Primary Care Management of Common Mental Health Disorders Flashcards
(57 cards)
How many people suffer from a mental illness?
1 in 4
Where is the majority of mental illness managed exclusively?
In primary care
During a GP consultation what things should make you more alert to the possibility of depression?
PMH of depression
Significant illness causing disability
Other mental health problems, e.g. dementia
NICE recommends the diagnosis of depression be made using what tool?
DSM IV criteria
For depression 5/9 criteria are required (including at least 1 of the first 2 criteria (low mood/anhedonia)
What does NICE say subthreshold depressive symptoms should be defined as?
Having <5 of the DSM IV criteria
What should the severity of depression be based on?
Functional impairment
When someone presents with depression, what risks should you assess for in the GP practice?
Suicide risk (ideation, intent, plans, previous attempts)
Homicidal risk
Social support
If someone is an immediate risk to themselves or others what should you do?
Refer urgently to specialist mental health services
What is the stepped care model used to treat depression?
Least intrusive method used first, if this is ineffective or declined offer next appropriate intervention
What are some initial interventions GPs may advise to help with depression?
Support Psycho-education Lifestyle advice Active monitoring Referral for further assessment/intervention
What may be used to treat mild-moderate depression?
Advice on sleep hygiene
Active monitoring
Low intensity psychological and psychosocial interventions (self help CBT, computerised CBT, group physical activity programme)
DO not routinely used antidepressants
What is involved in active monitoring of depression?
Discuss concerns, provide info on depression
Reassess in 2w
When should you consider using antidepressants in mild-moderate depression?
PPH of moderate-severe depression
Subthreshold symptoms have been present for 2y+
Subthreshold symptoms for <2y but not responding to other interventions
If a person is not responding to initial interventions for depression or has severe depression, what can be offered?
Antidepressants (e.g. SSRI)
High intensity psychological intervention (CBT, IPT, behavioural activation etc.)
What other things should you discuss in your consultation with someone with depression?
Fitness to work
Fitness to drive (significant memory/concentration problems, agitation, behavioural disturbance or suicidal thoughts may impair ability)
When is follow up arranged for people taking antidepressants?
2 weeks after staring
Every 2-3w for 3m
If younger/high risk may see more often
How long do you need to wait before considering changing an antidepressant if it is not working?
3-4 weeks at therapeutic dose if response absent or minimal
If response to an antidepressant is minimal or absent at 3-4w, what must you do?
Increase level of support and increase dose
OR
Switch to another antidepressant (initially a different SSRI, then a different class (e.g. TCA), then can augment (after liaison with psychiatrist only) with another antidepressant (e.g. mitrazapine)/lithium)
What advice should you give on stopping or reducing antidepressants?
Re risk of discontinuation symptoms
Must gradually reduce dose over 4w period
Which patients must you refer for multiprofessional/inpatient care?
Those with severe and complex depression
Risk to life
Severe self neglect
Psychotic symptoms
Should you refer if you suspect bipolar disorder?
Yes
What is generalised anxiety disorder?
Excessive worry about a number of different events
What is panic disorder?
Recurrent panic attacks and persistent worry about further attacks
What is social anxiety disorder?
Persistent fear of one or more social or performance situations that is out of proportion to the actual threat posed by the situation
