Mental Health Notes - Quiz and exam preparation materials. Quiz and exam preparation materials. Quiz PDF

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Quiz and exam preparation materials. Quiz and exam preparation materials. Quiz and exam preparation materials. Quiz and exam preparation materials....

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Mental Health Notes Module 1 & 2  MHCC stands for Mental Health Coordinating Council.  The Australian College of Mental Health Nursing (ACMH) is… Is a national professional body for mental health nursing.  Consumer centred approach to health care that is underpinned by the principles of hope, optimism, health and wellness  The National Standards for Mental Health Services states that recovery orientated practice is guided by 6 principles: 1. the uniqueness of the individual 2. real choices 3. attitudes and rights 4. dignity and respect 5. partnership and communications 6. evaluating recovery  45% of Australians aged between 16-85 will experience mental illness at some point in their lives  1 in 5 Australians will experience mental illness in any given year  Aboriginal and Torres strait Islander males between the ages of 15-19 yrs are 4.4 times likely to die by suicide than non-indigenous males  Aboriginal & Torres Strait Islander females are 5.9 times likely to die by suicide than non-indigenous young females  Aboriginal people may interpret the direct questioning about themselves as: Hostile because Aboriginal people ask questions that are community focussed not focussed on an individual  The rate of death from suicide among Aboriginal and Torres Strait Islander peoples is: 2.5 times the rate of non-indigenous people  The social determinants of mental health include: Housing and Food; Activity, Employment and Income; Education; Social Connectedness, Justice and Equity  Stigma, or discrimination against someone with a diagnosis of mental illness, can affect which parts of this person’s life? Employment, access to health services, education, insurance and personal relationships

 The prevalence of suicide is high in young people but they have relatively low use of mental health services  Somatisation can be defined as the development of physical symptoms in response to psychosocial distress  What is the most significant contributing factor to a person’s risk of suicide? Previous suicide attempts  According to Fukuo et al (2017), research conducted on erasing stigma of mental illness distinguishes 2 kinds of strategies. These are Education and contact  How many people in Australia will attempt to die by suicide every day? 30  The Recovery model recognises that: The person who is diagnosed with a mental illness is the expert in their experience of illness  Recovery is: A strength-based model of care  The Diagnostic and Statistical Manual V defines mental illness as: A syndrome characterized by clinically significant disturbance in an individual’s cognition, emotion regulation, or behaviour that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning  To provide culturally sensitive and quality care, nurses and midwives must: Acknowledge a person’s lived experience of their illness and their treatment  Cultural safety is defined as: An outcome of nursing and midwifery education that enables safe service to be defined by those that receive the service  Which part of the brain is responsible for emotions and memories: The Limbic System  The World Health organisation defines Mental Health as: A state of well-being in which every individual realises his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community  In the Recovery Model of Care the consumer is: Placed at the centre of care  Factors that promote a sense of well-being include: Being healthy, feeling safe and having a sense of achievement and purpose  The stigmatisation of people challenged by mental illness may cause the person to: To avoid getting help for their illness  Women are most vulnerable to experiencing mental illness when: They give birth to a baby

 Trauma Informed Care assists nurses and midwives to: Understand how to avoid retraumatising a person  What percentage of women will experience a mental illness after the birth of a child? 13- 20%

Module 3  Symptoms of anxiety: mind racing, sleep disturbances, feeling breathlessness, nausea, dizziness, light-headedness, tachycardia, difficulty swallowing, trembling  People with anxiety disorders usually delay treatment, often around 9-20 years.  Medication should not be the first line of treatment unless consent is given and that they understand the side effects of the medication  Nurses should build a therapeutic relationship, by taking a holistic approach.  Anxiety can be misdiagnosed with depression  PTSD most common anxiety disorder  GAD is a chronic disorder and is diagnosed after 6 months of symptoms  Anxiety is a normal reaction to danger or stressful situations that: Initiates the Flight/Fight or Freeze response to combat the danger  A phobia is: A persistent, intense and irrational fear reaction when a person is faced with a specific situation  Agoraphobia is: fear of open spaces or public spaces  Anxiety can distort emotions, leaving a person feeling: Overwhelmed, fearful and hopeless  An obsession is defined as: Intrusive, recurrent and persistent thoughts causing anxiety or distress  Some organic disorders can produce symptoms very similar to anxiety. These include: Asthma  A Recovery approach to Anxiety requires: A collaborative therapeutic relationship  Generalised Anxiety Disorder is characterised by excessive and difficult to control worry about events and activities  When nurses and midwives take a trauma informed care approach to anxiety, they: Consider any traumatic event that might contribute to the development of an anxiety disorder

 A person with Social Anxiety Disorder may believe that: They will be embarrassed, humiliated and judged negatively by others in social situations  A person’s response to stress can be affected by Genetic Vulnerability, Exposure to Stressful Events and patterned responses to stress  A person may develop Post Traumatic Stress Disorder by Witnessing trauma firsthand or by vicarious traumatisation  When a person experiences Post Traumatic Stress Disorder, it is hypothesised that their memories Are Incomplete, inappropriately stored and contain generalised, catastrophic threat cues  Treatment for Anxiety relies on Nurses and midwives assisting the person to regulate their own emotional responses  How can a nurse or midwife assist a person to engage with mental health services? Conveying a sense of unconditional positive regard  Medication should be used in Anxiety Disorder: When a person gives consent and understands the limitations and understands the side effects of medication  Nurses and midwives can provide psychoeducation to a person experiencing an anxiety disorder by Conducting a thorough assessment of the person’s experience and using the person’s own story to develop strategies to overcome their anxiety  Post Traumatic Stress Disorder has high co-morbidity rates with: Substance Abuse Disorder  A person’s usual adaptative response to stress can become debilitating (weakened) when a person Develops a potentially vicious cycle of anxious physiological reactions, anxious thinking, anxious feeling and anxious doing.  A person experiencing a panic attack might believe they are experiencing a heart attack

Module 4

 A person experiencing depression will have a collection of emotional, cognitive, physical and behavioural response. Feels sad, worthlessness, low attention, suicidal thoughts, increase/decrease appetite and sleep. Usually lasts for a long time. May/may not have a reason. ADL’s are greatly affected

 Low Mood – mainly emotional response, feels flat and sad, usually short term, related to recent stressful event, can still be reactive to people.  Dysthymia – chronic depressed mood  Depression physiological symptoms: poor/increase appetite, weight loss, psychomotor retardation, poor/excessive sleep, fatigue, headache, migraine.  Nursing intervention: develop positive client relationship, provide a sense of hope and recovery, beware of mental stigmas, Keep It Short and Simple, closed questions to engage initially.  Screening tools for depression: the Edinburgh Perinatal Depression Scale, Severity Measure for Depression (Youth 11-17), Kessler Psychological Distress Scale (adult), Geriatric Depression Scale.  The causes of postnatal depression could be Hereditary, a previous history of depression, difficult relationships and social isolation  Periods of sadness and grief are: A normal part of life  What are the 'Baby Blues'? A transient (temporary) disturbance in mood after the birth of a baby  Pro-Infammatory cytokines may: Underpin the body's inflammatory reaction to stress  Nurses and Midwives should treat anger when a person is depressed as: Part of the person's illness and not take it personally  Which system controls the release of cortisol and thyroid hormones: HypothalmicPituitary-Adrenal Axis  According to Bowlby, a person may go through the following stages when experiencing grief Shock and Protest; Preoccupation; Disorganisation; Resolution  Depression may not be identified because a person complains of: Physical Symptoms  Women are more likely to develop depression because: They may be more sensitive to social environments and have a greater inflammatory response to stress  Hypersomnia is: Sleeping for large amounts of the day  What percentage of women may experience postnatal depression? 10% to 15%  Psychomotor retardation is when a person: Moves, thinks and performs tasks more slowly  A person with depression should be treated with: Conditional positive regard  Symptoms of depression in older adults can mimic: Dementia

 An episode of grief may become major depression if A person is locked in the disorganisation and despair stage of Bowlby's Stages of Grief  Persistent depressive disorder can be diagnosed if a person reports mild depressive symptoms lasting for how long? 2 years  According to the Australian Bureau of Statistics in 2007/2008, how many Australians reported having a mood disorder? 2.1 million people  In June 2012, it was reported that the following percentage of older adults living in care had symptoms of depression? 52%  Nurses and midwives should help people with depression: To make positive decisions such as having a shower or making their bed

Module 5  Self-harm: non-lethal, no suicide intent, sometime impulsive, method of alleviating emotion distress.  Suicidal behaviour: lethal, has suicidal intent, mostly planned but can be impulsive, method to end suffering and extreme emotional pain.  Groups with increased risk to suicide: socioeconomically deprived, rural/remote areas, ATSI, justice system, lived experience of mental health, alcohol/drug users, dealing with trauma in workplace, bereaved by suicide, LGBT, men.  Violence: the intentional use of physical force or power, threatened or actual against oneself, another person or another group that either results in or has a high likelihood of resulting in an injury.  In 2013, there was 238 homicides in Australia.  People with severe mental illness are more likely to be victims of violence.  Risk factors of violence: Male, substance abuse, previous violence, young aged 1830 years.  In 2013, how many Australia males died by suicide in every 100, 000? 16.4  Deliberate self-harm is: A means of managing distressing emotions  If a person is considering suicide, nurses and midwives can make a profound difference by Developing a therapeutic relationship  Risks factors for violence include: Substance misuse and a previous history of violence  Social relationships are: Not bound by a time frame

 Clinical supervision is a time when: A nurse or midwife meets with a senior clinician and reflects on their practice in a process of continuous improvement  Engaging a person therapeutically after they self harm requires: That the nurse or midwife looks beyond the wound and develops a therapeutic relationship to understand why the person self-harms  Factors that contribute to the higher rate of indigenous people dying by suicide include Lower education rates, lower employment rates, poor access to health services  Person Centered Care is an important part of mitigating challenging behaviour: The person will understand what is expected of them in the clinical setting  Thoughts of suicide are often: Transitory and situation specific  A person who experiences depression is more likely to die by suicide: At the beginning or the end of their depressive period  Strategies to manage a person who self harms include: Teaching the person anxiety management techniques  The media often portrays people with mental illness as: violent  Risk management is: Translating identified risks to the person into a clinical and psychosocial interventions that mitigate the risk  What are important factors in mitigating challenging behaviours in the clinical setting? The knowledge, skills, attitudes and behaviours of health care staff  Indigenous Australians may find mental health care traumatic because Past experiences of government coercion and control  Challenging behaviour can be seen as: Socially constructed and dependent on the healthcare professional's subjective point of view  Long term strategies for non suicidal self injury are: Developing a care plan to help the person alleviate their stress without harming themselves  Therapeutic relationships in the professional context are: For the primary purpose of caring for the other person's needs  Talking about suicide will encourage a person to: Consider options that may prevent them from harming themselves  Challenging Behaviour is defined as: Any behaviour that disrupts relationships and healthcare delivery  A contributing factor to predicting if a person may self harm is Physical and sexual trauma histories

 Suicidal behaviour occurs When a person is deeply unhappy but does not necessarily have a mental disorder  Risk assessment is: Part of a dynamic and collaborative approach to assessing needs when a person presents at a mental health facility

Module 6  People living in rural and remote areas are 2.7x more likely to smoke daily.  Cannabis is the most widely used illicit drug in Australia  In 2016, 1 in 16 Australians put themselves or others at risk of harm when drinking alcohol.  Death involving methamphetamines are 4x higher than 1999.  The National Drug Strategy 2017-2026 Aims to build safe, healthy and resilient Australian communities through preventing and minimising the harms of licit and illicit drugs to individuals, families and communities

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 Why are certain people more likely to develop ongoing substance use problems? Biological/genetic theories - Predisposition to drug dependence, Personality theories - Personality traits, Sociocultural theories - Social forces, role models and adaptive responses to environmental stressors, Stress/vulnerability model, Trauma informed care  Why not seek help? 1. Fear of professional judgement 2. Poor access to care 3. Money 4. Inadequate CALD (cultural and lingual difference) service 5. Being labelled 6. Lack of confidentiality 7. Age 8. Gender 9. Fear of professional consequences 10. Lack of awareness 11. Feeling the benefits from substances are to great not to experience 12. Feel of losing purpose 13. Lost social connections  Mesolimbic dopamine pathway and the psychopharmacology of reward The pleasure centre  The final common pathway of reinforcement and reward in the brain is hypothesised to be the mesolimbic dopamine pathway  Natural high Triggering the release of dopamine in the mesolimbic pathway ranging from intellectual accomplishments to athletic accomplishment to enjoining a symphony, experience an orgasm. Mediated from endorphins, anandamide, acetylcholine, dopamine.  Drug-induced reward  Psychoactive drugs of misuse also cause the mesolimbic pathway to release dopamine, often in a manner more explosive and pleasurable than that which occurs naturally 

 Dependence – a preoccupation with obtaining or using a drug for its psychic effects: the need to keep taking a drug to feel okay. Physical dependence is referred to as neuroadaptation, and means that a person’s body has become adjusted to the substance so that the body needs it to function as normal  Tolerance – a decrease in response to a drug dose that occurs with continued use. Increased doses of the substances are required to achieve the effect originally produced by lower dose (connected with neuroadaptation)  Withdrawal – symptoms that occurs when a person stops or substantially reduces substance use, if they have been using for a long period and/or at high doses Purpose of assessment  Identify problems accurately  Predict effects of intoxication and plan intervention  Assess possibility of drug interactions  Predict the possibility of withdrawal and plan intervention  Assess risk behaviour including self-harm  Understand the whole person not just their symptoms  Applicable therapeutic relationships Name the key elements of assessment in relation to drugs and alcohol use.  type of drug (See Appendix 6 for street names)  route of administration  frequency of use  dose  duration of use  time and amount of the last dose, e.g. grams of alcohol, mls and mgs of methadone, grams of cannabis, etc. Assessment and treatment planning  

Intoxication or withdrawal are diagnoses of exclusion. Some conditions appear to be intoxication or withdrawal – head injury, septicaemia, meningitis, acute psychosis, hypoglycaemia, hypoxia Acute intoxication or withdrawal may require urgent medical assessment and attention

Comprehensive assessment     

Presentation Substance use – quantity: last use, duration of use, features of abuse or dependence, motivation to change, method of substance use Consequences of substance use – physical health problems, mental health problems, social functioning, risk for self/others Examination – mental state, investigation LFT, BBV screen Management plan – goals, risks, intoxication or withdrawal management and longer term treatment

Module 7

Ethical dilemmas in mental health 1. NSW Mental Health Act 2007 2. The place of medication 3. Seclusion 4. Electroconvulsive Therapy (ECT)

 Paternalism: When healthcare professionals believe they know what is best for the person with lived experience  Coercive care: enforcing care decisions that the person may not want or consent to  Capacity: a person’s ability to make decisions about their own healthcare  Recovery: a person-centred approach care in which the nurse collaborates with the person to develop suitable care plans. Show respect, empower and hope Principles of act under the NSW Mental Health Act People should receive the best possible care and treatment 

In the least restrictive environment enabling the care and treatment to be effectively given

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Care and treatment should be timely, high quality and in line with professionally accepted standards

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Care and treatment should be designed to assist people, whenever possible, to live, work and participate in the community

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Any restriction of liberty and interference with the rights, dignity and self-respect of a person is to be kept to the minimum necessary in the circumstances.

Principles of ethical nursing care Person who experience mental health illness can be: 

Traumatised

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Politically powerless to advocate for themselves

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Open to exploitation

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Vulnerable to harm caused by others

Ethical principles and the Recovery Model 

Developing therapeutic relationships with clients by empathetic and compassionate

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Advocating for their needs and working collaboratively to develop care plans

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Provide psychoeducation to the client and their family and other significant carers

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Allows give hope, treat the client with respect and empower the cl...