Mental Health Flashcards
WHO describes mental health as…
a relative and ongoing state of well-being in which individuals realize their abilities, cope with the normal stresses of life, work productively, and contribute meaningfully to the community.
Characteristics indicative on mental health include…
finding balance in all aspects of life - social, physical, spiritual, economic, and mental - and developing resilience, flexibility, and self-actualization.
Mental disorder
the medical term for mental illness and is defined and diagnosed in Canada according to criteria specified in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) by the American Psychiatric Association.
Abuse
When directed toward another, includes acts of misuse, deceit, or exploitation; the wrong or improper use or action toward another individual that results in injury, damage, maltreatment, or corruption.
Addiction
State of dependence or compulsive use. In relation to drug dependence, addiction incorporates the concepts of loss of control with respect to the use of a drug, taking the drug despite related problems and complications, and a tendency to relapse.
Coping mechanism
Method used to decrease anxiety.
Crisis
Temporary state of disequilibrium in which an individual’s usual coping mechanisms or problem-solving methods fail. Crisis can result in personality growth or personality disorganization.
Defense mechanism
Coping mechanism used in an effort to protect the individual from feelings of anxiety. As anxiety increases and becomes overwhelming, the individual copes by using defense mechanisms to protect the ego and decrease anxiety.
Milieu
Physical and social environment in which an individual lives. Milieu therapy focuses on positive physical and social environmental manipulation to produce positive change.
Restraints (security devices)
Physical restraints include any manual method or mechanical device, material or equipment that inhibits free movement. Chemical restraints include the administration of medications for the specific purpose of inhibiting a specific behaviour or movement.
Seclusion
Placing a client alone in a specially designed room that protects the client and allows for close supervision. Seclusion is the last selected measure in a process of maximize safety to the client and others.
Suicide
The ultimate act of self-destruction in which an individual purposefully ends his/her own life.
Suicide attempt
Any willful, self-inflicted, or life-threatening attempt by an individual that has not led to death.
Principles of Nurse-Client Relationship
- Genuineness, respect, empathic understanding
- Cared for in a holistic way
- Consider cultural beliefs and values
- Appropriate limits and boundaries
- Honest and opening communication
- Using therapeutic technique to encourage client to express thoughts and feelings
- Confidentiality
- Assist to develop problem-solving abilities and coping mechanisms
Phases of a therapeutic nurse-client relationship
- Preinteraction phase (focus on own preconceived ideas, stereotypes, biases and values that may impinge on the relationship.
- Orientation or introductory phase (acceptance, trust and boundaries established; expectations and time frame identified; goals are defined; termination and separation of the relationship discussed with the time limit).
- Working phase (exploring, focusing, evaluation of pt’s concerns and problems; attitude of acceptance and active listening; encouraging independence in pt’s recovery).
- Termination or separation phase (evaluate progress and achievement of goals; identify responses related to separation- anger, return of symptoms, etc.; encourage pt to express feelings about termination; identify strengths and need for follow-up care; refer pt to community resources).
Mental health is a lifelong process of…
successful adaptation to changing internal and external environments.
A mentally healthy individual is…
in contact with reality, can relate to people and situations in their environment, and resolve conflicts within a problem-solving framework. Also has psychobiological resilience.
Psychiatric illness is…
the loss of the ability to respond to the internal and external environment in ways that are in harmony with oneself or expectations of society.
Psychiatric illness is characterized by…
thought or behaviour patterns that impair functioning and cause distress.
Personality characteristics of psychiatric illness (7)
- Self-concept is distorted
- Perception of strengths and weaknesses is unrealistic
- Thoughts and perceptions may not be reality-based
- The ability to find meaning and purpose in life may be impaired
- Life direction and productivity may be disturbed
- Meeting one’s own needs may be problematic
- Excessive reliance or preoccupation on the thoughts, opinions, and actions of self or other may be present.
Diagnostic and Statistical Manual of Mental Health Disorders (published by the American Psychiatric Association)
Provides guidelines for health care personnel for identifying and categorizing mental illness. There are diagnostic criteria for each mental health disorder.
Dual diagnosis
Refers to the client who has both a mental health disorder and a substance-related disorder.
Types of Mental Heath Admissions
- Voluntary admission
2. Involuntary admission
Voluntary Admission
When patient or their guardian seeks admission for care; free to sign out of the hospital; detaining voluntary pt against their will is false imprisonment.
Involuntary Admission
May be necessary when pt is mentally ill, is a danger to self or other, or in need of treatment/care.
When a person is admitted or detained involuntarily for treatment; still retains their right for informed consent and still able to refuse treatments unless a separate and specific treatment order is obtained from the court. An order from judge is required for involuntary admissions except in emergencies.
Types of release from hospital
- Voluntarily
- Against medical advice
- With conditions (conditional release) – still may be receiving treatment as outpatient; trial days to see if they can cope and manage independently.
Therapeutic Communication Techniques
Clarifying and validating Encouraging formulating of a plan of action Focusing and refocusing Listening Maintaining neutral responses Maintaining silence Provide acknowledgement and feedback Providing nonverbal encouragement Reflecting Restating Sharing perceptions Summarizing Using broad openings and open-ended questions
Nontherapeutic Communication Techniques
Asking "why?" Being defensive or challenging the client Changing the subject Giving advice or approval or disapproval Making stereotypical comments Making value judgements Placing the client's feelings on hold Providing false reassurance
Types of Defense Mechanisms
Compensation; Conversion;
Denial; Displacement; Dissociation;
Fantasy; Fixation;
Identification; Insulation; Intellectualization; Introjection; Isolation;
Projection;
Rationalization; Reaction Formation; Regression; Repression;
Sublimation; Substitution; Suppression; Symbolization;
Undoing
Compensation (Defense Mechanism)
Putting forth extra effort to achieve in areas where one has a real or imagined deficiency.
Conversion (Defense Mechanism)
Expression of emotional conflicts through physical symptoms.
Denial (Defense Mechanism)
Disowning consciously intolerable thoughts and impulses.
Displacement (Defense Mechanism)
Feelings toward one person are directed to another who is less threatening, satisfying an impulse with a substitute object.
Dissociation (Defense Mechanism)
Blocking of an anxiety-provoking event or period of time from the conscious mind.
Fantasy (Defense Mechanism)
Gratification by imaginary achievements and wishful thinking.
Fixation (Defense Mechanism)
Never advancing to the next level of emotional development and organization; persistence in later life of interests and behaviour patterns appropriate to an earlier age.
Identification (Defense Mechanism)
Unconscious attempt to change oneself to resemble an admired person.
Insulation (Defense Mechanism)
Withdrawing into passivity and becoming inaccessible so as to avoid further threatening situations.
Intellectualization (Defense Mechanism)
Excessive reasoning to avoid feelings; the thinking is disconnected from feelings, and situations are dealt with at a cognitive level.
Introjection (Defense Mechanism)
Type of identification in which the individual incorporates the traits or values of another into themselves.
Isolation (Defense Mechanism)
Response in which a person blocks feelings associated with an unpleasant experience.
Projection (Defense Mechanism)
Transferring one’s internal feelings, thoughts, and unacceptable ideas and traits to someone else.
Rationalization (Defense Mechanism)
Attempt to make unacceptable feeling and behaviours acceptable by justifying the behaviour.
Regression (Defense Mechanism)
Returning to an earlier developmental stage to express an impulse to deal with anxiety.
Reaction Formation (Defense Mechanism)
Developing conscious attitudes and behaviours and acting out behaviours opposite to what one really feels.
Repression (Defense Mechanism)
Unconscious process in which the client block undesirable and unacceptable thoughts through conscious expression.
Sublimation (Defense Mechanism)
Replacement of an unacceptable need, attitude, or emotion with one more socially acceptable.
Substitution (Defense Mechanism)
Replacement of a valued unacceptable object with an object more acceptable to the ego.
Suppression (Defense Mechanism)
Conscious, deliberate forgetting of unacceptable or painful thoughts, ideas, and feelings.
Symbolization (Defense Mechanism)
Conscious use of an idea or object to represent another actual event or object; often the meaning is unclear because the symbol may be representative of something unconscious.
Undoing (Defense Mechanism)
Engaging in behaviour considered to be the opposite of a previous unacceptable behaviour, thought, or feeling.
Interpersonal Psychotherapy
A treatment modality that uses a therapeutic relationship to modify the client’s feelings, attitudes, and behaviours.
Want to establish a contract, clarify roles and timeframe to help meet the client’s goals.
Levels of psychotherapy (3)
- Supportive therapy (allows pt to express feelings, explore alternatives, and make decisions in a safe/caring environment; may need for short or long time; no plan for new methods of coping, but reinforcing their existing coping mechanisms).
- Reeducative therapy (learning new ways of perceiving/behaving; long time period; techniques: short term psychotherapy, reality therapy, cognitive restructuring, behaviour modification, develop coping skills).
- Reconstructive therapy (make major changes; takes years; focus is on all aspects of their life; emotional and cognitive restructuring of self; positive outcomes include greater understanding of self/others; development of potential abilities.
Behavior Therapy
Approach that uses principle of skinerian (operant conditioning) or pavlovian (classical conditioning) behaviour therapy to bring about behavioural change.
Operant conditioning
the manipulation of selected reinforcers to elicit and strengthen desired behaviour responses.
The reinforcer refers to the…
consequence of the behaviour, which is defined as anything that increases the occurrence of a behaviour.
Desensitization
a form of behavioural therapy whereby exposure to increasing increments of a feared stimulus is paired with increasing levels of relaxation, which helps reduce the intensity of fear to a more tolerable level.
Aversion therapy
form of behaviour therapy whereby negative reinforcement is used to change behaviour; a stimulus attractive to the client is pair with an unpleasant eve in hopes to endowing the stimulus with negative properties and dissuading the behaviour.
Modeling
is behavioural therapy whereby the therapist acts as a role model for specific identified behaviours so that the client learns through imitation.
Cognitive Therapy
Based on the principle that how individuals feel and behave is determined by how they think about the world and their place in it; their cognition is based on their attitudes or assumptions developed from previous experiences.
Transactional analysis
The 3 ego states of the individuals are examined. The goal is for the individual to communication from the proper ego states for the situation or response of others.
Rogerian therapy
Goal is to help express their feelings towards others during group session.
Gestalt therapy
emphasis on the “here and now”; emphasizes self-expression, self-exploration, and self-awareness.
Anxiety
A normal response to stress; A subjective experience that includes feelings of apprehension, uneasiness, uncertainty, or dread. Occurs when there is a misperceived threat or a threat to identity or self-esteem.
Types of Anxiety
- Normal : a healthy type of anxiety
- Acute : precipitated by imminent loss/change that threatens one’s sense of security.
- Chronic : Anxiety that persists as a characteristic response to daily activities.
Levels of Anxiety
- Mild (tension of everyday life; alert; perceptual field is increased; can be motivating, produce growth).
- Moderate (focus on imminent concerns; narrows perceptual fields; selective inattentiveness; learning and problem solving still occur).
- Severe (feeling something bad will happen; significant narrowing of perceptual field; focus is on minute or scattered details; all behaviour aimed at realizing anxiety; learning and problem solving are impossible; needs direction to focus).
- Panic (dread, terror, doom; disorganized; unable to communicate or function; increased motor activity; loss of rational thoughts with distorted perception; if prolonger can lead to exhaustion and death).
Interventions for Anxiety
Recognize the anxiety
Establish trust
Protect the client
Do not criticize coping mechanisms
Do no force into situations that provoke anxiety
Modify environment by setting limits or limiting interactions with others
Provide creative outlets
Monitor for signs of impending destructive behavior
Promote relaxation techniques (breathing, guided imagery)
Monitor vitals and administer antianxiety medications as prescribed
The immediate nursing action for a client with anxiety is to…
decrease stimuli in the environment and provide a calm and quiet environemnt.
Generalized Anxiety Disorder
is an unrealistic anxiety about everyday worries that persists over time and is not associated with another psychiatric or medical disorder.
Generalized Anxiety Disorder - Assessment findings
- Restlessness and inability to relax
- Episodes of trembling and shakiness
- Chronic muscular tension
- Dizziness
- Inability to concentrate
- Chronic fatigue and sleep problems
- Inability to recognize connection between the anxiety and physical symptoms
- Focused on the physical discomfort
Panic Disorder
produces a sudden onset of feelings of intense apprehension and dread; the cause usually cannot be identified; severe, recurrent, intermittent anxiety attacks last 5-30 minutes.
Panic Disorder - Assessment findings
1.
Phobias
Irrational fear of an object or situation that persists, although the person may recognize it as unreasonable. Associated with panic-level anxiety if object/situation is unavoidable. Defense mechanism commonly used are repression and displacement.
Acrophobia
Fear of heights
Agoraphobia
Fear of open spaces
Astraphobia
Fear of electrical storms
Claustrophobia
Fear of closed spaces
Hematophobia
Fear of blood
Hydrophobia
Fear of water
Monophobia
Fear of being alone
Mysophobia
Fear of dirt or germs
Nyctophobia
Fear of darkness
Pyrophobia
Fear of fires
Social phobia
Fear of situation where one might be embarrassed or criticized; fear of making a food of oneself.
Xenophobia
Fear of strangers
Zoophobia
Fear of animals
Obsessive-Compulsive Disorder
Obsessions: preoccupation with persistently instructive thoughts and ideas.
Compulsion: the performance of rituals or repetitive behaviour to prevent some event, unacceptable thoughts and decrease anxiety.
Compulsive behaviour patterns (behaviours or rituals)
Decrease the anxiety
The patterns are associated with the obsessive thoughts
The patterns neutralize the thought
During stressful times, the ritualistic behaviour increases
Deference mechanisms: repression, displacement, undoing.
Somatoform Disorders
Characterized by persistent worry or complaints regarding physical illness without supportive physical findings. Physical S&S increase with psychosocial stressors.
Conversion Disorder (a type of somatoform disorder)
The sudden onset of a physical symptom or a deficit suggesting loss of or altered body function related to psychological conflict or a neurological disorder. It is an expression of psychological conflict or need. No organic cause. The development of physical symptoms reduces anxiety.
Symptoms: blindness, deafness, paralysis, inability to talk.
Conversion Disorder - Assessment
- Rule out physiological cause for symptoms/deficits
- “La belle indifference” : unconcerned with symptoms
- Physical limitation or disability
- Feelings of guilt, anxiety, frustration
- Low self-esteem
- Unexpressed anger or conflict
- Secondary gain
Hypochondriasis (a type of somatoform disorder)
Preoccupation with fears of having a serious disease; No evidence of physical illness exists; Significantly impairs social and occupational functioning.
Hypochondriasis - Assessment findings
Frequently somatic complaints Complaints of fatigue and insomnia Anxiety Difficulty expressing feelings Extensive use of home remedies or nonprescription medications Repeatedly visiting a HCP Secondary gains
Somatization Disorder (a type of somatoform disorder)
Has multiple physical complaints involving numerous body systems; Cause of complaints is presumed to be psychological.
Ex: pain; denial of emotional problems; signs of anxiety, fear, low self-esteem
Dissociative Disorder
A disruption in integrative functions of memory, consciousness, or identity. Is associated with exposure to an extremely traumatic event.
Dissociative identity disorder (DID) (formally called multiple personality disorder)
2 or more fully developed, distinct, and unique personalities exist within the client. The host is the primarily personality and the others are referred to a “alters”. Alter personality may take full control over client and may/may not be aware of each other.
Dissociative identity disorder (DID) - Assessment findings
- Client may have an inability to recall important information (unrelated to ordinary forgetfulness).
- Transition from one personality to the other is related to stress or traumatic event and is sudden.
- Used as a method of distancing and defending one’s self from anxiety and traumatizing experiences.
Dissociative amnesia
Inability to recall important personal information because it provokes anxiety. Memory impairment may range from partial to almost complete.
Dissociative amnesia - Types
- Localized: blocks out all memories about a specific period.
- Selective: recalls some but not all memories about a specific period.
- Generalized: has a loss of all memory about past life.
Dissociative fugue
A client assumes a new identity in a new environment; may occur suddenly.
Client may drift from place to place; develops few social relationships; when the fugue phase lifts the client returns home and is unable t recall the fugue state.
Depersonalization Disorder
An altered self-perception in which one’s own reality is temporarily lost or changed.
Assessment: feelings of detachment; Intact reality testing.
Bipolar Disorder
Characterized by episodes of mania and depression with periods of normal mood and activity in between.
Bipolar Disorder - Medication
- Lithium carbonate –> medication of choice**
- Valproic acid (Depakote) –> acute or maintenance
- Carbamazepine (Tegretol) –> acute or maintenance
- Lamotrigine (Lamictal) –> maintenance
- Antianxiety agents to manage psychomotor agitation characteristics of mania
- Atypical antipsychotic medication may be used for their sedative and mood stabilizing effects (Olanzapine, Aripiprazole, Risperidone)
Lithium Carbonate for Bipolar Disorder
Can be toxic and requires regular monitoring of serum lithium levels to help keep the medication’s therapeutic index level appropriate. A stable intake of adequate dietary sodium and fluid (2-3 L daily) must be maintained to avoid toxicity.
Assessment findings for Mania - Bipolar Disorder
Becomes angry quickly Delusional self-confidence Pushing limits, manipulating, finding fault Distracted by environmental stimuli Extroverted personality Flight of ideas High and unstable affect Decrease in appetite Unlimited energy Inability to sleep or eat due to involvement of more important things Dress that is inappropriately bizarre Pressured speech Restlessness Urgent motor activity
Bipolar I
Sustained mania with depressive episodes
Bipolar II
At least one major depression episode with at least one hypomanic episode
Stressors for PTSD
natural disaster, terrorist attack, accident, rape/abuse, crime/violence
Assessment findings for Depression - Bipolar Disorder
Increased or decrease appetite Decrease ADLs Decreased emotion and physical activity Easily fatigued Inability to make decisions Poor concentration Introverted personality Social isolation Lack initiative and energy Low self-esteem Suicidal thinking
Depression
Affects feelings, thoughts and behaviours; Can occur after a loss or traumatic event; May be mild, moderate and severe; Treatment includes counseling, antidepressant medication and ECT.
Mild Depression
Lasts less than 2 weeks Feeling sad, let down, disappointed Mild alteration to sleep Less alert Irritability Disinterested in spending time with others Increase use of alcohol/drugs Increase or decrease appetite
Moderate Depression
Persists over time
Experience a sense of change and often seeks help
Dejected, gloomy, low self-esteem, helplessness, powerlessness, intense anxiety and anger
Diurnal variation (may feel better at certain time of the day)
Rumination (persistent thinking/talking about particular subject)
Anorexia, weight loss, fatigue
Negative thinking and suicidal thoughts
Social withdrawal
Severe Depression
Intense and pervasive Despair and hopelessness Guilt and worthlessness Flat affect Unkempt appearance Decreased speech Self-destructive thoughts Terminal insomnia Diurnal variation Delusion and hallucinations
Electroconvulsive Therapy (ECT)
An effective treatment for depression (not a cure); an electrical current is delivered though electrodes attached to the temples that cause a brief seizure within the brain.
ECT indications for use
- When antidepressant medications have no effect
- When there is a need for rapid definite response (ex. when suicidal)
- When extreme agitation or stupor present
- Major depressive and bipolar depressive disorder; Schizophrenia
Schizophrenia
A group of mental disorders characterized by psychotic features (hallucinations and delusions), disordered thought processes, and disrupted interpersonal relationships.
Disturbances in affect, mood, behaviour, and thought processes occur.
Schizophrenia - Physical Characteristics
Unkempt appearance
Body image distortions
May be preoccupied with somatic complaints
May neglect hygiene, eating, sleeping and elimination
Schizophrenia - Motor Activity Findings
Catatonic posturing (holding bizarre postures)
Catatonic excitement (moving excitedly with no stimuli)
Possible total immobilization
Inability to respond to command or only does same
Waxy flexibility
Repetitive or stereotyped movements
Motor activity increase (pacing)
Echolalia
Repeating the speech of another person
Echopraxia
Repeating the movement of another person
Waxy Flexibility
Having one’s arms or legs placed in a certain position and holding the same position for hours
Schizophrenia - Emotional Characteristics
Mistrust
View the world as threatening and unsafe
Affect blunted, flat or inappropriate
Abnormal Thought Processes - Definition
Abnormal thought processes displayed by mentally ill client that occur as a result of a psychiatric disorder.
Abnormal Thought Processes - Types
- Circumstantiality
- Confabulation
- Flight of Ideas
- Looseness of Association
- Neologisms
- Though Blocking
- Word Salad
Circumstantiality
Before getting to the point or answering a question, client gets caught up in countless details and explanations.
Confabulation
Filling a memory gap with detailed fantasy believed by the teller; the purpose of confabulation is to maintain self-esteem; seen in organic conditions such as Korsakoff’s psychosis.
Flight of Ideas
Constant jumping between topics is rapid succession; seen in manic states.
Looseness of Association
Haphazard, illogical, and confused thinking and interrupted connections in thought; most seen in schizophrenic disorders.
Neologisms
Client makes up words that have meaning only for the individual; often part of a delusional system.
Delusions
A false belief held to be true, even when there is evidence to the contrary.
Loss of Reference - Delusion
client believes that certain events, situations, or interactions are related directly to self.
Delusions of Persecution
Client believes that they are being harassed, threatened, or persecuted by some powerful force.
Delusions of Grandeur
False belief that one is a powerful and important person.
Somatic Delusions
Client believes that their body is changing or responding in an unusual way, which has no basis in reality.
Illusions
May be brief experiences with a misinterpretation or misperception of reality.
Hallucinations
Sense perception (5 senses) for which no external stimuli exist.
Types of Schizophrenia
- Catatonic Schizophrenia
- Disorganized Schizophrenia
- Paranoid Schizophrenia
- Residual Schizophrenia
- Undifferentiated Schizophrenia
Auditory Hallucinations
Hearing voices when none are present.
Gustatory Hallucinations
Experience taste in the absence of stimuli
Olfactory Hallucinations
Smelling smells that do not exist.
Tactile Hallucinations
Feeling touch sensations in the absence of stimuli
Visual Hallucinations
Seeing things that are no there.
Interventions: Active Hallucinations
- Monitor for cues and assess content of hallucinations.
- Intervene with one-on-one contact
- Decrease stimuli; move pt to different areas.
- respond verbally to anything real that they talk about.
- avoid touching pt
- encourage expressing feelings
- during hallucination, attempt to engage the pt’s attention through a concrete activity.
- administer meds as n prescribed.
- Safety first* ensure there is no commands to hurt self or others.
Interventions: Delusions
- Interact based on reality
- encourage to express feelings.
- do not dispute or try to convince the pt that the delusions are false.
Paranoid Disorders
Is a concrete, pervasive delusional system characterized by persecutory and grandiose beliefs. Exhibits suspiciousness and mistrust of others.
Paranoid Disorders- Behaviours
Suspicious and mistrustful Emotionally distant Distortion of reality Poor judgment Delusions Highly sensitive Evasive Concrete thinking Hostile, aggressive
Types of Paranoid Disorders
- Paranoid personality disorder
- Paranoid-induced state
- Paranoia
- Paranoid Schizophrenia
Paranoid Personality Disorder (Characteristics)
Suspicious
Nonpsychotic
No hallucinations or delusions
No symptoms of schizophrenia
Paranoia-induced State (Characteristics)
Abrupt onset in response to stress; subsides when stress decreases
No hallucinations, but experiences paranoid delusions
May be sensitive and suspicious before delusions
No symptoms of schizophrenia
Paranoia (Characteristics)
Exhibits an organized delusional system No hallucinations Reserved and sensitive before onset Psychotic state No symptoms of schizophrenia
Paranoid schizophrenia (Characteristics)
Becomes cold, withdrawn, distrustful, resentful, argumentative before onset.
Bizarre, numerous and changeable delusions occur.
Persecutory hallucinations occur
Psychotic state ensues.
All symptoms of schizophrenia are present.
Personality Disorders
Includes various inflexible maladaptive behaviour patterns or traits that may impair functioning and relationships. Usually remain in touch with reality, but lack insight into their behaviours.
Personality Disorders (Characteristics)
- Poor impulse control
- Mood characteristics (abandonment, depression, rage, guilt, fear, emptiness)
- Impaired judgment (difficulty problem solving, inability to perceive the consequences of behaviour)
- Impaired self-perception
- Impaired thought process
- Impaired stimulus barrier
Cluster A personality disorder types
- Schizoid
- Schizotypal
- Paranoid
Schizoid Personality Disorder (Characteristics)
Inability to form warm, close social relationships.
Lack of interest in others; interest in solitary activities; indifferent; restricted expression of emotions.
Schizotypal Personality Disorder (Characteristics)
Display abnormal or highly unusual thoughts, perceptions, speech, and behaviour patterns.
Suspicious; Paranoia; Magical thinking; Relationship deficits.
Paranoid Personality Disorder (Characteristics)
Suspiciousness and mistrust of others (paranoia).
Hostile; Rigid; Controlling; Distrusting
Cluster B personality disorder types
Include the overemotional, erratic types.
- Histrionic
- Narcissistic
- Antisocial
- Borderline
Histrionic Personality Disorder (Characteristics)
Overly dramatic and intensely expressive behaviour.
Enjoys being center of attention; Easily bored; Concern with appearance; Sexually provocative.
Narcissistic Personality Disorder (Characteristics)
An increased sense of self-importance and preoccupation with fantasies and unlimited success.
Need admiration for accomplishments; overestimation of abilities and underestimation of contributions of others; lack of empathy.
Antisocial Personality Disorder (Characteristics)
Comprises a pattern of irresponsible and antisocial behaviour, selfishness, inability to maintain lasting relationships, poor sexual adjustment, failure to accept social norms and tendency toward irritability and aggressiveness.
Borderline Personality Disorder (Characteristics)
Instability in interpersonal relationships, unstable mood and self-image, and impulsive and unpredictable behaviour.
Cluster C personality disorder types
Include the anxious, fearful types.
- Obsessive-compulsive personality
- Avoidant
- Dependent
Obsessive-Compulsive Personality Disorder (Characteristics)
Difficulty expressing warm and tender emotions, perfectionism, stubbornness, the need to control other, and a devotion to work.
Avoidant Personality Disorder (Characteristics)
Social withdrawal and extreme sensitivity to potential rejection.
Lack of social support; hypersensitive to reactions of others.
Dependent Personality Disorder (Characteristics)
Intense lack of self-confidence, low self-esteem, and inability to function independently.
General Interventions for a client with a Personality Disorder
Maintain safety against self-destruction;
Allow choices and be independent;
Provide consistency in response to behaviours;
Discuss consequences that will follow certain behaviours;
Set and maintain limits to decrease manipulation behaviours;
Encourage journal recording for emotions.
Dementia
A syndrome with progressive deterioration in intellectual functioning secondary to structural or functional changes.
The most common type of dementia is __.
Alzheimer’s disease
Alzheimer’s Disease
An irreversible form of senile dementia caused by nerve cell deterioration.
Stages and Major Characteristics of Alzheimer’s Disease
Stage 1 (mild): forgetfulness Stage 2 (moderate): confusion Stage 3 (moderate-severe): ambulatory dementia Stage 4 (late): end stage
Agnosia
Failure to recognize or identify familiar objects despite intact sensory function.
Amnesia
Loss of memory caused by brain degeneration.
Aphasia
Language disturbance in understanding and expressing spoken words.
Apraxia
Inability to perform motor activities, despite intact motor function.
Bisexuality
Sexual attraction to and activity with both genders.
Heterosexuality
Male-female sexual relationships.
Homosexuality
Sexual attraction to a member of the same gender.
Transvetisms
Obsession with wearing clothing of the opposite gender.
Sexuality
One’s sense of being a sexual individual; includes how one looks, behaves and related to others,
Transsexualism
Feeling that one’s gender is inappropriate and desiring to acquire sexual characteristics of the opposite gender.
Exhibitionism
Sexual urges and fantasies that result in exposure of genitals to strangers to bring sexual gratification or arousal.
Fetishism
Using nonliving objects for sexual gratification
Pedophilia
Desiring sexual activity with a child younger than 13 years old.
Sexual masochism
Sexual gratification that involves receiving pain.
Sexual sadism
Sexual gratification that involves inflicting pain.
Voyeurism
Sexual gratification through observing others disrobing or engaigng in sexual activity.
Zoophilia
Intense sexual arousal or desire when rubbing against a nonconsenting person.
Eating disorders are characterized by…
uncertain self-identification and grossly disturbed eating habits.
Compulsive overeating
Bingelike overeating without purging; Release tension but doesn’t produce pleasure; Aware eating patterns are abnormal and feels depressed after eating; Response to feelings by eating.
Anorexia Nervosa
Onset often associated with stressful life event; Fears obesity; Body image is distorted is common; Can be life-threatening.
Bulimia Nervosa
Indulges in eating binges followed by purging behaviours; Most clients remain within a normal weight range, but think their lives are dominated by the eating-related conflict.
Interventions for clients with an Eating Disorder
- Assess nutritional status and severity of medical problems.
- Establish rapport with client.
- Establish a contact concerning the nutritional plan for the day.
- Identify precipitants to the eating disorder.
- Encourage expression of feelings and feelings about their body.
- Be accepting and nonjudgmental.
- Work on exploring self-concept and identity.
- Implement behaviour modification techniques.
- Supervise during mealtimes and after; Monitor I&O.
- Monitor for signs of physical complications r/t to eating disorders.
- Weigh daily.
- Monitor/restore electrolytes and fluids.
- Assess and limit activity levels.
- Medications (antidepressants)
- Encourage psychotherapy and support groups.
Substance abuse disorders cause…
behavioural and physiological changes.
Substance Dependence
Is a pattern of repeated use of a substance, which usually results in tolerance, withdrawal, and compulsive drug-taking behaviour.
Substance taken is large amounts and over longer period than intended. Daily activities resolve around the use of substance.
Substance tolerance
is the need for increased amount of the substance to achieve the desired effect.
Substance abuse
uses substances recurrently; recurrent, significant harmful consequences r/t to the use are experienced; Common to have legal issues.
Substance withdrawal
Physiological and substance-specific cognitive symptoms occur; Experiences a decrease in blood levels of a substance on which the individual is physiologically dependent.
Factors to consider in a client with a substance-related disorder.
- Rebellion and peer group pressure in adolescence
- May be a coping mechanism to decrease pain/feeling
- Depression may precede or occur as a result
- Grief and loss may be associated
Codependency
refers to the presence of coexisting behaviours present in a significant other, which serves to enable the addict or alcoholic to continue the irresponsible patterns of use without experiencing consequences.
Alcohol Abuse
Is a CNS depressant affecting all body tissues.
Physical dependence is a…
biological need for alcohol to avoid physical withdrawal symptoms.
Psychological dependence refers to…
craving for the subjective effect of alcohol.
Compilations associated with Chronic Alcohol Use.
- Vitamin Deficiencies (Vitamin B causing peripheral neuropathies; Thiamine causing Korsakoff’s syndromes).
- Alcohol-induces persistent amnesic disorder, causing sever memory problems.
- Wernicke’s encephalopathy, causing confusion, ataxia, and abnormal eye movements.
- Hepatitis; cirrhosis of the liver.
- Esophagitis and gastritis.
- Pancreatitis.
- Anemias.
- Immune system dysfunctions.
- Brain damage.
- Peripheral neuropathy.
- Cardiac disorders.
What medication is commonly used for acute alcohol withdrawal?
Chlordiazepoxide (Librium)
Disulfiram (Antabuse) Therapy
is an alcohol deterrent that may be prescribed for alcoholic dependence. The medication sensitizes the client to alcohol so that a disulfiram-alcohol reaction occurs if alcohol is ingested.
CNS Depressants - Drug Dependency
Include alcohol, benzodiazepines, and barbiturates and act a a depressant, sedative, or hypnotic.
Intoxication for CNS Depressants (Symptoms)
- Drowsiness
- Hypotension
- Impairment of memory, attention, judgement, social or occupational functioning
- Incoordination and unsteady gait
- Irritability
- Slurred speech
Overdose for CNA Depressants
If client is awake, vomiting is induced and charcoal is administered; If not aware, maintain airways and gastric lavage with activated charcoal are the priorities; seizure precautions.
Overdose can produce cardiovascular or respiratory depression, coma, shock, seizures and death.
What medication may be used for benzodiazepine overdose to reverse the effects?
IV Flumazenil (Romazicon)
CNS Stimulants - Drug Dependency
Include substances such as amphetamines, cocaine, and crack.
Intoxication for CNS Stimulants (Symptoms)
- Dilated pupils
- Euphoria
- Hypertension
- Impairment of judgment and social or occupational functioning
- Insomnia
- N&V
- paranoia, delusions, hallucinations
- potential violence
- tachycardia
Overdose for CNA Stimulants
Can produce respiratory distress, ataxia, hyperpyrexia, seizures, coma, stroke, MI, and death.
Is treated with antipsychotics and managements of associated effects.
CNA Depressant withdrawal is treated with…
barbiturate such as phenobarbital or a long-acting benzodiazepine.
CNA Stimulant withdrawal is treated with…
antidepressants, a dopamine agonist, or bromocriptine (Parlodel).
Opioids - Drug Dependency
Include opium, heroin, meperidine (Demerol), morphine sulfate, codeine sulfate, methadone (Dolophine), hydromorphone (Dilaudid), oxycodone (OxyContin), hydrocodone (Lortab), and fentanyl (Sublimaze).
Intoxication for Opioids (Symptoms)
Constricted pupils Decreased respirations Drowsiness Euphoria Hypotension Impaired memory, attention, judgment Psychomotor retardation Slurred speech
Overdose for Opioids
Can produce respiratory depression, shock, coma, seizures, and death.
Treated with an opioid antagonist (naloxone)
What medication assist in reducing the severity of sympathetic nervous system-generated withdrawal discomfort of Opioids?
Clonidine (Catapres)
Hallucinogens - Drug Dependency
Include lusergic acide diethylamide (LSD), mescaline (peyote), psilocybin (mushrooms), and phencyclidine (PCP).
Intoxication for Hallucinogens (Symptoms)
Agitation Anxiety and depression Blank state; Bizarre behaviour Dilated pupils Hallucinations Elevated vital signs (BP) Incoordination Paranoia Seizures Tachycardia Tremors Muscular rigidity, jerking
Overdose effects of LSD, peyote, and psilocybin
Psychosis, brain damage, and death
Overdose effects of PCP
Psychosis, hypertensive crisis, hyperthermia, seizures, respiratory arrest
Treatment for LSD, peyote, psilocybin
Involves low environmental stimuli (speak slowly, clearly and in a low voice) and medications to treat anxiety.
Treatment for PCP
Possible gastric lavage (if alert); treatment to acidify the urine to assist to excreting the drug; interventions to treat behavioural disturbances, hyperthermia, hypertension, respiratory distress.
Inhalants - Drug Dependency
Include gases or liquids such as butane, paint thinner, paint and wax remover, airplane glue, nail polish remover, nitrous oxide.
Intoxication for Inhalants (Symptoms)
Enhancement of sexual pleasure
Euphoria
Excitation followed by drowsiness, lightheadedness, disinhibition, agitation
Giggling and laughter
Overdose effects of Inhalants
Can cause damage to the Nervous system and death.
Marijuana (Cannabis sativa) - Drug Dependency
Causes: euphoria, detachment, relaxation, talkativeness, slowed perception of time, anxiety, paranoia.
Other recreational and club drugs - Drug Dependency
Methylenedioxymethamphetamine (MDMA, ecstasy)
y-hydroxybutyrate (GHB)
Methamphetamine (crack, meth, crystal meth)
Ketamine (special K)
Withdrawal Nursing Care
Obtain info about type of drug and amount consumed
Assess vital signs
Remove unnecessary object from environment
One-to-one supervision if necessary
Provide quiet, calm environment
Maintain client orientation
Use security devices if necessary
Provide physical needs
Provide food and fluids as tolerates
Administer medications as prescribed to decreased withdrawal symptoms
Collect blood and urine samples for drug screening
Crisis
Is a temporary state of severe emotional disorganization caused by failure of coping mechanisms and lack of support.
Phases of a Crisis
Phase 1: External precipitating event
Phase 2: Perception of threat; increase anxiety; may cope or resolve the crisis.
Phase 3: Failure of coping; increased disorganization; emergence of physical symptoms; relationship problems.
Phase 4: Mobilization of internal and external resources; goal is to return the client to at least a pre-crisis level of functioning.
Types of Crises
- Maturational (R/t to developmental stages and role changes - marriage, birth of child, retirement)
- Situational (external source, often unanticipated, life event that upsets their psychological equilibrium - loss/change of job, financial status, death of loved one)
- Adventitious (r/t to crisis or event that is not part of everyday life, unplanned - flood, earthquake, assault, rape, murder, abuse)
Grief
A natural emotional response to loss that individuals must experience as they attempt to accept the loss. Usually involves moving through a series of stages to help resolve the grief.
Types of Grief
- Normal grief (physical, emotional, cognitive, behavior reactions; can take months-years for resolution).
- Anticipatory grief (occurs before the loss)
- Disenfranchised grief (when a loss of a loved one is experience and cannot be acknowledged openly - society doesn’t define the loss as a loss)
- Dysfunctional grief (prolonged emotional instability, lack of progression to cope with the loss).
- Grief in children is based on the developmental level of a child.
Stages of the Grief Response
Stage 1: Shock and Disbelief (numbness, difficulties with decision-making, emotional outbursts, denial, isolation).
Stage 2: Experiencing the Loss (ex. angry at the loved one who died or feelings of guilt about the death).
Stage 3: Reintegration (begins to reorganize their life and accepts the reality of the loss).
Loss
is the absence of something desired or previously thought to be available.
Moruning
is the outward and social expression of loss. May be dictated by cultural and religious beliefs.
Bereavement
includes the inner feelings and the outward reactions of the individual experiencing the loss. Includes grief and mourning.
Nurse’s Role: Grief and Loss
Allow opportunities for fully informed choices.
Facilitate the grief process; assess grief and assist them to feel the loss and complete the tasks of the grief process.
Multidisciplinary team approach (physically, psychologically, socially, spiritually).
The nurse caring for a depressed client always considers the possibility of __.
suicide
High-risk groups for Suicide
Hx of previous suicide attempts Family Hx of suicide attempts Adolescents Older adults Disabled or terminally ill clients Personality disorders Dementia Depressed or psychotic clients Substance abusers
Anger
A feeling of annoyance that may be displaced onto an object or person.
Is used to avoid anxiety and gives a feeling of power in situations in which they feel out of control.
Violence
Physical force that is threatening to the safety of self and others.
Bullying
The abuse of power by an individual on another through repeated aggressive acts.
Can be in the form of physical, isolation, exclusion, verbal harm; it is both intentionally cruel and unprovoked.
Types of Violence
Physical violence Sexual violence Emotional violence Physical Neglect Developmental Neglect Educational Neglect Economic Exploitation
Physical Violence
Inflicting of physical pain or bodily harm.
Sexual Violence
Any form of sexual contact without consent.
Emotional Violence
Inflecting of mental anguish.
Physical Neglect
Failure to provide health care to prevent or treat physical or emotional illnesses.
Developmental Neglect
Failure to provide physical and cognitive stimulation needed to prevent developmental deficits.
Educational Neglect
Depriving a child of education.
Economic Exploitation
Illegal or improper exploitation of money, funds, or other resources for one’s personal gain.
Latchkey Children
Children who do not have adult supervision before or after school hours; they are left to care for themselves during these times often when parent(s) work.
Interventions: encourage parent to teach child about self-care and self-help skills; assist to identify possible alternatives; inform about community resources B&A.
Actions to take when an Older Adult is Physically Abused
- Assess and treat the wounds.
- Ensure the victim is removed from the threatening environment.
- Adhere to mandatory abuse reporting law.
- Notify the caseworker of the situation.
- Document the occurrence, findings, actions take, and the victim’s response.
