1
Q
mental health - WHO definition
A
- Able to recognize own potential
- Cope with normal stress
- Work productively
- Make contribution to community
2
Q
mental illness
A
Significant dysfunction in mental functioning related to
- Developmental
- Biological
- Physiological disturbances
3
Q
resilience
A
- Ability and capacity to secure resources needed to support well-being
- Characterized by
Optimism
Sense of mastery
Competence - Essential to recovery
4
Q
diathesis stress model
A
- Diathesis: Biological predisposition (eg. schizophrenia)
- Stress: Environmental stress or trauma
- Nature + nurture
- Most accepted explanation for mental illness
- Combination of genetic vulnerability and negative environmental stressors
5
Q
social influences on mental health care
A
- Consumer/recovery movement (self help movement)
- Media
- National Mental Health Framework and Strategy
- Provincial Mental Health Legislation
- International Conventions and Human Rights
6
Q
epidemiology of mental disorders
A
Study of the patterns of mental disorders—risks and resiliency factors
Identify high-risk groups
Identify high-risk factors
7
Q
incidence
A
number of new cases of mental disorders in a healthy population within a given period of time
8
Q
prevalence
A
total number of cases (new and existing) in a given population within a specific period of time
9
Q
clinical epidemiology
A
A broad field that addresses what happens after people with illnesses are seen by clinical care providers
Groups treated for specific mental disorders studied for
- Natural history of illness
- Diagnostic screening tests
- Interventions
Results used to describe frequency of
- Mental disorders
- Symptoms appearing together
10
Q
1/5 Canadians will be living with a mental health problem or illness.
A
11
Q
diagnosing mental disorders
A
An accepted classification system with criteria related to alterations in:
- Mood and affect
- Behaviour
- Thinking and cognition
12
Q
DSM-5
A
- The Diagnostic and Statistical Manual of Mental Disorders, 5th edition
- Official medical guidelines of the American Psychiatric Association for diagnosing psychiatric disorders
13
Q
ICD-10
A
- International Classification of Diseases
- Used to define diseases, study disease patterns, monitor outcomes, and allocate resources
- Global
- Clinical descriptions of mental and behaviour disorders
2 broad classifications
Subclassifications
14
Q
diagnosis as labelling
A
Allows for both positive and negative consequences
Avoid negative labeling
15
Q
mental health literacy
A
- Being knowledgeable about mental health
- Being able to recognize mental health problems and symptoms
- Being comfortable speaking with others about mental health
- Being willing and able to provide initial support and guidance
- Mental Health First Aid Canada
16
Q
recovery
A
- Viewed as an active process unique to each individual, is a cornerstone of Canada’s approach to mental health care
- Viewed as learning how to live alongside of one’s illness to have a satisfying and hopeful life
- Focus on strengths, values, resources, and rights
- Shaped by culturally safe and competent practices
- Recovery related to mental illness means “gaining and retaining hope, understanding of one’s abilities and disabilities, engagement in an active life, personal autonomy, social identity, meaning and purpose in life and a positive sense of self.” It is not synonymous with “cure.”
17
Q
future challenges and roles with mental health
A
- Aging population (increase in dementia)
- Increasing cultural diversity (immigrants affected by mental illness)
- Expanding technology (genetic markers implicated in mental illnesses)
- Patient advocacy
- Community and social inclusion of mental health interventions and not simply “mental illness treatment” – attention to SDoH
- Political and legislative involvement
18
Q
15th century - small scale asylums
A
- Asylums - retreats from society, early intervention and several months of rest, would cure mental illness
- Charitable enterprises
- “Madhouses”
- Civilian charitable initiatives - no doctors or church involved
- London’s Bethlehem Hospital and Reinier van Arkel asylum
19
Q
17th, 18th, 19th centuries - asylums
A
- Grew larger; into institutions (Instructional Care)
- Religious orders/Church protection became involved
20
Q
Philippe pinel
A
removed chains at Bicetre (France)
“Moral treatment” - peaceful nurturing environments
21
Q
19th century (United States)
A
Care of the mentally ill became a public responsibility in the United States and Canada
22
Q
Dorothea Lynde Dix
A
- Was responsible for mental health care system reform in the United States, Canada, and Great Britain, advocated for state supported public care
- Diligently investigated the conditions of jails and the plight of mentally ill people
- Promoted the building of mental hospitals
- Advocated for improved treatment and public care of people with mental illnesses
- Was instrumental in Canada in advocating for mental institutions in Halifax and St. John’s
23
Q
where was Canadas first hospital for mentally ill people
A
Saint John, New Brunswick
24
Q
European “asylums”
A
- “Moral care” - shift away from physical restraints
- Focused on containment and sometimes punishment
25
Canadian “asylums” and history
- “Custodial care” - assistance with performing the basic daily necessities of life (dressing, eating, toileting, walking, etc)
- Social reforms
- Rural farm like
- Introduction of nurses to asylum work
- Training programs and the professionalization of nursing
- Provincial psychiatric hospital
26
life within early institutions (19th and early 20th centuries)
- Despite the good intentions of early reformers, the approach inside the institution was one of custodial care and practical management, and treatment rarely occurred.
- Major concern was management of a large number of people who were forced to live together.
- Overcrowding and resource shortages created rowdy, dangerous, and often unbearable situations. Men and women were often abused.
- Quiet patients were involved in work as institutions grew into self-contained communities that produced their own food and made their own clothing.
27
Charles K Clarke
- Played influential role in bringing about new models of care
- Superintendent of Ontario provincial psychiatric hospitals
- Made continuous improvements, including the introduction of nurse training for asylum personnel
- First nurse training schools for female personnel
- Established the Toronto Psychiatric Hospital opening in 1925
28
Clifford Beers
- Wrote of his abusive experience in several mental hospitals—A Mind That Found Itself
- Founded the National Committee for Mental Hygiene
- Led the committee’s efforts in the development of child guidance clinics, prison clinics, and industrial mental health approaches
29
Adolf Meyer
- Neuropathologist
- Development of Psychiatric and Mental Health Nursing
- promoted the introduction of training schools for mental nurses
30
In the early 1900s, there were two opposing views of mental illness mental disorders
- biologic origins
- environmental and social stresses
31
Integration of biologic theories in psychosocial treatment
- Psychopharmacology obtained a central place in the treatment of mental illness
- Insulin coma therapy
- ECT - application of short electrical current to the brain in order to generate a convulsion for a healing effect
- Lobotomy
32
deinstitutionalization
post 1960s
- Integration of psychiatric units into general community hospitals
- Implementation of community mental health 1970s to present
33
Expanded community-based mental health services development
Crisis management
Consultation-liaison
Primary care psychiatry
34
Mental Health Strategy for Canada
1) Promotion and prevention
2) Recovery and rights
3) Access
4) Disparities and diversity
5) First nations, Inuit, Metis
6) Leadership and collaboration
35
lobotomy side effects
blunted affect/apathy, disconnect between thoughts and feelings
36
mental health act
- a law that gives certain powers and sets the conditions (including time limits) for those powers to stipulated health care professionals and designated institutions regarding the admission and treatment of individuals with a mental disorder.
- It also provides a framework for mental health delivery of services and establishes rules and procedures that govern the commitment of persons suffering from mental disorders
37
involuntary admission
physician indicates that the person has a mental disorder, is likely to cause harm to self or others or to suffer substantial mental or physical deterioration or serious physical impairment
38
competence
being able to be informed and to understand (at a basic level) matters relevant to the decision and to understand the consequences of the decision. Competence is not a fixed capacity; it changes over time.
39
Canadian Nurses’ Responsibility Regarding Mental Health Legislation
Understand their Mental Health Act
Explain patient and family rights
Keeping track of certificate expiry dates
Reporting to review panels
Supervising CTOs
Provide information to clinicians and family
40
eligibility requirements for MAID
- have a serious and incurable illness, disease, or disability (excluding a mental illness until March 17, 2023)
- be in an advanced state of irreversible decline in capability
- have enduring and intolerable physical or psychological suffering that cannot be alleviated under conditions the person considers acceptable
- Natural death has become reasonably foreseeable
41
mandatory outpatient treatment
- conditional leave - an involuntary patient may return to the community if the admission criteria are still met and if stipulations for treatment are followed (eg. taking medications, meeting with a physician)
- CTO (community treatment order)
42
CTO
- a form of mandatory outpatient treatment
- an order to provide a comprehensive plan of community-based treatment to someone with a serious mental disorder
- Serve as an alternative to being hospitalized
43
health ethics
contemporary ethics
- two absolute values
1) profound respect for life
2) commitment to the human spirit
44
conscientious objection
- a situation in which a nurse informs their employer about a conflict of conscience and the need to refrain from providing care because a practice or procedure conflicts with the nurse’s moral beliefs
- the nurse must maintain the safety of the person receiving care until other nursing is available
- Eg. some providers won’t provide abortion medication because it is against their morals
45
virtue ethics
- emphasizes the character of the moral agent
- was the earliest approach to ethics used in nursing
46
principlism
- Based on a set of principles compatible with most moral theories
- Nonmaleficence: that one should do no harm
- Beneficence: one should do or attempt to do good and make things better for others when we can
- Respect for autonomy: an obligation to respect a person’s right to be self-governing
- Justice: fairness in the distribution of benefits and risk
47
causitry or case based ethics
- use of case comparisons to facilitate moral reasoning and decision-making
- Precedent is central
- Information comes from past cases
- Example: a mother gives a child a chewable Tylenol and allows them to think it is candy after multiple failed attempts (non compliance) to take the Tylenol in liquid form, the child has a fever of 39.0 degrees
48
ethics of care
- Care based
- connection/responsibility for others
49
ethical practice environment
- moral communities where practice is grounded in compassion, empathy, and professionalism
- “culture of questioning”
ethical questions are to be expected as an everyday aspect of practice
50
moral dilemma
conflict in which one feels a moral obligation to act but must choose between incompatible alternatives.
51
moral distress
embodied response (frustration, anger, anxiety, etc) that occurs when one acknowledges an ethical obligation, makes a moral choice regarding fitting ethical action, but is then unable to act on this moral choice because of internal or external constraints.
52
threats to dignity
- Violated dignity can lead to suffering. Patients remember how they were treated when you think they may not have been aware.
- Nurses and other health care professionals must consistently ask: What is it like to use our mental health services?
53
Behavior Control, Seclusion, and Restraint
- the least intrusive and restrictive interventions are used in protecting and reducing risk to patients
- Restrictive measures are to be used only when absolutely necessary and then with sensitivity and great caution
54
Psychiatric Advance Directives (personal directive)
- a legal resource for people to use for times when their decision-making ability is compromised by a mental illness
- Designation of SDM, can guide the SDM, expresses their wishes
55
research ethics
- improves the lives of persons with mental illness and their families and determines ways to prevent mental illness and foster mental health and wellbeing
- Informed consent (Voluntary, ongoing, informed)
- Vulnerable population
- Risks need to be evaluated
56
When to Admit and the Legal Process of Admission
The person is likely to cause harm to self or others or suffer substantial mental or physical deterioration or serious physical impairment
57
involuntary admission criteria
- is not suitable as a voluntary inpatient
- meets the definition of a mental disorder
- meets the criteria for harm
- likely to suffer substantial mental or physical deterioration
- in need of psychiatric treatment
- refusal of treatment
58
form 1
- 72hrs (hold) to get an assessment
- Assessment decides admitting or discharging
- Admitting → form 3
59
form 42
Notice to the pt
60
form 2
- Order for Examination (Justice of the Peace)
- Valid for 7 days
61
form 30
Notice to pt about rights advice (about form 3 or 4)
62
form 3
- Certificate of Involuntary Admission
- Only valid for 14 days; can be renewed
63
form 4
An extension of form 3 (if person needs to be kept for longer)
64
comprehensive assessment
- Includes: complete health history, physical exam, psychological, emotional, social, spiritual, ethnic, and cultural dimensions of health, clients health illness experience, lived experience
- Screening: recognize symptoms, risk factors, or emotional difficulties
- Develops a holistic understanding of the individual’s problems
- Rule out other possible diagnoses
65
focused assessment
- A collection of specific information about a particular need
- Briefer, narrower in scope, and more present oriented
66
The Assessment Process: Techniques
- observations
- examination
- interview
- collaboration with colleagues
67
barriers to effective interviewing
- lack of clarity about the purpose and parameters of the interview
- asking to many closed ended questions
- avoiding silence
- asking complex questions
- making assumptions
- avoiding or ignoring expressions of emotion
68
checklist of cognitive distortions
- all or nothing thinking
- overgeneralizations
- mental filter (focus on negatives)
- discounting the positives
- jumping to conclusions
- magnification or minimization
- emotional reasoning
- should statements
- labelling
- personalization or blame
69
source oriented documentation
each discipline is assigned a section of the client record (e.g., nurses’ notes or physicians’ notes)
70
problem oriented documentation
everyone involved with the care of an individual makes entries in the same section of the record. This facilitate interprofessional collaboration toward a common goal
71
biologic domain
health history
physical exam
72
psychological domain
- Includes manifestations of PMH problems/disorders; mental status; stress and coping; and risk assessment.
- Responses to Mental Health Problems
73
mental health status exam
- The mental status examination is a systematic assessment of an individual’s appearance, affect, behaviour, and cognitive processes.
- Reflects “a snapshot” of the examiner’s observations and impressions at the time of the interview.
- Evaluates developmental, neurologic, and psychiatric disorders.
74
components of the mental status exam
1) general observation (appearance, psychomotor, attitude)
2) mood
3) affect
4) speech
5) perception
6) thought (content, process)
7) sensorium
- LOC
- orientation
- memory
- attention and concentration
- comprehension and abstract reasoning
8) insight
9) judgement
75
risk factors
characteristics, conditions, situations, and events that increase the individual’s vulnerability to threats to safety or well-being
76
protective factors
attributes or conditions of an individual, family, and/or community when present reduces, mitigates, or eliminates risk
77
promotive factors
conditions or attributes of individuals, families, and/or communities that actively enhance well-being
78
Anhedonia
loss of interest
79
euthymic
normal
80
euphoric
elated
81
dysphoric
depressed, disquieted, restless
82
hallucinations
false sensory perceptions not associated with external stimuli and not shared by others
83
illusions
misperception or misrepresentation of real sensory stimuli (e.g., misidentifying the wind as a voice calling one’s name or thinking that a label on a piece of clothing is an insect)
84
insight
a person’s understanding of a set of circumstances. It reflects awareness of his or her own thoughts and feelings and an ability to compare them with the thoughts and feelings of others
85
judgement
the ability to reach a logical decision about a situation and to choose a reasonable course of action after examining and analyzing various possibilities.
86
delusion
a false, fixed belief, based on an incorrect inference about reality. It is not shared by others and is inconsistent with the individual’s intelligence or cultural background and cannot be corrected by reasoning.
87
delusions of control
the belief that one’s thoughts, feelings, or will are being controlled by outside forces.
-thought insertion
-thought broadcasting
-ideas of reference
88
thought insertion
the belief that thoughts or ideas are being inserted into one’s mind by someone or something external to one’s self.
89
thought broadcasting
the belief that one’s thoughts are obvious to others or are being broadcast to the world.
90
idea of reference
the belief that other people, objects, and events are related to or have a special significance for one’s self (e.g., a person on television is talking to or about him or her).
91
paranoid delusions
an irrational distrust of others and/or the belief that others are harassing, cheating, threatening, or intending one harm.
92
bizarre delusions
an absurd or totally implausible belief (e.g., light waves from space communicate special messages to an individual).
93
somatic delusion
a false belief involving the body or bodily functions.
94
delusion of grandeur
an exaggerated belief of one’s importance or power.
95
religious delusion
the belief that one is an agent of or specially favoured by a greater Being.
96
depersonalization
the belief that one’s self or one’s body is strange or unreal.
97
magical thinking
the belief that one’s thoughts, words, or actions have the power to cause or prevent things to happen; similar to Jean Piaget’s notion of preoperational thinking in young children
98
erotomania
the belief that someone (often a public figure) unknown to the individual is in love with them or involved in a relationship with them.
99
nihilism
the belief that one is dead or nonexistent.
100
obsession
a repetitive thought, emotion, or impulse.
101
phobia
a persistent, exaggerated, and irrational fear.
102
Loosening of association
the lack of a logical relationship between thoughts and ideas; conversation shifts from one topic to another in a completely unrelated manner, making it confusing and difficult to follow.
103
Circumstantiality
the individual takes a long time to make a point because his or her conversation is indirect and contains excessive and unnecessary detail.
104
Tangentiality
similar to circumstantiality, except that the speaker does not return to a central point or answer the question posed.
105
thought blocking
an abrupt pause or interruption in one’s train of thoughts, after which the individual cannot recall what he or she was saying.
106
neologisms
creation of new words
107
flight of ideas
rapid, continuous verbalization, with frequent shifting from one topic to another
108
word salad
an incoherent mixture of words and phrases
109
perseveration
a persisting response to a stimulus even after a new stimulus has been presented
110
clang association
the use of words or phrases that have similar sounds but are not associated in meaning; may include rhyming or puns.
111
echolalia
the persistent echoing or repetition of words or phrases said by others.
112
verbigeration
the meaningless repetition of incoherent words or sentences; typically associated with psychotic states and cognitive impairment.
113
pressured speech
speech that is increased in rate and volume and is often emphatic and difficult to interrupt; typically associated with mania or hypomania.
114
Biologic Basis of Practice
- All human behaviours have a biologic basis resulting from actions that originate in the brain and its dense interconnection of neural networks.
- Symptom expression = behavioural symptoms = brain dysfunction
- Aging changes the brain and, in turn, impacts our behaviour
115
population genetics
- involves the analysis of genetic transmission of a trait within families and populations to determine risks and patterns of transmission
- Family, Twin, and Adoption Studies
- It is likely that mental health disorders are polygenic
- more than one gene is involved
116
epigenetics
- study of the mechanisms by which gene expression is modified without changes in an organism’s genetic (DNA) sequence
- The epigenome marks (turns on or off) the genome through a variety of processes which may down-regulate or up-regulate gene expression
117
neuroplasticity
- Ability of the brain to change its structure and function in response to internal and external pressures
- Compensates for loss of function in specific area.
- Nerve signals may be rerouted.
- Cells learn a new function.
- Nerve tissues may be regenerated.
118
structural neuroimaging
- Allows for visualization of the brain
- Tissue abnormalities, changes or damages
- Shows structures but now how the brain is working
- CT and MRI
119
120
PET scan
- uses a radioactively charged particle (most commonly glucose)
- Consumption of glucose shows what parts of the brain are most active etc.
- used to measure regional cerebral blood flow and neurotransmitter system functions
121
Single photon emission computed tomography (SPECT)
- integrates CT and a radioactive tracer
- measures regional cerebral blood flow
- effective in evaluating blood flow in the brains of individuals with Parkinson disease (PD) and depression, effects of certain drugs
122
Refractoriness (desensitization) (Down-regulation)
A decreased response to continued stimulation of these receptors
123
Receptor Subtypes
- Each major neurotransmitter has several different subtypes for the chemical, allowing for different effects on the brain.
- Each major neurotransmitter has several different subtypes (e.g., dopamine: D1, D2, D3).
124
neurotransmitter categories
-Cholinergic neurotransmitters
-Biogenic amine neurotransmitters (sometimes called monoamines or bioamines)
-Amino acid neurotransmitters
-Neuropeptide neurotransmitters
125
Biogenic Amines
Synthesized from tyrosine
- Dopamine - cognitive and motor function, reward pathways
- Norepinephrine - generating and maintaining mood states, fight or flight, sleep and wakefulness
- Epinephrine - similar to norepinephrine, but very small amounts are produced and released in brain (more in the rest of the body)
Synthesized from tryptophan
- Serotonin - emotions, cognition, sensory perceptions, and essential biologic functions, such as sleep and appetite
Synthesized from histidine
- Histamine - arousal, cognition, learning and memory, sleep, appetite, and seizures.
- GABA
126
amino acids
GABA (g-aminobutyric acid) - primary inhibitory neurotransmitter
- Decreased GABA activity is involved in the development of seizure disorders.
- Alcohol, certain anaesthetics, benzodiazepine antianxiety drugs, and sedative–hypnotic barbiturate drugs work because of their affinity for GABA
Glutamate - most widely distributed excitatory neurotransmitter
127
GABA
inhibits the excitability of neutrons
seizure, agitation, and anxiety control
128
glutamate
excitatory
responsible for the bulk of information flow
129
serotonin
control of appetite, sleep, mood states, hallucinations, pain perception
130
dopamine
involved in motor control, mood states, pleasure and reward systems, judgement, reasoning, insight
131
norepinephrine
-learning and memory
-sleep and wakefulness
-fight or flight
132
acetylcholine
learning and memory
basic attention
peripherally activates muscles
133
Endocannabinoid System (ECS)
- CNS development, synaptic plasticity, and the response to insults originating inside (endogenous) and outside (exogenous) the body
- The EC system communicates its messages in a different way: it works backward. When the postsynaptic neuron is activated, ECs, which are made on demand from fat cells in the neuron, are released from the cell and travel backward to the presynaptic neuron where they attach to cannabinoid receptors.
- suspected that cannabis use increases the risk for schizophrenia and may elicit psychotic symptoms in susceptible individuals
134
selectively
drug specific for a receptor
135
affinity
degree of attraction
136
intrinsic activity
ability to produce a biologic response once it is attached to receptor
-This is a measure of “how much response” a drug produces and ranges from maximal response (full agonist) to partial response (partial agonist) to no response (antagonist).
137
efficacy
is the ability of a drug to produce a desired response.
138
potency
considers the amount of drug required to produce the desired biologic response
139
loss of effect: biologic adaptation
In some instances, the effects of medications diminish with time, especially when they are given continuously
140
target symptoms
measurable specific symptoms expected to improve with medication use
141
four processes of pharmacokinetics
- absorption
- distribution
- metabolism
- excretion
142
factors affecting distribution
Amount of blood flow
Lipophilic
Plasma protein binding
Anatomic barrier, BBB
143
IM administration
- Patient preference (some pts have been on these meds for years)
- Thinner patients with less muscle mass will likely have less discomfort with a gluteal injection. Obese patients require the use of a longer needle, 1.5″ – 2”.
- Needles – 21 g 1” and 1.5” needles for deltoid and gluteal injections
144
Recommended Maximum Volumes of Fluid for Each Muscle Group
Deltoid 2mL
Dorsogluteal 4mL
Ventrogluteal 4mL
Vastus lateralis 5mL
145
metabolic syndrome
- Hypertension, hyperglycemia, high cholesterol, excess body fat around waist
- This increases the risk of heart disease, stroke and diabetes.
146
neuroleptic malignant syndrome
- Neuroleptic malignant syndrome (NMS) is a rare and life-threatening reaction to the use of any neuroleptic medication. Neuroleptics, also known as antipsychotics
High fever
Stiff, rigid muscles that can lead to eventual muscle breakdown.
Altered mental status.
Autonomic nervous system dysfunction
Your ANS regulates certain body processes, such as BP and your rate of breathing. Autonomic dysfunction leads to wide swings in blood pressure, excessive sweating and excessive secretion of saliva (spit).
- NMS is potentially life-threatening and requires immediate medical attention in a hospital setting.
147
Psychosocial Issues in Biologic Treatments
- Of particular importance are issues related to adherence.
- Adherence refers to following the therapeutic regimen, self-administering medications as prescribed, keeping appointments, and following other treatment suggestions.
- Most often-cited reasons for nonadherence are related to side effects of the medication.
- Adherence can be improved by psychoeducation.
148
manifestations of TD (tardive dyskinesia)
-movement disorder that persists after the discontinuation of antipsychotic medication
Blinking rapidly.
Chewing motions.
Grimacing or frowning.
Smacking lips or making sucking motions with the mouth.
Sticking out your tongue or probing the inside of your cheeks with your tongue.
And potentially…
Make repetitive finger movements like playing the piano.
Thrust or rock your pelvis.
Walk with a duck-like gait.
149
how to monitor TD
Physical assessments
- Nervous system
BW and Urinalysis
- Infection
EEG
- measure electrical activity in your brain
EMG
- measure communication between muscles and nerves
150
severe complications of TD
Breathing issues.
Dental problems.
Difficulty swallowing.
Irreversible facial changes, such as drooping eyelids or mouth.
Speech difficulties.
151
management of TD
Lowering medication dose
Switching medication
Despite changes some require additional medication to manage symptoms
-Preventive measures include use of atypical antipsychotics, using the lowest possible dose of typical medication, minimizing use of PRN medication, and closely monitoring individuals in high-risk groups for development of the symptoms of tardive dyskinesia
-The earlier the symptoms are recognized, the more likely they will resolve if the medication can be changed or its use discontinued
152
CBT
- Cognitive-behavioural therapy (CBT) is a practical, short-term form of psychotherapy. It helps people to develop skills and strategies for becoming and staying healthy.
- CBT focuses on the here-and-now—on the problems that come up in day-to-day life. CBT helps people to examine how they make sense of what is happening around them and how these perceptions affect the way they feel.
- The cognitive interventions in CBT are used to modify maladaptive thinking or beliefs; its behavioural interventions are aimed at decreasing maladaptive responses while increasing adaptive ones and at the learning of new behavioural practices
153
CBT: Three levels of cognition
- core beliefs
- intermediate beliefs
- automatic thoughts
154
core beliefs (cognitive schema)
Basic beliefs that are accepted as absolute truths
“I am unloveable”
155
intermediate beliefs
attitudes, rules or expectations, and assumptions that influence one’s perceptions, affect, and behaviours.
“If I’m not liked by everyone, it means I’ve failed.”
156
automatic thoughts
- May not be logical
- “Knee-jerk” in the moment
- Words and images within a particular situation
- when a car cuts you off on the freeway, you might be more likely to respond with anger than to be aware of the thought behind the emotion of anger
157
DBT (dialectical behavior therapy)
- For suicide and self harm
- Dialectical means "the existence of opposites." In DBT, people are taught two seemingly opposite strategies: acceptance (i.e., that their experiences and behaviours are valid), and change (i.e., that they have to make positive changes to manage emotions and move forward).
- DBT consists of four treatment components: individual therapy, group skills training, telephone coaching, and therapist consultation teams
- A standard DBT program requires a one-year commitment.
focuses on
1) mindfulness
2) distress tolerance
3) interprofessional effectiveness
4) emotional regulation
158
ACT (acceptance and commitment therapy)
- acceptance - be willing to experience difficult thoughts
- cognitive defusion - observe your thoughts without being ruled by them
- being present - focus on the here and now
- self as context - notice your thoughts
- values - what is really important to you
-commitment - take action to pursue the important things in your life
159
group therapy
- Group therapy brings together eight to 12 people who are struggling with similar issues. It can help to reduce a person's sense of isolation.
- Groups are usually led by one or two mental health care providers who guide the group process and offer structure and direction where needed. Groups may focus on the issues that come up each week (process-oriented) or may follow a set structure.
- Group therapy can include many of the individual forms as well
Disease specific
Population specific
Inpatient unit populations
And more
160
family based therapy
- Family therapy is focused on changing the way families interact. It aims to increase understanding and improve communication among family members. It does so without placing blame on any one person. Family therapy is generally used when the family system is seen as contributing to one family member's difficulties (such as a child or adolescent's).
- Marriage/couples counselling
- Conflict resolution
161
where was the first asylum in Canada
Beauport Quebec
162
what province had the first psychiatric nurse training program
Ontario
163
when was the Canadian national association of trained nurses established
1908
164
anxiety
Apprehension, uneasiness, uncertainty, or dread from real or perceived threat
-Excessive fear resulting in altered perceptions and behaviour
165
fear
Reaction to specific danger
Fear is a response to present danger, anxiety is future oriented and helps one prepare for a potentially aversive situations
166
worry
negative thoughts and images centering on adverse outcomes that engender negative affect and are relatively uncontrollable. A symptom of fear and anxiety
167
mild anxiety
- Occurs in normal everyday life
- Can grasp problems and problem solve effectively
- Slight discomfort, restlessness, irritability
168
moderate anxiety
- Persons ability to think clearly is slightly hampered
- Problem solving can still take place
- Tension, pounding heart, increased pulse and resp rate, perspiration, gastric discomfort, headache
169
severe anxiety
- Focus on one particular detail or many scattered details
- Learning and problem solving are not possible
- Headache, nausea, dizziness increase, trembling, pounding heart, hyperventilate, sense of impending doom
170
panic
- Most extreme
- Noticeably disturbed behaviour
- Cannot process what is going on in the environment, may lose touch with reality
- Pacing, running, shouting, screaming, withdrawal
171
dread
occurs frequently in response to high probability negative events; its magnitude increases as the dreaded event draws near
172
anxiety: Epidemiology
- Anxiety disorders are one of the most common form of psychiatric disorders in Canada (11.6% of those over the age of 18 years)
- Increasing prevalence in children and youth with the highest increase in prevalence for those aged 5–10 years.
- girls and women more likely than boys and men to be diagnosed with any anxiety disorder during their lifetime
173
anxiety: comorbidity
- Frequently co-occur with other psychiatric problems
- Frequently co-occurring with depressive disorders
- treatments for both disorders are similar due to shared neurobiology, symptom similarities, and abnormalities of emotional processing
174
Etiology of Anxiety Disorders
Biological factors (genetic, neurobiological theories)
Social factors (ie., traumatic life events)
Psychological factors (psychodynamic, learning theories)
Environmental factors (ie., prenatal toxic exposure, adverse childhood events)
Sociocultural factors (ie., culture bound syndromes)
175
panic disorder
- Panic attacks - abrupt surges of intense fear or discomfort that peak within minutes and are associated with multiple key physical and cognitive symptoms
- Can occur in response to a serious threat or out of the blue with no trigger
Exacerbations and remissions
176
separation anxiety disorder
Developmentally inappropriate levels of concern over being away from a significant other
177
Agoraphobia
- Excessive anxiety or fear about being in places or situations from which escape might be difficult or embarrassing
- The person fears that if a panic attack occurred, help would not be available, so he or she begins to avoid such situations
- Such avoidance interferes with routine functioning and eventually renders the person afraid to leave the safety of home
178
social anxiety disorder
- Severe anxiety or fear provoked by exposure to a social or a performance situation that will be evaluated negatively by others
- highly sensitive to disapproval or criticism, tend to evaluate themselves negatively, and have poor self-esteem and a distorted view of personal strengths and weaknesses
179
generalized anxiety disorder
- Excessive worry that lasts for months
- unwarranted, enduring anxiety across life situations, especially those in which the individual feels a lack of control
- Onset of GAD is often early in life and often follows a chronic course with more severe symptoms being triggered by acute stressors.
- Persons living with GAD often feel powerless to change, frustrated with life, demoralized, and hopeless, and comorbid depression is very common
180
advanced practice interventions: anxiety
Cognitive therapy
Behavioural therapy
- Relaxation training
- Systematic desensitization
- Flooding
- Response prevention
- Thought stopping
Cognitive-behavioural therapy
- First line
181
obsessions
Thoughts, impulses, or images that persist and recur, so that they cannot be dismissed from the mind
182
compulsions
Ritualistic behaviours an individual feels driven to perform in an attempt to reduce anxiety
183
Obsessive-Compulsive Disorders
Obsessive-compulsive disorder
Body dysmorphic disorder
Hoarding disorder
Hair pulling and skin picking disorders
184
OCD; epidemiology
- The fourth common psychiatric illness.
- Typical age of onset is bimodal (10 years and 21 years)
- Males generally have an earlier onset than females.
- Childhood OCD diagnosed almost three times as frequently in boys than girls.
- Occurs in adults with equal frequency in women and men.
185
OCD: comorbidity
- Commonly co-occurs with other psychiatric conditions with symptoms of rumination (Mood Disorder) and worry (Anxiety Disorder), eating disorders
- Psychotic disorders may also occur, but people with only OCD are able to recognize that their thoughts are irrational, although they cannot control them.
186
treatment for OCD
Medication
- SSRI’s (ie. Zoloft) first line
Therapy (CBT)
ERP (exposure therapy)
187
DSM: Generalized anxiety disorder
- Excessive anxiety and worry (apprehensive expectations), occuring more days than not for at least 6 months, about a number of events or activities
- Difficult to control the worry
- Anxiety and worry associated with 3 or more of the following
restlessness/on edge
Easily fatigued
Difficulty concentrating or mind going blank
Irritability
Muscle tension
Sleep disturbance
- Anxiety and worry are causing clinically significant distress or impairment in social, occupational, or other important areas of functioning
- The disturbance is not attributed to a substance or another medical condition or mental disorder
188
DSM: Social Anxiety
- Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others (eg, social interactions, being observed, performing in front of others)
- Individual fears that they will act in a way or show anxiety symptoms that will be negatively evaluated
- Social situations almost always provoke anxiety or fear
Social situations are avoided or endured with intense fear or anxiety
- Fear or anxiety is out of proportion to the actual threat
- Fear or anxiety is persistent (lasts 6 months or more)
- causes clinically significant distress or impairment in social, occupational, or other important areas of functioning
- The disturbance is not attributed to a substance or another medical condition or mental disorder
189
DMS: Panic Disorder
- Recurrent unexpected panic attacks
- At least one of the attacks is followed by 1 month of
Persistent concern or worry about additional panic attacks or their consequences
A significant maladaptive change in behaviour related to attacks (eg. avoiding unfamiliar situations)
- causing clinically significant distress or impairment in social, occupational, or other important areas of functioning
- The disturbance is not attributed to a substance or another medical condition or mental disorder
190
DSM: OCD
- Presence of obsessions, compulsions, or both
- Obsessions
Recurrent and persistent thoughts, urges, or images, intrusive and unwanted, can cause anxiety and stress
Individual attempts to ignore or suppress thoughts, urges, images, or neutralize them with other thoughts or actions (eg. performing a compulsion)
- Compulsion
Repetitive behaviours or mental acts that the individual feels driven to perform in response to an obsession
Aimed at preventing or reducing anxiety or distress; or preventing some dreaded event or situation. These bahbours are not connected in a realistic way to what they are meant to neutralize or prevent
- Obsessions and compulsions are time consuming (take more than 1 hour/day) or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
- The disturbance is not attributed to a substance or another medical condition or mental disorder
191
risk factors for suicide
- 90% of people who attempt or die by suicide have a history of psychiatric or addiction disorder, and other complex risk factors such as:
Major depressive disorder
Alcohol and drug use
Hopelessness
Low self esteem
Lack of social support, family problems, financial hardship, legal problems
Childhood trauma
Male gender
Increasing age
Previous Suicide Attempts*
Untreated Depression (often manifested through * aggression)
Untreated Mental Illnesses (Bipolar Disorder, ADHD, * Anxiety Disorders and others)
Incomplete comprehension of death* (common with young children)
Risk taking behaviours*
Self-Harm/Self-Injury*
Access to means of suicide*
Physical ailments*
Abuse of drugs or alcohol*
Exposure to violence or abuse (physical, emotional, * sexual)
Family history of psychiatric problems/family member * who has died by suicide
Unstable family situation-frequent moves/multiple * caregivers if in foster care
Early stressful life events (for example, divorce)*
Negative school experiences (including bullying)*
192
suicide: epidemiology
- rates may actually be 2-3x higher than reported, due to underreporting
- 9th leading cause of death
- 10 deaths by suicide each day in Canada
- For every suicide death, there are 5 self-inflicted injury hospitalizations, 20-25 attempts, and 7-10 people affected by suicide loss
- Rates 5-7x higher for First Nation youth than general population
- Highest rates among adolescents and midlife
- Females more likely to self harm
- Men more likely to engage in highly lethal suicide attempts
83% had been seen by health services within the previous year
45% had seen a primary care service within the month before the death by suicide
193
suicide: biological factors
Causal relationship with serotonin; other biochemical markers are inconclusive
Low serotonin levels are related to depressed mood
Low cerebrospinal fluid 5-hydroxyindoleacetic acid (5-HIAA, the main serotonin metabolite) is a promising biological predictor of suicidal behaviour
194
suicide protective factors
Positive Relationships (family, extended family, teachers, * mentors, foster parents, peers and siblings)
Positive self-esteem*
Good problem solving and coping skills*
Solid family cohesion and supports*
Strong connections to school*
Supportive teachers and counsellors*
Engagement in extracurricular activities*
Involvement in faith etc
195
Nonsuicidal Self Injury (NSSI)
- Attempts to inflict shallow, yet painful injuries to the body without intending to end one’s life.
- Most often to self punish, alleviate psychic pain, pierce psychic numbness
- Common methods:
Cutting
Burning
Scraping/scratching skin
Biting
Hitting
Skin or hair picking
Interfering with wound healing
196
epidemiology of Nonsuicidal Self Injury
Estimated that 13-23% of Canadian adolescents engage in NSSI
Peaks at age 20-29 (17-35% globally)
Often comorbid with other mental health disorders including:
Depression
Anxiety
Eating disorders
Substance use disorders
197
Nonsuicidal Self Injury (NSSI): Nursing Interventions
Assessment and self-assessment
- Harm reduction
Basic treatment of physical injuries
Therapeutic relationship-building
- Boundaries, transference, limit-setting
Promotion of adaptive coping and problem-solving
- Contracting for safety - having the patient agree and commit, in writing, to no self-harm or suicide attempt for an agreed upon period of time
Development of recovery plan
Advanced nursing practice
- CBT, DBT
198
major depressive disorder
- Depressed mood or a loss of interest or pleasure in nearly all activities must be present for at least 2 weeks.
- four of the following seven symptoms are usually present: disruption in sleep, appetite (or weight), concentration, or energy; psychomotor agitation or retardation; excessive guilt or feelings of worthlessness; and suicidal ideation
- impairing functioning with:
Emotional
Cognitive
Physical, and
Behavioural symptoms
- And experienced for over 2 weeks
199
risk factors for major depressive disorder
Prior episode of depression
Family history of depressive disorder
Lack of social support
Stressful life events
Current substance use
Medical comorbidity
Economic difficulties
200
Hopelessness
combination of negative life events and thought patterns, self blame, inability to change our circumstances. a perception of having no hope that one’s life situation or circumstance will change or improve. It is characterized by feelings of inadequacy and an inability to act on one’s own behalf.
201
despair
is a sense of hopelessness about a persons entire life and future
When hopelessness seeps into all corners of our lives and combines with extreme sadness
202
bipolar symptoms
euphoria and depressed mood
sleeping significantly less than usual and feeling energetic despite lack of sleep
increased irritability/agitation
speaking faster than usual
restlessness difficulty focusing
working on multiple projects at once
203
depression symptoms
constantly feeling sad empty hopeless
changes in appetite and sleeping pattern
feeling fatigue/lack of energy
feeling guilty or worthless
frequently having thoughts of death or suicide
withdrawing from social activities
204
bipolar 1
manic episodes that last at least 7 days
one or more manic episodes generally with a major depressive occurence
205
bipolar 2
periods of major depression accompanied by at least one incidence of hypomania)
206
Cyclothymic disorder
periods of hypomanic episodes and depressive episodes that do not meet full criteria for an MDE
207
manic symptoms
feeling elated or excited
feeling jumpy or wired
feeling irritable or short-tempered
having racing thoughts and talking faster than usual
sleeping less than usual
feelings of grandeur
taking unusual risks or acting impulsively
208
bipolar epidemiology
- Leading cause of disability in younger generation
- Lifetime prevalence of 11.3%
- Higher prevalence rates in lower-income, unemployed populations, and for unmarried or divorced people
- Average onset is between 15 and 45 years of age
- Common in older adults – though not a normal part of aging
- Comorbidity
- Likely to have been diagnosed with depression, until the first manic episode
209
bipolar: etiology
- Biological factors
Genetic
Biochemical
Stressful life events
ACE’s
- Hormonal
- Inflammation
- Diathesis–stress model
210
bipolar Psychopharmacology
- antidepressants (SSRIs)
- lithium
- mood stabilizers
211
lithium levels
BW/Monitoring**
0.6-1.2 → good
1.2-1.4 → high
>1.5 → toxic
212
Other Treatments for Depression
Electroconvulsive therapy (ECT)
Transcranial magnetic stimulation
Vagus nerve stimulation
Deep brain stimulation
213
addiction
-a chronic, relapsing, and treatable medical condition, is the leading preventable cause of death, disability, and disease globally. It is a disease of the brain and not an expression of moral character.
-Most prevalent of all mental conditions
-Leading preventable cause of death and disease
-Often neglected and undertreated
214
addiction is characterized by
Inability to consistently abstain
Impairment in behavioural control
Craving
Diminished recognition of significant problems with one's behaviours and interpersonal relationships
Dysfunctional emotional response
Often involves cycles of relapse and remission.
Without treatment, addiction is progressive and can result in disability or premature death.
215
addiction neurobiology
Addictive substances (licit and illicit) are used and misused for many reasons:
- Pleasurable effects
- To alter mental status
- To improve performance
- To relieve boredom
- To self-medicate a mental disorder
-Stimulation of the reward pathway occurs in part through increasing extracellular dopamine concentrations in limbic regions.
-Chronic exposure may lead to pervasive changes in brain function at structural (molecular and cellular) and neurophysiologic levels. Undermining the individual’s voluntary control over its use
-Addiction comes to individuals who may be considered potentially susceptible
-Abuse is more prevalent among males.
-Women considered more vulnerable for developing addiction
216
all individuals who are exposed to addictive substances will develop addiction --> true or false
false
217
Substance-induced disorders
-development of a reversible substance-specific syndrome due to the recent ingestion of (or exposure to) a substance
-substance intoxication, substance withdrawal, and other substance/medication-induced mental disorders
218
substance use disorder
-Substance specific (alcohol, opioids, tobacco)
-11 behaviours (criteria) grouped into:
Impaired control
Social impairment
Risky use
Pharmacologic categories
219
SUD DSM
The DSM-5 recognizes 10 described classes of substances.
-alcohol; caffeine; cannabis (marijuana); hallucinogens; inhalants; opioids; sedatives, hypnotics, and anxiolytics; stimulants; tobacco; and other
-The diagnosis of an SUD can be applied to all 10 classes of substances except for caffeine.
-brain reward system is highly activated in all SUD
220
SUD clinical course
- Best described as a chronic disease
- Periods of sustained use interrupted by periods of complete or partial remission
- Contemporaneous use
- addiction to a single substance may lead to the contemporaneous use of (and possible addiction to) other psychoactive substances.
- tobacco and caffeine are often contemporaneously encountered with other substances
- Most persons with substance- related disorders will have one or more relapses during their process of recovery.
221
precursors to relapse
Cues
-sights, sounds, smells, or thoughts
-negative mood states
-positive mood states
-sampling the drug itself (even in small doses)
Cravings
222
Non–Substance-Related Disorders
-Gambling disorder
Not yet recognized by DSM-5:
Internet gaming addiction
Sex addiction
Exercise addiction
Shopping addiction
223
SUD Prevalence
-Over 70% of youth (aged 15 to 24) and 80% of adults (aged 25+) reported using alcohol in the past year
-Caffeine is the most widely used substance globally. Coffee, tea, and soft drinks are the major dietary sources of caffeine
-marajuana most commonly used illicit substance in Canada
-Canada has the world’s second-highest per capita levels of prescription opioid consumption
-Tobacco is the most important preventable cause of death and disease globally.
224
SUD Biologic Theories
-Environment and genes (epigenetics)
-The addicted brain has been demonstrated to be fundamentally different from the nonaddicted brain, and this is manifested by changes in gene expression, receptor availability, metabolic activity, and responsiveness to environmental cues
225
SUD psychological theories
-Psychological factors related to experiences, personal preference, and issues
-These theories suggest that some individuals are born with certain temperaments and subsequently develop particular personality traits, vulnerabilities, or even personality disorders that may make them more susceptible to addiction.
-From this theoretical perspective, addiction is considered a behavioural disorder occurring in a vulnerable phenotype
-vulnerabilities acquired early in life may predispose individuals to psychiatric conditions (ACEs, trauma)
226
SUD social theories
Depends on availability, cultural normalities, socioeconomic issues or lack thereof (what may seem like an issue in one country may not be in another)
227
SUD Prevention
-Onset of substance use typically begins during the adolescent years.
-prevention initiatives often target children and adolescents.
-Knowledge-based programs in schools have not been shown to be effective, and those that target social competence and social influence have shown a small effect
-Effective interventions imbed school programs within a comprehensive approach that includes programs that teach parents and other ways to monitor their children and the skills to communicate with them effectively.
-Future research is needed
228
principles of addiction treatment
Drugs abuse causes effects to the brain's structure that last after remission
No single treatment
Treatment needs to be readily available
must address the individual’s drug abuse and any associated medical, psychological, social, vocational, and legal problems
Remaining treatment for an adequate period of time (at least 3 months)
Behavioural therapies
Medications
Reassessment of treatment and modification as needed
Assess and treat other mental disorders
Drug use during treatment must be monitored
Treatment does not need to be voluntary to be effective
229
goals of addiction treatment
- Stabilizing the patient’s condition
- Altering the course of the substance-related disorder
- Facilitating the patient’s overall functioning
- Therapeutic alliance
the nurse should aim to minimize or avoid premature and inappropriate confrontations, judgment, negative interactions, advice without permission, and other approaches not congruent with motivation-based techniques
Nurse should → appropriate empathy, boundary setting, confidence, instillation of hope, and the provision of support and encouragement.
230
Brief intervention (Advice and Assess)
patients who do not meet the diagnostic criteria for alcohol use disorders but are exceeding safe drinking limits
231
CAGE
C - have you ever felt like you should cut back?
A - have people been annoyed by or criticized your drinking?
G - have you ever felt guilty about your drinking?
E - have you ever had a drink first thing in the morning (eye opener)?
232
SUD Multidimensional assessment
- Substance use assessment
- Comprehensive psychiatric assessment
- Comprehensive physical assessment
- Collateral information assessment --> Patients level of treatment acceptance, risk of relapse
233
Detoxification
process by which, under care of a health provider, individuals are systematically withdrawn from addictive substances in either an inpatient or outpatient setting
234
goals for detoxification
To provide a safe withdrawal
To protect the patient’s dignity
To prepare the patient for ongoing treatment
235
Motivational interviewing
-directive, patient-centred style of counselling that helps patients to explore and resolve their ambivalence (the presence of both positive and negative feelings) about changing
-avoid nontherapeutic responses such as directing and giving advice without patient permission, threatening with consequences, being coercive, and inappropriately raising concern without permission
236
SUD psychosocial interventions
Motivational interviewing (MI)
Cognitive–behavioural therapy (CBT)
12-step recovery programs
Group therapy
Family therapy
Brief therapies
237
Relapse prevention
-Relalpse is a possible part of the recovrry process, learn to identify warning signs
-Identify high risk situations
-Develop a recovery social network
-Identify and manage cravings
-Challenge cognitive distortions
-Consider medications
-HALT → Hungry, angry, lonely, tired
238
alcohol withdrawal
Symptoms of withdrawal typically start hours after the last consumption of alcohol
minor withdrawal: 6-12 hours after last drink, anxiety, vomiting, nausea, tremor, sweating , tachycardia, hypertension. resolve in 48-72 hours
intermediate withdrawal: 12-72 hours after last drink, symptoms of minor withdrawal, seizures, dysrhythmias, hallucinations, seizures
Major withdrawal (delirium tremens): 5-6 days after severe untreated withdrawal. severe agitation, gross tremulousness, marked psychomotor and autonomic hyperactivity, global confusion, disorientation, and auditory, visual, or tactile hallucinations. more severe at night. These may include severe diaphoresis and vomiting, tachycardia, hypertension, and fever. Sudden death can occur.
239
CIWA drugs
Benzodiazepines can prevent delirium tremens
Thiamine (vitamin B1)
Folic acid
Multivitamins
240
detoxification medications
Disulfiram
Naltrexone
Acamprosate
Topiramate (not yet approved for this use)
Gabapentin (not yet approved for this use)
241
Disulfiram
leads to unpleasant symptoms when alcohol is consumed
242
Acamprosate
helps with alcohol cravings
243
Caffeine-related disorders
Most popular psychoactive substance and most widely used drug
Can cause or exacerbate:
- Tremors; impair motor performance
- Anxiety, dysphoria, and insomnia
- Tachycardia; hyper respiratory, increased heart contractility
- Pulmonary and coronary blood vessel dilation
- Constricted blood flow to the cerebral vascular system
244
Caffeine Intoxication
restlessness, nervousness, excitement, insomnia, flushed face, diuresis, and gastrointestinal complaints
usually remit within the first day or so and no known long-lasting consequences
245
caffeine withdrawal
- Can be associated with unpleasant withdrawal symptoms when abruptly tapered or discontinued
- Withdrawal symptoms may include:
- Headache, insomnia, abnormal dreams
- Drowsiness, fatigue, impaired psychomotor performance
- Difficulty concentrating
- Craving, yawning, and nausea
- Caffeine should be reduced gradually in those considered to be consuming in excess
246
cannabis related disorders
- Can result in motor impairment, loss of coordination and balance, and slowing of reaction time
- Cannabis’ effects
relaxation, euphoria, at times dyscoria (abnormal pupillary reaction or shape), distortion of senses, spatial misperception, time distortion (time standing still), tachycardia, hypotension, and increased appetite/food cravings (“the munchies”)
motor impairment, loss of coordination and balance, and slowing of reaction time
- Long-term use may:
Impair consolidation of memory, recall ability, and impair cognition
Recognized as an independent risk factor in the development of schizophrenia and psychosis
- Treatment includes
The mainstay for the treatment of cannabis use disorders is psychosocial treatment.
Motivational enhancement, psychodynamic and interpersonal therapy, relapse prevention
No medication treatment
**psychosis
247
hallucinogen related disorders
-psychedelics (LSD, PCP, ketamine)
-changing the senses
- May induce euphoria or dysphoria
- Altered body image
- Distorted sensory perceptions, confusion
- Incoordination
- Impaired judgement and memory
**psychosis
248
Inhalant-related disorders
- A group of chemical vapours or gasses, including organic solvents, or volatile substances, that are inhaled (breathed in), causing a high.
- Are often available, accessible, and generally affordable. (often used lower SES, rural areas, teenagers because it is accessible)
-Four classes:
Volatile solvents (eg, glue, paint, nail polish remover, lighter fluid)
Aerosols (spray cans, hair spray, cooking spray, air fresheners)
Gases
Nitrates
-cause euphoria, sedation, emotional lability, and/or impaired judgment
249
opioid related disorders
- Cause CNS depression, sleep or stupor, and analgesia
- Quickly triggers addiction
- Effects of opiates
Pleasure
Relief of pain
- Side effects
Sweating, nausea, constipation, sedation, fatigue, confusion, cognitive impairment, respiratory depression
- Cause tolerance and physical dependence
250
opioid withdrawal
- rebound hyperexcitability withdrawal syndrome
- Flu like symptoms (respiratory and GI)
- The Clinical Opiate Withdrawal Scale (COWS)
251
COWS
-high heart rate
-sweating
-restlessness
-pupil size (super dilated)
-bone/joint aches
-rhinorrhea/lacrimation
-yawning
-anxiety/irritability
-gooseflesh (goosebumps)
252
opioid withdrawal treatment
Methadone
Buprenorphine; methadone; suboxone= Buprenorphine + naloxone
OD-naloxone/Narcan
Counselling (also treating any underlying MH issue)
253
Stimulant-related disorders
-Cocaine, amphetamines
Results in - euphoria, tachycardia, hypertension, dilated pupils, rise in body temp
-High doses can cause panic, mania, psychosis
-High is followed by an intense depressive stage in which the subject feels irritable, depressed, and tired and displays increased appetite and powerful cravings for the drug
-Cocaine and alcohol mixing is very dangerous
254
stimulant withdrawal
Usually relatively uncomplicated
High risk of relapse
Requires supportive care
255
stimulant use treatment
- Psychosocial interventions form the mainstay of treatment:
- A 12-step program is recommended.
- No current medication therapy.
256
Tobacco withdrawal
Cravings, irritability, restlessness, difficulty concentrating, depression, frustration, anxiety, insomnia, fatigue, and increased appetite
257
tobacco Detoxification interventions
-Nicotine replacement therapy (NRT)
-Bupropion
-Varenicline - block nicotinic receptors → patient experiences little to no withdrawal symptoms and no pleasurable sensation if a cigarette is smoked
258
Gambling disorder
-Gambling disorder typically develops over the course of years with most individuals gradually increasing their frequency of gambling and amount of wagering.
Treatment:
-Psychotherapy, specifically cognitive and behavioural modalities as well as brief interventions and motivational enhancement
-No registered pharmacotherapeutic treatment
-high rates of suicide
259
SUD: youths
Greater vulnerability to developing SUDs
Effects on brain development/epigenetics
Risky behaviour under influence…
Peer pressures
260
SUD Postsecondary education students
Peak lifetime alcohol use generally occurs in an individual’s late teens and early 20s
Certain types of substances abused…stimulants
Normalized drinking culture
261
treating addiction in pregnancy
Buprenorphine has been shown to have lesser fetal complications
262
lithium toxicity symptoms
nausea, vomiting, diarrhea, abdominal pain, mental status change, delirium, tremors, ataxia, muscle twitching, slurred speech, hyperefleexia, hyperthermia, agitation, tachycardia
Nurs 3034
flashcards
Decks in class (2)
# Cards
