Introduction and methods Flashcards
(23 cards)
What is evidence based medicine
Combining the best science with clinical experience and patients values to make the best medical decision
5 steps:
defining a clinically relevant question
Searching for the best evidence
Critically evaluate the evidence
Apply the evidence
Evaluate the performance
5 types of research evidence
systematic reviews+ meta analyses
Randomised controlled trial (RCTs)
Cohort study (longitudinal)
Case control studies
Case series and case reports
Systematic reviews and meta-analyses
Structured method of reviewing research on a specific question
Brings together a number of seperately conducted studies sometimes conflicting and synthesises the results.
+ transparent, less bias, comprehensive, critical appraisal, resolve conflicting results, identify gaps in research
- only published studies (tend to have an effect) conflict of interest, quality of induced studies
Randomised controlled trials
Patients either randomly assigned to placebo or treatment usually double-blind
Control either:
Active control- compare standard care to new treatment
Placebo control- sham treatment, undistinguishable from normal treatment
Wait list control- told treatment will be with held and given later (those not on treatment may say it has not improved because they want treatment)
Cohort study (longitudinal)
Recruit and follow participants with a common characteristic over a period of time
Rare and hard to conduct
Case control studies
Identify a group with the presence of the disorder and one without form the same population
Then compare prevalence of exposure to a potential risk factor between them using questionnaires, biological samples, interviews and medical records.
+ cost effective , no long follow up, can be used to study rare diseases or outcomes.
– potential risk factors are collected retrospectively and as a result may give rise to recall and observer bias
Case series and case reports
Descriptive studies to illustrate novel or atypical features identified in patients
Sparks new research questions
Risk factors for mental health conditions
- Genetics and brain structure/ function- psychological factors
- Stressors caused by life events and chronic stressors
- Conflict, disease outbreak, discrimination
- Compromised physical environment (air pollution)
- Poor financial standards- less likely to access health care
- Having positive relationships, work community help to build resilience to tackle stress
2 components of well being
Hedonism: achieve desires, reduce any negative feelings and pain
Eudonism: being authentic self, self-actualisation, doing virtuous things
This is seen as reductionist:
positive psychology integrates subjective states and objective elements. Family, community and the built environment
Wider structural domains also impact development, coping skills, thriving and building resilience
Knight and McNaught 2011 wellbeing framework
Positive and negative subjective evaluations and reactions are impacted by wider structural conditions and objective circumstances
Families mould individuals and provide love, money, information and status
Community: social, cultural and psychological need. And social capital: skills, goods and resources enabling individuals to develop
Society: needs met and individuals integrated thought collective sense of purpose and goals
Blodgett et al 2022 what works to improve wellbeing
Psychological, social, arts culture and the environment, physical health
psychological intervention
Resilience, self-management development
Larger effect on wellbeing
Including cognitive behaviour therapy, commitment therapy and counselling
Largest effects where more sessions over a long period of time
Social interventions
Parenting interventions - medium
Community- small
Social prescribing intervention - medium/high
Physical health intervention
Moderate effects including exercise and diet promotions
Mental health epidemiology
Study of mental disorders in a give population
Prevalence and incidence
Number of active cases in a population
Point: estimated proportion of cases of a condition
1 year: everyone who experienced condition at any time throughout the whole year
Life time prevalence: with the condition at any point, ill and recovered
Incidence number of new cases that occur over a give time- less than prevalence as excludes existing cases
Steel et al 2014
Low and middle income countries
One year prevalence was 1 in 5
30% nearly across the whole life time
Females more likely to experience mood or anxiety conditions
And substance/ alcohol abuse more likely in males
WHO 2022: world mental health report
Anxiety disorders become more prevalent at earlier ages
Anxiety and depression ages are most common
Varies with sex and age
In adults depressive disorders most common
In covid
Significant increase in depression
Adults higher anxiety
greater increase among younger age groups
Countries hit hardest had greatest increase.
DSM-5
Clinically significant disturbance in cognition, emotion regulation or behaviour indicating dysfunction in mental function associated with significant distress or disability
Indicators of a disorder
Personal distress
- low mood, anxiety, however not all disorders have this e.g. bipolar/ antisocial
Maladaptive behaviour
- Agoraphobia: become housebound, depression: isolate from friends and family
Violating statistical norm
- statistically infrequent or rare behaviour could be considered maladaptive
Violating societal norm
- could be considered disordered. However norms change over time
2 approaches to classification
Categorical: presence of symptom pattern. cut-off is arbitrary
Dimensional: symptoms vary on a continuum. Quantitative differences
Advantages and disadvantages of classifying disorders
+ Helps to structure information in a helpful manner
Identify causes and treatments of classified disorders
Insurance reimbursement, recognition of problems
Provides common nomenclature
– any shorthand leads to loss of information
stigma of having a mental disorder
stereotyping
labelling can lead to change in self-concept
