Mental Health Stats Flashcards
Proportion of adults with mental illness
1/5 43.8 million in US
Proportion of adults with serious mental illness
1/25 10million in US
Prevalence of mental illness by sex, race, age
Females, 21.2%
14.3 male
18-25 21.7%,
26-49 20.9%
29.5 mixed race 2 or more
28.3 American Indian, Alaskan native
19.3 white
18.6 black
16% hispanic
13.9 Asian
14.3% Native Hawaiian/Pacific Islander
Kids 13-18 with mental illness
20%
11% mood disorder
10% behavior
8% anxiety
Percent with depression
6.9%
%with anxiety
18.1%
%with bipolar
2.6%
% schizophrenia
1.1%
% of homeless with mental health probs,
% in state prisons
26%
24% with recent hx
Lost earning in US Per year
-193 billion
Suicide is the ________ th leading cause of death
10th…. 90% of suicides hav under lying mental illness
3rd for ages 10-14
2nd cause for ages 15-34
2x homicide rate! 44,193 vs 17,793
50x greater in schizophrenia compared to gen pop
How many have addiction and another Mental Illness
10.2 million
likelihood of mental illness in the LGBT community
2x more likely as straight individuals
percent of transgender being denied mental health care because bias
11%
suicide in LGBT and questioning community compared to straight youth
2-3X more likely
percent of those with mental illness who got help in the past year
(total pop, younger, and by race compared to whites)
60% total in US
only 50% if 8-15 y.o.
AA and Hispanics get 1/2 as much compared to whites, asians only a 1/3 compared to whites
Who uses more mental health services compared to others?
by race, by sex
women almost always more than men, except in Alaskan Natives and American Indian. (16%m: 15%w) White: 11:23 Black:7:10 Asian: 4:5 Hispanic: 6:9
Top 8 issues multicultural communities face
Less access to care Less likely to receive treatment Poorer quality of care Higher levels of stigma Culturally INsensitive health care system Racism, bias, homophobia, discrimination in Tx setting Language barriers Lower rates of Health Insurance
Who is NAMI and what do they do
National Alliance on Mental Illness
They insure Mental Health is treated equally to physical illness in insurance plans.
and secure $ for research to protect access
what is unique about biopsychosocial model
holistic, focuses on health and illness, focuses on what can be changed to make health better, multifactorial
Match: Biology, Psychology, Social Context
to the following…
Gender, Education, Attitudes, Family background, Personality, Genetic vulnerability, stress reactivity, cultural traditions, immune function, coping skills, trauma, neurochemistry, disability, learning/memory, social support, economic status
Bio:Gender Immune function stress reactivity Genetic vulnerability neurochem disability
Psycho: Attitudes, Personality Coping skills trauma Learning/Memory
Social: Education Family background cultural traditions Social Supports economic status
Purpose of Psych interview
Establish a relationship Assess risk DDX and Mgt. plan Negotiate & Start Tx Document
Difference between content and process, and goal of attending to both
content: what is being said
Process: the way/how and sometimes the why
Goal: to understand pt beyond their diagnosis to improve delivery of quality care
3 interview techniques for Psych Interview
Normalization: reduce shame/stigma/judgemt
continuation: acknowledge/engage pt
redirection: guide and focus pt
Top 12 tips for Psych Interview Techniques (part 1)
List step 1-4
1) Establish rapport with empathy statements, direct feeling questions, reflective listening statements
2) allow pt to talk w/o interruption for 3-4 min.
3) Determine Pt’s cc
4) Develop DDx
Top 12 tips for Psych Interview Techniques (part 2)
List steps 5-8
5) Use Open and closed questions
6) Focused questions to clarify DDx
7) Follow up on vague questions
8) May not try reasoning initially
Top 12 tips for Psych Interview Techniques (part 3)
9-12
9) Gradually move to tougher questions (drugs, sex, criminal behavior)
10) ALWAYS ask about suicidal and homicidal ideations
11) Provide adequate time for pt to ask ?s
12) Convey confidence/hope and acknowledge you will do your very best to provide care and address their concern.
Three phases of interview
Opening: ID self, and describe the purpose, and timing. Then learn why they are there
Body/Middle: balance clinical needs with pt’s needs
Closing: Thank pt, and allow them to ask final questions. Discuss assessment, negotiate tx/ follow up.
Psychiatric Encounter Notes
Pt ID, CC, source, reliability HPI, and psych ROS Past Psych Hx Fam Hx Social Development Hx Focused Medical Hx (PMH) MSE General Physical/ Neuro exam, WHODAS/4P Diagnostic Impression/ DDx Tx/ Management Plan
What is included in ID?
name, age, gender, Marital status, occupational status
how do you document cc
1) Open-ended questions, “What brings you here?”
2) Use patient’s own words cuz they provide window to mental status.
3) Duration of complaint
how do you document HPI
Symptoms new/recurrent Onset, Duration Timing, intensity, context, Modifying factors, Associated symptoms. Comorbid risks,(ETOH/Drugs), Impact/incapacitation of symptoms Tx/effectiveness/compliance Suicidal/ homocidal ideations
SOD TIC MAC ITS = MODIST CACTI’S= STICCADO MITS
ROS includes
Mood: Depression, Mania, Mixed/Other
Depression ROS includes…
Sleep, interest, guilt, energy, concentration, appetite, psychomotor agitation/slowing (SIGECAPS) + sadness, tearfulness, sexual function,
Mania ROS includes
Impulsivity, grandiosity, recklessness, excessive energy, decreased need for sleep, increased spending beyond means, talkativeness, racing thoughts, hypersexuality
IGR ESS TRH= GER SHIRTS= SHR TIGERS
Anxiety ROS
general anxiety symptoms, panic disorder symptoms, O-C symptoms PTSD Social anxiety Simple phobias
General Anxiety Symptoms
where, when, who how long, how frequent
Panic disorder symptoms
how long until peak, somatic: racing ehart, sweating, SOB, trouble swallowing, sense of doom, fear of recurrence, agoraphobia
OCD symptoms
checking, cleaning, organizing, rituals, hang-ups, obsessive thinking, counting, rational or irrational beliefs
PTSD
nightmares, flashbacks, startle response, avoidance
simple phobias
heights, planes, spiders
Psychosis includes:
Hallucinations: auditory, visual, olfactory, tactile,
Delusions: TV, radio, thought broadcasting, mind control, referential thinking
Pt’s Perceptions: spiritual or cultural context of symptoms, reality testing
Other
ADHD, eating disorder, personality disorder, substance/ addiction, somatization (no longer in DSM5)
Past Psych Hx Goal
Get info re: all psychiatric illness, course, symptoms, tx
Past Psych Hx includes
age of 1st diagnosis,
# of hospitalizations/ episodes
Course of previous episodes in chronological order (duration, symptoms, severity, hospitalization, tx)
Hx of violence
Past homicidal or suicidal ideations/attempts
Fam Hx:
Age, occupation of parents, siblings, kids
Fam Hx of mental illness, course, tx, outcome
Alcohol/drug/ criminal hx, severe depression, suicide, etc.
Social, cultural, educational background
Social Development Hx Goal
Establish pt’s dev’al / social hx through life
What’s included in social hx
Personal hx: demographics
birth place, childhood area
developmental/ social adjustments
sexual hx/ development/abuse
Plus ask about childhood, adolescence, adulthood
Childhood questions for social hx include
Childhood: behavioral concerns (temper tantrums, phobias, cruelty concerns)
Adolence questions for social hx include
Adolescence: family, peer, authority relationships, school performance, drugs, legal, disciplinary
Adult social hx includes
Education, occupation, marital and fam relationships, military hx, religious and cultural attitudes, financial situation, current living/ social situation, habits, support system, legal issues
Medical Hx
(focused) Current medical illness, chronic disease, meds,
Allergies, hospitalizations, surgeries, injuries
Hx of neuro disorders (seizure, HA, trauma, CNS disorders)
(illness, or drugs may impact tx options)
Safety during interview
1) distraction minimized,
2) 4-6 ft from pt and unobstructed exit,
3) someone within earshot for help,
4) wary of pt with hx of violence
5) watch for indicators of potential violence in voice/ rising temp/pitch, threats, insults,
6) watch for agitation, clenched fists
if sense danger, announce you’re leaving, then do so.
what is WHODAS 2.0
world health organization disability assessment schedule, version 2.0 to track change through time
Cognition, mobility, self-care, getting along, life activities, Participation
Rates 1=none 5= extreme disability
4 P’s Model
Predisposing Factors: why me
Precipitating factors: why now
Perpetuating factors: why still today
Protective factors: what’s my “ace in the hole,” strengths, support
WHODAS 2.0 scoring
Gen. disability score 85: 2.36 mild
Subscale: life activities 14: 3.5 moderate
Subscale: particiation in Society 28- 3.5
4 Ps for biological
Predisposing: genetics
Precipitating: alcohol
Perpetuating factors: addiction
Protective: access to care
4 Ps for Psychological
History of violent childhood
Stress of break up
Perpetuating thought of unworthiness
Wants to get better, seeking CBT
4 Ps for Social
vulnerable population
Coming out to family/ community
Social bias and phobias of community
Supportive friends and mentors, employment
