MENATL AND BEHAVIORAL

PROBLEMS AND VICIOUS CIRCLE

OF MENTAL HEALTH BURDEN
ZARNIGAR M.Sc. NURSING
ASSOCIATE PROFESSOR
NURSING CAMPUS
SUPERIOR UNIVERSITY LAHORE
MENATL AND BEHAVIORAL PROBLEMS
• Intellectual disability is fairly common, and it occurs in
approximately 1 to 2 percent of people. Psychiatric and
behavior problems occur three to six times more in these
individuals than in the general population, so the
assessment of these patients is important in treating these
issues.
 DIAGNOSIS OF INTELLECTUAL PROBLEMS
• Intellectual disability is normally diagnosed before the age of 18 and is
defined as when an IQ of a person is 75 or lower. Individuals will show
signs of difficulty in two areas of adaptive skills, such as social skills, health,
or safety. Significant psychiatric or behavioral problems are normally
present, although the IQ is not necessarily related to an underlying
psychiatric disorder. A person with intellectual disability may need
pharmacological or behavioral treatment if he is diagnosed with:
• Major depressive disorder
• Bipolar disorder
• Obsessive-compulsive disorder
• Schizophrenia
• Posttraumatic stress disorder
• Anxiety disorder
 TREATMENT OF BEHAVIOR PROBLEMS

• Behavior problems in an individual with intellectual disability

might be treated with medication or behavior therapy. If your
family member has an intellectual disability and has any of
these behaviors, treatment may be needed:
• Self-injury
• Physical aggression
• Destruction of property
• Hyperactivity
• Impulsivity
• Excessive dependency
• Sexually aggressive behavior
 CAUSES OF MENTAL PROBLEM
• The loss of a parent or friend
• Romantic breakups
• Being fired or losing a job
• Excessive noise
• School or work stress
• A lack of stimulation
• A lack of support from friends or family members
• Neglect
• Physical or sexual abuse
• Illness
• Sensory defects
• Seizures
• Trouble communicating
• A change of location
 PSYCHOSOCIAL TREAMENT
• Psychosocial treatment is a multidisciplinary team
approach. This means that you will be a part of your
family member’s treatment, as
• The cooperation of the family and the patient is very
important. The care will need to be continuous, and
the environment will need to meet the needs of the
individual with the behavioral or psychological
problems. The family will need to provide timely
access to care, to reduce psychosocial stress, and to
increase support.
• Families can change the environment of the patient,
which can help. For example, changing activities to
make them easier or changing the physical
environment can reduce some behavior issues.
• The family needs to discuss ways to manage the
behavioral or psychological condition.
• Social and communication skills training is normally
part of this process.
• Reinforcement procedures can help interrupt
problem behaviors and reinforce positive behaviors.
 DEALING WITH BEHACIORAL PROBLEMS

• Some problems can be helped with simple home strategies.

• For those with trouble sleeping, a regular bedtime routine
can help.
• Restricting caffeine, promoting exercise, and avoiding
hunger at bedtime may make it easier to sleep.
• For those with weight gain issues, making sure to watch
signs of weight gain carefully when taking new medications
is important.
• Structured meals, eating the right foods, and providing and
encouraging fun exercises are important as well.
 MEDICATION
• Medication is most likely to be prescribed when the presence of an
identifiable diagnosis is possible.
• Keeping the medication regiment as easy as possible. This could mean
once-a-day pills or extended-release pills.
• Start will smaller amounts of medications
• Avoid drug changes unless they are necessary
• Medication will likely be provided if an individual is diagnosed with:
• Schizophrenia
• Bipolar disorder, manic or depressed
• Major depressive disorder
• Psychotic disorder
• Obsessive-compulsive disorder
• ADHD
• Panic disorder
 VICIOUS CYCLE OF MENTAL HEALTH
• When we hear the term “mental illness”, the first
thought that crosses our mind is usually
depression or anxiety.
• The truth is, there are 5 editions of the Diagnostic
and Statistical Manual of Mental Disorders
(DSM), 947 pages and more than 250 classified
mental disorders with multiple subtypes of each.
• The disability-adjusted life year (DALY) is a
measure of overall disease burden, expressed as
the number of years lost due to ill-health,
disability or early death.
• In other terms, it is how many years a person
loses when they become a dysfunctional
member of a society due to an illness, be it
physical or mental – i.e. they skip school, work
or simply do not pursue their goals.
• Thirty years ago, infections and diarrhea were
the leading causes of global burden of disease.
• Recently, depression and anxiety disorders
have worked their way up the ladder and are
expected to become the 2nd leading cause of
burden of disease in 2020 (WHO).
• Recently, depression and anxiety disorders have
worked their way up the ladder and are expected to
become the 2nd leading cause of burden of disease
in 2020 (WHO).
• A tremendous amount of effort has been directed
towards eliminating social stigma towards mental
disorders.
• However, little has been done to improve the
concept of self-stigma whereby a person stigmatizes
against themselves for having a mental illness.
Statements like, “I am weak and unable to care for
myself!” often lead to negative emotional reactions,
especially low self-esteem, and self-efficacy.
• Because of this self-prejudice, persons with
mental disorders may fail to pursue appropriate
work opportunities or achieve their goals.
• This is not only due to their mental illnesses
but rather a combination of both, the illness as
well as their self-prejudice which hampers their
functionality as individuals and prevents them
from seeking medical help.
• An approach to mental illness is to think of it as a
cycle.
• For instance, a person with a binge eating disorder
may also suffer from Body Dysmorphic Disorder
(BDD) which is defined as the preoccupation with at
least one nonexistent or slight defect in physical
appearance (DSM V, 2013).
• These concerns about appearance lead to repetitive
behaviors (eg, mirror checking, excessive grooming,
or skin picking) or mental acts (eg, comparing one’s
appearance to that of others).
• The result could be in the form of significant
distress, psychosocial impairment, dissatisfaction,
and continuous efforts to change body image
which may eventually lead to depression.
• To deal with depression, the person might further
engage in binge eating which causes nothing but a
vicious cycle of binge eating, body dys morphic
disorder, depression, and anxiety.
• To break this vicious cycle, we need to target the
individual components that make it up: the
disorders and the self-prejudice associated with
them.
• Unfortunately, mental illnesses are often co-
morbid – i.e. they exist simultaneously.
• The issue of under-diagnosis due to patients not
seeking medical help makes matters worse, as
most mental illnesses are left untreated.
• Currently, 1 in 5 people suffer from depression.
• Another 1 in 50 people around the world are
preoccupied with their skinny bodies, oversized
hips or a bump on their nose.
• These numbers are merely the tip of the iceberg
which signifies the grave importance of diagnosing
these illnesses and treating them as soon as
possible.
• With the continuous change in the patterns of body
perception that we see with each decade, it is no doubt that
at every point in time, someone is dissatisfied with how they
look.
• For instance, men who suffer from muscle dys morphic
disorder – a subtype of BDD – constantly compare their
bodies to other men which lead to depression, anxiety, and
dissatisfaction.
• In the early 1900’s, people tried to eat as much as possible to
get the “Fat” look – a sign of wealth and higher social status.
• Fast-forward 100 years, people are now going under the
knife to carve their bodies to their satisfaction or following
extreme diets and workout routines to become lean and
bulky.
• As such, it is important to recognize the patterns
and cycles of mental disorders that we see in our
societies and the causes that led to their evolution.
• Treatment options for BDD and its other co-morbid
illnesses involve the use of drugs
– pharmacotherapy– and cognitive-behavioral
therapy (CBT).
•  CBT for BDD must be tailored to specifically address
BDD’s unique symptoms; otherwise, it is unlikely to
be helpful. This necessitates consulting a medical
professional which is often neglected, especially in
our part of the world.
• Techniques used in CBT include, but are not
limited to, psycho education, goal-setting,
eliminating exposure to triggers, prevention
of rituals, and habit reversal.
• The introductory sessions are often
motivational after which advanced cognitive
strategies target the core elements of BDD
such as excessive mirror checking, core
beliefs (e.g., “I am worthless”), and relapse
prevention.
• Not to mention pharmacological intervention which is
also required based on the severity of the illness and
can be addressed by a mental health professional only.
• To tackle these issues, we should start by engaging in
sports we actually enjoy for their mere health
benefits, seeking medical help for any signs of mental
disorders, increasing efforts to eliminate self-
prejudice, and increasing motivation and self-
acceptance.
• Only then will we be taking the first step in breaking
one of the most common cycles of mental health
disorders among youth today: body image disorders,
eating disorders, and depression