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Health and Society > Psyciatry > Flashcards

Psyciatry Flashcards

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1
Q

Epidemiology of psychological disorders ?

A
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2
Q

Discuss classification of mental health problems

A

DSM-V – American Psychiatric Association.
-The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition

ICD-10 - WHO
- International classification of diseases 10

National Institute of Mental Health’s Research and Domain Criteria

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3
Q

What are the issues with classifying mental health problems ?

A

Aetiology - cause of disease. Is it biological, due to socio cultural relationships, interpersonal relationships. Is there a genetic response, genetic predisposition

  • Multidimensional complexity - the condition can change and present differently between individuals
  • Comorbidities - often people do not have one single mental health problem, they could also have phobia, anxiety or a physical condition such as chronic illness.
  • Setting thresholds for diagnosis in clinical setting - trying to det diagnostic criteria that can be applied is actually very very tricky
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4
Q

How to identify and monitor mental health problems ?

A

-History
-Examination
-Screening Questions
-Tools

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5
Q

Assessment tools

A

PHQ9 : Patient Health Questionnaire 9

HADS: Hospital Anxiety and Depression scale

GAD-7: Generalized anxiety disorder 7

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6
Q

Describe distribution of symptoms of anxiety and depression in the community ?

A
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7
Q

What is the Adult Psychiatric Morbidity Survey ?

A
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8
Q

What is the Adult Psychiatric Morbidity Survey ?

A
  • These sort of surveys look at different types of anxiety and depression and anxiety based disorders that caused marked emotional distress and interfere with daily function
  • Focused on the main 6 types of common mental disorders so generalized anxiety disorders, panic disorders, depression, phobias, obsessive compulsive disorder
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9
Q

Describe how mental health problems relate to primary and secondary healthcare ?

A

Primary care: APPROXIMATELY 90% OF COMMON MENTAL HEALTH DISORDERS ARE MANAGED IN PRIMARY CARE

Opportunistic assessment using screening questions e.g., in patients with chronic health conditions

Secondary healthcare:

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10
Q

Describe how mental health may be measured at a population level ?

A

Why do we measure mental health ?
-Identify care needs of the patients

-Exploring causes

-Look at the trends in mental health

-Look at management

-Look at impact of events e.g., Coronavirus Pandemic

Difficulties measuring mental health ?

-Hard to categorise and diagnose

-Relapsing and remitting nature of mental health conditions

-A substantial amount of mental health services are delivered outside the health sector

-Huge numbers of people

-Sub-groups in the population

Options for measuring mental health ?

-Gathering existing data

-Biological measurements

-Diagnostic interview

-Assessment tools

Considerations for measuring mental health:
Identifying the outcomes you need to measure

Standards you are using to define mental illnesses

Using a pre-existing screening tool vs creating one

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11
Q

Differences in mental health

A
  • more mental health disorders in higher income countries
  • health and social problems are worse in more unequal countries
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12
Q

Define social gradient in health ?

A
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13
Q

Give some examples of socioeconomic inequalities and mental health ?

A
  • Poverty is both ‘a cause and a consequence’ of mental ill health
  • In the UK, children and adults in the poorest households are more than twice as likely to experience mental health problems as those with the highest incomes
  • Largest increase in mental health problems during UK Covid-19 lockdowns among those experiencing financial difficulties before the pandemic
  • Three in four adults (77%) report feeling worried about rising costs of living, with the highest proportion of those reporting feeling ‘very worried’ (31%) among those with a gross annual income of less than £10,000, compared to 12% in the highest income group
  • In November, 23% of people with existing mental health problems reported being behind on at least one household bill
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14
Q

Impact of social factors on mental health services ?

A
  • NHS providers report that social factors may be contributing to increased service demand
    This survey was undertaken in March 2019, prior to the pandemic
  • In deprived areas, patients referred for psychological therapy are less likely to receive treatment
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15
Q

Describe the Impact of the cost of living crisis on healthcare services

A
  • Reduced access to strategies to improve mental wellbeing, for example, costs associated with visiting support networks
  • Two thirds (66%) of therapists report that cost of living issues are causing deteriorating mental health among their existing clients, and around half (47%) report that clients are cancelling or pausing sessions due to money concerns

-Survey of NHS providers (response rate: 54%) found that 71% of Trust leaders surveyed reported staff were struggling to afford transport to attend work, and 61% reported a rise in sickness absence due to mental health. In addition, 75% reported a rise in mental health needs among patients relating to stress, debt or poverty

  • Potential wider impacts on other parts of the health and social care system
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16
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A
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17
Q

What can/should healthcare providers do about the social determinants of mental health?

A
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18
Q

What is health behavior ?

A

Health behaviour is any activity people perform to maintain or improve their health, regardless of their perceived health status or whether the behaviour actually achieves that goal. Researchers have noted that people’s health status influences the type of health behaviour they perform and their motivation to do it

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19
Q

What is health psychology ?

A

Health Psychology is devoted to understanding psychological influences on how people stay healthy, why they become ill, and how they respond when they do get ill. Health psychologists both study such issues and promote interventions to help people stay well or get over illness

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20
Q

Describe health impairing behavior’s ?

Describe health protective behavior’s ?

A

Health-impairing behaviour/habits
- Behavioural pathogens
- smoking, eating a high fat diet

Health protective behaviour
- Behavioural immunogens
- attending health check/screenings

What is health behavior’s:
Behaviours that are related to the health status of the individual

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21
Q

Outline why it is important to study health behaviour ?

A
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22
Q

Outline different theories of health belief: attribution theory, health locus of control, stages of change model

A

Attribution Theory : how the social perceiver uses information to arrive at causal explanations for events

Health locus of control: People differ to the degree in which they believe they can control their lives

As a healthcare practitioner how is this useful ?

provides the framework/checklist to guide understanding how patients psychologically represent the illness
can then correct inaccuracies that might affect their decision making process or management of their medical conditions
can impact on:
the treatment options that the client will trust/choose/consider effective or even not choose any treatment at all
whether to visit a GP, Hospital, spiritual leader, or religious leader for advice
whether the client/patient can accurately or inaccurately monitor the development/progress/prognosis of their medical condition(s)

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23
Q

Outline different theories of predictors of health behaviours: health belief model, protection motivation theory, theory of planned behaviour

A

Health belief model: has been used to predict and change health behavior’s. For example health promoting is used such as healthy eating and health risk

Protection Motivation Theory:

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24
Q

Outline different theories of predictors of health behaviours: health belief model, protection motivation theory, theory of planned behaviour

A
25
Q

Outline how theories of health belief and health behaviour can be used to explain health behaviours such as smoking

A
26
Q

Outline different theories of predictors of health behaviours: health belief model, protection motivation theory, theory of planned behaviour

A
27
Q

READ book chapter on this if you dont understand

A
28
Q

Statistics to do with addiction ?

A
  • Over a third of a typical GP’s patients will be smokers
  • Hospital doctors will see the impact of alcohol misuse in virtually every department.
    Admitted patients: 1 in 5 harmful drinking and 1 in 10 alcohol dependence
  • In England and Wales, there are more than 250,000 problem drug users
29
Q

The role of doctors and primary care ?

A
  1. Screening, case identification & monitoring

Interventions for low severity:
2. Brief interventions (Behaviour, lifestyle counselling)
3. Assessment of presenting disorder

Moderate severity:
4. Psychological support
5. Pharmacological interventions

Complex and severe:
Referral to specialist service
Collaborate in care

30
Q

What is considered to be the most harmful drugs ?

A

Alcohol
followed by heroin

31
Q

What is addiction ?

A

Mental and Behavioural Disorder: Continued repetition of a behaviour despite adverse consequences

32
Q

What are the characteristics of addiction ?

A

-Loss of control over the substance
-Compulsion to use substance
-With/without withdrawal phenomena

33
Q

What are the criteria of Alcohol dependence ?

A

Two or more of the following in last year:

-Impaired control over alcohol use

-Increasing precedence of alcohol use over other aspects of life, including maintenance of health, and daily activities and responsibilities, such that alcohol use continues or escalates despite the occurrence of harm or negative consequences

-Physiological features indicative of neuroadaptation to the substance, including:
Tolerance to alcohol
Withdrawal state upon cessation of alcohol
The use of alcohol to avoid withdrawal symptoms

34
Q

What are withdrawal effects ?

A

Tend to get two stages: Acute phase and protracted phase

Acute phase: clinical management, physiological symptoms, lasts between 5 -10 days.

  • Protracted phase: poor sleep, anxiety…. can last up to 3 months
35
Q

What is protracted withdrawal syndrome ?

A

Protracted withdrawal syndrome is a continuation of withdrawal symptoms, even after the body has healed from the physical side effects

Protracted syndrome (alcohol) characterized by:
Craving, sleep disturbance, anhedonia, anxiety and depression – related to neurochemical disturbances

36
Q

What causes dependence (addiction) ?

A
  • Alcohol consumption: volume and frequency
  • Social vulnerability factors: levels of development, culture, drinking context, alcohol production, distribution and regulation
  • Individual vulnerability factors: age, gender, familial factors, and socio economic status
37
Q

Alcohol and Inequities

A
  • For the most disadvantaged in society, inequities exist at all of these levels, leading to compounding disadvantage and a disproportionate impact of addiction (alcohol).
  • For example, poor, socially excluded groups are more likely to have increased exposure to life stressors; have fewer buffering and coping resources; live in neighborhoods with a higher density of alcohol sales outlets; have reduced access to affordable and appropriate support; experience greater adverse consequences for their household budget from alcohol consumption; live with or near people who also drink excessively; and are more likely to suffer co-morbidities such as mental health problems and other substance abuse disorders.
38
Q

Can genetics impact dependence ?

A
  • Genetics are thought to increase dependence up to 50%
39
Q

Give examples of environmental pathways to dependence ?

A

Prevalence trends: more permissive attitudes:
-Affordability (price x disposable income) & consumption
-Intoxication approved and promoted (media)
-Accessible

Individual
-Positive effects and expectations
-Influence of peers

Other factors
-Adverse childhood experiences (ACE)
-Poor family support – parenting (monitoring & endorsing use)
-Conduct and mood disorders
-Low self-control

40
Q

How does alcohol effect us ?

A

Alcohol prominent effects on gamma-aminobutyric acid (GABA)

Main effects – enhancing GABA and inhibiting other receptors (N-methyl-D-aspartate; NDMA)

Suppression of CNS = anxiety reduction, stimulant/euphoriant effect

41
Q

What does chronic consumption of alcohol do ?

A

-Chronic consumption neuroadaptation and brain changes (prefrontal cortex)

-Move from positive (Pleasure seeking) > negative (Stress reduction) reinforcement – maintenance of habit

42
Q

What does salience mean ?

A

Salience: behaviour is modified to prioritise substance use

43
Q

Describe the cycle of addiction ?

A

1.SALIENCE
2.MOOD MODIFICATION
3.TOLERANCE
4.WITHDRAWAL
5.CONFLICT – neglect of other activities
6.RECOVERY (QUIT ATTEMPTS) - RELAPSE

44
Q
  • People do not need to him rock bottom to stop dependence
A
  • People do not need to him rock bottom to stop dependence
45
Q

Treatment for people with addictions ?

A
  • to stop people drinking
  • or to reduce the amount people drink
46
Q

What should you expect from treatment for addiction ?

A
  • normally treatment lasts 6 months
  • 60% of those with alcohol addiction complete treatment
  • 30% are successful within a year, but there is a relapse rate of 70-80%

Factors associated with poorer outcomes:
Social instability/support, alcohol-free network, family history of dependence, mental ill health, previous treatment and failed attempts
Severity, chronicity, and complexity

47
Q

What are the social attitudes towards those with addiction ?

A

-social disintegration, comorbidity and tangible losses

-Stigma (internal/external) associated with reduced access

-Perceived as: responsible, to blame, dangerous, criminal, weak willed, etc -

-Considering addiction as a disease may be helpful in reducing some negative labels and assertions

-Clinicians high-levels of stigmatisation; failure to recognise addiction as a mental and behavioural disorder – limit interventions and treatment

48
Q

What is motivational interviewing ?

A
49
Q

What is behavior change counselling ?

A
50
Q

What are the perquisites for change ?

A

-Belief that change is a good idea
-Importance of change
-Confidence to change
-Knowledge of what to do
-Ready to attempt change

51
Q

What are the five general principles of Motivational Interviewing ?

A

-Express empathy
-Develop discrepancy
-Avoid argumentation
-Roll with resistance
-Support self-efficacy

52
Q

What is the role of the therapist in Motivational Interview ?

A

Integral to the project
Influential to the outcome by as much as 10-50%
Role as educator
Role as ‘supervisor’
Role as supervisee
Team member
Professional status
Role as researcher
Role as therapist – behaviour change counsellor

Interest in helping
Psychologically healthy
Skilled
Curious
Patient centred
Minimises preconceptions
Avoid assumptions
Focus on behaviour change NOT diagnosis
Empathy demonstrated
Self-efficacy promoted
Works with ambivalence

53
Q
A
54
Q

Behavioral change principles

A
55
Q

What is considered a mental illness changes over time …..

A
  • Homosexuality removed from DSM in 1973

1980: transsexualism was in the DSM

56
Q

How is ethnicity measured ?

A

Large, national surveys, using largely quantitative but also qualitative methods of research

57
Q

What is the ethnic minority population in England and Wales ?

A

14 %

58
Q

Ethnic minority variations in mental health ?

A

Chinese’s people - low rates of mental illness this is thought to be because they have close knit families and communities,

Irish people - have higher rates of hospital admissions for depression and alcohol problems than other ethnic minority groups

Black and African - more likely to be diagnosed with schrizophenia or psychosis

More likely to recieve physical treatments in care
More likely to be regarded as violent and have longer stays in medium secure care

Health and Society (5 decks)

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