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104 Cards in this Set

  • Front
  • Back

What is MHW?

Mental Health Worker

What is MHN?

Mental Health Nurse

What is RPN?

Registered Psychiatric Nurse

Define Mental Illness

A mental illness is a health problem that signifcantly affects how a person feels, thinks, behaves, and interacts with other people.

How is mental illness diagnosed?

It is diagnosed according to standardised criteria.

The term mental disorder is also used to refer to these health problems

What is another term for mental illness?

Mental disorder

Define mental health

A state of complete physical, mental and social well‐being, and not merely the absence of disease

What is the annual cost of mental health in Australia?

20 billion dollars

What percentage of Australians will have a mental disorder in any 12 month period?

1 in 5 or 20%

What percentage of Australians will have ONE mental disorder in any 12 month period?


What percentage of Australians will have TWO OR MORE mental disorders in any 12 month period?


What age range is usually when the peak onset of a mental illness occurs?

Between 18‐24 years of age

What is the estimated percentage of mentally ill homeless people?

Estimated at 85%

What age does most mental illness occur before?

75% happens before the age of 24 years of age

How many people per day commit suicide in Australia?

6 people per day commit suicide in Australia

(a further 30 attempt)

What was Australia's suicide rate in 2010-2011?

2,282 people

What is the percentage of a lifetime prevalence for mental illness? (Ages 16‐85yrs)


How many mental illnesses are there approx?


What is MSE?

Mental State Exam

Why do we call a mental health patient a client?

Consumer or client

What is the most common mental illness?

Anxiety disorders

What % of Australians suffer psychotic illness ?


What % of Australians suffer from an eating disorder?


What % of Australians suffer from a substance use disorder?


What is the annual cost of mental illness in Australia?

Approx $20 Billion

What % of the homeless are estimated to be mentally ill?


What percentage of young Aussies say they are unhappy with their lives?

25%/ 1 in 4

What % PA of Aussies are severely mentally ill?

2-3% or 600,000 Aussies

What % PA of Aussies are moderately mentally ill?

4-6% or 1 million

What % of Aussies are mildly mentally ill?

9-12% or 2million

What is recovery?

Being able to live a life without mental illness affecting the individual. Having a meaningful life.

Changing one's attitudes, feelings, values, feelings, goals, skills and/or roles

What are some traditional concepts of mental illness?

- Degenerative
- Life long
- Permanently disabling

- Medicinal treatment

- Not going to be successful/ independant/ living

- Consumers are passive recipients of care

What are some contemporary concepts of mental illness?

- Recovery is non-linear

- Treatment in community is best practice

- Need for balance of symptom reduction and acceptable medication regimes agreed upon by the patient

- Inability to return to pre-morbid levels is NOT failure

What are some things to include in a recovery framework?

- Culture of hope

- Promoting autonomy and self-motivation

- Collaborative partnerships

- Meaningful engagement

- Focus on strengths

- Holistic and personalised care

- Involvement of family, carers, support people and significant others

- Community participation and citizenship

- Responsiveness to diversity

- Reflection and learning

What makes recovery work?

- Right help at right time for right duration

- No judgement

- Help everyone equally

- Holistic approach

- Treat client with respect, dignity and equality

- Advocate consumer to take on competent roles

- Protect rights

- Provide support only when necessary

- Encourage use of support services

- Educate them on services access

- Workers much support core values

What is the first point of call for support for clients?

Family, friends and carers

What are some contributing factors to mental health and wellbeing?

- Individual attributes and behaviours
(including biological)

- Social and economic circumstances
(Where you live and how poor the area is/healthcare services/job opportunities and community)

- Environmental factors
(Service access/Discrimination)

Why are protective factors important?

- Moderate the impact of stress and symptoms on holistic parts of a consumers life

- Reduce development/exacerbation/relapses

- Resilience in the face of adversity.

What is a therapeutic relationship?

"One which a pt feels comfortable being open and honest with the nurse and is linked to the development of a productive and positive pt outcome"

Involves rapport, empowerment and collaboration

- empathy, genuineness, therapeutic use of self, unconditional positive regard

What is involved in a MSE?

Records findings between MHW and client recording....

- appearance

- speech

- motor activity

- behaviours

- alertness

- mood

- intelligence

- cognition

Interpret the data

Observe strengths/weaknesses and vital signs

Be aware that the pt is probably distressed/in denial/ disbelief

What makes an MSE successful?

- Respect pt

- Choose environment/privacy/safety

- Set goals

- Avoid negative personal judgements

- Tune into non-verbal cues

- Be mindful of responses

- Adopt a conversational approach

- Be aware (cognizant) of your non-verbal communication skills (eye contact)

How do you start an MSE?

- Introduce self and designation (RN, student ect)
- Purpose of conversation
Ask pt why they are here! Need their POV
- Tell them if you want to take notes
- Tell them about confidentiality and where is the information shared

What initial information do you get after introducing yourself etc?

- Identify person and preferred name

- Age / D.O.B

- Present address/ phone number


- GP / Psychiatrist

- Serology (In case physical illness)

- Obs
- Language spoken

- CT Scan

What information is within an MSE?

- Presenting data

- Life events

- Socioeconomic

- Sexual history

- A&OD history

- Med history

- Psych history

- Family history

- Forensic history

- Work history

- Values, spirituality, religious

- History from family and previous admissions

What is included in MSE regarding general appearance ?

- First impression of client

- Grooming / state of clothing

- Weight

- Clothing (Appropriateness -> Non judgemental)
eg/ Coats in summer

- Posture

- Malodorous?

- Age -> younger/older than they say?

- Tattoos, nose rings etc (To identify people if they escape)

- Glasses, hearing aids etc

What is absconding?

Running away

What is in an MSE regarding behaviour?

- Type and amount of movement (tics, grimace etc)

- Hostility, anger, agitation (verbal / physical - are you at risk)

- Psychomotor retardation (not moving) or Psych. agitation (restless)

- Social skills (positive or unpleasant habits)
(shy, withdrawn, overfamiliar)

- Evidence of bizarre behaviours

- Degree of co-operation with interview

Define mood


Must come from pt.

An internal state of mind that is exhibited through feelings and emotions

Is it congruent to what is observed

Mood states are usually elevated, depressed, anxious, labile, suspicious, euphoric, irritable, euthymic (normalish)

Rate mood 1-10

Consider duration of the mood and does it match expressed topics.

Get pt to describe mood cause its different for everyone

What can impact on mood?

- Appetite

(Increase or decrease)

- Sleep
(Hypersomnia, insomnia, quality, duration, how often do they wake, usual bedtime routine, sleep during the day, sedatives)

- libido
(Increased in mania, decreased in depression)


What is an affect in regard to mood?

An observable OBJECTIVE visual response (to a mood)

What are some types of affects?

- Appropriate

- Restricted

- Blunted (VERY restricted)
- Flat (no expression)

- Inappropriate (doesn't match)

- Labile (Changes a lot)

What should we look for regarding speech?

- Rate

- Quantity of information

- Quality

- Volume

What are some types of speech?

- Pressured (in mania)

- Rapid

- Slow

- Spontaneous

- Garrulous/loquacious

- Talkative

- Dramatic

- Monotonous

- Loud

- Whispered

- Slurred

- Staccato

- Spontaneous

- Mumbled

- Poverty of speech

- Disorganised

- Latency

Define garrulous / loquacious

Excessively talkative

What are the types of quantity of speech?

Poverty of speech (Too few words)

Poverty of content (lacks substance)

Voluminous (too many words)

What are the types of quality of speech?

(Unconscious replacement of fact with imagined or false experiences when the client believes it to be true)

Disorganised speech (unstructured)

What is involved with perception?





What is a hallucination?

A false sensory perception NOT involving external stimuli

Can involve the 5 senses (Sight, sound, touch, taste, touch, how the body moves

Empathise, validate their feelings but do NOT agree with them (I cant see what you see)

What is an illusion?

A misinterpretation of a real external stimuli

Usually in alcohol withdrawl

What is depersonalisation?

A feeling you are not yourself

You are not yourself / observer in own body

What is somatic hallucination?

Believing something is wrong in your body when there isnt

eg/ thinks they can feel cancer inside them when 'healthy'

What is kinaesthetic hallucination?

Not in control of own body, or feel they are being moved when they are not

What is de-realisation?

- Unreality or detached to surroundings / environment

Others or surroundings may be seen as 'foggy' or 'dreamlike'

What are the most common types of hallucinations?

Audio and Visual

How do you deal with a pt having hallucinations?

- Do not argue

- Trial and error approach (medication is not the first line)

- Try relaxation and anxiety relief

- Taking a walk / exercise

- Talking to someone

- Distraction

- Social activity (talking to friend)

- Low stimulus environment

- Staying with client : emotional support and reality feedback

- use of PRN meds anxiolytics / antipsychotics

What should you look at regarding a client's thought content?

Expressed ideas such as :
- Themes (paranoid, religious)

- Risk of harm (self / others)

- Antisocial thoughts, fantasies or urges

- Phobias (excessive or irrational fears)

- Preoccupations (illness/ symptoms)

- Obsessions (repetitive, intrusive thoughts, images or impulses

- Delusions

What are delusions?

Fixed false beliefs not shared by the general population

Are accepted without question regardless of realiy

What are some types of delusions?

- Grandeur

- Persecutory

- Paranoid

- Somatic

- Nihilistic

- Erotomanic

- Religious

What are the types of delusions of control?

- Thought withdrawal
(Someone stealing thoughts)

- Thought insertion
(Someone forcing ideas into your head)

- Thought broadcasting
(People can read my thoughts)

- Thought control
(People controlling your thoughs)

What is an erotomanic?

is a type of delusion in which the affected person believes that another person, usually a stranger, high-status or famous person, is in love with them.

The illness often occurs during psychosis, especially in patients with schizophrenia, delusional disorder or bipolar mania.

What is a bizarre delusion?

Unrealistic, unlikely and ridiculous delusions

What is a non-bizarre delusion?

Something possible that could happen

eg/ Someone is having an affair (but they aren't)

What is form of thought?

How thoughts are connected or expressed?

Is there excess or absence of thought?

Does it flow?
Are they easily interrupted?

Do they answer/reply with goal directed thinking or are they all over the place?

What is formal thought disorder?


- Loosening of associations

- Flight of ideas

- Tangentiality

- Circumstantiality

What is loosening of associations?

Poor progression of thoughts, ideas change rapidly and are unconnected

Unrelated & unconnected ideas shift from one topic to another

What is flight of ideas?

- Continued flow of accelerated speech which changes abruptly

- Can be based on environmental factors or understandable associations

- Rapid thinking in its extreme

What is tangentiality?

- Indirect replies to questions in an irrelevant way

- Digression may never get back to the topic, client goes "Off on a tangent"

What is circumstantiality?

A delay in reaching the goal due to the inclusion of excessive or irrelevant details

Like tangentiality but they are more likely to get to the point.

What are some formal thought disorders?

- Word salad

- Neologisms

- Clanging / Clang association

- Punning

- Thought blocking

- Echolalia

What is word salad?

An incoherent mixture of words or phrases.

Incomprehensible mixture of words and phrases

What is a neologism?

A newly created word (Like head-shoe for hat)

What is clanging?

words chosen for sound not meaning (Like rhyming)

What is punning

plays on words to sound funny

eg/ like a homophone

Using PUNS!

What is thought-blocking

Abrupt gaps in the flow of thought

Just stopping dead / pausing

What is echolalia?

Imitating word of others; often mocking, repetitive and persistent

What is sensorium & cognition?

- Organic brain functioning and IQ

- Insight

- judgement

- Cognition

- Abstract and concrete thinking

What is Insight?

Ability to understand the reasons for and meanings of behaviour and feelings

Capacity to gain an understanding of something

Capacity for client to understand their illness and knowing they are unwell

What is judgement?

Ability to understand consequences of actions

eg/ I slap someone, I know they will be angry

Ability to use previous learning in new situations

What is involved in cognition?

- Issues with consciousness usually involve organic brain impatient

- Orientation (TPP)
- Memory (Remote, recent-past, recent and immediate)
- Concentration

- Serial 7's or 3's (count back from 100 in 3's or 7's)

Our understanding and memory / concentration

What is DSH?

Deliberate self-harm

What do we need to be aware of in risk management and assessment?


- Suicide

- Interpersonal violence (to other pts or staff)

- Property damage (Thrown tv's)

- Absconding

- Substance misuse

- Vulnerability

- Medication non-adherence

What is a danger to the pt absconding?

Apparently approx 20% of those pt's commit suicide

What is ISOBAR?





Assessment and actions

Responsibility and risk management

What are the risk categories?

- Constant (Arms length)

Arms length at ALL TIMES

One on one (special)

- Constant (Visual)

1 on 1 and always within RN vision

- Intermittent
RN engages with the person at regular intervals

May be several set times per hour or random lengths of time between observations


- Low risk pts

- Negotiated frequency of engagement

What is a code grey

An aggression call

What is a code black

An aggression call when the pt has a weapon

What % of hospital workers have suffered verbal abuse?


What % of hospital workers have suffered physical abuse?


Approx how many code greys can happen per year?

over 13 thousand per year

What % of assaults are NOT reported in the hospital?

Approx 75%`

In risk management, what do we need to identify?

- Observations

- Threats

- Themes in conversations

- Actions

- Past history

- Conversations with carers

- Information provided by services

- Thorough and frequent mental state exams

In risk management, how do we manage a risk?

- De-stimulate the area

- Therapeutic interventions

- Observations (15/60s etc)?

- Documntation

- Frequent communication between staff

- Thorough hand-over

- Obtaining guarantees

- Restrictive interventions

- Medication adherence techniques
(Observations 45min after, deposits, wafers, serum levels etc.)


Way to remember the steps of an MSE



Mood and memory


General appearance









A way to remember the steps of a MSE

Behaviour and appearance

Thought form and content