Mental illness-

  • A health problem that affects how a person feels/thinks/behaves or interacts with other people
  • Its diagnosed according to standardised criteria

 

Mental health- 

  • “A state of complete physical, mental and social well-being, and not merely the absence of disease”

 

Models of care-

− A model of healthcare is a system that’s been formally developed to organise/guide the way which health professionals deliver healthcare within a particular setting

 

Influences of a medical model include:

  • Frameworks for diagnosis
  • Treatment decisions
  • Illness/disease driven model
  • Clinical leadership
  • Focus for pharmacological research

 

Current perspectives-

Recovery principles:

  • Being able to live a meaningful life in a community with or without the presence of mental health issues
    • Real choices Ø Shows dignity and respect
    • Aware of attitudes and right Ø Partnership and communication

 

Consumer lived experience:

  • Individuals who define their own experiences in recovering from a mental health disease
  • Recovery cant be “done” to/for someone with a mental health disease by a health professional
  • Reshaping of one’s personal identity through a holistic sense of self that includes psychiatric disability

 

Family and carer lived experience:

  • Understanding a lived experience through a person who has lived through the same/similar experience   A person who hasn’t had the experience cant know what it ‘feels like’

 

 

 

Recovery-

Traditional concepts of mental illness-

  • Degenerative, life long and permanently disabling
  • Medication is the focus of recovery
  • A diagnosis of mental illness doesn’t link to successful, independent living
  • Individuals are compliant recipients of care Contemporary concepts of mental illness-    Recovery isn’t a straightforward process  
  • Treatment in the community is best-practice (a method that’s accepted due to results)
  • Practitioners recognize the need of balance b/w reducing symptoms with acceptable medication regimes
  • Inability to return to premorbid levels of functioning doesn’t conclude failure

 

 

Working within a recovery framework-

  • Providing a culture of hope
  • Promoting independence & self-motivation
  • Focus on strengths
  • Holistic and personalised care
  • Involvement of family, carers, support people and significant others
  • Community participation
  • Awareness to diversity
  • Reflection & learning

 

Recovery works when health professionals…

  • Align people with the right help at the right time
  • Refrain from judgement
  • Adopt a holistic approach
  • Treat individuals with respect, dignity & equity
  • Protect rights
  • Provide support when necessary
  • rncourage consumer to use services/support and how to access them

 

Principles of Recovery Model of Practice-

•

•

 

 Uniqueness of the

individual  Real choices  

 

 •  Attitudes and rights  •  Dignity and rights   •

•

 Partnership and communication  rvaluating recovery
• Promote recovery- hope, power, purpose, connection
• Strength based- focus on individuals strengths
• Community focused- occurs in community context
• Person driven- self determination
• Culturally responsive- sensitive to social and cultural needs
• Reciprocity in relationships- allows for enhanced sense of value
• Grounded in life context- appreciate the individuals life story/sense of self
• Socioeconomic status- identify barriers i.e. poverty, housing etc
• Relationally mediated- relationships are central
• Optimises natural support- connections and support

 

 

Stigma, stereotyping and discrimination-

Stereotypes are fixed beliefs about particular people or things

Discrimination is an unjust treatment of a group of people- but also understanding of differences

Stigma is a sign of disgrace- associated with a particular circumstance, quality or people

 

− Language often feeds directly into stigma

− Language is powerful

− Language effects others’ perceptions of the issue

 

 

Contributing factors to Mental Health & Wellbeing-

 

Mental Health Determinants:

  1. Individual attributes and behaviours
  2. Social & economic circumstances
  3. rnvironmental factors

 

Therapeutic relationship-

− When a patient feels comfortable being open and honest with the nurse linking to a positive outcome

 

− rssential elements to therapeutic relationships:

  • Empathy- recognising the emotional perspective of another person
  • Unconditional positive regard- relating and accepting the client with genuine care
  • Genuineness- honest attitude towards a person
  • Therapeutic use of self

 

 

Mental State rxam (MSr)-

− An interview between a mental health professional and a patient  − Gathers information in areas of:

  • Appearance
  • Speech & intelligence
  • Motor activity
  • Behaviour/mood
  • Alertness/cognition
  • Thoughts

− Supports the process for clinical decision making

− Helps to plan appropriate interventions

− Gathers a baseline of data regarding the individual 

Initial information:

  • Identify person (preferred name etc), age & DOB
  • Present address, phone number
  • Language spoken- do they need an interpreter?
  • Name of GP/Psychiatrist
  • Next of kin (emergency contact)
  • Serology- (TFT, LFT, U&r, CBC, Urinalysis)
  • Baseline assessments (temp, respiratory rate, pulse, BP)
  • CT scan? (undiagnosed/unsuspected brain tumour, infection?)

 

Gathering information:

  • Presenting data- negative/positive life events
  • Socioeconomic status
  • Sexual history (could some particular medications affect their libido?)
  • Alcohol & drug history
  • Medical history
  • Psychiatric history
  • Family history
  • Forensic history
  • Values, spirituality, religious

 

General appearance:

Our first appearance of the client:

− Grooming (state of clothing, cleanly dressed)

− Weight

− Clothing (appropriateness?)

− Posture

− Malodorous (is there a smell?)

− Age (do they appear older/younger then they state?)

− Tattoos, nose rings etc

− Glasses, hearing aids etc

 

Observations, Psychomotor Activity & Attitude 

  • Observe clients behaviour and their degree of arousal
  • Type & amount of movement- mannerisms and gestures (tics, grimacing, tremors)
  • Hostility, anger, agitation- verbal or physical abuse
  • Psychomotor retardation (no movement, no eye contact)
  • Social skills- positive or unpleasant habits (shy, withdrawn, overfamiliar etc)
  • rvidence of bizarre behaviours
  • Degree of cooperation with interview

 

Mood 

  • Mood is an internal state of mind that is shown through feelings/emotions   Subjective data à what does the client tell you?
  • Is what they tell you congruent? (Stating their upset/angry but displaying a big smile)- information stated doesn’t match their exterior
  • Mood states can be desired as elevated, depressed, anxious, labile, suspicious, euphoric, irritable, euthymic
  • Ask the client to rate their mood (1-10)
  • Moods can fluctuate (labile mood)
  • Consider the duration of the mood

 

  • Appetite can affect mood – increased/decreased
  • Sleep can affect mood – insomnia, hypersomnia, quality of sleep, use of sedatives, do they wake? Why?
  • Libido affects mood – increased (mania) /decreased (depression) in some instances?

Affect 

  • Its an observable, objective and visual response to a mood
  • Affect is an emotional range
  • Affect can be described in terms such as:

− Appropriate affect

− Restricted affect

− Blunted affect

− Flat affect

− Inappropriate affect (i.e. laughing at a death)

− Labile affect (i.e. changing moods)

 

Speech 

  • Speech patterns described as rate of production, quantity, quality and volume
  • Rapid, slow, pressured, hesitant, emotional, talkative, loud, dramatic, whispered, slurred, mumbled, spontaneous
  • Common terms: pressured speech, poverty speech, disorganised speech, latency of speech (pauses)

 

 

Quality of speech-

• Poverty of speech= uses few words
• Poverty of content= lack of substance in conversation
• Voluminous= uses too many words
• Articulate= well spoken
• Congruent= content makes sense/easily understood/relevant
• Monotonous= monotone
• Spontaneous= conversation flows, without prompting
• Confabulation= unconscious placement of fact with false experiences
• Disorganised= speech is unstructured (lose track of what they’re saying)

 

Perception 

  • Looking at hallucinations and illusions

 

  • Hallucinations

− A false sensory perception of things that aren’t really there   

− Hallucinations involves senses:

  • Auditory (hear)
  • Gustatory (taste)
  • Visual
  • Olfactory (smell)
  • Tactile (touch)
  • Somatic (beliefs that something is physically wrong with you) Kinaesthetic (movement)  

 

− Don’t engage in an argument about voices

− Use distraction techniques (listening to music, taking a walk)

 

  • Illusions

− A misinterpretation of a real stimuli  

− Occurs in alcohol withdrawal  

 

  • Depersonalisation

− A feeling that you’re not “yourself:

 

  • Derealisation

− Unreality/detachment to surroundings

Delusions- thought content

  • Fixed false beliefs
  • Delusions are accepted without question, regardless of reality
  • Delusions of control:

− Thought withdrawal

− Thought insertion

− Thought broadcasting  − Thought control

 

Formal thought disorder 

  • Describes the way thoughts are connected & expressed

 

Loosening of associations

− Poor progression of thoughts, ideas change rapidly

− Unrelated/unconnected ideas from one topic to another

 

Flight of ideas

− Continued flow of accelerated speech which changes abruptly

− Rapid thinking in its extreme

 

Tangentiality

− Indirect replies to questions in an irrelevant way

 

Circumstantiality

− A delay in reaching to the goal due to irrelevant details

 

Word salad

− A jumbled mixture of words

 

Neologisms 

− A new creation of a word

 

Clanging/clang association 

− Words chosen for their sound, not meaning (rhyming)

 

Punning 

− Plays on words that are clever/humorous

 

Thought blocking 

− Abrupt gaps in the flow of thought

 

Echolalia 

− Imitating words of others (mocking a person)

 

Sensorium & cognition

  • Organic brain functioning and IQ
  • Insight

− Ability to understand the reasons for & meanings of behaviour/feelings

  • Judgement

− Ability to understand consequences of actions

  • Cognition

− Issues with consciousness usually involve organic brain impatient

− Memory (remote, recent-past, recent & immediate)

− Concentration

  • Abstract & concrete thinking

ACRONYMS–

  

PAMS GOT JIMI

Perception

Affect

Mood & Memory

Speech

General Appearance

Orientation

Thought

Judgement

Insight

Memory

Intelligence

 

 

 

 

 

 

 BATOMI-PJR

Behaviour & appearance

Affect

Thought form & content

Orientation

Mood

Insight

Perception

Judgement

Risk