Lecture 32: Common Mental Disorders - epidemiology and disability Flashcards
what are the anxiety disorders?
- panic disorder
- agoraphobia
- specific phobia
- generalised anxiety disorder
- post-traumatic stress disorder
- obsessive compulsive disorder
what is normal fear or anxiety?
- response to objectively dangerous/threatening situations
- protects from harm
- constructive action
what is a panic disorder?
recurrent unexpected panic attacks and at least one of the attacks has ben followed by 1 months (or more) of one or both of the following:
1) persistent concern or worry about having additional attacks or their consequences (heart attack, going crazy)
2) a significant maladaptive change change in behaviour related to the attacks
what is a panic attack?
a panic attack is not a disorder
- it is an intensive abrupt surge of fear that includes 4 or more of these symptoms and peaks within 10 minutes:
- palpitations, pounding heart, accelerated HR
- sweating
- trembling or shaking
- feelings of choking
- chest pain/discomfort
- nausea or abdominal distress
- dizzy, unsteady, lightheaded, faint
- chills or heat sensations
- numbness or tingling sensations
- derealisation or depersonalisation
- fear of losing control or going crazy
- fear of dying
what is agoraphobia?
marked fear or anxiety about two or more of the following:
- using public transport
- being in open spaces
- being in enclosed spaces
- standing in line or being in a crowd
- being outside of the home alone
- individual fears or avoids these situations due to concerns not able to escape or help not available or embarassing symptoms
- avoided/need a companion/endured with intense fear
- persistent (6 months or more)
- casues significant distress or impairment in functioning
- debilitating
- may affect all areas of functioning (social, occupational, routines)
Typical avoidance:
- being alone outside the home/or alone at home
- supermarkets, crowd of people, open space
- travelling in a car, bus, train or aeroplane
- bridges or elevators
what is specific phobia?
- marked fear or anxiety about a specific object or situation (flying, animals, injections, blood)
- almost always provoke fear/anxiety
- avoided or else endured with intesne anxiety
- the fear is recognised as excessive/unreasonable
- persistant, fear or anxiety significant distress or impairs functioning (e.g. social, occupational, routines)
what is social anxiety?
- marked fear or anxiety about one or more social situations in which individual is exposed to possible scrutiny of others (e.g. conversing, meeting new persons, eating in front of others, speeches)
- fears that he/she will act in a way or show anxiety symptoms that will be negatively evaluated (humiliating, embarrassing, rejection)
what is social phobia?
- social situations almost always provoke fear/anxiety
- avoided or else endured with intense anxiety
- the fear is recognised as excessive/unreasonable
- persistant, typically 6 months or more
- avoidance, fear or anxiety significant distress or impairs functioning (e.g. social, occupational, routines)
what is generalised anxiety disorder?
- excessive anxiety and worry occuring more days than not for at least 6 months about a number of events or activities
- individual finds it difficult to control the worry
- 3 or more of the following:
- on the edge, restless, keyed up
- easily fatigued
- cant concentrate/mind going blank
- irritability
- muscle tension
- sleep disturbance
- anxiety or worry causes significant distress or impairment in social, occupational or other important areas of functioning
what is exposure to trauma?
potentially traumatising event (PTEs)
- unpredictable/uncontrollable/severe/ catastrophic violation of fundamental beliefs and expectations about safety, physical integrity, trust and justice
- PTEs not uncommon
- population studies 50-89%
e. g. life threat, physical injury, exposure to violence, sexual assault, child sexual abuse, earthquake
what is post traumatic stess disorder?
- exposure to actual or threatend death, serious injury or sexual violence by the presence of one or more intrusive symptoms assocaited with the traumatic event
- intrusive distressing memories/dreams/flashbacks, intense distress of physiological reactions to internal or external clues
- persistent avoidance of stimuli assocaited with the event (external or internal)
- negative alterations in cognition or mood
- can’t remember, negative beliefs about self or world, seld blame, horror, anger, fear guilt shame, detached, not interested, not able to deel positive emotions, not trust
what is obsessive compulsive disorder?
OCD
- characterised by the presence of obsessions and compulsions
obsessions:
- recurrent and persistent thoughts (e.g. contamination) urges (e.g. to stab someone) or images (e.g. violent or horrific, sexual) that are experienced as intrusive and unwanted and cause marked distress or anxiety
- individual attempts to ignore or suppress such thoughts, urges or images, or neutralise them with a thought or an act (i.e., a compulsion)
Compulsions:
- repetitive behaviours (hand washing, checking, ordering) or mental acts (e.g. counting, repeating words silently) that person feels driven to perform in relation to an obsession or rulse that must be applied
- behaviours or mental acts aimed at preventing or reducing anxiety, or preventing some dreaded event or situation
- time consuming (more than one hour a day) or cause distress or impairment in functioning
mild to moderate (1-3 hours), severe constant intrusive thoughts or compulsions
what are the overall patterns of prevalence by age and sex?
Prevalence rates higher in younger people
Decreases with age
By the time adults are 65+, it is a lot lower
Anxiety disorders (yellow) females have higher prevalence rates
Depression - females higher than males
Bipolar - F higher than M
Alcohol abuse/alcohol dependence - Males higher than females
what are the gender differences of mental disorders?
Females are more likely to get depression and anxiety disorders
- hormonally differences
- more emotionally responsive
- more exposure to negative experiences
Males are more likely to get substance abuse disorders
- greater access to alchol
- use among peers
- social acceptability of males drinking
what are the age differences of mental disorders?
- older people less likely to have current mental disorders
- likely to experience age related changes in:
- emotional lability (how high and low your emotions swing and how quickly)
- selective focus - tend to focus more on positives as get older, and avoid dwelling on negatives
- perspective and experience, development of coping skills
what is the percent of reporting severse disability in NZ?
reports of severe disability is a lot higher than other physical conditions
WHY?
- Physical pain doesn’t affect cognition and emotion
- More able to cope with physical condition
- Mental disorders directly affect cognition and emotion
- Out of role is the highest disability - cant function the way they should
- Ability to think, make decisions is affected too
- Mobility and self care are affected less
- Social is effected less too
