CW

Mental Health Nursing Review

Mental Health: Core Concepts and Nursing Care

Mental Illness as a Disease of Exclusion

  • Mental health issues are considered diseases of exclusion, meaning other medical conditions must first be ruled out.

  • Mental health symptoms can mimic various physiological problems:

    • Cardiac issues

    • Thyroid issues

    • Brain problems: Like tumors or hormone imbalances (e.g., low estrogen in older women causing mood changes).

    • Infections: Such as UTIs in older individuals.

    • Injuries: Like concussions, which can cause confusion and other neurological symptoms, necessitating ruling out a physical injury before attributing symptoms to mental illness.

  • Prioritization: In mental illness, the number one rule is always to treat the medical issue first and rule out any underlying physiological cause before administering antidepressants or antipsychotics.

Key Terms in Mental Health

Psychosis

  • Definition: A disconnection from reality where individuals experience hallucinations and delusions.

  • Example (ICU psychosis): Common in hospital settings, especially ICUs.

Delusions

  • Definition: False ideas or beliefs accepted by a person as real, despite evidence to the contrary. They are very common in schizophrenic patients.

    • Common Delusion: Belief that people are

Mental Illness as a Disease of Exclusion

  • Mental health issues are considered diseases of exclusion, meaning other medical conditions must first be thoroughly ruled out.

  • Rationale for Exclusion: Physiological problems often present with symptoms indistinguishable from primary mental health conditions. Misdiagnosing a medical issue as a mental illness can lead to inappropriate treatment, delayed care for the underlying physical ailment, and potentially severe health consequences.

  • Mental health symptoms can mimic various physiological problems, leading to a need for comprehensive medical workup:

    • Cardiac issues: Arrhythmias or myocardial infarction can cause anxiety, panic attacks, or even confusion.

    • Thyroid issues:

      • Hyperthyroidism: Can manifest as anxiety, agitation, insomnia, and rapid mood swings, mimicking generalized anxiety disorder or bipolar disorder.

      • Hypothyroidism: Can lead to depression, fatigue, cognitive slowing, and apathy, resembling major depressive disorder.

    • Brain problems:

      • Tumors or lesions: Can cause personality changes, mood disturbances, cognitive deficits, or psychotic symptoms depending on their location.

      • Hormone imbalances: Such as low estrogen in older women (menopause) causing significant mood changes, irritability, and depression. Adrenal gland dysfunction can also mimic anxiety or depression.

      • Neurodegenerative diseases: Early stages of dementia can present with behavioral changes, depression, or psychosis.

    • Infections:

      • Urinary Tract Infections (UTIs): Especially common in older individuals, UTIs can cause acute confusion, delirium, agitation, and even hallucinations, often mistaken for psychiatric emergencies.

      • Sepsis or encephalitis: Can lead to profound changes in mental status, including psychosis and severe disorientation.

    • Injuries:

      • Concussions or traumatic brain injuries (TBIs): Can cause a range of neurocognitive and emotional symptoms, including confusion, irritability, depression, anxiety, and even psychotic features, necessitating ruling out a physical injury before attributing symptoms to mental illness.

    • Nutritional Deficiencies: Deficiencies in vitamins like B_{12} or folate can cause depression, cognitive impairment, and fatigue.

    • Substance Use/Withdrawal: Intoxication or withdrawal from alcohol, illicit drugs, or even certain prescription medications can induce profound psychiatric symptoms including anxiety, depression, mania, and psychosis.

  • Prioritization: In mental illness, the paramount rule for healthcare providers is to always treat the medical issue first and definitively rule out any underlying physiological cause before diagnosing a primary mental health disorder and initiating psychopharmacological interventions (e.g., antidepressants or antipsychotics). This ensures patient safety and appropriate, effective care.

Key Terms in Mental Health

Psychosis

  • Definition: A severe mental state characterized by a significant disconnection from reality. Individuals experiencing psychosis often struggle to differentiate between real and unreal experiences, leading to profound impairment in functioning.

  • Manifestations: The primary features include hallucinations and delusions, which are often distressing and can lead to disorganised thinking and behavior.

  • Common scenarios: While "ICU psychosis" (delirium) is common in hospital settings, especially ICUs, psychosis can also be a symptom of various mental health conditions (e.g., schizophrenia, severe bipolar disorder, severe depression with psychotic features), neurological disorders (e.g., Parkinson's disease, brain tumors), substance abuse, or medical conditions (e.g., high fever, severe infection).

Delusions

  • Definition: False, fixed beliefs that are firmly held despite clear objective contradictory evidence and are not consistent with the person's cultural or religious background. They are highly prevalent in conditions like schizophrenia.

  • Types of Delusions:

    • Persecutory/Paranoid Delusions: Belief that one is being tormented, followed, spied on, conspired against, or ridiculed. Example: "The government is tracking my thoughts through my phone."

    • Grandiose Delusions: Belief that one has extraordinary talents, wealth, power, or importance. Example: "I am the secret leader of a global organization."

    • Somatic Delusions: Beliefs involving one's body or bodily functions. Example: "My organs are rotting inside me, but doctors can't see it."

    • Erotomanic Delusions: Belief that another person, usually of higher status, is in love with them. Example: "A famous celebrity secretly sends me messages of love through coded signals on TV."

    • Nihilistic Delusions: Belief in the non-existence of self, part of self, others, or the world. Example: "The world ended last week, and I am just a ghost."

    • Delusions of Reference: Belief that common, innocuous events, objects, or behaviors of others have a specific, usually negative, meaning directed toward oneself. Example: "The news anchor is speaking directly to me through the television."

Hallucinations

  • Definition: Sensory perceptions that occur in the absence of an external stimulus. They can affect any of the five senses and are perceived by the individual as real.

  • Types of Hallucinations:

    • Auditory Hallucinations: Most common type, involving hearing sounds (e.g., voices, whispers, music) that aren't real. Voices can be commanding, critical, or conversational.

    • Visual Hallucinations: Seeing people, objects, lights, or patterns that aren't there.

    • Tactile Hallucinations: Feeling sensations on the body (e.g., bugs crawling under the skin, being touched) when nothing is physically there.

    • Olfactory Hallucinations: Smelling odors (e.g., smoke, chemicals, foul smells) that no one else can detect.

    • Gustatory Hallucinations: Experiencing tastes (e.g., bitter, metallic) that have no external source.

Anxiety

  • Definition: A normal and often healthy human emotion involving feelings of worry, nervousness, or unease, typically about an event or something with an uncertain outcome. However, when it becomes excessive, chronic, and interferes with daily functioning, it can be classified as an anxiety disorder.

  • Symptoms: Can include physical manifestations like increased heart rate, sweating, trembling, rapid breathing, and psychological symptoms such as persistent worry, restlessness, difficulty concentrating, and irritability.

  • Disorders: Generalized Anxiety Disorder (GAD), Panic Disorder, Social Anxiety Disorder, Specific Phobias.

Depression (Major Depressive Disorder)

  • Definition: A common and serious medical illness that negatively affects how you feel, the way you think, and how you act. It causes feelings of sadness and/or a loss of interest in activities once enjoyed. It can lead to a variety of emotional and physical problems and can decrease a person’s ability to function at work and at home.

  • Criteria (DSM-5 usually requires 5 or more symptoms for at least two weeks):

    • Depressed mood most of the day, nearly every day.

    • Markedly diminished interest or pleasure in all, or almost all, activities (anhedonia).

    • Significant weight loss or gain, or decrease or increase in appetite.

    • Insomnia or hypersomnia nearly every day.

    • Psychomotor agitation or retardation nearly every day.

    • Fatigue or loss of energy nearly every day.

    • Feelings of worthlessness or excessive or inappropriate guilt.

    • Diminished ability to think or concentrate, or indecisiveness.

    • Recurrent thoughts of death, recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.