Mental Health Exam 1

Question 1

Hierarchy of evidence

Answer 1

1-Systimatic review of Randomized Control Trial (RTC)
2 - Well designed RTC
3 - Controlled trail without randomization
4 -Single Nonexperimental study
5 - Reviews of qualitative study
6-Single qualitative study
7 - Opinion/reports of Authorities/ Experts

Question 2

Patient Advocate

Answer 2

ANA code of ethics - The nurse must be alert to and take appropriate action regarding any instances of incompetent, unethical, illegal, or impaired practices(s) by any member of the health team or the health care system itself, or any action on the part of others that places the rights or best interest of the patient in jeopardy.

Question 3

DSM-5

Answer 3

• The Diagnostic and Statistical Manual of Mental Disorders, fifth edition.
  -official guidebook for categorizing and diagnosing psychiatric mental health disorders in the United States. The DSM-5 provides clinicians, researchers, regulatory agencies, health insurance companies, pharmacological companies,
  and policy makers with a standard language and criteria for the classification of mental disorders.

Question 4

Factors affecting mental health

Answer 4

• Biological hormones/Genetics,
• Spirituality/ Religion
• Culture/Regional differences
• Family/Friends/Community
• Personality traits
• Health practices and beliefs
• Environmental experiences
• Economics

Question 5

Sigmund Freud

Answer 5

An Austrian neurologist, is considered the “father of psychiatry.” His work was based on psychoanalytic theory, in which Freud claims that most psychological disturbances are the result of early trauma or incidents that are often not remembered or recognized.

Question 6

The ID

Answer 6

The id is the primitive, pleasure-seeking, and impulsive part (according to Freud,
predominantly sexual pleasure) of our personalities that lurks in the unconscious mind.

Question 7

The EGO

Answer 7

• • The ego is the problem solver and reality tester that navigates in the outside world. It acts as
    an intermediary between the id and reality by using ego defense mechanisms, such as
    repression, denial, and rationalization.

Question 8

The SUPEREGO

Answer 8

• • The superego represents the moral component of the personality that Freud referred to as our
    conscience (our sense of what is right or wrong). The superego is greatly influenced by parents’
    or caregivers’ moral and ethical stances.

Question 9

Therapeutic Model

Answer 9

• Psychoanalytic therapy was Freud’s answer for a scientific method to relieve emotional disturbances. An often time consuming (e.g., three to five times a week for many years), expensive, and emotionally painful process, the goal of this therapy is to know and understand what is happening at the unconscious level in order to uncover the truth.

Question 10

Erikson’s Stages

Answer 10

Infancy: Birth to 1½ Years
- Trust vs. mistrust
Early Childhood: 1½–3 Years
- Autonomy vs. shame/doubt
Play Age: 3–6 Years
- Initiative vs. guilt
School Age: 6–12 Years
- Industry vs. inferiority
Adolescence: 12–20
- Identity vs. role confusion
Young Adulthood: 20–30
- Intimacy and solidarity vs. isolation
Adulthood: 30 to 65 Years
- Generativity vs. self-absorption
- Senescence: 65 Years to Death
- Integrity vs. despair

Question 11

Group therapy

Answer 11

• This therapeutic method is commonly derived from interpersonal theory. It operates under the assumption that interaction within the group can provide support or bring about desired change among individual participants.
  -Experts disagree on the ideal size of the group, but it is usually somewhere between 6 and 10 members

Question 12

Tuckman’s (1965) model of group development

Answer 12

four stages:
forming, storming, norming, and performing. A fifth stage, adjourning (mourning).

Question 13

Benefits of Group Therapy

Answer 13

more pragmatic and financially, than individual therapy. This efficiency is due to the fact that many people can engage in therapy at once. However, it is the nature of the interaction between people with common concerns and frames of references that seems to provide the greatest benefit to members.

Question 14

Major brain structures

Answer 14

• Cerebrum - (four lobes are the frontal, parietal, occipital, and temporal lobes)
• -brainstem (midbrain, pons, and medulla)
• Cerebellum
• -Limbic System - ( the hippocampus, the amygdala, and the basal ganglia.)
• Thalamus
• Hypothalamus

Question 15

The cerebrum

Answer 15

The cerebrum or cerebral cortex is made up of the four different lobes of the brain. It is also called the human brain or higher brain and is responsible for higher cognitive skills, self-awareness, and executive functions

Question 16

frontal lobe

Answer 16

frontal lobe is responsible for conscious movement, problem-solving skills, and speech production. The prefrontal cortex (PFC) is the most anterior part of the
frontal cortex and is involved in moderating social behaviors, goal setting and planning, and personality.

Question 17

The parietal lobes

Answer 17

The parietal lobes are involved in tactile sensation and spatial awareness.

Question 18

The occipital lobe

Answer 18

The occipital lobe is primarily responsible for vision and visual processing.

Question 19

The temporal lobe

Answer 19

The temporal lobe is responsible for hearing, language reception, and language comprehension

Question 20

Brainstem

Answer 20

• Basic life functions like regulation of heart rate, breathing, and sleep occur through the brainstem - composed of the midbrain, pons, and medulla. Projections from the brainstem, called the reticular activating system (RAS) control the level of consciousness and sedation. Many psychiatric medications can alter the signals sent through the brainstem, which can impact sleep and wakefulness, heart rate, and respiration.

Question 21

Cerebellum

Answer 21

• The cerebellum is involved in both motor control and cognitive processing.

Question 22

Limbic Brain

Answer 22

pockets of gray matter lying deep within the cerebrum: the hippocampus, the amygdala, and the basal ganglia. The hippocampus interacts with the PFC in making new memories. The amygdala plays a major role in processing fear and anxiety. The hippocampus and amygdala, along with the hypothalamus and thalamus, are a group of structures called the limbic system or “emotional brain.”

Question 23

Thalamus

Answer 23

• The thalamus filters sensory information before it reaches the cerebral cortex

Question 24

Hypothalamus

Answer 24

• The hypothalamus maintains homeostasis. It regulates temperature, blood pressure, perspiration, libido, hunger, thirst, and circadian rhythms, such as sleep and wakefulness.

Question 25

positron emission tomography (PET) and single-photon emission
computed tomography (SPECT)

Answer 25

-use ionizing radiation to localize brain regions associated with perceptual, cognitive, emotional, and behavioral functions.
-Decreased metabolism with depression or schizophrenia and
-increased metabolism in OCD.
-Dopamine system dysregulation in schizophrenia
-Loss of monoamines in depression.
-Alzheimer’s - Reduction in nicotinic receptors

Question 26

Functional magnetic resonance imaging (fMRI)

Answer 26

measures how well two regions of the brain communicate with each other.
-Schizophrenia, fMRI demonstrates that individual differences in striatal functional connectivity predict the response to antipsychotic drug treatment. Researchers hope that this striatal connectivity index (SCI) will eventually predict who will respond to medications and who will not.

Question 27

neurotransmitters types

Answer 27

The four major groups of neurotransmitters in the brain are
-monoamines
-amino acids
-peptides
-cholinergics

Question 28

psychotropic drugs alter concentration of which neurotransmitters

Answer 28

dopamine, acetylcholine, NE, serotonin, histamine, GABA, or glutamate.

Question 29

-receptor antagonists
-agonists

Answer 29

-blocking neurotransmitter activity
-promoting neurotransmitter activity,
-interference with neurotransmitter reuptake,
enhancement of neurotransmitter release, or inhibition of enzymes.

Question 30

Selective serotonin reuptake inhibitors (SSRIs),

Answer 30

which increase the level of serotonin by inhibiting reuptake, a mood-regulating neurotransmitter.
Side-effects - anxiety, insomnia, sexual dysfunction, and gastrointestinal disturbances. Serotonin toxicity

Question 31

Serotonin and norepinephrine reuptake inhibitors (SNRIs)

Answer 31

which increase the levels of both serotonin and norepinephrine, another neurotransmitter involved in mood and pain.

Question 32

Tricyclic antidepressants (TCAs),

Answer 32

which block the reuptake of serotonin and norepinephrine, as well as affecting other receptors in the brain.
-Side-effects - sedation and weight gain, dizziness and hypotension,

Question 33

monoamine oxidase inhibitors (MAOI)s

Answer 33

Block chemical that breaks down serotonin
-the vasopressor effect - when other sympathomimetics (amines that stimulate the sympathetic nervous system). The most feared vasopressor effect is the hypertensive crisis that can result if a patient takes over-the-counter medications with pseudoephedrine or consumes the adrenergic monoamine tyramine, commonly found in aged foods, fermented foods, and certain beverages. Dietary restriction of tyramine must be maintained for 2 weeks after stopping MAOIs to allow the body to resynthesize the MAO enzyme.

Question 34

First Generation Antipsychotics

Answer 34

FGAs were once called neuroleptics.
-Dopamine receptor agonists (DRAs) - bind to dopamine type 2 (D2) receptors and reduce dopamine transmission.
- D2 blockade achieves the therapeutic effect of decreasing positive symptoms in schizophrenia,
-side effects, such as dystonia (muscle stiffness), akathisia
(restlessness), TD, and drug-induced parkinsonism.

Question 35

Second-Generation/Atypical Antipsychotic Agents

Answer 35

-serotonin-dopamine antagonists (SDAs)
-have a higher ratio of serotonin (5-HT2) to dopamine D2-receptor blockade than first generation DRAs.
-Fewer side-effects than FGA
-Treat - bipolar disorder and depression
Side-effects - anticholinergic and antihistaminic activity.

Question 36

Patient-centered medical homes (PCMHs)

Answer 36

The focus of care is patient centered and provides access to physical health, behavioral health, and supportive community and social services.

Question 37

Community-based facilities

Answer 37

provide comprehensive services to prevent and treat mental illness. These services include assessment, diagnosis, individual and group counseling, case management, medication management, education, rehabilitation, and vocational or employment services.

Question 38

Psychiatric home care

Answer 38

The care may be coordinated by the community mental health system or through other agencies such as Visiting Nurse Services. Home care may reduce the need for
costly and disruptive hospitalizations and may provide a more comfortable and safer alternative to clinical settings.

Question 39

-Intensive outpatient programs (IOPs)
-Partial hospitalization programs (PHPs)

Answer 39

Monday through Friday, but IOPs are usually half a day, whereas PHPs are longer (about 6 hours
because they are “partially hospitalized”). These programs provide structured activities with nursing and medical supervision, intervention, and treatment. They tend to be located within general hospitals, in psychiatric hospitals, and as part of community mental health.

Question 40

Inpatient care

Answer 40

-most intensive. These facilities provide 24-hour nursing care in a safe and
structured setting. Such a setting is essential to caring for those who are in need of protection from suicidal ideation, aggressive impulses, medication adjustment and monitoring, crisis stabilization, substance use detoxification, and behavior modification.

Question 41

therapeutic milieu

Answer 41

Milieu refers to the
environment in which holistic treatment occurs and includes all members of the treatment team in a positive physical setting, with interactions among those who are hospitalized and activities that promote recovery.

Question 42

Affordable Care Act

Answer 42

2010, President Barack Obama
-helped millions of people who could not previously afford health care insurance. The ACA added millions of children and adults with mental health conditions who would no longer be denied health care because of preexisting conditions.
- young adults up to the age of 26 under the parents’ family policy
-people over 65 on Medicare—a 50% discount for name-brand drugs that reach
the Medicare “donut hole”
-cover preventive services such as depression screening and behavioral assessment for children

Question 43

Ethics

Answer 43

The study of philosophical beliefs about what is considered right or wrong in a society.

Question 44

Bioethics

Answer 44

A more specific term that refers to the ethical questions that arise in health care.

Question 45

Beneficence

Answer 45

The duty to act so as to benefit or promote the good of others - Spending extra time to help calm an extremely anxious patient

Question 46

Autonomy

Answer 46

Respecting the rights of others to make their own decisions - Acknowledging the patient’s right to refuse medication.

Question 47

Justice

Answer 47

The duty to distribute resources or care equally, regardless of personal attributes -Devoting equal attention to both a friendly patient and a patient who will not speak or make eye contact

Question 48

Fidelity

Answer 48

(nonmaleficence) - Maintaining loyalty and commitment to the patient and doing no wrong to the patient - Maintaining expertise in nursing skill through nursing education

Question 49

Veracity

Answer 49

One’s duty to communicate truthfully - Describing the purpose and side effects of
psychotropic medications in a truthful and nonmisleading way.

Question 50

Voluntary Admission

Answer 50

Generally, voluntary admission is sought by a patient or a patient’s guardian through a written application to the facility. Voluntarily admitted patients have the right to demand and obtain release at any time

Question 51

Involuntary admission

Answer 51

is made without the patient’s consent. Generally, involuntary admission
is necessary when a person is in need of psychiatric treatment, presents a danger to self or others, or is unable to meet his or her own basic needs due to mental illness.

Question 52

Emergency Involuntary Hospitalization

Answer 52

Most states provide a mechanism for emergency involuntary hospitalization or civil commitment for a specified period of hours or days to prevent dangerous behavior that is likely to cause harm to self or others.

Question 53

Long-term or Formal Commitment

Answer 53

Long-term commitment for involuntary hospitalization has, as its primary purpose, extended care and treatment of a patient with mental illness. Those who undergo extended involuntary hospitalization are committed through medical certification, judicial, or administrative action.

Question 54

Involuntary Outpatient Commitment

Answer 54

outpatient commitment as an alternative to forced inpatient treatment. Recently, states have begun using involuntary outpatient commitment as a preventive measure, allowing a court order before the onset of a psychiatric crisis that would result in an inpatient commitment.

Question 55

Right to treatment

Answer 55

With the enactment of the Hospitalization of the Mentally Ill Act in 1964,
the federal statutory right to psychiatric treatment in public hospitals was created. The act requires that medical and psychiatric care and treatment be provided to all public hospital patients.

Question 56

Right to Refuse Treatment

Answer 56

A companion to the right to consent to treatment is the right to withhold consent. A patient may withdraw consent at any time. Retraction of consent previously given must be honored, whether it is verbal or written.

Question 57

Right to Informed Consent

Answer 57

The principle of informed consent is based on a person’s right to self-determination.
-a medical provider
has an affirmative duty to disclose all of the known risks and complications of a proposed treatment to allow the patient to make an informed decision as to whether to proceed with that treatment.

Question 58

Rights Surrounding Involuntary Commitment and Psychiatric Advance Directives

Answer 58

Patients concerned that they may be subject to involuntary psychiatric commitment can prepare an advance psychiatric directive document that will express their treatment choices.

Question 59

Duty to Warn

Answer 59

• Exceptions to Confidentiality - Duty to Warn and Protect Third Parties - The California Supreme Court, in its 1974 landmark decision Tarasoff v. Regents of University of California, ruled that a
  psychotherapist has a duty to warn a patient’s intended victim of potential harm.

Question 60

Rights Regarding Restraint and Seclusion

Answer 60

The use of the least restrictive means of restraint for the shortest duration is always the general rule and even the law. Verbal
interventions or enlisting the cooperation of patients are examples of first-line interventions.

Question 61

Restraint use rules/time limits

Answer 61

Each order for restraint or seclusion used for the management of violent or self-destructive behavior that jeopardizes the immediate
physical safety of the patient, a staff member, or others may only be renewed in accordance with the following limits for up to a total of 24 hours:
- A. 4 hours for adults 18 years of age or older;
- B. 2 hours for children and adolescents 9 to 17 years of age; or
- C. 1 hour for children under 9 years of age.

Question 62

Torts

Answer 62

A category of civil law that commonly applies to health care practice. A tort is a civil wrong for which money damages may be collected by the injured party (the plaintiff) from the wrongdoer (the defendant). The injury can be to person, property, or reputation.