Mental Health Exam 3

Explain how to develop a therapeutic relationship with a homeless client.

listen, respect them, report

Describe risk factors for homelessness.

substance abuse, domestic violence, migrant, history of untreated mental health, families with children, runaway youths, incarcerated, veterans

Unshelterd

Bus station, car

Sheltered

womens shelter

Assessment priorities

vital signs (not always a mental health answer)

Relationship between homelessness and mental illness

Majority of homeless do not have mental illness

BUT mental illness can lead to homelessness

Symptoms of depression

anhedonia, sleep disturbances, pain

3 transmitter associated with depression

dopamine, norepinephrine, serotonine

Initial treatment for depression

activity, diet, deep breathing, no alcohol

Identify nursing diagnoses and interventions appropriate for people with depression.

ineffective coping

First line medication for depression

SSRI- takes a couple weeks to work

What do you not give to someone with active suicide?

Tricyclic (TCAs)

What happens if you take to much SSRI?

Serotonine syndrome

Symptoms of overdose on alcohol

CIWA test

- sweating

-seizure

Medication for alcohol withdrawl

Benzodiazepines

Antidote for benzodiazepines

Flumazenil

Medication for recovery for alcoholism

naltrexone

Opioid overdose symptoms

-respiratory distress

- blue color

give narcan

Medication for opioid recovery

methadone

Is overdose on Meth life threatening

no

Recall principles of harm reduction theory.

Drug test strips, not to drive, don't share needles

COWS

Opioid withdrawal screening tool

CAGE assessment

Cut back, annoyed, guilty, eye opener

Recognize the components and attitudes of motivational interviewing.

ORS

Help a person identify why they want to change

- open ended questions

- help them move toward a goal

List the drivers of de-institutionalization of mental health care

1. Money

2. Civil rights for patients- wanted them back out into the community

The major cause of homelessness is unemployment? true or false

false

Alcohol

CNS depressant

Identify the physical, behavioral, and emotional components of the DSM-V criteria for depression.

Physical: psychomotor agitation or retardation, weight change

Behavioral: anhedonia, insomnia, fatigue, decreased concentration

Emotional: depressed mood, thoughts of death

Describe the neurobiological theory of depression.

Heritable, dysregulation in norepinephrine, dopamine, and serotonin

Recommend self-care behaviors to people with depression.

deep breathing, exercise, nutrition, normal sleep patterns, wellness changes

Depression medications

Black box warning for suicide

- Tri-cyclic anti-depressants are more lethal

side effects:

- gastro intestinal effects, sedation, anti-cholinergic effects

SSRIs and SNRIs

MOAs

Alcohol use complications

Nutrient deficiencies: thiamine (b1), folic acid, magnesium

Korsakoff amnestic syndrome: problem with remembering

GI: esophagitis, pancreatitis, hepatitis

Cardiac: stroke, myopathy, dysrythmias

Substance use complications

- anxiety

-depression

- sleepy

- bad teeth

Harm reduction theory

needle exchange, condoms, safe injection rooms, designated drivers, eating before you drink, canned drinks

Naltrexone

alcohol and heroin prevention of relapse

reduces cravings

Disulfiram (Antabuse)

causes severe nausea and vomiting with even small amounts of alcohol

Naloxone

opioid antagonist

Motivational interviewing

open ended questions

the 5 A's

Ask

Advise

Assess

Assist

Arrange

Alcohol withdrawl

Tactile hallucinations, visual and auditory hallucinations

Depression diagnosis

present for at least 2 weeks

at least 4 symptoms present

Serotonin syndrome

SHIVERS

shivering

hyper reflexes

increased temp

vital sign instability

encephalopathy

restlessness

sweating

Cluster A

paranoid, schizoid, schizotypal

odd, eccentric, suspicious, withdrawn, irrational

Paranoid personality disorder

mistrust of others- inability to forgive

respect power and rank

commonly think their partner is cheating

Nursing: Psycotherapy (create trust)

Schizoid personality disorder

unable to expierence joy in life

- emotionally detached

- incapable of forming relationships

- interested in certain things (objects, animals)

Nursing: dont get frusterated

Schizotypical personality disorder

magical beleifs

Cluster B

antisocial, borderline, histrionic, narcissistic

dramatic, atenntion seeking, labile, shallow

BPD

Risk factor: sexual abuse

- extreme fear of abandonment/ sabatoge their own relationships

- splitting

Treatment: deletable behavioral therapy

avoid benzos

Nursing: teach to use I statements

Antisocial personality disorder

dont beleive that rules are made for them (msut have since age 15)

- seek power over others

- lack remorse

- most end up in jail or politics

Histrionic personality disorder

lively, dramatic, and draw attention

"life of the party"

- quick to form friendships

narcissistic personality disorder

Grandiose and inexhaustible need for admiration

Cluster C

avoidant, dependent, obsessive-compulsive

anxious, fear-filled

Avoidant personality disorder

shy and timid

Dependent personality disorder

clingy and need to be taken care of

Intermittent explosive disorder

severity of aggressiveness is out of proportion to the provocation

Kleptomania

cannot resist urge to steal-relieve stress

Pyromania

start fires

OCD interventions

SSRIs

Cognitive behavioral therapy

transcranial magnetic stimulation therapy