Mental Health Flashcards
define mental health
sense of wellbeing, confidence
and self esteem, enabling joy and appreciation
of other people, day-to-day life and our
environment”– Form positive relationships
– Use abilities to reach potential – Deal with life’s challenges
define mental illness
a condition which causes serious disorder in a person’s behaviour, thinking or interaction with other people.”
epidemiology of mental illness
- Affects1in5Australians
- High incidence in those with chronic physical
- Why?
- Acute or long term stress
- Biological factors • Substance abuse
- Cognitive patterns • Social factors
depression cognitive
thoughts of guilt, worthlessness, hopelessness
Depression somatic
loss energy, poor sleep, appetite disturbances, fatigue
Anxiety cognitive
fearful thoughts of dying, suffocating, collapsing or or making a fool of oneself
Anxiety somatic
palpitations, breathlessness, sweating
neuroses =
gross exaggeration of normal experiences – Depression, anxiety, obsessional illness
Psychoses=
totally different from normal experiences – Schizophrenia, bipolar
Organic Psych disorders =
due to physical factors – Drug, ETOH withdrawl, endocrine, steroid use
list 8 characteristics of mental illness
- common
- reoccurring
- Hidden
- varied presentations
- stress related
- distressing
- impair personal function
- associated with high risk
Impact of mental illness
• Depressiontop-ranking cause of non-fatal disease burden in Australia (Mathers et al, 2000)
• Mental disorders overall were responsible for nearly 30% of the non-fatal disease burden (Mathers
et al, 2000)
• Significant barriers for the mentally ill.
• Difficulty obtaining and keeping regular employment
• Have fewer friends
• May be cut off from family members
• Lower socioeconomic status & lower standards of living
• High mortality and reduced life expectancy
Impact of mental illness: University of WA study (2001) study conclusions
“ While there is little direct evidence in the literature of an excess incidence of physical disease associated with mental illness, there is evidence that people with mental disorder are exposed to unhealthy lifestyle risk factors that are known to be linked to a variety of common physical conditions. These factors include smoking, alcohol consumption and other drug use, poor diet, lack of exercise, obesity, and high risk behaviours.”
Psychotherapeutic treatment techniques
psychological
physical
social
psychological treatment techniques
counseling psychiatric review psychological review relaxation & distraction cognitive behavioural therapies
Physical treatment techniques
medications : antidepressants, antipsychotics, tranquilizers
ECT (under sedation)
Exercise
Division & creative therapies
Social treatment technqiues
carer support : education, practical help, emotional support
reduce social stressors
build up of structured daily activities
group therapies
addressing housing, physical problems, finances, social supports
Fox’s four functions of physical activity
- Prevent mental health problems
- Improve psychological wellbeing of general
public - Improve quality of life for people with mental health problems
- As treatment or therapy for existing mental illness
considerations
- Current levels of patient fitness
- Reinforce success & provide variety
- Use patient centred goal setting
- Create clear long term goals
- Know boundaries
risk assessment
- History of violence
- Self harm incl. suicide • Abuse
- Absconding
- ETOH/illicit drug use
fitness testing
•Establish levels of safety, motivation & clinical effectiveness
– Demonstrates likely tolerance of physical activity, can also increase adherence (Franklin, 1988)
• Screening or Outcome measure
working in mental health
- Educate yourself
- Avoid stigmatising mental illness
- Balance flexibility with firmness
- Good supervision is key
- Confidentiality
- Monitor your level of involvement • Focus on strengths
- Treat everyone as a person
Risk reduction
• Avoid showing overly rigid & controlling attitudes
• Don’t show fear response
• Respond/problem solve in a situation of
potential conflict
• Refer on if unable to establish successful therapeutic relationship
reduce aggressive behaviour
- Show warmth, respect & understanding • Know the person
- Communicate effectively within MDT
- Smart scheduling
- Be on time, allow time to engage
- Conduct non clinical risk assessment
- Develop dept. contingency plans
- Consider environment
- Anger control issue: establish & discuss triggers
If unsuccessful
1. Try to decrease anger • Show empathy • Paraphrase content of what is being said • Acknowledge persons feelings 2. Problem solve • Attempt to clarify problem • Generate solution with patient • Discuss together 3. Act • Help individual put into practice what was decided at step 2 • Implement departmental contingency plan • Create physical space
Main symptoms of depression
Cognitive: Depressive thinking, sadness, thoughts of guilt, suicidal ideation, hopelessness
Physical: disturbed sleep, loss energy, loss appetite & weight, loss concentration
Less severe forms: sx more variable, physical sx less prominent
Often associated with irritability, anxiety, tension
Main symptoms of anxiety
Cognitive: anxious thoughts, irrational fears of dying/falling/looking foolish
Physical: palpitations, sweating, breathlessness, P&N, GI sx
Can be acute (wk/mth) or chronic (yrs)
Can be associated with avoidance of situations that trigger anxiety (eg. Crowds, social occasions)
Can be associated with or co-exist with depression
exercise as therapy for depression and anxiety
• Effect of physical activity on emotional states:
• Most improvements caused by rhythmic, aerobic exercises, use of large muscle groups (jogging, swimming, cycling, walking)
• Moderate to low intensity
• Acute effectsendorphins & monoamines
• Strength training and aerobic training • Session frequency: 3-5 sessions/week
Duration 45-60min/session
Mutrie (2000) Kaur (2013)
Rethorst (2013) Intervention duration: minimum 10 wk
Exercise for elderly with depression
• Aerobic&anaerobiceffectiveinreducingmildto
moderate depression symptoms
• Effectiveasacomponentoftreatment
• Types:
• Aerobiccycling, brisk walking, jogging • Yoga & flexibility
• Progressive resistance training
• Endurance training
• High intensity home based exercise programs • Tai Chi
• Calisthenics & Functional exercises
• Falls prevention
schizophrenia (acute) main symptoms
Cognitive: bizarre false beliefs often of persecution, often hear frightening voices (auditory hallucinations)
Physical: sometimes bizarre disturbed or aggressive behaviour
Can be triggered in vulnerable individuals by stress (surgery, accident, childbirth)
Main symptoms of chronic schizophrenia
Cognitive: persistent false beliefs or voices, negative features such as poor motivation and social withdrawal
Associated chronic social, occupational and personal dysfunctions
Exercise therapy for psychoses
• Patients are vulnerable to obesity/weight gain due to antipsychotics (Fogarty, 2004)
• Comparison of exercise to standard care found to significantly improve negative sx of mental state
• Physical health improved significantly in exercise group
• Comparison of exercise vs. yoga – yoga had better
outcome for mental state, better QOL scores Gorczynski P (2010)
• CV exercise, 1-2x/week improved mental health and cardiovascular fitness and reduced need of care in
patients with schizophrenia.
Schweewe (2012)
• Yoga or aerobic exercise to reduce acute stress and
anxiety in schizophrenia
Vancampfort (2010)
Anorexia nervosa main symptoms
Cognitive: characteristic over- concern of shape & weight
Physical: active maintenance of low weight by excess dieting, exercise and self induced restrictions, amenorrhea, physical effects of starvation
Associated depression, anxiety, and obsessional symptoms
review comments
Bulimia main symptoms
Cognitive: characteristic over- concern of shape & weight
Physical: usually a normal body weight. Frequent bulimic episodes (bingeing) involves consumption of large amounts of food in an out of control way
Use of extreme behaviour to control shape and weight
Associated with depression, anxiety and substance abuse
review comments
review eating disorder issues
slide 44
Eating disorder management
inpatient or outpatient • Patients recognition of disorder, identify triggers, improvement of delusional thoughts and feelings towards body image/shape, achievement and maintenance of healthy weight, prevention of relapse
• Behavioural therapy, psychotherapy, family counselling, dietary and nutritional education, exercise guidance, pharmacological management, CBT
• Individuals with eating disorders can safely engage in monitored exercise programs as part of inpatient treatment (Hausenblas, 2007)
• Supervised exercise prescription does not adversely affect weight gain or the return of menstruation.
• Evidence indicates there is increased treatment compliance, improved therapeutic relationship, decreased food preoccupation, decreased bulimic symptoms and decreased negative exercise behaviours with supervised exercise
patients considered improving body experience as a core element of their treatment
physiotherapy intervention in eating disorders
• Educationandadvice
• levels of healthy active, fatigue and HR monitoring
• Understanding of body function and structure
• Provide guidelines for physical impairments (ie. High impact
vs. osteoporosis)
• Monitor orthostatic hypotension, bradycardia, muscle cramping due to malnutrition and low cal diets
• Exercise not recommended if BMI is at certain levels
• Exercise only introduced once individual maintains healthy weight and is medically stable
• PROM/stretching when on bed rest (when critically underweight/medically unstable)
Physiotherapy intervention #2
• Consider type:
• Stretching, light upper body, breathing ex and
relaxation, aerobic ex, hydro
• Limitations and management of healthy activity levels
• Set upper limits on reps, sets, time to prevent over exercising
• Focus on +ve benefits of exercise in general, not as a weight loss tool
• Consider physical activity diary (Bentley, 2011)
physio intervention #3
- Aerobic and resistance training significantly increased muscle strength, BMI, body fat % in anorexic patients.
- Aerobic, Yoga, massage and basic body awareness therapy significantly lowered scores of eating pathology and depressive sx in both anorexia and bulimia patients (nil adverse effects)
- Aerobic, massage, body awareness therapy and yoga MIGHT reduce eating pathology, and MIGHT improve mental and physical quality of life
BMI guidelines for physical activity
• BMI<14
– Exercise not recommended, weight gain priority
– Gentle bed exercises, phased intro to mobilising • BMI between 14 and 15
– Lying and sitting exercises: gentle pilates, taichi, yoga, relaxation • BMI 15-17
– Gradual progression to WB activities, group session • BMI 17+
– Focus is still on weight gain, but can become more involved with activity, consider swimming, dancing. Group sessions
excess exercise
- Deemed excessive when accompanied by intense guilt or undertaken solely to influence weight or shape (Mond et al 2006)
- May be overt, covert or persistent restlessness
- Signs and symptoms:
- Unexplained injuries
- Joint pain
- Bruising and friction burns
- Stress fractures
- Muscle and ligament injuries
review common pharmacology
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