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Chapter 45
Mental Health Problems
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Basic Concepts

Mental health involves the mind.
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Mental health and mental disorders involve
stress.
• Stress is the response or change in the body caused
•
•
by any emotional, physical, social, or economic factor.
Mental health means that the person copes with and
adjusts to everyday stresses in ways accepted by
society.
Mental disorder is a disturbance in the ability to cope
with or adjust to stress.

Other names include mental illness, emotional illness,
and psychiatric disorder.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Slide 2
Basic Concepts (cont’d)

Causes of mental health disorders include:
• Not being able to cope or adjust to stress
• Chemical imbalances
• Genetics
• Physical, biological, or psychological factors
• Drug or substance abuse
• Social and cultural factors
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Slide 3
Basic Concepts (cont’d)

Personality is the set of attitudes, values,
behaviors, and traits of a person.

Maslow’s theory of basic needs affects personality
development.
• Lower-level needs must be met before higher-level needs.
• Physical needs are met before safety and security, love and
belonging, self-esteem, and self-actualization needs.
Unmet needs at any age affect personality development.

•
Growth and development also affect personality
development.
• They occur in a sequence, order, and pattern.
• Certain tasks must be achieved at each stage.
• Each stage is the basis for the next stage.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Slide 4
Basic Concepts (cont’d)

Freud’s theory of personality development
• Involves three levels of awareness:
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•
Conscious—awareness of the environment and
experiences
Subconscious—memory, past experiences, and
thoughts of which the person is not aware-they are
easily recalled
Unconscious—experiences and feelings that cannot be
recalled
Also involves the id, ego, and superego
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Pleasure is the focus of id.
The ego deals with reality.
The superego is concerned with right and wrong.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Slide 5
Anxiety Disorders

Anxiety is a vague, uneasy feeling in
response to stress.
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Anxiety often occurs when needs are not met.
Some anxiety is normal.
• Persons with mental health problems have higher
levels of anxiety.

Signs and symptoms depend on the degree of
anxiety.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Slide 6
Anxiety Disorders (cont’d)

Anxiety level depends on the stressor.

A stressor is the event or factor that causes stress.
• A stressor may cause mild anxiety or it can cause higher
anxiety at another time.
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Coping and defense mechanisms relieve
anxiety.
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Some are healthy; others are not.
Defense mechanisms are unconscious reactions
that block unpleasant or threatening feelings.
• Some use of defense mechanisms is normal.
• With mental health disorders, they are used poorly.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Slide 7
Anxiety Disorders (cont’d)

Panic disorder
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Panic is the highest level of anxiety.
Panic is an intense and sudden feeling of fear,
anxiety, terror, or dread.
• Onset is sudden with no obvious reason.
• Signs and symptoms of anxiety are severe.
A panic attack can last for 10 minutes or longer.
• Attacks can occur often.
Panic disorder can last for a few months or for
many years.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Slide 8
Anxiety Disorders (cont’d)

Phobia means an intense fear.
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The person has an intense fear of an object, situation,
or activity that has little or no actual danger.
 When faced with the fear, the person has high anxiety
and cannot function.

Obsessive-compulsive disorder (OCD)
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An obsession is a recurrent, unwanted thought, idea,
or image.
 Compulsion is repeating an act over and over again
(a ritual).
• The act may not make sense.
• Anxiety is great if the act is not done.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Slide 9
Anxiety Disorders (cont’d)

Post-traumatic stress disorder (PTSD) occurs
after a terrifying ordeal.

There was physical harm or threat of physical harm.
 PTSD can develop after:
• Being harmed
• A loved one was harmed
• Seeing a harmful event happen
 Flashbacks are common.
• A flashback is reliving the trauma in thoughts during the day
and in nightmares during sleep.
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PTSD can develop at any age including childhood.
The person may also suffer from depression,
substance abuse, and other anxiety disorders.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Slide 10
Schizophrenia
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Schizophrenia means split mind.
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It is a severe, chronic, disabling brain disorder.
It involves:
• Psychosis—a state of severe mental impairment
• Delusion—a false belief
• Hallucination—seeing, hearing, smelling, or feeling
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•
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something that is not real
Paranoia—a disorder of the mind
Delusion of grandeur—an exaggerated belief of one’s
importance, wealth, power, or talents
Delusion of persecution—the false belief that one is
being mistreated, abused, or harassed
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Slide 11
Schizophrenia (cont’d)


The person with schizophrenia has severe
mental impairment (psychosis).
• The person has problems relating to others.
• The person may have difficulty organizing thoughts.
• Responses are not appropriate.
• Communication is disturbed.
• The person may withdraw.
• Disorders of movement occur.
• Some persons regress.
People with schizophrenia do not tend to be
violent.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Slide 12
Mood Disorders

Mood or affect relates to feelings and
emotions.
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Mood (or affective) disorders involve feelings,
emotions, and moods
• Bipolar disorder
• Major depression
• Depression in older persons
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Slide 13
Mood Disorders (cont’d)

The person with bipolar disorder (manicdepressive illness) has severe extremes in
mood, energy, and ability to function.
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The person may:
• Be more depressed than manic
• Be more manic than depressed
• Alternate between depression and mania
The disorder:
• Tends to run in families
• Usually develops during the late teens or early
•
adulthood
Requires life-long management
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Slide 14
Mood Disorders (cont’d)
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Major depression
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Depression involves the body, mood, and
thoughts.
Symptoms affect work, study, sleep, eating, and
other activities.
The person is very sad.
Interest in daily activities is lost.
Causes of depression may include:
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
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A stressful event
Some physical disorders
Hormonal factors in women
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Slide 15
Mood Disorders (cont’d)

Depression in older persons

Depression is common in older persons.
• They have many losses.
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•
Causes of depression in older persons
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Death of family and friends
Loss of health
Loss of body functions
Loss of independence
Loneliness
Side effects from some drugs
Depression is often overlooked.
• A wrong diagnosis is made.
• Depression is often not treated.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Slide 16
Personality Disorders
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Personality disorders involve rigid and
maladaptive behaviors.
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Maladaptive means to change or adjust in the
wrong way.
 Because of behavior, persons with personality
disorders cannot function well in society.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Slide 17
Personality Disorders (cont’d)
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Antisocial personality disorder
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This is a chronic disorder in which the person’s
thinking and behaviors show no regard for right
and wrong.
• The person has poor judgment, lacks responsibility,
•
•
•
and is hostile.
The person is not loyal to any person or group.
Morals and ethics are lacking.
The rights of others do not matter.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Slide 18
Personality Disorders (cont’d)
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Borderline personality disorder (BPD)
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The person has problems with moods, relationships, selfimage, behavior, and controlling emotions.
Aggression, self-injury, and drug or alcohol abuse may occur.
The person may have thoughts of suicide and other mental
health disorders.
BPD is more common in women than in men.
Risk factors may include:
• A family history of BPD
• Childhood abuse—sexual, physical
• Childhood neglect or being abandoned
• Changes in the brain
• Brain chemicals that do not function properly
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Slide 19
Substance Abuse
and Addiction
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Substance abuse or addiction occurs when a
person overuses or depends on alcohol or
drugs.
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Physical and mental health are affected.
The welfare of others is affected.
Substances involved affect the nervous
system.

They affect the mind and thinking.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Slide 20
Substance Abuse
and Addiction (cont’d)
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
Over time, heavy drinking damages the
brain, central nervous system, liver, kidneys,
heart, blood vessels, and stomach.
Alcoholism includes these symptoms:
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Craving—strong need or urge to drink
Loss of control—once begun, cannot stop
drinking
Physical dependence—withdrawal symptoms
when drinking is stopped
Tolerance—greater amounts of alcohol are
needed to get “high”
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Slide 21
Substance Abuse
and Addiction (cont’d)

Alcoholism is a chronic disease.
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Life-style and genetics are risk factors.
 Some people drink for relief from life stresses.
 The craving for alcohol can be as strong as the
need for food or water.
 Alcoholism can be treated but not cured.
• Counseling and drugs are used to help the person stop
•
drinking.
The person must avoid all alcohol to prevent a relapse.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Slide 22
Substance Abuse
and Addiction (cont’d)

Alcohol abuse is just as harmful as alcoholism.
• A person who abuses alcohol drinks too much but is
not dependent on alcohol.
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Problems linked to alcoholism and alcohol abuse
include:
• Not being able to meet work, school, or family
•
•
•
responsibilities
Motor vehicle crashes
Drunk-driving arrests
Drinking-related medical conditions
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Slide 23
Substance Abuse
and Addiction (cont’d)

Drug abuse and addiction
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Drug abuse
• The over-use of a drug for non-medical or non-therapy
effects.
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Drug addiction
• A chronic, relapsing brain disease.
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The person has an overwhelming desire to take a drug.
The person repeatedly takes the drug because of its
effect.
The person has to have the drug. Often higher doses are
needed.
The person cannot stop taking the drug without
treatment.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Slide 24
Substance Abuse
and Addiction (cont’d)
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
Drug abuse and addiction
• Affect social and mental function
• Are linked to crimes, violence, and car crashes
• Have physical effects
Legal and illegal drugs are abused.
• Legal drugs are approved for use in the United States.
• Illegal drugs are not approved for use. They are obtained
through illegal means.
Often, legal drugs also are obtained through illegal means.

•
Treatment depends on the drug and the person.
• A drug treatment program combines various therapies and
services to meet the person’s needs.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Slide 25
Eating Disorders
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An eating disorder involves extremes in eating
patterns.
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Eating disorders can develop in:
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Food intake is severely reduced or the person overeats
Childhood
The teen years
Young or later adulthood
Eating disorders are common in women and
girls.
Depression, anxiety disorders, and drug abuse
may be present.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Slide 26
Eating Disorders (cont’d)
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Anorexia nervosa occurs when a person has an
intense fear of weight gain or obesity.
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A fat body image is felt despite being dangerously thin.
Poor eating habits include:
• Avoiding food and meals
• Eating a few foods in small amounts
• Weighing and measuring food
Intense exercise and vomiting are common.
Enemas and laxatives are used to rid the body of food.
Diuretic abuse also may occur.
Death is a risk from cardiac arrest or suicide.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Slide 27
Eating Disorders (cont’d)
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In bulimia nervosa, binge eating occurs.
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The person eats large amounts of food. Then
the body is purged (rid) of the food to prevent
weight gain.
• Methods used include:
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Vomiting
Laxatives
Enemas
Diuretics
Fasting
Intense exercise
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Slide 28
Eating Disorders (cont’d)
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In binge eating disorder, the person often
eats large amounts of food.
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Eating is out of control.
Binge eating is not followed by purging, fasting,
or exercise.
Often, the person is over-weight or obese.
Other health problems can occur.
• High blood pressure
• Heart disease
• Diabetes
• Joint pain
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Slide 29
Suicide
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Suicide means to kill oneself.
According to a 2010 report from the CDC,
suicide was the:
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Eleventh leading cause of death in the U.S.
Third leading cause of death among persons
aged 15 to 24.
If a person mentions or talks about suicide,
take the person seriously.

Call for the nurse at once.
 Do not leave the person alone.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Slide 30
Suicide (cont’d)
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Agencies treating persons with mental health
problems must identify persons at risk for
suicide. They must:
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Identify specific factors or features that increase
or decrease the risk for suicide.
Provide the most appropriate setting to treat the
person.
Provide crisis information to the person and
family.
• A crisis “hotline” phone number is an example.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Slide 31
Suicide (cont’d)
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Suicide contagion is exposure to suicide or
suicidal behaviors within the family, peer group,
or media reports of suicide.
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The exposure has led to more suicides and suicidal
behaviors in persons at risk.
 Adolescents and young adults are at risk for suicide
contagion.
 Following suicide exposure, those close to the victim
should be evaluated by a mental health professional.
• They include family, friends, peers, and co-workers.
 Persons at risk for suicide need mental health
services.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Slide 32
Care and Treatment
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Treatment of mental health problems involves
having the person explore thoughts and feelings.
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This is done through psychotherapy and behavior,
group, occupational, art, and family therapies.
Often drugs are ordered.
The care plan reflects the person’s needs.
Communication is important.
Persons with mental health problems may
respond to stress with anxiety, panic, or anger.

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Some become violent.
Your first priority is to protect yourself.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Slide 33