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.
