Anxiety

Anxiety disorders are a group of disorders in which people feel anxious, frightened, distressed, or terrified to an extent that is more excessive than would be considered appropriate to the situation. They can interfere with a person’s life so much that the person with anxiety has trouble functioning in their everyday life. Anxiety can lead people to become depressed, have low self-esteem, abuse substances, and have suicidal thoughts. Anxiety disorders are very common and also very treatable.

Generalized Anxiety Disorder: Generalized Anxiety Disorder (GAD) is when people have anxiety every day for at least six months, which interferes with their ability to function in their everyday lives. They may feel constantly worried, afraid, and feel physical symptoms such as heart palpitations, trouble breathing, nausea, and headaches. Most of us worry and have anxiety at one time or another. The difference is that we can use positive coping skills to deal with our worries. People with GAD do not necessarily worry about something in particular and they are unable to use positive coping skills. GAD can lead to depression, substance abuse, loss of employment and relationships, and suicidal thoughts.

Phobias: Phobias are a type of anxiety disorder in which a person has an abnormal fear about something in particular. For example, some people may have a fear of germs, spiders, heights, being outside the home, crowds, closed in spaces, water, or animals. Most people have fears about many of those things, but the difference is that they are able to function when faced with their fear. A person with a phobia has an irrational fear, which is a fear that is not reasonable. They become unable to function in the face of these fears. In some cases, there may not be a reason for the fear, and in other cases, the person may have had a bad experience which has led to the excessive fear about the particular situation.

Obsessive-compulsive disorder: Obsessive-compulsive disorder (OCD) is a type of anxiety disorder in which the person has repetitive thoughts (obsessions) and repetitive behaviors (compulsions). These repetitive thoughts and behaviors impede (interfere with) the person’s ability to function in their everyday life. For example, a person who has a fear of germs may obsess (think continuously) about getting germs and spend excessive amounts of time washing their hands (compulsions). They may wash their hands for hours, leading to missing work and raw and bleeding hands.

Post-traumatic stress disorder: Post-traumatic stress disorder (PTSD) is a type of anxiety disorder in which the person has experienced a traumatic event such as sexual abuse, rape, a natural disaster, or combat and experiences severe distress afterward. The person may have flashbacks (replay the event in their mind) about the event, have insomnia (trouble sleeping), nightmares, and feel constantly on edge, irritable, scared, or angry. It is normal for people to experience these things right after a traumatic event. The difference is that a person with PTSD is unable to function in their everyday life, to cope with their thoughts and feelings in a positive way, and feel that no matter what they do, they cannot “get back to normal.”

Depression

Depression is an extremely common type of mental illness. Depression may involve extreme sadness, insomnia, trouble concentrating, over or under-eating, substance abuse, guilt, and thoughts of suicide. Depression often results in a disruption of a person’s ability to function normally in their life. They may have trouble getting out of bed, performing self-care, caring for their children, or going to work.

Depression left untreated can result in suicide, which is the 10th leading cause of death in the United States. In the elderly, depression is very common and is something a HHA/PCA should monitor when working with the elderly. Some people may have one episode of depression, while others experience recurrent depression, or depression that occurs periodically. It is important to assist a person with depression to seek help. Depression is a very treatable disorder with proper treatment.

Schizophrenia

Schizophrenia is a serious mental illness that impacts a person’s ability to think clearly, make decisions, have relationships with others, manage stress and emotions, and function in their everyday lives. People with schizophrenia have psychoses. Psychoses are a loss of contact with what is real. They can include delusions (abnormal thoughts) or hallucinations (seeing or hearing things that are not real). Delusions may demonstrate paranoia (thinking someone is out to hurt you).

Behavior may be bizarre. For example, a person with schizophrenia may not dress appropriate to the weather, become catatonic (motionless and not move any muscle or body part), have repetitive movements of body parts and speech that is disorganized (does not make sense). A person with schizophrenia may also have sleeping and eating problems, an inability to relate to others, and trouble providing self-care.

People with schizophrenia are at a very high risk of suicide. Most people with schizophrenia are not dangerous to other people. With medication, support from others, and the help of a psychiatrist and therapist, a person with schizophrenia can usually be able to regain their ability to function within the community.

 Treating Mental Illness

It is important to know that while mental illness can have long-term effects on a person’s physical, psychological, and social functioning, many people can recover and lead normal lives. There are many types of treatment available. The most common types of treatment include medication and psychotherapy (counseling). It is extremely important for a person with a mental illness to take their medication as prescribed. Home Health Aides/Personal Care Aides may come to observe patients who do not take their medication as prescribed. They should inform their supervisor and document their findings.

Sometimes a person who is suffering from a severe form of mental illness and who is unable to help themselves may need to be hospitalized for periods of time. Most people who suffer from a mental illness receive outpatient treatment, which is treatment outside of a hospital. Patients meet with a psychiatrist (a physician who specializes in treating mental health disorders) to discuss their thoughts and feelings and to obtain prescriptions for medications. Patients may also meet with a mental health therapist or social worker to talk about their thoughts and feelings and to learn better ways to cope with their stressors. Some people go to individual therapy (therapy focused on one person) and others may go to group therapy (therapy where many people with similar problems meet with a therapist) to talk about and solve their problems.

A common form of treatment is Cognitive Behavior Therapy. This treatment focuses on how a person’s thoughts, feelings, and behaviors are related. Patients are taught to recognize negative self-talk (what we tell ourselves in our head) and to turn these thoughts into more positive ones. More positive thoughts will lead to improved mood and behavior.

 Guidelines for Observing Behavior

1. Describe the unusual behavior. When does it occur? How often does it occur? How long does it last? Does it seem to occur during certain situations?
2. Does the behavior indicate a change in the patient’s personality? Is the behavior or thought extreme (bizarre and seem abnormal)?
3. Is the behavior or thought appropriate to the situation, or does it seem out of the ordinary and abnormal?
4. Is the behavior harmful to the patient, to their loves ones, or to the Home Health Aide/Personal Care Aide?

It is important to remember not to draw conclusions about the behaviors observed. The job of a HHA/PCA is not to diagnose or interpret behaviors or thoughts the patient expresses. Their job is to observe, record, and report what they see and hear.