Concepts of Mental Health and Mental Disorders (PDF)

Concepts of mental health and mental disorders, classification of mental disorders and their treatment  Agenda 1. Concepts of mental health and mental disorders Define mental health and mental illness Identify factors influencing mental health 2. Class...

Concepts of mental health and mental disorders, classification of mental disorders and their treatment  Agenda 1. Concepts of mental health and mental disorders Define mental health and mental illness Identify factors influencing mental health 2. Classification and treatment of mental disorders Describe the common signs and symptoms of mental disorders Name the common classifications of mental disorders Describe the common treatment for mental disorders 3. Role of mental health nurse Describe the role of mental health nurse Explain Clinical duties in the mental health setting Can you tell me how you would describe a person who is mentally healthy? Please find below some people’s description about a person who is mentally healthy. Would you agree with their opinion ? “Just a normal person with no illness. One who can do regular things which are done everyday like taking a bath, working, etc.” “A mentally healthy person should know how to dress himself properly, what he would do upon waking up in the morning, he goes to work on time.” “A person who has a healthy mind is always happy, hardworking and is good at associating with others.” “A person who has a healthy mind knows how to get along with others, family oriented type of person, efficient with his duties in the community, he is aware of his duty to the family and to himself and the most important is he is God-fearing.” “A person, who has a healthy mind, knows how to get along with others and has a decent way of facing whoever they may be. They are in control of their own and with other things and understand other people’s conduct.” Concepts of mental health and mental disorders  Mental health According to the World Health No single universal definition of Organization (WHO), there is “no mental health health without mental health”. Mental health is generally regarded as a state of emotional, psychological World Health Organization (2014) and social wellness evidenced by: views mental health as a state of Satisfying interpersonal well-being in which the individual relationships realizes his or her own abilities Effective behavior and coping can cope with the normal stresses Positive self-concept, and of life Emotional stability can work productively and Videbeck (2023) fruitfully, and is able to make a contribution to his or her community  Mental health Positive coping to stress The five ways to wellbeing Having a strong social support Research shows there are 5 simple network of family and friends things we can do as part of our daily Taking a positive view of the lives to boost our mental health and situation wellbeing: Using problem-solving skills 1. Connect to tackle the situation 2. Be Active Discussing personal 3. Take Notice concerns with others and 4. Keep Learning, and maintaining friendships 5. Give Knowing how to relax Striving for balance in life https://www.youtube.com/watch?v=_gJ5V525SCk Taking care of physical health by exercising regularly, eating healthy meals and getting enough sleep Mental health  Mental health and mental disorders Characteristics of good mental Concept of mental disorders health Mental disorders are health conditions Feeling of self-worth and having a characterized by change in thinking, feeling healthy self- concept & positive or behavior. Mental disorders will : identity 1. cause distress Ability to find meaning and hope in life 2. reduce people’s ability to function Have satisfying relationships with psychologically, socially, occupationally others or interpersonally Ability to help others and relate to 3. result in people’s problem in handling others Ability to interpret reality accurately daily activities, family responsibilities, Function well alone or with others relationships, work or school responsibilities Ability to make sound judgments Eby & Brown (2009) and accept responsibility for the outcomes Ability to adapt to change, cope with stress and develop resilience against negative life events Ability to maintain a balance between  Mental health and mental disorders Criteria of Abnormal Behavior Deviance 1. Deviance Behavior deviates from Mental the norms of society. Mental health illness/ Personal distress 2. Maladaptive behavior disorder There is impairment in the everyday adaptive behavior e.g., the use of Maladaptive behavior cocaine interferes with a person’s social and occupational functioning. People are judged to have mental disorders when their 3. Person distress behavior becomes extremely deviant, maladaptive or distressing. Individual reports great personal distress e.g.,  Prevalence of mental disorders WHO 1st WHO’s World Mental Health study Face-to-face Survey Initiative community surveys were Conducted by the WHO in 14 countries over 25,000 people in conducted in 17 countries in Africa, Asia, general health care America, Europe and Middle East with (Craig & Boardman, 1997) 85,052 respondents The prevalence of mental disorders (Kessler et al., 2007) was about 25% Overall prevalence of mental The most common disorders were Anxietyvaried disorders widely disorders across countries. (4.8-31.0%) depression (10%), generalised anxiety Mood disorder (3.3 – 21.4%) disorder (8%) and harmful use of Impulsive control disorders alcohol (3%). (0.3-25.0%) Psychotic disorders (such as bipolar Substance use disorders (1.3- affective disorder and 15.0%) Schizophrenia) are relatively uncommon in general practice. People with psychological disorders (HA, 2011; WHO, consult their GP with physical rather 2009) than psychological complaints e.g.  How common are mental disorders in HK ? Hong Kong studies Hong Kong studies A survey reported in 1997 involving Conducted by the Department of 1,300 adult patients from 13 primary Psychiatrist, CUHK in Shatin district care clinics detected a 20% prevalence between December 1984 and October of mental disorders. 1986 involving 7,229 people The Hong Kong Morbidity Survey (Chen et al., 1993) (2010-2013) revealed that the The most common disorders in prevalence of common disorders among male were tobacco dependence Chinese adults aged from 16 to 75 (26.56%), alcohol abuse and/or was 13.3%. The most common mental dependence (8.86%), generalized disorders were: anxiety disorder (7.77%), pathological mixed anxiety and depressive gambling (2.95%), and antisocial disorder (6.9%) personality (2.78%). generalised anxiety disorder (4.2%) The most common disorders in depressive episode (2.9%), and female were generalized anxiety disorder (11.11%), all phobias (3.73%), other anxiety disorders dysthymic disorder (2.83%), major including panic disorders, all depressive disorder (2.44%), and phobias and obsessive tobacco dependence (1.43%). compulsive disorder (1.5%) The Behavioural Risk Factor Survey How common are mental disorders in HK ? A survey was reported in 2022 by Baptist Oi Kwan Social Service and Education University involving 3,749 participants aged over 18 found that:  nearly half of residents suffer ‘moderate to severe’ signs of anxiety amid coronavirus fifth wave  those aged between 18 and 30, were found to be ‘most at risk’ from developing anxiety  number of people seeking online mental health counselling tripled in the first quarter compared with the same period last year.  How common are mental disorders in HK ? Youth mental health in Hong Kong A HKU survey involving over 3,000 Hong Kong residents aged 15 to 24 from 2019 to 2022 identified:  up to 25% of young people have suffered from mental disorders  the common mental disorders are depression, anxiety, panic disorder, bipolar disorder or psychotic disorder  over 40 % of those surveyed identified academic stress as their primary cause of anxiety, followed by work or career- related pressures  females and people living in public housing with lower income, were found to have a greater tendency for depression Factors influencing an individual’s mental health Inherited factors/Biological/hormonal influences/personality traits Cultural beliefs and values/spirituality religious influences/health practices and beliefs Environmental experience/demographic and geographic locations Family influences/developmental events/available supportive system Halter impaired psychosocial stressors (2022) parenting poverty WHO (2022)  4P biopsychosocial (holistic care) case formulation Predisposin Precipitatin Perpetuati Protecting g g ng Biological Psychologica l Social  Case illustration: schizophrenia relapse Mental condition related information Medical condition Roy, 36/M, single, clerical staff in bank, living alone Overall, healthy Diagnosis: schizophrenia. Onset since his 28 YO, presented with persecutory delusion (the strangers will hurt him and believe he was under monitoring), Psychosocial AH and Environmental (3nd person human voice, with commenting content). information SCS status: CC Currently, living alone in PHU History of suicide: Attempt JFH in 2020 under psychotic influence 3 psychiatric admissions due to poor drug compliance GM died in his 25 YO. Felt he was current admission is also due to poor drug compliance with poor insight alone and no one concern him History of SA, using Meth, recreational use from 25 to 28 YO. One courtship in 29YO who was Social smoker and drinker his colleague. Maintained one year and Personality and development information broken up as GF known he was Born in HK, single children schizophrenic patient Father was also suffering from schizophrenia. otherwise no other famiy HxofFew MI. close friends who are Parents divorced in this 3YO. Brought up by GM. Distance relationship with supportive and actively contacting parents. him Reported to had bullied experience in P4-P6. Studied up to F.7. Poor result in public exam. Global functioning information Worked as clerical staff in the bank for more than 15 years. Coped OK. Limited communication with other colleagues Good self care Had some friends from secondary school, some of them had SA. Able to cope with work personality: introvert, low self esteem No conflict with other  4P biopsychosocial (holistic care) case formulation Predisposing Precipitating Perpetuating Protecting Biological -Hx of SA -Poor drug -Poor drug compliance compliance Psychologic -attempt JFH in 2020 -Poor insight -Poor insight -Willing to al under psychotic -Low self esteem change influence -introvert Social -distant relationship -Limited social -Few supportive with circle friends parent -Hx of bullied -Broken up with GF due to Schizophrenia  Formulate the care plan Principle Minimize the effect of Predisposing factor Prevent the occurrence of precipitating factor Remove the Perpetuating factor Utilize the Protective factors Formulate the care plan Activity 15mins Classification and treatment of mental disorders  Definition of mental disorders/illness Diagnostic and Statistical Manual of The International Classification Mental Disorders: Fifth Edition Text of Diseases and Related Revision (DSM-5-TR) Health Problems Eleventh Mental, and Edition (ICD- A mental clinically disorder disturbance is a in 11) disorders behavioural are syndromes characterised neurodevelopmental syndrome significant characterizedby an by clinically significant disturbance in an reflects cognition,a dysfunction in the regulation, individual’s psychological, or individual's cognition, emotional emotion or developmental processes biological, behavior regulation, or behaviour that reflects a underlying that mental functioning. Mental dysfunction in the psychological, disorders with are usually associated significant or disabilityin biological, or developmental processes distress occupational, important social, activities. that underlie mental and behavioural expectable or or otherculturally An approved functioning. These disturbances are response to a common stressor or loss, usually associated with distress or such as the death of a loved one, is not a impairment in personal, family, social, mental disorder. Socially deviant behavior educational, occupational, or other (e.g., political, religious, or sexual) and important areas of functioning. conflicts that are primarily between the individual and society are not mental disorders unless the deviance or conflict results from a dysfunction in the  Definition of mental disorders/illness The Mental Health Act of New South Other criteria used to define Wales (2007) defined mental illness mental disorders impairment of a person’s ability to think as : impairment of a person’s ability to feel a condition which seriously impairs, either temporarily or permanently, the mental impairment of a person’s ability to make sound functioning of a person who is judgements characterized by the following symptoms: difficulty or inability to cope with reality a) delusion difficulty or inability to form strong personal b) hallucination relationships c) serious disorder of thought form statistical d) a severe disturbance of mood deviation from normal e) sustained or repeated irrational psychiatric diagnosis behavior indicating the presence of any Gorman & Anwar one or more of the symptoms referred cultural factor (2014) to in paragraphs (a) - (d) incomprehensibility  Diagnosis of Mental Disorders Mental disorders can be diagnosed by using: The Diagnostic and Statistical Manual of DSM-5- Mental Disorders, Fifth Edition Text Revision TR A classification of mental disorders with (DSM-5-TR), published by the American associated criteria designed to Psychiatric Association in 2022. facilitate more reliable diagnoses of ICD-10 Classification of Mental and mental disorders. Behavioural Disorders, published by Present defining characteristics or World Health Organization and which symptoms that conforms with DSM-IV-TR. The new edition of ICD-11 was released differentiate specific diagnoses. on June 18, 2018 as a preliminary version Provide a standardized nomenclature and and synchronizes with DSM-5. language for all mental health professionals. ICD-11 has been presented at the Aid in treatment of mental disorders. World Health Assembly in May 2019 A tool for collecting and communicating for adoption by Member States and has accurate public health statistics on come into effect on 1 January 2022. mental disorder morbidity and mortality rates.  DSM-5-TR Classification 1. Neurodevelopmental disorders 13. Sexual dysfunctions 2. Schizophrenia spectrum and other psychotic disorders 14. Gender dysphoria 3. Bipolar and related disorders 15. Disruptive, impulse-control and conduct disorders 4. Depressive disorders 16. Substance-related and addictive disorders 5. Anxiety disorders 17. Neurocognitive disorders 6. Obsessive-compulsive and related disorders 18. Personality disorders 7. Trauma- and stressor-related disorders 19. Paraphilic disorders 8. Dissociative disorders 20. Other mental disorders 9. Somatic symptom and related disorders 21. Medication-induced movement disorders and other adverse 10. Feeding and eating disorders effects of medication 11. Elimination disorders 22. Other conditions that may be a focus of clinical attention 12. Sleep-wake disorders ICD-11 Mental, behavioural or neurodevelopmental disorders  ICD-11 Mental, behavioural or neurodevelopmental disorders 1. Neurodevelopmental disorders 11. Disorders of bodily distress or bodily experience 2. Schizophrenia or other primary psychotic disorders 12. Disorders due to substance use or addictive behaviors 3. Catatonia 13. Impulse control disorders 4. Mood disorders 14. Disruptive behaviour or dissocial disorders 5. Anxiety or fear-related disorders 15. Personality disorders and related traits 6. Obsessive-compulsive or related disorders 16. Paraphilic disorders 7. Disorders specifically associated with stress 17. Factitious disorders 8. Dissociative disorders 18. Neurocognitive disorders 9. Feeding or eating disorders 19. Mental or behavioural disorders associated with pregnancy, 10. Elimination disorders childbirth and the puerperium 20. Psychological or behavioural factors affecting disorders or diseases classified elsewhere 21. Secondary mental or behavioural syndromes associated with disorders or diseases classified elsewhere  Mental state examination 1. Appearance, behavior and rapport 2. Speech and thought form 3. Mood and affect 4. Thought content 5. Perception 6. Cognitive function 7. Insight  1. Appearance, behavior, rapport A) Appearance -Physical state: e.g. general condition good? -Clothes and accessories: e.g. appropriate to circumstances? -Self care/hygiene: e.g. unkempt? -Self-harm evidence B) Behaviors -Abnormal behavior: e.g. shaky hands? -Psychomotor agitation or retardation -Retardation: speech is slow and monotonous; body movement: slow or absent -Agitation : speech is fast, body movement: inability to still/hand wringing skin or scratching clothes/pacing C) Rapport Cooperative, guarded, uninterested, hostile, over-friendly, challenging?  2. Speech and thought form Speech -Rate of production -Flow: fluent? -Quality: volume, tone, articulation -Speed, quantity, coherence, relevant , logic, Unusual speech, communication ability Thought form -Thought content (e.g. delusion, obsessive thought, hypochondriac) -Thought process(e.g. thought block, flight of ideas, circumstantial, loose association)  3. Mood and affect A) Mood (sustained subjectively experienced emotional state) -depressed, elated, anxious, angry B) Affect (observed, external expression of emotion): -By reactivity, facial expression, body movement. -Incongruous, blunted  4. Thought content and 5. Perception Thought content -Suicidal/ aggressive idea -Delusion -Preoccupation, worry and fear, obsessive thought Perception -Hallucination (auditory, visual, olfactory, gustatory, tactile) -Illusion -Derealization  6. Cognitive function -Disorientation (e.g. time, place and person) -Poor concentration and attention (e.g. easily distracted) -Memory impairment (e.g. memory loss, confabulation, forgetful) -Poor judgment -Abstract thinking  7. Insight -Understanding and acceptance of illness (Aware of symptoms; accepts it to be mental illness; treatment is needed.) -Coping of symptoms and relapse management -Motivation and sense of responsibility for change -Engagement to service and treatment opportunities  MSE activities Case : Ms Chan F/68. Single. Living alone. Known to PSY service for Schizophrenia since 1994.5 previous PSY admissions (1997, 2006, 2008, 2012, and 2014). Put on Special care since 1998. Multiple violence history. Put on Conditional Discharge in 2009.On Haldol depot and drugs treatment. Poor insight and refused oral treatment. Reported with residual psychotic symptoms: Paranoid delusion towards neighbor all along. Increased the volume of the radio to cover the noise created upstairs. On a normal diet. Nil chronic illness. Reason for current admission Informed by CPS that Ms Yuk was reported by the management office to show aggressive gestures towards a cleansing worker -- rushing towards her and attempting to hit her with her key. The management office has reported to the police, but the police has not yet found the patient. The management office requested support from CPS. Police memo to facilitate crisis intervention. Compulsory admission was arranged after PSY consultation. Progress Mental: Poor Insight. Auditory hallucination with a male voice. Scolded and yelled aloud at times. Felt disturbed by AH. Paranoid idea expressed. Physical: Stable. Discharge plan: MSE activities 15mins  Positive and negative symptoms of Positive symptoms schizophrenia Delusion Hallucina Delusion is a false belief, not shared by tion Hallucination is false persons of the same race, age and standard of education, which cannot be sensory perception not altered by logical argument. associated with external A delusion is a belief held with complete stimuli conviction, even though it's based on a Examples: Auditory mistaken, strange or unrealistic view. It hallucination may affect the way the person behaves. Examples: Visual Delusions can begin suddenly or may Persecutory develop over weeks or months. delusion hallucination Delusion of guilt Olfactory Nihilistic delusion hallucination Hypochondriacal Tactile delusion hallucination Delusion of grandeur Gustatory Delusion of hallucination reference Delusion of control Erotomanic delusion NHS (2019)  Positive and negative symptoms of schizophrenia Negative symptoms people appear to withdraw from the world around then, take no interest in everyday social interactions, and often appear emotionless and flat  Treatment of mental Therapeutic milieu disorders Physical treatment A safe and secure structured Psychotropic environment that medications and action of facilitates the therapeutic interaction Modifythe neurotransmitters at the the synapse which between clients and members of the has been associated release with the professional team development of mental health Characteristics: home-like, problems satisfaction of personal needs, purposeful activities, limit setting, staff Classification attitude, moral of the ward Antianxiety agents community, hospital policy Antidepressants Mood stabilizers Treatment team Antipsychotics (typical and atypical) Multidisciplinary team members Antiparkinsonian agents (e.g., psychiatrist, clinical Psychostimulants psychologist, psychiatric nurse, social worker, occupational therapist, dietician, recreation specialist, case manager, pastor, peer  Treatment of mental disorders Electroconvulsive therapy (ECT) Psychological treatment A medical procedure performed Individual psychotherapy under general anesthesia, in which an Group psychotherapy electric current is applied to Cognitive behavioral the brain through electrodes placed therapy on the temples. The current is sufficient ACT/MBSR/MBCT/BA to trigger a brief seizure, from which the Behavioral therapy desired therapeutic effect is achieved. Family therapy https://www.youtube.com/watch?v=LPBTE Couples therapy HYlZK4 Psychodrama Psychological telemental Transcranial Magnetic Stimulation (TMS) health An advanced treatment modality for individuals with treatment- Other types of therapy resistant depression (non-response to at Occupational therapy least 2 different antidepressants Recreational therapy from different classes). Play therapy It does not require anesthesia and Art therapy can be Movement therapy performed on an outpatient basis. Music therapy It involves the placement of a Horticultural therapy small, insulated electromagnetic coil on Pet therapy Role of mental health nurse  Mental health nursing practice The overall goal of psychiatric Multidisciplinary team approach nursing is to assist clients to Clients have multifaceted problems (e.g., reach their optimal level of work, family, functioning in activities of daily finance, relationship, childcare., etc.) living Provide HOLISTIC care to individual’s Psychiatric Nursing care has been unique problems by a wide range of shifted from traditional long-term expertise base care in psychiatric institutions Direct and regular contact among MDT to community-based mental health members to: care in the nationwide share information delegate work (division of labor) Two traditional roles in psychiatric better use of resources (avoid nursing: overlapping of service) 1) To provide physical care and gain mutual support for team other protective necessary care members to the mentally ill clients MDT includes psychiatrists, mental health nurse, 2) To follow psychiatrist’s occupational therapist, social worker, clinical orders to administer psychologist, (dietitian, physiotherapist, speech prescribed treatments therapist)  Role of mental health nurses In association with the core-competencies of registered nurse (Psy.) (The Nursing Council of Hong Kong, 2012) Competency 1: Professional, Legal and Ethical  Career Nursing Practice  Service Provider at 3 levels of health care:  Primary, Secondary, Tertiary Competency 2: Health Promotion and Education  Educator  Counselor  Health promoter  Care co-Ordinator  Client advocate Competency 3: Management and Leadership  Manager  Supervisor  Change agent  Leader  Public health advocate Competency 4: Nursing Research  Researcher Competency 5: Personal and Professional  Nurse professional Development  Mental health nursing practice Clinical duties in the mental health setting handling legal forms (MHO) F123, T/T, involuntary case certified in AED intake/risk assessment MSE, illegal drugs, weapon management of violence/ suicide clinical procedures IMI depot/sedation, physical restraint level I/II primary nursing system holistic care, regular consultation psychotherapeutic activities, psychoeducation, counselling visiting hours dangerous objects, sexual harassment home visit/crisis intervention in CPS liaise with family and community NGOs consultation liaison (screening case for admission, fit for consent) in AED triage in OPD  Extended role & expanded role Extended role  responsibility assumed by a mental health nurse beyond the traditional role and it is the scope of nursing outside the hospital, e.g.  Personalized Care Program (PCP)  Intensive Care Team (ICT)  Extended Consultation Liaison Service to AED  Psychogeriatric Mobile Nurse Clinic (PGMNC) Expanded role  responsibility assumed by a mental health nurse within field of practice autonomy e.g.  Advanced Practice Nurse (APN): function independently & having a master's degree in nursing  Associate Nurse Consultant (ANC): responsible for supporting frontline clinical care duties  Nurse Consultant (NC): nursing expertise in a special area of practice, such as, community psychiatric nursing service, child and adolescent psychiatric nursing  Next week tutorial Activity Day/Time Venue 3 hours (week 3, 6, 9 &12) Mon 09:30 am – 12:30 pm (Tut 4) R903 Mon 15:30 pm – 18:30 pm (Tut 2) U208 Tutorial Thu 12:30 pm – 15:30 pm (Tut 1) QR403 Thu 12:30 pm – 15:30 pm (Tut 3) R406  Referen ces American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed. Text Revision). APA Publishing. ANA & APNA. (2014). Psychiatric-mental health nursing: Scope and standards of practice (2nd ed.). American Nurses Association Chen, C. N., Wong, J., Lee, N., Chan-Ho, M. W., Lau, T. F. & Fung, M. (1993). The Shatin community mental health survey in Hong Kong: II. Major findings. Archives of General Psychiatry, 50(2), 125-133. Craig, T. K. J. & Boardman, A. P. (1997). ABC of mental health: Common mental health problems in primary care. British Medical Journal, 314, 1609-1612. Eby, L., & Brown, N. J. (2009). Mental health: Nursing care (2nd ed.). Pearson/Prentice Hall. Food & Health Bureau (2017). Mental Health Review Report. https://www.healthbureau.gov.hk/download/press_and_publications/otherinfo/180500_mhr/e_mhr_full_report.pdf Halter, M. J. (2022). Varcarolis’ foundations of psychiatric-mental health nursing: A clinical approach (9th ed.). Elsevier. Hospital Authority (2011). 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