Mental Health

Awareness During
The Pandemic
BKD Convention July 26, 2022
DDB Webinar 330PM

Benny Vicente, MD
Psychiatric Consultant
Presentation Outline
1. Health, Mental health & Mental Disorders
2. Warning signs & Sx of Mental Disorders
3. How Common is Mental Disorders
4. What Causes Mental Disorder
5. COVID Stress
6. 5 Components of Stress Mx
7. Chronic Care Mx Model
8. 7 Keys to Mental Health
9. Sleep Hyigene
 Definition of Health
• Health is not merely the absence of illness or
disability but actually a person’s overall state of
wellness, which includes not only his physical
state, but his social and mental well-being as
well.
-World Health Or ganization1946

• “…no health without mental health...”

• - World Health Assembly 2013
Spectrum of Health
Positive
Best Health Possible or
Health
Better Health

Freedom from Sickness

Unrecognized Sickness

Mild Sickness

Severe Sickness / Death RIP

Positive health equals:
Predicts Longevity
Health Cost
Better Mental Health in Aging
Better Prognosis when
illness (COVID) strike !
Positive health equals:

Better Mental Health

 is the successful
performance of mental function, resulting in

productive activities (WORK),

WORK
fulfilling relationships (LOVE)
LOVE SELF/
w/ other people ( and SELF) PLAY
& providing the ability to
SLEEP &
adopt to change SEX &…
2/3rd of Life-
Waking Life
& cope with adversity 1/3rd of life
spent in Bed
Vicente 2018
CONCEPT OF MENTAL DISORDER
•Abnormal manifestations in
Mood
Thinking
Behavior
+
•DISTRESS and/or DYSFUNCTION
•Sustained or recurring
Early Signs & Sx of Mental Disorders

MOOD:
1. Dramatic shifts in emotions/depressive feelings

2. Nervousness, fears or suspiciousness of others

3. Vague feeling of being disconnected from self

or surroundings, a sense of unreality
Early Signs & Sx of Mental Disorders
THINKING:
4. Problems w/concentration, memory or logical
thinking & speech that are hard to explain

5. Illogical, magical, childish thinking, unusual or

exaggerated beliefs about personal powers- to
understand meaning or influence events

6. Increased/heightened sensitivity to sights,

sounds, smell or touch – avoidance of
overstimulating situation
Early Signs & Sx of Mental Disorders
BEHAVIOR:
7. Sleep/appetite changes or decline in self care
8. Unusual drop in functioning in school, work or
social activities, quit sports, failing grades,
difficulty performing familiar task
9. Apathy- loss of initiative/drive to participate in
any activity
10. Recent social withdrawal/ lost of interest in
activities previously enjoyed
11. Unusual, odd or uncharacteristic behavior
Common Mental Disorders include:
•Unipolar depressive disorders
•Bipolar affective disorders
•Schizophrenia
•Epilepsy
•Alcohol & selected drug disorder
•Alzheimer’s disease & other dementias
•Post-traumatic stress disorder
•Obsessive & compulsive disorder
•Panic disodrers
•Primary insomnia
WHO, World Health Report 2001
•Anxiety Disorders
•Depression
•Substance Use Disorders
•Psychosis
ANXIETY- normal to feel anxious occasionally
when faced w/ a potentially harmful
situation. It serves as a signal for us to
address the danger around us.

ABNORMAL ANXIETY
Inappropriate –no real source of fear

Exaggerated or Excessive – source not sufficient

to account for the severity

Interfere with daily functioning & IPR

Chronic, sustained, lingering or recurrent

ANXIETY DISORDER
1. Generalized Anxiety Disorder
2. Panic Disorder
3. Social Anxiety Disorder (Social Phobia)
4. Specific Phobia
5. Agoraphobia
6. Separation Anxiety
7. Selective Mutism
8. Medically Induced Anxiety Disorders
•Sadness : inherent part of human experience

•Grief or bereavement : over loss or threatened

loss

•Depression as illness: impairment in functioning

DSM 5 Criteria for depression
5 or more symptoms – 2 week period at least one symptom
either (1) Depressed Mood or (2) loss of interest or pleasure

1. Depressed Mood most of the day

2. Markedly diminished interest or pleasure…

3. Fatigue or loss of energy

4. Slowing down of thoughts & a reduction of physical movement

5. Recurrent thoughts of death, suicide ideation, attempt or plan…

6. Feelings of worthlessness or excessive guilt..

7. Diminished ability to think or concentrate or indecisiveness

8. Significant weight loss(gain) when not dieting …

+ distress & dysfunction

1. A compulsion to seek and take drugs,
2. Loss of control in limiting intake and,
3. Emergence of a negative emotional
state when access to the drug is
prevented

Substance Abuse & Dependence merged

 2 Key Indicators of Drug
Dependence

Tolerance Withdrawal
o Need for increased o Characteristics of
amount Withdrawal
o Diminished marginal Syndrome
effects
UNODC
1. Gateway – alcohol, cigarettes, marijuana

2. Depressant – slows CNS, Alcohol, Barbiturates,

Tranquilizers
3. Stimulant – Amphethamines, shabu, caffeine,
nicotine, cocaine
4. Narcotics – pain meds, opiods, heroin, cannabis

5. Hallucinogens – LSD, psilocybin, mushrooms,

mescaline, cannabis
6. Inhalants – Acetone, Rugby, spray paint, Cleaning
fluids, Freon …
Ever Used

76%

2%

16%

92%

46%

13% -- 9% -- Anti-Anxiety
DSM 5 Criteria for Substance Use Disorder

1. Takingthe drug in larger amounts and for longer

than intended

2. Wanting to cut down or quit but not being able

to do it

3. Spending a lot of time obtaining the drug

4. Craving or a strong desire to use the drug

DSM 5 Criteria for Substance Use Disorder
5. Repeatedly unable to carry out major obligations at work,
school, or home due to drug use

6. Continued use despite persistent or recurring social or

interpersonal problems caused or made worse by drug use

7. Stopping or reducing important social, occupational, or

recreational activities due to drug use

8. Recurrent use of the drug in physically hazardous situations

DSM 5 Criteria for Substance Use Disorder
The Severity of each Substance Use Disorder
is based on:
0 criteria or 1 criterion: No diagnosis

2-3 criteria: Mild Substance Use Disorder

4-5 criteria: Moderate Substance Use Disorder

6 or more criteria: Severe Substance Use

Disorder
1. Compulsion to seek & take drugs
2. Craving for the drugs
3. Continued use in spite of
negative consequences
4. Loss of Control of drug use
1. Death – overdose-tolerance
 Increase dosage – miscalculated, poly drug use
 Usual dose after long abstinence
 Simply bad drugs with impurities
 Mismanaged withdrawal treatment
 Suicide

2. Psychosis & other mental disorders

Health :
RESILIENCY

PROMOTIVE

Risky Use

PREVENTIVE Use with

Problems

PSYCHOSIS
TREATMENT
DEATH

Vicente 2020
Psychotic Mental Disorder
•25% - life prevalence
•10% of adult population – point prevalence
•20% - of all patients seen by primary health care
professional have one or more mental disorders

One in four families is likely to have at least one

member with behavioral or mental disorders

2020 ---3.6M Filipinos suffering from one kind of

mental, neurological & SUD
Phil. WHO Special Initiative Study
 Meta analysis
5 studies (n= 9,074 ) STRESS --------- 29.6%
17 studies (n= 63,439) ANXIETY --------- 31.1%
14 studies (n=44,531) DEPRESSION – 33.7%

Conclusion – COVID does not only cause physical health

concerns but also psychological disorders
 vs (META-ANALYSIS)

Anxiety 14.3 % (31.1%)

Panic 5.6 %
Depression 5.3 % (33.7%)
Psychosis 4.3 %
Organic Impairment of memory 1.2 %
Substance Abuse 0.7 % (1.8M)** (1.67)#
Obsessive-Compulsive 0.6 %

* Perlas A.P, et. al. 1994. This community based study was undertaken in three provinces (Iloilo, Negros Oriental,
Antique) covering more than 3000 subjects.
**DDB 2015 Survey = 1.8M PWUDs – #DDB 2019 Survey = 1.67M Current User
Suicide Rates
2016 Global rate -------------------------------------10.53
( /100,000 popn)

Range= (Barbados – 0.4 - Guyana- 30.2)

South east asia –-------------------------------- 13.40
Philippines ------------------------------------------3.2
2018: 4.3/ 100K----- males
2.0/100K------ females WHO

Philippines Pandemic Suicide Incidence

2015 – 2020 ------ 2,630 average deaths/year
2019 ---------------- 2,808 deaths
2020 ---------------- 3.529 deaths 25.7% Phil. Statistical Authority

One person dies every 40 seconds –WHO 2019 ,every 11 minutes – USA 2017, every 2 & 1/2 hrs – RP 2020
 What Causes
Mental Disorder ?

NATURE OGK

NURTURE
STRESS

Vicente 2021
Diathesis – Stress Model / Formula

Vulnerability
Mental
for
mental disorder
Stress Disorder

Biological factors Acute Traumatic Stress

Psychological factors Chronic Stress
Social factors Covid Stress

OGK Vicente 2021

Diathesis – Stress Model / Formula
Vulnerability
for Addiction
mental disorder / DRUGS
SUD SUD

Biological factors Route of Administration,

Psychological factors effect of drug, early use,
Social factors availability, cost…

OGK Vicente 2021

 Vulnerability
for Mental
mental disorder
Stress Disorder

You may not be able to control your

VULNERABILITY

but
you can certainly manage
your STRESS!
 Vulnerability
for Stress Mental
mental disorder Disorder

Chronic Stress -influence physical & mental well being

Chronic Stress - shown to be asso. with disease
…directly or indirectly.
Depression wound healing
CVDs URT Infections
Asthma Autoimmune disease
Herpes viral infections Tumor progression
HIV/AIDS Psychosomatic disorders
Vicente 2021
 Acne
 Allergy  Herpes
 Angina  Irritable Colon
 Arrythmia  Migraine
 Asthma
 Neuro Dermatitis
 Chronic Pain
syndrome  Obesity
 Heart Disease  Dysmenorrhea
 Diabetes Mellitus  Rheumatoid
 Stress Ulcers Arthritis
 Hypertension  Warts
 90% of Stress Mx
is all about knowing
your Stressors!
Kinds of Stressors
ACUTE SOCIAL

BIOLOGICAL CONSCIOUS

COVID
-
UNCONSCIOUS STRESS ENVIRONMENTAL

PSYCHOLOGICAL CHRONIC
Vicente 2021
 Covid Stress
Fear & anxiety about COVID can
be overwhelming & will cause
strong emotional response in
almost every one!
How a person will respond to COVID Stress will depend on his /her
background, personality, the community where one lives and one’s current
health condition
Effect of Covid Stress
1. Fear (of danger & contamination) & worry about
ones health & family
2. Changes in sleep or eating patterns
3. Difficulty Sleeping or concentrating
4. Worsen chronic health problems
5. Worsen mental health conditions
6. Increase use of alcohol, tobacco or drugs
- adverse socio-economic
7. Fear of
8. Traumatic Stress symptoms e.g. nightmares
9. Compulsive checking
10. Xenophobia and others
Response to Covid Stress
will depend one’s background, personality, the

one’s
community where one lives and

current health condition

1. Time Management
2. Physical Exercise
3. Relaxation Training & Healthy
Pleasures
4. Social support & Communication
5. Nutrition - Diet
It ‘s not the load that breaks
you down, it’s the way you
carry it.” Lou Holtz
 I II
Lifestyle change, diet,
DIABETES Control of blood sugar, anti
sweets, exercise,
diabetics, insulin, etc.
stress management

Control of blood pressure, beta Lifestyle change, exercise,

HYPERTENSION blockers, statins, blood low fat, low salt diet, stress
thinners, etc. management

Lifestyle change, better

ADDICTION Control of craving for drugs, relationships with loved ones,
detox, substitute drugs, etc. spirituality, exercise, stress
mx, PSR

Control of signs & sx of Lifestyle change, better

MENTAL psychosis, eg. delusions, relationships with loved ones,
DISORDERS hallucinations, depression, etc., spirituality, exercise, stress
neuroleptics mx, PSR
Vicente 2018
 . Lifestyle Change

Life is a pie WORK

SELF CARE/
SLEEP PLAY
LOVE
sex &…

1/3rd or 7-8 hrs.

spent in bed 2/3rd or 16-17 hrs.
SLEEP PIE
Awake pie Vicente 2017
Drug Addict’s LIFE PIES?
No work, time
spent looking for
drugs, stealing, ...
3-4 days awake, Neglected self
then sleeps whole care; health Love replaced
day or two… problems: with hate,
hepatitis, distrust, shame,
HIV/AIDS, skin guilt, anger,
problem… separation…

Vicente 2017
Drug Addiction Treatment Simplified
I. CONTROL CRAVING

II. Replace addictive LIFE STYLE CHANGE

lifestyle with a
HEALTHIER
LIFESTYLE or LESS
HARMFUL
LIFESTYLE

III. MAINTAIN SOBRIETY

Vicente 2021
7 Side Effects of Sleep Deficiency
1. Long Term Mood Disorder & Anxiety

2. Sickness – lowers immune system

3. Diabetes - < 5 hrs increase risk DM

4. Infertility – reduce reproductive hormone

5. Weight Gain - < 7 hrs -30% more to be obese

6. Low Libido – poor quality = decrease interest

7. Heart Disease – Increase HR, HPN, inflamation

Lack of Sleep Hurts the Brain
1. Frontal lobe- Difficulty Focusing
Creativity Declines

2. Prefrontal lobe – Vision Worsens

3. Temporal Lobe – Speech becomes slurred

4. Neocortex – Difficulty learning new materials

5. Parietal Lobe - Information is processed slower

Problem solving skills decline
Boston College
 10 Sleep Hygiene Tips
1. 7-8 hrs. sleep only.
2. Get up the same time each AM
3. Regular exercise in AM deepens sleep
4. Proper sleep environment is conducive to sleep
5. Light snack may help sleep onset
6. Avoid drinking excessive H20 at night
7. Avoid cigarettes, alcohol & caffeine
8. Bed is only for sleep and sex
9. Time to wind down is conducive to sleep
10. Avoid worrying in bed about not being able to sleep
1. Connect -talk, listen, be there, feel connected,
give time, words & presence, pets, nature, God …
2. Be Active - do & enjoy what you can do,
move your mood, notice the simple things you enjoy
3. Managing Stress – become aware of what stresses you
4. Healthy Diet – avoid drugs and alcohol, balance diet
5. Quality Sleep – schedule at least 7 to 8 hrs of sleep
6. Keep Learning – embrace new experience, seek
oppurtunities, surprise yourself
7. Meaning & Purpose ! “ He who has a why to live
can bear with almost any how.” Victor Frankl
1. Recall Positive Life Events
2. Practice Mindfulness
3. Express Gratitude
4. Perform Acts of Kindness
Tips on how parents can help their
children avoid drug addiction
1) Address your child’s curiosity about drugs.
• Educate & Inform your child on the harmful effects
of drugs & why one should not take drugs

2) Address boredom by engaging your child

in activities that are intellectually
& socially fulfilling
• Keep your children in school, sports or other
activities that will promote self-esteem
& build social skill
Tips on how parents can help their
children avoid drug addiction
3) Teach your children how to effectively say
NO to drugs
• Know your child’s friends and whereabouts
• Assertiveness training may sometimes be
valuable
4) Be a good role model to your children
• Adopt good parenting style
• Foster positive family environment where open
communication exist and positive values are
instilled in children
• A policy of no smoking, alcohol and drugs in the
house is definitely helpful.
5) Seek professional advice when needed
 he family is the factory
where different kinds
of persons are made…

roubled families make troubled people and thus

contribute to crime, mental illness, alcoholism,
drug abuse, poverty, alienated youth and many
other social problems.
- V. Satir

SALAMAT !!!
Messenger Benny Vicente
09175412758