{"id":4682,"date":"2019-01-09T19:39:45","date_gmt":"2019-01-10T00:39:45","guid":{"rendered":"https:\/\/www.amyork.ca\/academic\/zz\/?p=4682"},"modified":"2019-05-25T22:55:53","modified_gmt":"2019-05-26T02:55:53","slug":"serious-mental-illness-co-occurring-problems","status":"publish","type":"post","link":"https:\/\/www.amyork.ca\/academic\/zz\/mental-health-nursing\/serious-mental-illness-co-occurring-problems\/","title":{"rendered":"Serious Mental Illness- Co-occurring Problems\u00a0"},"content":{"rendered":"<p>\u2212 People with serious mental and physical illness fall through the gaps between physical and mental health care systems<\/p>\n<p>&nbsp;<\/p>\n<p><strong>EPIDEMIOLOGY\u00a0 <\/strong><\/p>\n<p>\u2212 People with Serious Mental Illness (SMI) experience much poorer health outcomes than the general population\u00a0 \u2212 Life expectancy for people with SMI is 20 years less than those without<\/p>\n<p>\u2212 Around 1 in 9 people aged 16-85 experience SMI and a concurrent physical condition<\/p>\n<p>\u2212 Most common comorbidity was an anxiety disorder combined with a physical condition\u00a0 \u2212 People with SMI have higher smoking rates<\/p>\n<p>\u2212 Comorbidity increases with decreasing SrS<\/p>\n<h3><\/h3>\n<h3>Comorbidity<\/h3>\n<p>\u2212 Is the occurrence of more then one condition at the same time<\/p>\n<p>\u2212 Can Involve one or more mental health disorders or a mental disorder with a physical health disorder<\/p>\n<p>\u2212 Having multiple disorders results in; \u00d8 Increased health risks<\/p>\n<ul>\n<li>Increased disability<\/li>\n<li>Places greater demands on health resources<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p>\u2212 Its not just higher rates of mental illness and physical conditions, but its also higher rates of physical conditions and mental illness- it goes both ways!<\/p>\n<p>\u2212 Having a physical illness is one of the strongest risk factors for depression<\/p>\n<p>&nbsp;<\/p>\n<h3>Metabolic Syndrome<\/h3>\n<p>\u2212 A cluster of different clinical presentations that we typically see among people who are on particular antipsychotic medications<\/p>\n<p>\u2212 A range of abnormal clinical and metabolic findings that result in an increase of: \u00d8 NIDDM (Type II Diabetes)<\/p>\n<ul>\n<li>Cardiovascular disease<\/li>\n<\/ul>\n<p>\u2212 Associated with:<\/p>\n<ul>\n<li>Abdominal obesity<\/li>\n<li>High blood pressure<\/li>\n<li>High triglyceride<\/li>\n<li>Low HDL- cholesterol<\/li>\n<li>Insulin resistance<\/li>\n<\/ul>\n<p>\u2212 People with SMI have much higher rates of obesity<\/p>\n<p>\u2212 50% have abnormal lipid profiles<\/p>\n<p>\u2212 33% have elevated fasting blood glucose levels<\/p>\n<h3><\/h3>\n<h3>Diabetes<\/h3>\n<p>\u2212 Type II Diabetes (NIDDM)- progressive endocrine dysfunction characterised by:<\/p>\n<ul>\n<li>rlevated blood glucose levels<\/li>\n<li>Insulin resistance<\/li>\n<li>Beta cell dysfunction<\/li>\n<\/ul>\n<p><strong>Complications of Diabetes\u00a0 <\/strong><\/p>\n<ul>\n<li>Microvascular Disease- retinopathy &amp; nephropathy<\/li>\n<li>Diabetic neuropathies<\/li>\n<li>Coronary vascular disease<\/li>\n<li>Stroke (CVA)<\/li>\n<li>Peripheral vascular disease<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><strong>Uncontrolled Diabetes can cause: <\/strong><\/p>\n<ul>\n<li>Blindness<\/li>\n<li>Heart attack<\/li>\n<li>Brain haemorrhage<\/li>\n<li>Kidney problems<\/li>\n<li>Amputation of lower extremities<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<h3>Cardiovascular Disease<\/h3>\n<p>\u2212 Refers to any disease that affects the heart and blood vessels\u00a0 \u2212 The major risk factors are:<\/p>\n<ul>\n<li>Smoking<\/li>\n<li>Obesity<\/li>\n<li>Hypertension<\/li>\n<li>rlevated blood cholesterol<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<h3>Cancer<\/h3>\n<p>\u2212 Cancer rates for those with SMI and those without are the same<\/p>\n<p>\u2212 People with SMI although have a 30% greater mortality rate<\/p>\n<p>\u2212 People with SMI tend to present much later and often have metastases\u00a0 \u2212 People with SMI are less likely to receive specialised interventions<\/p>\n<p>&nbsp;<\/p>\n<h3>Infectious Diseases<\/h3>\n<p>\u2212 The prevalence of HIV is higher in those with SMI<\/p>\n<p>\u2212 rlevated rates of hepatitis virus infection have been reported in people with SMI<\/p>\n<p>&nbsp;<\/p>\n<h3>Respiratory Diseases<\/h3>\n<p>\u2212 People with SMI have higher rates of tuberculosis<\/p>\n<p>\u2212 People with schizophrenia are 1.3 times the risk of acute respiratory failure\u00a0 \u2212 Rates of chronic bronchitis am emphysema are higher in those with SMI<\/p>\n<p>&nbsp;<\/p>\n<h3>Oral health<\/h3>\n<p>\u2212 People with SMI experience higher rates of oral health problems:<\/p>\n<ul>\n<li>Dental cavities<\/li>\n<li>Periodontal disease<\/li>\n<li>Dental trauma<\/li>\n<li>Oral cancers<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p>\u2212 Reasons for poor oral hygiene:<\/p>\n<ul>\n<li>Dry mouth due to medications<\/li>\n<li>Cant afford dental care<\/li>\n<li>Smoking<\/li>\n<li>Lack of care (i.e. not brushing their teeth)<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<h3>Sleep patterns<\/h3>\n<p>\u2212 Sleep is necessary for memory encoding and consolidation<\/p>\n<p>\u2212 rmotional memory is susceptible to sleep deprivation (SD) \u2212 SD also leads to impaired cognition and attention<\/p>\n<p><strong>What conditions might affect sleep?\u00a0 <\/strong><\/p>\n<ul>\n<li>Insomnia- caused by mania<\/li>\n<li>Hypersomnia (over sleeping)- caused by depression<\/li>\n<li>Medications<\/li>\n<li>Schizophrenia- if people are hearing voices<\/li>\n<li>Anxiety- e.g. lying in bed overthinking\/worrying<\/li>\n<li>Paranoia- e.g. delusional thoughts, checking or watching things<\/li>\n<li>OCD- e.g. undertake rituals to sleep<\/li>\n<li>Internal restlessness e.g. pacing<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<h3>Trauma<\/h3>\n<p>\u2212 Trauma Informed Care and Practice (TICP) recognises that people with SMI have been exposed to trauma<\/p>\n<p>\u2212 60-70% of people with schizophrenia have been exposed to forms of childhood abuse<\/p>\n<p>&nbsp;<\/p>\n<h3>Intellectual Disability<\/h3>\n<p>\u2212 A person with an intellectual disability may have problems expressing themselves<\/p>\n<p>\u2212 May have problems with:<\/p>\n<ul>\n<li>rxpressing their thoughts<\/li>\n<li>Putting together sentences<\/li>\n<li>Learning new skills<\/li>\n<li>Doing day to day takes<\/li>\n<li>Making decisions<\/li>\n<li>Remembering things<\/li>\n<\/ul>\n<p>\u2212 A person with an intellectual disability AND a mental illness is called<strong>: Dual Disability<\/strong><\/p>\n<p>&nbsp;<\/p>\n<h3>SMI- Comorbidity Risk Factors<\/h3>\n<p><strong>Antipsychotic Medication\u00a0 <\/strong><\/p>\n<ul>\n<li>Can cause weight gain- Clozapine and Olanzapine have the highest incidence (15-20kg gains in 6 months) Increases the risk of hyperglycaemia and dyslipidaemia<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><strong>Smoking\u00a0 <\/strong><\/p>\n<ul>\n<li>66% with people with SMI are smokers compared to 15% of the general population<\/li>\n<li>People with SMI smoke more cigarettes per day<\/li>\n<li>People with SMI inhale more deeply<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><strong>Diet and Exercise\u00a0 <\/strong><\/p>\n<ul>\n<li>The sedation effect of antipsychotic drugs can cause decreased motivation \u00a0 Disorganisation due to SMI can lead to negative lifestyle factors such as:\n<ul>\n<li>Poor diet<\/li>\n<li>Lack of physical activity<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<ul>\n<li>People with SMI have poorer diets: \u00d8 Higher caloric intake\n<ul>\n<li>Higher in saturated fats \u00d8 Lower in fruit and fibre<\/li>\n<li>Lower in vegetables, legumes and diary<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><strong>Sexual Activity\u00a0 <\/strong><\/p>\n<ul>\n<li>People with SMI are more likely to be involved with high risk sexual behaviours such as: \u00d8 Unprotected sexual intercourse\n<ul>\n<li>Multiple partners<\/li>\n<li>Involvement in sex work (prostitution) and illicit drug use<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><strong>Drugs and Alcohol\u00a0 <\/strong><\/p>\n<ul>\n<li>People with SMI were:\n<ul>\n<li>At increased risk of consuming high levels of alcohol in the last 12 months<\/li>\n<li>6 times more likely to have used an illicit drug \u00d8 1.6 times more likely to have used cannabis<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<h3>Interventions<\/h3>\n<p>\u2212 All interventions are based on the principles of RrCOVrRY<\/p>\n<ul>\n<li>Uniqueness of the \u00d8 Attitude and \u00d8 Partnership and individual rights\u00a0 communication<\/li>\n<li>Real choices \u00d8 Dignity and \u00d8 rvaluating respect recovery<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><strong>Metabolic Syndrome\u00a0 <\/strong><\/p>\n<ul>\n<li>Ongoing assessment at least every 3 months o Monitoring waist circumference\u00a0 o Calculating BMI\u00a0 o Monitoring BP\u00a0 o Monitoring fasting lipids and blood glucose\u00a0 o Monitor<a href=\"https:\/\/www.studocu.com\/en?utm_campaign=shared-document&amp;utm_source=studocu-document&amp;utm_medium=social_sharing&amp;utm_content=nrsg210-semester-1-notes\">ing level of physical activity\u00a0 <\/a><\/li>\n<\/ul>\n<p><strong>Respiratory\u00a0 <\/strong><\/p>\n<ul>\n<li>Regular and ongoing respiratory assessment<\/li>\n<li>Cessation of smoking o Motivational interviewing\/counselling\u00a0 o Management of withdrawal symptoms\u00a0 o Nicotine replacement therapy\u00a0 o rducation<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<ul>\n<li>Maintaining physical activity<\/li>\n<li>Regular influenza vaccination<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><strong>Physical Activity\u00a0 <\/strong><\/p>\n<ul>\n<li>Motivational interviewing<\/li>\n<li>Face to face and group-based exercise sessions<\/li>\n<li>Structures exercise prescriptions<\/li>\n<li>Structure the exercise to suit age and ability<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><strong>Nutrition\u00a0 <\/strong><\/p>\n<ul>\n<li>rducation on balanced diet<\/li>\n<li>Suggestions for alternate dietary patterns<\/li>\n<li>Reducing the intake of high fat and high sugar foods<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><strong>Oral health\u00a0 <\/strong><\/p>\n<ul>\n<li>Smoking cessation<\/li>\n<li>Regular dental hygiene<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><strong>Sleep\u00a0 <\/strong><\/p>\n<ul>\n<li>Regularly assess sleep patterns<\/li>\n<li>Assess for obstructive sleep apnoea<\/li>\n<li>Commence a sleep diary<\/li>\n<li>Decrease caffeine intake before bed<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><strong>Sexual health\u00a0 <\/strong><\/p>\n<ul>\n<li>Promote regular screening- breast, prostate, cervical and STD<\/li>\n<li>rducation on safe sex<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><strong>Drug and Alcohol\u00a0 <\/strong><\/p>\n<ul>\n<li>Regularly assess for concurrent use of alcohol and drugs<\/li>\n<li>Motivational interviewing<\/li>\n<li>Formal rehab programs if warranted<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><strong>Disability\u00a0 <\/strong><\/p>\n<ul>\n<li>Advise\/organise support services as needed<\/li>\n<li>Differentiate b\/w the presentation f the disability and the signs\/symptoms of mental illness<\/li>\n<\/ul>\n","protected":false},"excerpt":{"rendered":"<p>\u2212 People with serious mental and physical illness fall through the gaps between physical and mental health care systems &nbsp; EPIDEMIOLOGY\u00a0 \u2212 People with Serious Mental Illness (SMI) experience&hellip; <a class=\"continue\" href=\"https:\/\/www.amyork.ca\/academic\/zz\/mental-health-nursing\/serious-mental-illness-co-occurring-problems\/\">Continue Reading<span> Serious Mental Illness- Co-occurring Problems\u00a0<\/span><\/a><\/p>\n","protected":false},"author":4,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[121],"tags":[],"_links":{"self":[{"href":"https:\/\/www.amyork.ca\/academic\/zz\/wp-json\/wp\/v2\/posts\/4682"}],"collection":[{"href":"https:\/\/www.amyork.ca\/academic\/zz\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.amyork.ca\/academic\/zz\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.amyork.ca\/academic\/zz\/wp-json\/wp\/v2\/users\/4"}],"replies":[{"embeddable":true,"href":"https:\/\/www.amyork.ca\/academic\/zz\/wp-json\/wp\/v2\/comments?post=4682"}],"version-history":[{"count":2,"href":"https:\/\/www.amyork.ca\/academic\/zz\/wp-json\/wp\/v2\/posts\/4682\/revisions"}],"predecessor-version":[{"id":4807,"href":"https:\/\/www.amyork.ca\/academic\/zz\/wp-json\/wp\/v2\/posts\/4682\/revisions\/4807"}],"wp:attachment":[{"href":"https:\/\/www.amyork.ca\/academic\/zz\/wp-json\/wp\/v2\/media?parent=4682"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.amyork.ca\/academic\/zz\/wp-json\/wp\/v2\/categories?post=4682"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.amyork.ca\/academic\/zz\/wp-json\/wp\/v2\/tags?post=4682"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}