Week 9 - Diabetes and Mental Health (B) Flashcards
Outline what a mini mental state examination tests for, including the rough categories
Tests for impaired cognition, especially in relation to dementia or head injury
Shouldn’t be used to make a diagnosis, but can be used to indicate the presence of cognitive impairment
Rough categories - ‘CORRAL’:
- Copying / drawing
- Orientation
- Registration
- Recall
- Attention
- Language
Outline what the scores from a MMSE mean, including the maximum score possible
Maximum score possible = 30
25 to 30 = normal
21 to 24 = mild cognitive impairment
10 to 20 = moderate cognitive impairment
< 10 = severe impairment cognitive impairment
Outline what a GP assessment of cognition test is used for and roughly outline what the 2 halves entail
GPCOG was developed as a more practical tool as the MMSE was too difficult to use in general practice (takes 4 mins rather than 10)
Part 1 - ask patient about various details including the date, draw a clock face and recent news events
Part 2 - speak to relative / close friend (informant) about what patient is like compared to a few years ago
Outline the range of scores for GPCOG, including max score possible and what they mean (part 1 and part 2)
Part 1: max score possible = 9
9 = no significant cognitive impairment, no further testing
5 to 8 = proceed to Part 2, informant section
0 to 4 = cognitive impairment, conduct further investigations
Part 2: max score possible = 6
Count number of ‘no issues’
4-6 ‘no issues’ = no cognitive impairment
0-3 ‘no issues’ = cognitive impairment, conduct further investigations
List some factors that may increase someone’s risk of suicide (non-modifiable, medical-related, modifiable)
Non-modifiable:
- Male gender
- Family history of mental disorder / suicidal thoughts / suicide
Medical:
- Other mental health issues: severe depression / anxiety / personality disorder
- Recent discharge from psychiatric inpatient care
- Physical illness (especially recently diagnosed, chronic or painful)
Modifiable:
- History of previous suicide attempts / self-harm
- Alcohol / drug abuse
- Exposure to suicidal behaviour
- Access to resources / means
List some protective factors against suicide
- Social support e.g. friends / family
- Religious beliefs
- Responsibility of children (especially young children)
Outline the similarities and differences between suicide and self-harm
The key difference between self-harm and suicide is intent, despite having similar risk factors
Self-harm:
- Destructive behavior without any intention of suicide
- Usually used to cope with their feelings and stressors
- Coping strategy for preserving and enhancing life, not ending their life
Suicide:
- Intent to end their life due to ending their suffering
- Usually comes from a place of despair, hopelessness, and worthlessness
Outline some resources for patients experiencing suicidal ideation
NHS 111 (24 hours)
Samaritans (24 hours)
PAPYRUS (mainly during working hours)
Campaign Against Living Miserably or CALM (5pm-midnight)
Shout Crisis Text Line - can text “SHOUT”
Plus local charities / companies
List some risk factors associated with self-harm
- Pre-existing depression or anxiety
- Feelings of worthlessness / isolation
- History of trauma / abuse
- History of chronic stress
- Alcohol or substance abuse (or previous)
- High emotional perception and sensitivity
- Poor effective mechanisms for dealing with emotional stress
Outline the relationship between self-harm and suicide
- Presence of non-suicidal self-injury is a risk factor for suicidal thoughts and behaviors
Self-harm and suicide both indicate underlying distress, it is important to assess whether self-harming individuals are also suicidal
If so, provide the necessary treatment for individuals in both of these categories
Outline the management steps to be taken in someone presenting with self-harm
- Assess injury severity and provide necessary treatment
- Patient’s current emotional and mental state and level of distress
- Assess whether there is immediate concern about the person’s safety and ASSESS SUICIDE RISK
- Identify any safeguarding concerns
Management plan:
- CBT – starting asap
- Create a safety plan e.g. establish method, reduce risks if possible, identify barrier to treatment, identify coping strategies, establish protective factors
- Provide contact numbers for safety netting
Outline some reasons to refer a self-harm patient to a specialist mental health service for assessment
- Increase in frequency or degree of self-harm / suicidal intent
- Patient requests further support
- Concern from professional or from patient’s family/friends
List some complications of T1DM
- Macrovascular
- Microvascular
- Metabolic
- Psychological
- Other
Macrovascular complications
- MI
- Stroke
- Peripheral arterial disease
Microvascular complications
- Retinopathy
- Nephropathy
- Neuropathy
Metabolic complications
- DKA
- Episodes of hypoglycaemia
Psychological complications
- Anxiety
- Depression
- Eating disorders
- Behavioural disorders, relationship difficulties and risk-taking behaviour
Increased risk of developing other autoimmune conditions e.g. thyroid disease, coeliac disease, Addison’s disease, and pernicious anaemia.
Reduced quality of life and life expectancy
Outline why the different microvascular and macrovascular complications occur
Macrovascular:
- Occurs due to chronic atherosclerosis, arteriosclerosis and inflammation
- Endothelial and smooth muscle dysfunction due to increased uptake of the glucose which doesn’t need insulin for this process (however glucose can’t actually reach the inside of the cell)
- Increased uptake of glucose leads to release of ROS, which causes inflammation and localised damage
- Dysfunctional endothelium allows LDLs into the cell and accelerates atherosclerosis
- Overall, leads to MI, stroke and peripheral arterial disease
Microvascular:
- Damaged caused by hypertension (from atherosclerosis and hyperglycaemia) causes blood vessel damage
- This reduces blood flow in small vessels in the eyes, kidneys and peripheral arteries leading to retinopathy, nephropathy and neuropathy
Outline how diabetes is diagnosed (including ranges)
Presence of one or more symptoms of diabetes:
- Polyuria
- Polydipsia
- Weight loss
Plus one of the following blood tests (need 2 if no symptoms, 1 week apart):
- Random plasma glucose concentration
(> 11.1 mmol/l)
- Fasting plasma glucose concentration
(> 7.0 mmol/l)
- Oral glucose tolerance test (OGTT) with 2 hour plasma glucose concentration > 11.1 mmol/l 2 hours after giving 75g glucose
List some symptoms in which patients with undiagnosed diabetes may present to GP
- Peeing a lot
- Excessive thirst
- Weight loss
Plus:
- Blurring of vision
- Frequent infections e.g. thrush
- Tiredness / lethargy / weakness
May also present acutely with symptoms of DKA:
- Reduced consciousness
- Abdominal pain
- Nausea and vomiting
- Pear drop breath
- Polydipsia / polyuria
Describe briefly what diabetes is, as if you were explaining it to a patient
Diabetes is a condition where the body is unable to regulate it’s own levels of sugar in the blood due to problems with insulin
Type 1 - can’t produce the insulin in the pancreas because it’s attacked by the body’s immune system
Type 2 - the cells of the body don’t respond to the insulin being produced
If left unmanaged, lots of complications can occur as a result of diabetes
Are there any screening programmes for T1DM and T2DM?
T1DM - no screening, based on presentation
T2DM - no screening, however NHS Diabetes Prevention Programme (DPP) identifies people with modifiable risk factors and non-diabetic hyperglycaemia (HbA1c 42 - 47 mmol/mol or 6 - 6.4%)
Outline the monitoring required for T1DM patients, including target HbA1c
Measure HbA1c levels at least:
- Every 3 months if < 18 yrs
- Every 3 to 6 months if adults
Target HbA1c = < 48 mmol/mol or < 6.5%
Requires regular monitoring of blood glucose (< 53 mmol/mol or < 7.0 %)
12 monthly:
- Thyroid function tests
- Diabetic eye screen (opticians)
- Urine ACR and eGFR
- Foot checks
- Review cardiovascular risk factors e.g. calculate BMI and BP
Outline the monitoring required for T2DM patients, including target HbA1c
Measure HbA1c levels at least:
- Every 3 to 6 months if things aren’t stable
- Every 6 months if stable
Target HbA1c = < 48 mmol/mol or < 6.5%, slightly less if on hypoglycemic risk medication
Only requires regular monitoring of blood glucose if on insulin treatment
12 monthly:
- Diabetic eye screen (opticians)
- Foot checks
- Urine ACR / eGFR
- Review cardiovascular risk factors e.g. blood pressure
- Bloods for lipid profile
