Mental Health Final part 2

• Deinstitutionalization


  A result of psychotropic medications, which reduced the patient population in state hospitals and other facilities dedicated to the care and treatment of people with mental illness
• Parenting Style: Authoritarian


  • Very strict rules
  • The child has little or no voice in family decisions
• Parenting Style: Authoritative


  • Firm, consistent rules and limits
  • Allows for discussion and flexibility
• Parenting Style: Permissive


  • Little structure
  • Few guidelines
  • The child is unsure of boundaries and has a hard time learning self control and situational appropriateness
• Cultural Competency


  What it is and how to become culturally competent
• Therapeutic Communication Techniques


  • Reflecting, repeating, parroting
  • Clarifying
  • Open ended questions
  • Asking for what you need or want
  • Identify feelings and thoughts
  • Using empathy
  • Silence
  • Giving information
  • Using general leads
  • Stating implied thoughts and feelings
• Therapeutic Communication Blocks


  • False reassurance
  • Minimizing /belittling
  • Why
  • Advising
  • Agree / disagree
  • Close ended questions
  • Providing the answer to questions
  • Changing subject
  • Approving or disapproving
• Defense Mechanisms


  Group of behaviors used to reduce or eliminate anxiety. Unconsciously falling into habits that give the illusion of coping but produce ineffective results
• Defense Mechanisms


  • Denial
  • Repression
  • Dissociation
  • Rationalization
  • Compensation
  • Sublimation
  • Regression
  • Isolation
  • Avoidance
• Dementia


  Gradual loss of previous levels of cognitive functioning which can include memory, language, executive functions and attention in a state of being fully alert
• Signs and Symptoms of Dementia


  • Slow onset
  • Disorientation of cognitive ability
  • Impaired long and short memory
  • Personality changes
  • Focus on one thing for a long period of time
  • Usually irreversible
• Treatment for Dementia


  There is no treatment but there is pharmacologic treatment to temporarily slow the symptoms from getting worse (Donepezil, Rivastigmine, Galantamine)
• Delirium


  A serious change in mental abilities. It results in confused thinking and lack of awareness of someones surroundings
• Signs and Symptoms of Delirium


  • Fluctuating levels of awareness
  • Sudden onset
  • Clouding of consciousness
  • Perceptual disturbance (hallucinations and illusions)
  • Memory disturbance
  • Highly distracted
  • Reversible possibility with treatment
• Treatment for Delirium


  Finding the cause could be due to medication, infection, or metabolic imbalance
• Bipolar Disorder


  Disorder characterized by mood swings from profound depression to extreme euphoria with intervening periods of normalcy
• Signs and Symptoms of Bipolar Disorder (Mania)


  • Very elevated mood (excess activity-hyperactivity, increased energy, racing thoughts, flight of ideas, talking a lot, very high self esteem)
  • Easily distracted
  • Little need for sleep (may feel rested after 3 hours of sleep)
  • Poor temper control
  • Easily agitated and irritable
  • Reckless behavior and lack of self control (drinking, drug use, binge eating, poor judgment, sex with many partners, spending sprees)
• Treatments for Bipolar Disorder


  • Mood stabilizer medication are the primary treatment; lithium, anticonvulsants including carbamazepine (tegretol), gabapentin (Neurontin), valproic acid (depakene) and lamotrigine (lamictal)
  • Psychotherapy helps with support and medication compliance
• Lithium Monitoring


  Requires close monitoring including regular blood levels. Therapeutic levels are between 0.5-1.2 (1.0-1.5 in acute mania). Blood levels can become elevated in dehydration, profuse sweating and chronic diarrhea leading to toxicity. Toxicity can cause tremors, confusing, seizures, coma, and even death. Early warning signs of toxicity include; nausea, vomiting, sedation
• Nursing Interventions for Bipolar Disorder Patients


  • Monitor lithium levels (monitor for side effects)
  • Promote honest therapeutic communication
  • Provide consistency in care
  • Encourage healthy nutrition
  • Encourage appropriate activity
  • Provide clear, firm limits
  • Ensure patient safety
• Schizophrenia


  There is a "split" between a patients thoughts and feelings, between his or her reality and society reality. Psychotic thought disorder where hallucinations and delusions dominate the patients thinking. Very serious, debilitating, lifelong psychiatric disorder
• Signs and Symptoms of Schizophrenia


  • Delusions (fixed, false beliefs that cannot be changed with logic)
  • Hallucinations (false sensory perceptions, can affect all 5 senses)
  • Illusions (mistaken perceptions of reality)
  • Echolalia (repetition of words)
  • Echopraxia (repetition of action, catatonia is impaired, motor activity including stupor)
  • Lack of desire to form social relationships, inappropriate social behaviors (pacing, rocking)
• Delusions


  Fixed, false beliefs that cannot be changed with logic
• Hallucinations


  False sensory perceptions, can affect all five senses
• Illusions


  Mistaken perceptions of reality
• Types of Hallucinations


  • Visual
  • Auditory (most common)
  • Tactile
  • Olfactory
  • Gustatory
  • Kinesthetic (bodily movement or sense)
• Treatments for Schizophrenia


  • Medications: Antipsychotics (may need to be on these for the rest of their life), Anticholinergics (to counteract extrapyramidal symptoms)
  • Psychotherapy (group and family)
  • Electroconvulsive therapy
  • Supportive milieu
  • Ongoing support and education
• Nursing Interventions for Schizophrenia


  • Never reinforce hallucinations, delusions or illusions
  • Never whisper or laugh when the patient is not aware of the whole conversation
  • Keep patient out of competitive or embarrassing situations
  • Develop trust
  • Maintain a calm, structured milieu
  • Maintain clear, concise communication
  • State what is acceptable and expected behavior
  • Give rational and consequences at the same time
• Anorexia Nervosa


  Morbid fear of obesity causes anxiety and obsessive fear of losing control of food intake. Distorted body image of self as fat. May or may not include purging. Self starvation and refusal to eat despite hunger. Excessive exercise after eating to use up calories
• Causes of Anorexia Nervosa


  • Negative self esteem
  • Depression
  • Internal struggles with autonomy, sexuality
  • Gender difference
  • Genetics
  • Hypothalamus dysfunction (appetite center)
  • Improper dopamine levels
  • Cultural/ethic differences may affect the tendency toward body build or weight gain
• Signs and Symptoms of Anorexia Nervosa


  • Excessive weight, usually more than 25% of body weight prior or dieting
  • Refusal to maintain normal weight
  • Intense fear of being fat
  • Restricting food intake often to only 200-300 calories per day
  • Excessive exercise
  • Obsessive thoughts
  • Perfectionism
  • Amenorrhea
  • Cachexia
  • Hair loss
  • Pedal edema
  • Distorted body image
  • Physical signs can include slow pulse rate, electrolyte imbalance, fatigue, dry skin, and lanugo
• Behaviors Associated with Anorexia Nervosa


  • Introverted
  • Socially isolated
  • Higher achiever
  • Excessive exercise
• Nursing Interventions for Anorexia Nervosa


  • Promote positive self concept and self acceptance
  • Promote healthy coping skills
  • Address feelings associated with foods
  • Promote education for adequate nutrition
  • Promote an appropriate amount of exercise
  • Focus on positive reinforcement of progress, not the amount of weight the person is "gaining" or losing
• Bulimia Nervosa


  Serious eating disorder marked by binging and purging, followed by methods to avoid weight gain
• Signs and Symptoms of Bulimia Nervosa


  • Extreme dieting
  • Dehydration
  • Use and abuse of laxatives or syrup of ipecac (induce vomiting)
  • Use and abuse pf diuretics
  • Obsession with food and eating
  • Thoughts about self harm
  • Routine use of the bathroom immediately after eating
  • Erosion of tooth enamel or hoarseness from vomiting
  • Extreme sensitivity to body shape and weight
  • Poor self concept
  • Likely to appear normal weight or slightly over weight
  • Impulsive
  • Chipmunk face
  • Feeling depressed, guilty and worthless
• Detoxification


  Medical treatment of an alcoholic or drug addict inviting abstention from drinking or drugs until the blood stream is free of toxins
• Signs and Symptoms of Substance Abuse Detoxification


  • Autonomic hyperactivity (high BP, tachycardia, fever)
  • Hand tremor
  • Nausea and vomiting
  • Anxiety
  • Transient visual tactile or auditory hallucinations or illusions
  • Early signs of delirium
  • Grand mal seizures
  • Red, watery eyes
  • Runny nose
  • Hostility
  • Paranoia
  • Needle tracks
  • Erratic, unpredictable behaviors
  • Risky behaviors including stealing, lying
• Eating disorder symptoms


  • Use and abuse of diuretics
  • Obsession with food and eating
  • Thoughts about self harm
  • Routine use of the bathroom immediately after eating
  • Erosion of tooth enamel or hoarseness from vomiting
  • Extreme sensitivity to body shape and weight
  • Poor self concept
  • Likely to appear normal weight or slightly over weight
  • Impulsive
  • Chipmunk face
  • Feeling depressed, guilty and worthless
• Signs and symptoms of substance abuse withdrawal


  • Autonomic hyperactivity (high BP, tachycardia, fever)
  • Hand tremor
  • Nausea and vomiting
  • Anxiety
  • Transient visual tactile or auditory hallucinations or illusions
  • Early signs of delirium
  • Grand mal seizures
  • Red, watery eyes
  • Runny nose
  • Hostility
  • Paranoia
  • Needle tracks
  • Erratic, unpredictable behaviors
  • Risky behaviors including stealing, lying to obtain the drug
  • May use alcohol to self medicate symptoms
• Substance abuse treatments


  • Narcotic anonymous use a 12 step approach
  • Group therapy
  • Individual psychotherapy
  • Detoxification is required for some drugs
  • Drug specific programs are base on the substance abused