Mental Health Facility Admissions

Types of Admission or Commitment to a Mental Health Facility

• Voluntary Admission: Patients admit themselves and can leave at any time. If they become a threat, it may transition to involuntary.
• Involuntary Commitment: Criteria include posing a threat to self or others, or being gravely disabled (unable to care for basic needs). Typically requires confirmation by two physicians. Specifics vary by state.
• Emergency Commitment: Used when the patient poses an imminent threat to themselves or others. Requires a court hearing within 24-72 hours (state-dependent) to determine if the person will be involuntarily committed or discharged.

Patient Rights

• Confidentiality: Protected under HIPAA. Patient information cannot be shared without consent, except in the case of a "duty to warn," if the patient threatens a third party.
• Right to Refuse Treatment: Applies to both voluntarily and involuntarily admitted patients. Nurses must educate on risks and benefits, but respect the patient's choice. Emergency situations where the patient is violent and poses a risk to themselves or others may allow treatment without consent.
• Right to the Least Restrictive Environment: Patients should receive care in the least restrictive environment possible. Restraints and seclusion are only used as a last resort.

Informed Consent and Nursing Ethical Principles

• Definition: Informed consent is the patient's voluntary agreement to a procedure after receiving adequate information about it, alternatives, and risks/benefits.
• Provider's Role: Explain the procedure, offer alternatives, and detail risks/benefits; answer questions to ensure understanding.
• Nurse's Role: Witness the patient signing the consent form. Verify patient has adequately received information, understands, and is consenting willingly.
• Patient Competency: To be competent, they need to be over 18, and not impaired by substance use, hallucinations, or dementia. Minors under certain circumstances may give valid consent.
• Patient's Rights: Patients can change their mind or refuse treatment at any time, even after signing the consent form.

Torts in Nursing

• Definition: Torts are legal wrongs that cause harm to a patient, classified as intentional or unintentional.
• Intentional Torts: Willful acts that violate a patient's rights, including assault (threat), battery (actual harm), false imprisonment (unlawful confinement), invasion of privacy, and defamation of character.

Restraints and Seclusion

• When to Use: Only when the patient poses an imminent threat to themselves or others.
• Types of Restraints: Physical restraints (mittens, belts, vests) and chemical restraints (benzodiazepines, antipsychotics).
• Documentation: Include the rationale, duration of use, and care provided during restraints.
• Before Restraints/Seclusion: Always try less restrictive alternatives first.

Phases of the Nurse-Client Relationship and Therapeutic Communication

• Pre-Orientation Phase: Reviewing the patient's chart, examining personal feelings, and preparing for the first meeting.
• Orientation Phase: Performing introductions, setting boundaries, and developing agreeable goals.
• Working Phase: Gathering data, teaching skills, addressing issues and evaluating progress towards goals.
• Termination Phase: Summarizing goals achieved, addressing discharge plans and assisting with future coping mechanisms.

Non-Therapeutic Communication Techniques

• False Reassurance: Claims everything will be fine, dismissing concerns.
• Passing Judgment: Evaluating or judging the patient's behavior.
• Giving Advice: Directing the patient to do something specific rather than asking about their feelings.
• Close-Ended Questions: Asking questions which restrict the conversation.
• Why Questions: Putting the other person on the defensive.
• Leading/Biased Questions: Suggesting an answer and limiting their ability to share their perspective.
• Changing the Subject: Dismissing the patient's concerns.

Mental Status Examination (MSE)

• Purpose: Evaluates a patient's mental health by observing and assessing specific components. It can be a mini MSE (short) or an in-depth MSE (more thorough).
• Components: Appearance (clothing, hygiene), Behavior (cooperative, agitated), Motor Activity (posture, tremors), Speech (rate, tone, clarity), Mood and Affect (expressed emotions), Thought Process and Content (organized or not), Perception (hallucinations), Cognition (orientation, memory), Insight (self-awareness), Judgment (decision-making ability), and possible current risks of suicide or harm.
• Application: Can be used in any healthcare setting for discharge planning, such as assessing patient capabilities to care for themselves, or if they need to be referred to other settings (skilled nursing, long term care)

Stress and Anxiety

• Stress: The body's physical and emotional response to pressure, usually occurring in three stages: alarm, resistance, and exhaustion.
• Anxiety: A response to stress that ranges from mild to panic levels. Each level of anxiety is characterized by different symptoms and a different degree of impact on a patient.
• Nursing Care: Assessing level of anxiety, using calming techniques, and providing support.

Defense Mechanisms

• Unconscious or conscious attempts to reduce anxiety. They are categorized as avoiding, compensating, converting, denying, displacing, dissociating, identifying , intellectualizing, projecting, rationalizing, reacting, regressing all the way to suppressing or splitting.

Primary, Secondary, and Tertiary Prevention of Mental Health Disorders

• Primary Prevention: Aims to prevent mental disorders before they develop by reducing risk factors and promoting protective factors.
• Secondary Prevention: Focuses on early detection and intervention to minimize the impact of developing disorders, such as screening programs.
• Tertiary Prevention: Seeks to prevent complications of existing disorders and promotes recovery for individuals, such as support groups or other therapy after a hospitalization.

Therapies for Mental Health Disorders

• Relaxation Techniques: Progressive relaxation, biofeedback, guided imagery, meditation, and other methods.
• Milieu Therapy: Creates a therapeutic environment to foster positive interactions amongst patients.
• Group Therapy: Offers socialization, support, and education in a group setting.
• Behavioral Therapy: Aims to decrease maladaptive behaviors.
• Operant Conditioning: Uses positive reinforcement to strengthen desired behaviors.
• Modeling: Patients learn by observing and imitating appropriate behaviors.
• Aversion Therapy: Pairs negative stimuli with an undesired behavior, creating a negative association.
• Systematic Desensitization: Gradually exposing patients to feared stimuli while practicing relaxation.
• Flooding: Exposing patients to the feared stimuli intensely to reduce anxiety over time.

Cognitive Behavioral Therapy (CBT), EMDR, and TMS

• CBT: Aimed at replacing negative thinking with positive, realistic thinking, and challenges underlying beliefs.
• EMDR: Processing traumatic memories and reducing associated distress while engaging in eye movements.
• TMS: Non-invasive procedure that stimulates brain areas related to mood regulation.

Electroconvulsive Therapy (ECT) and Vagus Nerve Stimulation (VNS)

• ECT: Using electrical currents in the brain, typically used for severe/treatment-resistant depression.
• VNS: A surgically implanted device delivers electrical pulses affecting neurotransmitters in the brain, often used for treatment-resistant depression.

Neurotransmitters and Patient Teaching for Psychiatric Medications

• Neurotransmitters: Chemical messengers in the brain, influencing mood, behavior, and other functions.
• Patient Teaching: Educate patients on side effects and interactions that different medications have with their bodies to manage those effects accordingly.

Medications for Anxiety - Benzodiazepines and Atypical Anxiolytics

• Benzodiazepines: Medications used short term for anxiety, but can cause dependence over time, and are associated with risks.
• Atypical Anxiolytics: Medications used long-term for anxiety, often without the risk of dependence associated with benzodiazepines. May also be used for other conditions.

Selective Serotonin Reuptake Inhibitors (SSRIs) and Selective Serotonin and Norepinephrine Reuptake Inhibitors (SNRIs)

• SSRIs and SNRIs: Increase serotonin and norepinephrine levels in the brain, used to treat anxiety and depression, among others.

Tricyclic Antidepressants

• Tricyclic Antidepressants: Affect levels of norepinephrine and serotonin, used to treat conditions like depression and neuropathy.

Monoamine Oxidase Inhibitors (MAOIs)

• MAOIs: Increase levels of norepinephrine, serotonin, and dopamine but can cause hypertensive crisis if combined with certain foods or medications.

Atypical Antidepressants

• Atypical Antidepressants: Varying mechanisms and applications, including depression, anxiety, and more.

Bipolar Disorder Medications

• Mood Stabilizers: Medications such as Lithium and anticonvulsants that help manage mood fluctuations, such as in bipolar disorder.

Schizophrenia Medications

• First-Generation Antipsychotics: Medications to treat positive symptoms of schizophrenia, including hallucinations and delusions.
• Second-Generation Antipsychotics: Medications to treat both positive and negative symptoms of schizophrenia.

Anxiety Disorders

• Generalized Anxiety Disorder (GAD): Chronic and excessive worry.
• Specific Anxiety Disorders: Include social anxiety, phobias (such as agoraphobia, arachnophobia, and claustrophobia), and others.

Major Depressive Disorder (MDD)

• Definition: Persistent low mood, loss of interest, and other symptoms lasting at least two weeks.
• Risk factors: Include personal and family history of depression, chronic illness, female gender, and unmarried status.
• Symptoms: Include persistently low mood, loss of interest, and changes in appetite or sleep.
• Diagnosis: Based on the presence of at least five specific criteria persisting for at least two weeks.

Other Depressive Disorders

• Persistent Depressive Disorder: Chronic low mood lasting at least two years.
• Premenstrual Dysphoric Disorder (PMDD): Severe depression and irritability in the week or two prior to menstruation.
• Seasonal Affective Disorder (SAD): Depression occurring during winter months, linked to decreased sunlight.
• Treatment options, including therapy, and different medications depending on the condition.

Explore the various types of admissions and commitments to mental health facilities, including voluntary, involuntary, and emergency commitments. Additionally, understand patient rights regarding confidentiality and treatment refusal. This quiz will test your knowledge on the legal and ethical aspects of mental health care.