372: Mental Health Flashcards
(79 cards)
1
Q
Principles of Milieu Therapy
A
- Fundamental respect for individuals
- Communication opportunities
- Autonomy reinforced
- Socialization facilitated
- Part of unit management
- Responsibility and accountability
- Peer pressure to reinforce rules
- Team approach
- Group discussions and temporary seclusion’s
- Nurses promote these goals
2
Q
Mental health exam (ABC STAMP LICKER)
A
Appearance Behaviour Cooperation Speech Thought process & content Affect Mood Perception LOC Insight Cognition Knowledge Endings Reliability
3
Q
Tardive Dyskinesia
A
Involuntary movements of face and arms/legs related to Antipsychotic medications
4
Q
Akathisia
A
Subjective feelings of muscular tension secondary to antipsychotic or other meds, causing restlessness, pacing, repeated sitting and standing
5
Q
Lutheran’s Recovery Model (HSSE RCR)
A
- Hope
- Security
- Support and managing symptoms
- Empowerment
- Relationships
- Coping
- Recovery education
6
Q
Personal medicine
A
RECOVERY + RESILIENCE
7
Q
What are the principles of informed consent?
A
- Nature of treatment
- Expected benefits
- Material risks and side effects
- Alternative courses of action
- Consequences of not having treatment
- Respond to requests for additional info
8
Q
What is the test for capacity to consent?
A
- UNDERSTAND information RELEVANT to decision
2. APRECIATE reasonable foreseeable CONSEQUENCES for decision or lack there of
9
Q
What is the SDM Hierarchy? (CARS PB RP)
A
- Court-appointed guardián
- Attorney for personal care
- Representative by CCB
- Spouse, common law partner
- Parents + children
- Brothers + sisters
- Relatives by blood, marriage, adoption
- Public Guardian or trustee
10
Q
What are the rules of emergency treatment without consent for an incapable person?
A
- There is an emergency
- Delay obtaining decision will prolong pts suffering and put at risk of serious bodily harm
- Treatment may continue until SDM is found
- If pt regains capacity, they decide
11
Q
Rules for emergency treatment without consent for apparently capable person
A
- There is an emergency
- Required communication cannot happen due to language barrier or disability
- Reasonable steps have been taken to enable communication without success
- Delay by enabling communication will prolong suffering or risk serious bodily harm
- No reason to believe the person does not want treatment
12
Q
Form 1
A
- MD must examine
- Conclusions may be based on combination of personal data and observations
- May sign within 7 days of exam
- Valid for 7 days
13
Q
Form 2
A
- Justice of peace may sign Form 2
- Directs police to apprehend and take the person for Form 1 exam
- Anyone may request
4? Valid for 7 days
14
Q
Form 3
A
- Valid for 14 days (including date of signature)
- Must be preceded by examination
- Signed regarding: voluntary or informal pts, detained on Form 1 and still within 72 hours
15
Q
Form 4
A
- Only if pt is already on Form 3 or 4 extension
2. First form = 1 month, second = 2 months, third = 3 months, etc
16
Q
Transference
A
Client’s unconscious projection of attitudes and feelings from past relationships onto therapist/nurse
17
Q
Countertransference
A
Therapist/nurse unconsciously and inappropriately displaces feelings related to significant figures onto patient
18
Q
Core interviewing skills for motivational interviewing
A
- Open questioning
- Affirm
- Reflect
- Summarize
- Informing and advising
19
Q
What are the 3 components of crisis?
A
- Precipitating/stressful event
- Perception of event
- Usual coping methods/supports
20
Q
What are the 3 components that resolution from a crisis depends on?
A
- Realistic perception of event
- Adequate supports
- Adequate coping mechanisms
21
Q
What is the ABC Model of Cognitive-Behavioural Therapy (CBT)?
A
- Activating event
- Beliefs that leads to emotions and behaviours
- Consequences
22
Q
Cognitive conceptualization
A
Links between thoughts, feelings, and behaviours
23
Q
Dialectical Behaviour Therapy (DBT)
A
CBT + Mindfulness
- For people with BPD and suicidality
- Emphasis on awareness of thoughts and actively shaping them
24
Q
Intersectionality
A
Theory which seeks to examine socially and culturally constructed categories interact to manifest as inequalities in society
25
Ideological hegemony
Situation where a particular ideology is pervasively reflected throughout society, culture/organization. Located in all social institutions and permeates cultural ideas and social relationships.
26
Social constructionism
Our realities are shaped through our experiences and interactions with others
27
Goffman’s Oseas in social identity
Self-constructed notion of identity works from perspective of individual to society.
Identity is a product of interaction between self and others in social environment
Damage to social identity = stigma
28
What are Goffman’s key points on social identity?
1. A process
2. Negotiated
3. Situational and contextual
4. Involves membership in group
5. Embeddedness of categories
29
What are the 5 faces of oppression?
1. Exploration
2. Marginalization
3. Powerlessness
4. Cultural imperialism
5. Violence
30
Cultural relativism
Principle of regarding the beliefs, values, and practices of a culture from the viewpoint of that culture itself, rather than be judged against another
31
Syndemic
Two or more afflictions interacting synergistically to contribute to excess burden of disease in a population
32
Syndemic Theory
Individual endémics sustained in populations because of harmful social conditions and injurious social connections
33
Engulfment
Degree to which individuals define themselves by their illness
34
What is associated with high engulfment levels?
1. Hopelessness
2. Depression
3. Low self-esteem
4. Lack of self-efficacy
5. Decreased social adjustment
35
Cultural determinism
Who we are is determined by our culture
Perpetuates stigmatization and marginalization
36
Structural determinism
Societal factors structure processes and outcomes
Limit access to resources which could potentially improve SES
37
Relative poverty
Social conditions that serve to create realities of poverty in a given time and place
Can’t have what the larger community regards as minimum necessary for decency
38
What are the barriers to accessing health care for homeless people? (SIMA)
1. Structural - transit, resources, etc
2. Individual - memory, fear, etc
3. Material - lack of ID, insurance, etc
4. Attitudinal - prejudice, stigma, discrimination
39
What are the 6 principles for WHO Mental Health Action Plan 2013-2020
1. Universal health coverage
2. Human rights
3. Evidence-based practice
4. Life-course approach
5. Multi sectional approach
6. Empowerment of persons with mental disorders and psychosocial disabilities
40
Risk factors for schizophrenia
1. Traumatic delivery
2. Maternal malnutrition
3. Exposure to toxins
4. Hypoxia
5. In uteri exposure to influenza virus
6. Late winter or early spring births
41
Residual schizophrenia
Negative symptoms continue
2+ positive symptoms
No prominent delusions, hallucinations, disorganized speech, or catatonic behaviours
42
Delusions of reference
Behaviour of others refers to oneself
43
Delusions of control
False belief that ones will, thoughts, or feelings are being controlled by external factors
1. Thought insertion
2. Thought withdrawal
3. Thought broadcasting
44
Negative symptoms of schizophrenia
Hypostimulation of D1 receptors
45
Alogia
Poverty of thought and speech
46
Avolition
Unable to start task, lack of motivation
47
Anhedonia
Inability to experience enjoyment
48
Extrapyramidal side effects
1. Tardive Dyskinesia
2. Pseudo-parkinsonian symptoms
3. Extreme muscle spasms
4. Restlessness/akathisia
5. Weakness
6. Muscle fatigue
7. Slowed movements
***ariprazole***
49
Pseudo-Parkinsonian symptoms
Rigidity, mask-like facial expression, stiff gait
50
Neuroleptic malignancy Syndrome
Serious rxn to neuroleptic drugs and dopamine blockage
1. ⬆️ temperature
2. Labile BP
3. Elevated CPK (creatinine phosphokinase from muscle damage d/t rigidity)
4. Altered LOC
5. Rigidity
6. Diaphoresis
7. Tachycardia
51
What is the treatment for neuroleptic malignancy Syndrome?
1. Discontinue meds
2. Keep cool
3. Hydrate well
52
Second generation antipsychotics
(+ and - symptoms)
1. Clozapine
2. Risperidone
3. Olanzapine
4. Quetiapine
5. Ziprasidone
6. Ariprazole (Abilify)
53
Types of delusions
1. Persecutory
2. Grandiose
3. Somatic
4. Religious
5. Guilt
6. Jealous
7. Erotomanic
54
First generation antipsychotics (+ve symptoms only)
1. Chlorpromazine
2. Thioridazine
3. Trifuouperazine
4. Thiothixene
5. Perphenazine
6. Piportil
7. Loxapine
8. Haloperidol
9. Fluphenazine
55
Cyclothymic
Alternating depressing and hypomania, not severe enough to be bipolar
56
Dysthymic
Low degree of depression, but hx of depressive character low mood lasting period of 2 or more years with moderate depression symptoms
57
Atypical affective Disorder
Symptoms not Sever enough to fit other categories of major affective disorders
58
Biological theory of causes of depression
Alterations in dopamine, NE, 5HT in areas that regulate appetite, sleep, and emotional processes
Higher risk for disrupted circadian rhythms
59
Behavioural-Social Learning Theory of depression
Reciprocal interaction between cognitive, behavioural, and environmental influences.
Stress disrupts involvement with others. Amount/quality of positive reinforcement reduced increase in negative self-evaluation and evaluation of the future.
60
Interpersonal Theory of depression
Interpersonal difficulties seems as antecedents and consequences of depression
Children: neglect, abuse, rejection, loss of parent, disharmony of family
Adults: separation, divorce, marital problems, losses, absence of supportive social relationships
61
Cognitive Theory of depression (Aaron Beck)
World view based on false belief about self, future, and the world
Negative view considered distortion of reality
62
Learned Helplessness Theory (Seligman) of depression
Pt feels have no influence over their environment.
| Feelings of helplessness, powerlessness, hopelessness, passivity, susceptibility to depression
63
Diathesis-Stress Model of depression
Stressful events trigger neurophysical and neurochemical changes in the brain
Some people are predisposed to depression
64
Risk factors for depression
1. Women > men
2. 20-50 years old
3. Family hx of depression, bipolar, or alcoholism
4. Recent life stressors
5. Personality: shy, insecure, worrisome, internalized feelings, not assertive, difficulty managing stress
65
Electroconvulsive Therapy (ECT)
1. Used to treat mania, paranoid and catatonic schizophrenia
2. Effective in pregnant women and safe in all trimesters
3. Given 2-3 times a week for 6-12 treatments
4. Vitals monitored q15min until stable
5. Loss of memory - return in 2 weeks
6. Temporary headaches
66
What are the signs and symptoms of PTSD? (DREAMS)
1. Detachment
2. Re-experiencing the event
3. Emotional effects (distress, numbing)
4. Avoidance
5. Medication (self-medication)
6. Sympathetic hyperactivity (hyper aroused)
67
Interventions for PTSD
1. CBT
2. Desensitization
3. Trauma-informed Care
4. Self-soothing techniques
5. Psychotherapy
6. Relaxation techniques
7. Medications: anxiolytics, antidepressants
68
What are signs and symptoms of Borderline Personality Disorder (BPD)?
1. Impulsive behaviours
2. Destructive behaviours
3. Mood: negative affect, intense anger, etc
4. Unstable interpersonal relationships
5. Self-image instability
6. Intense fear of abandonment
7. Antagonistic
9. “Splitting” (all or nothing, good/bad)
69
Antisocial Personality Disorder
1. Conduct Disorder in early childhood
2. Antagonistic, disinhibited behaviours
3. Lack of appropriate emotional response
4. Lack of remorse
5. Finds pleasure and enjoyment in others’ vulnerabilities
70
Dissociative Identity Disorder
1. 2+ alters with unique identity, feelings, memories
2. R/t extreme trauma, esp childhood sexual abuse
3. Rare and difficult to diagnose
71
Principles of Trauma-Informed Care
1. Physical and psychological safety
2. Trustworthiness and honesty among providers and clients
3. Collaboration and power balance
4. Empowerment for clients to make treatment decisions
5. Voice and choice for clients to express differences
6. Resilience and ability to grow & recover
7. Inclusiveness
8. Cultural and gender awareness
72
Disease model of addiction
Considers addiction a disease, but doesn’t consider social/environmental factors
73
Epigenetics Theory of addiction
Genes that can be “switched on” in response to stress
74
Neurobiology Theory of addiction
Mesolimbic areas of the brain (feelings, cognition, behaviours)
75
System Structures of addiction
Moving beyond disease and talking about the environment (SODH)
76
Reinforcing role of dopamine in addiction
1. Dopamine overstimulation by substance
2. Pathways and DA receptions down-regulate after repeated exposure
3. Increased stimuli needed to signal pleasure via DA receptors
4. Results in dependence on substance
77
What are the 4 categories of benzodiazepine discontinuation?
1. Symptom recurrence or relapse
2. Rebound
3. Pseudo withdrawal
4. Withdrawal
78
Motivational interviewing skills (OARSI)
```
O = ask OPEN questions
A = use AFFIRMATIONS
R = REFLECT what your pt is saying
S = SUMMARIZE
I = INFORM and advise
```
79
Stages of change model
1. Pre contemplation
2. Contemplation
3. Preparation
4. Action
5. Maintenance
