Mental Health

COGNITIVE ABILITY-

THE ABILITY TO THINK RATIONALLY AND TO PROCESS THOSE THOUGHTS RATIONALLY

MENTAL HEALTH are

INDIVIDUALS WITH GOOD MENTAL ARE PEOPLE WHO CAN BE FLEXIBLE, SUCCESSFUL, FORM CLOSED RELATIONSHIPS, MAKE APPROPRIATE JUDGEMENTS, SOLVE PROBLEMS, COPE WITH DAILY STRESS, HAVE A POSITIVE SENSE OF SELF.

MENTAL ILLNESS is an

IMPAIRMENT OF ABILITY TO THINK, FEEL, MAKE SOUND JUDGEMENTS, DIFFICULTY COPING WITH REALITY AND DIFFICULTY OR INABILITY TO FORM STRONG PERSONAL RELATIONSHIPS

MENTAL HEALTH-

POSITIVE ATTITUDES TOWARDS SELF GROWTH, DEVELOPMENT AND SELF ACTUALIZATION.

EMOTIONAL RESPONSIVENESS-

Ability to give and receive love and interact with society

what is the number 1 mental illness in the U.S?

Anxiety

PSYCHOSOMATIC DISORDERS MEAN THAT

YOUR MIND CAN ACTUALLY MAKE YOU PHYSICALLY SICK

EX- ENLARGED VENTRICLES ARE SEEN IN PTS WITH

SCHIZOPHRENIA.

INCREASED DOPAMINE IN

SCHIZOPHRENIA

MALADAPTIVE BEHAVIOR IS

LEARNED

COPING-

ADAPTATION THE WAY THAT ONE ADAPTS PSYCHOLOGICALLY, PHYSICALLY, AND BEHAVIORALLY TO A STRESSOR

STOKES/GORDON STRESS SCALE-

AN INDIVIDUAL'S CULTURE, RELIGION, INDIVIDUAL BELIEF SYSTEM PLAY A ROLE

GENERAL ADAPTATION SYNDROME:

FIGHT OR FLIGHT RESPONSE; WHEN A PERSON HAS A STRESSOR THEY ARE FIRST ALARMED, THEY THEN MUST ADAPT TO THE STRESSOR IF THEY DON'T, THEN THEY DIE. NEUROTRANSMITTER INVOLVED IS EPINEPHRINE.

VOLUNTARY-

INITIATED BY A PERSON SEEKING HELP FOR HIS/HER PROBLEMS. THIS PERSON IS AWARE THAT SUPPORT IS NEEDED. THESE PEOPLE ARE ABLE TO LEAVE THE HOSPITAL AT ANY TIME. THIS IS CONSIDERED A 206.

INVOLUNTARY-

INITIATED BY SOMEONE OTHER THAN THE PERSON NEEDING HELP. IS ACTUALLY A CIVIL COMMITMENT CALLED A 302. CAN ONLY BE DONE IF THE PATIENT IS A THREAT TO THEMSELF (SAY THEY WILL COMMIT SUICIDE) OR SOMEONE ELSE (THREATENING OR MAKE HOMICIDAL STATEMENTS) IF YOU HEAR THIS NOTIFY THE PCP AND THEY WILL INITIATE PAPERWORK.

EGO-

DEVELOPS FROM 6 MONTHS, LEARNS TO NEGOTIATE WITH AND ADAPT TO REALITY, USES JUDGMENT, REGULATION OF MOOD AND DRIVES WITHOUT ACTING THEM OUT BEHAVIORALLY

SUPER EGO-

3RD PERSONALITY STRUCTURE TO DEVELOP; BASICALLY YOUR CONSCIENCE OR EMPATHY-MISSING IN PSYCHOPATHS.

STRESS-

A SUBJECTIVE FEELING ( how you feel or how the pt feels) OF TENSION. INTERNAL FEELINGS OF STRESS ARE PHYSIOLOGICAL, EMOTIONAL, AND INTELLECTUAL RESULTING FROM A PERCEIVED THREATENING ENVIRONMENTAL EVENT. MUST USE COPING OR DEFENSE MECHANISMS TO DEAL WITH THE STRESS

many mental mechanisms (adjustment or coping mechanisms) are

CONSCIOUS, AUTOMATIC WAYS OF DEALING WITH STRESS TO PROTECT OUR SENSE OF SELF. MANY OF THESE DEVELOP IN CHILDHOOD WHEN WE ARE PLACED IN DIFFICULT SITUATIONS THAT WE CANNOT HANDLE.

DISPLACEMENT:

TAKE OUT AGGRESSION ON SOMEONE OR SOMETHING ELSE. YOU ARE MAD AT YOUR BOSS SO YOU KICK THE DOG OR BLAME YOUR SPOUSE.

RATIONALIZATION-

CREATING REASONABLE AND ACCEPTABLE EXPLANATIONS FOR UNACCEPTABLE BEHAVIOR: THIS IS THE MOST WIDELY USED COPING MECHANISM.

UNDOING:

TRYING TO COMPENSATE OR MAKE UP FOR BAD BEHAVIOR BY DOING THE OPPOSITE OR DOING SOMETHING GOOD.

" MY PLACE" ( Milieu therapy)

TRUSTED ENVIRONMENT WHERE A PERSON CAN FEEL SAFE AND ACCEPTED FOR ONESELF. FOCUSES ON THE CLIENT'S STRENGTHS AND CONSISTENCY. INCLUDES FIRM, KIND LIMITS. ALSO A QUIET, PEACEFUL ENVIRONMENT TO PROMOTE REFLECTION IS PART OF THE ENVIRONMENT

COGNITIVE/BEHAVIORAL

TREATMENT

FOCUSES ON IMPACT THAT THOUGHTS HAVE ON BEHAVIOR AND FEELINGS;ENCOURAGES THE USE OF RATIONAL THOUGHT TO ALTER PERCEPTIONS. THE PT. NEEDS TO UNLEARN PREVIOUS BEHAVIORS AND LEARN NEW ONES

physical illness has to be regulated before they can be admitted to

a mental health unit ( cannot admit a physically ill pt to a mental health unit)

PSYCHOANALYSIS-

ANALYZE THEIR COGNITIVE PROCESS

BEHAVIOR MODIFICATION:

REPLACE MALADAPTIVE BEHAVIORS WITH POSITIVE BEHAVIORS. USE POSITIVE REINFORCEMENT; WORKS WELL FOR EATING DISORDERS, SMOKING AND ADDICTION.

GOALS-

DECREASE CLIENTS EMOTIONAL DISCOMFORT, INCREASE THE CLIENTS SOCIAL FXN, INCREASE THE ABILITY OF THE CLIENT TO BEHAVE OR PERFORM IN AN APPROPRIATE MANNER TO EACH SITUATION

ANXIETY

STATE THAT IS SUBJECTIVELY EXPERIENCED AS A RESPONSE TO STRESS. IT RANGES FROM A VAGUE UNEASINESS TO OVERWHELMING APPREHENSION AND PANIC.

SEVERE anxiety-

HYPERVENTILATE, TACHYCARDIA, SYNCOPE,LOSS OF REALITY, USUAL DEFENSE MECHANISMS NO LONGER WORK.

PANIC anxiety

OVERWHELMED, PERSONALITY MAY DISINTEGRATE, FEELS HELPLESS, BRIEFLY PSYCHOTIC (LOSS OF REALITY), WILD AND DESPERATE, NEEDS IMMEDIATE INTERVENTION BEFORE THEY HARM SOMEONE LAST 15-30 MIN

S/S of GENERALIZED ANXIETY DISORDER

RESTLESSNESS, EDGINESS, EASILY FATIGUE, DIFFICULTY CONCENTRATING, MUSCLE TENSION, IRRITABILITY, SLEEP DISTURBANCES

loss of reality is labeled as

psychotic

ANTIANXIETY DRUGS

BENZODIAZEPINES (VALIUM, ATIVAN, XANAX, KLONOPIN, TRANXENE, SERAX), BUSPAR.

ANTIDEPRESSANTS MAY ALSO HELP AND SOMETIMES ANTIPSYCHOTICS SUCH AS

HALOPERIDOL

NEUROTIC DISORDERS

EMOTIONAL DISTURBANCE ACCOMPANIED BY VARIOUS AVOIDANCE BEHAVIORS AND ACTIONS AIMED AT REDUCTION OF ANXIETY

assault

verbal

battery

physical

KEY COMPONENT OF NEUROTIC DISORDERS

IS ANXIETY.

AGORAPHOBIA-

ABNORMAL FEAR OF HAVING A PANIC ATTACK IN A PUBLIC SPACE

ACROPHOBIA

IS FEAR OF HEIGHTS

SOCIAL PHOBIA

FEAR OF BEING THE CENTER OF ATTENTION OR BEING EMBARRASSED

DEPERSONALIZATION-

SEE THEMSELVES AS IF FROM A DISTANCE, THEY BECOME NUMB

ENTRAPMENT-

THE SENSE THAT ESCAPE ROUTES ARE EXTREMELY DANGEROUS.

TREATMENT to depersonalization and entrapment from PTSD

SSRI (ANTIDEPRESSANTS) ARE 1ST LINE MEDS. GROUP THERAPY, POSITIVE DREAMING HELPS PEOPLE WITH RECURRING NIGHTMARES, THEY ENVISION A POSITIVE ENDING TO THE DREAM AND THEN GO TO SLEEP.

beta blockers are used for (Inderal or propanolol)

anxiety and to lower BP

neurotic is the same as

anxiety

OBSESSIVE COMPULSIVE DISORDERS

AN EMOTIONAL DISORDER WHERE REPEATED THOUGHTS THAT CAUSE ANXIETY ARE ACCOMPANIED BY RITUALISTIC BEHAVIOR THAT RELIEVES THE ANXIETY.

obsession with OCD is the

thought (FEAR OF DIRT, GERMS, CONTAMINATION)

compulsion with OCD is

an act or behavior that is carried out to some degree against the persons wishes to < anxiety (EXCESSIVE HAND WASHING, EXCESSIVE CLEANING, COUNTING, CHECKING TO MAKE SURE DOORS ARE LOCKED)

tx for OCD

ANTI ANXIETY DRUGS, ANTIDEPRESSANTS (PROZAC), SSRI (ANAFRANIL), BETA BLOCKERS LIKE PROPANOLOL TO HELP WITH THE TACHYCARDIA. SET LIMITS (15 MIN FOLDING LAUNDRY OR WASHING HANDS),

severe anxiety disorder triggered by events

PTSD

eating disorders

CLIENT EXPERIENCES INCREASED ANXIETY AND DECREASED SELF ESTEEM AND USES CONTROL OVER EATING HABITS TO DECREASE ANXIETY AND INCREASE SELF ESTEEM. USUALLY THESE PEOPLE ARE HIGH ACHIEVERS, PERFECTIONISTS, RIGID, AND INFLEXIBLE. Live in Secrecy and excessive exercising

anorexia nervosa is a

psychotic disorder (disordered body image)

ANOREXIA NERVOSA

THEY HAVE AN ALTERED BODY IMAGE. THEY ARE USUALLY 1ST BORN WITH MOM ISSUES

s/s of bulimia (binging and purging)

RUSSELL'S SIGN-HAVE ABRASIONS ON KNUCKLES FROM STICKING THEIR FINGERS DOWN THEIR THROAT, ESOPHAGITIS AND POOR TEETH FROM CONSTANT THROWING UP. THEY FEEL GUILTY AND TELL YOU THEY USE LAXATIVES AND DIURETICS.

tx for bulimia

BEHAVIORAL THERAPY AND ANTIDEPRESSANTS

tx for compulsive overeating

ANTI-ANXIETY AND ANTIDEPRESSANTS, BEHAVIORAL THERAPY (ONLY EAT IN FRONT OF PEOPLE, NO SECRET EATING), GROUP, OR FAMILY THERAPY.

Goal of eating disorders-

RADUALLY OBTAIN A HEALTHY WEIGHT. OFTEN STAY ABOUT 28 DAYS.

melancholy

persistent negative outlook on things

euthymic

normal mood

what two neurotransmitters are decreased with depression

EPINEPHRINE AND SEROTONIN

PRE-MENTRUAL SYNDROME-

MOST WOMEN WHO BECOME VERY DEPRESSED HAVE A FAMILY HX

POSTPARTUM BLUES-

MOOD SWINGS AFTER BIRTH, HORMONAL NOT DEPRESSION, SLEEP DEPRIVATION

POSTPARTUM DEPRESSION-

AFFECTS 25% OF MOTHERS, IF DEPRESSED DURING PG WILL CONTINUE, MARITAL PROBLEMS, OBSTETRIC COMPLICATIONS

SUICIDE

HELPLESSNESS & HOPELESSNESS. STRONG FAMILY TENDENCY (IF FATHER KILLED HIMSELF CHILDREN ARE AT INCREASED RISK).

tx for anorexia nervosa

MUST TREAT PHYSICAL/ELECTROLYTE PROBLEMS 1ST. THEN NUTRITIONAL TX, DRUG TX (ANTIDEPRESSANTS) PSYCHOTHERAPY-WHOLE FAMILY COUNSELING. BEHAVIORAL THERAPY-EARN PRIVILEGES, DON’T LET THEM WEIGH THEMSELVES.

ECT (electroconvulsive therapy)

BREAKS UP THOUGHT PATTERNS IN THE BRAIN, FORGET PAINFUL PAST EXPERIENCES. MUST BE NPO, SEDATIVES, REMOVE DENTURES, VOID, VS, THEY HAVE RESTRICTED ACTIVITY FOR 24 HRS AFTER, HELPS SCHIZOPHRENIA OR DEPRESSION. THEY WILL HAVE A SEIZURE.

biggest nursing care point for depression

OBSERVE CLOSELY ESP WHEN DEPRESSION IS LIFTING, THIS IS A HIGH RISK TIME. DETERMINE PTS CAPACITY TO PLAN AND EXECUTE SUICIDE IF PT IS DEPRESSED AND THEN SUDDENLY APPEARS HAPPY, DO NOT EASE UP ON MONITORING, THIS IS THE HIGHEST RISK TIME FOR SUICIDE.

SE if ECT (electroconvulsive therapy)

COULD HAVE CARDIAC ARREST, FRACTURES, LOSS OF SHORT-TERM MEMORY

tx for depression

ANTIDEPRESSANTS: MAOI (NARDIL, PARNATE) REMEMBER THE SPECIAL DIET! ( No chocolate, pickled meats, peanut butter) AND NO MEPERIDINE (DEMEROL).

IMPROVEMENT USUALLY SEEN IN 3-6 WEEKS, MONITOR FOR COMPLIANCE

what does a person with a ANTISOCIAL PERSONALITY type lack?

moral conscience (NO GUILT, SHAME OR REMORSE) very charming

compulsive overeating

binge eat alone, eat when they are full. use food as a method of coping with stress altered body image and feel unattractive but then uses more food to compensate

MOST COMMON PSYCHOTIC DISORDER

SCHIZOPHRENIA

DELUSIONS-

FALSE, FIXED IDEAS OR BELIEFS NOT SUPPORTED BY LOGIC. USUALLY BIZARRE :THE TV IS GIVING ME SIGNALS AND I NEED TO CONTACT THE FBI.

DELUSIONS OF PERSECUTION:

PARANOIA: EVERYONE IS OUT TO GET THEM. COMMON THEME IS POISONING-WILL ONLY EAT UNOPENED, PRE-PACKAGED FOOD.

DELUSIONS OF GRANDEUR:

THEY THINK THEY ARE VERY IMPORTANT, LIKE A KING OR JESUS.

HALLUCINATIONS-

FALSE SENSORY PERCEPTIONS IN THE ABSENCE OF ANY EXTERNAL STIMULI- auditory (hearing) , visual (seeing) olfactory (hearing), gustatory (taste)

what med is really helpful for helping with auditory hallucinations

HALOPERIDOL (HALDOL)

HOW TO DEAL WITH HALLUCINATIONS:

"I KNOW THEY ARE SCARY. I DO NOT SEE OR HEAR THEM. THEY ARE NOT REAL. THEY ARE PART OF YOUR ILLNESS". THEN TRY TO GET THEM TO RE-FOCUS.

things to monitor for after administration of PHENOTHIAZINE OR THORAZINE (antipsychotics)

EPS (temporary) , tardive dyskinesia(irreversible) , malignant hyperthermia

CNS DEPRESSANTS:

OPIOIDS: HEROIN, FENTANYL, -CAUSES PHYSIOLOGICAL DEPENDENCE

NALOXONE

IS NEEDED TO REVERSE OPIOID OVERDOSE. instant withdrawal and instant pain

CNS STIMULANTS:

AMPHETAMINES, METHAMPHETAMINES, COCAINE- CAUSES HUGE PSYCHOLOGICAL DEPENDANCE. MAY PRESENT WITH NASAL MUCOSA PROBLEMS AND CAN HAVE CARDIAC ARREST/STROKES

METHADONE OR SUBOXONE:

SUBSTITUTES A LESS HARMFUL DRUG IN THE PLACE OF A DANGEROUS NARCOTIC. USED AS A LESSER EVIL TO HEROIN ADDICTION.

DOMESTIC ABUSE-

CAN HAPPEN IN CONJUNCTION WITH SUBSTANCE ABUSE.

S/S: VAGUE OR INCONSISTENT DESCRIPTIONS ABOUT INJURIES OR EXPLANATIONS DO NOT MATCH UP WITH THE PHYSICAL FINDINGS; MINIMIZING INJURIES, LONG PERIODS OF TIME BTWN THE INJURY AND SEEKING TREATING. OVER OR UNDER-REACTION BY FAMILY MEMBERS.

RAPE SYNDROME-

THEY FEEL VIOLATED. FIRST THING THEY MAY WANT TO DO IS BATHE OR SHOWER, THEY SHOULD NEVER DO THIS, BECAUSE THEY WILL NEED TO DO A SCREEN TO SEE IF THE PERSON WAS ACTUALLY RAPED AND DO DNA TESTING. VERY COMMON TO HAVE PTSD

WHEN PEOPLE FIRST HEAR THAT THEY HAVE AIDS

THEN THEY REACT LIKE MOST PEOPLE WITH DENIAL. BUT IT IS VERY IMPORTANT THAT THESE INDIVIDUALS DO NOT DO DANGEROUS THINGS LIKE HAVE UNPROTECTED SEX.

MANIA:

FRENZIED EUPHORIA COMMON IN PEOPLE WITH BIPOLAR DISORDER

dysthymic depression

people that have always been depressed from childhood on all days

melancholic depression

symptoms are worse in morning high risk for suicide

Seasonal affective disorder

DEPRESSION DURING FALL AND WINTER MONTHS, LIGHT THERAPY IS HELPFUL

traits of those with bipolar disorder

THEY ARE IMPULSIVE, AND WEAR FLASHY CLOTHES AND LOTS OF MAKEUP AND MAY SPEND EXCESSIVELY.

lithium is used

for manic phase of bipolar s/s of toxicity is confusion and diarrhea, narrow therapeutic window- 0.5~ 2.0

PSYCHOTROPIC DRUGS TO DECREASE

DOPAMINE AND TO CONTROL POSITIVE S/S, BUT DO NOT CURE THE DISORDER

people who drink alcohol need

high calorie diets with increased vitamins, assess for physical illness, provide safe environment, reality orientation, monitor VS

Librium is used for

alcohol withdrawal

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