FINAL REVIEW OF CRITICAL MENTAL HEALTH CONCEPTS

Freud: level of awareness

unconcsious

preconscious

conscious

Freud: 3 psychological processess of personality

ID—devil on shoulder —completely impulsive

EGO—angel on shoulder—should/should not

Superego—in the middle, making choices based on ID & ego

Interpersonal therapy

Seeks to improve interpersonal relationships and improve communication patterns

Hildegard Peplau

developed an interpersonal theoretical framework

foundation of psychiatric health nursing practice

Behavioral theorists argue that changing a behavior changes a personality

Pavlov

Skinner

Abraham Maslow

Erickson

Pavloc

classical conditioning —involuntary reaction caused by a stimulus

Skinner

operant conditioning—voluntary behavior is learned through reinforcement

Common behavioral treatments

modeling

operant conditioning

exposure therapy

aversion therapy

biofeedback

Cognitive theory

belief that thoughts come before feelings & actions.

thoughts may not be a clear representation of reality and may be distorted

Most commonly used, accepted & empirically validated psychotherapeutic approach

Focuses on ID, understanding, and changing thought patterns

Abraham Maslow

Theory of self-actualization & human motivation that is basic to all nursing education

Humans are motivated by unmet needs

Basic needs must be met before higher-level needs

A Biological Model of Mental Illness & treatment

pharmacotherapy & brain stimulation therapy

Erik Erikson

psychosocial stages & emphasized the social aspect of personality development

Practice settings

Treatment options based on the lest restrictive environment —setting that provides the necessary care while allowing the greatest personal freedom

Complete & accurate documentation of client needs & progress by nurses and other health care professional is needed to ensure quality care for each client

Criteria to justify admission

A clear risk of client’s danger to self or others

An inability to meet own basic needs

Failure to meet expected outomes of community-based treatment

A dangerous decline in mental health status of a client undergoing long-term treatment

A client having a medical need in addition to a mental illness

Levels of Prevention

Primary— promoting health, preventing illness

Secondary—early detection/screening

Tertiary—rehab and prevention of complications

Roles of the nurse-3 Rs

Recognition—memory, mood, appearance, speech, thoughts, perception, orientation

Relationship—concreteness, empathy, respect, genuineness

Resources/Referral—community agencies, hospitals, doctors, churches

Individual therapy

Focus—client needs/problems

therapeutic relationship

Goals—positive individual choices, productive life decisions, strong sense of self

Family therapy

Focus—family needs/problems/dynamics, improve family functioning

Goals—ways to deal with/ mental illness within the family, improve understanding within family max. positive interactions, a good way to teach medication management

Group therapy

Focus—individuals develop more functional/satisfying relationship in group setting

Goals—depend on group—should discover common experiences, feelings, thoughts & experience positive behavior changes as result of group interactions

Brain stimulation therapy

ECT uses electrical current to induce brief seizure activity while the client is anesthetized

The most effective depression treatment

Pychotic illness= 2nd most common indication

Primary treatment in:

severe malnutrition, exhaustion, dehydration due to lengthy depression

Safer than meds w/ certain medical conditions

delusion depression

Schizophrenia w/ catatonia

Contraindication to ECT THERAPY

Cardiovascular disorders

Cerebrovascular disorders

Preprocedural care to ECT therapy

2-3 x week for 6-12 treatments for depression

informed consent

pre work: chest x-ray, blood work, ECG

DC Benzodiazepines —interfere w/ seizure process

Medication management w/ ECT therapy

30 mins prior:

give atropine sulfate or glycopyrrolate is administered to decrease secretions that could cause aspiration & to counteract any vagal stimulation effect (bradycardia)

At procedure time:

short acting anesthetic via IV bolus

muscle relaxant to paralyze client during seizure activity

Nursing interventions for ECT THERAPY

Manage Hypertension

Monitor VS and mental status

Client/family education

IV line maintenance

EEG monitoring

ECG monitoring

COMPLICATIONS W/ ECT THERAPY

Memory loss/confusion: provide orientation, environmental safety, personal hygiene, support as needed

Reactions to anesthesia

Monitor Cardiac rhythm & VS

Relapse of depression —many need more sessions

Mild anxiety

Normal/healthy amount

allows one to have sharp focus & problem solve

Symp: nail-biting, tapping, foot jitters

Moderate anxiety

Thinking ability is impaired

Sharp focus & problem-solving can still happen at lower level

symp: GI upset, headache, shaky voice

Panic anxiety

Most extreme anxiety

unstable & not in touch w/ reality

symp: pacing, yelling, running, hallucinations

Anxiety disorders: separation anxiety disorder

normal in infancy, not adults

Anxiety disorders: Specific phonia

irrational fear

Social anxiety disoder

social phobia Sw/ embarrassment —real or fake physical symp.

Panic disorder

recurring panic attacks

10-15 mins. w/ physical manifestations

Agoraphobia

fear to go outside

Generalized anxiety disorder

6 months of uncontrolled worry:

muscle tension

irritability

sleep disturbance

energy

restlessness

attention

OCD

Intrusive

min-based

unwanted

resistant

disressing

ego-dystonic

reccurent

Therapeutic Millieu

Cognitive behavioral therapy

relaxation training

modeling

systematic densitization

flooding

response prevention

thought stopping

Nursing focus interventions for anxiety

suicide assessment

hopefullness

calm, quiet environments that focus on safety of client

postpone teaching until anxiety/panic subsides

Benzodiazepine sedative hynotic anxiolytics

short term use for panic attacks

Lorazepam, alprazolam, clonazepam, diazepam

Sedation concerns—take at night

Anticholinergic— fluids, fiber, exerice, sugar free gum

Don’t stop abruptly

Risk for dependence/addiction

Atypical anxiolytic

long term use

Buspirone= generalized disorder med

No risk for addiction

Not for breastfeeding clients

Selected antidepressants

select serotonin reuptake inhibitors SSRI

Other antidepressants

Tricyclic antidepressants —TCAs— Amitriptyline, imipramine, clomipramine

MAOIs— phenelzine

Antihistamines—hydroxyzine pamoate, hydroxyzine, hydorchloride

Mirtazapine

Trazodone

Beta Blocker

Propranolol

Centrally acting alpha-blocker

Prazosin

Acute stress disorder

3 days-1 month

Posttraumatic stress disorder

1 month—several days Trauam

Trauma sequence

Traumatic event

Re-experiencing

Arousal

Unable to function

Month or more

Avoidance

Adjustment disorder

changes in mood

function that effect normal activity

less severe than ASD OR PTSD

Dissociative Disorders

Depersonalization/derealiztion disorder

Depersonalization disorder

observing one’s own personality or body from a distance

Derealization disorder

feeling that outside events are unreal or part of a dream D

Dissociative amnesia

cant recall certain time or details

Dissociative fugue

can’t recall whole life

dissociative identity disorder

2 or more distinct personalities

Intervention focus for trauma

cognitive behavior therapy, group/family therapy

Crisis intervention

PTSD—use eye movement desensitization & reprocessing **not for clients w/ suicidal ideation, psychosis, severe dissociative disorders, detached retina or glaucoma, or unstable substance disorder

Anxiety/stress reducing techniquess

Nursing action for trauma

suicide assessment

Therapeutic relationship, encourage sharing feelings

Safe, non-threatening and routine environment

Dissociative—avoiding giving too much info. may increase stress

Medication for trauma—antidepressants

SSRI, SNRI, TCA, MAOI

Noradrenergic & specific serotonergic antidepressnant:

Mirtazapine

bata blocker:

Propranolol

Centrally acting alpha-blocker:

Prazosin

Centrally acting Alpha 2 agonist:

Clonidine

Major Depressive disorder affects/symptoms

Sleep

Interests

Guilt

Energy

concentration

appetite

psychomotor slowing

suicide

Seasonal affective disorder

use light therapy

Persistent depressive disorder

less extreme of MDD

early life onset

can become MDD

PHASES OF CARE FOR DEPRESSION

ACUTE:

assess suicide risk, may need hospitalization

Goal: reduction of manifestations

Continuation—goal: Prevent relapse w/ education, medication & psychotherapy

Maintenance —goal: Prevention of future depressive episodes

Intervention focus for depression

suicide risk

self care

communication —short sentences, time to respond, make observations instead of questions

Safe enviroment

Nursing interventions for depression

suicide assessment

Medication education—for antidepressants—don’t DC abruptly

therapeutic effects can take time

avoid hazardous activites due to potential sedation

notify provider for thoughts of suicide

avoid alcohol

exercise