* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Download purpose of mental health psychiatric assessment.
Recovery approach wikipedia , lookup
International Statistical Classification of Diseases and Related Health Problems wikipedia , lookup
Political abuse of psychiatry in Russia wikipedia , lookup
Narcissistic personality disorder wikipedia , lookup
Cases of political abuse of psychiatry in the Soviet Union wikipedia , lookup
Emergency psychiatry wikipedia , lookup
Moral treatment wikipedia , lookup
Dissociative identity disorder wikipedia , lookup
Anti-psychiatry wikipedia , lookup
Psychiatric rehabilitation wikipedia , lookup
Thomas Szasz wikipedia , lookup
Victor Skumin wikipedia , lookup
Child psychopathology wikipedia , lookup
Political abuse of psychiatry wikipedia , lookup
Mental status examination wikipedia , lookup
Psychiatric and mental health nursing wikipedia , lookup
History of psychiatric institutions wikipedia , lookup
Mental disorder wikipedia , lookup
Mentally ill people in United States jails and prisons wikipedia , lookup
Community mental health service wikipedia , lookup
Mental health professional wikipedia , lookup
Pyotr Gannushkin wikipedia , lookup
Deinstitutionalisation wikipedia , lookup
Causes of mental disorders wikipedia , lookup
Homelessness and mental health wikipedia , lookup
Abnormal psychology wikipedia , lookup
Diagnostic and Statistical Manual of Mental Disorders wikipedia , lookup
Controversy surrounding psychiatry wikipedia , lookup
Classification of mental disorders wikipedia , lookup
Mental Health Assessment Ms. Rica A. Santos, RN Objectives Describe the purpose and principles associated with the clinical interview. In the roles of teacher, caregiver and communicator, assess the client holistically using the balancing factors in crisis as a baseline. Differentiate client levels of insight. Describe the purpose of mental health psychiatric assessment. Perform the Mini Mental Status Examination. Compare and contrast the DSM-IV classification system to nursing’s NANDA system. Differentiate between nurse-administered mental health appraisals and projective psychological testing. Mental Health vs. Mental Illness Mental health vs. mental illness Depends on what a particular culture regards as acceptable or unacceptable. Myths and misconception Different and Odd Mental Illness Mental ill are those who violate social norms and thus threaten (or make anxious) those observing them. Psychopathology Mental Health Successful performance of mental functions, resulting in the ability to engage in productive activities, enjoy fulfilling relationships and change or cope with adversity. Provides people with the capacity for rational thinking, communication skills, learning and emotional growth, resilience and self-esteem (US Department of Health and Human Services, 1999) Mental Health Changes over time and reflects changes in cultural norms, society’s expectations and values, professional biases, individual differences, and political climate of the time Attributes of Mental Health Think clearly Ability to control one’s behavior Ability to take responsibility for one’s actions Ability to live without (undue) fear, guilt, or anxiety Capacity to deal with conflicting emotions Ability to love and experience joy Accurate appraisal of reality Ability to play and laugh Maintain a health self-concept and self-value Attributes of Mental Health Ability to work and be productive Negotiate each developmental task Attain self defined spirituality Relate to others Mental Health vs. Mental Illness Signs of mental health Signs of mental illness Happiness Major Depressive Episode Control over behavior Control disorder, undersocialized, aggressive Appraisal of reality Schizophrenic disorder Effectiveness in work Adjustment disorder in work (or Academic) Inhibition A Health Self Concept Dependent Personality Disorder Satisfying relationship Borderline personality disorder Effective coping strategies Substance Dependencies Continuum Ill Healthy Influences that can affect mental health Inherited factors Biological influences Hormonal influences Health practices and beliefs Cultural/subcultural beliefs and values Influences that can affect mental health Negative influences (psychosocial stressors, poverty, impaired/inadequate parenting) Demographic and geographic locations Personality traits and states Developmental events Family influences Spirituality, religious influences Available support system Environmental experiences The Nursing Process in Psychiatric Mental Health Nursing Assessment •Construct Data Base •Verify the Data Nursing Diagnosis •Identify Problem and etiology •Construct nursing Diagnoses •Prioritize Evaluation Outcome Identification Implementation Planning •Identifying interventions Assessment Mental Health/ Psychiatric History identifying information presenting problem history of present illness family history personal history current social status Mental Status Examination Personal Information Appearance Behavior Speech Affect and Mood Thought Perceptual Disturbances Cognition Personal Information Age Sex Marital status Religious preference Race Ethnic background Employment Living arrangements Appearance Grooming and dress Level of hygiene Pupil dilation or constriction Facial expression Height, weight, nutritional status Presence of body or tattoos, scars, other Relationship between appearance and age Posture Motor activity Voice Behavior Excessive or reduced body movements Peculiar body movements Abnormal movements Level of eye contact Cooperative Withdrawn Apathetic Suspicious Aggressive Compliant Histrionic Anxious Relaxed Hostile Speech Rate: slow, rapid, normal Volume: loud, soft, normal Disturbances Cluttering Affect and Mood Anxiety Suicidal/homicidal ideas “Beck Depression Inventory” Appropriate Flat Labile Sad Elated Angry Thought Process Logical Circumstantial Dissociated Obsessive Phobic Suicidal Flight of ideas Ideas of reference Perception Illusion Delusions Hallucination Cognition Orientation: time, place, person Level of conscious Memory Fund of knowledge Attention Abstraction Insight Judgement Open word file Mini mental state examination HEADSSS Psychosocial Interview Technique Home environment Education and employment Activities Drug, alcohol or tobacco use Sexuality Suicide risk or symptoms of depression Savagery Spiritual assessment Cultural and Social Assessment Psychological Testing Intellectual functioning (IQ test) “WAIS” Wechsler Intelligence Scale Find two words, one from each group, that are closest in meaning. Group A raise floor stairs A. raise and elevate B. raise and top C. floor and basement D. stairs and top E. floor and elevate Group B top elevate basement What is the missing letter? E B G D C A B B O B N ? Personality tests Objective – count the score against a standard Projective Rorshack (“inkblot” test) Thematic Apperception Test (TAT) Draw a person test – reflects body image Minnesota Multiphasic Personality Inventory The MMPI has 10 clinical scales that are used to indicate different psychotic conditions. Despite the names given to each scale, they are not a pure measure since many conditions have overlapping symptoms. Because of this, most psychologists simply refer to each scale by number. Scale Scale Scale Scale Scale Scale Scale Scale Scale Scale 1 2 3 4 5 6 7 8 9 0 – Hypochondriasis – Depression – Hysteria - Psychopathic Deviate – Masculinity/Femininity – Paranoia – Psychasthenia – Schizophrenia – Hypomania: – Social Introversion Examples Depression - “I often feel that life is not worth living” Paranoia - “Several people are following me everywhere” Schizophrenia - “I seem to hear things that other people cannot hear” Psychopathic deviance - “I often was in trouble in school although I did not understand for what reasons. Appraisals that can be Nurse Administered Tests for depression Beck depression inventory Geriatric depression scale Spices Self-rate scale 1-10 Happy face Suicide/self-harm assessment Mini-mental status exam Assessing Using Mental Health Assessment Tests Concentration (attention span) Memory; recent/remote Intelligence Abstract thinking Insight and judgment Mini-Mental Status Exam Brief Psychiatric Rating – thoughts and perceptions Psychosocial Assessment Social history Interpersonal relationships Sexual history Alcohol and substance dependency (abuse) Medical and Nursing Diagnosis of Mental Illness Diagnostic and statistical manual of mental disorders (DSM-IV-TR) Manual that classifies mental disorders Focuses on research and clinical observation when constructing diagnostic categories for a discrete mental disorder Medical Diagnosis and DSM-IV-TR A common misconception is that a classification of mental disorders classifies people when actually the DSM-IV-TR classifies disorders that people have Schizophrenic Alcoholic DSM-IV, Axis I-V Axis I – Clinical syndromes Axis II – Development disorders and personality disorders pervasive since childhood Axis III – Physical and medical disorders/conditions Axis IV – Severity of psychosocial stressors: Coded from 1 (none) to 6 catastrophic (death of child) Axis V – Global assessment of functioning: Coded from 100 (absent or minimal anxiety) to 10 or lower (persistent danger of suicide) DSM-IV-TR Multiaxial system Axis Axis I Clinical Disorders Other conditions that may be a focus of clinical attentions Axis II Personality disorder Mental retardation Axis III General medical conditions Axis IV Psychosocial and environmental problems Axis V Global Assessment Functioning Example Major depressive disorder Dependent personality disorder Diabetes Divorce 3 months previously 31 years old and unable to work or respond to family and friends Nursing Diagnosis and DSM-IV-TR Diagnosis and treatment of human responses to actual or potential mental health problems NANDA Impaired adjustment Anxiety Disturbed body image Caregiver role strain Acute Confusion Interrupted family processes Ineffective individual coping Spiritual distress DSM-IV-TR In culturally diverse populations Social bias Homosexuality is included in the first and second editions of DSM Over the past 4 months, George has struck and injured several dozen people, most of whom he hardly knew. Two of them has been sent the hospital. George expresses no guilt, no regrets. He says he would attack every one of them again of he got the chance. What should we do to George? A. Send him to jail B. Commit him to a mental hospital C. Give him an award for being the best defensive lineman in the league Aunt Tillie starts to pass out 5 dollar bills to strangers on the street corner and vows that she will keep on doing so until she has exhausted her entire fortune. Is she mentally ill? Caution must be exercised to avoid labeling or streotyping when a medical diagnosis or a nursing diagnosis is being formulated. That every society has its own view of health and illness and its own classification of disease has long been observed by anthropologists, historians, and students of cross-cultural society (Klerman, 1986) Balancing Factors in Crisis Perception of self and event. “How are you in the midst of all that’s going on in your life right now?” “What are your ideas about what is happening - - the causes or what the deeper crisis is?” “In what ways are you having trouble believing you’re going to be okay?” Balancing Factors in Crisis Situational support. “Who can you turn to?” “Who cares about you?” Coping mechanisms. “What do you usually do to help yourself feel better?” “What are your ideas about why this isn’t working now?” Case Last night the patient was caught shop lifting and was charged with a crime, and now he has a court date pending. He was released to his family. Shortly after his return home he ingested the tablets. He did not tell anyone until he was discovered to be vomiting profusely and taken to the emergency room by his mother. He told the physician that when he took them he wanted to die. His mood and affect are depressed and blunted. J.S. is a 19 year old college freshman, who was referred from the emergency room following an overdose of approximately 40 acetaminophen extra strength. He was cleared medically. He had been in outpatient counseling once a week since an initial overdose six months ago. He states his appetite and sleep have been poor and he believes he has lost 10 pounds over the last month. He is anhedonic and his grades are dropping due to inability to concentrate. He is unable to describe any reason for this. He has thought of suicide in spite of intervention. There is no evidence of psychosis or a thought disorder. Nursing Diagnoses Risk for violence: self-directed Ineffective individual coping Altered nutrition: less than body requirements