the screening test for common mental disorders in the military colonel bui quang huy 1, colonel cao...

THE SCREENING TEST FORTHE SCREENING TEST FOR COMMO COMMONN

MENTAL MENTAL DDISORDERS IN ISORDERS IN THE THE MILITARYMILITARY

Colonel Bui Quang Huy1, Colonel Cao Tien Duc1, Lieutenant Nguyen Trong Dao1, Sublieutenant Pham Thi Thu2 1 (Psychiatric department, Military Hospital 103)2 (15th resident physician class, Military medical university)

BACKGROUND

• There are many mental soldiers in the military. • Common mental disorders: depression,

bipolar disorder and schizophrenia• In Psychiatric department of Military Hospital

103, many conscripts were hospitalized suffering from mental disorders before enlistment because these diseases can’t be detected at examination for military service

• Causes: the lack of psychiatrist in the military.

• It is necessary to have a rapid test in order to eliminate early psychiatric patients out of the military. Furthermore, the test must be as easy as possible to use for the general doctors.

• Object:

To develop a sreening test for common mental disorders in the military

•In the world and Vietnam: using Beck depression scale, Zung anxiety scale, rating scale for depression, anxiety Hamilton

These scales just intend to determine the degree of the diseases rather than be a diagnotic tool.

•Diagnostic and Statistical Manual of Mental Disorders, 5th ed (DSM-5)•International Classification of Diseases, 10th ed (ICD-10)

have many specialized terms

•In the world and Vietnam: using Beck depression scale, Zung anxiety scale, rating scale for depression, anxiety Hamilton

These tool just supports intended to determine the degree of the disease rather than a diagnostic tool

•Diagnostic and Statistical Manual of Mental Disorders, 5th ed (DSM-5)•International Classification of Diseases, 10th ed (ICD-10)

uses many specialized terms relatively confusing for the general doctors as bizarre delusions, grandiose delusion, flight of idea...

1. Decreased need for sleep ( they just sleep 1-2 hours per day without fatigue).

Present Not present

2. Elevated mood (his face express the excitement and excessive happiness)

Present Not present

3. Inflated self-esteem (believe that he have many talents)

Present Not present

4. More talkative than usual or pressure to keep talking (he say fast, say constantly throughout the day, talking about all subjects).

Present Not present

5. Exessive happiness (his facial expression is very happy, joyful attitude, laughing chatter. He sings, reads poetry, acts drama passionately without knowing whether people around him want to enjoy it).

Present Not present

6. Flight of idea (his thoughts overlap like we monitored simultaneously 2 or 3 television programs, moving abruptly from one topic to another).

Present Not present

7. Distractibility (inability to concentrate attention, do not focus on a certain job if there is small external stimuli).

Present Not present

8. Increase in goal-directed activity (shopping very much, beyond their ability to pay, more sexual relations)

Present Not present

Delusion

• Persecutory delusion • Referential delusion• Delusion of control • Grandiose delusion • Bizarre delusions

Hallucination

• Comment auditory halucination • Command hallucination • Auditory hallucination • Visual hallucination •Tactile hallucination

Delusion


believe that they are abused, tortured, poisoned, would be killed by a person or a certain force

Hallucination

• Comment auditory halucination • Command hallucination • Auditory hallucination • Visual hallucination •Tactile hallucination

Delusion


believing that some books, essays, songs or

some other external information refer them with the special forms

Hallucination

• Comment auditory halucination • Command hallucination • Auditory hallucination

• Visual hallucination •Tactile hallucination

Delusion


believe that his actions are being acted on or manipulated by some

outside force

Hallucination



Delusion


believe that he have many talents, he can

climb the highest mountain of the world with his bare hands, he can do the math faster

than computers ...Hallucination



Delusion


believe that they can control the weather, they

live with the organ of another person, his

internal organs were replaced by someone but

they did not have an injury or scars

Hallucination



Delusion


Hallucination



he hears a voice that admire or decry him although no one said

around him

Delusion


Hallucination



he hears a voice that induce or order him to

do something

Delusion


Hallucination



talk to him like we talk on the phone

Delusion


Hallucination



he can see the images which are not real as

seeing bandits chased him, birds, ants ...

despite the fact there are nothing

Delusion


Hallucination



feeling of insects crawling under the skin,

feeling of snakes crawling in the stomach

THE RAPID SCREENING TEST FOR MANIC EPISODE

• Decreased need for sleep • Elevated mood • Inflated self-esteem • More talkative than usual or pressure to keep talking • Exessive happiness • Flight of idea • Distractibility• Increased in goal-directed activity

THE RAPID SCREENING TEST FOR DEPRESSIVE EPISODE


they just sleep 1-2 hours per day without fatigue



his face express the excitement and excessive happiness



Believe that he have many talents



He say fast, say constantly throughout the day, talking about all subjects



His facial expression is very happy, joyful attitude, laughing chatter. He sings, reads poetry, acts drama passionately without knowing whether people around him want to enjoy it



His thoughts overlap like we monitored simultaneously 2 or 3 television programs, moving abruptly from one topic to another



Inability to concentrate attention, do not focus on a certain job if there is small external stimuli



Shopping very much, beyond their ability to pay, more sexual relations

THE SREENING TEST FOR DEPRESSIVE EPISODE

• Sleep disturbances • Depressed mood • Diminished interest or pleasure in almost activities• Decreased appetite, weight loss • Psychomotor change • Dereased energy • Feelings of worthlessness or inapprociate guilt • Diminished ability to think or concentrate or indecisiveness • Thoughts of death or have suicidal behaviors



At least one of the following symtomps has been present: difficulty initialing sleep, difficlut maintaining sleep, waking up too early or sleep more than 10 hours every day



The patient's facial expression very monotonous, always sad, wrinkles reduce, even lose wrinkles



Individual may report not feeling any enjoyment in activities that were prevously considered pleasurable



Loss of appetite, eating less, forced to eat, lost more than 1kg in a month when not dieting



e.g., pacing, inability to sit still or slowed speech, thinking, and body movement; speech that is dereased in volume, amount and variety of content



Fatigue or exhaustion, even a smallest tasks seem to require substantial effort



believe that he was worthless, becoming a burden to family, institutions and society



Unable to read a short article, unable to listen all the songs they used to love, unable to watch a television program that they previously still interested



May range from not to awaken in the morning or a belief that others would be better if the individual were dead, to transient but recurrent thoughts of commitng suicide, to a specific suicide plan

proceeding through the three sections

compiling a total, composite score based upon the summation of each item

Manic episode Depressive episode

Psychosis episode

0-8 0-9 0-10

•Each item is scored independently based on a two-point, ratio scale.

•A rating of 1 and 0 indicates that the symptom is present and not present in the soldier, respectively.

Negative Doubl Possitive

≤ 2 3-4 ≥5DEPRESSIVE

EPISODE

Negative Doubl Possitive

≤ 2 3 ≥4MANIC

EPISODE

PSYCHOSIS EPISODE

Negative Possitive

0 ≥1

CONCLUSION

Possible application: can be used from the regimental

hospital or more. The general doctor needn’t be trained

more in psychiatry still being able to apply to diagnose

mental disorders easily.

The test has been applied in the whole army to mental

health screening.

Limitation: with the aims to exclude mental soldier from the military, the test is to determine whether or not the expression of mental disorders.

Therefore, there should be further studies to develop the questionnaire, which can help confirm the diagnosis of mental disorders.

THANK YOU FOR YOUR ATTENTION !!!

the screening test for common mental disorders in the military colonel bui quang huy 1, colonel cao...

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