Week 1: Mental Health Concepts

Mental Health Overview

• Mental health encompasses the ability to engage in activities, maintain relationships, and adapt to challenges.
• Mental illness involves significant shifts in thought, emotion, or behavior, causing distress or functional impairment.
• Diagnostic criteria from the DSM highlight dysfunction in work, relations, or self-care as indicators of mental illness.

Mental Health Continuum

• Represents a spectrum from wellness to illness.
• Categories: Excelling (optimal well-being), Thriving (manageable stress), Surviving (problems without distress), Struggling (significant distress), Crisis (severe impairment).

Fight or Flight Response

• Physiologically, the body reacts to perceived threats intended for survival, triggered by emotional and psychological stressors.
• Defined by Hans Selye as a non-specific response to any demand on the body.

Brain Structures Involved in Stress Response

• Cerebrum consist of four lobes:
  • Frontal: voluntary movement, emotions
  • Parietal: sensory input
  • Temporal: auditory functions, emotions
  • Occipital: visual processing
• Diencephalon includes thalamus and hypothalamus, crucial for emotional regulation.

The Nervous System

• Neurotransmitters are chemicals that transmit signals across synapses and are key in mood regulation, often targeted by psychiatric medications.

Understanding Anxiety

• Anxiety is discomfort or apprehension often associated with fear of danger but becomes problematic if it interferes with daily functioning.
• Peplau’s levels of anxiety range from mild (enhanced focus) to panic (complete disorientation).

Genetics and Mental Health

• Genotype refers to an individual’s genetic makeup; phenotype indicates the expression of those genes.
• Epigenetics studies the impact of environmental factors on gene expression.
• Twin studies assess genetic vs. environmental influences on mental health disorders, including schizophrenia risk associated with family genetics.

History of Mental Health

• Explores the evolution of mental health care from historical views to contemporary understanding and treatment approaches.

Mental Health Care Settings

• Outpatient Services: Include mental health clinics, telehealth, case management, and home-based services for nonacute needs.
• Inpatient Services: For patients needing intensive supervision, including crisis stabilization and long-term care.
• Specialty Care: Tailored treatment programs for specific demographics like veterans and children.

Disparities in Mental Health Care

• Social determinants—such as inequality, education, and poverty—affect mental health outcomes and access to care.

Building Therapeutic Relationships

• Essential in psychiatric nursing, involving mutual respect and psychosocial support.
• Phases of Therapeutic Relationship:
  • Orientation: relationship establishment,
  • Identification: recognize barriers,
  • Working: collaborative goal achievement,
  • Termination: transition of care.

Communication Strategies

• Utilize open-ended questions, affirmations, reflections, and summaries to facilitate effective nurse-patient communication.

Motivational Interviewing Steps

• Engage the patient to build rapport, focus on their goals, evoke discussions on change reasons, and plan actionable steps.

Bias-Free Language

• Use person-first language to refer to clients, avoiding stigmatizing terms.

Culturally Sensitive Nursing Care

• Cultural Formulation Interview assesses how cultural factors impact patient health beliefs.
• Importance of understanding cultural differences through practical examples.

Nursing Process and Clinical Judgment Action Model

• Establishes six steps, ensuring effective patient assessments and interventions.

Seclusion and Restraints

• Employed as last resort, requiring provider orders, with time limits based on patient age.
• Prioritize patient needs for comfort and safety during confinement.

Legal Considerations: Torts

• Intentional Torts: Actions damaging client rights (e.g., false imprisonment).
• Unintentional Torts: Failure to meet care obligations; includes negligence and malpractice.

Anxiety Disorders

• Defined by discomfort and dread, exacerbated when impairing functioning.
• Panic Disorder involves unpredictable panic attacks with physical symptoms.
• Complementary approaches include mindfulness and relaxation techniques.

Pharmacologic Treatments for Anxiety

• SSRIs are first-line for anxiety; Benzodiazepines for acute cases, with dependency risks.
• Buspirone is a non-sedating anxiolytic; Propranolol mitigates performance anxiety symptoms.

Nursing Interventions for Anxiety Disorders

• Maintain calm during panic attacks, reduce stimuli, and teach coping strategies.

Depressive Disorders

• Major Depressive Disorder characterized by a persistently low mood and lack of pleasure.
• Seasonal Affective Disorder typically linked to winter months; Persistent Depressive Disorder denotes chronic low mood.
• PMDD involves severe mood changes pre-menstruation, resolving shortly after menstruation begins.