L12 - Mental Health 1 Flashcards
Diagnosis and High Prevalence Conditions
Anxiety and depression are classified as ____ prevalence disorders
High
Define mental health as specified by the world health organisation (WHO).
“A state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.”
Define mental disorders (or mental illness) as described by the American Psychiatric Association (APA)
How do we classify mental illhealth (mental illness) in clinical settings?
What is the reference that we use?
The DSM-5 (Diagnostic and Statistical Manual of Mental Disorders
The DSM-5 focuses on ____ health conditions only.
Mental
The ICD-11 covers _____
1) Mental Health
2) Physical Health
3) Mental and Physical Health
Mental and Physical Health
Who wrote the DSM-5?
American Psychiatric Association
In the DSM-5 what criterions for each disorder are specified?
Diagnostic features and criteria
Prevalence rates
DEvelopment and course (etiology)
Risk and prognostic factors
Differential Diagnosis
In the DSM-5 there has been a shift toward a 1)______ approach and use of 2)_____ rather than discrete categories
1) Dimensional
2) Spectra
e. g. autism spectrum disorder - everyone is on a continuum (asburgers is high functioning autism (level 1))
Which manual has a more specific description of diagnostic criteria for mental health? DSM-5 or ICD-11?
DSM-5
(e.g. DSM-5 = ‘4 or more’ // ICD-11 = ‘several symptoms’)
Who writes the ICD-11?
World Health Organisation (WHO)
How many chapters are on mental and behavioural disorders in the ICD-11?
One
(chapter 6)
Is the DSM-5 and the ICD-11 similar in structure?
Yes
There are some differences in specifics, but generally are the same
Is ‘gender incongruence’ or ‘gender dysphoria’ included in either the ICD-11 or DSM-5?
Why would this be important?
‘Gender dysphoria’ in the DSM-5
Important so that those suffering from the disorder can get health insurance.
In Psychology, GAD stands for?
Generalised Anxiety Disorder
In any 12 month period, what % of Australians will experience an anxiety disorder?
How many will experience it in their lifetime?
Are males or females more likely to experience an anxiety disorder?
Females
What is the key concept surrounding anxiety disorders?
Fight/Flight/Freeze response
How does the Fight/Flight/Freeze Response work?
Amygdala tells the body that we are in danger.
This produces symptoms like rapid heartbeat, fast breathing, muscle tension, sweaty hands, feet feel frozen etc.
This is preparing us for either Fight, Flight (run away from danger), Freeze (stay still and hope the danger goes away)
What does the Amygdala do?
Part of the brain which detects safety or danger it sends of a signal to our body that there is danger nearby. This activates the Fight/Flight/Freeze response.
What are safety behaviours in regards to anxiety disorders?
Behaviour a person engages in to reduce their anxiety
(e.g. avoiding situations that bring on anxiety)
Safety behaviours in anxious individuals 1)____ anxiety in the short term, but 2)_____ _____ are not challenged
1) reduces
2) anxious beliefs
In anxious individuals safety behaviours can often __________
Get in the way of functioning
What are the 4 stages in the circle of anxiety disorders and safety behaviours?
Situation
Anxiety
Avoid/escape (safety behaviour)
Relief (short term)
repeat
What is ‘panic disorder’ as described in the DSM-5?
Recurrent unexpected panic attacks involving an abrupt surge of intense fear / discomfort that reaches a peak within minutes and during which time 4 or more of the following symptoms occur:
What disorder in the DSM-5 includes the following symptoms?
Fear of dying
Fear of losing control or going crazy
Derealization (feeling or unreality)
Sensations of shortness of breath or smothering
Panic Disorder
If someone has a panic attack in a certain environment, what safety behaviour is likely to occur in the future?
Avoidance of that environment where the panic attack occurred.
What is the prevalence of panic disorders?
Which gender is it more common in?
4%
Women
What is the typical “time from onset of symptoms” to treatment for panic disorders?
10 years
Explain the model for panic disorder
What happens in someone with a panic disorder when experiencing a stressful life event in comparison to a normal individual?
They misinterpret the body sensations created by the Fight/Flight/Freeze response in stressful situations as dangerous and this leads to a stronger Fight/Flight/Freeze response.
The panic disorder occurs when the individual worries that a panic attack will reoccur leading to psychological vulnerability and means the cycle is more likely to occur again
- It becomes cyclical*
- e.g. My heart rate is increasing, I’m about to have a heart attack*
Describe the 3 main features of person diagnosed with panic disorder?
How do we assess individuals for panic disorder?
Questionnaires
and
Clinical Interview with client
(a number of screening measures available)
What psychological treatment would we use to treat panic disorder?
Cognitive behavioural therapy (CBT)
What 3 CBT techniques can we use to help treat people with panic disorder?
1) Psychoeducation about the fight/flight/freeze response (that this is normal and not life threatening)
2) Exposure to the physical symptoms of panic (in a safe space with a good theraputic relationship. e.g. make them breath really quickly and then teach them relaxation techniques to calm symptoms)
3) Gradual exposure to situations that bring on panic symptoms (systematic desensitisation)
What are the 4 features of Generalised Anxiety Disorder (GAD)?
For someone to be diganosed with GAD, how often (1) and for how long (2) will they have had to experienced excessive anxiety and worry about a number of events or activities (such as work or school performance)
1) Occurring most days
2) At least 6 months
A person feels a lot of anxiety but manages to find ways to control it.
Is this a symptom of GAD?
No
Person must find it difficult to control the worry if to be diagnosed with GAD
Which DSM-5 disorder are these symptoms from?
Restlessness
Easily fatigued
Difficulty concentration
Irritability
Muscle Tension
Sleep Disturbance
Generalised Anxiety Disorder (GAD)
If a person has anxiety and worry but it doesn’t impair in social, occupational and other important areas of functioning;
Can this person be diagnosed with GAD?
Why/Why Not?
No
The anxiety, worry or physical symptoms must cause clinically significant distress or impairment in social, occupational or other important areas of functioning
What is the lifetime prevalence of GAD?
5%
When do symptoms typically commence for GAD?
Childhood
How would we assess the symptoms for someone we believe to suffer from GAD?
1) Questionnaires
(e.g. depression anxiety and stress scales DASS-21)
2) Clinical Interview
Describe the Wells (1995) GAD cognitive model
1) People with GAD tend to have 1) _____ beliefs about worry.
2) What does this mean?
3) What is this referred to in the GAD cognitive model?
1) Positive
2) They believe that their worry ‘helps them’ in some way.
3) Positive meta-beliefs activated
* e.g. by preparing them for the situation they are going to face - posit*
In the GAD cognitive model first there is a trigger, then positive meta-beliefs are activated -
What comes next and what is it?
Type 1 Worry
Type 1 Worry is ‘normal worry’, what everyone experiences.
In GAD, what happens after type 1 worry?
What does this mean?
Negative meta-beliefs activated
This means the people have over the top belief about worry
e.g. if I worry to much, the worries will get out of control and I’ll go crazy.
In the GAD cognitive model, what comes after ‘negative meta-beliefs activated’?
What does this mean?
Type 2 worry
“Worrying about worrying”
This produces thought control and safety behaviours. e.g. talking about worries over and over and focusing on those worries. All of these mean the worries aren’t challenged and the cycle continues.
What psychological treatment do we use for treatment for GAD?
Cognitive Behavioural Therapy (CBT)
What cognitive techniques can we use for psycholgical treatment for GAD?
1) Address positive and negative beliefs about worry (e.g. just because you think it doesn’t mean its true, learning to accept and move on)
2) Increase flexible thinking and ability to tolerate uncertainty (e.g. although exam will be hard that is ok and they can cope with that)
What behavioural techniques can we use for psycholgical treatment for GAD?
1) Relaxation strategies
(to help calm Fight/Flight/Freeze response)
2) Behavioural experiments
- (exposing the person to conditions where worries come up and not responding to the worries - don’t reinforce worrying when they reassurance seek, teaches them they don’t have to reassurance seek and they will be ok)*
- Challenging underlying beliefs and thoughts about worrying*
A child (9Y/O) presenting with worry about school performance, intruders in the home, peer relationships.
What might you diagnose her with?
Generalised Anxiety Disorder (GAD)
This treatment is an example of a treatment for __________
Generalised Anxiety Disorder (GAD)
Major Depressive Disorder and Bipolar disorder are examples of what type of disorder?
Affective Disorders
What is the lifetime prevalence of Major Depressive Disorder (MDD)?
Is it more common in males or females?
One in Seven (15%)
Females (1 in 6 compared to 1 in 8)
What factors contibute to someone being diganosed with Major Depressive Disorder (MDD)
Biological (genetic) factors
Psychological vulnerabilities (e.g. negative cognitive bias)
Environmental experiences (e.g. critical or harsh parenting)
How would we assess Major Depressive Disorder (MDD)?
Questionnaires
(e.g. Beck Depression Inventory (BDI), anxiety and stress scales (DASS-21), Kessler Scale of Psychological Distress (K-10))
Clinical Interview with client
What mental disorder are these symptoms a part of according to the DSM-5?
How many of these symptoms need to be present in order to be diganosed and for how long?
Major Depressive Disorder (MDD)
5 or more must be present during the same 2 week period and at least one is (1) or (2)
What is Anhedonia?
What disorder is this usually a part of?
Inability to feel pleasure in normally pleasurable activities
Major Depressive Disorder (MDD)
Describe the Beck (1976) cognitive model of depression.
For patients with MDD negative early life experiences lead to ____
Dysfunctional Beliefs about the world
- Also called ‘core beliefs’*
- e.g. “I am unlovable”*
Describe the Beck and Bredemeier (2016) Unified Model of Depression
What psychological treatment would we use for depression?
Interpersonal Therapy
Cognitive Behavioural Therapy
Third wave cognitive behavioural therapies
How would we use interpersonal therapy to treat MDD?
How would we use CBT to treat MDD?
How would we use third wave cognitive behavioural therapies to treat MDD?
What are the therapy aims regarding thoughts, feelings and behaviours for CBT when treating MDD?
