study notes Flashcards
Trauma informed care
A trauma-informed approach recognises and understands trauma can negatively affect whānau, groups, organisations and communities, as well as individuals.
Realisation
Recognition
Responding
Trauma informed care principles
Safety Trustworthiness and transparency Peer support Collaboration and mutuality Empowerment, voice and choices Cultural, historical, and gender
Substance disorders
a wide variety of problems associated with substance abuse. there is 11 criteria’s. Depending on how many criteria is met with the DSM-5 , determines the severity of substance abuse.
2-3 - mild substance use disorder
4-5 - moderate
6 or more - severe
transference
A person transfers beliefs, feelings, thoughts and behaviors that occurred in one situation, usually in their past, to a situation that is happening in the present.
Traditionally referred to the consumer with unconscious feelings or beliefs about someone in their past transferring these feelings or beliefs onto the therapist.
counter-transference
The response of the therapist to the consumer. Having strong feelings for the consumer, either negative or positive, might be a cue that one is experiencing counter-transference.
Interpersonal skills
behaviors and tactics a person uses to interact with others effectively. Clarifying paraphrasing active listening Pinpointing confronting interpersonal feedback linking summarizing
Pinpointing
verbalising what you have noticed or heard that the person may not have openly stated; for example, “it seems you may not see eye-to-eye on this”.
Confronting
addressing inconsistencies between what the person says and what the facts appear to be; for example, the person may look uncomfortable, but has not said anything about it.
Interpersonal feedback
Involves providing clear information about your own response to the person’s behaviour, or other people’s responses that you have noticed when the person behaves in a specific way.
Linking
Linking is the nurse’s uncovering of connections between consumer events and feelings, or behaviours and consequences. This joining together of experience and reaction helps the consumer make more sense of what is happening to them.
Summarising
Is pulling together main points, insights or agreements that emerged in conversation.
Emotional competence
refers to the essential social skills to recognize, interpret, and respond constructively to emotions in yourself and others achieved through: Self-management Self-awareness Social awareness Relationship management
Emotional competence:Self-management
You’re able to control impulsive feelings and behaviours, manage your emotions in healthy ways, take initiative, follow through on commitments, and adapt to changing circumstances.
Emotional competence:Self-awareness
You recognize your own emotions and how they affect your thoughts and behaviour. You know your strengths and weaknesses, and have self-confidence.
Emotional competence:Social awareness
You can understand the emotions, needs, and concerns of other people, pick up on emotional cues, feel comfortable socially, and recognize the power dynamics in a group or organization
Emotional competence: Relationship management
You’re able to develop and maintain good relationships, communicate clearly, inspire and influence others, work well in a team, and manage conflict.
Diagnostic criteria DSM V
how psychiatric disorders are classified
Axis I - Mental Disorder (schizophrenia, PTSD, Bipolar mood disorder)
Axis II - Personality, Developmental issues (Narcissistic disorder, borderline personality disorder)
Axis iii - Physical / medical issues of note (Diabetic, cardiovascular, HTN)
Axis IV - Psychosocial issues (Precipitating factors, financial, social)
GAF - Global assessment of Functioning (objective assessment: Score from 0-10 - 90-100, how well you function in society)
ICD 10-
classification of mental and behavioural disorders
Major Depression: Diagnosis
DSM-5: At least five symptoms, for more than 2 weeks with significant reduction in functioning: - loss of pleasure (anhedonia) - change in weight (up/down) - sleep disturbance - psychomotor retardation/agitation - dysthymic mood - feelings of worthlessness, guilt, impaired concentration - suicidal ideation
Factors that can increase risk of Generalised anxiety disorder
- neurochemical
- familial, genetic
- social/cultural, life experiences
Generalised anxiety disorder: S/S
irritability, feeling on edge, poor concentration, sleep disturbance, physical tension
Generalised anxiety disorder: Approaches to care
- practical lifestyle changes
- nutrition and exercise
- self-talk and strength based approach to concerns
- disrupting patterns/ linking feeling and drive to thinking and acting on behavioural responses
- anxiolytics (and for some antidepressants or low dose antipsychotics).
- Self-management in relaxation and occupation
Panic disorders
- Characterized by repeated panic attacks, combined with major changes in behavior or persistent anxiety over having further attacks.
- S/S- severe anxiety episodes (overestimating threat, and underestimation ability to cope).
E.g - Panic with agoraphobia include significant avoidance
Co-morbid depression and substance use is common.
Factors that can cause PTSD
Post traumatic stress disorder
major trauma (natural disasters); accidents, rape, combat, torture, postnatal. Symptoms persist more than 1 month with significant impairment or distress.
PTSD: S/S
- intrusive thoughts and feelings (nightmares, re-experiencing the event, flashbacks, anxiety/anger)
- avoidance
- anhedonia
- detachment
- social isolation
- physical manifestation (sweats, increased heart beat, hyper startle reflex, muscle tension).
PTSD: approaches to care
Specific talk around the intrusive thinking and avoidance. As for anxiety other symptoms
what is OCD?
Obsessive compulsive disorder
persistent and recurrent intrusive thoughts or feelings perceived to be inappropriate by person, obsession that leads to compulsion (acting in order to relieve anxiety)
OCD: S/S
pathological doubt, contamination, physical somatisation, need for symmetry (lining up, counting, checking), religious excessive compulsions, co-morbid substance use, particularly alcohol.
OCD: Approaches to care
- Linking thinking and changing drive in feeling and behaviour
- work on panic
- lifestyle changes
- medication (as for anxiety) with more use of typical anti-depressants
- self-talk work and gradual exposure to changes in behaviour.
Bipolar disorder- manic depression
Characterised by episodes of depression and mania (which last for more than one week). Mania by insomnia, increased energy, poor concentration, over activity, with persistent elevated mood, irritability and lability.
Bipolar I
- involves periods of severe mood episodes from mania to depression. (can require hospitalization)
- at least one episode of mania with more depression.
Bipolar II
episodes of depression and hypomania.
Self harm cycle
- > Shame/grief
- > Emotional suffering
- > Emotional overload
- > Panic
- > Self harm
- > Temporary relief
Precipitating factors (dynamic)
Factors that have caused the person to present now
Predisposing factors (static)
Factors that have occurred in the person’s life ( historical) that increase susceptibility
Perpetuating factors (static and dynamic)
• Factors that cause the continuation of problems
Protective factors
Factors that mitigate or reduce risks
Schizophrenia -Diagnosis
DSM 5 :
Two or more of the following for at least a one-month (or longer) period of time, and at least one of them must be 1, 2, or 3:
• Delusions
• Hallucinations
• Disorganized speech
• Grossly disorganized or catatonic behavior
• Negative symptoms, such as diminished emotional expression
1. Impairment in one of the major areas of functioning for a significant period of time since the onset of the disturbance: Work, interpersonal relations, or self-care.
2. Some signs of the disorder must last for a continuous period of at least 6 months.
3. Schizoaffective disorder and bipolar or depressive disorder with psychotic features have been ruled out:
Diagnosis made when no evidence of organic cause (no delerium, tumour, trauma, Psycho active substances, drug induced and intoxication or withdrawal).
Schizophrenia
Schizophrenia is a mental illness characterized by relapsing episodes of psychosis.
Includes positive and negative symptoms
S/S:
- hallucinations
- delusions
- disorganized thinking.
- social withdrawal, decreased emotional expression, and lack of motivation.
Delusion
a fixed false belief
Hallucination types
-5 senses
Seeing things that other people don’t (for example people’s faces, animals or religious figures). Visual
Experiencing tastes, smells and sensations that have no apparent cause (for example feeling insects crawling on your skin). Gustatory, olfactory & tactile
Hearing voices that other people don’t (these could be positive and helpful or hostile and derogatory y) Auditory
Typical antipsychotic examples
Holaperidol, Chloropromazine, Thioriazine
Atypical antipsychotic examples
Rispiradone, Olanzapine, Quitiapine, Clozapine,
NMS
Neuroleptic malignant syndrome (NMS) is a life-threatening reaction that can occur in response to neuroleptic or antipsychotic medication. Symptoms include high fever, confusion, rigid muscles, variable blood pressure, sweating, and fast heart rate.
A- akathasia D- dystonia O- occulurgic crisis P- parkinsonism T- Tardive Diskinesia
Metabolic syndrome
A cluster of conditions that increase the risk of heart disease, stroke and diabetes.
A doctor will often consider metabolic syndrome if a person has at least three of the following five symptoms:
1. visceral obesity
2. insulin resistance
3. HTN
4. high triglycerides
5. low HDL-cholesterol
De-escalation
refers to behavior that is intended to escape escalations of conflicts. It may also refer to approaches in conflict resolution.
De-escalation techniques for the nurse to use
- Identify who you are/ your purpose
- Ensure Safety
- Active Listening
- verbal and non-verbal techniques
- Reflections
- “Tell me if I have this right” (then summarize what the patient says)
- “I’m confused, help me understand”
- Emotional-less Response
- Small words
- Be concise
De-escalation tools for the client
- Deep Breathing- 5 to 10 deep breaths tracking the breath from nose to stomach
- Body Awareness
- Grounding- to the room, self, situation
- Mindfulness/relaxation -Object Focus, Senses
- Distraction
Mental Health Act
The act is designed to protect the rights of people with mental health problems, and to ensure that they are only admitted to hospital against their will when it is absolutely essential to ensure their well-being or safety, or for the protection of other people.
Activation of the MHA
In relation to any person, means an abnormal state of mind (whether of a continuous or an intermittent nature), characterised by delusions, or by disorders of mood or perception or volition or cognition, of such a degree that it —
(a) Poses a serious danger to the health or safety of that person or of others; or
(b) Seriously diminishes the capacity of that person to take care of himself or herself
Section 8A/B
Section 8A- carried out by anyone who feels the person need mental health support- is the application for assessment
Section 8B- carried out by health practitioner- accompanies the 8A
Section 111
A registered nurse considers that there are reasonable grounds for believing that the person may be mentally disordered; and needs urgent assessment.
The nurse may detain the person where they are until a medical practitioner has examined the patient or take the person to some other place to enable a medical practitioner to examine the patient, and detain the person at that other place until a medical practitioner has examined the patient.
(3)
no person shall be detained under this section for more than 6 hours from the time when the nurse first calls for a medical practitioner to examine the person.
Categories of patient
Under the MHA
- Required to undergo assessment & treatment under sections 11 or 13
- Subject to a Compulsory Treatment Order
- A ‘special patient’ (sections 42 to 53 of Act)
- A ‘proposed patient’ (introduced in 1999 Amendment Act)
- A ‘restricted patient’ (declared by court under section 55 of Act)
Postnatal or maternity blues
are very common. A new mother feels down and tearful in the week after her baby is born. This feeling passes after a few days.
Postnatal depression
- More serious condition, is also common
- The mother becomes seriously depressed in the first months following the baby’s birth.
- Can occur any time during the baby’s first year.
Postnatal psychosis
- involves symptoms of psychosis (being out of touch with reality) associated with changes in mood – either a depressed or an extremely high mood.
It usually begins in the first two weeks after the child is born.
Edinburgh scale
- 10-questions
- identifies patients at risk for perinatal´ depression.
Postnatal depression key interventions
- Taking care of the mother
- Taking care of the baby
- Taking care of the partner/whole family
Trauma care approach outcome
Peoples experience and behaviour in response to traumatic events (their own or others) can be improved if systematically addressed through:
- prevention
- treatment
- achieving wellbeing.
Typical anti-psychotics: adverse effects
- Postural hypotension
- anticholinergic S/E (Dry mouth, Blurred vision, Dry eyes, Constipation, Urinary retention)
- Sedation
- Weight gain
- NMS
A-Typical Anti-psychotics: adverse effects
- Weight gain
- Agranulocytosis- more prone to infection
- T2DM
- Acute severe hypertension
Assessment of risk: What to assess?
Risk:
- To self
- To others
- Ability to self care
- Exploitation/vulnerability
MSE- key areas
Mental state examination
Appearance/Behaviour (initial appearance, body language/posture) Rapport (how easily able to form relationship) Speech(rate, rhythm, how loud) Mood/Affect (congruent?) Cognition Perception Judgement/insight Risk
Difference between positive and negative symptoms of schizophrenia
Positive:
- Hallucinations
- Delusions
- Dis-organised speech, language, thought (zoning out, distracted, jumbles speech/word salad)
Negative:
- Alogia (poverty of speech)
- Flat affect
- Avolition (loss of motivation)
- Anhedonia (lack of pleasure)
- loss of social interest
- Attention deficits
Suicidality assessment focus and risk factors
S: Male sex A: Age (<19 or >45 years) D: Depression P: Previous attempt E: Excess alcohol or substance use R: Rational thinking loss S: Social supports lacking O: Organized plan N: No spouse S: Sickness
Lithium toxicity
It occurs when you take too much lithium, a mood-stabilizing medication used to treat bipolar disorder and major depressive disorder. Lithium helps reduce episodes of mania and lowers the risk of suicide in people with these conditions.
A safe blood level of lithium is 0.6 and 1.2 milliequivalents per liter (mEq/L). Lithium toxicity can happen when this level reaches 1.5 mEq/L or higher.
Positive and negative symptoms of schizophrenia
Positive:
Hallucinations
Delusions
Dis-organised speech, language, thought
Negative: blunting of affect, poverty of speech and thought, apathy, anhedonia, reduced social drive, loss of motivation, lack of social interest, inattention to social or cognitive input.
Recovery approach
Aspects – promoting social inclusion
Working to promote recovery
Hope, empowerment, choice, avoid coercion….
difference between depression, delirium and dementia
Dementia:
Slow and insidious onset; deterioration is progressive over time.
Symptoms are progressive over a long period of time; not reversible.
S/S- Wandering/exit seeking
Agitated
Withdrawn
Depression:
Recent change in mood persisting for at least two weeks
Typically worse in the morning. Usually reversible with treatment.
S/S- Usually withdrawn
Apathy
May include agitation
Depressed mood
Lack of interest or pleasure in usual activities
Change in appetite (increase or decrease)
Delerium:
Sudden onset
Short and fluctuating; often worse at night and on waking. Usually reversible with treatment of the underlying condition.
S/S-Disorganised, distorted, fragmented thoughts, cognition
Fluctuating emotions – for example: anger, tearful outbursts, fear
lithium toxicity moderate S/S
diarrhea vomiting stomach pains fatigue tremors uncontrollable movements muscle weakness drowsiness weakness
Lithium side effects
frequent urination thirst hand tremors dry mouth weight gain or loss gas or indigestion restlessness constipation rash muscle weakness
ADOPT
A- akathasia (restlessness)
D- dystonia (continuous spasms and muscle contractions)
O- occulurgic crisis (pasmodic movements of the eyeballs into a fixed position, usually upwards)
P- parkinsonism (characteristic symptoms such as rigidity)
T- Tardive Diskinesia- irreversible (irregular, jerky movements)
What is major depression?
A mental health disorder characterised by persistently depressed mood or loss of interest in activities, causing significant impairment in daily life.
Types of delusions
- Persecutory delusions
- Referential delusions
- Somatic delusions
- Erotomanic delusions
- Religious delusions
- Grandiose delusions
Grandiose delusions
- They consider themselves a major figure on the world stage, like an entertainer or a politician.
Persecutory delusions
- The feeling someone is after you or that you’re being stalked, hunted, framed, or tricked.
Referential delusions
- When a person believes that public forms of communication, like song lyrics or a gesture from a TV host, are a special message just for them.
Somatic delusions
-These center on the body. The person thinks they have a terrible illness or bizarre health problem like worms under the skin or damage from cosmic rays.
Erotomanic delusions
- A person convinced someone is in love with them or that their partner is cheating. Or they might think people they’re not attracted to are pursuing them.
Religious delusions
- Someone might think they have a special relationship with a deity or that they’re possessed by a demon.
