Mental Health

Question 1

define mental health

Answer 1

sense of wellbeing, confidence
and self esteem, enabling joy and appreciation
of other people, day-to-day life and our
environment”– Form positive relationships
– Use abilities to reach potential – Deal with life’s challenges

Question 2

define mental illness

Answer 2

a condition which causes serious disorder in a person’s behaviour, thinking or interaction with other people.”

Question 3

epidemiology of mental illness

Answer 3

• Affects1in5Australians
• High incidence in those with chronic physical
• Why?
• Acute or long term stress
• Biological factors • Substance abuse
• Cognitive patterns • Social factors

Question 4

depression cognitive

Answer 4

thoughts of guilt, worthlessness, hopelessness

Question 5

Depression somatic

Answer 5

loss energy, poor sleep, appetite disturbances, fatigue

Question 6

Anxiety cognitive

Answer 6

fearful thoughts of dying, suffocating, collapsing or or making a fool of oneself

Question 7

Anxiety somatic

Answer 7

palpitations, breathlessness, sweating

Question 8

neuroses =

Answer 8

gross exaggeration of normal experiences – Depression, anxiety, obsessional illness

Question 9

Psychoses=

Answer 9

totally different from normal experiences – Schizophrenia, bipolar

Question 10

Organic Psych disorders =

Answer 10

due to physical factors – Drug, ETOH withdrawl, endocrine, steroid use

Question 11

list 8 characteristics of mental illness

Answer 11

1. common
2. reoccurring
3. Hidden
4. varied presentations
5. stress related
6. distressing
7. impair personal function
8. associated with high risk

Question 12

Impact of mental illness

Answer 12

• Depressiontop-ranking cause of non-fatal disease burden in Australia (Mathers et al, 2000)
• Mental disorders overall were responsible for nearly 30% of the non-fatal disease burden (Mathers
et al, 2000)
• Significant barriers for the mentally ill.
• Difficulty obtaining and keeping regular employment
• Have fewer friends
• May be cut off from family members
• Lower socioeconomic status & lower standards of living
• High mortality and reduced life expectancy

Question 13

Impact of mental illness: University of WA study (2001) study conclusions

Answer 13

“ While there is little direct evidence in the literature of an excess incidence of physical disease associated with mental illness, there is evidence that people with mental disorder are exposed to unhealthy lifestyle risk factors that are known to be linked to a variety of common physical conditions. These factors include smoking, alcohol consumption and other drug use, poor diet, lack of exercise, obesity, and high risk behaviours.”

Question 14

Psychotherapeutic treatment techniques

Answer 14

psychological
physical
social

Question 15

psychological treatment techniques

Answer 15

counseling 
psychiatric review
psychological review 
relaxation & distraction 
cognitive behavioural therapies

Question 16

Physical treatment techniques

Answer 16

medications : antidepressants, antipsychotics, tranquilizers
ECT (under sedation)
Exercise
Division & creative therapies

Question 17

Social treatment technqiues

Answer 17

carer support : education, practical help, emotional support
reduce social stressors
build up of structured daily activities
group therapies
addressing housing, physical problems, finances, social supports

Question 18

Fox’s four functions of physical activity

Answer 18

1. Prevent mental health problems
2. Improve psychological wellbeing of general
   public
3. Improve quality of life for people with mental health problems
4. As treatment or therapy for existing mental illness

Question 19

considerations

Answer 19

• Current levels of patient fitness
• Reinforce success & provide variety
• Use patient centred goal setting
• Create clear long term goals
• Know boundaries

Question 20

risk assessment

Answer 20

• History of violence
• Self harm incl. suicide • Abuse
• Absconding
• ETOH/illicit drug use

Question 21

fitness testing

Answer 21

•Establish levels of safety, motivation & clinical effectiveness
– Demonstrates likely tolerance of physical activity, can also increase adherence (Franklin, 1988)
• Screening or Outcome measure

Question 22

working in mental health

Answer 22

• Educate yourself
• Avoid stigmatising mental illness
• Balance flexibility with firmness
• Good supervision is key
• Confidentiality
• Monitor your level of involvement • Focus on strengths
• Treat everyone as a person

Question 23

Risk reduction

Answer 23

• Avoid showing overly rigid & controlling attitudes
• Don’t show fear response
• Respond/problem solve in a situation of
potential conflict
• Refer on if unable to establish successful therapeutic relationship

Question 24

reduce aggressive behaviour

Answer 24

• Show warmth, respect & understanding • Know the person
• Communicate effectively within MDT
• Smart scheduling
• Be on time, allow time to engage
• Conduct non clinical risk assessment
• Develop dept. contingency plans
• Consider environment
• Anger control issue: establish & discuss triggers

Question 25

If unsuccessful

Answer 25

``` 1. Try to decrease anger • Show empathy • Paraphrase content of what is being said • Acknowledge persons feelings 2. Problem solve • Attempt to clarify problem • Generate solution with patient • Discuss together 3. Act • Help individual put into practice what was decided at step 2 • Implement departmental contingency plan • Create physical space ```

Question 26

Main symptoms of depression

Answer 26

Cognitive: Depressive thinking, sadness, thoughts of guilt, suicidal ideation, hopelessness Physical: disturbed sleep, loss energy, loss appetite & weight, loss concentration Less severe forms: sx more variable, physical sx less prominent Often associated with irritability, anxiety, tension

Question 27

Main symptoms of anxiety

Answer 27

Cognitive: anxious thoughts, irrational fears of dying/falling/looking foolish Physical: palpitations, sweating, breathlessness, P&N, GI sx Can be acute (wk/mth) or chronic (yrs) Can be associated with avoidance of situations that trigger anxiety (eg. Crowds, social occasions) Can be associated with or co-exist with depression

Question 28

exercise as therapy for depression and anxiety

Answer 28

• Effect of physical activity on emotional states: • Most improvements caused by rhythmic, aerobic exercises, use of large muscle groups (jogging, swimming, cycling, walking) • Moderate to low intensity • Acute effectsendorphins & monoamines • Strength training and aerobic training • Session frequency: 3-5 sessions/week Duration 45-60min/session Mutrie (2000) Kaur (2013) Rethorst (2013) Intervention duration: minimum 10 wk

Question 29

Exercise for elderly with depression

Answer 29

• Aerobic&anaerobiceffectiveinreducingmildto moderate depression symptoms • Effectiveasacomponentoftreatment • Types: • Aerobiccycling, brisk walking, jogging • Yoga & flexibility • Progressive resistance training • Endurance training • High intensity home based exercise programs • Tai Chi • Calisthenics & Functional exercises • Falls prevention

Question 30

schizophrenia (acute) main symptoms

Answer 30

Cognitive: bizarre false beliefs often of persecution, often hear frightening voices (auditory hallucinations) Physical: sometimes bizarre disturbed or aggressive behaviour Can be triggered in vulnerable individuals by stress (surgery, accident, childbirth)

Question 31

Main symptoms of chronic schizophrenia

Answer 31

Cognitive: persistent false beliefs or voices, negative features such as poor motivation and social withdrawal Associated chronic social, occupational and personal dysfunctions

Question 32

Exercise therapy for psychoses

Answer 32

• Patients are vulnerable to obesity/weight gain due to antipsychotics (Fogarty, 2004) • Comparison of exercise to standard care found to significantly improve negative sx of mental state • Physical health improved significantly in exercise group • Comparison of exercise vs. yoga – yoga had better outcome for mental state, better QOL scores Gorczynski P (2010) • CV exercise, 1-2x/week improved mental health and cardiovascular fitness and reduced need of care in patients with schizophrenia. Schweewe (2012) • Yoga or aerobic exercise to reduce acute stress and anxiety in schizophrenia Vancampfort (2010)

Question 33

Anorexia nervosa main symptoms

Answer 33

Cognitive: characteristic over- concern of shape & weight Physical: active maintenance of low weight by excess dieting, exercise and self induced restrictions, amenorrhea, physical effects of starvation Associated depression, anxiety, and obsessional symptoms review comments

Question 34

Bulimia main symptoms

Answer 34

Cognitive: characteristic over- concern of shape & weight Physical: usually a normal body weight. Frequent bulimic episodes (bingeing) involves consumption of large amounts of food in an out of control way Use of extreme behaviour to control shape and weight Associated with depression, anxiety and substance abuse review comments

Question 35

review eating disorder issues

Answer 35

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Question 36

Eating disorder management

Answer 36

inpatient or outpatient • Patients recognition of disorder, identify triggers, improvement of delusional thoughts and feelings towards body image/shape, achievement and maintenance of healthy weight, prevention of relapse • Behavioural therapy, psychotherapy, family counselling, dietary and nutritional education, exercise guidance, pharmacological management, CBT • Individuals with eating disorders can safely engage in monitored exercise programs as part of inpatient treatment (Hausenblas, 2007) • Supervised exercise prescription does not adversely affect weight gain or the return of menstruation. • Evidence indicates there is increased treatment compliance, improved therapeutic relationship, decreased food preoccupation, decreased bulimic symptoms and decreased negative exercise behaviours with supervised exercise patients considered improving body experience as a core element of their treatment

Question 37

physiotherapy intervention in eating disorders

Answer 37

• Educationandadvice • levels of healthy active, fatigue and HR monitoring • Understanding of body function and structure • Provide guidelines for physical impairments (ie. High impact vs. osteoporosis) • Monitor orthostatic hypotension, bradycardia, muscle cramping due to malnutrition and low cal diets • Exercise not recommended if BMI is at certain levels • Exercise only introduced once individual maintains healthy weight and is medically stable • PROM/stretching when on bed rest (when critically underweight/medically unstable)

Question 38

Physiotherapy intervention #2

Answer 38

• Consider type: • Stretching, light upper body, breathing ex and relaxation, aerobic ex, hydro • Limitations and management of healthy activity levels • Set upper limits on reps, sets, time to prevent over exercising • Focus on +ve benefits of exercise in general, not as a weight loss tool • Consider physical activity diary (Bentley, 2011)

Question 39

physio intervention #3

Answer 39

* Aerobic and resistance training significantly increased muscle strength, BMI, body fat % in anorexic patients. * Aerobic, Yoga, massage and basic body awareness therapy significantly lowered scores of eating pathology and depressive sx in both anorexia and bulimia patients (nil adverse effects) * Aerobic, massage, body awareness therapy and yoga MIGHT reduce eating pathology, and MIGHT improve mental and physical quality of life

Question 40

BMI guidelines for physical activity

Answer 40

• BMI<14 – Exercise not recommended, weight gain priority – Gentle bed exercises, phased intro to mobilising • BMI between 14 and 15 – Lying and sitting exercises: gentle pilates, taichi, yoga, relaxation • BMI 15-17 – Gradual progression to WB activities, group session • BMI 17+ – Focus is still on weight gain, but can become more involved with activity, consider swimming, dancing. Group sessions

Question 41

excess exercise

Answer 41

* Deemed excessive when accompanied by intense guilt or undertaken solely to influence weight or shape (Mond et al 2006) * May be overt, covert or persistent restlessness * Signs and symptoms: * Unexplained injuries * Joint pain * Bruising and friction burns * Stress fractures * Muscle and ligament injuries

Question 42

review common pharmacology

Answer 42

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