Insomnia severity index isi
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The Insomnia Severity Index is a 7 question assessment used to evaluate the severity of insomnia. Respondents rate their sleep difficulties over the past 2 weeks on a scale of 0-4 for each question. Scores are added up to determine the total: 0-7 indicates no clinically significant insomnia, 8-14 is subthreshold insomnia, 15-21 is moderate clinical insomnia, and 22-28 is severe clinical insomnia. The assessment evaluates difficulties falling asleep, staying asleep, waking too early, satisfaction with sleep patterns, noticeability of sleep problems to others, levels of worry about sleep, and interference of sleep problems with daily functioning.
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Problem gambling and anxiety disorders commonly co-occur, with studies finding 60% of those with problem gambling experiencing an anxiety disorder at some point in their life and high rates of comorbidity between problem gambling and disorders like panic disorder and social phobia. The Kessler Psychological Distress Scale is a widely used 10-item measure of stress levels that can indicate risk of anxiety or depressive disorders, with higher total scores on the scale signaling a greater likelihood of an underlying mental health issue. Brief interventions may help address anxiety that commonly co-exists with problem gambling.
DAY 2_Essentials of Mental Health.pptx.pdf
This document provides information on recognizing and responding to signs of mental distress. It discusses what distress is, common triggers for mental health issues like life changes, and physical, emotional, and behavioral signs of distress. These include lack of sleep, appetite changes, irritability, withdrawal, and changes in work performance. It also describes stress, acute stress disorder, chronic stress, anxiety, PTSD, and depression. The document recommends assessing immediate needs, clarifying the main concern, discussing an action plan, and following through. Psychological first aid principles like operating within an authorized system, offering assistance, and avoiding assumptions are covered.
A true supply curve shows the relationship between price and quant.docx
A true supply curve shows the relationship between price and quantity supplied. For the monopolist, the key issue to consider is that the monopolist does not make quantity decisions based on price, but rather based on marginal revenue.
This can be illustrated with the concept of price discrimination: The monopolist does not necessarily charge the same price for the same quantity in two separate markets for the same good, since the monopolist will first consider the elasticity of demand.
Consider the diagram below. Starting out with two different demand curves with corresponding marginal revenue curves (remember, MR has twice the slopes of the demand curve), just draw a marginal cost curve that crosses through the intersection of the two different marginal revenue curves. As you can see, since the two different MR curves represent different demand curves, the price will be different even when MC=MR gives the same quantity for each demand curve. In short, you do not have a one-for-one relationship between price and quantity, and this means that there is no stable supply curve here.
Question 2: In this context, in your own words carefully explain why economists say that a monopolistic firm does not have a true supply curve in the same sense that a perfectly competitive firm does.
Sit in Your Groups
While you wait – Share with your table group a goal you have for this semester.
INSTRUCTOR NOTE: Play music of your choice for about 5 minutes before class begins. We typically choose something upbeat and uplifting.
1
XXX
2
Questions
Mindfulness Activity
Participate
Happy Birthday to You
Happy Birthday to You
Happy Birthday dear STUDENT
Happy Birthday to You
4
Distress Tolerance and Willpower
Lesson 4
5
(DeCano & Cook, 2015)
Circled areas are related to the skills for today
6
Acceptance vs. Change
Acceptance
Validation
Change
Problem-Solving
Fulcrum or Balance of Life
We will learn Acceptance Skills
We will learn Change Skills
Again, a summary of the principle dialectic in DBT Skills: Acceptance and Change
7
Previous Lesson Summary
Goals are small attainable steps that help keep us moving towards our values. Values are the point at the end of a compass you can never reach, whereas goals are small achievable steps along the way. You can have values and related goals in many areas of your life.
When people live consistent with their values, their mental health is maximized, they report having a more satisfying life, and are more effective in their work and personal lives.
When we are faced with stressful situations, we can make impulsive choices that disconnect us from our values (that’s why clarifying them is so important!)
Highlight dialectics w/ love/hate parents
8
Previous Lesson Summary
Values also have transformational power to turn everyday routine, tedious, or annoying behaviors into meaningful and rewarding ones.
A dialectic is when two things that seem opposite are both true.
Using WOOP ...
A true supply curve shows the relationship between price and quant.docx
A true supply curve shows the relationship between price and quantity supplied. For the monopolist, the key issue to consider is that the monopolist does not make quantity decisions based on price, but rather based on marginal revenue.
This can be illustrated with the concept of price discrimination: The monopolist does not necessarily charge the same price for the same quantity in two separate markets for the same good, since the monopolist will first consider the elasticity of demand.
Consider the diagram below. Starting out with two different demand curves with corresponding marginal revenue curves (remember, MR has twice the slopes of the demand curve), just draw a marginal cost curve that crosses through the intersection of the two different marginal revenue curves. As you can see, since the two different MR curves represent different demand curves, the price will be different even when MC=MR gives the same quantity for each demand curve. In short, you do not have a one-for-one relationship between price and quantity, and this means that there is no stable supply curve here.
Question 2: In this context, in your own words carefully explain why economists say that a monopolistic firm does not have a true supply curve in the same sense that a perfectly competitive firm does.
Sit in Your Groups
While you wait – Share with your table group a goal you have for this semester.
INSTRUCTOR NOTE: Play music of your choice for about 5 minutes before class begins. We typically choose something upbeat and uplifting.
1
XXX
2
Questions
Mindfulness Activity
Participate
Happy Birthday to You
Happy Birthday to You
Happy Birthday dear STUDENT
Happy Birthday to You
4
Distress Tolerance and Willpower
Lesson 4
5
(DeCano & Cook, 2015)
Circled areas are related to the skills for today
6
Acceptance vs. Change
Acceptance
Validation
Change
Problem-Solving
Fulcrum or Balance of Life
We will learn Acceptance Skills
We will learn Change Skills
Again, a summary of the principle dialectic in DBT Skills: Acceptance and Change
7
Previous Lesson Summary
Goals are small attainable steps that help keep us moving towards our values. Values are the point at the end of a compass you can never reach, whereas goals are small achievable steps along the way. You can have values and related goals in many areas of your life.
When people live consistent with their values, their mental health is maximized, they report having a more satisfying life, and are more effective in their work and personal lives.
When we are faced with stressful situations, we can make impulsive choices that disconnect us from our values (that’s why clarifying them is so important!)
Highlight dialectics w/ love/hate parents
8
Previous Lesson Summary
Values also have transformational power to turn everyday routine, tedious, or annoying behaviors into meaningful and rewarding ones.
A dialectic is when two things that seem opposite are both true.
Using WOOP .
Insomnia - Common symptoms,causes and treatment
Do you have trouble falling asleep, or find yourself constantly waking up throughout the night ? You may have Insomnia. Take a self test @ https://www.sleepmedcenter.com/psychomotor-vigilance-test/
testanxiety2623.pptx
This document provides information about test anxiety and strategies to manage it. It defines test anxiety as a fear of failing or extreme distress when taking tests. Common physical and thought symptoms are described, such as rapid heartbeat, confusion, and negative self-talk. The document recommends positive thinking, connecting with support systems, avoiding procrastination, deep breathing exercises, positive self-affirmations, and seeking help from academic resources to help reduce test anxiety. A questionnaire is also provided to help determine if one's anxiety level is mild or more severe.
Eft basics
Emotional Freedom Techniques (EFT) is a self-help tool developed by Gary Craig in the mid-1990s based on Thought Field Therapy. EFT involves tapping on acupuncture points while focusing on an issue to reduce its intensity. It can help with stress, pain, phobias, depression and other issues. EFT works through the body's energy system to release emotions and restore balance like rebooting a computer. The document provides instructions for doing EFT with examples and answers frequently asked questions.
Understanding Vulnerabilities in the Treatment of Co-Occurring Disorders
Understanding Vulnerabilities in the Treatment of Co-Occurring DisordersDr. DawnElise Snipes ★AllCEUs★ Unlimited Counselor Training
The video for this presentation is available on our Youtube channel:
https://youtube.com/allceuseducation A continuing education course for this presentation can be found at https://www.allceus.com/member/cart/index/index?c=
Unlimited Counseling CEUs for $59 https://www.allceus.com/
Specialty Certificate tracks starting at $89 https://www.allceus.com/certificate-tracks/
Live Webinars $5/hour https://www.allceus.com/live-interactive-webinars/
CEs can be earned for this presentation at https://www.youtube.com/watch?v=krvEgvr7l_0
Instagram: AllCEUs
Pinterest: drsnipes
Learn about ways to help patients protect themselves to being susceptible to relapse.Group work - Stress management
Group work is required to form teams of 6 students each to develop a teaching plan on stress management for nurses using a 10 step process. The plan will be presented at Victoria Hospital and include definitions of stress, factors influencing workplace stress, and strategies to manage stress such as relaxation and seeking help. Visual aids, comparisons, and simple terms will be used to engage learners, who will be evaluated through discussion and a post-assessment.
Similar to Insomnia severity index isi (20)
Rc peds ql epilepsy module_2018-01-05_all_standard_acute
Rc peds ql epilepsy module_2018-01-05_all_standard_acute
Homework Post 9 Managing Negative EmotionsSkill Practice Refl.docx
Homework Post 9 Managing Negative EmotionsSkill Practice Refl.docx
CyberOm - Hacking the Wellness Code in a Chaotic Cyber World
CyberOm - Hacking the Wellness Code in a Chaotic Cyber World
Problem Gambling Coexisting Problems: Identifying Anxiety and Brief Intervent...
Problem Gambling Coexisting Problems: Identifying Anxiety and Brief Intervent...
A true supply curve shows the relationship between price and quant.docx
A true supply curve shows the relationship between price and quant.docx
A true supply curve shows the relationship between price and quant.docx
A true supply curve shows the relationship between price and quant.docx
Understanding Vulnerabilities in the Treatment of Co-Occurring Disorders
Understanding Vulnerabilities in the Treatment of Co-Occurring Disorders
More from Paul Coelho, MD
Suicidality Poster References.docx
This document contains summaries of several research papers on topics related to chronic pain, suicide risk, and bipolar disorder:
1) One study found that tapering opioid doses for chronic pain patients was associated with increased risks of overdose and mental health crisis compared to patients who did not taper. Higher tapering speeds were linked to even greater risks.
2) Another study observed chronic pain patients undergoing opioid tapering or transition to buprenorphine treatment. Higher initial opioid doses predicted needing buprenorphine, and benzodiazepine use predicted dropout. Pain levels varied after treatment.
3) Research on combat veterans found that those exposed to combat had higher rates of PTSD, suicide attempts, strokes and chronic pain
Labeling Woefulness: The Social Construction of Fibromyalgia
This document discusses the social construction of fibromyalgia and how it has been established as a legitimate disease label despite a lack of clear biological or clinical evidence. It argues that fibromyalgia serves social and economic purposes for various groups, including patients, doctors, pharmaceutical companies, and the media, but poses risks by medicalizing psychosocial problems. The document proposes that widespread pain is a normal human experience for some that is best addressed by exploring psychosocial factors rather than believing the solution lies in neurobiology. Examining fibromyalgia as a social construct may be more helpful for patients than continuing to medicalize their experiences.
Outcomes in Long-term Opioid Tapering and Buprenorphine Transition: A Retrosp...
This study analyzed outcomes for 240 patients with chronic pain who were prescribed long-term opioid therapy above 90 mg morphine-equivalent daily doses. Patients were offered an outpatient opioid taper or transition to buprenorphine if taper was not tolerated. 44.6% successfully tapered, 18.8% transitioned to buprenorphine, and 36.6% dropped out of treatment. Higher initial opioid doses predicted needing buprenorphine, and benzodiazepine/z-drug use predicted greater dropout. Pain intensity changes after treatment were mixed, with over half of tapered patients reporting increased pain and about half of transitioned patients reporting decreased pain.
Pain Phenotyping Tool For Primary Care
This document appears to be a questionnaire assessing symptoms of widespread pain and calculating a WPI (Widespread Pain Index) score and SS (Symptom Severity) score. It asks the respondent to indicate areas of pain on a diagram and rate the severity of symptoms like fatigue, thinking difficulties, and unrefreshed sleep. It also inquires about additional symptoms like abdominal pain, depression, and headaches. The final section rates pain-related worry and fear on a scale. Additional questions determine if the respondent has a workers compensation or disability claim related to their pain complaint.
Fibromyalgia & Somatic Symptom Disorder Patient Handout
Fibromyalgia is a condition that causes chronic aches and pains all over the body, fatigue, and often a sleep disorder. The doctor diagnosed the patient with fibromyalgia based on a score of 13 or more on the fibromyalgia questionnaire from the American College of Rheumatology, which is consistent with the syndrome. By focusing on and managing the diagnosis of fibromyalgia, the patient's other pain symptoms can decrease.
Community Catastrophizing
This document contains two studies related to psychological treatments for chronic conditions:
1) A study of chronic fatigue syndrome patients found that poorer outcomes were predicted by membership in a self-help group, receiving sickness benefits, and symptoms of dysphoria. Severity and duration of symptoms did not predict response.
2) A randomized controlled trial of 125 fibromyalgia patients compared operant behavioral therapy, cognitive behavioral therapy, and attention placebo. Both behavioral therapies significantly reduced pain intensity while cognitive therapy improved cognitive and affective variables and operant therapy improved physical functioning and behaviors. The attention placebo resulted in no improvement or deterioration.
Risk-Benefit High-Dose LTOT
This document summarizes three studies on the risks and efficacy of opioids for chronic non-cancer pain (CNP). The first study finds that while opioids were associated with small improvements in pain and physical functioning compared to placebo, they also increased the risk of vomiting. Comparisons to other medications found similar benefits to pain and functioning. The second study finds no difference in pain-related function between opioid and non-opioid groups over 12 months, and higher rates of adverse effects and pain intensity in the opioid group. The third study finds limited effectiveness of opioids for CNP, as opioid users did not report improvements in outcomes after 2 years. Regarding risks, higher opioid doses are associated with increased overdose risk across several patient groups in
Space Trial
1) This randomized clinical trial compared opioid vs nonopioid medication therapy over 12 months for patients with chronic back, hip, or knee pain.
2) It found no significant difference in pain-related function between the two groups, but pain intensity was significantly better in the nonopioid group. Adverse effects were significantly more common in the opioid group.
3) The study concludes that opioid therapy was not superior to nonopioid medications for improving pain-related function over 12 months, and the results do not support initiating opioids for moderate to severe chronic musculoskeletal pain.
Mortality quadrupled among opioid-driven hospitalizations notably within lowe...
This study analyzed national hospitalization data from 1993-2014 to examine trends in mortality and characteristics of hospitalizations related to opioids compared to other drug and non-drug hospitalizations. The key findings were:
1) Mortality among opioid-related hospitalizations quadrupled from 0.43% before 2000 to 2.02% in 2014, increasing 0.12 percentage points per year relative to other drug hospitalizations.
2) While total opioid-related hospitalizations remained stable, diagnoses shifted from opioid dependence/abuse to opioid/heroin poisoning, which have higher mortality rates. Hospitalizations for poisoning grew by 0.01 per 1,000 people annually after 2000.
3) Patients hospitalized for opioid/
Prescriptions filled following an opioid-related hospitalization.
This study analyzed prescription drug fills within 30 days of discharge for 36,719 patients hospitalized for opioid misuse. Only 16.7% received medications approved for opioid dependence, while 40.3% filled antidepressant prescriptions and 22.4% filled opioid pain medication prescriptions. Concurrently, 13.9% filled benzodiazepine prescriptions and 7.4% filled both benzodiazepine and opioid prescriptions, indicating a need for improved education on risks. Overall, more effort is required to ensure patients receive recommended post-hospitalization treatment and support services.
Jamapsychiatry santavirta 2017_oi_170084
This study examined the risk of psychiatric hospitalization in the offspring (second generation) of Finns who were evacuated to Sweden without parents during World War II (first generation), compared to offspring of Finns who were not evacuated. The study found that daughters of mothers who were evacuated during childhood had an elevated risk of psychiatric hospitalization, especially for mood disorders. However, there was no increased risk found for offspring of evacuated fathers or for male offspring of evacuated mothers. This suggests that early childhood adversity experienced by the first generation, such as war-related trauma, may be associated with mental health problems that persist into the second generation.
Correlation of opioid mortality with prescriptions and social determinants -a...
This study analyzed Medicare Part D data from 2013-2014 to examine the relationship between opioid prescription rates, socioeconomic factors, and opioid-related mortality rates at the county level in the United States. The results showed that higher county-level opioid prescription rates, especially those from emergency medicine, family medicine, internal medicine, and physician assistants, were associated with higher opioid-related mortality rates. Higher poverty levels and proportions of white populations in counties also correlated with increased mortality. Additionally, prescribers in the highest quartile of opioid prescription rates had a disproportionate impact on mortality compared to the remaining 75% of prescribers.
Gao recommendations to CMS
This report examines CMS's oversight of Medicare Part D beneficiaries who receive opioid prescriptions and providers who prescribe opioids to these beneficiaries. It finds that while CMS provides guidance to Part D plan sponsors on monitoring beneficiaries at high risk of opioid overuse, it lacks complete data on the full population of beneficiaries at risk. It also finds that CMS oversees prescribing through its contractor NBI MEDIC but does not specifically analyze opioid prescription data or require reporting on actions taken regarding inappropriate opioid prescribing. The report concludes that CMS needs more comprehensive oversight to reduce the risks of opioid misuse, overdose, and inappropriate prescribing among Medicare beneficiaries.
Prescribing by specialty
This study analyzed opioid prescription trends among medical specialties in the U.S. from 2007-2012 using a national prescription database. The key findings were:
- Primary care specialties (family practice, internal medicine, general practice) accounted for nearly half of all dispensed opioid prescriptions in 2012.
- Specialties treating pain conditions like pain medicine, surgery, and physical medicine had the highest rates of opioid prescribing.
- Overall opioid prescribing rates increased from 2007-2010 but stabilized from 2010-2012 as most specialties reduced rates.
- The greatest increase in opioid prescribing was among physical medicine specialists, while the largest decreases were in emergency medicine and dentistry.
The place-of-antipsychotics-in-the-therapy-of-anxiety-disorders-and-obsessive...
This document summarizes a research article about the use of antipsychotic drugs in the treatment of anxiety disorders and obsessive-compulsive disorders. The review finds evidence that certain second-generation antipsychotics (SGAPs), like quetiapine, risperidone, and aripiprazole, can be effective for generalized anxiety disorder (GAD) and obsessive-compulsive disorder (OCD). Quetiapine in particular receives a recommendation as a first-line treatment for GAD. However, the review finds insufficient evidence for SGAPs in the treatment of social anxiety disorder and panic disorder. First-generation antipsychotics are not recommended for any anxiety disorders based on their side effect profiles
Structured opioid refill clinic epic smartphrases
#*** I explained to the patient the risks of combining opioids and benzodiazepines based on medical literature. We agreed to slowly taper the patient off benzodiazepines and trial safer alternatives for sleep and anxiety issues.
#*** I showed the patient their fibromyalgia screening questionnaire results, which were consistent with a fibromyalgia diagnosis. Fibromyalgia can amplify other painful conditions and is often the primary source of morbidity when present with other chronic pain diagnoses.
#*** We discussed the patient's high risk opioid regimen based on their dose exceeding CDC guidelines. While willing to work on a harm reduction plan, it will require a taper or switching to buprenorphine due to safety concerns.
Opioids for the Treatment of Chronic Pain: Mistakes Made, Lessons Learned, an...
This document summarizes the key issues regarding the use of opioids for chronic pain treatment:
1) An overreliance on opioids to treat chronic pain has contributed to the prescription opioid abuse epidemic in the US, as outpatient use allows for abuse and diversion of these addictive drugs.
2) While clinical trials show opioids effectively treat acute pain and are initially effective for chronic pain, real-world use reveals increased risks of abuse, addiction, and poor functional outcomes over the long-term.
3) The evidence supporting chronic opioid therapy was limited and observational in nature, yet convinced the medical community until larger population studies showed increased abuse rates contrary to initial assumptions.
The potential adverse influence of physicians’ words.
The physician's words can inadvertently amplify patients' symptoms and increase somatic distress if not carefully considered. Learning about potential side effects from medications, procedures, or test results can lead patients to experience and report those effects more frequently through psychological mechanisms like misattribution and increased attention to bodily sensations. Discussing concepts like nocebo and viscerosomatic amplification with patients can help provide reassuring explanations for symptoms and make them feel less intrusive. Physicians should thoughtfully consider their word choices and focus on benefits as well as side effects to minimize undue distress.
Ctaf chronic pain__evidence_report_100417
This document is an evidence report published by the Institute for Clinical and Economic Review (ICER) that evaluates the comparative clinical effectiveness and value of cognitive and mind-body therapies for chronic low back and neck pain. It was authored by Jeffrey Tice and others from ICER. The report assesses the clinical evidence on therapies such as cognitive behavioral therapy and mindfulness-based stress reduction and presents economic analyses of the long-term cost-effectiveness and potential budget impact of these therapies. It also incorporates input from clinical experts and stakeholders.
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Fibromyalgia & Somatic Symptom Disorder Patient Handout
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Mortality quadrupled among opioid-driven hospitalizations notably within lowe...
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Prescriptions filled following an opioid-related hospitalization.
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Insomnia severity index isi
- 1. Insomnia Severity Index The Insomnia Severity Index has seven questions. The seven answers are added up to get a total score. When you have your total score, look at the 'Guidelines for Scoring/Interpretation' below to see where your sleep difficulty fits. For each question, please CIRCLE the number that best describes your answer. Please rate the CURRENT (i.e. LAST 2 WEEKS) SEVERITY of your insomnia problem(s). 4. How SATISFIED/DISSATISFIED are you with your CURRENT sleep pattern? Very Satisfied Satisfied Moderately Satisfied Dissatisfied Very Dissatisfied 0 1 2 3 4 5. How NOTICEABLE to others do you think your sleep problem is in terms of impairing the quality of your life? Not at all Noticeable A Little Somewhat Much Very Much Noticeable 0 1 2 3 4 6. How WORRIED/DISTRESSED are you about your current sleep problem? Not at all Worried A Little Somewhat Much Very Much Worried 0 1 2 3 4 7. To what extent do you consider your sleep problem to INTERFERE with your daily functioning (e.g. daytime fatigue, mood, ability to function at work/daily chores, concentration, memory, mood, etc.) CURRENTLY? Not at all Interfering A Little Somewhat Much Very Much Interfering 0 1 2 3 4 Guidelines for Scoring/Interpretation: Add the scores for all seven items (questions 1 + 2 + 3 + 4 + 5 +6 + 7) = _______ your total score Total score categories: 0–7 = No clinically significant insomnia 8–14 = Subthreshold insomnia 15–21 = Clinical insomnia (moderate severity) 22–28 = Clinical insomnia (severe) Used via courtesy of www.myhealth.va.gov with permission from Charles M. Morin, Ph.D., Université Laval Insomnia Problem None Mild Moderate Severe Very Severe 1. Difficulty falling asleep 0 1 2 3 4 2. Difficulty staying asleep 0 1 2 3 4 3. Problems waking up too early 0 1 2 3 4