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Medical Sciences B > Mental Health > Flashcards

Mental Health Flashcards

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USMLE® Step 1 flashcards
1
Q

What is the definition of mental health?

A
  • state of well-being
  • individual realizes his or her own abilities
  • cope with normal stresses of life
  • work productively and fruitfully
  • contribute to community
  • not just absence of mental illness
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2
Q

What is the definition of mental illness?

A

period of psychological dysfunction associated with distress or impairment in functioning that is not typical or culturally expected, and not explainable by other means

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3
Q

Why are mood disorders a yellow flag?

A

impacts perception of pain, compliance with treatment

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4
Q

What are risk factors for mental health issues?

A

Biological, psychological and social origins
• family history of mental illness
• child sexual abuse/neglect
• family/relationship instability
• poverty, social disadvantage
• stressful life events
• chronic physical illness and disability
• social isolation or poor social support

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5
Q

What are the effects of mental illness?

A

Basic functioning
• apetite, sleep, cognition, mood

Interpersonal functioning
• initiating and maintaining satisfying relationships

Occupational functioning
• work/study performance, engaging in activities

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6
Q

How do psychological factors effect chiropractic care?

A
  • impact health and ability to respond to chiropractic care
  • initial and long-term pain experience
  • therapeutic relationship
  • treatment outcomes
  • impact development and maintenance of chronic pain
  • predictors of disability
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7
Q

What are feelings associated with chronic pain?

A
  • perception of control of pain
  • negative emotion
  • poor coping skills
  • low social support
  • social reinforcement of pain behaviours
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8
Q

What are psychological and social barriers to recover from pain?

A
  • believe pain & activity are harmful
  • sickness behaviours (extended rest)
  • negative moods, social withdrawal
  • claims and compensation problems
  • Hx of time off work & other claims
  • poor job satisfaction, heavy work, unsociable hours
  • overprotective family / poor support
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9
Q

What is the difference between fear and anxiety?

A

Fear:
• satte of immediate alarm in response to a serious, known threat
• abrupt activation of sympathetic nervous system

Anxiety:
• state of alarm in response to vague sense of predicted threat
• somatic symptoms of tension

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10
Q

What does the sympathetic nervous system do when activated?

A

Increases:

  • HR
  • BP
  • respiration
  • adrenalin
  • corticosteroids
  • blood sugar
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11
Q

What is the difference between adaptive anxiety and maladaptive anxiety?

A

Adaptive:

  • appropriate for situation
  • enhances survival or success

Maladaptive:

  • triggered by inappropriate situations
  • disproportionately severe or lasting
  • impairs functioning
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12
Q

What is the definition of anxiety disorder?

A
  • persistent, excessive worry

- interfering with ability to carry out, or take pleasure in, day-to-day life

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13
Q

What are the key characteristics of anxiety disorders?

A
  • excessive/inappropriate anxiety
  • pervasive, persistent, uncontrollable symptoms
  • acknowledgement that fear is unrealistic
  • excessive avoidance and escapist tendencies (cognitive or behavioural)
  • causes clinically significant distress and impaired functioning
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14
Q

What are the anxiety disorders subtypes?

A
  • Panic disorder with/without agoraphobia
  • Generalized anxiety disorder
  • Specific phobias
  • Social phobia
  • OCD
  • PTSD
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15
Q

What is the prevalence of anxiety disorders?

A
  • more common than any other disorder in Australia

- affect women than men

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16
Q

What is the comorbidity of anxiety disorders?

A
  • common across anxiety disorders
  • 50% of patients have 1 or more secondary diagnosis
  • substance abuse often
  • common etiological factors
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17
Q

What are risk factors for anxiety disorders?

A
  • family Hx of anxiety disorders
  • childhood adversity
  • unpredictable or dangerous environment
  • abandonment and loss
  • traumatic or stressful life events
  • low support
  • mood disorders and substance abuse
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18
Q

What is Panic Disorder (with or without agoraphobia)?

A
  • occurence of repeated, unexpected panic attacks for which there is persistent concern
  • agoraphobia: extreme or irrational fear of open or public places
  • acute onset
  • 25-29yrs
  • high risk of suicide
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19
Q

What is Specific phobia?

A
  • clinically significant anxiety relating to a specific situation
  • recognize fear as unreasonable
  • avoidance of fear
  • begins at 15-20yrs (becomes chronic)
  • ex. blood, nature, animal, separation
  • reactions are automatic, uncontrollable
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20
Q

What is Social phobia?

A
  • clinically significant anxiety relating to social or performance situations
  • avoid or extreme distress
  • interferes ability to function
  • most common anxiety disorder
  • men = women
  • 18-29yrs
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21
Q

What is a panic attack?

A
  • abrupt experience of intense fear peaking within 10 min
  • chest pain, racing, pounding heart
  • dyspnoea, digestive problems
  • dizziness, shaking, trembling, sweating
  • dissociative, fear of dying
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22
Q

Compare obsession vs compulsion?

A

Obsession:
-intrusive, unwanted, distressing thoughts or images

Compulsion:
ritualistic thoughts or behaviours that temporarily neutralize the obsessions and consequently the accompanying anxiety

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23
Q

What is Obsessive-compulsive disorder?

A
  • fear of recurrent obsessions which are usually accompanied by compulsions and/or avoidance
  • tends to be chronic but often “waxes and wanes”
  • early adolescence
  • feeling trapped in the pattern, loosing control
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24
Q

What is PTSD?

A
  • re-experiencing of a highly traumatic event which is accompanied by heightened arousal and avoidance of stimuli associated with the event
  • affects functioning
  • symptoms present 1 month or more after trauma
  • tends to be chronic but “waxes and wanes”
  • withdrawn, on edge, flashbacks
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25
Q

What are psychological inventories?

A
  • assess symptoms, severity, efficacy of treatment
  • pre-test and post-test
  • score assessed against established norms
  • only by health professionals
  • only used as supplements to clinical interviews
  • provides symptom profile
  • does NOT provide aetiology
  • 2 types
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26
Q

What are the treatments available for anxiety disorders?

A

Psychopharmaceutical
• mild tranquilizers (benzodiazepines)
• antidepressants
• moderate reduction of symptoms in 60% people

Cognitive behavioural therapy
• psycho-education (nature of anxiety)
• relaxation (breathing, muscle relaxation)
• cognitive therapy
• behavioural therapy
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27
Q

How does anxiety affect chiropractic care?

A
  • can affect physical health and response to chiropractic treatment
  • initial and long-term pain experience
  • therapeutic relationship
  • treatment outcomes
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28
Q

How does pain affect chiropractic care?

A
  • higher muscle tension
  • PTSD or Hx of trauma makes for more likely to experiences somatic pain
  • anxiety have “fear-avoidance beliefs” about pain
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29
Q

What are indicators for referral in regards to anxiety disorders?

A
  • presents with anxiety disorder that impacts experience of pain
  • presents with anxiety disorder impacting engagement in treatment
  • physical health not improving despite treatment engagement, or deteriorating
  • suffering from untreated anxiety disorder warranting psychological help
  • experiencing ongoing and severe symptoms of anxiety
  • appears at risk of suicide
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30
Q

Is obesity an eating disorder?

A
  • NO
  • classified as a medical condition
  • an eating disorder can lead to obesity
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31
Q

What is anorexia nervosa? (BMI, expected weight, peak onset age)

A
  • maintenance of underweight by dietary restriction
  • intense fear of gaining weight
  • weight loss -15% below expected weight or BMI <17
  • 0.5-1.6% females; 0.1% males
  • 90% caucasian
  • chronic -20% don’t recover fully
  • peak onset at 12-15yrs
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32
Q

What is bulimia nervosa? (weight range, age)

A
  • minimum weekly overeating followed by extreme weight loss
  • binge eating and purging
  • 1.1-2.8% females; 0.1% males
  • 16-19yrs
  • chronic
  • complications: suicide, cardiac problems, obesity
  • normal weight range
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33
Q

What is binge-eating disorder?

A
  • min weekly episodes of overhang with sense of lost control with NO attempts to compensate
  • later onset than anorexia and bulimia
  • complication: obesity
  • more psychopathology
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34
Q

What are the main differences between anorexia and bulimia?

A

• weight and amenorrhea criteria

Anorexia:
• less regular binging and purging cycles
• carefully control food intake -but fear loosing control

Bulimia: heightened feelings of shame and feeling out of control

35
Q

What are the comorbidities for eating disorders?

A
  • anorexia becomes bulimia
  • anxiety, mood, substance use disorders
  • self harm and suicide
  • anorexia has highest mortality rate -18-20% die (50% from suicide)
36
Q

What are medical complications from extreme weight loss?

A
  • laugo, hair loss, brittle nails, sensitivity to cold, headaches
  • impairments in immune and endocrine system functioning, cardiovascular problems
  • brain shrinkage
  • osteoporosis
37
Q

What are medical complications from purging?

A
  • calluses, erosion of dental enamel, salivary gland enlargement
  • intestinal problems, permanent colon damage, electrolyte imbalance
  • kidney failure, cardiac arrhythmia, seizures
38
Q

What are key risk factors for eating disorders?

A
  • female
  • teens-20s
  • higher BMI
  • family Hx
  • childhood sexual abuse
  • mental illness
  • perfectionism
  • occupation (dancer, actor, athlete)
39
Q

What are warning signs of eating disorders?

A
  • great lengths to concealing
  • preoccupation with body shape, weight, appearance
  • sudden fluctuations in weight
  • calorie counting, dieting , fasting
  • avoidance of foods or meals
  • obsessive and repetitive body checking
  • baggy clothes
  • social withdrawal or isolation
  • fainting, dizziness, fatigue
  • laxative abuse, compulsive exercise
  • depression, anxiety, substance abuse
40
Q

What are good screening questions for eating disorders?

A
  • Are you satisfied with your eating patterns?
  • Does your weight affect how you feel about yourself?
  • Do you ever eat in secret?
  • Do you have or have had an eating disorder?
  • Family Hx of eating disorders?
41
Q

What are treatments for bulimia nervosa?

A

Psychopharmacological
• antidepressants (high dose)
• help reduce binging and purging and comorbid psychological disorders
• not efficacious long-term

Psychological
• cognitive behavioural therapy (#1)
• interpersonal therapy

42
Q

What are treatments for anorexia nervosa?

A

*weight restoration is important goal

Pharmacological - none

Psychological
• motivational enhancement therapy
• CBT
• family-based therapies (especially for adolescents)

43
Q

How do eating disorders affect chiropractic care?

A

Impact pain experience
• increased risk for developing broad range of physical/mental disorders
• compromised physical health (osteoporosis, overexercising)

Therapeutic relationship
• secrecy, shame, closeness, lying
• feeling exposed, vulnerable, sensitive to judgment

Treatment outcomes
• unlikely to look after their body
• difficult to maintain body centred relationship with chiro

44
Q

When do you refer a patient? (eating disorder)

A
  • Presents with an eating disorder impacting on their experience of pain
  • Presents with a Eating Disorder impacting on their ability to engage in treatment
  • Physical health not improving or deteriorating due to an Eating Disorder
  • Untreated Eating Disorder warranting psychological help
  • Appears at risk of suicide
45
Q

How prevalent are eating disorders among the obese population?

A

obese are 5x more likely

46
Q

List the eating disorders from most to least prevalent?

A

1) anorexia nervosa
2) bulimia nervosa
3) binge eating disorder
4) unspecified

47
Q

What is Unspecified eating disorder?

A
  • no criteria for formal criteria
  • associated with significant distress and social / academic / other impairment
  • ex. night eating syndrome: majority of food intake after evening meal or at night
  • ex. purging disorder: regular vomiting or laxatives for weight loss, with no binge
48
Q

What is muscle dysmorphia?

A
  • preoccupation with not being muscular enough

* extreme social, dietary, exercise habits

49
Q

What is the definition of Substance disorder?

A

problems with use and misuse of alcohol and drugs that alter patterns of thinking, feeling, behaving

50
Q

List the categories of substances

A
  • depressants
  • stimulants
  • opioids
  • hallucinogens
  • other drugs (inhalants, anabolic steroids)
51
Q

Compare depressants to stimulants?

A 
Depressants:
• influence GABA neurotransmitter system
• alcohol -initial stimulation and well being
• sedatives -calming
• hypnotic -sleep inducing
• anxiolytic -anxiety reducing

Stimulants
• increase alertness and energy
• caffeine, nicotine, amphetamines, cocaine

52
Q

What are opioids?

A
  • activate body’s enkephalins and endorphins
  • narcotic effects: euphoria, drowsiness, slow breathing
  • analgesics
  • heroin, opium, morphine, codeine
  • severe withdrawal, risk of HIV, high mortality rate
53
Q

What are hallucinogens?

A
  • alter perceptions of the world
  • delusions, paranoia, altered sensory perception
  • marijuana, LSD
54
Q

What are inhalants?

A
  • in volatile solvents (spray pain, hair spray, gasoline, nitrous oxide)
  • breathed into lungs (rapidly absorbed)
  • effects like alcohol, tolerance and withdrawal
55
Q

What are anabolic steroids?

A
  • steroids derive from testosterone
  • medicinally or to increase body mass
  • no high
  • long-term mood disturbance and helath issues
56
Q

caffeine

A
  • blocks feu-take of neurotransmitter adenosine
  • tolerance and dependence
  • tea, coffee, cola drink, cocoa products
57
Q

amphetamines

A
  • stimulate CNS by enhancing release of norepinephrine and dopamine (feu-take blocked)
  • dependence
  • followed by extreme fatigue and depression
58
Q

cocaine

A
  • blocks reuptake of dopamine

* highly addictive with insidious addiction

59
Q

What are the hallmark features of dependence?

A
  • tolerance
  • withdrawal
  • impaired control: using more than intended
  • impaired control: failed stop attempts
  • drug centredness (salience)
  • narrowing of behavioural repertoire
  • using despite contraindications
60
Q

What are the Australian guidelines for alcohol use?

A

*no level guaranteed safe
• <2 standard drinks / day
• < 4 standard drinks / occasion

61
Q

What are the big 3 psyhchological disorders in Australia?

A

1) mood disorders
2) anxiety disorders
3) substance-related disorders

62
Q

What are the risk factors for substance abuse?

A

Family:
• poor parental supervision, communication, conflicts
• inconsistent or severe parental discipline

Individual:
• Hx of abuse
• learning, emotional, impulse problems
• thrill-seeking
• low perceived drugs risk
63
Q

What are the elements of substance abuse clinical assessment?

A

1) clinical interview (best method)
2) clinical observation
3) psychological inventories

64
Q

What are psychological inventories?

A
  • self-report measures
  • assess specific susbtance, frequency, length, severity of physical and psychological symptoms
  • only administered by health professional sufficiently trained
  • only as supplements to clinical interviews
  • gives individual symptom profile NOT aeiological factors
65
Q

What are the principles of effective treatment for substance abuse?

A
  • notoriously difficult to treat
  • comprehensive treatment approach
  • respect
  • collaborative approach
  • intervention improves outcome
  • no single intervention is superior
66
Q

What are the treatments for substance abuse?

A

Pharmaceutical
• agonist substitutions, antagonist treatments, aversive treatments

Psychological
• individual, group, family therapy
• inpatient & outpatient rehab program (withdrawal program)
• controlled use versus complete abstinence
• community support programs (AA, 12 step, groups)

67
Q

agonist substitutions

A

substitute safe drugs with similar chemical composition (ex. methadone and nicotine gum or patch)

68
Q

antagonist treatments

A

drugs that block or counteract drug effects (ex. naltrexone implants for opiate dependence)

69
Q

aversive treatments

A

make use of drugs extremely unpleasant (ex. disulfiram “Antabuse” for alcohol dependence)

70
Q

What are the elements of a comprehensive psychological treatment program?

A
  • assessment
  • psychoeducation
  • motivational interviewing
  • CBT
  • community reinforcement
  • relapse prevention
71
Q

What are the elements in the circle of change?

A 
relapse
precontemplation
contemplation
determination
action
maintenance
72
Q

What are the principles of motivational interviewing?

A
  1. motivation is from client
  2. client’s task to articulate and resolve his ambivalence
  3. direct persuasion is ineffective
  4. counselling style is quiet and eliciting (NOT aggressive confrontation, argumentation)
  5. counselor helps client examine and resolve ambivalence
  6. readiness to change is fluctuating interpersonal interaction
  7. therapeutic relationship is a partnership / companionship
73
Q

What is the prevalence of depression?

A
  • women x2

* 2nd leading global burden of disease by 2020

74
Q

List the key subtypes of mood disorders

A
  • major depressive disorder
  • dysthymic disorder
  • double depression
  • bipolar 1 disorder
  • bipolar II disorder
75
Q

What is major depressive disorder?

A
  • extreme depressed mood >2 weeks
  • anhedonia
  • disrupted cognition (memory, concentration, decisions, problem solving)
  • disrupted physical function (appetite, sleep)
  • typical 4 episodes over a lifetime
  • 4-9 months episodes
  • 90% probability of remission within 5 years
76
Q

What is dysthymic disorder?

A
  • less severe than MDD
  • > 2 years (chronic)
  • can be > 20 yrs
  • 6% prevalence
  • early onset = poor prognosis
  • poorer prognosis than MDD
  • becomes major depressive episode (x2 depression)
77
Q

What is double depression?

A 
• MDD + dysthymic disorder
course / prognosis
• severe psychopathology
• problematic future course
• very high relapse rate
78
Q

What is bipolar I disorder?

A
  • most severe
  • alternating major depressive and manic episodes
  • onset 18 yrs, very acute
  • chronic
  • higher risk of suicide
79
Q

What is bipolar II disorder?

A
  • alternating major depressive and hypomanic episodes
  • less likely psychotic
  • less severe, better daily function
  • acute onset early 20s
  • chronic
  • suicides
  • maybe gets bipolar I
80
Q

manic episode

A
  • changes in mood, thought patterns
  • increased energy, increased sexuality, religion
  • impaired judgment, speech
81
Q

anhedonia

A

lost interest / pleasure in usual activities

82
Q

What is the difference between depression and grief?

A
  • depression during bereavement is normal (62% experience symptoms following loss)
  • becomes Complicated Grief if symptoms severe and unrelenting, disrupting daily functioning
  • complicated grief mimics depression, requires treatment
83
Q

What are risk factors for mood disorders?

A
  • poverty / unemployment
  • females x2
  • family Hx
  • sexual abuse or trauma
  • stressful life events
  • low social support
  • chronic illness and disability
  • long-term use of meds
  • alcohol & drug misuse
  • caring for chronic person
  • old adults in residential care
84
Q

What are the complications of anorexia nervosa?

A
  • suicide
  • medical instability
  • osteoporosis
  • cardiac problems
  • amenorrhea

Medical Sciences B (23 decks)

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