1. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Chapter 43 Mental Health Problems

2. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Basic Concepts  Mental relates to the mind.  Mental health involves 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 (mental disorder, emotional illness, psychiatric disorder) is a disturbance in the ability to cope with or adjust to stress. Slide 2

3. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.  Causes of mental health disorders include:  Not being able to cope or adjust to stress  Chemical imbalances  Genetics  Physical or biologic factors  Psychological factors  Drugs or substance abuse  Social and cultural factors Slide 3

4. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Anxiety Disorders  Anxiety is a vague, uneasy feeling in response to stress.  Often, anxiety occurs when needs are not met.  Some anxiety is normal.  Signs and symptoms depend on the degree of anxiety.  Anxiety level depends on the stressor.  A stressor is the event or factor that causes stress.  Coping and defense mechanisms are used to relieve anxiety. Some are healthy.  Persons with mental health problems have higher than normal levels of anxiety. Slide 4

5. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.  Panic disorder  Panic is an intense and sudden feeling of fear, anxiety, terror, or dread. It is the highest level of anxiety.  The onset of panic is sudden, with no obvious reason.  Panic attacks can last for 10 minutes or longer.  Signs and symptoms of anxiety are severe during a panic attack. The person may also have: Chest pain Chest pain Shortness of breath Shortness of breath Rapid heart rate; “heart pounding” Rapid heart rate; “heart pounding” Numbness or tingling in the hands Numbness or tingling in the hands Dizziness Dizziness A smothering sensation A smothering sensation Feeling of impending doom or loss of control Feeling of impending doom or loss of control  Panic disorder can last a few months or many years. Slide 5

6. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.  Phobias  Phobia means an intense fear, panic, or dread.  The person has an intense fear of an object, situation, or activity that has little or no actual danger.  Common phobias include fear of fire; water; strangers; spiders; night or darkness; the slightest uncleanliness; being in or being trapped in an enclosed or narrow space; being in pain or seeing others in pain; and being in an open, crowded, or public place.  The person avoids what is feared. When faced with the fear, the person has high anxiety and cannot function. Slide 6

7. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.  Obsessive-compulsive disorder (OCD)  An obsession is a recurrent, unwanted thought, idea, or image.  Compulsion is repeating an act over and over again (a ritual).  Common rituals are hand washing, constant checking to make sure the stove is off, cleaning, counting things to a certain number, or touching things in a certain order.  Some persons with OCD also have depression, eating disorders, substance abuse, and other anxiety disorders. Slide 7

8. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.  Post-traumatic stress disorder  Post-traumatic stress disorder (PTSD) occurs after a terrifying ordeal involving physical harm or the threat of physical harm.  Most people with PTSD have flashbacks.  A flashback is reliving the trauma in thoughts during the day and in nightmares during sleep. Flashbacks may involve images, sounds, smells, or feelings. Flashbacks may involve images, sounds, smells, or feelings. Everyday things can trigger flashbacks. Everyday things can trigger flashbacks. During a flashback, the person may lose touch with reality. During a flashback, the person may lose touch with reality. The person may believe the trauma is happening all over again. The person may believe the trauma is happening all over again.  Signs and symptoms may develop a few months after the harmful event, or not until years later.  The person may also suffer from depression, substance abuse, and other anxiety disorders. Slide 8

9. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Schizophrenia  Schizophrenia means split mind.  It is a severe, chronic, disabling brain disorder.  Schizophrenia involves:  Psychosis—a state of severe mental impairment  Delusion—a false belief  Hallucination—seeing, hearing, smelling, or feeling something that is not real  Paranoia—a mind disorder of false beliefs  Delusion of grandeur—an exaggerated belief of one’s importance, wealth, power, or talents  Delusion of persecution—the false belief that one is being mistreated, abused, or harassed Slide 9

10. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.  The person with schizophrenia:  Has severe mental impairment (psychosis)  Has disturbed thinking and behavior  Has delusions and/or hallucinations  May be paranoid  May have difficulty organizing thoughts  Disorders of movement occur.  Some persons withdraw or regress.  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. Slide 10

11. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.  People with schizophrenia do not tend to be violent.  Some persons with schizophrenia attempt suicide.  If a person talks about or tries to commit suicide:  Call for the nurse at once.  Do not leave the person alone. Slide 11

12. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Mood Disorders  Mood or affect relates to feelings and emotions.  The person with bipolar disorder has severe extremes in mood, energy, and ability to function.  There are emotional lows and emotional highs (depression and mania). The disorder also is called manic-depressive illness.  The person may: Be more depressed than manic Be more depressed than manic Be more manic than depressed Be more manic than depressed Alternate between depression and mania Alternate between depression and mania Become suicidal Become suicidal  If a person talks about or tries to commit suicide: Call for the nurse at once. Call for the nurse at once. Do not leave the person alone. Do not leave the person alone. Slide 12

13. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.  Major depression  Depression involves the body, mood, and thoughts.  Symptoms affect work, study, sleep, eating, and other activities.  The person is very sad and loses interest in daily activities.  Stressful events and some physical disorders can cause depression.  Depression is common in older persons.  Depression in older persons: Is often overlooked or a wrong diagnosis is made Is often overlooked or a wrong diagnosis is made Is often thought to be a cognitive disorder Is often thought to be a cognitive disorder Is often not treated Is often not treated Slide 13

14. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Personality Disorders  Personality disorders involve rigid and maladaptive behaviors.  Those with personality disorders cannot function well in society.  Personality disorders include:  Antisocial personality disorder—a chronic disorder in which the person’s thinking and behaviors show no regard for right or wrong  Borderline personality disorder (BPD)—a chronic disorder in which the person has problems with moods, relationships, self-image, and behavior. Slide 14

15. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. 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 addition affect the nervous system, the mind, and thinking. Slide 15

16. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.  Alcoholism and alcohol abuse  Alcoholism is a chronic disease, lasting throughout life.  Over time, heavy drinking damages the body’s organs.  Life-style and genetics are risk factors.  Some people turn to alcohol for relief from life stresses.  The craving for alcohol can be as strong as the need for food or water.  There is no cure.  Alcoholism (alcohol dependence) can be treated.  Alcohol’s effects vary with age; older persons have a lower tolerance.  Mixing alcohol with some drugs can be harmful, even fatal.  Alcohol makes some health problems worse. Slide 16

17. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.  Drug abuse and addiction  Drug abuse is the overuse of a drug for non- medical or non-therapy effects.  Drugs interfere with normal brain (mental) function and social function.  Drug addiction is a chronic, relapsing brain disease.  Physical effects can occur from one use, high doses, or prolonged use. Slide 17

18. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc.  Legal and illegal drugs are abused.  Withdrawal syndrome is the person’s physical and mental response after stopping or severely reducing the use of the substance that had been used regularly.  Treatment depends on the type of drug and the person.  Treatment is a long-term process. Slide 18

19. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. 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. Slide 19

20. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Care and Treatment  Treatment of mental health problems involves having the person explore his or her thoughts and feelings through various therapies.  The needs of the total person must be met, including physical, safety, security, and emotional needs.  Often, drugs are ordered.  The care plan reflects the person’s needs.  Communication is important.  You must take responsibility for your safety. Slide 20

21. Copyright © 2011, 2007, 2003, 1999 by Mosby, Inc., an affiliate of Elsevier Inc. Quality of Life  Persons with mental health problems have the right to quality of life. They have the same rights as other residents.  People do not choose to have physical or mental health problems.  Persons with mental health problems deserve the same dignity and respect given to persons with physical illnesses.  Protect the right to privacy and confidentiality.  Protect the right to personal choice.  Protect the person from abuse, mistreatment, and neglect.  Provide a safe setting. Slide 21