Emotional and Mental Health Assessment and Interventions

Question 1

Name the 3 times of stress

Answer 1

Eustress: good stress. motivating or inspiring
Neustress: neutral stress
Distress: bad stress. Information that is perceived as threatening

Question 2

2 types of distress

Answer 2

1. acute: short term, comes intensely and disappears quickly
2. Chronic: long-term, can arise intensely or less intensely and lingers

Question 3

What is the definition of a stressor?

Answer 3

A situation, circumstance or stimulus that is perceived to be a threat.

Question 4

What are the 4 categories of stressors?

Answer 4

1. psychological: thoughts, beliefs and perceptions
2. physiological: illness, infection, disease, hunger
3. social: major life changes, personal conflicts, financial insecurity
4. bioecological: weather, pollution, food additives, chemicals

Question 5

What are adverse childhood experiences (ACEs)?

Answer 5

1. They are potentially traumatic evens that occur in childhood.
2. They are very common with 6/10 adults experiencing at least one ACE before 18 yo
3. Examples: experiencing abuse or neglect, experiencing or witnessing violence, family member attempts or dies by suicide, household that has substance use, mental health problems or instability.

Question 6

Outcomes of ACEs

Answer 6

1. Linked to poor health and well-being outcomes, including poor mental health
2. ACE plus adult life stress and/or socioeconomic status has been shown to lead to psychological distress

Question 7

What mechanisms are involved in the body’s physiological arousal to survive a real or perceived threat?

Answer 7

Hypothalamic-pituitary- adrenal axis activation
release of the acute hormones epinephrine and norepinephrine
release of the chronic hormone cortisol

Question 8

Health effects of chronic stress

Answer 8

1. impaired immune function
2. inflammation
3. decreased bone density
4. problems with memory
5. increased appetite
6. weight gain
7. abdominal fat deposition
8. insulin resistance
9. increased glucose, cholesterol and triglycerides.
10. increased blood clotting
11. impaired wound healing
12. poor sleep
13. pain and fatigue
14. poor mood
15. adoption of less healthy habits
16. decreased longevity (decreased telomeres)

Question 9

How to manage the pathologic stress response without medications?

Answer 9

breathing tools
movement
mediation
connecting with nature
self-expression
community
reading self help books
massage
listening to music
light therapy

Question 10

What are some potential causes of major depressive disorder and/or anxiety disorders?

Answer 10

1. genetics, perinatal infections, environmental hazards. (non-modifiable)
2. stress, nutrition, financial strain, sedentary lifestyle, co-morbid conditions, addictions, social connections (modifiable)

Question 11

In regard to mental health physical activity has protective benefits against what?

Answer 11

Bipolar disorder
Efficacious in treating adhd, anxiety, major depression and psychotic disorders

Question 12

Explain the relationship between MDD and type 2 diabetes

Answer 12

There is a bidirectional association btwn MDD and type 2 diabetes. A dx of MDD predicts a future type 2 diabetes diagnosis and vice-versa.

Question 13

Diabetes and emotional health

Answer 13

1. Anxiety and depression are increased in the presence of lower perceived control over diabetes.
2. Poorer emotional health was associated with negative perceptions of diabetes including perceptions about the seriousness of the illness and severity of consequences

Question 14

Diabetes related risk factors for suicidal ideation

Answer 14

1. Use of insulin therapy
2. Duration of diabetes >5years
3. Unsatisfactory glycemic control

Question 15

What negative effects does depression have on Coronary artery disease?

Answer 15

Patients with depression suffer from increased abnormal platelet adherence, endothelial dysfunction, lower heart rate variability and worse adherence to lifestyle changes.

Question 16

MDD and CAD

Answer 16

1.MDD is an independent risk factor for cardiac events
2. Is a primary risk factor for developing ischemic heart disease and a secondary risk factor for worsened prognosis.
3. Increases cardiac risk by 15-20% in patients with cad
4. Doubles cardiac events
5. Is a modifiable risk factor for cad that generally precedes cad by several years.

Question 17

How can we screen for stress in the office?

Answer 17

Use the perceived stress scale. asks patients to reflect on the past month.

Question 18

What are occupational factors that can affect health?

Answer 18

1. Corporate downsizing increases cardiovascular disease death rates
2. Long hours had increased heart disease risk
3. Work stressors increased the incidence of type 2 diabetes in women by 2 fold.
4. Work stressors were an independent risk factor for diabetes

Question 19

Job stress can lead to what type of unhealthy responses

Answer 19

1. Stress
2. Smoking
3. Physical inactivity
4. Heavy alcohol use

Question 20

What is considered a positive PHQ-2 screen?

Answer 20

A score >3
72% sensitive
85% specific

Question 21

If phq-2 is positive what is next steps?

Answer 21

Requires further assessment with nine question PHQ, the Hamilton depression scale or Beck depression inventory.

Question 22

What is the dsm5 criteria for MDD

Answer 22

1. Person has to have 5 or more symptoms that have persisted nearly everyday for the same 2 week period and is a change from prior level of functioning.
2. Must have at least one of the following, depressed mood most of the day or lost of interest or pleasure
3. 4 or more must be present
   Significant weight loss or weight gain
   Insomnia or hypersomnia
   Psychomotor agitation, retardation, or increased irritability
   Fatigue or loss of energy
   Feelings of worthlessness or excessive guilt
   Trouble concentrating or indecisiveness
   Recurrent thoughts of death, recurrent suicidal ideation with or without a specific plan or suicide attempt

Question 23

Does USPSTF currently have recommendations for anxiety screening?

Answer 23

No

Question 24

How can you screen for anxiety in your clinic?

Answer 24

Use the general anxiety disorder two question screening tool. GAD2. A score >3 is considered positive.

Question 25

What do you do if GAD2 is positive?

Answer 25

Follow up with the Hamilton anxiety rating scale, GAD7 or beck anxiety Inventory

Question 26

DSM 5 criteria for anxiety

Answer 26

Person has the following symptoms for more than 1/2 the days over at least a 6 month period. 1. Excessive anxiety 2. Worry is difficult to control 3. At least 3 other symptoms: Restlessness Easily fatigued Difficulty concentrating Irritability Muscle tension Sleep disturbances 4.Significant impairment due to anxiety, worry or physical symptoms 5. Symptoms are not due to substance abuse 6. Symptoms not due to another disorder

Question 27

What is the patient health questionnaire? Phq-4

Answer 27

Briefly screening for depression and anxiety A positive score is greater than 3 Ask the patient over the past 2 weeks how often they have been bothered by the following problems. Feeling nervous, anxious or on edge Not being able to control or stop worrying Feeling down depressed or hopeless Little interest or pleasure in doing things

Question 28

What are some of the ways you can promote self management techniques for emotional well being and resilience with patients and their mental health

Answer 28

Encourage healthy coping skills Incorporate activities and hobbies that draw on creativity Keep a gratitude journal Take care of spiritual needs Limit screen time

Question 29

What is the role of the patient in their own mental and emotional health?

Answer 29

1.Promote self management techniques for emotional well being and resilience 2.Encourage the patient to use social support 3. Refer the patient to accessible community and online resources 4. Refer the patient to mental providers if necessary

Question 30

What is mindfulness?

Answer 30

1. Paying attention on purpose to what you are thinking and feeling. 2. Being fully present in the moment 3. Being aware of surroundings 4. Withholding judgment or interpretation

Question 31

What changes in the brain can you see with 8 wks of mindfulness?

Answer 31

1. Increased in thickness of the prefrontal cortex which is responsible for processing of information, decision making and memory 2. Increased grey matter density in the hippocampus which is responsible for learning and new memory formation, emotional regulation, perspective and self awareness. 3. Reduced grey matter density in the amygdala, the emotion area of the brain, which correlates with reduced stress, anxiety and negative thoughts

Question 32

What are the benefits of mindfulness in medicine and health care?

Answer 32

1. Enhances psychological hardiness 2. Leads to lasting decreases in physical and psychological symptoms 3. Reduces or helps alleviate inflammation, response to chronic pain, anxiety, depression and addiction 4. MBSR helps with relationships 5. Helps develop compassion and empathy for self and others, tolerance and resilience 6. Reduces loneliness in older adults

Question 33

What is cognitive behavioral therapy?

Answer 33

1. Evidence based structured psychotherapy effective in treating mental health disorders 2. Gold standard 3. Follows structured steps to change thoughts 4. Changing thoughts helps change emotions, potentially leading to changes in behavior 5. Focuses on current life, not the past

Question 34

What is the treatment plan for depression per American psychological association ?

Answer 34

First line treatment for adults up to age 64yo include psychotherapy, pharmacotherapy with a 2nd generation antidepressant or a combination of the two. Pharmacotherapy is the standard of care for moderate to severe depression.

Question 35

2nd line therapy options for treatment of depression

Answer 35

Exercise St. John’s wart Bright light therapy Yoga Acupuncture (in addition to pharmacotherapy)

Question 36

Treatment for anxiety and panic disorders

Answer 36

1. Psychotherapy with cbt 2. Pharmacotherapy (ssri) 3. Exercise (per AAFP)

Question 37

Fruit and vegetable consumption has been associated with what in regards to mental health?

Answer 37

1. Increased Dominic feelings and behaviors 2. Improvement in depression, anxiety and productivity 3. Few negative emotions 4. Higher optimism 5. Improved health, quality of life and productivity 6. Lower risk of depression 7. More positive attitudes on the days fruits and vegetables are consumed

Question 38

Which nutrients have been show to have positive outcomes on mood?

Answer 38

Omega 3 fatty acids Folate Saffron, turmeric, probiotics, flaxseeds, walnuts, and carbohydrate rich evening meal

Question 39

What are the benefits of self care for the clinicians?

Answer 39

1. Manage your emotional energy 2. Stay in good physical condition 3. Take a moment to clear your mind before entering a patient’s room 4. Practice self compassion 5. Elicit positive emotions in yourself and others by focusing on what’s going well to stay creative and resilient 6. Allows you to stay present and connected with those around you. 7. Work collaboratively 8. Allows you to address the distraction and stay present 9. After a visit you can take intentional time to pause and recover from what you have just experienced.

Question 40

What are the benefits of self care for the clinicians?

Answer 40

1. Manage your emotional energy 2. Stay in good physical condition 3. Take a moment to clear your mind before entering a patient’s room 4. Practice self compassion 5. Elicit positive emotions in yourself and others by focusing on what’s going well to stay creative and resilient 6. Allows you to stay present and connected with those around you. 7. Work collaboratively 8. Allows you to address the distraction and stay present 9. After a visit you can take intentional time to pause and recover from what you have just experienced.

Question 41

Can exercise prevent depression in young adults?

Answer 41

Yes, if it is regularly practiced in childhood

Question 42

How does at John’s wart effect depression

Answer 42

Can improve symptoms of mild to moderate MDD better than placebo and not significantly different than antidepressants

Question 43

How does folate/ vitamin b9 effect antidepressant medication

Answer 43

It has been shown to improve the efficacy and shorten response time.

Question 44

Explain how different types of fat effect depression

Answer 44

Diet higher in trans fat were associated with increased risk of MDD. Diets higher in mono and polyunsaturated fats were weakly associated with lower rates of depression.

Question 45

How do omega 3s effect depression

Answer 45

Help with bipolar depression but not mania Can yield antidepressant and/or mood stabilizing effects Has not been compared to exercise

Question 46

Lifestyle treatments for MDD

Answer 46

Physical exercise Light therapy Adequate sleep Avoidance of risky substances Improved nutrition Positive relationships Social support

Question 47

How has mindfulness has been shown to impact pain?

Answer 47

Mindfulness has been shown to impact the subjective experience of pain without any change to the intensity, level of pain or threshold of pain.

Question 48

how does folate impact serotonin?

Answer 48

Folate (vitamin B9) can help in the production of serotonin and dopamine. When used with antidepressant medication, it has been shown to improve the efficacy or shorten the response time.