Mental Health

Question 1

what are mental disorders

Answer 1

• disturbances of emotion, thinking, and behaviour
• may occur spontaneously
• severe (problematic to the individual and others)
• lead to functional impairment (interpersonal, social)
• prolonged
• often require professional intervention
• derive from brain dysfunctions
• is rarely, if ever, caused by stress alone

Question 2

How is the brain involved

Answer 2

The brain is made up of; cells, connections amongst the cells and various neurochemicals. The neurochemicals provide a means for the different parts of the brain to communicate. Different parts of the brain are primarily responsible for doing different things (e.g movement). Most things the brain does depends on many different parts of the brain working together in a network.
If the brain gets sick; neurochemicals messages that help different parts of the brain communicate are not working properly.
One or more of the brain functions will be disturbed . Disturbed functions that a person directly experiences (such as sadness, sleep problems, etc.) are called SYMPTOMS
Disturbed functions that another person sees (such as over activity, withdrawal; etc.) are called SIGNS

Both signs and symptoms can be used to determine if the brain may not be working well. The persons usual life or degree of functioning is also disrupted because of the signs and symptoms

Question 3

Mental disorders are associated with disturbances in 6 primary domains of brain function;

Answer 3

THINKING OR COGNITION=
- schizophrenia, delirium, dementia

PERCEPTION OR SENSING=
psychotic disorders e.g schizophrenia (hallucinations & delusions)

EMOTION OR FEELING=
-mood disorders e.g depression, dysthymic disorder, bipolar disorder

SIGNALING(being responsive and reacting to the environment)=
-all anxiety disorders (GAD, social phobia, OCD, panic disorder, PTSD)

PHYSICAL=
-eating disorders (bulimia nervosa, anorexia nervosa, binge eating)

BEHAVIOUR=
-ADHD, substance abuse, conduct disorder

Question 4

Difference between mental distress and mental disorders

Answer 4

Distress: common, caused by a problem or event, usually short lasting, & diagnosis not needed

Disorders: less common, may happen without any stress, often with high severity, usually long lasting, professional help usually needed, needs to be diagnosed

Question 5

Main cause of mental illness

Answer 5

Can be a lot of reasons

Genetics-the effect of genes on brain development and brain function

Environment-the effects of things outside the brain on the brain such as infection, malnutrition, sever stress etc

Question 6

Psychotic Disorders

Answer 6

Illnesses characterised by sever disturbances in the capacity to distinguish between what is real and what is not real.

Someone with psychosis exhibits major problems in thinking and behaviour. These include symptoms such as delusions and hallucinations. These result in many impairments that significantly interfere with the capacity to meet ordinary demands of life.

Question 7

Schizophrenia

Answer 7

-often begins in adolescence and there often may be a genetic component although not always.
_-family history of SCZ, history of birth trauma, history of fatal damage in utero increase
-significant marijuana use may bring on SCZ in young people

Question 8

What does schizophrenia look like

Answer 8

Delusions (one common delusion is persecutory in which person thinks they are being harmed in some way by another person of force)

Hallucinations (perceptions such as hearing sounds or voices, smelling scents)

Thinking is disorganised in form and in content (for example the pattern of speaking may not make sense to others or what is being said may not make sense).

Behaviour can be disturbed (self grooming and self care may be also compromised)

difficulty with concentration

negative symptoms (flattening of mood, decreased speech and a lack of will)

Question 9

Criteria for schizophrenia

Answer 9

1 - Positive symptoms as described above (delusions, hallucinations, disorganized thinking)
2 - Negative symptoms as described above
3 - Behavioural disturbances as described above
4 - Significant dysfunction in one or more areas of daily life (social, family, interpersonal, school/work, etc.)
5 - These features must last for at least 6 months during which time there must be at least one month of positive symptoms

Question 10

What are the different types of Depression

Answer 10

two common kinds of clinical depression, Major Depressive Disorder (MDD) and Dysthymic Disorder (DD). Both can significantly and negatively impact on people’s lives. They can lead to social, personal and family difficulties as well as poor vocational/educational performance and even premature death due to suicide. Additionally, patients with other illnesses such as heart disease and diabetes have an increased risk of death if they are also diagnosed with Depression. This is thought to be due to the physiological effects that Depression has on your body as well as lifestyle effects such as poor self-care, increased smoking and alcohol consumption. Individuals with clinical depression usually require treatment from health professionals but in mild cases may experience substantial improvement with strong social supports and personal counseling.

Question 11

What is a depressive episode?

Answer 11

A depressive episode is characterized by three symptom clusters: 1. mood 2. thinking (often called cognitive) and 3. body sensations (often called somatic). MDD may present differently in different cultures, particularly in the somatic problems that people present with. Some symptoms include:
Must be severe enough to cause functional impairment (stop the person from doing what he or she would otherwise be doing, or decrease the quality of what he/she is doing)
Must be continuously present every day, most of the day for at least two weeks
Cannot be due to a substance or medicine or medical illness and must be different from the persons usual
state

Question 12

Depression symptoms and criteria

Answer 12

Mood:
• Feeling “depressed”, “sad”, “unhappy” (or whatever the cultural equivalent of these descriptors is) • Feeling a loss of pleasure or a marked disinterest in all or almost all activities• Feelings of worthlessness, hopelessness or excessive and inappropriate guiltThinking:
• Diminished ability to think or concentrate or substantial indecisiveness • Suicidal thoughts/plans or preoccupation with death and dyingBody Sensations:• Excessive fatigue or loss of energy
• Significant sleep problems (difficulty falling asleep or sleeping excessively) • Physical slowness or in some cases excessive restlessness• Significant decrease in appetite that may lead to noticeable weight loss

FIVE of the above symptoms must be present EVERYDAY for MOST OF THE DAY during the same two week period; ONE of the FIVE symptoms MUST BE either depressed mood or loss of interest or pleasure.

Question 13

bipolar disorder

Answer 13

• Illness is characterized by cycles (episodes) of depression and mania
• Cycles can be frequent (daily) or infrequent (many years apart)
• During depressive or manic episodes the person may become psychotic
• Suicide rates are high in people with bipolar mood disorder

Question 14

How is mania different to feeling extremely happy

Answer 14

Mood is mostly elevated or irritable
Many behavioural, physical and thinking, problems
Significant problems in daily life because of the mood
Mood may often not reflect the reality of the environment
Is not caused by a life problem or life event

Question 15

Bipolar Disorder - what to look for:

Answer 15

History of at least one depressive episode and at least one manic episode
Rapid mood changes including irritability and anger outbursts
Self-destructive or self-harmful behaviours - including: spending sprees, violence towards others, sexual
indiscretions, etc.
Drug or alcohol overuse, misuse or abuse
Psychotic symptoms including: hallucinations and delusions

Question 16

what is generalized anxiety disorder?

Answer 16

GAD is described as excessive anxiety and worry occurring for an extended period of time about several different things. This persistent apprehension, worry and anxiety causes distress and leads to physical symptoms.

Question 17

How do you differentiate GAD from normal worrying?

Answer 17

Anxiety can be broken into four categories:
1) Emotions - i.e. feeling fearful, worried, tense or on guard.2) Body Responses - anxiety can cause many different responses of the body including increased heart
rate, sweating, and shakiness, shortness of breath, muscle tension and stomach upset.
3) Thoughts - when experiencing anxiety, people are more likely to think about things related to real or potential sources of danger and may have difficulty concentrating on anything else. An example is
thinking something bad is going to happen to a loved one.
4) Behaviours - people may engage in activities that can potentially eliminate the source of the danger.
Examples include avoiding feared situations, people or places and self-medicating with drugs or alcohol.

Question 18

When does anxiety become a disorder?

Answer 18

anxiety becomes a problem when:
It is greater intensity and/or duration then typically expected given the context
It leads to impairment or disability in work, school or social environments
It leads to avoidance of daily activities in an attempt to lessen the anxiety

Question 19

What are the criteria for the diagnosis of GAD?

Answer 19

Excessive anxiety and worry occurring for at least 6 months about several things
Difficulty controlling the worry
The anxiety and worry are associated with 3 or more of the following:
a. Restlessness or feeling on edge, fatigued, difficulty concentrating, muscle tension or sleep disturbance
Anxiety and worry are not due to substance abuse, a medical condition or a mental disorder
The anxiety and physical symptoms cause marked distress and significant impairment in daily functioning

Question 20

What is Social Phobia?

Answer 20

Social Phobia, also known as Social Anxiety Disorder, is characterized by the presence of an intense fear of scrutiny by others, which may result in embarrassment or humiliation.

Question 21

What are the criteria for diagnosis of Social Phobia?

Answer 21

The following must be present for someone to have Social Phobia:
• Marked and persistent fear of social
or performance situations in which the person is exposed to unfamiliar people; fear of embarrassment or humiliation
Exposure to the feared situation almost always provokes marked anxiety or panic
•
The person recognizes that the fear is excessive or inappropriate
The avoidance or fear causes significant impairment in functioning and distress

The feared social or performance situations are avoided or else endured with intense anxiety or distress
The symptoms are not due to a substance, medicine or general medical condition
In children, Social Phobia may be expressed by crying, tantrums, and a variety of clingy behaviours. Other psychiatric diagnoses that Social Phobia must be differentiated from include: Panic Disorder, Pervasive Developmental Disorder, and Schizoid Personality Disorder

Question 22

what is panic disorder

Answer 22

Panic Disorder is characterized by recurrent, unexpected, anxiety (panic) attacks that involve triggering a number of frightening physical reactions. The frequency and severity of panic attacks can vary greatly and can lead to agoraphobia (fear of being in places in which escape is difficult).

Question 23

What are the components of a panic attack?

Answer 23

The person has four of more of the following symptoms which peak within 10 minutes:
Palpitations, pounding heart or accelerated heart rate
Sweating
Trembling or shaking
Sensations of shortness of breath or smothering
Feeling of choking
Chest pain or discomfort
Nausea or abdominal pain
Feeling dizzy, unsteady, lightheaded or faint
Feeling of unreality or being detached from oneself
Fear of losing control or going crazy
Fear of dying
Numbness or tingling in the body
Chills or hot flashes

Question 24

What are the criteria for Panic Disorder?

Answer 24

Assessing Panic Disorder involves evaluating 5 areas:
Panic attacks
Anticipatory anxiety
Panic related phobic avoidance
Overall illness severity
Psychosocial disability
For a diagnosis of Panic Disorder, a patient must have:
Recurrent unexpected panic attacks
Oneormoreoftheattackshasbeenfollowedby≥1monthof:
- Persistent concern of having additional attacks
- Worry about the implications of the attack or its consequences
- A significant change in behaviour as a result of the attacks
Can be ± agoraphobia
Panic attacks are not due to substance abuse, medications or a general medical condition
Panic attacks are not better accounted for by another mental disorder

Question 25

OBSESSIVE COMPULSIVE DISORDER

Answer 25

(OCD) is an anxiety disorder characterized by obsessions and/or compulsions. Obsessions are persistent, intrusive, unwanted thoughts, images or impulses that the person recognizes as irrational, senseless, intrusive or inappropriate but is unable to control. Compulsions are repetitive behaviours, which the person performs in order to reduce anxiety associated with an
obsession. Examples of these are counting, touching, washing and checking. Both can be of such intensity that they cause a great deal of distress and significantly interfere with the person’s daily functioning. Obsessions are different from psychotic thoughts because the person knows that they are their own thoughts (not put inside their head by some external force) and the person does not want to have the thoughts.
Compulsions are different from psychotic behaviours because the person knows why he/she is doing the activity and can usually say why they are doing them.

Question 26

How do you differentiate between OCD and Psychosis?

Answer 26

This is a very important step to take if you suspect someone has OCD. In general, patients with OCD have insight into the senselessness of their thoughts and actions and often try to hide their symptoms. This distinguishes OCD from psychotic disorders such as Schizophrenia because those patients lack any insight into the senseless nature of their symptoms.

Question 27

WHAT IS POST TRAUMATIC STRESS DISORDER?

Answer 27

Post Traumatic Stress disorder (PTSD) develops after a trauma occurs that was either experienced or witnessed by the young person. It involves the development of psychological reactions related to the experience such as recurrent, intrusive and distressing recollections of the event. These may be in the form of nightmares, flashbacks and/or hallucinations.

Question 28

What does PTSD look like?

Answer 28

Re-experiencing Symptoms - recurrent, intrusive, distressing recollections or memories of the event in the form of memories, dreams, or flashbacks in which the individual perceives himself/herself to be re-living the event as though it was actually happening again in the present.
Avoidance & Numbing Symptoms - avoidance of anything - people, places, topics of conversation, food, drink, weather conditions, clothing, activities, situations, thoughts, feelings - that are associated with or are reminders of the traumatic event. In addition the person may experience a general numbing of emotions, a loss of interest in previously enjoyed activities, detachment from family and friends, and a sense of hopelessness about the future.
Hyperarousal Symptoms - sleep problems (difficulties falling asleep or staying asleep), irritability, angry outbursts, hypervigilance, exaggerated startle response, and difficulty concentrating.

Question 29

What are the criteria for the diagnosis of PTSD?

Answer 29

The person has been exposed to a traumatic event in which both of the following were present:
The person felt their life was in danger or witnessed someone else’s life put in danger
The person experienced extreme fear, helplessness or horror
Thetraumaticeventisre-experienced,includingoneormoreof:a. Recurrent intrusive memories, dreams or nightmares reliving the event which causes psychological
distress.
Avoidance of things associated with the event including 3 or more of:
a. Avoid thoughts, feelings or conversations, avoid activities, places or people, inability to recall aspect of the trauma, decreased interest or participation in activities, feeling detached or estranged from others, restricted range of affect, sense of foreshortened future.
4. Persistent symptoms of increased arousal including 2 or more of:a. Difficulty falling or staying asleep,irritability, difficulty concentrating,hypervigilance,exaggerated
startle response
5. Duration of symptoms greater than 1 month:
a. Severity of symptoms causes marked distress and impairment in daily functioning.

Question 30

What does Anorexia Nervosa look like?

Answer 30

Anorexia Nervosa (AN) is characterized by excessive preoccupation with body weight control, a disturbed body image, an intense fear of gaining weight and a refusal to maintain a minimally normal weight. Post-pubertal girls also experience a loss of menstrual periods. There are two subtypes of AN - a restricting subtype (in which the young person does not regularly binge or abuse laxative or self-induce vomiting) and a binge-eating/purging subtype (in which the young person regularly binges and abuses laxatives or self-induces vomiting).

Question 31

What does Bulimia Nervosa look like?

Answer 31

Bulimia Nervosa (BN) is characterized by regular and recurrent binge-eating (large amounts of food over a short time accompanied by a lack of control over the eating during the episode) and by frequent
and inappropriate behaviours designed to prevent weight gain (including but not limited to: self-induced vomiting, use of laxatives, enemas, excessive exercise).

Question 32

What are the criteria for the diagnosis of AN?

Answer 32

1 - Refusal to maintain body weight at or above a minimally normal weight for age and height resulting in a body weight less than 85% of that expected.
2 - Intense fear of gaining weight or becoming fat while underweight.3 - Substantial disturbances in body image (considers self to be fat even though is underweight) or denial of seriousness of current low body weight.4 - Loss of menstrual periods in post-pubertal girls.

Question 33

What are the criteria for the diagnosis of BN?

Answer 33

1 - Recurrent episodes of binge-eating where both of the following are present: a) - eating large amounts
of food in a short period of time; b) - feeling that eating is out of control.2 - Recurrent inappropriate behaviours in order to control weight (such as: self-induced vomiting; misuse of laxative, diuretics, enemas or other medications, fasting or excessive exercise.)3 - The above must occur an average at least twice a week for a period of 3 months.4 - Self perspective is overly influenced by body shape and weight.5 - The above does not occur exclusively during AN.
There are two subtypes of BN - the purging type (characterized by self-induced vomiting or misuse of laxative, diuretics, enemas, etc.); the non-purging type (no use of the above).

Question 34

What is Substance Abuse?

Answer 34

The abuse of substances is a maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by one (or more) of the following, occurring within a 12-month period:

1. Recurrentsubstanceuseresultinginafailuretofulfillmajorroleobligationsatwork,school,orhome(e.g., repeated absences or poor work performance related to substance use, substance-related absences, suspensions or expulsions from school, neglect of children or household)
2. Recurrent substance use in situations in which it is physically hazardous (e.g. driving an automobile or operating a machine when impaired by substance use)3. Recurrent substance -related legal problems (e.g.arrests for substance- related disorderly conduct)4. Continued substance use despite having persistent or recurrent social

Question 35

What is Substance Dependence?

Answer 35

Substance dependence is a maladaptive pattern of substance use, leading to clinically significant impairment or distress, as manifested by three (or more) of the following, occurring at any time in the same 12-month period:
1. Tolerance,asdefinedbyeitherofthefollowing:
A need for markedly increased amounts of the substance to achieve intoxication or desired effect.
Markedly diminished effect with continued use of the same amount of substance.
2.
3. 4. 5.
Withdrawal, as manifested by either of the following:
the characteristic withdrawal syndrome for the substance.
the same (or a closely related) substance is taken to relieve or avoid withdrawal symptoms. The substance is often taken in larger amounts or over a longer period than was intended. There is a persistent desire or unsuccessful efforts to cut down or control substance use.
Agreatdealoftimeisspentinactivitiestoobtain
thesubstance,usethesubstance,orrecoverfromits effects.
6. Important social, occupational or recreational activities are given up or reduced
because of substance use.7. The substance use is continued despite
knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance (e.g., continued drinking despite recognition that an ulcer was made
worse by alcohol consumption).

Question 36

What is Attention Deficit Hyperactivity Disorder?

Answer 36

Attention Deficit Hyperactivity Disorder (ADHD) is characterized by a persistent pattern of hyperactivity, impulsivity and substantial difficulties with sustained attention that is outside the population norm and is associated with substantial functional impairments at school, home and with peers. This disorder begins before age seven and continues into adolescence or for some people, even into adulthood.

Question 37

What are the criteria for diagnosis of ADHD?

Answer 37

There must be a number of symptoms from each of the following categories: inattention, hyperactivity, impulsivity, PLUS a duration of at least six months to a degree that the person demonstrates maladaptive behaviours and trouble functioning that is inconsistent with their level of development.
Inattention (at least six of the following)
1- Failure to give close attention or many careless errors in work requiring sustained attention (such as school work)2 - Difficulty sustaining attention in tasks or play3 - Does not seem to listen when spoken to directly
4 - Does not follow through on instructions
5 - Has difficulty organizing tasks and activities
6 - Avoids tasks that require sustained attention (such as homework)
7 - Loses things needed for tasks and activities
8 - Easily distracted by the environment
9 - Forgetful in daily activities
Hyperactivity
1 - Fidgets or squirms while seated
2 - Leaves seat in classroom or when is supposed to be seated
3 - Runs about or climbs excessively when not appropriate
4 - Has difficulty in solitary play or quiet activities 5 - Is usually on the go, as if motor driven
6 - Often talks excessively Impulsivity (are included in the number of symptoms for hyperactivity) 7 - Blurts out comments or answers to questions before he/she should 8 - Has difficulty waiting for his/her turn9 - Often interrupts or intrudes on others

Question 38

What are risk factors for suicide?

Answer 38

The following are the most common (and strongest) risk factors for suicide in young people. Remember that a risk factor does not mean something that causes an event to happen. Rather, it is something that is related to an event that happens.
Sex (male)
Depression or other mental disorder
Previous suicide attempt
Family history of suicide
Excessive alcohol or drug use
Impulsivity or juvenile justice history
Suicide risk is high in people with mental disorders, in particular those with: Depression (of all kinds), Bipolar Disorder (Manic Depression), Schizophrenia, and Substance Abuse. If a young person talks to you about suicide, take them seriously - it is a myth that people who talk about suicide will not attempt suicide.