7: Emotional and Mental Well being Assessment and Interventions

Question 1

1. Which of the following statement are true?

A. 70% on Primary care provider visits are related to stress and lifestyle

B. When people are stress and overwhelmed, they are more likely to engage in healthy habits.

C. Chronic stress may lead to activation of the immune system and long-term organ and tissue repair.

D. In one Finnish study 3-4 hours of overtime a day increased heart disease risk.

E. In a study, work stressors increased the incidence of type 2 DM by 2-fold in men.

Answer 1

Answer: 1. A D E

B less likely

C suppression of immune system and long-term organ and tissue damage
E women

Question 2

2. The following unhealthy behaviours results from job characteristics except:

A. Stress

B. Smoking

C. Physical activity

D. Unhealthy diet

E. Heavy alcohol use

Answer 2

2. C

Question 3

3. Unhealthy behaviours increase the risk of HT and Obesity which may lead to the following risk factor for CVD except

A. Sleep problems

B. Increased heart rate variability

C. Inflammation

D. Hypocoagulability and atherosclerosis

E. Decreased immune system functioning

F. Increased cortisol (HPA axis) and catecholamine production

Answer 3

3. B and D Its decreased heart rate variability and hypercoagulability

Question 4

4. Perceived stress scale assessment: the following are true

A. It is a 10-item questionnaire devised by psychologist Dr Sheldon Cohen in 1983

B. The higher the total score, the more perceived stress one is under.

C. Score 0f 0-13 is low stress

D. Score of 27-40 is moderate stress

Answer 4

4. D 14-26 is moderate stress and 27-40 is high stress

Question 5

5. In relation to screening for depression the following statement/s is/are true:

A. The grade B USPSTF 2016 recommendation is to screen the general population including pregnant and postpartum women excluding adolescents 12-18 years of age for depression in primary care setting that have adequate support systems in place.

B. PHQ-2 screening questions with score is >3= is a negative screen.

C. PHQ-2 sensitivity is 85% and specificity is 72%

D. A positive screen requires further assessment with the PHQ-9 or Hamilton depression scale (HAM-D) or Beck Depression inventory (BDI-II)

E. Diagnosis of major depressive disorder is made based on American Psychiatric Association Diagnostic and Statistical Manual (DSM-5) Criteria

F. Spanish speaking Latinos are less likely to endorse crying versus English speaking Latinos.

Answer 5

ANSWER: D and E

A. Adolescents are included
B; its positive screen
C; 72% sensitivity and 85% specificity
F; Spanish speaking Latinos are more likely to endorse crying vs English speaking Latinos

Question 6

6. Screening for Generalized Anxiety Disorder (GAD) which is/are not true

A. It is important to rule out anxiety before concluding symptoms are due to stress.

B. USPSTF currently has specific recommendations on anxiety screening.

C. A score of >3= is a positive screen to be followed up by HAM-A, GAD-7, DSM-5 or Beck Anxiety Inventory (BAI) diagnostic Criteria.

D. PHQ-4 is a brief screening for depression and anxiety.

E. A score of 6-8 is severe anxiety and depression

Answer 6

6. B and E B; no specific recommendation by the USPSTF E: score of 0-2= normal, 3-5= mild, 6-8= moderate, 9-12= severe

Question 7

7. In relation to emotional distress and poor health, modifiable risk factor include:

A. Stress, Nutrition, Environment

B. Genetics and perinatal infection

C. Sedentary lifestyle, Lack of light exposure, Addictions

D. Social cultural, economic, and political factors

Answer 7

7. A and C but Band D are non-modifiable

Question 8

8. There is over 100 potential causes of clinical depression and anxiety disorders that can be categorised into 10 categories. Among these nutritional causes include all except:

A. Not enough folate

B. Too less arachidonic acid

C. Not enough tryptophan, tyrosine, and antioxidants

D. Deficient in Omega-3

Answer 8

8. B it is too much Arachidonic acid

Question 9

9. The relationship between mental illness and chronic disease which statements are false:

A. Depression and diabetes have a unidirectional association.

B. Depression is associated with increased risk of cardiac disease, stroke, cancer, and diabetes.

C. Poorer emotional health was associated with positive perceptions of diabetes including perceptions about the seriousness of the illness and the severity of the consequences.

D. Insulin therapy, duration of diabetes and unsatisfactory glycaemic control (HbA1c >=6.5) are risk factors for suicidal ideation in individuals with diabetes.

Answer 9

9. A and C A; Bidirectional C: Negative perceptions

Question 10

10. Coronary Artery disease and Emotional Health which option/s is/are false:

A. Depression increases cardiac risk by 15-20% in patients with coronary artery disease

B. Depression is a non- modifiable risk factor for CAD that generally precedes CAD by several months.

C. Major depressive disorder and GAD predicted increased risk from cardia death, MI, cardiac arrest, and non-elective revascularisation over a 2 year follow up.

D. Patients with depression suffer from increased heart rate variability.

E. Treatment of depression improves survival in CAD.

F. Optimal treatment includes medication, psychotherapy, CBT, and reversal of associated lifestyle risk factors.

Answer 10

10. B, D and E. B: modifiable and several years D: decreased heart rate variability E: treatment improves symptoms and quality of life. There are no clear findings regarding survival.

Question 11

11. Non-pharmacological stress management plans include all except:

A. Light therapy especially red light

B. Abdominal breathing

C. Expressive and creative pursuits such as movement or dance, playing a musical instrument, singing, and creating art.

D. Massage

E. Tai Chi

F. Bibliotherapy (The use of books with the intent to bring medical and psychological healing) and self-help websites

G. Volunteering for meaningless causes

H. Spiritual and religious activities

I. Regular time indoors

J. Mindful exercises, meditation, relaxation, and time for contemplation

K. Physical exercise.

Answer 11

11. A G I A; blue light G: meaningful causes I: outdoor in nature

Question 12

12. Healthy coping skills for emotional well-being are all except:

A. Learning cognitive behavioural skills

B. Developing problem solving skills

C. Improving one’s sense of humour

D. Learning time management Techniques

E. Improving frustration tolerance via CBT techniques

F. Improving artificial intelligence

Answer 12

12. F its emotional intelligence

Question 13

13. The following statements are false except:

A. Exercise is more effective in depression treatment when compared with psychological or pharmacological therapies.

B. SSRIs/SNRIs are second line treatment for depression.

C. Refined grains, sugar and meat are associated with an increased risk of anxiety.

D. Meat, Fish, and eggs are rich in arachidonic acid which is associated with less depression.

E. Adults who eat fast food are 40% more likely to develop depression that those who avoid fast food.

F. Diets higher in trans fats were associated with increased risk of depression.

G. Among childbearing age women deficiencies of folate, B12, Ca, Iron, Zn, Selenium, and omega 3 fatty acids were more common among depressed Vs non depressed women.

H. Supporting patients’ autonomy and promoting patients’ self-efficacy are tips for supportive provider-patient relationship.

I. In ABC model for CBT A: action B: beliefs C: complications

Answer 13

13. E, F, G, H A: exercise is not more effective B: First line C: risk of depression D: These foods are risk on arachidonic acid leading to inflammation to and increase risk of depression I: C is consequences not complications.

Question 14

14. The provider’s role in promoting activities for emotional well-being are following except:

A. Help the patients with self-management

B. Help patients to focus on events that can’t be changed

C. Help with treatment plans

D. Help to prepare relapse prevention plan

E. Celebrate success

Answer 14

14. B cognitive restructuring is to not to focus on events that can’t be changed. Find another way to look at the situation.

Question 15

15. In relation to Positive psychology which options are false:

A. The ideal ratio of positive to negative emotions is 5:1

B. When ratio of emotions is below 3:1; Its likely people will be able to overcome the obstacles at the current time.

C. Experiencing contentment with the past, happiness in the present, hope for the future.

D. Only about one third of adults know what their strengths are.

E. Thinking about the sad days in one’s life frequently is one the practical techniques of positive psychology.

Answer 15

15. A, B, E A: ideal ratio 3:1 B: unlikely people will be able to overcome obstacles E: It’s happiest days

Question 16

16. Mindfulness based stress reduction program (MBSR) includes following except:

A. 9 classes structured over 8 weeks

B. 45 minutes of mindfulness practices.

C. Complete workbook activities

D. Participate in group activities

E. After the program is concluded, students are expected to maintain 45 minutes per day of home mindfulness practices 6 days per month.

Answer 16

16. E: its 6 days per week.

Question 17

Which of the following is NOT an element of MBSR

A. Being aware of surroundings
B. Being fully present in current moment
C. Focused meditation and mindful breathing
D. Paying attention on purpose to thoughts and feelings
E. Withholding judgment or interpretation

Answer 17

ANSWER: C

Adults can grow 700 neurons a day!

Question 18

18. 8 weeks of mindfulness training which options are true:

A. Increased activation of the left prefrontal cortex which is responsible for planning, personality, and happiness.

B. Increased Gray matter density in the hippocampus which is responsible for learning and memory.

C. Increased Gray matter density in the amygdala which is the emotion area of the brain

D. Increases other brain structures associated with self-awareness, compassion, and introspection.

Answer 18

18. A, B, D

C: decreased

Question 19

19. CBT has been associated with the following except

A. Better frontal cortex function

B. Better problem solving

C. Improvement in well being

D. Healthier neural response to perceived threats.

Answer 19

19. A: prefrontal

Question 20

20. ‘RAIN’ of compassion is as below True or false

A. Recognition

B. Acceptance

C. Investigate

D. Non-identification

Answer 20

20. True

Question 21

21. The things that are not helpful for the brain except:

A. Multi-tasking

B. Addiction to distractions: Media, Phones, watches etc.

C. Stress Overdose

D. Sleep Deprivation

E. High Octane diet

F. too much Physical Exercise

Answer 21

21. E and F E: low octane diet e:g white bread/white pasta/white rice/Bakery items F: too little physical exercise.

Question 22

Primary care physicians (PCP) note that lifestyles contribute greatly to an individual’s health. Which of the following observations is true?

A) Health habits can be engaged equally by a moderately stressed individual as compared to a mildly stressed individual.

B) The mood of an individual can be altered and equally impacted by healthy behavior change when engaged by a highly stressed individual as compared to an unstressed individual over the long follow-up period.

C) Roughly 70% of primary care physician visits are related to stress and lifestyle, despite this being a single-factorial relationship.

D) Multifactorial lifestyle variables contribute to nearly 70% of primary care provider visits and can be successfully diagnosed and treated.

Answer 22

D.
Multifactorial lifestyle variables contribute to nearly 70% of primary care provider visits and can be successfully diagnosed and treated.
Lifestyle medicine: contributes to 70% of primary care provider visits; is multifactorial both in disease generation and treatment; is less likely to be engaged by over-stressed and overwhelmed individuals; and is more likely to be impactful when people in need of close follow up are identified.

Question 23

Well-being and absence of disease is correlated to a healthy mental state. Depression can propagate further disease when it is noted in a primary care setting that:

A) A low scoring psychiatric assessment has been completed.

B) DSM-IV criteria has been met.

C) A diagnosis of depression has been made and is now under initial medication therapy.

D) A prior self-harm episode via ingestion of only three pills without hospitalization was not documented in the patient’s chart.

E) The patient decides to not use medications for their first time acute depression and wants to start tai chi as an alternative

Answer 23

D. A prior self-harm episode via ingestion of only three pills without hospitalization was not documented in the patient’s chart.
Depression causes more harm when it’s untreated, unrecognized or undocumented in a patient’s past medical history. It’s diagnosed with DSM-V and a high psychometric assessment score upon screening. Depression can be treated with lifestyle modifications rather than pharmaceuticals based on certain screening protocols

Question 24

Fitness and exercise is comparable to which of the following as it pertains to its effects on mental health?

A) Cognitive Behavioral Therapy (CBT)

B) MAO’s

C) Increasing omega 3 fatty acids when treating bipolar patients with mania

D) Reducing omega 3 fatty acids when treating bipolar patients with depression

Answer 24

A. Cognitive Behavioral Therapy (CBT).
Fitness and exercise is comparable to cognitive behavioral therapy (CBT), but it’s not as directly effective as pharmacotherapies. Increasing omega 3 fatty acids demonstrates a good response with bipolar depression and not mania

Question 25

With stress being identifiable and leading to pathological stress reactions, which of the following is a type of “suffering and unnecessary” that can lead to a stress reaction?

A) Old age

B) Separation from those we love

C) Illness

D) Death

E) Egocentricity

Answer 25

E. Egocentricity.
Unnecessary suffering is wanting a different outcome than the one that has happened. It begins with egocentricity (wants, likes, dislikes, attachments, cravings and aversions), has anticipatory thinking (imagining the worst), can include repeating stories about the past and trying to resist pain.

Question 26

Mindfulness-Based Stress Reduction (MBSR) has been noted to increase all of the following except?

A) Self-esteem

B) Empathy

C) Pain threshold

D) Stress threshold

E) Pain level

Answer 26

E.

Pain level.

Question 27

A woman presents to you and appears to be crying. She is a home health aid working 36 hours per week. Her husband is nearly bedridden at home and has been needing increased healthcare daily from her for nearly five years, as he has a history of cerebral vascular accident (stroke). She says to you that she is now having panic attacks intermittently when she goes to patient’s homes for work because she can relate so strongly to the suffering of the families. She feels guilty taking time for herself and has even missed her own doctor’s appointments. She hasn’t exercised for four years. She states, “How can I tell my husband I am exercising when he can barely move?” This is an example of which of the following:

A) Compassion fatigue

B) Compassion burnout

C) Normal compassion stress

D) Failed cognitive agility

Answer 27

A.
Compassion fatigue is distress and tension in which the helper is traumatized and preoccupied with suffering. Compassion fatigue can lead to poor coping, poor self-care and self-sacrifice, which is similar to PTSD. Compassion burnout is associated with lack of job satisfaction, to many hours, low pay and stress.

Question 28

Which of the following combinations is correct when describing mindfulness-based skills affecting the pre-frontal cortex and its respective task function?

A) The patient-physician relationship and interpersonal mindfulness

B) Cognitive agility and deep focus

C) Tight jaw or “TMJ” and increased fitness daily

D) Positive psychology and maintaining a journal about spiritual needs

Answer 28

B. Cognitive agility and deep focus.
Mindfulness skills enable presence, clarity and curiosity in a clinical encounter. These skills directly affect the pre-frontal cortex, thereby decreasing scattered brain states and allowing for deep focus inside of sequential tasking. This kind of focus is how roughly 95% of the population processes information and performs tasks, as opposed to the less than 5% of the population who are able to perform multitasking.

Question 29

According to the philosophy that the provider is a coach facilitating health behavior change, which of the following combinations have nearly the same effectiveness?

A) In-person coaching and phone coaching

B) Placebo and phone coaching

C) Self-awareness reflection by a wellness coach and a nutritionist

D) In-person coaching and use of medication with psychotherapy

Answer 29

A. In-person coaching and phone coaching.
Phone coaching has a 38% effectiveness rate, while in-person coaching has a 41% effectiveness rate. A placebo has a 19% effectiveness rate.

Question 30

A good patient-provider relationship directly impacts measurable patient health outcomes. All of the following are examples of “Coaching Mechanisms of Change and Action” except:

A) Developing growth-promoting relationship(s)

B) Eliciting self-motivation

C) Building confidence

D) Facilitating the change process

E) Measuring disease alteration and prevalence

Answer 30

E. Measuring disease alteration and prevalence.
Facilitating health behavior change is a process of altering a behavioral pattern from stimulus, to thought, to action via both internal and external resources. It isn’t a tool to measure an already existing disease pathology, the prevalence of that disease pathology, or the observable change of that disease pathology (regardless of mental or physical symptomatology and disease pathology).

Question 31

Describe the PHQ-2

Answer 31

2 question screening tool, over the past two weeks have you felt:
1. down depressed or hopeless
2. little interest or pleasure in doing things

0-3 points each, 3 or more = positivie

Question 32

MDD requires depressed mood most of the day OR anhedonia

4 or more (from a list of 7 symptoms) must also be reported to meet criteria for MDD. What are the 7?

Answer 32

1. unintended weight loss/anorexia
2. insomnia/hypersomnia
3. psychomotor changes
4. fatigue/loss of energy
5. feelings of worthlessness/excessive guilt
6. trouble concentrating/indecisiveness
7. recurrent thoughts of death/SI

Question 33

Describe the PHQ-4

Answer 33

Screening tool for anxiety and depression:
* over last two weeks
* 2Q anxiety
* 2Q depression (PHQ-2 questions)

Question 34

For the PHQ-4 screening tool…

1. What is the score indicating moderate risk?
2. What is the score threshold for further assessment?

Answer 34

Maximum score is 12
1. 6-8
2. 3 or higher