5/ Menal Health Flashcards
What are some contributors to suicidal thoughts in medical students?
- Unhappy about achievement
- Self criticism
- Stigma
- Don’t know who to go to
- Culture of bravado
- Feeling trapped
- Comparison
- Existential issues
- Sexual, sexuality or gender issues
What is your role in a situation where someone is suicidal?
- Depends on the person and your own needs
- Mostly keep them safe for now until someone else can take over
What are some high priority warning signs for suicide?
- Threatening to kill themselves
- Actively looking for ways to kill themselves
- Talking or writing about death, dying or suicide
What are some low priority warning signs for suicide?
- Hopelessness
- Anger, revenge seeking
- Risky behaviours
- Feeling trapped
- Inc. drug and alcohol use
- Social withdrawal
- Anxiety, agitation, sleep disturbance
- Significant mood changes
- N purpose, no reason for loving
What are the 3 steps to dealing with a suicidal person?
- Connecting with suicide (I care)
- Understanding choices (I hear you)
- Assisting life (I’ll help)
What are the three branches of understanding choices related to suicide?
- Ask about a plan
- Listen to their story
- Identify turning points
What are some examples of turning points related to a convo about suicide?
- Rejects suicide
- Hopes for something
- Uncertain about choices
- Willing to try
How do you assist life with a suicidal person?
- Develop a safety plan and confirm actions
2. Identify life protectors
What is the purpose of the mental state exam?
- Elicit symptoms and signs to aid diagnosis
- Ensure assessments are consistent across time and examiners
- Monitor the patient over time
What are the components of a mental state exam?
(ASEPTIC R)
- Appearance and behaviour
- Speech
- Emotion (mood, affect)
- Perception (hallucinations, illusions)
- Thoughts (form, content)
- Insight and judgement
- Cognition
- Risk
What are important aspects of behaviour in the MSE?
- Eye contact
- Co operativeness
- Motor activity
- Abnormal movements
- Expressive gestures
What aspects of speech do you assess in the MSE?
- Articulate disturbance
- Rate
- Volume
- Quantity
Distinguish between mood and affect
Mood = subjective (what the patient reports)
Affect = objective
What are important aspects of mood?
- Range
- Depth
- Appropriateness
- Volatility
Distinguish between hallucinations and illusions
Hallucinations = sense something in the absence of stimuli
Illusions = when something is there but you see it as something else
What are some aspects of thought form/process in the MSE
- Goal direct/organised
- Amount or speed of thought
- Continuity of ideas
- Disturbances in language
What are some different types of delusions?
- Religious
- Nihilistic
- Morbid jealous/infidelity
- Grandoise
- Guilt and worthlessness
- Somatic//hypochondriacal
- Erotomaniac
Distinguish between insight and judgement
Insight = what you know Judgement = what you do with that
What are two tools to assess cognition?
MMSE or MOCA
How do you assess cognition in the MSE?
- Level of consciousness/alertness
- Memory
- Orientation (time, place, person)
- Concentration
- Abstract ideas
What are the three types of risk you assess in the MSE?
- To self (suicide, self harm)
- To others (violence, homicide)
- From neglect
What are the 3 circuitries for happiness?
- Calm/contentment
- Excitement/drive
- Connection/Compassion
What is the difference between empathy and compassion?
Empathy is recognising suffering but compassion is wanting to alleviate it (motivation)
If the brain is wired for compassion why is there so much hate in the world?
- Only one mind state at a time
- The brain is wired for survival, not to be happy
- Compassion is difficult when you are under threat
Compassion is ____
Conditional
What are 4 barriers to compassion in medicine?
- Burnout/fatigue
- Difficult patient/family
- External distraction
- Clinical complexity
What are some clinician factors for enhancing compassion?
- Address burnout and fatigue
- Motivation
- Perspective
- Touch
- Mindfulness training
- Acts of kindness
Define social support
Any individual feeling being valued and cared for their social network or how well the individual is embedded into a network of communication and social obligation
Differentiate between functional and structural aspects of support
Functional - the amount of support provided by the social network
Structural - how the person perceives social support to be and the type of support they get from other people
What are four kinds of functional support?
- Emotional
- Instrumental
- Informational
- Appraisal
What kinds of functional support are doctors best placed to give?
Emotional and informational
What is the effect of social support on:
- Adherence
- Health behaviours
- Stress/inflammation
- Mental heatlh
- Adherence (improves)
- Health behaviours (improves)
- Stress/inflammation (reduces)
- Mental health (improves)
When can social support cause problems?
- Friends and relatives not supportive
- Provide wrong emotional support (e.g. not matched)
What is the Comprehensive Geriatric Assessment? What is its purpose?
Multidimensional/interdisciplinary diagnostic process to determine a frail older persons medical conditions, mental health, functional capacity and social circumstances
What are 3 strategies to reduce support breakdown in elderly patients?
- Minimise hospital stays
- Treat at home where possible
- Comprehensive Geriatric Assessment
What are some symptoms for diagnosing a major depressive episode?
- Depressed mood most of the day
- Markedly diminished pleasure in activities
- Significant weight loss or gain
- Insomnia or hypersomnia
- Feelings of worthlessness
- Psychomotor agitation or retardation
- Fatigue or loss of energy
- Guilt
- Diminished ability to think/concentrate
- Recurrent thoughts of death/recurrent suicidal ideation
What are some of the different kinds of anxiety disorders?
- Separation anxiety
- Selective mutism
- Specific phobia
- Social phobia
- Panic disorder
- Agoraphobia
- Generalised anxiety disorder
