NR 326 Exam 2
Student Name
Chamberlain University
NR-304: Health Assessment II
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Date
NR 326 Mental Health Nursing Exam 2 Overview
Psychotherapy Overview
Psychotherapy is an important intervention in mental health nursing, designed to promote behavioral and emotional change. It uses various therapeutic approaches, such as cognitive therapy, behavioral therapy, and integrated models like cognitive-behavioral therapy (CBT) and dialectical behavior therapy (DBT), to help clients manage psychological disorders effectively.
Cognitive Therapy
Cognitive therapy is founded on the cognitive model, which suggests that an individual’s thoughts have a direct influence on their emotions and behaviors. The goal is to identify and correct distorted thinking patterns that contribute to emotional distress. It is widely applied in the treatment of depression, anxiety, eating disorders, and other mental health conditions, encouraging clients to reassess their interpretations of life events (Beck, 2011).
Behavioral Therapy
Behavioral therapy, developed in contrast to psychoanalytic theories, is based on the idea that behaviors are learned and can be unlearned or modified through reinforcement. According to theorists such as Pavlov, Watson, and Skinner, maladaptive behaviors are responses to negative experiences and can be changed through structured interventions without examining underlying causes.
Key Behavioral Therapy Techniques
| Technique | Description | Application in Mental Health |
|---|---|---|
| Modeling | Learning behaviors by imitating role models | Improves interpersonal interactions in acute care |
| Systematic Desensitization | Gradual exposure to anxiety-provoking stimuli with relaxation techniques | Effective for phobias and anxiety disorders |
| Aversion Therapy | Pairing undesirable behavior with unpleasant stimuli | Applied in substance use, self-harm, or aggressive behaviors |
| Flooding | Intense exposure to anxiety-inducing situations | Reduces anxiety in conditions such as claustrophobia |
| Response Prevention | Blocking compulsive behaviors to reduce anxiety | Common in obsessive-compulsive disorder (OCD) |
| Thought Stopping | Interrupting negative thought patterns using verbal or behavioral cues | Improves self-regulation in intrusive thoughts |
| Time-Out | Removing the client temporarily from reinforcing environments | Used in behavioral modification for both children and adults |
| Validation Therapy | Recognizing and affirming feelings regardless of accuracy | Helpful in managing neurocognitive disorders |
Cognitive-Behavioral and Dialectical Behavior Therapy
CBT integrates cognitive and behavioral strategies to help clients understand the connections between their thoughts, emotions, and actions. DBT, a form of CBT, is particularly effective for individuals with personality disorders and emphasizes emotional regulation, distress tolerance, and mindfulness.
Dissociative Disorders
Dissociative disorders involve a disconnection between thoughts, identity, consciousness, and memory, often resulting from severe stress or trauma.
| Disorder | Characteristics |
|---|---|
| Dissociative Identity Disorder (DID) | Presence of two or more distinct personality states, often linked to childhood trauma |
| Depersonalization-Derealization Disorder | Feeling detached from oneself or the environment, resulting in altered perception |
| Dissociative Amnesia | Inability to recall essential personal information, typically trauma-related |
Common predisposing factors include psychological trauma, abuse, and overwhelming stress. Treatment aims to strengthen coping skills and restore a sense of continuity and reality (APA, 2013).
Somatic Symptom and Related Disorders
Somatic Symptom Disorder
Somatic symptom disorder involves multiple physical complaints without a medical explanation, accompanied by emotional distress and significant preoccupation with symptoms that impair daily functioning.
Assessment Tool: Patient Health Questionnaire 15 (PHQ-15) evaluates severity based on symptoms such as abdominal pain, back pain, headaches, chest pain, joint or menstrual problems, fatigue, dizziness, sleep disturbances, and gastrointestinal issues.
Illness Anxiety Disorder
This disorder involves persistent worry about having a serious illness despite medical reassurance. Individuals may either seek frequent medical attention (care-seeking type) or avoid it entirely (care-avoidant type). Childhood abuse and comorbid psychiatric disorders are common risk factors.
Conversion Disorder
Conversion disorder presents with neurological symptoms, such as paralysis or blindness, without a medical cause. Symptoms often follow psychological stress. A subtype, pseudocyesis, involves false pregnancy, usually after emotional trauma.
Factitious Disorder
Factitious disorder is the deliberate fabrication of symptoms to adopt the sick role, which may be imposed on oneself or another person (formerly called Munchausen syndrome by proxy).
Grief and Maladaptive Grieving
Grief is an individualized process that may occur before a loss (anticipatory grief) or persist beyond expected patterns. The Kübler-Ross model outlines five stages: denial, anger, bargaining, depression, and acceptance. Maladaptive grief can take the form of exaggerated or prolonged symptoms, stagnation in denial or anger, and emotional pain that prevents recovery.
Neurocognitive Disorders (NCDs)
NCDs are conditions involving cognitive decline that interfere with daily functioning, categorized as mild or major.
Delirium vs. Dementia
| Feature | Delirium | Major NCD (Dementia) |
|---|---|---|
| Onset | Sudden | Gradual |
| Duration | Short-term, reversible | Chronic, progressive |
| Causes | Infection, dehydration, medications | Alzheimer’s disease, vascular pathology |
Common symptoms include impaired judgment, personality changes, wandering, incontinence, and deficits in language and memory.
Etiological Subtypes of NCD
| Subtype | Cause |
|---|---|
| Alzheimer’s | Neurodegeneration |
| Vascular NCD | Stroke-related damage |
| Lewy Body Dementia | Abnormal protein deposits |
| Parkinson’s Disease | Dopaminergic degeneration |
| Huntington’s Disease | Genetic defect |
| HIV-related NCD | Viral neurological involvement |
Defense mechanisms may include denial of memory loss, confabulation to maintain self-esteem, and perseveration to avoid confusion.
Suicide in Mental Health
Suicide as a Behavior
Suicide is an intentional act of ending one’s life and is most often linked to psychiatric conditions, especially major depression. Over 90% of individuals who die by suicide have a diagnosable mental disorder. Psychological factors include hopelessness, shame, guilt, isolation, and unresolved trauma.
Comprehensive Suicide Risk Assessment
The nursing assessment identifies the presence and severity of suicidal ideation, distinguishing between thoughts, plans, and attempts. It is important to evaluate the intent behind self-injurious behaviors and to assess the client’s support system, psychiatric history, significant life events, and access to means.
| Assessment Criteria | Key Focus Areas |
|---|---|
| Suicidal Ideation | Presence of thoughts, plans, previous attempts |
| Psychiatric/Medical | History of depression, substance use, or chronic illness |
| Social Connections | Strength and availability of interpersonal support |
| Symptoms and Diagnosis | Current psychiatric or medical conditions |
| Risk Indicators | Verbal and behavioral warning signs, access to means, concrete plans |
Risk Factors Identified by ATI
| Risk Factor Type | Examples |
|---|---|
| Gender and Age | Males, particularly older adults, have higher completion rates |
| Identity and Occupation | LGBTQ+ individuals, military veterans |
| Comorbid Conditions | Depression, bipolar disorder, substance use, schizophrenia |
| Life Events | Job loss, declining health, bereavement |
| Biological | Family history, chronic illness (e.g., cancer, AIDS, MS) |
| Psychosocial | Hopelessness, trauma, interpersonal difficulties |
| Cultural | Highest rates among American Indian and Alaskan Native populations |
| Environmental | Access to firearms, inadequate mental health care, unemployment |
Pharmacological Interventions
| Medication Class | Examples | Indications |
|---|---|---|
| SSRIs | Citalopram, Fluoxetine, Sertraline | Depression, suicidal ideation |
| Benzodiazepines | Diazepam, Lorazepam | Anxiety, panic disorders |
| Mood Stabilizers | Lithium | Bipolar disorder |
| Second-Gen Antipsychotics | Risperidone, Olanzapine | Bipolar disorder, schizophrenia, adjunct in depression |
Electroconvulsive Therapy (ECT)
ECT is a treatment option when other interventions are ineffective, especially for severe depression, bipolar mania, or schizophrenia. The procedure involves delivering electrical currents under anesthesia to induce a controlled seizure, which can relieve symptoms.
| Component | Purpose |
|---|---|
| Anticholinergics | Reduce secretions |
| Anesthetics | Prevent discomfort |
| Methohexital/Propofol | Induce muscle relaxation |
Client and family education should cover pre- and post-procedure care, and possible side effects such as nausea, confusion, headaches, and temporary memory loss.
Depression: Types and Risk Factors
| Disorder Type | Characteristics |
|---|---|
| Major Depressive Disorder | Persistent low mood, loss of interest, symptoms >2 weeks, no mania |
| Dysthymia | Chronic mild depression lasting more than two years |
| Postpartum Depression | Irritability, fatigue, sleep disturbance, concerns about infant care |
Risk factors include hormonal imbalances, neurological changes, medication side effects, and cognitive distortions such as learned helplessness.
Bipolar Disorders
| Type | Description |
|---|---|
| Bipolar I | Manic episodes with or without depression |
| Bipolar II | Hypomanic episodes alternating with major depressive episodes |
| Cyclothymic | Chronic mood fluctuations not meeting full bipolar criteria |
Mania involves elation, hyperactivity, and impulsivity, whereas depressive episodes are characterized by hopelessness, suicidal ideation, and psychomotor changes.
NR 326 Exam 2
Trauma and Stress-Related Disorders
| Disorder | Key Features |
|---|---|
| PTSD | Flashbacks, emotional numbness, hyperarousal, potential for long-term disability |
| Acute Stress Disorder | Similar to PTSD but lasting 3 days to 1 month after trauma |
Nursing care should emphasize empathy, suicide risk assessment, and facilitating access to therapeutic and medical support.
Anxiety and Related Disorders
| Disorder Type | Characteristics |
|---|---|
| Phobias | Irrational fears causing avoidance or panic |
| Panic Disorder | Sudden episodes with physical symptoms such as palpitations and chest pain |
| Generalized Anxiety | Excessive worry lasting more than six months, with fatigue and poor concentration |
| Body Dysmorphic Disorder | Obsessive preoccupation with perceived physical flaws |
Obsessive-Compulsive Disorder (OCD)
OCD involves obsessions (intrusive thoughts) and compulsions (ritualistic behaviors to relieve distress). Both psychotherapy and SSRIs are common treatments.
References
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). Washington, DC: Author.
ATI Nursing Education. (2020). Mental health nursing review module (10th ed.). Assessment Technologies Institute.
Townsend, M. C. (2020). Psychiatric mental health nursing: Concepts of care in evidence-based practice (10th ed.). F.A. Davis Company.
U.S. Department of Health & Human Services. (2022). Suicide prevention. National Institute of Mental Health. https://www.nimh.nih.gov/health/topics/suicide-prevention
Centers for Disease Control and Prevention. (2022). Preventing suicide. https://www.cdc.gov/suicide/index.html
NR 326 Exam 2
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
Beck, J. S. (2011). Cognitive behavior therapy: Basics and beyond (2nd ed.). Guilford Press.
Townsend, M. C. (2020). Psychiatric mental health nursing: Concepts of care in evidence-based practice (9th ed.). F.A. Davis.