Mental health

MENTAL HEALTHMENTAL HEALTH

ASHRAF TANTAWYASHRAF TANTAWYProfessor of PsychiatryProfessor of Psychiatry

Suez Canal UniversitySuez Canal University

Ismailia, Egypt.Ismailia, Egypt.

OVERVIEWOVERVIEW PART IPART I


PART IIPART II

MENTAL HEALTH ISSUES MENTAL HEALTH ISSUES

PART IIIPART III

CAREGIVERS BURDENCAREGIVERS BURDEN

PART IPART I


DEFINITION OF HEALTHDEFINITION OF HEALTH

““A state of complete A state of complete

((Physical, Physical, Mental & SocialMental & Social) )

well-being” well-being”

(World Health Organization)(World Health Organization)

The 10 Health IndicatorsThe 10 Health Indicators1- Physical Activity.1- Physical Activity.2- Overweight and Obesity.2- Overweight and Obesity.3- Tobacco Use.3- Tobacco Use.4- Substance Abuse.4- Substance Abuse.5- Responsible Sexual Behavior.5- Responsible Sexual Behavior.

6- Mental Health.6- Mental Health.7- Violence and Injury. 7- Violence and Injury. 8- Environmental Quality.8- Environmental Quality.9- Immunization.9- Immunization.10- Access to Health Care.10- Access to Health Care.

MENTAL HEALTHMENTAL HEALTH The successful performance The successful performance of of

Mental Functions.Mental Functions. Resulting in Resulting in Productive activities Productive activities

& Fulfilling relationships. & Fulfilling relationships. The ability to adapt The ability to adapt to change & to change &

cope with stressors.cope with stressors. The successful adaptation The successful adaptation to to stressors are evidenced by stressors are evidenced by Thoughts, Feelings & Behaviors. Thoughts, Feelings & Behaviors.

MENTAL ILLNESSMENTAL ILLNESSA Clinically SyndromeA Clinically Syndrome, marked by , marked by

Distress, Disability, Suffering or Distress, Disability, Suffering or Loss of freedom.Loss of freedom.

Maladaptive Responses Maladaptive Responses to to stressors evidenced by thoughts, stressors evidenced by thoughts, feelings & behaviors, interfere with feelings & behaviors, interfere with the individual’s physical, social or the individual’s physical, social or occupational functions.occupational functions.

Mental Health/ Mental IllnessMental Health/ Mental IllnessConcept Must Be ClearConcept Must Be Clear

Continuum - Not StaticContinuum - Not Static((IntroversionIntroversion →→ Avoidant Personality Avoidant Personality →→ Social Phobia Social Phobia

→→ SchizophreniaSchizophrenia))

Mental Health Mental Illness

Maslow identified:Maslow identified:

A “A “Hierarchy of NeedsHierarchy of Needs”: ”: Self-actualization as fulfillment of Self-actualization as fulfillment of

one’s highest potential one’s highest potential


Maslow’s Hierarchy of Need (1954)Maslow’s Hierarchy of Need (1954)

Aspects of Mental HealthAspects of Mental HealthEmotional Intelligence:Emotional Intelligence:Emotions are skills for living.Emotions are skills for living.

Have emotional self control.Have emotional self control.

Recognize emotions in others.Recognize emotions in others.

Handle relationships.Handle relationships.

Resiliency:Resiliency: Emerge and grow from negative life events.Emerge and grow from negative life events.

Spirituality:Spirituality: That part of us that deals with relationships, values and That part of us that deals with relationships, values and

addresses questions of purpose and meaning in life.addresses questions of purpose and meaning in life.

Common & Serious Common & Serious Mental Health ProblemsMental Health Problems

Common Problems:Common Problems:– Depressive Disorders.Depressive Disorders.

– Anxiety Disorders.Anxiety Disorders.

Severe & Enduring Problems:Severe & Enduring Problems:– Schizophrenia.Schizophrenia.

– Bipolar disorder.Bipolar disorder.

– Major depression.Major depression.

– Dementia.Dementia.

Problems of Mental Disorders Problems of Mental Disorders

Lifespan vs. Health span.Lifespan vs. Health span.

Physical Burden.Physical Burden.

Poly-Pharmacy.Poly-Pharmacy.

Psychosocial Burden.Psychosocial Burden.

Biological Basis of Psychiatric Disorders.Biological Basis of Psychiatric Disorders.

Lifespan vs. Health spanLifespan vs. Health spanLifespan: Lifespan: Length of life increased.Length of life increased.

Health span: Health span: Length of healthy life before Length of healthy life before

Disability.Disability.

Factors affecting lifespan and health span:Factors affecting lifespan and health span:

1. Exercise: 1. Exercise: Improves mood and cognition.Improves mood and cognition.

2. Sleep pattern.2. Sleep pattern.

3. Eating pattern.3. Eating pattern.

4. Social networks: 4. Social networks: Protective against Protective against

Psychiatric disorders & Stressors.Psychiatric disorders & Stressors.

Physical BurdenPhysical BurdenComorbid Physical Diseases: Comorbid Physical Diseases:

NS, IS, CVS, RS, US & GIT.NS, IS, CVS, RS, US & GIT.

Disability: Disability: Physical & Mental.Physical & Mental.

Side Effects: Side Effects: Psychotropic Drugs.Psychotropic Drugs.

Physical ComorbidityPhysical ComorbidityDepressive Disorders:Depressive Disorders:

Diabetes.Diabetes.

Ischemic Heart Disease.Ischemic Heart Disease.

Stroke.Stroke.

Chronic Neurological Conditions.Chronic Neurological Conditions.

Cancer.Cancer.

Anxiety Disorders:Anxiety Disorders:COPD & Bronchial Asthma.COPD & Bronchial Asthma.

Physical ComorbidityPhysical ComorbiditySchizophrenia:Schizophrenia:

Obesity, Hypertension & Smoking.Obesity, Hypertension & Smoking.

Hepatitis C & HIV.Hepatitis C & HIV.

Drug related Movement Disorders.Drug related Movement Disorders.

Cancer Colon.Cancer Colon.

Rheumatoid Arthritis.Rheumatoid Arthritis.

Bipolar DisorderBipolar Disorder As for schizophrenia. +As for schizophrenia. +

Drug Related Thyroid Diseases.Drug Related Thyroid Diseases.

Drug Related Renal Diseases (Lithium).Drug Related Renal Diseases (Lithium).

Causes of Death among Mental Patients: Causes of Death among Mental Patients: Cardio-Cardio-Respiratory Disease & Infectious disease.Respiratory Disease & Infectious disease.

Poly-PharmacyPoly-PharmacyMultiple Pathology.Multiple Pathology.- Cardiac Disease: HPT, IHD.- Cardiac Disease: HPT, IHD.- Diabetes.- Diabetes.- Asthma/ COPD.- Asthma/ COPD.- Osteoporosis.- Osteoporosis.- Neurological Diseases.- Neurological Diseases.- Psychiatric Disorders.- Psychiatric Disorders.Multiple Medications.Multiple Medications.Multiple Adverse Effects.Multiple Adverse Effects.Drug-Drug Interactions.Drug-Drug Interactions.

Psychosocial BurdenPsychosocial BurdenSocial Isolation.Social Isolation.

Physical & Cognitive Dysfunctions.Physical & Cognitive Dysfunctions.

Loss of Social & Occupational Status.Loss of Social & Occupational Status.

Loss of Friends.Loss of Friends.

Lack of Adequate Health Care.Lack of Adequate Health Care.

Financial Insecurity.Financial Insecurity.

Death Preoccupation.Death Preoccupation.

Dependency on Their Families.Dependency on Their Families.

.

Cukor D et al. JASN 2007;18:3042-3055

©2007 by American Society of Nephrology

CAUSES OF MENTAL CAUSES OF MENTAL ILLNESSILLNESS

The concept of multiple The concept of multiple factors factors in the causation of in the causation of psychogenic disorders has psychogenic disorders has become generally accepted.become generally accepted.

The factors The factors are considered are considered to involve the individual, the to involve the individual, the family & the community. family & the community.

BrainEnvironment

Endocrine Glands Immune System

Physiology & Behavior

NervesHormonesAction

Biological Basis of Psychiatric Disorders

The Biological Basis of The Biological Basis of Psychiatric DisordersPsychiatric Disorders

MindBrain

Body

Psychoneuro-Immunology

Medically Unexplained

Physical Symptoms

BiopsychosocialModel

Diathesis-Stress ModelDiathesis-Stress ModelDiathesis

“Predisposing Causes”(Hereditary Predisposition)

Stress“Precipitating Causes”

(Situational Factors)

Disorder

Recovery

“Maintaining Causes”Physical Conditions

Bio-Psycho-SocialApproach

• Emphasizes Interaction of Biological and Social Factors

.

Cukor D et al. JASN 2007;18:3042-3055

©2007 by American Society of Nephrology

Well-being: Well-being: Physical, Psychological, Social & Spiritual.Physical, Psychological, Social & Spiritual.

Quality of LifeQuality of LifePhysical

Functional AbilityStrength/Fatigue

Sleep & RestNauseaAppetite

ConstipationPain

PsychologicalAnxiety

DepressionEnjoyment/Leisure

Pain DistressHappiness

FearCognition/Attention

SocialFinancial BurdenCaregiver Burden

Roles & RelationshipsAffection

Sexual FunctionAppearance

SpiritualHope

SufferingMeaning of Pain

ReligiosityTranscendence

Quality of Life

How Does The Public View How Does The Public View The Mentally Ill?The Mentally Ill?

They are fearful.They are fearful.

There is a big stigma.There is a big stigma.

The mentally ill are labeled. The mentally ill are labeled.

Care is rationed.Care is rationed.

People oppose care by using laws.People oppose care by using laws.

The mentally ill are losers when it The mentally ill are losers when it comes to the budget for care.comes to the budget for care.

What are The Costs What are The Costs of Mental Illness?of Mental Illness?

Police costs. Police costs.

Public health costs.Public health costs.

Safety costs.Safety costs.

Court costs.Court costs.

Business costs.Business costs.

Social costs.Social costs.

Jail costs.Jail costs.

Psychiatrists handle little Psychiatrists handle little number of real psychiatric number of real psychiatric patients, WHY?patients, WHY?

There are There are 5 levels 5 levels and and 4 filters4 filters..

L1:L1:Community (30%).Community (30%).

F1 : F1 : Illness behavior.Illness behavior.

L2:L2:Mental morbidity in primary care (25%).Mental morbidity in primary care (25%).

F2: F2: Ability to detect.Ability to detect.

L3:L3:Mental morbidity by doctors (10%).Mental morbidity by doctors (10%).

F3: F3: Referral.Referral.

L4:L4:Morbidity in mental health services (2.5%). Morbidity in mental health services (2.5%).

F4: F4: Admission.Admission.

L5: L5: Psychiatric inpatients (0.5%).Psychiatric inpatients (0.5%).

The Provider- Caregiver The Provider- Caregiver RelationshipRelationship

– Expectations.Expectations.

– Establish & Maintain Boundaries.Establish & Maintain Boundaries.

– Building on Strengths.Building on Strengths.

– Sharing One’s Own Family Life.Sharing One’s Own Family Life.

– Reciprocal & Positive Feelings.Reciprocal & Positive Feelings.

Talking with CaregiversTalking with CaregiversBeBe Positive. Positive.

BeBe Flexible. Flexible.

BeBe a Good Observer. a Good Observer.

WorkWork as Partner. as Partner.

ListenListen Actively. Actively.

BeginBegin Where The Caregiver Is. Where The Caregiver Is.

AskAsk Leading Questions. Leading Questions.

MakeMake Comments Thoughtfully. Comments Thoughtfully.

AnswerAnswer Personal Questions. Personal Questions.

Essential QualitiesEssential Qualitiesof Mental Health Team of Mental Health Team

Empathy.Empathy.

Respect.Respect.

Perseverance & Resilience.Perseverance & Resilience.

You Can DifferentiateYou Can Differentiate

Mental Health Mental Illness

PART IIPART II

MENTAL HEALTH MENTAL HEALTH ISSUESISSUES

MENTAL HEALTH APPROACHES MENTAL HEALTH APPROACHES

Primary Prevention.Primary Prevention.

Secondary Prevention.Secondary Prevention.

Tertiary Prevention.Tertiary Prevention.

PSYCHIATRY STRATEGIES PSYCHIATRY STRATEGIES

Integration of mental health with Integration of mental health with

primary health care through primary health care through

the national mental health program.the national mental health program.

Provision of tertiary care institutions for Provision of tertiary care institutions for treatment of mental disorders.treatment of mental disorders.

Eradication stigmatization of mentally ill Eradication stigmatization of mentally ill patients.patients.

Protecting patient rights through regulatory Protecting patient rights through regulatory institutions like the central mental health institutions like the central mental health authority.authority.

Numbers of People Numbers of People Affected GloballyAffected Globally

450 million people with mental disorders:450 million people with mental disorders:

– – 150 million with 150 million with Depression. Depression. – – 90 million with 90 million with Alcohol or Drug Use Disorder. Alcohol or Drug Use Disorder. – – 40 million with 40 million with Epilepsy.Epilepsy.– – 25 million with 25 million with Schizophrenia.Schizophrenia.–– 10 million 10 million Attempt Suicide Attempt Suicide every year.every year.– – 1 million 1 million Commit Suicide Commit Suicide every year.every year.

Did You Know?Did You Know?44 of the of the 1010 leading causes of leading causes of disabilitydisability are are mental disorders: mental disorders:

- - MD, Schizophrenia, Dementia & OCD.MD, Schizophrenia, Dementia & OCD.

6% 6% of the population suffers from of the population suffers from Severe & Severe & Persistent Mental IllnessPersistent Mental Illness: :

- - Dementia, Schizophrenia, BAD & MD.Dementia, Schizophrenia, BAD & MD.

13 % 13 % of the population has a diagnosis of: of the population has a diagnosis of:

- - Dysthymia, Panic Disorder, Phobia & Antisocial Dysthymia, Panic Disorder, Phobia & Antisocial Personality DisorderPersonality Disorder..

Psychiatry by NumbersPsychiatry by Numbers25% of the population has a mental 25% of the population has a mental disorder. disorder.

15% of patients in population have 15% of patients in population have depressive illnesses. depressive illnesses.

90% of the 10 most common 90% of the 10 most common complaints in psychiatric setting complaints in psychiatric setting have no organic basis. have no organic basis. 50% of mental health care can be 50% of mental health care can be delivered by Non-Psychiatrists. delivered by Non-Psychiatrists.

Relationship Between Relationship Between Psychiatry & MedicinePsychiatry & Medicine

A- A- Medical Conditions Medical Conditions that have that have psychiatric symptoms.psychiatric symptoms.B- B- PsychosomaticPsychosomatic Disorders. Disorders. C- C- Medically Unexplained Medically Unexplained Physical Symptoms. Physical Symptoms. D- D- Mental Disorders Mental Disorders that may that may have physical symptoms.have physical symptoms.

A- Medical Conditions That Have A- Medical Conditions That Have Psychiatric SymptomatologyPsychiatric Symptomatology

1- Neurological Diseases: 1- Neurological Diseases: Brain tumors, Epilepsy, MS, Parkinsonism,...Brain tumors, Epilepsy, MS, Parkinsonism,...2- Endocrine Syndromes: 2- Endocrine Syndromes: Thyroid, Suprarenal, Ovaries, Pancreas,…Thyroid, Suprarenal, Ovaries, Pancreas,…3- Infectious Diseases & Autoimmune Syndromes.3- Infectious Diseases & Autoimmune Syndromes.4- System Failures: 4- System Failures: Renal, Hepatic, Cardiac, Respiratory,...Renal, Hepatic, Cardiac, Respiratory,...5- Chronic Disability: 5- Chronic Disability: Blindness, Deafness, Muteness, Loss of limb,...Blindness, Deafness, Muteness, Loss of limb,...6- Blood Diseases: 6- Blood Diseases: Anemia, Leukemia, Hemolytic diseases,... Anemia, Leukemia, Hemolytic diseases,...

B- Psychosomatic DisordersB- Psychosomatic DisordersThe physical condition must show either The physical condition must show either demonstrable organic pathologydemonstrable organic pathology or a or a known patho-physiologic process.known patho-physiologic process.

They can influence not only the cause of They can influence not only the cause of the illness but can also worsen the the illness but can also worsen the symptoms & affect the course of the symptoms & affect the course of the disorder.disorder.

Examples: Examples: Angina, Hypertension, Angina, Hypertension, Bronchial asthma, Rheumatoid arthritis, Bronchial asthma, Rheumatoid arthritis, Duodenal ulcers, IBS, Eczema, Psoriasis Duodenal ulcers, IBS, Eczema, Psoriasis & Urticaria.& Urticaria.

C- C- Medically Unexplained Medically Unexplained Physical SymptomsPhysical Symptoms

Sometimes psychological factors can cause ill Sometimes psychological factors can cause ill health without actually causing a disease.health without actually causing a disease.

As a result of unhappiness, anxiety or stress due As a result of unhappiness, anxiety or stress due to personal problems, physical symptoms may to personal problems, physical symptoms may develop. develop.

A- A- Somatoform disorders.Somatoform disorders.B-B- Factitious disorders. Factitious disorders.

C-C- Malingering. Malingering.

Somatoform DisordersSomatoform Disorders1- Somatization Disorder.1- Somatization Disorder.

2- Hypochondriasis.2- Hypochondriasis.

3- Dissociative & Conversion Disorders.3- Dissociative & Conversion Disorders.

4- Somatoform Pain Disorder.4- Somatoform Pain Disorder.

5- Body Dysmorphic Disorder.5- Body Dysmorphic Disorder.

D- Mental Disorders That May D- Mental Disorders That May Have Physical SymptomatologyHave Physical Symptomatology

Neurotic Disorders: Neurotic Disorders:

Depression, Anxiety, OCD & Depression, Anxiety, OCD &

Adjustment disorder.Adjustment disorder.

Psychotic Disorders: Psychotic Disorders: Dementia, Dementia, Delirium, Schizophrenia, Mood Delirium, Schizophrenia, Mood disorders, Delusional disorder & disorders, Delusional disorder & Substance induced psychosis. Substance induced psychosis.

PART IIIPART III



Physical Burden.Physical Burden.

Financial Burden.Financial Burden.

Time Burden.Time Burden.

Role Burden.Role Burden.

Emotional Burden.Emotional Burden.

Others.Others.

Caregiving BurdenCaregiving BurdenSigns of Caregiver BurnoutSigns of Caregiver Burnout

1- Physical Burden:1- Physical Burden:

Weight Change: Weight Change: Gain or LossGain or Loss..

Unexplained Somatic Complaints: Unexplained Somatic Complaints:

((Chronic headaches, backaches or othersChronic headaches, backaches or others).).

Caregiver’s Syndrome:Caregiver’s Syndrome:

((Fatigue from physical strain & sleep lackFatigue from physical strain & sleep lack).).

Osteoporosis and Arthritis.Osteoporosis and Arthritis.

2- Financial Burden.2- Financial Burden.


3- Time Burden:3- Time Burden:

Caregiving is time-consuming.Caregiving is time-consuming.

Less time for other tasks.Less time for other tasks.

Activities can be stressful.Activities can be stressful.

4- Role Burden:4- Role Burden:

Feelings of being pulled in different Feelings of being pulled in different directions.directions.

Family responsibilities.Family responsibilities.

Pressure and tension.Pressure and tension.


5- Emotional Burden:5- Emotional Burden:Common feelings: Being overwhelmed, Anger, Frustration, Guilt, Exhaustion, Loneliness and Social withdrawal.Cognitive disturbances: Lack of concentration and finding it difficult to complete complex tasks.Sleep disorders: Sleeplessness / stressful dream.Anxiety: about facing another day and what the future holds.Depression: feeling sad and hopeless.Adjustment disorders.

Psychiatric Disorders Psychiatric Disorders Among CaregiversAmong Caregivers

Depression.Depression.

Anxiety disorders.Anxiety disorders.

Unexplained Somatic Unexplained Somatic

Complaints.Complaints.

Adjustment disorders.Adjustment disorders.

ConclusionsConclusionsMental disorders among patients & their Mental disorders among patients & their caregivers are frequent, associated with caregivers are frequent, associated with increased medical & functional morbidity.increased medical & functional morbidity.Attention to physical, psychological & spiritual Attention to physical, psychological & spiritual concerns are necessary.concerns are necessary.Use of medication, psychotherapy or Use of medication, psychotherapy or counseling in an integrated manner results in counseling in an integrated manner results in best outcomes.best outcomes.The good physician will treat the disease but The good physician will treat the disease but the great physician will treat the patient.the great physician will treat the patient.Mental health means enhancing physical Mental health means enhancing physical treatment & promoting mental health.treatment & promoting mental health.

Nursing Is Of Paramount Importance

Among Mental Patients

NO HEALTH NO HEALTH WITHOUT WITHOUT MENTAL MENTAL HEALTHHEALTH

Mental health

Education

Transcript of Mental health