Mental Health

y A lifelong process of successful adaptation to a changing internal and external environment y The individual is in contact with reality and the environment y Possesses the ability to love, work, and resolve conflicts within a framework of reasonability y Has psychobiological resilience

Psychiatric Illness
y Loss of ability to respond to the environment in ways that are in accord with oneself or the expectations of society y Characterized by thought or behavior patterns that impair functioning and cause individual distress

Characteristics
y Unaccepting of self and dislikes self y Unrealistic perception of strengths and weaknesses y Thoughts and perceptions may not be reality based y Unable to find meaning and purpose in life y Lacks direction and productivity in life y Has difficulty in meeting own needs y Depends on others for thoughts and actions

MENTAL HEALTH DISORDERS

ANXIETY
y A subjective, individual experience y A normal response to stress y Is a feeling of apprehension, uneasiness, uncertainty or dread y Occurs as a result of threat to identity or self esteem y May result when values are threatened y May precede new experiences

Types
y Normal- a healthy type of anxiety y Acute: precipitated by imminent loss or change that threatens the sense of security y Chronic: anxiety that the individual has lived with for a long time

Levels
y Mild
y y y y Associated with the tension of everyday life Individual is alert Perceptual field is increased Can be motivating, produce growth and creativity, and increased learning

y Moderate
y y y y Focus is on immediate concerns Narrows the perceptual field Selective inattentiveness occurs Learning and problem-solving still take place

y Severe
y y y y y y A feeling that something bad is about to happen A significant reduction in perceptual field occurs Focus is on specific deails or scattered details All behavior is directed at relieving the enxiety Learning and problem-solving are not possible Individual needs direction to focus

y Panic
y Associated with dread and terror and a sense of impending doom y Disorganized personality y Unable to communicate or function effectively y Increased motor activity] y Loss of rational thoughts with distorted perception y Inability to concentrate y Can lead to exhaustion and death

y Interventions
y y y y y y y y y y Recognize the anxiety Establish trust Protect the client Do not attack coping mechanisms Do not force the client into situations that provoke anxiety Decrease environmental stimulation Limit interaction with others Provide creative outlets Promote relaxation techniques Administer anti-anxiety medications as prescribed

y Identify thoughts and feelings that occurred before the onset of anxiety y During severe panic level
y y y y y y y Reduce anxiety quickly Use a calm manner Always remain with the client Provide clear, simple statements Use a low pitched voice Attend to the physical needs of the client Anti-anxiety meds

Generalized Anxiety Disorders

y It is an unrealistic anxiety in which the cause usually can be identified y Assessment:
y y y y y y y Restlessness Inability to relax Episodes of trembling and shakiness Chronic muscular tension Dizziness Inability to concentrate Chronic fatigue

y Sleep problems y Inability to recognize the connection between the anxiety and physical symptoms y Focused on the physical discomfort

y PANIC DISORDER
y y y y y Cause usually cannot be identified Sudden onset Intense feeling of apprehension and dread Severe, recurrent, intermittent anxiety attacks Lasting for 5-30mins

y Assessment
y y y y y y y y y y y Choking sensation Labored breathing Pounding heart Chest pain Dizziness Nausea Blurred vision Numbness or tingling of extremities Sense of unreality and helplessness Fear of being trapped Fear of dying

y Intervention
y Attend to physical symptoms y Assist client to identify the thoughts that aroused the anxiety y Use cognitive restructuring y Give anti-anxiety meds as prescribed

y Recurrent and intrusive dreams or flashbacks y Stressors

y y y y y y y y Natural disaster Terrorist attack Combat experience Rape Accidents Crime or violence Sexual, physical and emotional abuse Re-experiencing the event as flahbacks

Assessment
y Emotional numbness y Detachment y Depression y Anxiety y Sleep disturbances and nightmares y Flashbacks of the event y Hypervigilance y Guilt about surviving the event y Poor concentration

Interventions
y Promote desensitization y Instruct client in relaxation techniques y Encourage use of support groups y Use of hypnotherapy

y Irrational fear of an object or situation y Repression, displacement y Interventions

y y y y y Stay with the client Identify the basis for anxiety Allow client to verbalize feelings Promote desensitization Teach relaxation techniques
y Breathing exercise, muscle relaxation, visualization of pleasant situations

y Do not force the client to have contact with the feared object

y Obsession
y Pre-occupation with persistent intrusive thoughts and ideas

y Compulsion
y Repeated performance of rituals or purposeless behaviors y Divert unacceptable thoughts y Decrease anxiety

y Anxiety occurs when one resists obsessions or compulsions

y Inability to control thoughts (obsessions) and behaviors (compulsions) y Recognizes rituals are ridiculous but can't stop y O/Cs greatly interfere with ADLs y Could be a secondary gain involved.

Treatment
y Benzodiazepines y Non-reinforcement of secondary gains y Modeling desired behavior y Response delay
y wait longer and longer intervals to act out compulsion

y Thought stopping.

Nursing interventions
y initially, provide time to carry out rituals y little by little limit rituals y Do NOT interrupt a ritual once it is started y Assist with self care y Get him to journal about events surrounding the O/Cs.

y Acute: within 6 months of event y Delayed: later than 6 months

y Grieving behaviors after a major trauma

y rape, fire, MVA, war

y Sense of powerlessness y Extreme anxiety y Keep reliving event

y Benzodiazepines y Antidepressants y Individual therapy to gain cognitive mastery of the situation.

y Encourage talk/expression of emotions y Be non-judgmental y Safety y Might need suicide precautions y Support group for client and family

y Occurs within 1 month of traumatic event y Must display 3 dissociative symptoms

y y y y y y y numbing detachment derealization depersonalization dissociative amnesia reduced awareness of surroundings sense of absence of emotional responsiveness from the experience

y Relaxation techniques y Benzodiazepines y Individual therapy y Same as PTSD

Conversion Disorder
y Conversion
y Loss of physical function y no physical basis (paralysis, blindness, etc.)

y The loss of function is very real to the client y Could be a secondary gain.

y Must carefully rule out a physical problem first y Psychotherapy y Rehabilitation to overcome disability y Anxiolytics y antidepressants

y Remember it is real to them y Be non-judgmental y Encourage self-care as much as possible y Provide safety y Monitor for new symptoms y Suicide precautions y Support for family

Hypochondriasis
y Preoccupation with belief of having a serious illness y No physical basis y Could be secondary gain y Anxious y depressed

Hypochondriasis
y Must carefully rule out physical problem first y Psychotherapy y Relaxation techniques y Anxiolytics y antidepressants

y Remember it is real to them y Be non-judgmental y Relaxation techniques y coping skills y Monitor for new symptoms y Suicide precautions

Somatization
y Many physical complaints or belief of serious illness over many years y No physical basis y Must carefully rule out physical problem first y Psychotherapy y Anxiolytics y antidepressants

y Listen objectively but don't encourage dwelling on symptoms y Be non-judgmental y Involve client in his care.

Factitious
y Intentionally produced physical or psychological symptoms to gain attention y Malingering
y symptoms created for a secondary gain

y Munchausen's Syndrome
y usually a mother telling of child's S&S or actually causing S&S so as to bring attention to what a good mother she is

y Careful physical workup y Usually it is the mother (or other perpetrator) who needs treatment, not the client y Benzodiazepines y Relaxation techniques y Coping skills y Consider abuse and protocol for reporting y Care for client and perpetrator.

y All have denial of problems

y rarely seek psychiatric help

y They are not the problems--everyone else is y Rigid, maladaptive behaviors.

Cluster A
(odd & eccentric)

Paranoid
y Suspicious y Misperceives y Neuroleptic therapy y Symptoms management y Confrontation not effective.

Paranoid
y Clarify meanings and contexts of situations, conversations, etc.
y Can't whisper, etc.

y Develop/nurture trust
y might have to have foods in unopened containers, etc.

Schizoid
y Distant and aloof y Unable to form relationships y Usually solitary y Outpatient therapy to increase interpersonal comfort y Safety y Allow physical and emotional space as needed y Assist to develop social skills.

Schizotypal
y Eccentric behavior y Magical thinking y Difficulty with relationships y Neuroleptic therapy

Schizotypal
y Social skills y Assistance with daily affairs y Intensive psychotherapy usually not effective y Safety y Social skills y Assist with ADLs.

Cluster B
dramatic/emotional

Antisocial
y Irresponsible y impulsive y Manipulates and exploits others y Hostile outbursts y Believes actions are justified y Group psychotherapy y Confrontation of inappropriate behaviors

Antisocial
y Stable environment y Consistent and judicious behavioral limits y Assist to take responsibility for consequences of actions

Borderline
y Impulsive y Outbursts of anger/rage y Self-mutilation y Master of manipulation y Can get staff fighting among selves (called splitting) y Group psychotherapy y Individual psychotherapy y Supervised, structured living y Neuroleptics.

Borderline
y Stable, structured, consistent environment y Adhere strictly to treatment plan. y Refuse to engage in 3rd party conversations
y don't talk with him about others

Histrionic
y Melodramatic y Highlyenergetic y Bursts of exaggerated emotions y Temper tantrums y Demanding y Self-centered

Histrionic
y Outpatient therapy y Teach ways to delay needs for gratification y Assist in assuming mature, adult behavior y Assist to find ways to express self in socially acceptable ways.

Narcissistic
y Inflated sense of importance y Feels entitled to recognition y Needs constant attention y Individual or group therapy y Stable, safe environment y Consistent limit setting y Assist to find ways to express self in socially acceptable ways y Enhance self-esteem and self- worth.

Cluster C:
anxiety & fear-based

Avoidant
y Hypersensitive to rejection y Uncomfortable in social settings y Relaxation exercises y Assertiveness training y Social skills training y Role play--what if? y Enhance ability to confront social situations

Dependent
y Unassertive, passive y No decision making y Self-devaluation y Relaxation exercises y Assertiveness training

Dependent
y Enhance ability to speak up and assume age-appropriate responsibilities y Give assignments that involve risk-taking behaviors.

OCPD
y Preoccupied with order and rules. y Perfectionism y Inefficient due to constant worry about doing things right y Overly concerned with telling how to do things right

OCPD
y Behavior therapy y Cognitive therapy y Leisure activities y Confront invalid assumptions and assist client to develop new perspectives y Assist to identify new solutions to life situations