Chapter 2 Mental Health and Mental Illness

Question 1

Some of the harmful effects of stigma toward those with mental health issues include:

Answer 1

• Discrimination at work or school
• Difficulty finding housing
• Bullying, physical violence or harassment
• Health insurance that doesn’t adequately cover a person’s mental health dysfunction/disorder
• Instilling self-doubt regarding ability to succeed in certain challenges and perceiving that there is nothing that can help
• Further isolation from friends, family, and colleagues.

Question 2

Mental health and mental illness are not specific entities but rather they exist on a continuum. The mental health continuum is?

Answer 2

dynamic and ever-shifting, ranging from mild to moderate to severe to psychosis

Question 3

The groundbreaking Report of the Surgeon General (USDHHS, 1999) defines mental health as successful performance of?

Answer 3

mental functions, resulting in the ability to engage in productive activities, enjoy fulfilling relationships, and adapt to change and cope with adversity.

Question 4

Mental health is from early childhood until death

Answer 4

“the springboard of thinking and communication skills, learning, emotional growth, resilience, and self-esteem”

Question 5

Mental health is a state of well-being in which individuals are able to realize their?

Answer 5

abilities within the normal stresses of life and function productively within their personal lives as well as contribute to their community

Question 6

According to the National Alliance on Mental Illness (NAMI, 2011) mental illnesses are medical conditions that affect a person’s?

Answer 6

thinking, feeling, mood, ability to relate to others, and daily functioning. Basically, mental illness can be seen as the result of a chain of events that include flawed biological, psychological, social, and cultural processes. However, mental illnesses are treatable, and individuals can experience relief from their symptoms with treatment and support.

Question 7

Diagnostic and Statistical Manual of Mental Disorders (DSM). The DSM is the manual that classifies mental disorders and is considered the “bible” for mental health workers (e.g., psychiatrists, psychiatric nurses, psychologists, and others who plan care for people experiencing mental distress/dysfunction). The DSM focuses on?

Answer 7

research and clinical observation when constructing diagnostic categories for a discrete mental disorder.

Question 8

Attributes of mental health

Answer 8

• ability to love and experience joy
• capacity to deal with conflicting emotions
• ability to live without (undue) fear, guilt, anxiety
• ability to take responsibility for one’s own actions
• ability to control one’s own behavior
• think clearly (problem solve, use good judgment, reason logically, reach insightful conclusions, be creative)
• relate to to others (form relationships, have close, loving adaptive relationships, experience empathy towards others, manage interpersonal conflict constructively)
• attain self defined spirituality
• negotiate each developmental task
• ability to work and be productive
• maintain a healthy self concept and self value
• ability to play and laugh
• accurate appraisal of reality

Question 9

The World Health Organization declared that 4 of the 10 leading causes of disability in the United States and other developed countries are?

Answer 9

mental health disorders

Question 10

all human behavior lies somewhere along a continuum of?

Answer 10

mental health and mental illness

Question 11

One myth is that to be mentally ill is? Another misconception is that to be mentally healthy, a person must be?

Answer 11

• One myth is that to be mentally ill is to be different and odd.
• Another misconception is that to be mentally healthy, a person must be logical and rational. All of us dream “irrational” dreams at night, and “irrational” emotions not only are universal human experiences but also are essential to a fulfilling life.

Question 12

Psychiatry’s definition of normal mental health changes over time and reflects changes in?

Answer 12

cultural norms, society’s expectations and values, professional biases, individual differences, and even the political climate of the time.

Question 13

A characteristic of mental health that is increasingly being promoted is the concept of?

Answer 13

resiliency

Question 14

Resiliency is the ability to?

Answer 14

Recover from or adjust easily to misfortune and change. Resiliency is closely associated with the process of adapting and helps people facing tragedy, loss, trauma, and severe stress

Question 15

Being resilient does not mean that people are unaffected by stressors. It means that rather than falling victim to the negative emotions, resilient people recognize the?

Answer 15

feelings, readily deal with them, and learn from the experience given time

Question 16

some important aspects of mental health with those of specific mental disorders. These aspects include degree of

Answer 16

(1) happiness, (2) control over behavior, (3) appraisal of reality, (4) effectiveness in work, (5) healthy self-concept, (6) satisfying relationships, and (7) effective coping strategies.

Question 17

Epidemiology is the quantitative study of the distribution of disorders in human populations. Once the distribution of mental disorders has been determined quantitatively, epidemiologists can identify?

Answer 17

high-risk groups and high-risk factors. Study of these high-risk factors may lead to important clues about the etiology of various mental disorders.

Question 18

Clinical epidemiology is a broad field that addresses the outcomes of people with illnesses who are seen by providers of clinical care. Studies use?

Answer 18

traditional epidemiological methods and are conducted in groups that are usually defined by illness or symptoms, or by diagnostic procedures or treatments given for the illness or symptoms.

Question 19

The prevalence rate is the proportion of a population with a mental disorder at a given time. Kessler and colleagues (2005) latest study of the lifetime prevalence of mental disorders and concluded in their survey that about half of Americans will meet the criteria for a DSM disorder sometime in their life, with the first onset in?

Answer 19

childhood or adolescence. It is important to note that many individuals have more than one mental disorder at a time. For example, some people diagnosed with a depressive disorder may also have a coexisting anxiety disorder. Therefore some people have dual diagnoses (coexisting disorders).

Question 20

Many factors can affect the severity and progress of a mental illness, biologically based or otherwise, and these same factors can affect a “normal” person’s mental health as well. Some of these factors include?

Answer 20

available support systems, family influences, developmental events, cultural or subcultural beliefs and values, health practices, and negative influences impinging on an individual’s life. If possible, these influences need to be evaluated and factored into an individual’s plan of care.

Question 21

Affects men and women equally; may appear earlier in men than in women

Answer 21

Schizophrenia 2.2 million

Question 22

Women affected twice as much as men (12.4 million women; 6.4 million men); depressive disorders may appear earlier in life in those born in recent decades compared with past; often co-occurs with anxiety and substance abuse

Answer 22

Any affective (mood) disorder; includes major depression, dysthymic disorder, and bipolar disorder
18.8 million

Question 23

Leading cause of disability in the United States and established economies worldwide; nearly twice as many women (6.5%) as men (3.3%) suffer from a major depressive disorder every year

Answer 23

Major depressive disorder

9.9 million

Question 24

Affects men and women equally

Answer 24

Bipolar affective disorder

2.3 million

Question 25

Anxiety disorders; includes panic disorder, obsessive-compulsive disorder, posttraumatic stress disorder (PTSD), generalized anxiety disorder, and phobias

Answer 25

19.1 million Anxiety disorders frequently co-occur with depressive disorders, eating disorders, and/or substance abuse

Question 26

Panic disorder

Answer 26

2.4 million Typically develops in adolescence or early adulthood; about one in three people with panic disorder develops agoraphobia

Question 27

Obsessive-compulsive disorder

Answer 27

3.3 million First symptoms begin in childhood or adolescence

Question 28

PTSD

Answer 28

5.2 million Can develop at any time; approximately 30% of Vietnam veterans experienced PTSD after the war; percentage high among first responders to 9/11/01 terrorist attacks

Question 29

Generalized anxiety disorder

Answer 29

4 million Can begin across life cycle; risk is highest between childhood and middle age

Question 30

Social phobia

Answer 30

5.3 million Typically begins in childhood or adolescence

Question 31

The 1999 USDHHS report entitled Mental Health: A Report of the Surgeon General stated the following:

Answer 31

* Mental health is fundamental to health. * Mental disorders are real health conditions that have an immense impact on individuals and families. * The efficacy of mental health treatment is well documented. * A range of treatments exists for most mental disorders.

Question 32

One method many states use to determine coverage is by making a distinction of whether the problem is a biologically based mental illness, that is, a mental disorder caused by?

Answer 32

neurotransmitter dysfunction, abnormal brain structure, inherited genetic factors, or other biological causes. Another term for such an illness is psychobiological disorder.

Question 33

psychobiological disorder. These biologically influenced illnesses include the following:

Answer 33

* Schizophrenia * Bipolar disorder * Major depression * Obsessive-compulsive and panic disorders * Posttraumatic stress disorder * Autism

Question 34

Other severe and disabling mental disorders include the following:

Answer 34

* Anorexia nervosa * Attention deficit/hyperactivity disorder * Many of the most prevalent and disabling mental disorders have been found to have strong biological influences; therefore we can look at these disorders as “diseases.”

Question 35

The DSM cautions that the emphasis on the term mental disorder implies a distinction between “mental” disorder and “physical” disorder, which is an outdated concept, and stresses mind-body dualism:

Answer 35

“There is much ‘physical’ in ‘mental’ disorders and much ‘mental’ in ‘physical’ disorders”

Question 36

In the DSM each of the mental disorders is conceptualized as a clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and is associated with?

Answer 36

present distress (e.g., a painful symptom) or disability (i.e., impairment in one or more important areas of functioning) or with a significantly increased risk of suffering death, pain, disability, or an important loss of freedom.

Question 37

It is important to stress that the DSM classifies disorders that people have, and not the person. For this reason, the text of the DSM avoids the use of expressions such as “a schizophrenic” or “an alcoholic” and instead uses the more accurate terms?

Answer 37

“an individual with schizophrenia” or “an individual with alcohol dependence.”

Question 38

Spirituality is a much broader concept than just religion alone; spirituality

Answer 38

“provides an essential core, enriching experience, and a reason to live for many people”

Question 39

Favazza (2009) cites the following examples of how people obtain an altered state of consciousness, which is spiritually enriching and brings peace and serenity into people's lives.

Answer 39

Mysticism, meditation (e.g., Dhyana, a form of concentrated meditation taught by Buddha; Zen Buddhism, a Japanese practice in which a spiritual master instructs students in meditation, used throughout the United States; and transcendental meditation, a Hindu meditative process), and mindfulness meditation (derived from Buddhist practice) are just a few examples.

Question 40

Mindfulness meditation is used today and has many health benefits; it is a valuable tool for dealing with chronic pain and stress. It is actively employed with?

Answer 40

dialectic behavioral therapy (DBT), stress reduction programs, and some forms of cognitive therapy

Question 41

most widely used in the United States; it is used for many reasons and is also tied to many different cultures.

Answer 41

Prayer

Question 42

The DSM axis system forces the diagnostician to consider a broad range of information by requiring judgments to be made on each of five axes.

Answer 42

- Axis I: collection of signs and symptoms that constitute particular disorder (for example, schizophrenia) or a condition that may be a focus of treatment - Axis II: personality disorders and mental retardation. * Axes I and II constitute classification of abnormal behavior - Axis III the clinician indicates any general medical conditions believed to be relevant to the mental disorder in question - Axis IV is for reporting psychosocial and environmental problems that may affect the diagnosis, treatment, and prognosis of a mental disorder. These may include occupational problems, educational problems, economic problems, interpersonal difficulties with family members, and a variety of problems in other life areas - Axis V, called Global Assessment of Functioning (GAF), gives an indication of the person's best level of psychological, social, and occupational functioning during the preceding year, rated on a scale of 1 to 100 (1 indicates persistent danger of severely hurting oneself or others, and 100 indicates superior functioning in a variety of activities at the time of the evaluation, as well as the highest level of functioning for at least a few months during the past year)

Question 43

Stigma is a?

Answer 43

“collection of negative attitudes, beliefs, thoughts, and behaviors that influence the individual, or the general public, fear, reject, or avoid, be prejudiced, and discriminate people”

Question 44

Goffman's classic definition of stigma is

Answer 44

“an attribute that is deeply discrediting where a person is reduced from a whole unusual person to a tainted, discounted one”

Question 45

psychosocial processes that lead to stigmatization

Answer 45

Stereotyping, labeling, separating, status, loss, and discrimination in a context of power imbalance are many of the psychosocial processes that lead to stigmatization.

Question 46

GLOBAL ASSESSMENT OF FUNCTIONING (GAF) SCALE∗ | 100>91

Answer 46

Superior functioning in a wide range of activities, life's problems never seem to get out of hand, is sought out by others because of his or her many positive qualities. No symptoms.

Question 47

GLOBAL ASSESSMENT OF FUNCTIONING (GAF) SCALE∗ | 90>81

Answer 47

Absent or minimal symptoms (e.g., mild anxiety before an exam), good functioning in all areas, interested and involved in a wide range of activities, socially effective, generally satisfied with life, no more than everyday problems or concerns (e.g., an occasional argument with family members).

Question 48

GLOBAL ASSESSMENT OF FUNCTIONING (GAF) SCALE∗ | 80>71

Answer 48

If symptoms are present, they are transient and expected reactions to psychosocial stressors (e.g., difficulty concentrating after family argument); no more than slight impairment in social, occupational, or school functioning (e.g., temporarily falling behind in schoolwork).

Question 49

GLOBAL ASSESSMENT OF FUNCTIONING (GAF) SCALE∗ | 70>61

Answer 49

Some mild symptoms (e.g., depressed mood and mild insomnia) OR some difficulty in social, occupational, or school functioning (e.g., occasional truancy, or theft within the household), but generally functioning pretty well, has some meaningful interpersonal relationships.

Question 50

GLOBAL ASSESSMENT OF FUNCTIONING (GAF) SCALE∗ | 60>51

Answer 50

Moderate symptoms (e.g., flat affect and circumstantial speech, occasional panic attacks) OR moderate difficulty in social, occupational, or school functioning (e.g., few friends, conflicts with peers or coworkers).

Question 51

GLOBAL ASSESSMENT OF FUNCTIONING (GAF) SCALE∗ | 50>41

Answer 51

Serious symptoms (e.g., suicidal ideation, severe obsessional rituals, frequent shoplifting) OR any serious impairment in social, occupational, or school functioning (e.g., no friends, unable to keep a job).

Question 52

GLOBAL ASSESSMENT OF FUNCTIONING (GAF) SCALE∗ | 40>31

Answer 52

Some impairment in reality testing or communication (e.g., speech is at times illogical, obscure, or irrelevant) OR major impairment in several areas, such as work or school, family relations, judgment, thinking, or mood (e.g., depressed man avoids friends, neglects family, and is unable to work; child frequently beats up younger children, is defiant at home, and is failing at school).

Question 53

GLOBAL ASSESSMENT OF FUNCTIONING (GAF) SCALE∗ | 30>21

Answer 53

Behavior is considerably influenced by delusions or hallucinations OR serious impairment in communication or judgment (e.g., sometimes incoherent, acts grossly inappropriately, suicidal preoccupation) OR inability to function in almost all areas (e.g., stays in bed all day; no job, home, or friends).

Question 54

GLOBAL ASSESSMENT OF FUNCTIONING (GAF) SCALE∗ | 20>11

Answer 54

Some danger of hurting self or others (e.g., suicide attempts without clear expectation of death; frequently violent; manic excitement) OR occasionally fails to maintain minimal personal hygiene (e.g., smears feces) OR gross impairment in communication (e.g., largely incoherent or mute).

Question 55

GLOBAL ASSESSMENT OF FUNCTIONING (GAF) SCALE∗ | 10>1

Answer 55

Persistent danger of severely hurting self or others (e.g., recurrent violence) OR persistent inability to maintain minimal personal hygiene OR serious suicidal act with clear expectation of death.

Question 56

GLOBAL ASSESSMENT OF FUNCTIONING (GAF) SCALE∗ | 0

Answer 56

Inadequate information.

Question 57

Psychiatric mental health nursing includes the diagnosis and treatment of human responses to?

Answer 57

actual or potential mental health problems.

Question 58

NANDA International (NANDA-I) describes a nursing diagnosis as a?

Answer 58

clinical judgment about individual, family, or community responses to actual or potential health problems and life processes.

Question 59

the DSM is used to diagnose a psychiatric disorder, whereas a well-defined nursing diagnosis provides the framework for identifying?

Answer 59

appropriate nursing interventions for dealing with the phenomena a patient with a mental health disorder is experiencing (e.g., hallucinations, self-esteem issues, impaired ability to function).

Question 60

The DSM includes information specifically related to culture in three areas:

Answer 60

1. A discussion of cultural variations for each of the clinical disorders 2. A description of culture-bound syndromes 3. An outline designed to assist the clinician in evaluating and reporting the impact of the individual's cultural context

Question 61

Cultures differ not only in the way they view mental illness but also in the types of behavior categorized as mental illness. For example, the content of a person's delusions, hallucinations, obsessional thoughts, and phobias often reflects?

Answer 61

what is important in the person's culture.

Question 62

A number of culture-related syndromes appear to be more influenced by culture alone and are not seen in all areas of the world. For example, one form of mental illness recognized in parts of Southeast Asia is running amok, in which someone? - Pibloktoq is an uncontrollable desire to? -

Answer 62

(usually a male) runs around engaging in furious, almost indiscriminate violent behavior. - Pibloktoq is an uncontrollable desire to tear off one's clothing and expose oneself to severe winter weather; it is a recognized form of psychological disorder in parts of Greenland, Alaska, and the Arctic regions of Canada. -

Question 63

Many believe that the helpers of choice for many people from minority cultures are their traditional helpers/therapists. This is particularly true for problems that have psychological or psychosocial aspects. One example would be people of Central and Latin American cultures. Many people from this area of the world may prefer?

Answer 63

curanderos (male healers) or curanderas (female healers), who would be sought for healing a number of symptoms that are perceived to originate from psychological components, such as susto (fright) and mal de ojo (evil eye)

Question 64

Another example is that of the Mexican and Mexican Americans who primarily prefer?

Answer 64

female healers. The practices employed by these healers are a mixture of Catholicism, ancient Mayan and Aztec cultures, and herbology

Question 65

psychotherapy would be considered the treatment of last resort in many cultures because?

Answer 65

(1) it is unavailable, (2) shame is attached to using therapies in the dominant culture, or (3) there are more effective or preferred treatments in their own culture

Question 66

The most effective therapists will be those who are eclectic in their?

Answer 66

knowledge, come from a background of working with different cultures, have a broad knowledge of coping strategies, and are flexible in their approach

Question 67

What is stigma? | The American Heritage Dictionary (1991) defines stigma as

Answer 67

“a mark of infamy, disgrace or reproach.” People often feel that stigma disqualifies one from full social acceptance. Many groups are stigmatized in our society

Question 68

What are the effects of stigma? Stigma and discrimination against people with mental illness are often major barriers to success in?

Answer 68

relationships, employment, and treatment programs. Even worse, efforts to achieve rehabilitation and recovery from mental illness can be sabotaged by prejudice and negative assumptions. The availability of health care in general is also affected by the stigma of mental illness. People with mental illness receive fewer medical services than those not labeled in this manner

Question 69

Mental health can be conceptualized along a continuum, from?

Answer 69

mild to moderate to severe to psychosis.

Question 70

There are many important aspects of mental health

Answer 70

happiness, control over behavior, appraisal of reality, effectiveness in work, a healthy self-concept, presence of satisfying relationships, and effective coping strategies

Question 71

The processes that lead to stigmatization (labeling, stereotyping, status, loss, and discrimination in a context of power imbalance) can lead to an increase in?

Answer 71

social isolation, an enhanced struggle to recover, poor social functioning, significant barriers to obtaining psychiatric and medical services, and more. The mental anguish and excruciating pain caused by stigmatization effect tremendous damage to individuals and their families, groups, and/or cultures.

Question 72

The study of epidemiology can help identify?

Answer 72

high-risk groups and behaviors. In turn, this can lead to a better understanding of the causes of some disorders. Prevalence rates help us identify the proportion of a population with a mental disorder at a given time.

Question 73

Clinicians use the five axes of the DSM and the GAF scale as a guide for?

Answer 73

diagnosing and categorizing mental disorders, allowing for a more holistic approach to the assessment. Medical condition, psychosocial and environmental influences, and present and past levels of functioning are considered.

Question 74

Using well-conceived nursing diagnoses helps target the symptoms and needs of patients so that ideally they may achieve a?

Answer 74

higher level of functioning and a better quality of life.

Question 75

The influence of culture on behavior and the way in which symptoms present may reflect a person's?

Answer 75

cultural patterns. Symptoms need to be understood in terms of a person's cultural background.

Question 76

Caution is recommended for all health care professionals concerning the damage and disservice that stigmatizing/stereotyping can cause for medical and mental health patients. Stigmatizing is acknowledged to be a barrier to?

Answer 76

proper or appropriate mental health/recovery and medical services as well. Indeed, it may even prevent a person from accessing or receiving help. Stigmatizing/stereotyping causes shame and pain for the individual and their families, or the groups being stigmatized, and greatly impacts the quality of life or ability to lead a healthy life.

Question 77

Mental illness is defined in relation to the?

Answer 77

culture, time in history, political system, and group in which it occurs.

Question 78

Axis V of the DSM multiaxial system: 1. refers to medical illnesses. 2. reports psychosocial and environmental problems. 3. indicates a need for substance abuse treatment. 4. describes a person's level of functioning.

Answer 78

4.describes a person's level of functioning.

Question 79

Why is it important for a nurse to be aware of the multiple factors that can influence an individual's mental health?

Answer 79

The nurse diagnoses and treats human responses, which are influenced by many factors.

Question 80

Factors that affect a person's mental health are: (select all that apply) 1. support systems. 2. developmental events. 3. socioeconomic status. 4. cultural beliefs.

Answer 80

1. support systems. 2. developmental events. 4. cultural beliefs.

Question 81

The DSM-IV-TR diagnosis distinguishes a person's specific psychiatric disorder, whereas a nursing diagnosis offers a framework for identifying interventions for phenomena a patient is experiencing.

Answer 81

.

Question 82

Which question will the nurse ask in order to assess a client’s ability to think clearly? “Are you employed full time?” “Do you feel guilty about your recent divorce?” “How do you plan to afford getting your own apartment?” “What do you think is your most valuable personal characteristic?”

Answer 82

“How do you plan to afford getting your own apartment?” Clear thinking is demonstrated by the ability to problem solve using good judgment and logically reasoning to arrive at an insightful conclusion. Clear thinking would be demonstrated by arriving at a plan to live independently that demonstrates those qualities. Employment demonstrates productivity; identifying valuable personal characteristics is associated with a healthy sense of self-value; undue guilt reflects ability to manage anxiety and fear.

Question 83

The nurse, striving to minimize the bias of a Western view on what is considered acceptable behavior, will consult which mental health associated resource? - Cultural Formulation Interview (CFI) - Glossary of Cultural Concepts of Distress - The client’s past and present mental health assessment - The Diagnostic and Statistical Manual of Mental Disorders

Answer 83

Cultural Formulation Interview (CFI) The CFI assesses the client’s cultural perception of distress, social supports such as family and religion, and relationship factors between the patient and provider including language and discrimination experiences in the societal majority. While useful resources, none of the remaining options focus on these cultural perceptions.

Question 84

``` When considering prevalence, the nurse will focus on which disorder(s) when identifying the focus of a community mental health screening? Anxiety disorders Affective disorders Alcohol dependence Any substance abuse ```

Answer 84

Anxiety disorders Over a 12-month period, anxiety disorders have an 18.1% prevalence affecting an estimated 57 million people. Affective disorders 9.5% (30 million); alcohol dependence 6.3% (16.5 million); any substance abuse 9.4% (24.6 million).

Question 85

The nurse recognizes that the greatest barrier to successful mental health treatment and recovery is demonstrated by which client? The teenager who fears being rejected by his peers The young homeless adult who cannot keep clinic appointments The elderly Syrian immigrant who speaks only minimal English The middle-aged adult who cannot afford prescription medication

Answer 85

The teenager who fears being rejected by his peers Stigma is defined as a collection of negative attitudes, beliefs, and thoughts that influence public perception of the mentally ill. Stigma contributes to fear, rejection, and discrimination against the mentally ill that taint and discount the individual, and stigma has been acknowledged as a major barrier to mental health treatment and recovery. The teenager is afraid of being stigmatized by peers and so is much less likely to seek and/or comply with mental health treatment. The remaining options demonstrate barriers but none are as powerful as stigma.