HNN222 Mental Health Intervention Flashcards
Psychosis Interventions
Psychotherapeutic Counselling
* Cognitive behavioural therapy (CBT)
* Acceptance and commitment therapy (ACT)
* Family therapy
* Group therapy
* Social skills training
* Mindfulness-based therapy
Mental State Exam
A semi-structured interview that enables assessment of a person’s neurological and psychological status across several domains. MSE is only valid for the particular moment it is performed.
MSE Components
PAMSGOTJIMI
* Perception: hallucination, delusions
* Affect: objective - restricted, blunted, flat (facial expressions)
* Mood: subjective, rate mood, libido, appetite, sleep
* Speech: rate, tone, volume, quality
* General Appearance + Behaviour:
○ Grooming, do they appear their age
○ Eye contact, motor behaviour, hostile, amenable
* Orientation: time, place, person
* Thought: form, content, organised, delusional
* Judgement: understand consequence, risk taking
* Insight: understand personal experience and where things originate
* Memory: recent and past
* Intelligence + cognition: serial sevens (count from 100 backwards by 7; months of the year backwards)
Risk Assessment
(Types of Risk)
- Positive risk taking: acknowledges that all decisions carry a degree of risk. Weighs up the risks vs benefits of potential risks.
- Dignity of risk: opportunity to learn through making autonomous decisions within a supportive environment.
- Protective factors
Static Risk - Describes risk that are fixed and historical in nature. These are risk factors that we cannot change as they have happened in the past or are a part of the person either due to various demographic, biological, psychological or social reasons.
Instances of Risk
Risk to self
* Self-harm (non-suicidal self injury)
* Suicide
* Self-neglect
* Reputation
* Medication non-adherence (leads to mental state deterioration)
* Substance misuse
* Physical health co-morbidities
* Legal issues relating to offending behaviour
* Financial/loss of job or education
* Increased impulsivity and risk taking behaviour
Risk to others
* Threatening behaviour
* Physical violence
* Verbal, emotional abuse
* Stalking
* Damage to property
* Not able to provide care (if they have dependents)
Risk by others
* Assault
* Sexual exploitation or abuse
* Emotional exploitation or abuse
* Financial exploitation or abuse
* Verbal abuse
Compulsory Orders
Assessment Order: Person appears to have a mental health illness
* Person appears to need immediate assessment/treatment to prevent harm to individual or others
* Person can’t be treated outside of hospital (no less restrictive means reasonably available to enable the person to be assessed)
* Duration 24 hours
Temporary Treatment Order
* Person has a mental health illness and needs immediate treatment
* Requires hospitalisation
* Duration 28 days
Treatment Order
* Person has a mental health illness and needs immediate treatment
* Duration 6 months (inpatient) or 12 months (community)
Safewords (10 Key Interventions)
- Know each other
- Clear mutual expectations
- Mutual help meeting
- Calm down methods
- Bad new mitigation
- Soft words
- Talk down
- Reassurance
- Discharge messages
- Positive words
Open Questions
○ Experience: what happened?
○ Behaviour: what did you do?
○ Feeling: how did it feel?
○ Here and now: how do you feel now?
Transference, Countertransference, and Self-Disclosure
Transference: the process where a person transfers their feelings from important people (usually from childhood) onto a therapist or mental health nurse.
Countertransference: therapist’s emotional response to the person with whom they are working causes a distorted perception of the person’s behaviour.
Self-Disclosure: the sharing of personal information with therapeutic intent.
Formal diagnosis
Refers to a diagnosis that has been substantiated or confirmed.
Provisional diagnosis
Refers to a ‘running diagnosis’, where the clinician has made an educated guess about the most likely diagnosis but is not 100% whether this is the case.
Therapeutic Communication
- Active listening
- Open ended questions
- Closed ended questions
- Clarification
- Summarising
- Supportive confrontation
- Silence
- Paraphrasing
- Reassurance
- Non-verbal:
○ Face person squarely
○ Open posture
○ Leaning
○ Eye contact
○ Remain relaxed
Depression Interventions
Electro-Compulsive Therapy (ECT)
Involves passing a carefully controlled electric current through the brain, which affects the brain’s activity and aims to relieve severe depressive and psychotic symptoms. Very effective in catatonic depression.
Transcranial Magnetic Stimulation (TMS)
Non-invasive. Uses magnetic fields to stimulate nerve cells in the brain to improve symptoms. Low grade depression.
Criteria for Mechanical Restraint
- Needs to be specialled
- 15 minute observations
- 4 hourly physical exam
- Food, fluid, toileting
- MSE/risk assessment
Anxiety Intervention
- CBT
- ACT: acceptance and commitment therapy
- Self help
- Therapy
- Graded exposure
