HD module 5

MENTAL ILLNESS VOLUME 2 - MODULE 5 L. BRISKA RN BSN

  • Related Material: Introductory Mental Health Nursing, Womble, Kincheloe, Chapters 2, 5, 11, 12, 14 - 17

KEY TERMINOLOGY

  • Ketamine: A dissociative anesthetic with potential therapeutic effects in treatment-resistant depression.

  • Glutamate: A neurotransmitter involved in learning and memory; its dysregulation is implicated in various mental disorders.

  • Persecutory: Pertaining to the belief that one is being targeted or harmed by others, common in paranoid ideation.

  • Antagonist: A substance that blocks or dampens the biological effects of another (e.g., opioid antagonists block the effects of opioids).

  • Manic: A state of abnormally elevated or irritable mood, which affects a person’s ability to function normally.

  • Hypnagogic: Related to the state immediately preceding sleep, often associated with vivid hallucinations.

  • Hallucination: A sensory perception that occurs in the absence of an external stimulus, can involve any of the senses.

  • Psychosis: A severe mental disorder characterized by a disconnection from reality, including symptoms such as hallucinations or delusions.

  • Neurosis: A class of functional mental disorders marked by anxiety or avoidance behaviors but not involving a loss of touch with reality.

SCHIZOPHRENIA

  • Definition: Derived from Greek words, "Schizo" meaning to split and "Phrenia" meaning mind. Schizophrenia is a chronic and severe mental disorder that affects how a person thinks, feels, and behaves.

Epidemiology

  • Prevalence: 1 in 222 adults are affected; however, 2/3 do not receive appropriate medical treatment.

  • Life Expectancy: Individuals with schizophrenia live 10-20 years shorter than the general population.

  • Age of Onset: Typically begins in late adolescence to mid-30s, with men affected between ages 18-25 and women between 25-30. Symptoms in women tend to be less severe.

Core Symptoms

  • Disturbances in thinking, mood, and behavior.

  • Changes in reality perception, often accompanied by disorganization and discord.

PHASES OF SCHIZOPHRENIA

  1. Schizoid Personality: The initial phase characterized by secrecy, isolation, and a lack of interest in social relationships.

  2. Prodromal Phase: Features various mood changes (anxiety, depression, mood swings), sleep disturbances, irritability, alignment impairment, and eccentric behavior.

  3. Active Phase: Clear manifestation of schizophrenia symptoms, often classified as positive and including hallucinations and delusions.

POSITIVE SYMPTOMS

  • Definition: Symptoms that reflect an excess or distortion of normal functions. Evident early in the disease process.

  • Common types include:

    • Delusions: Strongly held false beliefs.

    • Word Salad: Disorganized speech lacking meaningful connection between words.

    • Clang Associations: Rhyming words or phrases without logical connection.

    • Thought Broadcasting: Believing that one's thoughts are being transmitted outside their mind.

    • Hallucinations: Sensory experiences without external stimuli.

    • Loose Associations: Disconnected, incoherent thoughts.

    • Neologisms: Making up new words.

    • Bizarre behavior and agitation.

    • Catatonia: A state characterized by lack of movement or responsiveness.

NEGATIVE SYMPTOMS

  • Definition: Symptoms that reflect a decrease or loss of normal function, developing slowly over time.

  • Types of negative symptoms include:

    • Flat Affect: Diminished emotional expression.

    • Avolition: Inability to initiate and sustain activities.

    • Anhedonia: Lack of pleasure in previously enjoyable activities.

    • Impoverished Speech: Decreased verbal expression.

    • Social Withdrawal: Inability to interact with others, often leading to isolation.

    • Increased risk of substance use, depression, and suicidal actions.

TYPES OF SCHIZOPHRENIA

  • Paranoid Schizophrenia: Exhibits suspiciousness, delusions, and often auditory hallucinations.

  • Disorganized Schizophrenia: Involves inappropriate emotional responses and disorganized behaviors.

  • Undifferentiated Schizophrenia: Symptoms are insufficient to fit into other categories but still significant.

  • Catatonic Schizophrenia: Characterized by extreme movements, either stupor or excited behavior.

PROGNOSIS

  • Rule of Quarters: An observational measure of recovery:

    • 25% fully recover.

    • 25% improve significantly but may have residual symptoms.

    • 25% experience chronic symptoms requiring support.

    • 25% have poor outcomes with severe symptoms.

  • Factors influencing prognosis include:

    • Time of onset: Early onset is generally associated with a worse trajectory.

    • Support systems: Good family support correlates with better outcomes.

    • Medication compliance: Essential for management and recovery.

SCHIZOAFFECTIVE DISORDER

  • Definition: A serious mental condition where the individual exhibits symptoms of schizophrenia (both positive and negative) alongside mood disorder symptoms (major depressive disorder or bipolar disorder).

  • Consequence: Often chronic and significantly disabling.

TREATMENT OF SCHIZOPHRENIA

  • Medication Approach: Includes regular use of antipsychotic medications, potentially requiring anticholinergic medications to manage side effects.

  • Long-Acting Injectables (LAI): Administered for non-compliance, these medications last from 2-4 weeks.

  • Adjuvant Therapies: Patients unresponsive to standard treatment may benefit from Allopurinol to decrease symptoms.

  • Electroconvulsive Therapy (ECT): Effective in changing neurotransmitter levels and managing severe cases.

  • Psychotherapy: Focus on social skills training and coping strategies is also integral to treatment.

ANTI-PSYCHOTIC MEDICATIONS

  • Potency: Defined as the amount of medication required for effectiveness and the frequency of side effects associated.

    • High Potency: Increased risk of extrapyramidal side effects; e.g., Haloperidol, Thiothixene.

    • Moderate Potency: E.g., Loxapine, Molindone.

    • Low Potency: Higher anticholinergic side effects; e.g., Chlorpromazine, Thioridazine.

CONTRAINDICATIONS

  • Hypersensitivity: Allergic reactions.

  • Severe Depression: Use caution due to potential exacerbation of depressive symptoms.

  • Organ Insufficiencies: Liver, renal, or cardiac issues hinder proper metabolism.

  • Blood Dyscrasias: Can disrupt blood cell production.

SIDE EFFECTS

  • Anticholinergic Reactions: Symptoms may include dry mouth, blurred vision, urinary retention, etc.

  • Extrapyramidal Side Effects: Include Akathisia (restlessness), Dystonias (muscle rigidity), and Tardive Dyskinesia (involuntary movements that can be irreversible).

  • Neuroleptic Malignant Syndrome: Serious condition with symptoms such as hyperthermia, severe muscle rigidity, altered mental status occurring shortly after starting treatment.

  • Tardive Dyskinesia: Characterized by involuntary muscle movements, primarily due to long-term antipsychotic use.

NURSING CARE FOR PATIENT WITH SCHIZOPHRENIA

  • Nursing Process: Addressing noncompliance with medications, knowledge deficits, activity intolerance, risk for injury, and ineffective coping strategies.

  • Interventions:

    • Monitor medication side effects, assist with daily activities, and ensure a calm atmosphere.

    • Promote reality orientation and avoid reinforcing hallucinations.

    • Recognize and manage physical health needs to assist with oral care and hydration.

SUBSTANCE ABUSE

  • Addiction: A chronic condition marked by physical and psychological dependence, characterized by withdrawal symptoms and a desire to continue using despite adverse consequences.

    • Tolerance: Need for increased amounts to achieve desired effects.

    • Withdrawal: Symptoms that arise from cessation after prolonged use.

    • Abstinence: Complete cessation of substance use.

    • Relapse: Return to substance use after a period of abstinence.

SUBSTANCE DEPENDENCY

  • Criteria: Establishing substance dependency requires the presence of at least three symptoms over one month.

    • Symptoms may include tolerance, withdrawal, unsuccessful attempts to cut down use, excessive time spent using, continued use despite problems, and use of substances in hazardous situations.

ALCOHOL (ETOH) ABUSE

  • CNS Depressant: Directly absorbed into the bloodstream.

  • Effects: Initially may induce relaxation but also leads to intoxication presenting symptoms such as slurred speech and impaired coordination.

LONG-TERM EFFECTS

  • Health Risks: Include cardiomyopathy, cirrhosis, vitamin deficiencies, gastrointestinal problems, and potentially fatal Wernicke-Korsakoff syndrome.

ASSESSMENT

  • Alcohol Assessment Tools:

    • MAST (Michigan Alcohol Screening Tool) and CAGE Questionnaire to evaluate drinking behavior.

TREATMENTS FOR ETOH ABUSE

  • Detoxification: Required prior to rehabilitation.

  • Management of Withdrawal Symptoms: Symptoms start 4-6 hours post last drink; may include anxiety, irritability, and potentially Delirium Tremors (DTs).

NURSING CARE DURING DETOXIFICATION

  • Support: Same as cognitive disorder care. Utilize medications such as Librium for DT's management.

  • Nutritional Support: Provide thiamine, B-12, niacin to prevent complications and manage withdrawal symptoms.

POST-DETox Nursing Care

  • Assessment of Physical and Psychological State: Close monitoring for signs of low self-esteem, depression, and risk of suicide.

  • Supportive Care: Engage in therapeutic communication and group therapy processes to foster recovery.

DRUG ABUSE SUMMARY

  • Characteristics: Individuals display low self-esteem, utilize defense mechanisms like denial, manipulate relationships, and showcase physical symptoms like watery eyes and anxiety.

COMMONLY ABUSED DRUGS

  • Marijuana: Contains THC, psychoactive effects include anxiety, increased appetite, and potential for psychological dependence.

  • Cocaine: Highly addictive, leading to vivid hallucinations, cardiovascular complications, and severe mood disorders.

  • Opiates: High tolerance develops quickly; includes morphine, heroin, etc., with overdose risks requiring swift treatment like Narcan.

  • Hallucinogens: Affect perception and reality; can lead to distress and altered states of consciousness.

  • Benzodiazepines: Abused for their sedative effects but present risks for dependence and withdrawal symptoms.

TREATMENTS FOR DRUG ABUSE

  • Support Groups: Narcotics Anonymous and therapy targeted at coping skills and rehabilitation.

  • Medications: Methadone as a substitute, Naltrexone for craving reduction, and psychosocial therapy with family support networks.

PERSONALITY DISORDERS

Features

  • Characteristics: Inflicts disruption in functioning, involves inflexible traits, and demonstrates maladaptive behaviors.

    • Early diagnosis typically made in childhood or adolescence.

CLUSTER CLASSIFICATIONS

  • Cluster A: Odd/eccentric behaviors (Paranoid, Schizoid, Schizotypal).

  • Cluster B: Dramatic/emotional behaviors (Borderline, Narcissistic, Antisocial, Histrionic).

  • Cluster C: Anxious/fearful behaviors (Avoidant, Dependent, Obsessive-Compulsive).

BORDERLINE PERSONALITY DISORDER (BPD)

  • Characterization: Commonly found in females, marked by unstable interpersonal relationships, intense emotions, and impulsive behaviors, sometimes resulting in self-harm or risky activities.

TREATMENT APPROACHES FOR BPD

  • Interventions: Focus on Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy, and developing coping strategies.

  • Medication management is typically adjunctive, primarily used for the management of depression or anxiety.

DISSOCIATIVE PERSONALITY DISORDER

  • Definition: A condition reflective of severe trauma during childhood leading to the fragmentation of identity.

GENERALIZED NURSING CARE

  • Implementation: Nurses must offer therapeutic communication, patience, and the establishment of safety protocols in their interactions with patients experiencing personality disorders.

EATING DISORDERS

  • Definition and Causes: Chronic disruptions in nutritional habits stemming from emotional challenges. Risk factors include poor self-image and a history of trauma.

MEDICAL COMPLICATIONS

  • Anorexia can lead to severe health risks including bradycardia, hypotension, and metabolic changes.

  • Bulimia may result in dental issues and electrolyte imbalances.

TREATMENT OF EATING DISORDERS

  • Nutritional Counseling: Emphasizing the need for healthy eating patterns alongside individual and group therapy when necessary.

SEXUAL DISORDERS

  • Scope: Disorders affecting sexual functioning, including dysfunctions related to interest/arousal, orgasmic issues, and pain disorders.

TREATMENT AND INTERVENTIONS

  • Integration of Therapies: Approaches include psychotherapy and potential medical interventions tailored to individual patient needs.

CRISIS INTERVENTION

  • Concept: Defined as an immediate response to a situation threatening to destabilize an individual's emotional or psychological functioning.

GOALS AND TACTICS

  • Focus: Ensure safety, identify issues, reduce anxiety, and help restore the patient to functioning.

THERAPEUTIC MILIEU

  • Setting: Cultured environment geared towards developing effective coping mechanisms and support for patients navigating crisis situations. Offers safety, security, and therapeutic engagement.