Special Interest: Mental health

Autism covers a wide spectrum across the dimensions of social communication, repetitive and stereotyped behaviours as well as other non-clinical and cognitive features. Individuals with autism can function well in certain environments, where there are fewer demands to multitask and factual information and pattern recognition are required, but they may not function well in highly social environments, or situations characterised by rapid and unpredictable change.

The prevalence of mild cognitive impairment in adults aged 65 and over is estimated to be 10-20%. It is likely that this figure will increase in line with trends in dementia diagnosis. In some cases, mild cognitive impairment may be a prodrome for dementia, and may be caused by any of the dementia pathology subtypes. It is important to obtain a history of cognitive changes over time, as well as information about the onset and nature of cognitive symptoms, confirmed by a reliable informant, if available.

The most common causes of young onset dementia are early onset forms of adult neurodegenerative conditions and alcohol. Vascular dementia is the second most common cause of young onset dementia after Alzheimer’s disease. Conventional vascular risk factors may be absent and diagnosis relies on imaging evidence of cerebrovascular disease. Those with suspected young onset dementia should be referred to a neurology-led cognitive disorders clinic where available as the differential diagnosis is considerably broader than in older adults and requires specialist investigation.

With a 10.5% lifetime risk, self-reported self-harm is common in the community: 5.6% have made a suicide attempt. Self-harm without lethal intent is slightly less common at 4.9%. Following an episode of self-harm the GP can offer assessment and practical support, for example, monitoring type and quantity of medication prescribed, and signposting or referral where relevant. GPs are ideally placed to support patients and their families following self-harm through an understanding and nonjudgmental approach which aims to alleviate distress.

Adults in the UK with a diagnosis of either ICD-10 depressive episode or ICD-10 mixed anxiety and depressive disorder have been estimated to have taken more than a quarter of the total number of days of sickness absence in one year. Few patients receive effective treatment. There are four reasons for this: failure to seek help (40% don't attend); failure of GPs to recognise depression (30-50% of cases); non-adherence or early cessation of treatment (only about 25% of patients complete a six-month course of antidepressant treatment);lack of treatment efficacy (50% with moderate depression don't respond to initial treatment). Only about one in ten patients receive effective treatment.

In bipolar disorder patients are intermittently severely ill and unable to function, but they usually return to their normally functioning self. The extremes of symptoms and experiences require intensive specialist care,  but the overall success of management will depend on an informed and complementary interaction between primary and secondary care. Bipolar disorder is at least twice as common as schizophrenia, and eminently treatable. It is perfectly suited to the well established outpatient model practised in general practice.

In recent decades the care of people with schizophrenia has shifted from hospital to the community. The GP's role has thus expanded, a fact reflected by the emphasis placed on primary care involvement in the recently updated NICE guideline on schizophrenia. On average GPs in the UK will have 7-12 people with schizophrenia on their lists, and for some of these patients they may be the sole provider of care.

There is a strong and independent association between manic episodes and a history of eating nitrate-cured meat products, a US study has found.

The children of women with severe persistent postnatal depression (PND) are at substantially increased risk of preschool behaviour problems, poor academic attainment and adolescent depression, a UK longitudinal cohort study has found.

If healthy adults exercise for a minimum of an hour each week, their risk of incident depression can be reduced by 12%, a Norwegian prospective cohort study has found.