Title :Mental Health Disorder.

Names: Id number:
Albra Ibrahim Alneami. 201911871
Majed Ali Fageery. 201912046.
Tariq Ali Fagheehi 201911835

Dr,Eman Mohammad.
Mental health indicates a capacity to cope effectively with and manage life’s stresses in an
effort to achieve a state of emotional homeostasis. Older people have an advantage over
other age groups in that they probably
Most older persons have few delusions regarding what they are or what they are going to be.
They know
where they have been, what they have accomplished, and who they really are. Immigrating
to a new country,
watching loved ones die from epidemics, fighting in world wars, and surviving the Great
Depression may be
among the numerous stresses that today’s older adults have faced and overcome. Such
experiences have
provided them with unique strength that should not be underestimated.However,
acknowledging this strength
does not imply that psychiatric illness is not a problem among the older population. More
people than ever are
surviving to old age, and many bring to their later years the mental health problems they
have possessed

AGING AND MENTAL HEALTH

Many myths prevail regarding mental health and older people. For instance, many people
still believe that loss of mental functioning, “senility,” or mental incompetence is a natural part
of old age. Descriptions of older

adults being childlike, rigid, or cantankerous propagate stereotypes about personality in later
life. Frequently,
these misconceptions are so widely accepted that when an older person demonstrates
pathological signs, it is

PROMOTING MENTAL HEALTH IN OLDER ADULTS:

Mental health in old age implies a satisfaction and interest in life. This can be displayed in a
variety of ways,

The quiet individual who stays at home does not necessarily have less mental capacity or
mental health than does the person who is actively involved in every possible community
program.

There is no single profile for mental health; thus, attempts to assess an older individual’s
mental status based on any given stereotype must be avoided.

Good mental health practices throughout an individual’s lifetime promote good mental health
in later life. To preserve mental health, people need to maintain the activities and interests
that they find satisfying.
They need opportunities to sense their value as a member of society and to have their
self-worth reinforced.

The same principles guiding the care of physical health problems can be applied to
the care of
persons with mental health problems. The following are actions related to those
principles that can be used in care:
● Strengthen the individual’s capacity to manage the condition: fostering improvement
of physical health,
good nutrition, increased knowledge, meaningful activity, stress management, income
supplements, and
socialization.

● Eliminate or minimize the limitations imposed by the condition: providing consistency

in care, not fostering
hallucinations, reality orientation, correction of physical problems, and modifying the
environment to
compensate for deficits.

● Act for or do for the individual only when absolutely necessary: selecting an adequate
diet, assisting with
bathing, administering medications, managing finances, and coordinating activities for the
patient

● Mental health conditions must be seen in the perspective of the patient’s total world.
Older adults confront
many problems that challenge their emotional homeostasis, such as the following:

● -Illness: coping, related self-care demands, pain, altered function or body image.
● Death: friends, family, pets, significant support person.
● Retirement: loss of status, role, income, social network, sense of purpose.

● Increased vulnerability: crime, illness, disability, abuse.

● Social isolation: lack of transportation, funds, health, friends.
● Sensory deficits: decrease in or loss of function of hearing, vision, taste, smell, and
touch
● Greater awareness of own mortality: declining health, increased number of deaths
among peers.
● Increased risk of institutionalization, dependency: loss of self-care capabilities to
varying degrees.

Before labeling the patient with a psychiatric diagnosis, the nurse should explore such
factors in the patient’s behavior and address the cause of the problem rather than its effects
alone.
Astute assessment of behavior and cognitive function aids in differentiating symptoms of
psychiatric illness from normal reactions to life events.
Depression
Depression is the most frequent problem that psychiatrists treat in older adults, and although
major
depression declines with advanced age, minor depression increases in incidence with age.
Various estimates have placed the prevalence of depression at 15% to 25% in
community-based older persons and as many as

25% in older adults who are residents of long-term care facilities; another 20% to 30% of
nursing home
residents display symptoms of depression although they are not diagnosed with clinical
depression (Centers

for depression to be a new problem in old age. This is not surprising when one considers the
adjustments and
losses older persons face, such as the independence of one’s children; the reality of
retirement; significant
changes or losses of roles; reduced income restricting the pursuit of satisfying leisure
activities and limiting the ability to meet basic needs; decreasing efficiency of the body; a
changing self-image; the death of family
members and friends, reinforcing the reality of one’s own shrinking life span; and overt and
covert messages
from society that one’s worth is inversely proportional to one’s age.

In addition, drugs can cause or aggravate:

● Antihypertensives and cardiac drugs: β-blockers, digoxin, procainamide,
guanethidine, clonidine.
● reserpine, methyldopa, spironolactone
● Hormones: corticotropin, corticosteroids. estrogens.
● Central nervous system depressants, antianxiety agents, psychotropics:
alcohol, haloperidol, flurazepam.
● barbiturates, benzodiazepines.
● Others: cimetidine, L-dopa, ranitidine, asparaginase, tamoxifen.
————————————————————————————————————————

MENTAL HEALTH*
GENERAL OBSERVATIONS
Assessment of mental status actually begins the moment the nurse meets the patient. Upon
initial
observation, pay attention to the following indicators of mental health:

● Grooming and dress: Is clothing appropriate for the season, clean and presentable,
appropriately
● worn? Is the patient clean? Is the hair clean and combed? Are makeup and
accessories excessive or
● bizarre?
● Posture: Does the patient appear stooped and fearful? Is body alignment normal?
● Movement: Are tongue rolling, twitching, tremors, and hand wringing present? Are
movements
● hyperactive or hypoactive?
● Facial expression: Is it masklike or overly dramatic? Are there indications of pain,
fear, or anger?
● Level of consciousness: Does the patient drift into sleep and need to be aroused (i.e.,
lethargic)? Does
● the patient offer only incomplete or slow responses and need repeated arousal (i.e.,
stuporous)?
 ● Are painful stimuli the only thing the patient responds to (i.e., semiconscious)? Is
there no
● response, even to painful stimuli (i.e., unconscious)? While observing the patient,
general
● conversation can aid in evaluating mental status.

INTERVIEW
Effective questioning can reveal much about the patient’s mental health. Ask direct questions
to unveil
specific problems, such as the following:
1. “How do you feel about yourself? Would you say others would say you are a good or
bad person?”
2. “Do you have many friends? How do you get along with people?”
3. “Has anyone harmed you or do you feel that anyone is trying to harm you? Who?
Why?”
4. “Are you moody? Do you quickly go from laughing to crying or from being happy to
sad?”
5. “Do you have trouble falling asleep or staying asleep? How much sleep do you get?
Do you use any
6. drug or alcohol to help you sleep?”
7. “How is your appetite? How do your appetite and eating pattern change when you
are sad orworried?”
8. “Do you ever have feelings of being nervous, such as palpitations, hyperventilating,
and
9. restlessness?”
10. “Are there any particular problems in your life or anything you are concerned about
now?”
11. “Do you see or hear things that other people do not? Have you ever heard voices? If
so, how do
12. you feel about them?”
13. “Does life bring you pleasure? Do you look forward to each day?”
14. “Have you ever thought about suicide? If so, what were those ideas like? How would
you do it?”
15. “Do you feel you are losing any of your mental abilities? If so, describe how.”
16. “Have you ever been hospitalized or had treatment for mental problems? Has any
member of your family.

PHYSICAL EXAMINATION
Physical health problems are often at the root of many cognitive disturbances. For example,
depression
can be related to diabetes, adrenal disease, congestive heart failure, tumors, strokes,
Parkinson’s disease,
and other medical conditions. Because of the potential for medical conditions to cause
depression,
 it is essential that a complete physical examination supplements the mental status
evaluation. A complete review of known diagnoses and medications being used is crucial. In
addition, a variety of laboratory
tests may be conducted, including the following:
● complete blood count
● serum electrolytes
● serologic test for syphilis
● blood urea nitrogen
● blood glucose
● bilirubin
● blood vitamin level
● sedimentation rate
● urinalysis

Signs and Symptoms

Depression is a complex syndrome and is demonstrated in a variety of ways in older
persons. The most common manifestations of this problem are the vegetative symptoms,
which include insomnia, fatigue,anorexia, weight loss, constipation, and decreased interest
in sex. Depressed persons may express self-deprecation, guilt, apathy, remorse,
hopelessness, helplessness, and feelings of being a burden. They may have
problems with their personal relationships and social interactions and lose interest in people.
Changes in sleep and psychomotor activity patterns can be evident. Hygienic practices may
be neglected. Physical complaints of headache, indigestion, and other problems often
surface. Altered cognition may be present, caused by malnutrition or other effects of the
depression. The symptoms of depression can mimic those of dementia;

Treatment
Psychotherapy and antidepressants can alleviate many depressions to varying degrees.
Electroconvulsive therapy has been shown to be effective in patients who have serious
depressions that have been unresponsive to other therapies. Some herbs have been
promoted to have antidepressant effects. These include St. John’s wort, which has been
shown to be effective for mild depression.

it can cause
photosensitivity and should not be used with an antidepressant medication. Acupressure,
acupuncture, guided imagery, and light therapy, in conjunction with psychotherapy, can
prove helpful. Good basic health practices, including proper nutrition and regular exercise,
can also have a positive effect on mood.
Selective Serotonin Reuptake Inhibitors
● Escitalopram (Lexapro)
● Fluvoxamine (Luvox)
● Fluoxetine (Prozac)
● Paroxetine (Paxil)
● Sertraline (Zoloft)
● Cyclic Compound.

● Amoxapine (Asendin)
 ● Desipramine HCl (Norpramin, Pertofrane)
● Doxepin HCl (Adapin, Sinequan)
● Imipramine pamoate (Tofranil)
● Nortriptyline HCl (Aventyl, Pamelor)
● Monoamine Oxidase Inhibitors
● Phenelzine (Nardil)
● Tranylcypromine (Parnate)

Nursing Guidelines
Dosages for older adults should begin at about one half that recommended for the general
adult population. Sedation commonly occurs during the initial few days of treatment; take
precautions to reduce the risk of falls.
At least 1 month of therapy is needed before therapeutic effects will be noted; advise and
support the patient during this period.
Bedtime administration is preferable with antidepressants that produce a sedative effect.
Prepare patients for side effects, including dry mouth, diaphoresis, urinary retention,
indigestion, constipation, hypotension, blurred vision, drowsiness, increased appetite, weight
gain, photosensitivity, and fluctuating blood glucose levels. Assist patients in preventing
complications secondary to side effects.

Be alert to anticholinergic symptoms, particularly when cyclic compounds are used.

Ensure that older adults and their caregivers understand dosage, intended effects, and
adverse reactions to the drugs. Instruct about drug–drug and drug–food interactions, for
example,antidepressants can increase the effects of anticoagulants, atropine-like drugs,
antihistamines, sedatives, tranquilizers, narcotics, and levodopa; antidepressants can
decrease the effects of clonidine, phenytoin, and some antihypertensives; alcohol and
thiazide diuretics can increase the effects of antidepressants.

Anxiety
Adjustments to physical, emotional, and socioeconomic limitations in old age and the new
problems that frequently are encountered due to aging add to the variety of causes for
anxiety. Anxiety reactions, not uncommon in older persons, can be manifested in various
ways, including somatic complaints, rigidity in thinking and behavior, insomnia, fatigue,
hostility, restlessness, chain-smoking, pacing, fantasizing, confusion, and increased
dependency. An increase in blood pressure, pulse, respirations, psychomotor activity, and
frequency of voiding may occur. Appetite may increase or decrease. Anxious individuals
often handle their clothing, jewelry, or utensils excessively, become intensively involved with
a minor task (e.g., folding a piece of linen), and have difficulty concentrating on the activity at
hand. Treatment of anxiety depends on its cause. Nurses should probe into the patient’s
history for recent changes or new stresses (e.g., new diagnosis or worsening of existing one,
rent increase, increased neighborhood crime, and divorce of child). The consumption of
caffeine, alcohol, nicotine, and over-the- counter drugs should be reviewed for possible
causes. In addition to drugs, interventions such as biofeedback,
guided imagery, and relaxation therapy can prove helpful. Anxious persons need their lives
to be simplified
and stable, with few unpredictable occurrences. Environmental stimuli must be controlled.
Nurses should plan interventions specific to the underlying cause.

Basic nursing interventions that could prove beneficial include the following:
● allow adequate time for conversations, procedures, and other activities
● encourage and respect the patient’s decisions over matters affecting his or her life
● prepare the individual for all anticipated activities
● provide thorough, honest, and basic explanations
● control the number and variety of persons with whom the patient must interact
● adhere to routines
● keep and use familiar objects
● prevent overstimulation of the senses by reducing noise, using soft lights, and
maintaining a stable room
● temperature

Substance Abuse
As the number of people reaching late life increases, so does the number of people with a
history of alcohol
and other substance use. This situation is compounded by the fact that the baby boomers, a
generation that
experimented with and accepted the use of illicit drugs, are reaching their senior years and
bringing their
substance use and its effects with them.

Most older adults who are substance abusers have used these substances heavil throughout
their lives. A significant number of chronic abusers die before reaching old age, contributing
to a decreased incidence of alcoholism and other substance abuse with age. The other type
of older substance abuser is the one who begins abusing in late life because of situational
factors (e.g., retirement, widowhood, or poor health status). Health care professionals may
possess the same stereotype of substance abusers as some people in the general public,
believing them to be sloppy, “skid row” types of people. Consequently, even professionals
may fail to detect substance abuse in the retired professional who smokes a joint after dinner
or the frail widow who begins sipping brandy at midmorning. Nurses must keep an open
mind and recognize that substance abusers come in many forms. In addition, substance
abuse can cause medical problems, such as gastrointestinal bleeding, hypertension, muscle
weakness, peripheral neuropathy, and susceptibility to
infections

Alcohol Abuse
Alcohol abuse can be manifested in a variety of ways, some of which may be subtle or easy
to confuse with other disorders.Symptoms can develop secondary to complications from
alcoholism, such as cirrhosis, hepatitis, and chronic infections (related to suppressed
immune system). These signs should be noted during an assessment and trigger questions
regarding the patient’s drinking pattern.

● Drinking alcohol to calm nerves or improve mood

● Gulping or rapidly consuming alcoholic beverages
 ● Memory blackouts
● Malnutrition
● Confusion
● Social isolation and withdrawal
● Disrupted relationships
● Arrests for minor offenses
● Anxiety
● Irritability
● Depression
● Mood swings
● Lack of motivation or energy
● Injuries, falls
● Insomnia
● Gastrointestinal distress
● Clumsines

Paranoia
Paranoid states frequently occur in older persons, which is not surprising considering the
following:
● Sensory losses, so common in later life, easily cause the environment to be
misperceived.
● Illness, disability, living alone, and a limited budget promote insecurity.
● Ageism within society sends a message of the undesirability of the old.
● Older people are frequent victims of crime and unscrupulous practices.

Managing Behavioral Problems

Behavioral problems are actions that are annoying, disruptive, harmful, or generally deviate
from the normal and that tend to be recurrent in nature, such as physical or verbal abuse,
resistance to care, repetitive actions, wandering, restlessness, suspiciousness, and
inappropriate sexual behavior and undressing. These problems can occur in persons with
altered cognitive status who are incapable of thinking rationally and making good judgments.
Any type of illness that lowers the patient’s ability to cope with changes and stress can also
contribute to these problems. Medications, environmental factors, a loss of independence,
and insufficient activity can cause problematic behaviors as well.
Assessing the cause of the behavior is the first step in assisting the patient who displays
behavioral problems. Factors associated with the behavior should be closely observed and
documented and include the following information:
● time of onset
● where it occurred
● environmental conditions
● persons present
● activities that preceded
● pattern of behavior
● signs and symptoms present
● outcome
● measures that helped or worsened the behavior
It is beneficial to correct the underlying cause of the problem whenever possible. Likewise,
factors that precipitate the behavioral problem should be avoided (e.g., if it is identified that
the patient becomes agitated when seated in a busy hallway, try to seat the patient in a quiet
area). Staff or caregivers can prevent behavioral problems by identifying signs and
symptoms that precipitate the behaviors and intervening ia timely
manner. Environmental considerations that can decrease behavioral problems include
maintaining a room temperature between 70°F (21°C) and 75°F (24°C), avoiding wall
coverings and linens that have busy patterns, limiting traffic flow, controlling noise,
preventing dramatic transitions from daylight to nighttime
darkness, and installing safety devices for monitoring, such as alarms on doors and video
cameras.
Online Resources
Al-Anon Family Group Headquarters (local chapters available)
http://www.al-anon-alateen.org
Alcoholics Anonymous (local chapters available)
http://www.alcoholics-anonymous.org
Anxiety Disorders Association of America
http://www.adaa.org
Mental Health America
http://www.nmha.org
National Depressive and Manic-Depressive Association
http://www.ndmda.org
National Institute of Alcohol Abuse and Alcoholism
http://www.niaaa.nih.gov
Substance Abuse and Mental Health Services Administration
http://www.samhsa.gov/

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Page number: 1068-1001.

Thank you