Title SCA- Mental Health- IMA- DR. A.Ibrahim_watermark.pdf ✅

SCA- MENTAL HEALTH Dr. Amr Ibrahim MB ChB, MD, Alexandria University, Egypt MSc, University of Tsukuba, Japan
PHQ-9 Questioner It is a questioner of 9 question to ask about your symptoms over last 2 weeks, it gives us idea how sever are your symptoms and it can be used to guide our Mx plan. How to explain depression: ▪ common mental health condition that affects how you think, feel, and act. ▪ It can cause a persistent feeling of sadness, loss of interest in activities, and a range of other symptoms. ▪ While everyone experiences ups and downs, depression is a more severe and persistent condition that can significantly interfere with your daily life.
Depression Qs to ask – Don’t forget to ask about ICE ▪ Start with Open Qs (Tell me more, have you noticed any other symptoms) ▪ Ask how long they feel low /have these symptoms? ▪ Over last 2 weeks, have you lost interests or pleasure in doing things that you used to enjoy? If Yes=> how often ▪ Over last 2 W, have you had any issues with sleep? If yes => how often, is it to fall a sleep or maintain good sleep? ➢ Alternatively,=> you could as any issues with sleeping? ▪ How is your appetite, have you noticed any wt. change ( ↑ or↓). ▪ Do you have any friends or family nearby? Do you socialize with them? Do you go for sports? ▪ Do you feel tired or loss of injury? Or do you feel tired all the time? ▪ Do you feel guilty or hopeless? ▪ What about your concentration? ▪ Do you see things that others can't see? ▪ Do you hear voices that others can't hear? ▪ Any thoughts of hurting yourself or ending your life? Any thoughts to hurt others? ➢ You could say it in a nice way: Mr X, some people when they feel low, they tend to hurt themselves or end their life's , have you ever thought about that (or done that) ? ➢ If pt tells you no => acknowledge it and say that’s good and reassuring ➢ If pt says I have thoughts but didn’t act on them => What do you think what made you not acting on them? ➢ If pt tells you yes and I have made a plan or I have tried to end my life => He needs same day Mental health r/v ➢ If pt tells you that they hurt themselves, ask how they have done that and was it to just release their stress or to end their life's. ▪ Ask what they have tried so far for their low mood, have they had any counselling? Did they try any meds? ▪ Ask any stressful events or any triggers can you think of as a cause of your low mood/anxiety? ▪ Lifestyle: VIP here ➢ Some people when they feel low, they tend to drink alcohol, or use some recreational drugs, have you done any like that? ➢ Work and IMPACT on work (have you been off sick because of low mood) and impact on daily life, impact on relationship. ➢ Who is at home? If no one, any family members or friends living nearby? Also ask about financial situation. ➢ Physical activity, hobbies
Diagnosis Assessment The core symptoms: 1. Persisting sadness or low mood 2. Anhedonia Other common symptoms: 1. Disturbed sleep / early morning wakening 2. Change in appetite/ weight 3. Fatigue 4. Agitation / or slowing of movements 5. Poor concentration. 6. Feelings of worthlessness / Guilt. 7. Suicidal ideations/thoughts of self-harm. The DSM-5 criteria: 1. Subthreshold depression: < 5 of the above symptoms, but > 2. 2. Mild depression: 5 or more symptoms with minimal impact on daily life 3. Moderate depression: 5 or more symptoms with functional impact being between severe and mild 4. Severe depression: several symptoms over the requirement for diagnosis. Some of those symptoms would be severe and markedly interfere with functionality. Here are some helpful phrases to broach the subject with patients: ➢ How do you see your future? ➢ Do you ever feel life is hopeless? ➢ Do you feel life is not worth living? ➢ Have you had any darker thoughts about your future? ➢ Have you had any thoughts about ending your life? ➢ Have you made any plans to end your life? If so, what are these plans, and what’s stopped you so far? Always consider factors that contribute towards higher suicide risk; male, young or old, living alone, prior suicide attempts, substance abuse. . Management plan Risk Management: Immediate intervention: For high suicide risk, refer to a crisis resolution team. Safeguarding concerns: Address any concerns related to children or dependents. Substance abuse: Manage substance abuse before addressing depression. Depression Management: Mild to moderate depression: Consider exercise, sleep hygiene, self-guided online CBT, or referral for talking therapies. Moderate to severe depression: Offer antidepressants and high- intensity psychological interventions. Regular follow-up: Monitor progress and adjust treatment as needed.