Exam 1 (Chapters 1, 2, 3, 5, 7, 8, 9, 34 Flashcards
What is the difference between mental health & mental illness?
Chapter 1
- Mental Health deals with a state of well-being & an individual’s ability to cope with normal life stress, work productively, contribute to the community, rational thinking, etc.
- Mental Illness refers to all psychiatric disorders that have a definable diagnosis. The disorders can be related to developmental, biological, or psychological disturbances and mental functioning
What is resilence?
Chapter 1
ability & capacity for people to secure the resources they need to support their well-being
Explain the Diathesis Stress Model
Represents NATURE (biological predisposition) and NURTURE (environmental stress or trauma)
- most accepted explanation for mental illness
Nature + Nurture
What is stigma?
Chapter 1
belief that the overall person is flawed
Characterized By :
* social shunning
* disgrace
* shame
Explain the Mental Health Parity Act of 1996
Chapter 1
Requires insurers to provide mental health coverage through annual & lifetime benefits in the same way they would provide medical or sugical coverage
Explain the Wellstone-Bomenici Parity Act of 2008
For all group health plans (including government plans), coverage for mental health & substance use disorders can have no greater financial requirements (deductibles, copays, etc.) or treatment limitations must be on par with the coverage received for medical & surgical conditions.
Explain how the Affordable Care Act of 2010 improved mental healthcare coverage
Chapter 1
- Medical history no longer resulted in denials or higher premiums for pre-existing conditions
- Required all individual & small group health plans to cover 10 essential health benefits with no annual or lifetime dollar limits; including mental health & addiction treatment
- Made health insurance with mental health benefits available for those whom were previously uninsured
- Allowed young adults to remain on their parent’s insurance through the age of 26 (most psychiatric disorders emerge in adolesence of early 20s)
What is the DSM-5 & what is it used for?
Chapter 1
Diagnostic & Statistical Manual (5th edition)
Used to diagnose psychiatric disorders
Explain the different levels of psychiatric nursing practice
Chapter 1
Registered Nurses: after 2 years as an RN (2 years full-time, 2000 clinical hours, & 30 hours of nursing psych education), to be RN-BC in mental health
Advanced Practice
* Psychiatric-mental health advanced practice registered nurse (PMH-APRN)
* MSN or DNP, can be a CNS (not PhD)
What is consciousness?
Chapter 2
Part of the mind that contains all the material a person is aware of.
Includes:
* perceptions
* memories
* thoughts
* fantasies
* feelings
What is the preconscious?
Chapter 2
Below level of awareness. Contains material that can be retreived easily through conscious effort
What is unconsciousness?
Chapter 2
Includes all repressed memories, passions, & unacceptable urges lying deep below the surface
- Memories/ emotions associated with trauma are stored here
- Unsconscious influences conscious thoughts & feelings
- An individual is usually needs assistance from a trained therapist to retreive unconscious material
What are the 3 Personality Structure Levels?
Chapter 2
- Id
- Ego
- Superego
Describe the ID personality
Chapter 2
- Totally unconscious & impulsive
- Operates according to pleasure principle (hungry, screaming infant)
- Lacks ability to problem solve & is illogical
Characteristics are unconscious impulsive; the source of all drives instincts, reflexes, & needs
Describe the EGO personality
Chapter 2
- resides in the conscious, preconscious, & unconscious levels of awarenss
- Problem solver & reality tester (tries to navigate the outside)
- Follows the principle “you have to delay gratification for right now”
- Ex: a hungry man feels tension arising from the id that wants to be fed. His ego allows him not only to think about his hunger, but also to plan where he can eat & to seek that destination (reality-testing = factoring in reality to implement a plan to reduce tension)
THINK, PLAN< DO
Describe the SUPEREGO personality
Chapter 2
Develops between ages 3 - 5
- Represents moral component of personality
- Resides in the conscious, preconscious, & unconscious levels of awareness
- Consists of the conscience that may induce guilt
- Seeks perfection (feels guilt when it falls short)
What happens when the ID personality is too powerful?
Chapter 2
The individual lacks control over impulses
What happens when the SUPEREGO personality is too powerful?
Chapter 2
The individual may be self-critical and suffer from feelings of inferiority
Who is the “mother” of psychiatric nursing?
Chapter 2
Hildegard Peplau
Who created the psychoanalytic theory & what does it involve?
Freud
- Conscious: tip of the iceberg (what you’re aware of)
- Preconscious: just below the surface of awareness
- Unconscious: repressed memories, passions, unacceptable urges that are deep below the surface
What happens when the SUPEREGO personality is too powerful?
Chapter 2
The individual may be self-critical and suffer from feelings of inferiority
What happens when the SUPEREGO personality is too powerful?
Chapter 2
The individual may be self-critical and suffer from feelings of inferiority
What are Freud’s Psychosexual Stages of Development?
Chapter 2
- Oral (birth - 1 year): new ego directs the baby’s sucking activities. If oral needs are not met appropriately, the individiual might develop habits such as **thumb sucking, fingernail biting, & chewing a pencil in childhood & overeating & smoking later in life.*
- Anal (1 - 3 years): Toliet training becomes a major issue between parents & child. If parent insists that children be trained before they’re ready or if they make too few demands, conflicts about anal control may appear in the form of extreme orderliness & cleanliness or messiness & disorder.
- Phallic (3 - 6 years): Children feel a sexual desire for the other-sex parent & hostility toward the same-sex parent. To avoid punishment & loss of parental love, they suppress these impulses and, instead, adopt the same-sex parent’s characteristics & values. As a result, the superego is formed, & children feel guilty whenever they violate standards
- Latency (6 - 11): Sexual instincts die down, & the superego develops further. The child acquires new social values from adults & same-sex peers outside the family.
- Genital (Adolescence): With puberty, the sexual impulses of the phallic stage reappear. If development has been successful during earlier stages, it leads to marriage, mature sexuality, & the birth & rearing of children. This stage extends through adulthood.
What are the ages & stages of Freud’s Psychosexual Stages?
Chapter 2
- Oral: Birth - 1 year
- Anal: 1 - 3 years
- Phallic: 3 - 6 years
- Latency: 6 - 11 years
- Genital: Adolescence
What is the difference in transference & countertransference?
Chapter 2
Transference: Patient to Healthcare worker
Countertransference: Healthcare worker to patient
Explain Transference
Chapter 2
Unconscious feelings that the patient has toward the healthcare worker that were originally felt in childhood for a significant other (family member, etc.)
- can be positive (affectionate) or negative (hostile)
Explain Countertransference
Chapter 2
Unconscious feelings that the healthcare worker has toward the patient
- EX: If the patient reminds you of someone you don’t like, you may unconsciously react as if the patient were that individual
- Problematic since it can impact the therapeutic relationship
What is the difference in psychodynamic theory & psychoanalysis?
Chapter 2
- Psychodynamic therapy = therapist has increased involvement & interact with teh patient more freely than in traditional psychoanalysis
- Psychodynamic therapy is oriented toward present, less time spent constructing development origins of conflict
What is psychodynamic therapy and who is it best for?
Chapter 2
talk therapy
- best for the “worried well”, not acutely mentally ill or have more severe disorders
What is psychoanalysis?
Chapter 2
Patient lying on couch & talks (old school)
According to Freud, which aspect of the personality motivates an individual to seek perfection?
a.) Id
b.) Ego
c.) Superego
d.) Not sure
Chapter 2
c.) Superego
What is interpersonal theory & who discovered it?
Chapter 2
Harry Stack Sullivan
A model for understanding psychiatric alteratiosn that focused on interpersonal problems
- believed human beings are driven by the need for interaction
- viewed lonliness as the most painful human condition
- emphasized early relationship with primary parenting figure (“significant other”) as crucial for personality development
- Purpose of all behavior: get needs met through interpersonal interactions, reduce or avoid anxiety
What is interpersonal therapy? What are the main types of problems that respond well to interpersonal therapy?
Chapter 2
- Short-term therapy
- Goal: reduce or eliminate psychiatric symptoms, mainly depression, by improving interpersonal functioning & satisfaction with social relationships
3 Problems that Respond Well:
* Grief & loss
* Interpersonal disputes
* Role transition
Who is Hildegard Peplau and how did she influence psychiatric nursing?
Chapter 2
Mother of psychiatric nursing
- Follower of Sullivan (interpersonal theory)
- Nurses are participants & observers in therapeutic conversation
- Identified that psych-mental health nursing is an essential element of general nursing & as a specialty
- self-awareness of the nurse is essential for keeping focus on the patient (and keeping the social & personal needs of the nurse out of the nurse-patient conversation)
Explain Peplau & the Therapeutic Relationship
Chapter 2
Patient-focused, therapeutic, meet the needs of the patient, work with the patient, decrease anxiety
What are the different types of behavioral therapy?
Chapter 2
Modeling: therapist may model the behavior, the patient learns through imitation. Therapist may do the modeling, proivde another person to model the behavior, or present a video for the purpose.
Operant Conditioning: uses positive reinforcement to increase desired behaviors. When goals are achieved or behaviors are performed patients may be rewarded with tokens, known as a token economy, when they can be exhanged for things
Exposure therapy: used for people who experience anxiety due to fears, phobias, or traumatic memories. Patients are slowly exposed to things that trigger them.
Aversion Therapy: uses negative stimuli when patients engage in harmful behaviors like EtOH use disorder, paraphilic disorders, shoplifting, aggressive behaivor, self-mutilation, etc.
Biofeedback: used to control the body’s physiological resposnes to stress & anxiety. Clinicians use technology to monitor various vital signs.
CBT: involves efforts to change thinking patterns. Strategies might include learning to recognize ones distortions & thinking that are creating problems & then to re-evaluate them in light of reality. Cognitive Distortions = Automatic Thoughts.
DBT: integration of opposites & helps people give up extreme positions. Developed for people with intractable behavioral disorders inolving emotional dysregulation. Success has been seen in patients of suicidal, self-injuring women with borderline personality disorder, etc. (previously thought to be untreatable populations)
What is the modeling behavioral therapy?
Chapter 2
the therapist provides a role model for specific identified behaviors & the patient learns through imitation
What is the Operant Conditioning behavioral therapy?
Chapter 2
basis for behavior modification uses positive reinforcement to increase desired behaviors
What is Exposure Therapy (behavioral therapy)?
Chapter 2
used for individuals who experience anxiety due to fears, phobias, or traumatic memories. Patients are enocuraged to face their fears & emotionally process them in a safe enviornment
What is Aversion Therapy (behavioral therapy)?
Chapter 2
Using negative stimuli to extinguish an undesirable behavior
What is biofeedback (behavioral therapy)?
Chapter 2
helps individuals control their body’s physiological response to stress & anxiety.
Explain Maslow’s Hierarchy of Needs
Chapter 2
1.) Physiolgoical Needs: food, water, oxygen, rest, elimiantion, sex, warmth, homeostasis
2.) Security & Safety: financial security, protection, stability, structure, limits
3.) Love & Belonging / Social Needs friendships, romance / sexual intimacy, meaningful relationships in social / community groups, affiliation, love, family and home
4.) Self-Esteem: confidence, respect by others, feeling accomplished, value / self-worth
5.) Self-Actualization: full potential, create, learn, problem solve, morals, no prejudice (becoming everything one is capable of)
What are different types of biologial therapies / models?
Chapter 2
Pharmacotherapy:
* dramatically improve the lives of those who suffer from severe psychiatric difficulties
* Psychotropic meds modify various neurotransmitters & help restore brain function
Electro-convulsant Therapy (ECT)
* involves electrical stimulation of the brain
* Treats psych & neuro dx like Parkinson’s, epilepsy, & pain conditions
What are Erikson’s 8 Psychosocial Stages? Include the Ages, Crisis, & Focus associated with each stage
Chapter 2
1.) Infancy
* Birth - 18 Months
* Trust vs. Mistrust
* Safety with caregiver
2.) Early Childhood
* 2 - 3 Years
* Autonomy vs. Shame & Doubt
* Independent from parents
3.) Preschool
* 3 - 5 years
* Initiative vs. Guilt
* Powerful within family & exploring
4.) School Age
* 6 - 11 years
* Industry vs. Inferiority
* Good with neighbors, classmates, & friends
5.) Adolescence
* 12 - 18 years
* Identity vs. Role Confusion
* Socializing & fitting in with peers
6.) Early Adulthood
* 19 - 25 years
* Intimacy vs. Isolation
* Love, partners, & friends
7.) Adulthood
* 26 - 64 years
* Generativity vs. Stagnation
* Family & occupation
8.) Old Age / Maturity
* 65+ years
* Integrity vs. Despair
* Reflection on life / facing death
What is the theory of moral development and who made it? Explain each of the 3 stages in a simple matter.
Chapter 2
Moral development coincides with cognitive development
Lawrence Kohlberg
- Preconventional (kids under 5) - doing something for a reward
- Conventional (6 - 12 years) - how do my actions affect others?
- Postconventional (13+ years) - thinking about the world in a more complex way
Explain the stages within the Theory of Moral Development
Chapter 2
PRECONVENTIONAL (children under 5)
1.) Obedience & Punsihment: focus on rules, listen to authority, obedience is the first method to avoid punishment
2.) Individualism & Exchange: learn that not everyone thinks the way you do. If someone decides to break the rules, they are risking punishment
CONVENTIONAL
3.) Good Interpersonal Relationships: Children begin to view right or wrong as related to motivations, personality, or the goodness or badness of the person. In general, people should get along & have similar views
4.) Maintaining the Social Order: “Rules are rules” mindset. Listening to authority maintains social order.
POST-CONVENTIONAL
5.) Social Contract & Individual Rights: Social order is important, but social order must be good (not corrupt). People’s rights should be protected.
6.) Universal Ethical Principles: Actions should create justice for everyone involved. We are obligated to break unjust laws
Explain Cognitive Development Theory (Piaget)
Chapter 2
Sensorimotor Stage (birth - 2 years): they think in the present moment through senses
Preoperational (3 - 6 years): imaginative, symbolic thought,“Magical Thinking”
* do NOT understand cause & effect
Concrete Operational (7 - 11 years): Logical thought; follow the rules, rigid thinking, there is only 1 way to do something
Formal Operational (12 - 15 years): Developing through abstract thought (Cause & Effect)
What is the Theory of Object Relations & who created it?
Chapter 2
Past relationships influence a person’s sense of self & their relationships
Created by Margaret Mahler
- Believed psychological problems were the result of disruption of separation
- Describes attachment