7128 Final Review Points PDF

General mental health and illness perspective (Week 1) 1. The continuum of health & illness 2. Objective vs. subjective experience 3. The WHO definition 4. The biomedical model of mental health and illness a. involves ‘expert’ health professionals assessing a person’s symptoms,...

General mental health and illness perspective (Week 1) 1. The continuum of health & illness 2. Objective vs. subjective experience 3. The WHO definition 4. The biomedical model of mental health and illness a. involves ‘expert’ health professionals assessing a person’s symptoms, making a diagnosis and devising treatment b. based on their scientific knowledge of the disease process. c. In turn, the unwell person follows the directions provided... to reduce the severity of their symptoms. d. The biomedical approach focuses on the cause (disease or condition), effect (illness or deficiency), treatment (pharmacological, surgical and rehabilitative) and outcome (cure or disability) of illness. 5. Galderisi (the view this course is based on) a. How it connected to other definitions of mental health b. What others definitions are lacking i. (other definitions tend to put too much emphasis on the happy spin of health and do not recognise the continuum as the Galderisi’s definition) The Recovery model (Week 2) 1. The impact of diagnosis a. Physical, psychological, spiritual and emotional impacts 2. Assertions, assumptions and principles of the approach a. Key assertions: It is possible to live a meaningful, satisfying life in the presence or absence of symptoms b. Assumptions c. Principles i. The Person 1. Experience = Expertise 2. Defines own needs & aspirations 3. Active involvement in treatment ii. Relationship 1. Nurturing connections to others essential 2. Fundamental role of families, friends, connection 3. Professional support good but less powerful iii. Hope 1. Primary motivator 2. No single clear source but environment & support necessary iv. Inclusion 1. Removal of structural barriers v. Participation  1. Experience = Expertise Service design Treatment choices vi. Change 1. Capacity to realistically adapt to new possibilities & opportunities 2. Willingness to work collaboratively for social & systemic change vii. Acceptance 1. Willingness to accept assistance 2. Recognition of limitations imposed by symptoms viii. Rights / Responsibilities 1. Takes active role in treatment (e.g. medication) 2. Assumes risk d. Four environment factors/elements for recovery i. Connectedness ii. Inclusion iii. Compassion iv. Acceptance 3. The example of the CHIME framework a. Connectedness b. Hope and optimism about the future c. Identity d. Meaning in life e. Empowerment Mood disorders (Week 3) 1. Mood and affect: definitions, descriptors and links Mood and Affect Mood: Emotional state over an extended period; linked to genetic, biological, psychological, social, cognitive, and experiential factors. Affect: Immediate expression of emotion, observed through behavior and appearance. Descriptors of Affect: ○ Euthymic: Normal display. ○ Hyperthymic: Intense emotion. ○ Dysphoric: Unease or dissatisfaction. ○ Labile: Rapidly changing. Congruence: Whether a person’s stated mood aligns with their observed affect. 2. Anxiety disorders: general information, CBT, treatment& responses Anxiety Disorders Essential Features:  ○ Intensity, Duration, and Response: Assess if anxiety matches circumstances, persists beyond a stressor, and whether the response is extreme. ○ Disorder Characteristics: Excessive, prolonged, and impacts functioning. Causative Theories: ○ Biological: Genetic predisposition, evolutionary fears, neurotransmitter regulation. ○ Cognitive: Distorted thinking that amplifies anxiety. ○ Learning: Anxiety learned through association and reinforcement. Treatment (CBT): ○ Focuses on changing negative thought patterns and behaviors. ○ Includes psychoeducation, relaxation techniques, graded exposure, and response prevention. 3. Depression: indicators, issues to assess Depression Characteristics: ○ Indicators include persistent sad or irritable mood, loss of energy, and motivation. ○ Key factors to assess: Intensity, Duration, Life-event Links, Impact on Functioning. Physical, Emotional, and Social Effects: ○ Physical: Reduced energy, sleep issues, cognitive slowing. ○ Emotional: Sadness, pessimism, fear, anhedonia. ○ Social: Isolation, stigma, potential unemployment. Contributing Factors: ○ Biochemical: Neurotransmitter imbalances, severe cases affecting noradrenaline and dopamine. ○ Psychological: Loss, significant life changes. ○ Social: Financial stress, isolation. 4. Intensity, frequency, duration, and impact on life Trauma (Week 5 – week 4 was the Ekka Holiday!) 1. DSM-5 vs. ICD-11 Definitions DSM-5: ○ Trauma requires exposure to actual or threatened death, serious injury, or sexual violence, through: Direct experience. Witnessing it in person. Learning of the event happening to a close friend or family member.  Repeated/extreme exposure to traumatic details (excluding media unless work-related). ICD-11: ○ Broader definition including: Short- or long-term exposure to events of extreme threat or horror (e.g., disasters, combat, torture). Emphasizes witnessing or learning about sudden and violent deaths. 2. PTSD: Diagnostic Features Must follow exposure to a traumatic event. Symptoms include: ○ Intrusive memories, dreams, or flashbacks. ○ Avoidance of reminders of the trauma. ○ Negative alterations in mood and cognition (e.g., persistent negative beliefs). ○ Arousal symptoms like hypervigilance and sleep disturbances. Duration of symptoms: More than one month, distinguishing PTSD from Acute Stress Disorder (ASD). 3. Complex PTSD vs. PTSD Complex PTSD (ICD-11 only): ○ Develops from prolonged/repeated trauma (e.g., torture, abuse). ○ Includes PTSD criteria plus: Persistent problems in emotional regulation. Negative self-perception (e.g., worthlessness, shame). Difficulty maintaining relationships. More common in children exposed to repeated trauma, with higher cognitive and behavioral challenges. 4. Trauma-Informed Care Assumptions Recognizes trauma's prevalence and its potential impact on behavior. Core principles: ○ Safety: Creating an environment of trust and predictability. ○ Choice: Empowering individuals to make decisions in their care. ○ Collaboration: Partnering with clients for shared decision-making. ○ Empowerment: Reinforcing self-efficacy by reframing trauma responses as survival mechanisms. Services aim to be sensitive to trauma without directly treating it. 5. Culture Notes Cultural interpretations of trauma vary, affecting responses and beliefs. Some cultures may attribute trauma to supernatural causes (e.g., karma, witchcraft).  Collectivist societies may emphasize community and family over individual responses. Traumatic stress can be heightened by culturally significant events, like the destruction of sacred sites. Eating disorders (Week 6) 1. Anorexia Nervosa and binge eating: symptoms, definitions Here's a summary of the key points on eating disorders, focusing on Anorexia Nervosa, binge eating, and the role of family: Anorexia Nervosa: DSM-5 Definition and Symptoms Definition: Characterized by: ○ Restriction of energy intake leading to significantly low body weight. ○ Intense fear of gaining weight or becoming fat, even at low body weight. ○ Disturbed self-perception regarding body weight or shape. Subtypes: ○ Restricting Type: No regular engagement in binge eating or purging. ○ Binge-Purge Type: Engages in recurrent binge eating or purging behavior. Core Features: ○ Severe weight loss. ○ Persistent behavior that interferes with weight gain. ○ Distorted body image. Binge Eating Disorder (BED): DSM-5 Definition and Symptoms Definition: Characterized by recurrent episodes of binge eating, without compensatory behaviors seen in bulimia nervosa. Symptoms: ○ Eating large quantities of food within a discrete time period. ○ A sense of lack of control during eating episodes. ○ Associated behaviors include: Eating rapidly. Eating until uncomfortably full. Eating large amounts when not hungry. Eating alone due to embarrassment. Feelings of disgust or guilt afterward. Diagnosis: Episodes occur at least once a week for three months. 2. Role of family  Role of Family in Eating Disorders Impact on Family: ○ Eating disorders can become the central organizing principle of family life, leading to significant stress and conflict. ○ Family members often feel anxious, frustrated, or helpless. Support and Involvement: ○ Families are seen as a crucial resource for recovery, especially in cases involving children and adolescents. ○ Pre-existing family dynamics, such as conflict avoidance, can be exaggerated by the presence of an eating disorder. ○ Families may face challenges accessing resources and navigating the healthcare system. Needs and Challenges: ○ Families often need clear information, support, and involvement in the treatment process. ○ Issues with healthcare interactions may leave families feeling misunderstood or blamed. Psychosis (Week 7) 1. General onset a. Common Onset: Psychotic symptoms often appear in late adolescence. b. Triggers: Episodes can be triggered by stress or substance use and may stem from organic causes like head injury or brain infection. c. Prodromal Phase: Early stage where symptoms gradually emerge, often subtly. 2. Key domains a. Delusions: Fixed beliefs that conflict with reality and remain unchanged despite evidence. b. Hallucinations: Sensory experiences without external stimuli, commonly auditory. c. Disorganized Thinking: Evidenced by disorganized speech (e.g., loose associations, incoherence). d. Grossly Disorganized/Abnormal Motor Behavior: Includes unpredictable actions or catatonia. e. Negative Symptoms: Diminished emotional expression, avolition, alogia, anhedonia, and asociality. 3. Schizophrenia: symptoms Positive Symptoms: Delusions (e.g., persecutory, grandiose). Hallucinations (auditory most common).  Disorganized speech and behavior. Negative Symptoms: Reduced emotional expression and motivation. Impaired social interactions (asociality). Catatonia: Marked by unresponsive behavior or excessive motor activity without purpose. 4. Bipolar 1 vs. Bipolar 2 Bipolar 1: Manic Episodes: Periods of extreme euphoria, heightened energy, reduced need for sleep, impulsivity, and potentially risky behavior lasting at least one week. May be followed by hypomania or major depression. Bipolar 2: Characterized by episodes of major depression and hypomania. Does not include full manic episodes. Key Differences: Bipolar 1 includes full manic episodes; Bipolar 2 features major depression and hypomanic episodes but no full manic episodes. Common Triggers: Life stressors, drug use, and major events (e.g., childbirth). Personality Disorders (Week 7 for slides – but PDs will not be covered until week 11) 1. Defining personality – ordered and disordered Ordered Personality: Represents consistent patterns of thinking, feeling, and behaving that characterize an individual. Typically stable over time and influenced by a combination of genetics, experiences, and social factors. Disordered Personality: An enduring pattern of inner experience and behavior deviating significantly from cultural expectations. Must manifest in at least two of the following areas:  ○ Cognition (perception and interpretation). ○ Affectivity (emotional response). ○ Interpersonal functioning. ○ Impulse control. Characteristics include being inflexible, pervasive, and leading to clinically significant distress or impairment. Onset traced back to adolescence or early adulthood and not better explained by other conditions or substances. 2. Clusters Cluster A (Odd/Eccentric): Paranoid Personality Disorder: Distrust and suspicion of others, interpreting benign interactions as threats. Schizoid Personality Disorder: Detachment from social relationships, limited emotional expression. Schizotypal Personality Disorder: Discomfort in close relationships, eccentric behavior, and cognitive distortions. Cluster B (Dramatic/Erratic): Antisocial Personality Disorder: Disregard for societal norms, deceitful, impulsive, aggressive, and lacking remorse. Borderline Personality Disorder: Intense, unstable relationships, fear of abandonment, impulsive behaviors, and mood swings. Histrionic Personality Disorder: Excessive emotionality and attention-seeking behaviors. Narcissistic Personality Disorder: Grandiosity, need for admiration, and lack of empathy. Cluster C (Anxious/Fearful): Avoidant Personality Disorder: Social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation. Dependent Personality Disorder: Excessive need for care, leading to submissive and clinging behavior. Obsessive-Compulsive Personality Disorder: Preoccupation with orderliness, perfectionism, and control (distinct from OCD as it lacks ritual behaviors). Substance Use (Week 8) 1. Rat Park! (Told you so) a. Concept: Rat Park was an experiment by Bruce Alexander that challenged the prevailing view that drug addiction was solely due to chemical hooks. It  suggested that environmental factors play a significant role in substance use and dependence. b. Findings: Rats in an enriched, stimulating environment (Rat Park) were less likely to consume drugs compared to isolated rats. This underscored the importance of social and environmental contexts in understanding substance use. 2. Harm minimisation Definition: A public health approach aimed at reducing the negative impacts of drug use without necessarily eliminating the use itself. National Drug Strategy: The Australian National Drug Strategy (2017–2025) emphasizes harm minimisation, focusing on: Reducing Supply: Law enforcement to limit drug availability. Reducing Demand: Preventing drug use and supporting people to reduce or stop usage. Harm Reduction: Strategies like needle exchange programs and safe injecting facilities. Key Principle: Harm reduction acknowledges that substance use can continue despite risks, aiming to make it safer. 3. Stages of Change model Model Overview: The Transtheoretical Model outlines the stages people go through when considering and making changes to their behavior, including substance use: 1. Pre-contemplation: No immediate intention to change; education and relationship-building are crucial. 2. Contemplation: Considering change but not committed; provide psychoeducation and explore readiness. 3. Preparation: Planning to act; goal setting and support systems are essential. 4. Action: Actively working on change; manage triggers and develop coping skills. 5. Maintenance/Relapse: Sustaining change and planning for possible setbacks; reinforce positive changes and address relapses as learning opportunities. Interventions: Tailored strategies at each stage ensure the approach is client-centered and effective in facilitating change. Suicide (Week 9) 1. Orbach’s theories Frustration of Fundamental Needs: Orbach theorized that suicide stems from the frustration of an individual's most important needs, leading to unbearable mental pain or "psychache." Psychache Clusters:  Self-Hate: Not just low self-esteem; the self feels deeply offended by its own existence, often stemming from an internalized critical voice. Unrelenting Loss: A perception of life as a continuous series of losses, with expectations of further losses, including social, emotional, or material setbacks. Mental Pain: This pain encompasses extreme negative emotions such as guilt, shame, and feelings of estrangement, leading to action tendencies like withdrawal and escape fantasies. 2. Risk factors a. Categories: i. Biological: Age (e.g., individuals over 65), ethnicity (e.g., Caucasians). ii. Psychological: Substance abuse, untreated mood disorders. iii. Cognitive: Impulsivity, rigid thinking. iv. Social: Unemployment, relationship breakdowns, poverty. b. Types of Risk Factors: i. Proximal: Immediate, situational factors (e.g., a sudden crisis like job loss). ii. Distal: Long-term, chronic stressors (e.g., chronic illness, socioeconomic disadvantage). c. Warning Signs: i. Verbal cues, such as talking about death or making statements like “I wish I were dead.” ii. Behavioral signs like giving away possessions or neglecting self-care. iii. Observable shifts in mood, including sudden improvement after deep depression. 3. Effective assessment a. Assessment Components: i. Thoughts: Evaluating suicidal ideation, distinguishing between passive and active thoughts. ii. Plans and Means: Assessing any planning or access to means of suicide. iii. Intent and Distress Level: Determining the severity of intent and emotional state. iv. Coping Potential: Gauging the individual's ability to manage stress and impulses. b. Approach: i. Use empathy and communication skills to engage and explore narratives. ii. Direct and specific questions should include terms like “suicide” and “death.” iii. Assess for ambivalence and impulsivity, and ensure collaborative engagement in creating a safety plan. Forensic Care (Week 10) 1. Mental Health Act: Treatment Authorities, Forensic Orders a. Treatment Authority (TA): i. Used when a consumer is deemed to lack the capacity to consent to treatment. ii. Can be issued by an authorised psychiatrist. iii. Includes either community or inpatient treatment and can be revoked once the consumer regains capacity. b. Forensic Orders (FO): i. Applied to individuals with major mental illness who have committed a serious crime and require treatment under the MHA. ii. Managed by an authorised mental health service, with conditions that may include housing restrictions, drug screenings, and a prohibition on possessing weapons. iii. Reviewed biannually by the Mental Health Review Tribunal (MHRT); only the MHRT can revoke it. iv. Includes higher supervision levels, often involving a Forensic Liaison Officer (FLO). 2. Capacity a. Definition: i. Capacity to consent involves understanding that one has an illness, grasping the nature and purpose of treatment, recognizing the risks and benefits of treatment, and understanding the consequences of not receiving treatment. b. Assessment: i. Regular evaluations are essential to determine whether an individual maintains or regains capacity. If capacity is regained, TAs can be revoked by a psychiatrist or the MHRT. 3. Case management a. Role and Approach: i. A case management model is commonly used in adult community mental health settings. ii. Case managers provide a biopsychosocial approach to care, coordinating clinical treatment and support. iii. Responsibilities include developing recovery goals, fostering resilience, coordinating referrals, and supporting involuntary consumers. b. Specialist Work: i. Involves working with consumers deemed 'high risk' or under forensic orders, ensuring safety, conducting risk assessments, and collaborating with multidisciplinary teams.  4. Purpose of the Mental Health Court a. Overview: i. Unique to Queensland, this court determines the mental state of individuals charged with serious criminal offences. ii. Composed of a Supreme Court judge and two psychiatrists who advise on psychiatric and medical issues. b. Decisions: i. Assesses whether the accused was of unsound mind or unfit for trial. ii. Outcomes may lead to forensic orders for treatment under the MHA instead of traditional criminal penalties. Assessment (Week 11) 1. Mental State Examination: goals, domains, language a. Goals: i. Evaluate a client's physical, emotional, and cognitive state at a specific point in time. ii. Assist in assessing risk and identifying immediate needs. iii. Provide a basis for comparison over time to track changes or progress. b. Domains: i. Appearance, Attitude, and Activity: Includes observations about grooming, dress, physical behaviors, and level of cooperation or hostility. ii. Mood and Affect: Mood is the client's subjective emotional state, while affect is the observable manifestation of emotion. iii. Speech: Assesses fluency, rate, tone, and volume. iv. Thought Process: Includes the flow and coherence of thoughts (e.g., flight of ideas, thought blocking). v. Thought Content: Evaluates themes such as delusions, obsessions, or phobias. vi. Perception: Assesses hallucinations or derealization experiences. vii. Cognition: Checks orientation, attention, and memory. viii. Insight and Judgement: Insight involves awareness of one's condition, while judgement assesses decision-making capability. c. Language: i. Uses standard, non-judgmental terminology to ensure clarity, objectivity, and to avoid stigma. 2. Thought disorders a. Thought Stream: i. Flight of Ideas: Rapid progression of thoughts with loose connections. ii. Thought Blocking: Sudden cessation of thought flow, potentially resuming with a new topic. b. Thought Possession:  i. Alienation: Involves phenomena such as thought insertion (belief that external forces are placing thoughts in one’s mind), thought withdrawal, and thought broadcasting. c. Thought Form: i. Derailment/Loosening of Associations: Shifting between unrelated topics without coherent connections. ii. Incoherence (Word Salad): Disorganized speech lacking clear meaning. iii. Neologisms: Creation of new, nonsensical words. iv. Tangentiality: Answers that stray from the point without providing relevant information. v. Word Approximation: Using unconventional combinations of words to express meaning.