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Year 3 core conditions > mental health > Flashcards

mental health Flashcards

1
Q

who gets depression?

A

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

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2
Q

risk factors for depression

A

history of depression or mental health/physical comorbidities

poor interpersonal relationships

poor living conditions

social isolation

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3
Q

presentation of depression

A 
lack of interest or pleasure
lack of emotional reactivity
loss of energy, fatigue
insomnia, early morning wakening (hypersomnia)
diurnal variation in mood
psychomotor retardation
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4
Q

signs on examination of depression

A

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

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5
Q

negative cognitive triad

A

self: worthless
world: critical, guilt
future: hopelessness

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6
Q

investigations for depression

A

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)

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7
Q

ICD-10 core symptoms of depression

A

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)

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8
Q

treatment of depression

A

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

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9
Q

who gets anxiety?

A

25% lifetime risk

F>M

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10
Q

types of anxiety

A

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

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11
Q

what is anxiety?

A

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
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12
Q

risk factors for anxiety

A

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
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13
Q

presentation of anxiety

A

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

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14
Q

who gets alcohol dependence?

A

M>W

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

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15
Q

classification of alcohol dependence

A

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

confirm diagnosis using ICD-10 criteria for alcohol dependence

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16
Q

ICD-10 for alcohol dependence

A

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
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17
Q

presentation of alcohol dependence

A

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

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18
Q

ataxia

A

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

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19
Q

treatment of alcohol dependence

A

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

20
Q

who self harms?

A

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

21
Q

risk factors of self harm

A 
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
22
Q

signs on examination of self harm

A

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

23
Q

treatment of self harm

A

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

24
Q

what is somatisation

A

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

25
Q

cuases of somatisation

A

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

26
Q

risk factors of somatisation

A

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

27
Q

presentation of somatisation

A

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

28
Q

investigations for somatisation

A

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)

29
Q

DSM-5 criteria for diagnosis of somatisation

A

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

30
Q

treatment of somatisation

A

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

31
Q

who gets delirium

A

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

32
Q

causes of delirium

A

multifactoral
PINCH ME

pain
infection
nutrition
constipation
hydration

medication
enviornment change/electrolytes

33
Q

presentation of delirium

A

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

34
Q

2 catagories of delirium

A

hyperactive = increased sensitvity to surroundings, agitation and restlessness

hypoactive = clouding of consciousness and reduced awareness

35
Q

investigations of delirium

A

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

36
Q

treatment of delirium

A

always treat underlying condition
low dose haloperidol short term <7days or low dose lorazepam

drug treatment no very effective

37
Q

who gets dementia

A

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

38
Q

types of dementia

A

alzheimers
vascular dementia
dementia with lewy bodies
+many others

39
Q

cause of alzheimers dementia

A

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

40
Q

vascular dementia cause

A

reduced blood supply to brain

caused by cerbrovascular disorders - large or multiple small infarcts, cerebral amyloid angiopathy etc

41
Q

dementia with lewy bodies causes

A

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

42
Q

risk factors of dementia

A 
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
43
Q

presentation of dementia

A

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

44
Q

investigations for dementia

A

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

45
Q

treatment of dementia

A

antiphsychotics - dont work very well. only in severely distressed patients at risk of harm to themselves or others

acetylcholinesterase inhibitors - donezepil galantamine and rivastigmine

Year 3 core conditions (15 decks)

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