MENTAL HEALTH UNIT III CHILDHOOD MENTAL HEALTH PROBLEMS

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MENTAL HEALTH UNIT III

MENTAL HEALTH UNIT III

CHILDHOOD MENTAL HEALTH PROBLEMS • Attention deficit hyperactivity – Needs structured environment with consistent

CHILDHOOD MENTAL HEALTH PROBLEMS • Attention deficit hyperactivity – Needs structured environment with consistent limits • Family education • Special education in school • Drug therapy – Ritalin – Concerta – Adderall

CHILDHOOD MENTAL HEALTH PROBLEMS • Behavioral or conduct disorders: persistent pattern of unacceptable behaviors

CHILDHOOD MENTAL HEALTH PROBLEMS • Behavioral or conduct disorders: persistent pattern of unacceptable behaviors – Defiant of authority – Aggressive – Refuse to follow society’s rules or norms • Focus on stable environment & consistent enforced limitations

CHILDHOOD MENTAL HEALTH PROBLEMS • Oppositional defiant disorder: recurring pattern of disobedient, hostile behavior

CHILDHOOD MENTAL HEALTH PROBLEMS • Oppositional defiant disorder: recurring pattern of disobedient, hostile behavior toward authority figures – Lose tempers with adults – Argue with adults – Deliberately annoy adults – Refuse to compromise – Blame others & test limits • Family therapy with limit setting & consistency

NORMAL MENTAL CHANGES IN OLDER ADULTS • See page 180, Table 16 -1

NORMAL MENTAL CHANGES IN OLDER ADULTS • See page 180, Table 16 -1

LATE ADULTHOOD PROBLEMS RELATED TO MENTAL HEALTH • Vulnerability, abuse, memory loss, dementia, &

LATE ADULTHOOD PROBLEMS RELATED TO MENTAL HEALTH • Vulnerability, abuse, memory loss, dementia, & Alzheimer’s Disease (AD) • Physical or biochemical disorders • Loneliness & social isolation

ELDER ABUSE Any action that takes advantage of an older person, their emotional well-being,

ELDER ABUSE Any action that takes advantage of an older person, their emotional well-being, or property • Domestic • Institutional • Self-abuse

DEPRESSION • Common mental health disorder of late adulthood • Retirement, lifestyle changes, losses

DEPRESSION • Common mental health disorder of late adulthood • Retirement, lifestyle changes, losses per death • Mask dementia • Medications • Effective therapies – Individual & group therapy – Reminiscing – Antidepressants (SSRI’s)

DEMENTIA Loss of multiple abilities: short –term / longterm memory, language, ability to think

DEMENTIA Loss of multiple abilities: short –term / longterm memory, language, ability to think & understand • Memory loss: inability to recall a certain detail or event • Delirium: change of consciousness that occurs over short period of time

 • Sundown syndrome: group of behaviors characterized by confusion, agitation & disruptive actions

• Sundown syndrome: group of behaviors characterized by confusion, agitation & disruptive actions • Unknown cause • Visual cues & social interactions decrease with the onset of nighttime = confused, irritable, agitated

ALZHEIMER’S DISEASE • Progressive, degenerative disorder affecting brain cells = impaired memory, thinking, &

ALZHEIMER’S DISEASE • Progressive, degenerative disorder affecting brain cells = impaired memory, thinking, & behavior • Diagnosis; rule out all other possibilities • Incidence increases with age • Can progresses slowly • Cognitive abilities lose • Can’t recall recent events or process new information

ALZHEIMER’S DISEASE • Increasingly forgetful; personality changes – Aphasia: loss of language – Apraxia:

ALZHEIMER’S DISEASE • Increasingly forgetful; personality changes – Aphasia: loss of language – Apraxia: loss of the ability to perform everyday activities – Visual agnosia: loss of recognition of previously known or familiar people & objects

ALZHEIMER’S DISEASE • Affective losses: loss of their personality • Stress & anger ↑

ALZHEIMER’S DISEASE • Affective losses: loss of their personality • Stress & anger ↑ fatigue levels • Minor anxieties become full catastrophic reactions = ↑ confusion, agitation, & fear • Wander, Noisy, act compulsively or behave violently

ALZHEIMER’S DISEASE • • Low stimuli environment Eliminate stress provoking situations Physical & emotional

ALZHEIMER’S DISEASE • • Low stimuli environment Eliminate stress provoking situations Physical & emotional support Medications to slow the disease (pg 197 Table 17 -3) (pg 199, common cholinesterase inhibitors)

ALZHEIMER’S DISEASE • Goals to therapeutic care – Provide safety & well-being – Manage

ALZHEIMER’S DISEASE • Goals to therapeutic care – Provide safety & well-being – Manage behaviors therapeutically – Provide support for family, relatives, & caregivers • Tables 17 -1, 17 -2 • Boxes 17 - 4, 5, 6, 7 • Table 17 -4, 17 -5

PSYCHOTHERAPEUTIC MEDICATION EFFECT • Interrupts chemical messenger pathways in the brain • Act in/around

PSYCHOTHERAPEUTIC MEDICATION EFFECT • Interrupts chemical messenger pathways in the brain • Act in/around the synapse - alters flow of neurotransmitters

ANXIETY • Uneasiness, uncertainty, & helplessness • State of tension sometimes associated with feeling

ANXIETY • Uneasiness, uncertainty, & helplessness • State of tension sometimes associated with feeling of dread or doom • Normal emotional response to a threat or stressor • Part of survival & growth

ANXIETY PURPOSES • Warning • Increase learning – help with concentration & focus •

ANXIETY PURPOSES • Warning • Increase learning – help with concentration & focus • Motivate

ANXIETY DISORDERS • Anxiety expressed ineffectively, coping mechanisms do not relieve the stress •

ANXIETY DISORDERS • Anxiety expressed ineffectively, coping mechanisms do not relieve the stress • 6 categories per DSM-IV-TR

GENERALIZED ANXIETY • Broad, long-lasting, excessive • Disturbance in emotional area of functioning eventually

GENERALIZED ANXIETY • Broad, long-lasting, excessive • Disturbance in emotional area of functioning eventually affects every aspect • Worried, anxious more times than not • Fret about numerous things • Difficult to control worries • Cannot complete simple tasks & responses way off base in relationship to actual situation

PANIC DISORDER • Brief period of intense fear or discomfort • Usually last 1

PANIC DISORDER • Brief period of intense fear or discomfort • Usually last 1 – 15 minutes with peak after 10 minutes • 2 types – Those associated with agoraphobia: anxiety about possible situations in which a panic attack may occur (public situations) – Those not associated with agoraphobia

PANIC DISORDER - TREATMENT Relaxation Educate Emotional support Medications Adaptive coping skills

PANIC DISORDER - TREATMENT Relaxation Educate Emotional support Medications Adaptive coping skills

PHOBIC DISORDER • Unnatural, obsessive fear • Dwell on object of fear almost to

PHOBIC DISORDER • Unnatural, obsessive fear • Dwell on object of fear almost to point of fascination • Immobilizes

OBSESSIVE-COMPULSIVE DISORDER (OCD) • OBSESSION: Distressing, persistent, recurring, inappropriate thought • COMPULSION: specific behaviors

OBSESSIVE-COMPULSIVE DISORDER (OCD) • OBSESSION: Distressing, persistent, recurring, inappropriate thought • COMPULSION: specific behaviors that must be performed to reduce anxiety

OBSESSIVE – COMPULSIVE DISORDER • Cleanliness, dirt & germs; aggression & sexual impulses; health

OBSESSIVE – COMPULSIVE DISORDER • Cleanliness, dirt & germs; aggression & sexual impulses; health concerns; safety concerns, order & symmetry • Thoughts, doubts, fears, images or impulses • Defense mechanism of repression • Focus anxieties into compulsive actions & engage in undoing behaviors to relieve stress • Know behaviors are maladaptive but cannot stop • Treated with behavioral therapy & antidepressants

BEHAVIORAL ADDICTIONS • Obsessive-compulsive activities taking on certain forms of addictive behaviors • Gambling,

BEHAVIORAL ADDICTIONS • Obsessive-compulsive activities taking on certain forms of addictive behaviors • Gambling, shopping, working, excessive sexual activity • Destruct personal & professional lives

POSTTRAUMATIC STRESS DISORDER (PTSD) • Reliving of traumatic event or situation • Traumatic experience

POSTTRAUMATIC STRESS DISORDER (PTSD) • Reliving of traumatic event or situation • Traumatic experience resulted in intense fear, horror, or helplessness • Flashbacks • Assure safety & reorientation • Meds, psychological therapy & emotional support

ANXIETY INTERVENTIONS Prevent Detect & treat early Antianxiety agents Systematic desensitization – learn to

ANXIETY INTERVENTIONS Prevent Detect & treat early Antianxiety agents Systematic desensitization – learn to cope with 1 anxiety situation at a time • Flooding – rapidly or repeatedly exposing client to the feared object or situation; phobias • Rational-emotive therapy – learn how their illogical thinking leads to maladaptive behaviors • Relaxation – deep breathing • •

ANTIANXIETY MEDS Reduce psychic tension of stress • Benzodiazepines (drug of choice) - Decrease

ANTIANXIETY MEDS Reduce psychic tension of stress • Benzodiazepines (drug of choice) - Decrease anxiety but also can provide sedation, induce sleep, prevent seizures, prepare clients for general anesthesia - Act by ↑ GABA neurotransmitter level - Onset 1 hr. & duration of 4 – 6 hrs. - Side effects are fatigue, sedation, dizziness & orthostatic hypotension; may experience diarrhea during withdrawal - Dependence can result = limited use; prn basis See page 214 Table 18 -3 for nursing actions • Nonbenzodiazepines - Antihistamines - Barbiturates

MOOD DISORDER Disturbance in emotional dimension of human functioning Maladaptive when interferes with effective

MOOD DISORDER Disturbance in emotional dimension of human functioning Maladaptive when interferes with effective living Mania to depression

DEPRESSION • Whole body illness • Last few days or several years; several levels

DEPRESSION • Whole body illness • Last few days or several years; several levels • MILD: short lived, triggered by life events or situations; usually self limiting • MODERATE: persists over time; interfere with ADL’s – – Fatigue, eating & sleeping difficulties Anhedonia: inability to enjoy life Impaired judgment & decision making Higher risk of suicide

DEPRESSION • MAJOR DEPRESSIVE EPISODE: severe depression lasting ≥ 2 weeks (familial) - Feelings

DEPRESSION • MAJOR DEPRESSIVE EPISODE: severe depression lasting ≥ 2 weeks (familial) - Feelings of worthlessness, guilt, despair - Suicidal thoughts begin - When episodes routinely repeat itself for ≥ 2 yrs. = MAJOR DEPRESSIVE DISORDER • DYSTHYMIC DISORDER: daily moderate depression lasting ≥ 2 yrs - Chronically sad, self critical - See self as incapable & uninteresting - See world from a negative point of view - Can carry out ADL’s but unable to enjoy them

BIPOLAR DISORDERS • • Sudden, dramatic shift in emotional responses Time intervals vary Behaviors

BIPOLAR DISORDERS • • Sudden, dramatic shift in emotional responses Time intervals vary Behaviors build in intensity during mania If untreated, manic stage can lasts 3 months when depressive stage steps in

BIPOLAR DISORDERS • BIPOLAR I – Episodes of depression alternating with mania episodes –

BIPOLAR DISORDERS • BIPOLAR I – Episodes of depression alternating with mania episodes – More severe & incapacitating – Delusions & hallucinations occur during mania • BIPOLAR II – 1 -2 weeks of severe lethargy, withdrawal followed by days of elevated/irritable mood, constant activity & risky decision making – May not be as severe as Bipolar I but still devastating

Bipolar Disorder • Cyclothymic disorder: repeated mood swings alternating between hypomania & depression •

Bipolar Disorder • Cyclothymic disorder: repeated mood swings alternating between hypomania & depression • No periods of “normal” functioning • Usually leads into full blown bipolar disorders

MOOD DISORDERS TREATMENT – Acute: 6 -12 wks • Reduce symptoms & inappropriate behaviors

MOOD DISORDERS TREATMENT – Acute: 6 -12 wks • Reduce symptoms & inappropriate behaviors • Inpatient hospitalization may be required • Medications – Continuation: 4 -9 months • Outpatient basis • Medication management • Psychotherapy – Maintenance • Preventing recurrences • Maintenance meds & psychotherapy • Current standard treatments…

MEDICATION CLASSES & CATEGORIES • ANTIDEPRESSANTS – Seritonin Specific Reuptake Inhibitors (SSRI) – Tricyclic

MEDICATION CLASSES & CATEGORIES • ANTIDEPRESSANTS – Seritonin Specific Reuptake Inhibitors (SSRI) – Tricyclic Antidepressants (TCA) – Monoamine Oxidase Inhibitors (MAOI’s) • ANTIMANICS – Antimanics – Anticonvulsants • ANTIPSYCHOTICS – Phenothiazines – Nonphenothiazines

ANTIDEPRESSANTS • • ↑ certain neurotransmitter activities 1 -2 weeks before symptom relief Side

ANTIDEPRESSANTS • • ↑ certain neurotransmitter activities 1 -2 weeks before symptom relief Side effects may be noticed soon after starting Monitor closely for ↑ energy when suicidal

ANTIMANICS • Lithium – natural occurring salt • • • Drug of choice for

ANTIMANICS • Lithium – natural occurring salt • • • Drug of choice for treatment bipolar disorder Pre lithium workup Educate Monitor side effects & toxic reactions Minimal difference therapeutic & toxic levels – too low = mania returns – too high (≥ 1. 5 m. Eq/L) = uncomfortable & life threatening side effects may occur Positive effects may take 3 weeks

ANTIPSYCHOTICS • Referred to as major tranquilizers or neuroleptics • Most treat symptoms of

ANTIPSYCHOTICS • Referred to as major tranquilizers or neuroleptics • Most treat symptoms of major mental disorders • Numerous & troublesome side effects & adverse reactions

EXTRAPYRAMIDAL SIDE EFFECTS • CNS side effects of abnormal movements produced by imbalance of

EXTRAPYRAMIDAL SIDE EFFECTS • CNS side effects of abnormal movements produced by imbalance of neurotransmitters in brain • PNS side effects: dry mouth, blurred vision, & photophobia • 1 st few weeks orthostatic hypotension possible

PSYCHOPHYSICAL DISORDERS • Known as somatoform disorders – stress related physical problems • DSM-IV-TR

PSYCHOPHYSICAL DISORDERS • Known as somatoform disorders – stress related physical problems • DSM-IV-TR = 6 types • Meet 3 criteria: 1. No medical condition 2. Level of functioning significantly disrupted or impaired 3. Unaware of or unable to express emotional distress

SOMATIZATION DISORDER • • S/S of illness - no traceable physical cause Long history

SOMATIZATION DISORDER • • S/S of illness - no traceable physical cause Long history vague complaints, colorful terms but few facts Multiple physicians Signs of anxiety, depression, with impulsive, antisocial & suicidal behaviors • 3 features – Multisystem involvement – Early onset, chronic condition with no physical changes – Absence of any lab values indicating physical involvement *******Deny psychiatric problem*******

CONVERSION DISORDER Sensory or Motor functions Result from emotional conflict ? Treatment: • Eliminate

CONVERSION DISORDER Sensory or Motor functions Result from emotional conflict ? Treatment: • Eliminate any physical causes • Identify conflicts responsible for S/S

HYPOCHONDRIASIS • Intense fear of or preoccupation with having serious disease or medical condition

HYPOCHONDRIASIS • Intense fear of or preoccupation with having serious disease or medical condition based on misinterpretation of body s/s • Constant fear • Minor abnormalities of body functions, vague physical sensations • Dr. shop; challenge to treat • Poor insight & little concern in finding source of problem • Treatment – Antianxiety & antidepressants

SOMATOFORM PAIN DISORDER • Pain / discomfort major focus of distress • No other

SOMATOFORM PAIN DISORDER • Pain / discomfort major focus of distress • No other cause of pain identified • Treatment: Pain clinic

BODY DYSMORPHIC DISORDER • Preoccupation with perceived physical difference or defect in one’s body

BODY DYSMORPHIC DISORDER • Preoccupation with perceived physical difference or defect in one’s body • Describe distress as tormenting, devastating, or intensely painful • Describe self as ugly, unacceptable & often avoid work, social or public gathering

FACTITIOUS & MALINGERING • Symptoms intentionally produced – Factitious = to assume the sick

FACTITIOUS & MALINGERING • Symptoms intentionally produced – Factitious = to assume the sick role – Malingering = to meet a goal – Factitious disorder by proxy = deliberate production of s/s in another person; usually mother to child (Munchausen's syndrome) • Rarely diagnosed, move Dr. to Dr. • Identify & treat underlying cause

DISSOCIATIVE DISORDERS Dissociation: interruption of fundamental aspect of waking consciousness – Normal common experience

DISSOCIATIVE DISORDERS Dissociation: interruption of fundamental aspect of waking consciousness – Normal common experience (daydreaming) – Coping mechanism to protect from trauma – Children dissociate more easily than adults & if used as defense mechanism can grow into dissociative disorder • Disturbance in the normally interacting functions of consciousness – Identity, Memory, Perception • Most anxiety producing aspect of self walled off from rest of personality in attempt to cope • DSM-IV-TR = 4 types

DEPERSONALIZATION • Feeling detached or unconnected to self • Response to severe anxiety associated

DEPERSONALIZATION • Feeling detached or unconnected to self • Response to severe anxiety associated with blocking of awareness & a fading of reality • Defense mechanism but not relieve the cause of stress = maladaptive behavior = attempt to escape distress & anxiety; lose identity

DISSOCIATIVE AMNESIA • Inability to remember personal information • Cant be explained by ordinary

DISSOCIATIVE AMNESIA • Inability to remember personal information • Cant be explained by ordinary forgetfulness • Attempt to avoid extreme stress by blocking memories from consciousness • Gaps in ability to recall certain events • Sights, sounds, odors, images may trigger emotional distress • Actual memories too painful so stay submerged but still inflict pain • Need high level of support • Primary concern = safety d/t suicide attempts

DISSOCIATIVE FUGUE • Sudden, unexpected travel with an inability to recall the past; response

DISSOCIATIVE FUGUE • Sudden, unexpected travel with an inability to recall the past; response to overwhelming stressful or traumatic event • Extreme expression of fight or flight • New identity, occupation, significant others • Return to prefugue state, – Experience aggressive impulses, conflict, depression, guilt, suicidal wishes • Recovery – Psychosocial care – Emotional support

DISSOCIATIVE IDENTITY DISORDER • 2 or more personalities, take control of behavior • Defense

DISSOCIATIVE IDENTITY DISORDER • 2 or more personalities, take control of behavior • Defense mechanism against trauma • Time losses, unexplained possessions or changes in relationships, out of body experiences • Each personality unique • All serve a protective purpose

DISSOCIATIVE IDENTITY DISORDER • • Primary personality = HOST All other personalities = ALTERS

DISSOCIATIVE IDENTITY DISORDER • • Primary personality = HOST All other personalities = ALTERS Transition usually sudden & r/t stress Sometimes cooperate but more often will struggle

DISSOCIATIVE IDENTITY DISORDER • Main treatment goal – Integrate personalities into 1 functional individual,

DISSOCIATIVE IDENTITY DISORDER • Main treatment goal – Integrate personalities into 1 functional individual, cope with stresses in a healthy manner • Stages of treatment – Assessment – Stabilization – Reworking past traumas • Based on symptoms • Short term use of antianxiety, antidepressants, antipsychotics; encourage coping skills to develop