Ch. 12: Care for Pts w/ M. Illness & Substance use disorders in Gen. Settings

Question 1

Intro: The client with mental illness…

Answer 1

• Has historically been misunderstood, misdiagnosed, and mistreated.
• We overlook people. Mental illness is not screened for in every setting.

Question 2

The need for education of healthcare providers

Answer 2

• clients with significant mental illness die 25 years earlier than the general population
• 60% of those deaths are related to preventable or treatable causes

Question 3

Diagnostic overshadowing

Answer 3

The phenomenon in which a person’s physical symptoms are attributed to their mental illness

Question 4

Depression is a risk factor for…

Answer 4

• cardiovascular disease, metabolic syndromes, diabetes, dementia, Asthma, arthritis, and hyperlipidemia.

Question 5

Screening

Answer 5

The use of screening tools is better than clinical judgment alone in the diagnosis of mental illness.

Question 6

Horowitz and associates tool for suicide screening in general practice

Answer 6

Starts with 2 questions:
- In the past month have you had thoughts about suicide?
- Have you ever made a suicide attempt?
- yes to either prompts this question –>
- Are you having thoughts of suicide right now?

Question 7

A good nurse manager…

Answer 7

• Keeps in touch with nurses
• Equips their staff with reliable and user-friendly tools

Question 8

Screening priorities. Those who are high risk:

Answer 8

• Trauma, suicide risk, substance use disorders

Question 9

Trauma

Answer 9

• Screen everyone
• Most individuals affected by violence are women and children
• It is ok to ask about trauma! You won’t re-traumatize them
• Trauma is linked to many physical and mental problems and early death

Question 10

Trauma informed care

Answer 10

• Nurses should recognize the risk of traumatizing patients if there is a lack of sensitivity to the impact of that trauma.

Question 11

Risk for suicide

Answer 11

• Certain groups of people like military personnelle with ptsd, older adults with depression, trauma victims should be specifically screened.

Question 12

A brief screening…

Answer 12

• …Is not enough to prevent suicide in some individuals
• Adapt to each patient and follow up! Don’t just “click a box”

Question 13

Risk for suicide: Nonsuicidal self-injuring behavior (NSSIB)

Answer 13

Typically a nonlethal, repetitive act used to reduce distress rather than end one’s life.

Question 14

Substance use disorders: facts about USA

Answer 14

• Opioid addiction can lead to overdose, and rates of opioid abuse have reached epidemic levels in the U.S.
• Methamphetamine use has also increased significantly. Withdrawal of this is associated with increased risk for suicide.

Question 15

Screening, brief intervention, and referral to treatment (SBIRT)

Answer 15

• It quickly asses the severity of substance use and identifies the appropriate level of TX
• Brief intervention: increase insight and awareness. Motivation toward change.
• Referral to TX provides those identified as needing more extensive treatment with access to specialty care

Question 16

Many patients may deny using substances, because they fear legal consequences

Answer 16

Establishment of trust, clear communication about why this information is being collected, and how it will be used are important first steps in the screening process.

Question 17

Referral

Answer 17

• Know if/when/where to refer to!
• Know the resources available in the area.
• If nurses lack clarity about their roles and responsibilities, referring the patient to needed services is unlikely to happen.

Question 18

The role of the nurse

Answer 18

• Take that extra minute to follow up with a patient you’re concerned about.
• Develop awareness of the negative impact of stigmatization