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.
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Documentation Cheat Sheets is the ultimate blueprint
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with these residents. As a group, discuss any questions or concerns
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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
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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:
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➤➤ 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.
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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.
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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.
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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
