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MENTAL HEALTH ISSUES IN PALLIATIVE CARE PATIENTS

MENTAL HEALTH ISSUES IN PALLIATIVE CARE PATIENTS. may be reversed controlled understood. MENTAL HEALTH ISSUES IN PALLIATIVE CARE . UNDERSTANDING AND RESPONDING WITH SENSITIVITY Terry Magee, . THE MYTHS OF MENTAL ILLNESS. Labels Mad Bad or Sad? Incapable Incompetent Vulnerable Weak

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MENTAL HEALTH ISSUES IN PALLIATIVE CARE PATIENTS

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  1. MENTAL HEALTH ISSUES IN PALLIATIVE CARE PATIENTS may be reversed controlled understood

  2. MENTAL HEALTH ISSUES IN PALLIATIVE CARE UNDERSTANDING AND RESPONDING WITH SENSITIVITY Terry Magee,

  3. THE MYTHS OF MENTAL ILLNESS Labels Mad Bad or Sad? Incapable Incompetent Vulnerable Weak Hysterical (esp. women) Attention seeking Potty, Bonkers, Nutty,Daft Eccentric. Incurable Nervy Artistic temperament Pandora's box A Magical shaman or guru

  4. MENTAL ILLNESS NATURE OR NURTURE?

  5. DEPRESSION AND ANXIETY IN PALLIATIVE CARE Depression and Anxiety are common in all patients with serious illness. They impact upon the psychosocial profile of the patient. They are often responsive to treatment . But a lack of attention to them may lead to ongoing dysphoria ( a disorder of affect characterised by depression and anguish) family conflict non compliance with treatment increased length of hospitalisation persistent worry suicidal ideation needless suffering

  6. What is it that becomes depressed ? might it be anger ? Is it because of our Genes? Is it a reaction to stress? Is it a chemical imbalance? (hormones or serotonin) Is it a result of our environment and socialisation? Is it our unconscious reacting to early childhood trauma or faulty parenting? DEPRESSION

  7. SYMPTOMS INDICATING DEPRESSIVE DISORDER IN THE MEDICALLY ILL • Enduring depressed or sad mood, tearful • Marked disinterest or lack of pleasure in social activities, family, and friends • Feelings of worthlessness and hopelessness • Excessive enduring guilt that illness is a punishment • Significant weight loss or gain not explained by dieting, illness, or treatments. • Hopeless about the future • Enduring fatigue • Increase or decrease in sleep not explained by illness or treatment • Recurring thoughts of death or suicidal thoughts or acts • Diminished ability to think and make decisions

  8. INTERVENTIONS TO ASSIST THE DEPRESSED PATIENTCOMPLEMENTARY THERAPIES • Guided imagery and visualisation • Aromatherapy and massage • Art and music therapy • Aerobic exercise • Life revue, life story and reminiscence therapy • Humour • Dance and movement therapy • Progressive somatic relaxation and biofeedback

  9. INTERVENTIONS TO ASSIST THE DEPRESSED PATIENTCOGNITIVE INTERVENTIONS Help the patient to identify and reality test Self defeating assumptions Negative automatic thoughts Rumination on failure Ability to set and achieve goals Ability to determine realistic expectations Teach “stop think strategy” Assist to accomplish personal enhancement activity Avoid denying the patient’s sadness Avoid chastising the patient for feeling low Minarik (1996)

  10. INTERVENTIONS TO ASSIST THE DEPRESSED PATIENTINTERPERSONAL • Enhance social skills through modelling, role play, feedback and positive reinforcement • Build rapport with frequent short conversations, exchanges and connectedness • Give attention even when the patient is withdrawn • Mobilise family creative and social support networks • Encourage open communication about feelings • Teach the family how they can help • Allow the patient time and space for reflection and reverie Minarik (1996)

  11. INTERVENTIONS TO ASSIST THE DEPRESSED PATIENTBEHAVIOURAL • Provide directed activities • Use graded task assignment hierarchy • Develop daily activity schedule • Encourage the patient to keep a journal of successful actions and revue • Use systematic application of reinforcement • Encourage self monitoring of predetermined behaviours such as sleep pattern, diet and physical exercise • Focus on goal attainment and adaptive coping

  12. SYMPTOMS INDICATING ANXIETY DISORDER IN THE MEDICALLY ILL • Chronic apprehension, worry, inability to relax which is not related to illness or treatment • Difficulty in concentrating • Irritability or outbursts of anger • Difficulty falling asleep or staying asleep • Trembling or shaking • Exaggerated startle response • Perspiring for no obvious reason • Chest pain and shortness of breath unrelated to medical condition • Extreme fear of places, events, certain activities. • Recurring and persistent ideas, thoughts or impulses • Repetitive behaviours to prevent discomfort • Fear or “going crazy” • Exaggerated fear of dying Barraclough (1997)

  13. INTERVENTIONS TO ASSIST THE ANXIOUS PATIENTLEVEL 1 PREVENTION • Provide concrete objective information • Ensure stressful event warning • Increase opportunity for control • Increase patient and family participation in care activity • Openly acknowledge fears • Explore near miss events • Control symptoms • Structure uncertainty • Limit sensory deprivation and isolation • Encourage hope

  14. INTERVENTIONS TO ASSIST THE ANXIOUS PATIENTLEVEL 2 RESPONSE • Hold the patient • Use presence as an emotional anchor • Support the open expression of feelings, doubts and fears • Explore near-miss events • Provide information and alternatives for restructuring fearful ideas • Teach anxiety reduction strategies e.g. focussed breathing, relaxation imagery • Use contact, therapeutic touch and massage • Review the day’s events and reduce stressors • Consult mental health experts

  15. INTERVENTIONS TO ASSIST THE ANXIOUS PATIENTLEVEL 3 MANAGEMENT • Stay with the patient • Calm the environment • Remove any unnecessary auditory, olfactory, visual, tactile and environmental stimulants • Administer anti anxiety medication • Use distraction and refocusing techniques • Repeat realistic reassurances • Communicate with repetition, clarity and simplicity • Consult mental health experts Leavitt 1996

  16. BIPOLAR DISORDER

  17. Emotional pendulum Roller coaster Manic high Omnipotent thoughts Paralysing low suicidal thoughts Nurturing calm BIPOLAR DISORDER

  18. SCHIZOPHRENIA

  19. SCHIZOPHRENIA Schizophrenia is characterised by ideas of reference, auditory and/or visual hallucination, thought blocking, delusional association and often the patient believes that they are being persecuted, possessed or accompanied by imaginary figures. There is often mania present with ideas of grandeur and often the individual will feel they possess vital information or talent. There is also often persistent worry, suspicion and anxiety which has no factual basis. In addition there are often severe abnormalities in thought, feeling and behaviour including compulsion. Schizophrenia is a serious illness which demands our compassion, our patience, our persistence and our utmost respect for the suffering that accompanies this illness.

  20. SCHIZOPHRENIA

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