7. Emotional Mental Flashcards
PHQ-2
0=not at all, 1=several days, 2=more than half the days, 3=nearly daily
Over the past 2 weeks, have you felt down, depressed or hopeless?
Over the past 2 weeks, have you felt little interest or pleasure in doing things?
Positive screen >3
Requires further Ax with PHQ-9 or Hamilton scale (HAM-D)
DSM-V
Major depressive disorder
At least one of:
- depressed mood most of day
- loss of interest or pleasure
Four or more as well:
- significant weight loss /gain (unintentional) or change in appetite
- insomnia or hypersomnia
- psychomotor agitation/retardation
- fatigue or loss of energy
- feelings of worthlessness or excessive guilt
- trouble concentrating or indecisiveness
- recurrent thoughts of death or suicidal ideation with/out a specific plan
GAD-2
Anxiety screening
0=none, 1=several days, 2=more than half the days, 3=nearly daily
In past 2 weeks, how often have you felt nervous, anxious or on edge?
In past 2 weeks, how often have you not been able to stop or control worrying?
Positive score >3
Follow up with HAM-A, GAD-7 or DSM-5 dx criteria
DSM-V
Anxiety
More than half the days over 6 months
Excessive anxiety and Worry difficult to control and At least three of: - restlessness - easily fatigued - difficulty concentrating - irritability - muscle tension - sleep disturbance Significant impairment has occurred due to anxiety, worry or physical symptoms and Symptoms above not due to substance use and Symptoms not from another disorder (eg OCD, anorexia, PTSD, etc)
Depression - risk factor for what medical conditions
Diabetes
Cardiac disease
Stroke
Cancer
As strong an independent marker for mortality as smoking
Risk factors for suicidal ideation in DM
Insulin therapy
Duration of diabetes
Unsatisfactory glycaemic control (HbA1c > 6.5%)
Lifestyle modification for depression
Exercise
Mindfulness, intentional distraction, relaxation therapy
Bibliotherapy
Light therapy
Computerized interventions
Sleep management
Positive relationships and social support
Address lifestyle-related precipitated of depression (eg lack of sleep, loneliness, poor diet)
RAIN of compassion
Recognition: what’s happening
Acceptance: make room for the experience
Investigate: be curious
Non-identification: witness the experience and rest in natural awareness
Compassion fatigue vs burnout
Burnout: lack of satisfaction with job, eg due to hours, pay, stress
Compassion fatigue: like PTSD but acute distress/tension
The helper is traumatized and preoccupied with suffering, leading to poor coping, poor self care or self sacrificing tendencies
Focus, awareness, content
First step to mindfulness to correct brain state to coach and assist patients
Focus: high control to uncontrolled mind wandering states, both states necessary for brain health
Awareness: inside& outside oneself. Awareness ranges from low or narrow (specific like musical song) to high/wide (being aware of many sensations at once eg watching sunrise, cool air, birds, dew)
Content: managing from detailed to big picture
Upgrade brain energy
Protect emotional energy
Improve physical energy:
- exercise (focus & creativity) and
- nutrition (for brain health: omega3, antioxidants, water
Working memory can be enhanced by:
Simplifying
Decluttering
Sleeping
Non pharmacological stress management strategies
1- Mindfulness exercises, meditation, relaxation, time for contemplation - Abdominal breathing - Expressive/creative pursuits eg movement, dance, musical instrument, singing, art - massage - tai chi - bibliotherapy - volunteering for meaningful causes - spiritual and religious activities 9- regular time in nature
Self management techniques for emotional well-being
- learn cognitive behavioral skills
- develop problem solving skills
- improve sense of humour
- learning time management techniques
- learn assertiveness techniques
Psychological treatment for depression
- CBT
- behavioral therapy
- interpersonal therapy
- psychotherapy
