Mental Health Week 9A (PDF)

# Mental Health ## **Week 9A** - Character y SSD * **Somatoform Disorders And The Nursing Approach** * **Somatic Symptom Disorders (SSD)** are characterized by persistent worry and distress over physical (pain, fatigue). Symptom * The distress may or may not be associated with a confi...

# Mental Health ## **Week 9A** - Character y SSD * **Somatoform Disorders And The Nursing Approach** * **Somatic Symptom Disorders (SSD)** are characterized by persistent worry and distress over physical (pain, fatigue). Symptom * The distress may or may not be associated with a confirmed medical condition * Their thoughts, feelings and behavior related to the symptoms are excessive * **Hypochondriaco:** is similar to SSD but they focus more on the fear/apporhy of illness rather than the physical symptoms themselves. * **NB:** SSD places a significant burden on the healthcare system due to frequent doctor visits, unnecessary tests, and potential misdiagnoses. * **Eg:** A patient who experiences frequent headaches while headaches are common this individual is convinced they have a brain tumor, despite repeated negative tests and reassurances from the doctor. * **Their fear consumes their thoughts**, disrupts their sleep, and prevents them from engaging in enjoyable activities. * **Eg:** A patient with irritable bowel syndrome who misses work frequently due to fear of having an accident while away from home. * **Eg:** An individual with mild arthritis who becomes convinced they have a debilitating autoimmune disorder, and spends hours researching treatment. * **Outline** * **Types of SSD** * **a. Conversion Disorder:** - Known as Conversion reaction (Involves a loss or altered change in physical functioning). * Manifestation of psychological duties * Characteristic Symptoms: Paralysis/blindness/seizures/difficult speaking. * **Eg:** Sudden inability to walk after a traumatic event without a physiological cause. * **b. Illness Anxiety Disorder:** - Intense fear of having/developing a serious illness despite little or no evidence (hypochondriasis). * **Minimal or no actual somatic symptoms** (physical symptom) * **Extreme anxiety** * **Excessive health-related behaviors** (eg frequent doctor visit, avoidance of hospital) * **c. Factitious Disorder:** - Intentionally faking or exaggerating physical or psychological symptoms. * Motivation is to assume the sick roles not for external rewards (eg money). * **Eg:** A parent might repeatedly bring their child to the doctor claiming the child is experiencing seizures. They may even injure the child or tamper with medical tests to create the appearance of illness. This behavior is motivated by a desire for attention and sympathy not by a genuine concern for the child's well-being. (Borderline Personality Disorder) * **Characteristics of SSD** * **One or more distressing physical symptoms** (eg pain, fatigue) * **Excessive thoughts, feelings or behavior about the symptoms** * **Symptoms are persistent** (lasting at least 6 months) * **Factors Influence by SSD** * **Biological Factors:** * Increased sensitivity to pain * Genetics * Neurological changes * **Psychological Factors** * Personality traits * Cognitive distortion * Previous trauma * Co-existing mental health d. * **Social and Cultural Factors** * Cultural belief * Family influence * Support system * Gender differences * Cultural norms * Stressful life event ## **Treatment** * **Psychottherapy** * **Medication (Antidepressant)** * **Life style changes** * **Support groups** # **Mental Week 10A** ## Affection Disorders & Nursing Approach. No Psychotic Symptoms are present. (mood Disorder) * **Depression** is considered the "common cold of psychiatric disorders" due to its wider spread occurrence. * **Types of Affective Disorder (mood Disorders)** * **1. Depressive Disorder** * **i. Major Depressive Disorder (MDD):** * Persistent feelings of sadness, hopelessness and lost of interest in activities. * It involves impaired social and occupational functioning for at least 2 weeks, with no history of manic behavior. * The presence of psychotic, catatonic, or melancholic features may also be noted. * Symptoms cannot be attributed to substance use or a medical condition * **ii. Persistent Depressive Disorder or Dysthymia:** - Chronic low-level depression lasting for at least 2 years in adult and 1 year in children and adolescents. * The mood can be described as "sad" or "down in the dumps" * **2. Bipolar Disorder** * Characterized by extreme shifts in mood, energy and functional capacity, encompassing periods of profound depression and intense euphoria (mania). * **i. Bipolar 1 Disorder:** characterized by episodes of mania (elevated mood, energy or irritability) and major depression during manic episodes the patients may experience hallucinations, delusions. * **ii. Bipolar 11 Disorder:** - include hypomanic episodes and major depressive episodes. But never have experienced a full-blown manic episodes * **iii. Cyclothymic Disorder:** - Chronic mood disorder fluctuations to mild depressive, and hypomanic syndromes over at least 2 years. * Individual never have symptoms for more than 2 months. * **Challenges in Dx and assessment** * **Subjectivity of Symptoms** * **Overtopping Symptoms** * **Comorbidity, misdiagnosis** * **Developmental Variations** * **Cultural Factors** ## **Mental W/OB** * **Features Symptoms of Affective Disorders** * **Manic and Hypomanic Symptoms** * **Manic Episodes** * Elevated mood * Grandiosity * Decrease needs for sleep * Risky behavior * Psychotic Symptoms * Increased activity * Racing thought * **Hypomanic Episodes** - Elevated mood * Energy * Psychotic symptoms * **Depressive Symptoms** * **Affective symptoms** - Sadness, loss of interest, hopelessness, worthlessness, anxiety. * **Behavioral symptoms & change in sleep** psychomotor retardation, agitation, social withdrawal. Changes in appetite * **Cognitive symptoms** - Difficulty concentrating, negative thoughts, suicidal thoughts * **Physiological symptoms** - pain, fatigue, gastrointestinal issues, change in libido. * **Suicide Risk Assessment and Management** * Nurse should ask the patient directly the following questions: * "Have you thought about hurting yourself?" * "Do you have a plan to hurt yourself?" * "Do you have access to the means to carry out your plan?" # **Mental Week 11A** ## **Schizophrenia & Psychotic Disorders** * **Schizophrenia** (means "split" and "mind"): - Is a chronic and severe mental disorder that affects a person's ability to think, feel and behave clearly. * People with schizophrenia may seem like they have lost touch with reality. * **Psychotic Disorders:** - Severe mental conditions characterized by a disrupting personality, deterioration in social functioning, and a loss of contact with reality - hallucination and delusion. * **Signs and symptoms of Schizophrenia:** * **Positive Symptoms** - they reflect an alteration or distortion of normal mental functions. Hallucination - seeing things, hearing voices, delusion: false belief, disorganized speech and thoughts. * **Negative Symptoms:** - Social withdrawal - reduce emotional & flat affect, apathy lack of interest. * **Cognitive Symptoms:** - Thought Disorders: Disorganized thinking, difficulty concentrating and problems with memory, eg: Associative Looseness, Neologism. * **Concrete thinking:** - Literal interpretations of the environment, with difficulty understanding abstract concepts. * **Clan Associations:** - Choosing words based on their sound rather than their meaning. * **Word salad:** - Incoherent speech with a jumble of words. * **Neologism:** - Inventing new words that having meaning only to the individual. * **Associative looseness:** - Ideas shift from one unrelated subject to another * **Schizophreni form disorder** * Symptoms are similar to Schizophrenia but last for a shorter duration (1-6 months) more than 6 months its dx as Schizophrenia. # **Rental 11B** ## **Schizoaffective disorder** * Combination of psychotic symptoms (hallucination. delusions) and significant mood disturbance (depression, mania) for at least 2 weeks in absence of a major mood episode. * **Bipolar disorder:** These are psychotic depression and psychotic mood disorders with psychotic features. * **a. Psychotic Depression major** * **b. Psychotic Bipolar disorder** (psychotic features occurring during manic/depressive phase) * **Delusions and Psychotic States:** * **Brief Psychotic Disorder:** - Sudden onset of psychotic Symptoms that last less than a month. * **Delusional Disorder:** - Persistent delusion for at least 1 month, without prominent hallucination/bizarre behavior. eg erotomanic, grandiose, jealous, persecutory somatic, mixed type and unspecified. * **Substance/medication-induced psychotic disorder:** - Psychotic symptoms that are directly attributable to the effects of substance (drugs, medication, toxins). * **Causes/ Risk factors of SPD:** * **Genetic predisposition** * **Brain structure change** * **Environmental factors** * **Biological factors** * Chemical imbalances * Social isolation and trauma * **Dx of Schizophrenia according to DSM-5 Criteria:** Patients must have the following symptoms to be dx with Schuzoprenia: * **Delusions:** fixed, false belief. * **Hallucination** - false sensory perception * **Disorganized speech** * **Grossly disorganized or catatonic behavior** * **Negative symptoms** # **Week 12A** * **Alcohol & Substance Addiction and Nursing Approach** * **Tolerance:** - The need to progressively increase the amount of substance used in order to achieve the same effect. Or a decrease in the effects when the same amount is used. * **Intoxication:** - The recent use of a substance or the person’s encounter with the substance, and the emergence of a reversible syndrome specific to the substance. * **Addiction:** - A mental disorder characterized by the compulsive need to use habit-forming substances and the inability to control this behavior. * **Classification of Substance (DSMV)** * **Alcohol** * **Caffeine** * **Cannabis** * **Hallucinogens** * **Inhalants** * **Opiates** * **Sedative, hypnotics, and Anxiolytic** * **Stimulant** * **Tobacco** * **Other/unknown substance** * **The Role of the Reward System & Dopamine:** - The final common pathway of the reward and reward system in the brain is the "mesolimbic dopamine pathway". * **Etiology of Substance Abuse:** * **Individual Factors:** - Those who are more affected by the environment. Those who seek novelty. Those who have disinhibition (who cannot control their behavior). Those with neurotic tendencies (co-occurring disorders) * **Co-occurring disorders:** - Schizophrenia, hypochondria, depression, hysteria, ADHD, anxiety disorder, bipolar disorder. * **Alcohol Negative effects on the body:** * Cardiomyopathy * Muscle weakness * Iron deficiency anemia * Diabetes * Enlarged spleen * Fetal alcohol syndrome * Mental health issues * **Rx:** - Naltrexone ,Disulfiram # **Week 12B** * **Names of Drugs/Substance:** * Amphetamines * Caffeine * Cannabis * Cocaine (most dangerous, ADDS) * Hallucinogens (absorbed from paper) * Inhalant * Nicotine * Opiates (known by white, powder, cheese) rx: Buprenorphine * Phencyclidine (known as Angel dust) rx: methadone (Colophia) * Heroin # **Week 13A** ## **Eating Disorder & Nursing Approach** * Eating disorders are a group of serious conditions characterized by abnormal eating habits that negatively affect a person’s physical and mental health. * **Eating Disorder & Mental Health:** * Anxiety * Depression * Substance use disorder * Obsessive-Compulsive Disorder (OCD) * Post-Traumatic Stress Disorder (PTSD) * **Types of Eating Disorders** * **a. Anorexia Nervosa:** A psychological eating disorder characterized by intense fear of gaining weight, distorted body image and severe food restriction, leading to significantly low body weight and potential health complications. * **b. Bulimia Nervosa:** - Recurrent episodes of binge eating followed by purging, fasting, excessive exercise to prevent weight gain. * **c. Binge Eating Disorder (BED):** - Involves a lack of interest in food, avoidance of certain foods due to sensory characteristics or a fear of negative consequences. * **Eating a lot of food at once and then trying to get rid of it** * **Like by vomiting to avoid weight gain (without purging or other behaviours to “undo” the eating** * **Signs of Binge Eating Disorder** - Eating until uncomfortably full, eating to ease stress and anxiety, recording weight fluctuation, consuming excessive amounts of food in short periods, feeling desperate to control eating, and lose weight, self-disgust, guilt, and depression after binge eating~. * **d. Other Specified Feeling or Eating Disorder (OSFED)** * A range of eating disorders that do not meet the full criteria for anorexia nervosa, bulimia nervosa, or BED * **e. Avoidant/Restrictive Food Intake Disorder (ARFID)** * **Obesity:** - Not a psychiatric disorder, defined as a body mass index (BMI) of 30 or greater. * **30.0-34.9** - obese * **Obese** - Higher risk developing cardiovascular disease, diabetes mellitus, osteoarthritis, certain cancers. # **Mental** ## **Risk Factors Associated with Psychological Signs:** * Genetics * Psychological factors * Trauma and stress * Social pressures * Dieting * Perfectionism * Other mental heath disorders * **Psychological Signs:** * Distorted body image * Low self-esteem * Anxiety, depression, irritability, difficulty concentrating mood swings * **Dialectical Behavior Therapy (DBT)** * **DBT Skills:** such as mindfulness, emotional regulation, interpersonal effectiveness, and distress tolerance. * **Common Features and Symptoms** * **Behavioral Signs:** * Restrictive eating patterns * Binge eating episodes * Purging behavior * Excessive exercise * Ritualistic behaviors around food * Social withdrawal * Preoccupation with food, calories and weight * **Physical Signs** * Weight loss * Electrolyte imbalances * Dehydration * Gastrointestinal problem (fire, soft, hay) * Amenorrhea * Fatigue, dizziness, fainting, lanugo # **Week 14A** ## **Sexual dysfunctions** * Human Sexual response * Excitement * Plateau * Orgasm * Resolution * Desire * **Identity disorder** * **Gender Dysphoria:** - occurs when a person experiences incongruence between their biological/assigned gender and their experienced/expressed gender (meaning they do not identify with the gender they were assigned at birth). * Sexual preversion is recurrent or preferred sexual fantasies or behaviors that involve: * Nonhuman objects * Suffering or humiliation of oneself or one’s partner * Nonconsenting people. * **Sexual Desire Disorders** * Male hypoactive sexual desire disorder * Female sexual interest/arousal disorder * **Sexual Arousal Disorders** * **Erectile Disorder:** * Primary disorder * Secondary disorder * **Orgasmic Disorders** * **Female Orgasmic Disorder** (Anorgasmic) * **Delayed Ejaculation** (Inhibited Male Organ) * Primary * Secondary * **Premature (Early) Ejaculation** (common in men) * **Sexual Pain Disorders** * **Genito-pelvic pain/penetration disorder** * Dyspareunia: Pain during sex intercourse * **Vaginismus** - involuntary muscle spasms around the vagina, making penetration difficult or impossible. * **DSM-5 - Trouble Specific Criteria for Diagnosing Sexual Dysfunction:** * **Symptom duration** (at least 6 months) * **Distress or impairment caused by the symptom** * **Ruling out other potential medical or psychological explanation** # **Mental Health 14B** * **Types of Paraphilic Disorders** * Exhibitionistic Disorder: Sexual arousal from exposing one's genitals to an unsuspecting person. * Fetishistic Disorder: - Sexual arousal from the use of non-living objects or specific non-genital body parts. * Pedophilic Disorder: - Sexual arousal from prepubescent or early pubescent children. Otherwise made to suffer. (rom-mercy) * Sexual masochism Disorder: - Sexual arousal from the act of being humiliated, beaten, bound or otherwise made to suffer.. * Sexual Sadism Disorder: - Sexual arousal from the physical or psychological suffering of another individual. * Transvestitic Disorder: - Sexual arousal from dressing in the clothes of the opposite gender. * Voyeuristic Disorder: - Sexual arousal from observing an unsuspecting person who is naked, disrobing, or engaging in sexual activity.. * **NAND-1 Dx** * **Sexual dysfunction:** - The state in which an individual experiences a change in sexual function that is viewed as unsatisfying, unrewarding, or inadequate. * **Ineffective Sexuality Pattern:** - Expressions of concern regarding one’s own sexuality. * **Nursing:** - Integrate information on sexuality into the care they give by focusing on: * **Preventive intervention** * **Therapeutic intervention** * **Educational intervention** * **Goal:** - to assist individuals in attaining, regaining, maintaining sexual wellness. # **Week 15** * **Family & Community Mental Health:** - A family dealing with a member’s mental illness and the nursing strategies used to support the family and integrate community resources. * **A community initiative aimed at increasing awareness and reducing stigma around mental health, and the role of nursing in this initiative.** * **The role of family in mental health: - Support System.** * **Influence on mental health:** - Early intervention * **Family-centered care involves:** * Engaging families * Strength-based approach * Education and support * **Role of Community in Mental Health:** * **Social Support** * **Resources and Services** * Stigma reduction * **Community-based interventions** - include: * **Community mental health programs** * **Outreach and advocacy** * **Partnerships** * **Principles of family community M+HN:** * **Holistic approach** * **Collaborative care** * **Prevention and education** * **Empowerment** * **Nursing Strategies Includes:** * **Assessment and evaluation** * **Therapeutic Communication** * **Care coordination** * **Crisis management** * **Challenges in family/community M+HN:** * **Stigma and misunderstanding** * **Resource limitations** * **Family dynamics** # **Week 16** ## **Consultation liaison nursing** * **Consultation-liaison Psychiatry Nursing (CLPN)** is a specialized area of psychiatric nursing that focuses on the emotional, developmental, cognitive, and behavioral responses of patients and families who enter the hospital / healthcare system due to a real or potential physical dysfunction. * **Example** * A patient with a chronic illness experiencing depression * A patient with a terminal illness exhibiting anxiety and distress. * **Consultation Liaison Nursing involves:** * Integration of mental health/medical care * Collaboration * Comprehensive assessment * **Key Roles** * Assessment * Intervention * Coordination * Education * **Key Functions Include:** * Mental health screening * Crisis Intervention * Care planning * Support and counseling * **Challenges:** * Stigma * Complex case * Resource limitation - include: * **Effective Strategies/Best Practices** * Integrated care models * Regular training * Collaborative practice * Patient-centered care # **Forensic Nursing In the Context of Mental Health and Diseases** * **Discuss the following:** * **1. Overview of Forensic Nursing** * **2. Importance of Forensic Nursing in mental health and legal contexts** * **3. Role of nurses in forensic settings** * **4. Definition of Forensic Nursing ** * **5. Scope of practice: linking mental health with legal and criminal justice systems** * **6. Historical development and evaluation of forensic nursing** * **7. Responsibilities of forensic nursing** * **8. Assessment of mental health and legal issues** * **9. Types of cases handled** * **10. Interventions in forensic nursing** * **11. Legal and Ethical Considerations in Forensic Nursing** * **12. Challenges in Forensic Nursing** * **13. Cultural Competences in Forensic Nursing** * **14. Training with Interpreters and Cultural Brokers**