Exam 1 Flashcards
what is the difference between poor mental health and mental illness
poor mental health = loss of psychological well being
mental illness = clincially recognized disorder
what are the 5 categories of adult mental illnesses
mood disorders
delusional disorders
anxiety disorders
personality disorders
substance related disorders
when should promotion and prevention strategies be implemented in order to be maximally effective
early, before the onset of mental disorder
what are the 3 categories of primary prevention
universal - general public
Selective - individuals or groups with increased risk
Indicated - people at high risk
what is secondary prevention
interventions to reduce prevelance
what is tertiary prevention
interventions to reduce disability, all forms of rehad, prevention of relapse
mental health promotion should enhance what 3 factors
social inclusion
freedom from discrimination and violence
access to economic resources
what is sense of coherence
the extent which one has a feeling of confidence that they will be able to deal with stress, that their environment is manageable, and that stress is a challenge to overcome
what is a health assest
any factor or resource that enhances ability to maintain health and well being
what level of risk (normal, mild-moderate, or high) would the following be:
1. history of assault
2. physical chronic disease
3.poor coping skills
4. risk taking or antisocial behavior
5.poverty
6.poor coping skills
1 - mild/moderate
2 - mild/moderate
3 - high
4 - high
5. mild/moderate
6. high
What are the 3 levels of contributing factors to mental health
individual
social circumstances
environmental factors
what is the single most important predictor for cognitive decline and dementia
older age
what is the recovery model
focuses on lived experiences, choices, self management and shared decision making
what mental illness’s increase risk for DM
depression and schizophrenia
what mental health condition increases risk for heart disease and stroke
depression
what mental illness is associated with increased rates of cancer
schizophrenia
true or false: people with arthritis have higher rates of serious mental illness
false, there are lower states of people with arthritis and serious mental illness although it is unclear if this is true or just lack of reporting
true or false: people with mental illness are less likely to be regularly screened for manageable chronic conditions
true
you can identify risk factors for mental illness but are unlikely to see any signs or symptoms before the age of ____
3-4 years old
what are the 2 categories of behavioral problems
ADHD
Conduct disorder
at what age do symptoms typically start to occur in ADHD
5-6 years old
true of false: over half of children with ADHD will continue to have the disorder in adulthood
true
preschoolers with high levels of noncomplience and aggression at age 4 are at increased risk for what condition
conduct disorder
why must prevention and intervention for conduct disorder occur very early in life
because intervention must occur before the disorder fully emerges and it is very difficult to treat
what childhood mental illness is defined by repetitive and persistent patterns of behavior in which the basic rights of others or the major age apporpriate society norms or rules are violated
conduct disorder
what are internalizing disorders
depression and anxiety
most mental disorders have their peak occurence at what age
adolescence and young adults
what is the most common mental illness in adolescence
anxiety
what chronic illness has one of the strongest connects with childhood mental illness
heart disease
what specific types of traumatic events in childhood increase risk for early onset psychosis
traumatic events related to an intent to harm like bullying or abuse
true or false: early psychotic symptoms in children does not increase risk for schizophrenia as adult
false
children showing signs of psychosis should also be screened for what
maltreatment
child abuse is associated with obesity in: childhood, adulthood, or both
adulthood
Should all clients be screened for history of childhood abuse or trauma?
no, there is no evidence for this
what mental illness’s begin in adolescence and early adulthood
anxiety and depressive disorders, personality disorders, bipolar disorders
what effect does cannabis have on risk for schizophrenia?
if already at risk for schizophrenia, heavy cannabis use double the risk
what disorders tend to peak in adulthood
bipolar and personality disorders
what is the most common addiction in adulthood
nicotine
what are the key risk factors for poor mental health in the elderly
lonliness and isolation
if an elderly person presents with new depression, what should you also screen for
dementia as depression may be an early indication of dementia
what are the dimensions of trauma
magnitude, complexity, frequency duration, internal or external source
what is developmental trauma
early exposure to repetitive trauma
what is dysregulation and what is it associated with
associated with trauma
difficulty controlling emotional behaviours, hyperarousal and hypervigilance or listenessness and numbness in stressful situations
what are the 3 symptom clusters in PTSD
intrusive recollections
avoidant/numbing symptoms
hyperarousal symptoms
why might someone be misdiagnosed if providers are not using trauma informed care
seeing what is actually trauma coping may be diagnosed and treated as a seperate condition
what is the difference between trauma informed services and trauma specific services
trauma informed is creating safe spaces where people feel in control
trauma specific is treatment and interventions specific for trauma
what are the 4 principles of trauma informed care
trauma awareness
emphasis and safety and trustoworthiness
opportunity for choice
strength based and skill building
what are the two aspects important for trauma informed practice at a personal level
self awareness and vicarious trauma
what are the ABCs of addressing vicarious trauma
Awareness of our needs
Balance between work and rest
Connection to ourselves and something greater
what are the 2 key areas of trauma informed practice at the practice level
trauma awareness
language - shift from what is wrong with you to what has happened to you
a mental health diagnosis should only be considered and made if _____
only if treatment is being considered
what are validated screening tools for depression
PHQ2 and PHQ9
what part of the brain is responsible for switching off anxiety
prefrontal cortex
what part of the brain is the emotional core that triggers fear and has an immediate response to anxiety
amygdela
what part of the brain perpetuates the fear response causing longer term anxiety
BNST
what part of the brain is responsible for memory
hippocampus
what is the DSM5 criteria for GAD
excess anxiety more than 6 months
difficult to control
3 or more symptoms (tense/on edge, easily fatigued, difficulty concentrating, irritability, muscle tension, sleep disturbances)
significant distress
no other cause
what is the DSM5 criteria for panic attacks
recurrent unexpected panic attacks
at least 4 symptoms (palptiations, SOB, chills/heat, unreal/detached, fear of dying, sweating, choking, n/v/d, numbness, shaking, CP, dizzy, losing control)
for at least 1 episode in the following period of 1 month there is continued worry about another attack and/or maladtive changes to prevent another attack
true or false: having panic attacks means you have panic disorder
false, other diagnoses can cause panic attack
what is the many cause of dysfunction in panic disorder
fear of another panic attack
what questionnaire can be used for panic disorder
Panic Attack Questionnaire
what is the imaginary audience and what mental illness is it associated with
imaginary brain seen in adolescence where they believe everyone is obsessed with them as they are
connect to social anxiety disorder
most adults with SAD have an anxious-ambivilant attatment style. How does this manifest
discomfort in close relationships
difficulty trusting others
greater anxiety about rejection or abandonment
what screening tools can be used for social anxiety disorder
the Liebowitcs Social Anxiety Scale
Social Interaction Anxiety Scale
what is the DSM5 criteria for social anxiety disorder
fear or anxiety about social situations
fear of acting in a way or showing that will embarras
social situations almost always provoke fear
social situations avoided or endure with extreme discomfort
fear out of proportion to threat
persistent, lasts at least 6 months
clinically significant distress
what is acute stress disorder
occuring after significant traumatic events lasting less than 1 month
what is the difference between acute stress disorder and PTSD
PTSD lasts beyond 1 months
what is DSM5 criteria for acute stress disorder
exposure to extreme threat
9 symptoms
lasts 3 days - 1 month
what are the 3 different responses in PTSD
fight or flight
freeze
dorsal vagal nerve (shutting down)
what is DSM5 criteria for TPSD
exposure to actual or threatened event
presence of at least 1: (recurrent intrusive memories, dreams with basis in trauma, dissociation flashbacks, intense prolonged psychogical distress)
persistant avoidance of triggers
negative changes in cognition
alteration in arousal and reactivity
more than 1 month
what is PTSD with delayed espression
PTSD occuring up to 6 months after the event
what is the difference between obsessions and compulsions
obsessions = unwanted intrusive thoughts
compulsions = behaviours, often ritualistic, to try to reduce anxiety
true of false: OCD does not have high rates of suicide attmepts
false
how are addictions different from compulsions
addictions are feelings of pleasure from the behavior
compulsions are behaviors that are trying to reduce fear and anxiety
do OCD symptoms constitute need for a brain scan?
not on their own. although symptoms may be associated with brain tumors, there would be more than just OCD symptoms present
what is the DSM5 criteria for OCD
presence of obsessions, compulsions or both
obsessions/compulsions are time consuming
no other cause
level of insight will determine treatment method
what screening tool can be used for OCD
obsessive compulsive inventory screening tool
what are some types of OCD
checking
contaminational/mental contamination
symmetry/ordering
ruminations/intrusive thoughts
hoarding (can be its own diagnosis or OCD if hoarding is down because of an obsessive worry or fear)
how might you differentiate a tic from a focal seizure
tic - people continue to go about their business
focal seizure - behavior arrest
tic - does not happen during sleep
focal seizure - can happen while awake or asleep
in terms of seasonal affective disorder, what is photoperiod and what is phase shift theory
photoperiod - seasonal changes in the length of daylight
phase shift theory - sleep wake cycle out of sync, similar to jet lag
what is the difference between the following seasonal affective disorders:
winter
summer
reverse
subsyndromal
winter - peak in winter and remits by spring
summer - onset in spring and remits in fall
reverse - in spring and summer but more hypomanic and hyperactivity
Subsyndromal - winter blues, not as severe and not as long
seasonal affective disorder is affected more by: temperature or latitude
latitude, the farther you are from the equator the more at risk you are
what are treatment options for seasonal affective disorder
light therapy
exercise
vitamin D
sometimes anti-depressants
what is adjustment disorder
anxiety/sadness/hopelessness occurring after significant life stress that is self limiting and resolves within 6 months
what is used for treatment of adjustment disorder
usually support, encouragement and reassurance is all that is needed. Sometimes counselling and psychotherapy. Monitor for SI
what is DSM5 criteria for adjustment disorder
symptoms due to identifiable stressor in last 3 months
clinically significant and includes at least one:
distress out of proportion or impairment in daily life
not another condition
not normal bereavement
once stressor gone, resolves within 6 months
what should you have a high suspicion for when people come in with vague complaints and no organic cause can be found
MDD
true of false: somatic complaints or not part of MDD
false, somatic complaints are valid indicators of depression
other than MDD, what other diagnosis should you consider for someone presenting with depressive symptoms and why
bipolar, often initially presents with depressive episode
what are the brain pathways for the following and indicated in MDD:
Serotonin
Norepi
dopamine
Serotonin - Rathe
Norepi - Locus coerules
dopamine - VTA
what screening tools can be used for MDD
Hamilton depression scale
PHQ9
Geriatric depression scale
what is the acronym SIGECAPS used for and what does it stand for
for the DSM5 criteria for MDD - at least 5 of the following symptoms during the same 2 week period and must include depressed mood and anhedonia
Sleep disturbances
Interest reduce
Guilt or worthlessness
Energy loss and fatigue
Concentration problems
Appetite changes or weight changes
Psychomotor agitation or retardation
Suicidal thought with or without intent
what is complicated grief
worsening, unrelenting state of mourning
is complicated grief seen more often with the loss of a parent or the loss of a child
loss of a parent
what is dysthymia
chronic low grade depressive like symptoms lasting more than 2 years
early onset dysthymia (before age 21) increases risk for what other mental illness
personality disorder
substance use disorder
what are the 2 subtypes of dysthymia and which medications may work better for each
anxious - SSRI
anergic - norepi and dompamine increasing medication
what is the DSM5 criteria for dysthymia
depressed mood most days for at least 2 years
at least 2 of the following:
disordered eating, disordered sleep, low energy, low self esteem, poor concentration, hoplessness
never without symptoms for more than 2 months
never had manic or hypomanic episode
how is a depressive episode in MDD differentiated from BPD
they present exactly the same but BPD must have history of manic or hypomanic episode at least once
true or false: the suicide risk is extremly elevated in people with BPD
true
migraine is highly associated with what mental illness
BPD
what are some physical causes of mood cycling that is not BPD
thyroid disease, STI, accidents
how is hypomania different from mania
hypomania is elevated mood for shorter time (4-7 days) and criteria for mania but no significant impairment
what are the categories for BPD
BPD1 - most severe, major depression and manic episodes
BPD2 - less severe and more common, depression with hypomania
what is the DSM5 criteria for mania
persistently elevated, expansive, or irritable mood with increased activity for more than 1 week
at least 3 of the following:
grandiosity, decreased need for sleep, pressured speech, racing thoughts, distractibility, high risk activities
why must you closely follow someone who has newly been prescribed antidepressants for MDD
because if it is BPD and they just havent had a manic episode yet, antidepressants can cause a manic episode
what is used to treat bipolar
combo antidepressants, mood stabalizers and sometimes neuroleptics
what screening tool can be used for BPD
Mood disorder questionnaire
CDI scale
true or false: patients suspected of having BPD should be referred to psychiatry
true
should you treat mild bipolar depression?
yet but treat with caution and closely monitor for medication side effects
what is the pneumonic DIGFAST used for and what does it stand for
symptoms of mania
Distractibility
Impulsivity, irresponsibility
Grandiose thoughts
Family history
Appetite changes and increased activity
Sleep disturbances
Talkative
can hypomania present with psychotic symptoms?
no, if psychotic symptoms are present in a mania presentation, it is mania
what is the DSM5 criteria for mania
distinct period of abnormally persistent elevated or irritable mood lasting at least 1 week
at least 3 symptoms (grandiosoty, decreased need for sleep, pressured speech, racing thoughts, distractibility, increased goal directed activity, risk taking behavior)
significant impairment and not due to medicaiton or substance
when might you consider CT, MRI or labs in a person presenting with mania
neuro symptoms, onset later in life, dramatic change in symptoms or episodes
what is the DSM5 criteria for hypomania
same as mania except:
lasts at least 4 days
causes less dysfunction but still different from baseline
no psychotic features or need to hospitalize
what is cyclothymia
episodes of both hypomania and low mood but not severe enough to fit criteria for MDD or mania
what is the DSM5 criteria for cyclothymia
recurrent episodes of low level hypomania and mild depression that do not meet criteria for hypomania or MDD and over a 2 year period
present at least half the time and no longer than 2 months at a time without symptoms
MDD, mania or hypomania criteria have never been met
significant distress or impair function
are depressive episodes required for a BPD diagnosis?
no, some people will only cycle between mania and hypomania
what is the acronym FESTIVAL and what is it used for
symptoms for depression and mania for BPD
Feeling low/high
Energy low/hig
Sleep more/less
Thinking slow/rapid
Interest low/rapidly changing
Value in self low/grandiose
Aches present/disappear
Live - suicidal/feel like they will live forever
is BPD1 or BPD2 more common?
BPD2
how does the diagnosis for BP1 and BP2 differ?
BP1 requires DSM5 mania and hypomania or depression
BP2 only requires hypomania with MDD
are people with BP1 or BP2 more likely to complete suicide
BP2
when is the usual onset of shizophrenia in men? in women?
men - late adolescence to mid thirties
women - mid twenties to early thirties
what are the features of psychosis
delusions
hallucinations
disorganized speech
behavior
what are each of the following delusions:
persecutory
Grandiose
erotomania
nihilistic
somatic
persecuroty - being watched, in danger
grandiod - super powers, wealth, notoriety
erotomania - others in love with them
nihilistic - something catastrophic will happen
somatic - something wrong with their body
what hallucinations are most common in delirium and dementia? which are most common in schizophrenia
delerium and dementia - visual
schizophrenia - auditory
disorganized speech in schizophrenia will present with one or more of the following: incoherence, derailment, tangential thoughts. What do each of these mean
incoherence - random words in sentences have the “song” of the language but no cognitive sense
Derailment - topic or train of thought changes without logical connection
Tangential - rambling from one topic to another, losing original topic altogether, often seen with answering questions
what is meant by positive and negative behaviors when discussing schizophrenia
Positive behaviors involve some kind of action (agitation, restlessness, calling out, violence)
Negative behaviors are little or no action (catatonia, avolition, mutism, anhedonia)
what needs to be done for patients that are catatonic?
hospitalize, this is severe mental distress
what other differentials might you consider for schizophrenic type symptoms
brain tumors
dementia
delirium
which two street drugs increase risk for schizophrenia the most?
methamphetamines
cannabis
what is cannabis induce acute persistent psychosis
psychotic symptoms that persist past the initial intoxication but usually resolve fairly quickly and do not recur without re use of cannabis
true or false: age of initial exposure to cannabis does not change the risk for psychosis
false, earlier exposure (before 14-17 years old) is assocaited with higher risk for psychosis
true or false: exposure to cannabis in adolescence increases risk for psychotic disorders in adulthood
true
what screening tool may be used to help differentiate delirium from dementia
The Confusion Assessment Method
when differentiating schizophrenia from MDD with psychotic features, what are some things that are seen in each to help differentiate
MDD is not likely to have disorganized speech or bizarre behavior and schizophrenia is not likely to be preceeded by depression
what age group do psychotic disorders typically emerge?
adolescence to 30’s
what is brief psychotic disorder
more than a day but less than a month
at least one of the following plus grossly disorganized or catatonic behavior:
delusions
hallucinations
disorganized speech
what is schizophreniform disorder
less than 6 months
at least one of the following:
delusions
hallucinations
disorganized speech
May also have:
grossly disorganized or catatonic
negative symptoms
no history of manic depressive episodes
what is the difference between schizophrenia and schizophreniform
schizophrenia must persist past 6 months and have significant loss of function
what is schizotypal personality disorder
chronic low level symptoms with personality disturbance, better global functioning than schizophrenia but aggresiveness is common
