MENTAL HEALTH PATIENTS

Mental Health Mental Health in the Hospital

Assessment History of present illness & patient’s perception Medical history Medication history Physical exam Diagnostic procedures

Interventions Determine priorities

ABC’s Maintain safety Assess life threatening emergencies Provide appropriate environmental setting Implement therapeutic modalities Educate patient and family/significant other

Age-Considerations Pediatric

Many disorders are age-specific onset related Determine what behavior is abnormal vs

adjustment to developmental changes “acting-out” signifies a problem if the

behaviors are socially or culturally unacceptable.

Age-Considerations

Geriatric Most commonly –

depression, suicidal, suspicious, anxiety, situational crisis

Assess for drug/alcohol abuse

Look at all meds & schedule

Rule out organic causes Personal losses and

stressors can precipitate emotional disorders

Anxiety Only 1 in 5 patients ever seek

medical treatment Only 25% of all patients diagnosed

with anxiety are ever treated Treatment is often indicated when

symptoms produce physiological disruption

Patients are often under treated due to fear patients will become addicted to medications

Depression Consists of specific alterations in mood,

often accompanied by a negative self-concept and physical changes, along with changes in activity & interest levels.

Can be suspected when characteristics last >2 weeks.

Characteristics

Loss of interest in usual activities Depressed mood Appetite increase or decrease Weight changes Insomnia or hypersomnia

Characteristics

Fatigue Decreased ability to think Recurrent thoughts of death Feelings of worthlessness Psychomotor agitation or retardation 5 of these >2 weeks = clinical depression

Suicidal Behavior Profile- adolescence or ≥45, male, white,

separated, divorced, widowed, living alone, unemployed

Assessment Precipitating factors Substance abuse

Suicidal Behavior

Treatment Orient to reality Provide safe environment Solutions to ineffective coping &

fear

Homicidal or Violent Behavior

“Acting out of the emotions of fear or anger to achieve desired goals.”

Psychosis Antisocial behavior Organic disease

Planning & Interventions Ensure safety of self and others Encourage patient to identify

feelings Help patient determine cause of

feelings Orient patient to place and time Administer medications as

ordered Haldol

Facilitate communication

Psychotic behaviors

Schizophrenia

Mania

Psychotic depression

Psychotic Behaviors The result of a pathological process that

may be acute or chronic Resultant behavior is distorted

perceptions, disorganized thinking, impaired judgment, impaired decision-making, regressive behavior

May be functional or organic

Treatment Diagnostics to R/O organic Orient to time, person, place Reduce stimuli Antipsychotics Reinforce reality Keep safe Family counseling

Bipolar Disorder“Manic-depressive illness that is

characterized by alternating euphoria & depressed mood periods”

Mood changes can occur over minutes, hours, or days & may be lengthy periods of stability between episodes.

Bipolar Disorder Behaviors-

Flight of ideas Impaired mentation Hostile & paranoid Flamboyant actions Impulsive behavior Disorganized activity Poor social judgment Inflated self-esteem

Treatment for Bipolar Orient to reality Remove from stimulating environment Remove objects of self-harm Medicate – Lithium Work on family & social support Observe closely