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Flashcards in Mental Health Deck (77):
1

Impairment definition

Organic disease/structural abnormality

2

Disability definition

Problem in functioning normally in the community

3

Chronic health issues in community prevalence

60% of adults

4

Adherence linked to

Therapist-patient relationship
Believing treatment is important
Patient's general social support

5

Adherence not related to

Illness severity
Age/personality/socioeconomic status
Info about treatment/illness
Complexity of treatment

6

Problem-focused coping vs emotion focused coping

Prioritises reducing stressful situations vs prioritising reducing distress, latter more successful

7

Adaptation promoted by

Information acquisition
Realistic planning
Acceptance, not resignation to condition

8

Leventhal's common sense model of Illness self regulation

Stimuli (diagnosis/symptom) triggers cognitive representation and emotional response, then coping procedures follow, then appraisal/self-evaluation

9

Disability rights commission (2007) aims to close gap between disabled/able by

Transforming service cultures and staff attitudes

10

Global prevalence of disability

15%

11

Social model of disability

Disability is result of physical, institutional and attitudinal barriers that result in exclusion of disabled

12

Social model of disability taken up in legislation/policies

UN convention on rights of disabled
World report on disability (2011)
WHO classification

13

Washington group short set questions purpose

Measure degree of impact of impairment on activities

14

Preventions of disability

1˚- avoid before it arises
2˚- detect at early stage
3˚- reduce established disease impact

15

Learning difficulty terms used

Intellectual/developmental disability, LD is ok too

16

Prevalence of LD

2%

17

Criteria for intellectual disability

Intellectual impairment (IQ<70)
Impairment of adaptive functioning (skills needed for independent living/social function)
Arises <18 years (during development)
Exclusions: poor education, brain trauma, progressive neuro disease, mental illness

18

LD vs ID

LD affects specific forms of learning but not associated with intelligence impairment

19

ID screening

Early development
May have difficulty telling time/paying bills, normal activities

20

ID classification by IQ

50-70 mild (conversational)
35-49 moderate (understanding often overestimated)
20-34 severe (simple/no speech)
<20 profound (full-time support for everything)

21

ID aetiology

60% idiopathic
Down syndrome
Fragile X syndrome (CGG repeat on non-coding region of FMR1 one arm of X chromosome)
Perinatal problems/foetal alcohol syndrome
Childhood problems (biological and psychosocial)

22

Physical disorders associated with ID

Disproportionate number of health probs
Some linked to conditions e.g. Down's and dementia, others due to broader environmental problems

23

Lifespan differences ID

Men 13 years less, women 20 years less

24

Communication with ID individuals

Opening - short sentences, easy language
Info gathering - allow time, check understanding
Summarising - recap points, involve family

25

Difficulties with ID and healthcare

Diagnostic overshadowing - issue tied to ID rather than curable cause
Physical/communication barriers
Staff attitudes/reluctance to attend
Poor understanding of health

26

Types of depression

Unipolar (15-30% of pop)
Bipolar (depression and mania, >1% of pop)
Other (psychotic, postpartum, SAD, drug use depression)

27

Impacts of depression

Biggest killer of young men
£9bn/year in UK cost
Hard to treat

28

DSM-5 criteria for depression

Diagnose depression, 1 of main symptoms and 4 of other present for 2 weeks
Dysphoria (inc negative feelings)
Anhedonia (dec + feelings)
Other - sleep changes, altered weight, motor changes, fatigue, guilt, lack of concentration, suicidal

29

Depression diagnosis

DSM-5
Patient health questionnaire
Abnormally high mood for mania

30

Genetics link of depression types

Unipolar 30-50% heritable
Bipolar ~80% heritable
Lots of small effect genes e.g. serotonin transporter polymorphisms

31

Depression treatments

Pharm (MAO inhibitors, SSRIs, lithium for mania)
CBT (NICE recommendation)
Self-remission
ECT
Surgery in extreme cases

32

Cognitive model of depression

Caused by dysfunctional view of the world due to early life events
Negative cognitive triad- neg view of self, world and future
Cognitive impairment is part of depression, possibly a cause and effect

33

MA hypothesis of depression

Thought that depression is due to lack of MA (serotonin mainly), but possibly through cognitive mechanisms as well since SSRIs take a while to work

34

Neurobiological model of depression and neuroimaging used

PET shows glucose use and blood flow increase
fMRI shows oxygen use through deoxyHb
Subgenual anterior cingulate cortex show reduced glucose use but inc blood flow in depression
Ventral striatum shows blunted response to unexpected stimuli in dopamine pathways, possible reason for anhedonia

35

Function of pain

Demands attention, protective
Conditions us to avoid in future

36

Gate control model of pain

Descending control modulates amount of pain felt

37

Plasticity in pain systems

Supraspinal - modulation of nociceptive transmission
Spinal - sensitisation etc
Peripheral - denervation, ectopic activity

38

Types of pain

Nociceptive (protective)
Inflammatory (protective)
Pathological (neuropathic/dysfunctional)

39

Chronic pain changes

Inhibitory system underachieve and opposite is overactive, less efficient opioid binding

40

Changes in movement/posture in pain

May reduce pain/be protective

41

Memory systems capabilities need to include

Encoding info
Storage over time
Retrieval when required

42

Long term memory types

Declarative (episodic/semantic)
Implicit (skill/priming/conditioning)

43

Patient HM and KC

HM had bilateral medial temporal lobectomy, hippocampus, amygdala and entorhinal cortex removed so new declarative memories couldn't be formed long-term
KC lost episodic but not semantic when bilateral hippocampal region

44

Testing declarative memory

Free recall
Cued recall
Recognition (perirhinal cortex)

45

Testing non-declarative memory

Skill memory
Priming
Conditioning

46

Consolidation occurs through

molecular methods (LTP)
Network/systems consolidation, initially stored in hippocampus then slowly moved to neocortex

47

Standard consolidation vs multiple trace theory

Hippocampus and MTL initially required for episodic memory, then it's moved to neocortex in standard
In multiple trace, cortical neurones never fully independent of hippocampal for memories, hippocampus mediates storage and retrieval through life

48

Only non-substance related addictive disorder

Gambling addiction

49

DSM-5 criteria for substance abuse

Impairment distress due to use within 12 month period
2 of 11 listed symptoms (withdrawal, cravings, taking longer than expected etc)
Severity ratings (2/3 symptoms = mild, 4-5 moderate, >6 severe)

50

Behavioural model of dependence

Classical and operant conditioning of use, conditioning for opposite response is treatment

51

Motivational model of dependence

Precontemplation
contemplation
determination
action (abstinence)
maintenance
(relapse)

52

Coginitive factors of dependence

Impairments of decision making and salience attribution

53

Biological theory of dependence

Brain circuitry
Genetic factors
Dopamine
Prefrontal cortex changes

54

Treatment barriers to dependence treatment

Only 20% enter treatment

55

Self-perception starts at

18-24 months, mirror recognition occurs

56

Self-perception disorders

Somatoparaphrenia - body part disownership
Phantom limbs
Somatotopagnosia - can't locate body parts
Body part aphasia - doesn't understand body part names

57

Levels of body representation

Semantic
Structural
Dynamic
Sensorimotor

58

Plasticity of embodiment

If visual cues match sensory, item is seen as owned e.g. prosthesis

59

Percentage of people distressed after miscarriage 1 year later

44%, longer term reduced a lot

60

Optimising antenatal care

Framing of screening test results in pos/neg way has huge effect

61

Conditions in pregnancy

Smoking - affects prematurity and birth weight
Alcohol
Suicide (associated with drugs/homelessness/HIV)
Abuse by others
HIV, not automatic transmission to baby, majority occurs during birth

62

Issues with age of parents

Older mothers have better outcomes, except from genetic issues
Older fathers no issues

63

Factors affecting pain during childbirth

Personal expectations
Support from caregivers
Caregiver relationship
Involvement in decision making

64

Prevalence and common cause of chronic PTSD from childbirth

1.5%
Related to high level of obstetric intervention and perceived inadequate care

65

when is postpartum disorders highest risk

Primiparous (1st birth), 10-19 days after

66

Postpartum depression causes and interventions

RF: high parity, prepartum distress, social isolation, previous psych illness
Psychosocial interventions effective

67

Postpartum psychosis

Previous psychiatric disorder, 51% relapse after childbirth

68

Paternal role

Greater cognitive development with supportive father due to play and social interaction
Paternal depression correlates with maternal

69

Average delay of presentation of breast lump to doctor

12 weeks, telling another person cuts in half by 6

70

Relapse psychology

1st relapse most stressful, even more so than initial diagnosis/end stage

71

Most feared symptom of cancer

Pain

72

Components of breaking bad news

Setting
Manner of communicating it
What/how much info provided to patient
Emotional support

73

Benefits of assessing quality of life in cancer diagnosis

Help doctor make decisions
Often best predictor of prognosis
Indicator of psychological distress

74

Stress effect in cancer and other illness

Increases tumour growth
Causes greater all cause mortality

75

What percentage of mental health problems begin in childhood

50%

76

Is depression inheritable

Limited evidence of specific genes driving depression but strong increase in depression in children with depressed parents

77

Factors influencing mental health in adolescents and treatment focus

Genetic polymorphisms that create vulnerability
Social system influences
Treatment focuses on maximising adaptation