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)
What specific component/cell type of the immune system is released with stress, certain food types and exercise?
Cytokines (can cause inflammation)
Depression is as strong an independent marker for mortality (particularly CAD) as what?
Smoking!
What 2 physical disease processes are closely linked to depressive disorder according to Board Review Manual?
Diabetes (?due to underlying inflammation)
Coronary Artery Disease (?due to underlying inflammation)
What 3 features have been proven risk factors for suicidal ideation in diabetics?
1) insulin therapy
2) Duration of diabetes
3) Unsatisfactory glycemic (HbA1c) control
What reasons are given for increased risk from cardiac death / CAD in those with depression?
a) increased abnormal platelet adherence
b) Endothelial dysfunction
c) Lowered HRV
d) Worse adherence to lifestyle changes
What anti-depressants are safe and unsafe in CAD and why?
Safe - SSRIs (may be beneficial in decreasing cardiac events)
Unsafe - TCAs (may cause QT prolongation and orthostatic hypotension)
Exercise compared with CBT is how beneficial in the treatment of mental health (particularly depression)?
Exercise is comparable to CBT in the treatment of mental health (can prevent and treat depression in particular)
What pharmacotherapy is currently first line in the treatment of depression?
SSRIs and SNRIs
How many see benefit in depression symptoms with SSRIs compared with placebo?
1 in 7-8
Number needed to treat for one to see benefit with TCAs for depression compared with placebo?
(e.g. amitriptylline, nortriptylline, duloxetine)
7-16
Which of the following responds well to omega-3 fatty acids:
1) bipolar
2) depression
3) mania
Bipolar and depression
flax/chia seeds, walnuts, avocados, fish, shellfish, sprouts, cola oil, navy beans etc
True or False?
Exercise is more effective when compared with psychological or pharmacotherapies in the treatment of depression?
False
Comparable to CBT, not psychotherapy and not pharmacotherapies
Which of the following is true?
1) exercise can help treat depression in the elderly
2) exercise may prevent depression in young adults if it’s regularly practised starting in childhood
Both!
Mindfulness-Based Stress Reduction (MBSR) has been noted to increase all but which of the following:
Empathy Self-esteem Pain level Stress threshold Pain threshold
Pain level
Define Compassion Fatigue and differentiate between this and Compassion Burnout
> Compassion Fatigue: Distress and tension related to caring for someone which results in the helper / carer becoming traumatised and preoccupied with suffering. Leads to poor coping, poor self-care and self-sacrifice similar to PTSD.
> Compassion Burnout: Associated with poor job satisfaction (many hours, low pay and stress)
What is the usual set up for Mindfulness-based stress reduction programmes?
9 classes over 8 weeks - 45 mins of mindfulness practise, workbook activities, group activities.
Expected to continue 45mins / day, 6 days a week independently
What is formal vs informal mindfulness?
Formal: Meditation
Informal: attentiveness to routine activities
What is Mindfulness?
Mindfulness
A practice which investigates the RELATIONSHIP between MIND and BODY and helps create an AWARENESS of the SPACE between the STIMULUS and the RESPONSE in a situation. About being PRESENT and FULLY EXPERIENCING a moment with CALMNESS and INSIGHT
What are the 6 attitudes of mindfulness?
1) Non-judging (witnessing)
2) Non-striving (relaxing)
3) Acknowledging what is happening
4) Patience
5) Keeping an attitude of self-reliance
6) Beginner’s mind - not afraid of failure
What physical impact can mindfulness have on the brain? (4)
Mindfulness can:
1) Increase activation of the left pre-frontal cortex (planning, personality and happiness)
2) Increase grey-matter density in the hippocampus (responsible for learning and memory)
3) increase structures assoc with self-awareness, compassion and introspection
4) Reduce grey matter in the amygdala (the emotion centre) therefore reducing stress
Mindfulness meditation promotes stronger connections between the pre-frontal cortex and amygdala aiding what functions?
Problem-solving and modulation of emotional responses
Mindfulness enhances psychological hardiness by increasing what 4 characteristics?
1) resilience
2) self-esteem
3) energy
4) enthusiasm for life
(improving ability to cope long/short-term stress and relax)
Mindfulness has been shown to lead to lasting decreases in physical & psychological symptoms including alleviating of…? (4)
inflammation
response to chronic pain
anxiety / depression
addiction
In what ways can mindfulness help relationships?
helps develop…4
Helps develop compassion, empathy (self/others), tolerance and resilience
(reduces loneliness in older adults)
What is the RAIN of compassion?
RAIN of compassion:
Recognition: what’s happening
Acceptance: make room for the experience
Investigate: be curious
Non-identification: witness the experience & rest in natural awareness
Selfcare is essential according to American Medical Association Code of Ethics. States physicians responsible for maintaining own health and wellbeing.
Self-care can ____ burnout, ____ empathy and ____ attitudes among primary care providers.
Self-care can PREVENT burnout, ENHANCE empathy and IMPROVE attitudes among primary care providers.
A coach/provider must move with agility between what 3 dimensions when leading mindfulness with patients?
Focus
Awareness
Content
Describe briefly what is meant by Focus when practising mindfulness.
Focus: high control to uncontrolled, wandering state (both necessary for brain health)
Describe briefly what is meant by Awareness when practising mindfulness.
Awareness: internal and external.
Ranges from low/narrow very specific e.g. breathing/music to high/wide being aware of range of sensations all at once (sounds & feel & smells)
Describe briefly what is meant by Content when practising mindfulness.
Content: detailed to big picture
What are the 8 mindfulness brain states through which one should aim to transition fully and with agility?
Present awareness Imagining Thinking and evaluating Flow (focus/absorption) Collaboration Mind wandering Creative thinking Strategic thinking
What are the 2 best ways of improving your physical energy?
Exercise
Diet (Omega-3 fatty acids, antioxidants, water)
Helps focus and creativity
What is meant by ‘naming the frenzy’?
The act of acknowledging negative emotions - don’t evaluate or judge. Let it go or lay it aside
Then focus on positive emotions - what’s going well or is enjoyable? Use compassion / gratitude
Connecting with others ___ brain function and ___ tone.
Allows for sharing ___ and ___ emotions and synchrony of thoughts and behaviours.
Connecting with others IMPROVES brain function and VAGAL tone. (parasympathetic NS)
Allows for sharing POSITIVE and NEGATIVE emotions and synchrony of thoughts and behaviours.
Working memory can be enhanced by what 3 measures?
Simplifying
De-cluttering
Sleeping
What executive function is deficient in ADHD?
Effective inhibition (required to avoid distraction)
