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December 2012 Vol. 10, No. 12 Mental illness Program Prep Caring for residents suffering from mental illness can be challenging even for experienced clinical staff. People with mental illness demonstrate various signs and symptoms, making it difficult to identify and diagnosis these disorders. Program time Approximately 30 minutes Learning objectives Participants in this activity will learn: ➤➤ The common symptoms of mental illness Mental illness can cause abnormal ways of thinking, feeling, or acting. The most common types of mental ➤➤ How to recognize the different types of mental illness ➤➤ The methods of treatment for mental illness illness are anxiety, cognitive, dissociative, mood, Preparation personality, and psychotic disorders. ➤➤ Review the material on pp. 2–4 As a CNA, you must know how to identify the symptoms of mental illness because recognizing these signs is vital to providing proper care to residents. Mental illnesses can be caused by reactions to stressful events, imbalances in the body’s chemistry, or a combination of several factors. This lesson will discuss the symptoms of mental ➤➤ Duplicate the CNA Professor insert for participants ➤➤ Gather equipment for participants (e.g., an attendance sheet, pencils, etc.) Method 1. Place a copy of CNA Professor and a pencil at each participant’s seat 2. Conduct the questionnaire as a pretest or, if participants’ reading skills are limited, as an oral posttest illness; how these illnesses affect a person’s thought 3. Present the program material processes, emotions, and/or behavior; as well as suggest- 4. Review the questionnaire ed treatments. 5. Discuss the answers Have a good day of training, and stay tuned for next month’s issue of CNA Training Advisor, which will cover professionalism and accountability. Your shortcut to compliant documentation Understanding mental illness The Long-Term Care Clinical Assessment and Caring for a resident who suffers from mental illness can be stress- Documentation Cheat Sheets is the ultimate blueprint ful, particularly for newer staff members who don’t have experience for how to provide resident-centered care. This with these residents. As a group, discuss any questions or concerns electronic-only resource provides nurses with a regarding the care of these patients. Ask staff members with related thorough list of what to check and what to document during experience to share their knowledge and expertise. every shift, based on the specific circumstances of a given resident. Best of all, the new electronic format of this content enables long-term care clinicians to easily search for the condition they Quiz answer key need to treat and access the appropriate checklist within seconds. 1. c 3. b 5. d 7. c 9. c 2. d 4. d 6. a 8. c 10. b For more information or to order, call 800-650-6787 or visit www.hcmarketplace.com/prod-9750. CNA Training Advisor Page 2 December 2012 mental illness Recognizing the signs of mental illness can be challenging because –– Changes in eating habits people living with mental illness can demonstrate a variety of symp- –– Alcohol, drug, or medicine abuse toms. Yet, without a diagnosis, many people do not receive the needed –– Very slow or fast speech or movements medications or treatments. CNAs should learn how to recognize mental –– Changes in hygiene practices illness and how to care for mentally ill residents. Mental illness is a brain disorder that causes abnormal ways of thinking, feeling, or acting. ➤➤ Symptoms of abnormal thinking include: –– Delusions, or believing things that are not true. A person might think someone wants to harm him or her. –– Hallucinations, or seeing or hearing things that are not really there. A person who is hallucinating might hear people talking to him or her when no one actually is. –– Confused thinking. The person might be illogical or not understand things happening around him or her. –– Suicidal thoughts. Someone with a mental illness might have frequent or constant thoughts of killing him- or herself. ➤➤ Symptoms of abnormal feelings include: –– Frequent mood changes –– Depression or sadness –– Anxiety, worry, or panic –– Irritability or anger –– Apathy, poor motivation There are many possible causes of mental health problems. Some mental disorders are genetic. Other mental illnesses are caused by reactions to stressful events, imbalances in the body’s chemistry, or a combination of several factors. The symptoms of mental illness occur because the brain is not functioning properly. This affects the person’s thought processes, emotions, and/or behavior. It is important to remember that mentally ill people usually cannot control the way they think, feel, or behave. Mental illness is not the person’s fault; they cannot help themselves. There are many categories of mental disorders, but the most common types are: ➤➤ Anxiety ➤➤ Cognitive ➤➤ Dissociative ➤➤ Mood ➤➤ Personality ➤➤ Psychotic –– Excessively low or high self-esteem –– Excessively energetic or euphoric –– Poor judgment, impulsiveness Anxiety disorders Anxiety causes physical symptoms such as rapid, shallow breathing, ➤➤ Symptoms of abnormal behavior include: increased heart rate, sweating, and trembling. It can cause emotional –– Disruptive or antisocial behaviors symptoms including alarm, dread, and apprehension. Treatment may –– Changes in sleeping routines involve medication, therapy, or a combination. There are many types of anxiety disorders, including: Don’t miss your next issue! If it’s been more than six months since you purchased or renewed your subscription to CNA Training Advisor, be sure to check your envelope for your renewal notice or call customer service at 800-650-6787. Renew your subscription early to lock in the current price. Editorial Board Project Director: Elizabeth Petersen Associate Editor:Melissa D’Amico [email protected] © 2012 HCPro, Inc. ➤➤ Panic disorder. This is a sudden onset of intense fear, apprehension, and impending doom that may last from minutes to hours. ➤➤ Post-traumatic stress disorder. Persons with this disorder reexperience the anxiety associated with a previous traumatic event. Many times it is caused by exposure to an extremely stressful event, such as abuse or rape. ➤➤ Phobias. A person with a phobia feels very anxious when exposed to a particular object or situation, such as a high place. The person fears and avoids whatever causes the anxiety. CNA Training Advisor (ISSN: 1545-7028 [print]; 1937-7487 [online]) is published monthly by HCPro, Inc., 75 Sylvan Street, Suite A-101, Danvers, MA 01923. Subscription rate: $149/year; back issues are available at $15 each. • Copyright © 2012 HCPro, Inc. All rights reserved. Printed in the USA. Except where specifically encouraged, no part of this publication may be reproduced, in any form or by any means, without prior written consent of HCPro, Inc., or the Copyright Clearance Center at 978-750-8400. Please notify us immediately if you have received an unauthorized copy. • For editorial comments or questions, call 781-639-1872 or fax 781639-7857. For renewal or subscription information, call customer service at 800-650-6787, fax 800-639-8511, or email [email protected]. • Visit our website at www.hcpro.com. • Occasionally, we make our subscriber list available to selected companies/vendors. If you do not wish to be included on this mailing list, please write to the marketing department at the address above. • Opinions expressed are not necessarily those of CTA. Mention of products and services does not constitute endorsement. Advice given is general, and readers should consult professional counsel for specific legal, ethical, or clinical questions. For permission to reproduce part or all of this newsletter for external distribution or use in educational packets, contact the Copyright Clearance Center at www.copyright.com or 978-750-8400. CNA Training Advisor December 2012 Page 3 mental illness ➤➤ Obsessive-compulsive disorder (OCD). OCD is characterized by the need to maintain control, order, neatness, cleanliness, and/or perfection. People with OCD feel compelled to perform repetitive acts such as hand washing or checking to be sure a door is locked. Personality disorders Personality disorders are chronic conditions with biological and psychological causes. Psychotherapy is the treatment, sometimes along with medications. Some common personality disorders are: Cognitive disorders Cognitive impairment is a loss of mental abilities and awareness that occurs in varying degrees with a variety of underlying causes. It can hinder a person’s ability to perform daily activities. In the elderly, it is usually caused by physical changes in the brain. Symptoms include: ➤➤ Borderline personality disorder. This disorder is characterized by impulsive behavior, unstable social relationships, and intense anger. These persons can have periods of psychotic thinking, para noia, and hallucinations. ➤➤ Obsessive-compulsive personality. These people tend to be high ➤➤ Loss of intellectual abilities achievers. They are dependable and orderly but can’t adjust to ➤➤ Personality changes change and are intolerant of mistakes. They can be uncomfortable ➤➤ Forgetfulness with relationships. This is not the same as obsessive-compulsive ➤➤ Inability to concentrate disorder. ➤➤ Passive-aggressive personality. These people hide hostile feelings ➤➤ Poor judgment ➤➤ Verbal confusion and try to control or punish others. ➤➤ Narcissistic personality. Persons with this disorder feel superior to Two cognitive disorders that are common among nursing home others and expect to be admired. They are seen as self-centered and arrogant. residents are: ➤➤ Alzheimer’s disease. This is the most common form of dementia ➤➤ Antisocial personality, formerly called psychopathic or sociopathic among people age 65 and older. It may begin with slight memory personality. These people show no regard for the rights and feel- loss and confusion, but eventually leads to a severe, permanent ings of others. They do not tolerate frustration and become hos- mental impairment that destroys the ability to remember, reason, tile or violent. They show no remorse or guilt and blame others for learn, and imagine. Approximately 75% of Alzheimer's patients ex- their behavior. They are prone to addictions, sexual deviation, job perience psychotic symptoms such as hallucinations, and behavior- failures, and abuse. Most are male. al symptoms such as aggression and agitation. ➤➤ Dementia. This disorder involves the parts of the brain that control thought, memory, and language. Healthy brain tissue deteriorates, Mood disorders Mood disorders usually involve chemical imbalances in the brain causing a steady loss in memory and mental abilities. Strokes or and are often treated with antidepressants and/or psychotherapy. changes in the brain’s blood supply may result in the death of brain The most common mood disorder among nursing home residents is tissue. Symptoms of dementia caused by problems with blood ves- depression. sels can appear suddenly, whereas symptoms develop slowly in Depression causes severe, prolonged sadness. It can affect a person’s persons with Alzheimer’s disease. Although found primarily in the thoughts, feelings, behavior, and physical health. Depression is not a elderly, 50% of people with AIDS develop dementia. normal part of aging. Due to its prominence among patients with other serious illnesses, such as heart disease, cancer, and Parkinson’s disease, Dissociative disorders These disorders come in many forms, all thought to stem from traumatic events. When an extremely stressful event occurs, the person is too overwhelmed to process it and tries to cope with the trauma by separating him- or herself from the experience. This can lead to loss of memory or the formation of separate personalities. Two types of dissociative disorders are: healthcare professionals may mistakenly conclude that depression is a normal consequence of these problems. These factors together contribute to the underdiagnosis and undertreatment of depressive disorders in older people. Depression can and should be treated when it co-occurs with other illnesses— untreated depression can delay recovery from or worsen the outcome of these other illnesses. ➤➤ Dissociative identity disorder. This disorder is evidenced by two or more personalities or identities that control a person’s consciousness at different times. It used to be called multiple personality disorder. ➤➤ Dissociative amnesia. Sufferers of this disorder forget some or all of their personal information, such as who they are or where they live. © 2012 HCPro, Inc. Psychotic disorders In acute phases of psychosis, a person loses touch with reality and is unable to meet the ordinary demands of life. Most psychotic episodes are brief. For permission to reproduce part or all of this newsletter for external distribution or use in educational packets, contact the Copyright Clearance Center at www.copyright.com or 978-750-8400. CNA Training Advisor Page 4 December 2012 mental illness Schizophrenia is a severe and chronic psychotic disorder that im- ➤➤ Psychotherapy. Psychotherapy is the use of psychological techniques to change behaviors, feelings, thoughts, or habits. pairs a person’s ability to think clearly, make decisions, and relate to It is recommended for persons experiencing emotional distress. others. Persons with this disorder suffer frightening symptoms that leave them fearful and withdrawn. One out of every hundred people ➤➤ Behavior management. The aim of behavior management is to has this treatable illness, men and women alike. It involves problems increase the occurrence of desirable behavior by rewarding the with brain structure and chemistry. person for acting correctly. Unsuitable behavior is reduced by imposing negative consequences. People with schizophrenia do not have a “split personality.” They may have delusions or hallucinations. They cannot tell what is real ➤➤ Cognitive therapy. Cognitive therapy emphasizes a rational and and what is not real. People with this disorder may talk to themselves, positive view. It attempts to change destructive thought patterns walk in circles, pace, and have difficulty carrying on conversations. that can lead to disappointment and frustration. This therapy is effective with anxiety and depression. There may be a lack of facial expression. They may be unable to follow ➤➤ Psychoeducation. Psychoeducation involves teaching people through with activities they start. about their illness, treatment, and how to recognize a relapse. Schizophrenia is manageable with medication and psycho therapy. Acute episodes are treated with hospitalization and Teaching coping skills to the family will help them deal with an antipsychotic drugs. ill relative. ➤➤ Self-help and support groups. Members of these groups give each other ongoing support. It’s comforting to know others have Treatment of mental illness the same or similar problems. These groups can also help families Mental health disorders are treatable, and many people can recover. Some common treatments for mental illness are: work together for needed research, treatments, and community ➤➤ Medications. Many of the medicines used to treat mental illness programs. n cause unpleasant side effects. Some of the more common ones are dry mouth, constipation, blurred vision, appetite changes, loss of sexual function, drowsiness, and weight gain. Drinking eight glasses of water a day and eating fruits and vegetables can help with Questions? Comments? Ideas? some of this. Antipsychotic drugs can cause tremors, stiffness, mus- Contact Associate Editor Melissa D’Amico cle contraction and rigidity, restlessness, and loss of facial expression. Elderly people and those who have taken these medicines for years sometimes develop a condition called tardive dyskinesia, Email [email protected] which is characterized by uncontrolled facial movements and jerk- Phone 781-639-1872, Ext. 3505 ing or twisting movements of other body parts. This condition can be treated with medication. CTA Subscriber Services Coupon q Start my subscription to CTA immediately. Options No. of issues Cost q Electronic 12 issues $149 q Print & Electronic 12 issues of each $149 Order online at www.hcmarketplace.com. 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Box 3049, Peabody, MA 01961-3049 Tel: 800-650-6787 Fax: 800-639-8511 Email: [email protected] Web: www.hcmarketplace.com © 2012 HCPro, Inc. For permission to reproduce part or all of this newsletter for external distribution or use in educational packets, contact the Copyright Clearance Center at www.copyright.com or 978-750-8400. December 2012 Vol. 10, No. 12 mental illness Mark the correct response. Name: 1. Date: Antisocial personality disorder was formerly known by what name? a. Obsessive-compulsive personality Recognizing the signs of mental illness can be challenging because people living with mental illness can demonstrate a variety of symptoms. b. Depression a. True c. Sociopathic personality b. False d. Narcissistic personality 2. 7. 4. a. Delusions a. stressful events b. Changes in eating habits b. the body’s chemistry c. Poor judgment c. hallucinations d. Unwillingness to cooperate 8. Mood disorders are often treated with ____. Approximately ____ of Alzheimer’s patients experience psychotic symptoms such as hallucinations, and behavioral symptoms such as aggression and agitation. a. social interaction a. 60% b. antidepressants and/or psychotherapy b. 25% c. physical therapy c. 75% d. exercise d. 90% What is the most common mood disorder among elderly residents? a. Depression Delusions are a symptom of abnormal ________. a. feelings c. thinking c. Hyperactivity d. none of the above d. Bipolar disorder Mental illness is a brain disorder that can cause abnormal ways of ____. a. thinking 9. b. behavior b. Anxiety 5. What is a common symptom of abnormal feelings? Mental health problems may be caused by ____. d. both a & b 3. 6. 10. Treatment through behavior management emphasizes a rational and positive view. This therapy attempts to change destructive thought patterns that can lead to disappointment and frustration. b. feeling a. True c. acting b. False d. all of the above A supplement to CNA Training Advisor