Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

GP block (Y3) > Week 7: Mental health 1 (depression and anxiety) > Flashcards

Week 7: Mental health 1 (depression and anxiety) Flashcards

1
Q

depression overview

A

Definition and overview

Refers to both negative affect (low mood) and/or absence of positive affect (loss of interest and pleasure in most activities) and is usually accompanied by a variety of emotional, cognitive, physical and behavioural symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

risk factors for depression

A
  • Female (esp postnatal)
  • Past history of depression
  • Physical illness
  • Other mental health problems e.g. dementia or schizophrenia
  • Psychosocial problems e.g. divorce, unemployment, poverty
  • Risk factors for children
    • Family discord
    • Bullying
    • Abuse
    • Drug and alcohol use
    • History of parental depression
  • Side effect of medication
  • Physical illness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

presentation of depression

A

Presentation

  • Sad mood that doesn’t go away
  • Loss of interest
  • Lack of energy
  • Loss of confidence
  • Poor concentration
  • Sleep disturbance
  • Change in appetite
  • Thoughts of suicide
  • Agitation
  • Feeling worthless
  • Panic
  • Apathy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Low mood vs depression

A

Low mood

  • Feeling low from time to time
  • Common after distressing event or major life changes, sometime happen for no obvious reasons
  • Low mood will often pass after a couple of days or weeks

When does it become depression

  • If you are feeling down or no longer get pleasure from things most of each day and this lasts for several weeks
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

management of depression

A
  • Managing comorbidity i.e. alcohol substance abuse, eating disorder etc
  • Managing safeguarding issues
  • Assessing and mitigating suicide risk
  • CBT
  • Counselling
  • Social prescribing i.e. physical activity programmes in groups
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

pharmacological management of depression

A

Antidepressants are not recommended for initial treatment of mild depression because risk: benefit ratio is poor

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

moderate to severe depression offer

A

antidepressants combined with CBT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

if suicicdal ideas or plans

A

make urgent psychiatric referral

  • use of mental health act may be necessary
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

types of antidepressants

A

SSRIs

SNRIs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

SSRIs

A
  • Selective serotonin reuptake inhibitors (SSRIs) are first line (less toxic in overdose and same effectiveness as tricylic)
    • Citalopram
    • Fluoxetine
    • Sertraline
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

SNRI

A
  • SNRI (serotonin noradrenaline reuptake inhibitors) used as second line
    • Duloxetine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

electroconvulsive therapy (ECT)

A

is occasionally used by specialists to gain fast and short term improvement of severe symptoms if other options have failed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

screening tool for depression

A

PHQ9 self assessment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

diagnosis of depression

A

DSM-5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

DSM-5 requires….

A
  • Requires at least one of the core symptoms (for >2 weeks)
    • Persistent sadness/ low mood
    • Loss of interest or pleasure in most activities
  • Plus at least ¾ of the following symptoms
    • Fatigue
    • Worthlessness/ inappropriate guilt
    • Recurrent thoughts of death
    • Diminished ability to concentrate
    • Insomnia
    • Changes in appetite/weight loss
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

monitoring of depression

A
  • See patients who are not considered to be at increased risk of suicide within 2 weeks of starting treatment and review as reg as appropriate
  • See patients with increased risk of suicide who are younger than 30 within one week of starting treatment and review reg
    • If pt high risk of suicide- prescribe a limited quantity of antidepressants
  • Monitor for signs of akathisia, suicidal ideas and increase anxiety and agitation
17
Q

treatment duration for depression

A
  • For patients who have benefited from SSRI- continue for at least 6 months after remission tor educe risk of relapse
  • When stopping antidepressants reduce dose gradually over a four week period
18
Q

complications of depression

A
  • For patients who have benefited from SSRI- continue for at least 6 months after remission tor educe risk of relapse
  • When stopping antidepressants reduce dose gradually over a four week period
19
Q

prognosis of depression

A
  • Average length is 6-8 months
  • Risk of recurrence is 50-%
  • Prognosis worse when psychotic features, anxiety and underlying personality disorder
20
Q

depression history taking

A
  • Opening the consultation
    • Wash hands
    • Introduce name and role
    • Confirm pt name and DoB
    • Ask pt if happy to talk with you about their current issues
  • PC
    • What has brought you to see me today?
    • Okay can you tell me more about that
  • HPC
    • Screening for depression
      • ‘during the past month have you felt…
        • Low, depressed or hopeless
        • Had little interest in doing things’
    • Exploring symptoms of depression
      • Ask about sleep
      • Ask about mood (persistent sadness most days)
      • Appetite change
      • Reduced libido
      • Reduced concentration
      • Negative attitude to the future
      • Negative perception of self
    • Assess suicide risk
      • “When people feel down and depressed, they can feel that life is no longer worth living. Have you ever felt like this?”
    • Screening for other psychiatric disorder inc bipolar, schizophrenia
      • E.g. features of mania suggestive of bipolar
        • ‘have you ever experienced periods of feeling particularly high, energetic, euphoric’
      • Features of schizophrenia
        • Voices speaking
        • Think people are discussing you negatively
        • Fear people are out to get you etc
  • Past psychiatric history
    • ‘Have you ever had any other periods of feeling particularly low’
  • Past medical history note any conditions e.g. hypothyroidisms that can cause mood disturbance
  • Allergies
  • Drug history
  • Family history
    • “Have any of your parents or siblings had problems with their mental health in the past?”
  • Social history
    • General context: accommodation, who they live with, if they can do ADL
    • Assess impact of depression on relationships and work
    • Smoking
    • Alcohol
    • Recreational drug use
    • Gambling
  • Assess insight
    • In severe depression may demonstrate loss of insight into illness
    • Ask: ‘what do you think the cause of the problem is’
  • Closing the consultation
    • Make sure ICE has been covered
    • Thank patient
    • Dispose of PPE
21
Q

generalised anxiety disorder

A

GAD is a syndrome of ongoing anxiety and worry about many events or thoughts that the patient generally recognises as excessive and inappropriate. The condition can be chronic and debilitating.

22
Q

risk factors for GAD

A
  • Women > men
  • 35-54
  • Being divorced
  • Living alone or a lone parent
23
Q

resentation of GAD

A
  • Excessive anxiety and worry for >6 months
  • Difficult to control worry
  • 3/6 symptoms
    • Restlessness
    • On edge
    • Fatigued
    • Difficulty concentrating
    • Irritability
    • Muscle tension
    • Sleep disturbance
  • Autonomic arousal
    • Palpitations
    • Sweating
    • Shaking
    • Dry mouth
  • Chest and abdomen
    • Nausea or abdominal distress
    • Difficulty breathing
    • Chest pain
  • General symptoms
    • Hot flushes or cold chills
    • Feeling dizzy
    • Fear of dying
24
Q

Difference between GAD and stress

A
  • Stress is typically caused by an external trigger
    • Trigger can be short term, such as a work deadline or a fight with love one
    • Can experience mental and physical symptoms
      • Irritability
      • Anger
      • Fatigue
      • Muscle pain
      • Difficulty sleeping
  • Anxiety is defined as persistent, excessive worries that don’t go away even in the absence of a stressor
    • Can lead to identical set of symptoms as stress
25
Q

screening tool for anxiety

A

GAD7

26
Q

diagnosis of GAD

A

Diagnosis

  • Used the DSM-V criteria or the icd-10
  • Clinical judgement based on history can be used
  • Physical exam
    • Increased HR
    • SoB
    • Trembling
    • Exaggerated startle response
27
Q

monitoring of anxiety

A
  • Review should be every 4-8 weeks
  • For patients on medication, NICE recommends 2-4 weeks for first 3 months
  • Medication should be continued for a minimum of one year
  • Self-complete questionnaire to monitor outcomes
28
Q

comolications of anxiety

A
  • Review should be every 4-8 weeks
  • For patients on medication, NICE recommends 2-4 weeks for first 3 months
  • Medication should be continued for a minimum of one year
  • Self-complete questionnaire to monitor outcomes
29
Q

prognosis of anxiety

A

chronic disease

30
Q

management of anxiety

A

In terms of long-term effectiveness, the best results are from psychotherapy, followed by medication, followed by self-help.

  • stepped-care model
31
Q

The stepped-care model

A
32
Q

psycholoigcal therapy for anxiety

A

CBT

33
Q

pharmacological treatment for anxiety

A
  • Where rapid response is required
    • Benzodiazepines- but only prescribe for up to 4 weeks
    • Antidepressants
      • Take longer to work than benzodiazepines but they can be continued for longer e.g. SSRI e.g. sitaloprm
34
Q

self help with anxiety

A

aerobic exercise training

35
Q

anxiety history taking

A
  • Opening the consultation
    • Wash hands
    • Introduce name and role
    • Confirm pt name and DoB
    • Ask pt if happy to talk with you about their current issues
  • PC
    • What has brought you to see me today?
    • Okay can you tell me more about that
  • HPC
    • Anxiety and worry on most days
    • Generalised- worry about everything
    • Long terms
    • Other symptoms inc.
      • 3/6 symptoms
        • Restlessness
        • On edge
        • Fatigued
        • Difficulty concentrating
        • Irritability
        • Muscle tension
        • Sleep disturbance
        • Palpitations
  • PMH
    • Have you been treated or experienced this before
  • Family history
    • “Have any of your parents or siblings had problems with their mental health in the past?”
  • Social history
    • General context: accommodation, who they live with, if they can do ADL
    • Assess impact of anxiety on relationships and work
    • Smoking
    • Alcohol
    • Recreational drug use
    • Gambling
  • Assess insight
    • In severe depression may demonstrate loss of insight into illness
    • Ask: ‘what do you think the cause of the problem is’
  • Closing the consultation
    • Make sure ICE has been covered
    • Thank patient
    • Dispose of PPE

GP block (Y3) (39 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions