Aims To identify some of the causes and symptoms of mental and emotional ill health, - PowerPoint Presentation

Slide1

AimsTo identify some of the causes and symptoms of mental and emotional ill health, and identify strategies for recognising, preventing and addressing these in themselves and othersTo demonstrate confidence in finding professional health advice and helping others to do so

Mental Health

Slide2

Lesson Title

Mental Health

What do you want to know?

Mental Health

Slide3

Lesson Title

Key facts about mental health

1

in 4 people

will experience some kind of mental health problem in the course of a year

Mixed anxiety and depression is the

most common mental disorder

in Britain

Women are more likely to have been treated for a mental health problem

than

men About 10% of children have a mental health problem at any one time Depression affects 1 in 5 older peopleSuicides rates show that British men are three times as likely to die by suicide than British women Self-harm statistics for the UK show one of the highest rates in Europe: 400 per 100,000 population Only 1 in 10 prisoners has no mental disorder

Mental Health

Slide4

Lesson Title

Depression is a serious illness that can happen to anyone, even people who seem to have it all.

Mental Health

Slide5

Lesson Title

Mental Health

Depression

Slide6

http://www.theguardian.com/commentisfree/2015/jan/30/battle-depression-taught-me-medicine-loveMental Health

Slide7

Lesson Title

Mental Health

Mental Health

What other mental health conditions can you name?

Slide8

Lesson Title

Mental Health

In small groups you are going to research a mental illness and present your findings to the rest of the class

Your presentation should include:

The name of the illness

General facts

Symptoms

Effects

How to treat it

Who it affects

Where to get help

You have 15 minutes to prepare and your presentation need to be three minutes longConditions to research:SchizophreniaDementiaObsessive Compulsive disorder

AutismTourette’s Syndrome

Slide9

Lesson Title

Mental Health

How does grief make you feel?

The way grief affects you depends on many things, such as the nature of the loss, your upbringing, your beliefs or religion, your age, your relationships, and your physical and mental health.

You can react in many ways to a loss. “But, ultimately, grief consists of several key emotions.

Anxiety

and

helplessness

often come first,” explains clinical psychologist Linda Blair.

Anger

is also common, including feeling angry at someone who has died for "leaving you behind". This is a natural part of the grieving process, and you shouldn’t feel guilty about that. “There’s also

sadness, which often comes later,” says Blair.

Slide10

Lesson Title

Mental Health

How does grief make you feel?

How can you deal with grief?

What signs might there be that a grieving person isn’t coping?

Slide11

Lesson Title

Mental Health

How can you deal with grief?

“Grief always requires a period of adjustment," Blair says. "Give yourself time to adjust and recover. Be respectful of yourself and your grief. You might feel hopeless for a while, but be patient with yourself.”

There's no instant fix. You might feel affected every day for about a year to 18 months after a major loss. After this time, the grief is less likely to be at the forefront of your mind.

Express yourself

. Talking is often a good way to soothe painful emotions. Talking to a friend, family member, health professional or counsellor can begin the healing process.

Allow

yourself to feel sad

. It’s a healthy part of the grieving process. Crying enables your body to release tension. Maintain a schedule. Psychologist Linda Blair recommends keeping “simple things in your routine. It reduces the panicky feelings. It’s important that you see other people at least once a week, because it grounds you.” Sleep

. Emotional strain can make you very tired. If you’re having trouble sleeping, see your GP. Eat healthily

. A healthy, well-balanced diet will help you to cope with your emotions.

Avoid

things that "numb" the pain

, such as alcohol. It will make you feel worse once the numbness wears off.

Go

to counselling if it feels right for you

, but perhaps not straight away. “Your emotions can overwhelm you at the beginning. Counselling may be more useful after a couple of weeks or months, but only you know when you’re ready,” says Blair.

Slide12

Lesson Title

Mental Health

What signs might there be that a grieving person isn’t coping?

You don’t feel able to cope with overwhelming emotions or daily life.

The intense emotions aren't subsiding.

You’re not sleeping.

You have symptoms of depression or anxiety.

Your relationships are suffering.

You're having sexual problems.

You're becoming accident-prone. You're caring for someone who isn’t coping well. Your GP surgery is always a good place to start. They can give you advice about other support services, refer you to a counsellor if appropriate and prescribe medication, if needed. Your GP also has contact details for support groups in your area.Alternatively, you can contact support organisations directly, such as Cruse Bereavement Care (0844 477 9400) or the Samaritans (0845 790 9090).

Slide13

Tweet of the Day:

……………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………

Lesson Title

Mental Health

Slide14

SchizophreniaSchizophrenia is a long-term mental health condition that causes a range of different psychological symptoms. Schizophrenia is one of the most common serious mental health conditions. About 1 in 100 people will experience schizophrenia in their lifetime, with many continuing to lead normal lives. Schizophrenia is most often diagnosed between the ages of 15 and 35. Men and women are equally affected.There is no single test for schizophrenia. It is most often diagnosed after an assessment by a mental health care professional, such as a psychiatrist.It is important that schizophrenia is diagnosed as early as possible, as the chances of recovery improve the earlier it is treated.S

ymptomsChanges in thinking and behaviour are the most obvious signs of schizophrenia, but people can experience symptoms in different ways.The symptoms of schizophrenia are usually classified into one of two categories: positive or negative.

Positive symptoms represent a change in behaviour or thoughts, such as hallucinations or delusions.

Negative symptoms represent a withdrawal or lack of function which you would usually expect to see in a healthy person. For example, people with schizophrenia often appear emotionless, flat and apathetic.

The condition may develop slowly. The first signs of schizophrenia, such as becoming socially withdrawn and unresponsive or experiencing changes in sleeping patterns, can be hard to identify. This is because the first symptoms often develop during adolescence and changes can be mistaken for an adolescent 'phase'.

People often have episodes of schizophrenia, during which their symptoms are particularly severe, followed by periods where they experience few or no positive symptoms. This is known as acute schizophrenia.

If you are experiencing symptoms of schizophrenia, see your GP as soon as possible. The earlier schizophrenia is treated, the more successful the outcome tends to be

.

Positive symptoms of schizophrenia

Hallucinations

A hallucination is when a person experiences a sensation but there is nothing or nobody there to account for it. A hallucination can involve any of the senses, but the most common is hearing voices

.Hallucinations are very real to the person experiencing them, even though people around them cannot hear the voices or experience the sensations. Research using brain-scanning equipment shows changes in the speech area of the brain in people with schizophrenia when they hear voices. These studies show the experience of hearing voices as a real one, as if the brain mistakes thoughts for real voices.Some people describe the voices they hear as friendly and pleasant, but more often they are rude, critical, abusive or annoying. The voices might describe activities taking place, discuss the hearer’s thoughts and behaviour, give instructions or talk directly to the person. Voices may come from different places or one place in particular, such as the television.DelusionsA delusion is a belief held with complete conviction, even though it is based on a mistaken, strange or unrealistic view. It may affect the way people behave. Delusions can begin suddenly or may develop over weeks or months.Some people develop a delusional idea to explain a hallucination they are having. For example, if they have heard voices describing their actions, they may have a delusion that someone is monitoring their actions. Someone experiencing a paranoid delusion may believe they are being harassed or persecuted. They may believe they are being chased, followed, watched, plotted against or poisoned, often by a family member or friend.Some people who experience delusions find different meanings in everyday events or occurrences. They may believe people on TV or in newspaper articles are communicating messages to them alone, or that there are hidden messages in the colours of cars passing in the street.Confused thoughts (thought disorder)People experiencing psychosis often have trouble keeping track of their thoughts and conversations. Some people find it hard to concentrate and will drift from one idea to another. They may have trouble reading newspaper articles or watching a TV programme. People sometimes describe their thoughts as ‘misty’ or ‘hazy’ when this is happening to them. Thoughts and speech may become jumbled or confused, making conversation difficult and hard for other people to understand.

Changes in behaviour and thoughts

Behaviour may become more disorganised and unpredictable, and appearance or dress may seem unusual to others. People with schizophrenia may behave inappropriately or become extremely agitated and shout or swear for no reason.

Some people describe their thoughts as being controlled by someone else, their thoughts are not their own, or that thoughts have been planted in their mind by someone else. Another recognised feeling is that thoughts are disappearing, as though someone is removing them from their mind. Some people feel their body is being taken over and someone else is directing their movements and actions.

http://www.nhs.uk/Pages/HomePage.aspx

Slide15

Negative symptoms of schizophreniaThe negative symptoms of schizophrenia can often appear several years before somebody experiences their first acute schizophrenic episode. These initial negative symptoms are often referred to as the prodromal period of schizophrenia.Symptoms during the prodromal period usually appear gradually and slowly get worse. They include becoming more socially withdrawn and experiencing an increasing lack of care about your appearance and personal hygiene.It can be difficult to tell whether the symptoms are part of the development of schizophrenia or caused by something else. Negative symptoms experienced by people living with schizophrenia include:•losing interest and motivation in life and activities, including relationships and sex •lack of concentration, not wanting to leave the house and changes in sleeping patterns •being less likely to initiate conversations and feeling uncomfortable with people, or feeling there is nothing to say The negative symptoms of schizophrenia can often lead to relationship problems with friends and family because they can sometimes be mistaken for deliberate laziness or rudeness

.The exact causes of schizophrenia are unknown, but research suggests that a combination of physical, genetic, psychological and environmental factors can make people more likely to develop the condition.

Current thinking is that some people may be prone to schizophrenia, and a stressful or emotional life event might trigger a psychotic episode. However, it is not known why some people develop symptoms while others do not.

Increased risk

Things that increase the chances of schizophrenia developing include:

Genetics

Schizophrenia tends to run in families, but no individual gene is responsible. It is more likely  different combinations of genes might make people more vulnerable to the condition. However, having these genes does not necessarily mean you will develop schizophrenia.

Evidence the disorder is partly inherited comes from studies of identical twins brought up separately. They were compared with non-identical twins raised separately and the general public. For identical twins raised separately, if one twin develops schizophrenia, the other twin has a one in two chance of developing it. In non-identical twins, who share only half of each other's genetic make-up, when one twin develops schizophrenia, the other twin has a one in seven chance of developing the condition.

While this is higher than in the general population (where the chance is about one in a 100), it suggests genes are not the only factor influencing the development of schizophrenia

.

Brain development

Many studies of people with schizophrenia have shown there are subtle differences in the structure of their brains or small changes in the distribution or number of brain cells. These changes are not seen in everyone with schizophrenia and can occur in people who do not have a mental illness. They suggest  schizophrenia may partly be a disorder of the brain.NeurotransmittersThese are chemicals that carry messages between brain cells. There is a connection between neurotransmitters and schizophrenia because drugs that alter the levels of neurotransmitters in the brain are known to relieve some of the symptoms of schizophrenia. Research suggests schizophrenia may be caused by a change in the level of two neurotransmitters, dopamine and serotonin. Some studies indicate an imbalance between the two may be the basis of the problem. Others have found a change in the body’s sensitivity to the neurotransmitters is part of the cause of schizophrenia.Pregnancy and birth complicationsAlthough the effect of pregnancy and birth complications is very small, research has shown the following conditions may make a person more likely to develop schizophrenia in later life:bleeding during pregnancy, gestational diabetes or pre-eclampsia abnormal growth of a baby while in the womb, including low birth weight or reduced head circumference exposure to a virus while in the womb complications during birth, such as a lack of oxygen (asphyxia) and emergency caesarean section TriggersTriggers are things that can cause schizophrenia to develop in people who are at risk. These include:StressThe main psychological triggers of schizophrenia are stressful life events, such as a bereavement, losing your job or home, a divorce or the end of a relationship, or physical, sexual, emotional or racial abuse. These kinds of experiences, though stressful, do not cause schizophrenia, but can trigger its development in someone already vulnerable to it.

Drug abuseDrugs do not directly cause schizophrenia, but studies have shown drug misuse increases the risk of developing schizophrenia or a similar illness.Certain drugs, particularly cannabis, cocaine, LSD or amphetamines, may trigger some symptoms of schizophrenia, especially in people who are susceptible. Using amphetamines or cocaine can lead to psychosis and can cause a relapse in people recovering from an earlier episode.

Three major studies have shown teenagers under 15 who use cannabis regularly, especially ‘skunk’ and other more potent forms of the drug, are up to four times more likely to develop schizophrenia by the age of 26.

Slide16

DiagnosisThere is no single test for schizophrenia. The condition is usually diagnosed after assessment by a specialist in mental health.If you are concerned you may be developing symptoms of schizophrenia, see your GP as soon as possible. The earlier schizophrenia is treated, the more successful the outcome tends to be.Your GP will ask about your symptoms and check they are not the result of other causes, such as recreational drug use.Community mental health team (CMHT)If a diagnosis of schizophrenia is suspected, your GP will probably refer you to your local community mental health team (CMHT).CMHTs are made up of different mental health professionals who support people with complex mental health conditions.A member of the CMHT team, usually a psychologist or psychiatrist, will carry out a more detailed assessment of your symptoms. They will also want to know your personal history and current circumstances.

To make a diagnosis, most mental healthcare professionals use a 'diagnostic checklist', where the presence of certain symptoms and signs indicate a person has schizophrenia.Schizophrenia can usually be diagnosed if:

•You have at least two of the following symptoms: delusions, hallucinations, disordered thoughts or behaviour or the presence of negative symptoms, such as a flattening of emotions.

•Your symptoms have had a significant impact on your ability to work, study or perform daily tasks.

•You have experienced symptoms for more than six months.

•All other possible causes, such as recreational drug use or depression, have been ruled out.

Related illnesses

Sometimes, it might not be clear whether someone has schizophrenia. If you have other symptoms at the same time, a psychiatrist may have reason to believe you have a related mental illness.

There are several related mental illnesses similar to schizophrenia. Your psychiatrist will ask how your illness has affected you so they can confidently confirm you have schizophrenia and not another mental illness, such as:

•Bipolar disorder (manic depression). People with bipolar disorder swing from periods of mania (elevated moods and extremely active, excited behaviour) to periods of deep depression. Some people with bipolar disorder also hear voices or experience other kinds of hallucinations or may have delusions.

•Schizoaffective disorder. Schizoaffective disorder is often described as a form of schizophrenia because its symptoms are similar to schizophrenia and bipolar disorder. But schizoaffective disorder is a mental illness in its own right. It may occur just once in a person’s life or may recur intermittently, often when triggered by stress.

Getting help for someone elseDue to their delusional thought patterns, people with schizophrenia may be reluctant to visit their GP if they believe there is nothing wrong with them.It is likely someone who has had acute schizophrenic episodes in the past will have been assigned a care co-ordinator. If this is the case, contact the person's care co-ordinator to express your concerns.If someone is having an acute schizophrenic episode for the first time, it may be necessary for a friend, relative or other loved one to persuade them to visit their GP. In the case of a rapidly worsening schizophrenic episode, you may need to go to the accident and emergency (A&E) department where a duty psychiatrist will be available.If a person who is having an acute schizophrenic episode refuses to seek help and it is believed they present a risk to themselves or others, their nearest relative can request a mental health assessment is carried out.The social services department of your local authority can advise how to do this.In severe cases of schizophrenia, people can be compulsorily detained in hospital for assessment and treatment under the Mental Health Act (2007).After diagnosisIf you (or a friend or relative) are diagnosed with schizophrenia, you may feel anxious about what will happen. You may be worried about the stigma attached to the condition, or feel frightened and withdrawn. It is important to remember that a diagnosis can be a positive step towards getting good, straightforward information about the illness and the kinds of treatment and services available.

http://www.nhs.uk/Pages/HomePage.aspx

Slide17

TreatmentSchizophrenia is usually treated with an individually tailored combination of therapy and medication.Good schizophrenia care The National Institute for Health and Clinical Excellence (NICE) has produced guidelines for how people with schizophrenia should be cared for. NICE recommends anyone providing treatment and care for people with schizophrenia should:•develop a supportive relationship with patients and their carers •explain causes and treatment options to everyone, keep clinical language to a minimum, and provide written information at every stage of the process •enable easy access to assessment and treatment •work with patients, and their families and carers if they agree, to write advance statements (see below) about their mental and physical healthcare •take into account the needs of the patient’s family or carers and offer a carers' assessment.

•encourage patients and their families and carers to join self-help and support groups Most people with schizophrenia make a recovery, although many will experience the occasional return of symptoms (relapses).

With support and treatment, you may be able to manage your condition so it doesn't have a big impact on your life.

Spotting the signs of an acute schizophrenic episode

Learning to recognise the signs you are becoming unwell can help you manage your illness. These can include losing your appetite, feeling anxious or stressed or having disturbed sleep. You may also notice some milder symptoms developing, such as feeling suspicious or fearful, worrying about people’s motives, hearing voices quietly or occasionally, or finding concentration difficult. You may also want to ask someone you trust to tell you if they notice your behaviour changing.

Recognising initial signs of an acute schizophrenic episode can be useful, as it may be prevented through the use of antipsychotic medicines and extra support.

If you have another acute episode of schizophrenia, your written care plan should be followed, particularly any advance statement or crisis plan. Your care plan will include the likely signs of a developing relapse and the steps to take, including emergency contact numbers

Read about treating schizophrenia for information about advance statements.

Avoiding drugs and alcohol

While alcohol and drugs may provide short-term relief from your symptoms of schizophrenia, they are likely to make your symptoms worse in the long run. Alcohol can cause depression and psychosis, while illegal drugs may make your schizophrenia worse.

Drugs and alcohol can also react badly with antipsychotic medicines.

If you are currently using drugs or alcohol and finding it hard to stop, ask your care co-ordinator or GP for help.Taking your medicationIt is important to take your medication as prescribed, even if you start to feel better. Continuous medication can help prevent relapses. If you have questions or concerns about medication you are taking or any side effects, talk to your GP or care co-ordinator.It may also be useful to read the information leaflet that comes with the medication about possible interactions with other drugs or supplements. It is worth checking with your healthcare team if you plan to take any over-the-counter remedies, such as painkillers, or any nutritional supplements. This is because these can sometimes interfere with your medication.Regular reviewsAs part of the care programme approach, you will be in contact with your healthcare team regularly. A good relationship with the team means you can easily discuss your symptoms or concerns. The more the team knows, the more it can help you.Self-careSelf-care is an integral part of daily life. It means you take responsibility for your own health and wellbeing with support from those involved in your care.Self-care includes things you do each day to stay fit, maintain good physical and mental health, prevent illness or accidents, and effectively deal with minor ailments and long-term conditions.People living with long-term conditions can benefit enormously if they have support for self-care. They can live longer, have less pain, anxiety, depression and fatigue, have a better quality of life and are more active and independent.

http://www.nhs.uk/Pages/HomePage.aspx

Slide18

DementiaDementia is a common condition that affects about 800,000 people in the UK. Your risk of developing dementia increases as you get older, and the condition usually occurs in people over the age of 65.Dementia is a syndrome (a group of related symptoms) associated with an ongoing decline of the brain and its abilities. This includes problems with:•memory loss •thinking speed •mental agility •language •understanding •judgement People with dementia can become apathetic or uninterested in their usual activities, and have problems controlling their emotions. They may also find social situations challenging, lose interest in socialising, and aspects of their personality may change.

A person with dementia may lose empathy (understanding and compassion), they may see or hear things that other people do not (hallucinations), or they may make false claims or statements. As dementia affects a person's mental abilities, they may find planning and organising difficult. Maintaining their independence may also become a problem. A person with dementia will therefore usually need help from friends or relatives, including help with decision making.

Your GP will discuss the possible causes of memory loss with you, including dementia. Other symptoms can include:

•increasing difficulties with tasks and activities that require concentration and planning

•depression

•changes in personality and mood

•periods of mental confusion

•difficulty finding the right words Most types of dementia can't be cured, but if it is detected early there are ways you can slow it down and maintain mental function.

Dementia is not a disease but a collection of symptoms that result from damage to the brain. These symptoms can be caused by a number of conditions. The most common cause of dementia is Alzheimer's disease.

Common symptoms of Alzheimer's disease and other forms of dementia include:

•memory loss, especially problems with memory for recent events, such as forgetting messages, remembering routes or names, and asking questions repetitively

•increasing difficulties with tasks and activities that require organisation and planning •becoming confused in unfamiliar environments •difficulty finding the right words •difficulty with numbers and/or handling money in shops •changes in personality and mood •depression Early symptoms of dementia are often mild and may get worse only very gradually. This means that the person with dementia and those around them may not notice these signs or take them seriously for some time. Also, people with dementia sometimes do not recognise that they have any symptoms.Dementia is progressive. This means that the person's brain will become more damaged and will work less well over time, and their symptoms will tend to change and become more severe. For this reason, it is important to talk to your GP sooner rather than later if you are worried that you may have problems with your memory.The speed at which symptoms get worse and the way that they develop will depend on the cause of the person's dementia, their overall health and their circumstances. This means that the symptoms and experience of dementia can vary greatly from person to person. Some people may also have more than one condition – for example, they may have Alzheimer's disease and vascular dementia at the same time.http://www.nhs.uk/Pages/HomePage.aspx

Slide19

As dementia progresses, memory loss and difficulties with communication often become very severe. In the later stages, the person is likely to neglect their own health and require constant care and attention.Memory symptoms in dementiaPeople with advanced dementia may not recognise close family and friends, they may not remember where they live or know where they are. They may find it impossible to understand simple pieces of information, carry out basic tasks or follow instructions. Communication problems in dementiaIt is common for people with dementia to have increasing difficulty speaking and they may eventually lose the ability to speak altogether. It is important to keep trying to communicate with them and to recognise and use other, non-verbal means of communication, such as expression, touch and gestures.Problems with mobility in dementiaMany people with dementia gradually become less able to move about unaided and may appear increasingly clumsy when carrying out everyday tasks. Some people may eventually be unable to walk and may become bedbound.

IncontinenceBladder incontinence is common in the later stages of dementia and some people will also experience bowel incontinence. Eating, appetite and weight loss

Loss of appetite and weight loss are common in the later stages of dementia. It's important that people with dementia get help at mealtimes to ensure they eat enough. Many people have trouble eating or swallowing and this can lead to choking, chest infections and other problems.

Diagnosis

If

you are worried about your memory or think you may have dementia, it's a good idea to see your GP. If you're worried about someone else, you should encourage them to make an appointment and perhaps suggest that you go along with them.

Just because you are forgetful, it doesn't mean you have dementia. Memory problems can also be caused by depression, stress, drug side effects, or other health problems. Your GP will be able to run through some simple checks and either reassure you, give you a diagnosis or refer you to a specialist for further tests.

A diagnosis of dementia affects both the person with the condition and those close to them. An early diagnosis gives you both the best chance to prepare and plan for the future, as well as receive any treatment that may be possible. With treatment and support, many people are able to lead active, fulfilling lives

.

Your

GP will ask about your symptoms and other aspects of your health, and will give you a physical examination. The doctor will organise some blood tests and ask about any medication you are taking, as these can sometimes cause symptoms similar to dementia.

You will also be asked some questions or given some mental exercises to measure any problems with your memory or your ability to think clearly.Find out more about the tests used to diagnose dementia.Referral to a dementia specialistDementia can be difficult to diagnose, especially if your symptoms are only mild. If your GP is unsure about your diagnosis, they will refer you to a specialist such as a neurologist (an expert in treating conditions that affect the brain and nervous system), an elderly care physician, or a psychiatrist with experience of treating dementia. The specialist may be based in a memory clinic alongside other professionals who are experts in diagnosing, caring for and advising people with dementia and their families.It's important to make good use of your consultation with the specialist. Write down questions you want to ask, make a note of any medical terms the doctor might use, and ask if you can come back if you think of any more questions you want to ask. Taking the opportunity to go back can be very helpful.The specialist will organise further tests, which may include brain scans such as a computerised tomography (CT) scan, or preferably a magnetic resonance imaging (MRI) scan.If they are still not certain about the diagnosis, you may need further brain scans, a lumbar puncture to measure levels of certain proteins in the spinal fluid or, rarely, an operation to remove a small sample of brain tissue for testing.Getting your dementia diagnosisOnce you've had the necessary tests, your doctor should ask you if you wish to know your diagnosis and if there is anyone else you would like to be told.They should explain what having dementia might mean for you, and should give you time to talk more about the condition and ask any questions you may have.

Unless you decide otherwise, your doctor or a member of their team should explain to you and your family:the type of dementia that you have, or if it is not clear, what the plan to further investigate will entail. Sometimes, despite investigations, a diagnosis may not be clear, in which case the doctors will review you again after a period of time to reassess you details about symptoms and how the illness might develop

treatments

care and support services in your area

support groups and voluntary organisations for people with dementia and their families and carers

advocacy services

where you can find financial and legal advice 

You should also be given written information about dementia.

http://www.nhs.uk/Pages/HomePage.aspx

Slide20

Dementia can affect the whole life of the person who has it, as well as their family. If you have been diagnosed with dementia, or you are caring for someone with the condition, remember that there is advice and support available to help you live well.Even if you have suspected for a while that you or someone you love might have dementia, the diagnosis may come as a shock. People with dementia should try to remain as independent as possible and continue to enjoy their usual activities.The symptoms of dementia will usually get gradually worse. How quickly this occurs will depend on the general health of the person with dementia and on the type of dementia they have.Over time, people with dementia will need help to cope at home and they may eventually need residential care in a nursing home. It is natural to feel worried about the future, but you are not alone – whether you have dementia or you care for someone with the condition. The NHS, social services and voluntary organisations can all provide advice and support to help you and your family.

Look after your healthLiving a healthy lifestyle is important for everyone, including people with dementia, and is the best way to help prevent dementia. Eating well and exercising are important for everyone to live well.

Changes in eating habits can occur, particularly if someone with dementia is struggling to find the words to ask for food, which can result in weight loss and poor nutrition

.

The Live Well section of NHS Choices has health and wellbeing information and advice for everyone.

Maintain a social life

It’s easy to feel isolated and alone if you or someone you care for has dementia. Keeping in contact with others is good for people with dementia because it helps them to keep active and stimulated. Some people find it difficult to talk about their own or a family member’s dementia, or want to help but don’t know how.

If a friend or a family member finds it hard to talk to you, don’t lose touch. Make the first move, explain that you still need to see them and tell them how they can help you. You may also find it helpful to join a local group of people with dementia and their families. You may not be someone who would normally join a group, but being part of a community of people with dementia or a group for families who have a member with dementia can be helpful. You are likely to be able to share experiences and gain insight and useful tips from others who are going through or have been through similar situations.

Practical tips

•keep a diary and write down things you want to remember

•pin a weekly timetable to the wall

•put your keys in an obvious place such as a large bowl in the hall •have a daily newspaper delivered to remind you of the date and day •put labels on cupboards or drawers •place helpful telephone numbers by the phone •write reminders to yourself – for example, put a note on the front door to take your keys •programme people’s names and numbers into your phone •install safety devices, such as gas detectors and smoke alarms •put bills on direct debit so you don't forget to pay them •a dosset box can be helpful for remembering which medications to take and when Try to sleep wellPeople with dementia often experience disturbed sleep. They may wake up during the night or be restless. These problems may get worse as the illness progresses. People with dementia may also have painful illnesses, such as arthritis, that cause, or contribute to, sleep problems.Some medication can cause sleepiness during the day and interfere with sleep at night. Sleeping pills can be used with care in people with dementia. However, "sleep hygiene" measures are best for people with dementia. These rules include having no naps during the day, keeping regular bedtimes and avoiding alcohol or caffeine at night.http://www.nhs.uk/Pages/HomePage.aspx

Slide21

Feeling downPeople with dementia can experience mood swings. They can feel sad or angry at times, or scared and frustrated as the disease progresses. If you or a family member have dementia, you may find it difficult to stay positive. Remember that you are not alone and that help and support are available. Talk to someone about your worries. This could be a family member or friend, a member of your local dementia support group or your GP, who can refer you to a counsellor in your area.If you are struggling to cope with low mood, stress or anxiety, you might find the NHS Choices Moodzone helpful. It contains practical, easy-to-understand information and advice on how to deal with mood-related problems. If you think someone with dementia is experiencing clinical depression, be sure to mention it to their GP.

Keep active and occupiedPeople with dementia should continue to enjoy their hobbies and interests. These activities are enjoyable and keep people alert and stimulated so they maintain an interest in life. Do not rule out an activity simply because you or your family member have dementia. Activities may change as the illness gets worse, but people with dementia can and should continue to enjoy their spare time.

Self care

Self care is an integral part of daily life and involves taking responsibility for your own health and wellbeing with the support of those involved in your care. It includes the actions you take every day to stay fit, maintain good physical and mental health and prevent illness or accidents, as well as the effective care of minor ailments and long-term conditions.

People living with long-term conditions can benefit enormously from receiving self care support. They can live longer, have less pain, anxiety, depression and fatigue, have a better quality of life and be more active and independent

.

Caring for Someone with Dementia

"From a carer's perspective, you go through stages. The first stage starts before the diagnosis. That's very awkward. It's a difficult time for the person with the illness and for the loved ones looking after them, as well as for the professionals. It's not an easy diagnosis, and it takes great skill and expertise. But if you're worried about the situation, don't put off finding out what's happening. Get it investigated.

"Then there's the stage after diagnosis. It's important to remember that this diagnosis isn't disastrous. Initially I thought it was, but it wasn't. And people with Alzheimer's don't become a different person overnight. It happens gradually, and people should be encouraged to live as normal and fruitful a life as possible, whatever a normal life means! Don't just sit there and do nothing.

"I'm a volunteer with the Manchester branch of the Alzheimer's Society. I joined in 1994 and help to run carer support groups. Carers are often on their own, and going to a support group gives them a chance to meet one another and release their emotions. They can also bring their loved ones along. We also have days out. Keeping people out of isolation is so important, because carers tend to become isolated. Judging from my own experience, you tend to keep to yourself.

"I'd say that one of the best things carers can do is join carer support groups. Meet other carers, share experiences and support one another. You can learn an awful lot."

http://www.nhs.uk/Pages/HomePage.aspx

Slide22

OCDObsessive compulsive disorder (OCD) is a mental health condition where a person has obsessive thoughts and compulsive behaviour. An obsession is an unwanted, unpleasant thought, image or urge that repeatedly enters a person's mind, causing them anxiety.The word "obsession" usually describes something enjoyable, but in OCD the obsession is unpleasant and frightening.A compulsion is a repetitive behaviour or mental act that someone feels they need to carry out to try to prevent an obsession coming true. For example, someone who is obsessively scared they will catch a disease may feel the need to have a shower every time they use a toilet.Obsessive compulsive disorder (OCD) affects people differently, but usually causes a particular pattern of thought and behaviour.Most people with OCD tend to follow a set pattern of thought and behaviour. This pattern has four main steps:

obsession – where your mind is overwhelmed by a constant obsessive fear or concern, such as the fear your house will be burgled anxiety – the obsession provokes a feeling of intense anxiety and distress compulsion

 – you then adopt a pattern of compulsive behaviour to reduce your anxiety and distress, such as checking all the windows and doors are locked at least three times before you leave your house

temporary relief

 – the compulsive behaviour brings temporary relief from anxiety, but the obsession and anxiety soon return, causing the pattern or cycle to begin again

Obsessive thoughts

Almost everyone has unpleasant or unwanted thoughts at some point in their life, such as a nagging worry that their job may not be secure, or a brief suspicion their partner has been unfaithful.

Most people are able to put these types of thoughts and concerns into context, and they can carry on with their day-to-day life. They do not repeatedly think about worries they know have little substance.

However, if you have a persistent, unwanted and unpleasant thought that dominates your thinking to the extent it interrupts other thoughts, you may have developed an obsession.

Some common obsessions that affect people with OCD include:

fear of deliberately harming yourself or others

 – for example, fear you may attack someone else, even though this type of behaviour disgusts you fear of harming yourself or others by mistake or accident – for example, fear you may set the house on fire by accidentally leaving the cooker on, which leads you to repeatedly check kitchen appliances are off fear of contamination by disease, infection or an unpleasant substance a need for symmetry or orderliness – for example, you may feel the need to ensure all the labels on the tins in your cupboard face the same way fear of committing an act that would seriously offend your religious beliefs Compulsive behaviourCompulsions arise as a way of trying to reduce or prevent the harm of the obsessive thought. However, this behaviour is either excessive or not realistically connected at all.For example, a person who fears becoming contaminated with dirt and germs may wash their hands 50 times a day, or someone with a fear of causing harm to their family may have the urge to repeat an action multiple times to try to "neutralise" the thought of harm. This latter type of compulsive behaviour is particularly common in children with OCD. Most people with OCD realise that such compulsive behaviour is irrational and makes no logical sense, but they cannot stop acting on their compulsion.Some common types of compulsive behaviour that affect people with OCD include:

cleaning handwashing

checking (such as checking doors are locked, or that the gas or a tap is off) 

counting

ordering and arranging

hoarding 

asking for reassurance

needing to confess

repeating words silently

prolonged thoughts about the same subject

"neutralising" thoughts (to counter the obsessive thoughts)

Symptoms

Despite much research being carried out into obsessive compulsive disorder (OCD), the exact cause of the condition has not yet been identified.

However, in certain individuals OCD is thought to be triggered by a combination of genetic, neurological, behavioural and environmental factors.

Genetics

Genetics is thought to play a part in some cases of OCD. Research suggests OCD may be the result of certain inherited genes (units of genetic material) that affect the development of the brain.

Although no specific genes have been linked to OCD, there is some evidence that suggests the condition runs in families. A person with OCD is four times more likely to have another family member with the condition compared with someone who does not have OCD

.

http://www.nhs.uk/Pages/HomePage.aspx

Slide23

Genetic and family studies have also shown OCD may be related to other conditions such as:tics – rapid, repeated, involuntary contractions of a group of muscles Tourette's syndrome – a condition that causes a person to make repetitive movements or sounds Some people with OCD may also have tics or Tourette's syndrome.Brain abnormalities Brain imaging studies have shown that people with OCD have abnormalities in some parts of their brain, including increased activity and blood flow, and a lack of the brain chemical serotonin. The areas of the brain affected deal with strong emotions and how we respond to those emotions. In the studies, brain activity returned to normal after successful treatment with cognitive behavioural therapy (CBT) or selective serotonin reuptake inhibitors (SSRIs).

SerotoninSerotonin also seems to play a part in OCD. It is a chemical in the brain (neurotransmitter) that transmits information from one brain cell to another. Serotonin is responsible for regulating a number of the body's functions, including mood, anxiety, memory and sleep.

It is not known for sure how serotonin contributes to OCD, but people with the condition appear to have decreased levels of the chemical in their brain.

Medication that increases the levels of serotonin in the brain, such as certain types of antidepressant, have proven effective in treating the symptoms of OCD.

Life events

An important life event such as a bereavement or family break-up may trigger OCD in people who already have a tendency to develop the condition (for example, due to genetic factors).

A life event can also affect the course of your condition. For example, the death of a loved one may trigger a fear that someone in your family will be harmed.

Stress, which can also be caused by life events, seems to make the symptoms of OCD worse. However, stress does not cause OCD on its own.

Parenting and family

OCD is not thought to be linked to upbringing, but certain factors such as having overprotective parents could increase your chances of developing OCD. 

Sometimes it can be unhelpful if a family member of someone with OCD intervenes. For example, a person with OCD may ask a member of their family for constant reassurance about one of their fears, such as whether they have locked the door.

If the family member continually reassures them that they have done something in order to make them feel better, it may prevent them seeking the help and treatment they need.DiagnosisIt is very important you visit your GP if you have symptoms of obsessive compulsive disorder (OCD).Many people with OCD do not report their symptoms to their GP because they feel ashamed or embarrassed. They may also try to disguise their symptoms from family and friends.However, if you have OCD, you should not feel ashamed or embarrassed. Like diabetes or asthma, OCD is a chronic (long-term) health condition, and it is not your fault you have it.Initial screeningWhen visiting your GP, they will probably ask a series of questions.The questions, which are part of the

Fineberg-Zohar screening questionnaire, will help determine whether you are likely to have OCD. But like all screening questionnaires, people who do not have OCD may score positively.The questions you will be asked may be similar to those listed below:

do you wash or clean a lot?

do you check things a lot?

do you have thoughts that keep bothering you that you would like to get rid of but cannot?

do your daily activities take a long time to finish?

are you concerned about putting things in a special order or are you upset by mess?

do these problems trouble you?

Assessment

If the results of the initial screening questions suggest you have OCD, the severity of your symptoms will be assessed either by your GP or a mental health professional.

There are several different methods of assessment. All involve asking detailed questions to find out how much of your day-to-day life is affected by obsessive-compulsive thoughts and behaviour.

During the assessment, it is important you are open and honest, as accurate and truthful responses will ensure you receive the most appropriate treatment.

Severity of OCD

The severity of OCD can be determined by how much your symptoms affect your ability to function normally on a day-to-day basis.

Healthcare professionals refer to the disruption of daily function as functional impairment. OCD is classified into three levels of severity. They are:

mild functional impairment

 – obsessive thinking and compulsive behaviour that occupies less than one hour of your day

moderate functional impairment

 – obsessive thinking and compulsive behaviour that occupies one to three hours of your day

severe functional impairment

 – obsessive thinking and compulsive behaviour that occupies more than three hours of your day

Getting help for others

The friends and relatives of a person with OCD sometimes "play along" with their strange behaviour to avoid upsetting them.

However, this is not recommended because it can reinforce the person's obsessive-compulsive behaviour. It is better to confront them with the reality of their unusual behaviour and suggest they seek medical advice.

Slide24

TreatmentIf you have obsessive compulsive disorder (OCD), your treatment will depend on the how much the condition is affecting your ability to function.As OCD develops, the unwelcome and obsessive fears that can be overwhelming vary from person to person. This is also the case for the compulsive behaviour people use to try to control their fears.How much impact OCD has on a person's life depends on:•the amount of time spent on a compulsive behaviour or ritual •the intensity of the behaviour •how much of it happens in their mind, rather than in their actions Your treatment planYour treatment programme is likely to involve:•behavioural therapy – to change the way you behave and reduce your anxiety

•medication – to control your symptoms Healthcare professionals refer to the disruption of daily function as functional impairment.OCD that causes mild functional impairment is usually treated with a short course of cognitive behavioural therapy (CBT). CBT is a talking therapy that can help you manage your problems by changing the way you think and behave.

If you have OCD that causes moderate functional impairment, it may be recommended that you have a more intensive course of CBT, or a type of antidepressant medication known as selective

seretonin

reuptake inhibitors (SSRIs). You may also be referred to a specialist mental health service.

If your OCD causes severe functional impairment, you will be referred to a specialist mental health service for a combination of intensive CBT and a course of SSRIs.

Children with OCD are usually referred to a healthcare professional with experience of treating OCD in children.

Behavioural therapy

CBT that involves graded exposure and response prevention (ERP) has been shown to be an effective treatment for OCD.

Exposure and response prevention (ERP)

ERP involves identifying a number of situations that cause you anxiety. These are placed in order from the situations that cause you the most to the least anxiety.

You and your therapist will identify tasks that will expose you to the situations that cause anxiety, but at a level you can cope with. You need to do the exposure tasks without carrying out your anxiety-relieving compulsions (the actions you usually take to help you cope with the situation). Although this sounds frightening, people with OCD find that when they confront their anxiety without carrying out their compulsion, the anxiety disappears completely in one to two hours. The same exposure task should be repeated two to three times a day. Each time, the anxiety is likely to be less and last for a shorter period of time. Once you have conquered one exposure task, you can move onto a more difficult task, until you have overcome all of the situations that make you anxious. People with mild to moderate OCD usually need about 10 hours of therapist treatment, combined with self-treatment exposure exercises between sessions. Those with moderate to severe OCD may need a more intensive course of CBT that lasts longer than 10 hours.MedicationYou may need medication if CBT fails to treat mild OCD, or if you have moderate or severe OCD. The different types of medication you may be prescribed are discussed below.

Selective serotonin reuptake inhibitors (SSRIs)Selective serotonin reuptake inhibitors (SSRIs) are a type of antidepressant that increase the levels of a chemical called serotonin in your brain. Serotonin is a neurotransmitter that the brain uses to transmit information from one brain cell to another.

Possible SSRIs that you may be prescribed include:

•fluoxetine

•fluvoxamine

•paroxetine

•sertraline

•citalopram

•

escitalopram

http://www.nhs.uk/Pages/HomePage.aspx

Slide25

Support groupsMany people with OCD find support groups helpful, as they can:•give you reassurance •reduce feelings of isolation you may have •give you a chance to socialise with others Support groups can also provide information and advice for family members and friends who may be affected by your condition. OCD Action and OCD-UK are both national charities for OCD that can provide information about support groups in your area. You can find information on their websites at the links below:

•OCD Action support groups

•OCD-UK support groups

Surgery

Surgery is the very last resort for treating severe OCD when all other forms of treatment have failed. It should not be considered at all until someone has

:

•received at least two full trials of different SSRIs or clomipramine at recommended doses

•had treatment for refractory OCD (OCD that does not respond to treatment) as well as antipsychotic medication or higher doses of SSRIs or mood stabilisers

•received unsuccessful CBT treatments both in a clinic and at home, as well as having been treated by the National Service for Refractory OCD

National Service for Refractory OCD

After the National Institute for Health and Clinical Excellence (NICE) published guidelines in 2005, the Department of Health (DH) commissioned a centre to treat people with severe, long-term refractory OCD. The National Service for Refractory OCD has been funded by the DH since April 2007 to treat people with the most severe form of the condition.

The National Service offers assessment and treatment to people with OCD who have not responded to treatments provided by their local and regional OCD speciality services. To be eligible for the National Service, you must have had a number of previous treatments and meet the severity criteria. Most people improve after receiving treatment from the National Service. Very few people, perhaps one to two a year, may be considered for neurosurgery.Many people with obsessive compulsive disorder (OCD) can trace some of their anxieties and compulsions back to their childhood.On average, compulsions start to interfere significantly with a person's life when they are 17-20 years of age. However, it can be as early as five years of age or as late as 70.The unwelcome and obsessive fears that threaten to become overwhelming as the condition develops vary from person to person. So too does the compulsive behaviour that the person uses to try to control the fears.

How much impact OCD has on a person's life depends on:•the amount of time spent on a compulsive behaviour or ritual •the intensity of the behaviour

•how much of it happens in their mind rather than in their actions

Rituals that involve checking can affect different people in different ways. For example, when leaving the house, a person with OCD might shut the door behind them and then think about it again and again for much of the day.

Their worry about the door being properly locked is constant, and so is the misery and depression that goes with it. Despite this, some people with OCD are able to hold down demanding jobs.

For others, the behaviour can take up all of their focus. When they try to leave the house they get stuck in the hallway, repeatedly checking the lock. In the most extreme cases, the anxiety and the thought of carrying out these rituals can prevent a person from moving for hours.

Supporting family members with OCD

Naturally, family members of someone who is openly affected by these behaviours will want to help. For a person who has not had mental health training and is unaware of the treatment options, this usually means trying to share the load. For instance, they may take on some of the rituals of a compulsive cleaner or checker.

This might seem the natural thing to do, but the whole family may end up constantly trying to protect the person with OCD from their own fears. However, this is counter-productive because the problem is not resolved and there is no hope of moving on. In this way, the whole family 'suffers from OCD'.

The best approach is to help the person with OCD to seek treatment and to support them as they change and recover. Once therapy has begun, the contribution and support of a partner is invaluable.

Sometimes, the person with OCD can feel embarrassed or ashamed and they will try to hide their rituals from others. When this involves a physical activity, such as hand washing, the first sign that something is wrong may be the appearance of their hands, or the length of time they spend in the bathroom. Mental rituals are often more difficult to notice.

Fortunately, when someone with OCD decides to get help, a good GP will be able to recognise the signs and seek further advice and support from specialists.

Slide26

AutismAutism spectrum disorder (ASD) is a condition that affects social interaction, communication, interests and behaviour. It includes Asperger syndrome and childhood autism. Some people also use the term autism spectrum condition or ‘neurodiverse’ (as opposed to people without autism being ‘neurotypical’). The main features of ASD typically start to develop in childhood, although the impact of these may not be apparent until there is a significant change in the person’s life, such as a change of school. In the UK, it's estimated that about one in every 100 people has ASD. There is no 'cure' for ASD, but a wide range of treatments – including education and behaviour support – can help people with the condition.

SymptomsAutism spectrum disorder (ASD) can cause a wide range of symptoms, and there are many different ways those symptoms can be grouped.

It is useful for parents to know the signs and symptoms of autism and Asperger syndrome that are related to their child’s stages of development.

See your GP if you notice any of the symptoms of ASD or if you’re concerned about your child’s development. You can discuss your concerns together in depth before deciding whether your child should be referred for a specialist assessment.

Read more about

diagnosing autism spectrum disorder

.

Signs of ASD in pre-school childrenThe features of ASD that often develop in pre-school children are explained below.Spoken languagedelayed speech development (for example, not speaking at least 10 different words by the age of two), or not speaking at

all frequent

repetition of set words and

phrases speech

that sounds very monotonous or flat preferring to communicate using single words, despite being able to speak in sentencesResponding to othersnot responding to their name being called, despite having normal hearingrejecting cuddles initiated by a parent or carer (although they may initiate cuddles themselves) reacting unusually negatively when asked to do something by someone elseInteracting with othersnot being aware of other people’s personal space, or being unusually intolerant of people entering their own personal spacelittle interest in interacting with other people, including children of a similar agenot enjoying situations that most children their age like, such as birthday partiespreferring to play alone, rather than asking others to play with themrarely using gestures (such as pointing) or facial expressions when communicatingavoiding eye contactBehaviourhaving repetitive movements such as flapping their hands, rocking back and forth or flicking their fingers playing with toys in a repetitive and unimaginative way, such as lining blocks up in order of size or colour, rather than using them to build somethingpreferring to have a familiar routine, and getting extremely upset if there are changes to their normal routine having a strong like or dislike of certain foods, based on the texture or colour of the food as much as the tasteSigns and symptoms of ASD in school-age childrenFeatures of ASD that can develop in older children and teenagers are explained below.

Spoken languagepreferring to avoid using spoken language speech that sounds very monotonous or flat speaking

in pre-learned phrases, rather than putting together individual words to form new

sentences seeming

to talk ‘at’ people, rather than sharing a two-way conversation

Responding to others

taking people’s speech literally and being unable to understand sarcasm, metaphors or figures of speech

reacting

unusually negatively when asked to do something by someone else

Interacting with others

not being aware of other people’s personal space, or being unusually intolerant of people entering their own personal

space little

interest in interacting with other people, including children of a similar age, or having few close friends despite attempts to form

friendships not

understanding how people normally interact socially, such as greeting people or wishing them

farewell being

unable to adapt the tone and content of their speech to different social situations, for example speaking very formally at a party and then speaking to total strangers in a familiar way

not enjoying situations and activities that most children their age

like rarely

using gestures or facial expressions when

communicating avoiding

eye contact

Behaviour

having repetitive movements such as flapping their fingers, rocking back and forth or flicking their

fingers playing

in a repetitive and unimaginative way, often preferring to play with objects rather than

people developing

a highly specific interest in a particular subject or

activity preferring

to have a familiar routine, and getting extremely upset if there are changes to their normal

routine having

a strong like or dislike of certain foods, based on the texture or colour of the food as much as the taste 

http://www.nhs.uk/Pages/HomePage.aspx

Slide27

CausesThe exact causes of autism spectrum disorder (ASD) are unknown, although it is thought that several complex genetic and environmental factors are involved.The causes of ASD can be described in two ways:•Primary ASD (also known as idiopathic ASD) – where no underlying factors can be identified to explain why ASD has developed. •Secondary ASD – where an underlying medical condition or environmental factor thought to increase the risk of ASD is identified. About 90% of cases of ASD are primary, and about 10% are secondary.Risk factorsFactors thought to increase the risk of developing ASD, known as ‘risk factors’, can usually be divided into five main categories:•Genetic factors – certain genetic mutations may make a child more likely to develop ASD. •Environmental factors – during pregnancy, a child may be exposed to certain environmental factors that could increase the risk of developing ASD.

•Psychological factors – people with ASD may think in certain ways that contribute towards their symptoms. •Neurological factors – specific problems with the development of the brain and nervous system could contribute to the symptoms of ASD.

•Other health conditions – certain health conditions associated with higher rates of ASD.

Each of these factors is described in more detail below.

Genetic factors

Most researchers believe that certain genes a child inherits from their parents could make them more vulnerable to developing ASD

.

Cases of ASD have been known to run in families. For example, younger siblings of children with ASD have an increased risk of developing the condition themselves and it is common for identical twins to both develop ASD.

At present, however, no specific genes linked to ASD have been identified and there are currently no tests that can screen for 'ASD genes'. However, the specialist seeing your child may screen them for genetic conditions that have similar features to ASD, depending on any additional symptoms your child has.

Environmental factors

Some researchers have argued that ASD is not primarily caused by genes, but also by environmental factors. The theory is that a person is born with a vulnerability to ASD, but the condition develops only if that person is exposed to a specific environmental trigger

.Some suggested environmental factors include being born before 35 weeks of pregnancy (premature birth) and exposure to alcohol or medications such as sodium valproate (a medication sometimes used to treat epilepsy) during pregnancy.No conclusive evidence has been found linking pollution or maternal infections in pregnancy with an increased risk of ASD.Psychological factorsMuch of the research into the possible psychological factors behind ASD is based on a concept known as 'theory of mind' (TOM). This is a person's ability to understand other people's mental states, recognising that each person they meet has their own set of intentions, beliefs, emotions, likes and dislikes. To put it simply, it's seeing the world through another person's eyes.It is thought that most children without ASD have a full understanding of theory of mind by around the age of four. Children with ASD develop a limited understanding or no understanding at all of theory of mind

.This may be one of the root causes of their problems with social interaction and may explain some of the psychological features of ASD, such as a tendency towards needing an order or routine and getting lost in detail

Diagnosis

In

most cases, parents notice the symptoms of autism spectrum disorder (ASD) when their child is around two or three years old.

In some instances, mild cases may not be detected until adulthood.

Diagnosing ASD in children

If you are worried about your child's development, visit your GP. If appropriate, they can refer you to a health professional or team who may specialise in diagnosing ASD, or someone who has access to such a team. They will make a more in-depth assessment.

This health professional may be:

a psychologist

 – a health professional with a psychology degree, plus further training and qualifications in psychology

a psychiatrist

 – a medically qualified doctor with further training in 

psychiatry

a paediatrician

 – a doctor who specialises in treating children

a speech and language therapist

– a specialist in recognising and treating communication problems

Some local health authorities now use multidisciplinary teams. These are made up of a combination of professionals who work together to make an assessment

.

Slide28

AssessmentThere are no individual tests to confirm a diagnosis of ASD, a diagnosis is instead based on the range of features your child is showing. The type of assessment carried out often depends on things such as access to additional information (for example nursery or school records) and the skills of the professional or team seeing your child. TreatmentThere is currently no 'cure' for autism spectrum disorder (ASD). However, a range of specialist education and behavioural programmes (often referred to as interventions) can be effective in improving the skills of children with ASD.There are many different types of intervention for ASD and it can be hard to judge which one will work best for your child as each person with ASD is affected differently.Some types of intervention can involve hours of intensive work, and this is not always possible for many families because of the practical, emotional and financial commitments necessary.

The National Autism Society website has information on the many different approaches, therapies and interventions available for ASD.Any intervention should focus on important aspects of your child's development. These are:communication skills

– such as the ability to start conversations

social interaction skills

– such as the ability to understand other people's feelings and respond to them

cognitive skills

– such as encouraging imaginative play academic skills

– the ‘traditional’ skills a child needs to progress with their education, such as reading, writing and maths Treatment for ASD often involves a team of different specialists working together, such as a paediatrician, a psychologist, a psychiatrist, a speech and language therapist and an occupational therapist.Some of the main treatments used for ASD are explained below.

Social-communication programmes

Your child may be offered a type of programme called a 'social-communication intervention'. This aims to help them communicate and interact with people and make social situations easier.

Depending on your child's age, these programmes may take place at school, or with a parent, carer or teacher

.Applied behaviour analysis (ABA)Applied behaviour analysis (ABA) involves breaking down skills (such as communication and cognitive skills) into small tasks and teaching those tasks in a highly structured way, as well as rewarding and reinforcing positive behaviour while discouraging inappropriate behaviour.ABA sessions are normally carried out at home, although some programmes can be integrated into schools or nurseries.An ABA programme usually begins with simple tasks that become more complex over time, which can help your child's development by gradually improving their skills. There are concerns from some health professionals about the intensity of certain ABA-based programmes and some professionals feel it is not always clear how useful the skills gained are outside of some highly structured programmes. However, there is good evidence to suggest early intervention programmes that integrate with education can be beneficial.Read more about ABA and early intensive behavioural intervention (EIBI) on the Research Autism website.TEACCHTEACCH (Treatment and Education of Autistic and Related Communication Handicapped Children) is a type of educational intervention that places great emphasis on structured learning by using visual prompts. This is because research has found that children with ASD often respond better to information that is presented visually.TEACCH is often delivered at special day centres, but you can also have training so you can continue the intervention activities at home.

Read more about TEACCH on the Research Autism website.Parent education and training

The parents of a child with ASD play a crucial role in supporting their child and helping them improve their skills.

If your child is diagnosed with ASD, it can be useful to find out as much as you can about life with the condition. The National Autistic Society has an excellent range of resources and advice about living with autism on its website.

Communication advice for parents

Communication is a particular challenge for children with ASD. Helping your child communicate can lead to reduced anxiety and improved behaviour.

You may find the following tips useful when communicating and interacting with your child:

use your child’s name so they know you are addressing them

keep background noise to a minimum

keep language simple

speak slowly and clearly with pauses between words

accompany what you say with simple gestures

allow extra time for your child to process what you have said 

Parent support programmes

For more in-depth advice, there are some programmes specifically designed to help parents of children recently diagnosed with ASD, such as the

EarlyBird

programme provided by the National Autism Society.

This is a free three-month course for families with a child who has been diagnosed with ASD but has not yet started school.

The programme aims to support and inform parents, as well as offering practical advice about looking after a child with ASD and helping to improve their skills.

Slide29

Tourette’s SyndromeTourette’s syndrome is a neurological condition (affecting the brain and nervous system) that is characterised by a combination of involuntary noises and movements called tics. The syndrome usually starts during childhood and continues into adulthood. In many cases it runs in families and it is often associated with obsessive compulsive disorder (OCD) or attention deficit hyperactivity disorder (ADHD).Tourette’s syndrome is named after the French doctor, Georges Gilles de la Tourette, who first described the syndrome and its symptoms in the 19th century.If your child has tics, it does not necessarily mean that they have Tourette’s syndrome.Children often develop tics before growing out of them after several months. These are known as transient tics.For tics to be classified as Tourette’s syndrome, they have to be present for at least a year and include at least one vocal tic.

Tics can be:vocal (sounds) – such as grunting, coughing or shouting out words physical (movements) – such as jerking of the head or jumping up and down

Tics can also be:

simple

 – for example, making a small movement or uttering a single sound

complex –

for example, making a series of movements or speaking a long phrase Most people who are diagnosed with Tourette’s syndrome have a combination of physical and vocal tics, which can be both simple and complex.

Simple vocal ticsExamples of simple vocal tics include:grunting clearing the throat coughing

screaming

sniffing

squeaking

blowing Simple physical ticsExamples of simple physical tics include:blinking jerking the head twitching the nose teeth grinding  rolling the eyes twisting the neck rotating the shoulders Complex vocal ticsExamples of complex vocal tics include:repeating other people’s phrases (echolalia) repeating the same phrase over and over again (palilalia) swearing loudly or shouting inappropriate words and phrases (coprolalia) Swearing is often associated with Tourette’s syndrome, but it is actually a fairly uncommon symptom that affects a minority of people with the syndrome.Complex physical ticsExamples of complex physical tics include:shaking the head

hitting or kicking objects jumping shaking

touching themselves or others

copying the movements of others (

echopraxia

)

making obscene gestures, such as giving someone 'the finger' (

copropraxia

)

Premonitory sensations

Most people with Tourette’s syndrome experience uncomfortable or unusual feelings before having a tic. These feelings are known as premonitory sensations.

Premonitory sensations are only relieved after the tic has been carried out, in a similar way to how an itch can only be relieved by scratching it.

Examples of premonitory sensations include:

a burning feeling in the eyes that feels as if it can only be relieved by blinking

tension in a muscle that can only be relieved by twitching or stretching the muscle

a dry or sore throat that can only be relieved by grunting or by clearing the throat

an itchy joint or limb that can only be relieved by twisting the joint or limb

Pattern of tics

If your child has Tourette’s syndrome, their tics will probably tend to follow a set pattern. They may be worse during periods of:

stress

anxiety

tiredness

illness

nervous excitement

relaxation after a busy day 

On the other hand, the tics are often reduced when they are doing an enjoyable activity that involves a high level of concentration such as reading an interesting book or playing competitive sports.

You may find that your child is able to control their tics when they are in situations where they would be particularly noticeable, such as in a school classroom. However, controlling tics can be difficult and tiring over prolonged periods of time.

Many children with Tourette’s syndrome often experience a sudden 'release' of tics after trying to suppress them – for example, after returning home from school

.

Slide30

CausesThe cause of Tourette’s syndrome is unknown. However, it is thought to be linked to problems with an area of the brain known as the basal ganglia.Basal gangliaThe basal ganglia are a group of specialised brain cells located deep inside the brain. The cells help regulate the body's movements.Research suggests that the basal ganglia may also play a role in higher brain functions such as motivation and decision making.In people with Tourette’s syndrome, it appears that tics are the result of a temporary problem that occurs inside the basal ganglia and disrupts the decision-making process.The person suddenly develops an unconscious urge to perform an action (the tic) that the conscious mind regards as both unwanted and unexplained.It is not known what actually goes wrong with the basal ganglia. One theory suggests that excessive levels of a naturally occurring chemical called dopamine, which can have powerful effects on the brain, could be responsible.Alternatively, the dopamine levels could be normal in people with Tourette’s syndrome, but they may be particularly sensitive to its effects.

Brain imaging studies have also shown that the structure of the basal ganglia is different in people with Tourette’s syndrome. However, it is unclear whether these changes are due to a dopamine imbalance or sensitivity, or the cause of it.Possible triggersAs with the cause of Tourette’s syndrome, it is not known what triggers it. There are several theories, which are outlined below.

Genetics

Genetics appears to play a part in some cases of Tourette’s syndrome, as it often runs in families.

Further evidence suggests that if one identical twin develops Tourette’s syndrome, there is about a 1 in 2 chance that the other twin will also develop it.

It may be that a genetic mutation disrupts the normal development of the brain, triggering the symptoms of Tourette’s syndrome. A genetic mutation is where the instructions contained in all living cells become scrambled in some way.

Childhood

infectionAnother theory is that Tourette’s syndrome may be linked to a childhood infection by streptococcal bacteria (bacteria that usually cause a sore throat).

In an attempt to fight off the infection, the immune system produces antibodies (proteins). The antibodies may interact with brain tissue, affecting the brain's functioning.

Following a throat infection, some children have developed the symptoms of Tourette’s syndrome, as well as the symptoms of obsessive compulsive disorder (OCD).

Some doctors believe that this may be a separate condition in its own right and have called it 'paediatric autoimmune neuropsychiatric disorders associated with streptococcal infections', or PANDAS for short

.DiagnosisThe first stage in diagnosing Tourette’s syndrome is to rule out other possible causes of your child’s symptoms.Other possible causes include:allergies – if they are sniffing and coughing vision problems – if they are blinking more than usual It is also necessary to rule out other conditions that can cause tic-like behaviours, such as: autistic spectrum disorder – a developmental disorder that causes problems with social interaction, learning and behaviour, and may cause mannerisms or stereotypies (repetitive movements) that can be mistaken for tics  dystonia – a condition that causes involuntary muscle spasms  To help rule out these conditions, your child may be referred to a number of experts, such as: a neurologist – a doctor who specialises in treating conditions that affect the brain and nervous system

a psychiatrist – a doctor who specialises in treating mental health conditions

an educational or clinical psychologist

 – healthcare professionals who work with children who have learning, developmental or behavioural difficulties

Brain-imaging scans can also be used to check for any brain or nervous system abnormalities that could suggest a neurological cause for your child’s symptoms, other than Tourette’s syndrome. However, most children with tics or Tourette’s syndrome do not require a brain scan.

Scans that can be used include a:

computerised tomography (CT) scan – where a series of X-rays are taken to build up a detailed 3D image of the brain

magnetic resonance imaging (MRI) scan – where strong magnetic fields are used to produce a detailed image of the inside of the brain

Confirming the diagnosis

There is currently no single test for Tourette’s syndrome. A diagnosis can only be made by assessing your child’s symptoms to see whether they follow the pattern that is usually associated with the syndrome.

A confident diagnosis of Tourette’s syndrome can usually be made if your child:

has symptoms that are not being caused by other medical conditions or any medication you are taking

started having tics before 18 years of age

has had several physical tics and at least one vocal tic

has tics that occur many times during the day, virtually every day

has been having tics for at least a year

http://www.nhs.uk/Pages/HomePage.aspx

Slide31

There are several treatment options available for people with Tourette's syndrome.Treatment planThe first and most important part of treatment for Tourette's syndrome is to ensure that you, your child and, if needed, your child’s teachers, friends and other family members all have good information and knowledge about the condition. This includes:•being able to explain Tourette’s syndrome to others if asked about tics •understanding that tics are not ‘put on’ •understanding that tics come and go and that sometimes they may be better than at other times •knowing that having tics does not generally stop you doing anything you want to do •knowing that treatments may help to relieve tics, but are unlikely to make them go away completely •being aware that most people ‘outgrow’ tics by the time they reach adulthood Next, the treatment plan for tics could involve one or more of the following:

•treatments that do not involve taking medication – such as behavioural therapy •medication – the three types of medication that may be prescribed are alpha2-adrenergic agonists, muscle relaxants and dopamine antagonists •surgery – in very rare, severe cases, surgical techniques may be suitable

Non-medical treatments alone, such as behavioural therapy, may be needed if the tics are relatively mild and infrequent.

In cases where a person's tics are more severe and disrupt day-to-day activities, a combination of therapy and medication may be recommended.

Surgery is usually only recommended as a 'treatment of last resort' if the tics are very severe and fail to respond to other treatment.

The doctor in charge of your or your child’s care, usually a neurologist (a brain and nervous system specialist), will recommend what they think is the best treatment option. However, the final decision will be yours.

If your child is old enough to understand fully the implications of their decision, they will be asked to decide what treatment they would prefer.

Detecting and treating mental health problems associated with Tourette’s syndrome, such as obsessive compulsive disorder (OCD), attention-deficit hyperactivity disorder (ADHD), depression and anxiety, is often seen as more important than treating the tics.

Behavioural therapy

Behavioural therapy is a widely used non-medical treatment for Tourette’s syndrome. It is a type of psychological treatment that is designed to change the pattern of your or your child’s behaviour.

Habit reversal

Habit reversal is a type of behavioural therapy that has proved successful in treating Tourette’s syndrome. It is based on the following two principles:•people with Tourette’s syndrome are often unaware of their tics •tics are used to relieve uncomfortable feelings, called premonitory sensations, that build up before tics The first stage is to monitor the pattern and frequency of the tics, and identify any sensations that are triggering them. The next stage is to find an alternative, less noticeable method of relieving the premonitory sensations instead of a tic. This is known as a competing response.http://www.nhs.uk/Pages/HomePage.aspx

Slide32

For example, your child may experience an unpleasant sensation in their throat that causes them to grunt. Therefore, the next time your child feels the unpleasant sensation, they are asked to take a series of deep breaths rather than grunting, to try to relieve the sensation.Habit reversal is often combined with relaxation therapy. Relaxation techniques, such as deep breathing or visualisation (thinking about something pleasant as a distraction), can help prevent feelings of stress and anxiety, which can often make tics worse.Exposure and response prevention (ERP)Exposure and response prevention (ERP) involves increasing exposure to the urge to tic in order to suppress the tic response for longer. This works on the theory that you get used to the feeling of needing to tic until the urge, and any related anxiety, decreases in strength.MedicationAlpha2-adrenergic agonistsAlpha2-adrenergic agonists are usually recommended for treatment of mild to moderate symptoms of Tourette’s syndrome.This type of medication is thought to stabilise levels of a brain chemical called norepinephrine. This is thought to decrease the risk of the basal ganglia misfiring and triggering tics.

Clonidine is the alpha2-adrenergic agonist that is widely used to treat Tourette’s syndrome.Common side effects of clonidine include:

•drowsiness

•headaches

•dizziness

•fatigue

•constipation •diarrhoea •a dry mouth

•difficulties sleeping These side effects are usually mild and should improve when the body gets used to the medication.Muscle relaxantsMuscle relaxants have been shown to be effective in helping control tics, particularly physical tics.

Baclofen and clonazepam are two muscle relaxants that are sometimes used to treat Tourette’s syndrome. You or your child may feel drowsy and dizzy after taking these.

Adults being treated with muscle relaxants should not drive or use tools or machinery if they feel dizzy or drowsy. You should also avoid drinking alcohol while taking muscle relaxants because it could make you feel very ill.

http://www.nhs.uk/Pages/HomePage.aspx

Slide33

Aims-To identify some of the causes and symptoms of mental and emotional ill health, and identify strategies for recognising, preventing and addressing these in themselves and others-To demonstrate confidence in finding professional health advice and helping others to do soTimeTask5

minsStudents create a spider diagram about what they want to know about mental health

i.e

symptoms, effects, causes etc. Discuss briefly with the class and reveal the key facts about mental health on the next slide

5

mins

Introduce depression briefly by highlighting that it is one of the more well known mental illnesses

. Show the students the video about depression and discuss briefly20

mins

Ask students to name as many mental illnesses as possible

and then introduce the task: students are to be split into groups of four to create a presentation about a mental illness using the resources provided.Diff: Consider how the groups are split. More able students might be provided with one of the lesser known mental illnesses such as bipolar disorder. You may ask students to state whether they have prior knowledge in any of the areas and consider that some students may experience some of the conditions themselves 15 minsStudents present their research to the class.5 minsExplain to students that they are all likely to have to deal with loss in their lifetime. Give students 3 minutes to consider the questions on the board. Reveal and discuss the answers as a class5 minsTweet of the day: Students write a tweet (no more than 140 characters, in their books) to summarise the lesson. This could be a key fact or question from the lesson