MH Flashcards
conditions that require DIRECT REFERRAL
depression, anxiety, eating disorders
most frequently treated diagnosis in outpatient hospitals, community-based settings, and mental facilities
schizophrenia
what kind of changes happen neurodevelopmentally, when do they usually appear?
late adolescence to early adulthood (YA to early adulthood)
- structural changes in neuroanatomy, biochemical imbalances
% lifetime prevalence and population in gainful employment for schiz
lifetime prevalence = 1%
gainful employment = 10-15%
symptoms and considerations for it to be considered schiz
2 of the ff: (with 1 being at least 1,2, or 3)
1. delusions
2. hallucinations
3. disorganized speech
4. disorganized behavior
5. negative symptoms
define delusion and describe its types of delusions (6)
premises that pt. cant be convinced otherwise of bizarre, non-bizarre)
1. persecutory - someone is going to kill/hurt them
2. grandiose - narcissistic
3. referential - someone/everyone is always talking about you
4. erotomanic - someone is in love with you
5. jealous - partner is cheating on you
6. somatic - something is wrong with your body
7. nihilistic - something bad is going to happen
risk factors for schiz
- genetic predisposition (late onset in father -> earlier and more intense presentation in kid)
- refugees (trauma, stress, envt)
- environmental factors (urban life)
suspected antecedents for schiz
- childhood cognitive, social, behavioral, emotional impairments
- specific motor abnormalities in fine motor fx. and balance in a kid with a family hx of schiz. before theyre 7 (e.g., clumsy, drops things)
difference between positive and negative symptoms (examples of schiz sx under these)
positive = sx that is not normal, added because of condition
- delusions, hallucinations, disorganized speech and behavior, catatonic behavior
negative = normal body process that is gone d/t condition
- flat effect, alogia, avolition
phases of schiz and describe
prodromal
- more withdrawn
- sx. can mimic other MH conditons like depression
active
- severe symptoms start to present (e.g., hallucinations, delusions, etc.)
residual
- similar to prodromal phase; more cognitive symptoms (e.g., unable to focus)
men vs women susceptibility
men are more likely to get it, sx. tend to present earlier (mid-twenties vs women late twenties) and sx are more severe
- estrogen control in dopamine regulation
duration of sx before theyre considered schiz
6 months of continuous disturbance and 1 month of active sx.
hallucinations (common form, describe other forms, normal presentations of hallucination)
sensorium additions
MC: auditory hallucinations
- hearing other people talking in their heads
visual, tactile hallucinations
hypnagognic (before going to sleep/lack of sleep), hypnopompic (after waking up, sedatives)
describe disorganized thinking, disorganized behavior, and negative sx in schiz
disorganized thinking
- manifests in speech
- tangential thoughts, word salad/incoherent, jumping from topic to topic
disorganized behavior/motor abnormalities
- agitated/child-like
- catatonic
negative sx.
- diminished emotional expression, avolition
schiz vs schizotypal (describe and differentiate)
schizophrenia - psychotic disorder
schizotypal - personality disorder
personality disorders are easier to manage usually bc they don’t have full-blown sx of psychosis (usually has difficulty connecting with others)
schizopreniform vs brief psychotic disorder vs schiz
schiz - more than 6months
brief psychotic disorder - more than a day less than a month (4 HALLMARKS)
schizopreniform - less than 6 mos; recovers after 6months, no fxal decline
bipolar disorder define and parts
- mood disorder wherein someone has manic and depressive/hypomanic states; depressive state is similar to depression, manic is periods of impulsivity, irritability, irrationality w sudden bouts of energy
mean onset and risk rates for suicide and vascular disease
early twenties mean onset
later onset mania = higher rates of suicide and vascular disease
risk factors for bpd (3)
- genetic link
- envtal factors
- other comorbidities
antidepressants can also trigger manic episodes (SSRIs)
types of bpd, differentiate
bipolar I - phases of manic and hypomanic/depressive; 15x suicide risk compared to gen pop
bipolar II - phases of hypomanic (4days) and depressive (2wks); higher suicide risk compared to bp1
cyclothymic - cycling bet hypomanic/manic and depressive for 2 years; 4 or more episodes of depression/mania in 1 year
mixed episodes - sx of both mania and depression
hallmarks of manic (7)
- at least 1wk, present most of the day (any time if hospitalized)
- can have psychotic sx; hospitalized if harmful to self or others
- at least 3 of the ff:
1. inflated self-esteem/grandiosity
2. dec need for sleep (negatively impacts how body deals w their condition)
3. increase in goal-directed activity or purposeless non-goal-directed activity (psychomotor agitation)
4. flights of ideas or racing thoughts
5. easy distractability, reported or observed
6. talking more/pressured to talk more
7. engaging in activities that have painful consequences
hallmarks of depressive (9) criteria [how many ax for how long]
- 5 or more for atleast 2wks, with 1 -> 1 or 2:
1. depressed mood
2. anhedonia
3. psychomotor agitation/retardation
4. suicide attempt/plan (ideation), thoughts of dying
5. no/low energy, fatigue
6. weight loss w/o trying to
7. cant concentrate/focus
8. insomnia / hypersomnia
9. feelings of guilt / worthlessness
hallmarks of hypomanic
- similar sx to manic except doesn’t affect day-to-day fxn, no hospitalization
- atlst 4 days of sx presentation, most of the day
4th leading cause of disability
depression
risk factors for depression (5)
- parents have depression or other psychiatric conditions
- associated psychopathologies (e.g., anxiety)
- poor psychosocial functioning (e.g, acads, parent relationship)
- childhood trauma/abuse
- changes in puberty
neurotransmitters that affect depression and what conditions they affect
serotonin (obsessions& compulsions), dopamine (attention, motivation, pleasure) , norepinephrine (anxiety, attention)
subtypes
postpartum, atypical (mood reactivity), dysthymia (milder sx)
depression and anxiety prevalence
depression lifetime prevalence: 20% (women), 12% (men)
anxiety: w > m
risk factors for anxiety (6)
- dev’tal (comorbid, childhood, parental separation)
- psychosocial fxn (e.g., death or loss)
- minority status
- poverty
- younger
- lower academic achievement
hallmarks of anxiety (6)
- at least 6 mos, more days with vs w/o sx.
- 3 or more of the ff:
1. keyed up, restless
2. irritable
3. muscle tension
4. easily fatigued
5. sleep disturbance
6. difficulty focusing
fear vs worry vs anxiety
fear - usually concrete or tangible; may be irrational/rational
worry- when you think about something too much and get anxious over it; normal
anxiety - increased vigilance and interferes in daily life; usually over something that doesn’t exist
- panic attacks - presentation of severe anxiety
obsessions vs compulsions
obsessions -recurring thoughts
compulsions- behavior/repeating actions to satisfy the obsessions
Obsessive compulsive disorders includes (5)
OCD, body dysmorphia, tricotillomania and excoriation, hoarding, substance use
types of feeding/eating disorders (2)
[anorexia] restrictive - doesnt eat
[bulimia] binging/purging - eats and forcefully expels
3 levels of risk for substance abuse
at risk = 1
mild = 2-3
moderate = 4-5
severe = 6+
hallmarks for substance abuse (11)
- take more than prescribed amount/for longer time
- unable to stop using substance
- intense cravings
- tolerance
- withdrawal after using substance
- spending more time looking for and taking in the substance
- neglecting responsibilities
- continue to use even w relationship problems
- not participating in desired/meaningful social and recreation activities bc of substance use
- using it even during potentially dangerous situations
- using substance even when it causes physical and psychological harm
comorbidities assoc w substance use (5)
DSPAP (depression, anxiety, paranoia, schizophrenia, panic disorder)
common side-effects of substance abuse (6)
- skeletal myopathy
- sexual dysfunction
- loss of coordination and motor control
- dec muscle performance
- visceral damage (e.g. liver - alcohol)
- weight changes, malnourished
mental health vs mental health problems vs mental illness
mental health - state of well-being (self-actualize); can contribute to community, work productive and fruitfully, cope with own stresses
mental health problems - negative MH experiences part of everyday life
mental illness - dysfunction of psych, bio,devt processes underlying mental fxn
common pharmacological interventions (5)
- sedative-hypnotics
- parkinson meds
- antipsychotics
- antidepressants
- alcohols
compare and contrast benzos and barbs (fxn, effect, mechanism of action, conditions used)
- anxiolytic, hypnotic, sedative, amnestic
- sedatives, depress CNS
- generally have similar sx (barbs just have the more extreme form): slowed breathing, drowsiness, dizziness or nausea, slowed HR and dec BP, headaches, confusion, tremors, diarrhea, syncope
- benzo (-pam/lam)
- resp arrest & depression
- thalamic, cortex, cerebellum
- milder compared to barbs
- makes GABA receptors more efficient
- prescribed first, work for seizures (i.e., stroke and TBI), insomnia, anxiety - barb (-ital)
- midbrain reticular formation
- prolongs effect of GABA
- for seizure disorders, neonatal withdrawal, insomnia, pre-op anxiety, coma induction
- additional sx: thirst, muscle weakness, hypothermia, cyanosis, rapid shifting of eyes
effects of alcohols (5)
sedation, ataxia, loss of inhibition, impaired judgment, slurred speech
effects of sedative-hypnotics (6)
sedation, hypnosis, medullary depression (main cause of overdose), anesthesia, tolerance & dependence, muscle relaxation
chronic effects of alcohols (9)
- tolerance & dependence
- CNS effect (e.g., Wernicke-Korsackoff syndrome - loss of thiamine B1)
- liver toxicity
- GI issues
- CV impairments
- fetal alcohol syndrome
- neoplasia/tumor
- immune system
- endocrine system
s&s of alcohol withdrawal syndrome (2)
- delirium tremens (hallucinations, sweating, tremor, confusion)
- insomnia, tremor, anxiety, nausea
tx for alcohol withdrawal syndrome (2)
- addressing electrolyte imbalance and thiamine administration
- sedative-hypnotics
describe the mechanism and sx. of parkinsons (6)
parkinsons = basal gangle, substantia nigra issues
- impairments in motor control (starting, ending activity)
- extraneous mvmt
- impairments in the feedback loop (whispering feels like shouting, small feels like big step)
- shuffling gait
- rigidity
- postural instab
medication commonly used for parkinsons and their mechanism of action
levodopa and carbidopa - sinimet
- levodopa is a dopamine precursor but sometimes it is “washed away” as it goes through the blood stream to get to the brain, so adding levodopa makes sure it reaches the brain
- carbidopa is the dopamine transport system
MAOI (MAO B inhibitors) - selegiline
- help with dopamine availability bc MAO B sweeps up dopamine that is seen as excess by the body, prevents breakdown of dopamine
CI for parkinsons meds
hx of or predisposition to psychosis/psychotic disorders
anti-psychotic drugs side-effects, reason
- can cause parkinson’s-like sx. because they inhibit dopamine
effects of using parkinsons meds (4)
- dyskinesias d/t LT use
- postural hypotension
- GI effects
- behavioral symptoms (ex., other psychological issues, psychotic-like sx.)
main fx of antipsychotics
reduce positive sx
side effects of antipsychotics (7)
- Reversible neurologic effects
- Tardive dyskinesias (choreoathetoid movements)
- Autonomic effects
- Endocrine and metabolic effects
- Significant weight gain, increased risk for diabetes
- Sedation
- Overdose toxicity
2 types of common antipsychotics, differentiate
dopamine receptor antagonists - block dopamine function
second generation antipsychotics - block serotonin and dopamine
antidepressant side effects (5)
- Sedation, lassitude, fatigue, confusion
- Cardiovascular effects (hypotension)
- Risk for seizures
- Weight gain
- Sympathomimetic effects (Fight or flight responses)
types of antidepressants (5)
- tricyclics
- heterocyclics
- SNRIs
- SSRIs
- MAOI
PT in MH relationships (4)
- mental health problems affecting physical health
- physical health affecting mental health
- correlated problems that are not clearly defined/related
- mental health problems independent of physical health
screening tools we can use to help w referral
DASS-21, SF-12
body awareness rating scale (what therapy uses this, for what disorders can it be used, how many positions)
used in BBAT (basic body awareness therapy), has 12 positions
- eating disorders, body image / dysmorphia issues, schizophrenia, depression
ax that can be used for eating issues and body dysmorphia
body attitude test
2 types of therapy for MH conditions (helps w what)
- BBAT - helps establish control for those with anxiety and depression; forms awareness of one’s self
- relaxation therapy - helpful for people with agitation sx. (insomnia, anxiety, schiz, aggression, PTSD, depression); decrease tension and peaceful
benefits of physical activity on MH (2; 1. [4])
- physiological benefits
- Increase serotonin and endorphins (similar to antidepressants)
- Enhance norepinephrine
- Decrease cortisol
- Increase neurotrophism thru BDNF (for neuroplasticity) - physical benefits - improve weight, body image, tone, etc.
evidence for depression
Improvements in depression scores in exercise + antidepressant groups
Positive impact in QoL of unipolar depressed individuals
Short-term positive outcomes for depressive symptoms of OA
evidence for anxiety
- moderate-hard intensity exercise had greatest benefits
- decrease in beck anxiety inventory score (teaches pt.’s how to cope with high stress in controlled envt; distraction)
- individual vs group classes - significant changes
- supervised classes had greater benefits compared to unsupervised
evidence for schiz
- large effect size in reducing sx. and significant improvements in negative sx
evidence for alcohol-use disorders
- Slight trend towards positive effects
- One study showed significant improvements in depression, mental state and mood
- 3 out of 5 studies – decreased anxiety symptoms after exercise
evidence from the HUNT Cohort Study (Nord-Trøndelag Health Study), which followed over 33,000 healthy individuals in Nord-Trøndelag, Norway, starting around 1985
- can help with prevention( no protective effect for anxiety; depression dec odds ratio by 44%)
- reports from px did mention feeling great after exercise; helping mitigate or manage anxiety
- better evidence for depression (better ANS tone- dec heart rate, CV fx)
