Chapter 9 - Mental Health, Violence, and Substance Use Disorder

sensitive issues

addressed during the assessment or later in the interview

(abuse, sexual violence, substance misuse, depression, anxiety, and suicide)

hate crimes

acts of physical harm and specific criminal threats motivated by animus
based on race, color, national origin, religion, gender, sexual orientation,
gender identity, or disability

vulnerable adults

those with physical and mental disabilities

elder abuse

neglect, financial exploitation, or abandonment

child abuse and maltreatment

abuse of children by caregivers; often more than one experience

human trafficking

use of force, fraud, or deception to recruit, transport, or harbor individuals

form of slavery

sexual violence

Forced sex in dating and marital relationships, gang rape, sexual harassment, inappropriate touching, molestation, sex with patient, forced prostitution, forced exposure to sexually explicit behavior

role of nurse in mental health

assessment is subtle and indirect

allow sufficient time to provide therapeutic interventions - assessments may trigger difficult traumatic thoughts

addiction

includes craving and obsession

dependence

increased tolerance and/or withdrawal

Clinical Institute Withdrawal Assessment for Alcohol (CIWA)

n/v, tremor, sweating, anxiety, agitation, tactile disturbances, auditory disturbances, visual disturbances, headache, orientation

opioid crisis

includes prescription opioids, heroin, synthetic opioids (fentanyl = 50x stronger than heroin), animal sedative (carfentanil = 10,000x that of morphine)

conduct patient interview in private, with no one else

What is the universal rule of interviewing patients about violence?

onset delirium

acute over few hours; lasting hours to weeks.

occurs in context of medical illness, substance misuse or withdrawal

onset dementia

slow, lasting months to years

onset depression

slow

current stressors and coping

pervasive worry or anxiety

altered mood or affect

memory, concentration, and problem-solving abilities

important topics of teaching and health promotion

SAD PERSONAS

not a precise risk predictor, but a way to assess if the patient may be at higher risk

suicidal ideation

euphoria

excessive sense of emotional and physical well-being inappropriate to actual situation or environmental stimuli

flat affect

no emotional tone or reaction

blunted affect

severe reduction in emotional expressiveness (often confused with flat affect)

elation

high degree of confidence, boastfulness, uncritical optimism, and joy accompanied by increased motor activity

exultation

reaction extending beyond elation and accompanied by feelings of grandeur

ecstasy

overpowering feeling of joy and rapture

anxiety

feeling of apprehension or worry, especially about the future

fear

emotional reaction to environmental threat

ambivalence

having 2 opposing feelings or emotions at the same time

depersonalization

feeling that oneself or one’s environment is unreal

irritability

feelin of impatience, annoyance, and easy provocation to anger

rage

furious, uncontrolled anger

liability

quick change of expression of mood or feelings

depression

feeling characterized by sadness, dejection, helplessness, hopelessness, worthlessness, and gloom