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MENTAL HEALTH

General practice deals with a great number of issues related to mental health. Many patients’ problems are short term, and resolve without medication or external support; others need medication and/or support from various disciplines, such as psychiatric team, community psychiatric nurse (CPN) or various counselling services. Patients with more severe illness need referral to the psychiatric unit for assessment. An acute episode/psychiatric emergency needs intervention by the local Crisis/Acute Intervention Team; this may entail a voluntary (informal) admission or involuntary detention under Section 12 of the Mental Health Act, in the interests of patient’s health and safety or the safety of others or both.

GP Notebook. Using the Mental Health Act in primary care. https://gpnotebook.com/en-gb/simplepage.cfm?ID=-1093664699

Royal College of Psychiatrists. Being sectioned (in England and Wales) https://www.rcpsych.ac.uk/mental-health/treatments-and-wellbeing/being-sectioned

Mental Health First Aid Mental health training online and face to face. https://mhfaengland.org

Practice Nurse featured article 

A Practice Nurse guide: Common mental health problems Dr Mandy Fry

ANXIETY

People with generalised anxiety disorder (GAD) feel anxious most days, with tension and apprehension affecting daily life (see Appendix for an assessment tool). GAD affects about 1 in 50 at some stage in their lifetime. Conditions causing severe anxiety include:

• phobias

• panic disorder

• post-traumatic stress disorder. Mixed anxiety/depression is common.

See also Depression

NICE CG113 Generalised anxiety disorder and panic disorder in adults: management; 2011 https://guidance.nice.org.uk/CG113

NICE NG116 Post-traumatic stress disorder (PTSD) The management of PTSD in adults and children in primary and secondary care, 2005 https://www.nice.org.uk/guidance/ng116

Practice Nurse featured article

Integrated therapy for anxiety Dr Mandy Fry 

A Practice Nurse Guide: Common mental health problems Dr Mandy Fry 

A Practice Nurse guide to common mental health problems: Anxiety disorders Dr Mandy Fry 

Practice Nurse Curriculum Module 

Anxiety

BIPOLAR AFFECTIVE DISORDER

Condition characterised by extreme mood swings between severe depression and over-excitability. Affects about 1% of the population at some time in life, with one or two, or many episodes. Occurs in both sexes, onset usually at 18-24 years.

NICE CG185 Bipolar disorder The management of bipolar disorder in adults, children and adolescents in primary and secondary care; 2014 (updated 2020) https://www.nice.org.uk/guidance/cg185

DEPRESSION

The most common mental health problem is a serious, under-detected condition in which severe feelings of sadness, hopelessness and loss of interest in life interfere with daily life and can last for weeks or months. Affects up to 1 in 3 at least once, and occurs in all age groups, including children and adolescents. Long-term medical conditions increase risk of major depression. A family history of depression also increases risk.

NICE NG222. Depression in adults: treatment and management; 2022 https://nice.org.uk/guidance/ng222

NICE CG91 Depression in adults with a chronic physical health problem: recognition and management; 2009 https://www.nice.org.uk/CG91

NICE QS48 Depression in children and young people2013 https://www.nice.org.uk/guidance/qs48

Clinical features of depression

  • Symptoms of low mood: little interest (anhedonia), poor concentration, apathy/helplessness/hopelessness, tearfulness, pessimism
  • Somatic symptoms: poor appetite, weight loss, insomnia, constipation, low libido.
  • Psychotic symptoms: hallucinations, delusions.

Screening for depression

In primary care settings, NICE guidance advises:

  • screening high-risk groups, e.g. if past history of depression, significant physical illnesses causing disability, long-term conditions, e.g. COPD, CVD, or other mental health problems such as dementia.
  • use of at least two questions concerning mood and interest; for example:

1. During the past month, have you often been bothered by feeling down, depressed or hopeless? and

2. During the past month, have you often been bothered by having little interest or pleasure in doing things?

A ‘no’ response to both questions makes depression highly unlikely. A ‘yes’ answer to either question is considered a positive test, and the person should be reviewed by a practitioner competent in mental health assessment. Mixed anxiety/depression is common.

See also Anxiety

 

Depression Alliance https://www.depressionalliance.org

Samaritans https://www.samaritans.org 116 123 email: jo@samaritans.org

Perinatal depression/Postnatal depression 

Depression that occurs during pregnancy or within a year of delivery. Postnatal depression affects c. 1 in 10 mothers and untreated can last weeks or months. Lack of support (emotional or practical), socioeconomic difficulties and a history of mental illness can increase risk.

Postnatal mental health - leaflets (in various languages) and videos for patients, carers and professionals. Royal College of Psychiatrists https://www.rcpsych.ac.uk

Practice Nurse featured articles

Prescribing in depression Dr Ed Warren 

Men and mental health Dr Ed Warren

Postnatal depression: a need for vigilance Pat MacDonald 

A Practice Nurse guide to common mental health problems: Depression Dr Mandy Fry

Practice Nurse Curriculum Module

 

Depression 

Obsessive-compulsive disorder (OCD)

Common mental health condition (2-3% of UK population) that may be mild or severe. Person repeatedly has unwanted thoughts/images/urges and compulsion to perform a certain behaviour/mental act that gives them no pleasure

NICE CG31 Obsessive-compulsive disorder: Core interventions in the treatment of obsessive-compulsive disorder and body dysmorphic disorder, 2005 (reviewed 2019, to be updated) https://www.nice.org.uk/guidance/cg31
OCD-UK (Support for children and adullts affected by OCD). https://www.ocduk.org

OCD-UK www.ocduk.org

Post traumatic stress disorder 

Post traumatic stress disorder (PTSD) is a mental health disorder that develops after exposure to a stressful event or situation of an exceptionally threatening or catastrophic nature. It is thought that 25 - 30% of people exposed to such an event or situation will develop the disorder. The incidence of PTSD has increased markedly since the conflicts in Iran and Afghanistan, but the condition also affects 'civilians' - for example, women who experience prolonged or difficult labour. 

Self-harm

Happens when a person hurts or harms themselves, usually while distressed and highly emotional. Self-harm expresses inner turmoil and can help the person feel better able to cope for a while; may be planned or sudden; may occur once or twice or be regular. Self-harmers may hit, cut or burn themselves; take an overdose; pull their hair; pick their skin; take too many drugs; drink too much alcohol. Self-harm affects about 1 in 10 young people at some point, but can occur at any age. • Be aware of unexplained skin damage/scars.

NICE CG16 Self-harm in over-8s: short-term management and prevention of recurrence; 2004 (reviewed 2019, to be updated). https://www.nice.org.uk/guidance/cg16

Royal College of Psychiatrists. Self-harm https://www.rcpsych.ac.uk/mental-health/problems-disorders/self-harm

Schizophrenia

Serious psychotic mental health condition. Symptoms include hallucinations and delusions; i.e, the person is unable to distinguish between reality and their imagination. One person in 100 will experience at least one acute episode; about a quarter recover within 5 years, about two-thirds have fluctuating symptoms over many years, 10-15% have severe long-term incapacity. Affects both sexes equally, with onset usually at 15–30 years in men, 25–30 years in women.

NICE CG178 Psychosis and Schizophrenia in adults: treatment and management, 2014 https://guidance.nice.org.uk/CG178

NICE CG155 Psychosis and Schizophrenia in children and young people: recognition and management; 2013 (updated 2016).  https://www.nice.org.uk/guidance/cg155

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