NUR2225 EXAM PREP

mental health

Recovery star

Biopsychosocial model

understand and treat mental illness in a holistic manner with the complex interplay of three dimensions

Personal:

• Bio-

• Psycho-

Society:

• Social

therapeutic relationship

• Establish therapeutic rapport

• Remain person centred and responsive to the person’s immediate needs using active listening skills, being supportive and providing reassurance

• Encourage the person to discuss their feelings and share their thoughts and associated experiences – acknowledge, validate, clarify and empathise

Person centred care

• ensuring that health services are tailored to people’s needs and are provided in partnership with the patient

benefits:

1. improves the trust, experience and outcomes

2. respect cultural and regious diversity

3. emprowering dignity and choice

Trauma informed care

• treat everyone as they have experienced trauma in their lives to prevent further harm.

• provides services and support that recognises and responds to impacts of trauma on individuals’ lives

principles:

1. safety

2. empowerment

3. choice

4. collaboration

5. trustworthiness

Stigma

Three components:

1. stereotype: negative belief about a group.

2. prejudice: cognitive and affective response that leads to discrimination and a behavioural reaction.

3. discrimination: behavioural response to prejudice.

Impacts:

1. societal exclusion.

2. denied access to life opportunities, employment, education, community acess.

The Mental Health and Wellbeing Act (2022)

• mental health law that reforms approaches to mental health treatment aiming to provide an diverse, compassionate and responsive care plan.

  • support dignity

  • ensure collaboration with their treatment of care

  • recognist role of family and carers

  • responds to diverse needs and preferences

assessment order: when psychiatrist intiates compulsory treatment when assessing severe declination if treatment if not provided to person.

Assessment order

person appears to have a mental illness and appears to need immmediate treatment to prevent:

• serious deterioation

• serious harm to self and others

Temporary Treatment Order (28 days)

Compulsory treatment criteria are:

• person (>18 years) has mental illness, and

• because needs immediate treatment to prevent:

  • serious deterioation, serious harm and

• and there are no less restrictive methods for person to recieve treatment.

Comprehensive holistic assessment

This advances person-centered care  approaches by providing appropriate services relevant to the person's individual needs and treating them as a whole.

• past mental history

• family history

• medications

• substance history

• foresensic history

• premorbid personality

Mental Health Examination (MSE)

1. Appearance: hygiene, weight, hair style/colour.

2. Behaviour/motor activity: posture, hyperactivity, movement.

3. Speech: volume, tone, paste, quality.

4. Mood: rating scale, emotions.

5. Perception: auditory, visual, olfactory, gustatory, tactile…

6. Thought content: obessions, delusions, magical thinking, harm.

7. Thought form/process: thought broadcasting, insertion…

8. Insight: personal belief about ones’ condition

9. Judgement: ability to make reasoned decisions

10. Memory

11. Orientation

12. Cognition: general intelligence, orientated to place/time/person.

BARRIERS TO:

Mental Health Examination (MSE)

• Lack of therapeutic relationship

• physical environment

• age

• health literacy

• cultural and language barriers

• stigma

• cognitive state or untellectual impairment

• mood altering substances.

Risk Assessment

Risk assessment is an process that identify and evaluate the potential risks that an individual may propose upon themselves or others. The primary goal is to enhance safety and well-being of the individual and their surroundings.

• harm to self/others

• suicidal tendencies

• suicidal history

• vulnerability

S: staring

T: tone of voice

A: anxiety

M: mumbling

P: pacing

management of psychosis:

ANTIPSYCHOTICS

role of MHN:

• education on benefits.

• education on side effects: weight gain, headache, sedation.

• administer and monitor the effect of treatment.

Types of irrational beliefs

• thought broadcasting:

  • inner thoughts are heard to external environments

• persecutory ideation:

  • fixed thoughts of one is being targeted, harmed, conspired against.

• thought insertion:

  • delusions and thoughts aren’t their own.

• ideas of references:

  • random, unelated external events are meant for them.

Interventions for:

ANXIETY

NON-PHARMACOLOGICAL:

• Breathing exercises

• Mental exercises

• Physical movement

• Mindfulness

• Sensory Modulation

• Reframing unhelpful thoughts

• Psychoeducation

PHARMACOLOGICAL:

antidepressants

selective serotonin reuptake inhibitors

Diagonostic & Statistical (DSM) criteria for:

Major Depressive Disorder

1. depressed mood, most & nearly everyday.

2. diminished interest and pleasure

3. significant weightloss (>%5 in a month)

4. insomnia or hypersomnia

5. agitation, restlessness

6. fatigue

7. worthlessness or guilt

8. diminished thinking and concentration

9. recurrent thoughts of death

DSM criteria for:

Bipolar Disorder Manic Episode

A. increase activity & energy lasting at least 1 week.

B. three (or more) of the following symptoms:

• inflated self esteem or grandiosity

• decreased need for sleep

• flight of ideas

• distractibility

• increase goal-directed activity

• excessive involvement in activities with painful consequences.

C. mood disturbance sufficiently severe that cause marked impairment

D. listed episodes are not attributed to substance abuse

DSM criteria for:

Bipolar Disorder hypomanic Episode

A. abnormal elevated, expansive, or irriritable mood lasting at least 4 consecutive days.

B. three or more of the following symptoms:

• Inflated self-esteem or grandiosity.

• Decreased need for sleep (e.g., feels rested after only 3 hours of sleep).

• More talkative than usual or pressure to keep talking.

• Flight of ideas or subjective experience that thoughts are racing.

• Distractibility

• Increase in goal-directed activity

• Excessive involvement in activities with high potential for painful consequences.

C. uncharacteristic of individual when not symptomic.

D. disturbance in mood and functioning observable by others

E. not severe enough to cause impairment in social or hospitalisation

F. not attributed to drug or substance usage.

MSE:

person experiencing mania

Appearance

• dishevelled, provacative, flamboyant

Behaviour

• restless, disorganised, innappropriate

Speech

• rapid, loud, increased

Mood

• euphoric, elevated, irritable

Affect

• euphoric

Thought content

• delusions, inflated self-esteem

Thought form

• flight of ideas, increased thought stream

Perception

• nil unless psychosis

Cognition

• short attention, racing thoughts

Judgement

• poor

Insight

• poor

Low mood, depression, mania, and bipolar disorder

Low mood:

• short period/temporary response to specific stressors or life events.

Depression:

• clinical diagnoses mental health condition that impacts daily functions, chronic period (>2 weeks) of low mood.

Mania:

• intense abnormal high energy, euphoric, impulsivity lasting (>7 days)

• can cause psychosis unliked hypomania (<4 days)

Bipolar Disorder:

• extreme mood swings, emotional highs such as mania and hypomania and extreme lows such as depression.

• depression and mania are associated symptoms of bipolar affective disorder.

Emotional dysregulation

• difficulties regulating painful emotions

• unable to control intense arousal and problems turning attention away from stimuli, cognitive distortions and failures in nformation processive and unable to control impulsive behaviours relating to strong emotions.

DSM for:

Borderline Personality Disorder (BPD)

instability of interpersonal relationships, self-image, and marked impulsivity beginning in adulthood.

1. frantic efforts to avoid real or imagined abandonment

2. identity disturbance.

3. impulsivity (self-damaging)

4. recurrent suicidal behaviour

5. affective instability due to reactivity of mood

6. chronic feelings of emptiness

7. innapropriate response to anger

8. transient, stress-related paranoid ideation or severe disassociative symptoms

BPD:

Transference & Countransference reactions

Transference:

• transferring feelings, thoughts or behaviours that occured in the past to a situation that is happening in their present

Countertransference:

• your response to the patient

Nursing considerations:

BPD

Mental Health Safety Plan:

• identify triggers to crisis

• link strategies to cope with triggers

Medications

• should not be primary treatment therapy

• high dosage can lead to overdose (high-risk patients)

• substance dependance (e.g. benzodiazepines)

• acute crisis if psychological therapy is insufficent

Psychotherapy

• Cognitive Behavioural TherapY (CBT)

DSM 5:

Personality Disorder (Cluster A)

odd, eccentric thinking or behaviour

1. Paranoid Personality Disorder

• distrust and suspiciousness of others & their motives are interpreted as harmful and against them

2. Schizoid Personality Disorder

• detachment from social relationships and restricted range of expression of emotions in interpersonal settings

3. Schizotypical Personality Disorder

• social and interpersonal deficits, accompanied by cognitive or perceptual distortions.

DSM 5:

Personality Disorder (Cluster B)

dramatic & erratic behaviours

1. Narcissistic Personality Disorder

• grandiosity (in fanatsy or behaviour), need for admiration, lack of empathy.

2. Borderline Personality Disorder

• instability of self-image, relationshps and marked impulsivity.

3. Histrionic Personality Disorder

• attention-seeking, excessive emotionality

4. Antisocial Personality Disorder

• pattern of disregard and violation of rights of others

DSM 5:

Personality Disorder (Cluster C)

anxiety and fear-driven behaviours

1. Avoidant Personality Disorder

• social inhibitation, feelings of inadequency and hypersensitivity to negative feedback.

2. Dependant Personality Disorder

• excessive need to be taken care of, clinging, fear of serperation

3. Obssessive Compulsive Personality Disorder (OCPD)

• preoccupation with orderliness, perfectionism and mental and interpersonal control

nursing management:

BPD

Mental Health Care Plan

• Identity triggers

• create coping strategies to alleviate negative promoting behaviour

Medication

• overdose for high suicide risk patients

• not the primary treatment therapy

• acute crissis if psychological therapy is insufficent

• medication dependancy

Psychotherapy

CBT (cogtive behavioural therapy):

• reframe negative thinking patterns and achieve stability and strategies to cope with emotions.

DBT (dialectical behavioural therapy)

• incoperaties cbt and talk therapy into understandign the relationship between emotions and behaviours

nursing management:

Personality Disorder

get what you want from another person

Describe the current situation, stick to the FACTS.

Express your feelings and opinions about the situation

Assert yourself and say no clearly

Reinforce (reward) person ahead of tim by explaining positive effects

Mindful: keep focus of goals and dont be distracted

Appear confident

Negotiation

DSM 5:

Substance-use disorders

mild = 2/3

moderate = 4/5

severe = > 6

1. taking substance in high doseses

2. wanting to cut down but unable to

3. spending alot of time using, recovering from use

4. cravings and urges

5. inability to function in daily life

6. continious usage even if problems arise in relationships

7. giving up on important events

8. continual usage despite dangerous circumstance

9. psychological/physical problems dont discourage use

10. needing more of the substance (tolerance)

11. experience withdrawal symptoms

Substance-related disorders

INTOXICATION & WITHDRAWAL

Intoxication

• any change in person’s perception, mood, cognition or behaviour after drug usage.

Withdrawal

• occurs afte stopping drug usage, or reducing amount

• range from mild to life-threatening

Substance-related disorders

CATEGORIES OF DRUGS

stimulants

• speeds up function of CNS

depressants

• decreases function of CNS

hallucinogens

• distort senses and change of experience

cannabinoids

• multiple effects and can fall in all three categories listed above;

Nursing Management OF Substance-related disorders:

PHARMACOLOGICAL

Opoid Substitution Therapy

• used for patients with dependancy on opoids (e.g. herion)

• prevents withdrawal

Nicotene Replacement Therapy (NRT)

• releases slow/lower doses of nicotene compared to smoking

Naltrexone

• used to patients who withdrawn from opoids and stop person from achieving “high”

• also alchohol abstainance to reduce cravings

Benzodiapenes:

• reduce and protect withdrawal signs

• modulates CNS activity

• doses depend on severity

OTHERS:

antipsychotics, paracetemol, metoclapramide

Nursing Management:

ALCOHOL WITHDRAWAL

1. Alchohol withdrawal scale:

   • mild: hypertension, headache, sweating

   • severe: hallucinations, disorientation, confusion

2. minising progression to severe withdrawal

3. reducing risk to self and others

4. reduce/elimination physical health problems

5. identify co-occuring illnesses that are masked

DSM 5:

Eating Disorders

1. Orhtorexia

2. Anorexia Nervosa

3. Bullimia Nervosa

4. Binge-Eating Disorder (BED)

5. Other Specified Feeding or Eating Disorder (OSFED)

6. Obesity

7. Pica

Diagnostic criteria

BULLMIA

• large amounts of eating in discrete period of time

• compensatory behaviours (purging, exercising)

• lack of self-control

• occurs at least once a week for (>3 months)

PHYSICAL - fainting, dizziness, damaged teeth, swollen face

PSYCHOLOGICAL - obession w/ food, intense fear of gaining, irritability surrounding meals,

BEHAVIOURAL - social isolation to avoid eating, secretive, laxatives, repititive behaviour, fasting, compulsive exercising, frequent bathroom trips

Diagnostic criteria

BINGE EATING DISORDR\ER

PHYSICAL - lethargy, poor sleep, constipation, bloating, w

PSYCHOLOGICAL - obsessive about food, guilt after binge, depression, suicidal tendencies

BEHAVIOURAL - food hoarding, secretive behaviour, discomfort regarding weight, isolation, shop-lifting, mass buying food products

Nursing management:

EATING DISORDER

• ECG monitoring

• vital signs

• meal support

• blood collection for electroyte monitering

• psychoogical support

• monitor weight

• regular MSE & risk assessments

• nasogastric tube for re-feeding

• medication and education

Counseling Technique (SOLER)

Sit squarely

Open body

Lean slightly

Eye contact

Relax

Atypical antipsychotics

(schizophrenia)

atypical medications:

• olanzapine

• clozapine

• quetiapine

• aripiprazole

• risperidone

• acuphase

factors of risk assessments

1. protective: reduce negative outcomes of risk (e.g peer support).

2. static: unchanging, baseline of probability of risk (e.g. criminal record).

3. dynamic: conditions that slowly change (bipolar mania/low periods)

psychosis

non-pharmacological interventions

• CBT therapy - increase function and wellbeing by reducing psychotic and affective symptoms.

• Music therapy - utilizing music as an method to express, reducing negative symptoms and improve quality of life

• Family support/education -  provide education to interpersonal relationships to enhance treatment and strategies outside of healthcare settings, improving daily functioning.

mood stabilisers

(bipolar)

• lithium carbonate

• sodium valproate

antidepressants

(anxiety, depression)

• escitalopram

• diazepam