Mental Health In Practice Nursing
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WHAT HAPPENS IF YOU CAN'T FIND IT WITHIN?
Research into what is going on in the brain for those people with mental health issues, continues apace.
. For example, depressed individuals had hyperactivity in the subgenual anterior cingulate cortex (sgACC: Drevets et al., 1997),
More recently, it has been proposed that using visuo-spatial distraction to prevent the initial consolidation of memories in the aftermath of traumatic exposure could act as a ‘cognitive vaccine’, stopping the development of flashbacks in the first place (Holmes et al., 2010)
There is still however, no distinct cause for many of the conditions discussed and mental health issues seem to be driven by a variety of factors
. For example, depressed individuals had hyperactivity in the subgenual anterior cingulate cortex (sgACC: Drevets et al., 1997),
More recently, it has been proposed that using visuo-spatial distraction to prevent the initial consolidation of memories in the aftermath of traumatic exposure could act as a ‘cognitive vaccine’, stopping the development of flashbacks in the first place (Holmes et al., 2010)
There is still however, no distinct cause for many of the conditions discussed and mental health issues seem to be driven by a variety of factors
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SCALE OF THE PROBLEM
- Generalised anxiety disorder 5.9 in 100 people
- Depression 3.3 in 100 people
- Phobias 2.4 in 100 people
- OCD 1.3 in 100 people
- Panic disorder 0.6 in 100 people
The next 3 slides show the scale of the problem and these figures do not include prison inmates or hospitalised patients.
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SCALE OF THE PROBLEM
- Post traumatic stress disorder (PTSD) 4.4 in 100 people
- Mixed anxiety and depression 7.8 in 100 people
- Suicidal thoughts 20.6 in 100 people
- Suicide attempts 6.7 in 100 people
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SCALE OF THE PROBLEM
- Self-harm 7.3 in 100 people
- Psychotic disorder 0.7 in 100 people
- Bipolar disorder 2.0 in 100 people
- From MIND 2016 [2] McManus S, Bebbington P, Jenkins R, Brugha T. (eds.) (2016). Mental health and wellbeing in England: Adult psychiatric morbidity survey 2014. Leeds:
90% of people with mental health problems are treated in the community.
30-50% have no input from mental health providers.
Gask L, Lester H, Kendrick T and Peveler R. (2009) Primary care mental health. London: Royal College of Psychiatrists.
30-50% have no input from mental health providers.
Gask L, Lester H, Kendrick T and Peveler R. (2009) Primary care mental health. London: Royal College of Psychiatrists.
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I HAD A BLACK DOG HIS NAME WAS DEPRESSION
https://www.youtube.com/watch?v=XiCrniLQGYc&sns=em
World Health Organisation video from Matthew Johnstone
https://www.mind.org.uk/media/944494/MIND_ProCEED_Training_Pack.pdf?ctaId=/...
World Health Organisation video from Matthew Johnstone
https://www.mind.org.uk/media/944494/MIND_ProCEED_Training_Pack.pdf?ctaId=/...
ANXIETY
The brains of humans and some animals naturally synthesize endocannabinoids, molecules that help regulate functions including appetite, mood and response to stress. An ample supply of endocannabinoids keeps anxiety under control.
When something stressful happens — a deadline approaches or travel plans go awry — the fight or flight response floods the brain with corticotropin-releasing hormone (CRC), this degrades the endocannabinoids and causes anxiety.
World of Psychology
About the Blog
Archives
New Research into Anxiety Disorders
When something stressful happens — a deadline approaches or travel plans go awry — the fight or flight response floods the brain with corticotropin-releasing hormone (CRC), this degrades the endocannabinoids and causes anxiety.
World of Psychology
About the Blog
Archives
New Research into Anxiety Disorders
Depression questions
•‘During the last month have you often been bothered by feeling down, depressed, or hopeless?’ Yes/No
•‘During the last month have you often been bothered by having little interest or pleasure in doing things?’ Yes/No
Anxiety questions:
•‘Do you feel nervous, anxious or on edge?’ Yes/No
•‘Do you feel unable to stop worrying?’ Yes/No
Help question:
•‘Is this something with which you would like help?’ No/Yes, but not today/Yes
https://www.mind.org.uk/media/944494/MIND_ProCEED_Training_Pack.pdf?ctaId=/...
Whooley questions come from ICD-10 diagnosis of depression.
Follow up with PHQ-9 questionnaire for depression.
The questions for Anxiety come from a questionnaire called GAD-2 follow up might be
GAD-7.
Whooley questions come from ICD-10 diagnosis of depression.
Follow up with PHQ-9 questionnaire for depression.
The questions for Anxiety come from a questionnaire called GAD-2 follow up might be
GAD-7.
Photo by Leo Reynolds
FACTORS FOR
GENES, AGE,MALE ,PREVIOUS ATTEMPTS,NEGATIVE LIFE EVENT AND SOCIAL PROBLEMS.
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QUESTIONS TO ASK
- Have you attempted this before?
- Have you made a plan?
- Have you got the tools to carry out the plan?
- What would stop you?
General questions may lead up to this.
Like you seem very down to me?
Is there available support? Family etc.
Be open and honest with the patient and ask their permission to record this information. Patients should also have a clear pathway for help.
Asking questions has not been shown to lead to an increased risk for patients so don't be afraid to ask them.
Assessment of suicide risk in people with depression
Centre for Suicide Research , Department of Psychiatry, University of Oxford.
Like you seem very down to me?
Is there available support? Family etc.
Be open and honest with the patient and ask their permission to record this information. Patients should also have a clear pathway for help.
Asking questions has not been shown to lead to an increased risk for patients so don't be afraid to ask them.
Assessment of suicide risk in people with depression
Centre for Suicide Research , Department of Psychiatry, University of Oxford.
Photo by Rakesh JV
REFERRAL
Varies from locality to locality but essentially there are several ways a patient can be referred. Many services encourage self-referral and the patient can be given details of their local team to contact.
Crisis team for patients with high suicide risk factors or anyone in mental health crisis.
GP and Health visitors for assessment and follow up.
Support from Social services, housing, alcohol and drug agencies.
The Improving Access to Psychological Therapies (IAPT) programme aims to put more trained therapists into GP surgeries. This should provide easier access to talking treatments on the NHS. The service is already available in some parts of England.
Although some IAPT services allow self-referrals, most will need a referral from a GP or another specialist mental health team.
The therapy offered will usually be a course with a fixed number of sessions of a particular type of therapy. Psychological therapies involve a person talking to a wellbeing practitioner or therapist, either one-to-one, in a group or with family and friends.
Types of psychological therapy that are approved for use within the NHS include:
cognitive behavioural therapy (CBT)
interpersonal psychotherapy (IPT)
brief dynamic interpersonal therapy (DIT)
eye movement desensitisation and reprocessing therapy (EMDR)
couples therapy for depression
counselling for depression
behavioural family therapy and cognitive behavioural family interventions
intensive placement employment support
Crisis team for patients with high suicide risk factors or anyone in mental health crisis.
GP and Health visitors for assessment and follow up.
Support from Social services, housing, alcohol and drug agencies.
The Improving Access to Psychological Therapies (IAPT) programme aims to put more trained therapists into GP surgeries. This should provide easier access to talking treatments on the NHS. The service is already available in some parts of England.
Although some IAPT services allow self-referrals, most will need a referral from a GP or another specialist mental health team.
The therapy offered will usually be a course with a fixed number of sessions of a particular type of therapy. Psychological therapies involve a person talking to a wellbeing practitioner or therapist, either one-to-one, in a group or with family and friends.
Types of psychological therapy that are approved for use within the NHS include:
cognitive behavioural therapy (CBT)
interpersonal psychotherapy (IPT)
brief dynamic interpersonal therapy (DIT)
eye movement desensitisation and reprocessing therapy (EMDR)
couples therapy for depression
counselling for depression
behavioural family therapy and cognitive behavioural family interventions
intensive placement employment support
MEDICATION
Medication for depression and anxiety include:-
•Selective serotonin reuptake inhibitors or SSRIs (fluoxetine, citalopram, sertraline, paroxetine), Others (mirtazepine, venlafaxine)
Drugs used for psychotic disorder:
•Antipsychotics (e.g. olanzapine, risperidone, aripiprazole, quetiapine, clozapine)
Drugs used for bipolar disorder:
•Antipsychotics, antidepressants, ‘mood stabilisers’ (lithium, valproate, lamotrigine, carbamazepine)
•Selective serotonin reuptake inhibitors or SSRIs (fluoxetine, citalopram, sertraline, paroxetine), Others (mirtazepine, venlafaxine)
Drugs used for psychotic disorder:
•Antipsychotics (e.g. olanzapine, risperidone, aripiprazole, quetiapine, clozapine)
Drugs used for bipolar disorder:
•Antipsychotics, antidepressants, ‘mood stabilisers’ (lithium, valproate, lamotrigine, carbamazepine)
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GLOSSARY
- CBT- cognitive behaviour therapy
- EMDR- eye movement desensitisation and reprocessing
- GAD- generalised anxiety disorder
- IAPT- improving access to psychological therapies
- HADS- hospital anxiety and depression scale
- OCD-obsessive compulsive disorder
- PHQ-9 9 item patient health questionnaire
- PTSD- post-traumatic stress disorder
- ERP-exposure and response prevention
- IPT-interpersonal therapy
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USEFUL WEBSITES
BALANCE
Practice nurses are ideally placed to recognise and refer on patients who have mental health issues. Often the first person people will talk to is a practice nurse.
Don't be afraid to inquire. So that patients can bring their lives back into balance.
Don't be afraid to inquire. So that patients can bring their lives back into balance.
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