Mental Health Issues and Behavioral Disorders

Question 1

Affective Disorders

Answer 1

Depressive and Bipolar disorders.
Disorders affecting mood.

Question 2

Major Depressive Disorder - Definition

Answer 2

Sad, empty or irritable mood, accompanied by somatic and/or cognitive changes.
Recurrent episodes of at least 2 weeks.
Symptoms cause distress or impairment in social , occupational or other important areas of functioning.
Cause and consequence of physiological + structural changes in the brain.

Question 3

Major Depressive Disorder - Specific Symptoms (9)

Answer 3

• Depressed mood*
• Diminished interest in all/almost all activities*
• Weight loss or gain, decreased or increased appetite.
• Insomnia or hypersomnia
• Psychomotor agitation or retardation
• Fatigue or loss of energy
• Feeling of worthlessness or excessive/delusional guilt
• Diminished ability to think, concentrate, make decisions
• Recurrent thoughts of death, suicide ideation, plan or attempt.

Question 4

Major Depressive Disorder - Additional Manifestations

Answer 4

Idiopathic pain
Anxiety and irritability
Motivation loss and isolation
Hypochondria
Attentional Disorders
Memory impairment

Question 5

Mechanism of Depression

Answer 5

Neurochemical imbalance in dopamine receptors in PFC and limbic system. ↓ DA.
↑ Cortisol → ↓BDFN, GDFN
→ Loss of gray matter volume in HPC, PFC, aCC, Caudate, Thalamus.

Question 6

Bipolar Disorder - Key Features

Answer 6

Combination of manic, hypomanic and major depressive episodes.
Impairment in social, occupational or other important areas of functioning.
Type I or II.

Question 7

Bipolar Disorder - Type I

Answer 7

Manic episodes, maybe followed by hypomanic or major depressive episodes. Mania itself impairing.

Question 8

Bipolar Disorder - Type II

Answer 8

Hypomanic and major depressive episodes, no mania. Major depressive symptoms or unpredictable shifts between the two is impairing. Most common.

Question 9

Bipolar Disorder - Episodes (4)

Answer 9

Euthymia: Stable neutral mood.
Manic: abnormally and persistently elevated, expansive or irritable mood and goal-directed behavior. At least one week.
Hypomanic: Less severe than manic, not impairing, lasting at least 4 days.
Major depressive: Low mood and excitability, lasting 2 weeks.

Question 10

Mania - Diagnostic Criteria (DSM5) (7)

Answer 10

Inflated self esteem
Decreased need for sleep
More talkative than usual
Flight of ideas or racing thoughts
Distractibility
Increase in goal-directed behavior (socially, work, school, or sexually)
Involvement in activity with high risk of painful consequences (shopping spree, foolish investment, illegal activities)

Question 11

Treatment - Bipolar Disorder

Answer 11

Pharmacological
Physical activity
Diet
Problem solving therapy
Cognitive behavioral therapy
Acceptance and commitment therapy
Mindfulness based interventions

Question 12

Anxiety Disorders - Definition

Answer 12

Excessive, irrational, non-adapted or persisting fear and anxiety and related psychological and somatic disturbances and symptoms.
Fear: response to real or perceived imminent threat.
Anxiety: anticipation of future threat.

Question 13

Anxiety Disorders - Characteristics

Answer 13

Physiological and structural (dlPFC) changes in the brain.
Affects executive functions: attention, memory, self control.
Agitation can lead to damage to body and social interaction affecting all ADLs.
Panic attacks common manifestation.

Question 14

Panic Attack - Definition

Answer 14

Abrupt surge of intense fear or intense discomfort, reaches a peak within minutes.
Not a disorder but a manifestation of mental or medical condition.
Can occur from a calm or anxious state, expected (trigger) or unexpected.

Question 15

Panic Attack - Specific Symptoms (13)

Answer 15

Palpitations, accelerated heart rate.
Sweating
Trembling
Sensation of shortness of breathe
Feeling of choking
Chest pain/discomfort
Nausea, abdominal distress
Dizzy
Chills or heat sensation
Numbness
Derealization or depersonalization
Fear of losing control
Fear of dying

Question 16

Anxiety and neuroplasticity

Answer 16

↑ AM activity → ↓ HPC and aCC activit
→ ↓ Dorsal executive network
→ Emotional reasoning takes over pragmatic reasoning in decision making.

Question 17

Generalized Anxiety Disorder - Definition, Impairments

Answer 17

Excessive persistent anxiety and worry a nr of different things, with out of proportion intensity, duration and frequency.
Symptoms interfere with tasks, leading to attention disorder.
Often also experience depression and panic disorder.
Impair social interaction, job, studies etc.

Question 18

Specific Symptoms of Generalized Anxiety Disorder

Answer 18

Restlessness or feeling on edge
Easily fatigued
Difficulty concentrating
Irritability
Muscle tension
Sleep disturbance (falling asleep, staying asleep, restless sleep)
3 symptoms for more days than not, for the past 6 months.

Question 19

Social Anxiety Disorder - Definition

Answer 19

Excessive, systematic and persistent fear or anxiety related to social situations for more than 6 months. Afraid of being negatively evaluated by others.
Avoidance behavior.
Impaired social interactions, job, studies.

Question 20

Panic Disorder - Definition

Answer 20

Recurrent panic attacks that occur without any obvious triggers.
Worry about having panic attacks and avoidance behavior.
High level of social, occupational and physical disability.
High risk of suicide.

Question 21

Specific Phobia - Definition

Answer 21

Irrational fear of an object, animal or situation.
Avoidance behavior.
Belief that the trigger is life threatening. Greater fear/avoidance than the normal reaction.
Can have a full panic attack.
impairs social, occupational or other important areas of functioning.

Question 22

Anxiety Disorders - Treatment

Answer 22

Cognitive behavioral therapy and mindfulness-based interventions very effective.
Pharmacological therapy.
Physical activity.

Question 23

How to manage a panic or anxiety attack (5)

Answer 23

Recognize thoughts and feelings, accept, identify triggers.
Reassure feelings are not dangerous and will pass.
Slow deep breathes.
Refocus attention
Listen to music

Question 24

Post Traumatic Stress Disorder - Definition

Answer 24

Reaction following exposure to one or more traumatic events.
Reliving the traumatic event, panic attacks, anhedonia, dissociative state, recurrent, involuntary and intrusive memories of the event for more than 1 month.
Avoidance of triggers.
Amnesia can be present.
Impacts attention and memory, may lead to depression.
Impairing social, occupational or other important areas of function.

Question 25

Role as a Physio (4)

Answer 25

Be able to recognize
Prevent development or aggravations
Be patient and understanding
Counsel and redirect to other health professionals