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MENTAL HEALTH

MENTAL HEALTH. UNIT III. 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.

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MENTAL HEALTH

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  1. MENTAL HEALTH UNIT III

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

  3. 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

  4. 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

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

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

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

  8. 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)

  9. DEMENTIA

  10. 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

  11. 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

  12. 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

  13. 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

  14. 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)

  15. 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

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

  17. 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

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

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

  20. 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

  21. 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

  22. PANIC DISORDER - TREATMENT

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

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

  25. 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

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

  27. 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

  28. 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

  29. 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

  30. MOOD DISORDER

  31. 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

  32. 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

  33. 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

  34. 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

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

  36. 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…

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

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

  39. 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 (≥ 1.5mEq/L) = uncomfortable & life threatening side effects may occur • Positive effects may take 3 weeks

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

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

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

  43. 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*******

  44. CONVERSION DISORDER

  45. 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

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

  47. 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

  48. 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

  49. 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

  50. 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

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