Mental Health patients

1. Mental Health patients

2. Mental Health • Mental Health in the Hospital • Assessment • History of present illness & patient’s perception • Medical history • Medication history • Physical exam • Diagnostic procedures

3. Interventions • Determine priorities • ABC’s • Maintain safety • Assess life threatening emergencies • Provide appropriate environmental setting • Implement therapeutic modalities • Educate patient and family/significant other

4. Age-Considerations • Pediatric • Many disorders are age-specific onset related • Determine what behavior is abnormal vs adjustment to developmental changes • “acting-out” signifies a problem if the behaviors are socially or culturally unacceptable.

5. Age-Considerations • Geriatric • Most commonly – depression, suicidal, suspicious, anxiety, situational crisis • Assess for drug/alcohol abuse • Look at all meds & schedule • Rule out organic causes • Personal losses and stressors can precipitate emotional disorders

6. Anxiety • Only 1 in 5 patients ever seek medical treatment • Only 25% of all patients diagnosed with anxiety are ever treated • Treatment is often indicated when symptoms produce physiological disruption • Patients are often under treated due to fear patients will become addicted to medications

7. Depression • Consists of specific alterations in mood, often accompanied by a negative self-concept and physical changes, along with changes in activity & interest levels. • Can be suspected when characteristics last >2 weeks.

8. Characteristics • Loss of interest in usual activities • Depressed mood • Appetite increase or decrease • Weight changes • Insomnia or hypersomnia

9. Characteristics • Fatigue • Decreased ability to think • Recurrent thoughts of death • Feelings of worthlessness • Psychomotor agitation or retardation • 5 of these >2 weeks = clinical depression

10. Suicidal Behavior • Profile- adolescence or ≥45, male, white, separated, divorced, widowed, living alone, unemployed • Assessment • Precipitating factors • Substance abuse

11. Suicidal Behavior • Treatment • Orient to reality • Provide safe environment • Solutions to ineffective coping & fear

12. Homicidal or Violent Behavior “Acting out of the emotions of fear or anger to achieve desired goals.” • Psychosis • Antisocial behavior • Organic disease

13. Planning & Interventions • Ensure safety of self and others • Encourage patient to identify feelings • Help patient determine cause of feelings • Orient patient to place and time • Administer medications as ordered • Haldol • Facilitate communication

14. Psychotic behaviors • Schizophrenia • Mania • Psychotic depression

15. Psychotic Behaviors • The result of a pathological process that may be acute or chronic • Resultant behavior is distorted perceptions, disorganized thinking, impaired judgment, impaired decision-making, regressive behavior • May be functional or organic

16. Treatment • Diagnostics to R/O organic • Orient to time, person, place • Reduce stimuli • Antipsychotics • Reinforce reality • Keep safe • Family counseling

17. Bipolar Disorder “Manic-depressive illness that is characterized by alternating euphoria & depressed mood periods” Mood changes can occur over minutes, hours, or days & may be lengthy periods of stability between episodes.

18. Bipolar Disorder • Behaviors- • Flight of ideas • Impaired mentation • Hostile & paranoid • Flamboyant actions • Impulsive behavior • Disorganized activity • Poor social judgment • Inflated self-esteem

19. Treatment for Bipolar • Orient to reality • Remove from stimulating environment • Remove objects of self-harm • Medicate – Lithium • Work on family & social support • Observe closely