Chapter 45 Mental Health Problems Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights...

Chapter 45Chapter 45

Mental Health ProblemsMental Health Problems

Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Basic ConceptsBasic Concepts

Mental health involves the mind.Mental health involves the mind. Mental health and mental disorders involve Mental health and mental disorders involve

stress.stress.• Stress is the response or change in the body caused Stress is the response or change in the body caused

by any emotional, physical, social, or economic factor.by any emotional, physical, social, or economic factor.

• Mental health means that the person copes with and Mental health means that the person copes with and adjusts to everyday stresses in ways accepted by adjusts to everyday stresses in ways accepted by society.society.

• Mental disorder is a disturbance in the ability to cope Mental disorder is a disturbance in the ability to cope with or adjust to stress.with or adjust to stress. Other names include mental illness, emotional illness, Other names include mental illness, emotional illness,

and psychiatric disorder.and psychiatric disorder.

Slide 2Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

Basic Concepts (cont’d)Basic Concepts (cont’d)

Causes of mental health disorders include:Causes of mental health disorders include:• Not being able to cope or adjust to stressNot being able to cope or adjust to stress

• Chemical imbalancesChemical imbalances

• GeneticsGenetics

• Physical, biological, or psychological factorsPhysical, biological, or psychological factors

• Drug or substance abuseDrug or substance abuse

• Social and cultural factorsSocial and cultural factors


Personality is the set of attitudes, values, Personality is the set of attitudes, values, behaviors, and traits of a person.behaviors, and traits of a person. Maslow’s theory of basic needs affects personality Maslow’s theory of basic needs affects personality

development.development.• Lower-level needs must be met before higher-level needs.Lower-level needs must be met before higher-level needs.• Physical needs are met before safety and security, love and Physical needs are met before safety and security, love and

belonging, self-esteem, and self-actualization needs.belonging, self-esteem, and self-actualization needs.• Unmet needs at any age affect personality development.Unmet needs at any age affect personality development.

Growth and development also affect personality Growth and development also affect personality development.development.• They occur in a sequence, order, and pattern.They occur in a sequence, order, and pattern.• Certain tasks must be achieved at each stage.Certain tasks must be achieved at each stage.• Each stage is the basis for the next stage.Each stage is the basis for the next stage.



Freud’s theory of personality development Freud’s theory of personality development • Involves three levels of awareness:Involves three levels of awareness:

Conscious—awareness of the environment and Conscious—awareness of the environment and experiencesexperiences

Subconscious—memory, past experiences, and Subconscious—memory, past experiences, and thoughts of which the person is not aware-they are easily thoughts of which the person is not aware-they are easily recalledrecalled

Unconscious—experiences and feelings that cannot be Unconscious—experiences and feelings that cannot be recalledrecalled

• Also involves the id, ego, and superegoAlso involves the id, ego, and superego Pleasure is the focus of id.Pleasure is the focus of id. The ego deals with reality.The ego deals with reality. The superego is concerned with right and wrong.The superego is concerned with right and wrong.



Anxiety DisordersAnxiety Disorders

Anxiety is a vague, uneasy feeling in Anxiety is a vague, uneasy feeling in response to stress.response to stress. Anxiety often occurs when needs are not met.Anxiety often occurs when needs are not met. Some anxiety is normal.Some anxiety is normal.

• Persons with mental health problems have higher Persons with mental health problems have higher levels of anxiety.levels of anxiety.

Signs and symptoms depend on the degree of Signs and symptoms depend on the degree of anxiety.anxiety.


Anxiety level depends on the stressor.Anxiety level depends on the stressor. A stressor is the event or factor that causes stress.A stressor is the event or factor that causes stress.

• A stressor may cause mild anxiety or it can cause higher A stressor may cause mild anxiety or it can cause higher anxiety at another time.anxiety at another time.

Coping and defense mechanisms relieve Coping and defense mechanisms relieve anxiety.anxiety. Some are healthy; others are not.Some are healthy; others are not. Defense mechanisms are unconscious reactions Defense mechanisms are unconscious reactions

that block unpleasant or threatening feelings.that block unpleasant or threatening feelings.• Some use of defense mechanisms is normal.Some use of defense mechanisms is normal.

• With mental health disorders, they are used poorly.With mental health disorders, they are used poorly.


Anxiety Disorders (cont’d)Anxiety Disorders (cont’d)

Panic disorderPanic disorder Panic is the highest level of anxiety.Panic is the highest level of anxiety. Panic is an intense and sudden feeling of fear, Panic is an intense and sudden feeling of fear,

anxiety, terror, or dread.anxiety, terror, or dread.• Onset is sudden with no obvious reason.Onset is sudden with no obvious reason.

• Signs and symptoms of anxiety are severe.Signs and symptoms of anxiety are severe.

A panic attack can last for 10 minutes or longer.A panic attack can last for 10 minutes or longer.• Attacks can occur often.Attacks can occur often.

Panic disorder can last for a few months or for Panic disorder can last for a few months or for

many years.many years.



Phobia means an intense fear.Phobia means an intense fear. The person has an intense fear of an object, situation, The person has an intense fear of an object, situation,

or activity that has little or no actual danger.or activity that has little or no actual danger. When faced with the fear, the person has high anxiety When faced with the fear, the person has high anxiety

and cannot function.and cannot function. Obsessive-compulsive disorder (OCD)Obsessive-compulsive disorder (OCD)

An obsession is a recurrent, unwanted thought, idea, An obsession is a recurrent, unwanted thought, idea, or image.or image.

Compulsion is repeating an act over and over again Compulsion is repeating an act over and over again (a ritual).(a ritual).• The act may not make sense. The act may not make sense.

• Anxiety is great if the act is not done.Anxiety is great if the act is not done.Slide 9Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.


Post-traumatic stress disorder (PTSD) occurs Post-traumatic stress disorder (PTSD) occurs after a terrifying ordeal.after a terrifying ordeal. There was physical harm or threat of physical harm.There was physical harm or threat of physical harm. PTSD can develop after:PTSD can develop after:

• Being harmedBeing harmed• A loved one was harmedA loved one was harmed• Seeing a harmful event happenSeeing a harmful event happen

Flashbacks are common.Flashbacks are common.• A flashback is reliving the trauma in thoughts during the A flashback is reliving the trauma in thoughts during the

day and in nightmares during sleep. day and in nightmares during sleep. PTSD can develop at any age including childhood.PTSD can develop at any age including childhood. The person may also suffer from depression, The person may also suffer from depression,

substance abuse, and other anxiety disorders.substance abuse, and other anxiety disorders.Slide 10Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.


SchizophreniaSchizophrenia

Schizophrenia means split mind.Schizophrenia means split mind. It is a severe, chronic, disabling brain disorder.It is a severe, chronic, disabling brain disorder. It involves:It involves:

• Psychosis—a state of severe mental impairmentPsychosis—a state of severe mental impairment

• Delusion—a false beliefDelusion—a false belief

• Hallucination—seeing, hearing, smelling, or feeling Hallucination—seeing, hearing, smelling, or feeling something that is not realsomething that is not real

• Paranoia—a disorder of the mindParanoia—a disorder of the mind

• Delusion of grandeur—an exaggerated belief of one’s Delusion of grandeur—an exaggerated belief of one’s importance, wealth, power, or talentsimportance, wealth, power, or talents

• Delusion of persecution—the false belief that one is Delusion of persecution—the false belief that one is being mistreated, abused, or harassedbeing mistreated, abused, or harassed


Schizophrenia (cont’d)Schizophrenia (cont’d)

The person with schizophrenia has severe The person with schizophrenia has severe mental impairment (psychosis).mental impairment (psychosis).• The person has problems relating to others.The person has problems relating to others.

• The person may have difficulty organizing thoughts.The person may have difficulty organizing thoughts.

• Responses are not appropriate.Responses are not appropriate.

• Communication is disturbed.Communication is disturbed.

• The person may withdraw.The person may withdraw.

• Disorders of movement occur.Disorders of movement occur.

• Some persons regress.Some persons regress.

People with schizophrenia do not tend to be People with schizophrenia do not tend to be violent.violent.


Mood DisordersMood Disorders

Mood or affect relates to feelings and Mood or affect relates to feelings and emotions.emotions. Mood (or affective) disorders involve feelings, Mood (or affective) disorders involve feelings,

emotions, and moodsemotions, and moods• Bipolar disorderBipolar disorder

• Major depressionMajor depression

• Depression in older personsDepression in older persons


Mood Disorders (cont’d)Mood Disorders (cont’d)

The person with bipolar disorder (manic-The person with bipolar disorder (manic-depressive illness) has severe extremes in depressive illness) has severe extremes in mood, energy, and ability to function.mood, energy, and ability to function. The person may:The person may:

• Be more depressed than manicBe more depressed than manic• Be more manic than depressedBe more manic than depressed• Alternate between depression and maniaAlternate between depression and mania

The disorder:The disorder:• Tends to run in familiesTends to run in families• Usually develops during the late teens or early Usually develops during the late teens or early

adulthoodadulthood• Requires life-long managementRequires life-long management


Major depressionMajor depression Depression involves the body, mood, and Depression involves the body, mood, and

thoughts.thoughts. Symptoms affect work, study, sleep, eating, and Symptoms affect work, study, sleep, eating, and

other activities.other activities. The person is very sad.The person is very sad. Interest in daily activities is lost.Interest in daily activities is lost.

Causes of depression may include:Causes of depression may include: A stressful eventA stressful event Some physical disordersSome physical disorders Hormonal factors in womenHormonal factors in women



Depression in older personsDepression in older persons Depression is common in older persons.Depression is common in older persons.

• They have many losses.They have many losses. Death of family and friendsDeath of family and friends Loss of healthLoss of health Loss of body functionsLoss of body functions Loss of independenceLoss of independence

• Causes of depression in older personsCauses of depression in older persons LonelinessLoneliness Side effects from some drugsSide effects from some drugs

Depression is often overlooked.Depression is often overlooked.• A wrong diagnosis is made.A wrong diagnosis is made.• Depression is often not treated.Depression is often not treated.



Personality DisordersPersonality Disorders

Personality disorders involve rigid and Personality disorders involve rigid and maladaptive behaviors.maladaptive behaviors. Maladaptive means to change or adjust in the Maladaptive means to change or adjust in the

wrong way.wrong way. Because of behavior, persons with personality Because of behavior, persons with personality

disorders cannot function well in society.disorders cannot function well in society.


Personality Disorders (cont’d)Personality Disorders (cont’d)

Antisocial personality disorderAntisocial personality disorder This is a chronic disorder in which the person’s This is a chronic disorder in which the person’s

thinking and behaviors show no regard for right thinking and behaviors show no regard for right and wrong.and wrong.• The person has poor judgment, lacks responsibility, The person has poor judgment, lacks responsibility,

and is hostile.and is hostile.

• The person is not loyal to any person or group.The person is not loyal to any person or group.

• Morals and ethics are lacking.Morals and ethics are lacking.

• The rights of others do not matter.The rights of others do not matter.


Borderline personality disorder (BPD)Borderline personality disorder (BPD) The person has problems with moods, relationships, self-The person has problems with moods, relationships, self-

image, behavior, and controlling emotions.image, behavior, and controlling emotions. Aggression, self-injury, and drug or alcohol abuse may occur.Aggression, self-injury, and drug or alcohol abuse may occur. The person may have thoughts of suicide and other mental The person may have thoughts of suicide and other mental

health disorders.health disorders. BPD is more common in women than in men.BPD is more common in women than in men. Risk factors may include:Risk factors may include:

• A family history of BPDA family history of BPD

• Childhood abuse—sexual, physicalChildhood abuse—sexual, physical

• Childhood neglect or being abandonedChildhood neglect or being abandoned

• Changes in the brainChanges in the brain

• Brain chemicals that do not function properlyBrain chemicals that do not function properly


Personality Disorders (cont’d)Personality Disorders (cont’d)

Substance Abuse Substance Abuse and Addictionand Addiction

Substance abuse or addiction occurs when a Substance abuse or addiction occurs when a person overuses or depends on alcohol or person overuses or depends on alcohol or drugs.drugs. Physical and mental health are affected.Physical and mental health are affected. The welfare of others is affected.The welfare of others is affected.

Substances involved affect the nervous Substances involved affect the nervous system.system. They affect the mind and thinking.They affect the mind and thinking.


Substance Abuse Substance Abuse and Addiction (cont’d)and Addiction (cont’d)

Over time, heavy drinking damages the Over time, heavy drinking damages the brain, central nervous system, liver, kidneys, brain, central nervous system, liver, kidneys, heart, blood vessels, and stomach.heart, blood vessels, and stomach.

Alcoholism includes these symptoms:Alcoholism includes these symptoms: Craving—strong need or urge to drinkCraving—strong need or urge to drink Loss of control—once begun, cannot stop Loss of control—once begun, cannot stop

drinkingdrinking Physical dependence—withdrawal symptoms Physical dependence—withdrawal symptoms

when drinking is stoppedwhen drinking is stopped Tolerance—greater amounts of alcohol are Tolerance—greater amounts of alcohol are

needed to get “high”needed to get “high”


Alcoholism is a chronic disease.Alcoholism is a chronic disease. Life-style and genetics are risk factors.Life-style and genetics are risk factors. Some people drink for relief from life stresses.Some people drink for relief from life stresses. The craving for alcohol can be as strong as the The craving for alcohol can be as strong as the

need for food or water.need for food or water. Alcoholism can be treated but not cured.Alcoholism can be treated but not cured.

• Counseling and drugs are used to help the person stop Counseling and drugs are used to help the person stop drinking.drinking.

• The person must avoid all alcohol to prevent a relapse.The person must avoid all alcohol to prevent a relapse.



Alcohol abuse is just as harmful as alcoholism.Alcohol abuse is just as harmful as alcoholism.• A person who abuses alcohol drinks too much but is A person who abuses alcohol drinks too much but is

not dependent on alcohol.not dependent on alcohol.

Problems linked to alcoholism and alcohol abuse Problems linked to alcoholism and alcohol abuse include:include:• Not being able to meet work, school, or family Not being able to meet work, school, or family

responsibilitiesresponsibilities

• Motor vehicle crashesMotor vehicle crashes

• Drunk-driving arrestsDrunk-driving arrests

• Drinking-related medical conditionsDrinking-related medical conditions



Drug abuse and addictionDrug abuse and addiction Drug abuse Drug abuse

• The over-use of a drug for non-medical or non-therapy The over-use of a drug for non-medical or non-therapy effects.effects.

Drug addiction Drug addiction • A chronic, relapsing brain disease.A chronic, relapsing brain disease.

The person has an overwhelming desire to take a drug.The person has an overwhelming desire to take a drug. The person repeatedly takes the drug because of its The person repeatedly takes the drug because of its

effect.effect. The person has to have the drug. Often higher doses are The person has to have the drug. Often higher doses are

needed.needed. The person cannot stop taking the drug without The person cannot stop taking the drug without

treatment.treatment.



Drug abuse and addictionDrug abuse and addiction• Affect social and mental functionAffect social and mental function

• Are linked to crimes, violence, and car crashesAre linked to crimes, violence, and car crashes

• Have physical effectsHave physical effects

Legal and illegal drugs are abused.Legal and illegal drugs are abused.• Legal drugs are approved for use in the United States.Legal drugs are approved for use in the United States.

• Illegal drugs are not approved for use. They are obtained Illegal drugs are not approved for use. They are obtained through illegal means.through illegal means.

• Often, legal drugs also are obtained through illegal means. Often, legal drugs also are obtained through illegal means.

Treatment depends on the drug and the person.Treatment depends on the drug and the person.• A drug treatment program combines various therapies and A drug treatment program combines various therapies and

services to meet the person’s needs.services to meet the person’s needs.Slide 25Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.


An eating disorder involves extremes in eating An eating disorder involves extremes in eating patterns.patterns. Food intake is severely reduced or the person over-Food intake is severely reduced or the person over-

eatseats Eating disorders can develop in:Eating disorders can develop in:

ChildhoodChildhood The teen yearsThe teen years Young or later adulthoodYoung or later adulthood

Eating disorders are common in women and Eating disorders are common in women and girls.girls.

Depression, anxiety disorders, and drug abuse Depression, anxiety disorders, and drug abuse may be present.may be present.


Eating DisordersEating Disorders

Anorexia nervosa occurs when a person has an Anorexia nervosa occurs when a person has an intense fear of weight gain or obesity.intense fear of weight gain or obesity. A fat body image is felt despite being dangerously thin.A fat body image is felt despite being dangerously thin. Poor eating habits include:Poor eating habits include:

• Avoiding food and mealsAvoiding food and meals

• Eating a few foods in small amountsEating a few foods in small amounts

• Weighing and measuring foodWeighing and measuring food

Intense exercise and vomiting are common.Intense exercise and vomiting are common. Enemas and laxatives are used to rid the body of food.Enemas and laxatives are used to rid the body of food. Diuretic abuse also may occur.Diuretic abuse also may occur. Death is a risk from cardiac arrest or suicide.Death is a risk from cardiac arrest or suicide.


Eating Disorders (cont’d)Eating Disorders (cont’d)

In bulimia nervosa, binge eating occurs.In bulimia nervosa, binge eating occurs. The person eats large amounts of food. Then The person eats large amounts of food. Then

the body is purged (rid) of the food to prevent the body is purged (rid) of the food to prevent weight gain.weight gain.• Methods used include:Methods used include:

VomitingVomiting LaxativesLaxatives EnemasEnemas DiureticsDiuretics FastingFasting Intense exerciseIntense exercise



In binge eating disorder, the person often In binge eating disorder, the person often eats large amounts of food.eats large amounts of food. Eating is out of control.Eating is out of control. Binge eating is not followed by purging, fasting, Binge eating is not followed by purging, fasting,

or exercise.or exercise. Often, the person is over-weight or obese.Often, the person is over-weight or obese. Other health problems can occur.Other health problems can occur.

• High blood pressureHigh blood pressure

• Heart diseaseHeart disease

• DiabetesDiabetes

• Joint painJoint pain



Suicide means to kill oneself.Suicide means to kill oneself. According to a 2010 report from the CDC, According to a 2010 report from the CDC,

suicide was the:suicide was the: Eleventh leading cause of death in the U.S.Eleventh leading cause of death in the U.S. Third leading cause of death among persons Third leading cause of death among persons

aged 15 to 24.aged 15 to 24. If a person mentions or talks about suicide, If a person mentions or talks about suicide,

take the person seriously.take the person seriously. Call for the nurse at once.Call for the nurse at once. Do not leave the person alone.Do not leave the person alone.


SuicideSuicide

Agencies treating persons with mental health Agencies treating persons with mental health problems must identify persons at risk for problems must identify persons at risk for suicide.suicide. They must:They must: Identify specific factors or features that increase Identify specific factors or features that increase

or decrease the risk for suicide.or decrease the risk for suicide. Provide the most appropriate setting to treat the Provide the most appropriate setting to treat the

person.person. Provide crisis information to the person and Provide crisis information to the person and

family.family.• A crisis “hotline” phone number is an example.A crisis “hotline” phone number is an example.


Suicide (cont’d)Suicide (cont’d)

Suicide contagion is exposure to suicide or Suicide contagion is exposure to suicide or suicidal behaviors within the family, peer group, suicidal behaviors within the family, peer group, or media reports of suicide.or media reports of suicide. The exposure has led to more suicides and suicidal The exposure has led to more suicides and suicidal

behaviors in persons at risk.behaviors in persons at risk. Adolescents and young adults are at risk for suicide Adolescents and young adults are at risk for suicide

contagion.contagion. Following suicide exposure, those close to the victim Following suicide exposure, those close to the victim

should be evaluated by a mental health professional.should be evaluated by a mental health professional.• They include family, friends, peers, and co-workers.They include family, friends, peers, and co-workers.

Persons at risk for suicide need mental health Persons at risk for suicide need mental health services.services.


Suicide (cont’d)Suicide (cont’d)

Treatment of mental health problems involves Treatment of mental health problems involves having the person explore thoughts and feelings.having the person explore thoughts and feelings. This is done through psychotherapy and behavior, This is done through psychotherapy and behavior,

group, occupational, art, and family therapies.group, occupational, art, and family therapies. Often drugs are ordered.Often drugs are ordered.

The care plan reflects the person’s needs.The care plan reflects the person’s needs. Communication is important.Communication is important. Persons with mental health problems may Persons with mental health problems may

respond to stress with anxiety, panic, or anger.respond to stress with anxiety, panic, or anger. Some become violent.Some become violent. Your first priority is to protect yourself.Your first priority is to protect yourself.


Care and TreatmentCare and Treatment

Chapter 45 Mental Health Problems Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights...

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