Study Guide for Mental Health Test 1

Erikson’s stages for growth and development
Trust v. Mistrust (birth-1 year)
Autonomy v. Shame/Doubt (1-3 years)
Initiative v. Guilt (3-6 years)
Industry v. Inferiority (6 years-puberty)
Identity v. Role Confusion (adolescence)
Intimacy v. Isolation (young adulthood)
Generativity v. Stagnation (middle adulthood)
Ego Integrity v. Dispair (older adulthood-senior citizens)

Sigmund Freud
“Father of Psychiatry”-developed theories of id, ego, and superego.

Freud’s “id”
The most primitive part of our psyche; we are born with it and it resides in our subconscious. Driven by primitive instincts of sexual and aggressive impulses. Believes purpose is to maximize pleasure while minimizing discomfort.

Freud’s “ego”
The 2nd part of our psyche to develop, this refers to our identity and sense of self. Derives from the “id” and gratifies it in accordance of reality. Operates on 3 levels of awareness: preconscious, conscious, and unconscious.

Freud’s “superego”
Operates according to morality principle; seeks what is good/moral above all else. Functions on all levels of awareness.

Anxiety
Vague feeling of apprehension that results from a perceived threat to self.

Stress
Nonspecific response of the body to any demand made on it.

Stressor
Stimulation, activity, or an event that produces stress.

Self-Concept
More than the total of 4 parts of self (personal identity, body image, role, self-esteem) this is the frame of reference individuals use for all that they know and experience.

Mental Health-Mental Illness Continuum
Each occupies a specific end. For placement, several components of mental health are assessed, including: positive self-concept, adaptability to change, effective communication, and others. Midpoint is considered normal mental health. On the illness side the individual is rarely in touch with reality.

Communication
Use of words and behaviors to send/receive both verbal and non-verbal messages.

Verbal Therapeutic Communication
This fosters a positive nurse and patient relationship by asking open-ended questions, focusing, clarifying, paraphrasing, restating, reflecting, summarizing, and offering the client information.

Non-therapeutic Communication
Advising, Disapproving, Disagreeing, Challenging, Testing, Defending, Generalizing, Stereotyping, Promising, Belittling, etc.

Self
A complex concept comprising 4 distinct parts: personal identity, body image, role, and set-esteem.

Common Behaviors Seen with Illness
Denial, Anxiety, Shock, Anger, Withdrawal.

Defense Mechanisms
Behavioral patterns that protect the individual against a real or perceived threat where the conscious awareness is blocked against threatening feelings.

Commonly Used Defense Mechanisms
Compensation, conversion, denial, displacement, dissociation, identification, introjection, projection, rationalization, reaction formation, regression, repression, sublimation, and suppression.

Compensation
Making up for a “deficiency” in one area by excelling or emphasizing another area.

Conversion
Emotional conflicts are turned into a physical symptom, providing the individual with some sort of benefit.

Denial
Reality is denied; it does not exist.

Displacement
Emotions are expressed toward someone or something other than the source of the emotion.

Dissociation
Separation and detachment of emotional significance and affect from an idea or situation.

Identification
Individual incorporates a characteristic of another individual or group; the individual does not give up personal identity.

Introjection
A quality or attribute of another is internalized and becomes part of the individual.

Projection
Attributing to other characteristics that the other person does not want to admit possessing; blaming personal shortcomings on someone else.

Rationalization
A process of constructing plausible reasons to explain or justify one’s behavior.

Reaction Formation
The conscious behavior is completely opposite to the unconscious process.

Regression
Behavior, thought, or feelings used at an earlier stage of development are exhibited.

Repression
The barring from conscious thought of painful, disagreeable thoughts, experiences, and/or impulses.

Sublimation
Sexual or aggressive energy/impulses are discharged in a socially acceptable way.

Suppression
An intentional exclusion of painful thoughts, experiences, or impulses.

Voluntary Admission/Hospitalization
Clients are willing to seek treatment and agree to be hospitalized if needed. The client also has the right to leave freely unless they are a danger to themselves or others.

Involuntary Admission/Hospitalization
Clients who are a danger to themselves or others can be committed for psychiatric care until they no longer are a threat. Each state has specific laws governing the civil commitment process but all are very similar. The client can be detained in a psychiatric facility 48-72 hours on an emergency basis until a hearing can be conducted.

Involuntary Admission Conditions
1. Reason to believe individual is mentally ill and has refused voluntary examination or is unable to determine for himself where exam may be necessary.
2. Without treatment, the individual is likely to suffer from neglect or refuse to self care or there is a substantial likelihood that in the near future the individual will inflict serious bodily harm on self or another.

Voluntary Admission Rights
The client has the right to leave the hospital if they are a voluntary admission, signs out AMA, or is discharged if they are no longer seen as a threat.

Dangerous Voluntary Client Rights
If this individual is dangerous yet insists on leaving the facility, the Psychiatrist can file for a civil commitment to detain the client against their will until a hearing can occur.

Legal Rights of Minors
A minor who has not been court-ordered to receive treatment is able to have a voluntary admission hearing where an objective professional asks the minor privately if they agree to obtain psychiatric care voluntarily or if coercion has occurred.

Basic Client Rights
-Right to treatment in the least restrictive environment appropriate to meet their needs
-Client does not have to be hospitalized if they can be treated in an outpatient facility
-Client has the right to be free from restraints and seclusion
-Patient Bill of Rights applies to all clients

Restraints
Direct application of physical force to a person without his or her permission to restrict freedom of movement. May also be chemical, human, or mechanical as well as a combination of each.

Panic
An attack of acute, intense, and overwhelming anxiety accompanied by a degree of personality disorganization where the individual cannot think clearly.

Nursing Interventions for Mental Health
-Support for the client
-Education of techniques to relieve stress
-Removal of any distracting stimuli

Alternative Therapies for Anxiety
-St. John’s Wart
-Kava
-Ginkgo and Ginseng
-Aromatherapy

Mental Health
One’s ability to cope with and adjust to the recurrent stresses of everyday living.

Mental Illness
Evidenced by a pattern of behaviors that is conspicuous, threatening, and disruptive of relationships or that deviates significantly from behavior that is considered socially and culturally acceptable; it is a manifestation of dysfunction.

Crisis
Time of change or turning point in life when patterns of living must be modified to prevent disorganization of person or family.

Community Mental Health Movement
Along with the holistic health movement, this has brought awareness to the public that all individuals, sick or healthy, have needs to be met. Mental health care is now practiced in many settings including public health, home health, acute care facilities, and hospitals.

Nonverbal Therapeutic Communication Techniques
-Active Listening
-Passive Listening
-Silence
-Touch
-Conveying Acceptance

Phases of Crisis
1. Confusion, disbelief, and high anxiety.
2. Denial.
3. Anger and remorse.
4. Sadness and crying.
5. Reconciliation.

Seclusion
Involuntary confinement of a person in a specially constructed, locked room equipped with security windows or cameras for monitoring.

Maslow’s Hierarchy of Needs
1. Physiological
2. Safety
3. Love and Belonging
4. Esteem
5. Self-actualization

Diagnostic and Statistical Manual of Psych Disorders
Published by the American Psychological Association, this is a multiaxial system that classifies mental disorders and outlines various disorders and descriptive references. Used by most health care professionals to facilitate medical diagnosis and to provide a guide to clinical practice.

Humoral Theory
Used by Hippocrates to classify mental illness; this view tied basic elements to corresponding body fluids and was considered an imbalance of humors.

Linda Richards
Considered the first psychiatric nurse; practiced during 1880’s.

NANDA Nursing Diagnosis for Psych/Mental Health
-Impaired adjustment
-Anxiety
-Disturbed body image
-Impaired verbal communication
-Ineffective coping
-Decisional conflict
-Ineffective denial
-Interrupted family processes
-Fear
-Grieving
-Hopelessness
-Disturbed personal identity
-Ineffective role performance

Mental Health Confidentiality
This can sometimes be a dilemma, as therapeutic effectiveness often depends on the patient’s willingness to discuss feelings/thoughts. The patient must be aware of all members of their healthcare team, and likewise, each employee must offer full disclosure to one another regarding patient behavior and disposition to prevent manipulation, harm, or injury.

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