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psychiatry > GP psychiatry > Flashcards

GP psychiatry Flashcards

1
Q

what should you do if someone is not responding to their anti-depressant in 3-4 weeks

A

increase level of support

increase dose OR switch to another antidepressant

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2
Q

what are 2 questions asked to screen for depression

A

“During the last month, have you often been botheredby feeling down, depressed or hopeless?” (low mood)
“During the last month, have you been botheredby having little interest or pleasure in doing things?” (anedonia)

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3
Q

are antipsychotics offered for anxiety disorder in primary care

A

no

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4
Q

what is the first line treatment for social anxiety disorder

A

CBT

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5
Q

what should you do if you think someone is an immediate risk to themselves or others

A

refer urgently to specialist mental health services

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6
Q

what things are on the 2nd list of the DSM 5 criteria for depression

A

Significant weight loss or gain, or change in appetite.
Sleep difficulties (including hypersomnia).
Psychomotor agitation or retardation.
Fatigue.
Feelings of worthlessness or inappropriate guilt.
Reduced concentration or indecisiveness.
Recurrent thoughts of death or suicidal thoughts

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7
Q

what is the first line treatment for mild to moderate depression

A

SSRI

individual CBT, interpersonal therapy, behavioural activation

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8
Q

what is different about the symptoms of grief from depression

A

positive emotions still experienced
symptoms worse when thinking about decreased
want to be social (depression alone)

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9
Q

what is some advice give regarding sleep hygiene

A

Avoid stimulating activities before bed
Avoiding alcohol/caffeine/smoking before bed
Avoid heavy meals/ strenuous exercise before bed
Regular day time exercise
Same bedtime each day
Ensure bedroom environment promotes sleep
Relaxation

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10
Q

what is the difference between obsessions and compuslions

A

Obsessions: unwanted intrusive thoughts, images or urges. Tend to be repugnant and inconsistent with a person’s values.
Compulsions:repetitive behaviours or mental acts the person feels driven to perform. Can be overt (checking they locked the door) or covert (mentally repeating a phrase in their head).

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11
Q

what are treatment options for grief

A

¥ Counselling eg Cruse
¥ Antidepressants for comorbid depression
¥ Behavioural/cognitive/exposure therapies
¥ Refer if significant impairment in functioning

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12
Q

what things will impair a depressed person ability to drive

A

must not drive if significant memory or concentration problems, agitation, behavioural disturbance or suicidal thoughts

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13
Q

when should you be suspicious of emerging psychosis

A

increasing distress and declining function – employment, relationship, hygiene
listen to family concerns

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14
Q

how premature do people with major mental illness die

A

women 12 years

men 16 years

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15
Q

what % of GP consultations have a a mental health component

A

40%

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16
Q

what are the 3 things in the DSM 5 classification of anxiety

A
  1. excessive anxiety and worry about a number of different things
  2. difficult to control worry
  3. symptoms
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17
Q

what is the treatment of mil- moderate panic disorder

A

Self help – books bases on CBT principles, support groups, exercise benefits
Review progress every 4-8 weeks

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18
Q

how is acute grief characterised

A

¥ Feelings of disbelief and difficulty comprehending the reality of the loss.
¥ Bitterness/anger/guilt/blame.
¥ Impaired functioning
¥ Intense yearning and sadness, and emotional and physical pain.
¥ Mental fogginess, difficulty concentrating, forgetfulness.
¥ Loss of sense of self or sense of purpose in life.
¥ Feeling disconnected from other people and ongoing life.
¥ Difficulty engaging in activities or making plans for the future.

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19
Q

when should you consider anxiety for specialist CMHT referral

A

¥ Severe anxiety disorder with marked functional impairment and:
¥ Risk of self-harm or suicide.
¥ Significant comorbidity (substance misuse, personality disorder, complex physical health problems).
¥ Self-neglect.
¥ OR failure to respond to step 3 interventions.

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20
Q

what is the 3rd line treatment for OCD

A

clomipramine (most SSRI like of tricyclics)

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21
Q

what is requires for the diagnosis os panic disorder

A

Recurring unforeseen panic attacks, followed by at least a month of persistent worry about having another
attack and concern about its consequences OR a significant change in behaviour related to the panic attacks

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22
Q

what is the DSM 5 classification for social phobia

A

A persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others
Exposure provockes anxiety attacks
recognise fear is excessive
feared situations are avoided

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23
Q

what symptoms may be present during a pancake attack

A
  • Palpitations, pounding heart, tachycardia - Dizzy, lightheaded, instability, feeling faint
  • Sweating - derelealisation/ depersonalisation
  • Muscle trembling, shaking - fears of losing control or going crazy
  • Shortness of breath, sensations of smothering - fear of dying
  • Choking sensations - numbness, tingling sensations
  • Chest pain or discomfort - chills/ hot flushes
  • Nausea, abdominal distress
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24
Q

if active monitoring is insufficient in managing anxiety, what are the next steps

A

low intensity psychological interventions - self help books, group counselling,

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25
Q

what are some examples of Low-intensity psychological andpsychosocial interventions used in primary care for depression

A

individual self-help based on CBT principles, computerised CBT, group CBT, group physical activity programme

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26
Q

what advice should be given to all those with generalised anxiety disorder

A

education about anxiety disorder, and active monitoring of patient’s function and symptoms.
Discourage over-the-counter treatments

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27
Q

what drugs should be considered if first line SSRI is not effective at managing anxiety

A

swap to an alternative SSRI or SNRI (venlafaxine/duloxetine)

pregabalin (beware abuse potential)

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28
Q

what is generalised anxiety disorder

A

Excessive worry about a number of different events

Can exist in isolation or comorbid anxiety/depressive disorders

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29
Q

where are the 2 most important criteria in the DSM 5 classification of depression

A
  • Depressed mood.

- Loss of interest or pleasure (anhedonia).

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30
Q

who gets to decide if a depressed person is fit to work

A

doctor objective

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31
Q

what drugs may an anti-depressant be augmented wit

A

lithium
antipsychotic (e.g. quetiapine, aripriprazole etc)
another antidepressant such as mirtazapine

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32
Q

how long should anxiety medication be taken to prevent relapse

A

12 months

33
Q

what are some screening questions used for OCD

A

¥ Do you wash or clean a lot?
¥ Do you check things a lot?
¥ Is there any thought that keeps bothering you that you’d like to get rid of and can’t?
¥ Do your daily activities take a long time to finish?
¥ Are you concerned about putting things in a special order? Are you very upset by mess?
¥ Do these problems trouble you?

34
Q

what are some hypnotics/ Z drugs licensed for severe insomnia

A

zolpidemzopiclone)
temazepam
(addictive potential, may interfere with next day tasks, avoid driving/operating machinery 8hrs after use)

35
Q

what are sign symptoms of lithium toxicity

A 
¥	Vomiting and diarrhoea 
¥	Coarse tremor (larger movements, especially of hands) 
¥	Muscle weakness 
¥	Lack of coordination including ataxia 
¥	Slurred speech 
¥	Blurred vision 
¥	Lethargy 
¥	Confusion 
Seizures
36
Q

what psychological therapy is offered for moderate - sever anxiety

A

1-2 hourly CBT sessions a week for 4 months

37
Q

what are sub threshold depressive symptoms defined as

A

having <5 of the DSM IV criteria

38
Q

what drugs may be considered in anxiety is no response to SSR

A

imipramine or clomipramine (TCA)

39
Q

how is the severity of depression graded in DSM 5 classification

A 
functional impairment 
(mild = mild functional impairment, severe = marked functional impairment)
40
Q

how long have depression symptoms been happening for a diagnosis

A

almost every day for 2 weeks

41
Q

why should SSRIs not be given to bipolar patients in a depressed phase

A

SSRIs - can precipitate a manic episode

42
Q

how long should a person take their anti-depressant after remission if they are at severe risk of relapse

A

2 years

43
Q

what other conditions may affect the development, course and severity of anxiety

A 
¥	Other anxiety disorder in addition to generalised anxiety disorder (e.g. panic disorder). 
¥	Depression. 
¥	Substance misuse. 
¥	Physical health problems. - chronic 
History of mental health problems
44
Q

how long are anxiety symptoms present for a diagnosis

A

> 6 months

45
Q

what is monitored for 1st and 2nd antipsychotics

A

1st - ECG for QT prolongation

2nd - cardiovascular risk footers

46
Q

what kind of illnesses os depression commonly secondly to

A

chronic illness causing disability e.g. cancer

47
Q

what should you think about when assessing the severity of anxiety

A

¥ Level of distress.
¥ Functional impairment.
¥ Number, severity and duration of symptoms.

48
Q

what are screening questions for social anxiety disorder

A

¥ Do you find yourself avoiding social situations or activities?
¥ Are you fearful or embarrassed in social situations?

49
Q

when prescribing venlafaxine, what must you do

A

monitor BP

50
Q

what is panic disorder

A

Recurrent panic attacks and persistent worry about further attacks

51
Q

what is featured on the 2nd list in the DSM 5 classification of depression

A

Significant weight loss or gain, or change in appetite.
Sleep difficulties (including hypersomnia).
Psychomotor agitation or retardation.
Fatigue.
Feelings of worthlessness or inappropriate guilt.
Reduced concentration or indecisiveness.
Recurrent thoughts of death or suicidal thoughts.

52
Q

what are expected side effects of tlithium

A 
¥	Fine tremor 
¥	Dry mouth 
¥	Altered taste sensation 
¥	Increased thirst 
¥	Urinary frequency 
¥	Mild nausea 
¥	Weight gain
53
Q

what is step 3 in the management of vernalised anxiety

A

A high-intensity psychological intervention or drug therapy

54
Q

what question should you always ask someone who is depressed

A

suicide risk assessment
Plans - vague, detailed, specific, already in motion
Previous attempts

55
Q

what is the most dangerous anti-depressant class to overdose on

A

TCA

56
Q

what can happen if you withdraw an antidepressant to fast

A

discontinuation symptoms

57
Q

what is the 2nd line treatment for OCD

A

SSRIs (sertraline/ citalopram/ fluoxetine/ paroxetine)

Often required at higher doses for longer duration –up to 12 weeks to see a response

58
Q

what is the follow up for depression

A

see people 2 weeks after starting, at intervals of every 2 to 4 weeks for 3 months and then at longer intervals if the response is good

59
Q

what are secondary causes of insomnia

A

¥ Anxiety/depression.
¥ Physical health problems (e.g. pain, dyspnoea).
¥ Obstructive sleep apnoea (
¥ Excess alcohol or illicit drugs.
¥ Parasomnias
Circadian rhythm disorder (especially in shift workers

60
Q

what is the 2nd line treatment for social anxiety disorder

A

sertraline or escitalopram

Continue for 6 months of treatment once treatment has become effective

61
Q

what are panic attacks characterised by

A

an abrupt surge of intense fear or physical discomfort, reaching a peak
within a few minutes,
+ at least 4 symptoms are present

62
Q

what is the first line drug treatment for generalised anxiety

A

SSRI - sertraline

63
Q

what are non pharamacoglogical methods of managing mild depression in primary care

A

support, psycho-education, lifestyle advice, active monitoring and referral for further assessment and interventions (3rd sector counselling)

64
Q

what are some short term drugs that can be used for insomnia in the elderly

A

melatonin

65
Q

what is included in a CMHT review

A

assessment of the problem and risks, including the impact on family and carers, previous treatment and the development of a comprehensive care plan.

66
Q

give some parasomnias that can give insomnia

A

restless legs, sleep walking/talking/sleep terrors/teeth grinding (bruxism), etc.

67
Q

for an OCD diagnosis, what must the obsessions and compulsions be

A

time consuming >1hr, or cause significant distress or functional impairment.

68
Q

what is the suicide risk in bipolar patients compared to the general population

A

20x higher

69
Q

how long should a person take their anti-depressant after remission

A

6 months

70
Q

what SSRI’s are licensed for panic disorder

A

citalopram, sertraline, paroxetine, escitalopram

71
Q

how does the DSM 5 depression classification work in terms of 1st and 2nd lists of criteria

A

if 2 form 1st list you need 3 form second
is 1 from first list you need 4 form 2nd
(5 in total)

72
Q

what is the 1st line treatment for OCD

A

CBT including Exposure and Response Prevention

73
Q

what is social anxiety disorder

A

Persistent fear of, or anxiety about, one or more social or performance situations that is out of proportion to the actual threat posed by the situation

74
Q

what are some symptoms of GAD in the DSM 5 classification

A

¥ Restlessness or feeling keyed up or on edge
¥ Being easily fatigued
¥ Difficulty concentrating or mind going blank
¥ Irritability
¥ Muscle tension
Sleep disturbance

75
Q

what is defined at a prolonged grief disorder

A

Marked distress and disability caused by the grief reaction.
AND the persistence of this distress and disability more than 6m after a bereavement.

76
Q

when should you prescribe antidepressants in primary care for depression

A

PMH of moderate- severe depression
sub threshold symptoms > 2 years
don’t respond to other interventions

77
Q

when switching anti-depressants, what should you switch an SSRI to

A

a different SSRI or a better tolerated newer generation antidepressant

78
Q

what criteria for depression diagnosis does nice recommend in primary care

A

DSM 5

79
Q

what is meant by A high-intensity psychological intervention

A

¥ CBT (one-to-one sessions, each lasting 1 hour, run weekly for 12–15w).
¥ Applied relaxation (one-to-one sessions, each lasting an hour, based on manuals tested in clinical trials, run weekly for 12–15w).

psychiatry (5 decks)

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