Exam 1 - Study Material Flashcards
What is Psychiatric nursing?
Nursing that focuses on the care and rehabilitation of people with identifiable mental illnesses or disorders
What is Mental health nursing?
Nursing that focues on well and at risk patients to prevent mental illness or to provide immediate treatment for those with an early sign of a disorder.
What is a Therapeutic Nurse-Patient Relationship?
It is a mutual learning experience and a corrective emotional experience for the patient. It is based on the humanity of the nurse and patient, mutual respect, and acceptance of sociocultural differences.
What are the different phases of the Psychiatric Nurse-Patient relationship?
- Preinteraction phase
- Introductory or orientation phase
- Working phase
- Termination phase
Describe the preinteraction phase of the Psychiatric Nurse-Patient relationship
- It is a time where the nurse explores his/her own professional strengths and limitations, explores thoughts and feelings about working in a psychiatric setting, gathers data about the patient and plans for the first interaction with the patient.
- Begins before the nurses 1st contact with the patient
- Involves self-analaysis on the nurses’s part
Describe the Introductory or orientation phase of the Psychiatric Nurse-Patient relationship
You meet with the patient to:
- Determine why the patient sought help
- Establish mutual goals for their care with them
- Determine where you are going to meet and how often
- Discuss issues of confidentiality
- Establish a climate of trust and understanding
- To explore their perceptions, thoughts, and feelings
- To help the patient identify their problems
Describe the working phase of the Psychiatric Nurse-Patient relationship
- The most therapeutic work is carried out during this phase
- The nurse and the patient explore stressors and promote the development of insight in the patient by linking perceptions, thoughts, feelings, and actions.
- This is the most difficult phase because patient do not want to change their behavior
Describe the termination phase of the Psychiatric Nurse-Patient relationship
- This phase involves reviewing the progress of the therapy, exploring feelings of loss and rejection,
- It’s important to help the patient work and grow through the termination process, establish the reality of the separation.
What are the different types of “space” a person has?
- Intimate
- Personal
- Social-consultative
- Public space
Describe intimate space
- up to 18 inches
- This small degree of separation between people allows for maximal inter- personal sensory stimulation.
Describe personal space
- 18 inches to 4 feet
- This zone is used for close relationships and when touching distance may be desired.
Describe Social-consultative space
- 9 to 12 feet
- This zone is less personal; it requires that speech be louder
Describe public space
- 12 feet and more
- This is used in speech giving and other large gatherings.
What are 2 requirements for therapeutic communication?
- All communication must preserve the self-respect of both individuals.
- One should communicate understanding and acceptance before giving any suggestions or advice.
What is the the first rule of a therapeutic relationship?
- Listen to the patient!
- It is the foundation on which all other therapeutic skills are built
What are some therapeutic communication techniques?
- Listening
- Using Broad Openings
- Broad Openings
- Theme Identification
- Restating
- Silence
- Clarification
- Suggesting
- Reflection
- Humor
- Informing
- Sharing Perceptions
- Focusing
Define the “listening” therapeutic communication technique, give an example, and its value in practice.
- Definition: an active process of receiving information and examining reaction to the messages received
- Example: maintaining eye contact and receptive nonverbal communication
- Therapeutic value: nonverbally communicates to the patient the nurse’s interest and acceptance
Define the “broad openings” therapeutic communication technique, give an example, and its value in practice.
- **Definition: **encouraging the patient to select topics for discussion
- Example: “What are you thinking about?”
- Therapeutic value: indicates acceptance by the nurse and the value of the patient’s initiative
Define the “restating” therapeutic communication technique, give an example, and its value in practice.
- Definition: repeating the main thought the patient expressed
- Example: “You say that your mother left you when you were 5 years old.”
- Therapeutic value: indicates that the nurse is listening and validates, reinforces, or calls attention to something important that has been said
Define the “clarification” therapeutic communication technique, give an example, and its value in practice.
- Definition: Attempting to put into words vague ideas or unclear thoughts of the patient to enhance the nurse’s understanding or asking the patient to explain what he means
- Example: “I’m not sure what you mean. Could you tell me about that again?”
- Therapeutic value: helps to clarify feelings, ideas, and perceptions of the patient and provides an explicit correlation between the nurse and the patient’s actions
Define the “reflection” therapeutic communication technique, give an example, and its value in practice.
- Definition: directing back the patient’s ideas, feelings, questions or content
- Example: “You’re feeling tense and anxious, and it’s related to a conversation you had with your husband last night?”
- **Therapeutic value: **validates the nurse’s understanding of what the patient is saying and signifies empathy, interest and respect for the patient
Define the “informing” therapeutic communication technique, give an example, and its value in practice.
- Definition: the skill of information giving
- Example:“I think you need to know more about how your medication works.”
- Therapeutic value: helpful in health teaching or patient education about relevant aspects of patient’s well-being and self-care
Define the “focusing” therapeutic communication technique, give an example, and its value in practice.
- **Definition: **questions or statements that help the patient expand on a topic of importance
- Example: “I think that we should talk more about your relationship with your father.”
- **Therapeutic value: **allows the patient to discuss central issues and keeps the communication process goal directed
Define the “sharing perceptions” therapeutic communication technique, give an example, and its value in practice.
- Definition: asking the patient to verify the nurse’s understanding of what the patient is thinking or feeling
- Example: “You’re smiling, but I sense that you are really very angry with me.”
- Therapeutic value: conveys the nurse’s understanding to the patient and has the potential for clearing up confusing communication
Define the “theme identification” therapeutic communication technique, give an example, and its value in practice.
- Definition: underlying issues or problems experienced by the patient that emerge repeatedly during the course of the nurse-patient relationship
- Example: “I’ve noticed that in all of the relationships that you have described, you’ve been hurt or rejected by the man. Do you think this is an underlying issue?”
- Therapeutic value: allows the nurse to best promote the patient’s exploration and understanding of important problems
Define the “silence” therapeutic communication technique, give an example, and its value in practice.
- Definition: lack of verbal communication for a therapeutic reason
- Example: sitting with a patient and nonverbally communicating interest and involvement
- Therapeutic value: allows the patient time to think and gain insights, slows the pace of the interaction, and encourages the patient to initiate conversation, while conveying the nurse’s support, understanding, and acceptance.
Define the “Humor” therapeutic communication technique, give an example, and its value in practice.
- Definition: the discharge of energy through the comic enjoyment of the imperfect
- Example: “That gives a whole new meaning to the word nervous,” said with shared kidding between the nurse and patient.
- Therapeutic value: can promote insight by making conscious repressed material, resolving paradoxes, tempering aggression, and revealing new options; a socially acceptable form of sublimation
Define the “suggesting” therapeutic communication technique, give an example, and its value in practice.
- Definition: presentation of alternative ideas for the patient’s consdieration relative to problem solving
- Example: “Have you thought about responding to your boss in a different way when he raises that issue with you? For example, you could ask him whether a specific problem has occurred.”
- Therapeutic value: increases the patient’s perceived options or choices
What are responsive dimensions?
Characteristics crucial to establish trust and open communication in a relationship and help convey a sense of hope
Examples:
- Genuineness
- Respect
- Empathic understanding
- Concreteness
What is genuineness?
To be an open, honest, sincere person who is actively involved in the relationship.
What is respect?
Giving someone unconditional positive regard; the patient is regarded as a person of worth
What is empathy?
The ability to enter into the life of another per- son, to accurately perceive the person’s current feelings and their meanings, and to communicate this understanding to the patient.
What is concreteness?
- The use of specific terminology rather than abstractions when discussing the patient’s feelings, experiences, and behavior.
- It involves asking for examples and details rather than generalities.
What is confrontation?
It is an expression by the nurse of perceived discrepancies in the patient’s behavior in which the nurse attempts to make the patient aware of incongruence in feelings, attitudes, beliefs, and behaviors.
What is immediacy?
The process of focusing on the current interaction of the nurse and the patient in the relationship.
What is self-disclosure?
- Subjectively true, personal statements about the self, intentionally revealed to another person.
- When self-disclosing, the nurse should have a par- ticular therapeutic goal in mind.
What is Catharsis?
- A process that envolves encouraging a patient to talk about things that are most bothersome
- Catharsis brings fears, feelings, and experiences out into the open so that they can be examined and discussed with the nurse
What is role playing?
- The process of acting out a particular situation
- It increases the patient’s insight into human relations and can deepen the ability to see the situation from another person’s point of view.
- it helps patients practice new and more adaptive behaviors.
What are therapeutic impasses?
They are blocks in the progress of the nurse-patient relationship
What are some examples of therapeutic impasses?
- Resistance
- Transference
- Countertransference
- Boundary violations
What is resistance?
- the patient’s reluctance or avoidance of talking about or experiencing troubling aspects of oneself.
- Often caused by the patient’s unwillingness to change when the need for change is recognized (usually during the working phase)
What is transference?
- An unconscious response in which patients experience feelings and attitudes toward the nurse that were originally associated with other significant figures in their life.
- It is characterized by the inappropriate intensity of the patient’s response.
What is countertransference?
- A therapeutic impasse created by the nurse’s specific emotional response to the qualities of the patient.
- In such cases nurses identify the patient with individuals from their past, and personal needs interfere with their therapeutic effective- ness
Describe boundary violations
- Occurs when a nurse goes outside the boundaries of the therapeutic relationship and establishes a social, economic, or personal relationship with a patient.
- As a general rule, whenever the nurse is doing or thinking of doing something special, different, or unusual for a patient, often a boundary violation is involved
What were Hildegard Peplau’s contributions to nursing?
- She was Hildegard Peplau the mother of psych nursing; identified the heart of psych nursing as the role of counselor or psychotherapist
- Differentiated between general practice nurses who worked on a psych unit and psychiatric nurses who have graduate degrees and specialize in psych nursing
- Identified nursing as a significant therapeutic process
What were Contributions of Linda Richards to nursing?
the first American psychiatric nurse; emphasized the physical AND emotional needs of the patient
Describe Custodial care in 1800s
- Focused on the patient’s physical needs, such as medications, nutrition, hygiene, and ward activities
- Psych nurses had limited psych training and mostly used med-surg principles; their main qualification was being kind and more patient
What are the functions of neurotransmitters?
- chemical “first” messengers
- Give rise to human activity, body functions, consciousness, intelligence, creativity, memory, dreams, and emotion
- Neurotransmission is a key factor in understanding how various regions of the brain function and how interventions, such as medications and other therapies, affect brain activity and human behavior
What is the function of Dopamine?
- Involved in control of complex movements, motivation, and cognition and in regulating emotional responses
- Dopamine plats a role in the sensation of pleasure
What is the function of Serotonin (5-HT)?
- Levels fluctuate with sleep and wakefulness, plats a role in arousal and modulation of general activity levels of CNS, particularly onset of sleep
- Involved in temperature regulation and pain-control system of body.
What is the function of melatonin?
Induces pigment-lightening effects on skin cells and regulates reproductive and immune function.
What is the function of acetylcholine?
- Plays a role in sleep-wakefulness cycle.
- Signals mus- cles to become active
What is the function of Glutamate and where is it found?
- glutamate receptors control the opening of ion channels that allow calcium (essential to neurotransmission) to pass into nerve cells, propagating neuronal electrical impulses
- Found in all cells of body, where it is used to synthesize structural and functional proteins
What are drugs that increase Gamma-aminobutyric acid (GABA) used for?
Drugs that increase GABA function, such as benzodiazepines, are used to treat anxiety and epilepsy and to induce sleep.
What is the function of histamine and where is it located?
- May play a role in alertness and learning
- Located in diencephalon
What are the functions of Endorphins, enkephalins, dynorphins, and endomorphins?
The opiates morphine and heroin bind to these endogenous opioid receptors on presynaptic neurons, blocking release of neurotransmitters and thus reducing pain
What is the function of substance P?
Found in pain transmission pathway. Blocking release of substance P by morphine reduces pain.
What are some changes seen in the brain with age?
- At birth, an infant’s brain is almost the same size as an adult’s brain and contains most of the brain cells for one’s entire life
- From birth, the brain matures from back to front. With aging, it degenerates in the opposite direction
- A newborn’s brain grows about three times its size in the first year
- The brains of 2-year-old children consume twice as much glucose as do adult brains
- Compared to an environment with little stimulation, a stimulating environment can give a child a 25% greater ability to learn
- By the age of 7 years, our brains are 95% their adult size
- It is a myth that we use only 10% of our brains. In fact, we use it all
- Your skin weights twice as much as your brain
- The brain can live for 4-6 minutes without oxygen, and then it begins to die. No oxygen for 5-10 minutes will result in permanent brain damage
What is the function of the Cerebral cortex?
critical in decision making and higher order thinking, such as abstract reasoning
What is the function of the limbic system?
involved in regulating emotional behavior, memory, and learning
Basal ganglia: coordinate involuntary movements and muscle tone
What is the function of the Hypothalamus?
regulates pituitary hormones; temperature; and desires such as hunger, thirst, and sex drive
What is the function of the Locus ceruleus?
makes NE, a neurotransmitter involved in the body’s response to stress
What is the function of Raphe nuclei?
make serotonin, a neurotransmitter involved in the regulation of sleep, behavior, and mood
What is the function of Substantia nigra?
makes dopamine, a neurotransmitter involved in complex movements, thinking, and emotions
What is a Mental status exam?
Represents a cross section of the patient’s psychological life and the nurse’s observations and impressions at one point in time
Describe the mental status exam
- The elements of the exam depend on the patient’s clinical presentation, as well as on the patient’s educational and sociocultural background
- Exam itself is usually divided into several parts; they can be arranged in different ways, as long as the nurse covers all the areas
- Some components of the exam are completed through simple observation of the patient, such as noting the patient’s clothing or facial expressions
- Other aspects require asking specific questions, such as those related to memory or attention span
- Most of all, the nurse should remember that the mental status exam does not reflect how the patient was in the past or will be in the future
- The mental status exam is an evaluation of the patient’s current state
- Info obtained during the exam is used along with other objective and subjective data
What sections are on the mental status exam?
- Appearance
- Speech
- Motor activity
- Interaction during the interview
- Affect
- Perceptions
- Thought content
- Thought process
- Level of consciousness
- Level of concentration and calculation
- Information and intelligence
- Judgment
- Insight
In a mental status exam what would you observe for with appearance and what are its clinical implications?
Observe:
- apparent age, manner of dress, cleanliness, posture, gait, facial expressions, eye contact, pupil dilation or constriction, general state of health and nutrition
Clinical implications:
- Dilated pupils are sometimes associated with drug intoxication
- Pupil constriction may indicate narcotic addiction
- Stooped posture is often seen in patients with depression
- Manic patients may dress in colorful or unusual attire
In a mental status exam what would you observe for with speech and what are its clinical implications?
Observe for:
- Rate: rapid or slow
- Volume: loud or soft
- Amount: paucity, muteness, pressured speech
- Characteristics: stuttering, slurring of words, or unusual accents
Clinical implications:
- Speech disturbances are often caused by specific brain disturbances. For example, mumbling may occur in patients with Huntington chorea, and slurring of speech may occur in intoxicated patients
In a mental status exam what would you observe for with motor activity and what are its clinical implications?
Observations:
- Level of activity: lethargic, tense, restless, or agitated
- Type of activity: tics, grimaces, or tremors
- Unusual gestures or mannerisms: compulsive behavior
Clinical implications:
- Excessive body movement may be associated with anxiety, mania, or stimulant abuse
- Little body activity may suggest depression, organic mental disorders, catatonic schizophrenia, or drug-induced stupor
- Tics and grimaces may suggest medication side effects
- Repeated motor movements or compulsive behavior may indicate OCD
- Repeated picking of lint or dirt off of clothing is sometimes associated with delirium or toxic conditiom
In a mental status exam what would you observe for when
Interacting during the interview and what are its clinical implications?
Observations:
- is the patient hostile, uncooperative, irritable, guarded, apathetic, defensive, suspicious, or seductive? The nurse may explore the observed behavior by asking, “You seem irritated by something. Is that true?”
Clinical implications:
- Suspiciousness may be evident in patients with paranoia
- Irritability may suggest an anxiety disorder
In a mental status exam what is “mood” and what would you observe for?
Mood is:
- a self-report of one’s emotional state and reflects the patient’s life situation
Observations:
- If the potential for suicide is suspected, the nurse should ask the patient directly about thoughts of self-harm. To judge a patient’s suicidal or homicidal risk, the nurse should assess the patients plans, the patient’s ability to carry out those plans, the patient’s attitude about death, and support systems available to the patient
In a mental status exam what is “affect”, what would you observe for, and what are its clinical implications?
Affect is:
- the patient’s apparent emotional tone
Observations: affect can be described in terms of
- Range
- Duration
- Intensity
- Appropriateness
- Flat affect: the absence of emotional expression, as seen by a patient who reports significant life events without showing any emotional response
- Labile affect: expression by undergoing frequent changes from one affective response to another quickly in the same conversation
- The nurse should also assess whether the patient’s emotional response is congruent or in agreement with the speech content; for example, it would be incongruent if a patient reports being persecuted by the police and then laughs
Clinical observations:
- Labile affect is often seen in patients with mania
- Flat affect and incongruent affect are often evident in those with schizophrenia
What are Hallucinations?
- A hallucination is a perception in the absence of a stimulus
- They are false sensory impressions or experiences
- These sensory impressions are generated by the mind rather than by any external stimuli, and may be seen, heard, felt, and even smelled or tasted by the patient
What are Illusions?
false perceptions or false responses to a sensory stimulus
What are Command hallucinations?
are those that tell the patient to do something, such as kill oneself, harm another, or join someone in the afterlife
In a mental status exam what would you observe for with perceptions and what are its clinical implications?
Observations: hallucinations may occur in any of the five major sensory modalities:
- Auditory – sound
- Visual – sight
- Tactile – touch
- Gustatory – taste
- Olfactory – smell
- Cenesthetic: feeling body functions such as blood pulsing through veins, food digesting, or urine forming
- Kinesthetic: sensation of movement while actually motionless
Clinical implications:
- Auditory hallucinations suggest schizophrenia
- Visual hallucinations suggest organic mental disorders
- Tactile hallucinations suggest organic mental disorders, cocaine abuse, and delirium tremens
In a mental status exam what is “thought content”, what would you observe for, and what are its clinical implications?
Thought content:
- refers to “what” the patient is thinking
**Observations: **
- Delusions: false belief that is firmly maintained even though it is not shared by others and is contradicted by social reality (may be religious, somatic, grandiose, or paranoid)
- Thought broadcasting: belief that one’s thoughts are being aired to the outside world
- Thought insertion: belief that thoughts are being placed into one’s mind by outside people or influences
- Depersonalization: the feeling of having lost self-identity and that things around the person are different, strange, or unreal
- Hypochondriasis: somatic over concern with and morbid attention to details of body functioning
- Ideas of reference: incorrect interpretation of casual incidents and external events as having direct personal references
- Magical thinking: belief that thinking equates with doing, characterized by lack of realistic relationship between cause and effect
- Nihilistic ideas: thoughts of nonexistence and hopelessness
- Obsession: an idea, emotion, or impulse that repetitively and insistently forces itself into consciousness, although t is unwelcome
- Phobia: a morbid fear associated with extreme anxiety
Clinical implications:
- Obsessions and phobias are associated with anxiety disorders
- Delusions, depersonalization, and ideas of reference suggest schizophrenia and other psychotic disorders
- it is important that the nurse only obtain information about the patient’s thinking and not challenge or try to correct the patient’s beliefs
In a mental status exam what is “thought process”, what would you observe for, and what are its clinical implications?
Thought process:
- “how” of the patient’s self-expression
Observations:
- Circumstantial: thought and speech associated with excessive and unnecessary detail that is usually relevant to a question, and an answer is eventually provided
- Flight of ideas: over-productive speech characterized by rapid shifting from one topic to another and fragmenting ideas
- Loose associations: lack of a logical relationship between thoughts and ideas that renders speech and thought inexact, vague, diffuse, and unfocused
- Neologisms: new word or words created by the patient; often a blend of other words
- Perseveration: involuntary, excessive continuation or repetition of a single response, idea, or activity; may apply to speech or movement, but most often verbal
- Tangential: similar to circumstantial but the person never returns to the central point and never answers the original question
- Thought blocking: sudden halt in the train of thought or in the middle of a sentence
- Word salad: series of words that seem totally unrelated
Clinical implications:
- Circumstantial thinking may be a sign of defensiveness or paranoid thinking
- Loose associations and neologisms suggest schizophrenia or other psychotic disorders
- Flight of ideas indicates mania
- Perseveration is often associated with brain damage and psychotic disorders
- Word salad represents at the highest level of thought disorganization
In a mental status exam what would you observe for with level of consciousness and what are its clinical implications?
Observations:
- Can be described as confused, sedated, or stuporous
- In addition, the patient should be questioned regarding orientation to time, place, and person
Clinical implications:
- Patients with organic mental disorders may give grossly inaccurate answers, with orientation to person remaining intact longer than orientation to time or place
- Patients with schizophrenic disorders may say that they are someone else or somewhere else or reveal a personalized orientation to the world
In a mental status exam what would you observe for with memory and what are its clinical implications?
Observations:
- Remote memory: recall of events, info, and people from the distant past
- Confabulation is a possibility, because the nurse can’t tell what is true and isn’t from the past; the patient may make up stores about situations or events that cannot be remembered
- Recent memory: recall of events, info, and people from the past week or so
- Immediate memory: recall of info or data to which a person was just exposed
Clinical implications:
- Loss of memory occurs with organic mental disorders, dissociative disorder, and conversion disorder
- Patients with Alzheimer disease retain remote memory longer than recent memory
- Anxiety and depression can impair immediate retention and recent memory
In a mental status exam what is “Level of concentration and calculation”, what would you observe for, and what are its clinical implications?
Concentration:
- is the patient’s ability to pay attention during the course of the interview
Calculation:
- is the person’s ability to do simple math
Observations:
- Calculation can be assessed by:
- Counting from 1 to 20 rapidly
- Do simple calculations
- Serially subtract 7 from 100
Clinical implications:
- Many psychiatric illnesses impair the ability to concentrate and complete simple calculations
- It is particularly important to differentiate among organic mental disorder, anxiety, and depression
In a mental status exam what would you observe for with Information and intelligence and what are its clinical implications?
Observations:
- The nurse should assess the patient’s last grade of schooling completed, general knowledge, and use of vocabulary
Clinical implications:
- The patient’s educational level and any learning disabilities should be carefully evaluated
- Mental retardation should be ruled out whenever possible
- The patient’s level of literacy may be part of a general assessment, but it also is an important factor in any health teaching or didactic information presented to the patient
- the nurse should be cautious about judging intelligence after a brief and limited contact typical of the time it takes to conduct a mental status exam
In a mental status exam what is “judgement”, what would you observe for, and what are its clinical implications?
Judgment:
- involves making decisions that are constructive and adaptive
Observations:
- can be evaluated by exploring the patient’s involvement in activities, relationships, and vocational choices
Clinical implications:
- Judgment is impaired in organic mental disorders, schizophrenia, psychotic disorders, intoxication, and borderline or low IQ
In a mental status exam what is “insight”, what would you observe for, and what are its clinical implications?
Insight:
- the patient’s understanding of the nature of one’s problem or illness
Observations:
- important for the nurse to determine whether the patient accepts or denies the presence of a problem or illness; in addition, the nurse should ask if the patient blames the problem on someone else or some external factors
Clinical implications:
- Insight is impaired in those with many psychotic illnesses, including organic mental disorders, psychosis, substance abuse, eating disorders, personality disorders, and borderline or low IQ
- Whether a patient sees the need for treatment is important to the formation of the therapeutic alliance, establishment of mutual goals, and implementation of and adherence to the treatment plan
- Motivational interviewing can assess the patient’s readiness to change
What is The mini-mental state examination (MMSE)?
a simplified, scored form of the cognitive mental status exam with 11 questions; requires 5-10 minutes
What are some Intelligence tests?
- Wechsler Adult Intelligence Scale (WAIS)
- Wechsler Intelligence Scale for Children (WISC)
- Projective tests: reflect aspects of a person’s personality, including reality testing ability, impulse control, ego defense, interpersonal conflicts, and self-concept
What is the purpose of Behavioral rating scales
?
- Measure the extent of the patient’s problems
- Make an accurate diagnosis
- Track patient progress over time
- Document the efficacy of treatment
What is Primary prevention?
lowering the incidence of a mental disorder by reducing the rate at which new cases of a disorder develop
What is Secondary prevention?
involves decreasing the prevalence of a mental disorder by reducing the number of existing cases through early case finding, screening, and prompt, effective treatment
What is Tertiary prevention?
attempts to reduce the severity of a mental disorder and its associated disability through rehabilitative activities
What are Maturational crises?
- developmental events requiring role changes
- Transitional periods during adolescence, parenthood, marriage, midlife, and retirement are key times for the onset of maturational crises
What are Situational crises?
- occur when a life event upsets an individual’s or group’s psychological equilibrium
- Examples: loss of a job, loss of a loved one, unwanted pregnancy, onset or worsening of a medical illness, divorce, school problems, witnessing a crime
What is Neurosis:?
describes a mental disorder characterized by anxiety that involves no distortion of reality; neurotic disorders are maladaptive anxiety responses associated with moderate and severe levels of anxiety
What is Psychosis?
- disintegrative and involves a significant distortion of reality; can emerge with the panic level of anxiety
- The medical diagnoses related to anxiety include panic disorder with or without agoraphobia, agoraphobia, specific phobia, social phobia, OCD, PTSD, acute stress disorder, and GAD
What is Stigma reduction?
An important aspect of mental health promotion involves activities related to dispelling myths and stereotypes associated with vulnerable groups, providing knowledge of normal parameters, increasing sensitivity to psychosocial factors affecting health and illness, and enhancing the ability to give sensitive, supportive, and humanistic health care
What is a stigma and what are the 3 types?
- Stigma: a mark of disgrace or discredit that is used to identify and separate out people whom society sees as deviant, sinful, or dangerous;
-
Three types:
- Public – what the public does to those with mental illness
- Self – when individuals internalize public stigma and harm themselves
- Label avoidance - when individuals who are not mentally ill avoid mental health care so as not to be marked with the label
Health consequences of stigmas?
- Makes people conceal or deny their symptoms
- Results in delays in treatment
- Discourages adherence to effective treatments
- Isolates the individual and family
- Lowers self-esteem and potential for self-care
- Limits access to quality health care
- Negatively affects the attitudes of health care providers
- Contributes to more severe forms of illness
- Limits the community’s response to illness
- Stigma reduction initiatives must take place on both individual and community levels
- Everyone needs to understand that no one is immune to mental illness or emotional problems and that the fear, anxiety, and even anger felt about some people who experience these problems may reflect some of our own deepest fears and anxieties
What does the DSMV 5 axes 1 classify?
clinical syndromes
What does the DSMV 5 axes 2 classify?
- personality disorders
- Axis I and II include the entire classification of mental disorders plus conditions that are not attributable to a mental disorder but that are a focus of attention or treatment
What does the DSMV 5 axes 3 classify?
- general medical conditions
- Axis III allows the clinician to identify any physical disorder relevant to the understanding or treatment of the individual
What does the DSMV 5 axes 4 classify?
- psychosocial and environmental problems
- Axis IV is for reporting psychosocial and environmental problems that may affect the diagnosis, treatment, and prognosis of mental disorders
What does the DSMV 5 axes 5 classify?
- global assessment of functioning
- Axis V is for reportingthe clinician’s judgment of the individual’s overall level of functioning
What is voluntary admission and what are some of its characteristics?
Voluntary admission:
- any citizen of lawful age may apply in writing for admission to a public or private psychiatric hospital
Characteristics:
- The person agrees to receive treatment and abide by hospital rules
- If someone is too ill to apply but voluntarily seeks help, a parent or legal guardian may request admission (people under the age of 16)
- Voluntary admission is preferred because it is similar to a medical hospitalization and indicates that the patient acknowledges problems in living, seeks help in coping with them, and will participate in finding solutions
- When voluntarily admitted, the patient retains all civil rights, including the right to vote, have a driver’s license, buy and sell property, manage personal affairs, hold office, practice a profession, and engage in a business
What is involuntary admission?
Involuntary admission (commitment):
- Means that the patient did not request hospitalization and may have opposed it or was indecisive and did not resist it; most laws permit commitment of the mentally ill on one or more of the following three grounds:
- Dangerous to self or others
- Mentally ill and in need of treatment
- Unable to provide for own basic needs
- Emergency hospitalization: most state laws limit the length of emergency commitment to 48-72 hours
*
Describe the commitment process
Commitment process:
- Begins with a sworn petition by a relative, friend, public official, physician, or any interested citizen stating that the person is mentally ill and needs treatment
- Then, one or two physicians must assess the person’s mental status (some states require psychiatrist)
- The decision of whether to hospitalize the patient is made next; the person who makes the decision determines the nature of the commitment:
- Medical certification means that physicians make the decision
- Court or judicial commitment is made by a judge or jury in a formal hearing
- Administrative commitment is determined by a special tribunal of hearing officers
What is Short term or observational hospitalization?
: used for diagnosis and short term therapy and does not require an emergency situation
What is the Circle of confidentiality?
- A model that shows with whom patient information may be shared with
- Within the circle are treatment team members, staff supervisors, health care students and their faculty, and consultants who actually see the patient
- All these people must be informed about the patient’s clinical condition to be able to help
- The patient is also inside the circle because they can reveal any aspect of their lives, problems, treatments, and expierences to anyone
