Emotional and Mental Wellbeing Flashcards
What percentage of primary care visits are stress- and lifestyle-related?
70%
What effect can stress have on the immune system?
Can suppress the immune system
What did the Virtanen study of 22,430 people demonstrate to be the effect of working long hours?
An increased risk of coronary heart disease
What did the Heraclides study show middle-aged women to be at increased risk of as the result of psychological stress at work?
Type 2 Diabetes
Stressful jobs can lead to what types of unhealthy responses typically?
Stress; Smoking; Physical inactivity; Unhealthy diet; Heavy alcohol use
Typical unhealthy behavioural responses to stressful jobs put people at increased risk of HTN and obesity. This intern may lead to what risk factors for developing CVD? (6)
Stress -> HTN & Obesity -> risk factors for CVD:
- Sleep disturbance
- Decreased HRV
- Inflammation
- Hypercoagulability (atherosclerosis)
- Decreased immune system functioning
- Increased cortisol and catecholamine production
What assessment tool may be used to assess an individual’s stress levels?
The perceived stress scale assessment (created by psychologist Dr Sheldon Cohen in 1983)
How is the Perceived Stress Scale Assessment calculated?
10 Q questionnaire
Qs 1, 2, 3, 6, 9 and 10 are negatively phrased and are scored 1-4 with 1 = NEVER and 4 = Very Often
Qs 4, 5, 7 and 8 are positively phrased and scored 1-4 with 1 = Very Often and 4 = NEVER
What are the score ranges for the Perceived Stress Scale Assessment?
0 - 13: Low Stress
14-26: Moderate Stress
27-40: High Stress
What other mental health disorders ought to be excluded prior to diagnosing stress in someone?
Depression and anxiety (there is often overlap / can present similarly often)
What initial / simplified screening tool should be used to help identify depression?
PHQ-2
What questions does the PHQ-2 tool ask?
Over the past 2 weeks have you felt:
1) Down, Depressed or Hopeless
2) Little interest or pleasure in doing things?
(Rated 0 = not at all to 3 = nearly every day)
What scores on the PHQ-2 tool should prompt further assessment for depression and what follow up tool should be used?
Further assessment with the PHQ-9 tool should be prompted by a PHQ-2 score >3
What is the sensitivity and specificity associated with the PHQ-2?
Sensitivity: 80-90%
Specificity: 70-85%
How is depression assessed via the PHQ-9?
what are the 9Qs
9 questions.
Over the last 2 weeks, how often have you been bothered by any of the following problems?
1) little interest or pleasure
2) down, depressed, hopeless
(one of these 2 must be present)
3) trouble falling / staying asleep or sleeping too much
4) tired or lacking energy
5) poor appetite / over-eating
6) feeling bad about yourself (failure / letting others down)
7) trouble concentrating
8) slowed speech or movement / agitated or restless
9) thoughts you’d be better off dead or of hurting yourself
(4 or more of these must be present)
0 = not at all 1 = several days 2 = >1/2 the days 3 = nearly all
What is the scoring system for PHQ-9?
1-4: Minimal depression 5-9: Mild 10-14: Moderate 15-19: Moderately Severe 20-27: Severe
What tool may be used (though is not specifically recommended by the US Preventive Services Task Force) to briefly screen for anxiety?
GAD-2
What is the US Preventive Services Task Force
The U.S. Preventive Services Task Force is an independent, volunteer panel of national experts in disease prevention and evidence-based medicine. The Task Force works to improve the health of all Americans by making evidence-based recommendations about clinical preventive services.
What questions are asked by GAD-2 screening tool?
In the past 2 weeks how often have you:
1) felt nervous, anxious, on edge?
2) not been able to stop or control worrying?
Scoring 0-3
0 = not at all 1 = some days 2 = >1/2 days 3 = nearly every day
According to DSM-5 diagnosis of anxiety is made if excessive anxiety and uncontrolled worry is present for >half the days over at least a 6month period AND at least 3 of what list of symptoms?
Restlessness Easily fatigued Difficulty concentrating Irritability Muscle tension Sleep disturbance
AND significant impairment has occurred due to worry or physical symptoms
AND symptoms above are not substance misuse related OR secondary to other disorders (e.g. OCD, anorexia, PTSD)
What screening tool may help you identify mixed depression and anxiety?
PHQ-4 (combination of PHQ-2 and GAD-2 questions)
What should a mild-moderate PHQ-4 score prompt in terms of management?
mild (3-5) to moderate (6-8) on the mixed depression and anxiety assessment may be managed with education or resources and should be re-screened at future visits
What is meant by the term ‘inflammation’ with regard to immune response to stress?
‘Inflammation’ is a heightened immune response to a stressor (physical or mental - evolutionarily to protect us acutely from infection or if under physical threat)
What disease processes can result from chronic inflammation? (4)
Neurodegenerative disease (Alzheimers / Vasc dementia)
Strokes
MIs
Remarkable link between inflammation and Depression (King’s College London study)
