Module 069

PYRAMID POINTS MODULE 69:
Mental Health
Disorders
COPYRIGHT © 2017, ELSEVIER INC. ALL RIGHTS RESERVED.
Slide 1

MENTAL HEALTH:
Mental Health Disorders
PYRAMID POINTS
I. Anxiety
 Description
 A response to stress that includes feelings of apprehensiveness,
uneasiness, uncertainty, or dread
 Types of anxiety
 Normal
 Healthy type of anxiety
 Acute
 Precipitated by imminent loss or change that threatens one's
sense of security
 Chronic
 Anxiety that persists as a characteristic response to daily
activities
Slide 2

MENTAL HEALTH:
PYRAMID POINTS
I. Anxiety (continued)
 Levels of anxiety
 Mild
 Can be motivating, produce growth, enhance creativity, and
increase learning.
 Moderate
 Learning and problem-solving still occur.
 Severe
 Individual needs direction to focus.
 Panic
 If prolonged, can lead to exhaustion and death
Slide 3

MENTAL HEALTH:
PYRAMID POINTS
 Interventions: General nursing measures
 Recognize the anxiety.
 Establish trust.
 Protect client.
 Do not criticize coping mechanisms.
 Provide creative outlets.
 Decrease stimuli in environment and provide calm and quiet
environment.
 Interventions: Mild to moderate levels
 Help client identify anxiety.
 Encourage discussion.
 Encourage problem solving.
 Encourage gross motor exercise.
Slide 4

MENTAL HEALTH:
PYRAMID POINTS
 Interventions: Severe to panic levels
 Reduce anxiety quickly.
 Use calm manner.
 Remain with client.
 Minimize environmental stimuli.
 Provide gross motor activity.
 Administer medications as prescribed.
Slide 5

MENTAL HEALTH:
PYRAMID POINTS
II. Generalized Anxiety Disorder
 Description
 Unrealistic anxiety about everyday worries that persists over
time and is not associated with a mental health or medical
disorder
 Assessment
 Restlessness, inability to relax
 Chronic muscular tension
 Chronic fatigue and sleep problems
 Client focused on physical discomfort
Slide 6

MENTAL HEALTH:
PYRAMID POINTS
II. Generalized Anxiety Disorder (continued)
 Unexpected and expected panic disorder
 Sudden onset of feelings of intense apprehension and dread
 Choking sensation
 Labored breathing
 Pounding heart
 Chest pain
 Fear of dying or being trapped
 Interventions
 Remain with client.
 Attend to physical symptoms.
 Administer medications as prescribed.
Slide 7

MENTAL HEALTH:
PYRAMID POINTS
III. Posttraumatic Stress Disorder
 Description
 After experiencing a psychologically traumatic event, the
individual reexperiences the event and has recurrent and intense
dreams and flashbacks
 Stressors
 Natural disaster
 Terrorist attack
 Combat experience
 Accidents
 Victims of rape, crime, or violence
 Sexual, physical, and emotional abuse
 Flashbacks of event
Slide 8

MENTAL HEALTH:
PYRAMID POINTS
III. Posttraumatic Stress Disorder (continued)
 Assessment
 Sleep disturbances and nightmares
 Flashbacks of event
 Poor concentration and avoidance of activities that trigger
recollection of event
 Emotional numbness, detachment, depression
Slide 9

MENTAL HEALTH:
PYRAMID POINTS
III. Posttraumatic Stress Disorder (continued)
 Interventions (Box 69-1)
 Assist client to recognize association of feelings and trauma
experience.
 Assist client to express feelings and develop adaptive coping
mechanisms.
 Hypnotherapy or systematic desensitization may be
recommended.
 Support groups
Slide 10

MENTAL HEALTH:
PYRAMID POINTS
IV. Specific Phobia
 Description
 An irrational fear of an object or situation that is associated with
panic-level anxiety if the object or situation cannot be avoided
 Types (Box 69-2)
 Acrophobia
 Agoraphobia
 Astraphobia
 Claustrophobia
 Hematophobia
 Hydrophobia
 Monophobia
Slide 11

MENTAL HEALTH:
PYRAMID POINTSIV. Phobias (Continued)
 Types (continued)
 Mysophobia
 Nyctophobia
 Pyrophobia
 Social phobia
 Xenophobia
 Zoophobia
 Interventions
 Remain with client when activity level is high.
 Identify basis of anxiety.
 Allow client to verbalize feelings.
 Teach relaxation techniques.
 Desensitization may be recommended.
Slide 12

MENTAL HEALTH:
PYRAMID POINTSV. Obsessive-Compulsive and Related Disorders
 Obsessions
 Preoccupation with persistent intrusive thoughts and ideas
 Obsessive thoughts can involve issues of violence, aggression,
sexual behavior, orderliness, or religion and uncontrollably can
interrupt conscious thoughts and the ability to function.
 Compulsions
 Performance of rituals or repetitive behaviors designed to prevent
some event, divert unacceptable thoughts, and decrease anxiety
 Related disorders
 Hoarding disorders, excoriation disorder, substance/medication-
induced obsessive-compulsive and related disorder, obsessive-
compulsive and related disorder due to another medical condition,
trichotillomania
Slide 13

MENTAL HEALTH:
PYRAMID POINTS
V. Obsessive-Compulsive and Related Disorders (continued)
 Compulsive behavior patterns (behaviors or rituals)
 Decrease anxiety, patterns associated with obsessive thoughts;
patterns neutralize the thought
 Ensure basic needs are met.
 Identify situations that precipitate the compulsive behavior.
 Encourage client to express feelings.
 Do not interrupt the compulsive behavior; set limits and protect
client from harm.
 Establish written contract that will assist client to decrease frequency
of behaviors.
Slide 14

MENTAL HEALTH:
PYRAMID POINTS
VI. Somatic Symptom and Related Disorders
 Description
 Characterized by persistent worry or complaints regarding
physical illness without supporting physical findings
 May unconsciously somatize for secondary gains such as
increased attention and decreased responsibilities
 Conversion disorder
 Expression of psychological conflict or need
 Interventions
 Assist client to relate feelings and conflicts to physical
symptoms.
 Discourage verbalization about physical symptoms.
 Allow specific time period to discuss physical complaints.
 Convey understanding that physical symptoms are real to client.
 Encourage diversional activities.
Slide 15

MENTAL HEALTH:
PYRAMID POINTS
VII. Dissociative Disorder
 Description
 A disruption in integrative functions of memory, consciousness,
or identity associated to extremely traumatic event
 Dissociative identity disorder (DID) (formerly called multiple
personality disorder)
 Dissociation used as method of distancing and defending one’s
self from anxiety and traumatizing experiences
 Dissociative amnesia
 Client has loss of all or partial memory about past life.
 Depersonalization/derealization disorder
 Altered self-perception in which one’s own reality is temporarily
lost or changed
Slide 16

MENTAL HEALTH:
PYRAMID POINTS
VII. Dissociative Disorder (continued)
 Interventions
 Encourage verbal expression of feelings and identify sources of
conflict.
 Explore methods of coping and focus on client’s strengths.
 Implement stress-reduction techniques.
 Psychotherapy to integrate dissociated aspects of personality or
memory and to expand self-awareness
Slide 17

MENTAL HEALTH:
PYRAMID POINTS
VIII. Mood Disorders
 Bipolar and related disorders
 Characterized by episodes of mania and depression with periods
of normal mood and activity in between
 Interventions for mania (Box 69-5)
 Maintain safe environment.
 Provide high-calorie finger foods, fluids.
 Provide physical activities, outlets for tension.
 Avoid competitive games.
 Provide gross motor activities.
 Supervise self-administration of medication.
 Depression: See Section IX
Slide 18

MENTAL HEALTH:
PYRAMID POINTS
IX. Depression
 Description
 Affects feelings, thoughts, and behaviors
 Treatment includes counseling, antidepressants,
electroconvulsive therapy.
 Can be mild, moderate, major
 Mild depression
 Feelings of sadness, less alert, irritability
 Moderate depression
 Despondent and gloomy, helplessness, powerlessness, difficulty
in concentrating, sleep disturbances
 Major depression
 Despair and hopelessness, flat affect, social withdrawal
Slide 19

MENTAL HEALTH:
PYRAMID POINTS
IX. Depression (continued)
 Interventions for depression (Box 69-6)
 Assess for suicidal ideation and provide safety.
 Assist with activities of daily living and attend to physiological
needs (e.g., nutrition, rest).
 Avoid presenting complex decision-making situations to client.
 Provide structured environment and activities in which client can
achieve success.
Slide 20

MENTAL HEALTH:
PYRAMID POINTSX. Electroconvulsive Therapy (ECT)
 Description
 Used to treat depression (not a cure)
 Consists of inducing a brief seizure of slight movement of
hands, feet, or toes by passing electrical current through
electrodes attached to the temples
 Before procedure
 Informed consent
 Vital signs
 NPO status
 Removal of hairpins, contact lenses, dentures
 Usual medication before procedure as prescribed
 During procedure
 Maintain airway.
 Provide safety during seizure.
Slide 21

MENTAL HEALTH:
PYRAMID POINTS
X. Electroconvulsive Therapy (ECT) (continued)
 After procedure
 Maintain airway.
 Vital signs
 Orient client.
 Assess gag reflex before administering anything via oral route.
 Potential side effects
 Memory deficits may occur, but usually client recovers
completely.
Slide 22

MENTAL HEALTH:
PYRAMID POINTSXI. Schizophrenia
 Description
 Characterized by psychotic features (hallucinations and delusions),
disordered thought processes, and disrupted interpersonal
relationships
 Disturbances of mood, behavior, and thought processes occur.
 Assessment (Figure 69-1)
 Physical characteristics
 Motor activity (Box 69-8)
 Emotional characteristics
 Mistrust, blunted, flat, or inappropriate
 Compulsive rituals
 Attempt to solve conflicting feelings
 Overcompliance
 Only doing what another person instructs exactly
Slide 23

MENTAL HEALTH:
PYRAMID POINTS
XI. Schizophrenia (continued)
 Assessment (continued)
 Affective disturbances
 Abnormal thought processes (Box 69-9)
 Types of delusions (Box 69-10)
 Perceptual distortions
 Illusions and hallucinations of senses
 Language and communication disturbances (Box 69-12)
Slide 24

MENTAL HEALTH:
PYRAMID POINTS
 Interventions: Active hallucinations
 Protect the client and ensure safety for self or others.
 Accept, do not joke about or judge, client’s behavior.
 Respond verbally to anything real that client talks about.
Slide 25

MENTAL HEALTH:
PYRAMID POINTS
 Interventions: Delusions
 Interact based on reality.
 Encourage expression of feelings.
 Do not argue with client about the delusion.
 Initiate activities on a one-on-one basis.
Slide 26

MENTAL HEALTH:
PYRAMID POINTSXII. Personality Disorders
 Description
 Personality disorders include various inflexible maladaptive behavior
patterns or traits that may impair functioning and relationships.
 Characteristics
 Poor impulse control
 Mood characteristics
 Impaired judgment
 Impaired reality testing
 Impaired object relations
 Impaired self-perception
 Impaired thought processes
 Impaired stimulus barrier
Slide 27

MENTAL HEALTH:
PYRAMID POINTSXII. Personality Disorders (continued)
 Personality disorder types
 Cluster A
 Odd, eccentric types—schizoid, schizotypal, and paranoid
 Inability to form warm, close social relationships
 Display unusual thoughts, perceptions, speech, and behavior
patterns
 Suspiciousness and mistrust of others
 Cluster B
 Dramatic, emotional, erratic types—histrionic, narcissistic,
antisocial, and borderline
 Overly dramatic and intensely expressive behavior
 Increased sense of self-importance with fantasies
 Irresponsible and antisocial behavior, selfishness, aggressiveness,
and irritability
 Impulsive and unpredictable behavior
Slide 28

MENTAL HEALTH:
PYRAMID POINTS
XII. Personality Disorders (continued)
 Personality disorder types (continued)
 Cluster C
 Anxious, fearful types of personality disorders—obsessive-
compulsive personality, avoidant, and dependent
 Difficulty expressing warm and tender emotions, perfectionism
 Social withdrawal and sensitivity to potential rejection
 Intense lack of self-confidence, low self-esteem
 General interventions for clients with personality disorder
 Maintain safety against self-destructive behaviors.
 Encourage client to discuss feelings rather than act on them.
 Discuss expectations and consequences that follow certain
behaviors.
 Assist client to deal directly with anger.
 Set and maintain limits to decrease manipulative behavior.
 Provide praise for positive behaviors.
Slide 29

MENTAL HEALTH:
PYRAMID POINTSXIII. Neurodevelopmental Disorders
 Autism spectrum disorder: See Chapter 42.
 Attention-deficit/hyperactivity disorder: See Chapter 42.
XIV. Neurocognitive Disorders
 Dementia and Alzheimer’s disease (Box 69-15)
 Interventions
 Orient client to environment frequently.
 Help client maintain independence.
 Use constant encouragement with client with steps-by-steps.
 Wandering
 Provide close supervision; use identification bracelets.
 Communication disorders
 Adapt to communication level of client; use calm voice.
 Ask one question at a time, and give one direction at a time.
Slide 30

MENTAL HEALTH:
PYRAMID POINTS
XIV. Neurocognitive Disorders (continued)
 Dementia and Alzheimer’s disease (continued)
 Impaired judgment
 Maintain safe environment for client; reduce hot water heater
temperature.
 Altered thought processes
 Orient client frequently.
 Maintain familiar routines; make tasks simple.
 Altered sleep patterns
 Allow client to wander in safe place until becomes tired.
 Agitation
 Reassure client, approach client slowly and calmly from the
front, and speak, gesture, and move slowly.
 Use touch gently.
Slide 31

MENTAL HEALTH:
AUDIENCE RESPONSE SYSTEM
QUESTION
(FOR USE WITH ICLICKER)A client is admitted to the mental health unit with a diagnosis
of depression. The nurse should develop a plan of care for
the client that includes which intervention?
1.Encouraging quiet reading and writing for the first few days
2.Identification of physical activities that will provide exercise
3.No socializing activities, until the client asks to participate
in milieu
4.A structured program of activities in which the client can
participate
Slide 32

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Module 069