midterm 2 day 2 Flashcards
crisis def, coping, psyc efects
Crisis: Acute state of psychological imbalance caused by an intensely felt threat or stressful event resulting in poor coping which causes distress and functional impairment (threat to a person’s self, self-esteem and/or security).
Coping with crisis = essential component of growth and development.
psychological effects = post-traumatic stress disorder and other anxiety or personality disorders
mal, adaptivr and crisis resolution
Maladaptive crisis ‘resolution’
- Distorted perception of event & No situational support & No coping mechanisms = Unresolved problem & ongoing crisis
Adaptive crisis ‘resolution’
- Realistic perception of event & Situational support & Coping mechanisms = Resolved problem & Resolved crisis
Crisis Resolution Goals:
- Stabilization of the situation,
- prevent further trauma,
- achieve pre-crisis level functioning,
- promotion of problem solving,
types of crisis
maturational, situational, adventitious
Maturational:
- Related to developmental changes in life without new coping mechanisms (Adolescent moving out of the house, welcoming a new child, last child moving out of the house, etc.)
Situational:
- Extraordinary life situations such as the loss of a job, the death of a loved one, an unplanned pregnancy, etc.
Adventitious:
- Situations that are not part of everyday life – they include disasters (natural and other) and violent crimes (assault, rape, murder, etc.).
- Persons witnessing other persons experiencing the direct situation may also be prone to be in a crisis situation (witness to an assault).
4 phases of a crisis
Phase 1:
- Crisis occurs threatening the ‘self’ = increased anxiety triggers coping mechanisms (defense mechanisms)
Phase 2:
- Failed coping mechanisms = continued anxiety and extreme discomfort leading to disorganised behaviours (trial-and-errors to fix the problem)
Phase 3:
- Trial-and-error fails & panic sets in = automatic relief (flight)
Phase 4:
- Problem remains unresolved = mental health emergency (considerations re: self-care, self-harm & harm to others)
- personality disorganization, depression, confusion
primary, secondary and tertiary care during crisis
Primary Care:
- Promote mental health & reduce incidents of crisis
- Teach coping skills (decision making, problem solving, assertiveness, meditation, relaxation, etc.)
Secondary Care: During acute crisis situation
- Safety #1
- Establish plan
Critical incident stress debriefing (CISD)
- post crisis to talk about the situation, emotions, behavioural responses & health education (situational support & coping).
Tertiary Care: After severe crisis
- Facilitate optimal level of functioning & reduce further emotional disruptions
emergency use of restraint
- Emergency use only
MHA
- does not authorize restraining voluntary or informal patients
- Unless it is to avoid harm to self or others
- the person will need to be assessed by a psychiatrist to determine if they meet the criteria for an involuntary admission under the MHA
- If not, all restraints must be discontinued immediately (Chemical restraint?)
Documentation
- must be clearly documented
10 nsg responsibiloties using restraints
- Understanding the person’s behavior
- Developing an individualized plan of care to meet the persons needs
- Collaborating with the interprofessional team
- Evaluating the plan of care and making changes PRN
- Using least restrictive restraints
- Discussing with the person (or SDM) to ensure informed decisions (about use of restraints in past – what scared the patient – de-escalation techniques that worked?)
- Being aware of agency policies
- Monitoring and reviewing the continued use of restraints
- Being aware that restrain use is a emergency temporary intervention
- Documentation
suicidal crisis process
- Stressful situation (Loss, feeling of hopelessness, etc.) = vulnerability
- Search for possible solutions
- Incapacity to find solutions = intensifying helplessness
- Risk of suicide
sad persons scale
1 point if yes for each
sex (1 for male ) for frmale –> wonen attempt more, men succeed more)
age
depression
previous attempt
ethanol abuse
rational thinking loss
soial support lacking
organized plan
no spouse
sickness
non suicidal injury and treatment
Includes:
- cutting, burning, scratching, hitting, hair picking, biting, etc.
- Self-punishment, alleviate psychic pain, pierce numbness = against dissociation
- Associated with other psychiatric disorders: anxiety, depression, eating disorders, borderline personality disorders.
Treatment:
- CBT, DBT, treatment of underlying mental disorders
mood
A pervasive and sustained emotion that colours one’s perception of the world and how one functions.
Normal variations in mood:
- Sadness
- Euphoria
- Anxiety
Variations occur in response to specific life experiences and are time limited
- Not normally associated with significant functional impairment
depressive disorders
risk factors, bio factors, psyc factors, evinron factors
Depression may be caused by one factor alone or a combination or factors including biological, psychological, and environmental (social and family) factors.
Biological factors
- Family history, genetic predisposition, etc.
- An imbalance of chemicals in the brain (e.g., s/e of medications, electrolytes, hormonal imbalances, etc.)
- Other physiological illnesses (e.g. brain aneurism, Huntington’s, Alzheimer’s, etc.)
Psychological factors
- Loss of an attachment ‘object’ (abandonment)
- Cognitive distortions
Environmental factors
- Difficult life events / Traumatic childhood:
Major Depressive disorder (MDD)
Depressed mood and/or a loss of interest or pleasure in nearly all activities
AND 4 or the following 7 additional
symptoms:
1. Disrupted sleep patterns
2. Appetite (weight) changes
3. Poor concentration
4. Loss of energy
5. Psychomotor agitation or retardation
6. Excessive guilt or feelings of worthlessness
7. Suicidal ideation
persistent depressive disorder (PDD)
Depressed mood for most days for at least 2 years AND 2 or more of the following:
- Poor appetite or overeating
- Insomnia or hypersomnia
- Low energy or fatigue
- Low self-esteem
- Poor concentration or diffculty making decisions
- Feelings of hopelessness
Depression with Psychotic Features (psychotic depression)
A person with MDD who experiences hallucinations and/or delusions
Negative, self-critical, self-punishing, self-blaming
May be associated with psychomotor agitation
Reason: Unknown
