Week 6 Flashcards
(61 cards)
1
Q
What percentage of people with mental health conditions in Canada are supported in community-based programs?
A
~70%
According to CIHI, 2023.
2
Q
What was the primary focus of mental health care in the 1950s?
A
Improvements in pharmacological management of symptoms
Largely institutional nursing.
3
Q
What major transition occurred in mental health care during the 1960s and 1970s?
A
Transition from institutions into community hospitals.
4
Q
What characterized the mental health care movement from the 1970s to the 1980s?
A
Shorter inpatient stays in hospital and movement towards deinstitutionalization.
Lack of resources and planning: “falling through the cracks”
5
Q
What challenges arose from the deinstitutionalization movement?
A
Lack of resources & planning; ‘falling through the cracks’.
6
Q
What has been a focus of mental health advocacy from 1990 to the present?
A
Advocacy, recovery, national mental health strategies.
7
Q
What are some nursing priorities for care in acute care settings?
A
- Milieu management
- Safety
- Suicide risk
- Behavioural management
- Admission/physical health assessment
- Structured activities
- Documentation
- Medication & symptom management.
8
Q
What are the roles/functions of a community mental health nurse?
A
- Biopsychosocial assessment
- Case management
- Promoting continuation/maintenance of treatment
- Interprofessional team member.
9
Q
What basic supports are needed for discharge planning?
A
- Accommodations
- Finances
- Follow-up therapy
- Employment or daytime activity
- Social life
- Medication.
10
Q
What is a personality disorder?
A
Enduring pattern of inner experience and behaviour that deviates from cultural expectations, pervasive, inflexible, stable over time, leading to distress or impairment.
11
Q
What are common features of personality disorders?
A
- Rigid, maladaptive personality traits
- Affects cognition, behaviour, interpersonal interactions
- Inadequate coping and disturbed self-image.
- irritable, hostile, demanding, fearful, maladaptive
*inadequate coping, disturbed self image, poor impulse control
*maladaptive perceptions of self and enviroment - inappropriate rsange of emotions
*reduced occupational functioning
12
Q
What are the general characteristics of Cluster A personality disorders?
A
- Pervasive distrust
- Social detachment
- Perception distortions
- Cognitive impairment.
- subsequent impairment in social and occupational functioning
** often avoid trying to get help
13
Q
What nursing interventions are suggested for Cluster A personality disorders?
A
- Respect client need for social isolation
- Be aware of paranoid and suspicious behaviours
- Assess for suicide.
- Engage with brief interactions.
14
Q
What is a key statistic regarding borderline personality disorder in Canada?
A
1 in 11 people meet criteria for borderline personality disorder.
15
Q
What are the general characteristics of Cluster B personality disorders?
A
- Instability or unpredictability
- Conflict with society due to impulsive behaviours
- Interpersonal relationship problems.
- limited insight into illness
- may be considered manipulative
- thought to function somewhere between neurosis and psychosis
16
Q
What treatments are recommended for Cluster B personality disorders?
A
- Guard against manipulation
- Provide clear boundaries
- Assess suicidal ideation.
- provide clear, consistent boundaries
- realistic and clear goals
17
Q
What are the general characteristics of Cluster C personality disorders?
A
- Fearful, restricted affect
- Difficulty expressing feelings
- Need for order; rigid behavioural patterns.
*unrealistic expectations of others - inability to be assertive and make decisions
18
Q
What nursing interventions are suggested for Cluster C personality disorders?
A
- Supportive, accepting approach
- Encourage independence and autonomy
*do not engage in power struggles - Recognize and manage defense mechanisms.
—> intellectualization, rationalization, reaction forming, isolation
19
Q
Continuum of psychiatric health treatment
A
Most acute treatment —> intensive outpatient treatment —> transitional outpatient treatment —> ongoing outpatient treatment
20
Q
Most Acute treatment
A
- short term
- locked inpatient unit
- 24 hour crisis bed
21
Q
Intensive outpatient treatment
A
- usually short term
- partial hospitalization program (PHP)
- psychiatric home care
- assertive community treatment (ACT)
- intensive substance use program
22
Q
Transitional outpatient treatment
A
- usually long term
- psychosocial rehabilitation program (PRP)
- clinical case management
23
Q
Ongoing outpatient treatment
A
- long term
- community mental health center (CMHC)
- private therapists office
24
Q
What are nursing priorities for care in community settings
A
- problem solving and clinical skills
- cultural competence
- knowledge of community resources
- autonomy/ accountability
roles/functions of community MH nurse - bio psychosocial assessment
- case management
- promoting continuation/ maintenance of treatment
- inter professional team member
25
What is primary prevention
- prevent injury or illness before it begins
- control of causal factors
26
What is secondary prevention
- reduce impact of injury or illness
- control of symptoms
27
What is tertiary prevention
- management of long term injury or illness
- retrain, rehabilitate, re-education
28
Cluster A- Paranoid
- chronic distrust, suspicion of others
- sensitive to perceived criticism or betrayal
- misinterprets neutral actions as threatening
- anxious, tense, and slow to relax
- difficulty adapting to change
- easily irritated; may respond with anger
- holds grudges, struggles to forgive
- emotionally guarded; may appear distant
- challenges with collaborative problem solving
- express jealousy without clear justification
29
Cluster A- Schizoid
- prefers solitude, limited interest in relationships
- emotionally distant or flat affect
- limited expression of emotion or warmth
- appears self contained or inward focus
- difficulty forming trust or social connections
- may have Brief stress related psychotic symptoms
- passive coping in times of stress or crisis
30
Cluster A- Schizotypal
- interprets events as having personal meaning
- strong beliefs in supersititon or paranormal ideas
- may believe in unusual powers or influence
- constricted, odd or inappropriate emotional expression
- social anxiety and discomfort in relationships
31
Therapies for Cluster B treatment
Pharmacological
- antipsychotics for anger/psychosis
- anxiolytics for anxiety / hyperactivity
- antidepressants for depression/anxiety
- mood stabilizers for impulsivity
Non-pharmacological
- best 1:1 therapies, not groups
- cognitive behavioural therapy
- dialectical behavioural therapy
32
treatment for Cluster A
Pharmacological
- antipsychotics for paranoia/distrust
- antidepressants for mood lability and suicidal ideation
Non-pharmaceutical
- group therapies for social interaction
- cognitive behavioural therapy
- 1:1 therapy for psychosocial support
33
Cluster B- Borderline
- unstable, intense relationships
- sees others as all goof or all bad
- impulsivity (ex. Reckless driving)
- difficulty with self-identity
- intense emotional reactivity (anger, emptiness)
- chronic feelings of emptiness or boredom
- self injury or suicidal ideation/behaviours
- fear of being alone or abandoned
34
Cluster B- Histrionic
- emotionally labile; easily influenced
- attention-seeking and overly focused on appearance
- dramatic or theatrical behaviour
- impressionistic, vague speech
- may use seductive behaviour to gain attention
- craves approval and immediate gratification
- may report physical symptoms for attention
- suicidal gestures or threats when feeling rejected
35
Cluster B- Narcissistic
- inflated self importance; grandiose self image
- preoccupied with fantasies of success, power or beauty
- seeks excessive admiration
- lacks empathy; difficulty recognizing others needs
- sensitive to criticism, may react with rage or shame
- exploitative in relationships
36
Cluster B- Antisocial
- persistent disregard for others rights
- deceitful, manipulative or agressive behaviour
- lack of remorse or empathy
- impulsive and irresponsible
- repeated rule breaking or unlawful behaviour
- initially charming, later cold or blaming
- prone to irritability or substance misuse
37
Cluster C- Avoidant
- fear of criticism, rejection or disapproval
- socially inhibited; avoids interpersonal contact unless certain of being liked
- withholds thoughts or emotions due to fear or disapproval
- chronic low self esteem and feelings of inadequacy
- hypersensitive to negative evaluation
38
Cluster C- Dependent
- submissive and clingy behaviour
- difficulty making everyday decisions without reassurance
- avoids conflict; struggles to express disagreement
- urgently seeks new relationships when one ends
- fears abandonment; lacks self confidence
- difficulty initiating or completing tasks independently
39
Cluster C- Obsessive compulsive
- preoccupied with order, perfection and control
- rigid adherence to rules and procedures
- excessive devotion to work at expense of leisure or relationships
- overly critical of self and others; perfectionism interferes with task completion
- reluctant to delegate unless others follow exact instructions
- miserly spending style; difficulty discarding objected
- emotionally restrained; may seem cold or formal
40
Cluster C- treatment
Pharmacological
- anxiolytics for anxiety/fear
- antidepressants for obsessions/depression
- beta-adrenergic antagonist to decrease physiological responses to stress
Non-pharmacological
- 1:1 therapy based on trust
- group therapy for social skills and assertiveness
- insight based therapies
- cognitive behaviour therapy (CBT)
41
What is stress?
An uncomfortable emotional experience accompanied by biochemical, physiological, and behavioral changes during difficult circumstances.
## Footnote
Sources: Flores-Kanter et al. (2021); Nasso et al. (2020)
42
Who proposed the Fight or Flight Response theory?
Walter Cannon
43
What are the stages of Hans Selye's General Adaptation Syndrome (GAS)?
* Alarm (acute stress stage)
* Resistance (adaptation stage)
* Exhaustion stage
44
Define distress in the context of psychological reactions to stress.
Destructive to health
45
What is eustress?
Beneficial stress that motivates energy
46
What neurotransmitter's synthesis may be impaired by stress?
Serotonin
Increase in serotonin recpetor sites and brains ability to utilize serotonin
- increase in serotonin synthesis
47
What is the immune stress response?
Interaction between nervous and immune systems during alarm phase of GAS
Negatively affecting the body’s ability to produce protective factors
48
What are the five major domains of Traditional/Complementary/Alternative Medicines (TCAM)?
* Whole medical systems
* Mind-body-spirit approaches
* Biologically-based approaches
* Manipulative approaches
* Energy therapies
49
What does Ayurvedic medicine emphasize?
Personal responsibility for health and holistic prevention with natural treatments.
50
What is the basis of homeopathy?
The Law of Similars – 'Like cures like'
51
List some biologically-based approaches to health.
* Herbal therapies
* Diet and nutrition
* Aromatherapy
52
What is St. John's wort used for?
Depression
53
What are mind-body-spirit approaches?
* Meditation
* Mindfulness
* Prayer
* Yoga
* Guided imagery
* Hypnotherapy
* Biofeedback
* Exercise
* Aromatherapy
* Humor
54
What is the Canadian T.R.U.S.T. Model?
A model for inclusive spiritual care
55
What are manipulative approaches in integrative nursing?
* Massage therapy
* Chiropractic medicine
* Reflexology
56
What does therapeutic touch aim to do?
Promote well-being and balance by directing life energy towards clients.
57
What is Reiki?
A process of laying-on of hands to channel limitless life force energy.
58
Name a Western treatment modality.
* Pharmacotherapy
* Behavioral therapy
* Cognitive therapy
* Individual psychotherapy
* Group therapy
* Family therapy
* Relaxation therapy
* Eye Movement Desensitization and Reprocessing (EMDR)
* Electroconvulsive therapy (ECT)
59
What are therapeutic groups intended to instill?
* Hope
* Universality
* Information
* Altruism
* Catharsis
* Social skills
* Imitative behavior
* Interpersonal learning
* Group cohesion
60
True or False: ECT is a form of pharmacotherapy.
False
61
Fill in the blank: The _______ model is used for inclusive spiritual care.
Canadian T.R.U.S.T.
