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PHAR253 > Psychiatry Intro > Flashcards

Psychiatry Intro Flashcards

1
Q

What is mental health?

A

a state of well-being in which the individual realises his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to contribute to his or her community

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2
Q

What is a mental health disorder?

A

results in significant changes in a persons thinking, emotional state and behavior, and ability to function in social and occupational settings
meets defined diagnostic criteria

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3
Q

What are examples of mental health disorders?

A

depression
anxiety
insomnia
bipolar
schizophrenia

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4
Q

What is a mental health problem?

A

broad term that includes mental health disorders and less severe mental health symptoms that do not meet diagnostic criteria but may disrupt personal, social, and occupational functioning
experienced and expressed uniquely by individuals

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5
Q

What are examples of mental health problems?

A

stressed
tired
anxious
worried

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6
Q

Describe the Canadian epidemiology of mental illness.

A

1/5 experience mental illness per year
-over $50 billion to our economy
8% of adults experience major depression in their lifetime
1% will experience bipolar or schizophrenia
by age 40, 50% will have or have had mental illness
suicide accounts for 24% of all deaths among 15-24yo and 16% among 24-44yo
mortality due to suicide is 4x higher in men

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7
Q

What percentage of people with mental health problems and mental illness do not seek help?

A

60%
-stigma is one of the main reasons

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8
Q

How does psychiatry view the mind?

A

psychiatry focuses on the mind being separate from the brain

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9
Q

What are the 3 components of the mind?

A

emotions
behaviors
thoughts

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10
Q

How does culture impact mental illness?

A

each culture has a unique perspective on mental health
-impacts the way people describe their symptoms
cultures differ in meaning and level of concern given to mental illnesses
-each culture has its own way of making sense of the highly subjective experience of understanding ones mental health
-each culture has its own opinions on mental illness (real or imagined, illness of body or mind or both, stigma, etc)
culture influences treatment decisions and coping

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11
Q

What is the belief about people with mental health concerns and violence?

A

believed that they are typically violent
they are more likely to be victims of crime

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12
Q

What is the Mental Health Services Act (MHSA)?

A

purpose:
-assist people suffering from serious mental illness in receiving treatment
encourages voluntary receipt of services

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13
Q

What is involuntary admission criteria?

A
  1. being found to be a person with a mental disorder who needs inpatient care
  2. not being fully capable of making an admission or treatment decision
  3. likely to harm self or others or suffer substantial mental or physical deterioration
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14
Q

Describe psychiatrists based on the following:
-background
-object of study
-field of study
-license
-work

A

background: physician
object of study: mental illnesses
field of study: biology, human behavior, medication
license: MD
work: examine emotions, thoughts, and behaviors at a biological level in addition to understanding mental processes

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15
Q

Describe psychologists based on the following:
-background
-object of study
-field of study
-license
-work

A

background: scientist or clinician
object of study: human mind and behavior
field of study: clinical and research psychology
license: PhD, PsyD
work: how mental processes coincide with emotions, thoughts, and behaviors

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16
Q

Describe therapists based on the following:
-background
-object of study
-field of study
-license
-work

A

background: several specialties
object of study: variable based on specialty and practice setting
field of study: counseling, social work
license: PhD, various certificates
work: help people navigate challenging emotions, thoughts, and behaviors

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17
Q

What is the difference between a physical and mental health diagnosis?

A

physical: objective
-signs and symptoms
-medical history
-lab tests
-diagnostic tests
psychiatry: subjective
-clinician impressions of the patients thoughts & feelings
-symptoms cross-referenced to a diagnostic/classification manual containing 100s of potential syndromes, and 1 or more diagnostic labels are applied

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18
Q

What is the current practice of psychiatry for diagnosing based on for most clinicians?

A

syndrome-based classification systems
-evolution of thinking toward a brain-based or biologically-based diagnostic system for mental illness might facilitate efforts to advance brain research, to develop better treatments, and improve patient care

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19
Q

What is involved in a clinical assessment in psychiatry?

A

combination of physical exam & clinical interview
Diagnostic Statistical Manual of Mental Disorders (DSM-5)

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20
Q

What is the DSM-5?

A

handbook used as a guide to diagnose mental disorders
contains descriptions, symptoms, and other criteria for diagnosing mental disorders
provides a common language for clinicians to communicate about their patients
establishes consistent and reliable diagnoses
a guide=combine with clinical judgement

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21
Q

What are the pros of the DSM-5?

A

provides criteria for standardizing diagnoses
designed to produce reliable diagnosis which are used to guide treatment decisions
provides standardized measure of assessing effectiveness of treatment
helps guide research in mental health
standardizes billing and coding

22
Q

What are the cons of the DSM-5?

A

defines illness too close to “normal” leading to over diagnosis
largely based on expert opinion
oversimplification of human behavior
reducing complex problems to a label may lose the unique human element
risk of misdiagnosis
stigmatization

23
Q

What is a clinical psychiatric interview?

A

a dialogue between HCP and patient that is designed to diagnose and determine a treatment plan
clearly defined roles and time period
interviewer is a well trained observer and collector
a conversation with a purpose

24
Q

What are the goals of a psychiatric interview?

A

establish rapport and engage patients in treatment
to build relationship of trust and openness
to collect historical information in details which are relevant to presenting problems
assess personality of the patient
to conduct MSE and assess psychopathology
to explain the working diagnosis to the patient and discuss treatment plan

25
What is the analogue to the physical exam in physical medicine for psychiatry?
mental status exam (MSE)
26
What are the components of a mental status exam?
general observations: -appearance -speech -behavior -cooperativeness thinking: -thought process & form -thought content -perceptions emotion: -mood -affect cognition: -orientation/attention -memory -insight -judgement
27
Differentiate between mood and affect.
mood: -subjective -inner feeling of emotion -the internal "amp" affect: -objective -external expression of emotional responsiveness -what comes out the "speakers"
28
Why might physical exams be performed for mental health?
rule out medical and/or medication induced causes lab work diagnostic procedures, as required (CT, MRI) -not common unless new neurologic changes
29
What are psychological tests?
used to screen for specific psychiatric disorders and can help confirm psychiatric diagnoses completed by psychologists
30
What are cognitive and functional assessments?
to assess cognitive function (e.g. IQ, memory) and functional abilities generally completed by occupational therapists
31
What is the Columbia-Suicide Severity Rating Scale?
suicide risk assessment -series of simple questions -help users identify whether someone is at risk for suicide
32
Does asking someone about suicide put the idea in their heads?
asking does not suggest suicide or make it more likely open discussion is more likely to be experienced as relief than intrusion
33
Is there a point in asking about suicidal thoughts?
many people are honest when asked even if they dont bring it up themselves
34
What are the benefits of the Columbia Protocol?
simple (no mental health training) efficient (increases likelihood of correct identification) effective (helps prevent suicide) evidence-based (validated questions) universal (all ages, populations, 100 languages) free
35
What are three specific questions to ask during a suicide risk assessment?
1. have you wished you were dead or wished you could go to sleep and not wake up? 2. have you been thinking about how you might kill yourself? 3. have you taken any steps toward making a suicide attempt or preparing to kill yourself?
36
What are some of the warning signs of suicide risk?
threatening to harm or end ones life seeking or access to means evidence or expression of a plan hopelessness withdrawing dramatic changes in mood
37
What is measurement based care?
the systematic use of measurement tools, such as validated scales, to monitor outcomes and support clinical decision making -can improve outcomes such as symptom remission and adherence -may be used to assess clinical symptoms, functioning, AE, or QoL
38
What are some examples of measurement based scales?
depression: HAM-D, PHQ-9, BDI anxiety: HAM-A, GAD-7 mania: YMRS function: Sheehan Disability Scale, WHODAS
39
What is the issue with E Caps and PHQ-9 for depression?
can be filled out manipulatively (seeking meds or a diagnosis)
40
True or false: measurement based care is highly used
false underutilized
41
What are the barriers to implementation of measurement based care?
response burden patient symptoms may be barriers to completing scales time, effort, cost negative attitudes toward MBC (belief that standardized measures are not as accurate as clinical judgement) concern that use of MBC may be used to judge skillfulness of practitioner
42
How is current psychotropic nomenclature determined?
based on indications the medications were first discovered
43
What is the issue with the current psychotropic nomenclature?
flawed and misleading -many drugs have multiple MOAs and are used to manage symptoms of various conditions -differences exist between drugs within current classifications -dose related differences in MOA
44
What are the limitations of the current psychotropic nomenclature?
outdated -based on earlier period of scientific understanding -does not recognize developments does not support clinical decision making -may complicate treatment decision for HCPs inconsistent with other areas of medicine -classification based on target receptors, enzymes, etc may confuse patients & exacerbate non-adherence negatively contributes to stigma
45
What are the goals of neuroscience-based nomenclature?
help clinicians make informed choices when working out the next pharmacological step system of naming that does not conflict with the actual use of medications be future-proof to accommodate new compounds help patients understand and accept prescribed treatment for a condition
46
What is stigma?
a mark or sign of disgrace which distinguishes someone from the rest of society and diminishes their worth as a person
47
What are the distinct components of stigma?
labeling someone with a condition stereotyping people who have that condition creating a division (us vs them) discriminating against someone on the basis of their label(s)
48
How does stigma impact diagnsosis and treatment?
fear of stigma delays diagnosis and treatment *self stigma is highly prevalent*
49
How can stigma be reduced?
change in behaviours and attitudes towards acceptance, respect, equitable treatment of people with mental health problems and mental illnesses
50
What are examples of stigmatizing language?
crazy, unhinged, psychotic -use: person living with x mental illness as an aggregate term -use: a mental illness afflicted by mental illness -use: living with mental illness mentally ill person -use: person with a mental illness normal behaviour -use: usual behavior or typical behavior committed suicide -use: died by suicide

PHAR253 (16 decks)

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