Risk factors 

  • Genetics
  • Biochemical
  • Pre & post-natal influences
  • Individual temperament
  • Psychosocial development

 

Infancy & rarly Childhood

General behaviour areas to assess

  • Internalising problems
  • rxternalising behaviours

Specific behaviour areas to assess  Protective factors 

  • Attachment to family
  • Supportive parenting
  • Social competence
  • rconomic security
  • Positive school/work environment
•       Somatic complaints – expressing their mood physical

•       Delinquent behaviour – e.g. rule breaking, misbehaving

•       Attention problems

•       Aggressive behaviours – e.g. bullying, teasing

•       Social problems – e.g. social impairment

•       Withdrawal – e.g. socially isolated, don’t take risks because of being afraid

•       Anxious/depressed behaviour

•       Thought disorders

 

MSr For Children
  • Good networks

 

  • Appearance
  • Sensorimotor development
  • Manner of relating to clinician & family
  • Mood/affect
  • Capacity/level of play – (obsessions with particular things)
  • Thought processes/content
  • Perceptual abilities
  • Cognitive abilities/intelligence
  • Attention level/concentration
  • Language/speech
  • Concept of self
  • Positive attributes/adaptive capacity
  • Temperament (overall)

 

 

Disorders Diagnosed in Infancy/Early Childhood 

  • Sleep, feeding & eating disorders
  • Pervasive development disorders
  • Relationship problems/attachment disorders
  • Anxiety disorders
  • Motor skill disorders
  • Attention deficit hyperactivity disorders/attention deficit disorder
  • Pica (eating things that aren’t food e.g. sand, rocks, grass etc)
  • Rumination disorder Feeding disorder

Tic disorders (e.g. Tourette’s syndrome)

Separation anxiety disorder

Youth Mental Health

− High prevalence & burden of mental ill health

− Unique challenges that affect their wellbeing and increase their vulnerability  − Peak period for emergence of mental ill-health: early teens to mid 20s

Ø 1 in 4 young people experience mental disorder in 12 month period

 

− Related impact on families, communities and society  − Youth mental health recognised as a speciality

 

Impact of Mental Illness on Youth 

  • Structural and functional changes in the brain
  • Autonomy, individuality, work/social networks, (sexual) relationships, (completing) education, employment
  • Impaired social functioning, poor educational achievement, unemployment, substance abuse, violence

 

Early intervention 

  • Preventing mental health disorders are greatest during childhood and youth
  • Aims is to prevent/minimise serious mental illness
  • rarly stages is critical as essential treatment is important to reduce risk of ongoing disability and focus on recovery

 

Engagement 

  • Crucial aspects of service delivery
  • Allow for enough time, patience & effort à trust/rapport
  • Helping parents develop skills around how to manage behaviours

 

Detection & Assessment 

  • rarly intervention
  • Families/carers
  • GPs
  • Teachers/sporting couches
  • Law enforcement (police, courts)
  • Mental state examination (MSr)

 

Psychosocial Assessment 

Holistic assessment

Developmental stage is important

Don’t make assumptions such as: asking about mum/dad, young women about ‘boyfriends’

  • 10 Domains:
    1. Home & environment

− Do you live at home? Do you like living at home?

  1. rducation & employment

− Have you missed school recently?

  1. Activities

− What do you like doing?

  1. Alcohol & other drugs

− Do you drink/smoke? What have you tried?

− Has anyone taken advantage of you while you’ve been intoxicated?

  1. Relationships & sexuality

− Are you in a r/ship? Have you been in one? − How would you describe your sexuality?

  1. Conduct difficulties & risk-taking

− Have you harmed yourself/others?

− Have you been involved with the police?

  1. Anxiety

− Have there been situations that make you stressed?

  1. rating

− Do you worry about your weight/food calories? − How do you feel about yourself?

  1. Depressions & suicide

− Have you thought about killing yourself?

  1. Psychosis & mania

− Have you ever felt that people are trying to hurt you/get you? − Have you seen/heard things you cant explain?

 

Underlying Principles 

  • Behaviour ranges/abilities expected at each age

− Intrinsic & extrinsic factors interweave

− Different psychological processes at different ages

− May change form, but still are manifestations of initial process

  • Major life events and transitions in social contexts

 

Immediate Management/Treatment 

  • Identity immediate risk to self or others
  • Drug/alcohol use
  • Psychological interventions (individual & families/carer)
  • Pharmacological interventions
  • Group/peer programmes
  • Multidisciplinary team input

 

Early/Late recovery 

  • Recovery is possible
  • Family/carer involvement Cultural/personal identity

Promote wellness & prevent relapse

Vulnerability to future exacerbations of mental health problems

 

Resources & Services 

  • Headspace (National Youth Mental Health Foundation)
  • ReachOut
  • Youth Beyond Blue
  • Young & Well Cooperative Research Centre (YAW CRC)

 

 

Older Persons Mental Health

AGEISM 

  • Negative stereotypical perceptions of older people
  • Ageist views à misdiagnosis/unwillingness to diagnose “because they’re old”

 

WHY DOrS IT OCCUR?

  • Old age is seen as:

− A process of degeneration

− Lack of productivity

  • Arise from generalisations

− “All old people are sick and depressed”

− “They are just waiting to die”

  • Results in

− Social exclusion

− Isolation

 

 

Mental Health Risk Factors 

  • Issues of retirement
  • Loss of financial capacity
  • Changes in family and friendship support networks

 

  • Increases rates of depression and anxiety due to:

− Illness (including poor health)

− Death of significant other

− Unwillingness to talk about mood

 

Prevention and Promotion 

  • Personal growth and learning needs
  • Interesting in health promotion activities (community activities)
  • Listening, acknowledging and accepting
  • Challenging of stereotypes

 

 

Health Issues in Ageing 

People over 65

− Vision impairment affects 60%

− Arthritis affects 49%

− Hypertension 38%

− Deafness 35%

 

MH Disorders in Older Populations 

  • Anxiety affects 10%
  • Depression affects 7%
  • Suicide rates highest for male and females over 85

− Use more violent methods (à higher success rates)

− Suicides by those 65+ make up 15% of total suicide rates

  • Substance misuse

− Dependence on prescription medications are common

− Approx. 1.1% of older people present with substance abuse disorders

− Under recognised/undertreated

  • Delirium
  • Dementia affects 9% of people over 65, 30% over 85

 

 

Prior to Assessment 

  • Persons willingness to participate
  • rnsure person is able to hear the nurse − Be mindful of deafness

− Use of functioning hearing aid

− Face the older person

− Turn off TV/eliminate background noises

 

** Ψ = psych. medications **

BIOLOGICAL DOMAIN PSYCHOLOGICAL DOMAIN SOCIAL DOMAIN
PRESENT & PAST HEALTH STATUS

•       Health records  

•       Collaborative info (patient, family/carers)

•       Identification of chronic health problems  

 

PHYSICAL EXAMINATION

•       Laboratory levels  

•       Urinalysis  

•       FBC, WBC, RBC

•       Fasting blood glucose  

•       Neurological tests  

•       Many Ψ medications  

– ↓seizure threshold

•       Movement disorders  

 RESPONSE TO MH PROBLEMS 

•       Reluctance to admit to psychiatric symptoms

•       Avoid arguing or confronting the person

 

MENTAL STATE EXAMINATION (MSE)

•       Mood/affect

•       Geriatric Depression Scale (GDS)

•       Cornell Scale for Depression in Dementia (CSDD)

•       Thought processes (logical thoughts?)

•       Cognition

•       Orientation, attention, short and long term memory

•       Some memory retrieval slowing

•       Mini-mental state exam

(MMSr)

 

BEHAVIOUR CHANGES

•       Neuropathological processes

•       Noticed first by family, carers

•       Apraxia

 SOCIAL SUPPORT

•       Relinquish life roles

•       Isolation from others

•       A sense of being a burden

•       Hopelessness

•       Helplessness

 

FUNCTIONAL STATUS 

•       Activities of daily living (ADLs)

•       Instrumental activities of daily

living

 

SOCIAL SYSTEMS 

•       Community resources (health education, assessment)

•       Income (personal superannuation, pension)

 

SPIRITUAL ASSESSMENT 

•       Reflect on successes and failures in life (Re-connect with God)

 

 

 
PHYSICAL FUNCTION

Mobility 

•       Personal devices (canes, walkers, wheelchairs)

•       rnvironmental devices (grab bars, shower chairs, hospital bed)

 

 
Nutrition and Eating 

•       Weight loss (physical problem, psychiatric issue)

•       Dysphagia- difficult swallowing

•       Tardive dyskinesia  

•       Xerostomia- dry mouth

(common anticholinergic Sr)

•       Assess alcohol intake  

 

Elimination 

•       Constipation  

•       ↑ urinary frequency

 

Sleep 

•       Sleep reduces in older age

•       Insomnia (inability to fall or remain asleep)

 •       Other behaviours: wandering,

irritability, aggression, apathy

 

STRESS AND COPING PATTERNS 

•       Unique stresses for older people

•       Bereavement- responses to loss (crying, anxiety, insomnia, loss of appetite)

 

RISK ASSESSMENT

•       Depression

•       Previous suicide attempts

•       Family history

•       Means and access (firearms at home)

•       Abuse of AOD

•       Other stresses

•       Chronic medical conditions (cancer, neuromuscular disorders)

•       Social isolation

  

LEGAL STATUS 

•       Importance of advocacy

•       Recognise signs of ageism, elder abuse or neglect

•       Perceived loss of rights (to marry, to privacy, to control funds)

 

QUALITY OF LIFE 

•       Absence of distressing physical symptoms

•       rmotional well-being

•       Functional status

•       Quality of close interpersonal relationships

•       Participation and enjoyment of

social activities

•       Satisfaction with medical and financial aspects of Tx

•       Sexuality, body image and intimacy
PAIN 

•       Greater likelihood due to chronic illness  

•       Significant (under-recognised & undertreated)

 

PHARMACOLOGIC ASSESSMENT

•       Polypharmacy very common  

•       Assess all medications  

•       ↑ sensitivity to medications with ↑ age

•       ↑ drug interactions

 

 

Nursing Management of Older People

  • Active listening
  • rncourage participation in physical and social activities
  • Assist understanding of disease processes
  • Assist understanding of safe administration of medication
  • Coping strategies to assist with losses