Lecture 10 - Mental Health

Question 1

What do mental health issues need to have to be diagnosed

Answer 1

Causing distress - impact
Meet set criteria DSMV
Clinical judgement

Question 2

How has mental health conditions been seen as a part of autism

Answer 2

Kanners 1943:
Fear and anxiety around objects/events
Depression
Insistence sameness

Question 3

What are the categories of risk/protective factors of mental health

Answer 3

Environment
Societal
Psychological
Biological

Question 4

What are examples of Environmental risk/protective factors to mental health

Answer 4

Stress
Bereavement 
Finances 
Bullying 
Unemployment

Question 5

What are examples of Societal risk/protective factors to mental health

Answer 5

Attitudes
Stigma
Policy - service provision
Poverty

Question 6

What are examples of Psychological risk/protective factors to mental health

Answer 6

Thinking style
Coping strategies
Resilience

Question 7

What are examples of Biological risk/protective factors to mental health

Answer 7

Genetic predisposition - family history

Brain structure and function

Question 8

Outline the Diagnosis of Autism

Answer 8

5 years autism
11 years - adulthood AS
Instruments can diagnose early 18 months

Question 9

Outline Growing up with Autism

Answer 9

Up to 75% bullying and peer victimisation 
Transition adulthood: 
Lack support 
Health and social difficulties 
Poor quality life
Low occupational achievement 
Social exclusion and isolation

Question 10

What are the social challenges of being autistic

Answer 10

Difficulty recognising other emotions, interpreting and predicting others behaviour and responding appropriately
Less readable
Double empathy problem
Negatively evaluated by non-autistic people

Question 11

Outline Sassoon et al 2017 study on autistic people being negatively evaluated by non-autistic people

Answer 11

Autistic individuals do a video tape selling themselves
Got neurotypical people rate these videos
Voted autistic individuals less favourably

Question 12

Outline how Autistic people camouflage

Answer 12

Camouflage to cope in social situations
Copy those who are neurotypical prevent judgement
More common in women contributing mid/under diagnosis
Toll on mental health - suicidal
Loss identity
Exhausting
Helps fit in neurotypical society (positive?)

Question 13

What are the mental health conditions associated with Autism

Answer 13

Depression
Anxiety
Anorexia Nervosa
Borderline Personality Disorder

Question 14

Outline DSMV criteria for major depressive disorder

Answer 14

Depressed mood 
Insomnia/Hyperion is 
Worthlessness Guilt 
Loss interest 
Psychomotor retardation/agitation 
Impaired concentration or indecisiveness 
Change weight/appetite 
Loss energy/fatigue 
Death or suicidal ideation/attempt

Question 15

Outline DSMV criteria for Persistent Depressive Disorder

Answer 15

Poor appetite/Over eating 
Insomnia/Hypersomnia 
Low energy/Fatigue 
Low self-esteem 
Impaired concentration or indecisiveness 
Hopelessness 
Never without symptoms for more 2 months

Question 16

Outline Depressive Prevalence

Answer 16

23% UK population experience mental health problem, depression most common
79% autistic adults meet criteria psychiatric condition some point - depression most common
Depression 30-50% autistic adults and 30% children

Question 17

Social consequences autism

Answer 17

Loneliness
Chronic isolation
Perceived inequality
Inadequacy

Question 18

Outline emotional consequences autism

Answer 18

Poor perceived self worth 
Stress 
Social anxiety 
Depression 
Difficulties in social problem solving skills

Question 19

Young adulthood and Autism

Answer 19

Young adulthood - increased social demands, expectations, comparisons. Support.
ASD - social struggles, difficulties understanding, developing and maintaining social relationships
This Age span associated increased susceptibility depressive episodes
Lock support and feelings loneliness

Question 20

Which societal difficulties may mediate increased depression in Autism

Answer 20

Social problem solving ability
Loneliness
Lack social support

Question 21

What makes a good assessment tool?

Answer 21

Structural validity and internal consistency - do they measure what I want to measure

Hypothesis testing - does the tool perform the way we expect it to

Criterion validity - does tool correlate with gold standard assessment

Content validity - are questions relevant, understandable to target group

Reliability - same result from different assessors? At different times?

Question 22

Diagnostic overshadowing and structural validity

Answer 22

Depression has 1 major factor explain consistency

Autism: some items assess autism? Different factor structure? Lower internal consistency of items?
More than 1 latent factor to explain. Might score completely different on factors
Factors do not necessarily correlate

Question 23

Outline structural validity

Answer 23

Acceptable internal consistency or both sub scales (anxiety and depression) in autism

Question 24

Outline Hypothesis Testing

Answer 24

Mild-moderate correlated with other measures

e.g. well-being and depression

Question 25

Outline cognitive aspects of ASD

Answer 25

Alexythymia: difficulty verbalising internal thoughts and feelings. ToM: difficulty putting yourself in others show Literal interpretation: difficulty reading between lines Reduced flexibility in thinking - executive functions

Question 26

Outline Atypical cognition and content validity

Answer 26

Ensure questions relevant and understandable, taking into account cognitive characteristics autism Feeling down —> Alexythymia

Question 27

Adapting depression tools for autism

Answer 27

Include autistic specific items capture unique presentation in autism Loss interest in previously intense interest Change in: eating, sleep, movement Sensory sensitivity, camouflaging BUT sensory hypo-sensitivity and depression look similar

Question 28

Why is depression highly prevalent in autism

Answer 28

Increased experience of psycho-social risk factors Due difficulties accurate identification - overestimate (overlapping) - under estimate (fail capture autism specific factors)

Question 29

Outline anxiety symptoms

Answer 29

``` Restlessness or feeling on edge Easily fatigued Difficulties concentrating Irritability Muscle tension Sleep disturbance ```

Question 30

Outline anxiety in autism

Answer 30

Insistence sameness Intolerance uncertainty, repetitive behaviours and sensory processing Sensory difficulties core feature and associated REBs Fear violation of logical rules or unpredictability social situations

Question 31

Outline Anxiety and Autism Assessment

Answer 31

Revised child anxiety and depression scale adapted children autism Additional autism specific areas include in measure: sensory anxiety, intolerance uncertainty, phobias Focus groups with parents refine content validity Survey established factor structure

Question 32

Overlapping between BPD and Autism

Answer 32

``` Overlap: Social difficulties Emotion regulation difficulties Frequent suicidal gestures Appear have very unstable and chaotic lifestyle - frequent changes or inappropriate friendships Camouflaging problem with identity ```

Question 33

Compared BPD and Autism

Answer 33

BOD more commonly diagnosed females Autism under diagnosed females High prevalence suicidal/self-injury and camouflaging in autistic females Lead misdiagnosis autistic females BPD 15% BPD met criteria co-occurring autism 1% general pop ASD and BPD high risk suicide, significantly lower negative self image Elevated autistic traits BPD was

Question 34

Summary BPD and Autism

Answer 34

Symptoms overlap Misdiagnosis Increased social difficulties Self-harm behaviours

Question 35

Outline Eating Disorders

Answer 35

Persistent restriction energy intake leading low body weight Intense fear gaining weight or becoming fat Persistent behaviour interferes weight gain Disturbance way ones body weight or shape experienced Anorexia - significantly underweight Bulimia - recurrent episodes binge eating followed inappropriate compensatory behaviours

Question 36

Outline Eating disorders and Autism being separate conditions

Answer 36

Autism - social function and flexibility, early onset first 3 years. Prevalent male BUT under diagnosed females. ED - adolescence, adulthood. Prevalent females ID more prevalent autism

Question 37

Outline Eating disorders and Autism overlapping

Answer 37

Autism increase ED Underlying lack flexibility, difficulties social functioning women EDs Indicative undiagnosed autism 0.3% female autism prevalence in general pop 8-37% females autism ED Increased prevalence autism ED

Question 38

Are behaviours being measured truly autistic?

Answer 38

Result co-morbid OCD, depression, anxiety, starvation Overlap autism Starvation temporarily increases rigidity and obsession food Mistake autism - narrow obsessive interest, sensory difficulties, social difficulties, rituals