Mental Health is a complex topic that can often spark misunderstanding. Stuart will take you through Anxiety, Depression, Personality Disorders, Psychosis and Dementia, revealing the truth about them.
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Hi, I'm Stuart and I'm a mental health Nurse and trainer.
In this video, I'd like to see if we can take away some of the mystery and ideas of hopelessness that surround mental disorder.
If you're a student Nurse or maybe a qualified Mental Health Nurse, but from a different specialty, a different part of the service, it may be that you harbour some very common, but actually very inaccurate ideas about mental health and disorder.
Things you've heard, or perhaps read about in tabloid newspapers, notions of dangerousness, or incurability that frighten you or otherwise give you the wrong impression, both about psychiatric patients and indeed about what people like me, mental health Nurses, actually get up to on a day-to-day basis.
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Dispelling The Myths
The first thing I want to point out is that like other forms of illness from emphysema to sciatica, from cataracts to COVID, outcomes vary, and the more we learn, the better those outcomes, those prognoses become.
And that's just as true of mental disorder.
Ask yourself this: Would you rather have a terminal cancer or a treatable, Depression or Anxiety state?
Would you prefer emphysema to a psychotic state that's well managed with medication or some other means?
Just as in other areas of healthcare, some people recover fully, some recover partially, and some need lifelong care of one sort or another.
There's nothing about psychiatry that's any less hopeful or optimistic than any other area of medicine.
As to the dangerous myth, well, you're far more at risk in an emergency department on a Friday night than in any psychiatric ward I've ever worked on.
Yes, aggression happens sometimes, but again, show me where it doesn't.
On the whole, psychiatric patients, if they hurt anyone at all, hurt themselves. And even that's probably less common than you think.
So I'm not going to talk much about hopelessness or aggression.
What then is this video about?
Well, it's an overview.
When student Nurses first encounter psychiatry, perhaps on their first few placements, they have real trouble trying to make sense of what they see.
It's just too big a topic and they can't easily organize it in their heads.
In this video, we'll work on breaking that topic down into five different parts, each with their own straightforward principles to help you make sense of what you see.
We'll begin with the most familiar, Anxiety, everyone's experienced that.
And we can all appreciate how unpleasant and annoying the constant feeling of Anxiety and worry or of outright fear can be.
There are two basic types of Anxiety, these are appropriate and inappropriate. Appropriate Anxiety is a call to action.
It's what gets you to move out of the way of that speeding car.
It's what stops you from going down that dark alley where you're likely to be assaulted, or the feeling that gets you up for work in the morning so you don't lose your job.
Appropriate Anxiety helps us out.
And once we've sorted the problem, it goes away.
But what if it didn't go away? What if your Anxiety is based upon a problem you can't solve? What if you don't even know what you're anxious about?
This is inappropriate Anxiety and it's a truly horrible feeling.
Anxiety is characterized by physical symptoms like racing heart, rapid, shallow breathing, muscle tension, digestive disturbances, loss of appetite and sleeping problems.
Psychologically, it's characterized by a form of fortune telling, the belief that we can predict the future, that it will be bad for us and that we won't be able to handle it when the worst happens.
We treat Anxiety in two main ways.
First, we treat the physical symptoms with medication.
Ideally, in ever decreasing doses to avoid dependence, that takes away the worst of the Anxiety so that people are able to function.
And then, we tackle the thoughts that give rise to the Anxiety.
We talk about the things that frighten people and help them to learn how to evaluate their fears to decide what's appropriate and what's inappropriate.
We help them to understand where their fears arose and we support them in measured ways to begin to experience things they thought were too scary to handle.
Over time, people begin to re-evaluate their fears and also their approach to life generally, so they don't simply deal with one fear and then swap it for another.
Like a lot of mental health work, it's easier to say than to do, but in essence, the principles are simple and straight forward.
From phobias to OCD, to PTSD, the principles underlying Anxiety are broadly the same and they're not complicated.
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Our next group is the opposite of Anxiety.
Whereas Anxiety is a call to action, the physiology of Depression, what happens in the body is all about slowing down, giving up.
Nobody bangs their head against a brick wall forever.
There comes a time when people who just can't find a way to solve their problems simply stop trying.
At that point, they lose energy and motivation, everything slows down, even their ability to think.
This is more than just the sadness or feeling out of sorts one day that many people describe as Depression.
This is a physical illness.
Depressed people can be treated with medication to reactivate their bodies, including their brain, but that's not usually enough on its own.
They also need to get active.
So we employ a technique called behavioural activation to encourage people to move, to eat better and to turn, people are happiest when their thoughts are directed outside of themselves.
As Albert Ellis, Director of Rational Emotive Therapy put it, “people are happiest when they're involved in some project or activity that they define as more important than themselves.”
So the trick with Depression is motivation, behavioural activation, identifying a cause, a purpose in life and also medication to kickstart the brain and the body.
These two concepts of working with both Anxiety and Depression are relevant for the majority of psychiatric patients, but they're not all you need to know. We're not doing detail here, just providing you with a mental hook to hang all this information on.
If you're a student on a mental health ward, for example, you'll see some pretty sophisticated stuff going on, but see if you can work out which hook to hang it on that way, you'll start to make sense of what you learn instead of becoming overwhelmed by a seemingly endless mass of unconnected ideas.
The third hook is Psychosis.
And for many, this is a little less familiar.
There are three basic elements of Psychosis, three first ranked symptoms, which are hallucinations, seeing, hearing, smelling, touching, tasting things that aren't actually there.
Delusions, which are fixed false beliefs that aren't dependent upon evidence and are extremely difficult to shake.
And thought disorders, problems, not with what a person thinks like a delusion, but with the way that their thoughts are organized.
People might make up new words or neologisms without realizing that others don't know what they mean, or conversations may go off on tangents without any clear rhyme or reason.
You'll notice that contrary to what the tabloid press might have you think, violence and aggression is not a symptom of Psychosis.
In fact, most psychotic people are too preoccupied with their voices to worry about hurting anyone.
Even those whose voices do command them to hurt others tend not to do so unless they already think it's okay to hurt people.
And that's not the norm in our society.
The real issue with Psychosis is the distress it causes for the patient. There are talking cures for Psychosis, but they're complicated and not really for an introductory video like this.
For the most part then, work with psychotic patients, people with diagnoses like Schizophrenia is based on medication.
But remember, that people with Psychosis are also very likely to experience Anxiety and Depression.
So, depending upon the issue at hand, you may also need to go back to those earlier principles too.
Now, they're the three main symptom groups, Anxiety, Depression, and Psychosis.
And although treatment is more complicated than it's time to discuss here, you can see that there are logical ways to make sense of what we see and work with through our patients.
There are two other categories to tell you about, these are different because they're not symptoms like the first ones, they're diagnoses.
Personality Disorders come in nine different flavours clustered into three different groups.
Three are essentially neurotic or Anxiety based, three are essentially psychotic or disorganized, and three are more or less in the middle.
These diagnoses include elements from both the other two groups.
Most of the Personality Disorders describe a vulnerability to one or more of Anxiety, Depression and Psychosis.
Emotionally unstable personality disorder sufferers, for example, otherwise known as EUPD or borderline personality disorder, experience major Anxiety states, as well as psychotic phenomenon, such as hallucinations.
So with personality disordered patients, the trick is to be as flexible throughout the whole range of symptoms as possible.
It's common for these patients to present them all at different times.
And the final group of diagnosis is the Dementias.
These are caused by physical deterioration in the brain and nervous system and are characterized by disorientation, memory loss, confusion, changes in levels of consciousness and gradual deterioration in physical ability.
But once again, the distress comes from Anxiety, Depression and Psychosis, a symptom of brain deterioration.
So, whilst there is, of course, much more detail to consider, you'll make better sense of what you see on any mental health placement if you keep in mind, these five categories. Anxiety, Depression, Psychosis, Personality Disorder, and Dementia.
Thank you for watching.
My name is Stuart Sorenson; I'm a mental health Nurse and trainer.