EHR525 Week 01b Understanding Mental Health Conditions PDF

WARNING This material has been reproduced and communicated to you by or on behalf of Charles Sturt University in accordance with section 113P of the Copyright Act 1968 (Act). The material in this communication may be subject to copyright under the Act. Any further reproduction or communication of th...

WARNING This material has been reproduced and communicated to you by or on behalf of Charles Sturt University in accordance with section 113P of the Copyright Act 1968 (Act). The material in this communication may be subject to copyright under the Act. Any further reproduction or communication of this material by you may be the subject of copyright protection under the Act. Do not remove this notice School of Exercise Science, Sport & Health 1 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 1 EHR525 EXERCISE FOR NEUROLOGICAL & MENTAL HEALTH CONDITIONS Understanding Mental Health Conditions Presenter: Jack Cannon School of Exercise Science, Sport & Health 2 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 2 What We Will Cover: 1. Terminology used in mental health. 2. Groups of mental health conditions (Schizophrenia, PTSD, and depression). 3. Behaviours and presentation of clients with mental health conditions. 4. Diagnostic criteria for different types of mental health conditions. 5. Aetiology and pathophysiology of mental health conditions. 6. Treatment and management of mental health conditions. School of Exercise Science, Sport & Health 3 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 3 Introduction ■ In Australia 1 in 5 people will experience mental illness that requires professional support at least once in their lives. ■ Mental illness is the third leading cause of total disease burden in Australia. ■ Mental illness has a significant impact on the national health budget ($10.6 billion in 2018-2019). ■ Mental illness is associated with an annual loss of productivity of $220 billion. ■ Impact of mental illness on individuals, families, and the community is extensive. School of Exercise Science, Sport & Health 4 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 4 TERMINOLOGY USED IN MENTAL HEALTH ■ Mental illness: A health problem that significantly affects how a person feels, thinks, behaves, and interacts with others. □ Diagnosed according to standardised criteria (DSM-5). ■ Mental health problem: Similar to mental illness but to a lesser extent. □ Does not meet all diagnostic criteria. □ Can be experienced temporarily as a reaction to life stresses. □ May progress to mental illness if they are not effectively managed. ■ Mental disorder: Previously used to refer to mental health illness when we thought it only involved the mind and perception. □ No longer used as our understanding of mental illness has evolved. School of Exercise Science, Sport & Health 5 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 5 Recovery-Orientated Mental Health Practice ■ Recovery-orientated approach: Focuses on achievement of an optimal state of personal, social and emotional wellbeing, as defined by each individual, whilst living with or recovering from a mental health condition. ■ A change in language is a key component of the recovery and mental health model. ■ Mental health issue or condition: New term used in preference to mental illness. ■ Mental health consumer: A person who has lived with or is in the process of recovering from a mental issue. School of Exercise Science, Sport & Health 6 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 6 GROUPS OF MENTAL HEALTH CONDITIONS ■ Mental health conditions are categorised into groups based on similarities in their underlying characteristics including their impact on how a person feels, thinks, behaves, and interacts with others. ■ Main groups of mental health conditions include: □ □ □ □ □ □ Psychotic disorders: e.g. Schizophrenia, Schizoaffective disorder. Mood disorders: e.g. Clinical depression, bipolar disorder. Trauma-related disorders: e.g. PTSD, acute stress disorder. Anxiety disorders: e.g. GAD, panic disorder, phobias. Eating disorders: e.g. Anorexia nervosa. Substance abuse disorders: e.g. Drug addiction. School of Exercise Science, Sport & Health 7 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 7 SCHIZOPHRENIA ■ Psychotic disorders: A groups mental illnesses characterised by abnormal thinking and perception. ■ Schizophenia: A severe mental illness that affects how person thinks, acts, expresses emotions, perceives reality, and relates to others. □ Difficulty distinguishing between what is real and what is imagined. ■ Affects about 1% of the Australia population. ■ Usually onset is 15-25 years and affects slightly more males than females. ■ One of the most chronic and disabling mental health conditions. School of Exercise Science, Sport & Health 8 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 8 BEHAVIOURS AND PRESENTATIONS ■ Behaviours and presentation of persons with Schizophrenia fall into four (4) domains. □ Positive symptoms: refer to added thoughts or actions that aren’t based in reality. □ Negative symptoms: refer to the absence of normal thinking or behaviours. □ Cognitive symptoms: refer to impair executive and cognitive functioning. □ Mood symptoms: refers to abnormal emotional states. School of Exercise Science, Sport & Health 9 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 9 Positive Symptoms ■ Delusions: False, mixed, or other strange beliefs that aren’t based in reality or fact that the person refuses to give up (e.g. believing other people can hear their thoughts). ■ Hallucinations: Perceiving sensations that aren't real (e.g. hearing voices, seeing things that aren’t there, smelling odours, feeling something touch you that is not there). ■ Catatonia: Involves a lack of movement and communication or unresponsiveness (e.g. the person may stop speaking and their body may be fixed in a single position for a very long time). School of Exercise Science, Sport & Health 10 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 10 Negative Symptoms ■ Negative symptoms of schizophrenia include: □ □ □ □ □ □ A lack of interest in the world. Not wanting to interact with other people (social withdrawal). An inability to feel or express pleasure. An inability to act spontaneously. Decreased sense of purpose. Not talking much. School of Exercise Science, Sport & Health 11 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 11 Cognitive Symptoms ■ Cognitive deficits in person with Schizophrenia include: □ Confusion, difficulty understanding information and using it to make □ □ □ □ □ decisions. Difficulty focusing or paying attention to relevant stimuli. Poor short- and long-term memory. Reduced capacity to use information effectively. Poor motor coordination. Inability to recognise that they have any cognitive limitations. School of Exercise Science, Sport & Health 12 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 12 Mood Symptoms ■ Mood symptoms may include: □ □ □ □ □ Loss of motivation. Loss interest or pleasure in things Demonstrating excessive mood behaviours. Demonstrating excessive fluctuations in mood. Having periods of time doing very little and periods of time being extremely active. School of Exercise Science, Sport & Health 13 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 13 DIAGNOSIS OF SCHIZOPHRENIA (DSM-5) ■ Diagnosis takes at least six months and is based on diagnostic checklist: □ Two or more of the following must be present for at least one month or longer. At least one of them must fall into the categories of 1, 2 or 3: 1. 2. 3. 4. 5. Delusions. Hallucinations. Disorganised speech. Grossly disorganised or catatonic behaviour. Negative symptoms, such as diminished emotional expression. □ Symptoms have had a significant impact on the ability to work, study or perform daily tasks. □ All other possible causes have been ruled out. School of Exercise Science, Sport & Health 14 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 14 AETIOLOGY OF SCHIZOPHRENIA ■ Development of Schizophrenia is multifactorial and includes genetic susceptibility and environmental influences. ■ Risk is approximately 10% for a first-degree relative and 3% for a seconddegree relative. □ Studies show that changes in the environment do not affect the risk of developing schizophrenia in children born to biological parents with the condition. ■ Environmental and social stressors are also linked to the development of schizophrenia, including childhood trauma, discrimination, social isolation, economic adversity. School of Exercise Science, Sport & Health 15 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 15 PATHOPHYSIOLOGY OF SCHIZOPHRENIA ■ Structural brain abnormalities: □ Cerebral atrophy (5% of brain volume). □ Smaller medial temporal lobes. □ Increased size of third and lateral ventricles. ■ Functional brain abnormalities: □ Abnormalities in neurotransmission due excess or deficient amounts of dopamine, serotonin, and/or glutamate. □ Influence one or more of the following pathways: • • • • Mesocortical pathway. Nigrostratial pathway. Mesolimbic pathway. Tuberoinfunibular pathway. School of Exercise Science, Sport & Health 16 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 16 School of Exercise Science, Sport & Health Patel et al.OF(2014) PTSCIENCE, SPORT & HEALTH17 17 SCHOOL EXERCISE MANAGEMENT OF SCHIZOPHRENIA ■ Goal of treatment is to ease the symptoms and reduce the risk of relapse. ■ Treatments may include: □ Medications: Anti-psychotics to relieve symptoms. □ Psychotherapy: To address behavioural, psychological, social, and occupational problems. □ Hospitalisation: For people with severe symptoms who might harm themselves or others or can’t care for themselves at home. □ Electroconvulsive therapy: May be used when medications no longer work or if severe depression or catatonia makes treatment difficult. School of Exercise Science, Sport & Health 18 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 18 First Generation vs Second Generation Antipsychotic Medications ■ First generation antipsychotics are D2 antagonists. □ Associated with higher risk of extrapyramidal symptoms. ■ Second generation antipsychotics are 5HT2A/D2 antagonists. □ Associated with lower risk of extrapyramidal symptoms. □ Associated with higher risk of metabolic side effects. ■ Both act on the mesolimbic, mesocortical, nigrostriatal and/or tuberoinfundibular pathways. ■ There is no evidence that one type of medication is more effective than the other treatment for cognitive and negative symptoms of schizophrenia. School of Exercise Science, Sport & Health 19 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 19 POST-TRAUMATIC STRESS DISORDER ■ Trauma-related disorders: A group of mental illnesses characterised by emotional and behavioural problems as a result of exposure to traumatic or stressful experiences. ■ PTSD: A mental illness involving intense, disturbing thoughts and feelings related to past experiences or witnessing an event that continue for well after the traumatic event has ended. □ May relive the event through flashbacks or nightmares, feel sadness, fear or anger, and/or may feel detached or distances from other people. ■ Affects about 12% of the Australia population. School of Exercise Science, Sport & Health 20 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 20 BEHAVIOURS AND PRESENTATIONS ■ Four main type of difficulties: □ Intrusive thoughts: e.g. re-living the event, distressing memories, nightmares that cause severe emotional or physical reactions. □ Avoidance: Of thinking or talking about the event, places, activities, or people that remind them of the event. □ Cognitive and mood changes: Memory problems, concentration difficulties, negative thoughts about self and others, hopeless, emotionally numb, detachment. □ Physical and emotions reactions: Easily startled or frightened, feeling tense or ‘on edge’, self-destructive, sleeping problems, irritability, angry outbursts, aggressive behaviour, shame or guilt. Symptoms usually occur within 3 mths of exposure but may appear later and often persist for months and sometimes years School of Exercise Science, Sport & Health 21 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 21 DIAGNOSIS OF PTSD (DSM-5) ■ For a person to be diagnosed with PTSD they must experience all of the following symptoms for one month or longer: □ □ □ □ At least one re-experience symptom. At least one avoidance symptom. At least two arousal and reactivity symptoms. At least two cognition and mood symptoms. ■ Symptoms must be serious enough to significantly interfere with daily function, such as work, school, or relationships with friends and family. ■ PTSD often occurs with other related conditions, such as depression, substance use, memory problems, and other physical and mental health issues. School of Exercise Science, Sport & Health 22 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 22 AETIOLOGY OF PTSD ■ No precise explanation for why some people develop PTSD and not others. ■ PTSD is multifactorial like most mental illnesses: □ Lifetime amount of exposure to severe traumatic or stressful experiences. □ Inherited mental health risks (e.g. family history of mental illness, such as anxiety or depression). ■ Personality traits and predisposition to symptoms. ■ Individual differences in the regulation of brain chemistry and hormone responses to traumatic and stressful experiences. School of Exercise Science, Sport & Health 23 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 23 GENERAL RISK FACTORS FOR PTSD ■ Exposure to intense or long-lasting trauma or stress. ■ Experiencing trauma earlier in life (e.g. childhood abuse). ■ Occupations related to traumatic and stressful events (e.g. military personnel and first responders). ■ Pre-existing mental health problems or family history (e.g. anxiety or depression). ■ Substance misuse (e.g. drugs or alcohol). ■ Limited support systems (e.g. family and friends). School of Exercise Science, Sport & Health 24 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 24 PATHOPHYSIOLOGY OF PTSD PTSD Brain Underactive prefrontal cortex + Overactive amygdala + Impaired memory storage and recall = More reactive, hypervigilant, and past becomes present School of Exercise Science, Sport & Health 25 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 25 MANAGEMENT OF PTSD ■ Psychological treatments: □ Trauma-focused psychotherapy. □ Cognitive processing therapy (CPT). □ Prolonged exposure (PE). ■ Medications to influence brain chemistry to manage fear and anxiety: □ Second generation SSRIs and SNRIs are most frequently used: • • • • Sertraline. Paroxetine. Fluoxetine. Venlafaxine. School of Exercise Science, Sport & Health 26 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 26 DEPRESSION ■ Mood disorders: A group of mental illnesses characterised by an abnormal emotional state. ■ Depression: A mental illness that characterised by persistent feelings of sadness and loss of interest or pleasure. □ Also associated with feelings of guilt or low self-worth, disturbed sleep or appetite, tiredness and poor concentration. ■ Affects about 10% of the Australia population. ■ Lifetime incidence is higher for females (1/14) than males (1/19). School of Exercise Science, Sport & Health 27 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 27 BEHAVIOURS AND PRESENTATIONS ■ Depression may occur only once during a lifetime though most people have multiple episodes. ■ Symptoms occur most of the day, almost every day and may include: □ □ □ □ □ □ □ □ □ □ □ Feelings of sadness, tearfulness, emptiness or hopelessness. Loss of interest or pleasure in most or all normal activities, such as hobbies or sports. Angry outbursts, irritability or frustration, even over small matters Sleep disturbances, including insomnia or sleeping too much. Tiredness and lack of energy so even small tasks require substantial effort. Reduced appetite and weight loss or increased cravings for food and weight gain. Anxiety, agitation or restlessness. Slowed thinking, speaking or body movements. Feelings of worthlessness or guilt, fixating on past failures or self-blame. Trouble thinking, concentrating, making decisions and remembering things. Frequent or recurrent thoughts of death, suicidal thoughts, suicide attempts or suicide. School of Exercise Science, Sport & Health 28 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 28 DIAGNOSIS OF DEPRESSION (DSM-5) ■ The person must be experiencing five (5) or more symptoms during the same 2-week period and at least one (1) of the symptoms must be either (1) depressed mood or (2) loss of interest or pleasure: 1. 2. 3. 4. 5. 6. 7. 8. Depressed mood most of the day, nearly every day. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day. Significant weight loss when not dieting or weight gain, or decrease or increase in appetite nearly every day. A slowing down of thought and a reduction of physical movement (observable by others, not merely subjective feelings of restlessness or being slowed down). Fatigue or loss of energy nearly every day. Feelings of worthlessness or excessive or inappropriate guilt nearly every day. Diminished ability to think or concentrate, or indecisiveness, nearly every day. Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide. School of Exercise Science, Sport & Health 29 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 29 AETIOLOGY OF DEPRESSION ■ Depression is a complex mental illness with multiple risk factors: □ □ □ □ □ □ □ □ □ □ Abuse. Age. Chronic disease or illness. Conflict. Death or loss. Gender. Family history. Major events. Stress. Substance misuse. ■ Involves a combination of genetic, environmental, and psychosocial factors that appear to influence brain structure and chemistry. School of Exercise Science, Sport & Health 30 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 30 PATHOPHYSIOLOGY OF DEPRESSION ■ Depression is linked with a wide range of mood, emotional, and cognitive abnormalities. ■ Many for pathophysiological mechanism theories have been developed: □ Neurochemical imbalances (NA,S,D). □ Neuroendocrine function (HPA-axis). □ Neuroanatomical changes (brain volume changes). School of Exercise Science, Sport & Health 31 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 31 Management of Depression ■ Medications: □ Antidepressants. □ Mood Stabilisers. ■ Psychotherapy. ■ Transcranial magnetic stimulation. ■ Electroconvulsive treatment. School of Exercise Science, Sport & Health Durstine, J. L., et al. (2016). ACSM's exercise management for persons with chronic diseases and disabilities. Champaign, IL, Human Kinetics. 32 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 32 Summary ■ Mental illnesses make a substantial contribute to the total disease burden in Australia. ■ People living with mental illness display a wide range behaviours and presentations due to impact on cognition and mood and emotional regulation. ■ It should be noted that people living with mental illness are more likely to be victims of violence that be perpetrators of violence. ■ Aetiology and pathophysiology of mental illnesses are highly complex and multifactorial involving diverse genetic and environmental influences. ■ Primary treatment for mental illness are medications that alter brain chemistry but they may be detrimental to motor function and/or metabolic health. School of Exercise Science, Sport & Health 33 SCHOOL OF EXERCISE SCIENCE, SPORT & HEALTH 33