mental health prevention Flashcards
what are the advantages and disadvantages of mental health Dx?
advantages
- can inform treatment
- can provide prognostic info
- monitor population health
disadvantages
- stigma
- badging
- can misinform prognostic options
how do we Dx mental health problems?
1) Hx presenting complaint
2) MSE
3) full psychiatric interview +- observation
4) diagnostic criteria via DSM5
what are the components of a MSE?
1) General Appearance
2) Psychomotor behaviour
3) Mood and affect
4) Speech
5) Cognition
6) Thought Patterns
7) Level of Consciousness
what are the statistics for depression?
- 1 in 7 Aus will experience depression
- 3rd highest burden of disease in Aus
what is the 2 question screening test for depression?
1) in the past month (or 2 weeks) have you often been bothered by feeling down, depressed or hopeless?
2) during the past month (or 2 weeks) have you been bothered by little interest in doing this?
Sn 97%, Sp 67%
what are some tools used to screen for depression?
- K10, DASS 21
what is the DSM5 criteria for MDD?
criteria A: 5 + (1 x )
1. Depressed mood, most of the day, nearly every day
2. Markedly diminished interest or pleasure in all or almost all activities, most of the day, nearly every day*
3. Significant weight change
4. Insomnia or hypersomnia
5. Psychomotor agitation/ retardation
6. Fatigue/loss of energy
7. Feelings of worthlessness/ excessive inappropriate guilt
8. Poor concentration, diminished cognition, indecisiveness
9. Recurrent thoughts of death, suicidal ideation (+/- plan)
B: symptoms cause clinically significant distress/functional impairment
C: episode is not attributable to the physiological effects of a substance or other medical condition.
what are the symptoms for depression according to the ICD10?
KEY SYMPTOMS (at least 1 most days for at least 2 weeks)
1) low mood
2) loss of interest
3) fatigue
ASSOCIATED symptoms
- disturbed sleep
- poor concentration/indecisiveness
- low self-confidence
- appetite changes
- suicidal ideation
- agitation/slowing of movements
- guilt /self-blame
10 symptoms define degree of depression (must be present 1month for most of every day)
- <4 = not depressed
- 4 = mildly depressed
- 5-6 = moderate depression
- 7+ = severe depression
what are the statistics for anxiety?
- most common mental health condition
- 14% in any 12month period
what are some tools used to screen for depression?
DASS21/ K10
what is the DSM5 criteria for GAD?
A: 6months of excessive anxiety + worry
B: difficult to control worry
C: associated with 3+
- restlessness
- easy fatigue
- difficulty concentrating
- irritability
- muscle tension
- sleep disturbance
D: causes significant clinical distress/ functional impairment
E: not attributable to substance effects/ medical condition
F: not better explained by another medical condition
what are the key symptoms for generalised anxiety according to the ICD10?
A: 6 months with tension, worry + apprehension about everyday problems
B: 4+ symptoms: autonomic arousal symptoms 1) palpitations/ increased HR 2) sweating 3) trembling/ shaking 4) dry mouth
chest and ab symptoms
5) difficultly breathing
6) feeling of choking
7) chest pain/discomfort
8) nausea/ ab distress
brain and mind symptoms
9) feel dizzy, unsteady, faint/ light headed
10) derealisation + depersonalisation
11) fear of losing control, going crazy/ passing out
12) fear of dying
general symtoms
13) hot flashes/ cold chills
14) numbness/ tingling
tension symtoms
15) muscle tension/ aches and pains
16) restlessness
17) feeling on edge
18) difficult to swallow/ lump in throat
other non specific symptoms
19) exaggerated responses
20) difficulty in concentrating (or going blank due to worrying/anxiety)
21) persistent irritability
22) difficulty going to sleep because of worrying
C: disorder doesn’t meet criteria for other mental conditions
D: not hyperthyroidism/ organic mental disorder/psychoactive substance related disorder (amphetamine consumption/ benzo withdrawal)
what are the statistics for PTSD?
- 5% aus experience in their lifetime
- 8% for defence force
- higher in ADF, police forms, refugees, workers in health/ welfare
what are some screening questions for PTSD?
- Do you avoid being reminded of the experience by staying away from certain places, people or activities?
- Have you lost interest in activities that were once important or enjoyable?
- Have you begun to feel more distant or isolated from other people?
- Do you find it hard to feel love or affection for other people?
- Have you begun to feel that there is no point in planning for the future?
- Have you had more trouble than usual falling or staying asleep?
- Do you become jumpy or easily startled by ordinary noise or movements?
Cut off at 4 Sn 71%, Sp 98% in individuals exposed to trauma
what is the DSM5 criteria for PTSD?
A: exposure to death, injury/ sexual violence either via direct experience, witnessing/ learning of event OR repeated exposure to details of traumatic
B: 1+ intrusive symptoms: memories, dreams, dissociative reactions, cue related distress
C: Persistent avoidance of stimuli associated with the trauma (avoidance of memories or external cues)
D: Negative alterations in cognition/mood (2 +):
- Inability to remember details of event
- Persistent and exaggerated negative beliefs or expectations
- Persistent distorted cognition about the cause or consequence of the trauma
- Persistent negative emotional state
- Markedly diminished interest or participation
- Feelings of detachment or estrangement from others
- Persistent inability to experience positive emotions
E: Marked alteration in arousal and reactivity (2 +):
- irritable or angry outbursts,
- reckless or self-destructive behaviour,
- hypervigilance,
- exaggerated startle response,
- problems concentrating,
- sleep disturbance
F: duration (B-E) more than 1 month
G: causes clinically significant distress or impaired functioning
H: not attributable to a substance or another medical condition.
