Question

Complete table below to include behaviours of mental health condition, treatment and nursing management. Complete table below to include behaviours of mental health condition, treatment and nursing management.

Mood disorders

Personality disorders

Anxiety disorders

Psychoses

Organic disorders

Panic disorder

Social phobia and specific phobias

Obsessive-compulsive disorder

Post-traumatic stress disorder

Depression

Bipolar disorder

Eating disorder

Borderline personality disorder

Schizophrenia

Dementia

Delirium

Answer 1

Mood disorders

Behaviours of mood disorders:

Persistent mild depression, persistent instability of mood between mild depression and mild elation(cyclothymia)

Treatment includes:

Tricyclic Antidepressants such as imipramine

Newer antidepressant

Selective serotonin reuptake inhibitors such as fluoxetine, sertraline

SNRIs such as venalafaxine, duloxetine

Lithium

Electroconvulsive therapy

Antipsychotics such as Risperidone, haloperidol, olanzapine

Mood stablizers such as sodium valproate, carbamazepine, benzodiazepines.

Nursing management includes:

● providing for safety: promoting appropriate behaviour.

●Meeting psychological needs: provide a quiet environment without noise or other distractions.

●promoting appropriate behaviour: direct their need for movement into social activities.

Personality disorders:

Behaviours of personality disorders:

Paranoid : suspicion and distrust of others

Schizoid: detach from social relationships

Schizotypal: acute discomfort in relationships

Antisocial: disregard for rights of others, rule and laws

Bordeline: unstable relationships

Histornic: excessive emotionality and attention seeking

Avoidant: social inhibition

Passive aggressive

Treatment includes:

●psychotherapy: to improve perceptions of and responses to social and environmental stresses.

●pharmacological therapy includes antidepressants such as SSRIs, Anticonvulsents such as diazepam, antipsychotics.

Nursing management includes;

● promoting client's safety: The nurse must always seriously consider suicidal ideation with the presence of a plan, access to means for enacting the plan, and self harm behavours and institute appropriate interventions.

● promoting therapeutic relationship: Regardless of the clinical setting, the nurse must provide structure and the limit settings in the therapeutic relationships; in a clinic setting, this may means seeing the client for scheduled appointments of a predetermined length rather than whenever the client appears and demands the nurse's immediate attention.

● Establishing boundaries in relationships: The nurse must be quite clear about establishing the boundaries of the therapeutic relationship to ensure that neither the client's nor the nurse's boundaries are violated.

● Teaching effective communication skills: It is important to teach basic communication skills such as eye contact, active listening, taking turns talking, validating the meaning of another's communication.

● Helping clients to cope and to control emotions: The nurse can help the clients to identify their feelings and learn to tolerate them without exaggerated responses.

● Reshaping thinking patterns: cognitive restructuring is a technique useful in changing negative thoughts and feelings to postive patterns of thinkings. Thought stopping is a technique to alter the process of negative of self critical thought patterns.

Anxiety disorders:

Behaviours of anxiety disorders

Hypervigilence, hyperventilation, tremors, headache, aching muscles, sleep disturbances, night tremors.

Treatment

Medical management includes anxiolytics such as benzodiazepines( clonazepam, diazepam) Azapirones( buspirone,gapirone) sedative antihistamines, beta blockers( propanolol) carbamates

Nursing management includes

● Maintain a calm or non threatening manner.

● Establish and maintain a trusting relationships by listening to the client, displaying warmth, amswering questions directly, offering unconditional acceptance.

● Remain with the client at all times when levels of anxiety are high; reassure client of his safety and security.

● Move the client to a quiet area with minimal stimuli such as small room, or seculsion area.

● provide reassurance and comfort.

● Educate patient and/or so that anxiety disorders are treatable

● Maintain awareness of your own feelings and level of discomfort

● Avoid asking or making the client to make choices.

●Adminster SSRI's as ordered.

psychosis

Behaviours of psychosis

●failure of reality testing

●Creation of new realities like delusions, hallucinations

Treatment

Medical management includes;

■Phenothiazine such as chlorpromazine, thioridaxine, Fluphenazine

■benzodiazepines  such as haloperidol, penfluridol, Trifluperidol

■Thioxanthenes such as Flupenthixol.

■Atypical antipsychotic such as clozapine, Risperidone, Quetiapine, Ziprasidone

Nursing management includes

To protect the client from hrming herself by removing the items.

Ensure the safety of the client.

Provide frequent rest periods to prevent exhaustion.

Ask family to stay with the client. This helps the client to prevent accidental falling or pulling out tubes.

Organic disorders

Behaviours of organic disorder

Hallucinations that may be visual or auditory

Delusions

Personality changes like lack of interest in day today activities, self centered, withdrawn, decreased self care

Memory impairment- recent and short term memory is critically affected.

Cognitive impairment- disorientation, poor judgement, decreased attention span, confabultion

Treatment

Medical management includes antipsychotics like olanzapine

Vitamin supplements

Zolpidem for insomnia

Antidepressants for depression

Tacrine for memory deficits

Enkephalins to slow disease progress.

Oxygen for hypoxia

Nursing management includes

Adminster prescribed medications. Serve medication according to time and dosage to deal with hallucination.

Manage the clients confusion.

Speak to client in a calm manner in a clear low voice and use simple sentence.

Allow adequate time for client to understand sentence and respond.

Provide orienting verbal clues when talking with the client.

Use supportive touch if appropriate.

Panic disorders

Behaviours of panic disorders

Upset stomach and nausea, sweating, dizziness, heart attack, swallow breathing, angina pectoris, fear of death

Medical management includes includes SSRIs such as sertraline, paroxetine, fluoxetine,

Benzodiazepines such as alprazolam, clonazepam, lorazepam

Other drugs includes tricyclic antidepressants, SNRI- venlafaxine; SSRI- excitalopram, citalopram

Nursing management includes

●Maintaining a calm environment

●Establish and maintain a trusting relationships by listening to the client

● Remain with the client at all times during panic episodes.

●provide reassurance and comfort measures

● support the client' s defends initially.

●Avoid forcing the client to make choices

● Encourage the clients participation in relaxation exercise such as deep breathing, muscle relaxation, meditation

Social phobia and specific phobia

Behaviours of phobias includes

The fear is out of propotions to demands of the situation

It cannot be explained or reasoned

It is beyond voluntary control

The fear leads to avoidance of feared situation

Physical symptoms includes sweating, trembling, choking sensation, fainting, chest pain.

Treatment

Supportive therapy

Individual psychotherapy

Behavioral therapy

Systemic desentization

Implosion therapy

Regroup/ family therapy

Medical management includes anxiolytics such as benzodiazepines, antihypertensive agents like beta blockers- propanolol, atenolol; antidepressants like tricyclic imipramine, MAO inhibitors.

Phenelzine

SSRIs are the first line treatment of social phobia.

Nursing management includes

Encourage the client to express the feelings without discussing the phobic situations specifically

Access the client to distinguish between the actual phobic trigger and problems related to avoidance behaviours

Encourage the client to practice relaxation until he/she is successful.

Explain systematic desensitization thoroughly to the client.

Reassure the client that you will allow him or her as much as time as needed at each step.

Obsessive- compulsive disorder

Behaviours of OCD

Obsessive symptoms includes repeated doubts (eg.repeatedly wondering if they lock the door or turned off an appliance)

A need to have things in a certain order.

Thought of agression

Compulsive symptoms: washing and cleaning- excessive hand washing or house cleaning; counting- counting number of times that something is done; checking over and over.

Treatment

Treatment choices depend on the problem and patients preferences.

Common therapy includes:

Behavioral therapy

Cognitive therapy

Medication- anxiolytics such as benzodiazepines(chlordiazepoxide or diazepam); antidepressants

SSRIs

Nursing management includes

Work with patient to determine the types of situation that increase anxiety and result in ritualistic behaviour

Support patients efforts to explore the meaning and purpose of the behaviour

Provide structured schedule of activities for patient, include adequate time for completetion of rituals.

Give postive reinforcement for non ritualistic behaviour

Encourage patient to discuss conflicts.

Post traumatic stress disorder

Behaviours includes

1) Re experiencing traumatic event

Upsetting memories of the event

Flashbacks

Night mares

Feeling of intense distress when remined of the trauma

2) Avoidance and numbing

Avoiding activities, place, thoughts that remined the trauma

3) Increased anxiety and emotional arousal

Difficulty falling or staying asleep

Difficulty in concentrating

Other symptoms includes anger and irritability, suicidal thoughts and feelings

Treatment

1) Medical management includes

Antidepressant- SSRIs, TCAs

Antianxiety drugs- lorazepam

2) Psychosocial treatment:

●trauma focused cognitive therapy

● exposure therapy

● cognitive restructuring therapy

●eye movement desensitization and reprocessing therapy

●family therapy

●Group psychotherapy

Nursing management includes

Establish therapeutic non judgemental relationships

Encourage patient to verbalize feeling of distress

Help patient recognise that memory loss is a defence mechanism

Help patient deal with anxiety producing experiences

Teach and acess patient in using reality based copying strategies

Teach family members techniques for dealing with patients memory loss

Depression

Behaviours in depression includes:

●EMOTIONAL SYMPTOMS: Delusions, hallucinations, suicidal thoughts, loss of interest and pleasure in usual activities, hobbies, Anhedonia

●PHYSICAL SYMPTOMS: palpitations, fatigue with or without headache, insomnia, increased or decreased appetite.

●COGNITIVE SYMPTOMS: Decreased ablility to concentrate, slowed thinking, poor memory, slowed or retarded in physical movements.

Treatment includes

■Selective serotonin reuptake inhibitors(SSRIs) such as citalopram, paroxetine, fluoxetine

■Serotonin and norepinephrine reuptake inhibitors(SNRIs) such as venlafaxine, desvenlafaxine

TCAs such as desipramine, imipramine etc

■Electro convulsive therapy , Rehabilitation, cognitive behavioural therapy

Nursing management includes:

●provide for patients physical needs: assist with self and personal hygiene. Plan activities for times when the patients energy level peaks.

● Assume active rolein initiating communication: this can be done by sharing observation of patients behaviour speaking slowly and allowing amble time for him to respond.

●Educate patient about depression: Explain that depression can be eased by expressing feelings and engaging in pleasurable activities.

Bipolar disorders

Behaviours includes

Depression form- constantly feeling sad or worthless, sleeping too much or too little; feeling tired and having little energy; appetite and weight changes; thought of suicide

Manic form- Increase in energy level, less need for sleep, easily distracted, nonstop talking, increased self confidence

Treatments

Mood stablizing medication- drug of choice

Lithium, Depakote

Atypical antipsychotics

Antidepressants

Psychotherapy includes

1) cognitive behavioural therapy

2) Family focused therapy

3) Psychoeducation

Electroconvulsive therapy

Nursing management includes

●providing for safety: provide safe environment for the client.

●Meeting physiologic needs: provide quiet environment without noise or other distractions

●providing therapeutic communication: when communicating they may not be able to handle a lot of information at once so the nurse breaks the information into many small segments.

● Managing medications: periodic serum lithium levels are used to monitor client safety.

Eating disorder

Behaviours includes

1) Eating and food behaviour

Dieting despite being thin

Obsession with calories, fat grams and nutrition

Pretending to eat or lying about eating

Strange or secretive food rituals

2) Appearance and body image

Dramatic weight loss

Feeling fat, despite being underweight

Fixation of body image

Denies being too thin.

Treatment

Medical management includes cyproheptadine- serotonin and histamine antagonist to stimulate appetite

Tricyclic Antidepressants like amitriptyline, imipramine

SSRIs like fluoxetine

Antianxiety agents like alprazolam

Antipsychotics like chlorpromazine

MAOIs- tranylcypromine

Cognitive behavioural therapy

Nursing management includes

Monitor the weight of the client

Correction of nutritional deficiency by providing nutritional diet.

Supervise the patient during meal times and for a specified period after meal time to prevent vomiting.

Provide smaller meals and supplemental snacks as appropriate.

Monitor exercise program and set limits on physical activities.

Borderline personality disorder

The behaviours of mental health condition, treatment and nursing management is same as that of personality disorder.

Schizophrenia

Behaviours includes:

Postive symptoms like

Deviant symptoms- patient lose the touch with with reality

Hallucinations; Delusion

Negative symptoms

Deficit symptoms; apathy; anhendonia; blunted affect; poverty of speech

Cognitive symptoms

Reflect the patient 's abnormal thinking

Thought disorder

Biazarre behaviour

Treatment

Drug therapy includes antipsychotics- typical ( chlorpromazine) and atypical

Electroconvulsive therapy

Other treatments- vocational counseling, supportive psychotherapy, rehabilitation, psychosocial treatment

Nursing management includes

Establish trust and rapport: Maintain a sense of hope for possible improvement

Maximize the level of functioning: increase the personal sense of responsibility in improving functioning

Promote social skills

Maintain a safe environment with minimal stimulation

Engage patient in reality oriented activities that involve human contact

Deal with hallucinations by presenting reality

Promote compliance and monitor drug therapy

Encourage family involvement

Dementia

Behaviours includes:

Memory impairment

Impairment in abstract thinking

Impairment in language ability

Personality changes

Disorientation

Impaired ability to perform motor activities

Delusions

Treatment

Medical management includes AChE like donepezil, Rivastigmine, Galantamine and NMDA receptor antagonist like memantine

Nursing management includes

Nutritional supplements like caprylidene is indicated for clinical dietary management of metabolic processes

Encourage caregivers about patient reorientation

Orient client

Enforce with positive feedback

Avoid cultivation of false ideas

Discourage spaciousness of others.

Observe client closely

Delirium

Behaviours includes:

Altered consciousness, extreme distractiblity, disorientation, Impaired reasoning, disturbance in the sleep wake cycle, incoherent speech, impairment of recent memory

Treatment

Fluid and nutrition

Reorientation techniques: Reorientation techniques or memory cues

Supportive therapy: Environment should be stable, quiet, reinforce orientation.

Medical management includes

antipsychotics, Benzodiazepines, vitamins, hypnotics

Nursing management includes

Assess level of anxiety: assess clients level of anxiety and behaviors that indicate the anxiety is increasing

Provide sn appropriate environment

Promote patients safety

Stay calm and reassure patient

Ask assistance from others when needed.

Teach relaxation exercise