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This comprehensive study guide covers key concepts for mental health exams, including therapeutic relationships, cognitive behavioral therapy (cbt), the diathesis-stress model, diagnostic tools (dsm-5, icd, nanda), and legal and ethical guidelines for safe practice. it delves into transference and countertransference, peplau's model of nurse-patient relationships, beck's cognitive triad, and criteria for involuntary commitment. the guide also explores derealization versus depersonalization, bioethical principles, patient rights, and legal procedures like the tarasoff rule and lps conservatorship. This resource is invaluable for students preparing for mental health examinations.
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The primary goal of the nurse-patient relationship in psychiatric nursing is to facilitate communication of distressing thoughts and feelings, aid the patient with problem-solving, help examine self-defeating behaviors and test alternatives, and promote self-care and independence.
Transference is when the patient unconsciously and inappropriately displaces onto the nurse feelings and behaviors related to significant figures in the patient's past. The patient is expressing their feelings about someone of importance from their past to the nurse, which is intensified in relationships of authority.
The Diathesis-Stress Model proposes that mental health disorders develop due to the interaction between genetic vulnerability (diathesis) and environmental stressors (stress). It helps explain why some people with a genetic risk develop mental health issues and others do not, highlighting the importance of early intervention and stress management in preventing vulnerable individuals.
The five principles of bioethics are: 1) Beneficence - the duty to promote good, 2) Autonomy - respecting the rights of others to make their own decisions, 3) Justice - distributing resources or care equally, 4) Fidelity (nonmaleficence) - maintaining loyalty and commitment; doing no wrong to a patient, and 5) Veracity - one's duty to always communicate truthfully.
The Tarasoff rule is an exception to patient confidentiality. It states that there is a duty to warn and protect third parties, and HIPAA can be broken for the Tarasoff rule. Healthcare providers, including nurses, are required to report abuse or neglect to protect at-risk populations such as children, the disabled, the vulnerable, and the elderly.
The criteria for involuntary commitment in California include: 5150 - 72- hour hold (danger to self, danger to others, gravely disabled), 5250 - 14-day hold (same criteria as 5150), 5260 - extends hospitalization for another 14
days (only for patients who remain a danger to themselves), and 5300 - 180- day hold (danger to others).
A Riese Petition is a medication capacity hearing that determines whether a psychiatric patient has the capacity to refuse medication. The judge or hearing officer will evaluate the patient's ability to understand their condition, comprehend the risks and benefits of medication, and make a rational decision.
The Lanterman-Petris-Short (LPS) Conservatorship is a legal process in California that allows for the court-appointed management of a person with a severe mental illness who is unable to care for themselves due to their condition. It can be temporary (30 days) or permanent (1-year, renewable), and the conservator has the power to place the individual in a locked psychiatric facility, approve or refuse psychiatric medications, and make financial and personal decisions related to the individual's care and treatment.
All least restrictive measures must be exhausted before seclusion and restraints are used. For adults 18 and older, seclusion and restraints are limited to 4 hours, for ages 9-17 it's 2 hours, and for ages 8 and below it's 1 hour. Chemical restraints, such as sedatives and antipsychotics, are also regulated.
Derealization (DR) is the perception of the external world being distorted or strange, where objects may seem distorted in size or people may appear distant or unrecognizable. Depersonalization (DP) is the feeling of being disconnected from one's own body, such as feeling like a robot or that one's body isn't their own.
The average onset of schizophrenia is in the late teens to early twenties, but it can occur as late as the mid-fifties.
Medical issues that need to be ruled out before schizophrenia can be diagnosed include meth use, traumatic brain injury, urinary tract infection, and hypoglycemia.
The common anticholinergic side effects of first-generation antipsychotics include dry mouth, constipation and urinary retention, blurred vision, and cognitive impairment.
Tardive dyskinesia involves involuntary, repetitive movements, often affecting the mouth, tongue, face, and limbs. It is a potential long-term side effect of first-generation antipsychotics.
High-potency first-generation antipsychotics (e.g., haloperidol, fluphenazine) have a higher risk of extrapyramidal symptoms (EPS) but lower sedation and anticholinergic effects. Low-potency first-generation antipsychotics (e.g., chlorpromazine) have lower EPS risk but higher sedation and anticholinergic effects.
The common EPS associated with first-generation antipsychotics include acute dystonia (bizarre muscle contractions), akathisia (inability to sit still), pseudoparkinsonism (tremors, pill rolling), and tardive dyskinesia (abnormal involuntary movements). These EPS are managed by administering anticholinergic medications like Artane, Benadryl, and Cogentin alongside the first-generation antipsychotics.
Second-generation antipsychotics treat both positive and negative symptoms of psychosis, with fewer extrapyramidal side effects and tardive dyskinesia compared to first-generation antipsychotics. They have reduced affinity for dopamine (D2) receptors and increased affinity for serotonin receptors. Second-generation antipsychotics are used to treat schizophrenia, bipolar disorder, behavioral disruptions in dementia, and other psychiatric conditions.
Clozapine is a highly sedating second-generation antipsychotic with an increased risk of seizures and weight gain. It is considered a last-resort option due to the risk of agranulocytosis, a severe reduction in white blood cells. Patients taking clozapine require regular blood tests to monitor their absolute neutrophil count, and a national registry tracks all individuals prescribed this medication.
First-generation antipsychotics work the fastest and are best for emergency situations, but have a higher risk of extrapyramidal side effects. Second- generation antipsychotics are more expensive but better for long-term use, with fewer side effects. Third-generation antipsychotics, like aripiprazole, have the pros of second-generation antipsychotics with even lower risk of metabolic side effects.
Neuroleptic malignant syndrome (NMS) is a rare, life-threatening reaction to antipsychotic medications, particularly first-generation antipsychotics. It is characterized by fever, autonomic instability, muscle rigidity, and renal impairment. NMS is managed by immediately discontinuing the antipsychotic, providing supportive care, and administering medications to control the symptoms.
Anticholinergic toxicity is characterized by hyperthermia, hot and dry skin, reduced bowel sounds, agitation, delirium, tachycardia, and potentially coma and death. It differs from neuroleptic malignant syndrome in that it is caused by the anticholinergic effects of certain medications, rather than being a reaction to the dopamine-blocking effects of antipsychotics.
The DSM-5 criteria for MDD include the presence of at least 5 of the following symptoms for a 2-week period, with at least one being depressed mood or loss of interest/pleasure: depressed mood, diminished interest/ pleasure, significant weight loss, insomnia/hypersomnia, psychomotor agitation/retardation, fatigue, feelings of worthlessness/guilt, difficulty concentrating, and suicidal thoughts. Subtypes of MDD include psychotic features, catatonic features, melancholic features, and seasonal features.
Tricyclic antidepressants (TCAs) prevent the reuptake of serotonin and norepinephrine, thereby increasing the availability of these neurotransmitters in the brain.
Key assessment findings for a patient with depression include urinalysis, complete blood count, screening for infection, urine toxicology, and thyroid function (to rule out hypothyroidism).
Serotonin syndrome is a potentially life-threatening condition caused by taking too much of an SSRI or combining an SSRI with another medication that increases serotonin levels in the central nervous system. Symptoms include mental status changes, agitation, myoclonus, shivering, hyperreflexia, labile blood pressure, ataxia, diaphoresis, and hyperpyrexia. Management involves supportive measures, discontinuation of the offending medication, and the use of benzodiazepines and anti-serotonergic agents. Prevention involves careful monitoring and avoidance of serotonin- increasing drug combinations.
Electroconvulsive therapy (ECT) is a treatment procedure in which an electric current is passed through the brain, inducing a generalized seizure. ECT is typically considered a last resort for the treatment of severe depression, acute mania, psychotic symptoms, and acute suicidality, when other treatments have been ineffective. The treatment is usually administered three times per week until a course of 12 treatments is completed. While ECT can be effective, it is an invasive and expensive procedure with the potential for transient short-term memory loss as a side effect.
Risk factors for suicidal ideation and self-injury include psychiatric disorders (especially those associated with low serotonin levels), alcohol or substance abuse, male gender, increasing age, and a family history of suicidal behavior. Protective factors include religion, culture, marriage, problem-solving skills, coping mechanisms, a strong support system, access to mental health care, and resilience. Cultural factors, such as the role of religion and extended family, can also serve as protective factors for certain ethnic groups.
According to Menninger, the three central desires that underlie suicide are:
According to Aaron Beck, the central emotional factor in suicide risk is hopelessness - the feeling that things will never improve and that there is no possibility of relief from emotional pain.
Suicidal fantasies refer to individuals experiencing repeated thoughts or fantasies about death, dying, or suicide. These can become more pervasive and difficult to control over time. When these suicidal fantasies are combined with real or perceived loss, individuals may feel more isolated, hopeless, and desperate, which can lead them to consider suicide as a solution to their pain.
A patient safety plan is a unique, patient-centered approach aimed at heightening the patient's commitment to safety and mental health treatment, developing coping strategies, and adherence to personal safety plan before acting on suicidal thoughts. The key components include identifying warning signs, coping strategies, social contacts, and professional support to be accessed during a crisis.
The different classifications of self-injurious behavior (SIB) include:
The key differences between Bipolar I and Bipolar II disorders are: Bipolar I: Mania occurs during high mood swings, with extreme energy, impulsive behavior, racing thoughts, and potential psychosis. Depression occurs during low mood swings, with sadness, loss of energy, and difficulty concentrating. The highs and lows are more drastic. Bipolar II: Hypomania occurs during high mood swings, which is a less extreme form of mania without psychosis. Depression also occurs during low mood swings. The highs and lows are not as drastic as in Bipolar I.
The key symptoms of mania in bipolar disorder include:
Benzodiazepines are used in the short-term to provide relief from mania or hypomania symptoms while waiting for the effects of longer-acting bipolar medications like lithium or valproic acid to take effect.
Fear is a reaction to a specific, identifiable danger, while anxiety is a more general apprehension, uneasiness, or uncertainty about a perceived threat. Fear is a necessary survival response, while anxiety can become maladaptive if it is disproportionate to the situation.
The four levels of anxiety are: 1) Mild - perceptual field slightly narrowed but sharpened, effective problem-solving; 2) Moderate - perceptual field somewhat narrowed, problem-solving more difficult; 3) Severe - perceptual field greatly narrowed, problem-solving significantly impaired; 4) Panic - perceptual field severely distorted, problem-solving impossible. As anxiety increases, the person's ability to perceive their surroundings and think clearly becomes increasingly compromised.
Repression is the defense mechanism that involves the unconscious suppression of distressing memories, thoughts, or feelings in order to protect the individual from anxiety or other uncomfortable emotions.
Separation anxiety disorder involves developmentally inappropriate levels of concern over being away from a significant other. In children, it typically lasts 4-6 weeks, while in adults it can persist for 6 months or more. Potential consequences include loss of independence, lack of a social circle, and increased isolation if the individual is unable to tolerate being away from their attachment figure.
Cognitive theories, such as Cognitive Behavioral Therapy (CBT), posit that anxiety disorders arise from irrational thoughts and beliefs that lead to maladaptive behaviors. Behavioral theories, on the other hand, suggest that anxiety disorders develop through classical conditioning (associating neutral stimuli with fear) and operant conditioning (using avoidance behaviors to reduce anxiety).
The primary characteristic of OCD is the presence of obsessions, which are persistent, intrusive thoughts, impulses, or images that the individual feels driven to act upon through compulsions, which are repetitive behaviors or mental acts performed to reduce the anxiety caused by the obsessions.
Social anxiety disorder is characterized by a persistent fear of social or performance situations where the individual may be negatively evaluated by others. This can lead to significant impairment in social, occupational, and other areas of functioning, as the individual may avoid these situations or endure them with intense distress, which can further isolate them and limit their opportunities for personal and professional growth.
The diathesis-stress model of anxiety disorders suggests that the development of these disorders is influenced by both a predisposition or vulnerability (diathesis) and the presence of stressful life events or environmental factors. The diathesis may be biological, psychological, or a combination of the two, while the stress can come from a variety of sources, such as traumatic experiences, interpersonal conflicts, or major life changes.
Reaction formation is the defense mechanism where an individual acts in a way that is the opposite of their true feelings in order to protect themselves from anxiety or guilt.
The patient appears to have obsessive-compulsive disorder (OCD). The described behavior of feeling compelled to use tissues to touch objects in order to feel clean and safe is indicative of OCD.
The appropriate short-term outcome is for the patient to communicate with staff and peers for at least 10 minutes within 5 days. This helps address the patient's social isolation and embarrassment by gradually increasing her social interaction.
Dissociative identity disorder (DID) is characterized by the presence of two or more distinct personality states, each with its own pattern of perceiving, relating to, and thinking about the self and the environment. This is often the result of repeated trauma that the individual has had to formulate new personalities to escape.
Wernicke-Korsakoff syndrome is characterized by ataxia (loss of coordination due to cerebellar dysfunction), somnolence and stupor (signs of progressing neurological decline that can lead to coma and death if untreated), as well as peripheral neuropathy, confabulation, and myopathies.
Signs of alcohol intoxication include slurred speech, lack of coordination, unsteady gait, blackouts, nystagmus, flushed face, and impaired judgment. Withdrawal symptoms develop within 4-12 hours after cessation and peak at 24-48 hours, including anxiety, agitation, tremors, tachycardia, hypertension, diaphoresis, hallucinations, nausea/vomiting, and delirium tremens (a medical emergency with severe autonomic instability).
The CAGE questionnaire consists of 4 questions: 1) Have you ever felt you should Cut down on your drinking? 2) Have people Annoyed you by criticizing your drinking? 3) Have you ever felt Guilty about your drinking?
The CIWA-Ar is used to recognize the process of alcohol withdrawal before it progresses to more advanced stages, in order to prevent over- or under- treatment. It assesses 10 signs and symptoms of withdrawal, including nausea/vomiting, tremors, sweating, anxiety, agitation, and sensory disturbances. Scores below 8-10 indicate mild withdrawal, while scores of 15 or more indicate severe withdrawal requiring aggressive pharmacological management.
Key pharmacological treatments for alcohol use disorder include:
Common signs of central nervous system stimulant abuse include dilated pupils, dryness of the oronasal cavity, excessive motor activity, elevated vital signs, insomnia, and psychosis. Examples of stimulants include cocaine, crack, caffeine, nicotine, and ADHD medications. Withdrawal symptoms can include depression, paranoia, lethargy, anxiety, insomnia, nausea, vomiting, and suicidal thoughts.
Nicotine is a psychoactive stimulating substance found in tobacco. It occupies the receptors for acetylcholine in both dopamine and serotonin neural pathways, acting on the brain's reward mechanisms. Nicotine addiction is associated with cancer, heart disease, emphysema, hypertension, and death. Withdrawal symptoms include irritability and headaches.
For a substance abuse treatment plan to be successful, key factors to consider include:
Key principles of smoking cessation pharmacotherapy include:
Flunitrazepam (Rohypnol) and Gamma hydroxybutyric acid (GHB) rapidly produce disinhibition, relaxation of voluntary muscles, and anterograde amnesia, making them dangerous "date rape" drugs.
Pathological gamblers show tolerance, dependence, and withdrawal, similar to substance use disorders. The brain's reward system and neural circuits react in similar ways, and pathological gamblers have a 17% rate of attempted suicide, as well as frontal lobe dysfunction, impulsive control dysregulation, and genetic factors.
The CAGE-AID is a screening tool that asks four questions: 1) Have you ever felt you should Cut down on your drinking or drug use? 2) Have people Annoyed you by criticizing your drinking or drug use? 3) Have you ever had a drink or used drugs first thing in the morning (Eye-opener) to steady your nerves or get rid of a hangover? 4) Scoring: 1 point for each 'Yes' answer. A score of 2 or more indicates a potential substance use disorder and suggests the need for further assessment or referral for treatment.
The nursing process for individuals with substance use disorders includes comprehensive assessment (screening, drug use history, family assessment, self-assessment), identifying potential nursing diagnoses (e.g., imbalanced nutrition, disturbed thought processes, risk for suicide), setting appropriate outcomes (e.g., withdrawal management, fluid balance, neurological status), and implementing interventions (e.g., referrals to support groups, addressing underlying causes, providing a safe environment).
The stage where the patient has no obvious symptoms, but changes in the brain have already started is the preclinical stage. This stage can last for years before symptoms appear.
The key characteristics of mild cognitive impairment (MCI) are mild memory problems, a slight struggle with activities of daily living (ADLs) but still able to complete them, and an increased risk of developing Alzheimer's disease, although not everyone with MCI will develop Alzheimer's.
In the severe cognitive decline stage (stage 7) of Alzheimer's disease, the patient experiences severe memory loss, apraxia (difficulty performing learned movements), agnosia (inability to recognize objects, sounds, or people), and aphasia (difficulty with language). The patient requires full- time care and assistance with all activities of daily living.
When caring for a patient with Alzheimer's disease, it is important to assess the following: cognitive function (memory, decision-making, and orientation), safety concerns (wandering, falls, and ability to find direction), mood and behavior changes (agitation, aggression, or depression), caregiver ability and strain, and availability of resources such as adult day care services, home health services, Alzheimer's Association, and senior transportation.
The common nursing diagnoses for patients with Alzheimer's disease include risk for injury, impaired verbal communication, impaired environmental interpretation syndrome, impaired memory, confusion, and caregiver role strain.
The pharmacological interventions for Alzheimer's disease include:
Effective non-pharmacological strategies for managing Alzheimer's disease symptoms include the use of live and animated stimuli (e.g., aquarium, music), bright lights, and physical contact (e.g., foot washing). These strategies can help address issues such as agitation, hallucinations, and disorientation.
C. Depression. Delirium, which is characterized by a sudden onset and fluctuating severity of disordered thinking, is often reversible if the underlying cause (e.g., infection, medications, metabolic imbalance) is
The schema or core beliefs associated with schizotypal personality disorder include: 1) Ideas of reference (belief that casual incidents or events are of particular significance), 2) Odd beliefs or magical thinking, 3) Suspiciousness or paranoid ideation, and 4) Lack of close friends or confidants.
The key characteristics of antisocial personality disorder include: failure to conform to social norms, deceitfulness, impulsivity, irritability and aggressiveness, reckless disregard for safety of self or others, irresponsibility, and lack of remorse. Individuals with this disorder are often charming and able to easily gain the trust of others.
The schema or core beliefs associated with borderline personality disorder include: 1) I am not sure who I am, 2) I will eventually be abandoned, 3) There is no place where I fit in, and my pain is so intense that I can't bear it,
Key nursing guidelines for working with clients with Cluster B personality disorders include: 1) Implement safety precautions, 2) Be alert to manipulation, 3) Set clear and realistic limits on behavior, 4) Do not seek approval or coax, 5) Confront inappropriate behaviors and consequences, 6) Avoid rejecting or rescuing, 7) Use a calm tone of voice and positive, friendly attitude, and 8) Express concern for the patient's wellbeing.
The three main types of Cluster C personality disorders are: 1) Avoidant personality disorder, 2) Dependent personality disorder, and 3) Obsessive- compulsive personality disorder.
The key features of Avoidant Personality Disorder include a pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation. Individuals with this disorder tend to avoid occupational activities, are unwilling to get involved with people, avoid intimate relationships, and are afraid of being criticized or rejected in social situations. They view themselves as socially inept, personally unappealing,
or inferior to others, and are reluctant to take personal risks or engage in new activities.
The core schemas associated with Dependent Personality Disorder include:
The key features of Obsessive-Compulsive Personality Disorder include a pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency. Individuals with this disorder are preoccupied with details, rules, lists, order, organization, or schedules, show perfectionism that interferes with task completion, are excessively devoted to work and productivity, and are overconscientious, scrupulous, and inflexible.
The nurse would anticipate finding grandiosity, a sense of self-importance, and a sense of entitlement in a client diagnosed with Narcissistic Personality Disorder. Individuals with this disorder often display a grandiose sense of self-importance and entitlement, along with a preoccupation with fantasies of success, power, beauty, or ideal love.
The appropriate initial nursing intervention for a patient with Antisocial Personality Disorder who is observed using a cell phone (contraband) in the bathroom is to confront the client about the behavior. Directly addressing the inappropriate behavior and setting clear boundaries is important, as individuals with Antisocial Personality Disorder often lack empathy and disregard social norms and rules.
The priority nursing intervention for a patient with Borderline Personality Disorder who is admitted to the psychiatric unit after self-harm and suicidal statements is to assess the client frequently for self-injurious behaviors. Individuals with Borderline Personality Disorder are at high risk for self-