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Behavioral Health

Behavioral Health

LEARNING OBJECTIVES
A participant in this lesson will be able to:
• Define behavioral health
• Describe characteristics of mental illness
• List treatments and care measures for mental illness
• Discuss medicines used in the treatment of mental illnesses

Mental health is a part of behavioral health. Mental illness occurs across all ages, all races, and all socioeconomic areas. Since people with mental illness can demonstrate many different symptoms, we often do not recognize the signs. As a result, many people do not receive the medications or treatments that might help. Caregivers should learn how to recognize mental illness and how to care for the mentally ill.

What Is Mental Illness?

Mental illness is a brain disorder that causes abnormal ways of thinking, feeling, or acting.
Symptoms of abnormal thinking include:
• Delusions. This means believing things that are not true. People with delusions might think someone wants to kill or hurt them.
• Hallucinations. This means seeing or hearing things that are not really there. People who are hallucinating might hear people talking to them when no one is.
• Confused thinking. Confused people might be illogical or not understand things happening around them.
• Suicidal thoughts. People with certain mental illnesses might have frequent or constant thoughts of killing themselves.

Symptoms of abnormal behavior include:
• Disruptive or antisocial behaviors
• Changes in sleeping routines
• Changes in eating habits
• Alcohol, drug, or medicine abuse
• Very slow or fast speech or movements

Symptoms of abnormal feelings include:
• Frequent mood changes
• Depression or sadness
• Anxiety, worry, or panic
• Irritability or anger
• Frequent crying, tearfulness
• Agitated behavior or fits of temper
• Changes in hygiene practices
• Unwillingness to cooperate
• Easily distracted, inability to pay attention
• Withdrawal from normal activities or from people
• Apathy, poor motivation
• Hopeless and/or helpless feelings
• Excessively low or high self-esteem
• Excessively energetic or euphoric
• Poor judgment, impulsiveness

Types of Mental Disorders

Many different things cause mental health problems. Sometimes mental disorders are genetic, meaning they run in families. Mental illnesses can be caused by reactions to stressful events, by imbalances in the body’s chemistry, or by a combination of several factors. The symptoms of mental illness occur because the brain is not functioning well. This affects the person’s thought processes, emotions, and/or behavior. It is important to remember that mentally ill people usually cannot control the way they think, feel, or behave. Mental illness is not a person’s fault; it is not something a person chooses to have.

The seven main types of mental disorders are cognitive, dissociative, anxiety, eating, mood, personality, and psychotic disorders.

Cognitive disorders
Cognitive impairment is a loss of mental abilities and awareness that occurs in varying degrees with a variety of underlying causes. In the elderly, it is usually caused by physical changes in the brain. Symptoms include loss of intellectual abilities, personality changes, forgetfulness, inability to concentrate, poor judgment, and verbal confusion. It can hinder a person’s ability to do daily activities.

Dementia. This disorder involves the parts of the brain that control thought, memory, and language. Healthy brain tissue deteriorates, causing a steady loss in memory and mental abilities. Strokes or changes in the brain’s blood supply may result in the death of brain tissue. Symptoms of dementia caused by problems with blood vessels can appear suddenly, whereas symptoms develop slowly in persons with Alzheimer’s disease. Although found primarily in the elderly, 50% of people with AIDS develop dementia.

Alzheimer’s disease. This is the most common form of dementia among people aged 65 and older. It may begin with slight memory loss and confusion but eventually leads to a severe, permanent mental impairment that destroys the ability to remember, reason, learn, and imagine. On average, people die within 10 years of getting Alzheimer’s. Alzheimer’s disease is the sixth leading cause of death in the United States.

Dissociative disorders
These disorders come in many forms, all thought to stem from traumatic events. When an extremely stressful event occurs, the person is too overwhelmed to process it and tries to cope with the trauma by separating himself or herself from the experience. This can lead to loss of memory or the formation of separate personalities.

Dissociative identity disorder. This disorder is evidenced by two or more personalities or identities that control a person’s consciousness at different times. It used to be called multiple personality disorder.

Dissociative amnesia. In this disorder, a person forgets personal information, such as name or residence.

Anxiety disorders
Anxiety causes physical symptoms such as rapid, shallow breathing, increased heart rate, sweating, and trembling. It can cause emotional symptoms, including alarm, dread, and apprehension. Treatment may include medication, therapy, or a combination.

Panic disorder. This is a sudden onset of intense fear, apprehension, and impending doom that may last from minutes to hours. Approximately 1 in 3 people with panic disorder develop agoraphobia. Persons with agoraphobia are afraid of having attacks in public, so they avoid leaving the house.

Posttraumatic stress disorder. Persons with this disorder reexperience the anxiety associated with a previous traumatic event. Many times it is caused by exposure to an extremely stressful event, such as abuse or rape.

Phobias. A person with a phobia feels very anxious when exposed to a particular object or situation, such as a high place. The person fears and avoids whatever causes the anxiety.

Obsessive-compulsive disorder (OCD). OCD is characterized by the need to maintain control, order, neatness, cleanliness, and/or perfection. People with OCD feel compelled to perform repetitive acts, such as hand washing or repeatedly checking to be sure a door is locked. Luvox is the drug used to treat this disorder.

Generalized anxiety disorder (GAD). This disorder may occur at any age. It is diagnosed after at least six months of persistent, excessive anxiety and worry. Drugs used to treat many forms of anxiety disorders include Tenormin, Tranxene, Valium, Xanax, Ativan, Centrax, Inderal, Serax, Buspar, and Klonopin.

Personality disorders
Personality disorders are chronic conditions with biological and psychological causes. Psychotherapy is the treatment, sometimes along with medications.

Borderline personality disorder. This disorder is characterized by impulsive behavior, unstable social relationships, and intense anger. These persons can have periods of psychotic thinking, paranoia, and hallucinations.

Obsessive-compulsive personality. These people tend to be high achievers. They are dependable and orderly but can’t adjust to change and are intolerant of mistakes. They can be uncomfortable with relationships. This is not the same as obsessive-compulsive disorder.

Passive-aggressive personality. These people hide hostile feelings and try to control or punish others.

Narcissistic personality. Persons with this personality feel superior to others and expect to be admired. They are seen as self-centered and arrogant.

Antisocial personality, formerly called psychopathic or sociopathic personality. These people show no regard for the rights and feelings of others. They do not tolerate frustration and become hostile or violent. They show no remorse or guilt and blame others for their behavior. They are prone to addictions, sexual deviation, job failures, and abuse. Most are male.

Mood disorders
Mood disorders usually involve chemical imbalances in the brain and are often treated with antidepressants and/or psychotherapy.

Depression. Depression causes severe, prolonged sadness. It can affect a person’s thoughts, behavior, and physical health. It may develop at any age. Depressed people often look sad or expressionless and lose interest in activities. Depression is the leading cause of disability in the United States, affecting more women than men.

Older people often think sadness is part of aging, or that forgetfulness, loss of appetite, and insomnia are symptoms of dementia. Depression is not a sign of old age. It is an illness and needs treatment.

Drugs used in the treatment of depression include:
• Tricyclics: Anafranil, Elavil, Tofranil, Norpramin, Pamelor, Sinequan, Vivactil, Aventyl
• Selective serotonin reuptake inhibitors (SSRIs): Celexa, Paxil, Luvox, Zoloft, Prozac
• Monoamine oxidase inhibitors (MAOIs): Parnate, Nardil, Marplan
• Others: Desyrel, Effexor, Remeron, Serzone, Wellbutrin, Buspar, Zyban

Bipolar disorder, also called manic depression, causes episodes of severe mania (euphoria, increased energy, and confidence) and depression (sadness, fatigue, poor concentration) that alternate with periods of normal mood. It occurs equally in men and women. This illness can be successfully treated with medications like Eskalith, Lithobid, Lithonate, Depakote, and Depakene.

Seasonal affective disorder (SAD). This disorder is characterized by recurrent bouts of depression in certain months of the year, usually fall and winter. Symptoms include oversleeping, carbohydrate craving, weight gain, lethargy, and social withdrawal. SAD is treated by bright fluorescent light, which alters the levels of brain chemicals. Sometimes antidepressants are used.

Psychotic disorders
In acute phases of psychosis, a person loses touch with reality and is unable to meet the ordinary demands of life. Most psychotic episodes are brief.

Schizophrenia. Schizophrenia is a severe and chronic brain disorder that impairs the ability to think clearly, make decisions, and relate to others. Persons with this disorder suffer frightening symptoms that leave them fearful and withdrawn. One out of every hundred people has this treatable illness, men and women alike. It involves problems with brain structure and chemistry. People with schizophrenia do not have a “split personality.” They may have delusions or hallucinations. They cannot tell what is real and what is not real. People with this disorder may talk to themselves, walk in circles, pace, and have difficulty carrying on conversations. They may demonstrate a lack of facial expression.

They may be unable to follow through with the activities they start. Schizophrenia is manageable with medication and psychotherapy. Acute episodes are treated with hospitalization and antipsychotic drugs.

Addiction
The occurrence of drug and alcohol abuse in the elderly is rising. In general, there are two types of substance abuse seen in the elderly: those that have been abusing substances for many years, and those who formed addictions late in life.

Causes of late-in-life addiction
There are several things that contribute to the elderly abusing substances. This includes personal health-related issues and socioeconomic stressors, including:
• Loss of spouse/partner
• Changes in income due to retirement
• Relocation or inability to live independently
• Family conflict
• Mental illness (depression, memory loss)
• Chronic illness (cardiac disease, diabetes, neurological disease)
• Physical pain
• Confusion

Identifying addiction and substance abuse in the elderly
Symptoms of addiction and substance abuse are often seen by family and healthcare professionals as being related to a disease. The following are signs of potential addiction and should be reported to the physician:
• Confusion/memory loss
• Changes in sleeping habits
• Unexplained bruises
• Changes in behavior (e.g., irritability, sadness)
• Unexplained chronic pain
• Changes in eating habits
• Isolating self from others
• Failing to bathe regularly
• Lack of interest in outside activities

In addition to personal changes, caregivers should be alert to the following warning signs:
• Running out of medication prior to the time of refill
• Empty bottles of liquor in trash cans
• Missing medications

Treatment of addiction and substance abuse
The treatment of addiction or substance abuse is important in the elderly due to the inability of the body to metabolize medication or alcohol. Overdosing is common due to the change in metabolism that comes with age. Treatment includes identification of the addiction, detoxification, and support services. Visit www. addictioncenter.com/addiction/elderly or http://americanaddictioncenters.org/rehab-guide/elderly for more information.

Treatment of Behavioral Health

Behavioral health illnesses are treatable, and many people recover. Medications, psychotherapy, psychoeducation, electroconvulsive therapy, and self-help and support groups are used in the treatment of mental illnesses. Anything that improves a person’s quality of life can help, such as pets, social events, activities, or reality orientation classes. Many communities and facilities are affiliated with mental health professionals that can screen for mental health problems and conduct therapy sessions.

Medications
Many of the medicines used to treat mental illness cause unpleasant side effects. Some of the more common ones are dry mouth, constipation, blurred vision, appetite changes, loss of sexual function, drowsiness, and weight gain. Drinking 8 glasses of water per day and eating fruits and vegetables can help with some of this.

Antipsychotic drugs can cause tremors, stiffness, muscle contraction and rigidity, restlessness, and loss of facial expression. Elderly people and those that have taken these medicines for years sometimes develop a condition called tardive dyskinesia. This causes uncontrolled facial movements and jerking or twisting movements of other body parts. This condition can be treated with medication.

Psychotherapy
Psychotherapy is the use of psychological techniques to change behaviors, feelings, thoughts, or habits. It is recommended for persons experiencing emotional distress.
• Behavior management. The aim of behavior management is to increase the occurrence of desirable behavior by rewarding the person for acting correctly. Unsuitable behavior is reduced by giving negative consequences.
• Cognitive therapy. Cognitive therapy emphasizes a rational and positive view. This therapy attempts to change destructive thought patterns that can lead to disappointment and frustration. It is effective with anxiety and depression.
• Psychoeducation. Psychoeducation is teaching people about their illness, treatment, and how to recognize relapse. Teaching coping skills to the family will help them deal with an ill relative.
• Electroconvulsive therapy. This treatment is used only for delusions and hallucinations, major depression, or serious sleep and eating disorders that cannot be effectively treated with drugs. Sedatives are given, and then low doses of electric shock are applied to the brain. Most people show rapid improvement.
• Self-help and support groups. These groups help because members give each other ongoing support. It’s comforting to know others have the same or similar problems. These groups can also help families work together for needed research, treatments, and community programs.