Flashcards in 1. Opening up to mental health Deck (25):
Red flags for potential mental problems?
• Unexplained chronic pain or fatigue
• Recurrent presentations
• Changes in eating or sleeping patterns
• Signs of impairment in work, school or home life
• Signs of past or present use of alcohol or drugs
• Previous mental health problem
• Chronic physical health problem
Relavent q's for mental health problem
• Identify ifatrigger
• Duration of symptoms, recurrent or isolated episode
• Consider own /family history
• Level of social support/ isolation
• Drugs, alcohol, cigarettes
• Employment history
• Forensic history
• Evidence of other mental health problems
• Response to previous treatments (if relevant) • Neglect
• Evidence of psychosis
Sources of support for mental health problems
Advise and inform re:
– Self help groups
– Support groups
– Other local and national resources
– Consider support for family/dependents/carers
*Person centred care*
Screening q's for depression
• During the last month, have you often been bothered by feeling down, depressed or hopeless?
• During the last month, have you often been bothered by having little interest or pleasure in doing things?
If yes to either of these questions needs a mental health assessment
How to assess for despression?
Using DSM-IV (Diagnostic and Statistical Manual of Mental Disorders,)
• persistent sadness or low mood; and/or • marked loss of interests or pleasure
At least one of these, most days, most of the time for at least 2 weeks.
Associated symptoms to depression?
• disturbed sleep (decreased or increased compared to usual)
• decreased or increased appetite and/or weight
• fatigue or loss of energy
• agitation or slowing of movements
• poor concentration or indecisiveness
• feelings of worthlessness or excessive or inappropriate guilt
• suicidal thoughts or acts.
What are the 4 severities of depression?
1. Subthreshold depressive symptoms: – Fewer than 5 symptoms.
2. Mild depression:
– Few, if any, symptoms in excess of the 5 required to make the diagnosis, and symptoms result in only minor functional impairment.
3. Moderate depression:
– Symptoms or functional impairment are between 'mild'
4. Severe depression:
– Most symptoms, and the symptoms markedly interfere with functioning
Treatment options for depression?
• Depends on nature and severity
• Lifestyle measures
• Self help/ guided self help
• Computerised Cognitive Behavioural Therapy (CCBT)
• Talking therapies
• Drug treatments
• Alternative/ complimentary therapies
• Group physical activity programmes
Treatment options for more severe depression?
• Referral to specialist mental health services
• Combined treatments
• Multi professional and in patient care
• Crisis service
• Electroconvulsive therapy (rarely used with few indications - severe depression, resistant mania, catatonia)
LIfestyle measures that can treat depression?
• Eat well
• Drink less
• Exercise more
• Get involved
• Quit smoking
• Sexual health
• Sleep hygiene
• Manage physical conditions
Different forms of talking therapy for depression?
• Cognitive behavioural therapy
• Interpersonal therapy
• Listening services
• Psychodynamic psychotherapy
• Group therapy
• Bereavement counselling
• Relationship counselling/ couples therapy
• Family therapy
• Mindfulness based therapies
Name the 5 main types of antidepressants?
1. Selective serotonin re-uptake inhibitors 9ssRIs) e.g. citalopram
2. Tricyclic and related antidepressants e.g. amitriptyline
3. Serotonin and noradrenaline reuptake inhibits (SNRIs) e.g. venlafaxine
4. Mirtazapine (presynaptic alpha2-adrenoreceptor antagonist)
5. Monoamine-oxidase inhibitors
Why must you `'safety net" when prescribing anti depressants?
NOTE: Some people too depressed to commit suicide. If on medication and improve mental state, may have drive to commit suicide. Make sure to safety net
What is GAD?
Generalised anxiety disorder
Key symptoms of GAD?
– excessive anxiety and worry about a number of events or activities
– difficulty controlling the worrying
– occurs on a majority of days for at least 6 months
– not in keeping with another anxiety disorder
Associated symptoms of GAD?
• being easily fatigued
• difficulty concentrating • irritability
• muscle tension
• disturbed sleep
Management of GAD?
• Stepped care model
• Step 1: Identification and assessment; education about GAD and treatment options; active monitoring
• Step 2: Low-intensity psychological interventions; individual non-facilitated self-help; individual guided self-help and psychoeducational groups
• Step 3: Choice of a high-intensity psychological intervention (CBT/applied relaxation) or a drug treatment
• Step 4: Highly specialist treatment, such as complex drug and/or psychological treatment regimens; input from multi-agency teams, crisis services, day hospitals or inpatient care
Drug treatment options for GAD?
• SSRI e.g. sertraline
• 2nd line alternative SSRI or SNRI
• 3rd line consider offering pregabalin
Do not offer a benzodiazepine for the treatment of GAD in primary or secondary care except as a short-term measure during crises.
Name 4 mental illnesses in which psychosis occurs/
Schizophrenia, depression, bipolar, puerperal psychosis and some neurological conditions
Also alcohol and drugs
Main symptoms of psychosis?
Delusions and hallucinations
What is a delusion?
A false, fixed, strange, or irrational belief that is firmly held. The belief is not normally accepted by other members of the same culture or group.
Characteristics: Certainty, incorrigibility, impossibility
Examples: Delusions of grandeur
Delusions of paranoia Somatic delusions
What is a hallucination?
Sensory perception without an appropriate stimulus
Seeing – visual
Hearing – auditory Feeling - tactile
Smelling – olfactory Taste – gustatory Posture – proprioceptive
Considerations when assessing psychosis?
• What is the nature of the hallucination or delusion?
• Is there are curringt heme?
• Have there been any recent major life events?
• Is there a history of substance abuse?
• Family history of mental illness?
What is an MSE form?
Mental state exam used for psychosis