Mental Health Flashcards
Cultural variables relating to mental illness
- The way that we perceive mental health and illness as a culture will influence our definition.
- Depression might be thought of as mental illness in some cultures, and a normal mood state in others.
- Our collective moral and religious beliefs might influence our interpretation of symptoms and therefore diagnosis.
What is the WHO definition of mental health?
“a state of well-being in which every individual realises his or her own potential, can cope with the normal stresses of life, can work productively ad fruitfully, and is able to make a contribution to her or his community.”
What are the two standardised sets of diagnostic criteria for Mental Illness in Australia?
DSM-V: The Diagnostic and - Statistical Manual of Mental Disorders (Currently volume 5). The DSM-V is currently the benchmark manual used in Australia for the clinical diagnosis of mental illness.
- ICD-10: The International Classification of Diseases, (Section 10: Classification of Mental and Behavioral Disorders). The ICD 10 is used in Australia to report and categorise diseases internationally. The ICD 10 is often referred to by clinicians but the diagnostic codes are not recorded in clinical practice
Methods for diagnosing mental illness
- Mental State Assessment (MSA)
- Significant medical history
- Social circumstances
- Circumstances of presentation
- Risk assessment
- Assessment is fluid and can change rapidly
Two broad categories of severe and enduring mental illness
1 - psychotic illness - schizophrenia - bi-polar affective disorder - drug-enduced psychosis - psychotic depression 2 - acute disorders that move between moderate and severe, e.g. depression with suicidal intent
Characteristics of schizophrenia
- the presence of psychosis a state in which a persons reasoning and thinking are distorted, leading to a loss of contact with reality
- hearing voices (auditory hallucinations), which are sometimes quite commanding
Pathophysiology of schizophrenia
- strong genetic influence in schizophrenia
- Multiple, interacting genes may be likely in the development of schizophrenia
- Schizophrenia is likely to be caused by a combination of genetic, environmental and neurodevelopmental factors
positive symptoms (exaggeration or distortion of normal function) of schizophrenia
- Hallucinations; commonly auditory. Most people with schizophrenia hear voices or noises in their head. Many also have visual, olfactory and tactile hallucinations.
- Thought disorders such as delusion (illogical or incoherent thinking)
- Disorganised speech and behaviour.
negative symptoms (reduction in normal functioning) of schizophrenia
- Apathy
- Lack of motivation
- Reduction in energy
- Low mood and depression
- Social inactivity
- Isolation
- Loss of pleasure
phases of schizophrenia
There are three distinct stages, often referred to as “phases” that traditionally informed our understanding and diagnosis of schizophrenia.
- Prodromal
- Acute
- Chronic
Not all people move through these phases and they’re not often used in contemporary services, but still useful to identify.
What is the prodromal phase of schizophrenia
- Commonly starts in adolescence.
- Characterised by loss of function
- Social functioning
- Organisation
- Intellectual
- Performing physical activity
Many parents interpret these as normal stages of adolescence, and schizophrenia is rarely diagnosed at this stage without the emergence of acute symptoms.
What is the acute phase of schizophrenia
Characterized by distortion of perception and further loss of functioning.
- Hallucinations
- Delusions
- Decreased self-care
- Isolation
- Acute distress and anxiety
What is the chronic phase of schizophrenia
Characterized by the “burnout” of positive symptoms and increase in negative symptoms:
- Social Isolation
- “Poverty of ideas”
- “Poverty of speech”
The chronic phase might also be a feature of the long term use of older style anti-psychotic medication and major tranquilizers reducing dopamine activity in the frontal cortex of the brain.
Treatment for schizophrenia
Pharmacological therapy Occupational Therapy - Physiotherapy - Cognitive Behavioural Therapy - Social and Welfare needs - Educational and career support - Ongoing support with physical health
pharmacotherapy for schizophrenia
- Anti-psychotic medication
- Typical anti-psychotics include:
- Chlorpromazine
- Haloperidol
- atypical anti-psychotic (2nd generation
- clozapine
- Olanzapine
- Risperidone
- Quetiapine
extrapyramidal side effects of typical anti-psychotics
- These can cause movement and muscle disorders which can be extremely distressing for the patient, often manifesting in symptoms similar to Parkinson’s disease.
- Long term use can cause Tardive Dyskenesia, a movement disorder affecting face, neck and trunk of the body.
- Dry mouth
- Constipation
- Photosensitivy
- Blurred vision
side effects of atypical anti-psychotics
- Weight gain
- Insulin dysregulation
- Loss of libido and sexual functioning
- (for clozapine) agranulocytosis
what is Bi-Polar Affective Disorder (BPAD)?
- BPAD is characterized by extreme cycles in a persons mood, and used to be referred to as manic-depression
-BPAD tends to fall into the category of the “severe and enduring” mental illnesses.
Many people with BPAD remain stable for long periods and are able to function at the highest level without active psychiatric treatment. Some people will also need to take a mood stabilizer and have their condition monitored regularly. - Any “affective” disorder is a mood disorder.
- There are other severe cyclic and enduring mood disorders however bi-polar requires further investigation due to it’s severe and enduring nature, and it’s management and treatment in acute services.
Pathophysiology of BPAD
- psychological, socio-environmental and biological factors.
- Neurotransmitter imbalance
- HPA axis significance
- Neuroanatomical influences (differences in blood flow to areas of the brain)
- Circadian rhythms are also all thought to be contributory factors to BPAD.
- biological factors (genetic, hormonal and neurochemical) have a stronger part to play than psychological factors
Presentation of BPAD
- BPAD is characterized by very extreme “highs” and “lows” in a persons mood that are much more significant than normal mood swings.
- Low periods present as major depressive phases, with significant loss of function and negative cognition.
- Acute mania, or “manic” phases are often accompanied by psychotic symptoms, commonly delusional thinking.
symptoms of acute mania phase of BPAD
- Behaviour: distractive, impulsive, increased sexual desire, extravagant with money & dis-inhibited behaviour
- Communication: pressure of speech, talkative, loud & argumentative
- Mood: elevated, euphoric, irritable, over-optimistic & inflated self-esteem
- Physical: increased activity, no time for food, fluids or rest, decreased sleep & exhaustion
- Cognitive: grandiose delusions & flight of ideas, racing thoughts, inability to focus.
Diagnostic criteria of acute mania phase of BPAD
- Grandiosity
- Increased sexual desire
- Decreased need for sleep
- Talkative than usual or pressured speech
- Flight of ideas, racing thoughts & irritability
- Distractibility & increased activity
- Extravagant with money, disinhibited
- Over-optimistic, loss of critical judgement & fore sight
- Excessive involvement in pleasurable activities
Potential nursing diagnoses during depressive phase of BPAD
- Risk of suicide
- Imbalanced Nutrition
- Self–Care Deficit
- Hopelessness
- Impaired Social Interaction
- Ineffective Coping
- Chronic Low Self-Esteem
- Disturbed Sleep Pattern
Potential nursing diagnoses during acute mania phase of BPAD
- Risk for Violence Directed to Self or Others
- Disturbed Sensory
- Perception
- Disturbed Thought Processes
- Impaired Verbal communication
- Impaired Social Interaction
- Ineffective Coping
- Non-Compliance
Pharmacological treatment for BPAD
- Each symptom of BPAD might need a different pharmacological approach, therefore the acute treatment of BPAD will differ depending on the phase presenting in acute care.
- Depressive symptoms – Anti-depressants
- Manic and psychotic symptoms – Anti-psychotics, anxiolytics and mood-stabilizers
- In all cases the treatment goal is to stabilize the cyclic nature of BPAD, and this is achieved through the use of mood stabilizers.
Mood stabilisers
- Lithium
- Lithium is a naturally occurring salt and is extremely effective in treating BPAD.
- Lithium has a very narrow therapeutic range, therefore regular monitoring of serum levels is required.
- Toxicity can be life threatening, affecting CNS and commonly renal systems.
- Anti-convulsants
- Sodium-Valporate, Carbamazapine and Lamotrigine
Treatments for BPAD
- pharmacological - mood stabilisers, anti-depressives, anti-convulsants
- psychological treatment - CBT
- occupational therapy
- Electro-Convulsive Therapy (rarely used)
