Section 7: Emotional and Mental Health Assessment and Interventions Flashcards
What are the 3 types of stress?
- Eustress (good)
- Neustress (neutral)
- Distress – acute or chronic
What are ACEs? Why are they important?
Adverse Childhood Events - potentially traumatic events that occur in childhood – links to poor health & wellbeing outcomes
What are the health effects of chronic stress?
sympathetic nervous system dominates
Health effects of chronic stress: impaired immune function, inflammation, impaired wound healing, telomere shortening, increased appetite, metabolic effects, increased clotting, worsened mood, sleep, pain/fatigue
What are some ways an individual can manage the stress response?
breathing, movement, meditation, nature, self-expression, community, self-help books, massage, music, light therapy
Describe potential non-modifiable and modifiable causes of depression/anxiety?
- Non-modifiable factors – genetics, perinatal or environmental exposures, socioeconomic-political environment
- Modifiable factors – stress, nutrition, financial strain, sedentary lifestyle, comorbid conditions, addiction, social connectedness
- Dose-response relationship of risk of depression to number of risk factors
Describe the relationship between diabetes and depression? Outline a possible mechanism?
Depression and type 2 diabetes have bidirectional association (insulin affects brain serotonin, noradrenaline, dopamine)
How are coronary artery disease and mental health linked?
depression alters platelet, endothelial function, independent risk factor for cardiac events - doubles cardiac events OR 2.55, similarly with anxiety OR 2.47
What proportion of primary care visits relate to stress and lifestyle?
80%
What is an appropriate screening tool for Stress?
Perceived Stress Scale: 10-item questionnaire, scored out of 40 (27+ is high stress)
How does occupation affect stress?
Occupational stress factors – increases heart disease and diabetes risk
Job stress promotes unhealthy responses – smoking, alcohol, physical inactivity
What is an appropriate screening tool for Depression?
Simple screen is the Patient Health Questionnaire two question screening tool (PHQ-2)
* Over the past 2 weeks, have you felt down, depressed, or hopeless?
* Over the past 2 weeks, have you felt little interest or pleasure in doing things?
* Score 0 = not at all, 1 = several days, 2 = more than half of the days, 3= nearly every day
* Screen is positive with score of 3 or more (sensitivity 73%, specificity 85%)
Follow up with further assessment – eg PHQ-9, Hamilton depression scale or Beck Depression Inventory.
Outline the DSM diagnosis for MDD:
5+ symptoms for nearly every day within 2 week period, and if symptoms are a change from previous functioning
What is an appropriate screening tool for Anxiety?
Screen with General Anxiety Disorder 2-question screening tool (GAD-2)
* In the last 2 weeks, how often have you felt nervous, anxious or on edge?
* In the last 2 weeks how often have you not been able to stop or control worrying?
* Positive is score 3+ (same scoring system)
Following up with Hamilton Anxiety Rating Scale, GAD07 or Beck Anxiety Inventory.
Rule out anxiety before ascribing symptoms to stress
What do DSM criteria require for a diagnosis of anxiety disorder?
symptoms of anxiety for more than half the days over a least 6 month period
How can a patient self-manage their mental and emotional health?
CBT, time management, positive psychology, gratitude journal, spiritual needs, limit screen time
Other than self-management techniques, what else should be recommended to a patient to help with their mental and emotional health?
- Social support: connect with others, preferably face-to-face, support groups
- Community, online and mental health providers as needed
What is the role of the practitioner in improving patients’ mental and emotional health?
- First, medically stabilise the patient
- Focus treatments on self-management, cognitive restructuring and relapse prevention
- Create action plans around an emotional challenge and include social support
- Focus on adding positive experiences
- Create relapse prevention plan, eg for challenging times
What is mindfulness?
- Paying attention to what you are thinking and feeling - creates awareness of a space between a stimulus and response
- Being fully present in the moment
- Being aware of surroundings, withholding judgement
Is there evidence that mindfulness helps with any symptoms?
2014 meta-analysis showed mindfulness meditation programs have moderate evidence of improved anxiety, depression, pain
Describe any known neurological changes that occur with mindfulness?
- Adult humans can grow approximately 700 new neurons a day??
- Can increase thickness of prefrontal cortex, grey matter in hippocampus, reduce gray matter in the amygdala
- Promotes stronger connections between prefrontal cortex and amygdala –> problem-solving and modulating emotional responses
Describe how mindfulness relates to self-awareness?
- Extended self-reference links one’s experiences across time
- Momentary self-reference is awareness of oneself in the present
Mindfulness training: individuals can activate these distinctly, rather than them being habitually linked
What are the known medical benefits of mindfulness?
Improves physical and psychological symptoms – reduces inflammation, response to chronic pain, anxiety, depression, addiction
Helps with relationships – empathy, loneliness
What is CBT?
Evidenced, structured psychotherapy - gold standard
* Involves structured steps to change thoughts -> change emotions -> change behaviour
* Focusses on current life, not past
* Creates awareness of automatic thoughts
* Thoughts are evaluated as helpful or harmful, positive or negative. Not neutralised, nor bring up memories
What are the benefits of CBT?
- Improves resilience, problem solving, wellbeing
- Better prefrontal cortex function
