Sections 7 and 10: Emotional and Mental Wellbeing, Connectedness, Positive Psychology 10% + 8%

Question 1

What are the pillars of POsitive Psychology? (PERMA)

Answer 1

Positive emotion
Engagement
Relationships
Meaning
Accomplishments

Question 2

Define POsitive psychology

Answer 2

“scientific study of strengths and virtues that create/ enable thriving, happiness and less misery” (J Shull, audio presentation)

Question 3

What factors can influence our feeling of well-being, according to positive psychology?

Answer 3

LEisure activities
Social networks
Finances
Personal freedom work Situation 
Relationships 
Physical health

Question 4

outline key points about positive emotions:

Answer 4

• impact our RESILIENCE
• broaden and expand
• usu occur in non-life threatening situations
• signs of fluorishing or optimal well being

Question 5

GAD DSM-5 criteria:

Answer 5

more than 1/2 days over at least 6 months

1. excessive anxiety AND
2. worry is difficult to control AND
3. at least 3 of:
   a) restless
   b) easily fatigued
   c) difficulty concentrating
   d) irritability
   e) muscle tension
   f) sleep disturbance
4. signif impairment due to anxiety/ worry/ physical symptoms AND
5. symptoms not due to other d.o/ substance use

Question 6

GAD 2

Answer 6

1. in the last two weeks, how often have you felt nervous/ anxious or on edge?
2. in the last two weeks, how often have you been able to stop or control worrying?
   score 0-3
   positive if score 3+

Question 7

T/F: Anxiety
A) grade B recommendation to screen for anxiety in primary care setting (USPSTF )
B) anxiety is recommended to be ruled out before symptoms are attributed to stress
C) PHQ4 is a brief screening for depression and anxiety

Answer 7

A) false: no recommendation from USPSTF
B) true
C)

Question 8

PHQ4

Answer 8

brief screening for depression and anxiety
scored 0-3 by pat. (0= never, 1= several days, 2= more than half days, 3= nearly every day)
How often have you experienced the following:
1. feeling nervous, anxious on edge
2. not being able to stop or control worrying
3. over the past two weeks, 2 weeks: have you felt down/ depressed or hopeless?
4. 2 weeks: have you felt little interest or pleasure in doing things?
any positive score (3 or more) = assess for SUICIDAL IDEAS

Question 9

PHQ2

Answer 9

screen every patient (depression)
score 0-3 , positive if >3–> furthter assessment (e.g phq9 or HAM-D); at the very least SCREEN FOR SUICIDAL IDEAS
1. 2 weeks: have you felt down/ depressed or hopeless?
2. 2 weeks: have you felt little interest or pleasure in doing things?

Question 10

T/F:
A) positive PHQ2 test result (>3/6) is highly predictive of presence of depression and requires further assessment (e.g. HAM-D)
B) PHQ2 should only be used for patients who present with low mood to screen for depression

Answer 10

A) true: high sensitivity: 80-90% AND specificity 70-85%

B) recomended to use for ALL patients

Question 11

T/F:
A) screening and brief discussion for stress is recommended for all patients
B) work related stress, such as working overtime daily can increase risk of chronic diseases such as cardiovascular disease and t2d
C) there are multiple pathways that can explain increased risk of chronic disease in people w/ chronic stress, these include adopting unhealthy habits, poor sleep, overeating, HPA axis
D) stress can be assessed using Perceived Stress Scale assessment

Answer 11

A) true
B) true: Finnish study of 22k municipal workers, 7.5y f/u, 2fold increase of t2d found in a study of women w/ 15y f/u
C) true

Question 12

T/F:
A) screening and brief discussion for stress is recommended for all patients
B) work related stress, such as working overtime daily can increase risk of chronic diseases such as cardiovascular disease and t2d
C) the assumed mechanism of increased risk of chronic diseases secondary to stress is high level of cortisol and its consequences
D) stress can be further assessed using Perceived Stress Scale assessment

Answer 12

A) true
B) true: Finnish study of 22k municipal workers, 7.5y f/u, 2fold increase of t2d found in a study of women w/ 15y f/u
C) FALSE: there are multiple pathways that can explain increased risk of chronic disease in people w/ chronic stress, these include adopting unhealthy habits, poor sleep, overeating, HPA axis
D) true

Question 13

T/F:
A) screening and brief discussion for stress is recommended for all patients
B) work related stress, such as working overtime daily can increase risk of chronic diseases such as cardiovascular disease and t2d
C) the assumed mechanism of increased risk of chronic diseases secondary to stress is high level of cortisol and its consequences
D) stress can be further assessed using Perceived Stress Scale assessment
E) depression and anxiety should be ruled out in people presenting with stress, using appropriate screening tools

Answer 13

A) true
B) true: Finnish study of 22k municipal workers, 7.5y f/u, 2fold increase of t2d found in a study of women w/ 15y f/u
C) FALSE: there are multiple pathways that can explain increased risk of chronic disease in people w/ chronic stress, these include adopting unhealthy habits, poor sleep, overeating, HPA axis
D) true
E) TRUE: big overlap; PHQ2, GAD2= good screening

Question 14

T/F:
A) each and every patient should be screened for depression in primary care
B) PHQ2 is a good screening test and if positive patient should be treatment or referred
C) gneder and cultural interpretations may make screening for depression more difficult
D) DSM-5 criteria for depression state that BOTH of the following must be present for 2 or more weeks, nearly every day: 1. depressed mood most of the day, 2. anhedonia/ poor motivation + 4 or more of psychosomatic symptoms or SI

Answer 14

A) false: grade B recomm. to screen adults and adolescents (12 and over) for depression IF SYSTEMS AVAILABLE in the practice (i.e. if positive screen can be managed in the practice), if NOT AVAILABLE the screening should NOT be automatically done
B) FALSE: PHQ2 high specificity and sensitivity but needs further assessment before treatment decisions made
C) TRUE: menle role may not allow them to disclose difficulties; spanish speaking latinos more likely to endorse crying vs english speaking latinos
D) FALSE: low mood OR anhedonia +4 or more other symptoms

Question 15

T/F:
A) HIGH SCORE in PHQ4 correlates well with presence of mental health disorder
B) depression is a comorbid illness for many chronic diseases and has a bidirectional association (e.g a diagnosis of t2d predicts a future diagnosis of depression and vice-versa)
C) depression is associated with increased risk of CVD, stroke, cancer, diabetes and is as strong of an independent marker for mortality as smoking

Answer 15

A) FALSE: association w/ impairment, disability days and health care use
B) TRUE
C) TRUE

Question 16

T/F:
A) anxiety and depression are increased in the presence of lower perceived control over diabetes
B) poorer emotional health is associated w/ negative perceptions of diabetes (seriousness of illness and severity of consequences)
C) risk factors for suicidal ideation in diabetics: insulin therapy include all of the following except:
1. insulin therapy
2. new diagnosis
3. unsatisfactory glycemic control (A1c 6.5 or more)
D) a diagnosis of t2d predicts a future diagnosis of depression and vice-versa

Answer 16

A) TRUE
B) TRUE
C) 2 IS FALSE: longer duration of diabetes
D) TRUE (p. 237)

Question 17

T/F:
A) depression usually develops secondary to cardiovascular disease and is not known to predict developing it
B) MDD (OR 2.55) and GAD (OR 2.47) predicted risk from cardiac death, MI cardiac arrest, non-elective revascularisation in a study w/ 2 year follow up
C) patients w/ depression have been shown to suffer from increased platelet adherence, endothelial dysfunction, lowered hr variability, worse adherence to lifestyle changes
D) treatment of depression in pat w/ coronary artery dis improves qol but doesn’t improve symptoms
E) SSRI’s are first line, TCAs are unsafe; optimal treatment is meds+ psychotherapy

Answer 17

A) FALSE: depression is an independent risk factor for cardiac events (doubles the risk), primary risk factor for IHD and secondary RF for wosened prognosis; increases risk by 15-20%in pat w/ known IDH
B) TRUE
C) TRUE
D) treatment of depression in pat w/ coronary artery dis improves symptoms and qol
E) TRUE

Question 18

T/F:
A) exercise can prevent or treat depression
B) exercise performs better at treating depression than psychotherapy
C) is a promising treatment intervention for the elderly and young adults

Answer 18

A) TRUE
B) FALSE: exercise = more effective than no treatment, not more effective than pharmaco or psychotherapy, has an impact comparable to CBT
C) TRUE; for young is esp effective if started at childhood (i.e prevents depression)

Question 19

T/F:
A) there is consistent and convincing evidence that healthy nutrition is beneficial for mental health
B) there is good evidence that ITLC (CHIP) is effective for symptoms of, as well as functional impairment secondary to depression and anxiety, this effect showed a correlation with reduced BMI during the 6 week intervention
C) for women of childbearing age, depression is more likely if there are proven nutriotional deficiencies, particularly folate, b12, Fe, Se, Zn, Omega-3 but there is no evidence to support “blind” supplementing to prevent or treat depression
D) fried foods, refined grains, sugary products, trans fats are associated w/ increased rates of depression and anxiety

Answer 19

A) FALSE
B) TRUE: improved Beck Depr. Index, social functioning scores, mental health scores, (6 week period) when there was a greater decrease in BMI p. 240
C) true
D) true: adulst who frequently eat fsat food are 40% more likely to develp depression vs those who avoid fast foods

Question 20

T/F:
A) meditation has been shown to be beneficial for depression and anxiety
B) patient-provider relationship can be therapeutic for emotional wellbeing
C) ABC model of CBT can be used for self management of depression and anxiety

Answer 20

A) FALSE: can decrease negative impacts of stress but more research needed
B) TRUE: use principles of MI
C) TRUE

Question 21

T/F:

outline principles of emotional- well being management

Answer 21

1. encourage SELF-MANAGEMENT: Connect, Activate, cognitive restructuring, positive psychology
2. COLLABORATE: to create a detailed ACTION PLAN, RELAPSE PREVENTION PLAN: pre-empt and plan for barriers and challenges, support team
3. CELEBRATE SUCCESS

Question 22

T/F:
A) positve emotions increase life satisfaction by building resiliency
B) ratio of 5 positive emotions to 1 negative emotion was shown to be a good measure of resiliency and predict whether a person is “ready to change”, an individual’s ratio can be assessed through an online quiz
C) encouraging positive emotions can enhance well being. Experiencing more positive emotions can be learned via online program
D) increased awareness of ones virtues and strengths can increase positive emotions

Answer 22

A) TRUE
B) FALSE: ratio is 3:1 (aka resiliency tippoint) ; 3:1 have resources to chgange, below 3:1 unlikely to overcome obstacle at the current time
C) TRUE
D) TRUE

Question 23

T/F:
A) MBSR is a formal training program developed to assist people in facing challenges of life, both physical and mental
B) core attitudes of MBSR are: non-judging, non-striving, acknowledging what’s happening, patience, self-reliance and beginner’s mind
C) conscious thought can re-train and shape the brain and emotional traits: mindfulness training activates momentary self-reference areas of brain and adjusts its habitual linking with the extended self-reference (habitual emotional responses to situations/ stressors)
D) functional imaging has demonstrated that 8-week mindfulness training can increase activation of amygdala

Answer 23

A) TRUE: MBSR (John Kabat-Zinn) ; 9 structured classes over 8 weeks: 45 min mindfulness practices, workbook and gp activities, once progr concludes students expected to maintain 45min/ day of mindfulness practice 6x/week
goal: integration and application of mindfulness into daily living and apply mindful approach to mental and physical challenges life brings
formal (meditation) and informal practices (awareness, attentiveness to routine activities)
B) TRUE
C) TRUE
D) FALSE: reduced grey matter density in amygdala and increased connection betw prefrontal cortex (planning, problem solving, exec. function) and amygdala (hence less reactive and better response to stress)

Question 24

T/F:
A) MIndfulness enhances psychological hardiness; increases resilience, self esteem, energy and enthusiasm for life, improves ability to cope with stress (short and long term) and ones ability to relax
B) mindfulness improves a number of symptoms, both psychological and physical: inflammation, chronic pain, anxiety, depression, addiction
C) MBSR helps w/ relationshiops: comassion , incl self-compassion, empathy, tolerance, resilience
D) MBSR reduces loneliness in older adults and can help prevent depression

Answer 24

A) true
B) true
C) true
D) true

Question 25

T/F)
A) mindfullness and regular self-care practice have been shown to reduce burnout and compassion fatigue
B) AMA Code of Ethics states that physicians are responsioble to maintain their own halth and wellness

Answer 25

A) TRUE

B) TRUE

Question 26

T/F:

The single most important predictor of hapiness and longevity is having social connections

Answer 26

A) True: Harvard long term follow up study (75 years) ; 700+ men