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Section V: Mental Health Issues

Section V: Mental Health Issues. Most common mental health issues seen in Veterans: Post traumatic stress disorder (PTSD) Depression Substance abuse Veterans Advisory Council, 2009. Post Traumatic Stress Disorder (PTSD).

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Section V: Mental Health Issues

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  1. Section V: Mental Health Issues • Most common mental health issues seen in Veterans: • Post traumatic stress disorder (PTSD) • Depression • Substance abuse Veterans Advisory Council, 2009

  2. Post Traumatic Stress Disorder(PTSD) • PTSD is characterized by persistent/severe reaction to a traumatic event • Combat • Terrorist attacks • Sexual or physical assault • Accidents • National/natural disasters • Symptom clusters • Avoidance • Re-experiencing the event • Hyperarousal • Occurs in about 30% of Veterans who were in war zones • Implications for EOL VA Advisory Council, 2009

  3. PTSD: Factors Associated with PTSD • Strong emotional and/or behavioral reaction to a traumatic event • Fears for their own life or another’s • Witnessed horrific events • Felt helpless in responding to the event • Research in pathophysiology of PTSD Koenigs & Grafman, 2009; Veterans Advisory Council, 2009

  4. PTSD: Screening and Assessment • Symptoms • Reliving the trauma • Avoiding reminders • Persistent hyperarousal • Risk Factors • Diagnosis and on-going assessment should be made by a mental health professional with experience in treating PTSD • PCL Veterans Advisory Council, 2009; Periyakoil, 2009

  5. PTSD: Treatment • Psychotherapy • Medications

  6. PTSD and End-of-Life Care • Illness/death can be a PTSD activator • Challenges social ties • May affect staff-Veteran relationships • Delirium or flashbacks? • Medication • GOAL: Reduce PTSD symptoms and create an emotionally safe environment Veterans Advisory Council, 2009

  7. Depression • 31% prevalence among Veterans • Symptoms may be on-going • Often unrecognized and undertreated • Early diagnosis is key • Should not be dismissed Veterans Advisory Council, 2009

  8. Causes of Depression • Disease related • Psychological • Medication related • Treatment related

  9. Symptoms • Assess various symptoms that have been present for at least two weeks.

  10. Assessment of Depression • Situational factors and/or symptoms • Previous psychiatric history • Other/Risk Factors • Lack of support • Pain • Culture Glass, et al., 2010; Pasacreta et al., 2010

  11. Examples of Screening Measures for Depression • Patient Health Questionnaire-2 (PHQ-2) • Patient Health Questionnaire-9 (PHQ-9) Karlin & Fuller, 2007

  12. Suicide Facts: Veterans and Suicide • 20% of all suicides in America are Veterans • 5 Veterans receiving VA health care commit suicide DAILY • Suicide rates among male Veterans are ~2 times greater than men in the general population • Risk factors Veterans Advisory Council, 2009

  13. Suicide Assessment • Warning signs • Important questions to ask • Interdisciplinary Care is CRITICAL!

  14. Responding to Suicide Risk Assure the patents immediate safety • Refer for mental health treatment or assure that follow-up appointment is made. • Inform and involve someone close to the patient. • Limit access to means of suicide • Increase contact and make a commitment to help the patient through the crisis.

  15. VA Resources for Suicide Prevention • Veterans Chat • VA’s National Suicide Prevention Hotline: • 1-800-273-TALK • VA Suicide Prevention Resource Center: • www.suicidepreventionlifeline.org/Veterans/Default.aspx

  16. Pharmacologic Interventions for Depression • Antidepressants • Stimulants • Non-benzodiazepines • Steroids

  17. Non-PharmacologicInterventions for Depression • Promote autonomy • Grief counseling • Draw on strengths • Use cognitive/ behavioral strategies • Team effort

  18. Anxiety • Subjective feelings • Apprehension • Tension • Insecurity • Uneasiness • Often without specific cause • Categories • Mild • Moderate • Severe • PTSD

  19. Causes of Anxiety • Medications • Other substances • Withdrawal • Uncertainties • Treatments • Lifestyle changes • Financial concerns • Family conflicts • Facing mortality • Others

  20. Assessment of Anxiety • Physical symptoms • Cognitive symptoms • Questions for assessment

  21. Pharmacologic Interventions for Anxiety • Antidepressants • Benzodiazepines/anticonvulsants • Neuroleptics • Non-benzodiazepines

  22. Non-Pharmacologic Treatments for Anxiety • Listening • Assurance and support • Concrete information • Cognitive behavior therapy

  23. Delirium/Agitation/Confusion • Delirium • Acute change in cognition/awareness • Agitation • Accompanies delirium • Confusion • Disorientation • Inappropriate behavior • Hallucinations • PTSD

  24. Infection Medications Hypoxemia Bladder distention Constipation Unrelieved pain Rapid withdrawal of certain meds and ETOH PTSD Other Heidrich & English, 2010; Lawlor & Bruera, 2002 Causes

  25. Assessment • Physical exam • History • Spiritual distress • Other symptoms

  26. Treatment • Pharmacologic • Evaluate medication • Reorientation • Relaxation • Distraction • Hydration

  27. Key Nursing Roles inSymptom Management • Patient advocate • Assessment • Pharmacologic treatments • Non-pharmacologic treatments • Patient/family teaching • Invaluable member of interdisciplinary team

  28. Conclusion • Multiple symptoms common • Coordination of care with physicians and other team members • Use drug and nondrug treatments • Veteran/family teaching and support

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