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Y3 Core Conditions > Mental Health > Flashcards

Mental Health Flashcards

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1
Q

Depression

A

Feelings of severe despondency, dejection, feelings of inadequacy and guilt. Accompanied by lack of energy and disturbance of appetite and sleep

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2
Q

How common is Depression

A 
Mid 30s
HIgher rates in older people 
Leading cause of disability and premature death
F:M 2:1
Low social class and unemployment
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3
Q

Pathophysiology of Depression

A

Abnormal concentrations of neurotransmitters

Dysregulation of the HPA axis

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4
Q

Risk Factors for Depression

A 
Age 65+ 
Post-natal status
FHx of depression and suicide
Corticosteorid, interferon or propranolol use
OCP
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5
Q

Symptoms of Depression

A 
Depressed mood (for 2 weeks)
Anhedonia (for 2 weeks)
Thoughts of death or suicide
Restlessness
Irregular sleep
Decreased evergy
Changes in mood
Insomnia
Indecisiveness
Appetite and weight loss
Tearfulness
Psychomotor retardation
Constipation 
Amnorrhoea
Loss of libido
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6
Q

Negative Cognitive Triad

A

Self: Worthless
Future: Hopeless
World: Critical, guilt

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7
Q

Screening Tools for Depression

A

Clinical History
PHQ-9
Geriatric Depression Scale (GDS)
Hospital Anxiety and Depression Scale (HAD)

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8
Q

Patient Health Questionnaire (PHQ-9)

A 
'Over the last 2 weeks, how often have you been bothered by any of the following problems?'
Each item rated 0-3
Total Score Depression Severity
0-4 None
5-9 Mild depression
10-14 Moderate depression
15-19 Mod Severe depression
20-27 Severe depression
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9
Q

ICD- 10 Core Symptoms of Depression

A

Low or Depressed Mood
Loss of interest and enjoyment
Loss of energy
Duration: more that 2 weeks

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10
Q

Differentials for Depression

A 
Bipolar Disorder
Dementia 
Anxiety Disorders
Alcohol Abuse
Hypothyroidism
Cushing's Disease
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11
Q

Biological Treatment for Depression

A

SSRI e.g. fluoxetine, citalopram, sertraline
Tricyclics e.g. amitriptyline, nortriptyline, lofepramine
NaSSA e.g. mirtazapine
SNRI e.g. venlafaxine, duloxetine

Continue antidepressant medication for at least 6 months after remission of depression- reduces risk of relapse

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12
Q

Psychological treatment for Depression

A

(For Low-intensity psychosocial interventions)

Improving Access to Psychological Therapies (IAPT) in Primary Care
Problem focussed, counselling
Cognitive Behavioural Therapy (CBT)
Computerised Cognitive Behavioural Therapy (CCBT)

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13
Q

Anxiety

A

Generalised Anxiety Disorder is 6 months of excessive worry about everyday issues that is disproportionate to any risk, causing distress or impairment

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14
Q

How common is Anxiety

A

More common in females
Prevalence increases in those with chronic diseases
Increases risk during pregnancy and in the post-natal period
Depression and Anxiety often co-occurs

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15
Q

Symptoms of Anxiety

A

Restlessness, easily fatigued, poor concentration, irritability, muscle tension, sleep disturbance, sweating, light-headedness, palpitations, dizziness, epigastric discomfort

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16
Q

Treating Anxiety: Psychological

A

IAPT in primary care
Relaxation, mindfullness, problem focussed counselling, graded exposure
CBT

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17
Q

When NOT to prescribe Benzodiazepines

A

for Panic Disorders

for GAD in primary and secondary care unless short-term measure during crises

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18
Q

When NOT to prescribe Antipsychotics

A

for Panic Disorders

for GAD in primary care

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19
Q

Alcohol Dependence

A

Increased tolerance to the effects of alcohol, presence of withdrawal signs and impaired control over the quantity and frequency of drinking

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20
Q

Pathophysiology of Alcohol Dependence

A

The pleasurable and stimulant effects of alcohol are mediated by dopaminergic pathway. Repeated, excessive alcohol ingestion sensitises this pathway and leads to dependence. Long term exposure causes:
Down-regulation of inhibitor neuronal GABA receptors
Up-regulation of excitatory glutamate receptors
Increased noradrenaline activity
Discontinuation of alcohol ingestion leaves this excitatory state unopposed resulting in the nervous system hyperactivity and dysfunction that characterises withdrawal

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21
Q

Risk Factors for Alcohol Dependence

A

FHx of alcoholism
Anti-social behaviour
High trait anxiety level

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22
Q

Symptoms and signs of Alcohol Dependence

A

Withdrawal: agitation, nercousness, sizsures, delirium
Jaundice, ascites, nausea and vomiting, abdominal pain, haematemesis, gastritis, peripheral neuropathy, HTN
urticarial reactions, flushing, pruritis, broad-based gait

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23
Q

Investigations for Alcohol-dependence

A 
Diagnostic Interview
Alcohol Breath
Carbohydrate-Deficient transferrin (CDT) increased
Gamma-GT, ALT, AST increased
Low platelets
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24
Q

Treatment for Alcohol-dependence

A

Detoxification and supportive medical care
Psychosocial interventions with aim to promote abstinence
Pharmacotherapy

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25
Treatment for Alcohol-dependence
Detoxification and supportive medical care Psychosocial interventions eg CBT, social network aim to promote abstinence Pharmacotherapy
26
What is the SADQ and LDQ
The Severity of Alcohol Dependence Questionnaire measure the severity of alcohol dependence. The Leeds Dependence Questionnaire is an indicator of how addicted a person is and therefore how difficult it will be to achieve a positive outcome
27
Complications of Alcohol Dependence
``` Mallory-Weiss Tear Delirium tremens Seizures Alcohol Liver Disease Liver Cirrhosis Nutritional Disorders Wernicke encephalopathy and Korsakoff psychosis-t thiamine deficiency ```
28
Self-harm
An intentional act of self-poisoning or self-injury, irrespective of the motivation or purpose and is an expression of emotional distress
29
How common is Self-harm
More common in adolescent and young adults 15-19 in females 20-24 in males F>M
30
Causes of Self-harm
Social problems Trauma Psychological causes
31
Risk factors for Self-harm
Socio-economic disadvantage Social isolation: single, divorce, living alone, single parent Stressful life event: relationship difficulties, veterans Mental health problems: depression, psychosis, schizophrenia, PTSD Alcohol or drug misuse
32
Symptoms of Self Harm
``` Unexplained cuts, bruises, cigarette burns- usually on wrists, arms, thighs and chest Keeping themselves fully covered Signs of depression Self-loathing Withdrawal Signs of alcohol or drug misuse ```
33
Treatment for Self Harm
Risk Assessment Assess physical risks: acute bleeding, acute liver failure Assess the risk of psychological harm and risk of further self-harm or suicide Assess for any safe-guarding concerns Identify psychosocial needs Risk factors and protective factors
34
Complications of Self Harm
Acute Liver Failure from paracetamol overdose | Permanent Scarring or skin damage to tendons and nerves
35
Somatisation / Somatic Symptom Disorder
Physical symptoms not explained by physical/mental disorder. Patients must have persistent thoughts about the seriousness of their symptoms, persistent levels of anxiety, excessive time and energy devoted to these symptoms or health concerns
36
How common is somatisation
Female predominance (75%)
37
Cause of Somatisation disorders
Too much stress leading to bodily symptoms | Having extreme sensitivity to bodily changes, common experiences are amplified
38
Risk factors to Somatisation disorders
Alexithymia - difficulty identifying and describing feelings | History of sexual or physical abuse, unstable childhood, trauma-related disorder, female
39
Symptoms and signs of Somatisation disorders
``` Unconventional behaviour during history Emotional processing problems Recent life stressors Unusual neurological deficits Inconsistent examination findings ```
40
Investigation for Somatisation
Bloods to rule out medical or neurological Electroencephalogram (EEG) Comprehensive neuro-psychological testing
41
Differentials for Somatisation
``` Bipolar Disorder Schizoaffective disorder Panic Disorder Schizophrenia Illness anxiety disorder Factitious disorder Malingering Dissociative disorder Neurological conditions: Epilepsy, Parkinson's, MS ```
42
Treatment for Somatization
``` Ecclectic Psychotherapy Psychiatric consultation intervention Graded physical exercise Biofeedback training Antidepressant Psychotherapy ```
43
Complications for Somatization
Depression Anxiety Suicidal ideation Substance use/abuse
44
Delirium
A state of mental confusion and reduced awareness of the environment that starts suddenly and is caused by a physical condition of some sort. Onset is rapid from hours to days.
45
How common is Delirium
Highes prevalence in patient who are in hospital and long-term care facilities Affects up to 50% of 65+ in hospital
46
Types of Delirium
Hyperactive Hypoactive Mixed
47
Causes of Delirum
Multifactorial Causes: Certain medication or drug toxicity Alcohol or drug intoxication or withdrawal A medical condition or a severe, chronic or terminal illness Metabolic imbalance e.g low sodium, calcium Fever and acute infection Malnutrition or dehydration Sleep deprivation or severe emotional distress Pain Surgery
48
Symptoms and Signs of Delirium
Altered cognitive function: disorientation, slow responses, confusion Inattention Disorganised thinking Altered perception: paranoid delusions or hallucinations Altered physical function ( 3 types of Delirium) Altered social behaviour: inappropriate and uncooperative Altered level of consciousness: clouding, reduced awareness, sleep-cycle disturbances Loss of appetite Acute onset
49
Investigation for Delirium
Confusion Assessment Method (CAM) DSM-IV Criteria Pulse oximetry, urinalysis, FBC, CRP, renal profile, calcium, LFTs, glucose, blood cultures, arterial blood gas, ECG, CXR
50
What is CAM?
(Think CA2 MS). Delirium diagnosis requires CA2 and either M or S Changeable course Acute onset + Attention poor Muddled thinking Shifting consciousness
51
Differential Diagnoses for Delirium
``` Dementia Depression Schizophrenia Dysphasia Hysteria/mania Non-convulsive epilepsy ```
52
Treatment for Delirium : Behavioural approaches
Correct any precipitating factors
53
Treatment for Delirium: Medication
Benzodiazepines e.g Lorazepam OR Haloperidol (antipsychotic drug). Patients must ahve an ECG before and after administration to check for long QT
54
Delirium Precipitants (Think DELIRIUM)
``` Drugs Electrolyte Imbalance Level of Pain Infection/ Inflammation Respiratory failure Impactation of faeces Urine retention Metabolic/ Myocardial infarction ```
55
Complications of Delirium
Increased mortality and increased length of hospital stay Infection Dementia Falls, pressure sores, continence, malnutrition, functional impairment
56
Dementia
Dementia is a syndrome in which there is deterioration in memory, thinking, behaviour and the ability to perform everyday activities.
57
Alzheimer's Dementia
Chronic, progressive neurodegenerative disorder characterised by a non-reversible impairment in cerebral functioning. Caused by over production of beta-amyloid proteins leading to formation of dense plaques causing neuritic injury and cell death
58
How common is Alzheimers
Most common type of Dementia F>M More common in black people
59
Risk factors for Alzheimers
Advance age, FHx, Presenilin genes, Downs Syndrome, Cerebrovascular disease, hyperlipidaemia, smoking, obesity, diet high in saturated fats, female
60
Treatment of Alzheimers
``` Supportive treatment Donepezil, Rivastigmine Cholinesterase inhibitors Antidepressants Antipsychotics Memantine ```
61
Dementia with Lewy Bodies (DLB)
A neurodegenerative disorder with Parkinsonism. Caused by deposits of Lewy bodies made of alpha-synuclein in the brain.
62
Risk factors for DLB
Male Increasing FHx
63
Treatment for DLB
``` Benzodiazepines Cholinesterase inhibitors SSRIs Clonazepam or melatonin if REM disorder Carbidopa/ Levodopa for motor symptoms ```
64
Vascular Dementia
Chronic decline in cognitive and executive functions such as planning more so than memory. Due to cerebrovascular causes to the brain such as infarction, haemorrhage, leukoaraiosis and small-vessel changes
65
Leukoaraiosis aka Subcortical leukoencephalopathy
Disease of white matter leading to loss of axons and myelin
66
Risk factors for Vascular Dementia
Age >60, obesity, HTN, smoking, diabetes, hypercholesteremia
67
Treatment for Vascular Dementia
Aspirin/clopidogrel if atherosclerotic ischaemic disease Warfarin/ Rivaroxaban if cardioembolic disease Cholineesterase inhibitors
68
Fronto-Temporal Dementia
Manifests as disruption in personality, social conduct, or primary language disorder. Often with Parkinsonism
69
Cause of Fronto-Temporal Dementia
Focal degeneration of the frontal or temporal lobes MAPT and PGRN genes Tau proteins
70
Risk factors for Fronto-Temporal Dementia
Mutations in the MAPT or PGRn genes Head Trauma Thyroid disease
71
Treatment for Fronto-Temporal Dementia
Supportive Care: home assistance, residential care Benzodiazepines SSRI Valporate semisodium for mania, impulsivity, agitation, aggression
72
Investigations for Dementia
Mini Mental State Examination (MMSE) FBC. U&Es, LFTs, TSH CT or MRI Genetic testing
73
Complications for Dementia
Pneumonia, depression, institutionalisation, UTI, falls, dangerous driving

Y3 Core Conditions (13 decks)

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