IMED2200

What chronic disease condition risks are associated with insufficient or poor quality sleep?

Cardiovascular diseases (hypertension, stroke, heart attack, arrythmias). Obesity and diabetes, greater dementia risk (more rapid progression).

How can inadequate sleep impact judgement and mental functioning?

Cognition, psychomotor function, mood. Lapses in attention and lack of focus, irritability, reduced motivation, compromised problem solving, confusion, impaired communication.

What factors have been associated with wellbeing?

Connectedness with close ones and broader community, lifestyle choices, attitude to life, hobbies and an interest in learning about the world. Age above 65+ (or not 25-34).

What was the risk of poor sleep and developing depression in healthy Australian women?

Increase of subsequent depression more than four-fold within a decade.

What was the cost of inadequate sleep to the Australian economy in 2016-17?

$66.3 billion

David Cunnington sleep and workplaces quote

'The culture of some workplaces could be detrimental to the sleep health of their employees... there are still some organisations actively glorifying lack of sleep and promoting a culture of late-night work'

What are the psychopathology disorders of primary school?

- ADHD - Oppositional defiant disorder - Tourettes - Anxiety disorders (school refusal) - Conduct disorder) - Childhood depression

What are the psychopathology disorders of preschool?

- Autism spectrum disorders - Elimination disorders (encopresis, enuresis)

What are the characteristics of bulimia?

- Eating in a discrete period of time an amount of food certainly larger than normal - A sense of lack of control over eating during binge episode - Recurrent inappropriate compensatory behaviours in order to prevent weight gain - Binge eating and inappropriate compensatory behaviour occur on average at least once a week for 3 months - Self evaluation unduly influenced by body shape and weight

What are the risk factors for social anxiety?

- Family history - Parenting/family environment: over control, lack of warmth/affection, rejection, neglect, parental divorce - Life events: bullying/teasing, rejection/humiliation as a child or teenager, family violence, abuse, academic failure - Personality/behaviours: shy or socially inhibited, clingy behaviour, cries easily, excessive timidity, perfectionism, dependent on others, worrier, low self esteem - Internalising coping style (difficult expressing feelings or being assertive)

What are the risk factors for depression?

- Genetic: family history of mental illness - Biochemical: hormonal or neurotransmitter imbalance - Personality and psychological factors: tendency to worry, low self-esteem, perfectionism, sensitive to criticism, self-critical and negative, pessimistic - Traumatic early life events: neglect, abuse, remarriage of parent, parental overprotection, neglect, inadequate discipline, discord with siblings - Substance use - Physical illness

What are the psychopathology disorders of infancy?

- Non-organic failure to thrive - Language disorders - Developmental delays

What are the psychopathology disorders of adolescence?

- OCD - Eating disorders - Substance abuse - Affective disorder - Psychosis (schizophrenia, schizoaffective disorder)

What are the characteristics of anorexia nervosa?

- Restriction of energy intake relative to requirements, leading to significantly low bodyweight (less than minimally normal/expected) - Intense fear of gaining weight or becoming overweight, persistent behaviour that interferes with weight gain - Disturbance in the way in which one's body weight or shape is experienced, undue influence of bodyweight or shape on self-evaluation

What % of people put more priority on mental health since Covid?

27% (changing diet, positive thinking, goal setting, mindfulness, physical activity)

What are the WHO three essential features of mental wellbeing?

1. Positive state related to, but distinct from, being free of mental illness. Implies success across emotional, cognitive, psychological, social, physical and spiritual domains. 2. Multidimensional terms with positive affect and positive functioning 3. Indivisible from the concept of health

How many Australian children regularly use screen-based devices at bedtime? How many Australian children report associated sleep problems?

1/2, 1/4 with sleep problems

What are the stats about inadequate sleep and car accidents?

1/6 accidents are because drivers don't concentrate, 1/4 accidents involving only 1 car on country roads are because the driver fell asleep. Cost to community of drowsy driving accidents is $2 billion annually.

How many 4-11yo have mental health problems compared with 12-16yo?

1/6 vs 1/5 across a 6 month period.

What is the recommended sleep for preschoolers?

10-13 hours

What is the recommended sleep for toddlers?

11-14 hours

What is the recommended sleep for infants?

12-15 hours

What is the recommended sleep for newborns?

14-17 hours

How many Australians aged 16-85 had experienced a 12-month anxiety disorder?

14.4%. Highest prevalence in 35-44 years group.

When was anorexia nervosa categorised as a diagnosis?

1873

What % of Australians reported their mental health to be worse or much worse than before Covid?

19%

When was bulimia nervosa categorised as a diagnosis?

1970s

How many Australians regularly experience inadequate sleep?

2/5

What % of Australians have experienced a mental disorder across the last 12 months?

20%

How many Australians are estimated to experience inadequate/poor sleep on a daily or near-daily basis?

20%+

By what % does habitual poor sleep increase the risk of development of chronic health conditions?

20-40%

What is the statistical link between working late and sleeping difficulties?

22% report doing work in the hour before work more than a few nights a week, 69% of these have sleep problems.

What are the key factors associated with mental wellbeing in Australian adults?

39% rated money/wealth as important (across income groups was similar), mindfulness for 52%, connections, sleeping, positive attitude and seeking broadening experiences.

How many Australians reported mental health to be excellent or very good between Jan 2021 and May 2021?

42% to 46%

What % of Australians have experienced a mental disorder across their lifetime?

45%

What is the recommended sleep for young adults?

7-9 hours

What is the recommended sleep for teenagers?

8-10 hours

What is the recommended sleep for school-aged children?

9-11 hours

What is the view of health as a commodity?

A good for which there is demand, but without qualitative differentiation across a market. Fashion and fitness a lucrative industry. Treatment and prevention for health problems can be bought.

What is normal mental health from a medical/clinical perspective?

A lack of significant deviation from the average.

What is sleep?

A period of reduced activity, brain remains active. Decreased responsiveness to external stimuli. Distinguished coma (easy to reverse). Physiological changes.

What is the definition of mental illness under the WA mental health act (1996)?

A person has a mental illness if the person suffers from a disturbance of thought, mood, volition, perception, orientation, or memory that impairs judgement or behaviour to a significant extent.

What is the WHO definition of mental health?

A state of wellbeing in which every individual realises their own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to their community.

What is a psychiatric diagnosis?

A statement specifying required symptoms and signs, onset, duration, reaction to treatment, possible outcome. Purpose for communication, reliability is questionable, validity is arbitrary, divided views on utility.

When does mental wellbeing typically decline in adolescence?

Between 11-16. Most mental disorders have their peak period of incidence at this stage of the lifespan.

What is cognitive therapy?

Aims to change the way a person thinks about a situation or issue, challenges flawed/negative thoughts about the self.

What is behaviour therapy?

Aims to teach techniques or skills to change behaviour.

What is prevention?

Any systematic attempt to change the circumstances that promote, initiate, sustain, or intensify mental health problems.

What are the ways normality can be defined for mental health?

As an average, as an ideal (striving for self-realisation and self-improvement), as a level of adjustment (to cope with life and fulfil social roles).

What are the principles/tools of CBT?

Assessment (questionnaires to identify problems), goal setting, mood checks, setting the agenda of important factors to change, practice of strategies, homework and action plan, education.

What are the facets of making a psychiatric diagnosis?

Atheoretical/phenomenological approaches, psychopathology, operational diagnostic criteria, strict inclusion/exclusion rules, diagnostic hierarchy, clinical judgement required.

What occurs with affect from the transition from childhood to adolescence?

Becomes less positive, continues to decline until late adolescence.

What were the most common environmental barriers to sleep?

Bedrooms that were too hot or cold (37%), interruptions by children (20%), external noise (17.5%)/

What is normal mental health from an individual/socio-cultural/ethico-legal perspective?

Being within socially agreed limits that define the range of normal functioning.

What is abnormal mental health?

Deviation from social norms, maladaptive behaviours, personal distress. Can be continuous (quantitative differences) or separate and distinctive states (eg hallucinations or danger to others)

What are the characteristics of a mentally normal person?

Efficient perception of reality (realistic view of own strengths/weaknesses), self-knowledge (understanding why we do things/have emotions), ability to control behaviour, self-esteem, forming close relationships, being productive

What was listed as the top response for having lived a good life in Australia in 2016?

Good health and wellbeing (57%)

What are the biggest factors contributing to child mental health in Australia?

Family SES, maternal mental health, maternal warmth/hostility, child temperament.

What psychosocial factors are associated with depression and GAD in uni students?

Feeling pressure to succeed, lack of confidence, difficulty coping with academic demands, issues with time management, exam anxiety, loneliness, managing work/life study balance, issues with sexual/gender identity, body image problems.

What are the symptoms of depression?

Feeling sad or down, loss of pleasure in normal activities (anhedonia), changes in sleeping patterns, feeling that life is meaningless, feeling unable to cope, tearful and upset, loss of appetite, difficulty concentrating, feeling irritable and restless, feeling hopeless, tiredness, negative thoughts, suicidal thoughts and ideation, unexplainable somatic symptoms.

What are the risk factors for anorexia nervosa?

Female gender, adolescent age group, changes in specific genes (first degree relative transferance common), significant life transitions, dieting and starvation, media use (social media).

What are the requirements for a depression diagnosis (DSM 5)?

Five or more symptoms must have been present in the same 2 week period and represent a change from previous functioning: depressed mood, loss of interest, altered appetite, insomnia or hypersomnia, psychomotor agitation or retardation, fatigue, feelings of worthlessness/guilt, diminished ability to think/concentrate, suicidal ideation.

What were the changes to the DSM with the release of the DSM-5?

Harmonisation with ICD-11, addition of dimensional approaches to diagnosis, 11 scientific validators for classification of illness, support of internalising vs externalising disorders. Developmental and lifespan considerations (early v late onset), cultural issues and diversification of syndromes, gender and sex differences accounted for.

What is normal mental health from a population perspective?

Having psychological characteristics shared by the majority of people in a population at a given time.

What is the APA definition of mental illness?

Health conditions involving changes in emotion, thinking or behaviour (or a combination of these). Associated with distress and/or problems functioning in social, work, or family activities.

What is the WHO definition of health?

Health is. state of complete physical, mental, and social wellbeing, and not merely the absence of disease or infirmity.

What is the structure of a psychiatric interview?

History (demographics, referral, medications, presenting complaint, history of presenting complaint, systemic inquiry, medication, family history, premorbid personality), mental state examination (mood and affect, appearance, behaviour, reactions, mechanics of talking/speaking, suicidality, perception/thinking, insight, judgement), formulation (longitudinal/cross sectional = integrative combination of mental state examination). Make diagnosis and differential diagnosis, and measure/treat through biospychosocial/medication/social/spiritual means.

What is the CBT intervention of cognitive restructuring?

Identifying and challenging negative thought patterns that maintain distorted beliefs about oneself and how one relates to others.

What are the common signs and symptoms of social anxiety?

In social situations- excessive perspiration, clammy hands, nausea, diarrhoea, trembling, blushing and stammering, hot and cold flushes, racing heart, tightening chest. Fear, apprehension, avoidance, anxiety about what was/nt said, fear of rejection/disapproval.

What are the personal impacts of inadequate sleep?

Increased risk of chronic diseases, mental health impacts, impaired judgement, increased risk of accidents, reduced productivity.

What are the three key groups of determinants for mental health?

Individual attributes and behaviours, social and economic circumstances, environmental factors. Work to enhance protective determinants and reduce risk determinants.

What are the metabolic impacts of inadequate sleep (5 hours for 5 days study)?

Induces prediabetic blood glucose levels, BAC equivalent of 0.05, testosterone drops as though aged by a decade, weight gain (increased fatigue, reduced physical activity), hormonal changes affecting hunger/appetite.

What is the value of mental health/wellbeing?

Integral part of capacity to lead a fulfilling life, ability to form relationships, study, work, leisure, make decisions.

What is selective prevention for eating disorders?

Intended to prevent ED by targeting individuals who do not have symptoms but who are at risk.

What is the CBT intervention of journalling?

Keeping track of feelings, thoughts, mood, and behaviours that cause symptoms so they can be challenge. Documents time of mood/thought, source, extent/intensity, response.

What are the signs of depression?

Looking miserable and sad, tearful, slumped posture, lack of eye contact, little body movement/slowness of movement, speech changes, weight loss or gains.

What are the subtypes of affective/mood disorders (depression)?

Major depressive disorder, dysthymia (milder, longer duration), psychotic depression/bipolar disorder

What are the DSM 5 requirements for a social anxiety diagnosis?

Marked fear/anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others. Person fears they will act in a way/show anxiety symptoms that will be negatively evaluated. Social situations almost always provoke fear and anxiety. Situations are avoided or endured, but with intense anxiety. Anxiety out of proportion to actual threat, persistent, clinically significant distress or impairment.

What is social phobia/anxiety?

Marked or intense fear of social situations in which the person fears being scrutinised by others, or being negatively evaluated. Fear that the anxiety symptoms will be noticed by others.

What is psychological wellbeing research?

Meaning or purpose of life, positive relastionships

What is phenomenology in psychiatry?

Method of access to the patient's inner world through an empathic approach to symptoms and signs.

What may be responsible for the decline in wellbeing typical of adolesence?

Neurobiological, cognitive, environmental shifts.

What were the risk factors for developing depression or GAD in uni students?

Not in a romantic relationship, moved location to start university, financial stress, first year of study, female students.

What are indications of an abormal mental state?

Overvalued ideas, illusions, limited insight, limited judgement, fleeting suicidality, induced states, substance use

How can exposure to light contribute to sleep disturbance?

Particularly in the blue area of visual spectrum- suppresses melatonin production.

What is hedonic wellbeing?

Positive affect

What is eudonic wellbeing?

Positive functioning

What are populations at increased risk of mental illness because of covid?

Pre-existing mental health problems for enhanced problems, health care workers, quarantine can have long-term psychological effects, unemployed and casual workforce, high job insecurity.

What is universal/primary prevention for eating disorders?

Programs or interventions aimed at an entire population, with the aim of preventing the development of ED in large groups with varying degrees of risk. Education, policy or legal action.

What is CBT?

Psychological therapy, structured that enables identification of unhelpful thoughts and behaviours, learn/relearn healthier skills and habits. Acknowledges that way of thinking and acting affects feelings/symptoms of depression/anxiety.

What are 'signs' of illness?

Quantifiable and observable traits that indicate changes to health state.

What are dimensional models of psychiatry?

Rating of character aspects with numerical data to produce scaled models. Places symptoms from normal -> trait/subsyndromal -> abnormal

What is an eating disorder?

Severe disturbances in eating behaviour, deriving primarily from an overvaluation of the desirability of weight loss that results in impairment.

What are assorted CBT interventions?

Strategies to promote more effective problem solving/goal setting/decision making, learning how to manage stress and anxiety through mindfulness, learning to gain a sense of control or predictability in situations that seem overwhelming, training in effective communication and assertiveness.

What is subjective wellbeing research?

Studying affect and life satisfaction

What are the 'symptoms' of depression?

Subjective, personal, only experienced by the individual and must be reported to be known.

What are the two key factors that inform a psychiatric diagnosis?

Symptoms and the effect of symptoms on normal functioning.

What is indicated/targeted prevention for eating disorders?

Targets who are at high risk due to warning signs/mild symptoms/risk factors.

What are categorical models of psychiatry?

Using groups of symptoms/signs to determine whether a patient falls in a category or not.

How do lifestyle factors lead to inadequate sleep?

Work pressures and lifestyle choices restrict sleep when they are prioritised in order to make enough time for family, leisure, social, work.