Mental Health Nursing Study Guide PDF

Mental Health Nursing Study Guide 1. Mental Health Basics Definition: ○ Mental health is the ability to: Recognize one’s potential. Cope with normal stress. Work productively and contribute to the community. ○ Tr...

Mental Health Nursing Study Guide 1. Mental Health Basics Definition: ○ Mental health is the ability to: Recognize one’s potential. Cope with normal stress. Work productively and contribute to the community. ○ Traits of mental health include rational thinking, effective communication, resilience, and realistic goals. Mental Illness: ○ Disorders with diagnosable symptoms and significant dysfunction. ○ Causes include developmental, biological, and physiological factors. 2. Resilience and Mental Health Resilience: ○ The capacity to recover from stress or trauma. ○ Traits include optimism, competence, and mastery. ○ Essential for recovery from mental illness. 3. Factors Influencing Mental Health Risk Factors: ○ Genetics (Diathesis-Stress Model: biological predisposition + environmental stress). ○ Social determinants: income, education, housing, and family support. Protective Factors: ○ Positive relationships and access to resources. 4. Social Influences on Mental Health Legislation: ○ Mental Health Parity Act: Equal insurance coverage for mental health. ○ Affordable Care Act: Increased access to mental health services. Consumer advocacy (e.g., NAMI initiatives). 5. Diagnostic and Classification Tools DSM-5: ○ Standard manual for diagnosing mental disorders. ICD-10-CM: ○ Classification for mental and behavioral disorders. Epidemiology:  ○ Major depressive disorder: Leading cause of disability (6.7% prevalence). ○ Anxiety disorders: Generalized anxiety (3.1% prevalence). 6. Psychiatric Mental Health Nursing Roles Promote mental health through assessment, diagnosis, and treatment. Employ theories and research to provide care. Advanced practice roles include PMH-APRNs. 7. Trauma-Informed Care Principles: ○ Safety, trust, empowerment, and collaboration. ○ Addresses cultural, historical, and gender-related factors. Adverse Childhood Experiences (ACEs): ○ Include abuse, neglect, and witnessing trauma. ○ Linked to increased risk for mental and physical health issues. 8. Therapeutic Relationships Establish a trusting nurse-client relationship. Use therapeutic communication to support client well-being. 9. Models of Care Recovery Model: ○ Focus on client strengths and recovery journey. Rehabilitation Model: ○ Focus on regaining lost skills and functionality. 10. Disparities in Mental Health Care Barriers: ○ Financial hardship, stigma, lack of services, and discrimination. Impact of Disparities: ○ Unequal access to care, treatment, and outcomes. Reducing Disparities: ○ Culturally competent care, legislative advocacy, and education. 11. Mental Health Continuum Everyone fluctuates along a continuum from mental health to illness. Reflects daily functioning and individual experiences. 12. Mental Health Care Settings Outpatient clinics, telehealth, case management, and community-based programs.  Emphasis on accessibility and holistic approaches. Study Tips 1. Mnemonic for Resilience: ○ R.O.C.: Resilience = Resources + Optimism + Competence. 2. Understanding DSM-5 vs. ICD-10: ○ DSM-5: Used in the U.S. for mental health. ○ ICD-10: Global classification system. 3. Therapeutic Relationship Key: ○ Remember T.R.U.S.T.: Time, Respect, Understanding, Support, Therapeutic communication. Psychopharmacology Nursing Study Guide 1. Basics of Psychopharmacology Key Neurotransmitters: ○ Monoamines: Dopamine, norepinephrine, serotonin. ○ Others: GABA, glutamate, acetylcholine. Neurotransmission: ○ Neurotransmitters are released from the presynaptic neuron. ○ They bind to specific receptors on the postsynaptic neuron. ○ Excess neurotransmitters are reabsorbed (reuptake) or deactivated by enzymes. 2. Classes of Psychotherapeutic Medications 1. Anxiolytics (Anti-Anxiety Medications): ○ Examples: Benzodiazepines (e.g., lorazepam, diazepam). ○ Action: Enhance GABA effects, reducing neural excitability. ○ Side Effects: Sedation, dependence, withdrawal symptoms. 2. Antidepressants: ○ Types: SSRIs: Selective serotonin reuptake inhibitors (e.g., fluoxetine). MAOIs: Monoamine oxidase inhibitors (e.g., phenelzine) – avoid tyramine-rich foods (e.g., aged cheese, wine). TCAs: Tricyclic antidepressants (e.g., amitriptyline). ○ Side Effects: Serotonin Syndrome: Agitation, fever, confusion (due to excess serotonin). Activation Syndrome: Restlessness, agitation. Discontinuation Syndrome: Flu-like symptoms when stopped abruptly. 3. Antipsychotics (Neuroleptics): ○ Types: Typical: Haloperidol (older, more EPS symptoms). Atypical: Risperidone (newer, less EPS). ○ Side Effects: Extrapyramidal Symptoms (EPS): Muscle rigidity, tremors. Neuroleptic Malignant Syndrome: Fever, altered mental status. 4. Mood Stabilizers: ○ Example: Lithium. ○ Side Effects: Lithium Toxicity: Nausea, confusion, tremors (monitor levels closely). Requires adequate hydration and sodium balance. 5. Sedative-Hypnotics:  ○ Use: Insomnia, anxiety. ○ Examples: Zolpidem, benzodiazepines. ○ Caution: Risk of dependence. 6. Stimulants: ○ Example: Methylphenidate (for ADHD). ○ Action: Increase dopamine and norepinephrine levels. ○ Side Effects: Insomnia, reduced appetite. 7. Herbal Remedies: ○ Examples: St. John’s Wort (for mild depression). ○ Caution: Interactions with other medications (e.g., SSRIs). 3. Common Adverse Effects Agranulocytosis: ○ Severe drop in white blood cell count (e.g., clozapine). ○ Monitor: CBC regularly. Serotonin Syndrome: ○ Symptoms: Hyperreflexia, shivering, tachycardia. ○ Treatment: Stop serotonergic drugs, supportive care. Extrapyramidal Symptoms (EPS): ○ Treatment: Anticholinergic medications (e.g., benztropine). 4. Detoxification and Withdrawal Protocols Alcohol: ○ Long-term use: CNS depressant effects, tolerance. ○ Withdrawal symptoms: CNS excitation (e.g., seizures). ○ Detox Protocol: Benzodiazepines for seizure prevention. Opiates: ○ Withdrawal symptoms: Muscle aches, increased norepinephrine release. ○ Detox Protocol: Opiate replacement therapy (e.g., methadone). 5. Nursing Considerations Monitor therapeutic drug levels (e.g., lithium, antipsychotics). Educate clients about: ○ Medication Adherence: Importance of taking meds as prescribed. ○ Dietary Restrictions: Avoid tyramine with MAOIs. ○ Recognizing Side Effects: Report symptoms of toxicity or serious side effects. Collaborate with an interprofessional team for detoxification and long-term care. 6. Study Tips 1. Mnemonic for Antidepressants: ○ S.T.M.: SSRIs (Safe), TCAs (Toxic), MAOIs (Manage diet carefully). 2. Recognizing Lithium Toxicity: ○ Think "L.I.T.H.I.U.M.": Levels monitored, Increased thirst, Tremors, Hydrate, Intake sodium, Urine output, Monitor labs. Mental Health Nursing Study Guide 1. Theories and Frameworks in Mental Health Nursing Foundational Theories: ○ Freud’s Psychoanalytic Theory: Components: Id (instinct), Ego (reality), Superego (morality). Defense mechanisms: Coping strategies to protect the ego. ○ Erikson’s Psychosocial Development: Focus on developmental tasks across the lifespan (e.g., trust vs. mistrust). ○ Behavioral Theories: Pavlov: Classical conditioning. Skinner: Operant conditioning (reinforcement/punishment). ○ Cognitive Behavioral Therapy (CBT): Focus: Identify and change unhealthy thought patterns leading to better behavior. Milieu Therapy: ○ Creates a therapeutic environment of safety and support. 2. Therapeutic Relationships Phases of Nurse-Client Relationship (Peplau): ○ Orientation: Build trust, establish boundaries. ○ Identification: Define client’s needs and barriers. ○ Working (Exploitation): Collaborate on goals. ○ Termination (Resolution): Evaluate progress and set future goals. Key Components: ○ Trust, respect, transparency. ○ Professional boundaries (avoid transference and countertransference). 3. Therapeutic Communication Strategies Nonverbal Communication: ○ Use SOLER technique: Sit squarely, Open posture, Lean forward, Eye contact, Relax. ○ Adjust approach for cultural comfort. Verbal Communication: ○ Ask open-ended questions. ○ Reflect client’s statements to clarify and validate. 4. Cultural Competence Transcultural Nursing Framework: ○ Preservation: Retain cultural practices (e.g., gender-specific care). ○ Accommodation: Modify practices for health outcomes. ○ Repatterning: Help clients adapt practices for wellness (e.g., diet changes). Cultural Formulation Interview (CFI): ○ Explore cultural context of client’s mental health. 5. Nursing Process in Mental Health 1. Assessment: ○ Areas to Assess: Psychosocial: Coping skills, social support. Physical: Vision, substance use, dental health. Cultural and spiritual beliefs. ○ Tools: Mental Status Exam, family and community assessments. 2. Diagnosis: ○ Use the DSM-5 for standardized diagnosis. 3. Planning: ○ Set SMART Goals: Specific, Measurable, Achievable, Realistic, Time-bound. 4. Implementation: ○ Include teaching, therapeutic interventions, and collaboration. 5. Evaluation: ○ Continuous reassessment to adjust care plans. 6. Motivational Interviewing Stages: ○ Engage: Build rapport. ○ Focus: Identify priorities for change. ○ Evoke: Use Likert scales for client confidence. ○ Plan: Set actionable goals. 7. Crisis and Suicide Prevention Suicide Risk Assessment:  ○ Warning signs: Sudden mood changes, withdrawal, giving away possessions. ○ Ask direct questions about intent and plan. Nursing Role: ○ Build a safe and supportive environment. ○ Implement prevention strategies. 8. Technology in Mental Health Care Telehealth Modalities: ○ Videoconferencing, online therapy, mobile apps. Advantages: ○ Increases access to care, especially in underserved areas. 9. Mental Health Interventions Individual Therapy: Focus on trust and goal-setting. Group Therapy: Peer support and shared experiences. Family Therapy: Improve communication and resolve conflicts. Psychobiological Interventions: ○ Medication management and monitoring. Study Tips 1. Mnemonic for Therapeutic Relationship Phases: ○ O.W.T.R.: Orientation, Working, Termination, Resolution. 2. Recognizing Nonverbal Cues: ○ Remember F.A.B.E.: Facial expressions, Appearance, Body movements, Eye behavior. Stress and Stress-Related Disorders Study Guide 1. Stress Overview Definition: Stress is a physiological or psychological response to a perceived threat or challenge. Types of Stress: ○ Eustress (Good Stress): Examples: Birth of a child, starting a new job, vacation. ○ Distress (Bad Stress): Examples: Death, financial problems, illness, or injury. 2. Physiological Stress Response Fight-or-Flight Response: ○ Triggered by the amygdala and mediated by the Hypothalamic-Pituitary-Adrenal (HPA) Axis. ○ Results in the release of cortisol and adrenaline, causing: 1. Increased heart rate. 2. Elevated blood pressure. 3. Heightened alertness. General Adaptation Syndrome (GAS): ○ Stages: 1. Alarm: Activation of the stress response. 2. Resistance: Body attempts to adapt. 3. Exhaustion: Prolonged stress depletes resources, causing illness. 3. Stress and Health Physical Effects: ○ Headaches, muscle tension, insomnia, high blood pressure, and digestive issues. ○ Chronic stress can lead to hypertension, type 2 diabetes, and heart disease. Psychological Effects: ○ Anxiety, depression, irritability, and substance use disorders. Immune System: ○ Chronic stress suppresses the immune system, increasing inflammation and susceptibility to illness. 4. Types of Stress 1. Acute Stress: ○ Short-term and resolves quickly. ○ Aligns with the alarm stage of GAS. 2. Chronic Stress: ○ Persistent and prolonged. ○ Can lead to mood disorders, eating disorders, and metabolic syndromes. 3. Toxic Stress: ○ Occurs during sustained exposure, especially in early development (e.g., Adverse Childhood Experiences - ACEs). ○ Causes lasting changes in brain development and increased lifelong health risks. 5. Somatic Symptom and Related Disorders Somatic Symptom Disorder: ○ Excessive focus on physical symptoms that disrupt daily life. Illness Anxiety Disorder: ○ Preoccupation with having a serious illness despite minimal symptoms. Functional Neurological Symptom Disorder: ○ Neurological symptoms (e.g., paralysis) without medical explanation. Factitious Disorder: ○ Falsification of symptoms for attention or care. 6. Dissociative Disorders Types: ○ Dissociative Identity Disorder (DID): Presence of two or more distinct identities. ○ Dissociative Amnesia: Inability to recall important personal information. ○ Depersonalization/Derealization Disorder: Feeling detached from self or surroundings. Etiology: ○ Linked to trauma, genetic predisposition, and environmental stressors. 7. Defense Mechanisms Adaptive (Healthy): ○ Sublimation, altruism, suppression.  Maladaptive (Unhealthy): ○ Denial, regression, displacement, projection. Examples: ○ Rationalization: Making excuses for behavior. ○ Regression: Returning to earlier developmental behaviors under stress. 8. Nursing Interventions for Stress-Related Disorders 1. Assessment: ○ Identify physiological, psychological, and behavioral signs of stress. ○ Use tools like the Mental Status Exam or Stress Assessment Scales. 2. Planning: ○ Develop SMART goals (Specific, Measurable, Achievable, Realistic, Time-bound). 3. Intervention: ○ Use therapeutic communication. ○ Teach relaxation techniques: deep breathing, guided imagery, mindfulness. ○ Encourage healthy coping strategies. 4. Evaluation: ○ Monitor for reduced symptoms and improved coping. 9. Stress Management Techniques Coping Styles: ○ Problem-focused: Addressing the source of stress. ○ Emotion-focused: Managing emotional responses. ○ Avoidant: Avoiding the stressor (can be maladaptive). Stress-Relief Practices: ○ Biofeedback, mindfulness meditation, and guided imagery. ○ Develop positive self-talk and realistic expectations. Anxiety and Related Disorders Nursing Study Guide 1. Overview of Anxiety Definition: ○ Anxiety is a normal response to stress but becomes a disorder when excessive or prolonged. ○ Anxiety disorders are the most diagnosed mental illnesses, affecting 30% of adults in the U.S. Physiological Response: ○ Increased heart rate, shallow breathing, GI distress, and sweating. ○ Fight, flight, freeze, or fawn responses. Distinguishing Stress vs. Anxiety: ○ Stress: Proportionate to a real stressor. ○ Anxiety: Response to real or perceived threats, often disproportionate. 2. Levels of Anxiety 1. Mild: Restless but manageable; can be motivational. 2. Moderate: Trouble concentrating, disrupted sleep. 3. Severe: Overwhelmed, physical symptoms like dizziness or chest pain. 4. Panic: Exhaustion, inability to respond to stimuli, terror. 3. Anxiety Disorders 1. Generalized Anxiety Disorder (GAD): ○ Excessive worry lasting >6 months, difficult to control. ○ Symptoms: Restlessness, fatigue, irritability, muscle tension, sleep disturbance. ○ Diagnostic Tools: GAD-7, Hamilton Anxiety Rating Scale (HAM-A). 2. Panic Disorder: ○ Sudden episodes of intense fear without an apparent trigger. ○ Symptoms: Palpitations, shortness of breath, dizziness. 3. Phobias: ○ Intense fear of specific objects or situations. ○ Common examples: Heights, animals, blood. 4. Social Anxiety Disorder: ○ Fear of social situations and being judged or embarrassed. ○ Symptoms: Sweating, blushing, difficulty speaking. 5. Separation Anxiety Disorder: ○ Inappropriate fear of separation from loved ones.  ○ Symptoms: Nightmares, reluctance to leave home. 6. Selective Mutism: ○ Failure to speak in specific social situations despite ability to speak. 7. Agoraphobia: ○ Fear of being in places where escape is difficult (e.g., open spaces, crowds). 4. Obsessive-Compulsive and Related Disorders 1. Obsessive-Compulsive Disorder (OCD): ○ Obsessions: Persistent, intrusive thoughts (e.g., fear of germs). ○ Compulsions: Repetitive behaviors to reduce anxiety (e.g., handwashing, counting). 2. Body Dysmorphic Disorder: ○ Preoccupation with perceived physical flaws. ○ Behaviors: Mirror checking, excessive grooming. 3. Hoarding Disorder: ○ Difficulty discarding possessions, leading to cluttered living spaces. 4. Trichotillomania: ○ Hair-pulling behavior to relieve tension. 5. Excoriation Disorder: ○ Skin-picking behavior causing lesions. 5. Risk Factors and Comorbidities Risk Factors: ○ Genetics, trauma, adverse childhood experiences (ACEs). ○ More common in individuals assigned female at birth. Comorbidities: ○ Mood disorders (depression, bipolar), substance use, eating disorders, PTSD, and medical conditions (e.g., IBS, heart disease). 6. Nursing Process for Anxiety and OCD 1. Assessment: ○ Recognize manifestations (restlessness, GI distress, fatigue). ○ Use screening tools (e.g., GAD-7, Yale-Brown Obsessive Compulsive Scale). ○ Identify triggers and duration of symptoms. 2. Analysis: ○ Prioritize safety first. ○ Focus on the client’s symptoms and stressors.  3. Planning: ○ Collaborate with the client and team to create SMART goals (e.g., "Client will report reduced anxiety after 4 sessions"). 4. Implementation: ○ Use therapeutic communication. ○ Administer medications as prescribed (e.g., SSRIs, benzodiazepines). ○ Provide a calming environment and teach relaxation techniques. 5. Evaluation: ○ Monitor for symptom reduction and improved functioning. 7. Treatment Approaches 1. Nonpharmacologic: ○ Cognitive Behavioral Therapy (CBT): Identify and change unhelpful thoughts and behaviors. ○ Exposure Therapy: Gradual exposure to triggers to reduce avoidance. ○ Relaxation Techniques: Deep breathing, guided imagery, mindfulness meditation. 2. Pharmacologic: ○ SSRIs (e.g., sertraline): First-line treatment for anxiety and OCD. ○ Benzodiazepines (e.g., lorazepam): For acute episodes, short-term use only. ○ Beta-blockers (e.g., propranolol): Manage physical symptoms like palpitations. 8. Nursing Interventions Client-Centered Care: ○ Foster trust and create a safe environment. ○ Teach the client about their disorder, treatments, and coping strategies. ○ Encourage participation in support groups. Cultural Sensitivity: ○ Address potential barriers (e.g., language, cultural stigma). ○ Use teach-back to ensure understanding. Study Tips 1. Mnemonic for Anxiety Levels: M.P.S.P. (Mild, Moderate, Severe, Panic). 2. Common Interventions: ○ A.C.T.: Assess, Communicate, Teach. 3. OCD Symptoms: ○ Obsessions: “Irrational Thoughts.” ○ Compulsions: “Irrational Actions.” Substance Abuse and Addiction Nursing Study Guide 1. Substance-Related and Addiction Disorders Overview Definition: ○ Chronic disease affecting brain circuits related to reward, motivation, and self-control. ○ Includes substance use disorders (SUDs) and behaviors like gambling addiction. Impact: ○ Affects physical health, mental well-being, relationships, and occupational functioning. ○ Associated with cognitive, behavioral, and psychological manifestations. 2. Etiology of Addiction Risk Factors: ○ Mental illness, stress, genetics, peer pressure, abuse. Protective Factors: ○ Strong family support, positive relationships, stable employment, access to community resources. Neurological Basis: ○ Reward Pathway: Dopamine bursts in the limbic system trigger euphoria. Basal ganglia: Overstimulation leads to addiction. Amygdala: Links anxiety, irritability, and cravings. Prefrontal cortex: Controls compulsive behaviors; dysfunction leads to poor decision-making. 3. Substances and Clinical Presentations 1. Alcohol: ○ Intoxication: Slurred speech, unsteady gait, impaired judgment. ○ Withdrawal: Tremors, sweating, increased heart rate, nausea, seizures. 2. Opioids: ○ Intoxication: Drowsiness, respiratory depression, pinpoint pupils. ○ Withdrawal: Muscle aches, sweating, diarrhea, yawning, anxiety. 3. Stimulants (e.g., cocaine, amphetamines): ○ Intoxication: Increased energy, tachycardia, paranoia. ○ Withdrawal: Fatigue, depression, vivid dreams. 4. Sedatives (e.g., benzodiazepines):  ○ Intoxication: Drowsiness, confusion, respiratory depression. ○ Withdrawal: Anxiety, tremors, seizures. 5. Hallucinogens (e.g., LSD, PCP): ○ Intoxication: Altered perception, paranoia, hallucinations. ○ Withdrawal: Rare but may involve psychological symptoms. 4. Warning Signs of Substance Use Changes in mood or behavior. Shifts in peer group or social isolation. Weight changes, disrupted sleep patterns. Loss of interest in health or daily activities. Financial problems, missing valuables. 5. Role of the Nurse 1. Prevention: ○ Address risk factors (e.g., mental health conditions, social influences). ○ Promote protective factors through education and community resources. 2. Assessment: ○ Use screening tools to evaluate substance use and risk factors. ○ Identify withdrawal or intoxication symptoms. 3. Treatment: ○ Provide safety during withdrawal (e.g., seizure precautions for alcohol withdrawal). ○ Administer prescribed medications: Opioids: Naloxone for overdose reversal. Alcohol: Benzodiazepines for withdrawal management. Stimulants: Supportive care. ○ Promote behavioral therapies: Cognitive Behavioral Therapy (CBT). Motivational interviewing. 4. Client and Family Education: ○ Reinforce understanding of addiction as a disease. ○ Discuss treatment options, including inpatient and outpatient care. ○ Teach coping strategies and relapse prevention. 6. Treatment Settings Outpatient: Regular appointments for counseling or medication.  Intensive Outpatient/Partial Hospitalization: Structured programs with frequent sessions. Inpatient: 24-hour care for severe cases or detoxification. Residential Treatment: Long-term care with focus on recovery. 7. Impaired Health Care Professionals Causes: ○ Stress, burnout, access to drugs (diversion), pain from occupational duties. Warning Signs: ○ Frequent absences, errors, or behavioral changes at work. Discipline: ○ May involve self-reporting, state board complaints, and license suspension. Nurse Assistance Programs: ○ Offer support, education, and rehabilitation to restore professional practice. 8. Nursing Process for Substance Use Disorders 1. Assessment: ○ Identify the substance used, amount, and duration. ○ Evaluate physical and psychological symptoms. ○ Conduct a thorough history, including family and social context. 2. Diagnosis: ○ Examples: Risk for injury, ineffective coping, impaired family processes. 3. Planning: ○ Develop goals such as “Client will remain free of substances for one week.” 4. Implementation: ○ Administer medications, provide therapeutic communication, and create a supportive environment. 5. Evaluation: ○ Monitor progress through client reports, reduced cravings, and improved functioning. 9. Quiz Yourself 1. What is the neurological pathway involved in addiction? 2. List three signs of alcohol withdrawal. 3. Describe the difference between outpatient and inpatient treatment for SUDs. 4. Name two protective factors against addiction. 5. What should a nurse do if they suspect a colleague is impaired? Study Tips 1. Mnemonic for Addiction Risk Factors: G.A.P.S.: ○ Genetics, Abuse, Peer pressure, Stress. 2. Mnemonic for Withdrawal Symptoms: T.A.R.G.E.T.: ○ Tremors, Anxiety, Respiratory issues, GI upset, Elevated vitals, Tachycardia. Mood Disorders, Depression, and Suicide Nursing Study Guide 1. Overview of Mood Disorders Definition: Mood disorders involve disruptions in mood that impair daily functioning. Diagnosed on a spectrum: ○ Mild: Treated outpatient. ○ Severe: May require hospitalization to prevent self-harm. Types: ○ Depressive Disorders: Persistent Depressive Disorder (dysthymia): Chronic low-level depression. Major Depressive Episode: Severe symptoms persisting for at least two weeks. ○ Bipolar Disorders: Bipolar I: At least one manic episode. Bipolar II: Hypomanic and depressive episodes. Cyclothymic Disorder: Alternating mild depressive and hypomanic symptoms for ≥2 years. 2. Depression Symptoms: ○ Sadness, emptiness, irritability. ○ Loss of interest (anhedonia), fatigue, difficulty concentrating. ○ Physical signs: Appetite changes, sleep disturbances, psychomotor agitation/retardation. Screening Tools: ○ PHQ-9, Beck Depression Inventory, Geriatric Depression Scale. Etiology: ○ Biological: Genetic predisposition, hormonal imbalances, neurotransmitter dysfunction. ○ Psychosocial: Stressful life events, trauma. 3. Bipolar Disorder Mania Symptoms: ○ Euphoria, grandiosity, decreased need for sleep, rapid speech, impulsive behaviors. Hypomania:  ○ Similar to mania but less severe; does not require hospitalization. Rapid Cycling: ○ Four or more mood episodes in a year. Assessment: ○ Speech patterns: Pressured, tangential, or flight of ideas. ○ Thought content: Grandiosity, delusions. Pharmacologic Treatment: ○ Mood Stabilizers: Lithium, Valproate. ○ Second-Generation Antipsychotics: Olanzapine, Risperidone. 4. Suicide and Nonsuicidal Self-Injury (NSSI) Suicide: ○ Intentional act of self-harm with fatal outcome. ○ Risk Factors: Psychiatric disorders (depression, bipolar). Substance use, prior attempts, social isolation. Demographic factors: Male, older age, veterans. ○ Warning Signs: Verbal expressions of hopelessness or worthlessness. Withdrawal, giving away possessions, risky behavior. ○ SAD PERSONS Scale: Risk assessment tool (e.g., 0-2 = low risk, 7-10 = high risk). NSSI: ○ Non-lethal self-injury to manage emotional distress. ○ Common methods: Cutting, burning, head banging. 5. Nursing Process 1. Assessment: ○ Evaluate mood, thought processes, physical behavior. ○ Identify suicide risks (lethality of plan, prior attempts). ○ Use self-assessment to manage feelings and biases. 2. Diagnosis: ○ Risk for self-harm, sleep disturbances, altered nutrition. 3. Planning: ○ Set SMART goals (e.g., "Client will verbalize suicidal thoughts to staff"). 4. Implementation: ○ Therapeutic communication, safety precautions (remove harmful objects). ○ Medication administration (e.g., SSRIs, lithium). ○ Engage in cognitive-behavioral therapy (CBT).  5. Evaluation: ○ Monitor mood stability, adherence to treatment, and functionality. 6. Treatment Approaches 1. Pharmacologic: ○ Antidepressants: SSRIs: First-line (e.g., fluoxetine). TCAs/MAOIs: Effective but with more side effects. ○ Mood Stabilizers: Lithium (therapeutic range: 0.8–1.4 mEq/L; toxic >1.5 mEq/L). Anticonvulsants: Valproate, carbamazepine. 2. Nonpharmacologic: ○ Electroconvulsive Therapy (ECT): For treatment-resistant depression, psychosis, or catatonia. ○ Transcranial Magnetic Stimulation (TMS): Non-invasive brain stimulation. ○ Light Therapy: For Seasonal Affective Disorder (SAD). 3. Psychotherapy: ○ CBT: Change maladaptive thought patterns. ○ Family-focused therapy: Address relational impacts. 7. Suicide Prevention Inpatient Safety: ○ Constant monitoring, removal of harmful objects, shared rooms. ○ Therapeutic communication and safety planning. Outpatient Safety: ○ Regular assessments for suicidal ideation. ○ Encourage sharing plans with a provider. ○ Provide crisis hotline information. Postvention: ○ Support for families of individuals who completed suicide. Quiz Yourself 1. What are the diagnostic criteria for a major depressive episode? 2. List three risk factors for suicide.  3. What is the therapeutic range of lithium, and what are symptoms of toxicity? 4. Describe the difference between Bipolar I and Bipolar II disorder. 5. Name two screening tools for depression. Study Tips 1. Mnemonic for Depression Symptoms: S.A.D. F.A.C.E.S.: ○ Sleep disturbance, Anhedonia, Depressed mood, Fatigue, Appetite changes, Concentration issues, Esteem (low), Suicidal thoughts. 2. Remember Bipolar Types: ○ Bipolar I: "1 Mania." ○ Bipolar II: "2 Episodes (Depression + Hypomania)." Neurodevelopmental Disorders Nursing Study Guide 1. Overview of Neurodevelopmental Disorders Definition: ○ Disorders that affect brain development and functioning. ○ Impair cognitive, social, communication, and behavioral abilities. Prevalence: ○ 20% of children and adolescents in the U.S. suffer from a major mental illness causing significant impairment. 2. Etiology and Risk Factors Biological Factors: ○ Genetics, neurobiological abnormalities. Psychological Factors: ○ Temperament, resilience. Environmental Factors: ○ Violence exposure, neglect, abuse, bullying. Cultural Factors: ○ Stigma and barriers to diagnosis and treatment. 3. Types of Neurodevelopmental Disorders 1. Attention Deficit Hyperactivity Disorder (ADHD): ○ Symptoms: Inattention: Distractibility, difficulty organizing. Hyperactivity: Excessive movement, fidgeting. Impulsivity: Acting without thinking, risky behaviors. ○ Etiology: Genetics (strong hereditary link), low birth weight, prenatal exposure to alcohol/tobacco. ○ Comorbidities: Learning disabilities, oppositional defiant disorder (ODD), substance use, anxiety. 2. Autism Spectrum Disorder (ASD): ○ Hallmark Features: Deficits in social interaction and communication. Repetitive behaviors, restricted interests. Sensory sensitivities.  ○ Severity Levels: Level 1: Needs support, appears “quirky.” Level 2: Needs substantial support, noticeable disability. Level 3: Needs very substantial support, severe deficits. ○ Etiology: Genetics, advanced parental age, no evidence linking vaccines. 3. Intellectual Disabilities: ○ Definition: Deficits in intellectual and adaptive functioning beginning in childhood. ○ Severity Levels: Mild: Can live independently with support. Moderate: Basic skills, requires assistance. Severe/Profound: Requires extensive support, often with coexisting medical conditions. 4. Communication Disorders: ○ Types: Speech disorders: Difficulty making sounds. Language disorders: Difficulty understanding or using words. Social communication disorder: Challenges with verbal and nonverbal communication. ○ Comorbidities: ADHD, ASD, hearing impairments, developmental disabilities. 5. Motor Disorders: ○ Developmental Coordination Disorder (DCD): Difficulty with fine and gross motor skills. ○ Tic Disorders: Tourette’s Syndrome: Motor and vocal tics lasting >12 months. Provisional: Tics