Emotional and Mental Health Assessment and Interventions Flashcards
Name the 3 times of stress
Eustress: good stress. motivating or inspiring
Neustress: neutral stress
Distress: bad stress. Information that is perceived as threatening
2 types of distress
- acute: short term, comes intensely and disappears quickly
- Chronic: long-term, can arise intensely or less intensely and lingers
What is the definition of a stressor?
A situation, circumstance or stimulus that is perceived to be a threat.
What are the 4 categories of stressors?
- psychological: thoughts, beliefs and perceptions
- physiological: illness, infection, disease, hunger
- social: major life changes, personal conflicts, financial insecurity
- bioecological: weather, pollution, food additives, chemicals
What are adverse childhood experiences (ACEs)?
- They are potentially traumatic evens that occur in childhood.
- They are very common with 6/10 adults experiencing at least one ACE before 18 yo
- Examples: experiencing abuse or neglect, experiencing or witnessing violence, family member attempts or dies by suicide, household that has substance use, mental health problems or instability.
Outcomes of ACEs
- Linked to poor health and well-being outcomes, including poor mental health
- ACE plus adult life stress and/or socioeconomic status has been shown to lead to psychological distress
What mechanisms are involved in the body’s physiological arousal to survive a real or perceived threat?
Hypothalamic-pituitary- adrenal axis activation
release of the acute hormones epinephrine and norepinephrine
release of the chronic hormone cortisol
Health effects of chronic stress
- impaired immune function
- inflammation
- decreased bone density
- problems with memory
- increased appetite
- weight gain
- abdominal fat deposition
- insulin resistance
- increased glucose, cholesterol and triglycerides.
- increased blood clotting
- impaired wound healing
- poor sleep
- pain and fatigue
- poor mood
- adoption of less healthy habits
- decreased longevity (decreased telomeres)
How to manage the pathologic stress response without medications?
breathing tools
movement
mediation
connecting with nature
self-expression
community
reading self help books
massage
listening to music
light therapy
What are some potential causes of major depressive disorder and/or anxiety disorders?
- genetics, perinatal infections, environmental hazards. (non-modifiable)
- stress, nutrition, financial strain, sedentary lifestyle, co-morbid conditions, addictions, social connections (modifiable)
In regard to mental health physical activity has protective benefits against what?
Bipolar disorder
Efficacious in treating adhd, anxiety, major depression and psychotic disorders
Explain the relationship between MDD and type 2 diabetes
There is a bidirectional association btwn MDD and type 2 diabetes. A dx of MDD predicts a future type 2 diabetes diagnosis and vice-versa.
Diabetes and emotional health
- Anxiety and depression are increased in the presence of lower perceived control over diabetes.
- Poorer emotional health was associated with negative perceptions of diabetes including perceptions about the seriousness of the illness and severity of consequences
Diabetes related risk factors for suicidal ideation
- Use of insulin therapy
- Duration of diabetes >5years
- Unsatisfactory glycemic control
What negative effects does depression have on Coronary artery disease?
Patients with depression suffer from increased abnormal platelet adherence, endothelial dysfunction, lower heart rate variability and worse adherence to lifestyle changes.
MDD and CAD
1.MDD is an independent risk factor for cardiac events
2. Is a primary risk factor for developing ischemic heart disease and a secondary risk factor for worsened prognosis.
3. Increases cardiac risk by 15-20% in patients with cad
4. Doubles cardiac events
5. Is a modifiable risk factor for cad that generally precedes cad by several years.
How can we screen for stress in the office?
Use the perceived stress scale. asks patients to reflect on the past month.
What are occupational factors that can affect health?
- Corporate downsizing increases cardiovascular disease death rates
- Long hours had increased heart disease risk
- Work stressors increased the incidence of type 2 diabetes in women by 2 fold.
- Work stressors were an independent risk factor for diabetes
Job stress can lead to what type of unhealthy responses
- Stress
- Smoking
- Physical inactivity
- Heavy alcohol use
What is considered a positive PHQ-2 screen?
A score >3
72% sensitive
85% specific
If phq-2 is positive what is next steps?
Requires further assessment with nine question PHQ, the Hamilton depression scale or Beck depression inventory.
What is the dsm5 criteria for MDD
- Person has to have 5 or more symptoms that have persisted nearly everyday for the same 2 week period and is a change from prior level of functioning.
- Must have at least one of the following, depressed mood most of the day or lost of interest or pleasure
- 4 or more must be present
Significant weight loss or weight gain
Insomnia or hypersomnia
Psychomotor agitation, retardation, or increased irritability
Fatigue or loss of energy
Feelings of worthlessness or excessive guilt
Trouble concentrating or indecisiveness
Recurrent thoughts of death, recurrent suicidal ideation with or without a specific plan or suicide attempt
Does USPSTF currently have recommendations for anxiety screening?
No
How can you screen for anxiety in your clinic?
Use the general anxiety disorder two question screening tool. GAD2. A score >3 is considered positive.
What do you do if GAD2 is positive?
Follow up with the Hamilton anxiety rating scale, GAD7 or beck anxiety Inventory
DSM 5 criteria for anxiety
Person has the following symptoms for more than 1/2 the days over at least a 6 month period.
1. Excessive anxiety
2. Worry is difficult to control
3. At least 3 other symptoms:
Restlessness
Easily fatigued
Difficulty concentrating
Irritability
Muscle tension
Sleep disturbances
4.Significant impairment due to anxiety, worry or physical symptoms
5. Symptoms are not due to substance abuse
6. Symptoms not due to another disorder
What is the patient health questionnaire? Phq-4
Briefly screening for depression and anxiety
A positive score is greater than 3
Ask the patient over the past 2 weeks how often they have been bothered by the following problems.
Feeling nervous, anxious or on edge
Not being able to control or stop worrying
Feeling down depressed or hopeless
Little interest or pleasure in doing things
What are some of the ways you can promote self management techniques for emotional well being and resilience with patients and their mental health
Encourage healthy coping skills
Incorporate activities and hobbies that draw on creativity
Keep a gratitude journal
Take care of spiritual needs
Limit screen time
What is the role of the patient in their own mental and emotional health?
1.Promote self management techniques for emotional well being and resilience
2.Encourage the patient to use social support
3. Refer the patient to accessible community and online resources
4. Refer the patient to mental providers if necessary
What is mindfulness?
- Paying attention on purpose to what you are thinking and feeling.
- Being fully present in the moment
- Being aware of surroundings
- Withholding judgment or interpretation
What changes in the brain can you see with 8 wks of mindfulness?
- Increased in thickness of the prefrontal cortex which is responsible for processing of information, decision making and memory
- Increased grey matter density in the hippocampus which is responsible for learning and new memory formation, emotional regulation, perspective and self awareness.
- Reduced grey matter density in the amygdala, the emotion area of the brain, which correlates with reduced stress, anxiety and negative thoughts
What are the benefits of mindfulness in medicine and health care?
- Enhances psychological hardiness
- Leads to lasting decreases in physical and psychological symptoms
- Reduces or helps alleviate inflammation, response to chronic pain, anxiety, depression and addiction
- MBSR helps with relationships
- Helps develop compassion and empathy for self and others, tolerance and resilience
- Reduces loneliness in older adults
What is cognitive behavioral therapy?
- Evidence based structured psychotherapy effective in treating mental health disorders
- Gold standard
- Follows structured steps to change thoughts
- Changing thoughts helps change emotions, potentially leading to changes in behavior
- Focuses on current life, not the past
What is the treatment plan for depression per American psychological association ?
First line treatment for adults up to age 64yo include psychotherapy, pharmacotherapy with a 2nd generation antidepressant or a combination of the two.
Pharmacotherapy is the standard of care for moderate to severe depression.
2nd line therapy options for treatment of depression
Exercise
St. John’s wart
Bright light therapy
Yoga
Acupuncture (in addition to pharmacotherapy)
Treatment for anxiety and panic disorders
- Psychotherapy with cbt
- Pharmacotherapy (ssri)
- Exercise (per AAFP)
Fruit and vegetable consumption has been associated with what in regards to mental health?
- Increased Dominic feelings and behaviors
- Improvement in depression, anxiety and productivity
- Few negative emotions
- Higher optimism
- Improved health, quality of life and productivity
- Lower risk of depression
- More positive attitudes on the days fruits and vegetables are consumed
Which nutrients have been show to have positive outcomes on mood?
Omega 3 fatty acids
Folate
Saffron, turmeric, probiotics, flaxseeds, walnuts, and carbohydrate rich evening meal
What are the benefits of self care for the clinicians?
- Manage your emotional energy
- Stay in good physical condition
- Take a moment to clear your mind before entering a patient’s room
- Practice self compassion
- Elicit positive emotions in yourself and others by focusing on what’s going well to stay creative and resilient
- Allows you to stay present and connected with those around you.
- Work collaboratively
- Allows you to address the distraction and stay present
- After a visit you can take intentional time to pause and recover from what you have just experienced.
What are the benefits of self care for the clinicians?
- Manage your emotional energy
- Stay in good physical condition
- Take a moment to clear your mind before entering a patient’s room
- Practice self compassion
- Elicit positive emotions in yourself and others by focusing on what’s going well to stay creative and resilient
- Allows you to stay present and connected with those around you.
- Work collaboratively
- Allows you to address the distraction and stay present
- After a visit you can take intentional time to pause and recover from what you have just experienced.
Can exercise prevent depression in young adults?
Yes, if it is regularly practiced in childhood
How does at John’s wart effect depression
Can improve symptoms of mild to moderate MDD better than placebo and not significantly different than antidepressants
How does folate/ vitamin b9 effect antidepressant medication
It has been shown to improve the efficacy and shorten response time.
Explain how different types of fat effect depression
Diet higher in trans fat were associated with increased risk of MDD.
Diets higher in mono and polyunsaturated fats were weakly associated with lower rates of depression.
How do omega 3s effect depression
Help with bipolar depression but not mania
Can yield antidepressant and/or mood stabilizing effects
Has not been compared to exercise
Lifestyle treatments for MDD
Physical exercise
Light therapy
Adequate sleep
Avoidance of risky substances
Improved nutrition
Positive relationships
Social support
How has mindfulness has been shown to impact pain?
Mindfulness has been shown to impact the subjective experience of pain without any change to the intensity, level of pain or threshold of pain.
how does folate impact serotonin?
Folate (vitamin B9) can help in the production of serotonin and dopamine. When used with antidepressant medication, it has been shown to improve the efficacy or shorten the response time.
