Mental Health Nursing IMental Health Nursing INURS 1300NURS 1300

Unit VUnit VMental Health AlterationsMental Health Alterations

Objective 1Describe the mood disorders

Mood disorder = a condition in which the prevailing emotional mood is distorted or inappropriate to the circumstances

Types of mood disorder major depression bipolar disorder

alternation between significantly depressed mood and significantly elevated mood (mania) over time

Mood disorders may present with psychotic symptoms

Objective 2Describe the nursing interventions and medical treatment for clients

with a mood disorder

See Objective 11 for medications for mood disorders

Objective 2 (cont’d)

Electroconvulsive therapy (ECT)

may be indicated for clients with severe depression that does not respond to other treatment

acts more quickly than medications, and may produce fewer side effects in older clients

Objective 2 (cont’d)Nursing diagnoses for clients with a

mood disorder – Risk for self-directed violence R/T

suicidal feelings Risk for violence directed toward

others R/T homicidal ideation Low-self esteem R/T depression Imbalanced nutrition, less than body

requirements R/T lack of interest in food

Disturbed sleep pattern R/T depression

Objective 3Describe characteristics of an

individual with suicide potential Females attempt suicide 2-3 times

more often than males Males are 4 times more likely to

complete a suicide Suicide by firearm is the most

common method of suicide for both men and women

Risk of suicide is higher for people with psychiatric conditions

Objective 3 (cont’d)

Specific high-risk populations include –

previous suicide attempt family history of suicide suicide of a loved one, friend, co-

worker, colleague, or role model suicide pacts anniversary dates

ANYONE THREATENING SUICIDE

Objective 4State common age groups for

suicide Adolescents

leading cause of death for people ages 13-18

considered a solution to an environmental or psychological problem

experience hostility toward themselves seek revenge on others by hurting

themselves

Objective 4 (cont’d) Elderly

Caucasian males over the age of 70 have the highest rate of suicide

fewer attempts, but more completed methods more lethal decreased ability to survive attempt

planned instead of impulsive bereavement real or perceived losses

often occur through covert measures self-inflicted falls refusing to eat or take medications

Objective 5Define personality disorders

A personality disorder is a pattern of perceiving, reacting, and relating to other people and events that is relatively inflexible and that impairs a person’s ability to function socially

Personality traits become rigid and dysfunctional

Personality disorders are chronic and maladaptive, impacting all aspects of one’s life

Objective 6Describe the types of personality

disorders

Grouped into three clusters according to the traits that describe them

Cluster A traits are behaviors considered odd or eccentric

Cluster B traits consist of dramatic, emotional, and erratic behaviors

Cluster C traits include behaviors that are anxious or fearful

Cluster A disorders Paranoid personality disorder Schizoid personality disorder Schizotypal personality disorder

Cluster B disorders Antisocial personality disorder Borderline personality disorder Histrionic personality disorder Narcissistic personality disorder

Cluster C disorders Avoidant personality disorder Dependent personality disorder Obsessive-Compulsive personality

disorder

Objective 7Identify the nursing interventions

and medical treatments for personality disorders

Medical Interventions – psychotherapy group therapy behavior modification medications

anxiety depression

Objective 7 (cont’d)

Nursing diagnoses – Ineffective coping R/T personality

disorder AEB reliance on maladaptive defense mechanisms

Risk for self-harm R/T unresolved fear of abandonment AEB attention-seeking behaviors and threats against self

Depression R/T self-directed anger AEB social withdrawal and isolation

Objective 8Describe behaviors of the

schizophrenic client and identify causes of schizophrenia

Schizophrenia refers to a group of very serious, usually chronic, thought disorders in which the affected person’s ability to interpret the world accurately is impaired by psychotic symptoms

Behaviors of schizophrenia

Disordered thinking Unusual speech Apathetic personality Changing behaviors Social isolation and withdrawal Distorted perceptions of reality

Etiology of schizophrenia

The cause of schizophrenia is unknown

Individuals may be genetically vulnerable to developing schizophrenia

Influencing factors may include environmental exposure to anything that interrupts brain development

Objective 9Differentiate the types of

schizophrenia

Catatonic type prominent psychomotor disturbances stupor waxy flexibility

Disorganized type disordered thoughts flat affect

Types of schizophrenia (cont’d)

Paranoid type delusions hallucinations

Residual type low intensity of symptoms

Undifferentiated type presence of symptoms from more than

one subtype of schizophrenia

Objective 10Discuss the medical treatment and

nursing interventions for the schizophrenic client

Medical treatment for the client with schizophrenia involves therapy modalities and antipsychotic medication

Therapies include psychotherapy, family education, and community support

Hospitalization is often required to treat severe delusions, hallucinations, or self-care deficits

Nursing diagnoses for schizophrenia

Disturbed thought processes R/T delusions/concrete thinking/paranoia AEB bizarre statements and behaviors

Disturbed sensory perception R/T hallucinations/illusions AEB inability to tolerate group therapy, talking to self, or looking for or at something that is not there

Impaired verbal communication R/T delayed thinking AEB very slow and delayed speech

Self-care deficit R/T withdrawal and loss of motivation and judgment AEB poor hygiene, poor grooming, and avoiding others

Nursing assessment and interventions for a client with

schizophreniaRefer to assigned readings for complete nursing

assessment of the schizophrenic client

Nursing interventions – use nonconfrontational speech and

mannerisms encourage communication and expression of

feelings and fears decrease stimuli and offer quiet activity seek clarification of statements provide recognition for constructive self-care

activities make adjustments in food preparation and

service for patients with paranoia

Objective 11Identify classifications, uses, actions, and side effects for selected classifications of

psychoactive medications as they relate to the above mental health

alterations

Refer to Psychoactive Medications handout