Mental Health

Mental health is a high-yield AKT topic. Questions cover diagnosis, management, prescribing, risk assessment, and the legal framework. Depression and anxiety account for the majority of questions, but you also need to know about psychosis, eating disorders, and the Mental Health Act.

Depression is diagnosed using ICD-11 criteria: persistent low mood, loss of interest or enjoyment, and reduced energy, plus at least two additional symptoms including poor concentration, low self-esteem, guilt, pessimism, sleep disturbance, appetite change, and suicidal thoughts. Severity guides treatment: mild depression is managed with guided self-help, exercise, and watchful waiting. Moderate to severe depression warrants an SSRI (sertraline is first-line per NICE) alongside psychological therapy.

SSRI prescribing: sertraline is first-line. Common side effects include nausea, headache, insomnia, and sexual dysfunction. The suicide risk warning applies to all antidepressants in under-25s. Discontinuation symptoms occur with abrupt cessation, particularly with paroxetine and venlafaxine. Serotonin syndrome is a rare but serious complication of excessive serotonergic activity (agitation, tremor, clonus, hyperthermia).

Anxiety disorders include generalised anxiety disorder (GAD), panic disorder, social anxiety, and OCD. NICE recommends stepped care: self-help and psychoeducation first, then CBT (the most effective psychological therapy for anxiety), then SSRI (sertraline for GAD and panic, fluoxetine for OCD) if psychological therapy alone is insufficient.

Psychosis in primary care: refer urgently to early intervention in psychosis services if first episode. Antipsychotics should ideally be initiated by a specialist. Know the metabolic side effects of antipsychotics (weight gain, diabetes, dyslipidaemia) and the need for metabolic monitoring (weight, glucose, lipids at baseline and annually).

The Mental Health Act 1983 (amended 2007): Section 2 is assessment for up to 28 days (requires two doctors and an approved mental health professional). Section 3 is treatment for up to 6 months. Section 136 allows police to remove a person from a public place to a place of safety. GPs can be one of the recommending doctors for Sections 2 and 3.

Risk assessment for suicide involves asking directly about suicidal thoughts (this does not increase risk), assessing intent, plan, means, and protective factors. High-risk features include a clear plan, access to means, previous attempts, social isolation, and substance misuse.