Mental Health Issues

Front 1

What is mental health?

Back 1

state of well-being in which each individual is able to realize his/her own potential, cope w/ normal stresses in life, work productively/fruitfully, and make a contribution to the community

Front 2

What is mental illness?

Back 2

clinically significant behavioral or psychological syndrome marked by the pt's distress, disability, or the risk of suffering disability or loss of freedom. Refers to all mental disorders with definable dx.

Front 3

Mental health continuum

Back 3

A conceptual line used to represent levels of mental health and illness that vary from person to person and vary for a particular person over time

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Resilience

Back 4

closely associated with the process of adapting and helps people facing tragedies, loss, trauma, and severe stress

Front 5

Culture-bound syndromes

Back 5

occur in specific sociocultural contexts and are easily recognized by people in those cultures (i.e. running amok, pibloktoq, anorexia)

Front 6

Psychosocial factors that affect mental health

Back 6

Family Influence
Religious Influence
Life Experience

Front 7

Purpose for DSM-IV-TR

Back 7

Provides clear description of diagnostic categories
Necessary for reimbursement

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Axis I

Back 8

Clinical Symptoms

Front 9

Axis II

Back 9

Developmental disorders/MR

Front 10

Axis III

Back 10

Physical Disorders

Front 11

Axis IV

Back 11

Psychosocial Stressors

Front 12

Axis V

Back 12

Global assessment of functioning (GAF)

Front 13

Behavioral Therapy

Back 13

Based on the assumption that changes in behavior can occur without insight into the underlying cause

Front 14

GAF Scale Code 100-91

Back 14

Superior functioning in a wide range of activities, life's problems never seem to get out of hand, is sought out by others because of his/her many positive qualities. No symptoms.

Front 15

GAF Scale Code 90-81

Back 15

Absent or minimal symptoms, good functioning in all areas, interested and involved in a wide range of activities, socially effective, generally satisfied with life, no more than everyday problems or concerns.

Front 16

GAF Scale Code 80-71

Back 16

If symptoms are present, they are transient an expected reactions to psychosocial stressors, no more than slight impairment in social, occupational, or school functioning

Front 17

GAF Scale Code 70-61

Back 17

Some mild symptoms OR some difficulty in social, occupational, or school functioning, but generally functioning pretty well, has some meaningful interpersonal relationships

Front 18

GAF Scale Code 60-51

Back 18

Moderate symptoms OR moderate difficulty in social occupational, or school functioning

Front 19

GAF Scale Code 50-41

Back 19

Serious symptoms OR any serious impairment in social, occupational, or school functioning

Front 20

GAF Scale Code 40-31

Back 20

Some impairment in reality testing or communication OR major impairment in several areas, such as work or school, family relations, judgement, thinking, or mood

Front 21

GAF Scale Code 30-21

Back 21

Behavior is considerably influenced by delusions or hallucinations OR serious impairment in communication or judgement OR inability to function in almost all areas

Front 22

GAF Scale Code 20-11

Back 22

Some danger of hurting self or others OR occasionally fails to maintain minimal personal hygiene OR gross impairment in communication

Front 23

GAF Scale Code 10-1

Back 23

Persistent danger of severely hurting self or others OR persistent inability to maintain minimal personal hygiene OR serious suicidal act with clear expectation of death

Front 24

GAF Scale Code 0

Back 24

Inadequate information

Front 25

Example of GAF Code 90-81

Back 25

*Mild anxiety before an exam
*Occasional argument with family members

Front 26

Example of GAF Code 80-71

Back 26

*Difficulty concentrating after family argument
*Temporarily falling behind in school work

Front 27

Example of GAF Code 70-61

Back 27

*Depressed mood and mild insomnia
*Occasional truancy, or theft within the household

Front 28

Example of GAF Code 60-51

Back 28

*Flat affect and circumstantial speech, occasional panic attacks
*Few friends, conflicts with peers or co-workers

Front 29

Example of GAF Code 50-41

Back 29

*Suicidal ideation, severe obsessional rituals, frequent shoplifting
*No friends, unable to keep job

Front 30

Example of GAF Code 40-31

Back 30

*Speech at times illogical, obscure, or irrelevant
*Depressed man avoids friends, neglects family, and is unable to work; child frequently beats up younger children, is defiant at home, and failing at school

Front 31

Example of GAF Code 30-21

Back 31

*Sometimes incoherant, acts grossly inappropriately, suicidal preoccupation
*Stays in bed all day, no job, home, or friends

Front 32

Example of GAF Code 20-11

Back 32

*Suicide attempts without clear expectation of death; frequently violent; manic excitement
*Smears feces
*Largely incoherent or mute

Front 33

Example of GAF Code 10-1

Back 33

*Recurrent violence to self or others
*Suicidal act with clear expecation of death

Front 34

Behavioral Therapy
Modeling

Back 34

Therapist provides a role model for specific identified behaviors, and the pt learns through imitation

Front 35

Behavioral Therapy
Operant Conditioning

Back 35

Basis for behavior modification and uses positive reinforcement to increase desired behaviors

Front 36

Behavioral Therapy
Systematic Desensitization

Back 36

Behavior modification therapy that involves the development of behavioral tasks customized to the pt's specific fears; these tasks are presented to the pt while using learned relaxation techniques. 4 step process

Front 37

Behavioral Therapy
Aversion

Back 37

*Used widely to tx alcoholism, sexual deviation, shoplifting, violent/aggressive behavior, and self-mutilation
*3 paradigms for using aversive techniques

Front 38

Three paradigms for using aversive techniques

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1. Pairing of a maladaptive behavior with a noxious stimulus, so that anxiety or fear becomes associated with the once-pleasurable stimulus
2. Punishment
3. Avoidance training

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Before initiating any aversive protocol, the therapist, tx team, or society must answer the following questions:

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1. Is this therapy in the best interest of the pt?
2. Does its use violate the pt's rights?
3. Is it in the best interest of society?

Front 40

Informal Admission

Back 40

*Voluntary admission similar to any general hospital admission
*Sought by pt
*Pt is free to stay or leave, even AMA

Front 41

Voluntary Admission

Back 41

*Sought by pt or pt's guardian through written application to facility
*Pts have right to demand/obtain release
*Pt may have to submit a written release notice to facility staff, who reevaluate pt condition for possible conversion to involuntary admission status

Front 42

Temporary Admission

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*Used for people who are so confused or demented they cannot make decisions on own
*For people who are so ill they need emergency admission
*Initiated by physician and confirmed by hospital psychiatrist
*Pt's can be held no more than 15 days

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Primary purpose of temporary admission

Back 43

Observation, dx, and tx of those who have mental illness or pose a danger to themselves or others

Front 44

Involuntary Admission

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*Admission to facility without the pt's consent
*Specified number of physicians must certify that a person's mental health status justifies detention and tx
*Close family members notified
*Pt can be kept up to 60 days

Front 45

Long-term Involuntary Admission

Back 45

*Primary purpose extended care and tx of mentally ill
*Admitted through medical certification, judicial review, or administrative action
*Generally lasts 60-180 days, but may also be for an indeterminate period

Front 46

Conditional Release

Back 46

Usually requires outpatient tx for a specified period to to determine the pt's adherence with med protocols, ability to meet basic needs, ability to reintegrate into the community

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Unconditional Release

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Termination of a pt-institution relationship. May be court ordered or administratively ordered by the institution's officials.

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Right to treatment criteria

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1. Humane environment
2. Qualified Staff
3. Individualized plan of care

Front 49

Criteria for Involuntary Commitment

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1. Dangerous to self or others
2. Mentally ill and in need of tx
3. Unable to provide for own basic needs

Front 50

Neologisms

Back 50

new word created by pt
Ex: "I was going to tell him the MANNEROLOGIES of his hospitatlity won't do."

Front 51

Word Salad

Back 51

incoherent mixture of words and phrases

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Circumstantiality

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indirect speech that is delayed in reaching the point

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Tangentiality

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inability to have goal-directed associates of thought

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Loose associations

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flow of though in which ideas shift from one subject to another

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Flight of ideas

Back 55

rapid, continuous verbalizations or play on words

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Perservation

Back 56

involuntary, excessive continuation or repitition of a single response, idea, or activity

Front 57

Thought blocking

Back 57

sudden halt in train of though in the middle of a sentence

Front 58

General rule regarding use of restraints

Back 58

Use the least restrictive means of restraint for the shortest duration

Front 59

____ interventions or asking the patient for cooperation are the first approach, and ____ are considered if verbal interventions fail.

Back 59

Verbal; medications

Front 60

Circumstances for using behavioral restraint and seclusion

Back 60

*behavior is physically harmful to pt or others
*when alt or less restrictive measures are insufficient to protect pt or others from harm
*when decrease in sensory overstimulation (seclusion only) is needed
*when pt anticipates that a controlled environment would be helpful and requests seclusion

Front 61

Use of seclusion and restraint are permitted under the following circumstances:

Back 61

1. on the written order of physician
2. When orders are confined to specific time-limited periods (e.g. 2-4 hr)
3. When pt's condition is reviewed and documented regularly (q 15 min)
4. When original order is extended after review and reauthorization (q 25 hr) and specifies type of restraint

Front 62

Assessment and Documentation of pt's in restraints

Back 62

Must be performed q 15-30 min assessing for physical needs, safety, comfort.

Front 63

Intentional torts

Back 63

Willful or intentional acts that violate another person's rights or property. Ex: assault, battery, false imprisonment, invasion of privacy, defamation of character

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Unintentional torts

Back 64

Unintended acts against another person that produce injury or harm. Ex: Negligence, malpractice

Front 65

Hypothyroidism may have the clinical appearance of _____.

Back 65

Depression

Front 66

Hyperthyroidism may appear to be a ______ phase of _____ ______.

Back 66

manic; bipolar disorder

Front 67

Abnormal ____ ____ levels can explain irritability, depression, and lethargy.

Back 67

liver enzyme

Front 68

People who have ___ ____ ___ often suffer from irritability, depression, lethargy when their BUN and electrolyte levels are abnormal

Back 68

Chronic Renal Disease

Front 69

Voluntary Admission

Back 69

*Written application by the pt
*D/C initiated by the pt
*Civil rights are fully retained
*Pt voluntarily seeks help

Front 70

Involuntary Admission

Back 70

*Application did not originate with pt
*D/C initiated by hospital or court
*May retain none, some or all civil rights, depending on state
*Mentally ill and meets one or more of criteria

Front 71

Milieu Therapy

Back 71

use of total environment and has focus on living, learning, or working. A type of psychotherapy using the total environment

Front 72

Polypharmacy

Back 72

The taking of more than one drug at any given time

Front 73

Concurrent

Back 73

different medications taken at the same time for dual dx

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Combination

Back 74

two or more drugs of the same class

Front 75

Augmentation

Back 75

bringing in another class of drug for the same dx

Front 76

Primary

Back 76

main drug used to tx the problem