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Module 13 Signs and Symptoms of Mental Illness Geriatric Aide Curriculum NC Division of Health Service Regulation Adapted from PowerPoint by Alison Rieber, LCSW, Johnston County Geriatric and Adult Mental Health Specialty Team 1 Signs and Symptoms of Mental Illness Objectives 1. Define mental health and mental illness. 2. Describe 3 major mental illness categories. 3. Recognize symptoms of mental illness. 2 Signs and Symptoms of Mental Illness Objectives 3. Discuss possible causes for symptoms. 4. Develop an understanding of what the resident experiences 5. Discuss the nurse aide’s role in helping a resident manage symptoms 3 Mental Health and Mental Illness • Mental health means that a person copes with and adjusts to everyday stresses in ways accepted by society. • Mental illness is a mild to severe disturbance in the ability to cope with or adjust to stress. 4 Get to Know the Resident • What do the symptoms of the resident look like? • What is the resident feeling? • What helps them manage these feelings and symptoms? 5 Myths About Mental Illness • People who need psychiatric care should be placed in institutions. • A person with a mental illness can never be normal. • An individual with mental illness is dangerous. • People with mental illness aren’t suited for important, responsible positions. 6 Facts About Mental Illness • A disease that causes mild to severe problems in thinking, feeling, and/or behavior. • Ability to cure a mental illness depends on the type and severity of the mental illness • Many mental disorders can be linked to biological or genetic origin, but many also have environmental and social causes. 7 Facts About Mental Illness • Anxiety disorders are the most common mental illnesses. • Constant stress and lack of using stress management techniques can lead to physical, emotional and behavioral problems 8 4 Major Categories of Mental Illnesses • Anxiety Disorders • Schizophrenia • Phobias • Panic disorders • Obsessive-compulsive disorders • Mood Disorders • Depression • Mania • Bipolar 9 Anxiety • Normal reaction to stressful situations. The intensity of feelings vary based on the intensity of the stressor. Anxiety Disorders • Anxiety without a specific stressor, a reaction bigger than the stressor, or ongoing fear, apprehension from an event that is over. 10 Anxiety Disorders • Phobias: Extreme fear or dread of an object or situation • Panic Disorders: Sudden, intense feelings of terror • Obsessive-Compulsive: Repetitive words or behaviors 11 Anxiety Disorders • Anxiety is overwhelming • Symptoms can take over a resident’s life • Very difficult to calm self down • May avoid situations to avoid symptoms • May become afraid of being anxious 12 Potential Causes of Anxiety • • • • • Genetics Trauma Ongoing stressors Psychological traits Other psychiatric conditions • Depression • Schizophrenia • Medical illnesses • Thyroid problems • Cardiovascular conditions • Respiratory problems • Medication side effects • Alcohol/Drug use or withdrawal 13 Common Symptoms of Anxiety Disorders • • • • • • Anxious or worried thoughts Feeling restless or on edge Feeling irritable Difficulty concentrating Problems sleeping Physical Symptoms 14 Physical Symptoms of Anxiety Disorders • • • • • • • Shortness of breath Heart palpitations Trembling or shaking Choking Nausea Numbness Dizziness • Hot flashes or chills • Feeling of being out of one’s body or unreal • Fear of dying • Fear of going crazy 15 Treatment • Therapy • Breathing exercises • Relaxation techniques • Medication 16 What Staff Can Do • Assist resident to relax, calm down • Pay attention to your voice tone • Calm Voice • Soothing Tone • Slow rate of speech • Provide reassurance • Address anxious thoughts • Help resident problem solve • Remind of past successes • Encourage ability to address issues 17 What Staff Can Do • Encourage relaxation breathing • Provide soothing music/sounds • Be reliable and consistent • Encourage exercise • Notice and report changes 18 Depression • Everyone has “down days” or times of sadness. • In depression the mood takes over • The individual feels sad, irritable, guilty, tired, and unable to experience pleasure or interest. • Feelings persists for several weeks or longer. 19 Facts About Depression in Older Adults • It is not a normal part of aging • Often not recognized, ignored, misdiagnosed, not adequately treated • Symptoms are atypical 20 Facts About Depression in Older Adults • Affects approximately 6 million American older adults • Only 10% receive treatment • Affects 10% to 26% of residents in long term care facilities (national statistic) • At greater risk to commit suicide 21 Causes of Depression • • • • • Long term stress Trauma Genetics Psychological traits Chronic illness • Chronic Pain • Dementia • Stroke • Medications • Blood Pressure • Cardiovascular • Pain • Alcohol/Drug use or withdrawal 22 Main Causes of Depression in Older Adults • Medical conditions • Loss of physical abilities • Powerlessness and loss of control • Lack of activity 23 Common Symptoms of Depression • Problems with sleep • Problems with appetite • Depressed or irritable mood • Loss of enjoyment or pleasure • Loss of interest • Loss of energy • Feelings of guilt, worthlessness • Suicidal Thoughts • Problems with concentration • Can have psychosis 24 Treatment • 80% of persons identified with depression can be successfully treated • Therapy • Medication 25 What Staff Can Do • Involve withdrawn residents • Encourage resident to be more active • Create meaningful activities • Sunshine and exercise • Focus on resident’s strengths • Notice and report symptoms 26 Mania • An abnormally elevated mood state with: • inappropriate elation (joy) • increased irritability • exaggerated self-importance • racing thoughts • hyperactivity (restlessness) 27 Causes of Mania • Bipolar disorder • Stimulant use/abuse • Medication side effects • Medical illness • • • • Overactive thyroid HIV infection Strokes Brain tumors • Steroids • Antidepressants 28 Common Symptoms of Mania • Significantly decreased need for sleep • Grandiose ideas • Mood very high or irritable • Racing thoughts • More talkative, can’t stop talking • Easily distracted • Involved in pleasurable but risky behavior • May have psychosis 29 Early Warning Symptoms of Mania • Changes in sleep • Change in mood; irritable or elevated • Racing thoughts • Restlessness, pacing 30 Treatment • Requires psychiatric attention • May require hospitalization 31 What Staff Can Do • Most residents in long term care with mania will have a history of these episodes • Notice symptoms early • Report symptoms to a nurse 32 Bipolar Disorder • A brain disorder that causes unusual shifts in an individual’s mood, energy level, and ability to function. • Mood swings from the highs of mania to the lows of depression 33 Causes and Factors of Bipolar Disorder • Cause is not known for certain • Factors • Heredity • Chemical imbalance • Personality 34 Common Symptoms of Bipolar Disorder • Manic Episode • • • • • • • • Increased energy, activity, restlessness Excessively “high”, overly good mood Extreme irritability Racing thoughts and talking fast Distracted easily Little sleep needed Unrealistic beliefs in one’s abilities and powers Poor judgment 35 Common Symptoms of Bipolar Disorder • Depressive Episode • Lasting sad, anxious, or empty mood • Feelings of hopelessness • Feelings of guilt, worthlessness, or helplessness • Loss of interest in activities • Decreased energy – feeling tired • Difficulty concentrating • Change in sleep or appetite 36 Treatment • Bipolar disorder is very treatable • Medication • Therapy 37 What Staff Can Do • Help resident learn to predict fluctuation in mood • Encourage medication compliance • Recognize symptoms early • Report observations to a nurse 38 Schizophrenia • A serious and complex mental illness with symptoms of emotional instability, detachment from reality, and withdrawal into the self. 39 Causes of Schizophrenia • There is no definite cause • Four primary theories: • • • • Heredity Chemical defect in brain Physical abnormality in brain Complications during pregnancy or childbirth 40 41 42 Symptoms of Schizophrenia • Hallucinations • Suspicion • Delusions • Flat affect • Disordered thinking/speech • Lack of pleasure in any activity • Agitation • Social withdrawal • Hostility • Lack of initiative 43 Treatment • Anti-psychotic medications • Psychotherapy 44 Psychosis • Loss of contact with reality. • A psychiatric disorder such as schizophrenia or mania that is marked by delusions, hallucinations and distorted perceptions of reality. 45 Causes of Psychosis • Symptom of mental illness • Depression • Bipolar Disorder • Schizophrenia • Drug use or withdrawal • Stimulants • Alcohol • Medical causes • Stroke • Brain tumor 46 Common Symptoms of Psychosis • Visual or auditory hallucinations • Images are frequently frightening • Voices often negative • Hallucinations are very real to the individual 47 Psychosis • Delusions • May range from suspiciousness to fear and paranoia • May lead to agitation or anxiety 48 How to Recognize Psychosis • Resident appears to be listening to something inside his/her head • Resident appears to be looking at, talking to things that you can’t see or hear • Resident talks about events, suspicions, beliefs, visions that are not real • Resident may appear fearful, agitated 49 What Staff Can Do • Notice resident’s behavior and report • New symptoms • Symptoms more intense • Resident recognizes having hallucinations or delusions: • Remind resident that this is part of the illness • Assure resident of being all right and safe • Distract resident, involve in activity 50 What Staff Can Do • Resident does not recognize hallucinations or delusions: • Reassure resident without buying into the false belief • Don’t argue about the delusion or hallucination • Try to help the resident move onto activity in the real world 51 General Guidelines for Helping Residents Manage Symptoms and Mental Illness • Symptoms are a part of the illness not willful behavior • Staff response to symptoms affects resident’s quality of life • Staff actions can help residents manage symptoms 52 General Guidelines for Helping Residents Manage Symptoms and Mental Illness • Notice changes in symptoms • Think about events surrounding changes • • • • Any recent stress Illness Change in medication Possible drug use 53 General Guidelines for Helping Residents Manage Symptoms and Mental Illness • Report any changes • Be specific about what has changed • Sleep • Appetite • Mood • Behavior 54 General Guidelines for Helping Residents Manage Symptoms and Mental Illness • Pay attention to changes • Symptoms can be signs of serious illness • Responding to symptoms can improve health of the resident 55 References • Training Manual for Caregivers, Therapeutic Alternatives, Inc • The North Carolina Geriatric Specialty Team Manual: Keys to Success, Therapeutic Alternatives, Inc 56 57