Mental health Exam 2

Neurotransmitters

Chemical messengers that transmit signals between nerve cells.

Dopamine (DA)

Regulates pleasure, motivation, and motor control.

Schizophrenia

A disorder characterized by hallucinations and delusions due to excess dopamine.

Parkinson's disease

A disorder resulting from dopamine deficiency.

Antipsychotics

Medications that block dopamine receptors to treat schizophrenia.

Stimulants

Medications that increase dopamine for ADHD treatment.

Serotonin (5-HT)

Involved in mood regulation, sleep, and appetite.

Depression

A disorder associated with serotonin deficiency.

SSRIs

Selective Serotonin Reuptake Inhibitors that increase serotonin.

SNRIs

Serotonin-Norepinephrine Reuptake Inhibitors that also target norepinephrine.

Norepinephrine (NE)

Involved in arousal, alertness, and stress response.

Anxiety

A disorder associated with norepinephrine excess.

Gamma-Aminobutyric Acid (GABA)

An inhibitory neurotransmitter that reduces excitability.

Epilepsy

A disorder associated with GABA deficiency.

Benzodiazepines

Medications that enhance GABA to reduce anxiety.

Glutamate

An excitatory neurotransmitter involved in learning and memory.

Neurotoxicity

Result of glutamate excess linked to Alzheimer's and schizophrenia.

Acetylcholine (ACh)

Involved in memory, learning, and muscle activation.

Alzheimer's disease

A disorder resulting from acetylcholine deficiency.

Cholinesterase inhibitors

Medications that slow cognitive decline in Alzheimer's.

Anxiolytics

Antianxiety medications that reduce anxiety.

Buspirone

A non-sedating, non-addictive anxiolytic that takes 2-4 weeks for full effect.

Monoamine Oxidase Inhibitors (MAOIs)

Prevent breakdown of serotonin, norepinephrine, and dopamine.

Tricyclic Antidepressants (TCAs)

Antidepressants with adverse effects including sedation and weight gain.

Selective Serotonin Reuptake Inhibitors (SSRIs)

First-line treatment for depression and anxiety.

Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)

Antidepressants that increase both serotonin and norepinephrine.

First-Generation Antipsychotics (FGAs)

Typical antipsychotics with risk of extrapyramidal symptoms.

Second-Generation Antipsychotics (SGAs)

Atypical antipsychotics with lower EPS risk but higher metabolic side effects.

Third-Generation Antipsychotics (TGAs)

Partial dopamine agonists with fewer side effects.

Lithium

Used for bipolar disorder with a therapeutic range of 0.6 - 1.2 mEq/L.

Toxicity signs of Lithium

Tremors, confusion, vomiting, severe ataxia.

Anticonvulsants

Used for mood stabilization in bipolar disorder.

Sedative-Hypnotics

Medications used for short-term insomnia treatment.

Stimulants

Medications like methylphenidate used for ADHD.

St. John's Wort

Used for depression but can cause serotonin syndrome if combined with SSRIs.

Serotonin Syndrome

Life-threatening condition caused by excess serotonin from SSRIs, SNRIs, MAOIs, or St. John's Wort.

Symptoms of Serotonin Syndrome

Sweating, hyperreflexia, tachycardia, rigidity.

Intervention for Serotonin Syndrome

Discontinue medication, supportive care.

Activation Syndrome

Caused by antidepressants increasing energy levels before mood improves, leading to suicide risk.

Symptoms of Activation Syndrome

Agitation, impulsivity, aggression.

Intervention for Activation Syndrome

Monitor closely, especially in young adults.

Antidepressant Discontinuation Syndrome

Caused by abrupt stopping of SSRIs/SNRIs.

Symptoms of Antidepressant Discontinuation Syndrome

Flu-like symptoms, insomnia, anxiety.

Intervention for Antidepressant Discontinuation Syndrome

Taper medication gradually.

Lithium Toxicity

Mild (1.5-2.0 mEq/L): Nausea, tremors, confusion; Severe (>2.5 mEq/L): Seizures, coma, death.

Intervention for Lithium Toxicity

Stop lithium, IV fluids, dialysis if severe.

Neuroleptic Malignant Syndrome (NMS)

Caused by antipsychotics blocking dopamine.

Symptoms of Neuroleptic Malignant Syndrome

Fever, muscle rigidity, autonomic instability.

Intervention for Neuroleptic Malignant Syndrome

Stop antipsychotic, supportive care.

Extrapyramidal Symptoms (EPS)

Includes dystonia, akathisia, tardive dyskinesia, pseudoparkinsonism.

Intervention for Extrapyramidal Symptoms

Switch to an SGA or use anticholinergic medications (e.g., benztropine).

Motivational Interviewing (MI)

A client-centered approach that enhances motivation to change by exploring and resolving ambivalence.

Engage in MI

Build rapport and establish trust using active listening and open-ended questions.

Focus in MI

Identify the client's priorities and concerns; encourage the client to define the problem in their own words.

Evoke in MI

Help the client explore the importance of change using scaling questions.

Plan in MI

Collaborate on realistic, measurable goals (SMART: Specific, Measurable, Achievable, Realistic, Time-bound).

Evaluation of MI Effectiveness

Client demonstrates increased motivation through verbal affirmations.

Therapeutic Communication

Goal is to establish a supportive nurse-client relationship to improve mental health outcomes.

Nonverbal Strategies in Therapeutic Communication

S.O.L.E.R. Technique: Sit squarely, Open posture, Lean forward, Eye contact, Relax.

Verbal Strategies in Therapeutic Communication

Includes open-ended questions, affirmations, reflections, and summarization.

Cultural Considerations in Therapeutic Communication

Assess cultural factors impacting communication and health beliefs.

Evaluation of Therapeutic Communication

Client expresses feeling understood and supported.

Integrating MI with Therapeutic Communication

Use MI techniques within therapeutic communication to facilitate client-driven change.

Orientation Phase

Establish trust and define the nurse-client relationship.

Identification Phase

The client expresses unmet needs.

Exploitation (Working) Phase

The client and nurse collaborate to achieve goals.

Resolution Phase

Goals are met, and a discharge or transition plan is developed.

Barriers to Trust and Rapport

Certain factors can hinder effective communication and trust-building.

Cultural Sensitivity Techniques

Use culturally sensitive communication techniques (e.g., assessing preferred eye contact norms).

Professional Boundaries

Boundary blurring can interfere with treatment goals.

Transference

Client redirects feelings onto the nurse.

Countertransference

Nurse projects emotions onto the client.

Cultural Maintenance

Support the client in keeping their cultural identity (e.g., respecting spiritual beliefs).

Cultural Negotiation

Help adapt cultural beliefs if they conflict with health outcomes.

Cultural Repatterning

Assist clients in modifying harmful practices while respecting cultural traditions.

Technology in Mental Health Care

Telehealth and electronic health records (EHRs) play a significant role in modern mental health nursing.

Telehealth Access

Almost 50% of mental health patients access care through telehealth.

Clinical Judgment Action Model (CJAM)

Integrates Tanner's Clinical Judgment Model with the Nursing Process to guide decision-making in patient care.

Assessment

Gather relevant data: Mental status exam (MSE), psychosocial assessment, substance use assessment, cultural/spiritual needs.

Safety Concerns

Identify safety concerns (suicide risk, aggression).

Standardized Tools

Use standardized tools (MMSE, Mini-Cog, Montreal Cognitive Assessment).

Analysis

Recognize patterns in symptoms and behaviors.

Prioritizing Care

Prioritize care based on urgency (e.g., suicide risk comes before anxiety management).

Planning

Collaborate with client and interprofessional team to define treatment goals.

SMART Goals

Set SMART goals (Specific, Measurable, Achievable, Realistic, Time-bound).

Example of SMART Goal

Client will report fewer than 3 panic attacks in 14 days.

Evidence-based interventions

Interventions supported by research, such as CBT, motivational interviewing, and psychopharmacology.

Client and family involvement

Engaging clients and their families in care to enhance adherence to treatment.

Medication education

Providing information on medications, relapse prevention, and coping strategies.

De-escalation techniques

Strategies used to calm aggressive clients and prevent escalation of conflict.

Cultural adaptation of interventions

Modifying interventions based on the client's culture, preferences, and literacy level.

Assessment of interventions

Evaluating whether interventions achieved the intended treatment goals.

Care plan modification

Adjusting the care plan as necessary based on ongoing assessments.

Ongoing communication

Maintaining regular communication with the client, family, and treatment team.

Documented progress

Recording progress or challenges to ensure continuity of care.

Clinical Judgment Action Model (CJAM)

A model that promotes structured, patient-centered decision-making to enhance safety and quality of care.

Cultural competence

The ability to understand and effectively respond to the cultural needs of clients in therapeutic settings.

Cultural Formulation Interview (CFI)

A tool to assess how culture influences a client's mental health experience.

Cultural definition of the problem

Understanding how the client perceives their mental health condition.

Cultural perceptions of cause

Exploring if religion, spirituality, or traditional beliefs affect the client's symptoms.