Psychiatry Intro

Question 1

What is mental health?

Answer 1

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

Question 2

What is a mental health disorder?

Answer 2

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

Question 3

What are examples of mental health disorders?

Answer 3

depression
anxiety
insomnia
bipolar
schizophrenia

Question 4

What is a mental health problem?

Answer 4

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

Question 5

What are examples of mental health problems?

Answer 5

stressed
tired
anxious
worried

Question 6

Describe the Canadian epidemiology of mental illness.

Answer 6

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

Question 7

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

Answer 7

60%
-stigma is one of the main reasons

Question 8

How does psychiatry view the mind?

Answer 8

psychiatry focuses on the mind being separate from the brain

Question 9

What are the 3 components of the mind?

Answer 9

emotions
behaviors
thoughts

Question 10

How does culture impact mental illness?

Answer 10

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

Question 11

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

Answer 11

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

Question 12

What is the Mental Health Services Act (MHSA)?

Answer 12

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

Question 13

What is involuntary admission criteria?

Answer 13

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

Question 14

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

Answer 14

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

Question 15

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

Answer 15

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

Question 16

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

Answer 16

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

Question 17

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

Answer 17

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

Question 18

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

Answer 18

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

Question 19

What is involved in a clinical assessment in psychiatry?

Answer 19

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

Question 20

What is the DSM-5?

Answer 20

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

Question 21

What are the pros of the DSM-5?

Answer 21

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

Question 22

What are the cons of the DSM-5?

Answer 22

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

Question 23

What is a clinical psychiatric interview?

Answer 23

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

Question 24

What are the goals of a psychiatric interview?

Answer 24

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

Question 25

What is the analogue to the physical exam in physical medicine for psychiatry?

Answer 25

mental status exam (MSE)

Question 26

What are the components of a mental status exam?

Answer 26

general observations:
-appearance
-speech
-behavior
-cooperativeness
thinking:
-thought process & form
-thought content
-perceptions
emotion:
-mood
-affect
cognition:
-orientation/attention
-memory
-insight
-judgement

Question 27

Differentiate between mood and affect.

Answer 27

mood:
-subjective
-inner feeling of emotion
-the internal “amp”
affect:
-objective
-external expression of emotional responsiveness
-what comes out the “speakers”

Question 28

Why might physical exams be performed for mental health?

Answer 28

rule out medical and/or medication induced causes
lab work
diagnostic procedures, as required (CT, MRI)
-not common unless new neurologic changes

Question 29

What are psychological tests?

Answer 29

used to screen for specific psychiatric disorders and can help confirm psychiatric diagnoses
completed by psychologists

Question 30

What are cognitive and functional assessments?

Answer 30

to assess cognitive function (e.g. IQ, memory) and functional abilities
generally completed by occupational therapists

Question 31

What is the Columbia-Suicide Severity Rating Scale?

Answer 31

suicide risk assessment
-series of simple questions
-help users identify whether someone is at risk for suicide

Question 32

Does asking someone about suicide put the idea in their heads?

Answer 32

asking does not suggest suicide or make it more likely
open discussion is more likely to be experienced as relief than intrusion

Question 33

Is there a point in asking about suicidal thoughts?

Answer 33

many people are honest when asked even if they dont bring it up themselves

Question 34

What are the benefits of the Columbia Protocol?

Answer 34

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

Question 35

What are three specific questions to ask during a suicide risk assessment?

Answer 35

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?

Question 36

What are some of the warning signs of suicide risk?

Answer 36

threatening to harm or end ones life
seeking or access to means
evidence or expression of a plan
hopelessness
withdrawing
dramatic changes in mood

Question 37

What is measurement based care?

Answer 37

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

Question 38

What are some examples of measurement based scales?

Answer 38

depression: HAM-D, PHQ-9, BDI
anxiety: HAM-A, GAD-7
mania: YMRS
function: Sheehan Disability Scale, WHODAS

Question 39

What is the issue with E Caps and PHQ-9 for depression?

Answer 39

can be filled out manipulatively (seeking meds or a diagnosis)

Question 40

True or false: measurement based care is highly used

Answer 40

false
underutilized

Question 41

What are the barriers to implementation of measurement based care?

Answer 41

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

Question 42

How is current psychotropic nomenclature determined?

Answer 42

based on indications the medications were first discovered

Question 43

What is the issue with the current psychotropic nomenclature?

Answer 43

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

Question 44

What are the limitations of the current psychotropic nomenclature?

Answer 44

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

Question 45

What are the goals of neuroscience-based nomenclature?

Answer 45

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

Question 46

What is stigma?

Answer 46

a mark or sign of disgrace which distinguishes someone from the rest of society and diminishes their worth as a person

Question 47

What are the distinct components of stigma?

Answer 47

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)

Question 48

How does stigma impact diagnsosis and treatment?

Answer 48

fear of stigma delays diagnosis and treatment
self stigma is highly prevalent

Question 49

How can stigma be reduced?

Answer 49

change in behaviours and attitudes towards acceptance, respect, equitable treatment of people with mental health problems and mental illnesses

Question 50

What are examples of stigmatizing language?

Answer 50

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