PAS week 3_ Prevention mental illness

Question 1

How many in 5 australians experience mental health illness in 12months?

Answer 1

1/5

Question 2

In terms of primary prevention, although we have a ltd understanding of mental health issues, what do we know helps?

Answer 2

• Hierarchy of needs: better outcomes if basic needs are met
• Connectedness: strong family ties, support networks, role models…
• Education: psychological understanding/ emotional intelligence
• Financial stability

Question 3

Rhetorical: is it more challenging to teach or create what isn’t there naturally?

Answer 3

We can find certain family structures or poor prognostic risk factors, but we know how to build coping mechanisms etc.. if it isn’t there already.

Question 4

There is a huge range in what is considered normal, so how might we define it?

Answer 4

The ability to function in society.

This means high functioning individuals suffering with menal illness may be neglected.

Question 5

screening tools:

• Are screening tools sensitive?
• Are screening tools specific?
• what are they used for?

Answer 5

• Screeing of mental illness is not diagnosis
• allows us to shrink pool of people who need a full assessement
• usually highly sensitive but NOT specific
• sensitive to things going wrong, but not specific to what.

Question 6

What are the advantages and disadvantages of diagnosis

Answer 6

Adv:

• can inform treatment options
• can provide prognostic info
• help monitor populationhealth

Disadv.

• stigma
• ‘badging’ (self imposed stigma “I have depression so I can’t…”)
• can misinform prognostic options: must address risks in education at time of diagnosis

Remember: individual symptoms are common and do not mean a diagnosis; transitory symptoms or temporary reactions to extreme events usually do not warrant a diagnosis.

Question 7

What might you consider before diagnosing someone with mental illness disorder?

Answer 7

• Consider WHY you are using diagnosis.
• is it helping individual or treatment plan OR
  is the label being used to isolate, excuse, marginalise, or exclude from services, or for expedience?

Question 8

How do we diagnose a mental health disorder?

Answer 8

• HPC
• Mental State examination
• full psychiatric interview +/- observation
• diagnosit criteria DSM 5 (2013

Question 9

What is the mini mental state examination used for?

Answer 9

MMSE: organic screen used to rule out organic diseases: eg. Alzheihmers

Question 10

List 7 categories assessed in mental state examination:

Answer 10

1. general appearance
2. psychomotor behaviour
3. Mood and affect
4. speech
5. cognition
6. thought patterns
7. level of consciousness

Question 11

List some examples of general appearance

Answer 11

appearance in relation to age
accessibility
body build
clothing
cosmetics
hygiene and grooming 
odor
facial expression
eye contact

Question 12

List some examples of psychcomotor behaviour

Answer 12

gait
handshake
abnormal movements
posture
rate of movements
co-ordination of movements

Question 13

List some examples of mood and affect

Answer 13

• appropriateness of affect
• range of affect
• stability of affect
• attitude toward nurse during - – encounter
• specific mood or feelings observed or reported
• anxiety level

Question 14

List some examples of speech

Answer 14

• rate of speech
• flow of speech
• intensity of volume
• clarity
• liveliness
• quantity

Question 15

List some examples of cognition

Answer 15

• attention & concentration
• memory (ST & LT)
• abstraction ( ability to think abstractly)
• insight into illness
• orientation
• judgement

Question 16

List some examples of thought patterns

Answer 16

• clarity
• relevance / logic
• flow

Question 17

List some examples of

Answer 17

ARe thoughts consistent with reality?
- obsessions- unwanted, recurring throughts
- delusions- persistent false beliefs not in keeping with the person’s culture or education (eg. grandeur, persecution)
> grandiose: unrealistic exaggeration of own importance
> persecutory: belief that one is being singled out for attack or harassment
> Influential: (active influence) belief that one is able to control others through one’s thoughts
(passive) belief that others are able to control the person.
Somatic: total misinterpretation of physical symptoms
Nihilistic: belief in non-existence of self, others, or world.
Others: delusions of sin, guilt etc…

Hallucinations: false sensory perceptions without external stimuli (eg. auditory, visual, olfactory, gustatory, tactile, kinesthetic)

Question 18

Level of consciousness:

Answer 18

totally unresponsive, responsive to painful stimuli only, responsive to touch, responsive to verbal stimuli only

Question 19

Basic diagnosis criteria:

Answer 19

set of symptoms/patients experience

• over a specified minimum time
• with a specified level of severity/impact on function
• not better explained by something else

Question 20

Depression: population health

number of people who will experience depression in their lifetime?

Answer 20

1 in 7 people will experience depression in a lifetime.

Question 21

What is the 2 question screening test for depression?

Answer 21

1. in the past month (or 2 weeks), have you been BOTHERED (is it causing them distress or is it a prob for them) by feeling down, depressed or hopeless?
2. During past month (2 weeks) have you been bothered by little interest in doing things?
   Sensitivity: 97%, Specificity: 66%

Question 22

List and describe use of screening tools:

Answer 22

DASS/DASS21: Depression, Anxiety, Stress
K10: distress: not specific for depression. Measures function and severity, measures psychological stress.
EPDS: edin.post natal depression scale

Question 23

In order to diagnose a major depressive episode, according to DSM, 5 or more of what symptoms must be present?

Answer 23

A. 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 hypersomna
5. pscychomotor agitation or retardation
6. Fatigue or loss of energy
7. Feelings of worthlessness or excessive inappropriate guilt
8. Poor concentration, diminished cognition, indecisiveness
9. Recurrent thoughts of death, suicidal ideation (+/-)plan
B. Symptoms cause clinically significant distress or functional impairment
C: episode not attributable to the psysiological effects of a substance or other medical condition.

Question 24

List degrees and corresponding number of existing positive ICD criteria?

Answer 24

Not depressed: <4 symptoms
mild depression: 4 symptoms
moderate depression: 5-6 symptoms
severe depression: 7 or more
Symptoms should be present for a month or more and every symptom should be present for most of every day.

Question 25

How may anxiety be assessed? (what tools)

What % of population affected in 12m period?

Answer 25

DASS or K10 for example

14% people affected in 12m period

Question 26

List anxiety diagnosis criteria

Answer 26

A: excessive anxiety and worry occurring more days than not, for at least 6 months, about a number of events or activities
B: The individual finds it difficult to control the worry
C: associated with 3 (or more) of: restlessness, easy fatigue, difficulty concentrating, irritability, muscle tension, sleep disturbance
D: causes clinically significant distress or functional impairment
E: Not attributable to the effects of a substance or medical condition
F: not better explained by another mental disorder

Question 27

PTSD:
What is prevalence/lifetime
Which occupations generally have higher prevalence.

Answer 27

• 5% Australians will experience an episode of PTSD in their lifetime.
• 8% for defence force (actual rate believed to be 30%)
• significantly higher in ADF, police, refugees, workers in certain fields healh/welfare (eg. child abuse investigators)

Question 28

What questions might you ask to screen a person for PTSD?

Answer 28

1. do you avoid being reminded of experience by staying away from certain places, people or activities?
2. Have you lost interest in activities that were once important or enjoyable?
3. Have you begun to feel more distant or isolated from other people?
4. Do you find it hard to feel love or affection for other people?
5. have you begun to feel that there is no point in planning for the future?
6. Have you had more trouble than usual falling or staying asleep?
7. Do you become jumpy or easily startled by ordinary noise or movement?

Sensitivity: 71%
Specificity: 98%

Question 29

List PTSD diagnosis DSM-V criteria.

Answer 29

A: Exposure to actual or threatened death, serious injury or sexual violence in one (or more) of the following ways:
1. direct experience
2. Witnessing in person the event occurring to another
3. Learning of the event to a close family member or friend.
4. Repeated or extreme exposure to aversive details of traumatic events (work related)
B: Presene of one (or more) intrusive symptoms: memories, dreams, dissociative reactions, cut related distress
C: Persistent avoidance of stimuli associated with the trauma (avoidance of memories or external cues)
D: Negative alterations in cognitions or mood (2 or more)
1. inability to remember details of event
2. Persistent and exaggerated negative beliefs or expectations
3. Persistent distorted cognition about the cause or consequence of the trauma
4. Persistent negative emotional state
5. Markedly diminished interest or participation
6. Feelings of detachment of estrangement from others
7. Persistent inability to experience positive emotions
E: Marked alteration in arousal and reactivity (2 or more): 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

Question 30

Define psychosis- diagnosis (schizophrenia)

Answer 30

Characterised by any 2 o more of the following for more than 6 months signs and symptoms: delusions, hallucinations, disorganized behaviour and impairment in reality testing.
- Schozoaffective and depressive or bipolar episde with psychotic features have been ruled out.
- Not attributable to a substance or another medical condition
F: specific to autism

Question 31

Who is at risk of suicide:

Answer 31

• coexisting depression
• history of self harm or previous suicide attempts
• childhood abuse
• other mental illness: schizophrenia, BPAD
• substance abuse
• low social status
• Aboriginal TSI people
• rural comms
• young men
• unemployed
• medical illness
• fam hx suicide
• certain occupations, incl Drs.

Question 32

List some warning signs of suicide:

Answer 32

Threats, talk of or joke about death

• making final arrangements
• expressions hopelessness “you’d be better off without me”
• sudden mood swings, abrupt changes in personality, sadness, frequent crying
• loss of interest in hobbies, sports, work, school
• withdrawal from family, friends, peers
• focus on death which may surface in artwork, poems or stories.

Question 33

Warning signs of suicide:

Answer 33

• inability to concentrate, make decision or accept alternatives
• excessive feelings of guilt, self blame, failure, worthlessness, poor self esteem
• fatigue, sleep disturbance
• increased or decreased appetite
• noticeable behaviour changes
• risk taking
• self criticism “i can’t do anything right”
• increased use drugs/alcohol

Question 34

What can I do to help someone who is showing signs of suicidal ideation?
C
A
R
E

Answer 34

C: communicate care: let them know they can talk to you safely and you are listening
A: ask questions: have they had thoughts of hurting themselves?
R: rate risk
E: engage help- work out safety plan, contact appropriate mental health workers (acknowledge your own limitations), be firm about your intentions to get help for them if they won’t.