Psych 30: Mental Health Basics & Addictions (Ch. 34-35)
Mental Health Basics
Difference between someone who is mentally healthy and someone with mental illness
Key indicators: coping with stress effectively and adjusting/adapting to stressors indicate mental health.
Two keywords to identify mental health vs illness:
Coping
Adaptation (adjustment)
Maladaptive coping/adjustment are red flags suggesting mental illness.
Examples of maladaptive coping and red flags (nurse-friendly list):
Irritability or defensiveness; aggression
Isolation or withdrawal; difficulty opening up to others
Substance abuse as a coping mechanism
Neglect of personal hygiene or self-care
Healthy coping behaviors (positive examples):
Meditation, journaling, support groups, openly talking about feelings
Regular self-care: daily routines like showering, brushing teeth/hair
Self-care neglect can signal mental illness and maladaptive coping.
Growth and development concepts (brief intro): Erik Erikson’s psychosocial development and Freud’s psychodynamic theory are foundational.
Erik Erikson: Psychosocial Development
Core belief: personality is achieved through task mastery at each stage of life.
Task mastery is required for optimal psychosocial development.
Example: toddler with toilet training—success or failure affects self-perception and future development.
Sigmund Freud: Psychoanalytic Theory
Freud as a foundational figure in psychiatry; he introduced the pleasure-pain (survival-pleasure) principle driving behavior.
Key idea: behaviors are often motivated by the pursuit of pleasure and avoidance of discomfort.
Personality structure: three parts
Id (eid): basic survival and pleasure-seeking principle
Ego: reality factor; mediates between id and the external world; conscious decision-making
Superego: morals and values; internal moral compass
Practical example: taking the bigger piece of pie from a sibling to satisfy desire—an everyday expression of the pleasure-seeking drive.
Note on memory of terms: Eid (id), Ego, Superego.
Self-Concept: Four Components
Personal Identity: who I am
Body Image: how I feel about my body and physical form
Role Performance: the roles we fill in life
Two types:
Ascribed: roles assigned by birth or biology (e.g., sex determined by chromosomes)
Assumed: roles taken on voluntarily (e.g., nursing student role you assumed since entering the program)
Self-Esteem: self-worth and value
All four components together define self-concept and influence behavior and coping
Interactions with defense mechanisms can alter thoughts/behaviors; improving self-concept can enhance coping and functioning
Stress and Anxiety: Subjectivity and Levels
Anxiety is highly subjective: it depends on how the individual perceives the stressor.
Definition: Anxiety is a perceived threat to self.
Anxiety levels (progression): mild → moderate → severe → panic
In mild anxiety, performance may be enhanced; in panic, problem solving declines
Panic attack: primary nursing intervention is to stabilize breathing (breathing techniques) to reduce symptoms and allow for further assessment.
Determinants of anxiety level:
Individual’s perception of the stressor (subjective view)
Number of stressors present simultaneously
Previous experiences with similar stressors (positive or negative)
Magnitude of change required (e.g., moving across the country vs. staying on the same floor)
Overall functioning at the time of stressors (health status, grieving, etc.)
Test-taking tip: expect more select-all-that-apply questions; identify potential topics that could appear in such questions.
Defense Mechanisms (Overview)
Important to know and recognize examples for exams; not all are listed here, but common ones include:
Denial: refusing to accept reality (e.g., after a spouse’s death, insisting the person is still alive)
Rationalization: making excuses to justify behavior (e.g., a student cites a past reason to explain why homework wasn’t done)
Example to illustrate rationalization in a test scenario:
A 15-year-old asked to complete homework due tomorrow for 20% of their grade uses an excuse linked to other obligations; this illustrates rationalization rather than an inability to perform the task.
Expect several questions on defense mechanisms on exams; be ready to identify the mechanism from a scenario or a quote.
Therapeutic Communication
Therapeutic communication techniques and nonverbal cues are tested on NCLEX-style questions.
Key approach: focus on the patient and their problem; use patient-centered prompts.
Silence can be a therapeutic tool, giving the patient space to respond.
Common effective prompts: "Tell me more about that" or "What would help you feel less overwhelmed?" (often start with "Tell me more about…" or "How does that make you feel?")
Example scenario: Patient says, "I’m overwhelmed by tomorrow’s diagnostic test." Best response: "You seem very overwhelmed about your diagnostic test tomorrow. Can you tell me a little more about that?"
Distractors to avoid: options that divert away from the patient’s main issue or are defensive/condescending in tone (e.g., offering a tour instead of addressing the test anxiety) or statements that do not address the patient’s concern.
Addictive Personality: Tolerance vs Dependence
Two key concepts in addiction: tolerance and dependence
Tolerance: the need for increasingly larger or more frequent doses to achieve the same effect; the substance’s effect diminishes over time
Example: initial buzz from one drink; later, more drinks are needed to achieve the same effect
Tolerance can decrease if the person stops using the substance; withdrawal may reduce tolerance over time
Expressed as: ext{Tolerance}
ightarrow ext{need more to achieve same effect}; ext{can decrease after cessation}
Dependence: a chronic, incurable, progressive disease where the body (and often the mind) requires the substance to feel normal
If the substance is removed, withdrawal symptoms or abnormal functioning occur
Stages of dependence:
Early stage: tolerance develops; patient may attempt to quit cold turkey and feel relatively normal
Middle stage: physical and psychological dependence develops; withdrawal symptoms occur if the substance is stopped; more use is to feel normal again
Late stage: the person never feels normal regardless of amount/frequency of use
Key distinctions: dependence implies withdrawal and ongoing need; tolerance is about needing more for the same effect, not necessarily ongoing withdrawal
Discussion of disorders related to addiction (brief): alcoholism and other substance use disorders; alcohol withdrawal syndrome is life-threatening and requires aggressive treatment; other withdrawals (e.g., opioids) are uncomfortable but not typically life-threatening on their own
Alcohol and Opioids: Key Effects and Management
Alcohol withdrawal syndrome: life-threatening if not properly treated; requires careful monitoring and management
Opioids:
CNS depressants
Most common side effect: constipation
Most severe risk: respiratory depression leading to death in overdose
Overdose antidote: Naloxone (also known as Narcan); use to reverse opioid effects
Naloxone is a critical component of opioid overdose management; resuscitation protocols should be in place
Other notes: opioids suppress the CNS, and withdrawal management may be necessary in detox protocols
Assessment and Phases of Recovery
Subjective assessment (patient’s perspective):
Normal pattern of use (frequency, quantity, timing)
Date and time of last use or last drink (crucial for withdrawal risk assessment)
Substances used and amounts
Prior legal history (e.g., arrests, DUIs) to gauge functioning and risk
Example: multiple DUIs in a short period may indicate late-stage dependence
Potential addition not listed in the slide: assess for psychosocial stressors and support systems
Phases of recovery from addiction:
Detoxification phase (safety-focused): primary concern is safety, including falls risk and preventing withdrawal complications
Rehabilitation phase (abstinence-focused): core goal is abstinence from the substance; emphasis on developing coping strategies and lifestyle changes
Rehabilitation priorities (in addition to abstinence):
Build a support system
Promote healthy diet and exercise
Develop healthy coping behaviors and relapse-prevention strategies
In rehab, the top intervention is abstinence from the substance; other objectives are important but abstinence is the primary goal
Drug-specific notes:
Opioids: constipation as common side effect; respiratory depression as the major life-threatening risk; naloxone as antidote
Nursing Process and Safety in Addiction Care
Nursing process emphasis: assessment is the first and most critical step to identify problems and guide interventions
Falls risk and safety are priorities during detoxification
Objective vs subjective data collection is necessary to form a complete clinical picture
The Chemically Impaired Nurse
Warning signs (as listed or implied in the slides): e.g., unexplained absences, patient complaints of pain, changes in behavior or performance
If a nurse suspects a chemically impaired colleague, the nurse’s responsibility is to report to a supervisor to protect patient safety
The safest and most effective approach when communicating with chemically impaired colleagues is nonjudgmental communication to maintain rapport and promote honest disclosure
Practical NCLEX and Study Tips Highlighted
Expect more select-all-that-apply questions; practice identifying potential items that fit such formats
Review the 50 NCLEX mental health practice questions on Blackboard; about 9 of those will appear on the actual exam
If you have questions, take advantage of instructor time and ask for clarification
Quick Reference Formulas and Key Numbers
Exam structure and practice questions: 30 questions for a review; 9 are word-for-word from the breakdown; 21 come from chapters 34 and 35
Practice set size: 50 NCLEX mental health practice questions
Test performance benchmarks: 20 ext{ extpercent} impact on your grade (example provided in the discussion)
Sleep/behavioral cues and risk assessment are case-based, with emphasis on identifying coping, anxiety levels, and withdrawal risk
Real-World Relevance and Ethical Considerations
Importance of compassionate, nonjudgmental care in mental health and addiction treatment
Ethical duty to protect patient safety when a nurse or healthcare worker is suspected of substance impairment
Recognition of the subjective nature of anxiety and stress underscores individualized patient care plans
The role of education in reducing stigma around mental health and encouraging help-seeking and treatment
Summary of Core Takeaways
Mental health assessment hinges on coping and adaptation
Erikson emphasizes task mastery across life stages; Freud emphasizes id, ego, superego and the pleasure/pain principle
Self-concept is composed of personal identity, body image, role performance (ascribed vs assumed), and self-esteem
Anxiety is a subjective, self-referential response; manage panic with breathing techniques and assess contributing factors
Defense mechanisms, especially denial and rationalization, are common exam topics; recognize and interpret them in scenarios
Therapeutic communication should center on the patient, employ open prompts like "Tell me more about…" and avoid defensive or distracting responses
Addiction concepts: tolerance vs dependence; stages of dependence; safety during detox; rehabilitation with abstinence as the primary goal
Alcohol withdrawal is life-threatening and requires aggressive management; opioids pose risk of respiratory depression; naloxone is the antidote
Comprehensive assessment includes both subjective patterns and objective indicators; plan safety-first detox and robust rehabilitation support
Always approach potential chemically impaired colleagues with nonjudgmental communication and report concerns to supervision
Leverage practice questions for test readiness and focus on assess-first strategies during exams