Module 3: Nursing Process in Mental Health

DSM 5

• Diagnostic and Statistical Manual of Mental Disorders

• manual for diagnosing mental health conditions, published by the American Psychiatric Association and provides a common language and standard criteria for the classification of mental disorders.

• used by mental health professionals including psychiatrists and psychologists to diagnose and treat mental health conditions

• Since May 2013

Reason for DSM-5 creation

• provide a standardized and evidence-based method for diagnosing mental health conditions.

• to improve the reliability and validity of mental health diagnoses and to provide a common language for mental health professionals to use when discussing and treating mental disorders.

• to reflect current scientific knowledge and understanding of mental disorders,

Neurodevelopmental

• disorders affecting the brain

• autism spectrum disorder

• Attention deficit and hyperactivity disorder

• intellectual disability

• specific learning disorders

Possible Nursing diagnosis

• Autism - Impaired Social Interaction

• ADHD – Risk for Injury

Schizophrenia Spectrum and Other Psychotic Disorders

• Hallucinations

  Hears voices

• Delusions

  • False belief

• Psychosis

  • Not in touch with reality

Possible nursing diagnosis

Psychosis – “I am the queen of the world” (delusion-false belief)

• Disturbed Thought Process

Bipolar and Related Disorders

• changes in mood, energy and activity levels

Possible nursing diagnosis

Bipolar – aggressive

• Risk for Other-Directed Violence

Depressive Disorders

• persistent feelings of sadness, hopelessness and lack of interest in life

Possible nursing diagnosis

Depression - suicidal

• Risk for Suicide

Anxiety Disorders

• excessive or unrealistic worry or fear

• generalized anxiety disorder and panic disorder

Possible nursing diagnosis

• anxiety

Obsessive-Compulsive and Related Disorders

• repetitive thoughts, behaviors or urges

Possible nursing diagnosis

• Obsessive Compulsive - Ineffective coping related to intrusive or inappropriate thoughts

Trauma- and Stressor-related Disorders

• response to traumatic or stressful life events, such as post traumatic stress disorder

Possible nursing diagnosis

• Post Trauma Syndrome

Dissociative Disorders

• disruptions in consciousness, memory, identity or emotion (amnesia)

Possible nursing diagnosis

• Disturbed Personal Identity

Somatic Symptom and Related Disorders

• focus on physical symptom - pain -to a level resulting to major distress or problems functioning

Possible nursing diagnosis

• ineffective coping

Feeding and Eating Disorders

• abnormal patterns of eating or weight regulation

• anorexia nervosa and bulimia nervosa

Possible nursing diagnosis

• Imbalanced Nutrition : Less than Body requirements

Elimination Disorders

• abnormal patterns of elimination

• enuresis / encopresis

Sleep-Wake Disorders

• abnormal patterns of sleep or wakefulness

• insomnia / narcolepsy

Sexual Dysfunctions

• difficulty with sexual desire, arousal or functioning

Gender Dysphoria

• incongruence between gender and assigned sex

Disruptive, Impulse-Control and Conduct Disorders

• Conduct disorder -disregard for others

• hostile and sometimes physically violent

Substance-Related and Addictive Disorders

• alcohol use disorder

• marijuana, amphetamine (shabu)

Possible nursing diagnosis

• Ineffective Individual Coping

Neurocognitive Disorders

• decline in cognitive functioning -dementia

Possible nursing diagnosis

• self-care deficit

Personality Disorders

• maladaptive patterns of thinking, feeling and behaving

• antisocial, borderline, dependent

Possible nursing diagnosis

• Impaired social interaction

Paraphilic Disorders

• recurrent, intense sexual urges, fantasies or behaviors that involve nonhuman objects, children non consenting persons

Other Mental Disorders

• disorders that don't fit in the categories - adjustment disorder

ILLUSION

misinterpretation of an actual external stimuli

HALLUCINATION

false sensory perception in the absence of external stimuli

NEOLOGISM

coining of words that people do not understand

CIRCUMSTANTIALITY

over inclusion of inappropriate thoughts & details

WORD SALAD

• incoherent mixture of words & phrases with no logical sequence

VERBIGERATION

• meaningless repetition of words & phrases

PERSEVERATION

• persistence of a response to a previous question

ECHOLALIA

• pathological repetition of words of others

APHASIA

• speech difficulty & disturbance

FLIGHT of IDEAS

• shifting of one topic from one subject to another in a somewhat related way

LOOSENESS of ASSOCIATION

• incoherent, illogical flow of thoughts (unrelated)

CLANG ASSOCIATION

• sound of word gives direction to the flow of thought

DELUSION

• persistent false belief, rigidly held

  Delusions of Grandeur –special / important way

  Persecutory –threatened

  Ideas of Reference –situation / events involve them

  Somatic – body reacting in a particular way

MAGICAL THINKING

• primitive thought process → thoughts alone can change events

AUTISTIC THINKING

• regressive thought process →subjective interpretations not validated with objective reality

INAPPROPRIATE

disharmony between the stimuli & the emotional reaction

BLUNTED

• severe reduction in emotional reaction

FLAT AFFECT

• absence or near absence of emotional reaction

APATHY

• dulled emotional tone

DEPERSONALIZATION

• feeling of strangeness from one’s self

DEREALIZATION

• feeling of strangeness towards environment

ECHOPRAXIA

• imitation of posture of others

WAXY FLEXIBILITY

• maintaining a position for a long period of time

ATAXIA

• loss of balance

AKATHISIA

– extreme restlessness

DYSTONIA

• uncoordinated spastic movements of the body

TARDIVE DYSKINESIA

• involuntary twitching or muscle movements

APRAXIA

• involuntary movements without purpose

CONFABULATION

• filling of memory gaps

Deja’ vu

• second-time like feeling

Jamais vu

• feeling of not having been to a place one has been before

AMNESIA

• memory loss , inability to recall past events

Retrograde – distant past

Anterograde – immediate past

Anomia – lack of memory items