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Questions and Answers
Effective strategies in a team include communication and collaboration.
True
The Calgary Cambridge Model is primarily a marketing framework.
False
Dr Brock Chisholm was the first Director-General of the World Health Organisation.
True
Public health does not consider social determinants of health.
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Understanding immunological processes is essential for explaining disease.
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Bacterial infections are unrelated to microbiological organisms.
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The Global Burden of Disease study provides data on morbidity and mortality.
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Pharmacology is irrelevant to understanding the biochemical fundamentals of life.
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Mental health is central to reducing the global burden of non-communicable diseases.
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Health anxiety is always pathological and should be avoided.
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The 'Big Four' non-communicable diseases refer to cardiovascular disease, diabetes, cancer, and hypertension.
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Common mental disorders include schizophrenia and bipolar disorder.
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Collaborative care supports the integration of mental health treatment into primary care.
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The biopsychosocial approach considers only biological factors in health.
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Depression can sometimes present symptoms similar to physical illnesses like anaemia.
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Common risk factors for non-communicable diseases include physical inactivity and tobacco use.
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Addressing mental illness in secondary care has no impact on cost reduction.
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Anxiety disorders are primarily managed in secondary care settings.
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Low energy and cognitive alterations can occur due to low iron levels affecting the basal ganglia.
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Sepsis has no association with mental health conditions such as depression.
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Dysphoric mood is considered a type of depressed mood.
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Common mental disorders like depression can lead to physical symptoms such as fatigue and weakness.
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Altered appetite can be a biological symptom of depression.
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Primary care consultations are irrelevant for recognizing mental disorders.
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1 in 8 people in the world live with a mental disorder.
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People living with a chronic physical health condition are 3 times as likely to have poor mental health.
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Anxiety disorders increased by 26% during the year following the pandemic.
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The mental state examination includes assessing risk.
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Health anxiety is always considered pathological.
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Depression ranked 13th leading cause of Disability Adjusted Life Years (DALYs).
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A person with severe mental illness experiences better outcomes than their peers.
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The biopsychosocial approach focuses solely on psychological factors.
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Acute sepsis can cause fluctuating mental state changes and inattention.
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Depression does not mimic symptoms of conditions like anaemia or thyroid dysfunction.
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Anxiety is always associated with physical symptoms such as muscle aches and rapid heartbeat.
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There is no association between anxiety and iron deficiency anaemia.
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The Mental State Examination provides a snapshot of a patient's thoughts, emotions, and behavior at the time of observation.
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Chronic low grade inflammatory response is not associated with depression.
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Difficulty concentrating and memory problems can be symptoms of hypoxia.
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Presenting symptoms of many conditions cannot mimic those of anxiety.
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The Calgary Cambridge Model includes communication as one of its frameworks.
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The Global Burden of Disease study focuses solely on mortality rates and ignores morbidity rates.
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Social determinants of health have little influence on public health initiatives.
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Understanding immunological processes is pivotal for explaining disease pathogenesis.
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Collaboration includes both teamwork and individual interventions in healthcare settings.
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Pharmacology is a secondary consideration in the understanding of biochemical fundamentals of life.
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Chronic health conditions do not usually impact mental health.
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Dr. Brock Chisholm was known for his efforts in linking physical health and mental health.
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Depression is unrelated to conditions like inflammation or sepsis.
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Low energy and altered cognition can be physical symptoms that overlap with depression.
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Common psychiatric disorders do not have any physical manifestations.
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Anaemia can have a direct association with depression.
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Dysphoric mood is considered a form of anxiety.
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Chronic low-grade inflammatory responses can contribute to mental health issues like depression.
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Sepsis and depression have no known relationships with post-viral symptoms.
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Physical health consultations are often insufficient for recognizing mental health disorders.
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Health anxiety can be beneficial in maintaining overall health up to a certain point.
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Severe mental disorders include common issues like depression and anxiety.
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Recognizing mental health issues in primary care can improve patient outcomes.
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The biopsychosocial approach solely examines biological factors impacting health.
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Collaborative care has been shown to be ineffective in integrating mental health treatment into primary care.
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Common risk factors for non-communicable diseases, such as tobacco use, are frequently found in individuals with mental illness.
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The 'Big Four' non-communicable diseases include chronic kidney disease as one of its components.
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Health anxiety is helpful in promoting health awareness but can become problematic if it leads to excessive worry.
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The biopsychosocial approach considers the complex interplay of physical, social, and psychological factors in health.
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People with chronic physical health conditions are not more likely to experience poor mental health.
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The Mental State Examination includes an assessment of a patient's insight and judgment.
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Anxiety disorders decreased by 28% following the pandemic.
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Mental disorders account for more than 1 in 10 leading causes of Disability Adjusted Life Years (DALYs).
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The combined disease burden in comorbid physical and mental illnesses is generally underestimated.
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Health anxiety is generally regarded as a positive trait that should always be avoided.
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Depressive disorders are not significantly impacted by social determinants of health.
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Depression and anxiety both can present symptoms that mimic physical conditions like anemia.
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Chronic low grade inflammation is unrelated to the development of depression.
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Anemia has no impact on cognitive function or mental health symptoms.
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The Mental State Examination (MSE) is designed to assess a patient's physical health primarily.
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Anxiety is typically characterized only by emotional distress, with no physical symptoms.
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There is a bidirectional relationship between anxiety and anemia.
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Symptoms of hypoxia can influence both cognitive and mental health.
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Sepsis is only a physical condition and does not affect mental health.
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The Global Burden of Disease study is solely concerned with tracking morbidity without considering mortality.
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Pharmacology plays a crucial role in understanding the biochemical fundamentals of life.
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Sepsis is completely unrelated to changes in mental health conditions.
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The Calgary Cambridge Model includes non-verbal cues and behaviors as crucial aspects of communication.
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Chronic low-grade inflammatory responses have no impact on mental health conditions such as depression.
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Addressing social determinants of health has a negligible influence on public health initiatives.
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Communication strategies in teamwork are not essential for effective collaboration in healthcare.
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The principles of microbiological diagnostic investigation are irrelevant to understanding bacterial infections.
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Common mental disorders such as depression and anxiety can coexist with conditions like cardiovascular diseases and diabetes.
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The biopsychosocial approach only addresses psychological factors in relation to health.
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Health anxiety is beneficial for maintaining health in all individuals.
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Collaborative care models have no proven impact on integrating mental health treatment into primary healthcare settings.
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The Global Burden of Disease study highlights the significant overlap between mental health issues and non-communicable diseases.
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Schizophrenia is classified as a common mental disorder.
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The WHO Mental Health Action Plan for 2013-2020 did not include considerations for mental disorders in the context of non-communicable diseases.
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Treatment for mental disorders in secondary care settings is unrelated to cost outcomes in healthcare.
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Depression is always completely unrelated to conditions like anaemia or inflammation.
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Conditions such as low energy and cognitive impairment can occur due to hypoxia, which is the result of various physical health issues.
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The basal ganglia solely controls motor functions without influence from iron levels.
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Sepsis is associated with inflammation and can result in both physical and mental health complications.
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Cognitive alterations resulting from depression do not overlap with symptoms caused by conditions like dizziness or weakness.
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Depression can coexist with chronic conditions, which may make its recognition in primary care more challenging.
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Altered appetite is an irrelevant biological symptom when diagnosing depression.
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Anxiety often presents with symptoms such as muscle aches and rapid heartbeat, which are unrelated to mental health conditions.
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The biopsychosocial approach considers the interplay of physical, social, and psychological factors.
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People with chronic physical health conditions are only slightly more likely to experience poor mental health.
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The Mental State Examination includes components such as mood and affect, cognition, and thought form.
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Depression and anxiety disorders increased by approximately 20% in the year 2020.
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Comorbidity of physical and mental illness leads to worse health outcomes and increased healthcare costs.
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1 in 5 individuals globally is estimated to live with a mental disorder.
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Health anxiety can be beneficial for maintaining health if it does not become excessive.
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A person with severe mental illness typically experiences longer life expectancy than their peers.
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The symptoms of thyroid dysfunction can sometimes mimic those of depression.
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Chronic inflammation is not associated with any mental health disorders.
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Anxiety can present with physical symptoms like stomach aches and rapid heartbeat.
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Iron deficiency anaemia has no correlation with cognitive issues.
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The presence of psychosocial stressors is irrelevant in the risk factors for mental health disorders.
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Sepsis is linked to varying mental states, including disorganized thinking.
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Physical symptoms of anxiety, such as headaches and weakness, can occur without any underlying sickness.
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The Mental State Examination is designed solely to diagnose physical health conditions.
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Study Notes
Introduction to Psychiatry
- Mental health is crucial for physical health.
- The World Health Organization (WHO) Mental Health Action Plan highlights the importance of mental health in NCDs.
- NCDs (Non-Communicable Diseases) include cardiovascular disease, diabetes, cancer, and respiratory diseases.
- Common mental disorders include depression and anxiety.
- Severe mental disorders include schizophrenia and bipolar disorder.
- Mental health conditions and physical health conditions often occur together, leading to increased burden of disease and worse outcomes.
Common Mental Disorders
- Depression: persistent low mood, often associated with biological symptoms (e.g., disrupted sleep, low energy, altered appetite, altered cognition).
- Anxiety: persistent anxiety or worry with associated biological symptoms (e.g., disrupted sleep, fatigue, irritability, restlessness, difficulty concentrating, impending danger or doom, headaches, muscle aches, rapid heart rate, sweating, trembling, weakness, pins and needles).
- Management: Mild to moderate cases are primarily managed in primary care.
Depression and Physical Health
- Depression is associated with anaemia due to iron deficiency.
- Low iron affects the basal ganglia, impacting emotional processing and leading to low energy, altered cognition, and fatigue.
- Depression is also associated with sepsis, inflammation, post-viral symptoms, and post-COVID conditions.
- Chronic low-grade inflammation and activation of cell-mediated immunity contribute to depression.
Anxiety and Physical Health
- Anxiety is linked to iron deficiency anaemia.
- Hypoxia associated with anaemia can lead to physical, cognitive, and mental health symptoms, including fatigue, weakness, dizziness, mood changes, and cognitive impairment.
Mental State Examination
- A mental state exam provides a snapshot of a patient's thoughts, emotions, and behavior at the time of observation.
- It helps diagnose mental conditions, assess severity, and identifies risks to self or others.
- Includes elements like appearance, behavior, speech, mood and affect, thought form, thought content, cognition, insight and judgment, and risk assessment.
Biopsychosocial Approach
- Considers the individual's physical environment, social environment, and psychological factors.
- Highlights the complex interplay of factors influencing physical and mental health.
Burden of Disease
- 1 in 8 people globally live with a mental disorder.
- Anxiety and depressive disorders increased significantly during the pandemic (2020).
- Mental health conditions are among the top causes of Disability-Adjusted Life Years (DALYs).
Comorbidity
- People with chronic physical health conditions are twice as likely to have poor mental health.
- Individuals with severe mental illness experience earlier morbidity and mortality compared to their peers.
- Comorbidity leads to worse outcomes, increased costs, and under-recognition and treatment.
Integrating Mental Health
- The course will explore the intersection of mental health and other non-communicable diseases (NCDs) throughout the curriculum.
- This integration aims to enhance awareness, improve outcomes, and reduce costs associated with comorbid conditions.
Introduction to Psychiatry
- Psychiatry focuses on mental health and its impact on physical health
- The World Health Organisation recognizes “Without mental health there can be no true physical health.” by Dr Brock Chisholm
FFP 1 Learning Outcomes
- The curriculum will use the Calgary Cambridge model to develop competency in communication and professionalism.
- The course will examine global trends in disease and mortality using Global Burden of Disease study data.
- Students will learn about the biomolecular, cellular, and biochemical fundamentals of life and the principles of pharmacology.
- Students will develop an understanding of the social determinants of health and the role of public health and health promotion.
- The course will cover the pathological and immunological processes underlying disease.
- Students will identify the characteristics of medically important microbiological organisms and the pathogenesis of bacterial infections.
- The course will explain the principles of microbiological diagnostic investigation.
Integrating Mental Health with Other Non-Communicable Diseases
- Mental health and well-being are crucial in reducing the global burden of non-communicable diseases (NCDs).
- The World Health Organization (WHO) Mental Health Action Plan for 2013-2020 focuses on integrating mental health and NCD care.
- The "Big Four" NCDs (cardiovascular disease, diabetes, cancer, and respiratory diseases) have been expanded to include mental disorders and environmental contributors (5x5 approach).
- Cardiovascular diseases, diabetes, cancer, and respiratory diseases often co-occur with common mental disorders and severe mental illnesses.
- Common mental disorders include depression and anxiety.
- Severe mental disorders include schizophrenia and bipolar disorder.
- Risk factors for NCDs (tobacco, unhealthy diet, physical inactivity, harmful alcohol use, environmental risk factors) are commonly found in people with mental illness.
- Integrating mental health treatment into primary care is supported by evidence, known as collaborative care.
- Awareness of mental illness and physical illness comorbidity in secondary care improves outcomes and reduces costs.
- Multidisciplinary teamwork and inclusion of mental health in medical curricula are crucial for effective care.
Activity Learning Outcomes
- Students will be able to describe common psychiatric disorders that present as physical illnesses.
- Students will develop an appreciation for the intersection of psychiatry with other medical fields.
- Students will outline the impact of the individual's environment on their physical and mental health using the biopsychosocial approach.
- Students will understand how health anxiety functions in promoting health and when it becomes pathological.
- Students will outline the components of a mental state examination.
- Students will learn how the biopsychosocial approach to self-care can improve engagement with patients, colleagues, and communities.
- Students will describe the combined disease burden and outcomes in comorbid physical and mental illness.
Common Mental Disorders
- Depression, characterized by persistent low mood, biological symptoms, and cognitive changes, is relevant to conditions like anaemia, inflammation, and sepsis.
- Anxiety, characterized by feelings of worry and biological symptoms, is also relevant to conditions like anemia, inflammation, and sepsis.
Mental State Examination
- The MSE provides a snapshot of a patient's thoughts, emotions, and behavior at the time of observation.
- It helps identify the presence and severity of any mental condition.
- Helps identify the presence of risk to self or others.
Biopsychosocial Approach
- The biopsychosocial approach considers the complex interplay of physical environment, social environment, and psychological factors in an individual's life.
Burden of Disease
- WHO states that 1 in 8 people globally live with a mental disorder.
- Between 2020 and 2021 there was a 26% increase in anxiety disorders and a 28% increase in depressive disorders.
- Depression and anxiety are ranked 13th and 24th leading causes of Disability-adjusted Life Years (DALYs).
Effect of Comorbidity
- People with chronic physical health conditions have a 2x higher chance of poor mental health.
- Severe mental illness leads to earlier morbidity and mortality.
- Worse outcomes and increased costs for those with co-occurring illness.
- Comorbidity is often under-recognized and poorly treated.
Introduction to Psychiatry
- 2023
- Dr Caragh Behan, Senior Clinical Lecturer
- Department of Psychiatry - Professor Charlotte Kamel, FRCPsychUK, Head of Department of Psychiatry
- 2023 FFP1 Learning Outcomes
2023 FFP1 Learning Outcomes
-
Use Effective Strategies
- As part of a team (i.e. communication, collaboration, interventions)
-
Describe Global Trends
- In morbidity and mortality using Global Burden of Disease study data
-
Display Knowledge of the Basic Framework
- of the Calgary Cambridge Model in communication
-
Discuss the Application of Professionalism
- Leadership, and resilience (i.e. the constructs of Personal and Professional Identity)
- To manage self and engage with patients, colleagues, and communities
-
Describe the Fundamental Nature of Life
- (e.g. biomolecular, cellular, and biochemical)
- And, the principles of pharmacology
-
Describe the Social Determinants of Health
- And the breadth and function of the public health and health promotion role
-
Explain the Pathological and Immunological Processes
- Underlying disease
-
Identify Characteristics of Medically Important Microbiological Organisms
- And the pathogenesis of bacterial infections
- Explain the Principles of Microbiological Diagnostic Investigation
Integrating Mental Health With Other Non-Communicable Diseases
-
Mental health and wellbeing are central
- To reducing the global burden of non-communicable diseases (NCDs)
-
WHO Mental Health Action Plan
- For 2013-2020
-
“Big Four” NCDs
- Cardiovascular disease, diabetes, cancer, and respiratory diseases
-
Expanded to a 5 x 5 Approach
- Including mental disorders and environmental contributors
- (2018)
Integrating Mental Health With Other Non-Communicable Diseases
-
Cardiovascular diseases, diabetes, cancer, and respiratory diseases
- Commonly co-occur with common mental disorders and severe mental illnesses
-
Common Mental Disorders
- Include depression and anxiety
-
Severe Mental Disorders
- Include schizophrenia and bipolar disorder
-
Risk Factors for NCDs
- Common to both and cluster in people with mental illness
- Include (e.g. tobacco, unhealthy diet, physical inactivity, harmful alcohol use, adverse environmental risk factors)
-
Collaborative Care
- Evidence supports integration of mental health treatment into primary care
-
Awareness of Mental Illness and Physical Illness Comorbidity
- At secondary care level improves outcomes, reduces costs
-
Professionalism
- Multidisciplinary team work
-
Inclusion in Medical Curriculum
- At an early stage-spiralling
Integrating Mental Health With Other Non-Communicable Diseases
-
Focus on introduction and awareness
- Common mental disorders
- Awareness of the presence of these in a consultation in primary care
- Introduction to more mental disorders
-
Spiralling to later years
- Comorbidity of mental illness and cardiovascular disease, endocrine disease, respiratory disease
- Treatment and management of mental disorders-psychiatry in year 4
-
Describe common psychiatric disorders that can present as physical illnesses
- With reference to conditions taught in FFP1
-
Develop an appreciation of where psychiatry interfaces
- With conditions taught in FFP1
- (e.g. anaemia, breast feeding immunology, and inflammation)
Common Mental Disorders
- Depression
- Anxiety
- Managed primarily in primary care (mild, stable)
-
How are these relevant to conditions like anaemia or inflammation or sepsis?
- How would these be recognized in a primary care consultation?
Common Mental Disorders - Depression
-
Low mood
- Persistent, most of the day, more days than not
-
Associated with biological symptoms
- Disrupted sleep, low energy, altered appetite, low energy, altered cognition
- Altered thinking including suicidal thoughts
-
Depressed mood
- Dysphoric mood, dysthymic mood
Common Mental Disorders - Depression
-
Presenting symptoms of conditions
- You learn about in FFP1 can mimic depression and vice versa
-
Depression
- Associated with anaemia
- Basal ganglia – responds to changing iron levels
- Responsible for movement but also shapes the processing of emotional stimuli
-
Low energy and altered cognition
- Hypoxia – physical, cognitive, and mental health symptoms including fatigue, weakness, dizziness, mood changes, cognitive impairment (trouble remembering, learning, concentrating, making decisions)
Common Mental Disorders - Depression
-
Depression
- Associated with sepsis – inflammation, post viral symptoms, post COVID
-
Low energy and altered cognition
- Hypoxia – physical , cognitive and mental health symptoms including fatigue, weakness, dizziness, mood changes, cognitive impairment (trouble remembering, learning, concentrating, making decisions)
-
Acute sepsis
- Encephalopathy - fluctuating mental state changes, inattention, disorganised thinking (delirium – more later)
Common Mental Disorders - Depression
-
Presenting symptoms of conditions
- Like anaemia, thyroid dysfunction, and post-viral symptoms can mimic anxiety/depression and vice versa
-
Depression
- Associated with a chronic low grade inflammatory response, activation of cell-mediated immunity
-
Range of common risk factors for depression and inflammation
- (e.g. Psychosocial stressors, poor diet, physical inactivity, obesity, smoking, altered gut permeability, atopy, dental cares, sleep, Vitamin D deficiency)
Common Mental Disorders - Anxiety
-
Feelings of anxiety or worry
- Persistent or intermittent, generalised or specific
-
Associated with biological symptoms
- Disrupted sleep, easily fatigued, irritable, restlessness, wound up increased appearance of energy, altered cognition (difficulty concentrating, paying attention, memory, feeling of impending danger or doom)
-
Associated with physical feelings
- (e.g. Headaches, muscle aches, stomach aches, unexplained pains, rapid heart beat, breathing rapidly, sweating, trembling, feeling weak, pins and needles in extremities)
Common Mental Disorders - Anxiety
-
Presenting symptoms of many conditions
- can mimic anxiety and vice versa
- Bidirectional association between anxiety and anaemia
- Iron deficiency anaemia
-
Low energy and altered cognition
- Hypoxia – physical , cognitive and mental health symptoms including fatigue, weakness, dizziness, mood changes, cognitive impairment (trouble remembering, learning, concentrating, making decisions)
-
Sepsis
- More in FFP2 and Year 2
How Would These Conditions Be Recognised in a Primary Care Consultation?
- Outline the components of a Mental State Examination (MSE)
Mental State Examination
- Snapshot of a patients thoughts, emotions and behaviour, at the time of observation
- Helps identify the presence and severity of any mental condition
- Helps identify the presence of risk to self or others
-
Structured format when written down
- But done during the interview while the patient is talking
Mental State Examination Content
- Appearance
- Behavior
- Speech
- Mood and Affect
- Thought form
- Thought content
- Cognition
- Insight and Judgment
- Risk assessment
Biopsychosocial Approach
- Complex interplay of conditions
Burden of Disease WHO
- 1 in 8 people in the world live with a mental disorder
- There was a 26% increase in anxiety disorders and a 28% increase in depressive disorders in one year due to the pandemic (2020)
-
Depression and anxiety ranked 13th and 24th
- Leading causes of Disability adjusted Life Years (DALYs)
Effect of Comorbidity
- People living with a chronic physical health condition are 2x as likely to have poor mental health
-
People with a severe mental illness
- Have earlier morbidity and mortality than their peers
- Worse outcomes and increased cost
- Under recognised and treated
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Description
Test your knowledge on the fundamentals of psychiatry, focusing on the interplay between mental and physical health. This quiz covers common and severe mental disorders, including depression and anxiety, and their implications for non-communicable diseases (NCDs).
