mental illness test 3

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mental illness test 3
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  1. Think of Erickson
    • Intimacy vs. Isolation- (18-25)
    • Generativity vs. Stagnation-(25-65)
  2. Adult growth and development
    • Men are completed with physical growth at about age 21
    • Women are completed with physical growth at about 17
    • Signs of aging start at about 30
    • Young adults choose partners, careers, finish education, marry, start families
  3. If problem solving is effectively learned and established in early life, then coping is usually effective as an adult
    • We should assess each persons level of stress, anxiety, and depression
    • About 15% of adults in the U.S. experience a major depressive problem at some time; Fewer than 1/3 receive treatment
  4. Middle aged adults commonly have drastic lifestyle changes
    Think about an adult man or woman who goes back to college to change careers
    We begin to reflect on our own mortality
    • What are the 3 C’s?
    • Commitment- to s.o. and career, children
    • Communication- with s.o., children and co-workers
    • Compromise- (negotiating when no one either wins or looses) with s.o., children and co-workers
  5. Some common problems in adulthood
    Adjustment disorders, Anxiety disorders, Sexual disorders, Mood disorders, Personality disorders, Health disorders, Lack of income, joblessness, poverty
  6. INTERNAL PROBLEMS (Developmental)
    When one allows anxiety, anger and or other emotions to be the focus…Effective adaptation does not occur as easily
  7. When an individuals ability to solve problems effectively is limited- behavioral and personality difficulties are much more common
    • If difficulties coping due to intellectual reasons- personality difficulties are more common
    • Emotional problems = difficulty with stress related issues
    • Anger management is a common problem with adults- if exposed to aggressive acts as children- effective coping will be more difficult
    • The use of drugs and alcohol leads to difficulties
    • dealing with stressors
  8. Have many opportunities to assist the individual client by offering emotional support and encouragement to problem solve
    Are a valued resource- you can help to direct clients to support groups and community resources
    • Help young adults develop a positive personal identity
    • Help guide occupational choices and goals
    • Help them differentiate b/t positive and neg. choices
    • Listen, Be an advocate
  9. Adulthood -
    If young adults seek relationships for the “wrong” reasons- to fill a void or to escape an unhappy situation- devastating consequences can develop!
    • Many homosexual couples seek the same stability in life as hetero couples, but have more stress because of the social stigma and discrimination
    • Some end up in violent/abusive relationships
    • Some wind up caring for aging adult parents while they
    • are still caring for their own children
  10. Dementia may appear as memory loss or delirium
    DEMENTIA is the loss of multiple abilities- including long/short term memory, language and the ability to think and understand
    Possible causes dementia: MEND A MIND
    Metabolic disorders, Electrical disorders
    Neoplastic disorders (cancer,leukemia); Degenerative disease; Arterial disease; Mechanical disorders; Infectious disease; Nutritional disorders; Drug toxicity
  11. Aphasia develops- Loss of language
    Apraxia- Loss of ability to perform ADL’S
    Visual Agnosia- Loss of recognition of previously recognized people and objects
    • “Affective Loss”- loss of one’s own personality (may have delusions/hallucinations/paranoia)
    • “Conative Loss”- the loss of the ability to make and carry out plans
    • often frustration and anger at the loss of the usual function
  12. sundowns syndrome- Keep patient’s out of overly stressful situations
    Keep stimuli to a minimum to decrease confusion
    Meds: Cognex, Aricept, and some calcium channel blockers, and some Antiinflammatories
    • perform functional assessment; mini-mentalstatus; Neuro How does the pt. eat, bathe, dress & help is needed?
    • Pictures of the patient in various stages of life may recognize
    • Some will progress beyond that point though
    • At some point they will not recognize loved ones or be
    • able to communicate
  13. Signal anxiety- a learned response to an anticipated event (testing!)
    Anxiety state- an individual’s coping abilities are overwhelmed and emotional control is lost (emergencies, accidents, trauma)
    Anxiety trait- reaction to a relatively non-stressful situation with anxiety
    • Biological Models- (most popular)- neurotransmitters in the brain, the dysfunction of 2 or more of these
    • Other studies have shown that there may be inappropriately activated norepi
    • Many medical disorders such as: hormonal imbalances, problems with substance abuse, fatigue
  14. 2) Psychodynamic Model-
    May be the result of attempts to defend oneself against anxiety, may be the result of a conflict b/t 2 opposing forces within
    }Remember id and ego?
    • 3) Interpersonal Model- Anxiety develops when early childhood interactions with significant others results in negative outcomes, over a period of time- may form a basis for low self esteem and poor self-concept
    • 4) Behavioral Model- Anxiety is a learned response. Anxiety may be due to a prior situation
  15. Pre-school- separation anxiety
    School-age- become members of groups
    Problems in children with anxiety- phobias(fears)
    Compulsion(Obsessive behavior)
    Overanxious (unrealistic anxiety lasting longer than 6 months, often seen in parents who focus on over achievement)
    Avoidant (the child refuses to cope with anxiety causing situations by ignoring them)
    • Adolescents-They often use denial to avoid bad situations (drugs, aggression, running away)
    • extreme anxiety- may lead to self-mutilation, anorexia nervosa, bulimia
    • There is a need to treat early. often signs of schizo, depression, and other psychoses that develop
  16. Anxiety is expressed in ineffective or maladaptive ways and one’s coping mechanisms (behavior) do not successfully relieve the distress
    • Generalized Anxiety Disorder (GAD)
    • seen in adolescence or early adulthood
    • Anxiety is broad, long-lasting and excessive
    • They have difficulty concentrating
    • Responses are way far out of proportion with the actual situation
    • Physical signs- muscle tension, increased Bp, fight or flight responses
    • Often seen in those with IBS, HA’s, sleep disturbances and substance abuse
  17. Panic attack- brief period of intense fear or discomfort
    lasts for 1-15 minutes with a peak after about 10 minutes
    More common in women, those who are separated/divorced, and persons b/t 24-44 (both sexes)
    • 2 types: Those with and w/o agoraphobia (Anxiety about possible situations in which a panic attack may occur)
    • These people avoid people, places and events that may be embarrassing if a panic attack occurs
    • Treatment focuses on education & more adaptive coping skills
  18. PHOBIA- unnatural fear, can be fear of animals, people, objects, situations, etc…
    Phobias are obsessive in nature
    Anxiety can be so high that it immobilizes people in a way that they may have been able to alleviate that anxiety SOCIAL PHOBIA- fear of situations where others may be judging, people worry about looking foolish. Special anxiety in the presence of authority figures
    • OCD
    • A distressing, persistent thought
    • Inappropriate and recurring
    • Specific behaviors that must be performed to reduce anxiety
    • Self-destructive
    • S/s can occur as early as the age of 3, but usually begins in adolescence
    • Affects men and women equally, but occurs in men about 5 years earlier
    • Most have other mental problems- depression and schizo
    • Most common- cleanliness, dirt and germs- constant hand washing, etc…
    • Also, health concerns, safety concerns, aggressiveness and sexual impulses, order and symmetry
    • Unable to have normal relationships, compulsions are too time consuming
    • May be genetic and hormonal
    • Needs drug and behavioral therapy- SSRI anti-depressants have been successful
    • Please review the OCD criteria in your textbook
  19. }ADDICTIVE BEAHVIORS- gambling, shopping, working, excessive sexual activity, eating, internet, and many more…
    }Think of the risks- for safety and for health!
    }Why do people become addicted?
    }Stimulation of dopamine secretion?
    }The brain of the addict has been found to have fewer D2 receptors…
    }Predisposition related to a high level of stress hormones
    }If there is a deficit on dopamine function and the “substance” (especially drugs) corrects it, these folks can more easily become addicted
    }Several genetic markers and genes have been linked to prove genetic disposition to addiction (especially alcohol)
    }Behavioral theorists believe that there is a positive effect of mood alterations and reduction in feelings of fear and anxiety when addiction is at work
    }Sociocultural theorists believe that economics, culture and ethnicity can be responsible for addiction (especially to drugs and alcohol)
    • }Psychodynamic theorists- addiction fills the need for immediate gratification, a way to escape, or feelings of euphoria
    • }Many may have a decreased tolerance for anxiety, fear, frustration
    • }Also… overprotection, under-supervision, maltreatment, undue responsibility, rejection as children may also add to the increased risk
  20. Traumatic stress reaction
    }series of behavioral and emotional responses following an overwhelmingly stressful event
    }Those exposed to or victims of violent acts, sexual abuse, spousal abuse, the homeless
    }Predictable clinical course: FEAR and ANGUISH, RECOVERY and REPAIR, ADAPTATION
    }Support and advocacy are very important to help with appropriate coping
    • Post Traumatic Stress Disorder (PTSD)
    • }Once exposed to or experienced an overwhelming, traumatic experience in which intense fear, horror and helplessness was experienced
    • }Loss of control of life is felt
    • }Symptoms include- flashbacks- reliving the experience which in turn causes extreme anxiety
    • }This can be an emotional event or a physical event
    • }The event might be experienced as a spectator or as a participant
    • }Interventions are to ensure safety and security, re-orient the client to reality and the surroundings
    • }Drug therapy and emotional support and counseling is a must
  21. interventions
    }Try to PREVENT anxiety
    }Learn to recognize symptoms of anxiety
    }Assess the client’s anxiety levels in each client
    }Teaching to cope effectively to minimize health care problems later in life
    }Medications
    }Mental health therapy
    • 2 Theories in therapeutic intervention
    • }Systematic desensitization- learning to cope with one anxiety causing stimulus at a time until each stressor is no longer anxiety causing



    • }Flooding-
    • Rapidly and repeatedly exposing the client to the object or situation of fear
    • until anxiety levels diminish
  22. }May be treated with benzo’s (most common anti-anxiety medication), antidepressants, antihistamines, propanolol, buspar.
    }Remember the side effects of benzo’s?
    }Need to complete physical assessment, thorough medical and surgical history
    }FIRST PRIORITY OF CARE: SAFETY!!!
    }Establish a trusting therapeutic relationship
    }Help in developing more effective coping mechanisms
    }Teach relaxation techniques
    }Encourage self control and autonomy- when safe to do
    • depression:
    • •Emotional responses can be growth promoting and adaptive OR
    • •They can lead to ineffective behaviors that can be maladaptive
    • •Adaptive: emotional responsiveness, uncomplicated grief
    • •Maladaptive: Supression, delayed grief, depression.mania
  23. theories:
    Mood- prolonged emotional state that influences one’s whole personality
    •Biological evidence
    •Genetic susceptibility- many with depression and bipolar disorders have family members with mood disorders
    •Biochemical imbalances- imbalance in monoamines, norepi and serotonin
    •Imbalances in serotonin, progesterone and estrogen- women are 2X more likely to develop depression
    • •Biological rhythms of depressed people are different than those who are not depressed
    • •Depression is also related to physical illness
    • •Childhood and adult experiences- those not nurtured as children are at higher risk, losses in role changes
    • •Social circumstances- poor social support, few friends and social acquaintances
  24. •Childhood- infants need their basic needs met- if not, there is mal-contentment
    •Toddlers and school aged children slowly learn to do so through education and nurturing and modeling, and as they age- peer pressure
    •Most children suffer from “situational depression” based on a specific situation- once the situation is resolved the depression is relieved
    • •Situational
    • depression occurs in all age groups

    • •Children
    • often have feelings of helplessness, low self-esteem, hopelessness, and they
    • will take blame for negative events

    • •They
    • are often irritable, tearful and sad- they spend time alone “zoning”, and
    • schoolwork/friendships slip
    • •Changes
    • in eating and sleeping habits

    • •The
    • incidence in childhood
    • depression is on the rise-



    • ASSESS for it at every age level!
  25. Emotions in adolescence- related to:
    •Self-esteem
    •loneliness
    •family strengths
    •parent-adolescent communications
    •So if with low self-esteem = negative emotions
    •Grades drop
    •Disinterest in activities that were usually liked
    • •Sometimes the parents expect overachievement, but there is seldom any reward
    • •Adolescents rebel: drugs, alcohol
    • •lack of interest
    • •change in friends
    • •lack of family interest, etc…
    • •Depression in adolescence must be recognized early or long standing problems can occur later in life
  26. Emotions in adulthood
    •Many have problems with family, career, coping
    •Drug use, ETOH, eating disorders*, refusal to seek help
    •Many are embarrassed to report problems
    •Many are raised that emotional problems show a weakness in character
    •Afraid of judgement
    • Emotions in the older adult
    • •Very common in the elderly!! ASSESS!!
    • •Highest in elderly women, medically ill, and those in long-term care
    • •Suicide is not as uncommon in the elderly as once believed
    • •Drug use and abuse as well as ETOH is not unheard of either
    • •Many afraid to be a burden so they do not report
  27. •Depression-
    illness that involves emotional, physical, intellectual, social and spiritual problems
    •Can be mild and short-lived (drugs and etoh may increase here)
    •Can be moderate(dysthymia)- begin to interfere with ADL’s, there is lack of energy
    Often there is:
    •There is fatigue
    •Changes in eating and sleeping habits
    •Changes in sexual dysfunction and menstral cycles
    •Jugement and decision making is clouded
    •Focus on proving how bad things are
    • Mania-
    • •Seen in bipolar disorders over-excitement and hyperactivity
    • •Major Depressive Episode- lasts more than 2 weeks and is severe
    • •There is no hope
    • •Can be agitated to paralyzing
    • •Feelings of worthlessness, guilt and despair
    • •Suicidal thoughts are entertained
  28. Major Depressive Disorder
    • Episodes routinely repeat themselves for more than 2 years
    •These people have a high mortality rate- suicide
    •There is a great increase in those over 55 who have been dx. with a major depressive disorder
    •Occurs 2X as often in adolescent girls and adult women than in men
    •Symptoms onset in the early 20’s
    •Families with one depressed family member have an increased risk of others developing the disorder
    • Dysthymic Disorder
    • •Moderate depression that lasts more than 2 years
    • •Chronic sadness and are self-critical
    • •Low energy and poor decision making skills
    • •See the world in a negative point of view
    • •Can begin in childhood or as late as adulthood
    • •ADL’s can usually be carried out, but there is no joy
  29. Bipolar Disorder
    •Sudden and dramatic from one extreme to the next
    •Normal to grandiose to depressed
    •Time intervals b/t each varies
    •“MANIA”- Persistently elevated mood, can be irritable
    •Mood can be extreme with risk taking behaviors
    • Stages:•Hypomania-
    • Exaggerated sense of cheerfulness
    • •Mania- Unstable high- grandiosity
    • •Delirium- if the mania is allowed to persist- incoherence, disorientation
    • •(See the text for description of behaviors)
  30. Cyclothymic Disorder
    •Repeated mood swings alternating b/t hypomania and depressive symptoms
    •Less intense swings
    •No periods of normal functioning however
    •Bounce from too high to too low on a daily basis
    •Less of a cyclic event vs. Bipolar disorder
    • Other mood disorders and problems with affect
    • 1) Seasonal affective disorder- S.A.D. “winter depression”
    • •Occurs from October to April
    • •Mild and moderate depression that begin to lif with the coming of Spring
    • •PHOTOTHERAPY- light exposure
    • •More common in areas with dark winters for extended periods of time (Alaska, the Netherlands)
    • 2) Post-partum depression- in the days and weeks (even months) following delivery
    • •HA
    • •Irritability
    • •Sleeplessness
    • •Sadness and crying, depression, isolation, anxiety
    • •Can be extreme (Andrea Yates)
  31. 3) Substance-abuse mood disorder- related to a specific chemical usually illegal drugs, but can be ETOH
    Can also be related to:
    •Analgesics
    •Antibiotics
    •Anticonvulsants
    •Antihypertensives
    •Anti-inflammatories
    •Antineoplastics
    •Antiparkinsons
    •Anti-Tb medications
    •Cardiovascular agents
    •CNS agents- those that lift and those that depress
    • Therapeutic Interventions: 3 Phases:
    • 1) Acute phase- lasts 6-12 weeks
    • •Goal is to reduce symptoms and inappropriate behaviors
    • •May need inpatient treatment
    • 2) Continuation Phase- to prevent relapses, lasts 4-9 months
    • •Outpatient basis
    • •Medications and psychotherapy
    • •Education and encouragement for new coping behaviors
    • •Maintenance treatment phase- prevents reoccurences
    • •Maintenance psychotherapy and meds
    • Some treatments may include:
    • •Psychotherapy- cognitive-behavioral therapy/support groups
    • •- ECT- electrical current through the brain
    • •Raises the level of neurotransmitter norepi
    • •Done only if other attempts have failed
    • •Causes a controlled seizure
    • •6-12 treatments over several weeks, 2-3 times a week
    • •Not in clients with MI, CVA, hypertension, hypotension, CHF- slows heart rate and lowers Bp, then a sharp increase in Bp… WHY?
  32. Procedure…
    •NPO for 8 hours
    •Informed consent
    •EEG monitoring
    •Airway
    •IV sedatives
    •O2
    •VS monitoring
    •Common side effects- HA, confusion, short term amnesia
    • Pharmacotherapeutics…
    • •Anti-depressants- usually take 2-4 weeks to start working
    • •TEACH compliance!
    • •Tricyclics were once the drug of choice
    • •SSRI’s are now prescribed more often- low incidence of s/e’s
    • •Last choice is MAOI’s- WHY?
    • •READ THIS INFORMATION…
    • •Remember liver and kidney problems with these drugs!
    • •Watch your labs
    • •Watch the side effects and toxic effects!
    • •LITHIUM- drug of choice in Mania
    • •Lithium doesnot bind to protein so it is not metabolized by the liver
    • •It does compete with Na+- is excreted through the kidneys more rapidly than Na
    • •Low salt intake or rapid loss- Lithium level increase
    • •High salt intake, lithium levels drop
    • •Frequent lithium levels- narrow therapeutic index
    • •Polydypsia and polyuria are experienced in the beginning of treatment

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