Mental Health across the lifespan

Question 1

A diagnosis of bipolar disorder has what impact on life expectancy?

Answer 1

9-20 years reduction

Question 2

A diagnosis of schizophrenia has what impact on life expectancy?

Answer 2

10-20 year reduction

Question 3

A drug and alcohol misuse disorder has what impact on life expectancy?

Answer 3

9-24 year reduction

Question 4

What is the most common disorder diagnosed children?

Answer 4

Disruptive behavioural disorders

Question 5

What are the two types of behavioural disorders and when is there peak onset?

Answer 5

Conduct disorder <12 years

Oppositional defiant disorder >12 years

Question 6

Why are early conduct disorders so worrying?

Answer 6

Very strong indicators of serious antisocial behaviour imprisonment and illicit substance misuse

Question 7

What is the management for disruptive behavioural disorders in children?

Answer 7

Early psychosocial intervention is key

Medication is rarely required.

Question 8

Why do parents seek a diagnosis if ADHD or ASD in their children?

Answer 8

As it allows them to access individual educational and social support.

Question 9

What is the epidemiology of ASD?

Answer 9

1 in 100/200 children

M:F 4:1

Question 10

Epidemiology of ADHD

Answer 10

4-5% of children

Question 11

What is the management for ADHD

Answer 11

In moderate to severe cases medication is required

Social educational and parental intervention

Question 12

When is separation anxiety normal in your child?

Answer 12

7 months to beginning of Preschool

Question 13

How is Separation anxiety disorder distinguishable?

Answer 13

Age inappropriate excessive and disabling anxiety developing into school refusal

Question 14

How do Trauma and Attachment disorders present?

Answer 14

PTSD symptoms
Anger
Avoidance
Irritabiilty
Anxiety
Oppositional behaviours

Question 15

What comorbidities do trauma and anxiety disorders have?

Answer 15

Substance misuse
Suicide
Psychotic disorders

Question 16

What groups have a higher incidence of Trauma and Anxiety disorders?

Answer 16

Asylum seekers
Refugees
Ethnic minorities
Fostered/Adopted

Question 17

Children of primary school age may have these benign presentations.

Answer 17

Developmental appropriate anxiety - strangers places 
Hyperactivity and short attention span
Grandiose Ideas and over-talkativeness
Imaginary friends
Intense interests
Non impairing tics

Question 18

Children of secondary school may present with these that aren’t related to mental illness.

Answer 18

Mood swings, sullenness, withdrawal, irritability, sleep changes
Peer pressure influenced thoughts
Rituals and OCD type behaviours
Intrussive thoughts and pseudo hallucinations

Question 19

What are some common peer pressure influence thoughts that teenagers present with?

Answer 19

Superficial self harming

Voicing suicidal thoughts without the features of mental illness

Question 20

Why is individual psychological therapy less likely to be beneficial to young children?

Answer 20

As they aren’t able to properly vocalise their issues and emotions
Less insight into their own issues
Working as a group can help increase emotional intelligence and social skills

Question 21

What are some common stressors in early adulthood?

Answer 21

Leaving school
Getting a job
Initiating a long term relationship
Buying a house
having children

Question 22

What are some common stressors in middle adulthood?

Answer 22

Maintaining professional and financial security
Managing relationships - diverse reunified families
Dealing with children leaving home

Question 23

What are some common stressors in late adulthood?

Answer 23

Adjustment to retirement and change in social role
Dealing with deteriorating physical health
Managing bereavement

Question 24

What is puerperium?

Answer 24

Period of six weeks post pregnancy where sexual organs return to normal

Question 25

Why is the puerperium period linked to an increase in new or relapsing mental disorders?

Answer 25

``` Loss of independence Hormonal changes Unremitting demands Chronic loss of sleep Psychotic medication may have been paused ```

Question 26

Epidemiology of Puerperal Psychosis?

Answer 26

1 in 1000 births | 2-4 week onset

Question 27

What are the major symptoms of puerperal psychosis?

Answer 27

Psychosis | Disinhibition and confusion

Question 28

What are some risk factors for developing puerperal psychosis?

Answer 28

``` Previous thyroid disorders previous episodes Family history Unmarried FIrst pregnancy C-section Perinatal death ```

Question 29

Epidemiology of postnatal depression

Answer 29

1 in 10 women | 1-4 weeks post pregnancy

Question 30

Risk factors for postnatal depression

Answer 30

``` Family or personal history of depression or anxiety Complicated or traumatic pregnancy Relationship difficulties History of abuse or trauma Lack of support Financial difficulties ```

Question 31

What percentage of over 65s have a mental illness?

Answer 31

25%

Question 32

Why are older patients less likely to present with depression?

Answer 32

More stigma surrounding mental health in that generation | More likely to try and tough it out

Question 33

In old age what is the most important mental disorder to be aware of?

Answer 33

DELIRIUM

Question 34

Symptoms of pseudodementia in the elderly

Answer 34

Fluctuating loss of memory and vagueness Good insight into loss of cognition Prominent slowing of movement and speech Consistently depressed mood

Question 35

What is the management of Pseudodementia?

Answer 35

Medication | ECT

Question 36

Why is it classed as "pseudo" dementia?

Answer 36

There is no sign of neurodegeneration

Question 37

What is late onset depression?

Answer 37

First occurrence of depression occurs later life

Question 38

What proportion of adolescents have a diagnosable health condition?

Answer 38

1 in 10

Question 39

What is the genetic basis of anxiety disorder | Adolescents

Answer 39

Overactive limbic system | Abnormal serotonin norepinephren dopamine or GABA

Question 40

What is the behavioural basis of an anxiety disorder? | Adolescents

Answer 40

Association of a threatening stimuli with a non threatening stimuli. Maintenance of fear by avoidance Observational learning - see others and copy

Question 41

What is the cognitive basis of an anxiety disorder? | Adolescents

Answer 41

``` Attentional biase - doesn't consider alternatives Selective attention - focus on negatives Distorted risk assessment Selective memory processing Perfectionism ```

Question 42

What is the management plan for mild anxiety disorder? | Adolescents

Answer 42

CBT

Question 43

What is the management plan for unresponsive or Moderate to severe anxiety disorders? Adolescents

Answer 43

SSRI's | Citalopram

Question 44

What SSRIs are considered in anxiety disorders? | Adolescents

Answer 44

Setraline Fluoxetine Fluvoxamine

Question 45

How long could medication take to have an effect on anxiety disorders? Adolescents

Answer 45

Up to 12 weeks

Question 46

When can BDZ be used in the context of anxiety? | Adolescents

Answer 46

If they become very agitated in the acute setting

Question 47

What medication is never used for anxiety in adolescents?

Answer 47

Propanolol

Question 48

What proportion of adolescents suffer from depression ?

Answer 48

4-8 in 100

Question 49

Which groups are at particular risk of suffering from depression? Adolescents

Answer 49

``` Young offenders LGBTQIA Ethnic minorities Disabled Homeless Fostered or adopted ```

Question 50

What are some risk factors for developing depression in adolescence? Adolescents

Answer 50

``` Family History Negative perception of world and self Stressful environment Family conflict Divorce Bullying Social disadvantage Bereavements School stress ```

Question 51

What is the management for an adolescent with mild depression? Adolescents

Answer 51

Watch and wait for 2 weeks | Group CBT - non directed support for 2-3 months

Question 52

What is the management for an adolescent with moderate to severe depression? Adolescents

Answer 52

Individual CBT or psychodynamic psychotherapy 4-6 sessions. Fluoxetine Setraline Citalopram

Question 53

What medication is first line for depression? | Adolescents

Answer 53

SSRIs

Question 54

If you have had a poor response to at least two SSRIs what is the next step? Depression Adolescents

Answer 54

Low dose antipsychotic. Olanzapine Risperidone Aripiprazole

Question 55

What can be used as an alternative to antipsychotic in the older age group? Depression

Answer 55

Venlafaxine SNRIs | Mirtazapine Tetracylcic

Question 56

What is the rule when medicating someone for depression? | Adolescents

Answer 56

Start low Go slow | Target symptoms not diagnosis

Question 57

What are some red flags for adolescent depression?

Answer 57

Suicidal behaviour Self harm Agitation/ Hostility Altered appetite

Question 58

What proportion of Adolescents self harm?

Answer 58

1 in 12-15

Question 59

What are some reasons adolescents self harm?

Answer 59

``` Coping with emotions Communicating stress Reconnect with oneself Attempt to end own life Life saving ```

Question 60

What is the physiological reasoning behind self harm?

Answer 60

Promotes release of endorphins which acts at temporary stress reliever. Negative reinforcement of action to repeat action as brain wants to avoid stress.

Question 61

Non suicidal adolescent self harm.

Answer 61

Periods of optimum and sense of self control Provides temporary release from unpleasant emotions Chronic and repetitive

Question 62

Suicidal adolescent self harm

Answer 62

``` Hopelessness and Helplessness is core dogma No release from discomfort in life Tunnel vision 'one way out' Escape pain Not repetitive or chronic ```

Question 63

What are some consequences of self harm?

Answer 63

50-100x more likely to commit suicide of history of self harm Serious long term health consequences e.g. liver transplant

Question 64

What is the management of an adolescent who self harms?

Answer 64

Listen and empathise Refer to specialist Normalise experience

Question 65

Anterograde amnesia

Answer 65

Difficulty acquiring new material

Question 66

Retrograde amnesia

Answer 66

Difficulty in remembering information prior to onset

Question 67

What are some typical complaints of someone with memory problems?

Answer 67

``` Forgetting messade losing track of conversation Forgetting to do routine things Inability to navigate familiar places Misplacing items ```