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?

Acute dystonia Signup and view all the answers

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

2-4 weeks Signup and view all the answers

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

Alogia Signup and view all the answers

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

Reinforcing the hallucinations Signup and view all the answers

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

Self-harm Signup and view all the answers

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

Irritable mood Signup and view all the answers

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

Day treatment Signup and view all the answers

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

Increase in the number of homeless patients Signup and view all the answers

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

Wyatt v. Stickney Signup and view all the answers

What does the M'Naghten Rule pertain to?

Determining criminal responsibility due to mental illness Signup and view all the answers

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

For the protection of patients or others Signup and view all the answers

What constitutes malpractice in the context of mental health care?

Professional negligence by a healthcare provider Signup and view all the answers

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

A physician's order Signup and view all the answers

Which of the following is considered a tort?

Negligence in treatment Signup and view all the answers

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

Unlawful restraint of a patient Signup and view all the answers

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

Showing interest and concern for the patient. Signup and view all the answers

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

Empathy Signup and view all the answers

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

It helps highlight an underlying message from the patient. Signup and view all the answers

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

To acknowledge behavioral cues and emotional states. Signup and view all the answers

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

Encouraging description of perceptions Signup and view all the answers

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

It offers an objective view without arguing. Signup and view all the answers

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

To help the patient reflect on changes over time. Signup and view all the answers

What does 'focusing' achieve in therapeutic communication?

Redirects the patient’s attention to the main issue. Signup and view all the answers

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

Encouraging decisions Signup and view all the answers

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

To help the patient practice social interactions. Signup and view all the answers

What is a characteristic behavior of bulimia nervosa?

Binge eating followed by compensatory behaviors Signup and view all the answers

Which is a common symptom experienced during alcohol withdrawal?

Tremors and anxiety Signup and view all the answers

What is the onset pattern of dementia?

Slow and gradual Signup and view all the answers

What is a key nursing consideration for patients with dementia?

Monitor food and fluid intake Signup and view all the answers

Delirium is characterized by which feature?

Identifiable cause and sudden onset Signup and view all the answers

What is the recommended treatment for delirium tremens?

Benzodiazepines Signup and view all the answers

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

24-48 hours Signup and view all the answers

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

Extreme weight loss Signup and view all the answers

Which of the following is a side effect of opioids?

Drowsiness Signup and view all the answers

Which sign is indicative of inhalant use?

Rash around the nose and mouth Signup and view all the answers

What is a common withdrawal symptom of opioids?

Chills Signup and view all the answers

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

Use terms like 'alcoholic' Signup and view all the answers

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

Abstinence Signup and view all the answers

What is a potential consequence of stimulant overdose?

Cardiac ischemia Signup and view all the answers

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

Contemplation Signup and view all the answers

Which of the following is a side effect of hallucinogens?

Impaired short-term memory Signup and view all the answers

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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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.