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Lifestyle Medicine > Mental Health > Flashcards

Mental Health Flashcards

1
Q

3 types of stress?

A stressor is a perceived threat

A

Eustress
- good stress

Neustress
- neutral

Distress
- bad, threatening
- acute vs chronicCa

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2
Q

Categories of Stressors

A
  1. Psychological (thoughts, beliefs, perceptions)
  2. Physiological
  3. Social
  4. Bioecological
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3
Q

What are Adverse Childhood Experiences

ACEs

A

Potentially traumatic events in childhood (0-17 yrs)

6/10 adults

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4
Q

Examples of ACEs

A
  • abuse or neglect
  • violence (experience / witness)
  • family member suicide
  • household substance use, MH, instability (parental separation)
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5
Q

Body’s mechanism to survive a perceived threat?

A
  1. HPA (hypothalamic-pituitary)
  2. Nor / epinephrine
  3. Cortisol
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6
Q

Sympathetic response > Parasympathetic response …in

A

Chronic stress

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7
Q

How to manage pathologic stress response ?

A
  1. Breathing tools
  2. Movement
  3. Meditation
  4. Connect with nature
  5. Self-expression
  6. Community
  7. Reading self-help
  8. Massage
  9. Listen to music
    10.Light therapy
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8
Q

What is a mental disorder?

(WHO)

A

Clinically significant disturbance in
- cognition
- emotional regulation
- behaviour
+
Distress
Impairment in function

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9
Q

Causes of MDD / Anxiety

A

Non modifiable
- genetics, perinatal, social, cultural

Modifiable
- stress, nutrition, financial, sedentary, addictions

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10
Q

Bidirectional association between MDD and T2DM? T/F

A

True

Insulin mediated mechanism for tryptophan and tyrosine –> serotonin, NA, Dop

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11
Q

Diabetes-related risk factors for suicidal ideation?

A
  • use of insulin
  • duration of diabetes > 5yrs
  • HbA1c > 6.5 (poor control)
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12
Q

Ppl with depression have higher risk of CAD, through?

A
  1. > abnormal platelet adherence
  2. endothelial dysfunction
  3. lower HR variability
  4. Poor adherence to lifestyle changes
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13
Q

MDD and heart disease

A

Independent risk factor for cardiac events!

Primary RF for IHD
Secondary RF for worse prognosis
15-20% higher cardiac risk
Doubles cardiac events
Modifiable; preceded by a few years

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14
Q

Screening for stress

Perceived Stress Scale (PSS)

A

10 - item questionnaire
Scale of 0 to 4
Higher score = More stress

(13, 26)

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15
Q

Longer work hours increase heart disease risk?

A

Yes

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16
Q

Work stress increases T2DM incidence?

A

Yes

Plus
- smoking
- physical inactivity
- heavy alcohol

(not BP or chol)

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17
Q

Screening for Depression?

What method

A

PHQ- 2

Over the past 2 weeks, have you felt:
1. down, depressed, hopeless?
2. little interest/pleasure

Rated 0-3

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18
Q

PHQ-2 Positive

Score?
What next?

A

> = 3

(72% sensitive)

Needs further assessment with
1. PHQ-9
2. HAM-D (Hamilton) (Beck)
3. BDI-II

to check severity

19
Q

Diagnosis of MDD

Criteria

A

> = 5 symptoms
Nearly every day for 2 weeks
Change from prior levels of fn

At least one of:
1. Depressed mood most of day
2. Loss of interest or pleasure

4 or more of:
- weight change
- sleep disturbance
- irritability
- fatigue
- feeling worthless / guilt
- diff concentrating / decisions
- suicidal ideation

20
Q

Screening for Anxiety

A

No recommendations

fear, worry, excessive apprehension

21
Q

Brief anxiety screening

GAD-2

A

In the last 2 weeks, how often

  1. Nervous, anxious, on-edge
  2. Not been able to stop or control worrying

Positive if score >= 3

22
Q

If GAD-2 positive?

A

Follow up with

  1. Hamilton Rating Scalen (HAM-A)
  2. GAD-7
  3. BAI (Beck Anxiety Inventory)
23
Q

Diagnosis of anxiety

Crieteria

A

More than half the days in 6 months:
1. Excessive anxiety
2. Worry difficult to control

At least 3 other:
- restlessness
- easily fatigued
- difficulty concentrating
- irritability
- muscle tension
- sleep disturbance

Significant impairment
Not due to substance use
Not from another cause

24
Q

Brief screening fro Depression AND Anxiety?

A

PHQ-4

Over past 2 weeks, how often:
1. nervous, anxious, on edge
2. cannot control worry
3. down, depression, hopeless
4. little interest / pleasure

25
Q

Healthy coping skills?

A
  1. Mgmt of stress response
  2. CBT skills
  3. Time mgmt skills
  4. Positive psychology techniques
26
Q

Role of patient in own mental health?

A
  1. Promote self mgmt techniques
  2. Use social support
  3. Community and online resources
  4. MH providers
27
Q

Self mgmt techniques for MH?

A

Healthy coping skills
Activities that draw on creativity
Gratitude journal
Spiritual needs
Limit screen time

28
Q

What is Mindfulness?

A

Paying attn to thining and feeling
Being fully present in moment
Aware of surroundings
Withholding judgement or interpretation

29
Q

MBSR strategies

(Mindfulness-based stress reduction)

A

Formal
- meditation

Informal
- attentiveness to routine activities

30
Q

Meditation

Systematic review and meta-analysis

A

Moderate evidence:
- anxiety, depression, pain

Low evidence:
- mood, stress, attn, sleep, weight

Not better, but not harmful

31
Q

MIndfukness ands neuroplasticity

What can it do to the brain?

A
  • increase thickness of pre-frontal cortex (processing, decision, memory)
  • increase grey matter in hippocampus (learning, new memory, emotional reg)
  • reduce grey matter in amygdala (emotions - stress, anxiety, negative thoughts)
32
Q

What is CBT?

A

Change thoughts –> emotions –> behaviour

Focus on current life (not past)

33
Q

Benefits of CBT?

A
  • thoughts are helpful vx harmful or positive vs negative
  • doesn’t bring up damaging memories
  • rational positive thoughts kept
  • improves resilience
  • improved coping with stress
  • healthy connectivity of brain regions
  • build empathy
  • increase grey matter in pre frontal cortex
  • rewire neural pathways
34
Q

Efficacy of CBT vs meds for Depression?

A

As efficacious
Less incidence of relapse

Also for panic disorder and OCD

35
Q

Physical activity helps prevents which MH disorders?

A

Bipolar

+ treat
ADHD
Anxiety
MDD
Psychosis

36
Q

Not smoking helps prevents which MH disorders?

A

Bipolar
ADHD
MDD
Psychosis

37
Q

Nutrition protective for which MH conditions?

A

MDD

+ treat MDD

38
Q

Sleep protective for which MH conditions?

A

Bipolar
ADHD
Anxiety

+ treat MDD

39
Q

Non-pharm tx for Depression?

If pharm/psych not wanted

A
  1. Exercise mono
  2. St John’s wort mono
  3. Bright light
  4. Yoga
  5. Acupuncture+ meds
  6. Other (Tai Chi, acupunture mono, omega 3, SAMe) –> insufficient evidence
40
Q

First line tx for MDD?

A

Psychotherapy
OR
Pharmaco
OR Combo

Pharmco if mod/sev

41
Q

First line tx for GAD/PD?

A
  1. Psychotherapy (CBT)
  2. Pharmacotherapy (SSRI)
  3. Physical activity

Plus other lifestyle txs

42
Q

Dietary pattern
or
Nutrient deficiencies

likely to account for depression?

A

Dietary pattern

WFPB

Fast food
Fried food
Trans fats
Refined grains; sugary
Red/proc meat

43
Q

RCT with plant based
- no meat fish or eggs
Depression improved in how long?

A

2 weeks

44
Q

Supplements for MH?

A

Omega 3
- bipolar, ptsd, depression
SAMe
St John’s Wort
Folate / Vit B9
- prod serotonin, dopamine

Lifestyle Medicine (9 decks)

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