Mental Health Disorders Quiz

Mental Health Disorders

• Major Depressive Disorder
  • Symptoms: loss of interest and pleasure in activities, no history of manic behavior, long-term
  • Part of every mental health disorder
• Bipolar Disorder
  • Associated with increased mortality, mood swings from depression to euphoria (mania)
  • Nurse-client relationship: utilizing communication techniques like humor, bargaining, and honest feedback
• Stress
  • Maladaptive coping: unable to satisfactorily progress through the stages of grieving to achieve resolution
  • Examples: psychological stress can impact medical conditions

Somatic Symptom Disorders

• Somatic Symptom Disorder
  • Symptoms: unrealistic interpretation of physical symptoms or sensations, extremely conscious of bodily sensations and changes
  • Anxiety and depression are common, obsessive-compulsive traits frequently accompany the disorder
• Conversion Disorder
  • Symptoms: lack of patient concern over physiological changes, loss of function that cannot be explained by a known medical diagnosis
  • Unconsciously triggered, difficulty diagnosing
• Factitious Disorders
  • Consciously feigning physical and/or psychological symptoms for attention
  • Secondary gain: attention, increased hospital visits, vague symptoms
• Hypochondriasis
  • Unrealistic interpretation of physical symptoms or sensations, leading to preoccupation and fear of having a serious disease
  • Constant anxiety, frequent hospital visits

Anxiety Disorders

• Obsessive Compulsive Disorder
  • Ritualistic tasks and compulsions, unable to interrupt because they must start over
  • Treatment: explore triggers, treat the trigger to get rid of feelings and anxiety
• Dissociative Disorders
  • Inability to recall important information, not directly caused by substance or neurological dysfunction
  • May not get back full memory, fugue, wandering, and inability to recall some or all of one's past
  • Treatment: family must be involved in therapy, provide safety
• Dissociative Identity Disorders
  • Multiple personality disorder, split into multiple personalities to protect themselves
  • Common in schizoaffective, must have a secondary disorder
  • Nursing interventions: establish rapport and trust, prioritize!

Schizophrenia

• Phases
  • Social maladjustment (premorbid), prodromal, active psychotic, and residual
  • Symptoms: hallucinations, delusions, disorganized speech, movement disorders, negative symptoms like depression and lack of interest
• Schizoaffective Disorder
  • Plan of care: safety, discharge planning, and evaluating outcomes
  • Nursing interventions: de-escalate, distract client, help client out of their own head and away from voices

Anxiety Disorders (Cont.)

• Acute Anxiety
  • Behaviors: social withdrawal
• General Anxiety Disorder (GAD)
  • Symptoms: irritability, pacing, fatigue, insomnia, restlessness
• Panic Anxiety
  • Symptoms: hyperventilation, insomnia, loss of reasoning, inability to concentrate, short of breath, chest pain
  • Nursing interventions: decrease stimulation, PRN medications (e.g., benzos), and leave client
• Social Anxiety
  • Excessive fear of situations in which the affected person might do something embarrassing or be evaluated negatively by others
  • Symptoms: depression or fear, palpitations, social isolation, sweating, upset GI, nausea, muscle tension
  • Interventions to help patient cope: flooding, systematic desensitization, CBT, thought stopping
• Phobia
  • Fear of going outside the home, leaving safety of personal space
  • Examples: traveling in public transportation, being in open spaces, shopping, and crowds

Substance Use Disorder (SUD)

• Wernicke's Encephalopathy
  • Pathophysiology: thiamine deficiency in alcoholic patients, vitamin B12 deficiency
  • Symptoms: muscle rigidity, decreased motor function, seizures
• Treatment
  • Withdrawal (alcohol): disulfiram (Antabuse), benzodiazepines, anticonvulsant medications
  • Opioid: Narcan (naloxone)

Key Terms

• Malingering: creating situations to avoid having to deal with the reality of another situation### Compulsions and Rituals
• Compulsions are repetitive, ritualistic behaviors or mental acts that an individual feels driven to perform to reduce anxiety associated with obsessive thoughts.
• Rituals help relieve anxiety, give a sense of feeling and control over life, and increase self-concept.

Medications

• Antidepressants, SSRIs, Prozac, Zoloft, and Luvox are commonly used to treat anxiety and depression.
• May require higher doses than what is effective for treating depression.

Body Dysmorphic Disorder

• Definition: Exaggerated belief that the body is deformed.
• Symptoms:
  • Anorexia
  • Bulimia
  • OCD
  • Depression
  • Social isolation
  • Decreased sleep
  • Decreased appetite
  • Multiple surgeries to fix perceived flaws.
• Treatment:
  • Therapy (group, individual, and family)
  • Medications (antidepressants)

Somatic Symptom Disorder

• Definition: Syndrome of multiple somatic symptoms that cannot be explained medically and are associated with psychosocial distress and frequent visits to healthcare professionals.
• Characteristics:
  • Expressing heightened emotions
  • Seductiveness and strong dependency needs
  • Anxiety
• Medication:
  • Antidepressants can treat pain.
• Preoccupied with perceived physical symptoms rather than underlying psychosocial issues.

Illness Anxiety Disorder (Hypochondriac)

• Definition: Unrealistic or inaccurate interpretation of physical symptoms that lead to preoccupation and fear of disease.
• Symptoms:
  • Increased hospital visits
  • Drug seeking
  • Constant worry
  • Hypervigilance
• Depression is common, and OCD traits often accompany this disorder.

Conversion Disorder

• Definition: Unconsciously triggered symptoms that affect voluntary motor or sensory functioning, suggestive of neurological disease.
• Characteristics:
  • Paralysis
  • Decreased respiratory function and decreased swallowing
  • Seizures
  • Coordination disturbances
  • Difficulty swallowing
  • Urinary retention
  • Akinesia
  • Blindness
  • Deafness
  • Inability to feel pain
  • Hallucinations
  • Pseudocyesis (fake pregnancy)
• Nursing care:
  • Deal with physical symptoms in a detached manner to avoid reinforcing secondary gain.
  • Give praise to the patient if they realize they are experiencing an anxiety disorder.

Factitious Disorder (Munchausen Syndrome)

• Definition: Conscious, intentional feigning of physical and/or psychological symptoms.
• Individual pretends to be ill to receive emotional care and support.
• Characteristics:
  • Secondary gain (attention)
  • Increased hospital visits
  • Giving vague symptoms
  • Disorder may be imposed on another person under the care of the perpetrator (formerly called factitious disorder by proxy).

Dissociative Disorders

• Dissociative Amnesia:
  • Definition: Inability to recall important personal information that is too extensive to be explained by ordinary forgetfulness.
  • Characteristics:
    • Repression: unconsciously avoiding/forgetting things.
    • Suppression: voluntary avoidance.
    • Localized and selective amnesia: related to a specific stressful event.
  • Nursing care:
    • Ask A&O questions.
    • Ask about traumatic events or history of memory problems.
• Dissociative Fugue:
  • Definition: Sudden, unexpected travel away from customary places or by with inability to recall some/all of one's past.
  • Characteristics:
    • Bewildered wandering.
    • Dissociation: unconscious defense mechanism in which there is separation of identity, memory, and cognition from affect.

Dissociative Identity Disorder (DID)

• Definition: Formerly called multiple personality disorder.
• Characteristics:
  • Different personality states referred to as alter identities or alters.
  • Only one alter is present at a time.
  • Not very common.
  • May be sudden, gradual, or quiet and dramatic transitions.
  • Most common with childhood physical/sexual abuse.
  • Increased anger and violence.
• Commonly misdiagnosed as depression, borderline, antisocial, schitzo, epilepsy, or bipolar.
• Primary therapeutic goal: Collaborate among subpersonalities to improve functioning.

Depersonalization-Derealization Disorder

• Definition: Temporary change in quality of self-awareness, often taking the form of feelings of unreality, changes in body image, feelings of detachment from the environment or sense of observing oneself from outside the body.
• Symptoms:
  • Anxiety
  • Depression
  • Fear of going insane
  • Obsessive thoughts
  • Somatic complaints
  • Disturbance in subjective sense of time
• Medications:
  • Antidepressants (clomipramine-Anafranil)
• Depersonalization: Disturbance in the perception of oneself.
• Derealization: Alteration in the perception of the external environment.

Epidemiologic Stats

• Younger ages
• Military personnel, lower SES, rural populations, less education
• Dissociative disorders (DIDs) are quite rare, more prevalent in women than men.

Predisposing Factors

• Neuroanatomical: Brain dysfunction (impairment)
• Pain
• Psychosocial impairment
• Psychodynamic theory
• Ego defense mechanism: Low self-esteem, feelings of worthlessness
• Cognitive theory: Counterproductive thinking patterns accompany maladaptive behaviors and emotional disorders.
• Learning Theory: Somatic complaints are often reinforced when the sick person learns that they may avoid stressful obligations or be excused from unwanted duties.

Definitions to Know

• Malingering: Faking illness to get out of something
• Maladaptive: Change in a person's internal or external environment that leads to disruptive patterns for that patient
• Negative coping mechanisms: Isolation, increased sleeping, decreased learning
• Non-compliance: Not adhering to prescribed treatments

Test your knowledge on symptoms and characteristics of Major Depressive Disorder and Bipolar Disorder, including mood swings, depression, and nurse-client relationships.