Psych Test 1

Mental health involves

Emotional, psychological, and social well-being.

What is the DSM-5?

The current official guidebook for categorizing and diagnosing psychiatric mental health disorders in the U.S.

In order to be diagnosed using the DSM-5, what does a patient have to have at least one of?

distress, impairment, or danger

symptom vs syndrome

symptom: one thing

syndrome: many things

diagnosis

when a syndrome matches diagnostic criteria

Major depressive disorder

leading cause of disability, women 2x more

Bipolar effective disorder

affects genders differently; men experience mania, women experience depression

Post traumatic stress disorder

can develop immediately or be delayed

Scizophrenia

affects men and women equally; appears earlier in men, and the prognosis is worse

Obsessive compulsive disorder

1st s/s manifest in childhood; women have an increased rate in adulthood, but men have a higher risk in childhood

Generalized anxiety disorder

highest risk b/n childhood and adolescents; most common disorder; 2x more common in childhood

when does social phobia typically manifest?

childhood or adolescence

Panic disorder

increased risk in women; median onset at 24, and risk decreases after age 60

combatting stigma:

talking openly, being conscious of language, treating physical and mental health equally, and showing compassion

What is a likely precursor to developing agoraphobia (fear of places)?

panic disorder

Anosognosia

A condition in which a person with an illness seems unaware of the existence of his or her illness.

What did the 1999 Olmstead decision involve?

Institutionalizing people became unjustified; mental illness became a disability; those with disabilities have a right to live in the community; hospital institutions -> community care

What was the 1st antipsychotic drug in the 1950s

Chlorpromazine

Outpatient care setting

can lessen the stigma; disadvantages include time constraints, lack of expertise

What are patient-centered medical homes?

provides access to physical health, behavioral health, supportive community, and social services from preventative care and acute care

what 5 characteristics must patient centered medical homes have?

1. comprehensive care

2. patient centered

3. coordinated care

4. accessible service

5. quality and safety

Community mental health centers

state-regulated; provide emergency services, community/home. based services, outpatient services

Crisis stabilization/observation units

Prioritize rapid stabilization and short length of stay (

Residential treatment programs

varying levels of supervision/support; psychoeducation, vocational training, and ADL retraining provided; learn how to access community support as an alternative to hospitalization; can be short or long-term living environments

State acute care systems

for the most seriously ill; the role depends on the available level of community care and payment by state medicaid programs; forensic care is provided for those found not guilty by reason of insanity

What is the role of the inpatient and outpatient psych nurse?

building a good repor, assessing, maiintaining safety and the milieu, managing comorbidities, deescalating

What are the 3 areas in the "art" of nursing?

caring, attending, patient advocacy

What is the recovery model?

social model of disability... focuses on rehab and recovery. Focused on helping individuals develop the knowledge, attitudes, and skills they need to make good choices or change harmful behaviors. Underlying principle = people can recover from mental illness and substance abuse to lead to a better life

Trauma informed care

recognizes that trauma is almost universally found in the histories of mental health patients and is a contributor to mental health issues, substance abuse, chronic health conditions, and contact with the criminal justice system

When assessing a psych patient, what information does the nurse need to know?

Home environment

Education and employment

Activities

Drugs, alcohol, tobacco

Sexuality

Suicide risk

Savagery (violence or abuse in home environments)

What is the mental status exam (MSE)

useful in differentiating b/n a variety of systemic conditions, as well as neuro and psych disorders ranging from delirium and dementia, to bipolar and schizophrenia. For acutely disturbed patients, it is normal for the clinician to administer this exam every day

hallucinations

Sensory experiences without external stimuli; may strike any sense

Illusions

misperceptions of actual existing stimuli

ex. seeing a rope on the ground and believing it's a snake; smelling smoke and believing the house will burn down

The Marcus Alert System

aims to improve response to behavioral health emergencies; enhances services for people in crisis; improves coordination b/n 911 and crisis call centers; establishes specialized behavioral health responders w/in law enforcement

Emergecy custody order (ECO)

The period of custody shall not exceed 8 hours from the time the law enforcement officer takes the person into custody.

Whats the purpose of an ECO

Obtain a face-to-face meeting with a mental health professional evaluator and a person thought to be mentally ill for the evaluator to form an opinion and provide expert evidence as to whether they need hospitalization or treatment for a mental illness, and otherwise meet statutory criteria for a temporary detention order

Temporary detainment order (TDO)

period of custody must not exceed 72 hrs prior to a commitment hearing unless the 72 hrs terminates on a day the court is lawfully closed

Primary purpose of a TDO is

Observation, diagnosis, and treatment. A court hearing is then held, where a decision for voluntary admission, involuntary commitment, or discharge is made

Involuntary outpatient commitment

an alternative to forced inpatient treatment; without the patient's consent; court-ordered; initially up to 90 days... additional petition and court order needed for recommitment, which can be up to 180 days

conditional release

requires outpatient treatment for a specific time to determine the patient's adherence to medication protocols, ability to meet basic needs, and the ability to reintegrate back into the community.

Unconditional release (discharge)

the termination of a patient-institution relationship; may be court-ordered or administratively ordered by the institution's officials

In an emergent situation... a person may need to be medicated; to medicate without a court hearing all of these criteria need to be met

1. serious mental illness

2. deteriorating function and the person is suffering of exhibiting threatening behavior

3. Benefits outweigh the cons

4. person lacks capacity to make a reasoned decision

5. less restrictive services have been found inadequate

What is competency?

legal term related to the degree of mental soundness a person has to make decisions or to carry out specific acts

time-out

Voluntary removal of a patient from a stimulating environment to regain control. The patient maintains control and may choose to return when ready; used as a behavioral intervention, often in children. Not considered a restraint as rights are not restricted

Seclusion

Involuntary confinement of a patient alone in a room or designated area; pt prevented from leaving, used only when the patient poses an immediate risk to self or others. Legally regulated - requires physician order, time limits, documents, documentation, and monitoring

Contraindications to restraints and seclusions

unstable medical and psych conditions, delirium/dementia leading to inability to tolerate decreased stimulation, severe suicidal tendencies, severe drug reactions or ODs, or the need for close monitoring or drug dosages, desire for the punishment of the patient, or the convenience of the staff

There are exceptions to confidentiality, but what is the nurses role in this?

observing and documenting verbal threats, behaviors, third party reports; immediatly communicating concern to the supervising APRN or MD; participating in team discussions

Failure to report known threats that could result in harm is negligence

Sigmund Freud

Father of Psych; Experiences during the early stages of life determine an individual's lifetime adjustment patterns and personality traits

Freud's levels of awareness

believed that there were 3 levels of psychological awareness in operation: conscious, preconscious, unconscious

The conscious mind

current awareness; thoughts, beliefs, and feelings

the preconscious mind

not the subject of our attention, it is accessible with conscious effort

the unconscious mind

the biggest chunk of our minds; the most primitive feelings, drives, and memories reside, esp those that are unbearable and traumatic

Freud's personality structure

In healthy individuals, the 3 systems of personality work together under the administrative leadership of the ego. Ego can evaluate solutions, limit id's impulses, and keep superego from becoming too rigid and obsessive

Id

We all have it at birth, totally unconscious and impulsive. source of all drives, instincts, reflexes, and needs. It can't tolerate frustration and seeks to discharge tension and return to a more comfy level of energy. It lacks the ability to problem solve and is illogical

Ego

within the 1st few yrs of life as one begins to interact w/ others. Resides in the conscious, preconscious, and unconscious. The problem solver and reality tester, it attempts to navigate the outside world

Superego

It resides in the conscious, preconscious, and unconscious. It holds the internalized moral standards and ideals that we acquire from parents/ society (sense of right and wrong). Can induce guilt and may feel pride

Psychodynamic theory

The therapist takes a more active role b/c the therapeutic relationship is part of the healing. They also intervene to keep the therapy on track. Sessions are held weekly but for a shorter amt of time (10-12 sessions).

Psychoanalytic Theory

A theory developed by Freud that attempts to explain personality, motivation, and mental disorders by focusing on unconscious determinants of behavior

- tools include dream analysis, free association, and defense mechanism recognition

Transference

the patient's transfer to the analyst of unconscious emotions linked with other relationships

- safe expression is vital

Countertransference

Refers to the nurse's behavioral and emotional response to the client's transference

- must be scrutinized to prevent damage

Free Association

a method of exploring the unconscious in which the person relaxes and says whatever comes to mind, no matter how trivial or embarrassing

- used to search for forgotten and repressed memories

Interpersonal Theory

focuses on what occurs b/n people, which is rooted in what occurs in the mind. Sullivan believed that social forces and interpersonal problems were the cause of psych alterations.

According to Sullivan's Interpersonal theory, what drives behaviors

Anxiety and self esteem

What theory is this from?

Loneliness is considered the most painful human experience. The early relationship with a caregiver is crucial for personality development and healthy relationships are needed for a healthy personality

Interpersonal theory

According to the Interpersonal Theory, how is anxiety transmitted?

from caregiver to child

Interpersonal Therapy (IPT)

The therapist is an active guide and challenges bad behaviors and distorted views, they become a participant observer. If people are aware of their issues and unrealistic expectations, they can be modified. The focus is to reduce symptoms via improving relationships.

Using the interpersonal theory, what mental illnesses can be improved?

depression

Pavlov's Classical Conditioniing

Involuntary behavior can be conditioned to respond to neutral stimuli.

ex. Dogs becoming used to receiving food after the ring of a bell; now they salivate after hearing the sound of a bell.

Watson's Little Albert Expirement

He rejected psychoanalysis and sought objective therapy that didn't focus on unconscious motivations. A baby was conditioned to be terrified at the sight of white fur/hair, using rats and loud noises. He concluded that by controlling the environment, this could mold behaviors

Skinner's research on operant conditioning

Used positive (a consequence that causes a behavior to occur more frequently) and negative (a consequence that causes a behavior to occur less frequently) reinforcement; was done by electrocuting a mouse with a power grid in its cage

Behavioral therapy or behavioral modification

It attempts to correct/eliminate maladaptive behaviors or responses by rewarding and reinforcing adaptive behavior

systemic desensitation

learned responses can be reversed by promoting relaxation and then gradually facing an anxiety-provoking stimulus.

systemic desensitation has been particularaly successfull in

Agoraphobia

aversion therapy

Used to eradicate unwanted behaviors by associating unpleasant consequences with them.

ex. disulfiram (Antabuse) will make those who take it get violently ill with ingestion of alcohol

Biofeedback

A technique where you can learn to control HR, BP, RR, and temp by providing visual/auditory biofeedback of the physiological response, and then using relaxation techniques such as slow breathing or meditation

Humanistic Theory: Maslow's

Physiological needs, safety needs, love and belonging, esteem needs, self actualization, self transcendant

Cognitive Theory

Cognitive appraisals of events lead to emotional responses; it's not the event itself that causes the response, but one's evaluation of the event.

Cognitive Behavioral Therapy

seeks to modify negative thoughts that lead to dysfunctional emotions/actions. Once these maladaptive patterns are identified, they can be replaced with rational thoughts.

What is schemata?

unique assumptions about ourselves, others, and the world around us

What theory does schemata underlie in?

Cognitive Behavioral Theory

This is a unique assumption about ourselves, others, and the world.

ex. If someone believes no one can be trusted, this individual will always question others' motives and expect deception

Which model dominates psychiatric care?

Biological Model

If mental disorders have physical causes, then they will respond to physical treatment.

What medications were used with the Biological Model?

Cocaine, then chlorpromazine (Thorazine)... was used as an anesthetic, then for schizophrenia. It reduced the use of restraints and seclusion

Peplau's Interpersonal relations in nursing

Mild... day-to-day alertness; learning can easily take place

Moderate... heightened sense of awareness; ex. taking an exam. The perceptual field is narrowed. Learning can take place, but may require more direction

Severe... interferes with clear thinking; all behavior is directed at reducing the anxiety

Panic... results in either paralysis or dangerous hyperactivity; no communication, function, cant follow directions

Benefits of group therapy

more efficient, pragmatically and financially, than individual therapy. Operates under the assumption that interaction w/in the group can provide support or bring about desired change among individual participants

Altruism

a benefit of group therapy. Giving appropriate help to other members... everyone should have a chance to speak

Cohesiveness

a benefit of group therapy. Feeling connected to other members and belonging to the group

Interpersonal learning

a benefit of group therapy. Learning from other members

a benefit of group therapy. catharsis

releasing feelings and emotions

a benefit of group therapy. Identification

modeling after a member or leader

A benefit of group therapy: Family reenactment

testing new behaviors in a safe environment

a benefit of group therapy. Existential factors

coming to understand what life is about

Terminology used in the National center for complementary and integrative health (NCCIH) refers to

complementary approaches in which nontraditional treatments are provided in addition to conventional medical treatments.

Integrative health in which conventional and complementary approaches are brought together in a coordinated way.

What are the goals of the nurse in the mental health setting to help the patient?

- Feel understood and comfortable

- Identify and explore problems relating to others

- discover healthy ways of meeting emotional needs

- experience satisfying interpersonal relationships

Cultural competence

being respectful of and responsive to the health beliefs and practices - and cultural and linguistic needs - of diverse groups. This takes time and occurs along a continuum

What are goals in a therapeutic relationship?

- Facilitating communication

- Assisting with problem-solving

- Help examine self-defeating behaviors and test alternatives

- Promoting self care and independence

What are examples of signs that signal relationship boundaries blurring?

being controlling, over-helping, and narcissistic behavior

What is the pre-orientation phase?

Nurses prepare for the interaction; chart review. May have many thoughts and feelings before the 1st clinical session

What is the orientation phase?

Introductions, state the purpose and the parameters of the relationship. Establishing Rapport. Discuss confidentiality, set goals, and begin to discuss termination

What is the working phase?

Maintain the relationship and gather further information. promote the patient's problem-solving, self-esteem, and use of language. Evaluate problems and goals, etc.

What is the termination phase?

summarize the goals achieved; review education, and discuss ways the patient can incorporate new coping skills. Exchange memories and explain it's okay to feel a sense of loss.