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Mental Health Disorders: Strategies for Approach & Treatment

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3/20/2019 Mental Health Disorders: Strategies for Approach & Treatment Transform 2019: OPTA Annual Conference Columbus, Ohio April 6th, 2019 Dawn Bookshar, PT, DPT, GCS Ian Kilbride, PT Marcia Zeiger, OTRL Objectives Participants will: • Understand the prevalence and impact of mental health disorders in client populations • Understand clinical conditions, and associated characteristics of common mental health diagnoses • Apply effective treatment approaches for clients with mental illness. • Produce effective clinical documentation to support intervention for clients with mental illness Mental Illness (MI) www.schizophrenia.com 1 3/20/2019 Mental Illness (MI) The term mental illness refers collectively to all diagnosable mental disorders defined as sustained abnormal alterations in thinking, mood, or behavior associated with distress and impaired functioning which substantially interferes with or limits one or more major life activities. National Institute of Mental Health Prevalence of MI • More than 50% will be diagnosed with a mental illness or disorder at some point in their lifetime. • 1 in 5 Americans will experience a mental illness in a given year. • 1 in 25 Americans lives with a serious mental illness, such as schizophrenia, bipolar disorder, or major depression. Centers for Disease Control & Prevention Prevalence of MI in LTC • 2/3 of people in nursing homes have a mental illness. • Nursing home residents with a primary diagnosis of mental illness range from 18.7% among those aged 65-74 years to 23.5% among those aged 85+ years. • Dementia, Alzheimer disease, and mood disorders are the most common diagnoses of mental illness in long-term care settings. Centers for Disease Control & Prevention 2 3/20/2019 Prevalence of MI in LTC Ohio • Residents with a diagnosis of schizophrenia and bipolar disorder increased from 9% to 16% between 2001 to 2016. • Ohio’s long-stay Medicaid population with a severe mental illness: o 47.5% age 0-64 o 26% age 65+ Shaping of Long Term Care in America Project at Brown University; Scripps Gerontology Center at Miami University Complicating Psychosocial Factors • Homelessness o 30% of people experiencing chronic homelessness have a serious mental illness o Up to 2/3 may have a substance use disorder o 48% have a history of mental illness o Different set of life skills: meaning to the individual Complicating Psychosocial Factors • Substance Use/Abuse o 260 million o Often co-occurs with mental health disorders o Prolonged substance abuse permanently alters activation of the brain 3 3/20/2019 Definition of Behavior • The manner of conducting oneself • Anything that an organism does involving action & response to stimulation • The response of an individual to its environment • The way in which something functions or operates Merriam-webster.com Definition of Behavior • Behavior to the actions or reactions of an object or organism, usually in relation to the environment. • Behavior can be: o Conscious or Unconscious o Voluntary or Involuntary Maladaptive Behavior The actions or reactions of persons in response to external or internal stimuli that is considered noxious to staff, other residents, the resident himself, or family. 4 3/20/2019 Maladaptive Behavior • Inhibit a person’s ability to adjust to particular situations or are inappropriate or disruptive in nature. • Used to reduce one’s anxiety related to their perceptions of the situation, but the result is dysfunctional and non-productive. • Not a synonym for bad behavior, rather, it is behavior that is inadequate, inappropriate or excessive in a given situation. Maladaptive Behavior • Staff intervene more when: o Physical behaviors are directed towards self or others o Offensive verbalizations are directed towards others • Staff intervene less when: o The resident talks all the time but never raises their voice o The resident sleeps too much o The resident is too weak to hurt anyone when they are aggressive Understanding the Maladaptive Behavior • What is the behavior? • When is it occurring? • Where is it occurring? • What happens before the behavior? VS • What happens as a result of the behavior? 5 3/20/2019 Causes of Maladaptive Behavior Internal Triggers External Triggers • Emotion (despair, anxiety, fear) • Lack of meaningful activity • Medication • Unpleasant events or actions of • Illness (physical or mental) others • Confusion • Demands of others • Pain or discomfort • Too bright or too dim lighting • Lifelong perceptions • Too much noise • Being misunderstood by others Common Behaviors • Aggression • Anxiety • Confusion • Mania • Manipulation (self injurious or suicidal) • Psychotic (hallucinations and delusions) Aggression Definition: a forceful, attacking action which may be physical, verbal, or symbolic. • Manifested behaviors: o Violence toward self, others, and/or property o Inability to control inappropriate behavior o Anxiety o Hostility o Hyperactivity o Restlessness o Decreased attention span o Impulsive and quick to escalate 6 3/20/2019 Anxiety Definition: a state in which an individual feels vague discomfort, nervousness, restlessness, dread, helplessness, and self doubt, in response to a perceived threat to their physical, emotional, or social security • Manifested behaviors o Shortness of breath o Insomnia o Heart palpitations Rigidity o Chest pressure o o Pacing and rocking o Choking sensation o Localized sweating o Nausea o Weakness o Rapid breathing o Paranoia and confusion o Increase in blood pressure Confusion Definition: a mental state characterized by a lack of clear and orderly thought and behavior. • Manifested behaviors o Memory deficits o Disruptive behavior o Failure to perform ADL o Restlessness or anxiety o Combativeness or belligerence o Rambling speech and confabulation o Disorientation (person, place, time, or situation) Mania Definition: extreme sense of excitement and euphoria with a loss of reality testing. • Manifested behaviors o Hyperactivity and excessive involvement in activities without thought of consequence, o Pressured speech, tangential thoughts, o Inflated self-esteem, o Decreased need for sleep or food, o Distractibility, o Impulsivity 7 3/20/2019 Manipulation Definition: the process of influencing others or the environment by passive or aggressive behavior in order to meet one’s own needs and desires. • Manifested behaviors o Threatening or actual harm to self or others o Drug seeking /substance Abuse o Impulsive and destructive o Lack of respect o Passive or refusal o Exaggerated self confidence, seductive Psychotic Behaviors Definition: characterized by a distorted or diminished sense of objective reality (delusions and hallucinations), psychomotor dysfunction, a radical change in personality, and impaired functioning. • Manifested behaviors o Flat affect o Loose associations o Depersonalization o Loss of interest in self care o Disorganized thoughts and speech o Poor impulse control and poor judgment o Suicidal or homicidal behavior (thoughts or actions) Selected Assessment Tools • Allen Cognitive Levels • SLUMS* • Global Deterioration Scale • PSFS* • Agitated Behavior Scale* • BCAT • Geriatric Depression Scale* • PainAD • Apathy Evaluation Scale* • DS-DAT 8 3/20/2019 Common Mental Health Conditions Schizophrenia, Bipolar Disorder, Anxiety Disorders Depression, Dementia, Delirium Levels of Brain Activation http://learn.genetics.utah.edu/content/neuroscience/brainimaging Schizophrenia 9 3/20/2019 Schizophrenia: Symptoms Impacting Function Positive Symptoms • Hallucinations o Visual, auditory, tactile, olfactory, gustatory. o "Voices" are the most common type of hallucination. • Delusions o False beliefs that are not part of the person's culture and do not change. o The person believes delusions even after other people prove that the beliefs are not true or logical. • Thought Disorders Unusual or dysfunctional thinking o Disorganized thinking o Thought blocking o Neologisms (new, meaningless words) Schizophrenia: Symptoms Impacting Function Negative Symptoms • Flat affect (emotions, feelings) • Lack of pleasure in everyday life • Lack of ability to begin and sustain planned activities • Speaking little, even when forced to interact. Cognitive Symptoms • Poor executive function (problem solving everyday tasks) • Trouble focusing or paying attention • Problems with memory Schizophrenia: Medication • Drowsiness • Skin rashes • Dizziness when changing • Rigidity positions • Persistent muscle spasms • Blurred vision • Tremors • Rapid heartbeat • Restlessness • Sensitivity to the sun 10 3/20/2019 Schizophrenia: Rehab Challenges • Sensory Disruption: visual, tactile, olfactory, auditory, gustatory • Cognitive Deficits: attention, concentration, communication, information processing, learning • Physical Impairment: uncomfortable sensations, vestibular impairment, vision impairment, fatigue • Psychosocial Impairment: anxiety/fear, anhedonia, distrust, no meaning/purpose, difficulty performing daily self-care Schizophrenia: Intervention Strategies • Build trust and rapport • Engage in meaningful, • Reduce distractions of positive purposeful, concrete activity symptoms • Be mindful of the environment • Present information simply and and alter as needed concisely • Consider minimizing sensory • Use patience and unconditional input support (empathy) • Consider progressive activities: from in room to more public areas Schizophrenia Research: Benefits of PT Intervention • Aerobic exercise, strength training, and yoga reduce psychiatric symptoms, anxiety, and psychological distress. • Aerobic
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