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Final Exam 2019, questions and answers

Course

Mental Health Foundations  (SSW 209)

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Humber College

Academic year: 2018/2019
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Mental Health Foundations Final Exam Review 2019

Substance Related Disorders

  1. What is a substance use disorder? – key concepts and DSM factors
    • Refers to a continued use of a substance despite substantial problems that can include up to 11 key cognitive, behavioural and physiological symptoms Key concepts and DSM factors: o Substance Use vs Substance Dependence o ‘Tolerance’ and ‘Withdrawal’ o ‘Lapse’ and ‘Relapse’

Cases of substance use disorder? - High unemployment - Family impact – parents abused substances - Dependency needs from childhood (lack of nurturing and support) - Tension reduction – early trauma - Self-medication against mental illness - Genetic predisposition

  1. What are the criteria for substance use disorder?

    1. Tolerance – need more to achieve desired effect
    2. Withdrawal symptoms – unique to substance
    3. Amount / Duration - The substance is taken in larger amounts or over a longer period than was intended.
    4. Control - persistent desire to cut down use, unsuccessful
    5. Cravings and urges to use
    6. Time - A great deal of time is spent in obtaining the drug, using the drug, or recovering from its effects.
    7. Activities / Commitments – Important activities are given up.
    8. Negative Consequences – use continues despite recurrent physical or psychological problems that are likely to have been caused or exacerbated by the drug (e. current cocaine use despite depression that is induced by the drug; alcohol use despite loss of relationships).

  2. What is a concurrent disorder?

    • Substance Use Disorders occurring at the same time as a Mental Health disorder
    • Significant complexities can occur when treating these disorders
    • History of Mental Health and Addictions sectors in Ontario (CAMH, CMHA agencies)

  3. What does substance abuse look like?

    • Excessive and chronic reliance on a drug that damages family, social relationships, employment, and may place others at risk.
    • Substance dependence (addiction) – more advanced version of substance abuse
    • Withdrawal – unpleasant, dangerous symptoms when drug or alcohol is stopped

  4. Binge drinking and Binge Drinking Disorder

    • Consuming 5 or more drinks within 2 hours is considered binge drinking
    • Binge Drinking Disorder is the gateway to developing an alcohol addiction

  5. What are the effects of alcohol dependence?

    • Alcohol dependence causes delirium tremens (hallucinations, seizures, shaking within 3 days of stopping alcohol)

  6. Fetal Alcohol Spectrum Disorder – criteria/effects

    • No amount of alcohol is safe during pregnancy
    • Fetal Alcohol Spectrum Disorder can develop if a woman drinks before she knows she is pregnant
    • Occurs 1 in 1000 births
    • Causes a range of abnormalities in child – cognitive difficulties, intellectual disability, hyperactivity, head and face abnormalities, heart defects, slow growth

  7. Opioids

    • Oxycontin, Percocet, Heroin, Morphine
    • Depress the central nervous system (reduce pain and emotional tension)
    • High intoxication and dependency potential
    • Severe withdrawal symptoms – anxiety, restlessness, sweating, rapid breathing, twitching, aches, fever, vomiting, diarrhea, high blood pressure, weight loss over period of 3 to 8 days.
    • Serious risk of overdose with heroin

  8. Hallucinogens

    • LSD, mescaline, psilocybin, Ecstasy
    • Induce altered perception – illusions and hallucinations that are exciting or frightening
    • Induce altered emotions
    • Sweating, palpitations, blurred vision, tremors, poor coordination
    • In a few users, longer term psychosis may develop along with flashbacks that can last months

  9. Stimulants

    • Cocaine, Crack, Methamphetamine
    • Euphoric feelings of well being
    • Fast pulse, high blood pressure, fast breathing, arousal and wakefulness
    • Over-stimulates the central nervous system – anger/aggression
    • Letdown involves depression, dizziness, and fainting, possible coma
    • Free basing – inhalation

  10. Marijuana and Hashish

    • Low doses – joy, relaxation or anxious, suspicious, or irritated
    • Reddening of eyes, faster heartbeat, increased blood pressure and appetite, mouth dryness, dizziness.
    • Hallucinations in higher doses
    • Prolonged use leads to dependency with flu like symptoms during detoxification
    • Dangers include panic attacks, psychosis accidents, loss of concentration, memory and thinking problems, contributes to lung diseases

  11. Withdrawal and symptoms

  12. What is a harm reduction strategy?

    • Any policy, philosophy or program that is directed at reducing the harm or risk of harm associated with use or abuse of alcohol or other drugs without requiring abstinence
    • Recog. the continuum of substance use
    • Range of options
    • Promotes respect / right to make own decisions
    • Redefines success
    • Promotes public health / safe communities

  13. Recovery and treatment options

    • Harm Reduction
    • Recognition (thoughts/feelings)
    • Stopping (behaviours)
    • Education
    • Counselling
    • Relapse Prevention
    • Dealing with Underlying Issues
    • Meaning and purpose, feeling a part of something larger

Treatment Options - Drug therapy for opioid addiction – methadone, Buprenorphine to ease withdrawal. - Aversion therapy for alcohol addiction – Antabuse - Contingency management – reward system - Cognitive behavioral – journaling + coping strategies - Detoxification – gradual withdrawal + symptom management – requires follow-up to raise success rates

Eating Disorders

  1. Anorexia Nervosa DSM Criteria

    • Restriction of energy intake relative to requirements o Leading to significant low body weight for age, sex etc.
    • Intense fear of gaining weight or behaviour that interferes with weight gain
    • Distorted view of body image o Lack of recognition of seriousness of low body weight
    • Body weight 15% below normal
    • Intense fear of gaining weight even though underweight
    • Disturbed body perception (poor self-worth due to negative perception of body)
    • Preoccupation with food
    • Denial of seriousness of low weight
    • Depression and anxiety, insomnia, substance abuse
    • Perfectionism
    • Obsessive compulsive symptoms very present (obvious)
    • Lowered body temperature, blood pressure, slow heart rate, bone density is compromised- cold all the time
    • Metabolic and electrolyte imbalances can lead to heart attacks and death

  2. Bulemia Nervosa

    • Recurrent 1) Binge eating and
  1. Compensatory behaviours (at least once per week for 3 months)
    • Compensatory behaviours = Self-induced vomiting, use of laxatives / diuretics / enemas to prevent weight gain, displaying compulsive beahviours
    • Weight is within normal range
    • Heightened risk of self-harm or suicide- purging of food is a self-harm practice
    • Very concerned about pleasing others and having intimate relationships
    • 90-95% of occurrence is in women
    • White women have a higher risk
    • History of mood swings, becoming easily bored or frustrated, problems controlling impulses
    • Serious dental problems
    • Potassium deficiencies cause weakness, intestinal disorders, kidney disease, or heart damage
    • One third may have borderline personality disorder diagnoses
  1. Binge Eating
    • Eating, within any 2-hour time period, an amount of food that is definitely larger than most people would eat during a similar time period and circumstance.
    • A sense of lack of control during the eating

Schizophrenia

  1. Types of symptoms
    • Positive symptoms
      • “add ons” – new symptoms that are there but normally should not be e., (delusions, hallucinations)
    • Negative symptoms
      • functioning that should be there but is not Positive
    1. Delusions
    2. Hallucinations
    3. Disorganized / unusual speech
    4. Catatonic Behaviour

Negative 1. Loss of ability to feel pleasure 2. Reduced amount of speech 3. Affective flattening 4. Withdrawal, loss of motivation

  1. DSM Criteria

    • 2 of 5 symptoms must be present for at least one month: delusions, hallucinations, disorganized speech, and negative symptoms. - and 1 of these 2 symptoms must be a positive symptom (i., delusions, hallucinations or disorganized speech)
    • DSM 5 eliminated the 3 subtypes (that were used in DSM 4

  2. Phases of Schizophrenia

  3. Prodromal – symptoms are not obvious, but person is deteriorating (withdrawal, odd speech, strange ideas etc)

  4. Active – may be triggered by stress, hallucinations, delusions begin to appear

Residual – return to less severe symptoms, similar to prodromal stage in some people - One quarter or more recover completely – especially in those who functioned well before the condition

  1. Types of Schizophrenia

Paranoid – organized system of hallucinations and delusions that guide their lives (persecution, delusions of reference – i. TV is stealing someone’s ideas)

Disorganized – confusion, incoherence, flat or inappropriate affect, attention and perception problems, extreme withdrawal, odd mannerisms

Undifferentiated – wide assortment of unusual patterns not otherwise accounted for

  1. Causes of Schizophrenia
  • Diathesis Stress Model - degrees of interaction of biology and environment
    • Genetic – may inherit a genetic predisposition – more common in relatives
    • Biochemical – dopamine and serotonin may affect misfiring of neurons – lead to use of antipsychotic drugs to reduce dopamine activity or prevent dopamine binding to receptors, preventing neurons from firing
    • Abnormal brain structure – enlarged ventricles (containers of cerebrospinal fluid) – in people with poorer social adjustment
    • Viruses – exposure to viruses before birth – may interrupt proper brain development
  1. Other types of psychoses
  • Schizoaffective Disorder
    • long term with hx of major depressive episode
  • Delusional Disorder
  • Catatonia (‘waxy flexibility’)
    • a specifier for Psychosis, Mood Disorders
    • when not a separate medical disorder
  1. Impacts and Treatment

Antipsychotic drugs - new drugs reduce positive and negative symptoms in up to 85% of people, and tend not to cause tardive dyskinesia (tremors, tic like movements) and other side effects over time (aim for lowest dose that works)  Clozaril, Risperdal, Zyprexa, Seroquel Psychotherapy - directive – individual or in groups

Family therapy  assistance to support the individual and reduce relapse  The earlier the treatment, the better  Ontario wide: Early Psychosis Programs / First Episode

  1. Causes of decline of dementia

    • “An increase in educational attainment was associated with some of the decline in dementia prevalence, but the full set of social, behavioral, and medical factors contributing to the decline is still uncertain.”

  2. What is delirium? What are the different support systems?

    • A common experience of many persons who are older
      • Not the same a dementia
      • Onset is sudden
      • Appear confused, disoriented and out of touch with their surroundings
      • Can be from medication, head injury, infections, drug withdrawal
      • Impaired attention a major symptom
      • Usually impaired motor skills, mood, perception and sleep-wake cycles are also involved. Can also involve delusions and hallucinations.
      • Usually resolves – dementia does NOT.

Intellectual Disability and ASD

  1. What is different in the new DSM? Compare to DSM 4

  2. Intellectual Disability was called Mental Retardation (MR)

  3. Old criteria for MR diagnosis included Intellectual Quotient (IQ) scores below 70

  4. Autism Spectrum Disorder was either an Autistic Disorder, Aspergers Disorder or Pervasive Developmental Disorder NOS

  • These no longer in official use

  1. What is an intellectual disability?

    • Difficulties in adaptive functioning and cognitive / intellectual functioning
      • e., self care, social/interpersonal, use of community resources, self-direction, academics, work, leisure, health, safety.

  2. DSM 4 levels

    • Mild, Moderate, Severe, Profound  80% of people with ID are in the Mild range
    • People with ID mild diagnosis are usually difficult to impossible to identify at first glance or at all in society.
    • When asked to identify the abilities of the average person with I. (i., those that are average are in the Mild range) research participants regularly underestimate their ability

  3. Causes  Cause for ~30% of individuals is not known - Biological – unfavourable conditions before, during or after birth ◦ too little iodine in mother, fetal alcohol syndrome, rubella in mother, prolonged lack of oxygen - Accidents - Genetic

  4. What is Autism Spectrum Disorder – DSM 5 criteria – Causes and treatment

DSM 5 says: 1.) Deficits in social-emotional reciprocity (lack of interest in reciprocal play, friendships, eye to eye gaze) 2.) Deficits in nonverbal communications (repetitive use of language, lack of initiation or sustained conversation) 3.) Deficits in developing, maintaining, and understanding relationships  (e., theory of mind)  3 to 6 children out of every 1,000 will have some form of autism.  Males are four times more likely to have autism than females

Personality Disorders

  1. What are the features of a personality disorder?

    • Leads to psychological pain for the person and social and occupational problems
    • Most people are unaware of their disorder
    • Typically becomes recognizable in adolescence or early adulthood
    • 9-13% of all adults may have a personality disorder

  2. Classification for personality disorders

    • The DSM-5 identifies 6 PDs and these can be separated into 3 “clusters”: Odd or eccentric behavior  1) Schizotypal PD Dramatic, emotional, or erratic behavior  2) Antisocial PD, 3) Borderline PD, 4) Narcissistic PD Anxious or fearful behavior  5) Avoidant PD 6) Obsessive-compulsive PD

  3. Schizotypal personality disorder

    • Characterized by a range of interpersonal problems, marked by extreme discomfort in close relationships, odd patterns of thinking and perceiving, and behavioral eccentricities  symptoms may include ideas of reference and /or bodily illusions  often have great difficulty keeping their attention focused; conversation is typically digressive and vague, even sprinkled with loose associations

  4. Dramatic Personality Disorders

    • The behaviors of people with these disorders are so dramatic, emotional, or erratic that it is almost impossible for them to have relationships that are truly giving and satisfying
    • These personality disorders are more commonly diagnosed than the others  Only antisocial and borderline personality disorders have received much study
    • The causes of the disorders are not well understood
    • Treatments range from ineffective to moderately effective

  5. Obsessive Compulsive

  • Focused on order and perfection
  • Lack flexibility, openness and efficiency
  • Unreasonably high standards for self and others
  • Refusal to seek help or work with a team
  • Rigid, stubborn
  • Trouble expressing affection – stiff, superficial relationships
  1. Obsessive Compulsive Personality Disorder
  • Stingy with time and money, hoard possessions
  • Affects 2-5% of the population
  • White, educated, married and employed people
  • Men affected twice as often as women
  1. Therapist reactions
    • Urge to rescue
      • Stop the pain, distress, FIX IT
      • Fear of self-harm, suicide (liability)
      • Fear of anger, submit to pressure
      • Reassure client (“you don’t care”)
  • Urge to control, distance, punish
    • Stop the destructive behaviours
    • Escape intense distress, feeling de-skilled
    • Act on rage at feeling manipulated, de-skilled, never-ending crises
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Final Exam 2019, questions and answers

Course: Mental Health Foundations  (SSW 209)

3 Documents
Students shared 3 documents in this course

University: Humber College

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Alexandra Rokkos MENTAL HEALTH FINAL EXAM REVIEW December 6, 2019
Mental Health Foundations Final Exam Review 2019
Substance Related Disorders
1. What is a substance use disorder? – key concepts and DSM factors
- Refers to a continued use of a substance despite substantial problems that can include up to 11
key cognitive, behavioural and physiological symptoms
Key concepts and DSM factors:
oSubstance Use vs Substance Dependence
o‘Tolerance’ and ‘Withdrawal’
o‘Lapse’ and ‘Relapse’
Cases of substance use disorder?
- High unemployment
- Family impact – parents abused substances
- Dependency needs from childhood (lack of nurturing and support)
- Tension reduction – early trauma
- Self-medication against mental illness
- Genetic predisposition
2. What are the criteria for substance use disorder?
1) Tolerance – need more to achieve desired effect
2) Withdrawal symptoms – unique to substance
3) Amount / Duration - The substance is taken in larger amounts or over a longer period than was
intended.
4) Control - persistent desire to cut down use, unsuccessful
5) Cravings and urges to use
6) Time - A great deal of time is spent in obtaining the drug, using the drug, or recovering from
its effects.
7) Activities / Commitments – Important activities are given up.
8) Negative Consequences – use continues despite recurrent physical or psychological problems
that are likely to have been caused or exacerbated by the drug (e.g. current cocaine use despite
depression that is induced by the drug; alcohol use despite loss of relationships).
3. What is a concurrent disorder?
- Substance Use Disorders occurring at the same time as a Mental Health disorder
- Significant complexities can occur when treating these disorders
- History of Mental Health and Addictions sectors in Ontario (CAMH, CMHA agencies)
4. What does substance abuse look like?
- Excessive and chronic reliance on a drug that damages family, social relationships,
employment, and may place others at risk.
- Substance dependence (addiction) – more advanced version of substance abuse
- Withdrawal – unpleasant, dangerous symptoms when drug or alcohol is stopped

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