Wednesday, July 31, 2024
: Suicide Risks and Prevention
Sunday, August 6, 2023
Metabolic encephalopathy
Metabolic encephalopathy is a problem in the brain. It is caused by a chemical imbalance in the blood. The imbalance is caused by an illness or organs that are not working as well as they should. It is not caused by a head injury. When the imbalance affects the brain, it can lead to personality changes.
What are signs and symptoms of metabolic encephalopathy?
Symptoms of Metabolic Encephalopathy Learning About Metabolic Encephalopathy | Kaiser Permanente
Symptoms may vary depending on the type of encephalopathy you have.
Delirium – Confused thinking and less attention span. It is a serious health concern and needs immediate attention.
Lethargy – Caused by a lack of nutrition and a high level of toxins in the body
Muscle weakness
Loss of memory or dementia
Difficulty in motor tasks such as walking, eating, writing, etc., is also known as ataxia
Illusions
Hallucinations
Decreased consciousness
Mood disorders
Breathing problems
Mental health issues such as depression, anxiety
Vision problems
Seizures
Thursday, July 6, 2023
Alzheimer's Disease
Alzheimer's disease is a type of dementia that can cause people to be disoriented.
Alert and Oriented x1, x2, x3, and x4 in Dementia
https://www.verywellhealth.com/what-is-orientation-and-how-is-it-affected-by-dementia-98571
Orientation is something healthcare providers check when screening for dementia and evaluating cognitive abilities.1
Merck Manual Professional Version. How to assess mental status.
It refers to a person's level of awareness of self, place, time, and situation.
Healthcare providers score a person's orientation on a scale of 1 to 4. The higher the number, the better oriented a person is considered. For example, if you are fully alert and oriented, x4 will be noted.
When testing a person's orientation, a doctor asks standard questions that may seem like small talk. But these questions are useful for testing recent and longer-term memories.
Typical questions include:
What is your name?
Where are you?
What is the date?
What time is it?
What just happened to you?
This article includes information about what different levels of orientation mean and how they relate to Alzheimer's disease, dementia, and delirium.
Orientation Levels
In certain health assessments, orientation is sometimes referred to as "alert and oriented" (AO or A&O) or "awake, alert, and oriented" (AAO). It is usually followed by the multiplication symbol (x) and a number. For example, it may be written like "AOx3" or "AAOx4."
The level—x1, x2, x3, or x4—is a way of measuring the extent of a person's awareness.
Here's what the types of orientation mean:
- Oriented to person: The person knows their name and usually can recognize significant others.
- Oriented to place: The person knows where they are, such as the hospital, clinic, or town.
- Oriented to time: The person knows the time of day, date, day of the week, and season.
- Oriented to situation: They can explain why they are talking to the doctor.
Sometimes a person can answer some of this information, but not all. For example, they may know their name and the date but can't say where there are or why. In that case, it would be notated as x2.
In some circumstances, healthcare providers might only ask about person, place, and time. In that situation, x3 is the highest level of orientation tested. When a doctor includes questions about the situation, the highest level would then be x4.
In addition to the value (i.e., x3), a healthcare provider's notes should also include the specific questions asked and answers given. What Is the Memory Impairment Screen (MIS)? (verywellhealth.com)
Tuesday, July 4, 2023
What is ASD? What is Autism Spectrum Disorder
Autism is diagnosed by observing a child’s behavior. There are several well-known diagnostic tools that are used to diagnose or confirm a diagnosis of autism. For example, The Autism Diagnostic Observation Scale (ADOS) and the Childhood Autism Rating Scale (CARS-2). In addition, The American Psychiatric Association’s Diagnostic and Statistical Manual, Fifth Edition (DSM-V) provides standardized criteria to help diagnose ASD and determine the level of support needed.
The broad criteria listed in the DSM-V are summarized below:
Persistent deficits in social communication and social interaction across multiple contexts.
Restricted, repetitive patterns of behavior, interests, or activities.
Symptoms must be present in the early developmental period.
Symptoms cause clinically significant impairment in social, occupational, or other important areas of current functioning.
These disturbances are not better explained by intellectual disability (intellectual developmental disorder) or global developmental delay.
Autism is considered to be a spectrum disorder; some individuals with autism may also have an intellectual disability, while others are only mildly affected. Although ASD, in most cases, is a life-long disability, early intensive behavioral intervention (EIBI) can result in significant progress, leading to successful, independent participation in learning, social, and community activities.
If you are concerned about your child’s development, schedule a diagnostic evaluation with our team.
Sunday, June 11, 2023
Maintaining healthy relationships with age
Positive relationships can be as important to your health and well-being as nutrition and physical activity. Even though relationships with others may evolve, maintaining a strong social network as you age can contribute to a longer, healthier life.
A social network is simply a group of people close to you. This network — made up of friends, family, co-workers, neighbors and others — is how you give and receive instrumental and emotional support.
Instrumental support is the tangible help you give or receive through acts, such as providing transportation for a neighbor to an appointment or offering child care for friends or family. Emotional support is intended to lift someone's spirits, relieve sadness, give encouragement or offer advice.
Giving relationships direction
Think of your networks and relationships as a convoy traveling down the road of life with you. Some of your relationships are in it for the long haul. Others use the on- or offramps, and some take different roads entirely. Relationships in your convoy change over time, but all provide support and contribute to your well-being along the journey.
As people age, the road can feel lonely. Caring for children or aging parents can make it challenging to maintain friendships. This is normal, and means you must be more intentional about establishing and maintaining relationships, which isn't easy.
Devoting time to relationships
If you're looking to expand your social network, try a few of these ideas:
Take note of current connections.
Do an inventory of who is already in your social network. Are there people you have already met you could reconnect with?
Make the effort to reach out.
In today's connected world, getting in touch with someone is as simple as a phone call, text message or video visit. If you prefer a method involving less technology, send a handwritten card or letter.
Go where people are.
Attend events, church or community activities. Look for classes or groups with people who have interests similar to yours.
Reap the benefits of volunteering.
Join or volunteer for a club or cause that interests you. Volunteering not only improves your physical and mental health, and provides a sense of purpose, but it's also a great way to build new relationships.
Extend and accept invitations.
Don't worry if your social skills feel a bit rusty. An invitation to meet for coffee or go for a walk around the neighborhood may brighten someone else's day as much as it does yours.
Be available.
Relationships take time and effort. Whether connecting with a friend you've known for a long time or someone you just met, be present in the moment, and give your full attention to the person and situation.
In addition to helping provide the necessary support, establishing and maintaining positive relationships also is good for your health. They can boost your happiness, reduce stress, improve confidence and help you cope with traumatic events.
Adults with a strong social network have a reduced risk of depression, lower blood pressure and tend to maintain a healthier body mass index, or BMI. Building new friendships and investing time in maintaining relationships can help you on the highway of life and the path to better health.
Bonnie Betts, Psy.D., is a licensed psychologist in Psychiatry & Psychology in Waseca,https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/maintaining-healthy-relationships-is-important-as-we-age
Living with bipolar disorder
Your friend recently bought a new car on a whim and announced he was leaving on a cross-country trip without planning a destination or duration. Now you discover he's uninterested in any activity and doesn't want to leave home. The spontaneous actions followed by inactivity could be a sign of a mental health condition called bipolar disorder.
Previously known as manic depression, bipolar disorder causes extreme mood swings of emotional highs and lows called episodes. The highs create a mania or hypomania state with euphoria and energy. A hypomania state is a less extreme mood shift than mania. The lows cause depression, sadness and hopelessness.
Types of bipolar disorder
The type of bipolar disorder is diagnosed based on the occurrence of mania, hypomania and depressive episodes.
People with bipolar I disorder have had at least one manic episode preceded, or followed by hypomanic or major depressive episodes.
Bipolar II disorder is a separate diagnosis and is not a milder form of bipolar I disorder. People with bipolar II disorder have had at least one major depressive episode and at least one hypomanic episode but have not had a manic episode.
For every high, there is a low
Everyone has periods of elevated mood, typically lasting for several hours. For someone with bipolar disorder, that elevated mood can last up to four days. Typical early warning signs include increased activity level and decreased need for sleep, along with an extended elevated mood.
During this time, the person may demonstrate risky behaviors, poor decision-making and an inability to think clearly. Their level of impulsivity is high, particularly with drug or alcohol use.
The body's physical response is raised, causing speech to have a quicker cadence or more force, and movement and actions to be more pronounced.
Usually, a person will spend more time in a depressive state with slowed actions, speech and responses. The person may lose interest in activities, need more sleep and experience intense sadness and hopelessness.
This is different from major depressive disorder, in which people do not experience the highs of bipolar disorder.
Risk factors for bipolar disorder
Certain factors increase the risk of developing the condition or may trigger the first episode of bipolar disorder, including:
Drug or alcohol misuse or abuse
Having a first-degree relative, such as a parent or sibling, with bipolar disorder
Stressful life events paired with latent genes for bipolar disorder
Living with bipolar disorder
Getting treatment early can help prevent bipolar disorder from worsening. Knowledge is power. Learn the symptoms of the disorder to manage them better.
As part of psychotherapy, psychoeducation provides the tools needed to anticipate and control changing moods. It can increase your feelings of empowerment and hope by understanding how treatable the condition is.
These strategies can lessen disruptions in your life due to bipolar disorder:
Avoid drugs and alcohol.
Using alcohol or nonprescription drugs changes the chemicals in the brain. This can worsen symptoms and make them more likely to return.
Watch for early warning signs.
Addressing symptoms early can prevent episodes from getting worse. Over time, you may have identified a pattern to your bipolar episodes and what triggers them.
Involve friends and family.
Share the warning signs and triggers you have identified with family, close friends and your health care team so they can better support you. Develop a specific plan and share how you would like them to cue you into your symptoms when you show signs of mania. They often can identify the behaviors and actions that signal a mania episode first and help you prevent your symptoms from reaching the highest level.
Engage in a purpose.
Explore ways to create a sense of purpose by evaluating your values and beliefs. Identify what is important to you and set goals matching those ideals.
Manage stress and recharge.
The brain and body react similarly to positive or negative stress, which can trigger an episode. Consider keeping a daily journal or record of your feelings, mood and any activities that affect your stress level. Find a creative outlet or physical activity to channel your energy. Yoga or meditation can be helpful relaxation techniques.
Keep a sleep schedule.
Sleep disturbance is a core symptom of bipolar disorder. Maintaining a consistent, scheduled sleep pattern with the same sleep-wake schedule daily is vital. Getting seven to nine hours of sleep per night is important. A work schedule that requires changing shift times can predispose a person with bipolar disorder to episodes.
Take your medications exactly as directed.
You may be tempted to stop treatment — but don't. Stopping your medication or reducing your dose on your own may cause withdrawal effects, or your symptoms may worsen or return. For some people, it can be tempting to stop medication during a manic episode because the symptoms produce a good feeling. This can lead to negative consequences, including taking longer to stabilize when back on medication.
Bipolar disorder is a lifelong condition, but it is treatable. Learn to manage your mood swings and other symptoms with the help of those who love and care for you. Call your health care team if you feel you're falling into an episode of depression or mania.
Janice Schreier is a child and adolescent clinical therapist in Psychiatry & Psychology in La Crosse, Wisconsin.
Overwhelmed by anxiety?
https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/overwhelmed-by-anxiety Stress and feeling anxious are common and normal. Your body naturally produces these reactions to situations that could lead you to harm's way.
Stress is a normal psychological and physical reaction to the demands of life. It's normal to feel anxious from time to time, especially during times of stress. This can be helpful, as it can help you remain focused and make better decisions.
However, people with anxiety disorders have frequent, sustained and excessive worry that they can't control. They also may feel fear, terror and panic in everyday situations.
There are many types of anxiety. Here are explanations of each, including symptoms and common treatments:
Generalized anxiety disorder
This type of anxiety involves persistent and excessive worry. If you have generalized anxiety disorder, you may have an uneasy feeling about most everything. This worry feels difficult to control and interferes with your daily life. You may overthink plans and solutions to worst-case scenarios. Or you may anticipate disaster and be overly concerned about money, health, family, work and other life events.
Generalized anxiety disorder can lead to worrying more than what seems warranted about situations or expect the worst even then there's no apparent reason to do so. You may feel an inability to relax or enjoy quiet time. You may feel tense all the time and have body aches.
You avoid stressful situations and may have difficulty concentrating. You may find it hard to tolerate uncertainty and may feel a sense of dread or impending doom. This disorder can cause you to struggle with intrusive thoughts about the worst that could happen.
Generalized anxiety disorder can cause you to not sleep well, or feel jumpy or restless. You may have an upset stomach or heart palpitations, shakiness, sweating, a dry mouth, difficulty breathing or a lump in your throat. You could feel dizzy; have cold chills, hot flashes, or numbness and tingling; or may have persistent irritability.
Ongoing generalized anxiety disorder may manifest physically through chronic neck and back pain, headache, irritable bowel syndrome, or stomach and abdominal pain.
There is evidence that biological factors, stressful life experiences, lack of personal security and lack of positive role-modeling of anxious behaviors can lead to generalized anxiety disorder.
Generalized anxiety disorder is treatable, but it takes persistence. A person can find significant relief with psychotherapy, relaxation and mindfulness techniques, or medication. Support groups also help.
Practicing helpful ways of thinking and stress coping skills can lessen the amount of worry. Seek healthy connections with others and a lower-stress lifestyle to find greater freedom from your anxiety. Set healthy boundaries in your life. Use humor and practice to manage your negative anxious tendencies. Exercise can help by relieving the built-up stress and tension.
One of the most important principles of overcoming anxiety is facing your fears. Therapy can help develop a plan, and little by little, you'll grow in self-confidence to manage and cope with anxiety.
Social anxiety
If you struggle with social anxiety, everyday interactions cause significant anxiety, self-consciousness and embarrassment. It is related to the fear of being scrutinized or judged negatively by others. It is intense and affects your work or social life.
You may worry about blushing, trembling, or fear you may look foolish or unintelligent to other people. You may have generalized anxiety disorder symptoms that are mainly associated with social situations. You may fear meeting new people, talking to others at work or school, or speaking in public. Some people with social anxiety fear using a public restroom, being seen eating or drinking in public, or having to perform in front of others.
You may experience feelings of panic or panic attacks, and feel self-conscious or awkward in front of others. You may have difficulty speaking and may avoid situations you feel may trigger anxiety.
Your body may feel rigid and tense while your voice may be soft during social interactions. You may have difficulty making eye contact with others and be sensitive to criticism. You may feel a low self-worth and have a lot of negative self-talk.
Sometimes people with social anxiety may not seek treatment because they feel this uncomfortable way of being is just a part of their personality. However, without treatment for this disorder, these people cannot achieve their potential at school, work or in their personal life.
Social anxiety is treated using the same methods as generalized anxiety disorder.
Panic disorder
A panic attack causes a sudden intense fear or discomfort that peaks within minutes. Other symptoms may include a rapid heart rate, sweating, shakiness, shortness of breath and hot flashes. A person may feel lightheaded, have a sense of impending doom, chills, nausea, abdominal or chest pain, headaches, and numbness or tingling.
Many people feel something is physically wrong when they have a panic attack and that they may be having a heart attack or stroke.
Expected panic attacks occur when there is an obvious cue or trigger, such as with generalized anxiety disorder or a specific phobia. Panic disorder is when a person has frequent, unexpected panic attacks. These panic attacks seem to come out of the blue without a trigger or apparent explanation. If you have panic disorder, you may not be able to stand the thought of experiencing the physical discomfort that has happened when you have panicked before and may always be on guard for another one potentially happening.
Treatment for panic disorder is similar to that of generalized anxiety disorder and social anxiety. Persistence and practice of healthy thinking and coping tools will help develop a better level of confidence in your ability to cope with stress, as well as with the strong feelings of anxiety or panic.
Phobias
Phobias are an overwhelming and unreasonable fear of objects or situations that pose little real danger but provoke anxiety and avoidance. Fear and phobia are different. Fear is a temporary emotion; whereas, a phobia is longstanding. Phobias can create fear that is so strong it becomes debilitating. When this occurs, a phobic fear has become an anxiety disorder.
Your sense of danger or fear is designed to protect you from danger. It can trigger your flight-or-fight instinct so you're ready to take action to protect yourself. A phobia overestimates the threat of a particular situation and triggers intense anxiety leading you to avoid that situation in the future. Avoidance worsens the phobia because it reinforces the brain's exaggerated association between the situation and its threat level.
There are various phobias, including a phobia of animals, insects or spiders; a phobia of natural phenomena like storms or water; and a phobia of blood or injury, blood tests or needles.
Social anxiety can lead to a phobia. Often this comes with agoraphobia, which is a phobia of any place or situation that you fear you can't escape or get help easily. You might avoid travel on public transportation, being in a crowded area or being alone in public. It's rooted in the fear of having intense anxiety or a panic attack in certain places rather than a fear of the place itself.
Health care professionals do not clearly understand why people develop phobias. Often, they begin in childhood — similar to panic disorders.
If you struggle with a phobia, you may notice a racing heart rate, difficulty breathing, trembling, sweating, nausea, dry mouth, and chest pain or tightness. You may feel an overwhelming anxiety or fear. You know your fear is irrational, but you feel powerless to overcome it. You may fear losing control and feel an intense need to escape.
According to research, cognitive therapy and exposure therapy tend to be the best treatment for phobias. Social skills training, mindfulness and medication may help, as well.
Obsessive-compulsive disorder
Obsessive-compulsive disorder, also known as OCD, is a pattern of unwanted thoughts and fears, or obsessions, that lead a person to do repetitive behaviors, or compulsions. The typical onset of OCD is before age 20.
OCD often develops related to a theme. For example, being fearful of germs — an obsession — leads to excessive hand-washing — a compulsion — to reduce the thoughts and fears. If you don't have control over your thoughts, you wash your hands more. This becomes a vicious circle that worsens, and it can become a debilitating lifestyle if not addressed.
Other types of OCD may be needing to have things in perfect symmetrical order; having taboo or other unwanted thoughts; having aggressive thoughts toward yourself or others; and fear of causing harm or danger to self or others by not turning off the stove or not locking the door, so you check and recheck.
Compulsions are the direct result of the obsessive thoughts that lead to repetitive behaviors. These are done in the hope of reducing the anxiety and preventing something bad from happening. Sometimes, actions bring temporary relief but no pleasure. Common compulsions include counting, checking, washing or cleaning; strict routines; orderliness; and a need for reassurance. Symptoms may come and go over time and seem to worsen when a person is under stress.
While adults may recognize their irrational fears and behavior, children may not. Usually, medication and psychotherapy are recommended and can help alleviate many OCD symptoms.
Post-traumatic stress disorder
If you suffer from post-traumatic stress disorder, you have significant anxiety and uncontrolled thoughts triggered by a terrifying or life-threatening event. This could be a terrible accident, a tornado, domestic violence, war, the sudden death of a loved one, critical illness, a near-death experience, kidnapping, terrorist attacks, an assault or a direct threat to your life, or witnessing someone else being attacked.
Some people work through these experiences and learn to cope and adjust with time. Occasionally, people find themselves reliving it, and this affects their ability to function. You may struggle with post-traumatic stress disorder if you get stuck in a state of fear and your symptoms don't improve or worsen.
Symptoms may include avoidance, intrusive memories, changes in emotional reactions, negative changes in thinking and mood, flashbacks, jumpiness and emotional detachment. You may struggle with an overwhelming sense of guilt or shame, sleep disturbances, difficulty concentrating, always being on guard for danger, irritability, angry outbursts, aggressive behavior, and self-destructive behavior. You may feel negative about yourself, have a lack of interest in activities you used to enjoy or have difficulty maintaining your relationships. You could experience memory problems, feelings of hopelessness about the future, and feeling emotionally numb or unable to experience positive emotions.
Having post-traumatic stress disorder increases your risk for depression, anxiety, eating disorders and substance use disorders. It is important to seek treatment if you struggle with intrusive memories, avoid thinking or talking about the trauma, have negative changes to your thinking and mood, and have changes in your physical and emotional reactions to life and others. Treatment may include psychotherapy, exposure therapy called EMDR, medication and other therapies.
For more information, watch this video for ways to combat stress and anxiety:
Panic attack and disorder Q & A
https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/what-is-a-panic-attack A panic attack is an episode of intense fear with an abrupt onset, lasting from several minutes to up to an hour. It has many mental and physical symptoms such as chest pain, shortness of breath, nausea, dizziness, chest pain and a sense of pending doom. These symptoms may cause significant worry in people as they may mimic signs of medical problems such as heart issues. However, panic attacks can occur when there isn't a real danger or apparent cause.
Panic attacks aren't life-threatening, but they can be frightening for the person experiencing the attack and their loved ones. These attacks can affect your quality of life, especially if you have multiple or unexpected panic attacks.
What are the signs of a panic attack?
A panic attack usually begins suddenly and without warning. Typically, symptoms peak in minutes, and you may feel tired and worn out after it subsides. Panic attacks can cause chest pain and breathing problems that lead some people to seek medical care.
To be diagnosed as a panic attack, the episode must have at least four of these symptoms simultaneously:
Chest pain or discomfort
Chills or heat sensations
Derealization (feelings of unreality) or depersonalization (being detached from oneself)
Fast beating, fluttering or pounding heart
Fear of dying
Fear of losing control or "going crazy"
Feeling dizzy, unsteady, light-headed or faint
Feelings of choking
Nausea or abdominal distress
Numbness or tingling sensations
Sensations of shortness of breath or smothering
Sweating
Trembling or shaking
Panic attack symptoms may also resemble other psychiatric conditions, such as:
Agoraphobia — marked fear or avoidance of two or more places or situations
Caffeine or nicotine dependence — high doses of either substance may result in increased anxiety
Obsessive-compulsive disorder — obsessions often leading to ruminations or brooding
Phobias — fear of specific objects or situations
Post-traumatic stress disorder — involves emotions from previous events affecting a current situation
Separation anxiety disorder — fear of separation from attachment figures
Social anxiety disorder — fear of social situations
Do I need to go to the emergency room if I have a panic attack?
In most cases, a single panic attack episode does not require emergency medical care. However, it's important to discuss your symptoms with your health care team. They will evaluate you for medical disorders that may contribute to your symptoms, such as cardiac arrhythmia, respiratory diseases, pulmonary emboli, thyroid disorders, adrenal tumors or medication side effects.
What's the difference between a panic attack and panic disorder?
A person with ongoing, unexpected panic attacks who spends time worrying about another panic attack may have a panic disorder. People with panic disorders may be afraid of experiencing more panic attacks and live in a constant state of fear that affects the quality of their lives. Often, they change their behaviors and habits so much that it interferes with daily activities. This could result in the person missing social events, school or work.
People with panic disorder have panic attacks with mental and physical symptoms. The attacks happen without warning and can last several minutes to an hour.
Such people also may:
Worry about having panic attacks in the future.
Avoid situations that might cause them to have a panic attack.
Seek medical care at a clinic or Emergency Department when experiencing a panic attack.
Is there a test for panic disorder?
No. There is no test, but your health care team can determine if you have panic disorder or another condition based on your symptoms. You may have a complete physical exam, blood test or psychological evaluation to discuss your symptoms, fears, stress and family history.
Can panic attacks be treated?
Yes, treatment can reduce the intensity and frequency of panic attacks and panic disorder.
Treatment may include:
Cognitive behavioral therapy
Usually, this is the first treatment offered for panic attacks and panic disorder. During cognitive behavioral therapy, you talk with a psychologist or counselor about your experiences and learn how to react to situations differently. This teaches you how to cope better with your feelings and overcome fears of situations you may have avoided because of panic attacks. In some cases, it is possible to participate in cognitive behavioral therapy virtually, such as meeting with a therapist online or through a video call, rather than in person.
Medications
Medications can help reduce symptoms associated with panic attacks and depression. There are many options, and if one medication doesn't work for you, your health care team may switch you to a different medication. All medications have a risk of side effects, so talk with your health care team about the best choice for your situation.
You don't need to suffer alone or avoid aspects of life because of panic attacks. Talk with your health care team about your symptoms and about treatment options that can make a difference.
Brian Hesler, M.D., is a psychiatrist in Psychiatry & Psychology in Albert Lea, Minnesota.
Could you be depressed?
Although we all experience grief and sadness, depression can be much more than that. An estimated 10% percent of the U.S. population suffers from some type of depression, so know that you aren't alone.
More than just a bout of the blues, depression isn't a weakness and you can't simply "snap out" of it. Depression may require long-term treatment. But don't get discouraged. There are ways to cope and manage if you feel that depression is taking over your life.
Signs of depression
Although depression may occur only once during your life, people typically have multiple episodes.
During these episodes, symptoms occur most of the day, nearly every day and may include:
Constant negative thoughts
Feeling of hopelessness, emptiness, sadness or tearfulness
Feeling tired or having less energy
Low mood
Overly self-critical or low self-regard
Thoughts of self-harm or suicide
Withdrawing from friends, relatives or work
Loss of interest or pleasure in most or all normal activities
Sleep disturbances, including insomnia or sleeping too much
Difficulty thinking, concentrating, making decisions or remembering things
For many people with depression, symptoms usually are severe enough to cause noticeable problems in day-to-day activities, such as work, school, social activities or relationships with others. Some people may feel generally miserable or unhappy without really knowing why.
Prevention
There's no sure way to prevent depression but these strategies may help:
Eat nutritious foods with plenty of fruits and vegetables
Exercise every day for at least 20–30 minutes
Get 7–8 hours of sleep each night
Keep thoughts balanced and positive
Take a Vitamin D daily supplement
Take steps to control stress
Reach out to family and friends, especially during times of crisis
Treatment
Medications and psychotherapy are effective for most people with depression. Your primary care doctor or psychiatrist can prescribe medications to relieve symptoms. However, many people with depression also benefit from seeing a psychiatrist, psychologist or other mental health professional.
If you have severe depression, you may need a hospital stay, or you may need to participate in an outpatient treatment program until your symptoms improve.
If you are thinking about self-harm or suicide, seek professional help immediately.
There are resources available for you, such as calling or texting 988 for the 988 Suicide and Crisis Lifeline or calling 911.
Depression is nothing to be ashamed of and is treatable. Talk with your health care provider or a mental health professional if you are concerned you may be depressed. The nonprofit organization Mental Health America also offers a free, confidential online depression screening.
For more information about depression and tips to help you feel more like yourself, watch this video:https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/could-you-be-depressed
How mindfulness meditation improves mental health
Quick and simple usually aren't terms used to describe medical treatments. Yet mindfulness meditation is a fast, easy way to reduce stress wherever you are.
It's often recommended as part of a comprehensive treatment for physical and mental health conditions. It's considered a type of mind-body complementary medicine. You can incorporate mindfulness meditation into your routine to improve your overall health.
Mindfulness meditation basics
Mindfulness meditation is the practice of purposefully being aware of and focusing your attention on the present moment. Mindfulness allows you to be in tune with your experience — right now in this moment — and to explore with curiosity whatever sensations, thoughts and emotions are present without expectations or judgment.
During meditation, you focus your attention and eliminate the stream of jumbled thoughts that may be crowding your mind and causing stress. This focus can result in enhanced physical and emotional well-being.
Benefits of mindfulness meditation
Mindfulness meditation engages the brain. Think of it as a form of brain exercise. Just as physical exercise keeps your body healthy, mindfulness meditation keeps your brain fit. Research has shown that just five to 15 minutes of daily meditation is all you need to begin experiencing benefits.
After decades of research into the practice, these benefits have been found to include an increase in:
Cognitive flexibility
Diabetes control
Emotion regulation
Empathy
Focus and attention
Immune system response
Memory
Positive emotions
Positive relationships
Relaxation
Self-compassion
Self-esteem
The practice also affects many negative physical and mental symptoms, including decreases in:
Addictive behaviors
Anger and hostility
Anxiety
Burnout
Depression
Emotional reactivity
Insomnia
High blood pressure
Need for pain medications
Physical pain
Post-traumatic stress disorder symptoms
Stress
How to use mindfulness meditation
Many people may think of mindfulness meditation as "sitting on a pillow, being still, with eyes closed." This may work for some, but there are many ways to practice mindfulness meditation.
Practicing mindfulness involves using breathing methods, guided imagery, and other strategies to relax the body and mind and help reduce stress.
To try focused breathing meditation:
Sit down, take a deep breath and close your eyes.
Focus on your breath as it moves in and out of your body.
Sitting and breathing slowly for even just a minute can help.
Here are a few other structured mindfulness exercises to try:
Body scan meditation
Lie on your back with your legs extended and arms at your sides, palms facing up. Focus your attention slowly and deliberately on each part of your body, in order, from toe to head or head to toe. Be aware of any sensations, emotions or thoughts associated with each part of your body.
Sitting meditation
Sit comfortably with your back straight, feet flat on the floor and hands in your lap. Breathing through your nose, focus on your breath moving in and out of your body. If physical sensations or thoughts interrupt your meditation, note the experience and then return your focus to your breathing.
Walking meditation
Find a quiet place 10 to 20 feet long and walk slowly. Focus on the experience of walking, being aware of the sensations of standing and the subtle movements that keep your balance. When you reach the end of your path, turn and continue walking, maintaining awareness of your sensations.
If you prefer guided imagery meditation, try one of these audio guides:
Ten breath practice introduction
Ten breath practice
What is mindfulness, and tips for the journey
Body scan
Mindful standing yoga practice
Mindfulness meditation on the breath
Mindfulness meditation on the body
Mindfulness meditation on sounds, thoughts and emotion
The 3-minute mindful breathing for the daily journey
Mindfulness is a supportive strategy to help manage many health issues. It pairs well with other medical treatments and counseling. It's a simple strategy that doesn't require a prescription or special equipment and can be practiced anywhere. Talk with your health care team about incorporating mindfulness meditation into your life, and see if it makes a difference in your health and general sense of well-being.
Joel Bobby is a licensed independent clinical social worker in Psychiatry & Psychology in Austin, Minnesota.
5, 4, 3, 2, 1: Countdown to make anxiety blast off
https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/5-4-3-2-1-countdown-to-make-anxiety-blast-off 5, 4, 3, 2, 1: Countdown to make anxiety blast off
TOPICS IN THIS POST
Anxiety
Behavioral Health
Balance Your Mental And Emotional Health
Back To School
Stress bomb illustration
Everyone feels anxious now and then. But there are things you can do to minimize those feelings. Mayo Clinic Health System staff suggests trying the exercise below the next time your mind is stuck on the worry setting.
Sit quietly. Look around you and notice:
5 things you can see: Your hands, the sky, a plant on your colleague’s desk
4 things you can physically feel: Your feet on the ground, a ball, your friend’s hand
3 things you can hear: The wind blowing, children’s laughter, your breath
2 things you can smell: Fresh-cut grass, coffee, soap
1 thing you can taste: A mint, gum, the fresh air
This exercise helps you shift your focus to your surroundings in the present moment and away from what is causing you to feel anxious. It can help interrupt unhealthy thought patterns.
For tips on boosting your brain’s happiness, watch this fun video from Mayo Clinic’s Complementary and Integrative Medicine program:
Saturday, May 27, 2023
Friday, May 12, 2023
Tuesday, May 2, 2023
Tuesday, February 21, 2023
Alcohol Withdrawl
Def : If you drink alcohol heavily for weeks, months, or years, you may have both mental and physical problems when you stop or seriously cut back on how much you drink.
Symptoms that occur when someone stops using alcohol after a period of heavy drinking.
Symptoms may occur from two hours to four days after stopping alcohol.
- headaches,
- nausea,
- tremors,
- anxiety,
- hallucinations, and
- seizures.
Sunday, September 11, 2022
Restraints
A score of 80 % correct answers on a test is required to successfully complete any course and attain a certificate of completion.
Introduction
Restraints are any actions or devices healthcare workers use to restrict a patient’s freedom (Scheepmans et al., 2017). The doctor, or RN using protocols, who follows up with the doctor, decides to use physical restraints. It is never OK for a CNA or HHA to start restraints without direction from a higher-level professional.
Certain conditions may make restraint use necessary when caring for patients for their safety:
- Impaired decision making
- Increased dependency
- History of falls or patients at increased risk of falling and impaired mobility
Underlying conditions that may make restraint use necessary include:
- Psychiatric disease
- Alcohol or drug intoxication
- Low blood sugar
- Head trauma (Boyce et al., 2016).
Other methods of de-escalation should be tried when caring for agitated patients. De-escalation means taking action to try to keep the agitation from increasing. Restraints should be the last resort. Using restraints when caring for patients in healthcare can negatively affect patients and staff. Consequences can be physical, social and psychological.
Examples of physical consequences of restraint use include:
- Pressure ulcers
- Incontinence
- Bruising
- Physical injury up to death
Social consequences include:
- Isolation
- Feeling withdrawn
Psychological consequences include:
- Depression
- Anger
- Fear
Restraint use can negatively affect family members by evoking feelings of anger, worry and guilt. Healthcare workers can also be negatively impacted by their feelings of guilt (Boyce et al., 2016).
Joint Commission Requirements for Checking Patient Who are Restrained
The Joint Commission has stringent requirements for using restraints in the healthcare setting. State, hospital and facility policies usually define how often restrained patients are checked. They define how often the patient’s vital signs are taken. The policies also detail skin integrity, toileting, and range of motion rules. The restraints can and should be removed as soon as the patient is calm and quiet. However, staff should continue to monitor the patient carefully for both the patient’s safety and that of other patients and the staff (Boyce et al., 2016).
While restrained, patients must be watched closely. Some of the checkings may be delegated to the CNA or HHA.
Vital Signs
Vital Signs: Heart rate, blood pressure, temperature, oxygen saturation and respiratory rate.
Comfort
Patient comfort: skin chafing under and around the restraints, hydration, personal hygiene and toileting needs.
De-escalation Techniques
De-escalation techniques should be tried before restraints are used. There are 3 phases of escalating violence. They are:
- Anxiety
- Defensiveness
- Physical aggression
These patterns of aggression are somewhat predictable. Developing violence can be identified before aggression takes place.
One technique is asking the patient, “how can we assist you?” This technique allows the healthcare worker to engage the patient while displaying compassion. Often this is sufficient to put an agitated patient at ease. Another technique is offering the patient food and drinks and helping with toileting if appropriate.
The goal is to treat the patient with dignity and empathy. If the patient continues to be agitated, untrained staff should immediately enlist the help of a trained staff member who can help defuse a potentially violent patient encounter. If the patient continues to be violent despite these efforts, facility security should be called to help keep the patient, staff and other patients safe. When security does arrive, they should gather at a safe distance but within the patient’s view. Sometimes a show of force is all that is required to calm the patient (Boyce et al., 2016).
Restraint Use in the Elderly
Safety in caring for the elderly sometimes requires the use of restraints. Overall, using restraints and restricting mobility in elderly people will result in loss of function in the long run (Dahlke et al., 2019).
Several things cause problems in safety when caring for elderly patients. These include:
- A lack of experience in caring for the elderly
- Mistaking functional decline in the elderly for a normal process of aging
- Lack of access to resources
Leaders at the institutional level must address organizational factors that increase the use of restraint; these may be poor staffing.
Types of Restraints:
Seclusion
Seclusion can be used in both inpatient units and specialized psychiatric units. It was used a lot in the 1980s, but its use has declined due to nursing staff shortages. In addition, most hospitals do not have space to provide seclusion to all patients who need it. Seclusion is a very effective technique for use in aggressive patients.
Note that seclusion can be combined with other forms of restraints, including physical or chemical restraints. Patients placed in seclusion must be reassessed as often as those placed in physical restraints (Kowalski, n.d.).
Limb Restraints
Physically restraining a patient’s limbs is the most common form of physical restraint. Limb restraints can be made from different materials, including leather and cotton. In general, restraints have to be comfortable, easy to apply, easy to remove and easy to clean. Of note, leather restraints are difficult to break or tear, but they are difficult to clean if they get soiled from bodily secretions. Sometimes hard leather restraints have a difficult application and removal processes relative to soft form restraints. Furthermore, that can be problematic when the patient is crashing in an acute setting. Leather limbs are usually reserved for combative and violent patients in whom the need for secure restraints is considered more important and worth the time it takes to apply or remove them (Kowalski, n.d.).
Soft Limb Restraints
Soft limb restraints are made from cotton or foam material, a single-use device. They are less rigid than hard restraints and are easier to apply. Soft restraints are reserved for patients who are agitated but are less aggressive. Soft limb restraints are less secure than hard leather restraints(Kowalski, n.d.). (Kowalski, n.d.). Four-point restraints are restraints on both arms and legs.
Fifth Point Restrains or Belts
Fifth-point restraints, or belts, are used as an adjunct to the four-point restraint. It functions by restricting the movement of the patient’s torso, pelvis or thighs. Fifth-point restraints are reserved for patients who continue to be dangerous to themselves or others while in a four-point restraint. It can also be used in patients whose behavior prohibits the medical staff from administering medically necessary care, including therapeutic interventions (Kowalski, n.d.).
Patients with a 5-point restraint are at increased risk of aspiration because they cannot turn to their sides if they start vomiting. Also, note that the 5-point restraint must be applied tight enough to prevent the risk of accidental suffocation in case the patient tries to slip under the restraint. These restraints usually require quick-release locks in an emergency (Kowalski, n.d.).
Jackets and Vests
Jacket and vest restraints are reserved for inpatients or patients in longer-term facilities. There are reports of death with the use of jackets or vests related to choking and suffocation (Kowalski, n.d.). In general, jackets and vests are rarely used in emergencies (Kowalski, n.d.).
Leg Restraints
Leg restraints are used in the transportation of patients. Leg restraints are limited in the inpatient or emergency setting (Kowalski, n.d.).
Why Restraints are Used
Restraints prevent agitated or violent patients from harming themselves, other patients or staff members. Restraints should only be used as a last resort after de-escalation techniques have failed. Patients who are noted to be an immediate danger to themselves or others should be promptly restrained without delay.
Patients may need to be restrained to receive life-saving medical care. For example, patients who are intubated and or patients who are sedated and require life-saving treatment.
In addition, patients at risk for elopement (escaping) may also be restrained in very specific circumstances.
Restraints should not be used when de-escalation techniques are adequate. Restraints should not be used on broken limbs, open wounds or skin infections. Also, restraints should be used cautiously in patients with poor vascular circulation. Fifth-point restraints should be avoided in patients with ostomies, feeding tubes, pelvic fractures or multiple rib fractures. Finally, patients with severe pulmonary or cardiovascular disease may not tolerate the presence of a fifth-point restraint over their chest.
How to Apply Restraints
Restraints should be applied rapidly and safely by personnel who are trained in the application of restraints. The restraints must be tied to a non-moving part of the bed frame out of the patient’s reach. A slip knot must be used so that restraints can be untied quickly.
When applying restraints to an actively violent patient, a team of five members is recommended, one team leader and one individual for each limb. Occasionally the presence of multiple team members will be enough to subdue the patient with the need to apply restraints. The patient and family members must be educated about why the restraints are being applied. Also, they should always get clear instructions on the entire procedure.
Problems from Restraint Use
Increased agitation can prevent good communication (Boyce et al., 2016).
Local skin breakdown: physically restricting the patient can prevent them from repositioning and moving. This restriction increases the risk of developing pressure ulcers.
Blood flow problems: If restraints are applied too tight, there is an increased risk of restricting blood flow to a limb.
Breathing problems: Patients with moderate to severe respiratory disease are at risk for breathing problems. For example, a patient with severe obstructive lung disease is at increased risk of respiratory failure if they are in a vest restrained or if they receive certain medication. Tied flat patients cannot easily move to throw up or spit.
That liquid might be sucked back into the lungs, causing pneumonia.
Heart problems: Patients with severe congestive heart failure may be unable to lay flat. If restrained and forced to lay flat, they may be at increased risk of heart and respiratory problems.
Case Study
You are working with a patient in four-point restraints. You are required to toilet the patient every hour while awake. When you re-tie the restraints, you check the tightness to be sure the blood flow is not cut off. If you do not check, a restraint that is too tight can cut off blood flow to the hand or foot. This cutting off blood flow could cause the patient to lose the use of the hand or have to remove the hand.
Summary
Healthcare workers are responsible for caring for patients even when they cannot make appropriate decisions for themselves. At times, ensuring a patient’s safety and the safety of others will require the use of restraints. If necessary, workers must provide compassionate care that follows state, federal and institutional policy.
References
- Scheepmans K, Casterlé BDD, Paquay L, Milisen K. Restraint use in older adults in-home care: A systematic review. International Journal of Nursing Studies. 2018;79:122-136. doi:10.1016/j.ijnurstu.2017.11.008.
- Boyce SH, Stevenson RJ, Cline DM. Prison Medicine. In: Tintinalli JE, Stapczynski J, Ma O, Yealy DM, Meckler GD, eds. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide. 8th ed. McGraw-Hill, New York, NY; 2016.
- Dahlke SA, Hunter KF, Negrin K. Nursing practice with hospitalized older people: Safety and harm. International Journal of Older People Nursing. 2019;14(1). doi:10.1111/opn.12220.
- Kowalski JM. Physical and Chemical Restraint. In: Roberts and Hedges’ Clinical Procedures in Emergency Medicine and Acute Care. 3rd ed.; 1481-1498.