Week 1-4 Flashcards
1
Q
What are the determinants of positive health
A
Genetic/biological factors Healthy childhood development Positive social support Access to education Employment Social inclusion Physical environment
2
Q
Define: Mental Health
A
“the capacity of individuals and groups to interact with one another and their environment in ways that promote subjective wellbeing, optimal personal development, and use of their abilities to achieve individual and collective goals
3
Q
What is the criteria for positive mental health
A
- positive attitudes towards self and others
- acceptance of self and self-awareness
- personal and social support with which to respond to life challenges
- meaning relationships with others
4
Q
Define: Resilience
A
is the ability to engage in competent, adaptive functioning despite the exposure to risk or adversity
5
Q
Define: Mental illness
A
is a general term for a group of illnesses that affect the mind or brain: and then inturn effect, mood, behaviour and thought
6
Q
What are the 4 National Mental Health Plan priority areas for 2009-2014
A
- Promotes social inclusion and recovery
- Prevention and early intervention
- Services access and continuity of care
- Service quality improvement
7
Q
What are the 5 types of misconceptions
A
Stereotype Intolerance Stigma Prejudice Discrimination
8
Q
Define: Stereotype
A
Stereotype—A depersonalized conception of individuals within a group
9
Q
Define: Intolerance
A
Intolerance—Unwillingness to accept different opinions or beliefs from people of different backgrounds
10
Q
Define: Stigma
A
Stigma—An attribute or trait deemed as unfavorable
11
Q
Define: Prejudice
A
Prejudice—A preconceived, unfavorable belief about individuals or groups that disregards knowledge, thought, or reason
12
Q
Define: Discrimination
A
Discrimination—Differential treatment of individuals or groups that is not based on actual merit
13
Q
What are the theories on mental illness
A
Chemical imbalances- serotonin, dopamine etc
- Anatomical abnormalities of the brain- enlarged ventricles etc
- Biological factors- genetics/hereditary
- Substance/drug abuse
- Sociocultural stressors- family, finance, employment etc
14
Q
Explain: The Stress Vulnerability Model
A
The Stress Vulnerability Model provides a conceptual framework for understanding the relationship between stress and vulnerability as an explanation for an individual vulnerability of developing a mental illness.
“It is assumed that exogenous and/or endogenous challengers elicit a crisis in all humans, but depending on the intensity of the elicited stress and the threshold for tolerating it, that is, one’s vulnerability, the crisis will either be contained homeostatically or lead to an episode of disorder.”
15
Q
What are the mental health nurse standards
A
- Promotion of health and wellness of individuals, families and communities
- Commits to ongoing education and professional growth, develops the practice through use of appropriate research findings
- Practice ethically incorporating professional identity, independence, interdependence, authority and partnership
- Culturally appropriate
- Establishes therapeutic relationships
- Provide systematic nursing reflecting contemporary practice
16
Q
What are the 10 components of Recovery
A
- Facilitating self direction for clients
- Individualised and person centred care
- Empowerment
- Holistic
- Nonlinear journey of growth: learning from experiences
- Strengths based
- Peer support
- Respect
- Responsibility
- Hope
17
Q
What are the classification systems for mental illness
A
ICD-10 AM- diagnostic categories for serious mental illness
DSM V TR- Diagnostic and Statistical Manual of Mental Disorders v5
18
Q
What is the first step in diagnosing mental disorders
A
a mental health assessment
19
Q
What is involved in a mental health assessment
A
- formulate a hypothesis about the person
- gather as much information about the person as possible
- decide if hypothesis is correct or incorrect
- interpret the information gathered
draw a conclusion about the persons mental health
20
Q
What is a clinical assessment
A
it is a systematic evaluation
- considers psychological, biological and social factors which a person may present with
21
Q
A mental health assessment occurs in conjunction with what?
A
a full clinical assessment
22
Q
Mental health assessment
What is essential to an assessment
A
understanding the lived experience of the consumer
23
Q
A mental health assessment consists of how many parts
A
2
24
Q
What are the 2 parts of a mental health assessment
A
- The mental health history looks at the person’s current condition, previous mental health concerns, development and personal history, interventions, treatments and family history.
- The Mental Status Examination identifies the person’s present mental health status including risk factors.
25
What are the 4 types of (MH) assessment process
Formal: ongoing continuous assessment
Structured: using formal assessment tools
Semi structured: the person is asked exploratory questions on various topics. Other questions arise out of the person’s answers.
Informal: done through observation, conversations with the person in an unstructured manner.
26
What are areas of possible assessment within a Recovery based framework and person-centered care
- Interests and hobbies
- Living environment
- Employment
- Learning
- Safety and legal concerns
- Finance
- Lifestyle and health
```
Transportation
Personal strengths
Choice making
Faith and spirituality
Relationships
Hope and dreams
```
27
What is the focus of a Recovery assessment
A recovery orientation shifts the focus to “the glass half full”. It is a perspective that allows us to see that no matter how disabled, all people have existing strengths and capabilities as well as the capacity to become more competent”
28
What are the components of the Mental Health Assessment (NSW Health)
- Reason for referral (include mental health legal status at presentation)
- Sources of information (people present at assessment, old notes accessed, interpreter used)
- Communication issues (language or cultural barriers, sensory impairment)
- History of presenting Problem (current experiences and concerns, time course of current presentation, any care or treatment already received for this presentation, current risks)
- Past mental health history (past hospitalisations, treatments, engagement with care, past episodes of current or other mental health concerns)
- Legal status (current legal orders e.g., guardianship, protective office, document past, current pending court cases, conviction for any offences, victim of crime)
- Drug and alcohol history (past and current use, amounts, frequency, features of dependence and abuse, prior treatments and their outcomes)
- Current functioning and supports (living situation, accommodation issues, family, relationships, other supports; social, educational, daily tasks, ability to undertake responsibilities, financial issues, gambling)
- Parental/Carer status and/or other carer responsibilities (details of children and/or other dependents)
- Mental State Examination (MSE)(see detailed MSE to follow)
- Risk assessment: risk of suicide, aggression... harm to others, risk of self neglect, risk to reputation
29
Define: MSE
Mental status examination
| It is the sum total of your observations and interpretations of the client’s behaviors at the present time
30
What are the 9 components of the Mental Status Examination
1. Appearance- physical description
2. Behaviour during interview- engagement, restlessness, friendly, afraid etc
3. Affect (observed emotional responses)- appropriate/normal, restricted, blunted, flat or congruent/incongruent (external emotion)
4. Mood (internal emotion)- pervasive or sustained emotion subjectively experienced and reported by patient
5. Speech- physical aspects of speech. rate, volume, tone etc
6. Thought form- refers to the amount of thought and its rate of production, continuity of ideas and language
7. Perception- refer to the person’s experience of their world through their senses.
8. Cognition and Intellectual functioning- level of consciousness, memory, orientation, concentration
9. Insight and judgment- the degree to which the person understands their current situation and ability to understand situation and identify consequences, draw conclusions
31
Define: Risk factors
are factors that increase the likelihood that an individual or group of people will develop a condition or illness
- A risk assessment should include risks of suicide, self harm, neglect, harm to others, risk to reputation
32
Explain: NSW Mental Health Act 2007
is an Act of Parliament that governs the care, treatment and control of people in NSW who experience a mental illness or Mental Disorder.
33
Under the NSW Mental Health Act 2007 define a "mentally ill person"
is someone who is suffering from a mental illness and owing to that illness there are reasonable grounds for believing that care, treatment or control of the person is necessary
34
Under the NSW Mental Health Act 2007, define Mental Illness
A condition that seriously impairs, either temporarily or permanently, the mental functioning of a person and is characterised by one or more of the following:
- delusions
- hallucinations
- serious disorder of thought form
- severe mood disturbance
- sustained or repeated irrational behaviour indicating the presence of one or more of the symptoms mentioned above
35
Under the NSW Mental Health Act 2007, define a Mentally Disordered person
A “mentally disordered person” is someone who behaviour is so irrational that there are reasonable grounds for deciding that the temporary care (up to 3 working days), treatment or control of the person is necessary to protect them or others from serious harm.
36
What are the possible ethical/legal considerations in mental health
- Client's rights to decide whether to engage with mental health services
- Client’s rights to decide on carer / family involvement when risks to self or / and others may be evident
- Ethics of obtaining personal information from a client and / or family
- Ethics of what the mental health services does with the information; how mental health services use the information; how the information is stored
- Ethics of obtaining information when considering safety management i.e.. informing other services such as child protection agencies or police
- Ethics of confidentiality as a nursing team / service as opposed to individual client and nurse
- Legal construct of Mental Health Act
- Ethics of positive nurse / client relationship balanced with enacting restrictions under the Mental Health Act e.g. freedom of movement
- Ethics of providing mental health related medications knowing they may have unwanted or unhelpful side effects
37
What are the 5 explanations for depression
Neurobiology: Neurotransmitter disturbances in the levels of serotonin, norepinephrine and dopamine have an important role
Genetics: Neurological, cognitive or social vulnerability
Learning theory: repeated sense of failure and an external locus of control can contribute to depression and low mood
Cognitive theory: negative schemes / core beliefs can contribute to a view of self as unworthy
Sociocultural/gender factors: discrimination of minority groups can contribute to depression or increase the vulnerability to depression
38
Define: Mood
refers to “state of mind and the feelings associated with it”
39
Define: Affect
facial expressions which are seen by others ie: blunted, flat, restricted, reactive
40
Define: Melancholia
a severe feeling of depression, limited interest in usual activities
41
Define: Anhedonia
a marked lack of pleasure in things which a person would normally find pleasurable
42
Define: Dysphoria
a general term for an unpleasant feeling of mood. A person may feel uncomfortable, sad or irritable
43
Define: Euphoria
a feeling of happiness or wellbeing
44
Define: Diurnal variation
where a person’s mood fluctuates during the day eg. worse in the am, better in pm
45
What are 4 types of affective disorders
- Depressive episodes
- Peri/postnatal depression
- Depression as a result of a medical condition
- Adjustment disorder
46
What is the criteria for a Major Depressive Episode (DSM-V)
Five (or more) of the following symptoms have been present during the same 2- week period and represent a change from previous functioning;
At least one of the symptoms is either:
(1) depressed mood or
(2) loss of interest or pleasure.
- Depressed mood most of the day, nearly every day
- Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day
- Significant weight loss when not dieting or weight gain
- Feelings of worthlessness or excessive or inappropriate guilt
- Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide
47
List some of the signs and symptoms of depression
```
Low mood
Reduced concentration / memory
Restlessness / agitation
Ruminating thoughts
Self esteem reduction
Difficulties making decisions
Psychomotor retardation
Reduced energy
Reduced interest
Hopelessness
Helplessness
Sleep changes: initial insomnia, early morning wakening
Guilt
Weight loss / gain
Self harm / suicide thoughts and behaviours
```
48
List some Interventions for depression
- Engagement / therapeutic relationship
- Psycho-education / give hope
- Mental health and risk assessment
- Low grade frequent exercise
- Planning of daily activities
- Goal setting
- Support from family
- Sleep hygiene / routines
- Reduction in substances: nicotine, alcohol, caffeine
- Good nutrition
49
What types of anti-depressants are usually prescribed
Selective serotonin reuptake inhibitors (SSRIs) (most common)
Serotonin and Noradrenalin reuptake inhibitors (SNRIs)- severe depression
Reversible Inhibitors of MonoAmine oxidase (RIMAs)- helpful for anxiety and sleeping difficulties
Tricyclic Antidepressants (TCAs)- effective but more harmful
Noradrenaline-Serotonin specific anti-depressants (NaSSAs)
50
What are common side-effects of anti-depressant medication
```
Sedation
Dry mouth
Headaches
Nausea
Sweating
Shaking
Fainting
Increase risk of suicide / harm to self
```
51
What does the therapeutic use of self involve
using aspects of the nurse’s personality, background, life skills and knowledge to develop a connection with a person who has a mental health problem or illness
52
What is the purpose of being self-aware
is to know those things in our background and our way of relating that might affect how we relate to clients.
53
What are the 2 types of stress
Distress (negative)
| Eustress (positive)
54
Define: Burnout
is used to describe a pattern of feelings of emotional exhaustion, frustration with work, clients and colleagues, and feelings of failure
55
Define: Wellbeing of a person
is embodied in the achievement of their abilities, coping with normal life stressors, working productively and contributing to the community
56
An initial mental health assessment includes..
a risk assessment
57
In a mental state examination "affect" refers to...
the patients external emotional response
58
In a mental state examination "mood" refers to...
is the patients individual perception of the world
59
In a mental state examination "appearance" refers to...
the patients physical appearance (according to assessors observations)
60
Define: Insight
is the patients awareness of their illness
61
When is seclusion of a patient permissible
in order to protect the patient or others from harm
62
Psychiatric diagnoses are assigned using what 2 diagnostic systems
DSM-5
| ICD-10-AM
63
Define: Crisis
can be very simply described as a difficult or dangerous situation that needs attention. A crisis may be associated with aspects of a person’s financial, social, environmental, political or personal life.
64
Define: Trauma or Traumatic event
can be described as a severe physical injury or a specific experience that triggers mental and emotional distress, and results in suffering and disruption to a person’s physical and/or emotional wellbeing.
65
Define: Loss
an be described as an event where something that belongs to you and is either precious or has meaning for you has been taken away or destroyed.
66
Define: Bereavement
generally refers to being deprived of an object or a person.
- Bereavement is usually used in the context of losing someone you love through death.
67
Define: Grief
has been defined as ‘the response to the loss in all of its totality—including its physical, emotional, cognitive, behavioural and spiritual manifestations—and as a natural and normal reaction to loss’
68
What are the 4 common types of crisis
Developmental crisis- major transitions between life stages
Situational crisis- these are situation specific. eg. loss of employment/love one, DV
Social crisis- arising from drug and alcohol abuse
Complex crisis- not part of everyday life. E.g diagnosis of terminal illness, seeking assylum
69
What are the 2 types of Behavioural Emergency
Direct behavioural emergency
| Indirect behavioural emergency
70
Define: Direct behavioural emergency
is a direct response to the crisis, when a person is so overwhelmed that confusion, functional decline (a marked decrease in managing everyday activities and self-care), self-injury, risk of suicide or violence towards others is an immediate threat.
71
Define: Indirect behavioural emergency
occur when people make bad decisions and end up placing themselves in potentially lethal situations’
72
What are the 5 stages of Grief
```
Denial
Anger
Bargaining
Depression
Acceptance
```
73
Explain: Emotion-focused coping strategies
enable a person to express and process the emotions arising from loss are essential where the situation is such that the person cannot change what has happened.
74
Define: Vulnerability
As humans, we are all prone to ‘moments of vulnerability’; that is, we are capable of being physically or emotionally wounded or hurt. A feeling of vulnerability may arise in a social interaction or a work situation.
75
What are 4 Crisis Intervention Models
Equilibrium model
Cognitive model
Psychosocial Transition model
Developmental-ecological model
76
Explain: Persistent depressive disorder
is more common than major depressive disorder. It can be considered an exaggeration of ordinary unhappiness.
The client may complain of feeling low, feeling hopeless (pessimism), fatigue, decreased concentration, decreased or increased sleep and/or decreased or increased appetite
77
What are Bowlby's 4 phases of normal response to the death of a loved one
Shock and protest—a numbing of emotions and disbelief punctuated by outbursts of intense distress, panic or anger. This may last from a few hours to a week.
Preoccupation—a yearning for and searching preoccupation with the loved one. This may last for weeks or months
Disorganisation—when the client begins to accept the loss of the loved one and begins to establish a new identity independent of the loved one, there is disorganisation of previous emotions and despair diminishes.
Resolution—the client begins to rebuild their life, there is a decrease in sadness and an enjoyment of life returns
78
What are the main Principles of mental health nursing
- Understanding
- Therapeutic relationship
- Empathy
- Assessment- history and presenting concerns, cognitions, emotions
- Person-centred- Client engagement and collaboration
- Community approach
- Stress/distress management
- Provide hope
- Psychosocial education and interventions
- Recovery
- Risk assessment management
- Least restrictive care
- Medication
79
What are the main purposes of recovery and traditional mental health assessment
- Engagement with client
- Clear baseline
- Identify journey change
- Provide historical picture as well as presenting concerns
- Provides details but also wider conceptualisation of an individuals presentation
- Holistic: physical/medical history alongside mental health history
- Help to identify early changes for a person
- Intervention in its own right to promote recovery, hope and psychoeducation
80
List the components of Recovery-based mental health assessment
- Interests and hobbies
- Living environment
- Employment
- Learning
- Safety and legal concerns
- Finance
- Lifestyle and health
- Transportation
- Personal strengths
- Choice making
- Faith and spirituality
- Relationships
- Hope and dreams
81
How many people in Australia have experienced a mental health concern in the past year?
3.2 million
2200 die by suicide, 44 people a week, 33 men each each
82
Which mental health concern has increased by 40% since 2006?
Anxiety disorders
83
What is the most common mental illness in Australia at this time?
anxiety, depression and substance abuse
84
Whats the difference between Mental Illness and Mental Health Problem
Mental Illness- is diagnosed. Is a health problem that significantly affects how a person feels, thinks, behaves and interacts with other people
Mental Health problem- also interferes with how a person thinks, feels, behaves but to a lesser extent than a mental illness
85
What are the main key components of the Stress Vulnerability Model for mental illness?
Markers for vulnerability
Intensity of stress and threshold of tolerating it will determine crisis or coping
Inborn vulnerability ie. Genetics
Acquired components of vulnerability eg. Influence of trauma, complications, family experiences, adolescent peer interactions, life events
86
Define: Stress
a variable that influences the manifestation of symptoms
87
Define: Ambient stress
day to day stress
88
Define: Life event stress
specific high levels of stress
89
Define: Protective factors (for stress)
something that helps manage stressful situations, they act as a buffer against stress., a good support network, physical activity, local church
90
What is recovery in the context of mental health and illness?
Recovery: is a journey undertaken by people with lived experience of mental illness/ emotional distress
Recovery orientated practice/ service provision: is how workers and services support people in their individual journey
91
What is the prevalence of suicide in 2015
- Australia's 13th leading cause of death
| - accounts for 33% of youth deaths
92
What is the rate of suicide deaths in males and females
MALES
- 12.4% 30 deaths per 100 000
- 15-19yrs 29.6% 12 deaths per 100 000
FEMALES
- 45-49yrs 10.4 deaths per 100 000
- 65-69yrs 4.5 deaths per 100 000
93
What is the difference between self-harm and suicide
Difference between suicide and self harm is the intent underlying the behaviour. People who attempt suicide want to kill themselves, while those who self harm may or may not.
- Self-harm can coexist with suicidality
94
Theories on suicide
Explain: Interpersonal factors
Suicide may result when people experience social isolation and become alienated from community, family and friends
95
Theories on suicide
Explain: Behavioural theory
Suicide is a learned problem-solving behaviour. There is internal reinforcement that the behaviour itself, serves to decrease anxiety
96
What are the features of an "at risk" mental state of suicide
- Major mental illness / disorder
- Preoccupation with despair, hopelessness & feelings of worthlessness
- Severe anger, hostility & poor impulse control
- Continual / specific thoughts of suicide (intent, plan, access to means, planning of time, notifying others) or thoughts, plans & symptoms that indicate a risk of suicide
- Command hallucinations or delusion about dying
- Recent interpersonal crisis or major life event
97
What are some reasons people self-harm
- Overwhelming sadness
- Anxiety
- Emotional numbness
- A way to manage intolerable feelings
- Or a way to experience some sense of feeling
- To relieve stress or pressure
- To feel in control of their bodies and minds
- To express feelings
98
If a person has perceptual abnormality a nurse should...
State his/her perception to indicate a discrepancy and then move into reality
99
Define: SSRI
Selective Serotonin Re-uptake Inhibitor
100
What are the differences between low mood and depression?
Low mood- is an emotional/symptomatic response to an internal or external stressor/factor/situation
Depression- is a cognitive, emotional, physical and behavioural responses which inc.
worthlessness, reduced self-esteem, suicide thoughts, sadness etc.
101
What may be the experiences for a person with low mood or depression? Consider this in terms of emotions, cognitions and behaviour.
- feeling down,
- reserved,
- weight changes,
- lack of motivation,
- constant low mood,
- feeling overwhelmed,
- negative thoughts,
- not enjoying previously enjoyable activities,
- withdrawing from social interactions,
- changes in appetite and sleep patterns,
- low self-esteem,
- difficulty concentrating,
- ruminating thoughts,
- fear,
- feelings of hopelessness
102
What does the Stress-Vulnerability Model do?
it conceptualises the link between stress and vulnerability in developing a mental illness
103
The Stress-Vulnerability Model identifies what 2 types of Stressors
Life event stressors
| Ambient stressors
104
Circle of security is an intervention used with....
Parents/ carers of toddlers
105
Name 2 SSRI medications and side effects
Citalopram
Fluoxetine
Side effects: nausea, headache, diarrhoea, potential insomnia
106
Name 2 Tricyclic medications and side effects
Amitryptyline
Clomipramine
Side effects: Sedation, dry mouth, constipation, blurred vision
107
Name 2 SNRI medications and side effects
Venlafaxine
Duloxetine
Side effects: headaches, sexual dysfunction and GIT
108
Name a Noradrenaline reuptake inhibitors
Roboxetine
Side effects: difficulty sleeping and Sweating, sexual difficulties, difficulty urinating after initial dose
109
What questions would you ask when conducting a suicide risk assessment
- What brought you here?
- How did you come to feel this way
- Have you / are you having thoughts to hurt or kill yourself?
- When you're feeling depressed, have you ever felt that there is no hope or that you will never feel better?
- Have you made plans to commit suicide?
- Are there any protective factors
