Week 4 Mental Health Conditions (PDF)

Learning Objectives Develop knowledge of the mental health conditions older and young people experience Become knowledgeable about the difference between Depression, Delirium and Dementia Be aware of transition stages and risks that older and younger people encounter ...

Learning Objectives Develop knowledge of the mental health conditions older and young people experience Become knowledgeable about the difference between Depression, Delirium and Dementia Be aware of transition stages and risks that older and younger people encounter  Childhood The WHO describes a child as someone who is 10-19 years old However, many mental health services that provide care to ‘young people’ include the ages 0-25 Mental health conditions are predicted to be present in 10-20% of people during their early life e  Childhood Mental Illness does not occur in isolation to other aspects of a child's life; therefore, it is vital to be holistic in assessment style Anxiety, Depression and Self harm are the most common presentations Healthcare workers require an understanding of developmental milestones to be able to engage with the child at an appropriate level e  Childhood: Impact of development Puberty impacts a child’s ability to regulate their emotions As independence and decision-making increases so can social isolation Pressures of schooling Peer pressure and risk taking e  Childhood: Risk taking Risk taking is often seen as a normal part of young people exploring their self identity Binge-drinking, reckless driving, smoking, illicit substance use, and risky sexual activity are the most common Can be exceptionally harmful to those who have predisposing genetic factors and can become maladaptive coping strategies for those who experience emotional distress e  Indicators of potential mental health struggles Duration and intensity of adverse emotions Functional impairment Sudden e Changes Isolation and Withdrawal Extreme Reactions Regression Persistent Fear or Worry Tics or Repetitive Behaviours School Refusal Self-Harm or Suicidal Thoughts Excessive Concern About Appearance Perfectionism  Childhood: Impact of technology 9/10 14–17-year-olds have a mobile phone Benefits: Social connectedness Risks: Cyberbullying, peer pressure and overdependency on being ‘liked’ e  Older Adults Typically considered as anyone over the age of 65 Referrals from community, care facilities or intrahospital transfers Can be more complex due to decline in level of independence e  Older Adults 15% of people over 60 experience a mental disorder Comorbidities are linked to poor mental health (pain, loss of independence, social isolation) Common mental health presentations in older adults include: Schizophrenia/Schizoaffective disorder Bipolar Affective disorder Depression and anxiety Cognitive impairments – including Dementias  Older Adults - Schizophrenia Schizophrenia is a severe psychiatric diagnosis that is defined by the presence of both positive and negative symptoms. Positive symptoms include: delusions and hallucinations Negative symptoms include: social withdrawal, impaired motivation and poor sleep Often same presentation as in younger adults Special considerations in older adults: The long-term impact of antipsychotics on their physical health Increased risk of stroke Increased risk of cardiac illness  Older Adults – Bipolar Affective Disorder (BPAD) Bipolar affective disorder is a mood disorder that is characterised by extreme changes in mood, with phases of depression and mania. Long term use of mood stabilisers Prolonged use of lithium can lead to decreased kidney function  Older Adults: Depression, Anxiety and Suicidal Ideation Often related to grief or sense of despair Experiences of loss such as loss of health, loved ones, physical mobility and independence Major life changes such as retirement, change in financial status, a transition into care facilities  Older Adults: Risks Older males are more likely to complete suicide than any other age group Youth: 1 in every 200 attempts result in death Older adults: 1 in every 3 attempts result in death (American Association of Suicidology, 2014)  Older Adults: Risks Medication related risks: Long term side effects of medications Ability of the patient's body to process the medications (consider impaired liver functioning etc) Increased sedation also increases the risk of falls  Cognitive Impairment vs Dementia Cognitive impairment is noted by poor performance on objective cognitive assessments that indicate a decline in performance A diagnosis of Dementia is supported by evidence of significant difficulties in daily life that interfere with independence caused by cognitive impairment.  Cognitive Impairment vs Dementia Alzheimer's Disease – 70% of Dementia diagnosis Caused by death of brain cells in the outer layer of the brain involved in memory, language and judgement. Progressive symptoms include: Apraxia – difficulty with movements Aphasia – difficulty with language (speech) Anomia – difficulty finding the words to use Agnosia – difficulty identifying people or objects Amnesia – difficulty with memory  Impact on Communication Dementia has a negative impact on a person's ability to communicate Confusion/ memory impairment Disorientation to time, place and person Inability to express their needs Aphasia (common in worsening Alzheimer’s Disease) When a person is unable to express their needs they often become: Frustrated and at times aggressive Fearful or embarrassed  Getting to know your patient When a person presents with any kind cognitive impairment, it is important to have a holistic understanding of who that person is Involve their family in care planning Learn their preferences: For example: Morning or afternoon shower? Tea or coffee? Favourite foods Likes and dislikes Ways they express themselves  Getting to know your patient If you know your patient, providing care for them becomes easier They are less likely to be fearful and frustrated as they feel safe It will be easier to build a trusting rapport with them  Verbal Communication When patients are living with a cognitive impairment: Short simple sentences are key Often offering too many choices can lead to further confusion One person talking at a time, giving clear directions to the person Be aware of your tone of voice and patients will be able to pick up on your frustration  Non-Verbal Communication Be aware of your patient’s non-verbal communication Body language Cues (hunger, thirst, toileting, pain) – importance of knowing your patient Unlike other mental health settings, touch is vital in the care of people living with cognitive impairments. Require assistance with ADL’s Comforting them in times of crisis  Environment New environments can be even more disorientating and distressing Use of familiar items in bed space Reduce bed movement Colour differences in furniture and flooring Dementia friendly signage (Large font and clear pictures)  Patient Centred Care Goals of care – end of life care/ palliative care Involve family Involve patient where appropriate and possible Involve current care facility  Older Adults: Dementia, Delirium and Depression Features Dementia Delirium Depression Onset and Slow deterioration over Sudden onset – hours Mood change over 2 e time – months to years or days weeks and may be Duration linked to a life event of loss of a loved one Course/ Slow and progressive Sudden, short and Fluctuations cognitive decline (non- fluctuating (reversible (reversible with Progression reversible) when underlying correct treatment) cause is treated) Signs and Wandering, agitation, Restlessness, Withdrawn, difficultly with word fluctuations in hopelessness, Symptoms recall. Fluctuations in agitation. appetite and symptoms Hallucinations and concentration mood changes, changes disorganised thinking  Older Adults: Delirium screening e  Importance of age Mental illness was once more taboo – this needs to be considered with your interactions with people The willingness to discuss thoughts and feelings may depend on someone's age, as well as yours The language you use needs to be appropriate for the person  Tutorials Case Studies Group Work