Week 2 Flashcards
mental health definition
a state of well-being in which each individual is able to realize his or her own potential, cope w normal stresses of life, work productively and fruitfully, and make a contribution to the community
describe mental illness
- alteration in cognition, mood, or behaviour coupled w significant distress and impaired functioning
4 possibilities from that weird continuum
- optimal mental health w no mental illness
- poor mental health w mental illness (needs assistance)
- optimal mental health w mental illness (has schizophrenia diagnosis but symptoms in remission)
- poor mental health w no mental illness (someone stressed w/o psychiatric disorder)
what is the two continua model of mental health and illness
- mental health and illness intersect and are experienced to varying degrees simultaneously with fluctuations over time and in response to life circumstances
throughout history there have been 3 general theories of etiology of mental illness: just state them
- supernatural
- somatogenic
- psychogenic
these theories exist throughout the ages, but are not linear in transition. instead, they coexist and are recycled over time
describe supernatural theory
attribute mental illness to possession by evil or demonic spirits, displeasure of gods, eclipses, planetary gravitation, curses, and sin
describe somatogenic theory
disturbances in physical functioning resulting from either illness, genetic inheritance, brain damage or imbalance
describe psychogenic theory
traumatic or stressful experiences, maladaptive learned associations and cognitions, or distorted perceptions
describe 6500 BCE
trephination is an ex of the earliest supernatural explanation for mental illness. Examination of prehistoric skulls and cave art has identified surgical drilling of holes in skulls to allow evil spirits trapped within the skull to be released.
describe 2700 BCE
Yin and Yang, Chinese medicine’s concept of complementary positive and negative bodily forces, attributed mental (and physical) illness to an imbalance of these forces
describe 1900 BCE
Mesopotamian and egyptian papri describe women suffering from a mental illness resulting from a wandering uterus (later named hysteria by the Greek), where it was believed the uterus would attach to other part of the body. Somatogenic treatment of strong smelling substances to guide the uterus back to to its proper location
describe classic antiquity (8 BCE - 5 CE)
return to supernatural theories of demonic possession or godly displeasures to account for abnormal behaviour. temple attendance with religious healing ceremonies and incantations to the gods were employed to assist in the healing process
describe 400 BC
hippocrates attempted to separate superstition and religion from medicine by systematizing the belief that a deficiency/excess in one of the 4 humors (blood, yellow bile, black bile, and phlegm), was responsible for mental illness
- someone who was too temperamental suffered from too much blood and thus letting would be treatment
- classified mental into 4 categories: epilepsy, mania, melancholia, brain fever
late middle ages (1100-1500 CE)
economic and political turmoil threatened the power of the Roman Catholic Church, were supernatural theories of mental disorders again dominated Europe, fueled by natural disasters like plaques and famine. Treatments included prayer rites, relic touching, confessions, atonement
1300 CE
mentally ill began to be persecuted as witches who were possessed (especially woman). witch hunting did not decline until the 17th and 18th centuries, after more than 100,00 presumed witches had been burned at the stake
17th century
treatment of mentally ill was primarily a family responsibility. pts who could not be cared for at home were placed in jails and poorhouses.
- overcrowded, poor sanitary conditions, inadequate food and heating, no intervention or treatment
- the mentally ill were often caged or kept in barred rooms, and were thought to be morally unfit and were treated as “sinners”
1835
asylum for the insane was opened in Saint John, New Brunswick
1841
Asylum for the Insane was opened in Toronto in an abandoned jail
describe continuum of psychiatric mental health treatment
- most acute treatment (short term)
- locked inpt unit
- 24 hr crisis bed
(danger to themselves or others)
*danger to themselves or others - intensive outpt treatment (usually short term)
- partial hospitalization program
- psychiatric home care
- assertive community treatment
- intensive substance abuse program
Go to a center and receive therapy group work, extensive, but you are not admitted usually there 8am-4pm for a week - transitional outpt treatment (usually long term)
- psychosocial rehabilitation program
- clinical care management
Longer term, no longer in acute phase, more about maintenance and sense of recovery for the individual. Weekly or biweekly check ins. - Ongoing outpt treatment (long term)
- community mental health centre
- private therapists office
what is crisis intervention team
- interprofessional team w collaborative partnership
- decreased criminalization and improved access to care
partial hospitalization program
- inpt, intensive short-term treatment where the person can return home each evening
assertive community treatment
intensive case management of pts in community who have had repeated hospitalizations or cannot participate in traditional treatment options
describe MSE
- important part of clinical assessment process
- evaluates current cognitive, affective (emotional) and behavioural functioning
(domains: appearance, behaviour, speech, mood, disorders of thought, perceptual disturbances, cognition, ideas of harming self or others) - data collected through direct and indirect means
- different from MMSE
acronym for MSE
ASEPTIC
what is the threshold of maturity
youth 14-18
- no chronological age defined
- can be deemed a “mature minor”
MMSE
mini-mental state examination
- 30 point questionnaire used to measure severity and progression of cognitive impairment in older adults
(most frequently used as a screening test for dementia)
- test takes btwn 5-10 min
- examines functions including registration, attention and calculation, recall, language, ability to follow simple commands and orientation
- different from the mental status examination
what is CAGE questionnaire
for detecting alcoholism
1. have you ever felt you should CUT down on drinking
2. have people ANNOYED you by criticizing your drinking
3. Have you ever felt GUILTY about your drinking
4. have you ever had a drink first thing in the morning (EYE opener)
what does a PHQ-9 score 5-9 mean + treatment recommended
minimal symptoms
- support, educate to call if worse, return in one month
what does a PHQ-9 score 10-14 mean + treatment recommended
minor depression
- support, watchful waiting
dysthymia
- antidepressant or psychotherapy
major depression - mild
- antidepressant or psychotherapy
what does a PHQ-9 score 15-19 mean + treatment recommended
major depression - moderately severe
- antidepressant or psychotherapy
what does a PHQ-9 score >20 mean + treatment recommended
major depression, severe
- antidepressant and psychotherapy (especially if not improved on monotherapy)
what is the PHQ-9 scale
Grading scale associated w above to test for depression. As well as treatment recommendations.
People fluctuate with recovery.
PHQ-9 this can be dependent on what is going on with their life as well and stressors they may be experiencing.
Good tool to assess where the patient currently is with depression.
Can help facilitate conversations and discussions.
what is a therapeutic relationship
- focus is on pt’s ideas, experiences, feelings, personal issues (NOT caregivers needs)
- outcomes: pt needs identified and explored, clear boundaries are established, alternative problem solving approaches taken, new coping skills and insight is developed (behaviour change is encouraged)
what is transference
- pt unconsciously and inappropriately displaces (transfers) onto the nurse his feelings and behaviours related to significant figures in their past
- intensified in relationships of authority
counter-transference
occurs when a nurse unconsciously and inappropriately displaces feelings and behaviours related to significant figures in his or her past onto the pt
