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Lecture notes Sept 5th - Oct 8

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University of Guelph
PSYC 3690
Benjamin Gottlieb

1 September 10, 2013 1. What is mental health, what are the signs or criteria that mean an individual is mentally healthy BRAINSTORM - Absence of mental illness - Emotional self-regulation - Good coping skills - Ability to withstand life stressors - Positive support network - Social skills - Able to function in every day life - Self - acceptance - Appropriate processing of environment - Sense of control (actual or cognitive) - Sense of purpose (meaningful goals) - Sense of future possibilities (hopefulness) Definitions of Well-being (wont ask for these) - Self Acceptance: o Higher Scorer: possesses a positive attitude toward the self; acknowledges and accepts multiple aspects of self, including good and bad qualities; feels positive about past life o Low Scorer: feels dissatisfied with self; is disappointed with what has occurred in past life; is troubled about certain personal qualities; wishes to be different than what he or she is - Positive Relation with Others o High Scorer: has warm, satisfying, trusting relationships with other is concerned about the welfare about others capable of strong empathy, affections, and intimacy; understands give-and-take of human relationships o Low Scorer: has few close, trusting relationships with others; finds it difficult to be warm, open and concerned about others; is isolated and frustrated in interpersonal relationships; is not willing to make compromises to sustain important ties with others - Autonomy: o High Scorer: is self-determining and independent is able to resist social pressures to thinks and act in certain ways; regulates behaviour from within; evaluates self by personal standards o Low Scorer: is concerned about the expectations and evaluations of others; relies on judgments of others to make important decisions; conforms to social pressures to think and act in certain ways - Environmental Mastery o High Scorer: has a sense of mastery and competence in managing the environment, controls comples array of external activities; makes effective use of surrounding opportunities; is able to choose or create contexts suitable to personal needs and values 2 o Low Scorer: has difficulty managing everyday affairs; feels unable to change or improve - Purpose in Life: o High scorer: has goals in life and a sense of directness; feels there is meaning to present and practice beliefs that give life purpose; has aims and objectives for living - Personal Growth o Has a feeling of continued development; sees self as growing and expanding - There is no line that neatly divides the mentally healthy form unhealthy. There are many different degrees of mental health, no one characteristic by itself can be taken as evidence of good mental health, nor the lack of any one as evidence of an illness, as no body has all the traits of good mental health all the time 2. Why do people become mentally ill? - Genetic loading - Stress - Trauma - Non-normative stressful events (off-time events) - Insecure/disorganized attachments - Ineffective, harmful or absent coping mechanisms - Iatrogenic – treatment that’s creates more illness than it fixes - Constitutional weakness - Loss - Effort not equal to reward - Abusive relationships - Noxious physical or social environment - Past psychiatric disorder - Life threatening illness or injury - Pessimistic trait 3. What can be done to prevent mental illness? Promote mental health - Educate the public about symptoms - Healthy family functioning - Good parenting - Open & honest communication - Bibliotherapy (self-help books) - Teaching Coping skills - Removing negative social stigmas about mental health and seeking help - Fostering a positive learner centered social and intellectual climate @ school - Universal, selective, indicated (programs) September 12, 2013 What is Community Mental Health as a Field of Practice & Where Did it Come From? - Psychoactive Med Development 3 o Allowed people to be treated in the community because their symptoms were under more control o Allowed out-patient treatment o Many of these medications have side-effects (Tardif dyskinesia [uncontrollable trembling]) which makes them need alternate medication in order to rid them of the side effects o Some people don’t want to take these medications because it forces them to acknowledge that they have an issue - Deinstitutionalization o Evidence that nothing was going on in institutions by way of effective treatment, largely custodial environments or warehouses for the mentally ill, conditions were appalling o Pseudo-patient studies in which journalist would pretend they had mental health issues so they could see what life was like on the inside they found that the environment is socially constructed in a way as to say to people you are mentally ill and we expect you to behave as such. Some journalists felt like they were going crazy in that environment. The more that the journalists protested that this was an experiment and that they weren’t actually crazy, the more they were told that they were delusional. o Law-suits led to mental patients being integrated into the community, however the early conditions of the community living areas were worse than conditions in the mental hospital - Publics help-seeking choices o Hierarchy of Help-Seeking  1. Family  Female Spouse or Female Partner (for men) Female Friend aka. BFF (for women)  2. Close Friends  3. Family Doctor  People often express their psychiatric problems through physical symptoms, which they report to their family doctor (cant sleep, joint pain).  Family health teams are new organizational structures for family doctors to practice in, several doctors all packed into one building, and many have nurses who are specialized in mental health, or physiotherapists right on site.  People come to family doctors at the beginning of their symptoms before it has progressed to far.  4.Clergy  5. Coaches and Teachers  6. Bibliotherapy (self-help books)  7. Hairdresser  8. Chat Rooms, Blogs… Mutual Aid Self-Help Groups 4 o Many people go to professionals as a last resort, many people go through this hierarchy and only when it doesn’t prove effective then they may seek professional help. o Early intervention is a preventive strategy and this helps to do so.  Distress centers, hotlines, crisis lines - Supply & need imbalance o Prevalence of disorder (static)  Number of existing cases in the population at a point in time (# of people at any point in time that have a specific disorder [major depression] o Incidence of disorder (dynamic)  More dynamic concept, the rate or number, at which new cases of the disorder arise in the population  ** Need to know these terms well and be comfortable with them throughout the course* September 19, 2013 - Analysis Question for the Reading by Stice et al for the week of September 23 - * Not going to be graded however reading is crucial to understanding the course - Answers in writing for September 24 Handout w/ Questions on it posted on course link… Designs for Epidemiological Research: Aim is to identify risk (and protective) factors - a) Case Control Design: (cross-sectional) o Begins with 2 groups of people:  Have the disorder (cases)  Do not have the disorder (controls)  People in groups are matched to each other on as many background variables as possible so they are as similar as possible  The goal is to identify factors that are present among the cases and absent among the controls i.e. risk factors  When going into the research we always have some idea of what the risk factors are and what we are looking for, we get these ideas from multiple places such as prior research and clinical practice  It may not be that what we are finding among the cases is completely absent in the controls, it may be that the cases have the factors in higher degree than the controls do  If we find factors that exist to a higher degree among the cases then we have hypothesized = likely risk factors  If we find a statistically different factors between the 2 groups than we can conclude we have significant results and identify the risk factors 5 o Do not confuse the term control with an experimental design, because we are not manipulating variables here, we are just recording data - b) Cohort Design (prospective/longitudinal): o Capitalizes on the findings of the case-control design o 2 groups of people  Have the hypothesized risk factor(s)  Don’t have the hypothesized risk factor(s)  Want these people to be as much alike as possible (same as before)  Both well at beginning of the study (they have to be well because you are testing the predictive strength of your risk factors)  Goal: to determine whether and how strongly the risk factors predict the illness that i.e. increase the incidence of the disorder o Relative Risk Ratio  A statistic obtained at the end of the study that tells you how much more likely the group with the risk factor is of having the target disorder  E.g. Smokers are 15 times more likely to get lung cancer than non-smokers o This study goes forward in time, you have to wait for results Two Frameworks for thinking about Prevention - 1.a) Primary o Reduction in incidence of disorders o Health promotion  Foster optimal health (exercise, diet) - b) Secondary o Early intervention to “nip in the bud” as soon as the disorder becomes present (it is not before the disorder manifests it is as soon as it manifests…diagnosed)  Case Finding (not waiting for people to come to you who have a disorder but also doing outreach) - c) Tertiary o Harm reduction, relapse prevention  Harm reduction: the goal here is to minimize the additional adverse consequences of having a disorder  In tertiary prevention we accept the fact that there are people who will have a disorder and we simply want to ensure that (additional) worse things do not happen to that person ex. Safe Site Programs (clean needles for drug addicts) - 2. This Framework revolves around Risk Considerations - a) Universal o Prevention for all members of society or specific subgroups 6  Ex. Restrictions on alcohol, speed limits, seat belts, PPE - b) Selective o Programs for a sub-group of people known to be at risk as a group  Ex. Women with the BR gene for breast cancer.  Children with a depressed parent - c) Indicated o Programs where each person has been individually screened and found to have the risk factors  Ex. A progra
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