Week 1 Study Guide Flashcards
What is the definition of mental health?
State of well-being in which everyone can realize thier own potential, cope with the normal stress of life, work productively, and contribute to the community.
What does mental health provide people with?
Capacity for rational thinking, communication skills, learning, emotional growth, resilience, and self-esteem
What is considered emotional problems or concerns?
Mild to moderate distress
Mild or temporary impairment
What is considered mental illness?
Markes distress
Moderate, disabling, or chronic impairment
What attributes contribute to mental health?
Rational thinking
Effective coping
Resiliency
Self-control
Self-awareness
Developmentally on task
Happiness
Positive self-concept
Learning and productivity
Effective communication
Meaningful relationships
Spiritual satisfaction
Fight stigma:
Talk…
openly about mental health
Fight stigma:
Educate yourself…
and others on mental health
Fight stigma:
Be conscious …
of your language
Fight stigma:
Show empathy and…
compassion for those living with mental illness
Fight stigma:
Stop the criminalization…
of those living with mental illness
Fight stigma:
Push back against…
the way people who live with mental illness are portrayed in the media
Fight stigma:
Advocate…
for mental health reform
Fight stigma:
Encourage equality in…
how people perceive physical and mental health
Fight stigma:
See the…
person not the illness
What is the purpose of mental health parity?
Parity = equivalence
How can we achieve mental health parity?
Require insurance companies to provide equal treatment coverage for psychiatric disorders
Barriers to mental health access:
mental health need…
is increasing
Barriers to mental health access:
Long waits such as…
60-90 days for appt, delay in follow up care
Barriers to mental health access: Cost such as…
Income
Insurance parity
Barriers to mental health access: Knowledge and
STIGMA
Barriers to mental health access: feeling like…
just a number
Client rights:
Receive…
treatment
Client rights: Refuse…
treatment
Client rights: Be treated with…
dignity
Client rights: be involved…
in treatment and planning decisions
Client rights: leave the hospital…
against medical advice
Client rights: be protected.,,
against harming self or others
Client rights: a timely…
evaluation in the event of involuntary
Client rights: hospitalization and…
legal counsel
Client rights: communicate privately…
by telephone and in person
Client rights: informed…
consent
Client rights: least restrictive…
means of treatment
Client rights: participate in…
religious worship
Client rights: have…
confidentiality
Least restrictive means of treatment: access the patient…
to see what’s wrong
Least restrictive means of treatment: encourage the patient…
to go to their room to decrease stimulation
Least restrictive means of treatment: offer…
PRN medications orally
Least restrictive means of treatment: escort…
to a secluded area
Least restrictive means of treatment: administer…
PRN medications IM
Least restrictive means of treatment: restraints…
only used if patient is danger to self or others
What is a therapeutic milieu?
Refers to the surroundings and physical environment of the inpatient hospital unit
What does a therapeutic milieu provide?
Since of security/safety
Real life training ground for practicing communication and coping skills
Activities
RULES
Reality orientation
What is containment?
Provision of basis needs, such as food, shelter, safety and security
What is support?
offer encouragement, praise, positive feedback
What is validation?
respecting privacy, cultural needs, feelings lead to the client’s holistic health
What is structure?
Control and limitation of maladaptive behaviors and settings limits
What is involvement?
Promoting the self-efficacy of the client
What are the 5 parts of therapeutic milieu?
Containment
Support
Validation
Structure
Involvement
What is deinstitutionalization?
Legislation that resulted in the mass movement of severely mentally ill persons from state hospitals to outpatient care
What is the definition of stigma?
Widespread fear and misunderstanding of mental illness
What is stigma heightened by?
focus on extraordinary symptoms in film and literature
What is the diathesis-stress model?
Combination of genetic vulnerability and negative environmental stressors
Diathesis-stress model:
What is stress?
environmental stress or trauma
What model is the most accepted explanation for mental illness?
diathesis-stress model
Diathesis-stress model: What is the diathesis?
Biological predisposition
What does NAMI stand for?
National Alliance for Mental Illness
What are the goals of NAMI?
Communicating
Eliminating
Advocating
Improving
Integrating
Services
NAMI goals: Communicating…
that mental illnesses are brain disorders
NAMI goals: Eliminating…
stigma and discrimination
NAMI goals: Advocating…
for people with mental illness
NAMI goals: Improving…
access to treatment services
NAMI goals: Integrating…
mental illness into community life
NAMI goals: Services…
Support groups
Educational programs
Public Awareness events
Family to family
In our own voice
Participation station
Warm line
NAMI Walk
What is victimization?
Verbal abuse, bullying, threats, theft, physical assaults, rape
What is dual diagnosis?
co-occuring mental illness and substance use disorder
What is an acute care hospital?
Highly structured setting that optimizes safety and addresses crisis intervention
Average length of acute care hospital stay?
3-7 days
What is voluntary admission?
Both the individual and the health care professionals agree with the need for treatment and hospitalization. The individual signs a consent for treatment
How long can an individual be involuntarily held?
72 hrs against will
During a 72 hour hold…
Pt may become better with treatment and sign themselves in thus becoming voluntary
After 72 hour hold and patient still doesn’t want to be in hospital…
Healthcare professionals deem it necessary, court system must be petitioned for further care
Medication adherence def:
Managing one’s own care based on the plan of care developed as part of the health care team. Sticking to this developed plan of care
Recovery definition:
process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.
Partial hospitalization definition:
Alternative for those that continue to need some supervision but are not appropriate for inpatient hospitalization
When is long-term hospitalization recommended?
Recommended if patient requires longer than 7 days for illness/symptom stabilization
Resilience definition:
Ability and capacity to secure resources needed to support well-being
What is resilience characterized by?
Optimism; Sense of mastery; Competence; Essential to recovery
What is the parietal lobe responsible for?
Receive and identify sensory information
Concept formation and abstraction
Proprioception and body awareness
Reading, mathematics
Right and left orientation
What is the frontal lobe responsible for?
Personality
Formulate goals
Initiate, plan, terminate actions
Decision making
Insight
Motivation
Social judgment
Voluntary motor ability starts in frontal lobe
What is the temporal lobe responsible for?
Language comprehension
Stores sounds into memory
Connects with limbic system “the emotional brain”
What is the occipital lobe responsible for?
Interprets visual images
Visual association
Visual memories
Language formation
What does damage to the frontal lobe cause?
• Paralysis, Inability to plan sequence of steps/actions; Persistence of a single thought (Perseveration) ***); Inability to focus on task (Attending); Mood changes (Emotionally Labile); Personality changes; Difficulty with problem solving; Inability to express language (Broca’s Aphasia)
What is inability to express language term?
Broca’s Aphasia
What is Broca’s aphasia?
Inability to express language
What does damage to the parietal lobe cause?
Problems with reading, naming objects, drawing, & math.; Difficulty in distinguishing left from right. Lack of awareness of certain body parts and/or surrounding space. Apraxia: difficulty controlling fine and gross motor movement; (Schizophrenia & nihilistic delusions: things or even everything does not exist
What is apraxia?
difficulty controlling fine and gross motor movement
Apraxia is associated with damage to the…
parietal lobe
Schizophrenia and nihilistic delusions are associated with damage to the…
parietal lobe
What does damage to the temporal lobe cause?
Prosopagnosia: Difficulty in recognizing faces ; Wernicke’s Aphasia: Difficulty in understanding spoken words; Difficulty with identification of, and verbalization about objects.; Short term memory and long-term memory loss.; Manic symptoms such as: Increased or decreased interest in sexual behavior, persistent talking.; Increased aggressive behavior.
What is difficulty in recognizing faces?
Prosopagnosia
What is Wernicke’s aphasia?
Difficulty in understanding spoken words
What two conditions are associated with damage to the temporal lobe?
Wernicke’s aphasia
Prosopagnosia
What is damage to the occipital lobe associated with?
Visual illusions - inaccurately seeing objects (See a person in the corner instead of a coat tree); Word blindness - inability to recognize words.; Difficulty in recognizing drawn objects. ; Inability to recognize the movement of object (Movement Agnosia).
What is word blindness?
Inability to recognize words or drawn objects
What is movement agnosia?
Inability to recognize the movement of an object
Word blindness is associated with damage to what lobe?
Occipital
Movement agnosia is associated with damage to what lobe?
Occipital
What does the corpus callosum do?
Relays information between hemispheres of brain
Damage to the corpus callosum is associated with…
people cannot integrate emotions and logical information.
Corpus callosum damage: What happens if left side of the brain is dominiant?
If the left (logical) brain side is dominant = less ability to feel emotion
Corpus callosum damage: what happens if the right side is dominant?
If the right (emotional) brain side is dominant = difficult to control emotions and problem-solve; loss of object constancy
What is the limbic system responsible for?
learning, memory, emotions and visceral responses
What do abnormalities in the limbic system cause?
Excessive emotional response
What is the hippocampus responsible for?
memory, and controls the endocrine and immune systems
What condition associated with alcoholism causes damage to the hippocampus?
Korsakoff’s syndrome
What is Korsakoff’s syndrome?
A person cannot form new memories despite intact intelligence
What does the amygdala do?
processes emotions; anxiety, fear, and pleasure
What does damage to the amygdala result in?
Damage has resulted in rage in animals. Plays a role in anxiety and OCD
What do the basal ganglia do?
Coordinated and aids in moving skeletal muscles
How perception works:
The __ __ __ sends us a signal- “I am being touched by something”
peripheral nervous system
How perception works:
The __ __ evaluates the sensation - “What does it feel like?”
sensory cortex
How perception works:
The __ is responsible for recalling memory - “Have a I been touched like this before?”
Hippocampus
How perception works:
The __ attaches an emotional response to the stimulation based on past experiences
Amygdala
How perception works:
The __ __ spring us into action - withdrawal, fear, return touch, etc.
basal ganglia
What imaging techniques show structure of anatomy?
CT
MRI
What imaging techniques show function of anatomy?
PET
SPECT
fMRI
What does a SPECT stand for?
single photon emission computed tomography
What concept is related to brain growth?
Learning, memory and perception are influenced by past experiences and the ability of the brain to organize information
Nursing interventions that lead to changes in brain activity:
Social…
connections
Nursing interventions that lead to changes in brain activity:
Give community…
resources
Nursing interventions that lead to changes in brain activity:
New…
learning
Nursing interventions that lead to changes in brain activity:
Healthy…
diet
Nursing interventions that lead to changes in brain activity:
Sleep and…
exercise
Nursing interventions that lead to changes in brain activity:
Healthy __….
anxiety
Nursing interventions that lead to changes in brain activity:
meditation and….
gratitude
Nursing interventions that lead to changes in brain activity:
ANT killing to combat…
cognitive disorders
Interventions that decrease stress will…
decrease cortisol levels which positively impact the PNS
What are the two main inhibitory/calming neurotransmitters?
Serotonin and GABA
What are the two main excitatory neurotransmitters?
Dopamine and glutamate
What does serotonin regulate?
modulates mood, emotion, sleep, pain and appetite as related to mood, temperature regulation; some cognitive function
Serotonin is __ in people with depression and anxiety
LOW
What does GABA do?
reduces anxiety, aggression, and stress; regulates norepinephrine, adrenaline, dopamine and serotonin
GABA is DECREASED in which conditions?
Anxiety, mania, and schizophrenia
Do decrease anxiety, GABA needs to be __
increased
What does dopamine do?
pleasurable feelings, complex motor activities, plays a role in hallucinations
Dopamine is decreased in these conditions
Depression, addiction
Dopamine is increased in these conditions…
Mania, positive symptoms in schizophrenia
Too much glutamate results in…
Seizure activity and neurodegeneration in Alzheimers
Glutamate is decreased in these conditions…
Psychosis
Autism
OCD
Depression
Schizophrenia
What neurotransmitters are considered “other”
acetylcholine
histamine
norepinephrine
What is acetylcholine responsible for?
cognitive functioning; sleep–wake cycles. Plays a role in learning, memory. Regulates mood: mania, sexual aggression
Acetylcholine is low in…
Alzheimer’s and sleep disorders
Acetylcholine is high in…
depression
What is norepinephrine responsible for?
level in the brain affects mood, attention, and arousal. Stimulates sympathetic branch of autonomic nervous system for “fight or flight” stress response
Norepinephrine is decreased in…
depression
Norepinephrine is increased in…
mania, anxiety, and schizophrenia
What is neuroplasticity?
The ability of the brain to change with learning is what is known as neuroplasticity; It is the lifelong ability of the brain to reorganize neural pathways based on new experiences.
What is synaptic pruning?
A neurological process which removes unnecessary or damaged neuronal structures from the brain; Improving the “networking” capacity of a particular area of the brain. Pruning = “weeding out” the weaker synapses.
Over pruning in schizophrenia may result in…
hallucinations
Gene theory suggests over pruning takes place in…
late adolescence and young adulthood
What are nursing interventions for family consultation?
Help understanding
Develop effective parenting skills
Teach about suicide risks
Stinking thinking #1
All…
All-or nothing thinking
Stinking thinking #2
Over…
overgeneralization
Stinking thinking #3
Mental…
mental filter
Stinking thinking #4
Dis…
discounting the positive
Stinking thinking #5
Jump…
jumping to conclusions
Stinking thinking #6
Mag…
magnification
Stinking thinking #7
emot….
emotional reasoning
Stinking thinking #8
Should…
“should” statements
Stinking thinking #9
Lab..
labelling
Stinking thinking #10
person…
personalization and blame
3 types of talk behavioral therapy
Interpersonal therapy
CBT
Dialectic behavior therapy (DBT)
What does interpersonal therapy focus on?
Focuses on interpersonal relationships by improving functioning and communication patterns
What are 3 techniques of interpersonal therapy?
Identification of emotion
Expression of emotion
Dealing with emotional baggage
Interpersonal therapy
Identification of emotion:
Helping the person identify what their emotion is and where it is coming from
Interpersonal therapy
Expression of emotion
This involves helping the person express their emotions in a healthy way
Interpersonal therapy
Dealing with emotional baggage
Looking at how past relationships affect current relationships.
What is CBT?
Based on cognitive psychology & behavioral theory. Thoughts cause feelings and behaviors, not external things, like people, situations, or events.
What is the benefit of CBT?
we can change the way we think in order to feel/act better even if the situation does not change
How long is CBT typically don?
Brief, time limited and structured, usually 16 sessions
How is CBT conducted?
Homework and self-counseling skills
Collaborative effort between therapist and patient Goals are identified by the patient
What is DBT?
Developed to treat chronically suicidal individuals commonly with borderline personality disorder; Combines cognitive and behavioral techniques with mindfulness.; Emotional regulation; Interpersonal effectiveness; Distress tolerance; Mindfulness; Self Management skills
What are the 4 primary modes of DBT?
Group skills training
Individual psychotherapy
Telephone contact
Therapist consultation and team meetings
A group consists of..
two or more people; Pursuing common goals and/or interests
Each group has characteristics that influence it’s progress and outcomes…
Size; Defined purpose; Degree of similarity among members; Rules; Boundaries; Content (what is said in the group); Process (underlying dynamics among group members)
Psychoeducation group:
Groups to increase knowledge or skills about a specific psychological or somatic subject
Examples of specific psychologic or somatic subjects
Medication or Health education; Dual-diagnosis; Symptom management; Goal Setting/Review; Recreational Activity; Interpersonal Skills
Therapeutic community meeting group:
Every interaction occurring on an inpatient milieu has the potential to be therapeutic. The community meeting is the essential venue at which unit happenings are processed and integrated into treatment
Support and self-help group:
These groups are structured to provide patients with the opportunity to maintain or enhance personal and social functioning through cooperation and shared understanding of life’s challenges (i.e. AA, survivors of Cancer, bereavement…)
Group psychotherapy:
This is a specialized group intervention requiring skilled leaders such as an advanced practice nurse. Expertise is necessary for this group since the goal is to bring about personality change.
What are some advantages of working with groups?
Engage multiple patients in treatment at the same time; Participants benefit from feedback, knowledge, and life experiences of others; Provides a safe setting to try out new behaviors and communication skills; Promotes a feeling of belonging
What are some disadvantages of working with groups?
Time constraints an individual may feel cheated for participation time; Concern for confidentiality; Disruptive members; Not all patients benefit from group treatment
Intervention for monopolizing group member?
Remind entire group to provide equal chances to contribute
Speak directly to member, privately when necessary
Intervention for demoralizing group member
Listen objectively; ask in private about cause of anger; empathize matter-of-factly
Intervention for silent member
Determine cause; require response to ease group discomfort; provide extra time for member to think about a response and come back to them
4 phases of group development are…
Planning
Orientation
Working
Termination
Group development:
Planning phase
Name, objectives, schedule, setting, types of patients for inclusion of the group
Group development:
Orientation phase
Leader structures atmosphere of respect, confidentiality and trust. Group purpose and rules are stated
Group development:
Working phase
Group leaders encourages a focus on problem solving. As group members begin to feel safe, conflicts may be expressed and pose a growth opportunity for the group “storming, norming and preforming”
Group development:
Termination phase
Encourage members to reflect on progress made and identify post termination goals.
What are individual informal roles of group members?
Agressor
Blocker-oppositional
Recognition seeker
Play person
Dominator
Functional roles:
Task Roles-
Initiator-contributor:
Suggests or proposes new ideas or different ways of regarding the problem or goal
Functional roles:
Task Roles-
Information seeker
tries to clarify the groups roles
Functional roles:
Task Roles-
Information giver
Provides facts or shares experiences as an authority figure
Functional roles:
Task Roles-
coordinator
Shows or clarifies how ideas can work
Functional roles:
Task Roles-
orienteer
notes progress towards goal
Functional roles:
Task Roles-
Recorder
Keeps notes and acts as memory
Yalom’s therapeutic factors:
Instillation of hope
Leader shares optimism about successes of group treatment, and members share their improvements
Yalom’s therapeutic factors:
Universality
Members realize that they are not alone
Yalom’s therapeutic factors:
Imparting of information
Participants receive formal teaching by the leader or advice from peers
Yalom’s therapeutic factors:
Altruism
Members gain/profit from giving support to others improving self-value
Yalom’s therapeutic factors:
Corrective recapitulation
Members repeat patterns of behavior in the group that they learned in their families; with feedback from the leader and peers, they learn about their own behavior
Yalom’s therapeutic factors:
Development of socailizing skills
Members learn new social skills based on others feedback and modeling
Yalom’s therapeutic factors:
Imitative behavior
Members may copy behavior from leader or peers and can adopt healthier habits
Yalom’s therapeutic factors:
Interpersonal learning
Gain insight based on feedback
Yalom’s therapeutic factors:
Group cohesiveness
This arises in a mature group when each member feels connected to the other members, the leader, and the group. Members can accept both positive feedback and constructive criticism.
Yalom’s therapeutic factors:
Catharsis
Through experiencing and expressing feelings, therapeutic discharge of emotion is shared.
Yalom’s therapeutic factors:
Existential resolution
Members examine aspect of life, (i.e. loneliness, mortality, responsibility) that affect everyone in constructing meaning.
What is photolight therapy?
First-line treatment for depression with a seasonal onset
Efficacy due to influence of light on melatonin
Effective as medication
What are negative effects of photolight therapy?
Headache and jitteriness
What is electroconvulsive therapy?
Under anesthesia and with a muscle relaxant, ECT is the application of electricity to temporal regions of the brain to induce a brief seizure. Unilateral (electrodes placed on one hemisphere of brain/scalp) vs. bilateral- one electrode on each temple area
Most effective treatment for depression
ECT
ECT is the primary treatment in…
severe malnutrition, exhaustion, & dehydration d/t lengthy depression
What is the second most common indication for ECT?
Psychotic illness
What is the course of treatment for ECT?
• 2-3 treatments per week for a total of 6 to 12 treatments; Must reorient for several hours after treatments
ECT is also used in…
Delusional depression; Failure of previous med trials-refractory depression; Schizophrenia with catatonia
What are the risks of ECT?
Stress on heart at seizure onset and up to 10 minutes post
Stresses the brain as a result of increased cerebral oxygen, blood flow, and intracranial pressure
Confused and disoriented for several hours-must reorient frequently
Retrograde amnesia-loss of memory of events leading up to and including the treatment
When is ETC contraindicated?
Brain tumors and subdural hematomas
What should the nurse assess for prior to ECT and after?
HTN
CHF
Arrhythmias
What is Transcranial magnetic stimulation?
MRI-strength magnetic pulses stimulate focal areas of the cerebral cortex
What is contraindication of transcrainial magnetic stimulation?
metal
What are adverse reactions of transcranial magnetic stimulation?
Headache and lightheadedness
No neurological deficits or memory problems
Seizures rarely
Most are mild and include scalp tingling and discomfort at administration site.
What are invasive procedures?
Vagus nerve stimulation and deep brain stimulation
What is vagus nerve stimulation?
Originally used to treat epilepsy; Decreases seizures and improves mood; Used for treatment resistant depression; Electrical stimulation boosts the level of neurotransmitters
What are the side effects of vagus nerve stimulation?
Voice alteration (nearly 60% of patients)
Neck pain, cough, paresthesia, and dyspnea, which tend to decrease with time
What is deep brain stimulation?
More invasive than VNS; Surgically implanted electrodes (in the brain) Stimulates regions identified as underactive in depression
What was deep brain stimulation originally used to treat?
Parkinsons
What is St Johns Wort?
Flower processed into tea or tablets; Thought to increase serotonin, norepinephrine, and dopamine; Useful in mild to moderate depression
What is Ginseng for?
stress and fatigue
What is Valerian root or chamomile used for?
stress
insomnia
depression