Mental Health Exam PDF

Milieu Therapy Eight Conditions Promoting a Therapeutic Milieu Core Concepts (Townsend & Morgan, 2018) Definition of Milieu Therapy:...

Milieu Therapy Eight Conditions Promoting a Therapeutic Milieu Core Concepts (Townsend & Morgan, 2018) Definition of Milieu Therapy: 1.Basic Physiological Needs Fulfilled: Foundation for "Milieu" (French): "Surroundings" or "Environment." higher-level functioning (Maslow, 1968). Therapy involving the physical, social, and emotional environment, crucial for healing. Principles (Based on Skinner, 1979): 2.Safety: Physical, psychological, and emotional safety. 1. Realize and encourage the health within every individual. 3.Conducive Physical Facilities: Create an environment 2. Use every interaction as a therapeutic opportunity. that supports therapeutic goals. 3. Empower clients to own their environment. 4. Encourage clients to take responsibility for their behavior. 4.Democratic Self-Government: Include clients in 5. Use peer pressure as a powerful therapeutic tool. decision-making through community meetings. 6. Address inappropriate behaviors immediately. 5.Balanced Client Management: Maintain equilibrium in 7. Avoid restrictions and punishments. treatment approaches. Analogy 6.Responsibilities Based on Capabilities: Assign roles to Basic Needs: Rich soil supports growth, just as meeting clients' basic needs encourage independence. enables higher-level functioning. 7.Structured Social and Work Activities: Promote active Safety: A protective fence ensures security, mirroring the need for a safe and meaningful engagement. therapeutic environment. 8.Community and Family Inclusion: Integrate external Conducive Facilities: Optimized garden layout (pathways, sunlight, tools) support into the therapy program. reflects facilities that promote therapy. Democratic Governance: Gardeners collaboratively plan and decide, akin to shared decision-making in therapy. Nurses’ Roles in Milieu Therapy Balanced Management: Balanced care (water, sunlight, nutrients) Meet the 8 therapeutic conditions. represents equilibrium in treatment approaches. Focus on: Roles by Capability: Gardeners handle tasks suited to their skills, fostering independence like in therapy. Fulfilling physiological and safety needs. Structured Activities: Gardening tasks (planting, weeding) provide structure, Managing the therapeutic environment. mirroring therapeutic programs. Encouraging participation in structured activities. Community Inclusion: Family gatherings in the garden symbolize integrating Supporting independence and self-governance. external support into therapy.  Anxiety Predisposing Factors (APA, 2013) Types of Anxiety Disorders (DSM-5, APA 2013) Biological: 1. Neurochemical imbalance (norepinephrine, GABA, serotonin 1. Separation Anxiety Disorder: Fear of separation from dysregulation). attachment figures. 2. Genetic predisposition influenced by environment. 2. Selective Mutism: Inability to speak in social settings despite normal speech ability. Psychological: 3. Panic Disorder: Recurrent panic attacks with fear of recurrence 1. Early exposure to fear. 4. Generalized Anxiety Disorder (GAD): Excessive worry affecting 2. Effects of parenting, self-esteem, and resilience. efficiency and confidence. 5. Phobias. Behavioral: 6. Obsessive-Compulsive Disorder (OCD): 1. Frustration from unmet goals. Obsessions/compulsions causing distress or impairment. 2. Conflicts from competing drives causing anxiety. Pharmacotherapy: TNPR: Build trust, assess anxiety, and provide 1. SSRIs selective serotonin reuptake inhibitors (e.g., Sertraline) 1st line: Inhibit clear instructions. serotonin reuptake to restore normal levels. (Indication: treat depression, anxiety) Milieu Therapy: Minimize triggers, reduce Side effects: Drowsiness, GI discomfort, tremors, insomnia, agitation, decreased stimulants, and enhance comfort with calming libido, and serotonin syndrome. measures. 2. SNRIs Serotonin and norepinephrine reuptake inhibitors (e.g., Venlafaxine, Psychoeducation: Teach triggers, coping Duloxetine): Alternative when SSRIs are ineffective. (Indication: treat depression, strategies, and relaxation techniques like deep anxiety) breathing. 3. Benzodiazepines (e.g., Lorazepam, Alprazolam, Diazepam, Clonazepam): Exercise & Diet: Promote exercise for (Indication: Short-term management of acute anxiety.) serotonin and a balanced diet for resilience. Side effects: Drowsiness, rebound insomnia, impaired memory, paradoxical Somatic Therapy: Use aromatherapy, excitation, loss of balance. massage, and acupressure to ease tension and cognitive symptoms. Somatic Therapy Repetitive Transcranial Magnetic Stimulation (rTMS) Types of Somatic Therapy Mechanism of Action: 1.Electroconvulsive Therapy (ECT) Magnetic pulses stimulate specific brain areas to improve 2.Repetitive Transcranial Magnetic Stimulation (rTMS) symptoms. Indications: Electroconvulsive Therapy (ECT) Depression. Mechanism of Action: Obsessive-compulsive disorder (OCD). Controlled electrical stimulation induces a therapeutic seizure. Other neuropsychiatric conditions. Indications: Contraindications: Severe depression. Metallic implants. Mania. History of seizures. Catatonia. Use of certain medications (e.g., benzodiazepines, antiepileptics). Treatment-resistant mental health disorders. Adverse Effects: Contraindications: Mild headache. Increased intracranial pressure. Scalp discomfort. Unstable cardiovascular conditions. Benefits: Adverse Effects: Non-invasive procedure. Short-term memory loss. No need for sedation. Headache. Minimal recovery period. Muscle soreness. Role of Nurses in rTMS Benefits: Ensure no medication changes one month prior to therapy (e.g., Rapid symptom relief. benzodiazepines or antiepileptic drugs). Effective in severe and treatment-resistant cases. Monitor patient response to treatment and adjust care plans accordingly. Role of Nurses in ECT Pre-ECT: Obtain informed consent. Ensure the patient is fasting. Prepare necessary equipment and medications. Post-ECT: Monitor vital signs. Manage confusion and disorientation. Ensure patient safety during recovery. Impaired Cognition_Alzheimer's Disease and Delirium Nursing Diagnoses: 1.Risk for Fall/Injury: Linked to confusion, unsteady gait. Delirium: 2.Risk for Violence: Due to agitation, emotional reactions. Definition: Acute disturbance in attention, awareness, and cognition.3.Acute/Chronic Confusion: Caused by Delirium or Alzheimer’s Dise DSM-5 Criteria: Nursing Interventions: Sudden onset and short duration (hours to days). Delirium: Memory deficits, disorientation, or perception changes. Treat the underlying cause first. Not explained by other neurocognitive disorders. Use reality orientation techniques (e.g., clocks, Caused by medical conditions, substances, or toxins. calendars). Predisposing Factors (Keltner & Steele, 2019): Ensure safety by preventing falls and monitoring vital Age, infections, medication side effects, dehydration, or severe signs. illness. Dementia (Alzheimer’s): Use reminiscence therapy and diversional therapy. Alzheimer’s Disease: Promote structured routines and safety precautions. Definition: Progressive neurodegenerative disorder causing cognitive Encourage social engagement to maintain cognitive decline. abilities. DSM-5 Criteria: Outcomes: Significant cognitive decline in attention, memory, or language.1.No falls or injuries during hospitalization. Interference with daily independence. 2.Reduced agitation and improved calmness. Excludes delirium or mental disorders. 3.Feeling safe and responding well to orientation strategies. Symptoms (Halter, 2018): 4.Maintaining proper nutrient intake. Memory loss, confusion, disorientation, impaired judgment, language difficulties. Stages: Early: Mild forgetfulness, mood changes. Middle: Difficulty in daily tasks, increased confusion. Late: Severe memory loss, dependence, loss of physical abilities. Family Nursing Support Impact of Mental Illness on Families (Family Burden) Objective Burden: Increased caregiving responsibilities, financial strain, social Characteristics of a Healthy Family disruptions, and burnout. 1. Supports and affirms one another. Subjective Burden: 2. Spouses collaborate for collective well-being. 1. Grief: Loss of the person they knew and shared future plans. 3. Strong parental relationships provide security for children. 2. Guilt: Belief they could have prevented the illness. 4. Clear boundaries and importance of relationships within the family. 3. Anger: Directed at the patient, other family members, or the healthcare system. 5. Open communication; conflict resolution; service-oriented attitudes. 4. Powerlessness and Fear: Long-term illness realization, fear for the future. Six Stages of the Family Life Cycle Interventions 1. Single Young Adults Leaving Home: Independence and self-discovery. 1. Evaluate client behavior impact on family. 2. Joining Families Through Marriage: Developing marital roles and merging systems. 2. Psychoeducation (e.g., coping skills, support systems, community resources). 3. Families with Young Children: Parenting and adapting to new roles. 3. Family therapy to enhance communication and resilience. 4. Families with Adolescents: Allowing independence while maintaining support. 4. Competence model: Focuses on family strengths and empowerment. 5. Launching Children and Moving On: Adjusting to an empty nest and new roles. 5. Promote positive home environments with regular sessions, shared activities, 6. Retirement and Later Life: Reflection, adjustments to aging, and legacy building. and goal setting. Family Assessment Tools Barriers to Family Involvement 1. Genogram: Visual family tree indicating relationships and health issues. 1. Professional bias and fears (e.g., breaching confidentiality). 2. Ecomap: Maps the family’s interactions with external environments. 2. Administrative constraints in managed-cost environments. 3. Attachment Diagram: Highlights emotional ties and attachment levels. 3. Negative past experiences with therapy. Calgary Family Assessment Model (CFAM) Key Psychoeducational Programs 1. Structural: Family composition and roles. 1. Diagnosis 2. Developmental: Life cycle and transitions. 2. Family dynamics 3. Functional: Communication and problem-solving. 3. Stress management 4. Communication 5. Advocacy. Topic Key Points Healthy Family Traits Supportive, clear boundaries, strong parental roles, open communication, conflict resolution. Family Life Cycle Single adults, new couple, families with children/adolescents, launching children, retirement. Assessment Tools Genogram, ecomap, attachment diagram. Impact of Mental Illness Grief, guilt, anger, powerlessness; increased responsibilities, financial/social strains, burnout. Interventions Psychoeducation, therapy, empowerment, fostering positive environments. Barriers Professional bias, confidentiality fears, administrative issues, family mistrust of therapy.  Neurons and Neurotransmitter Mechanism Types of Psychotropic Drugs Promoting Medication Adherence Psychopharmacotherapy Neurons: ~100 billion in the brain. Establish a therapeutic relationship. 1. Antidepressants: Functions of the Brain 1. Respond to stimuli. Monoamine Oxidase Educate clients and families on: Monitor external changes and body fluid 2. Conduct electrical impulses. Inhibitors (MAOIs). Regular medication composition, Facilitate intellectual functions, 3. Release neurotransmitters. language, and sensory data processing. Reuptake Inhibitors (SSRIs, schedules. Neurotransmitters (NT): Regulate: 1. Activate behavior in specific brain regions. SNRIs, TCAs). Side effect management. 1. Skeletal muscle contractions. Use depot injections for long-term 2. Internal organs. 2. Imbalances may result in behavioral or 2. Anti-Anxiety Agents: 3. Basic drives (e.g., hunger, thirst, sex). mental disturbances. Benzodiazepines. therapy. Mediate: Deficiency in neurotransmitter transmission:3. Antipsychotics: 1. Conscious sensation. Example: Serotonin deficiency. Typical and Atypical (e.g., Mechanism of Action (MOA) of 2. Memory storage and retrieval. Symptoms: Behavioral disturbances. Psychotropic Drugs 3. Mood and emotions. Excess neurotransmitter transmission: Clozapine, Risperidone). 4. Mood Stabilizers. Monoamine Oxidase Inhibitors 4. Sleep cycle regulation. Example: Dopamine excess. (MAOIs): Adverse Effects and Precautions of Psychotropic Drugs Symptoms: Psychotic effects like Antidepressants hallucinations and delusions. Role of Nurses in Psychotropic Drug Prevent the breakdown Common Side Effects: Administration of monoamines by Sedation, orthostatic hypotension, sexual dysfunction, insomnia, weight gain. Monitor: inhibiting the enzyme Tricyclic Antidepressants (TCAs): Anticholinergic effects (e.g., dry mouth, constipation); For Extra-Pyramidal Side Effects (EPSE) most dangerous is cardiac toxicity, especially in overdose. monoamine oxidase. and administer antidote (e.g., IM Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs): May elevate blood pressure and Reuptake Inhibitors: Benztropine). heart rate due to noradrenergic activity. Neuroleptic Malignant Syndrome (NMS) Increase Serotonin Syndrome: neurotransmitter levels Onset: 2-72 hours after treatment with multiple serotonin-modulating drugs. signs. Symptoms: Agitation, tremors, fever, altered mental status. Educate: (e.g., serotonin, Resolution: Discontinuing the causative drug. On the necessity of consistent medication norepinephrine) by Suicide Risk: schedules. blocking reabsorption. Heightened during early treatment; close observation required. Side effects and their management. Antipsychotics Psychotropic Drugs Atypical Antipsychotics: Clozapine: Agranulocytosis risk; requires periodic full blood count (FBC). Antidepressants: Side effects: Sedation, weight gain, metabolic issues, gynecomastia, galactorrhea, and Prozac (Fluoxetine): Blocks serotonin reuptake. sexual dysfunction (notable with Risperidone). Clomipramine (Anafranil): Increases serotonin levels. Depot Antipsychotics: Antipsychotics: Long-term injectable therapy for schizophrenia. Clozapine, Olanzapine, Quetiapine: Common side No increased side effect risks compared to oral forms. effects include sedation and weight gain. Monitoring Requirements: Antidote for Extra-Pyramidal Symptoms (EPS): Watch for Neuroleptic Malignant Syndrome (NMS) and extra-pyramidal symptoms (EPS). Benztropine: Administered for symptom relief. Administer antidotes like IM Benztropine for EPS Community Mental Health Team (CMHT) Community Psychiatric Nurse (CPN) Roles: Goal: 1.Assessor: Provide regular assessment, treatment, support, and rehabilitation for mental 1. Conduct mental state exams (MSE). 2. Assess nursing needs and home environments. health clients. 3. Plan, deliver, and evaluate care effectiveness. Minimize relapse and hospital readmissions. 2.Clinician: Promote client independence and integration into the community. 1. Administer depot injections at home for resistant clients. Enhance the quality of life for clients. 2. Supervise hygiene, diet, and medication compliance. Objectives:Regular assessment, treatment, and rehabilitation. 3.Consultant: Promote independence and community integration. 1. Advise other healthcare professionals. Reduce relapse duration and hospital stays. 2. Collaborate with primary care teams. 4.Case Manager: Roles of the Community Mental Health Team 1. Organize and prioritize care efficiently. Provide team-based care for preventive, chronic, and acute mental health needs. 5.Advocate: Ensure continuity of care and adherence to clinical standards. 1. Speak on behalf of clients. 2. Ensure multidisciplinary teams meet client needs. Coordinate care across geographical regions. 6.Educator: Community-Based Mental Health Services in Singapore 1. Teach clients and caregivers about mental illness, medication, and coping skills. 1.CHAT (Community Health Assessment Team): Tasks: 1. Promotes mental health awareness among youth through workshops and Perform CBT for eligible clients. Monitor compliance with treatment plans. collaborations. Provide psychoeducation and psychological support for caregivers. 2.APCATS (Aged Psychiatry Community Assessment and Treatment Services): Counsel clients and encourage self-management strategies. 1. Supports the frail elderly and reduces caregiver burden. 3.REACH (Response, Early Intervention, and Assessment in Community Mental Health): Exclusion Criteria for CPN Services 1. Addresses emotional, social, and behavioral issues in schools and Clients with diagnoses such as drug dependence, severe mental retardation, or communities. antisocial personality disorder. 4.Mental Health GP Partnership Programme: Unreceptive clients or those with no fixed address. 1. Trains GPs to manage clients with stable mental illness within community Clients with violent tendencies or who consistently default on treatment. settings. Community Psychiatric Nurses as Crisis Team Members Illness Self-Management and Recovery (ISMR) Handle triage and activation of mobile crisis teams. Focuses on: Provide de-escalation, psychoeducation, and anger management. Coping and symptom management. Administer depot injections and counsel clients. Preventing relapses and building skills for independence. Discharge Criteria from CPN Services Motivating individuals to integrate into work, school, or social settings. Stable mental state and regular follow-ups. Client or caregiver requests discharge. Persistent non-compliance or aggression despite interventions.