Mental Health Law and Deinstitutionalization
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Questions and Answers

What is the primary goal of milieu therapy?

  • To improve medication adherence
  • To provide individual therapy sessions
  • To reduce the need for psychiatric medication
  • To help the patient learn communication with peers (correct)

Which of the following antipsychotics is a first-generation medication that primarily addresses positive schizophrenic symptoms?

  • Chlorpromazine (correct)
  • Amitriptyline
  • Fluoxetine
  • Sertraline

What is a common side effect associated with first-generation antipsychotics like Haloperidol?

  • Increased energy and focus
  • Enhanced libido
  • Increased serotonin levels
  • Sedation and dry mouth (correct)

Which symptom occurs within a few hours to days after taking antipsychotics and is treated with Benadryl?

<p>Acute dystonia (B)</p> Signup and view all the answers

How long does it typically take for SSRIs to become effective as an antidepressant?

<p>2-4 weeks (A)</p> Signup and view all the answers

What is a common symptom associated with negative (Type 2) symptoms in schizophrenia?

<p>Alogia (A)</p> Signup and view all the answers

What should a nurse avoid doing when interacting with a patient experiencing hallucinations?

<p>Reinforcing the hallucinations (A)</p> Signup and view all the answers

What is a potential risk that must be assessed in patients with schizophrenia?

<p>Self-harm (B)</p> Signup and view all the answers

Which of the following is characteristic of a manic episode in bipolar disorder?

<p>Irritable mood (D)</p> Signup and view all the answers

What type of care is typically provided for stable but chronic schizophrenia patients?

<p>Day treatment (A)</p> Signup and view all the answers

What was a significant consequence of deinstitutionalization in the late 1960s and 70s?

<p>Increase in the number of homeless patients (A)</p> Signup and view all the answers

Which legal case established the right to treatment in the least restrictive environment?

<p>Wyatt v. Stickney (D)</p> Signup and view all the answers

What does the M'Naghten Rule pertain to?

<p>Determining criminal responsibility due to mental illness (C)</p> Signup and view all the answers

Under what circumstance can a patient's rights be suspended?

<p>For the protection of patients or others (C)</p> Signup and view all the answers

What constitutes malpractice in the context of mental health care?

<p>Professional negligence by a healthcare provider (C)</p> Signup and view all the answers

What is required within one hour of a patient's restraint according to patient rights?

<p>A physician's order (C)</p> Signup and view all the answers

Which of the following is considered a tort?

<p>Negligence in treatment (A)</p> Signup and view all the answers

What is the definition of false imprisonment in the context of mental health care?

<p>Unlawful restraint of a patient (C)</p> Signup and view all the answers

What is meant by 'offering self' in therapeutic communication?

<p>Showing interest and concern for the patient. (B)</p> Signup and view all the answers

Which technique emphasizes understanding the patient's feelings by acknowledging their pain?

<p>Empathy (C)</p> Signup and view all the answers

What does the technique of 'verbalizing the implied' achieve?

<p>It helps highlight an underlying message from the patient. (A)</p> Signup and view all the answers

What is the purpose of 'making observations' during communication?

<p>To acknowledge behavioral cues and emotional states. (D)</p> Signup and view all the answers

Which communication strategy involves asking the patient to explore what they think is happening to them?

<p>Encouraging description of perceptions (D)</p> Signup and view all the answers

How does 'presenting reality' differ from other communication techniques?

<p>It offers an objective view without arguing. (B)</p> Signup and view all the answers

What is the goal of 'encouraging comparisons' in a therapeutic setting?

<p>To help the patient reflect on changes over time. (D)</p> Signup and view all the answers

What does 'focusing' achieve in therapeutic communication?

<p>Redirects the patient’s attention to the main issue. (D)</p> Signup and view all the answers

Which technique asks the patient to determine necessary changes in their behavior?

<p>Encouraging decisions (D)</p> Signup and view all the answers

What is the purpose of 'role playing' in therapeutic communication?

<p>To help the patient practice social interactions. (D)</p> Signup and view all the answers

What is a characteristic behavior of bulimia nervosa?

<p>Binge eating followed by compensatory behaviors (B)</p> Signup and view all the answers

Which is a common symptom experienced during alcohol withdrawal?

<p>Tremors and anxiety (C)</p> Signup and view all the answers

What is the onset pattern of dementia?

<p>Slow and gradual (A)</p> Signup and view all the answers

What is a key nursing consideration for patients with dementia?

<p>Monitor food and fluid intake (A)</p> Signup and view all the answers

Delirium is characterized by which feature?

<p>Identifiable cause and sudden onset (C)</p> Signup and view all the answers

What is the recommended treatment for delirium tremens?

<p>Benzodiazepines (D)</p> Signup and view all the answers

How soon can withdrawal symptoms appear after the last drink for alcoholics?

<p>24-48 hours (D)</p> Signup and view all the answers

Which of the following is NOT a symptom of bulimia nervosa?

<p>Extreme weight loss (B)</p> Signup and view all the answers

Which of the following is a side effect of opioids?

<p>Drowsiness (C)</p> Signup and view all the answers

Which sign is indicative of inhalant use?

<p>Rash around the nose and mouth (A)</p> Signup and view all the answers

What is a common withdrawal symptom of opioids?

<p>Chills (B)</p> Signup and view all the answers

Which intervention is NOT appropriate in the nursing-patient relationship for substance abuse?

<p>Use terms like 'alcoholic' (B)</p> Signup and view all the answers

What is the primary goal of nursing interventions for patients with substance abuse issues?

<p>Abstinence (C)</p> Signup and view all the answers

What is a potential consequence of stimulant overdose?

<p>Cardiac ischemia (D)</p> Signup and view all the answers

Which stage of the transtheoretical model involves recognizing behavior as a problem?

<p>Contemplation (D)</p> Signup and view all the answers

Which of the following is a side effect of hallucinogens?

<p>Impaired short-term memory (C)</p> Signup and view all the answers

Flashcards

Deinstitutionalization

A late 1960s/70s movement to discharge patients from mental institutions and classify mental illness as a disability.

M'Naghten Rule

Mental illness standard for criminal responsibility; a defendant is not criminally responsible if they were unable to understand the nature and quality of their actions due to mental illness.

Right to Treatment (Wyatt v.Stickney)

Patients have the right to receive treatment in the least restrictive environment.

Right to Refuse Treatment (Rogers v. Okin)

Patients have the right to refuse treatment against their will.

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Duty to Warn (Tarasoff v.Regents of UNC)

Mental health professionals have a legal duty to warn potential victims of threats of harm from their patients.

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Negligence

Failure to act as a reasonable person would in a given situation; a civil wrong.

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Involuntary Patient

A patient admitted to a facility against their will, typically when they are deemed a danger to themselves or others.

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Patient's Rights

Legal rights of patients concerning their care, including the right to confidentiality, freedom from restraints and seclusion, and consent to treatment.

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Milieu Therapy Goal

Pt learns communication and interpersonal skills in a community setting (like a psych unit).

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Chlorpromazine (Antipsychotic)

1st generation antipsychotic targeting positive schizophrenia symptoms.

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EPS (Extrapyramidal Symptoms)

Side effects of typical antipsychotics affecting movement.

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Acute Dystonia (EPS)

Sudden muscle spasms, typically within hours to days of starting an antipsychotic.

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SSRIs (Antidepressants)

Antidepressants that increase serotonin levels; may take 2-4 weeks to work.

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Therapeutic Communication

A way of communicating with patients to understand their feelings, thoughts, ideas, and needs.

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Offering Self

Showing interest and concern for the patient by saying something like, "I'll sit with you for a while."

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Active Listening

Paying attention to both verbal and nonverbal cues of patients, including patterns in their behaviors and feelings.

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Silence

Allowing the patient time to think and express themselves without interrupting.

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Empathy

Understanding and sharing the feelings of another person, recognizing their emotional state.

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Questioning

Involving using open-ended questions to gather information.

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General Leads

Words or phrases that encourage the patient to continue speaking without interrupting.

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Restating

Repeating the patient's words to clarify understanding.

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Presenting Reality

Providing the patient with a factual view of the situation.

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Gravely Disabled

Inability to provide basic needs like food, shelter, etc., due to a mental illness.

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Schizophrenia Delusions

False beliefs, often involving thoughts that others are harming or controlling the person.

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Negative Symptoms (Schizophrenia)

Symptoms involving a lack or absence of normal behaviors, such as reduced speech, energy, and motivation.

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Bipolar Disorder

A mood disorder characterized by extreme mood swings, including periods of both mania and depression.

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Manic Episode (Bipolar)

A period of elevated or irritable mood, accompanied by increased energy and activity.

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Schizophrenia Patient Care

Nursing care for a patient experiencing schizophrenia, focused on not challenging the delusions or hallucinations and focusing on real-life situations

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Opioid Withdrawal

Symptoms like runny nose, sweating, tremors, and muscle aches that occur when opioid use is stopped.

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Opioid Side Effects

Effects like slowed breathing, constipation, low blood pressure, small pupils, slow heart rate, and drowsiness.

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Inhalant Signs

Physical evidence of inhalant use, like rashes around the nose and mouth, and residue on the face and clothing.

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Stimulant Overdose Symptoms

Rapid heart rate, high blood pressure, potential for heart problems, seizures, and coma due to stimulant overuse.

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Hallucinogen Side Effects

Changes in perception, impaired judgment, and increased heart rate and dilated pupils.

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Substance Abuse Treatment Goal

The ultimate goal in substance abuse treatment is complete abstinence from the substance.

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Transtheoretical Model Stages

A model that describes the stages of change in a person's readiness to quit substance use; like precontemplation, contemplation, preparation, action, maintenance, and relapse.

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Naloxone

An antidote for opioid overdose, reversing the effects of the drug by binding to opioid receptors, preventing them from over-activating.

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Bulimia Nervosa

Recurrent binge eating followed by behaviors to avoid weight gain, happening at least twice a week for three months. The person often appears normal weight, but has imbalances. There are also often GI problems due to binge/purge cycles.

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Delirium - Cause

Delirium has a specific reason, often related to sickness (medical condition) or medication interactions. It appears suddenly.

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Dementia - onset

Dementia develops gradually over a long period, starting with forgetfulness and getting worse over time.

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Alcohol Withdrawal Risk

Stopping alcohol abruptly after a period of use can be very dangerous, sometimes fatal. Symptoms can range from tremors and anxiety to seizures.

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Delirium Tremens

A potentially life-threatening complication of alcohol withdrawal, often appearing in the early days of withdrawal. Symptoms include confusion, heart racing, and excessive sweating

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Alcohol Withdrawal Symptoms

Symptoms include tremors, anxiety, nausea and vomiting, sleep problems, rapid heartbeat, high blood pressure, and profuse sweating. These may appear 6 to 8 hours after the last drink.

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Dementia Nursing Considerations

Focuses on safety, nutrition, and communication. Use simple instructions, well lit environment, provide finger foods and a bowel schedule.

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Substance Abuse Assessment

Using specific tools like the Michigan Alcoholism Screening Test (MAST) or the CAGE questionnaire to identify alcohol or drug problems.

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Study Notes

Deinstitutionalization

  • Occurred in the late 1960s/70s
  • Led to the discharge of patients from institutions
  • Classified mental illness as a disability
  • Increased homelessness among patients with severe mental illness
  • Universalized understanding of involuntary admittance regulations
  • Patients cannot be dropped off and declared unfit

Common Laws

  • Cognitive standard (M'Naghten Rule): not criminally responsible if experiencing mental illness at the time of the act.
  • Right to treatment (Wyatt v. Stickney): safe care in the least restrictive environment
  • Right to refuse treatment (Rogers v. Okin): patients cannot be forced to take medication against their will
  • Duty to warn (Tarasoff v. Regents of UNC): duty to warn others of threats of harm made by patients.

Torts (Civil Laws)

  • Negligence: failure to act as a reasonable person would
  • Malpractice: professional negligence
  • Assault: threatening someone with the ability to carry out the threat
  • Battery: unlawful touching of another
  • False imprisonment: unlawful restraint

Patient's Rights

  • Right to treatment in the least restrictive environment
  • Right to confidentiality of records
  • Right to freedom from restraints and seclusion
  • Physician's order needed within 1 hour of restraint; reassess every 2 hours
  • Right to give or refuse treatment.
  • Suspension of Rights: for self-risk of harm or the risk of harming others.

Me, Meds, Milieu

  • Nurse-patient relationship
  • Therapeutic communication (offering self, active listening)
  • Patterns of thinking, feelings, and behaviors.

Role Playing, Supportive Confrontation, Limits

  • Role Playing: simulating a scenario to practice communication.
  • Supportive Confrontation: acknowledging difficulty but encouraging action.
  • Limits: discouraging unproductive behaviors while encouraging productive ones.

Milieu Therapy (Environment)

  • Nurses create the environment
  • Nurse's role: manage milieu for safety.
  • Nurse implements structure
  • Consistency helps patient success.

Medications (Antipsychotics)

  • Chlorpromazine
  • Haloperidol (1st generation/typical), works on positive symptoms of schizophrenia.

Other Medications

  • Amitriptyline (antidepressant)
  • SSRIs (selective serotonin reuptake inhibitors): take 2-4 weeks to achieve full-effect; sexual dysfunction as a side effect.
  • Aripiprazole: schizophrenia, bipolar disorder
  • Clozapine: atypical antipsychotic
  • Escitalopram, Fluoxetine: MAOI

Bipolar Disorder

  • Extreme mood swings (mania and depression)
  • Manic episodes: elevated, irritable mood lasting days to months
  • Hypomanic episodes: less severe than manic episodes
  • Depressive episodes
  • Treatment focuses on stabilizing mood

Suicide

  • Risk factors include male, Caucasian, age ≥ 60, hopelessness, family history, substance abuse, and living alone

OCD

  • Characterized by obsessions (intrusive thoughts) and compulsions (repetitive behaviors)
  • Focus on basic needs (food, rest, grooming)
  • Emphasize simple, achievable activities

Personality Disorders

  • Cluster A (odd/eccentric): paranoid, schizoid, schizotypal
  • Cluster B (dramatic/erratic): antisocial, borderline, histrionic, narcissistic
  • Cluster C (anxious/fearful): avoidant, dependent, obsessive-compulsive

Eating Disorders

  • Anorexia nervosa: extreme fear of gaining weight (low body weight)
  • Bulimia nervosa: binge eating followed by compensatory behaviors
  • These disorders have various symptoms, physical consequences, and necessitate treatment

Dementia

  • Gradual, insidious onset of cognitive decline
  • Includes symptoms like forgetfulness

Substance Use Disorders

  • Alcohol and inhalants (sedatives/depressants).
  • Opioids (depressants)
  • Stimulants (amphetamines)
  • Hallucinogens (alter mental perception)
  • Recognizing addiction behaviors are critical in providing support and treatment

Stages of Change

  • Precontemplation (no change planned)
  • Contemplation (considering change)
  • Preparation (intention to take action)
  • Action (making changes)
  • Maintenance (sustaining change)
  • Relapse (falling back to old behaviors)

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Related Documents

Unit 2 Exam 144 Condensed Review PDF

Description

Explore the pivotal changes in mental health law, including deinstitutionalization, key legal cases, and civil law concepts like negligence and malpractice. Understand the rights of patients and the implications of mental health legislation. Test your knowledge on how these laws shaped the treatment and rights of individuals with mental illnesses.

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