How much do you know about the mental health needs of people with physical conditions?

This brief exercise that should take no more than 10-15 minutes.  It is aimed primarily at non-mental health professionals but others may find it interesting. Your answers will not be scored, so if you are unsure - just guess!

1.	Before we begin, which of these roles, if any, describe you?
	Non-mental health professional in a general hospital
	Primary care professional
	Mental health professional
	Social services professional
	Voluntary sector professional
	Patient, carer or member of the public
	Other (please state below)

Thanks! Click 'Next' to begin...

2.	How many people with physical illness experience mental health problems?
	1 in 16
	1 in 8
	1 in 4

Answer - 1 in 4.  Approximately one quarter of people with physical illness develop mental health problems as a consequence of the stress of their physical condition.  In these cases, the process of adjustment fails, and people develop depression, anxiety, panic or some other form of mental disorder.                                                         Depression is characterised by a persistent and severe low mood which is qualitatively different from ‘normal distress’.  Symptoms include loss of interest in life, difficulty concentrating and making decisions, feeling tired, restless or agitated, sleeping problems and loss of appetite.   Anxiety is characterised by severe agitation and apprehension which is qualitatively different from ‘normal worry’. Symptoms include constant worry, sleeping difficulties, palpitations, sweating, muscle pain and tension, faintness and digestive problems.

3.	The times when patients are most likely to become anxious and depressed are:
	When the physical illness is first diagnosed
	After major surgery
	When experiencing unpleasant side effects
	During relapse or recurrance of the illness
	When the illness stops responding to treatment
	All of the above

No prizes for guessing that these are all potentially stressful stages of a person's illness - but in reality, do you think that patients are asked about their emotional or psychological wellbeing often enough throughout their illness?       Did you know... Studies about people with head and neck cancer suggest that anxiety is often highest at the point of diagnosis, whereas depression peaks about two to three months after diagnosis.

4.	Approximately how many cases of depression in general hospital patients go undetected?
	A quarter
	Half
	Three quarters

Over half of all cases go unrecognised by medical staff.  This might be because the patient or clinician is reluctant to talk about it, or because some symptoms of depression (like tiredness) overlap.  In other cases, depression might not be discussed because it is seen as an inevitable consequence of illness and therefore not worth treating.   Depression is treatable though, and it can be detected using tools such as the one below, which are sometimes used by GPs: Two question depression screen: “During the last month have you been feeling down, depressed or hopeless?” and “During the last month have you often been bothered by having little interest or pleasure in doing things?”   Yes to either question has 96% sensitivity and 57% specificity compared to research interviews.

5.	How many hospital patients over the age of 65 experience mental health problems?
	20%
	40%
	60%

Up to 60% of older-aged people have or will develop a mental disorder during their admission, compared to 16% of older people in the general community.   The most common disorders in older-aged hospital patients are the three D's: Dementia   Delirium Depression

6.	Which of these '3 D's' is most commonly present in older-aged hospital patients?
	Dementia
	Delirium
	Depression

Dementia is the most common, closely followed by depression. A third of older people in hospital will have dementia   About 29% will have depression A fifth will have delirium                               For more information on the mental health needs of older patients, see the 'Who Cares Wins' report at www.bgs.org.uk

7.	According to a national survey, what percentage of 5-15 year olds has a mental disorder?
	5%
	10%
	15%

Around 10% of 5-15 year olds has a mental disorder, including 4% with anxiety and depression.   Children with medical conditions have a much higher incidence of mental health problems than the average population, and a higher incidence of learning disabilities, developmental disorders and autistic spectrum disorders.             Unfortunately, many hospitals have insufficient access to the child and adolescent mental health professionals required to help prevent, diagnose and treat these problems.

8.	How can depression and anxiety impede a person’s recovery from physical illness?
	The person may be less inclined to take part in treatment or rehabilitation
	Pain can become more difficult to control
	In extreme cases, the patient can come to believe that they are a burden on their family or the hospital and would be better off dead
	All of the above

All of the above. Once chronic illness develops, it can cause physical deterioration, inability to exercise, poorer quality of life, job loss and financial insecurity.  This can lead to problems such as relationship difficulties and worrying about the future. There might also be maladaptive health behaviours (such as increased alcohol consumption) and brain changes (both early and late).   For some people, this causes further depression or anxiety, affecting treatment compliance, ability to function and the perception of pain and other physical symptoms.  Interventions can help with many of these problems.

9.	Which of these is most likely to influence the level of stress experienced by a patient with any long-term condition?
	The severity of the illness
	The person's perception of the illness
	Both would have equal influence

The degree of stress experienced is more closely related  to the patient’s perception of the illness than the severity of the illness itself.   If a person perceives their illness to be very threatening, stress and fear will increase.  The opportunity to talk through fears and clarify the facts can help to reduce negative feelings.  This can lead to better symptom control and increased psychological wellbeing, even if the overall prognosis is poor.

10.	What percentage of outpatients with medically unexplained symptoms (MUS) will have diagnosable anxiety and depression?
	20%
	30%
	40%

40% of outpatients with MUS will have diagnosable anxiety and depression.  MUS also account for 20% of new presentations to primary care.  In many cases, no obvious physical cause is identified.  That is not to say that people with MUS are making it up, or attention seeking.  Often the patients concerned experience a great deal of suffering. Symptoms often overlap and might include: Fatigue Tension headaches Dizziness Palpitations Indigestion Constipation or diarrhoea Hand tremor Patients come away from consultations with clinicians feeling empowered: - If they feel understood and respected, and not dismissed - If they receive an explanation of their symptoms which makes sense to them - If their psychosocial issues are acknowledged

11.	How many people who experience an episode of acute coronary syndrome (such as after unstable angina or myocardial infarction) will experience post-traumatic stress disorder?
	5%
	15%
	25%

Answer - Post-traumatic stress disorder (or PTSD) occurs in about 15% of cases and is associated with poorer health and quality of life outcomes, reduced adherence to treatments and increased likelihood of readmission. Symptoms include depression, headaches, irregular heartbeats, muscle pains and flashbacks.     Treatment can include psychotherapy, cognitive behavioural therapy and/or symptom reducing medication, such as anti-depressants.

12.	Cognitive-behavioural programmes can be effective in reducing anxious and depressive symptoms in COPD patients in as little as a....
	2 hour session
	5 hour session
	7 hour session

Answer - Cognitive-behavioural programmes that focus on relaxation and changes in thinking are thought to be effective in reducing anxious and depressive symptoms in as little as a 2 hour session. Education about COPD can also reduce anxiety about the disorder and help individuals to develop a strategy for self-management, thus increasing their autonomy and confidence.

13.	This is the end of the quiz  - did you find it informative?
	Yes thanks
	No, not really

	Any comments or ideas for future exercises?

Thanks very much -now please click submit.