Opening up to mental health Flashcards
How common are mental health problems?
- Major health challenge
- 1 in 4 affected by a mental health problem each year in UK
- 40% of GP appointments involve mental health
- Most common mental health disorder in Britain is mixed anxiety and depression
- 784 probable suicide registered in Scotland 2018; increase from 680 in 2017
Who is most at risk of suicide ?
Risk of suicide is grater in those in middle years (35 - 44) and more common in males, although is rising faster in females
How many Scots take an antidepressant every day?
1 in 8 (12%) Scots take an antidepressant every day?
What should you do when talking about mental health?
- Begin the dialogue and seem comfortable with it
- Active listening and open questions
- Be sensitive and be encouraging, build relationship of trust
- Non judgemental
- Acknowledge how they are feeling, vaildate
- Good time and place to talk, not rushd
- Confidentiality, dignity and respect
- Take care of yourself to take care of your patient
- Provide information appropriate to level of understanding
- Avoid clinical language without adequate explanation
- Provide written information where necessary
- Use interpreters where necessary
- Establish consent where necessary
What should you NOT do when talking about mental health?
- Make dismissive comments like ‘snap out of it’, ‘cheer up’, ‘forget about it’, ‘pull yourself together’
- say ‘you know how they feel’ if you don’t
- point out that others are worse off
- blame the individual
think of mental illness as a personal weakness or failing - use words that stigmatise
What are Red Flags for potential mental health problems ?
- Unexplained chronic pain or fatigue
- Recurrent presentations
- Changes in eating or sleeping patterns
- Signs of impairment in work, school or home life
- Signs of past or present use of alcohol or drugs
- Previous mental health problem
- Chronic physical health problem
What are relevant questions for any mental health problem that you should ask?
- Identify if a trigger
- Duration of symptoms, recurrent or isolated episode
- Consider own/family history
- Dependents
- Level of social support / isolation
- Drugs, alcohol, cigarettes
- Empolyment history
- Forensic history
- Childhood and development
- Evidence of other mental health problems
- Response to treatments (if relevant)
- Evidence of neglect
What is the Brief Mental Status Exam (MSE) form?
1). Appearance
2). Attitude
3). Behaviour
4). Speech
5). Affect
6). Mood
7). Thought process
8). Thought content
9). Perception
10). Orientation
11). Memory / Concentration
12). Insight / judgement
What are some sources of support for mental health problems?
Advise and inform re;
- Self help groups
- Support groups
- Other local and national resources
- Consider support for family / dependents / carers
Person centred care
Sign posts;
- Mood cafe
- Samaritans
- Mind info-line
- Carers trust
- Childline
- Own GP
Out Of Hours (OOH) 111
- A + E 999
What questions do we ask to screen for depression ?
During the last month, have you often been bothered by feeling down, depressed or hopeless?
During the last month, have you been bothered by having little interest or pleasure in doing things ?
If yes to either of these questions they need a mental health assessment
What does the depression in adults NICE guideline suggest?
NICE Guideline “Depression in adults: recognition and
management”
“When assessing a person who may have depression,
conduct a comprehensive assessment that does not rely
simply on a symptom count. Take into account both the
degree of functional impairment and/or disability
associated with the possible depression and the
duration of the episode.”
What are the key features of anxiety?
There are different types of anxiety - focus on Generalised Anxiety Disorder (GAD) today
Key symptoms;
- excessive anxiety and worry about a number of events or activities
- Difficulty controlling the worrying
- Occurs on a majority of days for at least 6 months
- Not in keeping with another anxiety disorder
What are the symptoms of Generalised Anxiety Disorder (GAD)?
- Restlessness
- Being easily fatigued
- Difficulty concentrating
- Irritability
- Muscle tension
- Disturbed sleep
What is the management of Generalised Anxiety Disorder (GAD)?
Stepped care model;
Step 1 - identification and assessment; education about GAD and treatment options; active monitoring
Step 2 - Low intensity psychological interventions; individual non-facilitated self-help; individual guide self-help and psychoeducational groups
Step 3 - Choice of a high-intensity psychological intervention (CBT/applied relaxation) or a drug treatment
Step 4 - Highly socialist treatment, such as complex drug and/or psychological treatment regimens; input from multi-agency teams, crisis services, day hospital or inpatient care
What drugs should be prescribed for GAD?
- SSRI (e.g sertraline)
- 2nd line alternative SSRI or SNRI
- 3rd lin consider offrent pregabalin
Do not offer a benzodiazepine for the treatment of GAD in primary or secondary care except as a short-term measure during crises
