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Mental health


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Published in: Education, Health & Medicine

Mental health

  1. 1. MENTAL HEALTHASHRAF TANTAWY Professor of Psychiatry Suez Canal University Ismailia, Egypt.
  4. 4. DEFINITION OF HEALTH “A state of complete(Physical, Mental & Social) well-being”(World Health Organization)
  5. 5. The 10 Health Indicators 1- Physical Activity. 2- Overweight and Obesity. 3- Tobacco Use. 4- Substance Abuse. 5- Responsible Sexual Behavior. 6- Mental Health. 7- Violence and Injury. 8- Environmental Quality. 9- Immunization. 10- Access to Health Care.
  6. 6. MENTAL HEALTHThe successful performance ofMental Functions.Resulting in Productive activities& Fulfilling relationships. The ability to adapt to change &cope with stressors. The successful adaptation tostressors are evidenced by
  7. 7. MENTAL ILLNESSA Clinically Syndrome, marked byDistress, Disability, Suffering orLoss of freedom.Maladaptive Responses tostressors evidenced by thoughts,feelings & behaviors, interfere withthe individual’s physical, social or
  8. 8. Mental Health/ Mental Illness Concept Must Be Clear Mental Health Mental IllnessContinuum - Not Static(Introversion → Avoidant Personality → Social Phobia → Schizophrenia)
  9. 9. MENTAL HEALTH Maslow identified: A “Hierarchy of Needs”:Self-actualization as fulfillment of one’s highest potential
  10. 10. Maslow’s Hierarchy of Need (1954)
  11. 11. Aspects of Mental HealthEmotional Intelligence: Emotions are skills for living. Have emotional self control. Recognize emotions in others. Handle relationships.Resiliency:Emerge and grow from negative life events.Spirituality:That part of us that deals with relationships, values andaddresses questions of purpose and meaning in life.
  12. 12. Common & SeriousMental Health ProblemsCommon Problems: – Depressive Disorders. – Anxiety Disorders.Severe & Enduring Problems: – Schizophrenia. – Bipolar disorder. – Major depression. – Dementia.
  13. 13. Problems of Mental Disorders Lifespan vs. Health span. Physical Burden. Poly-Pharmacy. Psychosocial Burden.Biological Basis of Psychiatric Disorders.
  14. 14. Lifespan vs. Health spanLifespan: Length of life increased.Health span: Length of healthy life before Disability.Factors affecting lifespan and health span:1. Exercise: Improves mood andcognition.2. Sleep pattern.3. Eating pattern.4. Social networks: Protective against
  15. 15. Physical BurdenComorbid Physical Diseases:NS, IS, CVS, RS, US & GIT.Disability: Physical & Mental.Side Effects: Psychotropic Drugs.
  16. 16. Physical Comorbidity Depressive Disorders: Diabetes. Ischemic Heart Disease. Stroke. Chronic Neurological Conditions. Cancer. Anxiety Disorders: COPD & Bronchial Asthma.
  17. 17. Physical ComorbiditySchizophrenia: Obesity, Hypertension & Smoking. Hepatitis C & HIV. Drug related Movement Disorders. Cancer Colon. Rheumatoid Arthritis.Bipolar Disorder As for schizophrenia. + Drug Related Thyroid Diseases. Drug Related Renal Diseases (Lithium).Causes of Death among Mental Patients: Cardio-Respiratory Disease & Infectious disease.
  18. 18. Poly-PharmacyMultiple Pathology.- Cardiac Disease: HPT, IHD.- Diabetes.- Asthma/ COPD.- Osteoporosis.- Neurological Diseases.- Psychiatric Disorders.Multiple Medications.Multiple Adverse Effects.Drug-Drug Interactions.
  19. 19. Psychosocial BurdenSocial Isolation.Physical & Cognitive Dysfunctions.Loss of Social & Occupational Status.Loss of Friends.Lack of Adequate Health Care.Financial Insecurity.Death Preoccupation.Dependency on Their Families.
  20. 20. . Cukor D et al. JASN 2007;18:3042-3055©2007 by American Society of Nephrology
  21. 21. CAUSES OF MENTAL ILLNESSThe concept of multiplefactors in the causation ofpsychogenic disorders hasbecome generally accepted.The factors are consideredto involve the individual, thefamily & the community.
  22. 22. Biological Basis of Psychiatric DisordersNerves EnvironmentHormones BrainAction Endocrine Glands Immune System Physiology & Behavior
  23. 23. The Biological Basis of Psychiatric Disorders Brain Mind Biopsychosocial ModelPsychoneuro- Medically Immunology Unexplained Physical Symptoms Body
  24. 24. Diathesis-Stress Model Diathesis Stress “Predisposing Causes” “Precipitating Causes”(Hereditary Predisposition) (Situational Factors) Bio-Psycho-Social Approach Disorder “Maintaining Causes”• Emphasizes Interaction of Physical ConditionsBiological and Social Factors Recovery
  25. 25. . Cukor D et al. JASN 2007;18:3042-3055©2007 by American Society of Nephrology
  26. 26. Quality of LifeWell-being: Physical, Psychological, Social & Spiritual. Physical Psychological Functional Ability Anxiety Strength/Fatigue Depression Sleep & Rest Enjoyment/Leisure Nausea Pain Distress Appetite Happiness Constipation Fear Pain Quality of Cognition/Attention Social Life Spiritual Financial Burden Hope Caregiver Burden SufferingRoles & Relationships Meaning of Pain Affection Religiosity Sexual Function Transcendence Appearance
  27. 27. How Does The Public View The Mentally Ill?They are fearful.There is a big stigma.The mentally ill are labeled.Care is rationed.People oppose care by using laws.The mentally ill are losers when itcomes to the budget for care.
  28. 28. What are The Costs of Mental Illness? Police costs. Public health costs. Safety costs. Court costs. Business costs. Social costs. Jail costs.
  29. 29. Psychiatrists handle littlenumber of real psychiatricpatients, WHY?There are 5 levels and 4 filters.
  30. 30. L1:Community (30%). F1 : Illness behavior.L2:Mental morbidity in primary care (25%). F2: Ability to detect.L3:Mental morbidity by doctors (10%). F3: Referral.L4:Morbidity in mental health services (2.5%). F4: Admission.L5: Psychiatric inpatients (0.5%).
  31. 31. The Provider- Caregiver Relationship– Expectations.– Establish & Maintain Boundaries.– Building on Strengths.– Sharing One’s Own Family Life.– Reciprocal & Positive Feelings.
  32. 32. Talking with CaregiversBe Positive.Be Flexible.Be a Good Observer.Work as Partner.Listen Actively.Begin Where The Caregiver Is.Ask Leading Questions.Make Comments Thoughtfully.Answer Personal Questions.
  33. 33. Essential Qualitiesof Mental Health Team Empathy. Respect. Perseverance & Resilience.
  34. 34. You Can Differentiate Mental Health Mental Illness
  36. 36. MENTAL HEALTH APPROACHESPrimary Prevention.Secondary Prevention.Tertiary Prevention.
  37. 37. PSYCHIATRY STRATEGIESIntegration of mental health withprimary health care throughthe national mental health program.Provision of tertiary care institutions fortreatment of mental disorders.Eradication stigmatization of mentally illpatients.Protecting patient rights through regulatoryinstitutions like the central mental healthauthority.
  38. 38. Numbers of People Affected Globally 450 million people with mental disorders:– 150 million with Depression.– 90 million with Alcohol or Drug Use Disorder.– 40 million with Epilepsy.– 25 million with Schizophrenia.– 10 million Attempt Suicide every year.– 1 million Commit Suicide every year.
  39. 39. Did You Know?4 of the 10 leading causes of disability aremental disorders:- MD, Schizophrenia, Dementia & OCD.6% of the population suffers from Severe &Persistent Mental Illness:- Dementia, Schizophrenia, BAD & MD. 13 % of the population has a diagnosis of:- Dysthymia, Panic Disorder, Phobia & Antisocial Personality Disorder.
  40. 40. Psychiatry by Numbers25% of the population has a mentaldisorder.15% of patients in population havedepressive illnesses.90% of the 10 most commoncomplaints in psychiatric settinghave no organic basis.50% of mental health care can bedelivered by Non-Psychiatrists.
  41. 41. Relationship Between Psychiatry & MedicineA- Medical Conditions that have psychiatric symptoms.B- Psychosomatic Disorders.C- Medically Unexplained Physical Symptoms.D- Mental Disorders that may have physical symptoms.
  42. 42. A- Medical Conditions That Have Psychiatric Symptomatology1- Neurological Diseases: Brain tumors, Epilepsy, MS, Parkinsonism,...2- Endocrine Syndromes: Thyroid, Suprarenal, Ovaries, Pancreas,…3- Infectious Diseases & Autoimmune Syndromes.4- System Failures: Renal, Hepatic, Cardiac, Respiratory,...5- Chronic Disability: Blindness, Deafness, Muteness, Loss of limb,...6- Blood Diseases: Anemia, Leukemia, Hemolytic diseases,...
  43. 43. B- Psychosomatic DisordersThe physical condition must show eitherdemonstrable organic pathology or aknown patho-physiologic process.They can influence not only the cause ofthe illness but can also worsen thesymptoms & affect the course of thedisorder.Examples: Angina, Hypertension,Bronchial asthma, Rheumatoid arthritis,Duodenal ulcers, IBS, Eczema, Psoriasis& Urticaria.
  44. 44. C- Medically Unexplained Physical SymptomsSometimes psychological factors can cause ill health without actually causing a disease.As a result of unhappiness, anxiety or stress due to personal problems, physical symptoms may develop. A- Somatoform disorders. B- Factitious disorders. C- Malingering.
  45. 45. Somatoform Disorders1- Somatization Disorder.2- Hypochondriasis.3- Dissociative & Conversion Disorders.4- Somatoform Pain Disorder.5- Body Dysmorphic Disorder.
  46. 46. D- Mental Disorders That MayHave Physical SymptomatologyNeurotic Disorders:Depression, Anxiety, OCD &Adjustment disorder.Psychotic Disorders: Dementia,Delirium, Schizophrenia, Mooddisorders, Delusional disorder &Substance induced psychosis.
  48. 48. CAREGIVERS BURDEN Physical Burden. Financial Burden. Time Burden. Role Burden. Emotional Burden. Others.
  49. 49. Caregiving Burden Signs of Caregiver Burnout1- Physical Burden: Weight Change: Gain or Loss. Unexplained Somatic Complaints: (Chronic headaches, backaches orothers). Caregiver’s Syndrome: (Fatigue from physical strain & sleep lack ). Osteoporosis and Arthritis.
  50. 50. Caregiving Burden Signs of Caregiver Burnout3- Time Burden: Caregiving is time-consuming. Less time for other tasks. Activities can be stressful.4- Role Burden: Feelings of being pulled in differentdirections. Family responsibilities. Pressure and tension.
  51. 51. Caregiving Burden Signs of Caregiver Burnout5- Emotional Burden:Common feelings: Being overwhelmed, Anger,Frustration, Guilt, Exhaustion, Loneliness andSocial withdrawal.Cognitive disturbances: Lack of concentrationand finding it difficult to complete complex tasks.Sleep disorders: Sleeplessness / stressful dream.Anxiety: about facing another day and what thefuture holds.Depression: feeling sad and hopeless.Adjustment disorders.
  52. 52. Psychiatric Disorders Among CaregiversDepression.Anxiety disorders.Unexplained SomaticComplaints.Adjustment disorders.
  53. 53. ConclusionsMental disorders among patients & theircaregivers are frequent, associated withincreased medical & functional morbidity.Attention to physical, psychological & spiritualconcerns are necessary.Use of medication, psychotherapy orcounseling in an integrated manner results inbest outcomes.The good physician will treat the disease butthe great physician will treat the patient.Mental health means enhancing physicaltreatment & promoting mental health.
  54. 54. Nursing Is Of Paramount ImportanceAmong Mental Patients