Psych 1 .pdf

WEEK 1: INTRODUCTION Stressor: a biological, psychological, social, or chemical factor that causes physical or emotional tension and may contribute to the development of certain illnesses (Townsend & Morgan, 2018). ○ subjective term, exam can be a stressor for others it ca...

WEEK 1: INTRODUCTION Stressor: a biological, psychological, social, or chemical factor that causes physical or emotional tension and may contribute to the development of certain illnesses (Townsend & Morgan, 2018). ○ subjective term, exam can be a stressor for others it can be fun, cannot be avoided, natural Adaptation: positive, healthy response to stressor- behavior that maintains integrity of individual ○ part of genetics, thats what make us unique Maladaptation: negative, unhealthy response to stressor- when behavior disrupts integrity of individual Coping Mechanism: thoughts & behaviors consciously and voluntarily mobilized to manage internal and external stressful situations (different from defense mechanism) Defense Mechanism: often unconscious and automatic as a result of a trigger MENTAL HEALTH VS MENTAL ILLNESS No clear definition, in general, mentally healthy when s/he possesses knowledge of self, meets basic needs, assumes responsibility, has learned to integrate thoughts, feelings, and actions, and can resolve conflicts successfully. Able to adapt to change in their environment. Mental health is an essential piece of total wellness. Wellness is not the absence of disease or stress; it involves having a purpose in life, being actively involved in satisfying work and play, having joyful relationships, having a healthy body and living environment, and being happy. *Mentally ill show deficits in functioning. or take maladaptive techniques MENTAL HEALTH DISORDER A mental illness/disorder is a syndrome, a set of symptoms that cluster together that may have multiple causes and may represent several different disease states that have not yet been defined. They are clinically significant disturbances in cognition, emotion regulation, behavior that reflect a dysfunction in the psychological, biological, or developmental processes underlying mental dysfunction. Defined by clusters of behaviors, thoughts, and feelings, not by underlying biologic pathology. Laboratory tests are not generally used in diagnosing mental disorders. everybody is at risk for illness and no study favors a certain religion over another but those that do have some spirituality/ faith in them they can help them better recover WEEK 2: THERAPEUTIC COMM., DEFENSE MECHANISM, CULTURE THERAPEUTIC MILIEU is creating a structured environment (both physical and social) that provides a safe treatment method for mental health issues designed to teach psychosocial skills and limit the disruptive and maladaptive behavior of patients. Requires knowing the patient, what makes them feel safe, what things fo they like ex: darkness vs light GOALS OF COMMUNICATION To establish a nurse-client relationship, collaborating to set appropriate goals Client-centered, recognizing client’s needs Guide the client towards identifying a plan of care To promote the client insight into problematic behavior Meeting both the physical and psychological needs of the client TYPES OF COMMUNICATION Verbal/ nonverbal (has more meaning) Congruent/ incongruent (when the expression matches with what is being said verbally) Mood is what people tell you they are feeling - I feel happy Affect is what we think/ we observe (think “A” for “assessment”) - they are smiling, fidgeting, COMMUNICATION TECHNIQUES 1. Giving broad openings - Never ask closed ended questions, we have blank blank blank, not do you want blank? Give them options to choose from. What would you like to discuss today? How can I help you? NOT - Do you need help? 2. Paraphrasing - reassurance/ clarify 3. Offering general leads - Giving message that I am interested - aha, hmm, okay, go one, conitune, 4. Reflecting feelings - Involves empathy, it seems like you are feeling blank. Never tell the patient what they should do, never “you should” instead maybe “If i were in your position I would think about”. We need to understand what they are feeling/thinking 5. Focusing - Be almost like a moderated, help them focus on a certain situation/emotion/event 6. Voicing doubt - That doesn’t sound like blank, how did that happen? 7. Clarifying - So….? 8. Placing events in time sequences - When did that start? After this or before? Put time frames to things 9. Giving information 10. Encouraging formulation of a care plan 11. Testing discrepancies - 12. Active listening 13. Restating 14. Silence 15. Making observation - From the minute you walk into the room 16. Encouraging description of perceptions - Explore, describe their feelings, tell me more, what do you think it happening, what is going through your mind 17. Exploring - Can you tell me more, can you give me examples 18. Summarizing NONTHERAPEUTIC COMMUNICATION  1. Asking closed ended questions - Questions that can be answered with a simple yes or no 2. Disagreeing or Belittling 3. Social responding - Chit chatting like with friends, remember they are customers who are paying for a service regarding their condition ex. Talking about sports 4. Making stereotyped comments 5. Offering false reassurance - Never make promises 6. Moralizing - Imposing your values, religion, culture on others. Ex: sensitive topics like divorce, abortion 7. Interpreting 8. Challenging 9. Why Questions- You can not start a sentence with why and make it therapeutic DEFENSE MECHANISMS 1. Compensation: the act of “making up” for 2. Conversion: transferring of a mental conflict into a physical problem -ex going mute, losing vision 3. Denial: conscious refusal to face reality - “i don't have a drinking problem, I can stop whenever i want” 4. Displacement: transfer feelings from one person to another - Displacing anger on someone other than the situation or person that caused it. Creates a chain reaction/ channeling anger or emotions to others. “Kick the dog syndrome” 5. Dissociation: separating and detaching emotionally charged conflict from one’s consciousness- Completely detaching from situation or event to the point you don’t even recall it, as if it never happened 6. Fantasy: imagined events 7. Identification (the imitator): unconscious attempt to identify with the personality and traits of another - Copying the behavior and or actions of someone else 8. Intellectualization: transferring emotions and feelings into the intellectual sphere. - Suppress emotion and instead of feeling them you reason think logically. Easier to do when family or close friends are not involved. Block out emotion and only think rationally 9. Introjection: attributing to oneself the good qualities of another - Not acting or pretending to be someone, they truly believe that they are that person 10. Isolation: process of separating an unacceptable feeling 11. Projection: blaming someone, “scapegoat” defense mechanism - im cheating so i accuse my partner of cheating 12. Rationalization: unconsciously justify ideas, “self-deception” at its subtle best - Not the same as denial. When you understand the problem but try to justify it. Ex. i don't have a drinking problem vs drinking helps me because i have so much stress and it relieves that 13. Reaction Formation: overcompensation - Do the opposite of what you really want to or believe in 14. Regression: retreating to past levels of behavior that reduce anxiety 15. Repression: “burying alive mechanism” - It is involuntary 16. Sublimation: unacceptable urges are channeled into socially accepted way 17. Substitution: act of replacing a goal when it is blocked 18. Suppression: putting unacceptable thought for feeling out of one’s mind with the ability to recall later - It is voluntary - 19. Symbolization: objects represent feelings - Ex. wedding ring 20. Undoing: negation of a previous consciously intolerable action WEEK 3: DSM, LEGALITY OF METAL HEALTH, NEUROSCIENCE WHAT IS DSM? The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) is a classification of mental disorders with associated criteria designed to facilitate more reliable diagnoses of these disorders.It is organized based on the developmental hierarchy - means that disorders that are usually seen in infancy, childhood, and adolescence are listed in the first chapter PURPOSE OF DSM? Diagnostic tool to organize psychiatric disorders. Common language for healthcare providers. Communicating with other professions To make appropriate diagnosis Case presentation, insurance companies, forensic purpose, disability benefit Criminal trials, civil case, child custody cases NEUROTRANSMITTERS Acetylcholine (Ach) - excitatory neurotransmitter (opens Na channels so that na comes and the cell becomes more active) Function is to promote rest/sleep, muscle control, memory formation, sensory responses Increased levels: Depression (because the Decreased levels: Alzheimer’s disease (memory function of Ach is to promote rest/sleep deficit), Huntington’s disease, dry mouth, blurry parasympathetic), Drooling, EPS, and vision, constipation. Decreased motor function Parkinsonian symptoms. and memory deficits Dopamine Function: cognition, voluntary motion, reward pathway, influence movement, learning, attention, and emotion Increased levels: psychosis, schizophrenia Decreased levels: Parkinson’s disease, depression Norepinephrine Function: helps control alertness and arousal. Produce activity at sympathetic postsynaptic nerve terminals in the ANS results in flight or fight. Increased levels: anxiety, mania, psychosis Decreased levels: depression Serotonin Function: regulates mood, sleep, pain perception, temperature, libido, and appetite. Muscle control and intestinal movement control. Increased levels: sedation or increased Decreased levels: depression, OCD, sleep aggression. dysregulation, loss of appetite and libido Gamma-aminobutyric acid (GABA) - opens chloride channels, so chloride come in and cells become less active Function: It prevents postsynaptic excitation; interrupts the progression of electrical impulses at the synaptic junction. We need this when we need to slow down or put a brake on the activity. * Common cause of anxiety disorders Increased levels: sedation, impaired memory Decreased levels: anxiety, irritability, insomnia, tremors, seizures Glutamate and Aspartate Function: primary excitatory neurotransmitter in the brain, stimulates neurons to send signals. essentially, it "turns on" other neurons to perform their functions and keep brain functioning properly Increased levels: anxiety, panic, bipolar, Decreased levels:poor memory, learning psychosis, huntington disease difficulty, low energy, negative symptoms of schizophrenia LEGALITY OF MENTAL HEALTH ETHICAL CONCEPTS Autonomy: Self-determinism is based on a person’s fundamental right to autonomy.- Unless they are danger to self or others and at that time the only medication you can actually force them to take is antipsychotic medications, not any other even though they may need it like blood pressure meds Beneficence: one’s duty to benefit or promote the good of others - You have to help Nonmaleficence: healthcare providers do not harm their clients; I believe this is more important than beneficence; that is, it is more important to avoid doing harm than it is to do good. - Do not harm Justice: fairness Veracity: duty to be always truthful LEGAL CONCEPTS Tort (civil wrongdoing) that causes harm to another person or their property, for which the injured party can seek legal compensation (usually though money). Torts are not crimes, but civil wrongs, and they can result from intentional actions, negligence, or strict liability. The goal of tort law is to compensate the injured party, not punish the wrongdoer. - Main point it to compensate for the wrongdoing but not punish Intentional Tort: occurs when a person deliberately performs an action that harms another individual. The key aspect is intent—the person intended to commit the act, even if they didn’t intend the exact harm. Examples include Assault: a fear or apprehension that an individual will be touched without consent Battery: unconsented touching Do not need consent if gravely disabled, danger to self or others False imprisonment: need informed Consent (unless emergency, harm to self or others) Defamation of character: when shared information is false/ malicious and is detrimental to the client’s reputation Slander- oral Libel: written (be careful when you write progress note, be objective)  Negligence (unintentional harm due to carelessness): any person can be negligent if he or she does not provide the standard of care that a reasonably prudent person would have exercised in a similar situation (unintentionally below legal standard care). Ex: driver causing a car accident by running a red light. Malpractice: negligence or incompetence on the part of a professional. Must meet the following four elements of negligence to prove malpractice: 1. Duty: you had a legal duty to provide services; 2. Breach of Duty: you have breached that duty; 3. Proximate Cause: that the breach of that duty is the cause of injury; 4. Damages: the client has been substantially injured, result of breach in standard of care. Competency: A legal concept (not medical) - To determine if a client can make reasonable judgements and decisions regarding health. As a clinician, we assess if the client has the “capacity” to make medical decisions. PATIENT RIGHTS Generally speaking, all patients have the same rights. A person with a mental illness has the same right as someone admitted for chest pain or someone recovering from appendectomy, etc. The pt has a right to privacy, the right to have access to a phone, mail, right to select treatment, refuse medication, get a second opinion, access to an attorney, etc. RESTRAINT Any manual method or medication used to restrict a patent’s freedom of movement Always use least restrictive method 1:1 is must, Never PRN, never used as punishment, never used for staff convenience RN must obtain order within 1 hour of placing patient in restraints, IM meds given- goal is to remove restraints, Individual observed at all times For age 18 and up- orders are good for 4 hours For age 9-17- orders are good for 2 hours For age