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Rural Health West au Feb 11 mental health
Rural Health West au Nov 11 Mental Health Case Studies
NICE CG123 Common mental health disorders May 2011
Royal College of Psychiatrists UK
Psychiatry Teacher Newcastle Vimeo
Stockholm Psychiatry Lectures youtube
iTunes U ALTC multidisciplinary mental health practice
Mental health examination / psychiatric interview
Psychiatric equivalent of a physical examination and should be used for formal assessment of suspected psychiatric disorders.
Mini Mental State should suffice for general health assessments particularly when screening for/assessing cognitive impairment including dementia or acute confusional states.
PC
HPC
FH
PH
SH
PPH
PMH
Premorbid Personality
Current Circumstances
MSE
Appearance Behaviour
Speech
Mood
Thoughts
Perception
Cognition
Insight
Formulation
ABC of mental health: Mental health assessment BMJ 1997
MSE frontier psychiatrist.co.uk
Mini mental state examination MMSE
Mental state examination – “Assessed Mental State To Be Positively Clinically Unremarkable”
Appearance and behaviour [observe state, clothing…]
Mood [recent spirit]
Speech [rate, form, content]
Thinking [thoughts, perceptions]
Behavioural abnormalities
Perception abnormalities
Cognition [time, place, age…]
Understanding of condition [ideas, expectations, concerns]
QOF and mental health review
hacking-medschool/qof-mental-health
International classification of diseases ICD10
ICD 10 Classification In Psychiatry
International standard diagnostic classification for epidemiological, health management purposes and clinical use.
DSM IV American Psychiatric Association
Affective Disorders
Depression
Mania / Hypomania
Depression
SIGN qrg 114 non-pharmocological Rx depression Jan 10
NICE CG90 Depression in adults (update) Oct 2009
7 As of depression
Anhedonia
Appetite loss
Anergia
Am waking
Amenoorhoea
Asexual – decreased libido
Affective
DESPAIRS
Depressed mood/Disinterest
Energy loss
Sleep disturbance
Pessimism hopelessness worthlessness
Appetite loss
Impaired Concentration
Retardadtion or agitation
Suicidal thoughts
Diagnosing depression
presence of at least four indicates clinical depression:
1 low mood, loss of happiness or equanimity lasting 4 weeks
2 mood not improved by pleasant events or relationships
3 loss of enjoyment of everyday life, lasting 4 weeks
4 loss of interest in things and people, lasting 4 weeks
5 sleep disturbance from insomnia to spending most of the day in bed
6 difficulty in concentrating and making decisions
7 withdrawal from personal relationships
8 motor retardation’ slowing of thought processes and physical activity
Depression screening
No Benefit, Possible Harm From Routine Depression Screening Medscape News Sep 2011
HAD
Hospital Anxiety and depression score
PHQ9
Depression treatments
Newer antidepressants BMJ Feb 2012
Seasonal affective disorder SAD
Seasonal Affective Disorder PUK
SAD rcpsych.ac.uk
NHS Choices Beating the winter blues
Post natal depression PND
NICE CG45 Antenatal and postnatal mental health Feb 2007
Edinburgh Post Natal Depression ScaleDownload pdf
Post Natal Depression direct.gov
Suicide and DSH
fms teaching ncl.ac.uk suicide and DSH
Suicide and Chronic Ill Health – Demos Pamphlet @ NHS Networks
http://hacking-medschool.com/suicide-parasuicide-deliberate-self-harm
Bipolar disorder BPD
Hypomania
persistant mild elevation of mood lasting at least several days
Mania
as hypomania + psychotic symptoms including grandiose delusions and auditory hallucinations
NICE CG38 Bipolar disorder Jul 2006
Lithium
http://hacking-medschool.com/lithium-toxicity
http://hacking-medschool.com/lithium-2
Anxiety
Gad-2
GAD-7
Panic Disorder
Phobic anxiety disorders
Agoraphobia
Social phobia
Post-traumatic stress disorder PTSD
Condition brought on by experiencing or witnessing extremely stressful often life-threatening event such as assault, abuse, battlefield trauma etc. Features include anxiety, panic attacks, hypervigilance and increased arousal, insomnia nightmares and flashbacks, avoidance behaviour, depression and substance abuse
PTSD Clinical review BMJ 2007;334:789–93
EMDR
Obsessive-compulsive disorder OCD
NICE CG31 Obsessive compulsive disorder (OCD) and body dysmorphic disorder (BDD) Nov 2005
Recurrent repetitive intrusive and distressing thoughts leading to compulsive stereotyped behaviours or rituals despite the patients attempts to resist. Examples include ritual hand washing or other hygiene rituals, checking locks and doors repeatedly, unpleasant obsessive thoughts and ruminations to the extent that they may severely impact on daily living.
Anxiety treatments
Benzodiazepines BZDs
Eating disorders
Internal Link to Paeds/Teenage Health
Cardiff University online Resource
NICE CG9 Eating disorders Jan 2004
Anorexia nervosa deliberate and significant weight loss (15%+) usually through calorie restriction accompanied by a distorted body image where the patient views themselves as obese even though underweight
Bulimia nervosa repetitive and excessive binge eating followed by compensatory vomiting and or laxative or diuretic abuse. There is preoccupation with body image and weight but not the distortd body image as in anorexia nervosa.
youtu.be/1O-fIt-GYx4
youtu.be/FPVK_HkKYYg
Personality disorders
Diverse group of conditions in which the patient thinks feels and behaves dysfunctionally and maladaptively wrt cultural norms causing either personal distress and/or impairement of social and occupational functioning.
Psychopathic
Avoidant
Borderline
Dependant
Histrionic
Narcissistic
Paranoid
Schizoid
NICE CG78 Borderline personality disorder (BPD) Jan 2009
NICE CG77 Antisocial personality disorder Jan 2009
mind.org.uk personality disorders
rcpsych.ac.uk personality disorders
4degreez.com personality disorder test
Schizophrenia and psychosis
NICE CG82 Schizophrenia (update) Mar 2009
Group of disorders characterised by
abnormal thoughts (delusions)
disorders of thought process and speech
abnormal perceptions – hallucinations
abnormal affect
passivity phenomena – thought insertion or broadcasting
cognitive impairement
lack of insight
Positive symptoms
Negative symptoms
Cognitive impairment
( Clinical finals and how to pass them – Henretty et al CL 2008)
Schizo affective disorder
Schizo affective disorder MIND
Diagnostic category to describe patients showing features of both schizophrenia and affective disorder during a single episode of illness – without satisfying diagnostic criteria of either single diagnosis (I feel like I’m making this up)
Delusional disorder
Condition in which patients show persistant (>1 month) delusional symptoms in the absence of frank psychosis or significant mood disorder. Delusions may relate to patients own life circumstances rather than being bizarre or psychotic. Examples include persecutory and hypochondriacal delusions, morbid jealousy and erotomania.
Catatonia
Antipsychotics
rcpsych antipsychotic medication
Antipsychotics & Behavioural Disturbance in the elderly Internal Link
Atypical antipsychotics
nimh.nih.gov mental health medications
understand-schizophrenia.com Atypical antipsychotics
MHRA Drug Safety Update CON111764
Psychopharmocology
Paranoia
Delusions
Thought Block
Pressure of Speech
Hallucinations
<a href=”http://youtu.be/PAY1qysiTvo”youtu.be/PAY1qysiTvo
@@@ Psychosis – breaking the ice
I gather your (mum) is worried about you. I wonder why that is? [pause] or Do you know why this is?
Some Useful Screening Questions
Do you hear voices when no-one is around? What do they say?
Do you ever think that people are talking about you or gossiping about you, maybe even thinking about trying to get you?
Do you ever think that somehow people can pick up on what you are thinking or can manipulate what you are thinking?
Assessing perception hallucinations
Visual olfactory or gustatory hallucinations should make you consider an organic cause?
Does your imagination ever play tricks on you?
Do you ever get the feeling that there is something odd going on that you cannot explain?
Is there anything unusual about the way things look sound or smell?
Auditory Hallucinations?
Do you
Assessing Delusions
Is there any subject you often get into arguments with others with?
Assessing Thought Block
Do you ever experience your thoughts stopping quite unexpectedly so that there are none left in your mind even when your thoughts were flowing freely?
Assessing Thought Interference
Does anything interfere with your thoughts in any way?
Dementia and memory loss
see also in Older People Internal Link
Providing support for dementia patients and carers NPC Rapid Review May 2011
Alzheimers
Lewy Body dementia
Multi-infarct (vascular) dementia
Insomnia
Psychiatric emergencies
250textbooks/psychiatric-emergencies
Understanding Psychiatric Emergencies ppt Emergencies Brian Bledsoe
lifeinthefastlane.com mental health in the ed
psychiatrist-blog psychiatric emergency
Acute confusion / delirium
acutemed.co.uk Acute Confusional State
nmhdu.org.uk delirium or acute confusional state
Managing aggression
Emergency sedation
Childrens Hospital Melbourne Emergency Restraint & Sedation
Emergency Sedation of Agitated Patients Journal Watch (password)
Treatment of Psychiatric Patients in Emergency Settings primarypsychiatry.com
MHA 1983 Mental Health Act
mind.org.ukMental Health Act 1983
direct.gov.uk Mental Health Act
Mental Health Commission – now CQC
Mental Welfare Commission Scotland
Section 12 MHA
rcpsych.ac.uk mental health act 2007
Psychology / psychiatry / psychotherapy
Psychology, psychiatry and psychotherapy NHS careers
Anti psychiatry
Anti-Psychiatry @ Critical Psychiatry
Mind body dualism molecular and neuro-psychiatry
Psychology Skinner Lacan
History of psychotherapy
History of Psychotherapy psychcentral.com
just noticeable differences psychology blog history of psychotherapy freud
Freud
youtu.be/EnVARmZxA-Uhttp://youtu.be/6a8mwidjG8s
Jung
Cognitive behavioural therapy
NLP neurolinguistic programming
Choice theory
Anger management
mind.org.uk dealing with anger
Relaxation techniques
helpguide.org stress relief meditation_yoga_relaxation.htm
mindtools.com stress and relaxation techniques
Relaxation techniques University Maryland Medical Centre
Relaxation Techniques brianmac.co.uk
Community psychiatric services
History of mental health and community care mind.org.uk
mental health services mentalhealthcare.org.uk
Crisis intervention
Early intervention in psychosis
Early intervention Rethink.org
Mental health self help
Self-Help and Serious Mental Illness Medscape
mentalhelp.net online self-help book
National Mental Health Consumers Self-Help Clearinghouse
Substance abuse and mental health services.gov Recovering Your Mental Health A Self Help Guide
lifeline.org.au Mental Health Resource Centre