Week 6 Mental Health I 2022 PDF - Centennial College

Therapeutic Communication Centennial College PARA 127 Week 6: Mental Health Issues I (as they relate to Paramedicine) Overcoming Stigmas About Mental Health - Centre for Addiction and Mental Health (CAMH) 1 person in 5 in Canada (over 6 million peopl...

Therapeutic Communication Centennial College PARA 127 Week 6: Mental Health Issues I (as they relate to Paramedicine) Overcoming Stigmas About Mental Health - Centre for Addiction and Mental Health (CAMH) 1 person in 5 in Canada (over 6 million people) will have a mental health problem during their lifetime. 1 in 7 Canadians aged 15 and older (about 3.5 million people) have alcohol-related problems. 1 in 20 (about 1.5 million) have cannabis-related concerns; and some have problems with cocaine, speed, ecstasy (and other hallucinogens), heroin and other illegal drugs. 7 – 12% of EMS calls are psychiatric emergencies → immediate and urgent Mental health and substance use problems affect people of all ages, education and income levels, religions, cultures, and types of jobs. Mental Health Etiology – source: Mental Health: A Report of the Surgeon General Its precise etiology is not completely understood. What we do know is that mental illness results in some dysfunction in the brain, and that there are three broad categories of factors that interact to influence all health and disease, including mental health. 1. Biological - Brain injury from trauma, infection, genetic abnormalities, malnutrition, hormonal imbalance, toxins – can all contribute to increased risk of mental illness. → for example, HIV patients may get dementia as it enters through the brain. 2. Psychological - stressful events → for example, natural disasters/war. 3. Social/cultural - parents, socioeconomic status, race, culture, religion, interpersonal relationships. The DSM-5 captures Psychotic and Schizophrenia-related disorders together under the broad category of Schizophrenia Spectrum and Other Psychotic Disorders, which includes: Schizotypal (personality) Disorder Delusional Disorder Brief Psychotic Disorder Schizophreniform Disorder Schizophrenia Schizoaffective Disorder Substance / Medication-Induced Psychotic Disorder Therapeutic Communication Centennial College PARA 127 Psychotic Disorder Due to Another Medical Condition Psychosis – definition: a condition in which a person experiences a disconnection with reality, usually involving delusions or hallucinations. Delusions – false beliefs that significantly hinder a person’s ability to function. → for example, if someone thinks they are Mohammed Ali and want to do spontaneous things. Hallucinations – false perceptions that relate to any of the five senses. → paranoia, visual distortion, hearing random sentences. Types of Psychotic Disorders Brief Psychotic Disorder – occurs after an extremely stressful or traumatic event. Signs and symptoms only last for a short period of time (usually < 1 month). Shared Psychotic Disorder – (no longer listed as a separate disorder, but it’s included under ‘other specified schizophrenic spectrum and other psychotic disorders) psychotic signs and symptoms appear to become contagious. → signs and symptoms of psychosis become shared. for example, cults (Jim Jones moment). Psychotic Disorder Due to Another Medical Condition – signs and symptoms are linked to physiological effects of some medical condition. → Diagnosed, for example, electrolyte imbalances, problems in the brain. → Brain Injury can cause a lot of personality changes. Substance / Medication-induced Psychotic Disorder – happens when the delusions or hallucinations are the direct result of drug abuse, prescribed medication, or toxic exposure. → Marijuana induced psychosis. Schizophrenia (Asynchronization of brain function, combination of symptoms, rather than a unique disease) Definition: a persistent, often chronic mental disorder involving disturbances in thought, perception, affect, sense of self, motivation, behavior, or interpersonal functioning. ○ Formerly believed to be split personality Therapeutic Communication Centennial College PARA 127 ○ Affects 1% of population ○ Incidence: 10% of population with first-degree relative with schizophrenia ○ Onset - males: early 20’s | females late 20’s & early 30’s → Middle Age = 45 ○ Exact causation unknown, but imbalance in serotonin & dopamine ○ Minimum 6 months of specified symptoms, 1 month active. 2 or more symptoms (DSM-5). 1. Delusions 2. Hallucinations 3. Disorganized speech 4. Disorganized or catatonic behaviour 5. Negative symptoms Signs & Symptoms Explained: o disorganized speech = ‘flight of ideas’; alogia = speechlessness (not speaking at all) disorganized behaviour: avolition – unwillingness to respond or act. anhedonia – inability to experience pleasure. activity – flattened or heightened, paranoid, defensive. catatonia: affective flattening – ↓ emotions, facial expressions, responsiveness to environment. o negative symptoms: decrease in emotional range, poverty of speech, loss of interests & drive, marked inertia. Treating Psychosis & Schizophrenia Usual: antipsychotic drugs and/or psychotherapy Common antipsychotic drugs (also used to treat psychosis): atypical, second generation (safer, less undesired effects) → very expensive as well. Brand Name Generic Name Risperdal risperidone Seroquel quetiapine Zyprexa olanzapine Clozaril clozapine (best one) Haldol haloperidol Therapeutic Communication Centennial College PARA 127 Problems with Antipsychotic Medications Antipsychotic medications are expensive AND have several undesirable side effects: Extrapyramidal symptoms → for example dystonia (disorder of muscle contractions), dyskinesia, erratic writhing movements of face, arms, legs etc. Hypotension Seizures Stroke Suicidality Sexual dysfunction Tachycardia Weight gain Liver toxicity Because of these side effects, many patients will go off their medications and lapse into a significant state of their illness. Also of note: the older generation antipsychotics (typical antipsychotic) have a much higher incidence of extrapyramidal symptoms, including Tardive Dyskinesia. The newer ones (atypical antipsychotics) are relatively safer, except for clozapine – which has a significant risk of agranulocytosis (loss of white blood cells). That said, even the atypical antipsychotics (2nd generation) do have a chance of causing extrapyramidal symptoms. Pre-hospital Considerations for Psychosis & Schizophrenia Ensure safety in approaching! Call in more resources as needed. Shelf your stigmas about mental health. → remember that they may also have actual medical conditions at that moment. Approach slowly, using non-threatening verbal, non-verbal communication. Rule out life-threatening illnesses. Be calming and supportive. Don’t ‘play along with’ delusions or hallucinations o Re-orient to reality. Encourage assessment by physician at hospital. Consider if MHA if necessary. Therapeutic Communication Centennial College PARA 127 Anxiety Disorder Definition: a class of mental health disorders characterized by irrational fear and intense anxiety that leads to significant detriment to an individual’s quality of life (Review) Anxiety: a feeling of apprehension, worry, uneasiness, or dread frequently accompanied by physical symptoms. We identified four levels of anxiety: mild, moderate, severe, panic. Classifications of Anxiety Disorders o Panic attack and panic disorder – consumed with terror, need to escape. o Social Phobia (Social Anxiety Disorder) – characterized by a rather extreme, often irrational fear of being in public places. It tends to occur in very specific situations and is a response to the belief that the individual will be victim to sudden public embarrassment. o Specific Phobias – aversions to specific things that become disproportionate to the level of threat posed by them. o Generalized Anxiety Disorder (GAD) – marked by severe, often nonspecific anxiety that plagues a person throughout most of his/her daily functions. An overwhelming, unrelenting feeling of anxiety. REMEMBER THE NAMES OF DRUGS Treatment for Anxiety Disorders – common treatment for anxiety disorders are anxiolytic drugs and selective serotonin reuptake inhibitors (SSRI’s). Psychotherapy is also common. GENERIC NAME = cheaper? Maybe found off the counter Common anxiolytics: lytic = to break, therefore to break anxiety Brand Name Generic Name Ativan lorazepam Rivotril* clonazepam Valium diazepam Restoril temazepam *Canadian version of Klonopin Therapeutic Communication Centennial College PARA 127 Common SSRIs: Brand Name Generic Name Prozac fluoxetine Luvox fluvoxamine Paxil paroxetine Celexa citalopram Obsessive-Compulsive and Related Disorders OCD used to be grouped under anxiety disorders in the DSM-4. Now it has its own category, which also includes: Body Dysmorphic Disorder Hoarding Disorder Trichotillomania (Hair-Pulling Disorder) Excoriation (Skin-Picking) Disorder Substance / Medication-Induced Obsessive-Compulsive and Related Disorder, etc.) Obsessive Compulsive Disorder (OCD) – manifested by signs of both obsession and compulsion. → recurrent thoughts that often cause worries, to suppress these worries, they have abnormal patterns. Repetitive behaviours that ease their intrusive thoughts o Obsessions – “persistent ideas, thoughts, impulses, or images that are experienced as intrusive and inappropriate and that cause marked anxiety or distress”. Obsessions usually fall into one of four categories: 1. checking-relate → e.g., checking their stove too many times a day. 2. need for symmetry and order 3. cleanliness or hypochondrias 4. hoarding-like behaviours. o Compulsions – “repetitive behaviours, either observable or mental, that are intended to reduce the anxiety engendered by obsessions.” Therapeutic Communication Centennial College PARA 127 Trauma and Stressor-Related Disorders (new category for DSM-5) Both Acute Stress Disorder and PTSD used to be classified as anxiety disorders in the DSM-4. Now they have their own classification. Difference between acute and PTSD = time based, furthermore cannot be substance induced Acute Stress Disorder – signs and symptoms consistent with extreme fear and anxiety that have detrimental effects on an individual’s quality of life. Patients may have symptoms for 2 – 28 days after an extremely stressful event. May include overwhelming emotional stress, flashbacks, and panic attacks. Post-Traumatic Stress Disorder (PTSD) – similar manifestation to acute stress disorder but symptoms present for more than a month, usually carrying on for years after a traumatic event. Diagnosis also includes social and/or occupational impairment, and it can’t be caused by medication, substance abuse, or other illness. → do not mistake crisis vs acute & PTSD. PTSD is caused by: - direct or indirect exposure to death, - threatened death, - actual or threatened serious injury, or - actual or threated sexual violence. Hallmark symptoms of PTSD include: a. Re-experiencing – unwanted dreams, flashbacks, or other prolonged psychological distress b. Avoidance –avoidance of trauma-related stimuli (thoughts, feelings, reminders) c. Negative Cognition & Mood – persistent and distorted sense of blame of self and others, estrangement from others, markedly diminished interest in activities, inability to remember key aspects of event d. Arousal – aggressive, reckless, or self-destructive behavior, sleep disturbances, hypervigilance, hyper arousal, or related problems In addition to the criteria for diagnosis, an individual also experiences high levels of the following in reaction to trauma-related stimuli: 1. Depersonalization – experience of being ‘outside of or detached from oneself’ 2. Derealization – experience of unreality, distance, or distortion Therapeutic Communication Centennial College PARA 127 Pre-hospital Considerations – for Anxiety Disorders, OCD-related, Trauma & Stressor- Related Disorders o Empathy o Respect o Reassurance (even coach breathing if necessary) – of course, the calm voice and language o Transport for definite care o o Last resort – call ACP for anxiolytic therapy. This would be rare.