Mental Health Exam #1 part 1

What were the beliefs around mental illness before 800 BCE?

• It was devine/demonic

• Religions were involved

What is the importance of Hippocrates in regards to mental health?

He was one of the first to study mental disorders

What is the importance of Aristotle in regards to mental health?

He connected the relationship of physical disorders to mental disorders

What was Trephination?

• It was used to treat mental health disorders a long time ago

• It involved cutting a piece of the skull out and leaving it open so the bad spirits could leave

What is the importance of St. Augustine in regards to mental health?

They proposed that mental illness was caused by demons

What were Asylums originally run by?

Religious orders

What was the importance of Englads hospital of St. Mary of Bethlehem?

• It was VERY inhumane

• Patients were abused and tours were given for entertainment

What is the importance of Benjamin Franklin in regards to mental health?

He founded the first hospital for the mentally ill

What is the importance of Benjamin Rush in regards to mental health?

• Is considered the father of American Psychiatry

• Showed that the psychicians/patient relationship can be curative (nurses can be healing!)

• Faulty blood curculation to the brain

What is the importance of Borthea Dix in regards to mental health?

• Wanted humame, but isolated treatment

T/F: Scientific racism was used to justify slavery and is still evident in healthcare today

TRUE!

What is Drapetomania?

Treatable “mentall illness” that caused black slaves to flee captivity (considered this until 1914)

How was Schizophrenia impacted by scientific racism?

• It started out as a neurosis of middle class houswives

• Became a “violent social disease”, now black men are 4 times more likely to be diagnosed with this and it is seen as scary.

What did early mental health instisutions in Iowa believe in regards to treatment?

• Keep the patients alive and dont let them hurt eachother

• Self contained communities where patients work supported themselves

• Minimal to no oversight- male nurses

What treatments were used in the early institutions?

• Lobotomies

• ECTs (no sedation)

• Insulin shock therapy

• Ice water therapy

• Restrains and seclusion

How did psychosocial rehabilitation evolve?

• Many mentally ill pts were in public hospitals

• Outpatient clinics were created

• Chlorpromazine and lithium were introduced as anitpsychotcis (big change!)

• Joint commision of mental health and community mental health centers

T/F: Iowa is ranked in the top 10 for best mental health

FALSE!

Iowa has been ranked one of the WORST states in the nation for mental health

What needs fixing in regards to mental health in iowa now?

Lack of treatments space available and lack of providers both inpatient and outpatients

What are intensive outpatient programs?

The patient comes in, 9-5 therapy, then goes home

What is the Crisis Stabilization Unit?

Keeps patients safe in times of crisis while nurses set up what they need. Intended for short term

What is the Housing First Initiative in Iowa City?

• Gives people housing which increases their liklihood to recieve treatment for mental health.

• Homelessness + stess= may turn to substances

What is the GuideLink Center?

• Mental health access center

• Sobering unit here so they can safely come off alcohol and come home

What are the myths around mental illness?

• Mentally ill people always violate social norms

• People without mental illness are always logical and rational

• Mentally ill people have violent tendencies and are dangerous

T/F: Mental illness is a physical illness

True! The brain is an organ

T/F: Awareness had grown so much in mental health and there is no longer prejudice

False! Awareness has grown so it is less stigmatied, but there is still prejudice.

_______ safety before emotional safety

Physical

What are the seven signs of mental wellness

• Happiness

• Control over behavior

• Apprasial of reality

• Effectiveness in work

• Health self-concept

• Satisfying relationships

• Effective coping strategies

What is the DSM-5 used for?

This is the main tool used to diagnosed mental disorders

What does the DSM-5 say about mental disorders?

• Mental disroders are considered a manifestation of a behavioral, psychiological, and/or biological dsyfunction of the individual

• Psychological is hard to determine besides subjective reports, no way to measure biological in a living person, vast majority is behavioral.

The term _________ should be used rather than “average” or “normal”

Baseline (it is the general bell average)

Mild to Moderate

• Lifes normal up and downs

• Movements is often mild to moderate then back to baseline with no or some treatment

• Usually pretty functional

• Ex: Psychological responses to illness, greiving a loss

Moderate to Severe

• The patient goes back and forth, these are chronic illnesses that arent necessarily curable but treatable

• Ex: Anxiety disorders, Personality disorders, Eating disorders

Severe to Psychotic

• Movement is chronic and often progressive

• Generally not curable but working on management

• Ex: Mood disorders (bipolar, depression), thought disorders (schizophrenia), cognitive disorders (dementia)

What is Psychosis?

A detachment from reality. It can have 2 different symptoms

• Hallucinations

• Delusions

Hallucinations vs Delusions

• Hallucinations are sensory based

• Delusions are are thought processes (ex: pt thinks they are jesus)

________% of the adult population had any mental illlness in 2020

21%

Do more men or more women have any mental illness?

More women (however it is probably more equal but it is less socially acceptable for men to express this so they may be less likely to report)

The prevalence of any mental illness is highest from the ages of _______ to _______ and decreases with________.

• 18-25 years old

• the older population

Any mental illness is highest in what demographic (besides age)?

Multiracial people

What is the average delay between onset of symptoms and treatment?

10 years!

How does the prevalence of severe mental illness compare to any mental illness?

• The same

• Higher in women than men

• Highest in 18-25 year olds

When does the onset of a severe mental illness (such as psychotic disroders, bipolar, etc) occur?

Onset is often in the early 20s

Generally the more severe an illness the ________ common it is

Less

What are the influences on mental health?

• Biology (bipolar is one of the most inherited illnesses)

• Support systems

• Family influences (different dynamics)

• Developmental events (trauma at young age)

• Cultural beliefs and values (is mental health discussed?)

• Health practices

• Negative influences

What are the influences of episodic mental illness?

• A combination of biology and other influences (environmental)

• Ex: panic attacks, depression, etc

What are the influences of severe and chronic mental illness?

Biology is usually the most influential factor

What must nurses know in regards to mental health?

• DSM-5

• Recognize the signs/symptoms

• Possible influences

• Techniques to assess, diagnose, and intervene for disorders

• Adapt for the individual

Erickson

• 8 stages of development (personality develops throughout life and a failure in one stage can be recified at another stage)

• Helps determine what types of interventions are most likely to be effective (different interventions based on their stage in development)

Trust vs mistrust

• 0-1.5 years

• Connecting with others

Autonomy vs. Shame and Doubt

• 1.5-3 years

• Learnig to be independent

Initiative vs. Guilt

• 3-5 years

Industry vs. Inferiority

• 5-12 years

• taking initiative in things, or are they dependent on others and feel lesser than

Identity vs. Role Confusion

• 12-18 years

• Period of time where we have adult impulses and child frontal lobes, messy!

Intimacy vs. Isolation

• 18-40 years

Generativity vs. Stagnation

• 40-65 years

Ego Integrity vs Despair

• 65+ years

What are Maslows Hierarchy of needs?

• If the lower needs are not met, other higher up needs may not be met

• Ex: If someone is having a panic attack, they probably are not concerned about other things until the problem is resolved

What was Maslows Theory and how did it relate to nursing?

• Emphasis on human potential and the patients strengths

• Prioritizing nursing actions in the nurse-patient relationship

• Focus on physiological and safety needs first when patients are acutely ill

What is Peplau’s influence on nursing?

• Interpersonal Relations in Nursing (book)

• Changes nurses from being the “custodians” in healthcare to doing work to help the patient heal—> Nurse using theraputic communication is a DIRECT means to help them recover

Orientation phase of the nurse vs patient

• Nurse: Introduce self, set contract, build trust, set goals, assess patient

• Patient: Meet nurse, agree to contract, understand expectations, participate in goal setting

Working phase of the nurse vs patient

• Nurse: Maintain relationship, facilitate expression

• Foster change

• Patient: Examine own worldview, test new behaviors, try alternate solutions

Termination phase of the nurse vs patient

• Nurse: Summarize achievements, validate expereincee, maintain limits

• Patient: Examine thoughts, discuss plans, accept termination

Neurons

• Responds to stimuli and release chemicals called neurotransmitters

• Presynaptic neuron —> synapse —→ postsynaptic neuron

How are neurotransmitters destroyed

• Enzymes

• Reuptake

How does mental illness relate to neurotranmitters?

• Many hypothesis that mental illness has to do with low/high levels of different neurotranmitters however it is not that simple

• Other things can cause mental illness, its not consistent, there are many theories

Why do side effects occur for psychotropic medications?

A particular transmitter is often used by different neurons to carry out different activities. Taking medication can alter these activities

What are side effects of psychotropic medications?

• Alterations to mental status

• Changes in sleep patterns

• Changes in body movement

• Changes in autonomic functions (temp regulation)

What is the purpose of psychiatric assessment?

• Establish rapport with patient

• Obtain understanding of the problem

• Assess psychological functioning

• Identify goals

• Perform mental status exam

• Identify areas to be modified to effect positive changes

What is important when establishing rapport with a patient?

• Be respectful

• Be genuine

• Be trustworthy

T/F: Nurses know better than the patient

False

What should be looked for during an assessment in mental health?

• LOC

• Physical appearance (look for baseline, does clothing make sense)

• Behavior

• Cognitive/intellectual abilities

• Psychosis

• Potential for violence

• Suicide risk

Mood vs Affect

• Mood: subjective from the patient, how they feel

• Affect: what the nurse is observing

Mini Mental Status Exam (MMSE)

• Screening tool

• Asseses orientation to time/place, attention span, ability to calculate counting backwards, recall ability, language

Glasgow Coma Scale

• Screening tool

• Assesses basline LOC by ear, verbal and motor responses

MOCA exam

Cognitive exam to assess fuctionality

Why is self-assessment important as a nurse?

• Know biases/feelings/fears as a nurse and how this may impact care for a patient

• Ex: if working with a pedophile, must still give the patient care like others

Difference between a friendhsip and a patient realationship

• Friendship: Both people connect and talk about personal experiences

• Patient relationship: We talk about then, dont bring up similar experiences if you have had them

T/F: It is not worth building a theraputic relationship and positiv raport if the nurse will only be with the patient for a short time

False! Even time limited can have a positive impact

Positive factors of a nurse

• Consisent approach to interaction (scripting)

• Adjustment of pace to patients needs

• Attentive listening

• Positive inital impressions

• Comfort level during relationship

• Self awareness of own thoughts and feelings

• Consistent availability

Positive factors of a patient

• Trusting attitude

• Willingness to talk

• Active participation

• Consistent availability

Empathy vs sympathy

• Empathy: Ability to understand how someone feels and sit with them while they feel. This takes energy!

• Sympathy: Feeling pity, relief of not having the same probelsm

What is Transference?

• The patient veiws the nurse as having characteristcis of another person who has been significant in the patients life

• Includes expective exclusive serivce from nurse, jealousy, compares nurse to former authority figures

• Ex: calling a nurse mom

• Not healthy!

What is Countertransference?

• Nurse displays characteristics on the patient

• Includes nurse over-identifying with the patient, competes with the patient, argues with the patient

The more stressed someone is the __________ their bubble of personal space may be.

Bigger

Important components of nursing patient relationships

• Time

• Active listening

• Caring attitude

• Honesty

• Trust

• Empathy

• Non-judgemental attitue

Theraputic Communication Techniques

• Validation

• Silence

• Active Listening

• Open ended questions

• Close ended questions

• Projective questions

• Presupposition questions

• Restating

• Reflecting

• Paraphrasing

• Exploring

• General leasa dn brod opening statements

• Acceptance

• Focusing

• Giving information

• Presenting realtiy

• Summarizing

• Offering Self

• Making observation

• Encouraging

• Voicing doubt

• Fomulating a plan of action

Validation

• Acknowledging emotions without judegement

• Separate from action

• If dont use empathy it will come off as sarcastic

• Example: “You are feeling______” or “that makes sense”

How can using silence and activie listening be helpful?

This spaces out the conversation. People often dont like silence so they may try to talk to fill it

How are open ended questions helpful?

• It allows for spontaneous responses and a more interactive discussion

• Most questions should be this

• Ex: “how are you feeling today”

How are close ended questions helpful?

• Helpful if used sparingly to obtain specific information

• Ex: are you feeling suicidal?

How are projective questions helpful?

• It uses “what if” to assist in exploring feelings

• Ex: “if i could give you a pill to fix your biggest problem, what would it be”

How are presupposition questions helpful?

• Explores motivations and goals with hypothetical questions in which the patient does not have a mental illness

• Ex: “What would you bring with you on a deserted island”

Restating

• Uses the patients exact working

• Lets them known whether they have een undertood and that you are paying attention

• If they correct you, you are still using it right

Reflecting

• Mirroing with different wording

• Directs the questions/feelings back to the patient so they may be recognized and accepted

Paraphrasing

• Restates thoughts and feelings to confirm what has been communicated

Exploring

• Delving further into a subject, idea, experience or relationship

• Gathering and organizing information about the patient

• Ex: use a word/phrase that sticks out to you- “you said you feel lonely, can you tell me more about that”

Offeing general leads and broad opening statements is helpful because

• Allows the patient to select a topic

• Leading: “slept well last night” this implies there is a correct answer

• Broad opening: “how did you sleep last night” this allows them to decide

Showing acceptance is helpful because

• It conveys positive regard

• Regardless of their choice, you will care about them

• Importance for abuse

How is focusing helpful

• Taking notice of a single idea of single word

• Bas for anxiety

How is giving information helpful?

• Provides details the patient may need to make a decision

• Ex: asking about the side effects of a medication, the nurse gives info and not advice