Core Module Training

Question 1

Who can someone contact in a mental health emergency?

Answer 1

1. Emergency Services - 000
2. Mental Health Line - 18000 011 511 - they can organise urgent after hours assessment by acute mental health services if necessry.
3. Attend any Hospital Emergency Department.

Question 2

What are some crisis support phone services or website contacts?

Answer 2

• After hours Suicide Support Service - 1800 859 585
  
  • 5pm to 9am everyday.
• Suicide Call back Service - 1300 659 467
• Lifeline- 13 11 14
• Salvo Care Line - 1300 363 622
• SANE helpline - 1800 187 263
• Mensline Australia 1300 789 978

Question 3

What does SET A PACE stand for?

Answer 3

• S -
• E - Education
• T- Therapeutic Relationship
• A
• P
• A
• C
• E

Question 4

What are some web-based resources that can be used in mild-moderate depression?

Answer 4

• MoodGYM - teaches the principles of CBT, relaxation and meditation.
• CRUfAD - THIS WAY UP CLINIC - an online CBT program - requires a GP referral and involves a small cost.
  
  • 6 Online Modules and Homework involves CBT.
  • Website: https://thiswayupclinic.org/users/clinicianDashboard
  • Login - Irondukesteve@gmail.com
  • Password - Richard6259
• E-Couch - self- help interactive program with modules for depression, anxiety, relationship breakdown, loss and grief.

Question 5

After how many weeks should you stop an antidepressant if it doesn’t appear to be working?

Answer 5

6 weeks

Question 6

After how many months, should you consider referring to a specialist if the patient doesn’t respond to antidepressants?

Answer 6

3 months

Question 7

How long should antidepressants be prescribed for a first episode of depression?

Answer 7

6-12 months

Question 8

How long should antidepressants be prescribed for recurrent episodes?

Answer 8

2-3 years

Question 9

What are the diagnostic criteria for GAD (Generalized Anxiety Disorder)?

Answer 9

1. Excessive anxiety and worry occuring more days than not for >= 6 months about a number of activities.
2. They find it difficult to control the worry.
3. The Anxiety is associated with >3 of the following 6 symptoms for 6 months:
   
   1. Restlessness
   2. Easily fatigued
   3. Difficulty concentrating or mind going blank.
   4. Irritability
   5. Muscle tension
   6. Sleep disturbance.

Question 10

Excessive or unreasonable fear of circumscribed object or situation, usually associated with avoidance of a feared object.

Answer 10

Specific phobia

Question 11

Excessuve or unrealistic fear of social or performance situations; intolerance of embarassment or scrutiny by others.

Answer 11

Social anxiety disorder (SAD)

Question 12

Recurrent unexpected panic attacks without situational triggers; the patient may actively avoid situations where PA are predicted to occur.

Answer 12

Panic disorder.

Question 13

What questionnaire is used to help diagnose GAD?

Answer 13

GAD-7

Question 14

What is the psychological management for specific phobias?

Answer 14

1. Psycahological interventions - CBT

Question 15

What is the psychological treatment of choice for social anxiety disorder?

Answer 15

CBT with exposure based therapy and social skills training.

Question 16

What is the psycholgical treatment of choice for panic disorder?

Answer 16

CBT

Panic control treatment - exposure to deliberately induced symptoms plus trechniques to control the symptoms.

Question 17

What is the firstline psychological management technique to deal with generalised anxiety disorder (GAD)?

Answer 17

Psychoeducation and relaxation techniques in the form of CBT provided by trained clinicians.

Question 18

What is the first line pharmacological treatment for aniety related disorders?

Answer 18

1. SSRI/SNRI are first line.
2. Benzodiazepines can occasionally be used but should not be prescribed for longer than 4 weeks.

Question 19

When should we review patients after starting SSRIs/SNRIs for aniety?

Answer 19

Every 2-4 weeks during the first 3 months.

And then every 3 months thereafter.

Question 20

What is the first line pharmacological management for specific phobias?

Answer 20

Generally only psychotherapy is needed.

Sometimes short term diazepam use can be required.

Question 21

What is the first line pharmacotherapy for Social Anxiety Disorder?

Answer 21

SSRIs or venlafaxine for 6-12 months.

For non-generalised SAD - propranolol can be prescribe to help.

Question 22

What is the first line pharmacoptherapy for panic disorder?>

Answer 22

SSRIs/Venlafaxine or TCAs for 6-12 months.

Question 23

What i the first line pharmacotherapy used in generalised anxiety disorder?

Answer 23

SSRIs

Venlafaxine and duloxetine are efficacious.

Short term Benzos may bee needed.

Question 24

What is the number for the OCD and anxiety helpline

Answer 24

1300 269 438

Good for patients and family and friends.

Question 25

What are the two types of bipolar depression and how are they different?

Answer 25

**Bipolar Depression 1** - swings between mania and depression. **Bipolar Depression 2** - hypomania and depression.

Question 26

Why shouldn't only antidepressants be used for bipolar depression?

Answer 26

It can exacerbate **manic episodes**.

Question 27

When can antidepressants be used in bipolar disorder?

Answer 27

They can be used in conjunction with **lithium**, **sodium valproate** or an **antipsychotic** (e.g. an **atypical antipsychotic** such as **quetiapine**)

Question 28

If drug therapy fails, what can be an effective treatment in bipolar depression?

Answer 28

ECT

Question 29

When symptoms of depression have resolved in bipolar disorder, when is it ok to withdraw antidepressants?

Answer 29

2-3 months after the depression resolves.

Question 30

What is the first line drug of choice in bipolar disorder?

Answer 30

Lithium

Question 31

If a patient fails to respond to monotherapy with lithium, what can be done?

Answer 31

Combination therapy: * **Lithium + Sodium Valproate**.

Question 32

How long should treatment continue after the first episode of acute mania?

Answer 32

6-12 months

Question 33

When should a patient with bipolar disorder be referred to secondary care?

Answer 33

* There is poor/partial response to treatment. * The person's function declines significantly. * Treatment adherence is poor. * The person develops intolerable/medically important side effects. * Alcohol or drug misuse is suspected. * The person is considering stopping their medication. * A woman with bipolar disorder is pregnant or planning a pregnancy.

Question 34

What are the positive symptoms and what are the negative symptoms in schizophrenia?

Answer 34

* **Positive symptoms -** * Hallucinations * Delusions. * **Negative symptoms** * Emotional apathy * Lack of drive, * Poverty of speech * Social withdrawal * Self Neglect

Question 35

There can sometimes be called a third syndrome in schizophrenia...what is this?

Answer 35

Disorganisation

Question 36

How should GPs monitor patients with schizophrenia?

Answer 36

Review at least annually. * Weight * Waist circumference * Pulse and Blood Pressure * Fasting Blood Glucose, HBA1C, Blood Lipid Profile & Prolactin Levels. * Assessment of any movement disorders. * Assessment of nutrional status, diet and level of physical activity.

Question 38

What is the HEADSS approach to questioning?

Answer 38

HEADSS * Home * Education and Employment * Activities * Drugs * Sexuality * Suicide Risk/Depression

Question 39

What can be used to screen for anxiety and depression in young people?

Answer 39

The Revised Children's Anxiety and Depression Scale RCADS

Question 40

In psychosis, why are atypical antipsychotics prescribed over typical antipsychotics?

Answer 40

**Atypical antipsychotics** have a reduced risk of **extrapyramidal** side effects.

Question 41

Antipsychotics should be started by a psychiatrist, but here are some examples of starting doses of antipsychotics.

Answer 41

* Risperidone 0.5-1mg/day * Quetiapine 25-50mg/day * Amisulpride 50-100mg/day * Aripriprazole 5-10mg/day Depending onacuiy and risk - doses should be adjusted every 2-3 weeks until desired effects are reached.

Question 42

What are some side effects of atypical antipsychotics?

Answer 42

* Extrapyramidal side effects * Weight gain * Hypertension * Diabetes * Hypercholesterolaemia * Erectile Dysfunction

Question 43

Describe the 3 types of extrapyramidal side effects which may occur in the initial reatment period:

Answer 43

1. **Acute dystonic reactions** - oculgyric crisis. 2. **Pseudo**-**parkinsonism** - muscle stiffness, tremor and hypokinesia. 3. **Akathisia** - feeling of motor restlessness.

Question 44

How should patients with psychosis be monitored whilst being treated with antipyshcotics?

Answer 44

* **Beginning** - Weight, BMI, BP, Smoking status. * **Monthly for the first 3 months and then 3 monthly thereafter** * Weight and abdominal circumference. * Total cholesterol and triglyceride levels * Blood Glucose * White cell and neutrophil counts * LFTs * U&Es * Prolactin Levels * Check for extrapyramidal side effects

Question 45

What screening tool is used to assess for drug use and its severity?

Answer 45

CRAFFT