MENTAL HEALTH CONCEPTS LAB

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MENTAL HEALTH CONCEPTSLAB

• JO ANN NORRIS, RN, MN, CORLN

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RESPECT

• NONJUDGMENTAL
• ESTABLISHING A THERAPEUTIC RELATIONSHIP
• COMMUNICATION IS THE MEANS BY WHICH WE INFLUENCE
  THE BEHAVIOR OF OTHERS
• APPEAR SELF CONFIDENT AND COMPOSED

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CONFIDENTIALITY

• SIGNED STATEMENT ON ADMISSION TO SCHOOL
• WE DO NOT ANSWER THE PATIENT PHONES IN THE DAY
  AREA
• NO DISCUSSION OF CLIENTS IN PUBLIC AREAS
• NO AUDIO TAPING IN CLASS
• SELF DISCLOSURE
• MAY COVER LAST NAME ON BADGE

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THERAPEUTIC COMMUNITYMILIEU THERAPY

• Crisis Stabilization Unit
• Safe environment
• Community meeting every day
• Peer pressure a useful tool
• Every interaction an opportunity for therapeutic
  intervention

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GROUP THERAPY

• Group leader will try to involve all in the
  discussion
• Start and stop at a set time
• Respectful of others in the group
• Students will sit outside the group and observe

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MEMBERS OF THE THERAPY TEAM

• Psychiatrist
• Psychiatric Nurse
• Clinical Psychologist
• Psychiatric Technician
• Psychiatric Social Worker
• Recreational Therapist
• Pet Therapist

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• Dietitian
• Chaplain
• Clients Family or Significant Other

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PRECAUTIONS

• Close observations observed q 30 minutes
• Suicide precautions observed q 15 minutes
• Elopement precautions
• Assault precautions
• Falls Risk
• Seizure precautions
• Withdrawal precautions

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COMMITMENT ISSUES

• VOLUNTARY
• Psychiatrist can admit
• Patient can present in the ED
• INVOLUNTARY
• Danger to himself or others
• Observation and treatment of a mental
• illness
• Gravely disabled

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INVOLUNTARY COMMITMENT

• 4TH Amendment protects all from unlawful
• searches and seizures.
• Any one can initiate commitment papers
• Judge makes the final decision for commitment
• May be a legal hold until the judge makes a
• ruling

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Causes of Mental Illness Brain Disease

• NEUROTRANSMITTERS
• Highly specialized chemicals that conduct
  electrical impulses cross the synapse between the
  axon and the dendrite
• All behavior is regulated by the
  interrelationship of chemicals and structural
  components of the CNS

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NEUROTANSMITTERS

• All behavior is regulated by the
  interrelationship of chemicals and structural
  components of the CNS
• Alterations in any part of the system may result
  in behavioral modifications
• CNS function is dependent on actions of
  neurotransmitters.
• Neurotransmitters are target for action in many
  psychotropic drugs

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TYPES OF TRANSMITTERS

• Cholinergics
• Acetylcholine
• Sleep, memory, arousal, movement
• Monamines
• Norepinephrine
• Cardiac function, mood, cognition
• Dopamine
• Coordination, movement, emotions,
  voluntary
• judgment

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• Serotonin
• Mood, libido, sleep and arousal, changes
• in behavior.
• Histamine
• Unclear as to function, may influence
• mood
• Amino Acids

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• GABA (gamma aminobutyric acid)
• decrease of body activity
• Glycine
• Inhibition of motor neurons
• Glutamate and Aspartate
• Relay of sensory information and
• regulation of various motor and
  spinal
• reflexes

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• Neuropeptides
• Endorphins
  
• Modulate pain
• Somatostatin
• Inhibits norepinephrine
• Structural changes in the brain

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PSYCHOPHARMACOLOGY

• BEGINNING IN THE 1950S SAW WIDESPREAD USE OF
• ANTIPSYCHOTIC
• ANTIDEPRESSANT
• ANTIANXIETY
• PSYCHOTROPIC DRUGS RELIEVE PHYSICAL AND
  BEHAVIORAL SYMPTOMS THEY DO NOT CURE MENTAL
  ILLNESS

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ANTIANXIETY DRUGS

• DESIGNED FOR SHORT TERM USE
• DEPRESSES ALL LEVELS OF CNS
• BENZODIAZEPINES MOST COMMON
• USE WITH CAUTION IN CLIENTS WITH LIVER AND RENAL
  DYSFUNCTION
• DO NOT MIX WITH ALCOHOL
• DO NOT WITHDRAW ABRUPTLY

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ANTIDEPRESSANTS

• ULTIMATELY WORK TO INCREASE THE CONCENTRATION OF
  NOREPINEPHRINE, SERATONIN, AND/OR DOPAMINE
• CLASSES TRICYCLIC
• MONAMINE OXIDASE
• INHIBITORS
• SELECTIVE SEROTONIN
• REUPTAKE
  INHIBITORS

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SIDE EFFECTS OF ANTIDEPRESSANTS

• ANTICHOLINERGIC CANT SEE, CANT SPIT, CANT
  POOP, AND CANT PEE
• ORTHOSTATIC HYPOTENSION
• HYPERTENSIVE CRISIS INGESTING FOODS CONTAINING
  TYRAMINE WHILE TAKING MAOIs
• MAOIs POTENTIALLY LETHAL IN OVERDOSE

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MOOD-STABILIZING

• LITHIUM
• MONITOR EFFECTIVENESS BY SERUM LEVELS
• THERAPEUTIC LEVEL 0.6-1.5
• TOXIC LEVEL 1.5-3.5
• ANTICONVULSANTS

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ANTIPSYCHOTIC

• CONVENTIONAL ANTIPSYCHOTICS
• PHENOTHIAZINES
• BUTYROPHENONES
• ATYPCAL ANTIPSYCHOTICS
• NEW GENERATION ANTIPSYCHOTIC

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SIDE EFFECTS

• EXTRAPYRAMIDAL SIDE EFFECTS
• PSEUDOPARKINSONISM
• NEUROLEPTIC MALIGNANT SYNDROME
• TARDIVE DYSKINESIA
• AKATHISIA
• DIMINISHED LIBIDO
• WEIGHT GAIN
• AGRANULOCYTOSIS