lecture 1- mental health and mental illness Flashcards
what is mental health
able to recognize own potential
cope with normal stress
work productively (occupation)
make contribution to community (varies per person)
what are traits of mental health (7)
think rationally
communicate appropriately
learn
grow emotionally
be resilient
have a healthy self-esteem
realistic goals and reasonable function within the individual’s role
what is mental illness
disorders with definable diagnosis
significant dysfunction in mental functioning related to: developmental, biological, physiological disturbances
culturally defined
describe resilience
ability and capacity to secure resources needed to support well-being
ex: “strength” to recover, ability to bounce back
essential to recovery!
what is resilience characterized by
optimism
sense of mastery
competence
what are the risk and protective factors of mental health
individual attributes and behaviors
social and economic circumstances
environmental factors
describe the diathesis stress model
-biological predisposition of mental illness due to environmental stress or trauma
- combination of genetic vulnerability and negative environmental stressors (ex: someone develops major depression d/t inherited and biological vulnerability that alters brain chemistry or through stressful environment
what is assertion in relation to diathesis stress model
describes how most psychiatric disorders result from a combination of genetic vulnerability and negative environmental stressors
describe the mental health parity act (1996)
parity = equivalence
- required insurance companies to provide EQUAL treatment coverage for psychiatric disorders
describe patient protection and affordable care act
- coverage for most uninsured Americans through expanded medicaid eligibility (for very poor)
- created health insurance exchanges to offer more choices
- “insurance mandate” for coverage
what is epidemiology of mental disorders
quantitative study of the distribution of mental disorders in human population
- identifies high risk groups
- identifies high risk factors
what is incidence in relation to epidemiology
number of new cases in a given time
what is prevalence in relation to epidemiology
number of cases regardless of when they began
- total number of cases
what is lifetime risk in relation to epidemiology
risk that one will develop a disease in the course of a lifetime
what are examples of prevalence
- major depressive disorder: 6.7% prevalence
- schizophrenia: 1.1% prevalence
- panic disorder: 2.7% prevalence
- generalized anxiety: 3.1% prevalence
what is clinical epidemiology
examines health and illness at population level
groups treated for specific mental disorders are studied for:
- natural history of illness
- diagnostic screening tests
- interventions
clinical epidemiology results used to describe frequency of (2)
mental disorders + symptoms appearing together (physical)
what is the DSM-V
the diagnostic and statistical manual of mental disorders
- official medical guidelines of the american psychiatric association for diagnosing psychiatric disorders
- based on specific criteria influenced by multi professional clinical field trials
what is the ICD-10-CM
international classification of diseases
- clinical descriptions of mental and behavior disorders
- 2 broad classifications & subclassifications
what is the role of psychiatric mental health nurses
- main: promoting mental health through assessment, diagnosis, and treatment of behavioral and mental disorders
- use nursing, psychosocial, neurobiological theories and research
- work with people throughout the life span
- employed in a variety of settings and among varied population
what is within NANDA-I
standardized nursing diagnoses
what is within NOC (nursing outcomes classification)
standardized outcomes, definitions of these outcomes, and measuring scales
what is within NIC (nursing interventions classification)
seven domains of nursing interventions
describe the basic level of psychiatric nursing practice
- psychiatric mental health registered nurse (PMH-RN)
- 2 years full time, 2000 clinical hours, 30 hours continuing education, followed by certification exam to add “BC” to RN title (RN-BC)
describe the advanced practice of psychiatric nursing practice
- psychiatric mental health advanced practice registered nurse (PMH-APRN)
- master of science or doctorate
what are some future challenges and roles of the mental health domain
education - less availability
aging population - increasing prevalence in alzheimers + dementias
cultural diversity - adjust practices to meet needs of cultures
science, technology, and electronic health care - telepsychiatry
patient advocacy
legislative involvement - nurses aren’t given a seat in policy making
what is the psychoanalytic theory focused on?
sigmund freud
level of awareness
- conscious (perceptions, memories, thoughts, fantasies, feelings)
- preconscious (materials retrieved easily through conscious effort)
-unconscious (all repressed memories, passions, and unacceptable urges deep below surface)
what are the 3 personality structures in the psychoanalytic theory
Id
ego
superego
what is the ID
unconscious, impulsive
pleasure principle (source of drives, instincts, reflexes)
reflex action (cannot tolerate frustration)
primary process (illogical)
what is the ego
conscious, preconscious, unconscious
problem solver (can differentiate subjective experiences, memory images, objective reality)
reality tester (factors in reality to implement plan to decrease tension)
what is the superego
moral component (“should nots” “should”)
- perfectionist
what happens if the id>ego
impulse control issues
what happens if superego>ego,id
self critical, feelings of inferiority
describe defense mechanisms and anxiety relation
- operate on unconscious level
- deny, falsify, or distort reality to make it less threatening
-ex: projection
what occurs during oral years (0-1 years)
teething, biting
what occurs during anal years (1-3 years)
toilet training
what occurs during phalliac/oedipal years (3-6 years)
identifies sexual identity (mom is female, dad is male)
what occurs during latency years (6-12 years)
growth of ego functions
what occurs during genital years (12 years and beyond)
development of sexual and emotional relationships (planning life goals)
what is classical psychoanalysis
- intrapsychic conflict no longer considered to be the cause of all mental illness
- valid tools and concepts
what is transference
patient is transferring onto you
ex: “you look exactly like my sister”
what is countertransference
you are transferring onto patient
ex: treating them differently if they remind you of someone you don’t like
what is psychodynamic therapy
-newer psychoanalytic model
- focuses more on here and now
- uses many tools of psychoanalysis
- best candidates = “worried well” -> are intelligent and well motivated for change
- rapid back and forth between therapist and patient
what is interpersonal theory
- purpose of all behavior is to get needs met through interpersonal interactions and to reduce or avoid anxiety
- 3 topics: anxiety, security operations, self-system
describe anxiety from interpersonal theory
painful feeling or emotion that arises from social insecurity or prevent biological needs from being satisfied
describe security operations from interpersonal theory
measures the individuals employs to reduce anxiety and enhance security
describe self system from interpersonal theory
all of the security operations an individual uses to defend against anxiety and ensure self-esteem
what is interpersonal therapy most effective in training? (3)
- grief and loss
- interpersonal disputes
- role transition
describe sullivan’s theory and nursing
foundation for Hildegard peplau’s theory
- participant observer including: mutuality, respect for the patient, unconditional acceptance, empathy
describe Hildegard Peplau’s theory of interpersonal relationships in nursing
- influenced by Sullivan’s work
- “the art of nursing”
- “the science of nursing”
describe “the art of nursing” described in Hildegard Peplau’s theory of interpersonal relationships in nursing
- provide care, compassion, and advocacy
- enhance comfort and well-being
describe “the science of nursing” described in Hildegard Peplau’s theory of interpersonal relationships in nursing
- application of knowledge to: understand a board range of human problems and psychosocial phenomena, intervene in receiving patients suffering and promote growth
describe Peplau and the therapeutic relationship
4 levels of anxiety (mild, moderate, severe, panic)
- interventions to lower anxiety
- aim to improve patient’s ability to think and function
what are the 3 behavior theories we learned in class
1) Pavlov’s classical conditioning theory: neutral stimulus + stimulus = conditioned response (involuntary)
2) Watson’s behaviorism theory: controlled environment = mold behavior and anyone can be trained
3) Skinner’s operant conditioning theory: learning through rewards + punishment = voluntary behavior
what are the implications for nursing in behavior theories
- modifying or replacing behaviors
- behavior management
what are the 5 types of behavioral therapy
modeling
operant conditioning
systematic desensitization
aversion therapy
biofeedback
Tip: MO SAD
describe modeling in relation to behavior therapy
therapist is the role model for specific identified theories
- pt. learns through imitation/role playing
describe operant conditioning in relation to behavior therapy
slowly exposed to something that is not triggering (positive reinforcement)
describe systematic desensitization
development of behavior takes customized to patient’s specific fears, via learned relaxation techniques
describe aversion therapy
treats behaviors like alcoholism, paraphilia disorder, shoplifting, violent & aggressive behavior, self mutilation
- pairing negative stimulus with specific target behavior, thereby suppressing behavior.
- ex: painting foul-tasting substances on fingernails of nail biters
describe biofeedback in relation to behavior therapy
controlling body’s physiological response to stress and anxiety
what is cognitive theory and therapies
dynamic interplay between individuals and the environment
- thoughts come before feelings and actions
- thoughts about the world and our place in it are based on our own unique perspectives, which may or may not be based on reality
what are the 2 cognitive theories we learned in class
Rational-emotive behavior therapy (Ellis)
cognitive behavioral therapy (Beck)
what is rational-emotive behavior therapy
- aims to eradicate irrational beliefs (negative thinking)
- recognize thoughts that are not accurate
ex: ABC (activating event -> beliefs -> emotional consequence)
what is cognitive behavioral therapy
test distorted beliefs and change way of thinking; reduce symptoms
- challenge negative thinking and substitute with positive, rational thoughts
- learn to recognize when thinking is based on distortions/misconceptions
describe theory of human motivation
- asserts that psychology must go beyond experiences of hate, pain, misery, guilt, and conflict to include love, compassion, happiness, exhilaration, and well-being
describe Maslow’s hierarchy of needs
- human beings are active participants in life, striving for self- actualization
- when lower needs are met, higher needs are able to emerge
- physiological, safety, belonging and love needs, esteem needs, self- actualization
what does theory of human motivation emphasize and prioritize
- emphasis on human potential and the patient’s strength
- prioritizing nursing actions in the nurse-patient relationship
describe the biological model
1) focuses on:
- neurological, chemical, biological, genetic
- qualities of a therapeutic relationship, understanding patient’s POV, communicating to facilitate recovery
2) how the body and brain interact to create:
- emotions, memories, perceptual experiences
3) consider other influences that play a role in the development and treatment of mental disorders
- social, environmental, cultural, economic
describe the psychopharmacology therapy
use of medication to treat psychiatric illness
what are 4 brain stimulation therapies
Electroconvulsive therapy (ECT): depression, mania, Catatonia (cortical)
Trans-cranial magnetic stimulation - repetitive (rTMS): depression (cortical)
Vagus nerve stimulation (VNS): depression (cervical cranial nerve)
Deep brain stimulation (DBS): depression, ocd (subcortical)
- similar to hard reset
- works sometimes, sometimes not
what are the 4 developmental theories (cognitive development) by Piaget
sensorimotor stage
pre operational stage
concrete operational stage
formal operational stage
describe the sensorimotor stage
birth -> 2 years
- basic reflexes, purposeful movements, spacial activities, hand-eye coordination
describe the pre operational stage
2-7 years
- describe thinking about objects
describe the concrete operational stage
7-11 years
- logical thoughts appears, abstract problem solving is possible
describe the formal operational stage
11 - adulthood
- conceptual reasoning commences at approximately same time as puberty.
- abstract thinking and problem solving reflects those of an adult
describe theory of psychosocial development (Erickson)
eight stages of development
- personality continues to develop through old age
what age is trust vs. mistrust
0 - 1.5 years
what age is autonomy vs. shame-doubt
1.5 - 3 years
what age is initiative vs. guilt
3 - 6 years
what age is industry vs. inferiority
6 - 12 years
what age is identity vs. role confusion
12 - 20 years
what age is intimacy vs. isolation
20 - 35 years
what age is generativity vs. self-absorption
35 - 65 years
what age is integrity vs. despair
65+ years
describe the theory of object relations
past relationships influence sense of self and present relationships
- “object” = significant person
- disruption of early separation: psychosocial problems were the cause of this
describe progression from black and white thinking to complex decision making (3 levels)
pre-conventional level
conventional level
post-conventional level
describe pre conventional level
stage 1: obedience/punishment (rules, listening to authority)
stage 2: individualism/exchange (not everyone is the same)
describe conventional level
stage 3: good interpersonal relationships (right/wrong r/t motivation, personality, good/bad in people)
stage 4: maintaining social order (rules are rules)
describe post-conventional level
stage 5: social contract/individual rights (social justice for equality)
stage 6: universal ethics principles (actions should create justice for everyone involves. obliged to break unjust laws)
describe ethics of care theory
Gilligan and Kohlberg
- morality of care vs. “justice view” of morality (we should do right no matter personal cost or cost to those we love)
why is development theories in nursing important
they help determine what types of interventions are most likely to be effective
schemata, automatic thoughts, and cognitive distortions are terms that relate to:
a) rational-emotive behavioral therapy
b) cognitive -behavioral therapy
c) operant conditioning therapy
d) biofeedback
B) cognitive behavioral therapy
