MH Exam 3 Part 2

Cluster A traits and behaviors

Traits: odd, eccentric, peculiar

Behaviors

Paranoid - distrust and suspicious of others, grudges

Schizoid - detachment from social relationships, flat affect

Schizotypal - odd beliefs, social anxiety, lack of relationships

Cluster B traits and behaviors

Traits: dramatic, emotional, erratic

Behaviors:

Antisocial - deceitful, lie steal cheat, no rules, disregard to safety of themselves or others

Borderline - suicide risk, don't want to be alone, impulsive, intense anger

Histrionic - center of attention, follower, lots of friends, thinks relationships are closer than they are

Narcissistic - they are special, no one is like them, lacks empathy, doesn't care for others

Cluster C traits and behaviors

Traits: anxious, fearful

Behaviors:

Avoidant - dependent on others, low self esteem, fearful of criticism

Dependent - can't make decisions, doesn't express disagreement, feels uncomfortable alone, needs a relationship

OCD - inflexible, detailed, doesn't spend money

Cluster A therapeutic presence and care planning

Help process feelings and emotions they cant share with others, not too nice but matter of fact

Find and maintain interpersonal relationships

Cluster B therapeutic presence and care planning

Nurse needs to set boundaries

Safety, emotional regulation and set limits on dramatic and inappropriate behaviors

Cluster C therapeutic presence and care planning

Reassure, suggest coping skills, empower

Decrease anxiety

Depression

symptom and disorder

symptoms can be present throughout the lifespan triggered by stressors

diagnosis is DSM by symptoms on a spectrum overtime

Mania

symp - overactivity, not sleeping, talking quickly, sexual, unsafe

Hypomania

mild version of mania, not depression, not as severe as mania

Bipolar I

major depression and mania

Bipolar II

hypomania and depression

Cyclothymia

alternates between mania and mild to moderate depression for at least 2 years, not as severe as bipolar I or II

Risk factors and warning signs for suicide

SAD PERSONS

sex, age (

Suicide (plan) assessment

- develop before discharge

- what to do if thoughts return (multiple steps and options)

- give numbers/resources -> coping skills -> counselor -> ER

- have them sign safety plan to be committed and hold themselves accountable

Community and societal increased risks for suicide

barriers to access healthcare, cultural beliefs (noble resolution), community cluster, stigma, access to meds or weapons, media portrayals

DSM criteria for MDD

SNRI indications, risks, side effects, med names

Names: xine, tine, pran

Indications: ADHD and depression

Risks: serotonin syndrome, suicide risk, high BP

Side effects: N/V, dizziness, headaches, LOA, dry mouth, diaphoresis

TCA indications, risks, side effects, med names

Names: end in -tyline or -mine

Indications: Antidepressant

Risks: likely to die if overdose, long QT interval, dont mix with other CNS depressants

Side effects: Anticholinergic effects (dry mouth, blurred vision, constipation), drowsiness, weight gain

Adverse Effects off Antipsychotic Meds

1st - lower WBC (agranulocytosis), infection, fever, cough, not healing, respiratory issues

2nd - no WBC problems, wt gain, insulin resistance, inc waist circumference, increase in triglycerides

Nurses Role in ECT

- monitor client status and respond to emergencies

- NPO 6-8hrs before

- discontinue benzos

- give anesthetic and muscle paralyzer before

- blood pressure cuff on lower legs

Different types of brain stim treatments

ECT, Vagus nerve stimulation, repetitive transcranial magnetic stimulation, deep brain stimulation

Contraband, unsafe materials, and milieu

- scissors, knitting needles, belts, lighters, spiral notebooks

- safe and therapeutic environment

Unit checks, monitoring and responsibility of the nurse

- check for safety, suicide risk patients always have eyes on

Analyzing cues - safety first

- check for suicide risk and harm to others

- giving away possessions, dont allow in personal room during group, observed at all times

Nursing interventions for client with mania

Inpatient - high calorie, high quality finger foods, unit is quiet at night and designated quiet periods, make sure client is not roaming unit during evening, low stimuli, scheduled meds

Outpatient - high calorie, high quality finger foods, good sleep hygiene

"take action" intervention for client with depression

Inpatient - body slows down, need structured plan for daily activities, BM may be slowed so allow walking, fiber in diet, extra fluids, stool softener, monitor for suicide risk

Outpatient - need case management to coordinate both med management and psychotherapy

Expected outcomes for clients with mood disorders

Short term - free of injury, ability to care for self, alterations in thought processes, ability to function and heal in outpatient setting, mood stability, knowledge of disorder, absence of suicidal ideations

Long term - adherence with meds and treatment, lack of suicidality, functional in relationships and life

Components of mental status exam

- Observation (appearance, speech, eye contact, motor activity, affect)

- Mood

- Cognition (orientation, memory, attention)

- Perception (hallucinations, derealization/depersonalization)

- Thoughts (suicide or homicide)

- Behavior

- Insight

- Judgement

Diagnosis, first episode "psychotic break"

- Diagnosed as brief psychotic disorder when symptoms last 1 day to 1 month

Risks to client with schizophrenia

- early mortality, suicide risk, challenges in daily functioning, personal relationships, employment, more stigma, discrimination, and social isolation

Environmental RF for schizophrenia

- cannabis use, living in populated city, poverty, ACES, discrimination

Positive/negative/cognitive manifestations

Positive - hallucinations, paranoia, delusions, disorganized speech

Negative - alogia (lack of speech), anergia (lack of energy), anhedonia (lack of pleasure)

Cognitive - poor concentration, slow thinking, poor memory

Types of Delusions and therapeutic communication

Persecutory delusions (believing one is being targeted or harmed)

Grandiose delusions (believing one has great power or importance)

Somatic delusions (false beliefs about the body)

Reference delusions (believing random events are directed at oneself)

Erotomanic delusions (believing someone is in love with them)

Nihilistic delusions (believing a catastrophe will occur or that one is dead/nonexistent)

Therapeutic communication - listen actively, do not argue or reinforce delusion, focus on feelings and safety

Catonia

extreme withdrawal or unusual movements and behaviors. It can present as immobility, rigidity, or purposeless agitation

Tardive dyskinesia

involuntary and repetitive movements

Pseudoparkinsonism

medication induced slumped posture, shuffling gait, drooling, tremors, and 'pill-rolling' finger movements

Therapeutic Communication techniques and tips

- affirmations, reflection, summarizing, open ended questions

Clients with delusions nursing considerations

- safety

- be aware of meds that may cause delusions

- avoid arguing, use clear and non confrontational language, acknowledge client feelings

- dont reinforce delusion but gently redirect to reality

Clients with hallucinations nursing considerations

- stay calm, use clear and simple language

- acknowledge their feelings without reinforcing hallucination ("i understand this might feel frightening)

- encourage reality reorientation

- ensure safety

Client/Family Teaching

- Educate clients and families on medications, including their purpose, dosage, and side effects during hospitalization, outpatient visits, and at discharge.

- Discuss the nature of the mental disorder, expected behaviors, and ways to respond effectively.

- Include signs of relapse and steps to take for prevention.

- Reinforce concepts learned in therapy and provide ongoing support.