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225 Cards in this Set
- Front
- Back
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WHO definition of disease |
complete state of physical, mental and social well-being + not merely the absence of disease or infirmity |
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5 Determinants of health (and the two largest components) |
1. genes/biology 2. health behaviours 3. medical care 4. total ecology - where you grow up 5. social/societal characteristics *4 and 5 are the largest |
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5 behaviours that "cure" |
1. diet 2. exercise/non-sedentary 3. smoking 4. adherence to medical recommendations 5. alcohol/drug use |
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4 Stress reactions |
1. exposure to stressors 2. perception of danger 3. better coping strategies 4. impairment (mental health) |
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Psychological factors that impact health |
1. stress reactions 2. attachment and belongings 3. health behaviours |
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What are the 3 body states that match up with the stages of polyvagal theory |
stage 1: parasympathetic 2: sympathetic 3. social |
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What is stage 1 of polyvagal theory? |
A primitive passive feeding and reproduction system creating a metabolic baseline of operations to manage oxygen and nutrient-rich blood. Parasympathetic system |
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What is stage 2 of polyvagal theory? |
A more sophisticated set of responses enabling mobility for feeding, defense and reproduction via limbs and muscles. Sympathetic |
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What is stage 3 of polyvagal theory? |
A sophisticated set of responses supporting massive cortical development (ie. enabling maternal bonding (extended protection of vulnerable immature cortex processors) and social cooperation (language and social structures) via facial functions. Social |
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What does the environment entail? 6 |
1. famly 2 peers 3. job situation 4 living situation 5 concept of self 6 one's role in society |
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The Bio-Psycho-social model developed in 1977 can do justice to (4) |
1. our understanding of medical illness and stress 2. our evolving understanding of the psychophysiological conditions 3. the broad range of psychosocial factors that are involved in triggering illness 4. the ongoing process of providing care and attending to the needs of the patient |
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What did the Bio-P-Social model help do? |
Provided a significantly broader understanding of disease process, and included the key contribution of the effect of the doctor-patient relationship |
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The need for a new medical model: a challange for biomedicine was developed when? |
1977 George Engel |
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George Engel said: |
biomedical model is no longer adequate for the scientific tasks and social responsibilities of medicine |
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What has replaced infectious disease as the major health problem of post industrial nations? |
stress induced disorders |
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What are the 4 afflictions of civilizations? |
1. cardiovascular disease 2. cancer 3. arthritis 4. respiratory disease |
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5 psychosomatic illnesses: |
1. GI 2. respiratory 3. MSK 4. hormonal 5. other |
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5 definitions of stress |
1. challenging events that impact us 2. our subjective (internal) responses to such events (normal acute reactions) 3. points at which we begin to feel overwhelmed (distressed) 4. The load of burnt out feelings that accumulate as these challenges continue 5. irreversible physical damage from chronic stress |
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Parasympathetic responeses to stress (6) |
1. re-establishes homeostasis in the system 2. reconstructive process following stressful expierience 3. slows the heart rate and decreases blood pressure 4. decreases muscle tension 5. slows respiration 6. neutralizes fight or flight responses |
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3 major systems to respond to physical stress |
1. nervous 2. endocrine 3. immune |
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Match 4 Bros with what they did: Stephen Porges, Bruce McEwen, Walter Cannon, Hans Selye, 1. flight or fight 2. non-specific physiological mechanisms 3. allostasis vs. load 4. polyvagal theory |
Cannon- fight or flight Selye: non-specific physiological mechanisms McEwen: allostatis vs. load Porges: polyvagal theory |
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6 reactions of SNS |
1. increase HR and blood pressure 2. constriction of peripheral blood vessels 3. respiration rates increase 4. bronchial tubes dilate 5. pupils dilate 6. prepares the body for intense motor activity |
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Physiological mechanism of SNS |
increase hypo, increase sympathetic fibres, increase adrenal medualla, epi and nor (catecholamines) |
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Hans Selye wanted to study... |
all the common features of illness |
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Glucocorticoids does what? (6) |
1. signal liver to release stores of glycogen 2. protein and fat get metabolized into glucose 3. reduce inflamation (Suppress immune cells) 4. increase hungar to rebuild energy stores 5. instruct the body to store more fat 6. increase blood volume and pressure |
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What is cortisol primary function? |
increase blood sugars |
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Difference btw SAM and HPA. Time, Organs stimulated. Hormones released |
SAM - rapid, short term HPA - slower but longer lasting SAM - sympathetic NS stimulates Adrenal M HPA - CRF (hypo) -->ACTH (pituitary)-->cortisol (adrenal cortex) SAM - epinephrine and norepinephrine, HPA - glucocorticoids and mineralocorticoids |
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What co-ordinates the stress systems? |
pre-frontal cortex |
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What is the normal process of responding to stress and who developed it? |
Bruce McEwen Allostasis |
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What is the negative residue of stress? |
allostatic load (bruce mcewen) |
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What role does brain, endocrine and immune play in stress? |
brain: perceives threat endocrine: mobilizing body immune: internal defence |
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What helps to facilitate the "all clear sign" |
neuropeptides |
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4 interacting processing systems of stress? |
1. mind 2. nervous 3. endocrine 4. immune |
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5 positives of stress |
1. stimulation 2. energy 3. perceptive and capable 4. useful warning signs 5. develop better coping in future |
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Negative effects of unremitting stress (6) on physical function. |
1. increased hunger 2. increased abd fat deposits 3. disrupted sleep 4. hypertension 5. cholesterol increased 6. decreased immune function |
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Negative effects of unremitting stress (5) on psychological function |
1. unpleasant feeligns 2. intrapersonal problems 3. anxiety and depression 4. alcohol and other substance increase 5. increase suicide and violence |
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excessive cortisol can cause (7) |
1.abdominal fat 2. loss of protein in muscle 3. bone mineral loss 4. seek more fatty foods 5. atrophy of hippocampus 6. reversal of cortisol's circadian rhyhm 7. suppress immune fxn |
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Coping skills the individual believes they have (or not) is related to what? |
allostatic load and allostasis |
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Not hearing the "all clear" can result in what physical consequences? 6 |
1. hypertension 2. insulin resitance and fatigue 3. disrupted sleep 4. weight gain 5. decreased bone mineral density 6. decreased immune fxn |
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Not hearing the "all clear" can result in what psychological consequences? 6 |
1. damage to hippocampus 2. obesity 3. increase anticipatory agent 4. (decreased?) poor performance 5. avoidant behaviours 6. increased preoccupations (jealousy, obsessions) |
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adrenal fatigue can be do to what? 3 |
1. low CRF 3. low cortisol production |
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What 6 disorders result in inflammatory diseases? |
1. allergies 2. asthma 3. auto immune disorders 4. fibromyalgia 5. chronic pain disorder 6. chronic fatigue syndrome |
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List 4 societal stressors? |
1. low socio-economic status 2. prejudice and discrimination 3. economic and employment problems 4. social change and uncertainty |
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Holmes and Rahe "Social Adjustment Rating Scale" SRRS has what 4 components?` |
1. assigns relative weights to a variety of RECENT PSYCHOSOCIAL stressors 2. used to relate social and environmental stress to health status of the individual 3. prompted an extensive research literature 4. now included in "multiaxial" psychiatric diagnosis |
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What is the biggest loss of points life event? |
death of spouse |
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Holmes and Rahe Score for chance for stress? |
<150 = 30% 150-299 = 50% >300 = 80% |
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Lazarus and Folkman 1984 believed what about stress? |
That the perception of stress was more important |
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3 possible outcomes of primary appraisal (determine threat to their well-being) |
1. irrelevant (no implicaton) 2. benign-positive (increase well being) 3. stressful (harmful, threatening, challenging) |
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6 examples of social ANS |
1. love 2. transactions 3. social structures and hierachies 4. language 5. empathy 6. contact |
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4 examples of sympathetic ANS |
1. sexual climax 2. recreational and vocational excitement 3. mobilization 4. daytime alertness and metabolism, muscular activity |
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5 examples of parasympathetic ANS |
1. rest and rebuild 2. meditative states 3. sexual arousal 4. sleep 5. baseline metabolism |
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Differentiate btw harm/loss, threat and challenge. |
harm/loss: actual physical or psychological loss threat: the anticipation of harm or loss challenge: event is perceived as stressful, person's confidence/personal excitement |
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What is secondary appraisal? |
how a person copes with threat |
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3 questions to ask with regards to secondary appraisal? |
1. what coping options are available 2. likelihood that one can apply the strategy 3. likelihood that any given option will work |
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4 elements of coping definition |
1. coping is a process of constant evaluation of the success of one's strategies 2. coping is learned as one encounters situations 3. coping requires effort 4. coping is an effort to manage. "Good enough" result |
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Coping is dynamic, wellbeing is enhanced by: (4) |
1. positive belief 2. problem solving skills 3. social skill 4. social support |
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Difference btw problem focused and emotion focused coping? |
problem: changing situation, alternatives, acting emotional: change emotional state, used when nothing can be done to change situation (like a test) |
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3 persistant stresses? |
1. chronic stress 2. compounding events 3. depressed mood |
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4 current challenges of stress |
1. psychological distress 2. sense of control 3. sleep disruption 4. sleep apnea risk |
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Porges social engagement system is mediated by which cranial nerves? |
5, 7, 9, 10, 11 |
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Describe the vagus branch and "involvement" of porges social, sympathetic and parasympathetic responses? |
1. social: newer vagal, social engagement, social interactions 2. stress mobiliztiation: sympathetic. older vagal fight/flight/active freeze 3. Para: oldest vagal. immobilized. Collapse posture |
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Oxytocin and vasopressin are assoicated with what ANS level? |
social |
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corisol and adrenaline are assoicated with what ANS level? |
SNS |
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serotonin and endorphin are assoicated with what ANS level? |
PNS |
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Porges was all about what coping mechanism? |
social bonding, emotional, social engagement |
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Describe co-regulation phase I and II |
Porges I - social engagement (facial expressions) II - physical contact without fear - safety |
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what is neuroception? |
perception of danger or safety to trigger polyvagal neural circuits |
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What is the vagal break? |
Taking in environmental and cortex cues to decide what vagal state (social, SNS, PNS) the brainstem will send via efferents to the heart |
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John hughlings jackson said what? |
when higher nervous arrangements (social) go down the lower take over (PNS) |
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Who's theory was the polyvagal? |
Porges |
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diaphragmatic breathing does what for stress |
self-regulates vagal break |
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What are 6 higher value SRRS? |
100 Death of spouse 73 divorce 65 martial separation 63 death of a family member 53 major injury or illness 50 marriage |
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What are the most powerful major life events? |
personal attachments and our sense of safety and identity |
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What is grief? |
a multi-faceted reaction to LOSS with emotional, phy, cognitive and behavioural dimensions |
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3 impacts of loss on stress level |
1. social influence 2. perception of loss 3. personality/coping resources |
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Emotions after a loss (7) |
1. sadness 2. anger 3. guilt 4. anxiety 5. loneliness 6. shock 7. numbness |
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physical sensations after a loss (6) |
1. tightness in the throat 2. weakness in the muscles 3. lack of energy 4. hollowness in the stomach 5. shortness of breath 6. tightness in the chest |
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cognitions after a loss (5) |
1. disbelief 2. confusion 3. preoccupation 4. sense of presence 5. hallucinations |
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behaviours after a loss (7) |
1. sleep disturbance 2. social withdrawal 3. searching and calling out 4. restless over activity 5. crying 6. reminiscing 7. avoiding reminders of the deceased |
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Freud's 4 suggestions of grief |
1. a profoundly painful dejection 2. turning away from any activity not connected with the deceased 3. loss of interest in the outside world 4. loss of capacity to adopt a new 'love object' |
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Lindemann 3 purposes for grief: |
1. freeing the mourner from an attachment 2. readjusting to a new life situation without the deceased 3. a process necessary for allowing the building of new relationships |
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Descriptive stags of the normal grief reaction. 6 |
1. intial shock 2. searching and pining for dead 3. surfacing of many mixed feelings 4. loss of support, disorganization and despair 5. reorganizaton, develop new coping patterns 6. reconnection with the world/resolution |
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___ K6 Questionnarie for grief |
Kessler's |
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Kesslers K6 questionaire |
1. nothing could cheer you up 2. nervous 3. restless 4. hopeless 5. everything was an effort 6. worthless |
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5 tasks of grieving - Worden |
1. to accept the reality of loss 2. to work through pain of grief 3. to adjust to new environment 4. to emotionally relocate the deceased and move on with life 5. to make new attachments |
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When is grief "over" (4) |
1. recurrent memories never go away 2. when the griever is able to think of the deceased without waves of pain 3. when the mourner is able to gratefully accept condolences 4. when the person regains an interest in life |
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3 grief reactions |
1. normal 2. pathological 3. regressive |
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Davanloo 7 characteristics of delayed mourning |
1. prolongation of mouring 2. delay and rejection of grief 3. grief of abnormal intensity 4. somatic complaints 5. denial of feelings..woodenness 6. altered relationships with friends 7. increased hostility |
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6 causes of delayed mourning |
1. highly ambivlent/hostile relatiohship 2. unexpected, sudden death 3. survivor responsible for the death 4. survivor witnessed or escaped the death 5. ego adaptive capacity 6. ego state |
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3 Characteristics of resilience |
1. resilience is different from recovery 2. resilience is common (50%) 3. there are mulitple & sometimes unexpected pathways to resilience |
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describe chronic, delayed, recovery and resilliacnce with respect to normal functioning over time |
chronic: severe functioning problems over long period delayed: good at first then gets worse recovery: bad at first then gets better resilience: opposite of chronic. low and stays low |
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7 factors related to resilience |
1. famliy functioning 2. good support system 3. hardiness (+ cognitive perceptions of self) 4. self-enhancement 5. repressive copers (reduction of emotional reactions) 6. positive emotion and laughther 7. level of education |
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Do's of grief management (10) |
1. frequent short visits better than infrequent long 2. help the survivor to identifty and express feelings 3. validate "normal" grief response 4. encourage griever meetiings with family and friends 5. be aware of anniversary reactions 6. help the survivor to actualize the loss 7. assist in living without the deceased 8. provide contining support 9. a mourner grieving a suicide may need you to ask about their memories 10. be aware of pathological grief or the development of depression, refer |
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Don'ts of grief management |
1. don't tell them not to cry or get angry 2. don't refer the griever for medications |
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Don'ts of grief management |
1. don't tell them not to cry or get angry 2. don't refer the griever for medications |
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American college of sports medicine advocates ALL exercise specialists develop effective interpersonal skills to be competent in: (4) |
1. build a positive rapport with patients 2. use this empathy to be able to complete a competent health assessment 3. facilitate patients in accepting responsibility for their health behaviour 4. assist in management of transient life crises |
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The heart of coaching is___ |
the relationship |
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Three core coaching skills? |
1. mindful listening 2. open ended inquiry 3. perceptive reflections |
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State the 5 stages of the optical lens model? |
1. stessors 2. personality and cognitions 3. behaviour 4. psychophysical responses 5. responses to arousal |
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What are the top 4 health behaviours? |
BMI <30 = 84.3% Diet Index >Median = 50% Never smoke = 48.1% PA>3.5 h/wk = 31.8% |
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How did the adjusted HR vary when some did all 4 health behaviours or did just 1? |
0.23 (all 4) to about 0.6 with just 1 |
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What was the most important health behaviour if you did just one? |
BMI <30 |
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What were the two best health behaviours if you did only two? |
diet index > median PA >3.5 h/wk |
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What is the worst health behaviour |
obesity |
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7 negative health choices |
1. sedentary 2. junk food 3. coffee, pop, cigarettes 4. poor sleep ( less than 6.5 hours) 5. few relationships 6. bored 7. dependant on others for rewards |
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6 positive health choices |
1. exercise (150min walk, 90min run) 2. good diet 3. regular sleep (8 hrs) 4. strong relationships 5. mental stimulation 6. rewarding yourself for successes |
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3 C's of hardiness? |
commitment: to what they are doing control: they control their life challenge: thrived on challenge |
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How many steps and mins a day for adequate health (not weight) and for optimal health |
adequate: 30 mins, 3500 steps optimal: 45 mins, 5250 steps |
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How to recognize psychological difficulties? |
1. symptom complaints 2. non-productive beliefs 3. non-productive behaviours 4. non-productive relationships 5. poor response to tx |
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Three persistant stresses? |
1. chronic stress 2. compounding events (major life events) 3. depressed mood |
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Chronic stress leads to hormones doing what immunologically? |
increaese: corticosteroids, catecholamines and opoids decrease (chronic): growth hormone, prolactin |
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Risk of MSK pain goes up or down with stress? |
up (more shoulder and LBP) |
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Pratt's threshold for diagnosing psychiatric disorders on K6 scale? |
11-24 |
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Depression only affects mind? |
false mind and body (immune, hormonal, nervous) |
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What are two conclusions of stress management? |
1. effects of stress reduced if organism has sense of control 2. feedback that one's behaviour is effective, is efective |
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4 current challanges of stress profile? |
1. sense of control 2. psycholgical distress 3. sleep disruption 4. sleep apnea |
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Macy's medical evaluation (3) |
1. identify the problem = diagnosis 2. develop a strong alliance = assist patient to more active in their health care 3. education: improve patient understanding |
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Social polyvagal buzzword |
connected engaged clear language empathetic fully involved |
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sympathetic polyvagal buzzwords |
preoccupied agitated overwhelmed |
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parasympathetic polyvagal buzzwords |
collapsed disorganized withdrawn hopeless despairing |
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clinical interaction: five levels of interviewing? |
1. medical issues -physian centered 2. collaborative information exchange 3. affective involvement 4. basic psychosocial intervention 5. individual or family therapy |
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mental processes of patient interview (6) |
1. perceptual disturbances 2. orientation 3. memory 4. impulse control 5. judgement 6. insight |
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Thought processes of patient interview (5) |
1. stream of thinking 2. content of thoughts 3. abstract thought 4. intelligence 5. concentration |
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Mood and affect of patient interview (5) |
1. mood 2. affect 3. appropriateness 4. lability 5. range |
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mini-mental state assessment of patient interview (5) |
1. orientation 2. recall 3 objects 3. attention/calculation 4. recall 5. language (various tests) |
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Carol Ryff - 6 characteristics of "Well being" |
1. self acceptance 2. autonomy 3. personal growth 4. positive relationships 5. environmental mastery 6. purpose in life |
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What is autonomy |
self-determining and independant |
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personal growth is the most important of Carol Ryff's 6 keys to well being |
true. Autonomy is last (of the 4 given) |
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Male or female suicide is on the rise (more on the rise than the other) |
male (4:1 ratio) |
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How many ppl committ sucide in 2000 and what is the rate per 100,000 |
1 million in 2000 16/100,000 top 10 cause of death in all age groups |
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what is the 3rd cause of death among 15-24s |
suicide |
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largest suicide rates in canada |
territories and quebec |
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Warning signs of suicide (5) |
1. a major change in behaviour 2. history of impulsivity 3. making arrangements 4. alludes to futility of their life 5. presence of significant or severe life stress |
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What does stress do, 1 word physiologically |
inflammation |
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3 adverse effects of cytokine therapy |
1. flu-like symptoms 2. mood changes 3. cognitive changes |
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Engagement: (with regards to suicidal risk) |
crucial to detection, assessment and management limits of confidentiality are discussed |
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detection: (with regards to suicidal risk) |
involves identification of risk factors it is important and safe to ask about suicide risk |
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Three target enquiries of suicide mangement (alienation and hopelessness major themes) |
1. person difficulties faced 2. postive resources they have 3. complete a suicide risk evaluatino |
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6 personal difficulties with patient with suicide risk |
1. current stress 2. alienation 3. family difficulties 4. mental disorders 5. cultural issues (and pressures) 6. hopelessness |
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4 positive resources with patient with suicide risk |
1. important people in their lives 2. stability of relationships 3. belonging to a community 4. risk taking vs. resilience |
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6 suicide risk evaluations |
1. suicide thoughts 2. suicide plan 3. availability of means 4. lethality of attempt 5. barriers to committing suicide 6. previous suicide attempts |
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correlates of a "high risk" patient for suicide (5)_ |
1. explicit suicidal intent 2. hopelessness or alienation 3. a well formulated plan (SAL) 4. previous attempts 5. being in an "at risk" group |
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management of high suicide risk (3) |
1. reduce immediate risk (provide safety) 2. involve a mental health counsellor in management (never work alone) 3. establish who the primary contact is *get help |
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management of moderate suicide risk (4) |
1. reduce immediate risk (provide safety) 2. develop an "affirmative action plan" 3. discuss limits to confidentiality 4. involve supports in the overall plan *can handle yourself |
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resolve stresses to resolution of suicide risk |
1. precipitating events 2. ongoing life events 3. mental disorders |
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our professor |
reiiav |
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What percent of ppl have current mental disorders according to world health organization study |
24% |
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Most popular ICD-10 disorder (mental health disorder) |
current depression |
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Detection rates of mental health disorders? By GPs? CIDI? |
48.9% GPs - 24.2% CIDI - 32.5% |
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What is the prevalence of our patients with symptom impairment (mental)
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1/3 |
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detection rates of mental health in primary practice |
50% |
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How to improve detection of mental health (4) |
1. personal relationships 2. improved communication skils 3. use specific assessment screens 4. better understanding of tx choices |
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What are the 4 top priorities for chiropractors with regards to training for psychosocial problems? |
1. chronic pain 2. depression 3. malingering 4. non-compliance |
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What are 3 moderate priorities of chiropractors with regard to training for psychosocial problems? |
1. abuse 2. grief 3. phase of life problem |
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What are the 4 top priorities for chiropractors with regards to training for psychiatric problems? |
1. major depression 2. sleep disorders 3. anxiety disorders 4. addictions |
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What are the 4 moderate priorities for chiropractors with regards to training for psychiatric problems? |
1. somatization 2. bipolar 3. hypochondria 4. eating disorder |
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Two criteria for impairment based on ____ status. Doctor needs evidence that one or both are impacted by their symptoms |
functional status 1. withdrawn from social interactions 2. difficulty keeping up with school or work responsbilities |
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What is DSM |
Diagnosis and statistical manual of mental disorders |
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Examples of DSM diagnosis - Adjustment disorder (5) |
1. with anxiety and depressive mood 2. no diagnosis 3. herniated disc 4. with moderate psychosocial stressors 5. GAF of 65% |
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what is GAF |
global assessment of functioning |
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best strategies for screening psychosocial problems found in community practice? |
1. ask key questions that are strategic 2. preferably about main features of the most common condition 3. explore only if results are positive |
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5 persistant reactions to stress with regards to trait anxiety |
1. ANS symptoms 2. CNS symptoms 3. motor tension symptoms 4. psychological (mental) symptoms 5. behavioural symptoms |
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anxiety (chronic stress) will not impact prognosis |
false. Increase pain and physical symptoms |
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lifetime prevalence of anxiety and ratio of male/female |
25%. 2:1 female to male |
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What is the best strategy to deal with anxiety? (3) |
1. ask key questions that are strategic 2. preferably about main features of the most common condition 3. explore only if results are positive |
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what questionnarie is best for common psychiatric condictions |
PRIME-MD Primary care evaluation of mental disorders |
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7 follow-up questions after PRIME-MD questionnaire |
1. presence of arousal and anxiety symptoms 2. expierience intense or sudden fear unexpectedly 3. expierience fear in specific situations 4. expierience fear in social situations 5. onset 6. family history 7. use of medications and drugs |
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Heart, skin and GI symptoms with ANS anxiety symptoms |
Heart: palpitations skin: sweating, chills GI: nausea, dry mouth |
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motor tension symptoms |
muscle: tense, sore chest: tight, choking |
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behavioural symptoms of anxiety |
avoidance OCD |
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Psych (mental) symptoms of anxiety |
apprehension, fear, panic |
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DSm provides 12 diagnoses in 3 clusters: |
1. anxiety (peristant stress) 2. anxiety surges (panic and agoraphobia) 3. phobic (avoidance) states |
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4 persistant anxiety states: |
1. generalized anxiety disorder (worry) 2. panic disorder (recurrent panic) 3. acute stress disorder and post traumatic stress disorder (trauma) 4. OCD (rumination) |
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How to best diagnose generalized anxiety disorder |
excessive worry and anxiety for 6 months+ |
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What do patients expierience a variety of physical sensations of ____ with panic attack anxiety |
intense autonoic arousal |
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trigger of acute stress disorder |
extreme traumatic stressor |
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3 phobic states of avoidance pattern |
1. agoraphobia (fear of crowded spaces, leaving the house) 2. specific phobia 3. social phobia |
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Agoraphobia is a codeable disorder and is added as a feature of clinical presentation to another anxiety disorder |
Everything is true except not a codeable disorder |
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specific phobia is what? |
persistant distress cued by the presence of a specific object or situation |
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social phobia is what? |
social situations with unfamiliar ppl situation is avoided |
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How can chiropractor help anxious patient (4) |
1. patients who are first expieriencing anxiety can be monitored closely, and education about anxiety provided to the patient 2. teach patients how to abdominal breath 3. help make changes in lifestyle: behavioural avoidance 4. get help from family and friends of patient |
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What can you help a patient with anxiety with> (3) |
1. determine what triggered the problem 2. understand that anxiety patterns can be modified across time 3. if patient struggles refer to psychologist or psychiatrist (for meds) |
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Mild vs. chronic anxiety interventions |
mild: breathing, web-helps, community chronic: enhanced primary care services, community mental health programs, specialized regional treatment centres, day programs |
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anxiety spectrum symptoms are uncommon |
false. common |
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anxiety disorders are assoicated iwth increased physical symptoms |
true |
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many patient symptoms are not picked up |
true |
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chiropractors can't help with anxiety |
false |
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depression is 10 most common medical illness |
true |
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WHO rates what as a serious threat to well being? |
depression |
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What is depression ranked on the WHO disability? |
4th |
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female or male higher depressin? |
female 2:1 |
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6 kinds of depression |
1. depression due to a medical condition 2. adjustment disorder 3. dysthymia 4. seasonal affective disorder (SADs) 5. major depression 6. bipolar depression |
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What to use to screen for depression? |
PRIME-MD |
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what is anhedonia? |
inability to expierience pleasure |
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what is an example of depression due ot medical condition |
chemotherapy |
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Depression due to a medical condition is characterized by: (4) |
1. increased CRH 2. increased Cortisol 3. activation of centralized pro-inflammatory activity 4. behavioural responses (activated sickness syndrome): apathy, poor concentration |
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pain and depression share similar pathways in amygdala? |
false. limbic system |
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if pain results in loss of independance or decreasing participation, what follows? |
depression |
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what has a strong link with pain |
depression |
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difference btw grief and depression |
grief: waves, diminshes over time, healthy self image depression: constant, depletion, worthlessness |
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what is anhedonia and what two disorders is it associated with? |
inability to feel pleasure grief and depression |
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suicide is common in grief and depression |
false just in depression |
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difference btw grief and depression with regard to guilt, preoccupation and what it elicits |
grief: focused on aspect of loss, preoccupation with self and elicits sympathy, concern and embrace depression: focused on negative self image, preoccupied with self, elicits frustration and avoids |
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what is dysthymia? and what is the key feature |
moderate constant depression key feature: no sense of enjoyment |
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6 DSM requirements of dysthymia (mild constant depression) (need 2 to diagnose) |
1. poor appetite or overeating 2. low energy 3. low self-esteem 4. poor concentration 5. feeling of hopelessness 6. insomia |
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what is seasonal affective disorder |
depressed mood, loss of interest occurs when sunlight is absent or reduced |
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key feature of major depression |
no positive affect (Capacity for pleasure) |
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Need 4 of what 10 disorders to diagnose major depression |
1. depressed mood 2. loss of interest 3. insomia 4. fatigue 5. psychomotor agitation (pacing, wringing hands) 6. change in weight 7. change in sexual interest 8. worthlessness 9. cognitive problems 10. thoughts of suicide |
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presence of physical signs is a low predictor for depression drugs |
false. favourable response |
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key feature of bipolar disorder? |
presence of one or more epsiodes of mania |
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mania = ____ |
bipolar |
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what type of depression should you treat with lifestyle and problem solving? |
adjustment disorder or mild depression |
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What should you do if the patient is worsening on depression meds? |
consult a expierienced colleague or specialist |
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What should the chiro do to detect and respond to the depressed patient (3) |
1. focus on overall wellness 2. screening for mood is not difficult 3. better outcomes when depression is treated |
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What to do with all patients, mild depressed and severe depressed patients? |
all: education mild: make lifestyle changes (Breathing) severe: refer for CBT or meds |
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2 steps for patient education on depression |
1. discuss and tell them they have a common problem 2. direct clear, easy to understand ways to help |
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5 ways to help patient with lifestyle |
1. diaphragmatic breathing 2. negative thinking reframed 3. physical health addressed 4. SPEAK approach 5. determine what created the problem |
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nutriton for depression (3) |
1. B12 2. folate 3. eat healthy |
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what does speak stand for? |
s- schedule your week p - do one pleasurable thing a day e-exercise a-assertiveness; practice being direct k - kind thoughts about yourself |
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what comes first: sleep disturbance or depression |
sleep disturbance |
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insomia is linked to what |
depression |
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HPA axis linking sleep and depression (3) |
1. increased ACTH and cortisol 2. highest at first part of night 3. cortisol inversely correlated with sleep efficiency |
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What did Reitav do in 2001 to link depression? |
treat insomia |
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depression is not associated with sleep disturbance |
false |
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best action plan for depression |
breathing exercises |
