Mental Health Exam 1 Flashcards
Hierarchy of evidence
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
Patient Advocate
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.
DSM-5
- 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.
Factors affecting mental health
- Biological hormones/Genetics,
- Spirituality/ Religion
- Culture/Regional differences
- Family/Friends/Community
- Personality traits
- Health practices and beliefs
- Environmental experiences
- Economics
Sigmund Freud
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.
The ID
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.
The EGO
- 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.
- The ego is the problem solver and reality tester that navigates in the outside world. It acts as
The SUPEREGO
- 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.
- The superego represents the moral component of the personality that Freud referred to as our
Therapeutic Model
- 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.
Erikson’s Stages
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
Group therapy
- 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
Tuckman’s (1965) model of group development
four stages:
forming, storming, norming, and performing. A fifth stage, adjourning (mourning).
Benefits of Group Therapy
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.
Major brain structures
- 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
The cerebrum
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
frontal lobe
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.
The parietal lobes
The parietal lobes are involved in tactile sensation and spatial awareness.
The occipital lobe
The occipital lobe is primarily responsible for vision and visual processing.
The temporal lobe
The temporal lobe is responsible for hearing, language reception, and language comprehension
Brainstem
- 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.
Cerebellum
- The cerebellum is involved in both motor control and cognitive processing.
Limbic Brain
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.”
Thalamus
- The thalamus filters sensory information before it reaches the cerebral cortex
Hypothalamus
- The hypothalamus maintains homeostasis. It regulates temperature, blood pressure, perspiration, libido, hunger, thirst, and circadian rhythms, such as sleep and wakefulness.
positron emission tomography (PET) and single-photon emission
computed tomography (SPECT)
-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
Functional magnetic resonance imaging (fMRI)
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.
neurotransmitters types
The four major groups of neurotransmitters in the brain are
-monoamines
-amino acids
-peptides
-cholinergics
psychotropic drugs alter concentration of which neurotransmitters
dopamine, acetylcholine, NE, serotonin, histamine, GABA, or glutamate.
-receptor antagonists
-agonists
-blocking neurotransmitter activity
-promoting neurotransmitter activity,
-interference with neurotransmitter reuptake,
enhancement of neurotransmitter release, or inhibition of enzymes.
Selective serotonin reuptake inhibitors (SSRIs),
which increase the level of serotonin by inhibiting reuptake, a mood-regulating neurotransmitter.
Side-effects - anxiety, insomnia, sexual dysfunction, and gastrointestinal disturbances. Serotonin toxicity
Serotonin and norepinephrine reuptake inhibitors (SNRIs)
which increase the levels of both serotonin and norepinephrine, another neurotransmitter involved in mood and pain.
Tricyclic antidepressants (TCAs),
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,
monoamine oxidase inhibitors (MAOI)s
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.
First Generation Antipsychotics
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.
Second-Generation/Atypical Antipsychotic Agents
-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.
Patient-centered medical homes (PCMHs)
The focus of care is patient centered and provides access to physical health, behavioral health, and supportive community and social services.
Community-based facilities
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.
Psychiatric home care
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.
-Intensive outpatient programs (IOPs)
-Partial hospitalization programs (PHPs)
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.
Inpatient care
-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.
therapeutic milieu
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.
Affordable Care Act
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
Ethics
The study of philosophical beliefs about what is considered right or wrong in a society.
Bioethics
A more specific term that refers to the ethical questions that arise in health care.
Beneficence
The duty to act so as to benefit or promote the good of others - Spending extra time to help calm an extremely anxious patient
Autonomy
Respecting the rights of others to make their own decisions - Acknowledging the patient’s right to refuse medication.
Justice
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
Fidelity
(nonmaleficence) - Maintaining loyalty and commitment to the patient and doing no wrong to the patient - Maintaining expertise in nursing skill through nursing education
Veracity
One’s duty to communicate truthfully - Describing the purpose and side effects of
psychotropic medications in a truthful and nonmisleading way.
Voluntary Admission
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
Involuntary admission
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.
Emergency Involuntary Hospitalization
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.
Long-term or Formal Commitment
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.
Involuntary Outpatient Commitment
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.
Right to treatment
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.
Right to Refuse Treatment
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.
Right to Informed Consent
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.
Rights Surrounding Involuntary Commitment and Psychiatric Advance Directives
Patients concerned that they may be subject to involuntary psychiatric commitment can prepare an advance psychiatric directive document that will express their treatment choices.
Duty to Warn
- 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.
Rights Regarding Restraint and Seclusion
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.
Restraint use rules/time limits
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.
Torts
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.
