Mental Health + Contraception Flashcards
(70 cards)
1
Q
Define generalised anxiety disorder
A
Disproportionate, pervasive, uncontrollable and widespread worry and range of somatic, cognitive and behavioural symptoms that occur on a continuum of severity
2
Q
ICD-10 criteria for generalised anxiety disorder
A
Symptoms of anxiety to be present for most days for several months
- apprehension
- motor tension
- autonomic overactivity
3
Q
Risk factors for generalised anxiety disorder
A
Female sex FH of psychiatric disorders Childhood adversity - maltreatment - parental problems - exposure to overprotective or overly harsh parenting style - bullying or peer victimisation Environmental stressors - physical or emotional trauma - domestic violence - unemployment - low socioeconomic status Substance dependence Chronic/painful illnesses
4
Q
Complications of anxiety
A
Serious disability and impaired quality of life Impaired social and occupational functioning Comorbidities - depression - social anxiety disorder - alcohol and drug misuse - chronic pain - asthma - COPD - IBD Suicidal ideation and attempts
5
Q
Differential diagnosis of GAD
A
Situational anxiety Adjustment disorder Depression Panic disorder Social phobia OCD PTSD Medication induced anxiety Cardiac disease Pulmonary disease Hyperthyroidism Anaemia Infection IBS Pheochromocytoma
6
Q
Stages of suicide risk assessment
A
Do you ever think about suicide
Have you made plans for ending your life
Do you have the means for doing this available
What has kept you from acting on these thoughts
Protective factors
- what keeps you
- anything that makes your life worth living
7
Q
Risk factors for suicide risk
A
Previous attempts at suicide or self-harm Feelings of hopelessness Male gender Age < 30 Advanced age Single/living alone History of substance or alcohol abuse FH of suicide Recent initiation of antidepressant treatment Psychosis Anxiety, agitation, panic attacks Severe depression
8
Q
Management of GAD
A
Individual non-facilitated or guided self-help
Psychoeducational groups
Psychological intervention - CBT or applied relaxation
Drug treatment
- SSRI - sertraline or pregabalin
9
Q
Define depression
A
Persistent low mood and/or loss of pleasure in most activities and range of associated emotional, cognitive, physical and behavioural symptoms
10
Q
Risk factors for depression
A
Chronic comorbidities Medicines Female Older age Recent childbirth Psychosocial issues - divorce, unemployment, poverty, homelessness PMH Genetic and FH Adverse childhood experiences Past head injury
11
Q
Complications of depression
A
Exacerbation of pain, disability or distress Reduced QoL Increased morbidity and mortality Impaired ability to function normally Increased risk of substance abuse
12
Q
Complications of antidepressants
A
Risk of self-injurious behaviour Sexual adverse effects Undesired weight gain Hyponatraemia Agitation or excessive activation Risk of suicide
13
Q
Diagnosis of depression
A
At least one of the two core symptoms present most days, most of the days for at least 2 weeks
- bothered by feeling down, depressed or hopeless
- little interest/pleasure in doing things
14
Q
Associated symptoms of depression
A
Disturbed sleep
Decreased or increased appetite and/or weight
Fatigue/loss of energy
Agitation or slowing of movements
Poor concentration or indecisiveness
Feelings of worthlessness or excessive/inappropriate guilt
Suicidal thoughts/acts
15
Q
Stages of depression
A
Subthreshold - 2-5 symptoms
Mild - more than 5 but minor functional impairment
Moderate - symptoms or functional impairment are mild-severe
Severe - most symptoms and marked interference with functioning
16
Q
Differential diagnosis of depression
A
Grief reaction Anxiety disorders Bipolar disorder Premenstrual dysphoric disorder Neurological conditions - Parkinson's - MS - dementia Substance and adverse drug effects - CO poisoning - substance misuse Hypothyroidism Obstructive sleep apnoea syndrome
17
Q
Management of depression
A
Low-intensity psychosocial intervention
Group based CBT
Antidepressant
High-intensity psychosocial intervention
18
Q
Consider starting an anti-depressent if
A
History of moderate or severe depression
Subthreshold depressive symptoms that have persisted for a long period - 2 years
Mild depression that persists despite other interventions
Mild depression complicating care of chronic physical health problem
19
Q
Causes of fatigue
A
Physiological - pregnancy - breastfeeding - inadequate rest/sleep - excessive exercise Physical - anemia - DM - glandular fever - malignancy Psychological - depression - anxiety - loss - stress Chronic fatigue
20
Q
Risk factors for chronic fatigue
A
Female
Higher BMI
Lower educational attainment
21
Q
Clinical features of chronic fatigue syndrome
A
Fatigue - persistent (4 months) or recurrent - new or specific onset - unexplained by other conditions - resulted in substantial reduction in activity level - characterised by post-exertional malaise / fatigue Other features - difficulty sleeping - muscle or joint pain without inflammation - headaches - painful lymph nodes without enlargement - sore throat - cognitive dysfunction - worsening symptoms on exertion - general malaise/flu-like symptoms - dizziness/nausea - palpitations
22
Q
Investigations for fatigue
A
FBC - anaemia - polycythaemia - haematological malignancy ESR and CRP - infection - inflammation - autoimmunity LFTs U&Es - kidney disease - electrolyte imbalance Thyroid function tests - hypo - hyper HbA1c - DM IgA tissue transglutaminase - coeliac
23
Q
Method of action of COCP
A
Inhibit ovulation
- no LH and FSH surge
Oestrogen - endometrium proliferation and growth
Progesterone - prevents hyperplasia of endometrium
24
Q
When to start COCP
A
Postpartum - breastfeeding = 6 weeks to 6 months - not breastfeeding = 21 days No regular contraception - day 1 of menstrual cycle
25
Advantages of COCP
More effective than barrier methods
Sexual intercourse not interrupted
Menstrual bleeding usually regular, lighter and less painful
Reduced risk (50%) of ovarian and endometrial cancer
Reduced risk of colorectal cancer
Reduced severity of acne
Normal fertility returns immediately after stopping
26
Disadvantages of COCP
Temporary adverse effects when start
Does not protect against STIs
Less effective than long-acting reversible methods
27
Risks/adverse effects of COCP
```
Nausea and abdo pain
Headache
Breast pain/tenderness
Menstrual irregularities
Hypertension
Changes in lipid metabolism
MI and stroke
VTE
Breast cancer
Cervical cancer
Mood changes
```
28
Drug interactions to be aware of with COCP
Liver enzyme-inducing drugs
- antibiotic - rifampicin
- antiepileptics - carbamazepine, phenytoin
- antiretrovirals - ritonavir
- St John's wort
29
Missed pill rules
Take missed pill asap
Emergency/barrier contraception required if
- 9 or more days since last pill over break
- 2-7 pills missed
30
Advantages of combined transdermal patch
Applied weekly - more convenient than daily pill
Do not become less effective if user vomits/diarrhoea
As effective as COCP
31
Disadvantages of combined transdermal patch
```
Can be seen
May become detached from skin - compromises efficacy
Less effective if > 90kg
Skin irritation, N+V
Delay in return to normal fertility
```
32
Mechanism of action of intrauterine system
Progestogenic effect on endometrium
- prevents implantation of fertilised ovum
- changes in mucus inhibit sperm penetration
33
Advantages of an intrauterine system
Very safe and effective
Long-term - replaced every 3-5 years
Sex not interrupted
Periods usually lighter, shorter and less painful
Normal fertility returns as soon as device removed
34
Disadvantages of an intrauterine system
Internal pelvic exam needed to check suitable and insert device
- pain/discomfort for few hours after insertion
Trained healthcare provider must remove device
Does not protect against STIs
May be expelled without women knowing
35
Adverse effects of intrauterine system
```
Pain on insertion
Perforation of wall of uterus
Expulsion
PID
Ectopic pregnancy
Ovarian cysts
Acne, breast tenderness, headache
Unscheduled bleeding
Hypersensitivity
Depression
```
36
What is natural family planning
Method of birth control where a woman monitors and records different fertility indicators during her menstrual cycle to determine when she is least/most fertile
- Fertility Awareness Methods (FAM)
- Lactational Amenorrhoea Method (LAM)
37
What do fertility awareness methods of contraception involve?
Monitoring and recording fertility signs
- cervical secretions - volume of cervical secretions which are wet, slippery and clear indicates ovulation is approaching
- changes in cervix - fertile window cervix changes from being low and firm to being high and soft
- basal body temperature - slight rise in temp that persists for 3 days indicates that fertile time has ended
- calculate menstrual cycle and fertile period - over minimum of 12 cycles
Computerised monitoring devices - urine dipsticks to follow changes of hormone concentrations
38
What does the lactational amenorrhea method of contraception involve
Breastfeeding after childbirth to prevent pregnancy
- delays the return of ovulation by disrupting gonadotrophin release
First 6 months after giving birth provided
- complete amenorrhoea
- fully or very nearly fully breastfeeding
- less than 6 months since birth
39
Advantages of fertility awareness methods
```
Can be used by most couples
Do not involve use of chemicals or physical products
No physical or hormonal adverse effects
No contraindications for use
Help women recognise normal and abnormal vaginal secretions
Acceptable to all faiths and cultures
Initial and continuing costs can be low
Immediatley reversible
```
40
Disadvantages of fertility awareness methods
Only moderately effective
Require continuing cooperation and commitment by both partners
Must be taught by someone trained to teach natural family planning
Takes 2-3 menstrual cycles to learn how to identify fertile time accurately
Not suitable for women with irregular cycles
Does not protect against STIs
41
Advantages of lactational amenorrhea method
```
Can be effective up to 6 months
Encourages exclusive breastfeeding
Can be used immediately after childbirth
No need to anything at the time of sexual intercourse
No direct cost
No hormonal adverse effects
Encourages starting follow-up method at proper time
Does not involve abstinence
```
42
Disadvantages of lactational amenorrhea
Does not protect against STIs
Becomes unreliable after 6 months and when other foods are introduced into baby's diet
Frequent breastfeeding can be inconvenient
43
Method of action of progestogen-only pills (POPs)
```
Suppression of ovulation
- suppression of mid-cycle of LH and FSH
Production of hostile blocked mucus
- poor sperm penetration
Prevents implantation
- reduction in number and size of endometrial glands and inhibition of progesterone receptor synthesis in endometrium
Reduction in activity of cilia in the Fallopian tube
Prevent conception
```
44
Advantages of POP
Very effective when taken correctly - better than barrier
Sex not interrupted
Used when COCP not suitable
Reduce risk of endometrial cancer
Desogestrel may be beneficial in managing dysmenorrhoea
Normal fertility returns when POP stopped
45
Disadvantages of POP
Pills must be taken at same time each day - within 3 hours
Adverse effects
Does not protect against STIs
46
Adverse effects of POP
```
Menstrual irregularities
Breast tenderness
Ovarian cysts
Ectopic pregnancy
Increased risk of breast cancer
```
47
Method of action of progesterone implant
Inhibit ovulation
| Changes in cervial mucus - inhibit sperm
48
Advantages of progesterone implant
```
Very effective
Users do not have to think about contraception for 3 years
Sexual intercourse not interrupted
Used when breastfeeding
Normal fertility returns as soon as removed
Used when COCP not suitable
May help alleviate dysmenorrhoea
May reduce risk of endometrial cancer
Effective in women of all weights
```
49
Disadvantages of progesterone implant
50% will experience changes in menstrual bleeding
Bleeding patterns likely to remain irregular
Efficacy reduced with liver enzyme-inducing drugs
Does not protect against STIs
50
Adverse effects of progesterone implant
```
Menstrual irregularites
Acne
Complications of insertion and removal
Increased breast cancer risk
VTE
```
51
Advantages of progesterone injectables
Very effective
Do not have to think about contraception for 8-12 weeks
Used when breastfeeding
No know interactions with any medications
May reduce heavy periods and help with PMS
Used when COCP not suitable
Used by women with BMI over 35
May reduce risk of ovarian and endometrial cancer
52
Disadvantages of progesterone injectables
Not rapidly reversible
- delay up to 1 year until normal fertility returns
Does not protect against STIs
Adverse effects - unscheduled bleeding and weight changes
53
Adverse effects of progesterone injectables
```
Menstrual irregularities
Weight gain
Increased risk of breast cancer
Small loss of body mass index
Injection site reactions
```
54
Types of male sterilisation (vasectomy)
```
Scalpel method
Minimally invasive vasectomy (MIV)
Occlusion of vas deferens achieved by
- coagulation/cauterisation
- ligation with sutures/metal clips
- insertion of intra-vas devices or plugs
```
55
Types of female sterilisation (tubal occlusion)
Hysteroscopic - micro-inserts passed through hysteroscope and insert into proximal section of fallopian tube
Laparascopic - tubal rings/clips used to occlude fallopian tubes or diathermy to destroy segment of tube
Mini-laparotomy - fallopian tubes partially removed and ligated or occluded with tubal ring or clip
56
Advantages of vasectomy
Very effective in preventing pregnancy
Permanent
Sex not interrupted
57
Disadvantages of vasectomy
Require minor surgical procedure - small risk of haematoma and infection
Effective contraception required until azoospermia confirmed - 12 weeks
Regret
Not easily reversed - not routinely on NHS
Does not protect against STIs
Failure
58
Risks of vasectomy
Small risk of testicular or scrotal chronic pain
59
Advantages of tubal occlusion
Very effective in preventing pregnancy
Permanent
Sex not interrupted
60
Disadvantages of tubal occlusion
```
Requires surgical procedure
Regret
Cannot be easily reversed
Does not protect against STIs
Can fail
```
61
Risks of tubal occlusion
Laparoscopic procedure - bowel, bladder or blood vessel damage
If occlusion fails pregnancy may be ectopic
Requires general anaesthetic
No increased risk of heavier/irregular periods when over 30
62
Method of action of copper IUDs
Toxic effects of copper on ovum and sperm - preventing fertilisation
63
Advantages of copper IUDs
Very safe and effective
Effective immediately after insertion - emergency contraception
Long term - replaced every 5-10 years
No hormonal side effects
Sex not interrupted
Immediately reversible
Used with breastfeeding
Inserted from 4 weeks postpartum
Used immediately following surgical or medical termination
No drug interactions
Reduced risk of endometrial and cervical cancer
64
Disadvantages of copper IUDs
Internal pelvic exam - prior to insertion
Some bleeding/spotting may occur immediately after insertion
Severe cramps and pain beyond 3-5 days insertion
Woman cannot discontinue on her own - must be removed by trained professional
Adverse effects
65
Adverse effects of copper IUD
```
Pain on insertion
Perforation of wall of the uterus
Expulsion
PID
Ectopic pregnancy
Unscheduled bleeding
```
66
Define medically unexplained symptoms
Persistent physical complaints that don't appear to be symptoms of a medical conditions
67
Examples of medically unexplained symptoms
Tingling in hands/feet
Tremor in hand
Headaches/migraines
Changes in sight
68
Possible causes of medically unexplained symptoms
Chronic fatigue syndrome
IBS
Fibromyalgia
69
Management of medically unexplained symptoms
```
Lifestyle changes
- regular physical activity
- better rest
- manage stress
CBT
Antidepressant drugs
Neurology
Psychotherapy
```
70
Risk factors for medically unexplained symptoms
Women
Younger people
People who've recently had an infection or physical illness or those affected by ill health or death of relative
Previous depression or anxiety
