assess capacity?

Answer 5

(Complicated in practice)
Impairment or disturbance of functioning of the mind or brain
Unable to understand, retain or weigh up information to make decision of communicate decision

Question 6

What are the cardinal symptoms of depression?

Answer 6

Low mood, lack of energy, loss of interest (at least 2 out of the 3 usually)

Question 7

What are the other symptoms of depression (non-cardinal)?

Answer 7

Reduced concentration, reduced self-esteem, guilt, pessimistic thoughts, disturbed sleep and appetite, thoughts and actions of self-harm/suicide
If gets really bad, hallucinations and psychotic beliefs

Question 8

How do you treat depression?

Answer 8

Antidepressants and/or psychological therapy
CBT (wait lists are long)

Question 9

How long does it take for antidepressants to start working?

Answer 9

Might have a worse effect first
Can take about 3 weeks to start working

Question 10

What is bipolar disorder?

Answer 10

Mania/hypomania and episodes of depression

Question 11

What is mania and hypomania?

Answer 11

Mania = lots of energy and drive to do things
Hypomania = mania to a less extent - mania will mean you’re admitted to hospital and hypomania is just less than this.

Question 12

What are the symptoms of mania/hypomania?

Answer 12

Elated mood/irritability
Excess energy/motivation
Rapid thoughts and speech
Increased libido
Loss of inhibitions
Psychotic symptoms (mania)

Question 13

How do you treat bipolar disorder?

Answer 13

Mood stabilisers and antipsychotics. Avoid antidepressants if possible because can turn from depression to mania.
Antipsychotics include lithium, sodium balporate

Question 14

What are the symptoms of psychotic disorder (eg schizophrenia)?

Answer 14

Hallucinations
Delusions
Disorganised thoughts and speech
Negative symptoms
Catatonia

Question 15

What are hallucinations?

Answer 15

Where a perception of something in any modality
Most common = hearing voices/sounds that aren’t there
Can be taste, smell, sight etc

Question 16

What are delusions?

Answer 16

Something where you have a believe that is based on no evidence. Any challenge that you are given you will hold it with conviction. Reason is because you believe it is a fact - no evidence will change your mind.

Question 17

Negative symptoms of schizophrenia occur when someone has been chronically unwell for a long period of time. What are these symptoms?

Answer 17

Similar to depression - eg lacking motivation, still, don’t move much
Negative symptoms affect your functioning and cognition so much that if untreated from an early age you cannot function. Even with treatment your function tends to deteriorate.

Question 18

Catatonia is the most extreme form of symptom in schizophrenia and severe depression. What is catatonia?

Answer 18

Where you have odd mannerisms:
- can be very stiff to the point where you can put their body in a position that would normally be very uncomfortably and hold it for hours
- people standing in a hall for hours not responding to communication
- start speaking to them and they’ll just repeat back what you say

Question 19

How do you treat psychotic disorders like schizophrenia?

Answer 19

Antipsychotic medication
Decision based on side effects

Question 20

What are the symptoms of anxiety?

Answer 20

Symptoms commonly associated with depression.
Psychological symptoms - worry thoughts, feelings of dread, foreboding
Somatic anxiety - tension, inability to relax, dry mouth, palpitations, gastrointestinal symptoms
Phobia - anticipatory, anxiety and avoidance
OCD symptoms - ruminations, compulsions, try to resist (cause the anxiety). They recognise thoughts as own thoughts.

Question 21

What is treatment for anxiety?

Answer 21

Antidepressant/other medication, psychological treatment
Make worse to start with but then work

Question 22

What are some different anxiety disorders?

Answer 22

Generalised anxiety disorder, phobias, OCD, panic disorder

Question 23

What are some different eating disorders?

Answer 23

Anorexia, bulimia nervosa, binge eating disorder
Lots are related to body dysmorphic disorder

Question 24

What are the symptoms of eating disorders?

Answer 24

Distorted body image - believing they are overweight when not
Preoccupied with losing weight
Restricting intake
Binging and purging
Use of laxative or emetics
Effects of the weight loss

Question 25

What is the treatment for eating disorders?

Answer 25

Treatment of the effects of low weight and refeeding. Psychological therapy.

Question 26

What are some oral manifestations of eating disorders?

Answer 26

Traumatic lesions (eg to palate) from objects to induce vomitting
Angular cheilitis, glossitis, or oral mucosal ulceration due to malnutrition
High risk of decay
Dental erosion, higher in those that vomit compared to those that don’t, also due to malnutrition
Bilateral parotid swelling in those that vomit

Question 27

What are the signs to look out for for people who might be at risk of suicide or self-harm?

Answer 27

Evidence of previous self harm
Threatening suicide
Making preparations
Recent life crisis
Sudden calmness
(more likely to affect those out of work and who live alone)

Question 28

What should you do when treating patients with phobias?

Answer 28

Allow them to look around first
Early appointments can be,o
Take things slowly
Be understanding
Agree signal with patient if they need a break
Controlled breathing
Consider sedation clinic

Question 29

What should you do if you suspect a new psychiatric problem/deterioration?

Answer 29

Recommend patient sees GP or A&E if more urgent
If immediate risk to self or others call police. Can physically restrain and take for assessment.