Lecture 10 - Mental Health Flashcards
What do mental health issues need to have to be diagnosed
Causing distress - impact
Meet set criteria DSMV
Clinical judgement
How has mental health conditions been seen as a part of autism
Kanners 1943:
Fear and anxiety around objects/events
Depression
Insistence sameness
What are the categories of risk/protective factors of mental health
Environment
Societal
Psychological
Biological
What are examples of Environmental risk/protective factors to mental health
Stress Bereavement Finances Bullying Unemployment
What are examples of Societal risk/protective factors to mental health
Attitudes
Stigma
Policy - service provision
Poverty
What are examples of Psychological risk/protective factors to mental health
Thinking style
Coping strategies
Resilience
What are examples of Biological risk/protective factors to mental health
Genetic predisposition - family history
Brain structure and function
Outline the Diagnosis of Autism
5 years autism
11 years - adulthood AS
Instruments can diagnose early 18 months
Outline Growing up with Autism
Up to 75% bullying and peer victimisation Transition adulthood: Lack support Health and social difficulties Poor quality life Low occupational achievement Social exclusion and isolation
What are the social challenges of being autistic
Difficulty recognising other emotions, interpreting and predicting others behaviour and responding appropriately
Less readable
Double empathy problem
Negatively evaluated by non-autistic people
Outline Sassoon et al 2017 study on autistic people being negatively evaluated by non-autistic people
Autistic individuals do a video tape selling themselves
Got neurotypical people rate these videos
Voted autistic individuals less favourably
Outline how Autistic people camouflage
Camouflage to cope in social situations
Copy those who are neurotypical prevent judgement
More common in women contributing mid/under diagnosis
Toll on mental health - suicidal
Loss identity
Exhausting
Helps fit in neurotypical society (positive?)
What are the mental health conditions associated with Autism
Depression
Anxiety
Anorexia Nervosa
Borderline Personality Disorder
Outline DSMV criteria for major depressive disorder
Depressed mood Insomnia/Hyperion is Worthlessness Guilt Loss interest Psychomotor retardation/agitation Impaired concentration or indecisiveness Change weight/appetite Loss energy/fatigue Death or suicidal ideation/attempt
Outline DSMV criteria for Persistent Depressive Disorder
Poor appetite/Over eating Insomnia/Hypersomnia Low energy/Fatigue Low self-esteem Impaired concentration or indecisiveness Hopelessness Never without symptoms for more 2 months
Outline Depressive Prevalence
23% UK population experience mental health problem, depression most common
79% autistic adults meet criteria psychiatric condition some point - depression most common
Depression 30-50% autistic adults and 30% children
Social consequences autism
Loneliness
Chronic isolation
Perceived inequality
Inadequacy
Outline emotional consequences autism
Poor perceived self worth Stress Social anxiety Depression Difficulties in social problem solving skills
Young adulthood and Autism
Young adulthood - increased social demands, expectations, comparisons. Support.
ASD - social struggles, difficulties understanding, developing and maintaining social relationships
This Age span associated increased susceptibility depressive episodes
Lock support and feelings loneliness
Which societal difficulties may mediate increased depression in Autism
Social problem solving ability
Loneliness
Lack social support
What makes a good assessment tool?
Structural validity and internal consistency - do they measure what I want to measure
Hypothesis testing - does the tool perform the way we expect it to
Criterion validity - does tool correlate with gold standard assessment
Content validity - are questions relevant, understandable to target group
Reliability - same result from different assessors? At different times?
Diagnostic overshadowing and structural validity
Depression has 1 major factor explain consistency
Autism: some items assess autism? Different factor structure? Lower internal consistency of items?
More than 1 latent factor to explain. Might score completely different on factors
Factors do not necessarily correlate
Outline structural validity
Acceptable internal consistency or both sub scales (anxiety and depression) in autism
Outline Hypothesis Testing
Mild-moderate correlated with other measures
e.g. well-being and depression
Outline cognitive aspects of ASD
Alexythymia: difficulty verbalising internal thoughts and feelings.
ToM: difficulty putting yourself in others show
Literal interpretation: difficulty reading between lines
Reduced flexibility in thinking - executive functions
Outline Atypical cognition and content validity
Ensure questions relevant and understandable, taking into account cognitive characteristics autism
Feeling down —> Alexythymia
Adapting depression tools for autism
Include autistic specific items capture unique presentation in autism
Loss interest in previously intense interest
Change in: eating, sleep, movement
Sensory sensitivity, camouflaging
BUT sensory hypo-sensitivity and depression look similar
Why is depression highly prevalent in autism
Increased experience of psycho-social risk factors
Due difficulties accurate identification
- overestimate (overlapping)
- under estimate (fail capture autism specific factors)
Outline anxiety symptoms
Restlessness or feeling on edge Easily fatigued Difficulties concentrating Irritability Muscle tension Sleep disturbance
Outline anxiety in autism
Insistence sameness
Intolerance uncertainty, repetitive behaviours and sensory processing
Sensory difficulties core feature and associated REBs
Fear violation of logical rules or unpredictability social situations
Outline Anxiety and Autism Assessment
Revised child anxiety and depression scale adapted children autism
Additional autism specific areas include in measure: sensory anxiety, intolerance uncertainty, phobias
Focus groups with parents refine content validity
Survey established factor structure
Overlapping between BPD and Autism
Overlap: Social difficulties Emotion regulation difficulties Frequent suicidal gestures Appear have very unstable and chaotic lifestyle - frequent changes or inappropriate friendships Camouflaging problem with identity
Compared BPD and Autism
BOD more commonly diagnosed females
Autism under diagnosed females
High prevalence suicidal/self-injury and camouflaging in autistic females
Lead misdiagnosis autistic females BPD
15% BPD met criteria co-occurring autism
1% general pop
ASD and BPD high risk suicide, significantly lower negative self image
Elevated autistic traits BPD was
Summary BPD and Autism
Symptoms overlap
Misdiagnosis
Increased social difficulties
Self-harm behaviours
Outline Eating Disorders
Persistent restriction energy intake leading low body weight
Intense fear gaining weight or becoming fat
Persistent behaviour interferes weight gain
Disturbance way ones body weight or shape experienced
Anorexia - significantly underweight
Bulimia - recurrent episodes binge eating followed inappropriate compensatory behaviours
Outline Eating disorders and Autism being separate conditions
Autism - social function and flexibility, early onset first 3 years. Prevalent male BUT under diagnosed females.
ED - adolescence, adulthood. Prevalent females
ID more prevalent autism
Outline Eating disorders and Autism overlapping
Autism increase ED
Underlying lack flexibility, difficulties social functioning women EDs
Indicative undiagnosed autism
0.3% female autism prevalence in general pop
8-37% females autism ED
Increased prevalence autism ED
Are behaviours being measured truly autistic?
Result co-morbid OCD, depression, anxiety, starvation
Overlap autism
Starvation temporarily increases rigidity and obsession food
Mistake autism - narrow obsessive interest, sensory difficulties, social difficulties, rituals
