Module 5: Mental health in medical contexts

Question 1

What are the 4 healthy principles?

Answer 1

o Don’t smoke
o Drink in moderation
o Eat high fiber and lots of fruits and veggies
o 30 mins to hour of exercise

Question 2

What is life expectancy for someone that’s living with a severe mental health problem?

Answer 2

15 to 20 years less than the general population

That’s 1.5 to nearly 2 decades

Question 3

What is the difference between healthy coping and positive thinking?

Answer 3

Healthy coping implies the capacity to tolerate and express concerns and emotions not just the ability to put anxieties aside.
“Positive thinking” may represent an attempt to avoid confronting the distress of chronic illness

Question 4

How many Australians per 100,000 does TBI impact?

Answer 4

107

more than 22700 hospital admissions

Question 5

What is a mild TBI classification?

Answer 5

o. initially loses consciousness for 15 minutes or less
o. If they have any memory loss about the trauma event, or they feel dazed, disoriented or confused. It’s often called a concussion.
o. The majority of traumatic brain injuries are initially rated as mild.

Question 6

What is a moderate TBI classification?

Answer 6

loss of consciousness from 15 minutes to a few hours, followed by a few days or weeks of confusion.

Question 7

What is a severe TBI classification?

Answer 7

involve a loss of consciousness for six hours or longer after injury, or after a period of clarity.

Less than 10% of patients

Question 8

Right after brain injury, what tool may a medical team use to measure alertness? What does it measure?

Answer 8

The Glasgow Coma Scale

Measures: eye response, verbal response and motor response

Question 9

What is the Glasgow Coma Scale range?

Answer 9

Range = 3-15
15 = awake
13 or higher = a mild brain injury.
9 to 12 = a moderate injury, 
8 or less = a severe brain injury

Question 10

What is Axonal shearing?

Answer 10

brain’s axons or main channels of communication are stretched to the point of breaking causing the damaged brain cells to die.
Rising pressure inside the brain can cause parts to shift out of place, or what’s referred to as a ‘brain herniation’

Question 11

What is Cerebral atrophy? What can it be caused by?

Answer 11

Loss of the brain’s neurons or nerve cells and the connections between them.
Can be in one particular area or affect the whole brain.
Can be caused by stroke, traumatic brain injury or other disease.

Question 12

What is Oedema’ ?

Answer 12

Swelling

Question 13

What is haematoma?

Answer 13

a pool of blood or a bruise inside the skull caused by damaged blood vessels. Haematomas can increase pressure inside the brain

Question 14

How is intracranial pressure or ‘ICP’ monitored?

Answer 14

by a catheter threaded into one of the brain’s cavities or just inside the skull

Question 15

What are the 3 stages of consciousness?

Answer 15

o Minimally conscious state - detectable small, consistently identifiable and deliberate behaviour by the patient.
o Semi-coma or vegetative state - eyes open but not always aware of themselves or their surroundings.
o Coma is a deep state of unconsciousness.

Question 16

What is ‘Sympathetic storming’ ?

Answer 16

An elevated stress response that occurs in roughly 1/3 TBI patients.
Can occur any time from 24 hours to a week after injury.
Thought to be a sign of returning activity up the sympathetic or protective nervous system.

Question 17

What are the consequences of TBI?

Answer 17

• Neurological (fatigue, pain, headache, dizziness, etc)
• Cognitive changes (declines in attentio, processing speed, problems with memory (particularly new learning), and impaired executive functions)
• Behavioural - (increased irritability, impulsivity, verbal and physical aggression, and inappropriate social or sexual behaviour)
• psychological consequences (MDD, BD, Anxiety)

Question 18

What areas of the brain are seen as most vulnerable in TBI for cognitive changes?

Answer 18

Temporal Regions and Frontal Regions

Question 19

What is the prevalence of MDD in TBI?

Answer 19

25-50%

Question 20

What is the cause of depression in TBI?

Answer 20

Physical changes in the brain (e.g., change in neurotransmitter levels, damage to the amygdala),

Emotional responses to the injury,

Social and vocational changes after injury,

Predisposing factors that are unrelated to the injury (e.g., genetics).

Question 21

What are the 3 main components of ACT?

Answer 21

a) accept what they have and what cannot be changed, b) chose the direction in life that they value,
c) take action to bring about that meaningful life.

Question 22

Eames (1988) has pointed out, a brain-injured individual’s behaviour is the result of a complex interplay of causative factors of:

Answer 22

1. Brain injury
2. Person
3. Context

Question 23

If using contingency management approaches (behaviour modification) what should consequences be?

Answer 23

Meaningful
Immediately follow behaviour
Obvious
Be given frequently and consistently

Question 24

What is Negative reinforcement

Answer 24

removal of something undesirable

Question 25

What is incidence?

Answer 25

rate or frequency of the disease usually expressed as the number of mutations in a given time period (year)

Question 26

What is Prevalence?

Answer 26

the number of cases within the population, including new diagnoses, people who have been living with the disease for an extended period, or who were diagnosed and are now disease free.

Question 27

What are the 5 most common cancers in Aus in order?

Answer 27

1. Prostate
2. Colorectal
3. Breast
4. Melanoma
5. Lung

Question 28

What changes in the brain are seen in ‘chemo brain’?

Answer 28

Decreases in gray matter density in bilateral frontal, temporal, and cerebellar regions as well as the right thalamus.
Increased activation in the prefrontal cortex and the cerebellum

Question 29

What is Fear of Cancer Recurrence (FCR)?

Answer 29

• essentially is a pathological anxiety that cancer will return or progress.
• characterised by increased levels of distress, by lower quality of life, high levels of anxiety, and obsessive behaviours, often around checking and health related behaviours.
• 22-87% of survivors = moderate to high levels
• Up to 15% of survivors have high levels

Question 30

What factors are proposed to have relationships with FCR?

Answer 30

younger age, the experience of physical symptoms (especially if these symptoms are severe), psychological distress, and lower quality of life or functioning.
Some female and lower education

Question 31

What is distress?

Answer 31

A multifactorial unpleasant emotional experience of a psychological (cognitive, behavioural, emotional), social, and/or spiritual nature that may interfere with the ability to cope effectively with cancer, its physical symptoms and its treatment.

Question 32

Arguments for Distress Screening:

Answer 32

• Distress occurs commonly and can be treated.
• Untreated distress is associated with multiple poor outcomes.
• Distress is often overlooked by oncology professionals.
• Validated screening instruments are readily available.
• People may be unaware of their need for help.

Question 33

Arguments against distress screening:

Answer 33

• Screening is inefficient for improving patient well-being.
• There is no systematic evidence to support the benefit of screening.
• The potential harms of universal screening have not been well considered.

Question 34

Once patients are screened for distress, do they utilise supportive care services that they may be referred to?

Answer 34

• research suggests that patients who are identified as distressed do not want psychosocial intervention or referral.

Question 35

What is Attention Training Technique (ATT)?

Answer 35

o is based on metacognitive theory of psychological disorder which states that a style of thinking called the Cognitive Attentional Syndrome (CAS) is responsible for psychological disorders.

Question 36

What are the phases of Attention Training Technique (ATT)?

Answer 36

1st phase - selective attention - focus on individual sounds and spatial locations, whilst trying to maintain selectivity and reduce distraction.
2nd phase - rapid switching of attention between different sounds and spatial locations.
3rd phase - dividing attention and trying to attend to as many simultaneous sounds and spatial locations as possible.

Question 37

What are socratic techniques?

Answer 37

based on systematic questioning and inductive reasoning, often with a focus on self-improvement and cultivating virtue in everyday life.

Question 38

What are the 3 important concepts in the care giver literature?

Answer 38

• Caregiver burden (has both objective elements (e.g., the social changes that arise from the caregiving role) and subjective elements (e.g., the carers perception of the emotional strain)
• Unmet needs (unmet caregiver needs are often related to the patient’s condition, including fear of recurrence, reducing stress for the patient, and having greater insight into the patient’s condition)
• Carer benefit finding (despite the costs there are findings of greater sense or purpose and improved relationships)