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exam 1

What are the four axes of the Multiaxial Diagnostic System?

Axis I - clinical disorders;
Axis II - personality disorders & mental retardation,
Axis III - general medical conditions,
Axis IV - psychosocial/environmental problems and
Axis V - global assessment of functioning(GAF)

What is the primary and secondary burden to mental illness (disease)

primary- suffering the symptoms
secondary- carrying the label and facing judgement

how can the stigma of mental illness be reduced?

education of Public to increase respect and decrease stereotyping

*core mental health profession that employs purposeful use of self as its art and a wide range of nursing, psychosocial, and neurobiological theories and research evidence as its science

psychiatric mental health nursing

Who is considered the mother or psychiatric nursing

Hildregard Peplau

What are the Models of Treatment

Evidence-based practice
Recovery- empowering those with mental illness to find meaning and satisfaction, realize potential and function at maximum level of independence

What are the benefits of evidence-based practice

aids in effective decision making
helps prevent habitual practice
enhances clinical performance

Process for integrating EBP

Ask a question
Acquire literature
Appraise the literature
Apply the evidence
Assess the performance

Evidence Based Guidelines for Practice

Internet mental health resources- short list of pop.MH sites
clinical practice guidelines- identify, appraise, and summarize the best evidence about prevention, diagnosis, prognosis, therapy and other knowledge
clinical algorithms- step by step guideline in a flow chart
clinical/critical pathways- usually specific to institution

The "art" of nursing

patient advocate

seven signs of mental health

control over behavior
appraisal of reality
effectiveness in work
healthy self-concept
satisfying relationships
effective coping strategies

mental health:

is presented through a linear (continuum) paradigm that depicts optimal mental wellness to extreme mental disorder

mental disorder:

implies a distinction between mental and physical disorders
**there is much "physical" in 'mental' disorders and much 'mental' in 'physical' disorders

factors affecting severity and progress of mental illness

support systems, family influence, developmental events, cultural beliefs and values, health practices, negative influences


definitions and classifications of specific disorders

DSM-IV-TR uses:

multiaxial system for diagnosis
classifies mental disorders
evaluates individuals from numerous cultural/ethnic groups
establishes criteria for classification of mental disoders

Axis I

mental disorders
-focus of treatment

Axis II

personality disorder and mental retardation

Axis III

general medical conditions
-relevant to Axis I diagnosis

Axis IV

psychosocial and enviromental problems

Axis V

Global Assessment of Functioning (GAF)

Freud's theory is also called ____ theory.


In Freud's theory, the part of the mind that functions in the irrational and emotional; the primitive mind; pleasure principle


In Freud's theory, the part of the mind that functions with the rational part of the mind; reality principle


In Freud's theory, the part of the mind that represents morals and principles; conscience



(oral) birth - 1 1/2 yr
pleasure-pain principle
mouth primary source of pleasure
task- develop a sense of trust that needs will be met


(anal)- 1 1/2- 3 yr
reality principle- learning to defer pleasure
focus on toilet training- retaining/ letting go; power struggle


(phallic) 3-7 yrs
reward and punishment principle
task: develop sexual identity through identification with same sex parent

Freud's Latency

De-sexualization Libido diffused
task; sexuality is repressed; learn to form close relationships with same sex peers

Freud's Genital Phase

Adolescence- 13-20yrs
very ambivalant and labile, seeking life goals
dependence vs independence
task; form close relationships with opposite sex

methods of psychoanalytic therapy

free association and dream analysis


pt projects feelings onto therapist


therapist have unconscious emotional response to patient

interpersonal theory focuses on

conflicts of adolescence

behavioral therapy

systematic desensitization- classical conditioning, first promoting relaxation and then gradually facing a anxiety-provoking stimulus - Agaraphobia (fear of open places)
aversion therapy- classical and operant conditioning and used to eradicate unwanted habits by assoc. unpleaseant consequences with them- Antabuse- alcohol become Extremely ill
biofeedback control responses like breathin rates, heart rates, blood pressure, brain waves and skin temp

cognitive-behavioral therapy

modify neg thoughts, feeling and behaviors

cognitive theory Piaget stages

sensorimotor (0-2 yr) reflex acitivity to imagining and solving problems thru senses and movement
preoperational (2-7yr) learns to think in terms of past, present and future
cognitive operational (7-11yr) able to classify order, and sort facts
formal operational (11-16yr) able to think abstractly and logically

Psychosocial theory Erikson

Trust vs. mistrust (0-1yr)
Autonomy vs. shame/doubt (1-3yr)
Initiative vs. guilt (3-6yr)
Industry vs inferiority (7-11yr)
Identity vs. role confusion (12-18yr)
Intimacy vs. isolation (young adulthood)
Generativity vs. stagnation (middle adulthood)
Integrity vs. despair (late life)

Maslows hierarchy of neeeds

self-transcendent needs(cognitive needs)
self-actualization needs
esteem needs- competency, achievement, & esteem from others
love & belonging- relationships and love
safety- security, protection, stability, structure,order,& limits
physiological- food, water, O2, elimination, rest, and sex

Peplau focus was on

interpersonal relationships and stages of nurses-patient relationship

stages of nurses-patient relationship

preintoduction-before pt and nurse meet, receive shift assissment
orientation- pt and nurse meet and introduction, and contract for time(how long they will meet)
working phase- 1st part- pt identify with the nurse, and trust and raport are maintained. pt identify problems but resist working on them 2nd part- growth is evident
termination- feelings of loss and anxiety. goals are achieved and pt is stronger and able to stand alone

Peplau four levels of anxiety

mild- healthy, day to day, alertness
moderate- heightened sense of awareness, like taking exam
severe- problem, interferes with clear thinking and perceptual field is deminished, vomiting, diarrhea
panic- overwhelming and results in paralysis or dangerous hyperactivity, cannot communicate, function, or follow directions

role of nursing in group therapy

basic level RN: teach psychoeducational groups
advanced practice RN lead psychotherapeutic groups

therapeutic milieu

setting for mental health care combining healthy environment and social structure

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