Mental Health Conditions

Question 1

Who is typically affected by alcohol dependence?

Answer 1

More common in MEN
LOW SOCIO ECONOMIC
LOW EDUCATION LEVELS

Question 2

What is the cause for alcohol dependence?

Answer 2

It is defined as a:
CRAVING
TOLERANCE 
PREOCCUPATION
- social factors
- genetic factors
- environmental factors

Question 3

What are the risk factors associated with alcohol dependence?

Answer 3

NON-MODIFIABLE- age, family history, social/cultural factors
MODIFIABLE- steady drinking over time
PMH- depression/mental health problems

Question 4

What are some of the symptoms of alcohol dependence?

Answer 4

Inability to limit alcohol consumption
Trying to cut down
Craving alcohol
Failing to fulfill major obligations
Giving up other activities
Using alcohol in unsafe situations
Developing tolerance to alcohol
Experiencing withdrawal symptoms

Question 5

What are the clinical signs of alcohol dependence?

Answer 5

More than a score of 2 on the CAGE test

Stigmata of liver disease

Question 6

What comprises the CAGE test?

Answer 6

Cutting down?
Annoyed by criticism?
Guilty about drinking?
Eye-opener (ever needed a drink in the morning/steady nerves/cure hangover?)

Question 7

What other investigations are needed in suspected alcoholism?

Answer 7

BLOODS: GGT (raised in alcohol dependence), MCV (raised in alcohol dependence but also many other things), CDT
CAGE
AUDIT-C
AUDIT QUESTIONNAIRE

Question 8

What is the best management for alcohol dependence?

Answer 8

Determine the severity of the dependence
Admit/refer for specialist treatment
Individual treatment plan
Assisted alcohol withdrawal
Extended brief intervention
Advice (harm, barriers to change, practical strategies)

Question 9

Who is most commonly affected by anxiety?

Answer 9

WOMEN

ELDERLY

Question 10

What are some of the risk factors for anxiety?

Answer 10

Age 35-54
Divorce/separation
living alone/lone parent

Question 11

What are the key symptoms experienced in anxiety?

Answer 11

Autonomic arousal symptoms- palpitations, tachycardia, sweating, shaking, dry mouth

Chest/Abdo. symptoms- difficulty breathing, chest pain, choking sensation, nausea/abdo. distress

Mental symptoms- dizziness, fear of death, loss of control, derealisation

General symptoms- restlessness, hot flushes/cold chills, muscle tension

Question 12

What are the differential diagnoses associated with anxiety?

Answer 12

Panic disorder
PTSD
OCD
Social phobia
Schizophrenia
Dementia
Alcoholism

Question 13

What investigations can be done in suspected anxiety?

Answer 13

Mostly history- but ICD-10

Question 14

What is the treatment for anxiety?

Answer 14

Graded care plan

• low intensity psychological support/self-guided help
• cognitive behavioural therapy, drug treatment
• specialist drug/psychological treatment

Question 15

Who is typically affected by delirium?

Answer 15

ELDERLY

Question 16

What is delirium?

Answer 16

ACUTE, fluctuating syndrome of disturbed consciousness, attention, cognition and perception

• HYPERACTIVE
• HYPOACTIVE
• MIXED

Can also be MULTIFACTORIAL

• infective
• metabolic
• intracranial
• endocrine

Question 17

What are the key risk factors in delirium?

Answer 17

NON-MODIFIABLE- old age

MODIFIABLE- poor nutrition, excessive alcohol, lack of stimulation

PMH- cognitive impairment (dementia), frailty/multiple comorbidities, significant injuries, functional impairment, metabolic disturbance, any other systemic disorder.

Question 18

What are the notifiable symptoms in delirium?

Answer 18

Acute behaviour changes
Altered cognitive function
Inattention
Disorganised thinking
Altered perception
Increased sensitivity to immediate surroundings
Agitation, restlessness, sleep disturbance
Lethargy, reduced mobility, lack of interest in ADLs, reduced appetite, withdrawn.

Question 19

What are some differentials associated with delirium?

Answer 19

Mood disorder
Psychotic illness
Dementia

Question 20

What investigations are carried out in suspected delirium?

Answer 20

AMTS

Question 21

What comprises the AMTS?

Answer 21

Name
DOB, Age
Address- 42 West Street
Current location
Current time
Current year
Current Monarch/ Prime minister
Year of WW2 (start/end)
Recognition of people
Counting backwards 20-1
Repeat address

Question 22

What is the treatment for delirium?

Answer 22

Identify and treat the underlying cause
Provide environmental and supportive measures
Avoid sedation
Regular clinical review

Question 23

Who is typically affected by dementia?

Answer 23

ELDERLY

Question 24

What are the primary causes of dementia?

Answer 24

Alzheimer’s disease
Vascular dementia
Dementia with Lewy bodies
Frontotemporal dementia

Question 25

What are the risk factors associated with dementia?

Answer 25

NON-MODIFIABLE- old age, genetics, low socioeconomic status MODIFIABLE- smoking, excessive alcohol PMH- mild cognitive impairment, learning difficulties, diabetes, hypercholesterolaemia, hypertension, Parkinson's, stroke, depression

Question 26

What are the symptoms associated with dementia?

Answer 26

``` Memory problems Repetitive and expressive dysphagia Difficulty in carrying out coordinated movements Disorientation Psychosis Agitation, emotional liability Depression and anxiety Withdrawals Difficulties with ADLs ```

Question 27

What are the differentials of dementia?

Answer 27

``` Age related memory changes Mild cognitive impairment Depression Delirium Vitamin deficiency Hypothyroidism ```

Question 28

What investigations should be carried out in suspected dementia?

Answer 28

MMSE 6-CIT IMAGING: MRI, CT

Question 29

What is the management for dementia?

Answer 29

Identify the type | Care plans- care givers, dossett boxes

Question 30

Who is most commonly affected by depression?

Answer 30

WOMEN

Question 31

What are the risk factors for depression?

Answer 31

NON-MODIFIABLE- genetic factors, personality, failure of adaptive mechanisms to stressors SOCIAL- psychosocial issues PMH- chronic comorbidities, past head injury

Question 32

What are the symptoms associated with depression?

Answer 32

``` Low mood, hopelessness Little interest/pleasure in doing things Fatigue Worthlessness/ excessive guilt Recurrent thought about death/suicide Diminished ability to think Psychomotor agitation or retardation Insomnia/hypersomnia Significant appetite/weight loss ```

Question 33

What are the clinical signs associated with depression?

Answer 33

Hypersomnia Neglectful appearance/hygiene Obviously low mood

Question 34

What are the differentials for depression?

Answer 34

``` Grief reaction Dementia Substance abuse Adverse drug effects Hypothyroidism ```

Question 35

What investigations should be carried out in depression?

Answer 35

QUESTIONNAIRES- PHQ-9. HADS. BDI-II Assess suicide risk Look out for co-morbid conditions Biochem and Haematology to rule out other causes.

Question 36

What is the appropriate management for depression?

Answer 36

Watchful waiting Source support low and high psychological interventions counselling and short term psychodynamic Antidepressants - generic SSRI (citalopram, fluoxetine, paroxetine, sertraline)

Question 37

Who is most likely to be affected by self harm?

Answer 37

ADOLESCENTS and YOUNG ADULTS | slightly more prevalent in FEMALES

Question 38

What are the risk factors associated with self-harm?

Answer 38

``` Socio-economic disadvantage Social isolation Mental health problems Chronic physical health problems Alcohol/drug misuse Child maltreatment/domestic violence ```

Question 39

What are the symptoms of self harm?

Answer 39

Depressive symptoms

Question 40

What clinical signs of self harm can be manifest?

Answer 40

Marks on the skin Neglectful appearance/hygiene Extreme weight loss

Question 41

What is the management for self-harm?

Answer 41

Manage any sustained injuries Manage psychosocial needs Remove access to means of self-harm if possible CAMHS

Question 42

What is somatisation?

Answer 42

The manifestation of physical symptoms without physical cause/stimulus

Question 43

Who is most likely to be affected by somatisation?

Answer 43

WOMEN | before the age of 30

Question 44

What are the risk factors for somatisation?

Answer 44

``` IBS Chronic pain PTSD Antisocial personality disorder Sexual/Physical abuse ```

Question 45

What are the symptoms of somatisation?

Answer 45

CARDIAC- sob, palpitations, chest pain GI- vomiting, pain, dysphagia, nausea, bloating, diarrhoea MSK- pain in joints and limbs NEURO- headaches, dizziness, amnesia, visual changes, paralysis/parasthesia UROGENITAL- pain on urination, low libido, impotence, dyspareunia, dysmenorrhea

Question 46

What are the differentials for somatisation?

Answer 46

Bipolar disorder Schizophrenic disorder Panic disorder Anxiety

Question 47

What investigations are carried out for somatisation?

Answer 47

Structured history/interview

Question 48

What is the management for somatisation?

Answer 48

``` BATHE Background Affect Trouble Handle Empathy ``` Take seriously and treat with empathy