Mental health

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 



MBBS Psychiatry Newcastle

youtube Doctor of Mind MD

Opening Skinner’s box

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.

Premorbid Personality
Current Circumstances
Appearance Behaviour


ABC of mental health: Mental health assessment BMJ 1997

MSE frontier



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



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

Mania / Hypomania



SIGN qrg 114 non-pharmocological Rx depression Jan 10

NICE CG90 Depression in adults (update) Oct 2009


7 As of depression
Appetite loss
Am waking
Asexual – decreased libido

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



Hospital Anxiety and depression score





Depression treatments

Newer antidepressants BMJ Feb 2012


Seasonal affective disorder SAD

Seasonal Affective Disorder PUK

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

Suicide and DSH

fms teaching suicide and DSH

Suicide and Chronic Ill Health – Demos Pamphlet @ NHS Networks


Bipolar disorder BPD

persistant mild elevation of mood lasting at least several days

as hypomania + psychotic symptoms including grandiose delusions and auditory hallucinations

NICE CG38 Bipolar disorder Jul 2006




NICE CG113 Anxiety Jan 11



Panic Disorder


Phobic anxiety disorders

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

NICE CG26 PTSD Mar 2005

PTSD Clinical review BMJ 2007;334:789–93

PTSD algorithm RACGP


EMDR Training


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


NICE Self-Help Resourses pdf


Benzodiazepines BZDs

BZDs medscape

Benzodiazepines RACGP


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.


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.


NICE CG78 Borderline personality disorder (BPD) Jan 2009

NICE CG77 Antisocial personality disorder Jan 2009 personality disorders personality disorders 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.





rcpsych antipsychotic medication

Antipsychotics & Behavioural Disturbance in the elderly Internal Link

Antipsychotics PUK

MHRA antipsychotics


Atypical antipsychotics

NICE CG82 mental health medications Atypical antipsychotics

MHRA Drug Safety Update CON111764




Paranoia paranoia



Thought Block

Pressure of Speech



Hallucinations medline plus

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@@@ 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

Dementia Alliance

Providing support for dementia patients and carers NPC Rapid Review May 2011

Lewy Body dementia
Multi-infarct (vascular) dementia



Insomnia BMJ April 2011

Melatonin @ MedlinePLus

Melatonin @

NHS choices Insomnia

Insomnia PUK

deep sleep App andrew johnson

Sleep Diary PUK


Psychiatric emergencies



Understanding Psychiatric Emergencies ppt Emergencies Brian Bledsoe mental health in the ed

psychiatrist-blog psychiatric emergency


Acute confusion / delirium



Acute confusion Medscape

Acute Confusional State PUK Acute Confusional State delirium or acute confusional state


Managing aggression

Aggresive patients medscape


Emergency sedation

Childrens Hospital Melbourne Emergency Restraint & Sedation

Emergency Sedation of Agitated Patients Journal Watch (password)

Treatment of Psychiatric Patients in Emergency Settings Violent patients


MHA 1983 Mental Health Act

250textbooks/mha Health Act 1983 Mental Health Act

MHA Downloadable Forms


Mental Health Commission – now CQC

Care Quality Commission

Mental Welfare Commission Scotland


Section 12 MHA mental health act 2007


Psychology / psychiatry / psychotherapy

Psychology, psychiatry and psychotherapy NHS careers


Anti psychiatry

Critical psychiatry website

Anti-Psychiatry @ Critical Psychiatry


Mind body dualism molecular and neuro-psychiatry


Psychology Skinner Lacan


History of psychotherapy

History of Psychotherapy

just noticeable differences psychology blog history of psychotherapy freud





cg jung


Cognitive behavioural therapy

Ten Minute CBT

10 minute CBT videos Scion


CBT NHS Choices



NLP neurolinguistic programming


the nlp


Choice theory


Anger management dealing with anger

NHs Choices Anger management anger control


Relaxation techniques stress relief meditation_yoga_relaxation.htm stress and relaxation techniques

Relaxation techniques University Maryland Medical Centre

Relaxation Techniques


Community psychiatric services

History of mental health and community care

Mental Health

Community Care

mental health services


Crisis intervention

Crisis Intervention PUK


Early intervention in psychosis


Early intervention


Mental health self help

Self-Help and Serious Mental Illness Medscape online self-help book

National Mental Health Consumers Self-Help Clearinghouse

Substance abuse and mental health Recovering Your Mental Health A Self Help Guide Mental Health Resource Centre



Book Prescription Scheme Wales

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