1. MENTAL HEALTH
ASHRAF TANTAWY
Professor of Psychiatry
Suez Canal University
Ismailia, Egypt.

2. OVERVIEW
PART I
MENTAL HEALTH
PART II
MENTAL HEALTH ISSUES
PART III
CAREGIVERS BURDEN

3. PART I
MENTAL HEALTH

4. DEFINITION OF HEALTH
“A state of complete
(Physical, Mental & Social)
well-being”
(World Health Organization)

5. The 10 Health Indicators
1- Physical Activity.
2- Overweight and Obesity.
3- Tobacco Use.
4- Substance Abuse.
5- Responsible Sexual Behavior.
6- Mental Health.
7- Violence and Injury.
8- Environmental Quality.
9- Immunization.
10- Access to Health Care.

6. MENTAL HEALTH
The successful performance of
Mental Functions.
Resulting in Productive activities
& Fulfilling relationships.
The ability to adapt to change &
cope with stressors.
The successful adaptation to
stressors are evidenced by

7. MENTAL ILLNESS
A Clinically Syndrome, marked by
Distress, Disability, Suffering or
Loss of freedom.
Maladaptive Responses to
stressors evidenced by thoughts,
feelings & behaviors, interfere with
the individual’s physical, social or

8. Mental Health/ Mental Illness
Concept Must Be Clear
Mental Health Mental Illness
Continuum - Not Static
(Introversion → Avoidant Personality → Social Phobia
→ Schizophrenia)

9. MENTAL HEALTH
Maslow identified:
A “Hierarchy of Needs”:
Self-actualization as fulfillment of
one’s highest potential

10. Maslow’s Hierarchy of Need (1954)

11. Aspects of Mental Health
Emotional Intelligence:
Emotions are skills for living.
Have emotional self control.
Recognize emotions in others.
Handle relationships.
Resiliency:
Emerge and grow from negative life events.
Spirituality:
That part of us that deals with relationships, values and
addresses questions of purpose and meaning in life.

12. Common & Serious
Mental Health Problems
Common Problems:
– Depressive Disorders.
– Anxiety Disorders.
Severe & Enduring Problems:
– Schizophrenia.
– Bipolar disorder.
– Major depression.
– Dementia.

13. Problems of Mental Disorders
Lifespan vs. Health span.
Physical Burden.
Poly-Pharmacy.
Psychosocial Burden.
Biological Basis of Psychiatric Disorders.

14. Lifespan vs. Health span
Lifespan: Length of life increased.
Health span: Length of healthy life before
Disability.
Factors affecting lifespan and health span:
1. Exercise: Improves mood and
cognition.
2. Sleep pattern.
3. Eating pattern.
4. Social networks: Protective against

15. Physical Burden
Comorbid Physical Diseases:
NS, IS, CVS, RS, US & GIT.
Disability: Physical & Mental.
Side Effects: Psychotropic Drugs.

16. Physical Comorbidity
Depressive Disorders:
Diabetes.
Ischemic Heart Disease.
Stroke.
Chronic Neurological Conditions.
Cancer.
Anxiety Disorders:
COPD & Bronchial Asthma.

17. Physical Comorbidity
Schizophrenia:
Obesity, Hypertension & Smoking.
Hepatitis C & HIV.
Drug related Movement Disorders.
Cancer Colon.
Rheumatoid Arthritis.
Bipolar Disorder
As for schizophrenia. +
Drug Related Thyroid Diseases.
Drug Related Renal Diseases (Lithium).
Causes of Death among Mental Patients:
Cardio-Respiratory Disease & Infectious disease.

18. Poly-Pharmacy
Multiple Pathology.
- Cardiac Disease: HPT, IHD.
- Diabetes.
- Asthma/ COPD.
- Osteoporosis.
- Neurological Diseases.
- Psychiatric Disorders.
Multiple Medications.
Multiple Adverse Effects.
Drug-Drug Interactions.

19. Psychosocial Burden
Social Isolation.
Physical & Cognitive Dysfunctions.
Loss of Social & Occupational Status.
Loss of Friends.
Lack of Adequate Health Care.
Financial Insecurity.
Death Preoccupation.
Dependency on Their Families.

20. .
Cukor D et al. JASN 2007;18:3042-3055
©2007 by American Society of Nephrology

21. CAUSES OF MENTAL
ILLNESS
The concept of multiple
factors in the causation of
psychogenic disorders has
become generally accepted.
The factors are considered
to involve the individual, the
family & the community.

22. Biological Basis of Psychiatric Disorders
Nerves Environment
Hormones Brain
Action
Endocrine Glands Immune System
Physiology
& Behavior

23. The Biological Basis of
Psychiatric Disorders
Brain Mind
Biopsychosocial
Model
Psychoneuro-
Medically
Immunology
Unexplained
Physical Symptoms
Body

24. Diathesis-Stress Model
Diathesis Stress
“Predisposing Causes” “Precipitating Causes”
(Hereditary Predisposition) (Situational Factors)
Bio-Psycho-Social
Approach
Disorder “Maintaining Causes”
• Emphasizes Interaction of Physical Conditions
Biological and Social Factors
Recovery

25. .
Cukor D et al. JASN 2007;18:3042-3055
©2007 by American Society of Nephrology

26. Quality of Life
Well-being: Physical, Psychological, Social & Spiritual.
Physical Psychological
Functional Ability Anxiety
Strength/Fatigue Depression
Sleep & Rest Enjoyment/Leisure
Nausea Pain Distress
Appetite Happiness
Constipation Fear
Pain Quality of Cognition/Attention
Social Life
Spiritual
Financial Burden
Hope
Caregiver Burden
Suffering
Roles & Relationships
Meaning of Pain
Affection
Religiosity
Sexual Function
Transcendence
Appearance

27. How Does The Public View
The Mentally Ill?
They are fearful.
There is a big stigma.
The mentally ill are labeled.
Care is rationed.
People oppose care by using laws.
The mentally ill are losers when it
comes to the budget for care.

28. What are The Costs
of Mental Illness?
Police costs.
Public health costs.
Safety costs.
Court costs.
Business costs.
Social costs.
Jail costs.

29. Psychiatrists handle little
number of real psychiatric
patients, WHY?
There are 5 levels and 4 filters.

30. L1:Community (30%).
F1 : Illness behavior.
L2:Mental morbidity in primary care (25%).
F2: Ability to detect.
L3:Mental morbidity by doctors (10%).
F3: Referral.
L4:Morbidity in mental health services
(2.5%).
F4: Admission.
L5: Psychiatric inpatients (0.5%).

31. The Provider- Caregiver
Relationship
– Expectations.
– Establish & Maintain Boundaries.
– Building on Strengths.
– Sharing One’s Own Family Life.
– Reciprocal & Positive Feelings.

32. Talking with Caregivers
Be Positive.
Be Flexible.
Be a Good Observer.
Work as Partner.
Listen Actively.
Begin Where The Caregiver Is.
Ask Leading Questions.
Make Comments Thoughtfully.
Answer Personal Questions.

33. Essential Qualities
of Mental Health Team
 Empathy.
 Respect.
 Perseverance & Resilience.

34. You Can Differentiate
Mental Health Mental Illness

35. PART II
MENTAL HEALTH
ISSUES

36. MENTAL HEALTH APPROACHES
Primary Prevention.
Secondary Prevention.
Tertiary Prevention.

37. PSYCHIATRY STRATEGIES
Integration of mental health with
primary health care through
the national mental health program.
Provision of tertiary care institutions for
treatment of mental disorders.
Eradication stigmatization of mentally ill
patients.
Protecting patient rights through regulatory
institutions like the central mental health
authority.

39. Numbers of People
Affected Globally
450 million people with mental disorders:
– 150 million with Depression.
– 90 million with Alcohol or Drug Use Disorder.
– 40 million with Epilepsy.
– 25 million with Schizophrenia.
– 10 million Attempt Suicide every year.
– 1 million Commit Suicide every year.

40. Did You Know?
4 of the 10 leading causes of disability are
mental disorders:
- MD, Schizophrenia, Dementia & OCD.
6% of the population suffers from Severe &
Persistent Mental Illness:
- Dementia, Schizophrenia, BAD & MD.
13 % of the population has a diagnosis of:
- Dysthymia, Panic Disorder, Phobia & Antisocial
Personality Disorder.

41. Psychiatry by Numbers
25% of the population has a mental
disorder.
15% of patients in population have
depressive illnesses.
90% of the 10 most common
complaints in psychiatric setting
have no organic basis.
50% of mental health care can be
delivered by Non-Psychiatrists.

42. Relationship Between
Psychiatry & Medicine
A- Medical Conditions that have
psychiatric symptoms.
B- Psychosomatic Disorders.
C- Medically Unexplained
Physical Symptoms.
D- Mental Disorders that may
have physical symptoms.

43. A- Medical Conditions That Have
Psychiatric Symptomatology
1- Neurological Diseases:
Brain tumors, Epilepsy, MS, Parkinsonism,...
2- Endocrine Syndromes:
Thyroid, Suprarenal, Ovaries, Pancreas,…
3- Infectious Diseases & Autoimmune Syndromes.
4- System Failures:
Renal, Hepatic, Cardiac, Respiratory,...
5- Chronic Disability:
Blindness, Deafness, Muteness, Loss of limb,...
6- Blood Diseases:
Anemia, Leukemia, Hemolytic diseases,...

44. B- Psychosomatic Disorders
The physical condition must show either
demonstrable organic pathology or a
known patho-physiologic process.
They can influence not only the cause of
the illness but can also worsen the
symptoms & affect the course of the
disorder.
Examples: Angina, Hypertension,
Bronchial asthma, Rheumatoid arthritis,
Duodenal ulcers, IBS, Eczema, Psoriasis
& Urticaria.

45. C- Medically Unexplained
Physical Symptoms
Sometimes psychological factors can cause ill
health without actually causing a disease.
As a result of unhappiness, anxiety or stress due
to personal problems, physical symptoms may
develop.
A- Somatoform disorders.
B- Factitious disorders.
C- Malingering.

46. Somatoform Disorders
1- Somatization Disorder.
2- Hypochondriasis.
3- Dissociative & Conversion Disorders.
4- Somatoform Pain Disorder.
5- Body Dysmorphic Disorder.

47. D- Mental Disorders That May
Have Physical Symptomatology
Neurotic Disorders:
Depression, Anxiety, OCD &
Adjustment disorder.
Psychotic Disorders: Dementia,
Delirium, Schizophrenia, Mood
disorders, Delusional disorder &
Substance induced psychosis.

48. PART III
CAREGIVERS BURDEN

49. CAREGIVERS BURDEN
Physical Burden.
Financial Burden.
Time Burden.
Role Burden.
Emotional Burden.
Others.

50. Caregiving Burden
Signs of Caregiver Burnout
1- Physical Burden:
Weight Change: Gain or Loss.
Unexplained Somatic Complaints:
(Chronic headaches, backaches or
others).
Caregiver’s Syndrome:
(Fatigue from physical strain & sleep lack ).
Osteoporosis and Arthritis.

51. Caregiving Burden
Signs of Caregiver Burnout
3- Time Burden:
Caregiving is time-consuming.
Less time for other tasks.
Activities can be stressful.
4- Role Burden:
Feelings of being pulled in different
directions.
Family responsibilities.
Pressure and tension.

52. Caregiving Burden
Signs of Caregiver Burnout
5- Emotional Burden:
Common feelings: Being overwhelmed, Anger,
Frustration, Guilt, Exhaustion, Loneliness and
Social withdrawal.
Cognitive disturbances: Lack of concentration
and finding it difficult to complete complex tasks.
Sleep disorders: Sleeplessness / stressful dream.
Anxiety: about facing another day and what the
future holds.
Depression: feeling sad and hopeless.
Adjustment disorders.

53. Psychiatric Disorders
Among Caregivers
Depression.
Anxiety disorders.
Unexplained Somatic
Complaints.
Adjustment disorders.

55. Conclusions
Mental disorders among patients & their
caregivers are frequent, associated with
increased medical & functional morbidity.
Attention to physical, psychological & spiritual
concerns are necessary.
Use of medication, psychotherapy or
counseling in an integrated manner results in
best outcomes.
The good physician will treat the disease but
the great physician will treat the patient.
Mental health means enhancing physical
treatment & promoting mental health.

56. Nursing Is Of
Paramount
Importance
Among Mental
Patients

57. NO HEALTH
WITHOUT
MENTAL
HEALTH