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Psychiatry symposium

GPs have a pivotal role in bipolar disorder

25 May 2020Paid-up subscribers

Bipolar disorder is a complex, recurrent, severe and potentially lifelong mental illness. The peak age of onset is 15-19 years, with most cases developing before the age of 30. It is crucial to distinguish bipolar from unipolar depression not only as an essential starting point for appropriate treatment and risk management, but also to avoid antidepressant monotherapy which can exacerbate the frequency and severity of mood symptoms and cause resistance to appropriate medications.

Diagnosis and treatment of obsessive compulsive disorder

25 May 2020Paid-up subscribers

Obsessive compulsive disorder (OCD) consists of obsessions (repetitive, intrusive thoughts, urges, impulses or doubts) and compulsions (ritualistic, deliberate behaviours performed in response to obsessions). As well as contamination and safety fears, many patients experience distressing thoughts of causing harm. Sexual obsessions are common, including thoughts regarding sexual orientation, aggressive sexual behaviour or child molestation. Typical compulsions include checking, washing, ruminating, and counting.

 

Paediatric mental health

Optimising the management of depression in children

24 Jul 2020Registered users

In a large meta-analysis, the prevalence of depression was twice as common in adolescents (5.7%) than children (2.8%). The 2:1 female to male ratio of depression seen in adults becomes apparent from the age of 12 years. Three quarters of children aged 3-17 years with depression also have anxiety, and almost half have associated behaviour problems. Depression should be treated by child and adolescent mental health services unless the episode is mild and of < 2-3 months’ duration.

Diagnostic assessment key in autism spectrum disorder

22 Jun 2020Paid-up subscribers

Autism spectrum disorder (ASD) is a complex pervasive neurodevelopmental disorder with an estimated lifetime prevalence of 1%. ASD presents across a wide range of intellectual ability and persists throughout life. Core symptoms include abnormal social interaction and communication, restricted and repetitive interests or activities, associated with lack of cognitive flexibility, and unusual sensory responses. ASD is highly heritable and polygenic. The male:female ratio of ASD is 3:1. Although the behavioural presentation has a childhood onset, approximately 40% of children with ASD are undiagnosed.

 

PTSD

Treating psychological trauma in the real world

23 Jan 2020Paid-up subscribers

After a potentially traumatic event (PTE), many individuals experience either no distress or only transient distress, while others suffer considerable morbidity and may develop post-traumatic stress disorder (PTSD). Around one-third of people experiencing a PTE will develop PTSD, though this varies depending on the type of traumatic event and rates of PTSD are higher with type 2 trauma. Type 2 trauma involves repeated traumatic experiences over extended periods. Although PTSD symptoms can be present acutely, the diagnosis requires the persistence of symptoms for at least one month and the symptoms should cause functional impairment.

Identifying patients with complex PTSD

01 Aug 2016Registered users

Type 2 or complex trauma results from multiple or repeated traumatic events occurring over extended periods. Complex trauma is often associated with other adversity and stressors such as neglect, loss or deprivation. For many individuals these traumas occur at a developmentally vulnerable time with the perpetrator often in a caregiving role. Patients who have experienced complex trauma should be assessed for the core symptoms of PTSD. In addition, patients should be assessed for disturbances in the three domains of emotional dysregulation, negative self-concept and interpersonal disturbances.

 

Women's mental health

Prompt detection vital in postpartum mood disorders

24 Jun 2019Registered users

Common mental health disorders affect around one in five women during pregnancy and the first year following childbirth. Depression and anxiety disorders are the most prevalent mental health disorders during this period as they are at other times of life. It is important to distinguish postnatal depression from baby blues, which is common and requires no treatment, although it is a potential risk factor for postnatal depression. Postpartum psychosis affects 1 in 1,000 women and can develop very quickly in the first two weeks postpartum, often requiring urgent admission to a specialised mother and baby unit. One in six women with bipolar disorder will develop postpartum psychosis. 

Be vigilant for perinatal mental health problems

23 Mar 2015Paid-up subscribers

The postnatal period appears to be associated with higher rates of adjustment disorder, generalised anxiety disorder, and depression. Women who have a history of serious mental illness are at higher risk of developing a postpartum relapse, even if they have been well during pregnancy. Postnatal depression is more severe than baby blues, follows a chronic course and may relapse outside the perinatal period. Bipolar disorder may present as a first depressive episode in pregnancy or the postnatal period. In the postpartum period women have a high risk of severe relapse.

 

Mental health in older people

Diagnosing and managing dementia in primary care

25 Sep 2019Paid-up subscribers

In patients with suspected dementia, the history should cover cognitive, behavioural and psychological symptoms, and the impact symptoms have on daily life. A physical examination is necessary to look for any focal neurological signs and to exclude any visual or auditory problems. Baseline blood tests should be carried out. A medication review should be undertaken as many commonly prescribed drugs have anticholinergic effects which can exacerbate cognitive impairment. A brief cognitive screening test should be performed before referral to a memory clinic.

Diagnosing and treating mood disorders in older people

05 Feb 2019Registered users

Depression in older adults is common. Depressive symptoms may be part of a recurrent depressive disorder or experienced for the first time in later life as a result of changes in risk and resilience factors. There is an association between cerebrovascular pathology, vascular risk factors and depression. Physical illnesses, particularly those associated with frailty, are also important risk factors for depression. Depression has a distinct presentation in late life and low mood may not be the predominant presenting symptom. Older patients may present with physical symptoms, apathy, cognitive symptoms, agitation, retardation, fatigue or weight loss.

 

Research reviews: Mental health

Evaluating therapies for depression in children and adolescents

24 Jul 2020Registered users

Fluoxetine, either alone or in combination with cognitive behaviour therapy, appears to be the most effective treatment for children and adolescents with moderate to severe depression, a systematic review and network meta-analysis has concluded. NICE recommends that antidepressants should not be initiated in primary care.

Substance use disorder raises risk of treatment resistant depression

23 Apr 2020Paid-up subscribers

Recent or current substance use disorder is associated with treatment resistance in patients who receive prescription treatment for depression, a nested case control study has found.

 

Editorials

Delirium linked to cognitive decline

24 Sep 2020

Delirium is associated with an increased risk of subsequent cognitive decline and there is evidence to suggest that the association is causal, a systematic review and meta-analysis has found. Every study found that those with delirium experienced greater cognitive decline than controls and the combined odds for a given cognitive decline were more than doubled in patients with delirium; OR 2.30. Subgroup analyses provided evidence that delirium is a causative factor rather than a marker of vulnerability to dementia.

Inactivity and depression in adolescence

22 Jun 2020Registered users

Sedentary behaviour during adolescence is associated with an increased risk of depressive symptoms at the age of 18, a UK study has found. Healthcare practitioners should ensure that parents and carers are aware of government advice on how much physical activity children and young people should be doing (i.e. at least 60 minutes of moderate-vigorous activity per day). Adolescents should be routinely asked about physical activity and sedentary behaviour levels, and every opportunity taken to emphasise the mental health benefits of physical activity.