Final Mental Health Lecture 04_23_15 -2

MENTAL HEALTH AH 4243 Healthcare Issues for the Health Professional

What is Mental Health?

Mental Health is a dynamic process in which a person’s

physical, cognitive, affective, behavioral, and social

dimensions interact functionally with one another and the

environment.

Mental illness is an abnormal mental condition or disorder

that disrupts a person’s thinking, feeling, mood, ability to

relate to others, and daily functioning (NAMI – National

Alliance on Mental Illness, 2007).


• 1 in 4 people in the world will be affected by

mental or neurological disorders (World Health

Organization)

• Most common mental illnesses in adults are

anxiety & mood disorders

• People with mental illness have an increased risk

of injuries. They are also more likely than people

without mental illness to use tobacco products

and to abuse alcohol and other drugs


• Categories of mental disorders are very broad

and there is a significant overlap among

specific disorders

• Patients may manifest symptoms from more than

one of the categories of mental health

• Major challenge in diagnosing and treating

patients• Each individual is different and symptoms often vary from

person to person

Categories of Mental Health

4 Broad Categories of Mental Disorders

• Anxiety

• Psychosis

• Disturbances of Mood

• Disturbances of Cognition


Anxiety

• “Vitally important physiological response to dangerous

situations that prepares one to evade or confront a threat

in the environment”

• Fight or flight response

• Anxiety disorders occur in 31.2% of the population

• phobias, panic disorder, and generalized anxiety

disorder (GAD)—other manifestations of anxiety

include obsessive-compulsive disorder (OCD) and post-

traumatic stress disorder (PTSD)


Psychosis

• Disorders of perception and thought process

• Characteristically associated with schizophrenia, but

psychotic symptoms can occur in severe mood disorders

• Most commonly observed symptoms are

• Hallucinations: sensory impressions that have no basis in reality

• Delusions: false beliefs held despite evidence to the contrary,

such as paranoia

• Schizophrenia affects 1.1% of the US. Onset is generally

during young adulthood-earlier and later onset does occur

Video https://www.youtube.com/watch?v=syjEN3peCJw

https://www.youtube.com/watch?v=syjEN3peCJw


Disturbances of Mood

• Disturbances of mood characteristically manifest

themselves as a sustained feeling of sadness (major

depression and dysthymia)

• Or sustained elevation or fluctuation of mood

• Bipolar disorders (1 and 2, cyclothymic disorder, “mixed features”)

• Mood disorder symptoms: disturbances of in appetite,

sleep patterns, energy level, concentration, and memory

• Major depression is often associated with thoughts of

suicide

• Mood disorders occur in 21.4% of the total US population


Disturbances of Cognition

• The ability to organize, process, and recall information, as

well as to execute complex sequences of tasks, may be

disturbed in a variety of disorders

• Alzheimer’s disease-progressive deterioration of

cognitive function, or dementia

https://www.youtube.com/watch?v=yJXTXN4xrI8

https://www.youtube.com/watch?v=yJXTXN4xrI8

Case Study

Which mental

health category

does this

illness belong

to?

(anxiety, psychosis,

mood disturbance or

cognitive disturbance)

What mental

illness is Yvonne

most likely

diagnosed with?


Other categories

• Behavioral/ Impulse-control disorders• ADHD, oppositional-defiant disorder, conduct disorder,

• 25% is impulse control disorder

• Substance disorders• Alcohol abuse with/without dependence

• Drug abuse with/without dependence

• Nicotine dependence,

• Any substance disorder

• 35.3% is substance disorder

• Development disorder• Autism spectrum disorders: autistic disorder, Asperger’s, Pervasive

Developmental Disorder Not Otherwise Specific

• ADHD

Childhood Mental Health

• Both biological and psychosocial experiences during

childhood may influence the risk that a child will develop a

mental disorder

• Quality of the relationship between infants or children and

their primary caregiver = primary importance to mental

health across the lifespan

• Risk factor may/may not impact the child depending on

individual differences among children and age the child is

exposed to it—or alone or associated with other risk

factors


• Risk factors for children:

• Biological: exposure to alcohol or cigarettes, environmental

exposure to lead, malnutrition of pregnancy, birth trauma, specific

chromosomal syndromes

• Psychosocial: Maternal depression increases risk of depressive

and anxiety disorders, conduct disorder and alcohol dependence in

the child, living in overcrowded homes, large families, abuse,

violence

• Quality of the relationship between infants or children and

their primary caregiver = primary importance to mental

health across the lifespan


Source: American Psychological Association; National Institute of

Mental Health

The 20/20 Problem

• 20% of children have a

mental disorder but

only 20% of those get

the help they need


• Early childhood detection is KEY

• Infant-early childhood mental health (I-ECMH)

• The developing capacity of the child from birth to 5 years of age to

form close and secure adult and peer relationships, experience,

manage, and express a full range of emotions. Explore the

environment & learn-all in the context of family, community & culture

• Sometimes referred to as social and emotional development


Autism Spectrum Disorder (ASD)

• Severe, chronic developmental disorder characterized by

severely compromised ability to engage in, and by a lack

of interest in, social interaction

• 2000 CDC Survey: 1 in 110 children are diagnosed with

autism

• The prevalence in boys is about 4 to 5 times higher than

girls


• There is a strong genetic influence to autism

• Twin studies

• Identical twin of autistic individual will also have autism in 9

out of 10 cases

• Researchers are identifying particular genes that may

increase the risk of autism


Autism Spectrum Disorder

• Name change to autism spectrum

o The latest Diagnostic and Statistical Manual of Mental

Disorders (DSM-5) no longer includes Asperger's

Syndrome. The symptoms of Asperger’s syndrome are

now included in this broad term.

• The term “spectrum” refers to a wide range of

symptoms, skills, and levels of disability. Some children

are mildly impaired by their symptoms while others are

heavily impaired (NIMH)


Attention deficit/hyperactivity disorder (ADHD)

• A chronic condition including symptoms of hyperactivity,

difficulty in paying attention and staying focused and

impulsiveness

• The most commonly diagnosed behavior disorder of

childhood, with a prevalence four times higher in boys

than in girls

• Often persists into adulthood

• Twin studies indicate strong genetic component

• Treatment: psychoactive stimulants, medication +

behavioral therapy is most effective


Attention deficit/hyperactivity disorder (ADHD)

• Major concern for health professionals:

Is ADHD over diagnosed/over prescribed?

• Huge health care debate! Many medical concerns of over

prescription of “unnecessary” psych stimulants

administration

• The Centers for Disease Control and Prevention (CDC) reported in

2013 that 1 in 9 kids had received a diagnosis of ADHD which is a

significant increase from the previous decade.

• This increase also represents a huge market for powerful stimulant

medications prescribed for ADHD


On the debate of over prescription of ADHD

medication…

What do you think?

https://www.youtube.com/watch?v=UJeSZ9mPM_o

https://www.youtube.com/watch?v=UJeSZ9mPM_o

ADHD Medications

• ADHD medications abuse on college campuses

• Have you every used ADHD medications to

help with school work and studying?

• A)Yes

• B)No

• C)No, but know someone who has

http://newyork.cbslocal.com/2013/06/25/colleges-universities-crack-down-on-study-drugs/


• Other mental illnesses commonly diagnosed in

children

oAnxiety disorders

oEating disorders

oObsessive-compulsive disorder

oSubstance abuse disorders (mainly adolescence)

Mental Health in Older Adults

• Population of 55 years and older

• Depression, Alzheimer's disease, alcohol/drug abuse,

anxiety, late-onset schizophrenia, Post Traumatic Stress

Disorder (PTSD) are most common

• Depression is very common in elderly due to the loss of a

spouse

• Of all age groups, older adults have the highest rates of

suicide, often as a consequence of depression

• Risk factors: medical conditions , nursing home

admission, isolation, high number of medications

Clicker Question

•Have you experienced any of the

mental health disorders that we’ve

discussed?

•A) No

•B) Yes

•C) Unsure

Clicker Question

•Where you able to get professional

help if needed?

•A) Yes

•B) No, couldn’t get the help

•C) No, I handled it on my own

•D) N/A

Cause of Mental Health Disorder?

Cause of Mental Health Disorders

Exact cause is still unknown!

But it is certain that various factors shape

them


• The causes of mental disorders are viewed as a product

of the interaction between biological, psychological and

sociocultural factors

• Genetic factors are very important in some mental

disorders

• Environmental factors exert a significant role, and

therefore there is a possibility of intervening to prevent the

development of certain disorders


From the list of mental illnesses we’ve discussed today,

which illness(es) has/have a very strong genetic

influence, according to twin studies

A. Schizophrenia

B. Autism Spectrum Disorder

C. Attention Deficit Hyperactivity

D. All of the Above


From the list of mental illnesses we’ve discussed today,

which illness has a very strong genetic influence, according

to twin studies

A. Schizophrenia

B. Autism Spectrum Disorder

C. Attention Deficit Hyperactivity

D. All of the Above

*Bipolar Disorders also have very strong genetic influence

Prevention

Prevention of a mental illness depends on identification of risk factors that can be targeted, especially in children

Risk factors include:

• Individual factors o Insecurities, fear of failure, loss of self-worth, negativity, physical

illnesses, difficult temperament, neurophysiological deficits (serotonin imbalance)

• Family factors

• Marital discord, social disadvantage, overcrowding/large family size, paternal criminality, maternal mental disorder, foster care, financial burdens

• Community factors

• Living in an area with high rate of disorganization and inadequate schools

Mental Health Barriers

• Stigma has always been one of the biggest barriersto seeking treatment for mental health patients, second

only to the unaffordable costs of American mental

health care

• Over 37% of the Americans who should have received

treatment in 2011 didn’t believe that they needed any or

thought that it wouldn’t help; another 35% were afraid of

the negative social consequences or being

institutionalized


Decline in Mental Health Reform since

Newtown Tragedy

• From 2009 to 2012 states cut mental health budgets by

$4.35 billion

• In 2013- 36 states and the District of Columbia began to

restore funding, in the wake of increased public

awareness of mental health needs

• In 2014- only 29 states and the District of Columbia

increased funding for mental health services

Treatment

• Therapies • Individual, group and family therapy

• Hypnotherapy

• Psychotherapy approaches

Treatment


• Freudian Psychoanalysis

o Psychoanalytic therapy looks at how the unconscious mind influences thoughts and behaviors.

• Cognitive-behavioral therapy

o Alters faulty cognitions and replaces them with thoughts that promote positive adaptive behavior

• Prolonged Exposure (PE) Therapy:

oHelps people confront their fear and feelings about the trauma they experienced in a safe way through mental imagery, writing, or re-visiting and reencountering a negative experience

Treatment


• Cognitive Processing Therapy: patient is asked to

recount his or her traumatic experience and a

therapist helps the patient redirect inaccurate or

destructive thoughts about the experience

• Electroconvulsant Shock Therapy—often referred

as shock treatment in which seizures are electrically

induced to provide relief from psychiatric illnesses,

mainly used for severe mood disorders

Treatment

• Medications

• Antipsychotics: for individuals with psychosis disorders (ex:

schizophrenia)

• Anxiolytics: inhibits anxiety

• Antidepressants: for mood disorders, like major depression

• Antimanics: controls symptoms of mania

• Anticonvulsants: prevent or reduce severity in seizure

• Stimulants: amphetamine or methylphenidate for ADHD

(athealth.com, 2007)

Treatment

• In 2013, antidepressants were the most commonly prescribed drug in United States

• Selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed antidepressants.• They can ease symptoms of moderate to severe depression, are relatively safe

and generally cause fewer side effects than other types of antidepressants do.

• Work by changing the levels of one or more of these neurotransmitters.

• SSRIs are called selective because they seem to primarily affect serotonin, not other neurotransmitters.

• Citalopram (Celexa)

• Escitalopram (Lexapro)

• Fluoxetine (Prozac)

• Paroxetine (Paxil, Pexeva)

• Sertraline (Zoloft)

Treatment

Case Study

Casey always has negative thoughts which trigger her to

feel very anxious. Casey sees a therapist at the Counseling

and Mental Health Services at UConn who decides it’s

necessary to find ways to stop her destructive thoughts and

replace them with positive adaptive behavior. What type of

psychotherapy approach is the therapist implementing?

A. Prolonged Exposure Therapy

B. Cognitive Behavioral Therapy

C. Electroconvulsant Shock Therapy

D. None of the above

Case Study

Casey always has negative thoughts which trigger her to

feel very anxious. Casey sees a therapist at the Counseling

and Mental Health Services at UCONN who decides it’s

necessary to find ways to stop her destructive thoughts and

replace them with positive adaptive behavior. What type of

psychotherapy approach is the therapist implementing?

A. Prolonged Exposure Therapy

B. Cognitive Behavioral Therapy

C. Electroconvulsant Shock Therapy

D. None of the above

Case Study

Casey informs her therapist about her severe,

uncontrollable panic attacks before exams. The therapist

refers her to one of the psychiatrists at CMHS. The

psychiatrist informs Casey of medication options to help

tone down her anxiety levels to prevent the occurrences of

panic attacks. What type of medications would the

psychiatrist most likely prescribe?

A. Antidepressants

B. Antimanics

C. Stimulants

D. Anxiolytics

Case Study

Casey informs her therapist about her severe,

uncontrollable panic attacks before exams. The therapist

refers her to one of the psychiatrists at CMHS. The

psychiatrist informs Casey of medication options to help

tone down her anxiety levels to prevent the occurrences

of panic attacks. What type of medications would the

psychiatrist most likely prescribe?

A. Antidepressants

B. Antimanics

C. Stimulants

D. Anxiolytics

Treatment

Lifestyle

Changes!

Thank you!

Final Mental Health Lecture 04_23_15 -2

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