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Mental Health Unit 30

Adonis K. Lomibao, R.N.11/22/11

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Objectives

Identify different types of anxiety, affective, eating, and substance abuse disorders.

Understand patient behaviors including the topics of defense mechanisms, coping, demanding, and maladaptive behaviors.

Understand professional boundaries

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Mental Health

Means exhibiting behaviors that reflect a person's adaptation or adjustment to the multiple stresses of life.

Stressors-situations, feelings, or conditions that cause a person to be anxious about his or her physical or emotional well-being.

Coping-handling stressful situations

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Anxiety Disorders

Anxiety-fear, apprehension, or a sense of impending danger.

Anxiety disorder- recognized mental illness involving anxiety reactions in response to stress.

Includes: Generalized anxiety, Panic disorder, OCD, PTSD, & Phobias

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Agitation

Agitation- inappropriate verbal, vocal, or motor activity due to other causes other than disorientation or real need.

Includes behavior such as: pacing, cursing, biting, demanding attention,etc. (p.498)

Contributing factors include: Noise, loneliness, depression, etc. (p.499)

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Panic Disorder

Panic Disorder-characterized by unexpected, chronic panic attacks (bouts of overwhelming fear)

Person feels he is in danger, but has no specific cause or basis of the fear.

May be so fearful that he is unable to function

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Obsessive-Compulsive Disorder

OCD- patient has recurrent obsessions, frequent thoughts, ideas,impulses or compulsions

Person has no control & derives no pleasure from the ritualistic behavior

Obsession- a frequent idea, impulse, or thought that is usually unrelated to current conditions and does not make sense.

Compulsion-purposeful, repetitive behavior that is done many times each day

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Posttraumatic Stress Disorder

PTSD-the development of unusual symptoms after a psychologically traumatic event.

Person may relive the event,have nightmares or flashbacks.

May have trouble with normal emotional responses, feel detached from others, feel anxious, have difficulty sleeping, remembering, or concentrating.

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Phobias

Phobia-an unfounded, recurring fear that causes the person to feel panic.

Expressed as an unreasonable fear. Usually an object, insect,activity, or situation. Reaction to phobia may range from a feeling of

dread to terror.

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Affective Disorders

A group of mental disorders characterized by a disturbance in mood.

Also called mood disorders & are marked by a profound and persistent sadness.

Include:

-Bipolar affective disorder

-Schizoaffective disorder

-Seasonal affective disorder

-Borderline personality disorder

-Depression

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Bipolar Affective Disorder

Also called manic or bipolar depression Person has marked mood swings from elation

(mania) to severe depression. Most have many cycles of depression or mania.

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Schizoaffective Disorder

Combination of schizophrenia and a mood disorder.

Person will have symptoms of schizophrenia (delusions, hallucinations, etc.) & symptoms of major depression or manic episode.

Must have delusions and hallucinations to be diagnosed.

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Seasonal Affective Disorder

A depression that recurs each year at the same time Usually starts in fall or winter and ends in the spring or

summer. Believed to be related to the lack of sunlight exposure

or abnormal melatonin levels. Symptoms include sleepiness, carb-cravings, weight

gain, etc. (p 501). May be treated with light therapy

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Borderline Personality Disorder

Controversial diagnosis and speculation about the cause.

People with BPD feel unstable, impulsive, fear abandonment, are manipulative, and are prone to self-injurious behavior.

Mutilation, suicide attempts, difficulty maintaining stable relationships

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Depression

Most common in elderly, but also in the young. Signs may include: crying spells,feeling of

dejection, feeling of worthlessness, etc. (p.502) Risk factors: sudden loss of support system,

sudden decision to donate body parts, changes in behavior,the very old, persons with unrelieved chronic pain, etc. (p.503)

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Depression- Nursing Care

Implement suicide precautions per protocol Be observant for clues to suicide intent or

attempts Work to restore the patient's self-esteem, self-

worth, & self-respect. Never ignore the person's statements or threats

about suicide (p.504)

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Hypochondriasis

Imagines or magnifies each physical ailment. May be an expression of depression and is the

individual's way to reduce stress. Reassure understand person, but do not

encourage focus or belief of the person's supposed ill-ness.

Report all complaints and never judge the person as a hypochondriac.

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Paranoia

An extreme maladaptive response to stress. Characterized by a heightene, false sense of

self-importance and delusions of being persecuted.

Delusions- false beliefs about oneself, other people, and events.

They believe everyone is against them

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Eating Disorders

Characterized by disturbances in appetite or food intake.

Anorexia nervosa- disturbed body image, limit intake through diet, exercise, purging, & using laxatives and diuretics. 15% below average weight.

Bulimia nervosa- binge-eat then purge to undo the binge. Feelings of guilt, depression, and self-condemnation. Also attempts to lose weight.

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Anorexia

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Substance Abuse

Substance Abuse- characterized by the use of one or more substances that alter mood or behavior, resulting in impairment.

Results in maladaptive pattern that strains finances, causes irresponsibility, makes user unable to fulfill obligations.

Can be swallowed,inhaled, injected, or smoked substances.

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Alcoholism

A dependency on alcohol. Regarded as a disease. Is a drug and mixes unfavorably with other drugs. Can mask symptoms of other conditions Delirium tremens- serious withdrawal syndrome S&S include severe confusion, tremors,hallucinations,

seizures, & overactive nervous system.

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Defense Mechanisms

Psychological reaction or technique for protection against a stressful environmental situation or anxiety.

Harmful when it is the major means of coping with stress. (does not recognize reality or use problem-solving methods.

Common defense mechanisms on (p.506)

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The Demanding Patient

The demanding patient is frustrated by loss of control.

Behavior is a coping mechanism. Nursing care:

-Show that you care while controlling emotions

-Maintain open communications..listen!

-Allow pt. To regain control by making choices. (p.507)

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Maladaptive Behavior

Occur when behaviors and responses disrupt the person's ability to function smoothly within the family, environment, or community.

May include: physical responses, emotional responses, and patient behavior.

May result in: Depression, disorientation, agitation, or paranoia.

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Disorientation

A condition in which a person shows a lack of reality awareness with regard to time, person, or place.

Reality Orientation- making the disoriented patient aware of person, place, and time by visual reminders,activities, and verbal cues.

Protection of the patient is the most important nursing responsibility.

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Professional Boundaries

Unspoken limits on the physical and emotional relationship with patients.

Limit how healthcare workers act with patients. Involve using your best behavior, ethical

practices, and good judgement in patient care. Relationship danger zones: (p.510)

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