Recognising Managing Mental Illness Difficult Behaviours Robyn Bradey

Recognising & Managing Mental Illness & Difficult Behaviours Robyn Bradey

General Indicators • • • Constant repetition of the same expression Agitation Rocking or repetitive movements Appearing to have difficulty concentrating May appear to be hearing someone other than you Paranoia A feeling something is not quite right here. All reasonable attempts at communication lead nowhere. Inability to own responsibility for own behaviour Emotional lability Extremely withdrawn

Depression • Definition: A clinical condition where the person reports feeling unable to cope. They are emotionally labile, have trouble getting to sleep and wake early in the morning. Or they have trouble staying awake and fall asleep many times a day. Appetite is usually reduced though some people ‘comfort eat’. They have trouble concentrating and cannot make every day decisions. Depression is chemically driven and not just "feeling sad". Some depressions are reactive in response to life events such as bereavement and trauma. Some are endogenous and emerge for no clear reason. About a quarter of all people suffer depression at some stage in their life. • NB Bi-polar disorder (previously known as manic depression) causes people to have swings between periods of intense activity and confidence and extreme lows. This is usually a chronic condition.

Depression Presentation • • • Flat affect or emotionally labile Unable to make decisions Sleep problems Change in eating patterns Lack of motivation Withdrawal Headaches. A sense of hopelessness "What's the point? " Other people are worried about them Low grade physical illness

Depression Management • • • Reactive depression usually responds to talk therapy and assistance with the original problem. This does not work for other forms of depression which usually respond well to medication. Exercise Relaxation therapy. Diet Normalising Non-blaming reassurance Short term, concrete, achievable action plans Lots of support Intervention with significant others. Liaison with GP s and psychiatrists. Refer early as long term depression can lead to suicide.

Anxiety is the most common mental health complaint in the community, most people do not recognise they have an anxiety disorder or present for treatment.

Anxiety Definition: we are talking here about anxiety that interferes with a person's normal functioning. - where a person has difficulty in certain areas of their life because anxiety about the outcome. It can be learned behaviour or it can be in response to a trauma.

Types of anxiety • Phobias - where there is disruptive fear and avoidance of something (spiders, flying etc) which is out of proportion or ‘over the top’. • Panic disorder - characterised by sudden inexplicable attacks of jarring symptoms which can be distressing through to immobilising e. g. agoraphobia • Generalised anxiety disorder - persistently anxious about minor things • Obsessive compulsive disorder - persistent uncontrollable thoughts resulting in a compelling repetitive action. • Acute Stress Disorder - normal temporary reaction to an extreme stressor. • Post Traumatic Stress Disorder - same as above but still there a month later.

Common symptoms of anxiety • Physical symptoms include: agitation, breathlessness (hyperventilation), heart palpitations through to full blown panic attacks. • Emotional/psychological symptoms include a feeling of fear or dread, feeling trapped and needing to avoid certain situations or people. • Cognitive symptoms include an inability to make decisions through to catastrophising.

Anxiety Management Support, education and understanding Cognitive behavioural therapy Systematic desensitisation Exposure, flooding Inducing attacks and teaching techniques to deal with it. • Relaxation strategies • Psychotherapy to get at underlying causes. • Medications include benzodiazapines and anti depressants • • •

Bi-Polar Mood Disorder This condition is a mood disorder where the sufferer experiences depression as previously discussed, but also experience “highs” or mania.

Bi-polar cont. • Type 1 has dramatic mood swings, with an emphasis on the mania • Type 2 has more moderate swings and the sufferer is more likely to become depressed. It is sometimes called “hypo-mania”

Bi-polar cont • There is also a cluster of conditions that include: • Rapid cycling • Being manic & depressed at the same time • And other mood swing variations

Presentation • The depression looks the same but the mania includes: • Lack of sleep • Fast talking • Wild ideas • Risk taking

Presentation cont • • Delusions of Grandeur Gambling Promiscuity Inappropriate behaviour

Management • • • Early diagnosis Regular sleep patterns Exercise Diet Mindfulness techniques Care Plan

Borderline Personality Disorder Definition: A person who borders on psychosis in that the only view of the world they can operate from is their own. They lack the ability to see things from another's point of view and have a poor sense of where they stop and others begin. So they project a lot and take everything personally.

BPD-practical diagnosis I find myself doing more for this person than I would for anyone else under the same circumstances and it is never enough!

Origins of BPD Most people with this condition have a history of childhood abuse.

BPD - Presentation • They have always seen other counsellors and been to other agencies and none of them have helped. • They have a history of chaos in relationships and at. work. • The presentation of these problems is that it was always someone else's fault. • They lack personal and empathic insight.

BPD-Presentation cont. • They project all the time • Early in the relationship with you, they put you on a pedestal. "You're better than all the rest. . " or "I've never told anyone this before" • The first time you refuse them, you fall from grace and they become hostile. • They always want to know about your personal life. • They ring up a lot in between appointments and want longer sessions. • It is very difficult to engage them in facing and changing their own behaviour.

BPD-Management suggestions Don't believe undeserved flattery Stick to the issues Strict boundaries Don't reveal personal details, nor seek information beyond what is needed • Communication and unified approach from the whole team • Keep "batting back" projection; "Yes but what could you do to change that? " • Supervision for you. • •

Schizophrenia • • Repeated phrases and repetitive movement Slow movement & slurred speech if medicated Fast speech and manic behaviour if not Paranoia

continued • Agitation and aggression • Distracted behaviour • Delusions, primarily auditory and visual, but sometimes tactile or all three • High risk of suicide, some risk of assault and homicide

To sum up • • • Respectful approach Use their name Be prepared to repeat things Use short sentences in a clear voice Be concrete Don’t say you can see or hear things you can’t

Still summing up • Calm them, reassure them, remove the source of the fear • Keep coming back to the point of your interaction • If you are part of their delusion refer • Refer for psych help quickly • Crisis mental health team