Using Health Psychology to Help
Patients:
Common Mental Health Disorders and
Psychological Distress
We as upcoming nurses need to be aware to the likelihood of a
patient experiencing psychological distress, and to have the skills to detect
and manage this. Listening to our patients is of the utmost importance and
knowledge of essential screening tools can be used to facilitate interactions with
our patients. Anxiety and Depression are
common in the general population and even more frequent in patients with
chronic illness or disabilities.
Some of the common symptoms of anxiety found in the Diagnostic
and Statistical Manual of Mental Disorders, 5th ed (DSM-5) are: Excessive worry –Anger- Irritability - Fear -Difficulty concentrating - Increased startle -Hypervigilance – Compulsions- Obsessions -Restlessness - Muscle tension
-Shortness of breath -Sleep disturbance -Easily fatigued –Palpitations-Choking
A two question screen, The GAD-2 has been found to work well
in detecting anxiety disorders such as; generalized anxiety disorder, panic
disorder, social anxiety disorder and, to a slightly lesser extent, PTSD
(Kroenke et al, 2007). However, the GAD-7 provides more detailed information
about the nature of and severity of said anxiety. Patients who screen positive
should be referred to a specialist for assessment and diagnosis by a mental
health professional.
Example of GAD 2: Over
the past 2 weeks, how often have you been bothered by:
1) Feeling nervous, anxious or on edge? 2) Not being able to stop or control worrying?
There is a choice of
four response options: Not at all (0), several days (1), more than half the
days (2), or nearly every day (3). If an individual scores 3 or more, the
possibility of an anxiety disorder should be considered.
Diagnoses of mental
illness are made by mental health professionals but nurses should be able to
recognize patients at risk. It’s important, they may not ask for help because
of embarrassment, or not even recognizing there may be a problem. Older people may feel as though admitting to
feelings of sadness or fatigue could be seen as weakness.
Some of the common symptoms of depression found in the
Diagnostic and Statistical Manual of Mental Disorders, 5th ed (DSM-5) are: Low mood -Loss of interest and pleasure or loss of energy number - Significant weight loss or gain - Physical agitation - Fatigue or loss of energy - Significant distress or impairment - Feelings of worthlessness or
excessive guilt - Reduced concentration – Indecisiveness.
The simplest screen for depression is the PHQ-2 or ‘Whooley
questions they consist of two questions concerning the core features of
depression (Whooley et al, 1997). It can
be administered as a questionnaire but can also be asked in conversation. The
use of these two questions alone can identify 95% of people who have
depression.
PHQ-2: Whooley questions (for depression)
1) During
the past month, have you often been bothered by feeling down, depressed, or
hopeless? 2) During the past month, have you often been bothered by little interest or pleasure in doing things?
A positive response to
either or both questions is an indication of possible depression and the PHQ-9
administered as a questionnaire (which includes the Whooley questions), may be
more useful in determining symptom severity or monitoring changes over time
(Kroenke et al, 2001)
Mental illness treatment usually follows a ‘stepped care’
approach (NICE, 2011a). Starting out with the least invasive bus most effective
intervention. If a person does not benefit from that or declines it, they are
offered another intervention. Treatment can range from counseling, to group
therapy or medication, or a combination of any of the three. Can even go as far as an inpatient admission
whether voluntarily or court ordered.
It is of the utmost importance to keep the patient’s wishes
an integral part of their treatment. It
enables them and gives them a sense of control.
Respect is key in any relationship, especially when you are asking
someone to basically put their future into your hands.
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