HNN222 mental health exam revision

trauma informed care

an approach to healthcare that recognises the widespread prevalence and the profound impact of trauma on individuals

key principles of trauma informed care

• safety

• trustworthiness and transparency

• peer support

• collaboration and mutuality

• empowerment, voice and choice

• cultural, historical and gender awareness

recovery (mental health context)

a non-linear, individualised journey of healing and growth, wherein individuals gain control over their life and achieve their own recovery goals.

what are recovery principles?

a set of guidelines that emphasises a person centered approach that focuses on gaining and retaining hope, focuses on individual strengths and goals, rather than cessation and reduction of symptoms

examples of recovery principles

• hope

• person-centered

• empowerment

• holistic approach

• peer support

• respect and signity of risk

• collaboration

role of the nurse in supporting an individual experiencing mental health conditions and distress

• establish a therapeutic relationship

• assessment and early recognition

• promoting recovery principles

• psychoeducation and health promotion

• medication management

• crisis intervention

• advoaccy and rights protection

• collaboration and coordination of care

• supporting families and carers

key elements of interpersonal communication within the nurse-consumer relationship

• active listening

• verbal communication

• non-verbal communication

• empathy and validation

• trust and respect

• boundaries

what is a lived experience worker?

they are people employed in mental health services who draw on their perosnal experience of mental health challenges, recovery, or supporting someone with a mental health condition

role of lived experience workers

• provide hope and connection

• reduce stigma

• empower consumers

• improve service quality

mental health and wellbeing act 2022

centres people with mental health conditions in decision-making about their care and includes strong safeguards to uphold their rights and autonomy

purpose of the mental health and wellbeing act

• promotes rights and dignity of people living with mental health conditions

• places individuals at the centre of decision making about their treatment and care

• ensure access to safe-high-quality and person-centered mental health services

• establish care sfaegaurds and oversight mechanisms to protect human rights

• creates a mental health system that is compassionate, inclusive and recovery-oriented

• respond to government act recommendations to reduce stigma and improve outcomes

what are compulsory treatment orders?

legal orders under the mental health and wellbeing act that allow a person with a mental illness to be treated without their consent

• these orders are typically issued when a person has a mentaal illness and needs immediate treatment to prevent serious harm to them selves or others

conditions for a CTO

→ the person has a mental illness

→ immediate treatment is needed to prevent serious harm

→ the treatment cannot be provided less restrictively

→ the person cannot give informed consent

what are assessment orders?

legal authorisations under mental health legislation that allow a person to be assessed for a mental illness, often without their consent, to determine if they need compulsary treatment

• an assessment order can only be made wihtin 24 hours of the examination

• it expires at 24 hours after the person is recievd at the designated mental health service OR 72 hours after the order is made

what are temporary treatment orders?

a legal order made under the mental health and wellbeing act 2022 that allows a person to be given compulsory mental health treatment for a limited period of time, with or without their consent

REVOKED:

• by a psychiatrist or mental health tribunal

• expires at the end of 28 days

• detained to a designated mental health service under the crimes act

what are treatment orders?

legal authorisations under the mental health and wellbeing act 2022 that allow a person to recieve compulsory mental health treatment, even if they do not consent

REVOKED

• at the end of the specified duration or if it is revoked earlier

• the person is made subject to a new treatment order

• detained to a designated mental heslth service under the crimes act

definition of mental health

a state of wellbeing where individuals can realise their potential, cope with normal stressors of life, work productively and contributes to the community

definition of mental illness

mental illness are conditions that affect mood, behaviour and thought processes

difference between mental health and mental illness

• mental health is a broad term that includes emotional, social and psychosocial health

• mental illness refers to the specific diagnosable conditions that affect feeling, mood and behaviour

what is psychosis?

a state where a person loses contact with reality, characterised by disturbances in thought, perception, mood and behaviour

signs and symptoms of psychosis

• hallucinations

• delusions

• disorganised thinking, speech and motor behaviour

• social isolation, flat affect, lack of motivation

positive and negative symptoms

positive → added to normal experince, related to excess dopamine activity in the mesolimbic pathway

negative → loss of normal functioning, related to reduced dopamine activity in prefrontal cortex

what are the underlying causes of psychosis?

• mental illness 

• susbtance use → acutely increase dopamine, dysregulate neurotransmitter systems

• genetic predisposition

schizophrenia

a chronic mental disorder that typically present with psychotic symptoms

PRODROME PHASE → the early emerging stage, mild symptoms, can last years

ACTIVE PHASE → presence of positive and negative symptoms, psychosis is present, distressing behaviours and beliefs are prominent

RESIDUAL PHASE → recovery stage, more intense symptoms of decreased

nursing care for a person experiencing psychosis

• ensure safety → assess risk of harm to self and others, rmeove hazards

• establish trust and relationship → calm, non-judgemental attitude, respect personal space

• support reality orientation → do not argue delusions, acknowledge experiences without validating false beliefs

• promote medication adherence

• encourage self care

• involve family and support

what treatments are available for psychosis?

• antipsychotic medication

• psychotherapeutic counselling approaches

• early intervention

• menthal health service support

what are typical antipsychotics?

1st generation antipsychotics developed in the 1950s, that primarily work by blocking dopamine D2 receptors in the brain

• affective in reducing positive symptoms of psychosis (hallucinations, delusions, disorganised thinking)

MOA → work by antagonising post-synaptic dopamine to receptor sites which blocks dopamine transmission and decreases the amount of dopamine in the brain and therefore reducing the symptoms of psychosis

examples of typical antipsychotics

• haloperidol

• chlorpromazine

• thioridazine

• flupentixol

adverse effects of typical antipsychotics

• sedation

• photosensitivity

• weight gain

• anticholinergic

what are extrapyramidal effects (EPS)?

they are drug induced movement disorders caused by dopamine blockade

• tardive dyskinesia: involuntary muscle movements

• acute dystonia: muscle spasms

• parkinsonism

what are neuroleptic malignant syndrome (NMS)

a rare but life threatening reaction to antipsychotic medications, resulting from sudden, severe dopamine blockade in the central nervous system

• hyperthermia

• mental status challenge

• muscle rigidity

• sutonomic instability

what are atypical antipsychotic medications?

they are 2nd generation antipsychotics that act on both dopamine D2 and serotonin (5-HT2A) receptors, which helps reduce both positive and negative symptoms

MOA → block subtype serotonin receptors and therefore exert an effect over serotonin levels, 

examples of atypical antipsychotics

• olanzepine

• risperidone

• quetiapine

• ziprasidone

• clozapine

adverse effects of atypical antipsychotics

• sedation

• constipation

• dizziness

• increased hunger

• weight gain

• anticholinergic effects (dry mouth, orthostatic hypotension, blurred vision and tachycardia)

• cardiac effects

• agranulocytosis (depletion of white blood cells)

what is metabolic syndrome?

a cluster of risk factors and a group of conditions that occur together, increasing the risk disease

• hyperglycaemia

• hypertension

• hyperlipademia

• central obesity

what are depots?

long acting sustained release antipsychotics given as an IM injection that are typically administered every 2-4 weeks to ensure the person recieves the prescribed medication

nursing considerations for depots

• adverse effects can take longer to appear and resolve

• can be a traumatic method of medication administration

• dignity, respect and privacy must be upheld at all times

• client communication and education is essential

what is a mental health assessment?

enables the nurse to formulate a holistic and individualised care plan, therefore a good understanding of all dimensions of mental health assessment is crucial to providing quality and safe care

• history of presenting psychiatric problem

• mental state examination

• medical history

• developmental history

• family history

• substance use

• forensic and legal history

• goals for treatment

• current functioning

what are two types of diagnoses in mental health?

• provisional diagnosis refers to a running diagnosis where the clinician has made an educated guess about the most likely diagnosis but it not 100% whether this is the case

• formal diagnosis refers to a diagnosis that has be substained or confirmed

what is the mental status examination?

a structured assessment tool used by mentaal health professionals to evaluate a persons current psychological functioning

• appearance

• behaviour

• mood

• affect

• thought form and content

• speech

• orientation

• perception

• insight and judgement

what are risk assessments?

a structured process used to identify and evaluate potential risks that may affect the safety and wellbeing of the person, other or the community

• risk to self

• risk to others

• risk by others

what are the two categories of risk?

static risk → risks that are fixed and historical in nature. they cannot be changed as tehy have happened in the past and are now apart of the person due ro various demographic, biological, psychosocial or social reasons

dynamic risk → risk factors that fluctuate and change in duration and intensity and are present for a set period of time

what are risk factors?

characteristics or conditions that increase the liklihood of developing a mental health disorder

what are protective factors?

traits or conditions that help reduce the risk and promote resilience and mental wellbeing

what is depression?

a common and serious mental health disorder characterised by peristsent feelings of sadness, hopelessness and a loss of interest or pleasure in activities

• it affects a persons thoughts, emotions, behaviours and physical health

causes of depressive disorders

BIOLOGICAL

• changes in neurotransmitter activity; dopamine, serotonin and norepinephrine

• comorbid chronic illness

• altered hormonal regulation

• genetic vulnerability (family history of mental illness or depression)

• sleep disruptions (insomnia or history of poor sleep)

PSYCHOSOCIAL AND ENVIRONMENTAL

• psychosocial stressors (relationship breakdown, loss of employment)

• cultural aspects (migration, loss or change of identity, discrimination)

• antipsychotic medications and antidepressants

• social isolation

signs and symptoms of depressions

• persistent sadeness or low mood

• loss of interest or pleasure in usual activities

• fatigue or low energy

• changes in sleep (insomnia or sleeping too much)

• changes in appetite or weight

• difficulty concentrating or making decisions

• feelings of worthlessness or excessive guilt

• thoughts of death or suicide

what are antidepressants?

medications used to treat depression and other mood or anxiety disorders by modifying neurotransmitter activity in the brain

MOA → modifying the levels or activity of neurotransmitters in the brain, primarily serotonin, norepinephrine and dopamine to improve mood, energy, and cognitive function

examples of antidepressants

• often combined with mood stabilisers to prevent manic episodes

• SSRIs

serotonin syndrome

results when there is too much serotonin at the synapse, casuing excessive neuron activity

• headaches

• altered conscious state

• hyperthermia

• diaphoresis

• tachycardia

• unstable blood pressure

• nausea and vomiting

• tremors, ataxia and risk seizures

what are tricyclic antidepressants (TCAs)?

they work by stopping the reuptake of serotonin and noradrenaline into the synapse, therefore they increase the amount of these neurotransmitters in the synaptic space and promote their transmission

• hypotension

• imapired cardiac function → arrhythmias and heart blocks

• toxic and life threatening in excess

what are monoamine oxidase inhibitors?

they work by preventing the breakdown of serotonin and noradrenaline, which increases the amount of these neurotransmitters in the synaptic space

• they interact witj tyramine rich food

• interact with medications including stimulants, hay fever and asthma medications, narcotics and vasoactive agents

• hypertensive crisis

what are selective serotonin reuptake inhibitors (SSRIs)?

they work by selectively inhibiting serotonin receptors to prevent the reuptake of serotonin back into the synapse, therefore increasing teh amount of serotonin in the synaptic space and promoting serotonin transmission

• safer due to less side effects

• should not be stopped abruptly, causing withdrawal syndrome

what are atypical antidepressants?

these medications have a combination effect on serotonin, noradrenaline and dopamine

• serotonin-noradrenaline reuptake inhibitors

• noradrenaline reuptake inhibitors

• noradrenaline-dopamine reuptake inhibitors

what is bipolar disorder (BPD)?

a chronic mental health condition characterised by extreme mood fluctuations that include episodes of mania or hypomania and depression

• these shifts go beyond normal ups and downs, they are intense, disruptive and can severelt impact ability to function

CAUSES

• genetic factors

• neurobiological factors

• environmental and psychosocial factors

what are the types of bipolar disorder?

bipolar I disorder → characterised by severe mania and severe depression

bipolar II disorder → characterised by episodes of hypomania and severe depression

what is mania?

• severe

• duration of at least a week

• major impairment (psychosis present)

what is hypomania?

• milder

• duration of atleast 4 consecutive days

• noticeable change but no marked impairment (psychosis not present)

what are psychotropics?

medications that act on the brain and nervous system to influence mood, thoughts, emotions and behaviour

what are mood stabilisers?

a class of psychotropic medications used to treat and prevent episodes of mania, hypomania, and depression in mood disorders

MOA → they work by modulating neurotransmitters (dopamine, glutamate, GABA) and stabilising neuronal actvity in the brain

examples of mood stabilisers

• lithium → mood stabiliser

• valproate (sodium valproate) → anticonvulsant/mood stabiliser

• carbamazepine → anticonvulsant/mood stabiliser

• lidesamotrigine → anticonvulsant/mood stabiliser

• lorazepam and clonazepam → benzodiazepines

• topirmate → anticonvulsant

• lamotrigine

nursing considerations for mood stabilisers

• monitoring required: lithium levels, liver function (valproate), and blood count

• side effects: weight gain, tremor, sedation, GI upset

• adverse effects: lithium toxicity, hepatoxicity

• patient education: adherence, hydration, recognition of early toxicity signs and avoiding abrupt cessation

what are antipsychotics?

medications used to manage psychotic symptoms

MOA → they work by modulating neurotransmitters in the brain, primarily blocking D2 receptors

• olanzapine

• quetiapine

• risperidoone

• aripiprazole

nursing considerations for antipsychotics

• monitor vital signs, weight, metabolic parameters, and neurological status for movement disorders

• educate patients about adherence, side effects and signs of toxicity

• encourage hydration, healthy diet and exercise to minimise metabolic risks

• observe for changes in mood or behaviour, especially in early treatment or dose adjustments

• ensure regular follow up and collaboration with multidisciplinary team for ongoing care

what are psychological therapies?

they are structured, evidence based interventions that help individuals understand and manage their thoughts and emotions, and behaviours to improve mental health and wellbeing

• cognitive behavioural therapy

• psychoeducation

• family therapy

what is anxiety?

a natural human response to stress, involving feelings of worry, nervousness, or fear about a real or percieved threat

what are the types of anxiety disorders?

generalised anxiety disorder → when you experience symptoms of anxiety most of the time

panic attacks → sudden, unpredictable attacks of anxiety in situations you find difficult or they may be unprovoked

phobias → fear of something that is not dangerous

signs and symptoms of anxiety

PHYSICAL

• palpitations, rapid heart rate, shortness of breath, hyperventilation, nausea, abdominal discfomfort, muscle tension, headaches, trembling/shaking, sweating, chills, hot flushes, difficulty falling or staying awake, non-restoritive sleep

COGNITIVE AND EMOTIONAL

• excessive worry, impaired concentration, cognitive distortions, anticipatory anxiety, irritability and restlessness, apprehension, low mood or depressive feature

BEHAVIOURAL

• avoidance behaviours, reassurances seeking, compulsive behvaiour, hypervigilence

what are the main causes of anxiety?

• BIOLOGICAL → genetics, neurochemical imbalances, over activation of the amygdala

• PSYCHOLOGICAL → personality traits, cognitive biases, past trauma or adverse childhood experiences

• ENVIRONMENTAL AND SOCIAL → stressful life events, workplace or academic stress, social isolation or lonliness, finanacial stress

what are anxiolytics?

they are from the benzodiazepine family, generally used in the treatment of acute anxiety symptoms by enhancing the GABA A receptors activity, producing a calming effect

what are beta-blockers?

commonly prescribed for those who experience panic symptoms, as they can address physical symptoms

non-pharmacological interventions for anxiety

• graded exposure

• systemic desensitisation

• e-therapies

• cognitive behavioural therapy

• acceptance and commitment therapy

• relaxation methods

what are the signs of a deteriorating mental state?

BEHAVIOURAL SIGNS

• sudden withdrawal or isolation

• agitation or restlessness

• increased aggression or hostility

• changes in speech

• disorganised bhevaiour

• poor self care or neglect of hygiene

EMOTIONAL AND COGNITIVE SIGNS

• increased anxiety or panic

• expressionf of hopelessness or worthlessness

• paranoia, delusions or hallucinations

• confusion or disorientation

• mood swings or extreme emotional reactions

• sucidal ideations

PHYSICAL AND PHYSIOLOGICAL SIGNS

• insomnia or excessive sleeping

• noticeable changes in appetite or weight gain

• substance misuse

• psychomotor agitation or retardation

what are the predictors of aggression?

PATIENT RELATED FACTORS

• illicit drug use

• gender age

• diagnosis

• substance misuse

ENVIRONMENTAL FACTORS

• consumer overcrowding

• peak times

• staff rigidness

• staffing profiles

• staff inability to manage demanding patients promptly due to stress

• staff react to violence

• medication administration

• restraint

• care provision

INTERACTIONAL FACTORS

• limitation fo consumer freedoms

• consumer-consumer provocation

• previous history of violence

• involuntary admission

• staff assualts

• aggresive behaviour

what are saftey considerations in the clincial setting?

• ensure clear exit pathways

• maintain a calm, respectful posture

• call for assistance early if you percieve tension

• use open body lnaguage

• minimise environmtal risks

what are deecalation techniques?

• be concise

• identify wants and feelings

• listen to what teh consumer is saying

• respect personal space

• do not be provocative

• establish verbal contact

• agree to disagree

• set clear limits

• offer choices and optimism

• debrief the client and staff

• notice changes in body language

what are signs of escalating behaviour and aggression?

• increased volume

• change in tone

• swearing

• threats

• changes in eye contact

• agitated and fidgety

• refusal to communicate

• difficult to comply and calm down

• insulting

• physical abuse

• incoherent speech

• tense posture

what is LASSIE?

the LASSIE technique is a structured method used in de-escalation

Listen actively

Ask questions

Stay calm

Show empathy

Identify needs

Explore solutions

what is set and setting?

set → a persons state of mind, previous encounters with a drug and expectations of whats going on

setting → the environment in which someone consumes a drug

stimulants

a type of drug class that speed up messages between the brain and body, making a person feel more awake, alert, or energetic

• caffeine

• nicotine

• cocaine

symptoms of stimulants

• euphoria

• heightened feelings of wellbeing

• increased heart rate and blood pressure

• increased alertness

• reduced appetite

• anxiety, tension

• increased body temp

• nausea

• tremors and seizures

depressants

these substnaces reduce arousal and stimulation, by affecting the central nervous system, slowing down the messages between the brain and the body

symptoms of depressants

• reduced inhibitions

• enhanced mood

• reduced anxiety and stress

• slowed reaction time

• impaired judgement

• slowed breathing

• vomiting

• irregular breathing

opioids

drugs that act on opioid receptors in the brain and any natural or synthetic drugs that are made from or related to opium poppy

symptoms of opioids

• extreme relaxation

• drowsiness

• confusion and slurred speech

• slow breathing and heart rate

• diaphoresis

• cyanosis

• respiratory depression

• constipation

• dependence

psychedelics

a class of psychoactive substances that produce changes in perception, mood and cognitive process

• they affect the senses

symptoms of psychedelics

• feeling of euphoria

• sense of relaxation

• confusion and trouble concentrating

• dizziness

• bad trips → frightening hallucinations

• flashbacks → re-experiemce the drug days later

cannabinoids

a chemical substance, regardless of structure or origin that joins the cannabinoid receptors of the body and brain 

symptoms of cannabinoids

• euphoria

• feelings of wellbeing

• spontaneous laughter and excitement

• increased appetite

• dry mouth

• quiet and reflective mood

dissociative

a class of psychedelic drug which causes people to feel separated or detached from their body or physical environment

symptoms of dissociatives

• euphoric

• floaty

• happy

• relaxed

• pain-free

• numb

• protected

• safe

• unconscious

• unaware

• ketamine bladder syndrome

empathogens

they increase a persons feeling of empathy and benevolence towards others as well as feelings of being socially accepted and connected

symptoms of empathogens

• feeling connected

• having a sense of belonging

• feeling warm

• sexual arousal

• becoming anxious

• sweating

• mood swings

• energised

• depressed

• dehydration

what is the spectrum of use?

• abstinent (no AOD use)

• experimental (occasional, sensation seeking)

• recreational (more regular, non-problematic use)

• regular (regular use with occasional negative consequences)

• dependent (habitual, compulsive use)

what is tolerance?

a physiological process where repated exposure to a substance reduces its effects over time, requiring higher doses to achieve the same response

what is dependence?

a state where the body or mind has adapted to regular substance use, resulting in a compulsion to continue use

what is overdose?

the ingestion or administration of a substance in quantities that overwhelm thebodies ability to metabolise or tolerate it

what is withdrawal?

a range of physical or psychological symptoms that occur when a person who is dependent on a substance reduces or stops use abruptly, due to the body readjustng to the absence of the drug

what is the continuum of substance use

• substance misuse

• hazardeous substance use

• harmful substance use

• tolernace

• dependences

• withdrawal symptoms

• addiction

AOD use assessment techniques

• alcohol use disorders identfication (AUDIT)

• drug use disorders identification test (DUDIT)

• alcohol smoking and substance involvement screening test (ASSIST)

• alcohol withdrawal scale (AWS)

what is the demand reduction pillar?

• demand reduction → preventing the uptake and or delayng the onset of use of alcohol or substances, and supporting people to recover

• supply reduction → preventing, stopping, disrupting or reducing the production snd supply of drugs

• harm reduction → reducing adverse health, social and economic consequences of substance use