mental health

Question 1

who gets depression?

Answer 1

mid 30s if recurrent
can occur any age
F>M
lower social class and unemployment

Question 2

risk factors for depression

Answer 2

history of depression or mental health/physical comorbidities

poor interpersonal relationships

poor living conditions

social isolation

Question 3

presentation of depression

Answer 3

lack of interest or pleasure
lack of emotional reactivity
loss of energy, fatigue
insomnia, early morning wakening (hypersomnia)
diurnal variation in mood
psychomotor retardation

Question 4

signs on examination of depression

Answer 4

somatic symptoms - back pain, headache, loss of apetite, wt loss, constipation, amenorrhoea, loss of libido, psychomotor agitation

psychological symptoms - poor conc or attention, indecisiveness pessimistic (negative cognitive triad), poor self esteem and low confidence, guilt and worthlessness, hoplessness and thoughts of self har or suicide

Question 5

negative cognitive triad

Answer 5

self: worthless
world: critical, guilt
future: hopelessness

Question 6

investigations for depression

Answer 6

mental state examination - psychotic features, suicidal thoughts, risk screen (self harm/suicide, risk to self, risk to others)

PHQ-9 questionnaire

geriatric depression scale (GDS), hospital anxiety and depression scale (HAD)

Question 7

ICD-10 core symptoms of depression

Answer 7

low or depressed mood
loss f interest and enjoyment
loss of energy
duration (more than 2 weeks - shorter can just be reactive to ife events and each symptom should present at sufficient severity for most of everyday)

Question 8

treatment of depression

Answer 8

bio-psycho-social = CBT _manage underlying physical disorders/alcohol and drug missuse

for biological causes, use antidepressants - carry on for 6 months after remission - SSRIs, tricyclics, NaSSA, SNRI
- only if severe depression or for a long time or treatment resistive

investigate improving social circumstances

Question 9

who gets anxiety?

Answer 9

25% lifetime risk

F>M

Question 10

types of anxiety

Answer 10

disabling - agoraphobia
life damaging - OCD
potentially life threatening - PTSD

Question 11

what is anxiety?

Answer 11

normal emotional feeling, part of flight or fight repsonse

becomes a problem if:

• interferes with daily life
• response is out of proportion to threat
• more prolonged
• occurs without a threat and if focus is on physiological repsosne

Question 12

risk factors for anxiety

Answer 12

aetiology is multifactorial

• environmental stressors
• genetic factors (5x if first degree relative has it)
• substance dependent
• cognitive styles of negative thinking
• chronic illness or painful disorders such as arthritis

Question 13

presentation of anxiety

Answer 13

psychological
- free floating anxiety, worry, apprehension, persistent nervousness, poor concentration, irritability

arousal
- hypervigilance, restlessness, increased startle response

fears
- fear of losing control, impeding danger, unrealistic ideas of danger, cant cope, fear of dying

motor
- muscle tension, headaches, trembling

autonomic symptoms

obessessions
- repeitive intrusive involuntary anxiety provoking thoughts, recognised by patient as own

compulsions

PTSD

Question 14

who gets alcohol dependence?

Answer 14

M>W

less likely in ethnic minority groups who are less likely to drink

Question 15

classification of alcohol dependence

Answer 15

score of >20 in AUDIT questionnaire (alcohol use disorders identification test)

confirm diagnosis using ICD-10 criteria for alcohol dependence

Question 16

ICD-10 for alcohol dependence

Answer 16

3 or more of following present during previous year

• strong desire or sense or compulsion to drink alcohol
• difficulty controlling drinking in terms of onset, termination or level of se
• physiological withdrawal state - tremor sweating, tachycardia, anxiety, insomnia, less commonly seizures, disorientation, hallucinations

Question 17

presentation of alcohol dependence

Answer 17

wernickes encephalopathy - presence of neurological symptoms caused by biochemical lesions of the CNS after exhaustion of vitamin B reserves (particularly thiamine)

triad of symptoms: mental confusion, ataxia, opthalmoplegia

Question 18

ataxia

Answer 18

Ataxia is a term for a group of disorders that affect co-ordination, balance and speech.

Question 19

treatment of alcohol dependence

Answer 19

reduce alcohol consumption
adivse about driving restircitons, heavy machinery etc
involve friends, family and carers
AA involvement
if suspect wernickes encephalopathy, admit urgently to hospital with parenteral thiamine
off prophylactic thiamine to harmful or dependent drinker if: malnourished, decompensated liver disease, acute withdrawal is planned)
refer to psychological treatments such as CBT

Question 20

who self harms?

Answer 20

adolescents and young adults peak 15-19 in females and 20-24 in males
5.6% in lifetime

Question 21

risk factors of self harm

Answer 21

socio-economic disadvantage
social isolation
stressful  life events
mental health problems
chronic physical health problems
alcohol and drug missuse
invovlement in crimincal justice system
child maltreatment or domestic violence

Question 22

signs on examination of self harm

Answer 22

detailed history
risk assessment - physical risks, risk of further harm or suicide (explore hopelessness, suicidal intent, understanding of their own self harm, emotional distress, mental state)
assess safeguarding concerns in children, young peiple or vulnerable adults

Question 23

treatment of self harm

Answer 23

ensure follow up within 48hrs or soner
manage psychoscial needs that you can
remove access to means of self harm where possible
offer written or verbal info to person or family, carers or significant others
info about local or natonal sources of support
arrnage for review and follow up
manage underlying conditions

Question 24

what is somatisation

Answer 24

extreme focus on physical symptoms sych as pain or fatigue that causes major emotional distress and problems functioning

may not be diagnosed with condition associated with these symptoms but reaction to symptoms is not normal

often think worset of symptoms and frequently seek medical care

health concenrs are cnetral focus of life and hard to function- can lead to disability

Question 25

cuases of somatisation

Answer 25

genetic and biological factors - increased sensitivity to pain family influence - genetic, environmental personality trait of negativity decreased awareness of or problems processing emotions learned behaviour - gained attention from illness

Question 26

risk factors of somatisation

Answer 26

anxiety or depression medical condition or recovering from one being at risk of devleoping a medical condition - strong family history experiencing stressful life events, trauma or violence having past trauma lower level of education and socio-economic status

Question 27

presentation of somatisation

Answer 27

specific sensations or general symptoms- pain, SOB, fatigue, weakness unrelated to any medical cause or more significatn than usually expected excessive thoughts, feelings or behaviours which cause significant problems

Question 28

investigations for somatisation

Answer 28

physical examination to determine if any health conditons that need treating psychosocial evaluation and talk about symptoms, fears or concerns fill out psychological self assessment or questionaire ask about alcohol or substance use DSM-5 (diagnostic and statistical manual of mental disorders)

Question 29

DSM-5 criteria for diagnosis of somatisation

Answer 29

one or more somatic symptoms that are distressing or cause problems in dialy life excessive and persistent tohughts aobut seriousness of symptoms continue to have symptoms for more than 6 months even though symptoms my vary

Question 30

treatment of somatisation

Answer 30

prevention - seek help in anxiety and depression, recognise when stressed and how it affects body, stick to treatment plan improve symptoms and ability to function in dialy life - psyhotherapy/talk therapy CBT, family therapy to examine family relationships medications - antidepressatns can reduce symptoms associated with depression

Question 31

who gets delirium

Answer 31

prevalence in >65yo in long term care is 10-40% up to 50% of older people in hospital 30% older people in emergency department complicates 17-61% major surgery

Question 32

causes of delirium

Answer 32

multifactoral PINCH ME ``` pain infection nutrition constipation hydration ``` medication enviornment change/electrolytes

Question 33

presentation of delirium

Answer 33

acute behaviour changes - hours to days clinical evidence of udnerlying preciptating factors lucid intevrals occur during day disorientation, memory and language impairment, worsened conc, slow repsonses, confusion, may not recall details of current illness altered perception

Question 34

2 catagories of delirium

Answer 34

hyperactive = increased sensitvity to surroundings, agitation and restlessness hypoactive = clouding of consciousness and reduced awareness

Question 35

investigations of delirium

Answer 35

take history froms omeone that knows patient well so can assess how they have changed and what time frame

Question 36

treatment of delirium

Answer 36

always treat underlying condition low dose haloperidol short term <7days or low dose lorazepam drug treatment no very effective

Question 37

who gets dementia

Answer 37

very common W>M >65 1/3-1/2 of those in care homes

Question 38

types of dementia

Answer 38

alzheimers vascular dementia dementia with lewy bodies +many others

Question 39

cause of alzheimers dementia

Answer 39

atrophy of cerebral cortex formation of amyloid plaques and enurofibriliary tangles acetylcholine production ina affected neurons is reduced

Question 40

vascular dementia cause

Answer 40

reduced blood supply to brain caused by cerbrovascular disorders - large or multiple small infarcts, cerebral amyloid angiopathy etc

Question 41

dementia with lewy bodies causes

Answer 41

2nd most common degenrative type cortical and subcortical lewy bodies similar features to parkinson disease in dementia

Question 42

risk factors of dementia

Answer 42

``` age mild cognitive impairment genetics (e.g. APOE4 for alzheimers) cardiovascular disease risk factors parkinson disease stroke depression heavy alcohol consumption low social engagement and support ```

Question 43

presentation of dementia

Answer 43

cognitive impairment including memory problems, difficulty retaining info, receptive or expressive dysphagia, difficulty with coordinated movements, disorientation behavioural and psychological symptoms fluctuate may last for 6 months or more: psyhosis, agitation, emotionbal labiliy, depression and anxiety, motor disturbance, disinhibition, insomnia, repeat phrases or questions

Question 44

investigations for dementia

Answer 44

assess capacity for each decision MRI or CT for structural imaging to excluyde non-dementia cerbral pathology such as normal pressure hydrocephalus identify type of dementia from history

Question 45

treatment of dementia

Answer 45

antiphsychotics - dont work very well. only in severely distressed patients at risk of harm to themselves or others acetylcholinesterase inhibitors - donezepil galantamine and rivastigmine