Mental Health ch1
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| Mental health | state of well-being in which each individual is able to realize their own potential, cope with normal stresses of life, work productively, and make contribution to community.
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| Resilience | characteristic of mental health, increasingly being promoted and essential to the recovery process. Being able to cope and adapt in a healthy way
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| Mental Illness | clinically significant behavioral syndrome marked by the patient’s distress, disability or the risk of suffering disability or loss of freedom. Culturally defined.
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| Diathesis-Stress model | biologic predisposition (genetic factor), most accepted explanation for mental illness. Combination of genetic vulnerability and negative environmental stressors
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| Social influences on mental health care | mental health movement, National alliance on mental illness, decade of the brain (1990), new freedom commission on mental health and mental health parity act
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| Epidemiology of Mental Disorders | study distribution of mental disorders (quantitative in the human population) ID high-risk groups and factors. Lead to etiology of mental disorder. Use information to improve clinical practice, plan public health policies.
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| Clinical Epidemiology | groups treated for specific mental disorders studied for natural history of illness, diagnostic screening tests, interventions. For people with illness once they are seen by providers of clinical care
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| Axis I and II | mental disorder that is the focus of treatment (the state they’re in. : personality disorders and mental retardation
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| Axis III and IV | general medical disorder relevant to the mental disorder in axis I (mental and medical). psycholosocial and environmental problems (death of a spouse)
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| Axis V | global assessment of functioning
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| ICD-10 | international classification of disease, clinical descriptions of mental and behavior disorders, divided into 10 disease classifications. Not used in psychology, used in pediatrics.
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| Level of psychiatric Nursing practice: | promote MG- the assess, diagnosis&treatment of human responses to mental health problems and psychiatric disorders. Basic level BSN with certification. Advanced practice RN psychiatric mental health (APRN-PMH) master’s degree.Can give meds with dr on call
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| trends in mental health | increased aging population, increased cultural diversity, expanding technology, more outpatient and shorter hospital stay
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| Freud | Level of awareness; Consciousness: talking, perception, memories, thought. Preconscious: can retrieve easily. Unconscious: repressed memories, with trauma
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| Id | pleasure principle, reflex action, primary process, instinct, impulses
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| Ego | develops because the needs, wishes, and demands of id cannot be satisfactorily met through primary processes and reflex action. 4th/5th month develops. Problem solving and reality tester
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| Superego | moral component what you should/shouldn’t do, last portion of the personality to develop. Represents the ideal rather than the real; it seeks perfection, as opposed to seeking pleasure of engaging reason
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| Freud stages | Experiences during the early stages of life determine an individual’s lifetime adjustment patterns and personality traits. oral (0-1) ex; weaning, Anal (1-3) ex: toilet training, Phallic (3-6) Oedipus and electra, Latency (6-12), gential (12+)
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| Freudian Theory | formation of personality, consciousness & unconscious influences, importance of ind sessions, listening, transference: pt has feelings towards therapist. countertransference: healthcare unconscious personal response to the pt “pt reminds you of someone”
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| Erickson first 4 stages | infancy (0-1 ½) trust vs mistrust. Early childhood (1 ½ -3) autonomy vs shame and doubt. Late childhood (3-6) Initiative vs guilt. School age (6-12) industry vs inferiority.
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| Erickson last 4 stages | Adolescence (12-20) identity vs role confusion. Early adulthood (20-35) intimacy vs isolation. Middle adulthood (35-65) generativity vs self-absorption. Later years (65+) integrity vs despair.
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| Sullivan’s interpersonal theory: | purpose of all behavior is to get needs met through interpersonal interactions and to decrease or avoid anxiety. Anxiety; any painful feeling or emotion that arises from social insecurities or prevents biological needs from being satisfied
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| Sullivan | Participant observer; professional helpers cannot be isolated from the therapeutic situation if they are to be effective. Mutuality; respect for the patient, unconditional acceptance and empathy.
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| Hildegrard Peplau’s theory | Sullivan was foundation. Provide care, compassion & advocacy, enhance comfort & well-being. Understand a broad range of human problems & psychosocial phenomena, intervene in relieving patient’s suffering & promote growth. observe, interprete& intervention
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| Hildegrard Peplau’s level's of anxiety | Levels of anxiety are mild, moderate, severe, and panic. She promoted interventions to lower anxiety with the aim of improving patient’s ability to think and function at more satisfactory levels.
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| Behavioral theories | behaviorists have no concern with inner conflicts but argue that personality simply consists of learned behavior. These models emphasize the ways in which observable behavioral responses are learned and can be modified in a particular environment.
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| Conditioning | Behavior can be influenced through a process referred to as conditioning, pairing a behavior with a condition that reinforces or diminishes the behavior’s occurrence
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| John B watson | Believed that personality traits and responses were socially learned through classical conditioning. Personality is objective and measurable
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| Ivan Pavlov | worked with dogs, conditioned them with classic conditioning; involuntary. “If a child gets sick after eating something, as an adult the smell of that food may make them sick”
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| B.F. Skinner operant conditioning | voluntary behaviors learned through consequences & behavioral responses are elicited through reinforcement, which cause a behavior to occur more frequently. Positive reinforcement; getting an award. Negative: removal of an objectionable stimulus
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| Modeling and Operand Conditioning | therapist provides a role model for specific id behaviors, and the pt learns through imitation. uses positive reinforcement to increase desired behaviors. Reward system is known as a token economy.
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| Systematic desensitization | patients fear is broken down into its components. The pt is incrementally exposed to the fear. The patient is instructed in how to design a hierarchy of fears and then the patient practices these techniques every day.
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| Aversion therapy | akin to punishment. Treatment of choice when other less drastic measures have failed to produce the desired effects. Pairing of a maladaptive behavior with a noxious stimulus, punishment, avoidance training.
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| Maslow | Physiological, safety, belongingness & love, esteem needs and self-actualization
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| Milieu | philosophy of care in which all parts of the environment are considered to be therapeutic opportunities for growth and healing. Includes the people, setting, structure and emotional climate
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| tests on the brain | Computer tomography (CT), MRI, PET, SPECT
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| Parasympathetic | SLUGG Salvation, lacrimation, urination, digestion, defecation
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| Dopamine | though, emotion, involved in decision making. Decreased in parkinson’s and depression and increased in schizophrenia and mania
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| Norepinephrine/ noradrenaline | attention and arousal, stimulates sympathetic branch of “fight or flight”. Decreased in depression increased in mania, anxiety and schizophrenia
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| Serotonin | Sleep, pain, sex, mood, aggression. Decreased in depression, increased in anxiety states
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| Histamine | alertness, stimulates gastric secretions. Decrease in sedation and weight gain
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| GABA | roles in inhibition; reduces aggression, excitation, and anxiety. May appear cognition & psychomotor functioning. Anticonvulsant & muscle-relaxing properties. Dec in anxiety disorders, schizophrenia, mania, huntington’s disease.
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| Glutamate | excitatory, AMPA plays a role in learning and memory. Dec in psychosis and inc in Alzheimer’s disease
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| Acetylcholine | parasympathetic NS, learning and memory, regulates mood; mania, sexual aggression. Decreased in alzheimer’s disease, huntington’s and parkinson’s. increased in depression
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| Substance P | centrally active SP antagonists has antidepressant and antianxiety effects in depression. Involved in regulation of mood and anxiety
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| Somatostatin | altered levels associated with cognitive disease
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| MAOI | monoamines (norepinephrine, epinephrine, dopamine, serotonin) MAO are enzymes that destroy monoamines. MAOI block MAO to increase the hormones
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| Areas of the brain | Brainstem:internal organs &vital functions like regulation of blood gases & the maintenance of BP. Cerebellum: regulate of skeletal muscle coordination & contraction & the maintenance of equilibrium. Cerebrum: mental activity & conscious sense of being.
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| Antipsychotic | Clozapine and Olanzapine have the highest risk of causing metabolic syndrome
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| Ethics | the study of philosophical beliefs about what is considered right or wrong in a society
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| Ethical dilemma | : conflict between two or more courses of action. Each with favorable and unfavorable consequences
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| Bioethics | used in relation to ethical dilemmas surrounding health care
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| Autonomy | respect the rights of thers to make their own decisions
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| Beneficience | the duty to promote good
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| Justice | distribute resources or care equally
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| Fidelity (nonmaleficence): | maintaining loyalty and commitment; doing no wrong to a pt
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| Involuntary admission | without consent. Necessary when a person is in need of psychiatric treatment, presents a danger to self or others. Have the access to legal counsel and the right to take their case before a judge, who may order a release. Can be hospitalized for 60 days.
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| Temporary admission | used for people who are confused or demented they cannot make decision on their own or for people who are so ill they need emergency admission. The length of time and procedures vary from state to state. No more than 15 days
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| Voluntary admission | sought by the pt or the pt guardian through a written application to the facility. Also have the right to obtain release.
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| Informal admission | one type of voluntary admission that is similar to any general hospital admission in which there is no formal or written application
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| Writ of habeas corpus | “formal written order” to “free the person”. Used to challenge unlawful detention by the government
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| Civil right of persons with mental illness | Right to: vote, civil service ranking, make purchase & enter contractual relationships, humane care and treatment, right to religious freedom and practice, right to social interaction, right to exercise & participate in recreational opportunities
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| Confidentiality | any discussion involving a pt should be conducted discreetly & with individuals who have a need and a right to know this information. A person’s reputation can be damaged even after death, do not divulge information that couldn’t be shared before death.
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| Duty to warm and protect third parties | a psychotherapist has a duty to warn a patient’s potential victim of potential harm. Assessing & predicting the pt’s danger of violence toward another, ID specific persons being threatened, taking appropriate action to protect the ID victim
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| Tort | civil wrong where money may be collected by the injured party from the responsible party. Intentional is assault, battery, false imprisonment. Unintentional is negligence and malpractice (duty, breach of duty, cause in fact, proximate cause and damages
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| assessment | gather data- know lifestyle, work, exercise, substance abuse, history of violence, coping methods, weakness and strengths.
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| diagnosis | Problem (unmet need), Etiology (r/t), supporting data of S/S (AEB)
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| Outcome | reflect the maximal level of pt health that can realistically be achieved through nursing interventions
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| Planning | safe, compatible and appropriate, realistic and individualized, evidence-based.
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| Implementation | coordination of care, health teaching and health promotion, milieu theory, pharmacological, biological and integrative therapies.
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| Evaluation | systematic, ongoing and criteria based
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| Mental | appearance, behavior, speech, mood, disorders of the form of thought, perceptual disturbances, cognition, ideas of harming self or others
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| social relationship | a relationship that is primarily initiated for the purpose of friendship, socialization, enjoyment or accomplishment or a task. Mutual needs are met during social interactions
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| Therapeutic relationship | focus is the patient’s ideas, experiences and feelings. The needs of the pt are id and explores, clear boundaries are established, alternate problem-solving approaches are taken. New coping skills may be developed. Behavioral change is encouraged.
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| Peplau’s model of the nurse and patient relationship | orientation phase (first meeting, setting parameters of relationship). Working phase (evaluate problems and goals). Termination phase summarize goals and objectives achieved)
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| Empathy | accurately perceiving the pt situation, perspective and feelings. Communicating understanding to the patients and check with the patient for accuracy. “something similar happened to me last year and I had mixed emotions. What thoughts are you having?”
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