Mental Health Disorders Chapter 38 Mental Health Disorders All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.

Basic Concepts Mental relates to the mind. Therefore mental health involves the mind. Mental health and mental illness involve stress. Stress is the response or change in the body caused by any emotional, physical, social, or economic factor. Mental health means that the person copes with and adjusts to everyday stresses in ways accepted by society. Mental disorder (mental illness, emotional illness, psychiatric disorder) is a disturbance in the ability to cope with or adjust to stress. The whole person has physical, social, psychological, and spiritual parts. Each part affects the other. With mental illness, behavior and function are impaired. All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 2

Causes of Mental Health Disorders Causes of mental health disorders include: Not being able to cope or adjust to stress Chemical imbalances Genetics Physical or biologic factors Psychological factors Drugs or substance abuse Social and cultural factors All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 3

Anxiety Disorders Anxiety is a vague, uneasy feeling in response to stress. Often, anxiety occurs when needs are not met. Some anxiety is normal. Signs and symptoms depend on the degree of anxiety. Anxiety level depends on the stressor. A stressor is the event or factor that causes stress. Coping and defense mechanisms are used to relieve anxiety. Some are healthy. Persons with mental health problems have higher than normal levels of anxiety. The person may not know the cause. Danger or harm—real or imagined—is sensed. The person acts to relieve the unpleasant feeling. Review Box 38-1 on p. 599. Stressors can be physical, emotional, social, or economic. Past experiences and the number of stressors affect how a person reacts. The same stressor may produce mild or higher anxiety. Defense mechanisms are unconscious reactions that block unpleasant or threatening feelings. Review Box 38-2 on p. 600. All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 4

Panic Panic disorder Panic is an intense and sudden feeling of fear, anxiety, terror, or dread. It is the highest level of anxiety. The onset of panic is sudden, with no obvious reason. Panic attacks can last for 10 minutes or longer. Signs and symptoms of anxiety are severe during a panic attack. The person may also have: Chest pain Shortness of breath Rapid heart rate; “heart pounding” Numbness or tingling in the hands Dizziness A smothering sensation Feeling of impending doom or loss of control Panic disorder can last a few months or many years. During a panic attack, the person cannot function. The person may feel that he or she is having a heart attack, losing his or her mind, or on the verge of death. Attacks can occur at any time, even during sleep. Many people avoid places where panic attacks occurred. For example, a person had a panic attack in a shopping mall, so the person avoids malls. All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 5

Phobia Phobias Phobia means an intense fear, panic, or dread. The person has an intense fear of an object, situation, or activity that has little or no actual danger. Common phobias include fear of fire; water; strangers; spiders; night or darkness; the slightest uncleanliness; being in or being trapped in an enclosed or narrow space; being in pain or seeing others in pain; and being in an open, crowded, or public place. The person avoids what is feared. When faced with the fear, the person has high anxiety and cannot function. Review the common phobias listed on p. 599. All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 6

Obsessive-Compulsive Disorder Obsessive-compulsive disorder (OCD) An obsession is a recurrent, unwanted thought, idea, or image. Compulsion is repeating an act over and over again (a ritual). Common rituals are hand washing, constant checking to make sure the stove is off, cleaning, counting things to a certain number, or touching things in a certain order. Some persons with OCD also have depression, eating disorders, substance abuse, and other anxiety disorders. The person with obsessive-compulsive disorder (OCD) has obsessions and compulsions. Compulsions may not make sense, but the person has much anxiety if the act is not done. Some people are obsessed with microbes, dirt, violent thoughts, or things forbidden by religious beliefs. Compulsive rituals can take over an hour every day. They are very distressing and affect daily life. All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 7

Post-Traumatic Stress Post-traumatic stress disorder Post-traumatic stress disorder (PTSD) occurs after a terrifying ordeal involving physical harm or the threat of physical harm. Most people with PTSD have flashbacks. A flashback is reliving the trauma in thoughts during the day and in nightmares during sleep. Flashbacks may involve images, sounds, smells, or feelings. Everyday things can trigger flashbacks. During a flashback, the person may lose touch with reality. The person may believe the trauma is happening all over again. Signs and symptoms may develop a few months after the harmful event, or not until years later. The person may also suffer from depression, substance abuse, and other anxiety disorders. Review Box 38-3 on p. 600. PTSD can develop after being harmed, after a loved one was harmed, or after seeing a harmful event happen to loved ones or strangers. PTSD can result from many traumatic events: war; a terrorist attack; mugging; rape; torture; kidnapping; being held captive; child abuse; a crash—vehicle, train, plane; a bombing; or a natural disaster—flood, tornado, hurricane. Some people recover within 6 months, but the condition may become chronic. PTSD can develop at any age, including during childhood. All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 8

Schizophrenia Schizophrenia means split mind. Schizophrenia involves: It is a severe, chronic, disabling brain disorder. Schizophrenia involves: Psychosis—a state of severe mental impairment Delusion—a false belief Hallucination—seeing, hearing, smelling, or feeling something that is not real Paranoia—a mind disorder of false beliefs Delusion of grandeur—an exaggerated belief of one’s importance, wealth, power, or talents Delusion of persecution—the false belief that one is being mistreated, abused, or harassed The person with psychosis does not view the real or unreal correctly. An example of a delusion is when a person believes that a radio station is broadcasting the person’s thoughts. A person who has hallucinations sees or hears things that are not real. A person with paranoia is suspicious. For example, a person may believe that others are cheating, harassing, poisoning, spying upon, or plotting against him or her. An example of a delusion of grandeur is when a man believes he is Superman or a woman believes she is the Queen of England. An example of a delusion of persecution is when a person believes that someone is “out to get” him or her. All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 9

Schizophrenia (Cont’d) The person with schizophrenia: Has severe mental impairment (psychosis) Has disturbed thinking and behavior Has delusions and/or hallucinations May be paranoid May have difficulty organizing thoughts Disorders of movement occur. Some persons withdraw or regress. In men, the symptoms usually begin in the late teens or early 20s. In women, symptoms usually begin in the mid-20s and early 30s. The person has problems relating to others. He or she is not involved with people or society. Responses are not appropriate. Communication is disturbed. The person may ramble, repeat what another says, or make up words. Sometimes speech cannot be understood. Disorders of movement include being clumsy and uncoordinated, involuntary movements, grimacing, unusual mannerisms, or sitting for hours without moving, speaking, or responding. To regress means to retreat or move back to an earlier time or condition. All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 10

Schizophrenia (Cont’d) People with schizophrenia do not tend to be violent. Some persons with schizophrenia attempt suicide. If a person talks about or tries to commit suicide: Call for the nurse at once. Do not leave the person alone. However, if a person with paranoid schizophrenia becomes violent, it is often directed at family members. Review Focus on Communication: Schizophrenia on p. 601. All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 11

Mood Disorders Mood or affect relates to feelings and emotions. The person with bipolar disorder has severe extremes in mood, energy, and ability to function. There are emotional lows and emotional highs (depression and mania). The disorder also is called manic-depressive illness. The person may: Be more depressed than manic Be more manic than depressed Alternate between depression and mania Become suicidal If a person talks about or tries to commit suicide: Call for the nurse at once. Do not leave the person alone. Mood (or affective) disorders involve feelings, emotions, and moods. Bipolar means two poles or ends. Mood changes are called “episodes.” Bipolar disorder tends to run in families. It usually develops in the late teens or in early adulthood. Bipolar disorder can damage relationships and affect school or work performance. Life-long management is required. Review Box 38-4 on p. 602. All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 12

Depression Major depression Depression involves the body, mood, and thoughts. Symptoms affect work, study, sleep, eating, and other activities. The person is very sad and loses interest in daily activities. Stressful events and some physical disorders can cause depression. Depression is common in older persons. Depression in older persons: Is often overlooked or a wrong diagnosis is made Is often thought to be a cognitive disorder Is often not treated Review the symptoms of depression in Box 38-5 on p. 602. Hormonal factors may cause depression in women—menstrual cycle changes, pregnancy, miscarriage, after birth (post-partum depression), and before and during menopause. Older persons have many losses—death of family and friends, loss of health, loss of body functions, and loss of independence. Loneliness and the side effects of some drugs also are causes. All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 13

Personality Disorders Personality disorders involve rigid and maladaptive behaviors. Those with personality disorders cannot function well in society. Personality disorders include: Antisocial personality disorder—a chronic disorder in which the person’s thinking and behaviors show no regard for right or wrong Borderline personality disorder (BPD)—a chronic disorder in which the person has problems with moods, relationships, self-image, and behavior. Maladaptive means to change or adjust in the wrong way. The person with antisocial personality disorder has poor judgment, lacks responsibility, and is hostile. The person with antisocial personality disorder is not loyal to any person or group. The rights of others do not matter. The person does not learn from experiences or punishment. In BPD, persons may have intense bouts of anger, depression, and anxiety that last hours or most of the day. Aggression, self-injury, and drug or alcohol abuse may occur with BPD. All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 14

Substance Abuse and Addiction Substance abuse or addiction occurs when a person overuses or depends on alcohol or drugs. The person’s physical and mental health are affected. The welfare of others is affected. Substances involved in abuse and addition affect the nervous system, the mind, and thinking. Some abused substances depress the nervous system. Others stimulate it. All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 15

Alcohol Abuse Alcoholism and alcohol abuse Alcoholism is a chronic disease, lasting throughout life. Over time, heavy drinking damages the body’s organs. Life-style and genetics are risk factors. Some people turn to alcohol for relief from life stresses. The craving for alcohol can be as strong as the need for food or water. There is no cure. Alcoholism (alcohol dependence) can be treated. Alcohol’s effects vary with age; older persons have a lower tolerance. Mixing alcohol with some drugs can be harmful, even fatal. Alcohol makes some health problems worse. Alcohol slows down brain activity. It affects alertness, judgment, coordination, and reaction time. According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), alcoholism (alcohol dependence) includes these symptoms: craving, loss of control, physical dependence, and tolerance. Counseling and medications are used to help the person stop drinking. The person must avoid all alcohol to avoid a relapse. Alcohol abuse—in which a person drinks too much but is not dependent on alcohol—is just as harmful as alcoholism. Even small amounts of alcohol can make older persons feel “high.” Older persons are at risk for falls, vehicle crashes, and other injuries from drinking. All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 16

Drug Abuse Drug abuse and addiction Drug abuse is the over-use of a drug for non-medical or non-therapy effects. Drugs interfere with normal brain (mental) function and social function. Drug addiction is a chronic, relapsing brain disease. Physical effects can occur from one use, high doses, or prolonged use. While the drugs create temporary powerful feelings of pleasure, they have long-term effects on the brain. At some point, changes in the brain can turn drug abuse into addiction; then the person has an overwhelming desire to take a drug. Review the list on p. 603 that is used to make a diagnosis of drug abuse or addiction. Three or more of these must be present. Drug abuse and addiction are linked to crimes, violence, and motor vehicle crashes. Physical effects include HIV and AIDS (from risky sexual behavior; Chapter 33), cardiovascular disease, stroke, sudden death, hepatitis, lung disease, and cancer. All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 17

Drug Abuse (Cont’d) Legal and illegal drugs are abused. Withdrawal syndrome is the person’s physical and mental response after stopping or severely reducing the use of the substance that had been used regularly. Treatment depends on the type of drug and the person. Treatment is a long-term process. Review Table 38-1 on pp. 605-606. Legal drugs are approved for use in the United States. Doctors prescribe them. Illegal drugs are not approved for use. They are obtained through illegal means. Often legal drugs also are obtained through illegal means. Withdrawal syndromes may include anxiety, restlessness, insomnia, irritability, impaired attention, and physical illness. The same (or similar) substance is taken to relieve or avoid withdrawal symptoms. A drug treatment program combines various therapies and services to meet the person’s needs. Drug abuse and addiction are chronic problems. Relapses can occur. A short-term, one-time treatment is often not enough. All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 18

Suicide Suicide means to kill oneself. Suicide is most often linked to: Depression and other mental health disorders Alcohol or substance abuse Stressful events such as separation or divorce If a person mentions or talks about suicide: Take the person seriously. Call for the nurse at once. Do not leave the person alone. According a 2012 National Institute of Mental Health (NIMH) report, suicide was the 10th leading cause of death in the United States. Review Box 38-6 on p. 607. The highest rate of suicide is among white men age 85 years and older. Review Focus on Communication: Suicide on p. 607. The NIMH defines suicide contagion as exposure to suicide or suicidal behaviors within the family, peer group, or media reports of suicide. Persons at risk for suicide need mental health services. All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 19

Care and Treatment Treatment of mental health problems involves having the person explore his or her thoughts and feelings through various therapies. The needs of the total person must be met, including physical, safety, security, and emotional needs. Often, medications are ordered. The care plan reflects the person’s needs. Communication is important. You must take responsibility for your safety. Be alert to nonverbal communication. This includes the person’s nonverbal communication and your own. Persons with mental health problems may respond to stress with anxiety, panic, or anger. Some may become violent. Your first priority is to protect yourself. Once you are safe, the health team can work together to protect the person and others. To protect yourself, call for help. Do not try to handle the situation on your own. Keep a safe distance between you and the person. Be aware of your surroundings. Do not let the person get between you and the exit (see Workplace Violence, Chapter 10, p. 141). See Focus on Communication: Care and Treatment on p. 608. All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 20

Quality of Life Persons with mental health problems have the right to quality of life. They have the same rights as other residents. People do not choose to have physical or mental health problems. Persons with mental health problems deserve the same dignity and respect given to persons with physical illnesses. Protect the right to privacy and confidentiality. Protect the right to personal choice. Protect the person from abuse, mistreatment, and neglect. Provide a safe setting. How you view the person’s illness affects the way you treat the person. Persons with mental health problems may respond to stress in different ways. Treat the person with kindness and respect. Share what the person said or did only with the nurse. The person may have problems making choices. Limiting choices may help the person make simple choices and feel in control. Report signs of abuse, mistreatment, or neglect to the nurse. Some persons with mental disorders are dangerous to themselves or others. The care plan includes safety measures. If suicide is a threat, all harmful items are removed from the person’s setting. The nurse tells you what to do. All items and derived items © 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved. 21