Mental Health Final Study Guide PDF

**Chapter 1: Mental Health and Mental Illness** **DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition)** - **Purpose**: The DSM-5 is a comprehensive classification system that standardizes the definitions and diagnostic criteria for mental health disorders. It is cr...

**Chapter 1: Mental Health and Mental Illness** **DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition)** - **Purpose**: The DSM-5 is a comprehensive classification system that standardizes the definitions and diagnostic criteria for mental health disorders. It is crucial for mental health professionals to diagnose and categorize mental health conditions based on observable symptoms, etiology, and outcomes. The DSM-5 also helps guide treatment planning and prognosis. - **Structure**: It includes a range of disorders such as mood disorders, anxiety disorders, psychotic disorders, and more. Each disorder is described with criteria that must be met to confirm a diagnosis. **Nursing Diagnoses** - Nursing diagnoses in psychiatric-mental health nursing focus on the holistic care of patients, addressing both physiological and psychological aspects. These diagnoses are used to guide nursing interventions and improve outcomes. - Common examples of nursing diagnoses in psychiatric settings include: - **Ineffective Coping** - **Risk for Self-Harm** - **Disturbed Thought Processes** - **Anxiety** - Nurses use their clinical judgment to identify these diagnoses, often in collaboration with the rest of the treatment team. **Chapter 2: Theories and Therapies** **Cognitive Behavioral Therapy (CBT)** - **Definition**: CBT is a structured, time-limited psychotherapy focused on changing unhelpful cognitive patterns that contribute to emotional distress and maladaptive behaviors. It is one of the most researched and effective therapies for various mental health conditions, including anxiety, depression, and PTSD. - **Key Concepts**: - **Cognitive Restructuring**: Helps patients identify and challenge distorted thinking patterns (e.g., \"I'm a failure because I made a mistake\"). - **Behavioral Interventions**: Uses techniques such as exposure therapy to help individuals confront feared situations in a controlled manner. - **Goal-Oriented**: Focuses on achieving specific goals in a relatively short time frame. **Nursing Theory** - **Nursing theories in psychiatric care** emphasize holistic approaches to patient care, incorporating biopsychosocial models. Theories such as **Peplau's Interpersonal Relations Theory** guide psychiatric nurses in forming therapeutic relationships and understanding how interpersonal dynamics impact mental health. - Other relevant theories include: - **Orem's Self-Care Deficit Theory** (focuses on the individual\'s ability to meet their own care needs). - **Roy's Adaptation Model** (focuses on the process of adaptation to stressors in a patient's environment). **Chapter 3: Psychopharmacology** Psychopharmacology is the study of medications used to treat mental health disorders. It focuses on the role of medications in managing symptoms, as well as the side effects, risks, and nursing responsibilities related to their use. This chapter provides an in-depth look at various categories of psychiatric medications. **Medications in Psychiatric Emergency** In psychiatric emergencies, medications are used to stabilize patients quickly. These include: - **Benzodiazepines** (e.g., Lorazepam, Diazepam): - **Use**: For immediate relief of severe anxiety or agitation, often given intramuscularly or intravenously. - **Action**: CNS depressants that enhance the effect of GABA, a neurotransmitter that calms the brain. - **Considerations**: They act quickly but can lead to dependence if used long-term. - **Antipsychotics** (e.g., Haloperidol, Olanzapine): - **Use**: To manage acute psychotic episodes or severe agitation. - **Action**: Block dopamine receptors in the brain, helping to stabilize mood and thought processes. - **Considerations**: Must be used cautiously due to potential side effects like sedation or extrapyramidal symptoms (EPS). - **Antidepressants** (e.g., Fluoxetine, Sertraline): - **Use**: If depression is contributing to the emergency, medications like SSRIs can be used in the long-term treatment. - **Action**: Increase serotonin levels in the brain, helping to alleviate depressive symptoms over time. **Medications for Alzheimer's -- Side Effects** Medications for Alzheimer\'s Disease aim to reduce symptoms and improve quality of life but have side effects. The main classes used include: - **Cholinesterase inhibitors** (e.g., Donepezil, Rivastigmine): - **Action**: These drugs increase acetylcholine levels in the brain, which can improve memory and cognitive function. - **Side Effects**: Nausea, diarrhea, fatigue, muscle cramps, and dizziness. Serious side effects may include bradycardia (slow heart rate) or syncope (fainting). - **NMDA receptor antagonists** (e.g., Memantine): - **Action**: Regulates the activity of glutamate, which is involved in learning and memory. - **Side Effects**: Dizziness, confusion, headache, constipation, and elevated blood pressure. **Therapeutic Range for Lithium** - **Lithium** is commonly used to treat **bipolar disorder**, especially during manic episodes. - **Therapeutic Range**: 0.6--1.2 mEq/L. Blood levels need to be monitored regularly because the therapeutic range is narrow, and the risk of toxicity increases with blood levels above 1.5 mEq/L. - **Nursing Considerations**: Ensure adequate hydration, regular renal function tests, and monitoring of sodium levels, as lithium toxicity can occur if sodium levels are low. **Signs of Lithium Toxicity** Signs of **Lithium toxicity** include: - **Early Symptoms** (1.5--2.0 mEq/L): Nausea, vomiting, diarrhea, and coarse hand tremors. - **Moderate Toxicity** (2.0--2.5 mEq/L): Confusion, ataxia (lack of coordination), stupor, and blurred vision. - **Severe Toxicity** (\>2.5 mEq/L): Seizures, coma, renal failure, and death. Immediate medical intervention is required if toxicity is suspected. **Medication Alternatives for Lithium** For patients who cannot tolerate lithium or for whom it is ineffective, **anticonvulsants** and **atypical antipsychotics** are often used as alternatives: - **Anticonvulsants**: - **Valproate (Valproic acid)**: Used to treat bipolar disorder, especially in mixed episodes or rapid cycling. - **Lamotrigine (Lamictal)**: Often used for maintenance therapy in bipolar disorder to prevent depressive episodes. - **Atypical antipsychotics**: - Medications such as **Olanzapine**, **Quetiapine**, or **Aripiprazole** can be used for mood stabilization in patients with bipolar disorder. **Long-Acting Antipsychotic Medications** - **Characteristics**: Long-acting injectable antipsychotics are designed to provide consistent therapeutic levels and improve adherence, as they are administered less frequently (usually every 2--4 weeks). - **Examples**: - **Risperidone (Risperdal Consta)** - **Aripiprazole (Abilify Maintena)** - **Paliperidone (Invega Sustenna)** - **Administration**: These are injected intramuscularly. Patients need to be monitored for side effects at the site of injection (e.g., pain, redness, swelling). **Side Effects of Antipsychotic Medications** - **Neuroleptic Malignant Syndrome (NMS)**: - **Symptoms**: Fever, muscle rigidity, altered mental status, autonomic dysregulation (e.g., unstable blood pressure, heart rate, sweating). - **Intervention**: Discontinue the antipsychotic immediately, provide supportive care (e.g., cooling measures), and monitor vital signs closely. - **Tardive Dyskinesia (TD)**: - **Symptoms**: Involuntary, repetitive movements, such as grimacing, tongue thrusting, or lip smacking. - **Intervention**: Early detection is crucial. Atypical antipsychotics may be preferred because they have a lower risk of TD, but if it occurs, the medication may need to be switched or discontinued. **Clozaril (Clozapine)** - **Actions**: Clozapine is an atypical antipsychotic used for treatment-resistant schizophrenia and other severe mental health conditions. - **Mechanism**: It works by blocking dopamine and serotonin receptors in the brain, which helps alleviate symptoms of schizophrenia. - **Side Effects**: - **Agranulocytosis**: A potentially life-threatening decrease in white blood cell count. Regular blood tests are required to monitor for this. - **Other side effects**: Weight gain, sedation, hypotension, and metabolic syndrome. **Monoamine Oxidase Inhibitors (MAOIs)** - **Actions**: MAOIs, such as **Phenelzine** and **Tranylcypromine**, work by inhibiting the monoamine oxidase enzyme, which increases levels of serotonin, dopamine, and norepinephrine in the brain. - **Side Effects**: Orthostatic hypotension, dry mouth, blurred vision, constipation, and sexual dysfunction. - **Dietary Restrictions**: Patients must avoid foods containing **tyramine** (e.g., aged cheese, cured meats, and certain alcoholic beverages) as combining these with MAOIs can cause a hypertensive crisis. - **Education**: Patients should be educated about these dietary restrictions and the signs of hypertensive crisis (severe headache, nausea, elevated blood pressure). **Lamictal (Lamotrigine)** - **Actions**: Lamotrigine is an anticonvulsant mood stabilizer used to treat bipolar disorder, particularly for preventing depressive episodes. - **Mechanism**: It works by inhibiting voltage-gated sodium channels in neurons, stabilizing mood. - **Warnings**: A serious risk of **Stevens-Johnson syndrome** (a potentially fatal skin reaction) can occur, especially during the early stages of treatment. - **Education**: Patients should be instructed to notify their healthcare provider immediately if they develop any rashes. **Important Patient Information about SSRIs** - **Selective Serotonin Reuptake Inhibitors (SSRIs)** (e.g., **Fluoxetine**, **Sertraline**) are commonly used to treat depression, anxiety, and OCD. - **Risk of Increased Suicide Ideation**: Especially in children, adolescents, and young adults, SSRIs can increase the risk of suicidal thoughts and behaviors. This risk is higher during the initial stages of treatment or when dosages are adjusted. - **Side Effects**: Include nausea, headache, sexual dysfunction, insomnia, and weight changes. - **Patient Education**: Patients should be monitored closely during the early weeks of therapy, and any signs of worsening depression or thoughts of suicide should be reported immediately. **Medications for Anxiety** - **Benzodiazepines** (e.g., **Lorazepam**, **Diazepam**) are often used for short-term relief of anxiety symptoms. - **Action**: Enhance the effect of GABA, which has a calming effect on the CNS. - **Side Effects**: Drowsiness, dizziness, memory impairment, and potential for dependency. - **SSRIs/SNRIs** (e.g., **Escitalopram**, **Venlafaxine**) are preferred for long-term management of anxiety disorders. - **Action**: Increase serotonin (SSRIs) or both serotonin and norepinephrine (SNRIs) in the brain. - **Side Effects**: Similar to other SSRIs, including sexual dysfunction, insomnia, and gastrointestinal issues. **Medications for Impulsivity and Aggression** - **Mood Stabilizers** (e.g., **Valproic Acid**, **Lamotrigine**): - Used for conditions like **intermittent explosive disorder** or in patients with **bipolar disorder**. - **Action**: Stabilize mood and reduce impulsivity. - **Antipsychotics** (e.g., **Risperidone**, **Olanzapine**): - Used for managing **impulsive behaviors** and aggression, particularly in conditions like **schizophrenia** or **bipolar disorder**. **Chapter 4: Treatment Settings** **Environmental Safety on an Inpatient Psychiatric Unit** - **Safety Concerns**: Psychiatric inpatient units are specialized environments where safety is a priority to protect both patients and staff. Features include: - **Locked Units**: To prevent patients from leaving against medical advice or potentially harming themselves or others. - **Restricted Items**: Items that could be used for self-harm or harm to others (e.g., sharp objects, cords, medications) are often removed. - **Observation**: Continuous observation of patients is necessary, especially those at risk for suicide, self-harm, or violence. - **Seclusion and Restraint**: Used only in emergencies when a patient's behavior poses a risk to themselves or others. **Role of RN vs NP on an Inpatient Psychiatric Unit** - **Registered Nurse (RN)**: The RN on a psychiatric unit is responsible for direct patient care, including administering medications, conducting assessments, providing therapy, and developing care plans. RNs also provide support to patients and families, ensuring they have the resources and information needed to navigate mental health issues. - **Nurse Practitioner (NP)**: NPs, particularly those with specialization in psychiatric-mental health, have advanced training and can diagnose psychiatric disorders, prescribe medications, and provide psychotherapy. They often have a larger scope of practice in terms of treatment planning and the ability to order diagnostic tests or adjust medications. **Chapter 5: Cultural Implications** **Barriers to Getting Mental Health Care** - **Cultural Barriers**: Language differences, stigma surrounding mental illness, and a lack of culturally competent providers are significant barriers. - **Structural Barriers**: These include limited access to mental health services, especially in rural or underdeveloped areas, long wait times, and inadequate insurance coverage for mental health care. - **Economic Barriers**: High cost of mental health services and medications often prevent individuals from seeking help. **Stigma** - **Definition**: Stigma refers to the negative stereotypes, discrimination, and prejudice that individuals with mental illness often face. This can lead to feelings of shame, isolation, and reluctance to seek treatment. - **Types of Stigma**: Public stigma (society's negative beliefs), self-stigma (internalized negative beliefs), and institutional stigma (discriminatory practices in healthcare settings). **Steps to Becoming Culturally Competent** - **Awareness**: Recognizing one\'s own biases and prejudices. - **Knowledge**: Learning about the cultural backgrounds and health beliefs of the populations being served. - **Skills**: Developing skills in cross-cultural communication and understanding how cultural factors influence health and healthcare practices. - **Attitudes**: Developing a respect for diversity and a commitment to providing equitable care. **Chapter 6: Legal and Ethical** **Patient Rights** - **Right to Privacy**: Includes confidentiality and the protection of personal information. - **Right to Treatment**: Patients have the right to receive care that is medically appropriate and to refuse treatment, except under specific conditions like involuntary commitment. - **Right to Informed Consent**: Patients must be informed about their treatment and have the right to accept or decline it. **Voluntary vs. Involuntary Admission** - **Voluntary Admission**: The patient agrees to stay in the facility for treatment. They have the right to leave unless they are deemed a danger to themselves or others. - **Involuntary Admission**: Occurs when a person is admitted to a psychiatric unit without their consent, typically due to concerns about their safety or the safety of others. Laws vary by state, but common criteria include: - Danger to self or others. - Inability to provide for basic needs due to mental illness. **Chapter 7: The Nursing Process and Standards of Care** **Nursing Diagnosis/DSM-5 Diagnosis** - The **nursing diagnosis** focuses on the patient\'s response to their mental health condition (e.g., \"Ineffective Coping\" or \"Risk for Self-Harm\"), while the **DSM-5 diagnosis** focuses on the medical classification of the disorder (e.g., Major Depressive Disorder). **RN/APRN Roles** - **RN**: The RN focuses on the implementation of care, monitoring patient progress, and providing support. They work under the supervision of a physician or NP. - **APRN**: Advanced Practice Registered Nurses (APRN), such as Psychiatric Nurse Practitioners (PMHNP), have additional training and are involved in diagnosing, prescribing medications, and providing psychotherapy. They often lead the care planning process. **Milieu Therapy** - **Definition**: Milieu therapy is the use of the therapeutic environment as a tool for healing. It involves creating a safe, supportive, and structured environment where patients can learn and practice new coping skills. - **Key Elements**: - A structured daily routine to help patients regain a sense of control. - Group therapy to provide social support and enhance interpersonal skills. - Staff collaboration to maintain a consistent approach to care. **Chapter 8: Therapeutic Relationships** **Phases of Therapeutic Interaction** Therapeutic relationships in psychiatric nursing develop in structured phases that facilitate patient trust and healing. These phases are: 1. **Orientation Phase**: - **Purpose**: The nurse and patient meet and begin to establish rapport. The nurse clarifies the purpose of the relationship and sets boundaries. - **Nursing Role**: Assess the patient\'s needs, provide information about the treatment process, and establish trust. - **Challenges**: Patient may feel uncertain, fearful, or resistant. 2. **Working Phase**: - **Purpose**: The patient and nurse work together to achieve goals, address problems, and implement interventions. - **Nursing Role**: Facilitate problem-solving, provide emotional support, and help the patient understand their thoughts and behaviors. - **Challenges**: Patient may experience resistance, anxiety, or ambivalence about change. 3. **Termination Phase**: - **Purpose**: The nurse and patient reflect on progress and plan for the patient's continued care after the relationship ends. - **Nursing Role**: Summarize the work accomplished, provide encouragement for future goals, and ensure continuity of care. - **Challenges**: Separation anxiety for both patient and nurse; emotional closure. **Therapeutic Responses** Therapeutic responses involve communication that facilitates patient expression, promotes reflection, and supports emotional processing. These include: - **Active Listening**: Fully concentrating on the patient's message, which helps create an empathetic connection. - **Reflection**: Mirroring the patient\'s feelings or thoughts to help them gain clarity. - **Restating**: Paraphrasing the patient's words to confirm understanding. - **Open-Ended Questions**: Encouraging the patient to explore feelings and experiences. - **Validation**: Acknowledging the patient's feelings as legitimate, regardless of how unusual they may seem. **Personal vs. Professional Relationship** - **Personal Relationships**: Involve mutual exchanges of care and affection. Boundaries in personal relationships are more flexible and informal. - **Professional Relationships**: Focus on the patient's needs, are goal-directed, and maintain strict professional boundaries. The nurse\'s role is to support the patient's well-being while maintaining clear, ethical limits and avoiding personal involvement. **Chapter 9: Therapeutic Communication** **Application of Specific Therapeutic Communication** Therapeutic communication is essential in building trust and promoting healing. Specific techniques include: - **Silence**: Gives the patient time to reflect and collect thoughts. - **Focusing**: Directing the conversation toward specific issues or topics that are important to the patient. - **Clarifying**: Asking for clarification when the patient's message is unclear. - **Offering Information**: Providing accurate information to help the patient make informed decisions. - **Summarizing**: Reviewing key points of the conversation to ensure understanding. **Best Therapeutic Response in Different Situations** - **Patient expresses confusion or irrational thoughts**: - Therapeutic Response: \"Can you help me understand what you mean by that?\" - **Patient is angry or upset**: - Therapeutic Response: \"I can see you\'re upset. Let\'s talk about what\'s bothering you.\" - **Patient is non-communicative or withdrawn**: - Therapeutic Response: \"I notice you're not talking much today. Is there anything you'd like to share?\" - **Patient expresses fear**: - Therapeutic Response: \"It sounds like you\'re feeling afraid. Let's talk about what\'s making you feel this way.\" - **Patient offers personal details or concerns**: - Therapeutic Response: \"I hear you're feeling anxious about that. Let\'s explore that together.\" **Chapter 10: Stress Responses and Stress Management** **Signs of Stress** Stress manifests in physiological, emotional, and behavioral symptoms, which may include: - **Physiological**: Increased heart rate, sweating, muscle tension, headaches, digestive issues. - **Emotional**: Irritability, anxiety, feelings of overwhelm, mood swings. - **Behavioral**: Changes in eating or sleeping patterns, substance use, withdrawal from social interactions. **Coping Mechanisms** Coping mechanisms are strategies used to manage stress and maintain emotional equilibrium. These include: - **Problem-Focused Coping**: Taking direct actions to address the stressor (e.g., time management, seeking resources). - **Emotion-Focused Coping**: Managing the emotional response to stress (e.g., relaxation techniques, mindfulness). - **Avoidance Coping**: Avoiding the stressor or denying its existence (e.g., denial, substance use). This is generally less adaptive. **Life Changes Questionnaire** The **Life Changes Questionnaire** (often used in stress research) assesses how recent life events (positive or negative) contribute to stress. Events like moving, divorce, death of a loved one, or changes in health status can significantly impact mental health. Nurses may use this tool to help patients identify and understand stressors in their lives. **Chapter 11: Childhood and Neurodevelopmental Disorders** **Temperament** Temperament refers to the inherent personality traits that influence how children respond to their environment. Key temperamental types include: - **Easy**: Adaptable, positive mood, regular eating and sleeping patterns. - **Difficult**: High activity levels, negative mood, and difficulty adjusting to changes. - **Slow-to-warm-up**: Initially cautious or withdrawn, but eventually adapts to new situations with time. **Therapeutic Responses in Different Situations with Children and Adolescents** Therapeutic communication with children and adolescents requires different approaches based on their developmental level: - **Children**: Use simple language, engage in play therapy, and allow for physical activities to help them express feelings. - **Adolescents**: Respect privacy, establish trust, and support their autonomy while providing appropriate guidance and boundaries. **Age-Appropriate Activities** - **Children (4--7 years)**: Creative play (e.g., drawing, playing with toys), storytelling, games that involve motor skills. - **Adolescents**: Discussion groups, role-playing, and group therapy can help them express feelings and explore relationships. **ADHD - Symptoms, Assessment, and Outcomes of Care** - **Symptoms**: - Inattention, hyperactivity, and impulsivity. - Difficulty following instructions, fidgeting, inability to stay seated, interrupting conversations, and lack of focus. - **Assessment**: The nurse assesses behavior across multiple settings (e.g., home, school) to determine if the symptoms align with ADHD criteria. Behavioral observations, parent and teacher reports, and standardized scales (e.g., Conners Rating Scale) are used. - **Outcomes of Care**: - Improving focus and attention through behavior management and medication (e.g., stimulants like Methylphenidate). - Enhancing social skills and coping mechanisms. - Providing educational support and adjustments (e.g., structured routines, clear expectations). **Autism Spectrum Disorder (ASD) - Asperger's Syndrome and Tic Disorders** - **Autism Spectrum Disorder (ASD)**: - Symptoms: Social communication difficulties, restricted interests, repetitive behaviors. - Treatment: Behavior therapy, structured environments, and social skills training. - **Asperger\'s Syndrome**: - A subtype of ASD where the individual typically has normal intelligence but may struggle with social interactions, non-verbal communication, and sensory sensitivities. - **Tic Disorders**: - Symptoms: Involuntary, repetitive movements or vocalizations (e.g., blinking, throat clearing, or verbal outbursts). - Treatment: Behavior therapy (e.g., Habit Reversal Training), medications (e.g., antipsychotics, alpha agonists). **Chapter 12: Schizophrenia Spectrum Disorders** **Assessment of Psychotic Symptoms -- Negative and Positive Symptoms** - **Positive Symptoms**: Reflect an excess or distortion of normal functioning: - **Hallucinations**: Perceptions of things that are not present (e.g., hearing voices, seeing things). - **Delusions**: Fixed false beliefs (e.g., believing one is being persecuted or has special powers). - **Disorganized Thinking**: Incoherent speech or thoughts. - **Negative Symptoms**: Reflect a decrease or loss of normal functioning: - **Affective Flattening**: Reduced emotional expression. - **Avolition**: Lack of motivation to engage in purposeful activities. - **Anhedonia**: Inability to experience pleasure. - **Social Withdrawal**: Lack of interest in social interactions. **Mental Status Exam Findings** Key components of the **Mental Status Exam (MSE)** for assessing schizophrenia include: - **Appearance**: Disheveled, inappropriate clothing, poor hygiene. - **Behavior**: Agitation, catatonia, or odd movements. - **Speech**: Rapid, pressured speech, or incoherent speech. - **Mood and Affect**: Flat or inappropriate affect (e.g., laughing at serious situations). - **Thought Process**: Disorganized, tangential, or circumstantial thinking. - **Cognition**: Impaired attention, memory, and concentration. - **Insight**: Lack of awareness of illness. **Specific Psychotic Symptoms -- Hallucinations, Delusions, etc.** - **Hallucinations**: Auditory (hearing voices), visual (seeing things), or tactile (feeling sensations). The nurse should approach the patient with a calm demeanor and validate their experience without reinforcing the hallucination. - **Delusions**: Fixed false beliefs that are resistant to reasoning (e.g., paranoia). Nurses should provide a reality-based response while respecting the patient's experience. **Therapeutic Communication Techniques** - **Reality Testing**: Gently pointing out inconsistencies between the patient's delusions and reality (e.g., \"I understand that you believe the voices are real, but others don\'t hear them\"). - **Grounding Techniques**: Helping the patient focus on the present moment to reduce anxiety. **Nursing Interventions and Outcomes of Care** - **Nursing Interventions**: - Providing a structured, supportive environment. - Administering antipsychotic medications to reduce symptoms. - Teaching coping strategies for managing stress and anxiety. - Supporting family education and involvement. - **Outcomes of Care**: - Reduction of psychotic symptoms. - Improved social functioning and community engagement. - Increased understanding of the illness and treatment adherence. **Chapter 13: Bipolar Disorder** **Signs and Symptoms** - **Manic Episode**: A manic episode is characterized by a period of abnormally elevated or irritable mood and increased energy, often lasting for at least one week. Symptoms include: - **Euphoria**: Extreme happiness or excitement that may appear excessive or inappropriate. - **Grandiosity**: Inflated self-esteem or feelings of superiority. Individuals may believe they are invincible or possess special powers. - **Pressured Speech**: Rapid, incessant speech that is difficult to interrupt. Speech may be tangential or flighty, reflecting the individual's racing thoughts. - **Impulsivity**: Engaging in risky behaviors like spending sprees, unprotected sex, or reckless driving. - **Decreased need for sleep**: People may feel rested after only a few hours of sleep. - **Flight of ideas**: Rapid shifts from one thought to another. - **Increased goal-directed activity**: An individual may start many projects but may not complete them. - **Hypomanic Episode**: Similar to mania but less severe, lasting at least 4 days. Symptoms include elevated mood, increased energy, and racing thoughts, but without significant impairment in functioning or psychosis. **Therapeutic Responses to Behavior and Symptoms** - **Manic Behavior**: Provide a calm, structured environment. Minimize stimuli to reduce agitation and hyperactivity. Set limits to prevent risky behaviors, and ensure safety. Maintain a non-judgmental attitude to reduce defensiveness. - **Hypomanic Behavior**: Encourage positive, constructive activities. Maintain a calm and reassuring approach to prevent escalation. Set clear expectations for behavior. - **Therapeutic Communication**: Use simple, clear, and direct language to reduce confusion. Be patient and allow time for responses. **Assessment** - Assess mood (euphoria, irritability), energy levels, sleep patterns, speech patterns, and thought processes. - Monitor for signs of self-harm or dangerous behavior. - Evaluate family dynamics and stressors. - Use the **Mood Disorder Questionnaire (MDQ)** or **Hamilton Rating Scale for Depression (HAM-D)** for clinical evaluation. **Terms** - **Euphoria**: Excessive, often inappropriate happiness or joy. - **Labile**: Rapid, unpredictable mood swings, especially from euphoria to irritability. - **Grandiose**: Overestimating one's abilities or self-worth, common in manic episodes. - **Pressured Speech**: Rapid, forceful, and loud speech that often conveys a sense of urgency. **Phases of Illness and Appropriate Intervention** 1. **Acute Phase** (manic or depressive episode): - **Intervention**: Hospitalization may be necessary. Focus on stabilization and safety. - Medications (mood stabilizers, antipsychotics, benzodiazepines for agitation) are commonly prescribed. 2. **Continuation Phase** (6-12 weeks post-episode): - **Intervention**: Focus on treatment adherence, psychoeducation, and support groups. Risk for relapse remains high. 3. **Maintenance Phase** (ongoing): - **Intervention**: Encourage long-term medication use and therapy (e.g., CBT, family therapy). Lifestyle modifications and stress management are key. **Chapter 14: Depressive Disorders** **Risk for Suicide: Safety and Risk Assessment** - **Safety Assessment**: Involves asking direct questions about suicidal ideation, plans, and means. Assess access to firearms, medications, or other tools that could be used for self-harm. - **Risk Assessment**: Factors include: - History of previous suicide attempts. - Family history of suicide or mental illness. - Presence of psychiatric disorders, particularly depression. - Chronic illness, social isolation, or stress. - Substance abuse. **Nursing: Self-Reflection and Support** - **Self-Reflection**: Nurses must be aware of their emotional responses when working with patients at risk for suicide. Empathy, validation, and active listening are critical. - **Support**: Building a therapeutic alliance, being nonjudgmental, and encouraging the patient to express their feelings can reduce the risk of harm. **Terms** - **Dysthymia**: A chronic, low-grade form of depression that lasts for at least 2 years in adults or 1 year in children. It often presents with symptoms of hopelessness and low self-esteem. - **Anhedonia**: Loss of interest or pleasure in activities that were once enjoyable. - **Anergia**: Lack of energy, often leading to fatigue and difficulty performing daily activities. - **Vegetative Signs**: Physical symptoms associated with depression, including changes in appetite, sleep disturbances, and decreased libido. **ECT (Electroconvulsive Therapy)** - **Description**: ECT involves electrical stimulation of the brain while the patient is under general anesthesia. It is often used for severe depression that does not respond to other treatments. - **Side Effects**: - Temporary memory loss or confusion. - Physical side effects such as headaches, muscle aches, or nausea. - Possible cognitive disturbances during and after treatment. **TMS (Transcranial Magnetic Stimulation)** - **Patient Teaching**: TMS is a non-invasive procedure that uses magnetic fields to stimulate nerve cells in the brain. It's often used for patients with depression who haven't responded to medication. - **Side Effects**: Common side effects include headache, scalp discomfort, and lightheadedness. Rarely, TMS may cause seizures or other adverse effects. **Chapter 15: Anxiety and Obsessive-Compulsive Disorder** **Levels of Anxiety and Nursing Interventions** - **Mild Anxiety**: Occurs in everyday situations. **Intervention**: Encourage the patient to engage in problem-solving or relaxation techniques. - **Moderate Anxiety**: Disturbance in the patient's ability to think clearly. **Intervention**: Use grounding techniques, provide reassurance, and reduce environmental stressors. - **Severe Anxiety**: Cognitive and perceptual distortions occur. **Intervention**: Provide a quiet, safe environment and offer medications if necessary. - **Panic Anxiety**: Total loss of control. **Intervention**: Stay with the patient, offer clear instructions, and use physical interventions to ensure safety. **Characteristics of Phobias -- Agoraphobia** - **Phobias**: Intense, irrational fears of specific objects or situations, such as heights, spiders, or enclosed spaces. - **Agoraphobia**: Fear of being in situations where escape might be difficult or help unavailable if a panic attack occurs (e.g., crowded places or public transportation). **Obsessive-Compulsive Disorder (OCD)** - **Signs**: Obsessions (recurrent, intrusive thoughts) and compulsions (repetitive behaviors performed to reduce anxiety). For example, hand-washing rituals or checking locks multiple times. - **Interventions**: - Cognitive-behavioral therapy (CBT) with exposure and response prevention (ERP). - Medication: SSRIs like fluoxetine may help reduce symptoms. **Priorities of Care for Different Anxiety Disorders** - **Generalized Anxiety Disorder (GAD)**: Promote relaxation techniques, provide cognitive restructuring, and encourage coping skills. - **Panic Disorder**: Help the patient manage panic attacks through education, relaxation strategies, and breathing exercises. - **Phobias**: Gradual exposure therapy and desensitization. - **OCD**: Encourage exposure and response prevention strategies and provide support for managing compulsive behaviors. **Chapter 16: Trauma, Stressor-Related, and Dissociative Disorders** **ACES Study (Adverse Childhood Experiences Study)** - The **ACES Study** identifies and links early childhood trauma (e.g., abuse, neglect) to higher risks for mental health disorders, substance abuse, and physical health issues later in life. **PTSD (Post-Traumatic Stress Disorder)** - PTSD can develop after exposure to a traumatic event, resulting in flashbacks, nightmares, hypervigilance, and avoidance behaviors. - **Nursing Interventions**: Encourage trauma-focused therapy (e.g., cognitive processing therapy, EMDR), provide a safe environment, and validate the patient's experiences. **Dissociation** - A mental process where a person disconnects from their thoughts, feelings, memories, or sense of identity. It can manifest as amnesia, depersonalization, or derealization. - **Interventions**: Grounding techniques, developing coping mechanisms, and trauma-focused therapy. **Nursing Interventions for Trauma and Stressor-Related Disorders** - Focus on safety, stabilization, and building trust. Empower the patient to regain control over their lives. Provide a non-judgmental, empathetic space for processing trauma. **Chapter 17: Somatic Symptom Disorders** **Characteristics of Each Disorder** - **Somatic Symptom Disorder**: Characterized by excessive focus on physical symptoms that cause distress or dysfunction, even in the absence of a medical explanation. - **Illness Anxiety Disorder**: Excessive preoccupation with having or acquiring a serious illness despite lack of symptoms. - **Conversion Disorder**: Neurological symptoms (e.g., paralysis, blindness) without a medical cause, often linked to psychological stress. **Munchausen Syndrome (Factitious Disorder)** - A condition in which an individual deliberately fabricates symptoms of illness to gain attention or sympathy. In **Munchausen by Proxy**, the caregiver induces or fabricates illness in another person, typically a child. **Chapter 18: Eating and Feeding Disorders** **Characteristic Symptoms** - **Anorexia Nervosa**: Severe restriction of food intake, intense fear of gaining weight, and distorted body image. Symptoms may include significant weight loss, amenorrhea, and preoccupation with food. - **Bulimia Nervosa**: Recurrent episodes of binge eating followed by inappropriate compensatory behaviors such as vomiting, excessive exercise, or laxative use. Often, individuals maintain a normal weight. **Outcomes of Care** - **Anorexia**: The goal is to restore weight and normalize eating patterns. Psychotherapy (e.g., CBT) and family therapy are key components. - **Bulimia**: Focus on developing healthy eating habits, addressing underlying emotional issues, and preventing binge-purge cycles. **Chapter 19: Sleep-Wake Disorders** **Normal Sleep Pattern** - **Sleep Stages**: Normal sleep consists of four stages of NREM (Non-Rapid Eye Movement) sleep (Stage 1--4), and REM (Rapid Eye Movement) sleep. These cycles repeat every 90 minutes throughout the night. - **Stage 1**: Light sleep, lasting a few minutes. - **Stage 2**: Deeper sleep, body temperature drops, heart rate slows. - **Stage 3 & 4**: Deep sleep (also called slow-wave sleep), body repairs and regenerates tissues. - **REM Sleep**: Associated with vivid dreams, brain activity increases, and muscles are temporarily paralyzed. In a normal adult, sleep lasts 7--9 hours, with about 20--25% of sleep spent in REM. **What Interferes with Sleep Hygiene** - **Environmental Factors**: Excessive noise, light, uncomfortable bedding, temperature fluctuations. - **Psychological Factors**: Anxiety, stress, depression, and mood disorders can disrupt sleep. - **Poor Sleep Habits**: Irregular sleep schedule, excessive naps during the day, stimulating activities before bed (e.g., screen time), caffeine or alcohol consumption late in the day. - **Medical Conditions**: Sleep disorders like insomnia, obstructive sleep apnea, restless leg syndrome, and others can disturb normal sleep hygiene. **Chapter 20: Sexual Dysfunction, Gender Dysphoria, and Paraphilic Disorders** **Mental Health Needs of the LGBTQ+ Population, Especially Transgender Individuals** - **Gender Dysphoria**: Refers to distress caused by a mismatch between one's gender identity and assigned sex at birth. Transgender individuals may experience this distress, along with social, emotional, and mental health challenges. - **Mental Health Needs**: These can include depression, anxiety, social isolation, and trauma-related disorders, often stemming from discrimination or lack of acceptance. - **Transgender-Specific Care**: Focuses on providing gender-affirming care (e.g., hormone therapy, surgeries), supporting identity expression, and reducing stigma. **Effect of Stigma and Healthcare Organization Stigma** - **Stigma**: LGBTQ+ individuals, particularly transgender individuals, often face significant stigma, which can affect their self-esteem, increase vulnerability to mental health issues, and discourage seeking care. - **Healthcare Organization Stigma**: Discrimination or lack of awareness among healthcare providers can lead to negative healthcare experiences for LGBTQ+ individuals. This can worsen mental health outcomes and create barriers to care. **How to Get a History** - **Ask Open-Ended Questions**: Use inclusive language, and avoid making assumptions about gender or sexual orientation. \"What pronouns do you use?\" or \"Can you tell me about your sexual health?\" - **Create a Safe Environment**: Ensure privacy, nonjudgmental attitudes, and sensitivity to cultural norms when gathering information about sexual and gender identity. **How to Provide Inclusive Care** - **Use Correct Pronouns**: Always ask and use the patient's preferred name and pronouns. - **Be Nonjudgmental**: Accept and support all sexual orientations and gender identities without imposing biases. - **Cultural Competence**: Understand and respect the cultural, religious, and individual perspectives of the LGBTQ+ population. - **Provide Resources**: Offer referrals to LGBTQ+-friendly healthcare services and mental health support when appropriate. **Characteristics of Paraphilic Disorders** - **Definition**: Paraphilic disorders involve intense sexual urges, fantasies, or behaviors that deviate from cultural norms and can cause distress or impairment. - **Types of Paraphilic Disorders**: - **Exhibitionism**: Exposure of one\'s genitals to unsuspecting individuals. - **Fetishism**: Sexual arousal from inanimate objects or non-genital body parts. - **Pedophilia**: Sexual attraction to prepubescent children. - **Voyeurism**: Watching others engage in sexual activity without their consent. - **Sadism and Masochism**: Deriving sexual pleasure from inflicting or receiving pain or humiliation. **Medications That Can Affect Sexual Function** - **Antidepressants (SSRIs, SNRIs)**: Can cause sexual dysfunction, including decreased libido, delayed ejaculation, or difficulty achieving orgasm. - **Antipsychotics**: May cause erectile dysfunction, reduced libido, and orgasmic issues. - **Beta-Blockers**: Can lead to erectile dysfunction and reduced sexual desire. - **Opioids**: Often cause reduced sexual interest, erectile dysfunction, and hormonal imbalances. - **Antihypertensives**: Some may interfere with sexual arousal and performance. **Chapter 21: Impulse Control Disorders** **Characteristics of Each Disorder** - **Intermittent Explosive Disorder**: Characterized by impulsive outbursts of anger or aggression that are disproportionate to the situation. - **Kleptomania**: The compulsive urge to steal, typically without need or financial gain. - **Pyromania**: The deliberate setting of fires to experience excitement or gratification. - **Trichotillomania**: Compulsive hair-pulling, leading to hair loss. - **Pathological Gambling**: Persistent and uncontrollable gambling, despite negative consequences. **Therapeutic Interventions** - **Cognitive Behavioral Therapy (CBT)**: Often used to address the distorted thinking patterns contributing to the behaviors. - **Impulse Control Training**: Teach individuals to recognize triggers and develop coping strategies. - **Medications**: Antidepressants, mood stabilizers, and SSRIs are sometimes prescribed to manage impulsivity. - **Support Groups**: Encourage participation in support groups like Gamblers Anonymous or other specialized programs. **De-escalation Techniques** - **Remain Calm**: Use a calm voice and avoid power struggles. - **Validate Feelings**: Acknowledge the person's distress or frustration. - **Clear Boundaries**: Set clear, non-threatening boundaries to prevent escalation. - **Physical Space**: Give the person enough personal space to reduce feelings of being trapped or threatened. **Chapter 22: Substance-Related and Addictive Disorders** **Care of Patients in Delirium Tremens (DTs)** - **DTs** are a severe form of alcohol withdrawal, presenting with confusion, agitation, hallucinations, seizures, and autonomic instability. - **Interventions**: Provide a safe, calm environment; administer benzodiazepines (e.g., lorazepam) to manage withdrawal symptoms; monitor vital signs closely; consider hydration and electrolyte balance. **Illnesses from Substance Use** - **Liver Disease**: Alcohol use can cause cirrhosis, hepatitis, and liver failure. - **Cardiovascular Issues**: Chronic use of stimulants or alcohol can lead to hypertension, cardiomyopathy, or arrhythmias. - **Respiratory Problems**: Chronic use of nicotine or other inhalants leads to lung disease, COPD, or cancer. **Narcan (Naloxone) -- Actions** - **Mechanism of Action**: Narcan is an opioid antagonist, which rapidly reverses opioid overdose by displacing opioids from receptor sites in the brain. - **Administration**: Can be given intranasally or intramuscularly, and the effects are typically seen within 2--3 minutes. - **Side Effects**: Can induce withdrawal symptoms in individuals dependent on opioids. **Risk Factors for Overdose** - **Polypharmacy**: Concurrent use of opioids and benzodiazepines or alcohol increases overdose risk. - **Tolerance**: A decrease in tolerance can lead to accidental overdose when the person resumes using drugs after a period of abstinence. - **Mental Health Disorders**: Depression, anxiety, and PTSD can contribute to higher risk of overdose in individuals with substance use disorders. **Signs of Intoxication and Withdrawal** - **Intoxication**: - Alcohol: Slurred speech, ataxia, drowsiness, and impaired judgment. - Stimulants: Agitation, increased heart rate, dilated pupils, hyperactivity. - Opioids: Pinpoint pupils, sedation, slowed breathing. - **Withdrawal**: - Alcohol: Tremors, sweating, anxiety, nausea, seizures, and delirium. - Opioids: Sweating, nausea, vomiting, muscle aches, anxiety, yawning. - Stimulants: Fatigue, depression, increased appetite, and vivid dreams. **Chapter 23: Neurocognitive Disorders** **Assessment and Outcomes of Care** - **Assessment**: Includes cognitive testing, a review of medical history, and evaluation of functional abilities. Tools like the Mini-Mental State Examination (MMSE) or the Montreal Cognitive Assessment (MoCA) are often used. - **Outcomes of Care**: Focus on maintaining current cognitive function, managing behavioral symptoms, and improving quality of life. Reducing caregiver burden is also a goal. **Therapeutic Communication with Patient and Family** - **With the Patient**: Use simple language, be patient, avoid correcting memory gaps, and engage in reality-based conversations. - **With Family**: Provide education on the disease, emphasize the importance of routine, offer support, and encourage self-care for caregivers. **Difference Between Dementia and Delirium** - **Delirium**: Acute onset, fluctuating course, typically caused by an underlying medical condition (e.g., infection, medication). - **Dementia**: Chronic and progressive decline in cognitive function, not typically reversible (e.g., Alzheimer\'s disease). **Frontotemporal Dementia** - **Characteristics**: Progressive damage to the frontal and temporal lobes, causing changes in personality, behavior, and language. Early onset is common. - **Symptoms**: Disinhibition, apathy, poor judgment, and language difficulties. **Characteristics of Different Types of Dementia** - **Alzheimer's Disease**: Memory loss, difficulty in learning, language impairment, and executive function decline. - **Vascular Dementia**: Often follows a stroke, with cognitive decline linked to poor blood flow to the brain. - **Lewy Body Dementia**: Visual hallucinations, motor symptoms similar to Parkinson\'s disease, fluctuating cognitive abilities. **Terminology** - **Aphasia**: Loss of ability to understand or produce speech. - **Agnosia**: Inability to recognize objects, faces, or sounds. - **Apraxia**: Difficulty planning and executing movements, even though motor function is intact. **Stages of Alzheimer\'s Disease** - **Early Stage**: Mild memory loss, difficulty with complex tasks. - **Middle Stage**: Significant memory and cognitive decline, difficulty with activities of daily living. - **Late Stage**: Severe cognitive decline, inability to communicate, total dependence on caregivers. **Interventions for Dementia** - **Group Interventions**: Reminiscence therapy, music therapy, and cognitive stimulation groups. - **Individual Interventions**: Reality orientation, one-on-one therapy, and activity-based interventions tailored to the person's abilities. **Chapter 24: Personality Disorders** **Characteristics of Each Disorder:** 1. **Cluster A: Odd or Eccentric Behaviors** - **Paranoid Personality Disorder**: Mistrust and suspicion of others. - **Schizoid Personality Disorder**: Detachment from social relationships, limited emotional expression. - **Schizotypal Personality Disorder**: Acute discomfort in relationships, eccentric behavior, odd beliefs. 2. **Cluster B: Dramatic, Emotional, or Erratic Behaviors** - **Antisocial Personality Disorder**: Disregard for others\' rights, deceitful, manipulative, and impulsive. - **Borderline Personality Disorder (BPD)**: Unstable relationships, self-image, and intense emotional reactions, often with self-harming behaviors. - **Histrionic Personality Disorder**: Attention-seeking behavior, excessive emotionality. - **Narcissistic Personality Disorder**: Grandiosity, need for admiration, lack of empathy. 3. **Cluster C: Anxious or Fearful Behaviors** - **Avoidant Personality Disorder**: Social inhibition, feelings of inadequacy, hypersensitivity to criticism. - **Dependent Personality Disorder**: Excessive need to be taken care of, leading to submissiveness and clinging behavior. - **Obsessive-Compulsive Personality Disorder (OCPD)**: Preoccupation with orderliness, perfectionism, and control. **Interventions for Each Disorder:** - **Therapeutic Communication**: Emphasize validation, consistency, and boundary setting. - **Cognitive Behavioral Therapy (CBT)**: Aims to modify dysfunctional thought patterns. - **Dialectical Behavior Therapy (DBT)**: Especially effective for BPD, focusing on emotional regulation and interpersonal skills. - **Medications**: Antidepressants (SSRIs), mood stabilizers, or antipsychotics may be prescribed based on symptoms. **Risks, Safety Issues:** - **Self-harm**: Especially in BPD, due to emotional instability. - **Violence**: Antisocial and narcissistic behaviors can result in harm to others. - **Impulsivity**: Common across multiple personality disorders, potentially leading to unsafe behaviors. **Defenses (Splitting):** - Splitting refers to viewing people or situations as all good or all bad, with no middle ground. It\'s commonly seen in BPD and can affect interpersonal relationships and treatment. **Impulsivity:** - Often seen in BPD, Antisocial, and Narcissistic Personality Disorders. Can lead to reckless behaviors such as substance abuse, unsafe sexual practices, and self-injury. **Chapter 25: Suicide and Non-Suicidal Self-Injury** **Plan of Care and Outcomes:** - **Short-Term Goal**: Ensure safety and prevent immediate risk. - **Long-Term Goal**: Improve coping skills, manage underlying mental health conditions, enhance social support. - **Outcome Measurement**: Reduction in suicidal ideation, improved mood, safety contracts. **Assessment - Risk Factors, Protective Factors:** - **Risk Factors**: - Mental health disorders (depression, bipolar, schizophrenia). - History of previous suicide attempts. - Substance abuse, chronic illness, major stressors (e.g., job loss). - **Protective Factors**: - Strong social support, religious faith, engagement in treatment, access to mental health care. **Warning Signs:** - **Verbal Cues**: \"I can't go on,\" \"Everyone would be better off without me.\" - **Behavioral Cues**: Giving away possessions, withdrawing from social interactions. - **Physical Cues**: Sudden improvement in mood after a period of depression (indicating decision to act on suicidal thoughts). **Chapter 26: Crisis and Disaster** **Interventions:** - **Psychological First Aid**: Provide immediate, supportive care to reduce emotional distress. - **Crisis Counseling**: Short-term therapy to address immediate needs and emotional responses. - **Referral**: Connect individuals with long-term care resources and support. **Needs:** - **Physical Needs**: Shelter, food, water, medical care. - **Emotional Needs**: Emotional support, reassurance, stabilization. - **Social Needs**: Connection with family, community resources, or support groups. **Chapter 27: Anger and Aggression** **Safety Assessment:** - Assess for potential danger to the patient, staff, and others. Includes evaluating for physical aggression, destructive behavior, or verbal threats. **Signs of Crisis:** - Increased agitation, physical restlessness, yelling, clenching fists. - Nonverbal cues like glaring, pacing, or hostile body language. **Verbal De-escalation:** - Use calm, clear communication to acknowledge feelings and promote a resolution. - Use a non-threatening posture and remain calm, empathetic, and firm. **Sensory Approaches:** - Encourage relaxation techniques like deep breathing, music therapy, or visual distractions to calm the individual. **Restraint:** - Use as a last resort when there is imminent risk of harm. - Ensure the restraint process is done according to legal and ethical guidelines. **Chapter 28: Child and Intimate Partner Abuse** **Risk Factors for Abuse:** - **Child Abuse**: Parental substance abuse, mental illness, history of being abused, poverty, social isolation. - **Intimate Partner Abuse**: Prior abuse, substance abuse, financial dependence, isolation, history of trauma. **Cycle of Violence:** - **Tension Building Phase**: Stress and conflict escalate. - **Acute Battering Phase**: Physical violence occurs. - **Honeymoon Phase**: Perpetrator apologizes and promises change. **Nursing Care:** - **Observation**: Look for signs of abuse (physical injury, fearfulness). - **Documentation**: Accurately record physical injuries and statements made by the victim. - **Mandated Reporter**: Nurses are legally required to report suspected abuse to appropriate authorities. **Trauma-Informed Care:** - Approach care with an understanding of how trauma affects health and behavior. - Prioritize safety, trust-building, empowerment, and respect. **Chapter 31: Older Adults** **Risk of Depression:** - Depression is common in older adults due to chronic illness, loss of loved ones, social isolation, and life changes. **Suicide Risk:** - Increased risk due to chronic illness, loss of independence, and feelings of isolation. **Pain Assessment and Management:** - Older adults may underreport pain due to fear of becoming a burden or because of cognitive decline. - Use pain scales appropriate for older populations, such as the PAINAD scale. **Stigma:** - Older adults may experience stigma related to mental health, including perceptions of "aging out" of relevance or fear of judgment for seeking help. **Therapeutic Communication:** - Focus on active listening, respect, and empathy. - Avoid making assumptions about older adults; include them in care decisions. **Chapter 32: Serious Mental Illness** **Therapeutic Intervention - Non-Adherence:** - **Non-adherence** is common in serious mental illness (e.g., schizophrenia). Use a collaborative approach to care, include family, and address concerns regarding medication side effects. **Needs:** - **Psychosocial Support**: Education, stable housing, employment support, community resources. - **Medical Support**: Regular follow-up for medication management and therapy. **Chapter 36: Integrative Care** **Education - Herbal Products - Risks and Benefits, Actions:** - **Herbal Remedies**: Common options include St. John\'s Wort (for mild depression), valerian root (for anxiety), and ginseng (for energy). - **Risks**: Herbal products may interact with prescribed medications, causing side effects or reducing the efficacy of drugs. **Difference Between CAM and Western Traditional Medicine:** - **CAM (Complementary and Alternative Medicine)**: Includes acupuncture, chiropractic, herbal medicine, and mind-body techniques. These are used alongside or instead of traditional Western treatments. - **Western Medicine**: Typically focuses on pharmacology, surgery, and evidence-based practices. **Different Practices in CAM:** - **Acupuncture**: Insertion of fine needles to stimulate energy flow. - **Chiropractic Care**: Focus on spinal alignment and nervous system function. - **Massage Therapy**: Aims to relieve muscle tension and improve circulation. - **Mind-Body Practices**: Meditation, yoga, mindfulness.