MENTAL HEALTH NURSING

MJ30303 MENTAL HEALTH NURSING GLORIA SARAH BEN L1 INTRODUCTION TO BASIC CONCEPTS IN PSYCHIATRIC AND MENTAL HEALTH NURSING 1.​ Define Mental Health.​ -​ A state of well-being in which every individual...

MJ30303 MENTAL HEALTH NURSING GLORIA SARAH BEN L1 INTRODUCTION TO BASIC CONCEPTS IN PSYCHIATRIC AND MENTAL HEALTH NURSING 1.​ Define Mental Health.​ -​ A state of well-being in which every individual realises their own potential. -​ Can cope with the normal stresses of life -​ Can work productively -​ Able to make a contribution to their community 2.​ Define Mental Illness -​ Disorders that affect a person’s mood, thinking, according to WHO. and behaviour associated with personal distress and impaired functioning. 3.​ List the characteristics of -​ Emotional stability a good mental illness.​ -​ High self-esteem -​ Effective coping strategies -​ Positive relationships with others 4.​ List the characteristics of -​ Changes in one’s thinking, perception, feeling mental illness. and judgement. -​ Changes in behaviour which appear to be deviant from previous personality or from the norms of the community. 5.​ State the Historical Perspectives of Mental Health. Ancient Times -​ Mental illness was seen as supernatural; treatments included punishment. Middle Ages -​ Shift toward care and responsibility. 18th-19th Century -​ Moral treatment emerged (Pinel, Dix). 20th Century Onward -​ Psychotropic medications, deinstitutionalization, and patient-centered care. 6.​ Lists the factors that can influence mental health : a)​ Biological b)​ Psychological c)​ Sociocultural a)​ Biological -​ Genetic -​ Chromosomal mutation -​ Endocrine abnormalities -​ Abnormal brain b)​ Psychological -​ Early development -​ Personality trait -​ Poor parenting -​ Childhood trauma -​ Maternal emotional deprivation MJ30303 MENTAL HEALTH NURSING GLORIA SARAH BEN -​ Disturbed peer relationship -​ Stress environment c)​ Sociocultural -​ Poverty -​ Lack of resources -​ Discrimination -​ Gender bias -​ Cultural beliefs -​ Inadequate parenting 7. Explain the stage of the Stress Adaptation Model (Hans Selye’s GAS Model) 1.​ Alarm stage -​ Fight or flight response 2.​ Resistance -​ Body attempts to return to homeostasis stage 3.​ Exhaustion -​ Prolonged stress leads to depletion of resources and stage potential illness 8. State the concept of Adaptation. Problem-Focused Coping -​ Addressing stressors directly. Emotion-Focused Coping -​ Managing emotional responses. 9. State the Adaptive and Maladaptive Response. Adaptive -​ Healthy coping (relaxation, social support). Maladaptive -​ Unhealthy responses (substance abuse, aggression). MJ30303 MENTAL HEALTH NURSING GLORIA SARAH BEN L2 FOUNDATIONS FOR PSYCHIATRIC Concepts of -​ The connection between brain function and mental Psychophysiology health. Brain Areas in Psychiatric Conditions Prefrontal Cortex Decision-making, linked to schizophrenia and ADHD. Limbic System Emotion and memory, linked to PTSD (Amygdala and and mood disorders. Hippocampus Basal Ganglia Movement control, linked to OCD. Neurotransmitters in Mental Health Serotonin -​ Mood regulation (low in depression). Dopamine -​ Pleasure and motivation (high in schizophrenia, low in Parkinson’s). GABA -​ Calming effect (low in anxiety disorders). Neuroplasticity -​ The brain’s ability to reorganize itself through learning and therapy. Stress and Mental -​ HPA Axis Activation: Triggers cortisol release. Health -​ Chronic Stress Effects: Leads to immune dysfunction, depression, and anxiety. Biopsychosocial -​ Biological Factors: Genetics, brain chemistry. Model of Mental -​ Psychological Factors: Coping skills, personality. Health -​ Social Factors: Family, culture, environment. Genetics & -​ Genetic Risks: Family history of schizophrenia or bipolar Epigenetics in Mental disorder. Health -​ Epigenetics: Stress and trauma affecting gene expression. Mind-Body -​ Psychophysiological Feedback: Mental states affecting Connection physical health. -​ Mindfulness and Relaxation: Reducing stress and improving coping. MJ30303 MENTAL HEALTH NURSING GLORIA SARAH BEN FREUD’S PSYCHOANALYTIC THEORY PSYCHOANALYTIC THEORY Id The primitive part of personality, driven by instincts and desires (pleasure principle). Ego The rational self that balances the Id and Superego (reality principle). Superego The moral conscience that enforces social norms (morality principle). PSYCHOSEXUAL STAGES OF DEVELOPMENT Oral Stage (0-1 year) -​ Focus on sucking (can lead to habits like smoking). Anal Stage (1-3 -​ Focus on control (linked to OCD or rebellious years) behavior). Phallic Stage (3-6 -​ Identification with same-sex parents. years) Latency Stage -​ Social and intellectual skills develop. (6-puberty) Genital Stage -​ Sexual maturity and relationships form. (puberty-adulthood) DEFENSE MECHANISM Repression -​ Blocking unwanted thoughts. Denial -​ Refusing to accept reality. Projection -​ Attributing one's feelings to others. Displacement -​ Redirecting emotions onto another object. MJ30303 MENTAL HEALTH NURSING GLORIA SARAH BEN ERIKSON’S PSYCHOSOCIAL THEORY Trust vs. Mistrust (0-1 year) Developing a sense of security. Autonomy vs. Shame (1-3 years) Developing independence. Initiative vs. Guilt (3-6 years) Developing confidence in decision-making. Industry vs. Inferiority (6-12 years) Developing competence in skills. Identity vs. Role Confusion (12-18 Developing a sense of self. years) Intimacy vs. Isolation (Young Developing close relationships. adulthood) Generativity vs. Stagnation (Middle Contributing to society. adulthood) Integrity vs. Despair (Late Reflecting on life with satisfaction or regret. adulthood) PIAGET’S COGNITIVE DEVELOPMENT THEORY Sensorimotor Stage (0-2 Learning through senses and movement, developing years) object permanence. Preoperational Stage (2-7 Egocentric thinking, using symbols and imagination. years) Concrete Operational Logical thinking about concrete concepts, Stage (7-11 years) understanding conservation. Formal Operational Stage Abstract thinking, problem-solving, moral reasoning. (12+ years) MJ30303 MENTAL HEALTH NURSING GLORIA SARAH BEN CARL ROGERS HUMANISTIC THEORY Self-Actualization The innate drive to fulfill one’s potential. Self-Concept How a person views themselves (can be positive or negative). Unconditional Accepting and valuing individuals without judgment. Positive Regard KAREN HORNEY’S NEO-FREUDIAN THEORY Basic Anxiety A deep sense of helplessness and isolation due to childhood experiences. Neurotic Needs Excessive behaviors people adopt to cope with anxiety (e.g., seeking approval, needing power). JOHN BOWLBY’S ATTACHMENT THEORY Secure Attachment Leads to healthy relationships. Anxious Attachment Leads to clinginess and fear of abandonment. Avoidant Attachment Leads to emotional distance. Disorganized Leads to confusion and fear in relationships. Attachment MJ30303 MENTAL HEALTH NURSING GLORIA SARAH BEN L3 ETHICAL AND LEGAL ISSUES IN PSYCHIATRIC NURSING Ethical Principles in Psychiatric Nursing Autonomy Respecting patients’ rights to make informed decisions. Beneficence Acting in the best interest of the patient. Non-maleficence Avoiding or minimizing harm to patients. Justice Ensuring fair treatment and access to mental health services. Fidelity Maintaining trust and confidentiality in patient care. Common Ethical Dilemmas Involuntary Balancing patient autonomy vs. need Admission for treatment. Use of Restraints Ethical concerns in using restraints only as a last resort. Confidentiality Reporting threats while protecting vs. Duty to Warn privacy. End-of-Life Ethical concerns in psychiatric patients Decisions refusing life-saving treatments. Legal Aspects of Psychiatric Nursing Mental Health Laws on involuntary commitment and Acts and patient rights. Regulations Patient Rights in Right to refuse treatment, dignity, and Psychiatric Care privacy. Confidentiality Protecting patient data while meeting and Privacy legal reporting requirements. Malpractice and Legal consequences of medication Negligence errors, inappropriate restraint use, or neglect. MJ30303 MENTAL HEALTH NURSING GLORIA SARAH BEN Psychiatric Advance -​ Legal documents where patients specify future mental Directives health care preferences when they lose decision-making capacity. Cultural -​ Different cultural perceptions of mental illness. Considerations in -​ Cultural barriers to care (language, stigma, mistrust). Psychiatric Nursing -​ Culturally sensitive interventions (traditional healing, community involvement). Spiritual -​ Spirituality as a coping mechanism. Considerations in -​ Identifying and respecting a patient’s spiritual beliefs. Mental Health Care -​ Ensuring non-coercive spiritual support. Integration of -​ Holistic mental health care approach. Cultural & Spiritual -​ Respecting cultural and religious values in treatment Competence planning. -​ Involving family and community resources where appropriate. MJ30303 MENTAL HEALTH NURSING GLORIA SARAH BEN L4 THERAPEUTIC APPROACHES IN PSYCHIATRIC NURSING CARE RELATIONSHIP DEVELOPMENT Purpose of -​ Building a trusting relationship is the foundation of psychiatric Relationship nursing. Development in -​ Involves empathy, consistency, and maintaining boundaries. Psychiatric Nursing Phases of Nurse-Patient Orientation Phase -​ Introduction, establishing trust, Relationship setting expectations. Working Phase -​ Addressing patient needs, implementing interventions. Termination Phase -​ Preparing for discharge, reflecting on progress. Nurse’s Role in -​ Provide consistent emotional support. Relationship -​ Establish clear professional boundaries. Development -​ Maintain patient confidentiality and safety. Therapeutic Factors -​ Universality: Realizing others share similar struggles. in Group Therapy -​ Altruism: Helping others improves self-esteem. -​ Instillation of Hope: Seeing others improve fosters motivation. Nurse’s Role in -​ Facilitation: Leading or co-leading group sessions. Therapeutic Groups -​ Monitoring: Ensuring group members remain engaged. -​ Conflict Resolution: Managing disputes within the group. -​ Creating a Safe Space: Encouraging open discussion. Challenges in -​ Managing Group Dynamics: Ensuring participation from all Therapeutic Groups members. -​ Dealing with Dominant Personalities: Preventing one person from controlling discussions. -​ Cultural Sensitivity: Respecting diverse backgrounds. -​ Privacy Concerns: Maintaining confidentiality. MJ30303 MENTAL HEALTH NURSING GLORIA SARAH BEN THERAPEUTIC COMMUNICATION Define Therapeutic -​ Purposeful, goal-directed communication used to promote Communication mental well-being. Key Techniques in Therapeutic Active -​ Demonstrating attention and interest. Communication Listening Open-ended -​ Encouraging patients to elaborate. Questions Reflection -​ Repeating the patient's words to enhance self-awareness. Clarification -​ Preventing misunderstandings. Silence -​ Allowing patients to process thoughts. Nurse’s Role in -​ Assess patient needs through effective questioning. Therapeutic -​ Facilitate emotional expression in a safe environment. Communication -​ Educate patients and families about mental health. Therapeutic Communication Non-Verbal -​ Body language, facial expressions, eye Strategies Communicatio contact. n Empathy vs. -​ Understanding emotions (empathy) Sympathy rather than pity (sympathy). Congruence -​ Ensuring verbal and non-verbal communication match. MJ30303 MENTAL HEALTH NURSING GLORIA SARAH BEN THERAPEUTIC GROUPS Define Therapeutic -​ Structured interventions led by a therapist or nurse to provide Groups in Psychiatric support, education, and skill-building. Nursing Types of Therapeutic Groups Psychoeducational -​ Teach patients about their condition Groups and coping strategies. Support Groups -​ Provide emotional support and shared experiences. Cognitive -​ Help change negative thinking Behavioral Groups patterns. Skills Training -​ Teach practical skills (e.g., stress Groups management, social skills). Benefits of Group -​ Encourages social interaction and reduces isolation. Therapy -​ Provides peer support and shared experiences. -​ Facilitates learning of coping mechanisms. Key Principles of -​ Group Dynamics: Understanding interaction patterns. Therapeutic Groups -​ Roles in Groups: Leader (nurse/therapist) facilitates, members share experiences and support each other. Therapeutic Factors -​ Universality: Realizing others share similar struggles. in Group Therapy -​ Altruism: Helping others improves self-esteem. -​ Instillation of Hope: Seeing others improve fosters motivation. Nurse’s Role in -​ Facilitation: Leading or co-leading group sessions. Therapeutic Groups -​ Monitoring: Ensuring group members remain engaged. -​ Conflict Resolution: Managing disputes within the group. -​ Creating a Safe Space: Encouraging open discussion. Challenges in -​ Managing Group Dynamics: Ensuring participation from all Therapeutic Groups members. -​ Dealing with Dominant Personalities: Preventing one person from controlling discussions. -​ Cultural Sensitivity: Respecting diverse backgrounds. -​ Privacy Concerns: Maintaining confidentiality. MJ30303 MENTAL HEALTH NURSING GLORIA SARAH BEN L5 MENTAL HEALTH NURSING–INTERVENTION WITH FAMILIES 1.​ Outline the Assessment of Family Dynamics in Psychiatric Care. Family as a Unit of -​ Assess family structure, relationships and Care communication patterns. Assessment Tools -​ Genograms and Techniques -​ Ecomaps -​ Family interview 2.​ List the common -​ Caregiver Role Strain related to managing a family nursing diagnoses member with a chronic mental illness. related to Family -​ Impaired Family Coping related to the stress of Interventions. caring for a patient with a psychiatric disorder. -​ Interrupted Family Processes due to the disruption caused by the patient’s psychiatric condition. -​ Knowledge Deficit regarding the psychiatric condition and available treatment options. 3.​ Outline the Planning and Goal Setting with the Family Members of Psychiatric Patients. Setting Collaborative -​ Involving families in the goal-setting process, Goals ensuring that both patient and family members' needs are addressed. -​ Focus on improving family communication, strengthening support systems. Educational -​ Teaching family members about the nature of Interventions the patient’s psychiatric illness, treatment options, medication management, and potential side effects. -​ Providing education on how to support the patient during crises or relapses. -​ Offering resources for family members, such as support groups or counseling services. 4.​ Outline the Implementations of Family Interventions of Psychiatric Patients. Therapeutic -​ Engaging in open, non-judgmental communication Communication to address family concerns and feelings. -​ Active listening and empathy are key to building trust with family members. Psychoeducation -​ Structured educational sessions about the patient’s mental illness, expected course of MJ30303 MENTAL HEALTH NURSING GLORIA SARAH BEN treatment, and recovery process. -​ Discussing ways to manage daily stress and enhance family functioning. Supportive -​ Providing emotional support to family members Counseling who may be experiencing grief, guilt, anger, or frustration related to the patient’s condition. -​ Encouraging families to express their emotions in a safe and therapeutic environment. Family Therapy -​ Collaborating with mental health professionals to conduct family therapy sessions aimed at resolving conflicts, improving communication, and fostering understanding within the family. Crisis Intervention -​ Assisting families during psychiatric emergencies. -​ Providing guidance on how to manage crises at home and when to seek immediate care. 5.​ Outline the Evaluations done for the Family Interventions. Evaluating Family -​ Measuring the effectiveness of interventions Progress through family feedback and patient outcomes. -​ Indicators of success may include improved family communication, reduced caregiver burden, and better adherence to the treatment plan. Ongoing Support -​ Continually assessing family needs and providing and Follow Up additional interventions or referrals to community resources as required. -​ Monitoring changes in family dynamics over time to ensure long-term success. MJ30303 MENTAL HEALTH NURSING GLORIA SARAH BEN L6 MILIEU THERAPY Define Milieu Therapy. -​ A treatment modality in which the therapeutic environment itself is a key component of care. -​ It involves the structured use of the physical and social environment to support emotional, psychological, and behavioral well-being in psychiatric patients. Principles of Milieu Therapy. Safety and Structure Ensuring physical/emotional safety through clear rules and schedules. Involvement and Encouraging patient participation in Engagement therapy and decision-making. Supportive Social Peer support and healthy Interactions relationships modeled by staff. Therapeutic Use of Group therapy, recreational Activities activities, and life skill training. Responsibilities and Patients take on responsibilities Autonomy within the community to build self-sufficiency. Goals of Milieu Therapy. Promote Personal Fosters self-awareness, Growth responsibility, and self-discipline. Enhance Social Skills Encourages conflict resolution, communication, and social interaction. Facilitate Behavioral Uses role modeling, Change reinforcement, and peer feedback to modify behaviors. Improve Supports patient autonomy in Decision-Making and real-life scenarios. Coping Skills Support Recovery and Prepares patients for Reintegration independent living and mental health management. Components of a Therapeutic Community Physical Open, safe spaces promote interaction Environment and relaxation. MJ30303 MENTAL HEALTH NURSING GLORIA SARAH BEN Social Environment Positive relationships with peers and staff, therapeutic communication. Therapeutic Group therapy, art therapy, music Activities therapy, and recreational activities. Nurse’s Role in Milieu -​ Maintaining a Safe and Structured Environment: Therapy Enforcing rules, managing crises. -​ Facilitating Communication and Socialization: Encouraging interactions and resolving conflicts. -​ Role Modeling: Demonstrating positive behaviors, emotional regulation, and social skills. -​ Educating Patients: Teaching mental health management, coping strategies, and life skills. -​ Crisis Management: De-escalating psychiatric crises, ensuring patient and community safety. Evaluation of Milieu -​ Patient Progress: Improvements in social skills, Therapy self-care, emotional regulation. -​ Engagement: Participation in activities, adherence to rules, peer interactions. -​ Community Feedback: Nurses and patients assess the effectiveness of therapy. -​ Relapse Prevention and Transition Planning: Assessing readiness for independent living and coping outside therapy. Crisis Intervention in Mental Health Nursing CRISIS Definition Example Phases A sudden -​ Suicidal -​ Problem emotional ideation Recognition distress event -​ Psychosis -​ Emotional overwhelming -​ Acute Escalation coping anxiety -​ Crisis State mechanisms. -​ Trauma. -​ Resolution. Nurse’s Role in Crisis -​ Assessment: Evaluate the crisis severity, risk of harm, Intervention and coping mechanisms. -​ De-escalation Techniques: Use calm communication, active listening, and relaxation techniques. -​ Safety Planning: Develop a strategy to prevent future crises, ensuring support. -​ Therapeutic Communication: Provide reassurance, validate emotions, and guide problem-solving. -​ Follow-up Care: Arrange ongoing therapy or community support. MJ30303 MENTAL HEALTH NURSING GLORIA SARAH BEN L7 ASSERTIVENESS TRAINING ASSERTIVENESS Define Assertiveness -​ A communication style that allows individuals to express thoughts, feelings, and needs directly, honestly, and respectfully. -​ Promotes self-confidence and healthy relationships. Assertiveness vs. Other Styles Passive -​ Avoiding conflict, suppressing needs. Aggressive -​ Demanding, disrespectful behavior. Passive-Aggressive -​ Indirectly expressing frustration. Assertive -​ Clear, respectful, and confident expression. Strategies to Develop -​ Use “I” Statements: Express feelings without Assertiveness blame. -​ Set Clear Boundaries: Communicate limits politely. -​ Stay Calm: Speak in a steady tone, maintain eye contact. -​ Practice Active Listening: Show respect for others’ opinions. -​ Provide Constructive Feedback: Focus on solutions. -​ Practice in Low-Stakes Situations: Build confidence gradually. MJ30303 MENTAL HEALTH NURSING GLORIA SARAH BEN SELF ESTEEM Define Self Esteem -​ How individuals view and value themselves, influencing mental health, confidence, and coping abilities. Factors Influencing Self-Esteem Social Environment Supportive families and positive friendships enhance self-esteem; bullying or neglect lowers it. Personality Traits Resilience, optimism, and assertiveness contribute to high self-esteem. Cognitive Style Positive thinking patterns improve self-worth. Achievements and Success in academics, work, or Competence hobbies boosts self-esteem. Mental Health Anxiety, depression, and body image issues can lower self-esteem. Relationship Between Self-Esteem & Mental Positive Feedback High self-esteem promotes Health Loop better mental well-being. Negative Feedback Low self-esteem leads to Loop negative thoughts and worsened mental health. Buffering Effect Strong self-esteem helps people cope with stress and setbacks. Strategies to Enhance -​ Positive Reinforcement: Celebrate achievements, Self-Esteem use specific praise. -​ Cognitive Restructuring: Challenge negative thoughts, replace them with realistic perspectives.- -​ Self-Compassion: Treat oneself with kindness, avoid self-criticism. -​ Mindfulness: Focus on the present moment, practice self-awareness. -​ Write a Self-Compassion Letter: Reinforce a supportive inner voice. MJ30303 MENTAL HEALTH NURSING GLORIA SARAH BEN Physiological Triggers of Anger Hormonal Changes Cortisol, adrenaline, and high testosterone levels increase anger. Neurological Factors Overactive amygdala, low serotonin levels cause impulsive reactions. Sleep Deprivation Lack of sleep reduces emotional control. Substance Use Alcohol and drugs lower inhibition and increase aggression. Physical Health Issues Chronic pain, neurological disorders, and mental illnesses can heighten irritability. Psychological Triggers of Anger Stress & Anxiety High stress makes people more reactive to frustration. Unresolved Trauma Past trauma can lead to defensive anger responses. Negative Thought Cognitive distortions like Patterns catastrophizing fuel anger. Low Self-Esteem & Feeling judged or inadequate can Insecurity trigger defensive anger. Perceived Injustice Feeling disrespected or ignored or Boundary can provoke anger. Violations Evidence-Based -​ Relaxation Techniques: Progressive muscle Techniques for Anger relaxation (PMR), deep breathing exercises. Management -​ Biofeedback: Using technology to monitor physiological responses to anger. -​ Cognitive Behavioral Therapy (CBT): Restructuring irrational thoughts to prevent anger escalation. -​ Anger Management Training: Identifying triggers, keeping an anger log, learning self-regulation. -​ Social Skills Training: Conflict resolution, empathy, and perspective-taking. -​ Exercise and Physical Activity: Reduces stress hormones and increases mood-enhancing endorphins. MJ30303 MENTAL HEALTH NURSING GLORIA SARAH BEN L8 THE SUICIDAL CLIENT Define Psychiatric -​ A disturbance in thought, mood and/or action. Emergency -​ Causes sudden distress to the individual/others and sudden disability or death. Common -​ Suicide attempts Psychiatric -​ Acute psychotic episodes Emergencies -​ Drug/alcohol withdrawal -​ Severe depression or catatonia -​ Panic attacks or dissociation Risk Factors for -​ Mental illness: Depression, bipolar disorder, schizophrenia Suicide -​ Substance abuse: Drugs, alcohol -​ Previous suicide attempts -​ Chronic illness and pain -​ Social isolation, trauma, or abuse Warning Signs of -​ Talking about death or hopelessness Suicide -​ Increased substance use -​ Withdrawing from friends & family -​ Mood swings or sudden calmness -​ Giving away possessions Protective Factors -​ Strong support system (family, friends) -​ Access to mental health care -​ Good coping skills & problem-solving ability -​ Cultural or religious beliefs discouraging suicide -​ Restricted access to suicide methods Suicide Risk Assessment – SAD SAD PERSONS SCALE PERSONS Scale Sex 1 if male. Age 1 if 44. Depression 1 if present. Previous Attempt 1 if present. Ethanol Abuse 1 if present. Rational Thinking Loss 1 if present. Social Support Lacking 1 if present. Organized Plan 1 if a lethal plan is made. No Spouse 1 if divorced, widowed, or single. Sickness 1 if chronic illness is present. MJ30303 MENTAL HEALTH NURSING GLORIA SARAH BEN Crisis Intervention -​ Assess risk level (thoughts, intent, access to means) -​ Build trust and listen actively -​ Reduce emotional distress -​ Involve family/friends for support -​ Refer to mental health services Safety Planning for -​ Identify personal triggers and warning signs Suicidal Clients -​ Develop coping strategies (relaxation, distractions) -​ List support contacts (family, friends, professionals) -​ Restrict access to harmful means -​ Create an emergency action plan Behavior Therapy for Suicide Positive Reinforcement Encouraging healthy behaviors through Prevention rewards. Techniques Systematic Gradual exposure to anxiety triggers. Desensitization Relaxation Therapy Techniques to reduce stress and anxiety. Cognitive Therapy -​ Identifying Negative Thoughts: Challenging irrational beliefs. for Suicide -​ Cognitive Restructuring: Replacing harmful thoughts with Prevention positive ones. -​ Core Beliefs and Schemas: Addressing deep-rooted beliefs about self-worth.  MJ30303 MENTAL HEALTH NURSING GLORIA SARAH BEN L9.1 BASIC PRINCIPLES OF PSYCHOPHARMACOLOGY Class Mechanism of Action Uses Examples and Dosages Antidepressants Increase -​ Major 1.​ Fluoxetine (Prozac) neurotransmitters depressive [SSRI]: 20-80 mg/day (serotonin, disorder. (blocks serotonin norepinephrine, -​ Anxiety reuptake) dopamine) to improve disorders. 2.​ Venlafaxine (Effexor) mood and reduce -​ OCD. [SNRI]: 75-375 anxiety. mg/day (blocks serotonin & norepinephrine reuptake) Antipsychotics Block dopamine (D2) -​ Schizophrenia 1.​ Olanzapine: 5-20 and serotonin (5-HT2) -​ Bipolar mg/day (blocks receptors to reduce disorder. dopamine & serotonin) hallucinations, -​ Severe 2.​ Risperidone: 2-6 delusions, and mood agitation. mg/day (similar instability. mechanism) Mood stabilizers Regulate -​ Bipolar 1.​ Lithium: 600-1200 neurotransmitter disorder mg/day (modulates levels and ion (mania and dopamine & channels to prevent depression). glutamate, enhances mood swings. serotonin) 2.​ Valproic Acid: 500-2000 mg/day (enhances GABA, inhibits excitatory signals) Anxiolytics Enhance GABA -​ Generalized 1.​ Diazepam (Valium) (inhibitory anxiety [Benzodiazepine]: neurotransmitter) to disorder. 2-10 mg, 2-4x/day reduce anxiety and -​ Panic (enhances GABA-A promote relaxation. disorder. receptors) -​ Insomnia. 2.​ Buspirone (BuSpar) [Non-benzo]: 15-30 mg, 2-3x/day (partial serotonin agonist)  MJ30303 MENTAL HEALTH NURSING GLORIA SARAH BEN L9.2 COMMONLY PRESCRIBED PSYCHOTROPIC MEDICATIONS Class Subtypes Examples Mechanism of Adult Dose Common side Action effects Antidepressants SSRIs (Selective Fluoxetine Increase Fluoxetine: Nausea Serotonin (Prozac), serotonin 10-80 mg/day Dry mouth Reuptake Sertraline levels by Sertraline: Sexual Inhibitors) (Zoloft) blocking 50-200 mg/day dysfunction reuptake SNRIs Venlafaxine Increase Venlafaxine: Increased BP (Serotonin-Norepi (Effexor), serotonin and 75-375 mg/day Sweating nephrine Duloxetine norepinephrine Duloxetine: Dizziness Reuptake (Cymbalta) by blocking 30-120 mg/day Inhibitors) reuptake TCAs (Tricyclic Amitriptyline Block reuptake Amitriptyline: Dry mouth Antidepressants) (Elavil), of serotonin 25-150 mg/day Blurred vision Imipramine and Imipramine: Weight gain (Tofranil) norepinephrine 75-200 mg/day Antipsychotics Typical Haloperidol Block Haloperidol: Tremors (First-Gen) (Haldol), dopamine (D2) 2-20 mg/day Rigidity Chlorpromazine receptors Sedation (Thorazine) Atypical Olanzapine Block Olanzapine: Weight gain (Second-Gen) (Zyprexa), dopamine and 10-20 mg/day Drowsiness Risperidone serotonin Risperidone: Dizziness (Risperdal) receptors 2-8 mg/day Mood Lithium Lithium Modulates 900-1200 Tremor Stabilizers Carbonate dopamine, mg/day Weight gain serotonin, and Kidney issues glutamate Anticonvulsants Valproate, Enhance Valproate: Nausea Lamotrigine, GABA, 1000-2000 Dizziness Carbamazepine stabilize mg/day Liver toxicity neuron activity Lamotrigine: 200-400 mg/day MJ30303 MENTAL HEALTH NURSING GLORIA SARAH BEN L9.3 EVALUATION AND INDICATION 1.​ State the common Psychotropic Medications Antidepressants -​ To manage depression and anxiety. Antipsychotics -​ To manage schizophrenia and bipolar disorder. Anxiolytics -​ To reduce anxiety. 2.​ State the Evaluation of -​ Accurate Diagnosis – Ensure the psychiatric Medication Indication. condition is properly diagnosed. -​ Therapeutic Benefits – Evaluate medication effectiveness. -​ Evidence-Based Practice – Follow clinical guidelines. 3.​ State the Types of Drug Interactions. Pharmacokinetic -​ Affects absorption, metabolism, and excretion. Pharmacodynamic -​ Alters medication effects (amplified or diminished). Additive Effects -​ Combining drugs can increase risks. 4.​ List the factors that can -​ Patient Factors – Age, genetics, liver/kidney affect Drug Interactions. function, comorbidities. -​ Medication Factors – Drug properties, enzyme effects. -​ Environmental Factors – Diet, alcohol, herbal supplements. 5.​ State the Nursing -​ Assessment – Monitor effects and side effects. Responsibilities in -​ Documentation – Record medication use and Pharmacotherapy. patient responses. -​ Administration – Ensure correct dosage and timing. -​ Coordination – Work with the healthcare team for safety. 6.​ State the patient -​ Medication Purpose – Explain benefits. education on Medication -​ Administration – Provide dosing and timing Management. instructions. -​ Monitoring – Educate on side effects & when to report issues. MJ30303 MENTAL HEALTH NURSING GLORIA SARAH BEN L10.1 COMPLEMENTARY THERAPIES 1.​ Define Complementary -​ Medical interventions that are currently not Therapies. an integral part of conventional medicine. 2.​ List the nursing -​ Assessing a patient’s use of complementary responsibilities for CAM and alternative therapies. Therapies. -​ Assess possible risk of complications or adverse interactions with conventional therapies. -​ Promoting safety and serving as a resource. -​ Providing holistic self-care and holistic nursing care. -​ Serving as a provider. -​ Participating in research. 3.​ Outline the classifications of CAM Therapies. 1.​ Alternative Medical -​ Systems of medicine that developed Systems independently of conventional Western medicine. -​ e.g Traditional Chinese Medicine, Homeopathy, Ayurveda. 2.​ Mind-Body -​ Relaxation breathing Interventions -​ Prayer -​ Meditation -​ Imagery -​ Hypnosis -​ Music therapy -​ Art therapy -​ Journaling -​ Animal assisted therapy 3.​ Manipulative and -​ Chiropractic therapy Body based methods -​ Acupressure -​ Massage therapy -​ Yoga 4.​ Energy Therapies -​ Therapeutic touch -​ Healing touch -​ Reiki -​ Magnet therapy 5.​ Biologically based -​ Herbal therapy treatments -​ Nutraceuticals -​ Nutritional therapy -​ Aromatherapy MJ30303 MENTAL HEALTH NURSING GLORIA SARAH BEN L10.2 ELECTROCONVULSIVE THERAPY (ECT) Definition of ECT -​ A psychiatric treatment where an electric current is applied to the brain to induce a controlled seizure, helping to treat severe mental illnesses. Types of ECT Direct -​ Given without anesthesia or muscle relaxants (less common today). Modified -​ Uses anesthesia and muscle relaxants to prevent full-body convulsions. Medications Used in Modified ECT Atropine (0.6 mg) Reduces saliva and prevents heart rate drop. Sodium Induces anesthesia. Thiopentone (150–250 mg) Scoline (30–50 Muscle relaxant to prevent mg) convulsions. Indications for ECT -​ Severe Depression: Especially with suicidal thoughts or psychosis. -​ Schizophrenia: Cases with catatonia or psychotic features. -​ Bipolar Disorder: Severe mania or depression resistant to medication. Contraindications -​ Severe heart conditions (recent heart attack, unstable angina). -​ Brain conditions (cerebral aneurysm, high intracranial pressure, recent stroke). -​ Severe lung disease (chronic obstructive pulmonary disease, pneumonia). Mechanism of Action -​ ECT increases neurotransmitter levels (serotonin, dopamine, norepinephrine), similar to antidepressant effects. Treatment Schedule -​ 6–10 sessions, typically twice per week. -​ Given under general anesthesia with muscle relaxants to minimize risks. Pre-Treatment -​ Educate patients and family about the procedure. Nursing -​ Ensure informed consent is signed. Responsibilities -​ Assess the patient's physical and mental status. MJ30303 MENTAL HEALTH NURSING GLORIA SARAH BEN -​ Enforce NPO (nothing by mouth) for at least 6–8 hours before ECT. -​ Complete pre-op checklist (vital signs, remove dentures, jewelry, glasses). Nursing -​ Ensure all equipment and emergency drugs are ready. Responsibilities on the -​ Confirm the patient's fasting status. Day of ECT -​ Administer prescribed medications (Atropine, anesthetics, muscle relaxants). -​ Monitor oxygen saturation and attach electrodes for seizure monitoring. During Treatment – -​ Assist anesthesiologist and psychiatrist. Nursing -​ Record oxygen levels and seizure duration. Responsibilities -​ Monitor for any adverse reactions. Post-Treatment -​ Monitor vital signs and consciousness level. Nursing -​ Reorient patient (help with confusion). Responsibilities -​ Offer fluids and light meals. -​ Advise no driving or important decisions for 24 hours. Common Side Effects -​ Temporary memory loss and confusion: Provide and Nursing Care reassurance, reorient patient. -​ Headache and nausea: Offer mild pain relief, hydration. -​ Muscle soreness: Encourage gentle movement. MJ30303 MENTAL HEALTH NURSING GLORIA SARAH BEN L11 ALTERATIONS IN PSYCHO-SOCIAL ADAPTATION DISORDERS AUTISM SPECTRUM DISORDERS (ASD) Characteristics -​ Persistent deficits in social communication and interaction across multiple contexts. -​ Restricted, repetitive patterns of behaviour, interests, or activities. Nursing -​ Provide structured environments with predictable routines. Interventions -​ Use visual aids (e.g., communication boards, schedules). -​ Work with families on behavior management strategies. -​ Collaborate with schools to develop Individualized Education Plans (IEPs). ATTENTION DEFICIT HYPERACTIVITY DISORDER (ADHD) Characteristics -​ Inattention, hyperactivity, impulsivity inappropriate for age. -​ Difficulty focusing, completing tasks, following instructions. -​ Struggles with academic performance and social relationships. Nursing -​ Develop behavior modification plans with teachers and Interventions families. -​ Use positive reinforcement for desired behaviors. -​ Monitor medication effects (stimulants like methylphenidate). -​ Teach parents strategies to manage hyperactivity at home. CONDUCT DISORDER (CD) AND OPPOSITIONAL DEFIANT DISORDER (ODD) Characteristics Conduct Disorder (CD) Oppositional Defiant Disorder (ODD) -​ Persistent behavior -​ Frequent defiance, violating rights of irritability, refusal to others (aggression, comply with authority. theft, destruction). Nursing -​ Set clear boundaries with consistent consequences. Interventions -​ Use Cognitive Behavioral Therapy (CBT) to modify negative thought patterns. -​ Provide family counseling to improve communication. -​ Create structured environments with positive reinforcement. MJ30303 MENTAL HEALTH NURSING GLORIA SARAH BEN ANXIETY DISORDERS Characteristics Separation Anxiety Disorder Generalized Anxiety Disorder -​ Fear of being away from -​ Excessive, persistent caregivers, school worry about multiple refusal. aspects of life. Nursing -​ Teach relaxation techniques (deep breathing, mindfulness). Interventions -​ Implement gradual exposure to anxiety-provoking situations. -​ Educate parents on recognizing and managing anxiety symptoms. -​ Collaborate with schools to provide accommodations (quiet spaces, flexible schedules). DEPRESSIVE DISORDER Characteristics -​ Persistent sadness, hopelessness, irritability. -​ Changes in appetite, sleep patterns, fatigue, thoughts of self-harm. -​ Withdrawal from social interactions, academic decline. Nursing -​ Use therapeutic communication to encourage expression of Interventions emotions. -​ Monitor for self-harm or suicidal ideation and ensure safety. Encourage participation in enjoyable activities to boost mood. -​ Educate families on emotional support and seeking therapy. MJ30303 MENTAL HEALTH NURSING GLORIA SARAH BEN L12 DRUGS IN PSYCHIATRIC NURSING Types Examples Actions Indications Side Effects L13.1 MOOD DISORDERS DEPRESSIVE DISORDERS 1.​ Define Mood Disorder. -​ Mental health condition. -​ Characterized by disturbances in emotional state. -​ Impacts daily functioning. MJ30303 MENTAL HEALTH NURSING GLORIA SARAH BEN 2.​ Outline the types of Depressive Disorders and its symptoms. MAJOR DEPRESSIVE DISORDER (MDD) Emotional -​ Persistent sadness/low mood. -​ Loss of interest or pleasure. -​ Feeling of worthlessness. Physical -​ Fatigue or lack of energy. -​ Changes in appetite or weight. -​ Sleep disturbances. -​ Psychomotor changes. Cognitive -​ Fatigue or lack of energy. -​ Changes in appetite or weight. -​ Sleep disturbances. -​ Psychomotor changes. PERSISTENT DEPRESSIVE DISORDER (PDD) Characteristics -​ Chronic low-grade depression lasting ≥ 2 years. -​ Less severe than MDD but longer lasting. Symptoms -​ Low energy -​ Sleep disturbances -​ Low self-esteem -​ Poor concentration -​ Hopelessness. BIPOLAR DISORDERS 3.​ Outline Bipolar Disorder. Definition -​ Chronic mental health condition. -​ Characterized by extreme fluctuations in mood, energy, activity levels and behaviour. -​ Mood shifts include episodes of mania or hypomania and MJ30303 MENTAL HEALTH NURSING GLORIA SARAH BEN episodes of depression. Key features Mania -​ Periods of abnormally elevated, expansive, or irritable mood. -​ Last at least 1 week or requiring hospitalization. -​ Accompanied by increased energy or activity. Hypomania -​ A milder form of mania lasting at least 4 consecutive days. -​ Not severe enough to cause marked impairment or hospitalization. Depression -​ Periods of low mood, lack of energy, and other depressive symptoms. -​ Lasting at least 2 weeks. Types Bipolar I Disorder -​ At least one manic episode. -​ With or without depressive episodes. Bipolar II Disorder -​ Hypomanic episodes. -​ Major depressive episodes Cyclothymic Disorder -​ Periods of hypomania. -​ Mild depression for at least 2 years. Causes/Risk Factors Biological -​ Neurotransmitter imbalance e.g. serotonin, norepinephrine. -​ Genetic predisposition. Psychosocial -​ Trauma, stress, adverse childhood experiences. Others -​ Chronic illness, medication side effects, substance abuse. L13.2 ANXIETY DISORDERS 1.​ Define Anxiety Disorders. -​ Excessive fear, worry, or nervousness that interferes with daily functioning. 2.​ State the causes of Anxiety Disorders. MJ30303 MENTAL HEALTH NURSING GLORIA SARAH BEN Biological -​ Genetic -​ Medical condition -​ Medications -​ Drugs and alcohol Psychological -​ Personality -​ Traumatic event -​ Childhood abuse -​ Stress built up -​ Low self esteem -​ Low coping skills -​ Cognitive distortion -​ Depression Social -​ Negative life events–Bullied, humiliated/scolded in public. -​ Authoritarian parenting -​ Dysfunctional family -​ Critical parents 3.​ State the treatments for Anxiety Disorder. Pharmacotherapy -​ Selective Serotonin Reuptake Inhibitors SSRIs–sertraline, fluoxetine. -​ Serotonin-Norepinephrine Reuptake Inhibitors SNRIs–venlafaxine, duloxetine. -​ Benzodiazepines–alprazolam, lorazepam. -​ Non-addictive options–buspirone. Cognitive Behavioral -​ Helps identify and challenge negative thought Therapy (CBT) patterns and behaviors. -​ Teaches coping skills and strategies to manage anxiety. Exposure Therapy -​ A subset of CBT, particularly effective for phobias and social anxiety. -​ Gradual exposure to anxiety-provoking situations to reduce fear response. Acceptance and -​ Focuses on accepting anxiety rather than fighting Commitment Therapy it. (ACT) -​ Helps align actions with personal values despite anxiety. 4.​ Outline the types of Anxiety Disorders. SPECIFIC PHOBIA 1.​ Define Specific Phobia. -​ An intense, irrational fear of a particular MJ30303 MENTAL HEALTH NURSING GLORIA SARAH BEN object, situation, or activity that poses little to no actual danger. 2.​ State the four major Specific Phobia Categories. Natural environment -​ Astraphobia -​ Hydrophobia -​ Dendrophobia Animals -​ Batrachophobia -​ Cynophobia -​ Equinophobia Mutilation/Medical -​ Dentophobia treatment Situations -​ Claustrophobia -​ Glossophobia 3.​ State the symptoms of Specific Phobia. Physical -​ Rapid heartbeat (tachycardia) -​ Shortness of breath -​ Sweating -​ Trembling -​ Nausea -​ Dizziness -​ Chest tightness -​ Feeling of choking -​ Hot or cold flashes Emotional -​ Intense fear or anxiety when exposed to the phobic stimulus or even thinking about it. -​ Feelings of panic or dread. -​ Overwhelming need to escape the situation or avoid the object. -​ Loss of control or feeling "trapped. Behavioral -​ Avoidance behavior -​ Interference with daily life -​ Reassurance-seeking SOCIAL ANXIETY DISORDER (SAD) 1.​ Define Social Anxiety -​ Social phobia. Disorder. -​ Intense fear of social situations where one MJ30303 MENTAL HEALTH NURSING GLORIA SARAH BEN might be judged, embarrassed, or scrutinized. 2.​ State the key features/symptoms of Social Anxiety Disorder. Emotional -​ Intense fear of social situations. -​ Fear of negative evaluations. -​ Anticipatory anxiety. Physical -​ Blushing. -​ Sweating. -​ Trembling or shaking. -​ Increased heart rate -​ Shortness of breath. -​ Dizziness or nausea. Behavioral -​ Avoidance–public speaking, parties, or meetings. -​ Safety behaviors–avoiding eye contact, staying quiet, or sticking with familiar people. -​ Interference with daily life–difficulty performing tasks like attending school, work, or engaging in relationships. 3.​ List the common -​ Speaking in public or giving presentations. situations that can trigger -​ Meeting new people or interacting with panic attacks in SAD. strangers. -​ Eating or drinking in front of others. -​ Using public restrooms. -​ Being the center of attention. PANIC DISORDER 1.​ Define Panic Disorder. -​ A type of anxiety disorder characterized by recurrent and unexpected panic attacks. -​ Sudden episodes of intense fear or discomfort that reach a peak within minutes. 2.​ State the key features of Panic Disorder. Physical -​ Rapid heartbeat or palpitations. -​ Sweating. -​ Trembling or shaking. -​ Shortness of breath or a sensation of choking. -​ Chest pain or discomfort. -​ Dizziness, lightheadedness, or fainting. -​ Nausea or abdominal distress. -​ Chills or hot flashes. -​ Numbness or tingling sensations (paresthesia). Psychological -​ Fear of losing control or "going crazy." -​ Fear of dying. MJ30303 MENTAL HEALTH NURSING GLORIA SARAH BEN -​ A sense of detachment from reality or oneself (derealization or depersonalization) Behavioral -​ Avoidance of situations or places where a panic attack might occur. (agoraphobia) Fear of future -​ Persistent worry about having additional panic attacks attacks. -​ Anxiety about the consequences of an attack, such as having a heart attack or losing control in public. GENERALIZED ANXIETY DISORDER (GAD) 1.​ Define Generalized -​ Excessive, persistent, and uncontrollable Anxiety Disorder. worry about various aspects of daily life, such as work, health, finances, or relationships. -​ Not focused on a specific event or situation and can span multiple areas of life. 2.​ State the key features of Generalized Anxiety Disorder. Physical -​ Restlessness or feeling "on edge." -​ Fatigue, even with adequate sleep. -​ Muscle tension. -​ Difficulty concentrating or "mind going blank." -​ Irritability. -​ Sleep disturbances. Behavioral -​ Avoidance of situations that may provoke anxiety. -​ Procrastination or over-preparation for tasks. -​ Seeking reassurance frequently from others. L13.3 SUBSTANCE RELATED DISORDERS 1.​ Define Substance Related -​ Conditions involving the misuse of substances Disorders. leading to significant impairment or distress. MJ30303 MENTAL HEALTH NURSING GLORIA SARAH BEN 2.​ List the three categories -​ Substances Use Disorders of Substances Related -​ Substances-Induced Disorders Disorders. eg. Intoxication, Withdrawal, Psychosis -​ Common Substances eg. Alcohol, Opioids, Stimulants, Cannabis, Nicotine. 3.​ List the types of substances and provide Depressants -​ Alcohol examples. -​ Benzodiazepines -​ Barbiturates Stimulants -​ Cocaine -​ Methamphetamine -​ Caffeine Opioids -​ Heroin -​ Morphine -​ Oxycodone Hallucinogens -​ LSD -​ Psilocybin -​ MDMA Cannabis -​ Marijuana -​ Hashish 4.​ List the risk factors for Substance Related Biological -​ Genetic Disorders. -​ Brain chemistry Psychological -​ Trauma -​ Mental health disorders Social -​ Peer pressure -​ Family dynamics Environmental -​ Socioeconomic status 5.​ List the signs and symptoms of Substance Behavioural -​ Cravings Related Disorders. -​ Neglect responsibility -​ Risky behaviour MJ30303 MENTAL HEALTH NURSING GLORIA SARAH BEN Physical -​ Changes in appearance -​ Weight loss -​ Sleep disturbances Psychological -​ Mood swings -​ Anxiety -​ Depression Cognitive -​ Impaired judgement -​ Memory problems 6.​ Lists the screening tools -​ AUDIT used in DSM-5 Criteria for -​ CAGE Questionnaire Substance Use Disorders. -​ DAST 7.​ List the DSM-5 Criteria for -​ Impaired control Substance Use Disorders. -​ Social impairment -​ Risky use -​ Pharmacological criteria (tolerance/withdrawal) 8.​ List the impact of -​ Physical and mental health issues Substance Related -​ Reduced quality of life Disorders. -​ Strained relationship -​ Financial burden -​ Healthcare costs -​ Lost productivity 9.​ List the treatments for Substance Use Disorders. Behavioural -​ CBT therapy -​ Motivational interviewing -​ 12 steps program Medications -​ Naltrexone -​ Methadone -​ Buprenorphine -​ Disulfiram Support -​ Rehabilitation services -​ Peer support groups Holistic care -​ Address co-occurring mental health issues -​ Lifestyle changes 10.​Outline the nursing roles in substance use Assessment -​ Identify signs of use disorders. -​ Screen for co-occurring MJ30303 MENTAL HEALTH NURSING GLORIA SARAH BEN conditions Intervention -​ Provide education on risks and treatment options. -​ Administer medications eg. NRT, Methadone. -​ Offer support and counselling. Advocacy -​ Promote harm reduction and public health initiatives. L14.1 EATING DISORDERS MJ30303 MENTAL HEALTH NURSING GLORIA SARAH BEN 1.​ Define Eating Disorder. -​ Severe and persistent disturbance in eating ​ behaviors. -​ Associated distressing thoughts and emotions. 2.​ State the etiology and risk factors for Eating Disorders. Biological -​ Genetic -​ Disturbance in hypothalamic function Psychological -​ Disturbed body image -​ Low self-esteem -​ Trauma -​ Having anxiety during childhood -​ Stressful life event -​ Difficulty handling stress. Social -​ Society emphasis appearance and thinness -​ Learned maladaptive behaviour -​ Dysfunctional families– overly critical environment, over protection, family members having unusual interest in food and physical appearance. 3.​ State the nursing -​ Establish therapeutic relationship interventions for patients -​ Maintain strict IO chart with eating disorders. -​ Monitor status of skin and oral mucous membrane. -​ Encourage patient to verbalize feelings -​ Educate patients to keep a journal to monitor high risk situations that trigger binging. -​ Encourage family members to participate in treatment. -​ Avoid discussions that focus on food and weight. -​ Control vomiting by making the bathroom inaccessible for at least 2 hours after food. -​ Explain risk of laxative, emetic and diuretic abuse. ANOREXIA NERVOSA 4.​ Define Anorexia Nervosa. -​ A person maintains a deficient weight by MJ30303 MENTAL HEALTH NURSING GLORIA SARAH BEN exercising too much or suppressing diet. 5.​ Lists the clinical features of -​ Restriction of energy intake to requirements Anorexia Nervosa. -​ Intense fear of gaining weight -​ Preoccupied with body size -​ Body weight 15% below standard weight 6.​ Lists the complications of -​ Edema around eyes Anorexia Nervosa. -​ Dental caries -​ Hypothermia -​ Hypotension -​ Bradycardia -​ Arrhythmias -​ Amenorrhea -​ Lethargy -​ Difficulty concentration -​ Headaches -​ Breast atrophy -​ Epigastric pain -​ Dry skin BULIMIA NERVOSA 7.​ Define Bulimia Nervosa. -​ Frequent episodes of binge eating, followed by frantic efforts to avoid gaining weight. -​ Repeated episodes of binge eating followed by compensatory behaviours. 8.​ Lists the complications of -​ Hypotension Bulimia Nervosa. -​ Anemia -​ Dizziness -​ Stomach ulcers -​ Dehydration -​ Amenorrhea -​ Cavities -​ Fatigue -​ Stomach ulcers L14.2 PERSONALITY DISORDERS MJ30303 MENTAL HEALTH NURSING GLORIA SARAH BEN 1.​ Define Personality -​ A way of thinking, feeling and behaving Disorders. that deviates from the expectations of the culture. -​ Causes distress or problems functioning, and lasts over time. 2.​ List the causes and risk -​ Likely multifactorial. factors of Personality -​ Genetic. Disorders. -​ Brain abnormalities -​ Environmental/social. -​ Psychological–abandonment, trauma, insecure attachment. 3.​ Outline the subtype of personality based on DSM-5. CLUSTER A–Odd Eccentric Schizoid Personality -​ Lack of interest in social relationships Disorder -​ Preference for solitude and emotional coldness -​ Limited range of emotional expression. -​ Indifference to praise or critism. -​ Minimal desire for sexual or close relationship. CLUSTER B–Emotional Dramatic Borderline Personality -​ Intense fear of abandonment. Disorder -​ Unstable interpersonal relationships alternating between idealization and devaluation. -​ Impulsive behavior–substance abuse, reckless spending. -​ Recurrent suicidal behavior or selfharm. -​ Emotional instability, chronic feelings of emptiness, and difficulty controlling anger. Antisocial Personality -​ Disregard for the rights of others Disorder -​ Deceitfulness, impulsivity, and irresponsibility -​ Aggressive or unlawful behavior -​ Lack of remorse or empathy for harming others -​ Chronic violation of societal norms Narcissistic -​ Grandiose sense of self-importance. Personality Disorder -​ Preoccupation with fantasies of success, power, or beauty. -​ Need for excessive admiration. -​ Lack of empathy for others. -​ Arrogant or haughty behaviors or attitudes. CLUSTER C–Anxious Fearful Avoidant MJ30303 MENTAL HEALTH NURSING GLORIA SARAH BEN Dependent Personality -​ Excessive need to be cared for–leading to Disorder submissive behavior. -​ Difficulty making decisions without excessive reassurance. -​ Fear of abandonment and difficulty expressing disagreement. -​ Willingness to go to great lengths to gain support. -​ Urgent seeking of new relationships when one ends. Obsessive -​ Preoccupation with orderliness,perfectionism, and Compulsive control. Personality Disorder -​ Excessive devotion to work to the detriment of leisure or relationships. -​ Rigidity and stubbornness in attitudes and behaviors. -​ Reluctance to delegate tasks unless done their way. 4.​ State the treatments for Personality Disorders. Pharmacotherapy Category Function Example Mood stabilizer -​ For mood swings and -​ Lithium impulsivity in borderline -​ Valproate personality disorder. -​ lamotrigine. Antidepressants -​ Address co-occurring -​ SSRIs or SNRIs– depression, anxiety, or fluoxetine, sertraline. -​ obsessive-compulsive traits. Antipsychotics -​ Manage paranoia, -​ Risperidone impulsivity, or severe -​ Aripiprazole disorganized thinking. Anxiolytics -​ Treat acute anxiety or -​ Benzodiazepines agitation. -​ Buspirone Psychotherapy -​ Dialectical behavior therapy–specialized form of CBT designed for Borderline Personality Disorder (BPD). -​ Cognitive behaviour therapy. -​ Family therapy. MJ30303 MENTAL HEALTH NURSING GLORIA SARAH BEN -​ Psychodynamic psychotherapy–explores unconscious conflicts and past experiences influencing behavior. -​ Schema-focused therapy (CBT + IPT + experiential + psychoanalytic). -​ Mentalization-Based Therapy (MBT). L14.3 SOMATOFORM AND DISSOCIATIVE DISORDERS SOMATOFORM DISORDERS MJ30303 MENTAL HEALTH NURSING GLORIA SARAH BEN 1.​ Define Somatoform -​ Physical symptoms with no identifiable Disorders. medical cause. -​ Symptoms are real and distressing for the patient. -​ Often linked to psychological stress or trauma. 2.​ State the key types and characteristics of Somatoform Disorders. Somatic -​ Excessive focus on physical symptoms (e.g., pain, Symptom fatigue). Disorder -​ Causes significant distress and impairment. Illness Anxiety -​ Preoccupation with having or acquiring a Disorder serious illness. -​ Minimal or no somatic symptoms present. Conversion -​ Neurological symptoms (e.g., paralysis, blindness) Disorder without medical explanation. Factitious -​ Intentional production of symptoms to assume the Disorder sick role. 3.​ List the causes and risk -​ Childhood trauma or abuse. factors of Somatoform -​ High levels of stress. Disorders. -​ Genetic and environmental factors. DISSOCIATIVE DISORDERS 1.​ Define Dissociative Disorders. -​ Disruption in consciousness, memory, identity, or perception. -​ Often a response to overwhelming stress or trauma. 2.​ State the key types and characteristics of Dissociative Disorders. Dissociative Identity Disorder -​ Presence of two or more distinct (DID) personality states. -​ Gaps in memory inconsistent with normal forgetfulness. Dissociative Amnesia -​ Inability to recall important personal information. -​ Often related to traumatic or stressful events. Depersonalization/Derealization -​ Feeling detached from self Disorder (depersonalization) or environment (derealization). 3.​ List the causes and risk -​ Severe trauma, particularly during MJ30303 MENTAL HEALTH NURSING GLORIA SARAH BEN factors of Dissociative childhood. Disorders. -​ Chronic stress or neglect.