CARING FOR PERSONS WITH MENTAL HEALTH PROBLEMS Chapter 27 CARING FOR PERSONS WITH MENTAL HEALTH PROBLEMS Elsevier items and derived items © 2010 by Mosby, Inc. an affiliate of Elsevier Inc. All rights reserved

Mental relates to the mind. The whole person has physical, social, psychological, and spiritual parts. Mental relates to the mind. Mental health and mental illness involve stress. Stress is the response or change in the body caused by any emotional, physical, social, or economic factor. Mental health means that the person copes with and adjusts to everyday stresses in ways accepted by society. Mental illness is a disturbance in the ability to cope with or adjust to stress. ● Each part affects the other. ● Mental relates to the mind. ● With mental illness, behavior and function are impaired. Elsevier items and derived items © 2010 by Mosby, Inc. an affiliate of Elsevier Inc. All rights reserved

Causes of mental health disorders include: Mental disorder, emotional illness, and psychiatric disorder also mean mental illness. Causes of mental health disorders include: Not being able to cope or adjust to stress Chemical imbalances Genetics Drug or substance abuse Social and cultural factors Elsevier items and derived items © 2010 by Mosby, Inc. an affiliate of Elsevier Inc. All rights reserved

ANXIETY DISORDERS Anxiety is a vague, uneasy feeling in response to stress. Often anxiety occurs when needs are not met. Some anxiety is normal. Persons with mental health problems have higher levels of anxiety. Signs and symptoms depend on the degree of anxiety. Coping and defense mechanisms are used to relieve anxiety. Defense mechanisms are unconscious reactions that block unpleasant or threatening feelings. With mental health problems, they are used poorly. ● Review the contents of Box 27-1 on p. 000 in the textbook. ● Some coping and defense mechanisms are healthy; others are not. ● Review the contents of Box 27-2 on p. 000 in the textbook. ● Some use of defense mechanisms is normal. Elsevier items and derived items © 2010 by Mosby, Inc. an affiliate of Elsevier Inc. All rights reserved

Some common anxiety disorders are: Panic disorder Panic is an intense and sudden feeling of fear, anxiety, terror, or dread. Phobias (Phobia means an intense fear.) Obsessive-compulsive disorder (OCD) An obsession is a recurrent, unwanted thought, idea, or image. Compulsion is repeating an act over and over again. Post-traumatic stress disorder (PTSD) occurs after a terrifying ordeal. Flashbacks are common. A flashback is reliving the trauma in thoughts during the day and in nightmares during sleep. ● With panic disorder, onset is sudden with no obvious reason. The person cannot function. Signs and symptoms of anxiety are severe. ● The person with a phobia has an intense fear of an object, situation, or activity that has little or no actual danger. When faced with the fear, the person has high anxiety and cannot function. ● The person with obsessive-compulsive disorder (OCD) has much anxiety if an act or ritual is not done. ● Review the contents of Box 27-3 on p. 000 in the textbook for signs and symptoms of PTSD. ● PTSD may become chronic. ● PTSD can develop at any age. Elsevier items and derived items © 2010 by Mosby, Inc. an affiliate of Elsevier Inc. All rights reserved

SCHIZOPHRENIA Schizophrenia means split mind. It is a severe, chronic, disabling brain disorder that involves: Psychosis (A state of severe mental impairment) Delusion (A false belief) Hallucination (Seeing, hearing, smelling, or feeling something that is not real) Paranoia (The person has false beliefs and is suspicious.) Delusion of grandeur (An exaggerated belief about one’s importance, wealth, power, or talents) Delusion of persecution (The false belief that one is being mistreated, abused, or harassed) People with schizophrenia do not tend to be violent ● Thinking and behavior are disturbed. ● The person has problems relating to others. ● The person may withdraw. ● Disorders of movement occur. ● Some persons regress (retreat or move back to an earlier time or condition). ● In men, the symptoms usually begin in the late teens or early 20s. ● In women, symptoms usually begin in the mid-20s and early 30s. ● If violence occurs, violence is often directed at family members. ● Some people with schizophrenia may attempt suicide. ● Review the Focus on Communication: Schizophrenia Box on p. 000 in the textbook. Elsevier items and derived items © 2010 by Mosby, Inc. an affiliate of Elsevier Inc. All rights reserved

MOOD DISORDERS Mood disorders involve feelings, emotions, and moods. Two common mood disorders are: Bipolar disorder (manic-depressive illness) The person has severe extremes in mood, energy, and ability to function. Signs and symptoms can range from mild to severe. Major depression Depression involves the body, mood, and thoughts. The person is very sad. Causes include a stressful event, physical disorders, and hormonal factors in women. ● Mood relates to feelings and emotions. ● Review the contents of Box 27-4 on p. 000 in the textbook. ● With bipolar disorder, there are emotional lows (depression) and emotional highs (mania). ● Bipolar disorder tends to run in families. It usually develops in the late teens or in early adulthood. ● Signs and symptoms of bipolar disorder can range from mild to severe. Some people are suicidal. ● The person with major depression loses interest in daily activities. Body functions are depressed. ● Review the Focus on Older Persons: Mood Disorders (Major Depression) Box on p. 000 in the textbook. ● Review the contents of Box 27-5 on p. 000 in the textbook. Elsevier items and derived items © 2010 by Mosby, Inc. an affiliate of Elsevier Inc. All rights reserved

PERSONALITY DISORDERS Personality disorders involve rigid and maladaptive behaviors. Maladaptive means to change or adjust in the wrong way. Antisocial personality disorder The person has poor judgment. He or she lacks responsibility and is hostile. Morals and ethics are lacking. Borderline personality disorder (BPD) The person has problems with moods, interpersonal relationships, self-image, and behavior. The person has intense bouts of anger, depression, and anxiety. ● To adapt means to change or adjust. ● Those with personality disorders cannot function well in society. ● The person with antisocial personality disorder is not loyal to any person or group. The rights of others do not matter. The person does not learn from experiences or punishment. ● With borderline personality disorder, aggression, self-injury, and drug or alcohol abuse may occur. Elsevier items and derived items © 2010 by Mosby, Inc. an affiliate of Elsevier Inc. All rights reserved

SUBSTANCE ABUSE AND ADDICTION Substance abuse or addiction occurs when a person overuses or depends on alcohol or drugs. The person’s physical and mental health are affected. The welfare of others is affected. Substances involved in abuse and addiction affect the nervous system. All affect the mind and thinking. Elsevier items and derived items © 2010 by Mosby, Inc. an affiliate of Elsevier Inc. All rights reserved

Alcoholism includes these symptoms: Craving (The person has a strong need or urge to drink.) Loss of control (The person cannot stop drinking once drinking has begun.) Physical dependence (The person has withdrawal symptoms when he or she stops drinking.) Tolerance (The person needs to drink greater amounts of alcohol to get “high.”) Alcoholism is a chronic disease lasting throughout life. It can be treated but not cured. ● Alcohol slows down brain activity. It affects alertness, judgment, coordination, and reaction time. ● Over time, heavy drinking damages the brain, central nervous system, liver, heart, blood vessels, kidneys, and stomach. It can cause forgetfulness and confusion. ● Counseling and drugs are used to help the person stop drinking. The person must avoid all alcohol to avoid a relapse. ● Review the Focus on Older Persons: Abuse and Addiction (Alcoholism) Box on p. 000 in the textbook. Elsevier items and derived items © 2010 by Mosby, Inc. an affiliate of Elsevier Inc. All rights reserved

Drug abuse and addiction Drug abuse is the overuse of a drug for non-medical or non-therapy effects. Drug addition is a chronic, relapsing brain disease. The person has an overwhelming desire to take a drug. The person has to have the drug. Often higher doses are needed. The person cannot stop taking the drug without treatment. ● Drugs interfere with normal brain function. They create powerful feelings of pleasure. Elsevier items and derived items © 2010 by Mosby, Inc. an affiliate of Elsevier Inc. All rights reserved

Drug abuse and addiction: Affect social and mental function Are linked to crimes, violence, and motor vehicle crashes Have physical effects Legal and illegal drugs are abused. A drug treatment program combines various therapies and services to meet the person’s needs. Drug abuse and addiction are chronic problems. ● The following can occur from one use, high doses, or prolonged use: ○ Human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) ○ Cardiovascular and lung diseases ○ Stroke ○ Sudden death ○ Hepatitis ● Legal drugs are approved for use in the United States. Doctors prescribe them. ● Illegal drugs are not approved for use. They are obtained through illegal means. Often legal drugs also are obtained through illegal means. ● Treatment is a long-term process. Elsevier items and derived items © 2010 by Mosby, Inc. an affiliate of Elsevier Inc. All rights reserved

SUICIDE Suicide means to kill oneself. Suicide is most often linked to: Depression Alcohol or substance abuse Stressful events If a person mentions or talks about suicide: Take the person seriously. Call for the nurse at once. Do not leave the person alone. ● Risk factors for suicide are listed in Box 27-6 on p. 000 in the textbook. ● Agencies that treat persons with mental health problems must: ○ Identify persons at risk for suicide ○ Identify specific factors or features that increase or decrease the risk for suicide ○ Meet the person’s immediate safety needs ○ Provide the most appropriate setting for treating the person ○ Provide crisis information to the person and family ● Review the Focus on Communication: Suicide Box on p. 000 in the textbook. ● Suicide contagion is exposure to suicide or suicidal behaviors within one’s family, one’s peer group, or media reports of suicide. ● Persons at risk for suicide need mental health services. Elsevier items and derived items © 2010 by Mosby, Inc. an affiliate of Elsevier Inc. All rights reserved

CARE AND TREATMENT Treatment of mental health problems involves: Having the person explore his or her thoughts and feelings Drugs as ordered by the doctor Reflecting the person’s needs in the care plan Using good communication skills ● The needs of the total person must be met. ● Be alert to nonverbal communication. This includes the person’s nonverbal communication and your own. ● Review the Focus on Communication: Care and Treatment Box on p. 000 in the textbook. ● Review the Focus on PRIDE: The Person, Family, and Yourself Box on p. 000 in the textbook. Elsevier items and derived items © 2010 by Mosby, Inc. an affiliate of Elsevier Inc. All rights reserved