MH Exam 3

Levels of Anxiety (what they are)

- low, moderate, severe, panic

MildAnxiety Manifestations

- the good anxiety

- restless

- seeking reassurance

- voicing concern

- increased senses and focus

Moderate Anxiety Manifestations

- frustration

- restlessness

- difficulty concentrating

- increased worry

Severe Anxiety Manifestations

- impacts cognition

- increased anxiety, restlessness

- anger

- feel dread/doom

Panic Anxiety Manifestations

- terror

- exhaustion

- cannot communicate, detached from reality

Anxiety Interventions (for each level)

- mild: encourage problem-solving

- moderate: use simple/short sentences, guide back to the task

- severe: therapeutic environment, stay with client, short/simple sentences

- panic: stay calm, stay with patient, safety first, may need meds

OCD definitions and examples (obsession, compulsion)

- Obsessions: persistent and recurrent thoughts or urges that are unwanted and intrusive

-- fear of safety, concern for cleanliness, thoughts about being harmed, fear of forgetting something important

- Compulsive: repetitive behaviors performed to lessen or prevent anxiety from obsessions

-- steps for handwashing, locking doors many times, repeating activity multiple times, hair pulling

Risk factors for Anxiety and OCD (what they are)

- brain chemistry (GABA)

- social influence

- family background (growing up)

- lifestyle (diet)

- genetics

ACEs Examples

- child not close to their family

- cannot talk about their feelings

- few/no friends

- inconsistent discipline

- low levels of monitoring/supervision

PCEs Examples

- unconditional love

- spending time with friends

- volunteering/helping others

- active in a social group

- mentor outside of family

- basic needs met (housing, food)

- opportunities to learn

- having hobbies

- being active/playing sports

- routine and fair rules at home

Physical Manifestations of Anxiety

- increased HR and RR

- dry mouth

- sweating

- fatigue/exhaustion

- difficulty concentrating

- GI disturbances

- sleep disruptions

Panic Disorder/Attacks (what it is, impacts)

- unexpected with no reason

- begin to avoid situations, people, and events that trigger attacks

- worry that another attack will occur

Generalized Anxiety Disorders (what it is, impacts)

- excessive anxiety and worry in numerous situations (work, school, relationships, performing)

- have these feelings daily and impact daily life

Types of OCD Disorders (what they are)

- OCD

- Body dysmorphic

- hoarding

- trichotillomania

- excoration

OCD (what it is, examples)

- pattern of uncontrollable obsessive thoughts and associated compulsive behaviors/rituals

- cleaning, washing hands, forbidden thoughts, counting objects

Body Dysmorphic (what it is, examples)

- persistent preoccupation with perceived defects or flaws in one's appearance

- mirror checking, grooming, reassurance, possible eating disorder

Hoarding (what it is, examples)

- persistent difficulty or inability to discard possessions

- excess accumulation that overwhelms the living area

Trichotillomania (what it is, examples)

- serially and intentionally pulling one's hair

- behaviors triggered by boredom/anxiety

- pulling hair decreases tension, causes gratification, pleasure, and a sense of relief

Excoriation Disorder (what it is, examples)

Trauma-Informed Care (aspects)

- safety

- trustworthiness

- peer support

-collab and mutuality

- empowerment, voice, choice

- consider cultural, historical, and gender issues

Trauma-Informed Care (what to do)

- figure out what happened

- make sure basic needs are met, then focus on emotions

- look at current manifestations, life stressors, functional impairment

- demostrate positive regard

- predictabilityy and follow through

- AVOID RETRAUMATIZING

Exposure Therapy for Anxiety (what it is, examples)

- exposed to the underlying cause of anxiety that they are avoiding to become more comfortable with the activity

-ex: riding in elevators

Lifestyle Treatment for Anxiety (what it is, examples)

- help make better choices

- healthy diet, exercise, avoid caffeine and substances

Meds for Anxiety (what they are, uses)

- Benzos: typically used in emergency

- SSRIs: first line

- SNRIs

- antidepressants: paroxetine, venlafaxine

Resilience and Protective Factors (examples)

- positive self-esteem/coping skills

- connected to community

- secure attachment with caregiver

- strong support system

- access to healthcare/resources

- ability to regulate emotions

- healthy diet

- economically stable

- meeting milestones

- sense of hope

Manifestations of Toxic Stress in Children (categories, examples of each)

- developmental: failure to thrive, learning difficulty

- behaviors: engaging in risky behavior (sex, smoking)

- physiological: risk of autoimmune disease, obesity, headache, sleep problems, asthma

- mental health: suicide attempts

Signs of PTSD in Adults (what they are, examples)

- intrusive manifestations (bad thoughts)

- avoidance (do not talk about it, avoid similar situations)

- negative mood/cognition (low self-esteem, anger, blame self, do not remember)

- arousal/reactive (flashbacks, nightmares, hard time concentrating)

- depersonalization: detached from self (feel out of body, in a dream, looking at self from above)

- derealization: out of reality (dreamlike, distorted)

Protective Factors/PCE or PACEs (what they are)

- unconditional love

- spending time with friends

- volunteering/helping others

- active in a social group

- mentor outside of family

- basic needs met (housing, food)

- opportunities to learn

- having hobbies

- being active/playing sports

- routine and fair rules at home

Populations at an Increased Risk of Trauma (what they are)

- women (2x more likely)

- adolescents (increased recently)

- Black, Hispanic, Indigenous

- LGBTQ+

- Military

- First Responders

Historical Trauma (what it is, examples, risks)

- ex: Holocaust, slavery, genocide

- ancestors go through trauma, then it is passed down

- risk: increased risk for inherited risk factors (anxiety, worry, hypertension) impacting future generations (if trauma is not resolved)

Acute Stress Disorder vs Post-Traumatic Stress D/O (definitions of each, similarities)

- PTSD: S/S longer than one month

- Acute Stress: 3 days to 1 month post-trauma

- both: intrusion and negative alterations in cognition/mood

Child Behavior in Reactive Attachment and Disinhibited Social Engagement Disorder (differences)

- Reactive attachment: not attached to the caregiver

- DSE: kids like strangers and seek attention from them

PTSD S/S in Children (what they are)

- time skew: remember events in a different sequence

- Omen formation: believe they missed warning signs and can prevent future trauma if they stay alert

- post-traumatic play and reactment: compulsive, repetitive behavior based on recreating trauma

Depersonalization/Derealization r/t Trauma (what each are, why they happen)

- depersonalization: being an outside observer or detached from self (this is not happening to me; feel in a dream)

- derealization: experience of unreality, distortion, distance (things not real)

- both happen because of stress; most know that it is not real

Key Principles of Trauma-Informed Approach

- safety

- trustworthiness and transparency

- peer support

- collaboration and mutuality

- empowerment, voice, choice (voice taken away during trauma)

- cultural, historical, gender issues

Non-pharm Treatment of Trauma-Related Disorders (what they are, purpose)

- CBT

- Prolonged Exposure Therapy: facing what they have avoided to address feelings

- Cognitive Processing Therapy: helps change beliefs about trauma

- Eye Movement Desensitization and Reprocessing

- Parent/Child Interaction: parent learns how to change negative aspects

Criteria for Somatic Symptom Disorders (what it is, example, timeline)

- one or more S/S of SSD that are distressing or disrupt daily functioning

- ex: disproportionate thoughts, feelings, and behaviors with somatic symptoms or spending excessive time thinking of manifestations or health

- must be present for 6 months or more

Factitious Disorder (what it is)

- harm themselves on purpose to seem sick

- done so that their emotional needs are met or to maintain a relationship with the healthcare provider

Treatment and Mgmt of Somatic Symptom D/Os (for each disease)

- SSD: try to get the person to understand it's emotional (therapy, support system)

- Illness Anxiety: antidepressants, CBT

- Functional Neurological: needs lots of treatment (PT, OT, psychotherapy, meds, CBT, coping skills)

- Factitious: safety, SSRI, reduce treatments and tests, therapy, coping skills

Nursing Interventions for Somatic Symptoms D/Os (what they are)

- therapeutic communication

- healthy coping strategies and skills

- encourage healthy lifestyle

- psychosocial education

Nursing Process: Implementation - Dissociative D/O (what to do)

- therapeutic communication

- provide routine, help with decision-making

- confirm identity

- reflect and affirmation

- teach stress reduction, coping strategies

- safe environment

- explain that symptoms are from stress

Personality Disorders- Clusters and Types in each (what they are)

- A: odd, eccentric (paranoid, schizoid, schizotypal)

- B: dramatic, emotional, erratic (antisocial, borderline, histrionic, narcissistic)

- C: anxious, fearful (avoidant, dependent, OCD)

Etiology of Personality Disorders (what it is)

- not fully known

- diathesis-stress model (emotions, stress as a child)

Risk Factors of Personality Disorders (what they are)

- genetics (same cluster passes down)

- abuse, neglect, hostility (ACEs)

Paranoid S/S (what they are)

- suspect that others are exploiting, harming, or deceiving them

- unjustified doubts about the loyalty and trustworthiness of friends

- do not confide in others because of use against them

- reads hidden/demeaning meaning into remarks and events

- bears grudges/unforgiving

- perceive attack on own character and react angrily

- suspicious of fidelity

Schizoid S/S (what they are)

- doesn't want close relationships or to be part of a family

- chooses solitary activity

- little interest in sex

- takes pleasure in few activities

- lack friends

- don't care what others think

- emotional coldness, detachment, flat affect

Antisocial DSM Criteria/Traits (what it is, age)

- failure to conform to social norms/laws

- deceitful (lying, aliases, conning for pleasure)

- impulsive/do not plan ahead

- sweet and manipulative (to get what they want)

- irritable and aggressive

- do not care about safety of self or others

- irresponsible

- lack of remorse

-age: since 15 years (conduct disorder before)

Borderline Personality D/O Traits r/t Safety

- recurrent suicidal behavior, gestures, threats, self-mutilating behavior

- unstable self-image and sense of self

- affective instability due to marked reactivity of mood (dysphoria, irritability, anxiety)

- intense anger, difficulty controlling

-unstable/intense relationships

- DO ANYTHING TO AVOID ABANDONMENT

Narcissitic P/O S/S

-m need for admiration, grandiosity, lack of empathy

- expected to be recognized as superior

- fantasises of success, power, love

- believe they are the best at everything and that no one is at their level (everyone jealous)

- only care about themselves (arrogant)

- takes advantage of others

- lack empathy

Excoriation Disorder (what it is, examples)

- recurrent picking at skin, resulting in lesions

- may pick at pimples, scabs

- extensive time spent picking

- attempt to cover with clothing or makeup

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.