Understanding Mental Health and Illness Review PDF

Created by Turbolearn AI 📚 DSM 5 and Mental Health vs. Mental Illness DSM 5 The DSM 5 is a system used to diagnose psychiatric disorders. It provides specific criteria for diagnosing each type of disorder. "The DSM 5 is basically a system that has...

Created by Turbolearn AI 📚 DSM 5 and Mental Health vs. Mental Illness DSM 5 The DSM 5 is a system used to diagnose psychiatric disorders. It provides specific criteria for diagnosing each type of disorder. "The DSM 5 is basically a system that has specific criteria to diagnose each type of psychiatric disorders." Mental Health vs. Mental Illness Mental Health Mental Illness A condition that affects thoughts, behaviors, A state of emotional Definition and mood, making it difficult to maintain stability and well-being daily functions Genetics, brain chemistry, Clinical significance and ineffective stress Characteristics and life experiences response Essential for managing Impact stressors and emotional Can cause significant impairment in daily life stability Key Differences Mental health is a normal state of being, while mental illness is a condition that requires treatment. Mental health is essential for reaching one's full potential, coping with stressors, and being productive. Mental illness can cause significant impairment in daily life, including relationships, work, and daily functions. 📊 Continuum of Mental Health and Illness The continuum of mental health and illness is a scale that ranges from mild to moderate to severe. A person can shift positions on this continuum as their situation improves or deteriorates. Mental Health Continuum: A range of states from mild to moderate to severe, with varying levels of emotional stability and well-being. Mental Illness Continuum: A range of states from mild to severe, with two extreme ends: good or bad. 🏥 Settings for Pediatric and Psychiatric Care Inpatient Hospitalization Patients requiring inpatient hospitalization need crisis care, which is protection from harm due to suicidal or aggressive impulses, substance abuse, or other behaviors that cannot be controlled. Crisis Description Care Page 1  Created by Turbolearn AI Protection from harm due to suicidal or aggressive impulses, substance abuse, or Definition other behaviors that cannot be controlled Purpose To ensure the safety of the patient and others Examples Patients who are suicidal, aggressive, or have substance abuse issues 👩‍⚕️Role of the Nurse in Psychiatric Care Priorities Safety: The top priority in psychiatric care, ensuring the safety of the patient and staff. Patient Safety: Ensuring the patient is safe from harm, including removing unsafe objects and providing a safe environment. Responsibilities Remove unsafe objects from the patient's environment. Provide medication, such as sedation, based on the patient's mood and behavior. Recognize signs of suicide and assess the patient's risk. Role of the Nurse Description Patient Safety Ensuring the patient is safe from harm Staff Safety Ensuring the safety of the nursing staff Medication Providing medication, such as sedation, based on the patient's mood Management and behavior Suicide Assessment Recognizing signs of suicide and assessing the patient's risk When assessing a patient's suicidal thoughts, it's essential to ask specific questions to determine the level of risk. Ask the patient if they have thoughts of harming themselves and if they have a plan. If the patient has a plan, ask for details about the plan. Do you have thoughts of harming yourself? Do you have a plan to harm yourself? What is your plan? If the patient has a plan, take immediate action to ensure their safety, such as removing any items that could be used to harm themselves and providing constant supervision. 🤝 Involuntary vs. Voluntary Commitment 🤝 Involuntary Commitment Voluntary Commitment The patient is committed to a hospital The patient voluntarily checks Definition or institution without their consent due themselves into a hospital or to a risk to themselves or others. institution for treatment. The patient may be a harm to The patient is aware of their Characteristics themselves or others and requires need for treatment and can leave constant supervision. the hospital at any time. Page 2  Created by Turbolearn AI A helpful way to remember the difference between involuntary and voluntary commitment is to think of a person who is "mentally unstable" and requires hospitalization without their consent (involuntary) versus a person who checks themselves into a hospital for treatment (voluntary). 😬 Levels of Anxiety 😬 Level of Characteristics Anxiety Restlessness, nail biting, finger tapping. The patient's perceptual field is still Mild large, and they can focus. Uncontrollable worry most days of the week. The patient may need medication. Moderate Selective inattention occurs, and the perceptual field narrows. Overly focused on one detail, reduced ability to learn and solve problems, Severe sense of dread and impending doom. Tunnel vision, inability to focus on anything else, hyperventilation, sense of Panic doom. Nursing care for patients with severe anxiety or panic includes creating a calm environment, using therapeutic communication, and de-escalation techniques. 📝 Patient Rights and Exceptions 📝 Right to Confidentiality: Confidentiality can be broken when there is potential harm to a third party or to oneself. Informed Consent: The patient must be of sound mind to give consent for treatment. Never obtain consent when a patient is sedated, distracted, or in pain. 🤔 Ego Defense Mechanisms 🤔 Ego defense mechanisms are used to buffer anxiety. There are healthy and immature defense mechanisms. Healthy Defense Mechanisms Mechanism Definition Altruism > Meeting the needs of others to gratify one's own needs. Sublimation > Channeling unwanted urges into productive activities. Examples of altruism include volunteering for group therapy or grief counseling to cope with anxiety. Sublimation involves redirecting unwanted urges into creative or productive activities. Note: The chart on page 142-144 in the book provides more information on ego defense mechanisms.## Defense Mechanisms 🚫 Defense mechanisms are psychological strategies that people use to cope with stress, anxiety, and other forms of emotional distress. Page 3  Created by Turbolearn AI Healthy Defense Mechanisms Sublimation: Channeling emotions into a creative or productive outlet. "Sublimation is a healthy defense mechanism where you redirect your emotions into something positive, like turning anxiety into a creative project." Humor: Using laughter to diffuse tension and make light of a situation. Intermediate Defense Mechanisms Repression: Forgetting or suppressing unwanted memories or emotions. "Repression is a defense mechanism where you push away memories or emotions that are too painful or uncomfortable to deal with." Reaction Formation: Developing the opposite behavior to cope with unwanted emotions. "Reaction formation is when you adopt a behavior that is opposite of what you're really feeling, like pretending to like something you actually dislike." Somaticization: Converting emotional distress into physical symptoms. "Somaticization is when you experience physical symptoms like headaches or stomachaches as a way to avoid dealing with emotional pain." Immature Defense Mechanisms Defense Description Mechanism Acting Out Expressing emotions through aggressive or destructive behavior. Disconnecting from reality or experiencing a disruption in memory, Dissociation consciousness, or identity. Splitting Dividing people or situations into good or bad categories. Projection Attributing one's own thoughts or feelings to someone else. Denial Refusing to acknowledge or accept reality. Biological Basis of Understanding Psychopharmacology 💊 Neurotransmitters Neurotransmitter Function Dopamine Enhances mood and is used to treat psychiatric disorders. Norepinephrine Used to treat depression. Serotonin Used to treat depression. GABA Plays a big role in treating anxiety disorders. Page 4  Created by Turbolearn AI Histamine Used for sedative and hypnotic effects. Communication Skills and Therapeutic Relationships in the Clinical Interview 💬 Stages of Therapeutic Relationship Stage Description Pre-orientation Before meeting the patient, reviewing their client information and Phase medical history. Building trust and gathering data about the patient's strengths and Orientation Phase needs. Working Phase Promoting the patient's insight and coping behaviors. Termination Phase Discharge and ending the therapeutic relationship. Crises 🌪️ Types of Crises Developmental and Maturational Crises: Stages of life milestones, such as getting married or having a baby. Situational Crises: External events, such as job loss or the death of a loved one. Advantages Crises: Natural disasters, such as hurricanes or tornadoes.## Crisis Intervention 🚨 Assessment Priorities When a client indicates they are having a crisis, the priority is safety. This is a need-to-know concept, and it's essential to understand that safety is the top priority. Types of Crises There are different types of crises, including: Adventitious crisis: Caused by an external event, such as a natural disaster or a sudden loss. Situational crisis: Caused by an external source, such as an unplanned pregnancy. "Think of advent as an event. Something's going on. Something hit her house. Something and then, then just know the differences rather than the definitions." Indicators of Crisis Resolution A crisis is considered resolved when the individual returns to their daily routine functioning. Indicator Description The individual is able to perform daily tasks and activities without Return to daily routine significant disruption. Page 5  Created by Turbolearn AI Improved emotional The individual is able to manage their emotions and respond to regulation situations in a healthy way. De-escalation Techniques When dealing with angry or aggressive behavior, the goal is to de-escalate the situation and ensure safety. Prioritize safety: Ensure the safety of yourself and others in the situation. Provide a calm environment: Create a calm and peaceful environment to help reduce tension. Intervene early: Intervene early to prevent the situation from escalating further. Avoid confrontational language: Avoid using confrontational language or tone, which can escalate the situation. Suicidal Ideation 🤕 Assessment When assessing a client for suicidal ideation, it's essential to ask direct and straightforward questions. Ask about suicidal ideation: Ask the client if they have thoughts of harming themselves or others. Assess for prior attempts: Ask about any prior attempts or history of suicidal behavior. Assess for family history: Ask about any family history of suicidal behavior. Response to Suicidal Ideation If a client indicates suicidal ideation, it's essential to respond in a calm and supportive manner. Do not leave the client alone: Ensure the client is not left alone and is closely monitored. Gather information: Gather as much information as possible about the client's suicidal ideation. Ask about plans: Ask the client about any plans they may have to harm themselves. Grief and Loss 💔 Types of Grief There are two types of grief: Uncomplicated grief: Normal grief that occurs in response to a expected loss, such as the loss of a loved one who was terminally ill. Complicated grief: Grief that is intense and prolonged, often in response to an unexpected loss, such as the sudden death of a loved one. "Complicated grief is like, it's something that was very unexpected. Like, if my brother died tomorrow, he had no health history problems. He had nothing, and he just died. I would experience complicated grief because I didn't see it coming." Risk Factors for Complicated Grief Risk Factor Description Page 6  Created by Turbolearn AI Unexpected The loss was sudden and unexpected. loss Guilt or shame The individual feels guilty or ashamed about the loss. The loss occurred recently, and the individual is still in the acute grieving Recent loss phase. Young age The individual is young, and the loss is particularly traumatic. Caring for the Dying 🌟 Therapeutic Communication When caring for the dying, it's essential to use therapeutic communication techniques. Assess for grief: Assess the individual and their family for grief and provide support. Practice silence: Practice silence and allow the individual to express their emotions. Encourage support groups: Encourage the individual and their family to participate in support groups. Educating the Client It's essential to educate the client about the grieving process and how to cope. Explain the grieving process: Explain the normal grieving process and what to expect. Provide coping strategies: Provide coping strategies and support to help the individual manage their grief.## PTSD and Dissociative Disorders 🤕 PTSD Symptoms and Treatment Flashbacks, nightmares, and dissociation are common symptoms of PTSD. SSRIs (Selective Serotonin Reuptake Inhibitors) are the first-line treatment for PTSD. Examples of SSRIs include sertraline and loxetine. Serotonin Syndrome: a potentially life-threatening condition caused by excessive levels of serotonin in the body. Medication Use SSRIs First-line treatment for PTSD Antipsychotics Treatment-resistant PTSD Prazosin Nightmares associated with PTSD Short-term treatment for panic attacks (use with caution due to addictive Benzodiazepines potential) Therapies for PTSD Cognitive Processing Therapy (CPT): helps patients evaluate and change upsetting thoughts associated with trauma. Prolonged Exposure Therapy: teaches patients to gradually approach trauma-related memories and situations. Page 7  Created by Turbolearn AI Eye Movement Desensitization and Reprocessing (EMDR): changes how people react to traumatic memories. "EMDR is a therapy that changes how people react to the memory of trauma." Dissociative Disorders Dissociation: a protective mechanism that helps individuals avoid traumatic memories or experiences. Dissociative Amnesia: a type of amnesia that blocks out important information about oneself, often related to traumatic events. Fugue: a temporary state of memory loss, often resulting in unexpected travel or arrival at an unknown location. Dissociative Description Disorder Dissociative Blocks out important information about oneself, often related to Amnesia traumatic events Temporary state of memory loss, often resulting in unexpected travel or Fugue arrival at an unknown location Anxiety Disorders 😬 Generalized Anxiety Disorder Diagnosed when symptoms are severe or panic attacks occur, resulting in a decline in functioning. Symptoms include: Restlessness Fatigue Poor concentration Irritability Sleep disturbance Panic Disorder Sudden onset of extreme apprehension or fear, often accompanied by physical symptoms such as a racing heart and shortness of breath. Agoraphobia: a fear of places or situations that may trigger panic attacks, leading to avoidance behaviors. Obsessive-Compulsive Disorder (OCD) A continuum of symptoms, not necessarily requiring a diagnosis to exhibit obsessive- compulsive behaviors. Obsessions: recurring, intrusive thoughts or urges. Compulsions: repetitive behaviors or mental acts aimed at reducing anxiety or preventing perceived harm. "Anxiety is a reaction to a perceived threat, whereas fear is a reaction to an immediate danger."## 🚨 Managing OCD and Anxiety Disorders 🚨 Page 8  Created by Turbolearn AI Interrupting Rituals in OCD Patients When dealing with patients who have Obsessive-Compulsive Disorder (OCD), it's essential to understand the importance of not interrupting their rituals. Rituals are repetitive behaviors or mental acts that a person feels compelled to perform in response to an obsession or according to rules that must be applied rigidly. "If a patient is washing their hands 8 times, don't interrupt them. Instead, try to reduce the frequency of the ritual over time, such as from 8 to 6 to 4 times." Medications for OCD and Anxiety Disorders SSRIs Selective Serotonin Reuptake Inhibitors (SSRIs) are commonly used to treat OCD and anxiety disorders. They should be taken consistently and daily. Benzodiazepines Benzodiazepines are used for acute anxiety management and safety concerns only. They are highly addictive and have severe withdrawal symptoms, making them contraindicated for long-term use. They are often used in cases of severe panic attacks causing disruption. Benzodiazepine Use Description Acute Anxiety Used for short-term relief of severe anxiety symptoms Management Safety Concerns Used in cases of severe panic attacks causing disruption Long-term use due to high risk of addiction and severe withdrawal Contraindications symptoms Somatic Symptom Disorders Overview Somatic Symptom Disorders are maladaptive responses to stress, often stemming from anxiety. Patients may exhibit excessive thoughts, feelings, or behaviors related to bodily sensations or symptoms. Characteristics Frequent access to healthcare services Frequent hospital visits Difficulty controlling symptoms Belief in the reality of their symptoms, even if they are not supported by medical evidence Interventions Assess patient history and course of disease process Evaluate social life and potential contributing factors Understand that patients may not have control over their symptoms Assess for primary, secondary, and tertiary gains Evaluate ability to communicate needs Page 9  Created by Turbolearn AI Monitor medication use and potential for rebound anxiety and withdrawal symptoms Types of Somatic Symptom Disorders Disorder Description Somatic Symptom Disorder Multiple symptoms impairing functioning, with an obsession (SSD) with health Excessive worry about having a serious illness, despite medical Illness Anxiety Disorder (IAD) evidence Factitious Disorder Deliberate fabrication or self-injury without obvious reward Malingering Fabrication or exaggeration of symptoms for monetary gain Key Points to Remember Hypochondria: excessive worry about having a serious illness, despite medical evidence. Factitious Disorder: deliberate fabrication or self-injury without obvious reward, often imposed on oneself or others. Malingering: fabrication or exaggeration of symptoms for monetary gain.## Somatic Disorders 🤕 Conversion Disorder Conversion disorder is a condition in which a person experiences neurological symptoms that cannot be explained by any medical condition. These symptoms can include: Blindness Paralysis Seizures Weakness "Conversion disorder is a manifestation of anxiety, where the anxiety is so severe that it is expressed physically." Treatment of Somatic Disorders The treatment of somatic disorders typically involves medication, such as SSRIs (Selective Serotonin Reuptake Inhibitors), which are commonly used to treat anxiety. Primary, Secondary, and Tertiary Gain Type of Gain Definition Primary Gain Avoiding stressful obligations or being excused from unwanted duties Secondary Gain Seeking attention and becoming the focus of attention due to the illness Tertiary Gain Relieving conflict within the family by shifting concern to the ill person Interventions for Somatic Disorders Promoting healthy coping skills Acknowledging and validating the patient's feelings Cognitive restructuring: changing the way the patient processes their thoughts and emotions Page 10  Created by Turbolearn AI Assessing safety and ability to meet basic needs Fictitious Disorder Imposed by Another Fictitious disorder imposed by another, also known as Munchausen syndrome by proxy, is a condition in which a person fabricates or induces symptoms in another person, usually a child, in order to gain attention and sympathy. Medication Interactions and Polypharmacy When a patient is taking multiple medications, there is a risk of medication interactions and polypharmacy. It is essential for nurses to review the patient's medications to ensure safe and effective treatment. Assessing Success in Stress Management When assessing the success of stress management interventions, such as yoga, look for outcomes that indicate improved well-being, such as: Improved mood Increased energy Enhanced sleep quality Return to normal daily activities Caregiver Support It is essential to assess the caregiver's well-being and provide support when necessary. Long-term stress can manifest physically and emotionally, and caregivers may benefit from referral to a Primary Care Physician (PCP) for a full assessment.## 🚨 Assessing Suicidal Risk 🚨 When working with veterans, it's essential to assess for suicidal risk, as they are at high risk for PTSD and suicidal ideation. Safety is the nurse's first priority. Defense Mechanisms 🤔 Rationalization A defense mechanism in which an individual creates a logical explanation or excuse to justify unacceptable behavior. Example: An adult with type 2 diabetes declines an invitation to go hiking, citing "hiking issues" as the reason, when in reality, they are concerned about difficulty with blood glucose management during strenuous activity. Altruism A healthy defense mechanism in which an individual donates time, money, or effort to help others, often to distract themselves from their own problems. Examples: Volunteering Philanthropy Page 11  Created by Turbolearn AI Donating to charity Levels of Anxiety 😬 Level of Characteristics Nursing Interventions Anxiety Low Perceptual Narrowed focus, difficulty Give short, simple statements, Field processing information specific instructions Use calm, gentle tone, provide High Anxiety Panic, severe distress emotional support Somatic Symptom Disorders 🤕 Individuals with somatic symptom disorders often exhibit: Increased healthcare use Changing providers Failure to consider that physical issues could be imagined Example: "I've been to so many doctors, but no one can find out what's wrong with me." Involuntary Mental Health Commitment 🚔 The primary factor considered when determining the need for an involuntary mental health commitment is: Danger posed by the individual's behaviors to themselves or others Inability to meet their own needs due to mental health issues If an individual is a danger to themselves or others, or is unable to meet their own needs, an involuntary mental health commitment may be necessary. Page 12