Transcript Mental Illness review

Mental illness
A synopsis and review
What is mental illness?
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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
What is behaviour?
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a person’s observable conduct or activity
Behavioural emergency
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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
Biological causes
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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’
Psychological causes
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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
Sociocultural causes
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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
Mental Illness
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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
Anxiety
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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)
Anxiety
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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
Levels of Anxiety
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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
Signs & Symptoms of
Severe Anxiety or
Emotional Shock
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Active
Agitation
Wringing of hands
Loud screaming or
crying
Hyperactivity
Nausea/vomiting
Rapid speech,
breathing
Flushed face
Emotionally out of
control
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Inactive
Inactivity
Syncope
Staring into space
Dull eyes
Hypotension
Pale, clammy,
diaphoretic skin
Wandering about
aimlessly
Management of Mild/Moderate
Anxiety
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Observe behaviours carefully
Ask, “what are your feeling now?”
Connect the feeling to the behaviour
– Is is congruent?
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Explore with the patient/client what
happened before they felt this anxious
Discuss alternatives for dealing with the
situation or cause
Management of Severe
Anxiety
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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”
Delusion
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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)
Hallucination
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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)
Illusion
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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)
Neurosis
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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
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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
Nonpathogenic or neurotic
depression
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A mood state characterized by a feeling of sadness,
dejection, despair, discouragement or hopelessness
Phobia
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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)
Psychosis
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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
Symptoms displayed in
psychosis
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Disorganized thinking, disorientation, inattention,
loss of control over behaviour
Delusions
Hallucinations
Emotional extremeness
Disturbance of motor behaviour
Neurotic behaviour Psychotic behaviour
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Reality oriented
Demonstrates socially
acceptable behaviour
Interacts with the real
environment
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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 behavior Psychotic behaviour
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Does not exhibit
maladaptive behaviour
eg. Hallucinations or
delusions
Uses coping
mechanisms in an
attempt to decrease
anxiety
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Exhibits maladaptive
behaviour
Coping mechanisms
are ineffective,
resulting in
disintegration of one’s
personality
Specific psychiatric
disorders
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To define specific conditions, mental health
professionals use the Diagnostic and Statistical
Manual of Mental Disorders, fourth edition
Cognitive disorders
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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
Delirium
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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
Dementia
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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
Schizophrenia
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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
Anxiety and related
disorders
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Characterized by a dominating apprehension and
fear
Panic attack
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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
Panic attack presentation
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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
More signs and symptoms
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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
Phobias
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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
Do you know your phobias?
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Achluophobia
darkness
Bathmophobia
stairs or steep slopes
Cacophobia
ugliness
Dystychiphobia
accidents
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Lockiophobia
childbirth
Mysophobia
dirt & germs
Nosocomephobia
hospitals
Octophobia
figure 8
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Phobophobia
phobias
Scolionophobia
school
Trypanophobia
injections
Venustraphobia
beautiful women
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Ephebiphobia
teenagers
Heliophobia
sun
Iatrophobia
doctors
Koinoniphobia
rooms
Post traumatic stress
syndrome
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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
Mood disorders
A pervasive and sustained emotion that colours the
person’s perception of the world
Depression
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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
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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
Bipolar disorder
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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
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Manic episode: a distinct period of abnormally and
persistently elevated, expansive or irritable mood
lasting for at least a week
Somatoform disorders
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Characterized by physical symptoms that have no
apparent physiological cause
The person believes that the symptoms are serious
and real
Major somatoform disorders
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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
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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
Dissociative disorder
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Condition in which the person avoids stress by
separating from their core personality
Very rare
Includes: psychogenic amnesia, multiple personality
disorder, depersonalization
Eating disorders
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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
Management of behavioural
emergencies
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Ensure scene safety
Provide a calm and supportive environment
Treat existing medical conditions
Do not leave the person alone
Do not confront or argue with the person
Provide realistic reassurance
Respond in a direct, simple manner
Use restraints only when necessary
Assessment of psychiatric
emergencies
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Look at the person’s appearance
Determine the person’s thought process
General appearance (clothing, grooming)
Motor skills
Expressions and gestures
Orientation – person, place & time, memory,
concentration
Mood
Thanks to Jean Wigle, RN for this
material