Mental illness

1. Mental illness A synopsis and review

2. What is mental illness? • It is estimated the up to 20% of the population has some type of mental illness • A common misconception is that all people with psychiatric conditions exhibit bizarre or unusual behaviour. In reality, most function normally. • Most are treated as outpatients • Another misconception is that all people with mental illness are unstable and dangerous

3. What is behaviour? • a person’s observable conduct or activity

4. Behavioural emergency • A situation in which a patient’s behaviour becomes so unusual, bizarre, threatening or dangerous that it alarms the patient or another person • Often requires intervention by EMS and/or mental health personnel

5. Biological causes • May result from disease processes such as infections and tumors or from structural changes in the brain from such things as abuse of drugs and alcohol • ‘biological’ may be interchanged with ‘organic’

6. Psychological causes • Are related to the person’s personality style, dynamics of unresolved conflict or crisis management methods • Environment plays a large part in psychological development • May be in addition to or in combination with genetic predisposition and brain chemistry

7. Sociocultural causes • Related to a person’s actions and interactions within society • To such factors as socioeconomic status, social habits, social skills and values • Problems are usually attributable to events that change the person’s social space, social isolation or otherwise have an impact on socialization • examples: rape, assault, death of a loved one, war, riots

8. Mental Illness • Can take many forms • Episodic to permanent life altering • Consider the following definitions • Recall medication to treat the symptoms and their very negative side effects • Strategies to help

9. Anxiety • A feeling of dread and nervousness about the future without a specific cause for that feeling (Mitchell & Resnick) • A term used to describe feelings of uncertainty, uneasiness, apprehension or tension that a person experiences in response to an unknown object or situation (Shives)

10. Anxiety • Stems from the anticipation of danger • Emotional response to a consciously recognized and unusually external threat or danger • Feeling of impending doom • Ranges from mild to severe

11. Levels of Anxiety • Normal: mild anxiety, productive • Anxiety: Moderate anxiety, productive but decreased return for energy used • Anguish: Serious anxiety, counter productive • Panic: Severe anxiety, exhausting, debilitating • Terror: Death producing

12. Active Agitation Wringing of hands Loud screaming or crying Hyperactivity Nausea/vomiting Rapid speech, breathing Flushed face Emotionally out of control Inactive Inactivity Syncope Staring into space Dull eyes Hypotension Pale, clammy, diaphoretic skin Wandering about aimlessly Signs & Symptoms of Severe Anxiety or Emotional Shock

13. Management of Mild/Moderate Anxiety • Observe behaviours carefully • Ask, “what are your feeling now?” • Connect the feeling to the behaviour • Is is congruent? • Explore with the patient/client what happened before they felt this anxious • Discuss alternatives for dealing with the situation or cause

14. Management of Severe Anxiety • Remove from the scene to a less threatening environment • Assure the patient you will help them • Use clear, concise statements • Maintain eye contact • Provide simple directions • “Tell me your name”, “sit down here”, “Let’s walk to the other room together”, “put the knife down”

15. Delusion • A false belief which cannot be changed by reasoning or demonstration of facts to the contrary (Mitchell & Resnick) • False belief not true of fact and not originally accepted by other members of the person’s culture (Shives)

16. Hallucination • A false perception, the acceptance of images and sensations form within the individual as if they exist in reality (Mitchell & Resnick) • Sensory perceptions that occur in the absence of an actual external stimulus. They may be auditory, visual, olfactory, gustatory or tactile (Shive)

17. Illusion • A mistaken or distorted perception, as in seeing a branch as a snake. An illusion is similar to a hallucination except the object exists in reality but is misinterpreted by the person’s mind. (Mitchell & Resnick) • A false interpretation or perception of a real environmental stimulus that may involve any of the senses. (Shives)

18. Neurosis • A descriptive term to differentiate non-psychotic symptoms. (Shives) • Considered to be an emotional disturbance in which the person experiences increased subjective psychological pain or discomfort • As a result of stress the person handles anxiety or internal conflict in a maladaptive way

19. Neurotic symptoms reduce the efficiency of the individual and cause great anguish but do not necessarily prevent the person from functioning normally in their job, relationships and everyday activities • Most people experiencing neurosis do not fit a precise pattern and will show a combination of symptoms: anxiety, depression & phobias

20. Nonpathogenic or neurotic depression • A mood state characterized by a feeling of sadness, dejection, despair, discouragement or hopelessness

21. Phobia • An irrational fear of an object, activity or situation that is out of proportion to the stimulus and results in avoidance of the identified object or situation (Shives)

22. Psychosis • A mental disorder in which a person experiences an impairment of the ability to remember, think, communicate, respond emotionally, interpret reality and behave appropriately (Shives) • Examples: schizophrenia, bipolar depression, paranoia

23. Symptoms displayed in psychosis • Disorganized thinking, disorientation, inattention, loss of control over behaviour • Delusions • Hallucinations • Emotional extremeness • Disturbance of motor behaviour

24. Reality oriented Demonstrates socially acceptable behaviour Interacts with the real environment Out of contact with reality or denies reality Bizarre, inappropriate behaviour Creates a new world or environment and withdraws from reality in an effort to seek security Neurotic behaviourPsychotic behaviour

25. Does not exhibit maladaptive behaviour eg. Hallucinations or delusions Uses coping mechanisms in an attempt to decrease anxiety Exhibits maladaptive behaviour Coping mechanisms are ineffective, resulting in disintegration of one’s personality Neurotic behavior Psychotic behaviour

26. Specific psychiatric disorders • To define specific conditions, mental health professionals use the Diagnostic and Statistical Manual of Mental Disorders, fourth edition

27. Cognitive disorders • Psychiatric disorders with organic causes, such as brain injury or disease. May also be caused by physical or chemical injuries due to trauma, drug abuse or reactions to prescription drugs

28. Delirium • Characterized by a relatively rapid onset of widespread disorganized thought • May include inattention, memory impairment, disorientation or confusion • May experience vivid hallucinations • May be reversible

29. Dementia • Involves gradual development of memory impairment and cognitive disturbance • May be due to medical problems • Common causes: Alzheimer’s disease, vascular problems, Parkinson’s disease, substance abuse • Usually develops over months • Is irreversible

30. Schizophrenia • Involves significant changes in behaviour and a loss of contact with reality • Symptoms include: delusions, hallucinations, disorganized speech, catatonia, flat affect • Definitive cause is unknown • Usually diagnosed in early adulthood

31. Anxiety and related disorders • Characterized by a dominating apprehension and fear

32. Panic attack • Recurrent extreme periods of anxiety resulting in great emotional distress • Are usually unprovoked, peaking within 10 minutes and dissipating in less than an hour • May resemble a cardiac or respiratory condition

33. Panic attack presentation • A period of intense fear or discomfort during which 4 or more of the following are present: • Palpitations • Sweating • Trembling • Sensations of shortness of breath or smothering • Choking • Chest pain or discomfort

34. More signs and symptoms • Nausea or abdominal distress • Dizziness, unsteadiness, feeling light headed or faint • Feelings of unreality or being detached from oneself • Fear of losing control or going crazy • Fear of dying • Numbness or tingling sensation • Chills or hot flashes

35. Phobias • Generally considered an intense, irrational fear • Exposure to the situation or item will induce anxiety or a panic attack • Some people experience extreme phobias that prevent or limit normal daily activities

36. Do you know your phobias? • Achluophobia darkness • Bathmophobia stairs or steep slopes • Cacophobia ugliness • Dystychiphobia accidents

37. Lockiophobia childbirth • Mysophobia dirt & germs • Nosocomephobia hospitals • Octophobia figure 8

38. Phobophobia phobias • Scolionophobia school • Trypanophobia injections • Venustraphobia beautiful women

39. Ephebiphobia teenagers • Heliophobia sun • Iatrophobia doctors • Koinoniphobia rooms

40. Post traumatic stress syndrome • A reaction to an extreme, unusual life-threatening stressor • Characterized by a desire to avoid similar situations, recurrent intrusive thoughts, depression, sleep disturbances or nightmares • The person may feel guilty for surviving the event • Substance abuse may frequently complicate the condition

41. Mood disorders A pervasive and sustained emotion that colours the person’s perception of the world

42. Depression • One of the most prevalent psychiatric conditions affecting 10 – 15% of the population • When it is prolonged or severe it is a major depressive episode • To be severe, symptoms last for 2 weeks or more

43. Symptoms (5 or more) - depressed most of the day, nearly everyday - markedly diminished interest in pleasure - significant weight loss or gain - insomnia or hypersomnia - psychomotor agitation or retardation - feelings of worthlessness or excessive inappropriate guilt - diminished ability to think or concentrate or indecisiveness

44. Bipolar disorder • Characterized as one or more manic episodes (periods of elation) with or without subsequent or alternating periods of depression • Rare: 1% • Usually develops in adolescence or early adulthood • Manic-depressive episodes are not “Jekyll and Hyde”, however often begin suddenly and escalate rapidly over a few days • Many have several depressive episodes before having a manic episode

45. Manic episode: a distinct period of abnormally and persistently elevated, expansive or irritable mood lasting for at least a week

46. Somatoform disorders • Characterized by physical symptoms that have no apparent physiological cause • The person believes that the symptoms are serious and real

47. Major somatoform disorders • Somatization disorder: preoccupied with physical symptoms • Conversion disorder: the person sustains a loss of function, usually involving the nervous system (ie: blindness, paralysis) unexplained by a medical illness • Hypochondriasis: exaggerated interpretation of physical symptoms as a serious illness

48. Body dysmorphic disorder: person believes he has a defect in physical appearance • Pain disorder: the person suffers from pain, usually severe, that is unexplained by a physical ailment • All of these are difficult to identify and any medical cause must be ruled out

49. Dissociative disorder • Condition in which the person avoids stress by separating from their core personality • Very rare • Includes: psychogenic amnesia, multiple personality disorder, depersonalization

50. Eating disorders • Anorexia nervosa - loss of appetite - excessive fasting and refusal to eat • Bulimia nervosa - recurrent episodes of binge eating - often with compensatory self-induced vomiting, diarrhea or excessive exercise