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Mental Health Flashcards

1
Q

What is defined as excessive anxiety and worry occurring more days than not for at least 6 months, about a number of events or activities, disproportionate to any risk?

A

Generalised Anxiety Disorder

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2
Q

What needs to be present for most of the time to diagnose generalised anxiety disorder?

A

At least 3 of:
-Restlessness or nervousness
-Being easily fatigued
-Poor concentration
-Irritability
-Muscle tension
-Sleep disturbance

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3
Q

Is generalised anxiety disorder multifactoral?

A

Yes

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4
Q

What broad categories of factors play a role in anxiety disorders?

A

Genetic factors and environmental factors

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5
Q

In which sex is generalised anxiety disorder more common?

A

Female - twice as common as in men

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6
Q

What other conditions increase the risk of developing generalised anxiety disorder?

A

Panic disorder
Social phobia
OCD

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7
Q

What childhood factors can increase risk of generalised anxiety disorder?

A

Childhood adversity e.g. maltreatment, family disruption, domestic violence, parental mental health problems, bullying

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8
Q

Which group of psychiatric disorders is most common?

A

Anxiety disorders

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9
Q

When does prevalence of generalised anxiety disorder peak?

A

In middle age (between 35 and 55 years)

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10
Q

Are GAD and depression frequently comorbid?

A

Yes - around 62% of those with GAD have at least one major episode of depression in their lifetime

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11
Q

How does generalised anxiety disorder affect social and occupational functioning?

A

Reduced work productivity and increased days of missed work

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12
Q

Are suicidal ideation and attempts more common in those affected by generalised anxiety disorder?

A

Yes

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13
Q

In which secondary care specialism do patients with generalised anxiety disorder present to most ommonly?

A

Gastroenterology

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14
Q

In addition to those who present with typical anxiety symptoms, who should we consider GAD in?

A

Those who attend primary care frequently with a chronic physical health problem, those seeking reassurrance for somatic symptoms, or those presenting with wide ranging issues.

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15
Q

Can generalised anxiety disorder present with solely physical symptoms?

A

Yes

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16
Q

What physical symptoms can generalised anxiety disorder present with?

A

-Headaches
-Muscle tension
-Motor restlessness
-GI symptoms
-Back pain
-Insomnia

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17
Q

Why is it important to check medication history (prescribed, herbal, and OTC) in a presentation of suspected anxiety?

A

Anxiety can be a side effect of some medications

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18
Q

Which medications can cause side effects mimicking anxiety?

A

Salbutamol
Theophylline
Beta blockers
St John Wart
Ma huang
Ginseng
Guarana
Belladonna
Corticosteroids

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19
Q

Which screening/assessment tools can be used when assessing a patient with suspected anxiety?

A

GAD-2 or GAD-7

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20
Q

What physical symptoms may be seen in clinic when a patient presents with generalised anxiety disorder?

A

Increased heart rate
Shortness of breath
Trembling
Exaggerated startle response

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21
Q

How many questions are in the GAD-7?

A

7

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22
Q

How is GAD-7 scored?

A

Each of 7 questions is assigned a score between 0 and 3 depending on how frequently they experience the symptoms

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23
Q

What is situational anxiety?

A

Controllable anxiety that is not generally associated with pathological symptoms and relates to particular life events

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24
Q

What is adjustment disorder?

A

Temporary anxiety that has occurred in response to a life stressor and persists for no longer than 6 months after the stressor ends

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25
Q

What is panic disorder?

A

Recurrent episodes of sudden onset anxiety in absence of multi-themed worry, with physical symptoms during each attack, and often accompanied by avoidance behaviours.

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26
Q

What is step 1 in management of generalised anxiety disorder?

A

-Communication and explanation of disorder
-Active monitoring
-Treat any comorbid conditions

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27
Q

What is step 2 in management of generalised anxiety disorder?

A

-Individual non-facilitated self-help
-Individual guided self-help
-Psychoeducational groups

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28
Q

What is step 3 in management of generalised anxiety disorder?

A

-Individual high-intensity psychological intervention such as CBT or applied relaxation
-Drug therapy

29
Q

Which drug treatment should be offered in step 3 of generalised anxiety disorder management?

A

SSRIs - sertraline first line

30
Q

After sertraline is offered for anxiety, what other drugs are offered if it is ineffective?

A

Other SSRIs e.g. paroxetine or escitalopram
SNRIs e.g. duloxetine or venlafaxine

31
Q

If a patient with generalised anxiety cannot tolerate any SSRIs or SNRIs, what can we consider offering in terms of medication?

A

Pregabalin

32
Q

What initial adverse effects should a patient be counselled on when starting an SSRI/SNRI for anxiety?

A

Increased anxiety, agitation, sleep problems for a couple of weeks

Potential especially in under 30s of increased risk of suicidal thinking/self harm

33
Q

How frequently should drug treatment efficacy be reviewed in generalised anxiety disorder?

A

Every 2-4 weeks in first 3 months, then 3 monthly thereafter.

34
Q

What should step 3 management of generalised anxiety disorder be when managing a pregnant woman?

A

-Ideally high intensity psychological therapy
-Can discuss medication
-If already on medication, discuss tapering down and switch to psychological therapy while pregnant

35
Q

What does SSRI or SNRI treatment at or after 20 weeks of pregnancy increase risk of?

A

Persistent pulmonary hypertension of newborn

Neonatal withdrawal

36
Q

What is step 4 of management of generalised anxiety disorder?

A

-Referral for specialist assessment
-Ensure steps 1-3 have been offered if not trialled or accepted

37
Q

What lifestyle modifications should be suggested to those with generalised anxiety disorder?

A

Sleep hygiene
Regular exercise

38
Q

If a medication is effective for generalised anxiety disorder, how long should a patient take it for to minimise risk of relapse?

A

1 year

39
Q

Which of sertraline, paroxetine, and escitalopram does the evidence suggest is the most effective for generalised anxiety disorder?

A

None of them - the evidence says they are all equally effective

40
Q

Is sertraline licenced for treatment of GAD?

A

No although it is most commonly used - informed consent should be obtained and documented

41
Q

What are the clinical advantages of sertraline in managing GAD over paroxetine?

A

Fewer drug interactions
Lower risk of symptoms of discontinuation

42
Q

What are the clinical advantages of sertraline in managing GAD over escitalopram?

A

Lack of associated ECG changes

43
Q

After what time period do most patients see maximal benefit once commenced on drug treatment for anxiety?

A

6 weeks

44
Q

When should SSRIs not be prescribed?

A

-Manic pahse of bipolar disorder
-Taking MOAIs or recently stopped MOAIs
-Taking pimozide
-Poorly controlled epilepsy or new onset seizures

45
Q

What ECG changes can escitalopram cause?

A

QT interval prolongation
Torsade de Pointes

46
Q

In whom should SSRIs be prescribed with caution?

A

-History of bleeding disorders especially GI tract
-FHx of QT prolongations
-Daiebets
-Mania
-Epilepsy
-Those susceptible to angle-closure glaucoma

47
Q

What common CNS side effects can SSRIs cause?

A

Dizziness
Headache
Tremor

48
Q

What common GI side effects can SSRIs cause?

A

Nausea
Vomiting
Abdominal Pain
Dyspepsia
Constipation
Diarrhoea

49
Q

What other common side effects can SSRIs cause?

A

-Hot flushes
-Palpitations
-Sexual dysfunction
-Visual disturbance
-Yawning

50
Q

What biochemical abnormality can occur due to SSRIs?

A

Hyponatraemia

51
Q

What is characterised by absence of a positive affect, low mood, and associated range of emotional, cognitive, physical and behavioural symptoms?

A

Depression

52
Q

How does DSM-5 define depression?

A

Presence of at least 5/8 possible defining symptoms during same 2-week period, where at least one symptom is depressed mood or loss of interest/pleasure

53
Q

What assessment tool can be used to screen for and assess the severity of depression?

A

PHQ-9 scale

54
Q

What score on PHQ-9 scale separates less severe and more severe depression?

A

16 - less severe if less than this, more severe if equal to or more than.

55
Q

Over what time period does chronic depression span over?

A

2 years or more

56
Q

What condition is defined as episodes of depression which recur annually at the same time each year with remission in between?

A

Seasonal affective disorder

57
Q

What are some of the risk factors for depression?

A

-Female sex
-Older age
-Personal or family Hx of depression
-Personal/social/environmental factors
-Post-partum
-Chronic health conditions
-History of other mental health conditions

58
Q

What risk factors are there for relapse of depression?

A

-Older age of onset
-Hx of recurrent episodes
-Incomplete response to previous treatment
-Unhelpful coping mechanisms
-Chronic physical/mental health conditions

59
Q

How much higher is the risk of suicide in those being treated for a mental health condition than the general population?

A

10 times higher

60
Q

How might depression present in an older patient?

A

Physical symptoms and cognitive decline are more common in older population

61
Q

What are the two key features of depression that can be used to identify when a patient has depression?

A

-Feeling low/down/depressed/hopeless
-Little interest or pleasure doing things

62
Q

Other than the 2 key symptoms, what associated symptoms might a patient report with depression?

A

-Disturbed sleep
-Change to appetite and/or weight
-Fatigue
-Agitation or slowing down of thoughts/movements
-Poor concentration/indecisiveness
-Feeling worthless or inappropriate guilt
-Recurrent thoughts of death

63
Q

What lifestyle questions should be asked when screening for depression?

A

-Diet
-Physical activity
-Sleep
-Alcohol
-Substance misuse
-Any forensic history

64
Q

What is the maximum score in the PHQ-9 scale?

A

27

65
Q

What is the HADS?

A

Hospital Anxiety and Depression Scale

66
Q

What is the BDI-II?

A

Beck depression Inventory II

67
Q

Can depressive symptoms be present when a person is in a state of bereavement?

A

Yes, usually transiently

68
Q

https://cks.nice.org.uk/topics/depression/management/

A

this is where i am up to

akt (22 decks)

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