Adult Psychiatry in Primary Care

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Adult Psychiatry in Primary Care

• A symptom-based overview

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Epidemiology of Mental Health
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Bad, Mad or Sad?

• Personality Disorders
• Major Mental Illness
• Minor Mental Illness

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Presentation

• I cant cope
• I feel anxious
• I think Im going mad
• Theres nothing wrong, my wife just thought I
  ought to get checked out ...

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Common things are common

• Depression
• Anxiety
• Substance Misuse
• Dementia
• Schizophrenia

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Depression (F 32)

• Physical
• Sleep (EMW), fatigue
• Poor appetite, or comfort eating
• Psychomotor
• retardation
• agitation
• Libido
• Psychological
• Cognitive

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Depression (F 32)

• Physical
• Psychological
• Low mood
• Guilt, self-blame
• Hopeless
• Irritable
• Suicidal ideation
• Cognitive

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Depression (F 32)

• Physical
• Psychological
• Cognitive
• Poor concentration
• Poor memory
• Hypercritical
• Ruminating

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Depression

• Management
• Drug Rx?
• Therapy
• Family
• Cognitive (individual)
• School liaison

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Drug Therapy

• Tricyclic
• Amitriptyline, Motival
• Dothiepin, Trazodone
• SSRI
• Fluoxetine, Paroxetine
• Venlafaxine, Sertraline
• Other
• MAOI, Tryptophan

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Other Depression

• Postnatal Depression
• Seasonal Affective Disorder

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Manic-Depressive Illness (F30.0)

• Strong genetic predisposition. onset often early
  (lt30)
• euphoria, pressure of thought/speech, insomnia,
  restlessness, lack of insight
• Management
• neuroleptic
• Lithium
• Carbamazepine/Valproate/Verapamil/Clonazepam

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Anxiety F40-48

• Generalised
• Panic Disorder (F41.0)
• Phobias (F40)

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Phobias and all that.

• Agoraphobia F40.0
• Social phobias F40.1
• Simple phobia F40.2
• Obsessive-Compulsive Disorder F42
• Panic Disorder F41.0
• PTSD F43.1

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Substance Abuse

• Alcohol
• Opiate
• Stimulant
• Street Jargon
• Drug/Alcohol Team
• Addaction Lincolnshire

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Schizophrenia
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Psychiatric Emergencies
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The Mental Health Act 1983

• Allows for Assessment
• Treatment still requires consent
• Detention for fixed period
• Treatment only of Mental Health Problem

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MHA Section 2

• Admission for assessment OR
• Admission for assessment/treatment
• up to 28 days
• application nearest relative or ASW
• recommendation 2 Drs
• 1 Section 12approved
• 1 previous knowledge of patient

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MHA Section 3

• Admission for treatment
• up to 6 months, renewable
• recommendation 2 doctors
• application nearest relative or ASW
• if nearest relative objects, ASW cannot apply
• ASW can apply to Court to have relative removed

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MHA Section 4

• Admission in emergency for assessment
• up to 72 hours
• section 2 will be organised on admission
• application nearest relative or ASW
• recommendation nearest relative/ASW plus one
  doctor with prior knowledge of patient

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OCD

• Obsessive Compulsive Disorder
• intrusive, repetitive thoughts
• anxiety-provoking
• ?abnormal 5HT transmission

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Eating Disorders

• Anorexia Nervosa F50.0
• Deliberate weight loss resulting in a bodyweight
  more than 15 below the norm
• Bulimia Nervosa F50.2
• Repeated bouts of overeating and an excessive
  preoccupation with the control of bodyweight

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Anorexia Nervosa

• Weight reduced by
• avoidance of food
• overactivity
• excessive exercise
• appetite suppressants
• laxatives/diuretics

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Anorexia Nervosa complications
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Anorexia Nervosa management

• Aim to restore healthy weight and diet
• Gradual work towards patient accepting need
  responsibility for healthy weight
• Hospital admission?
• Behavioural therapy

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Bulimia Nervosa

• Differs from Anorexia
• Binge Eating
• Purging
• vomiting
• laxatives, diuretics
• Prevalence 0.5-1, peak age in 20s

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Bulimia Nervosa

• Physical features
• salivary gland enlargement
• erosion of dental enamel
• calluses dorsum of hand (Russells sign)
• metabolic disturbances
• Management
• Behavioural therapy
• ?SSRI

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Other specific disorders

• Obsessive Compulsive Disorder F42
• Sleep Disorders
• Trichotillomania
• Tic

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Tic disorders

• Involuntary rapid, recurrent, non-rhythmic motor
  movements or vocal production
• Gilles de la Tourettes Syndrome
• multiple tics
• facial, limb
• compulsive utterances
• coprolalia
• Treatment