THE SCREENING TEST FOR THE SCREENING TEST FOR COMMO COMMO N N MENTAL MENTAL D D ISORDERS IN ISORDERS IN THE THE MILITARY MILITARY Colonel Bui Quang Huy 1 , Colonel Cao Tien Duc 1 , Lieutenant Nguyen Trong Dao 1 , Sublieutenant Pham Thi Thu 2 1 (Psychiatric department, Military Hospital 103) 2 (15 th resident physician class, Military medical university)
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THE SCREENING TEST FOR COMMON MENTAL DISORDERS IN THE MILITARY Colonel Bui Quang Huy 1, Colonel Cao Tien Duc 1, Lieutenant Nguyen Trong Dao 1, Sublieutenant.
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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
• 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
• 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
they just sleep 1-2 hours per day without fatigue
THE RAPID SCREENING TEST FOR DEPRESSIVE 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
his face express the excitement and excessive happiness
THE RAPID SCREENING TEST FOR DEPRESSIVE 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
Believe that he have many talents
THE RAPID SCREENING TEST FOR DEPRESSIVE 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
He say fast, say constantly throughout the day, talking about all subjects
THE RAPID SCREENING TEST FOR DEPRESSIVE 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
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
THE RAPID SCREENING TEST FOR DEPRESSIVE 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
His thoughts overlap like we monitored simultaneously 2 or 3 television programs, moving abruptly from one topic to another
THE RAPID SCREENING TEST FOR DEPRESSIVE 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
Inability to concentrate attention, do not focus on a certain job if there is small external stimuli
THE RAPID SCREENING TEST FOR DEPRESSIVE 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
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
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 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
The patient's facial expression very monotonous, always sad, wrinkles reduce, even lose wrinkles
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
Individual may report not feeling any enjoyment in activities that were prevously considered pleasurable
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
Loss of appetite, eating less, forced to eat, lost more than 1kg in a month when not dieting
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
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
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
Fatigue or exhaustion, even a smallest tasks seem to require substantial effort
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
believe that he was worthless, becoming a burden to family, institutions and society
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
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
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
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.