1. Define the following term:
Mental health
a general term that refers to the normal functioning of emotional and intellectual abilities.

2. 1. Identify seven characteristics of mental health
These are characteristics of a person who is mentally healthy:
Gets along with others
Adapts to change
Cares for self and others
Gives and accepts love
Deals with situations that cause stress, disappointment, and frustration
Takes responsibility for decisions, feelings, and actions
Controls and fulfills desires and impulses in an appropriate manner

3. Define the following terms:
Mental illness
a disease that affects a person’s ability to function at a normal level in the family, home, or community; often produces inappropriate behavior.
Situation response
a temporary condition that may be caused by a crisis, temporary changes in the brain, side effects from medications, interactions among medications, or severe change in the environment.

4. 2. Identify four causes of mental illness
The following may cause or worsen mental illness:
Physical factors such as
Illness
Disability
Aging
Substance abuse
Chemical imbalance
Environmental factors such as weak family relationships or traumatic childhood experiences
Heredity or family influence
Stress, including coping abilities

5. Define the following term:
Fallacy
a false belief.

6. 3. Distinguish between fact and fallacy concerning mental illness
REMEMBER:
People who are mentally ill cannot control their illness and choose to be well. Mental illness is a disease like any other physical illness.

7. 3. Distinguish between fact and fallacy concerning mental illness
REMEMBER:
Mental retardation and mental illness are not the same thing. One common point, however, is that residents with either condition will need emotional support in addition to care and treatment.

8. 4. Explain the connection between mental and physical wellness
REMEMBER:
Mentally healthy people can reduce stress and prevent some physical diseases. People with mental illness may experience more stress and therefore more illness.

9. 4. Explain the connection between mental and physical wellness
Think about this question:
What do you do to reduce or relieve stress in your life?

10. Transparency 20-1: Good Communication with Mentally Ill Residents
Use simple, clear statements and normal tone of voice (not like speaking to children).
Communicate respect and concern.
Sit or stand at normal distance.
Use posture that says you’re listening (body language).
Be honest and direct.
Avoid arguments.
Maintain eye contact.
Listen carefully.

11. 5. List guidelines for communicating with mentally ill residents
Think about this question:
Good communication is important with every resident. Why do you think it might take a special effort to maintain good communication with a mentally ill resident?

12. Define the following term:
Defense mechanisms
unconscious behaviors used to release tension or cope with stress.

13. 6. Identify and define common defense mechanisms
The following are categories of defense mechanisms:
Denial
Projection
Displacement
Rationalization
Repression
Regression

14. 6. Identify and define common defense mechanisms
REMEMBER:
All people use defense mechanisms at some time, but mentally ill people tend to use them to a greater degree.

15. Define the following term:
Anxiety
uneasiness or fear, often about a situation or condition.
Phobia
an intense form of anxiety.
Claustrophobia
the fear of being in a confined space.

16. Define the following term:
Panic disorder
a disorder in which a person is terrified for no apparent reason.
Obsessive-compulsive disorder
a disorder in which a person uses obsessive behavior to cope with anxiety.
Post-traumatic stress disorder
an anxiety-related disorder brought on by a traumatic experience.

17. Define the following term:
Apathy
lack of interest in activities.
Major depression
a serious mental illness which may cause mental, emotional, and physical pain and disability; if untreated, it may result in suicide.

18. Define the following term:
Bipolar disorder
illness which causes a person to swing from deep depression to extreme activity; also called manic depression.
Schizophrenia
brain disorder which affects a person’s ability to think and communicate clearly.
Paranoid schizophrenia
a brain disorder that centers mainly on hallucinations and delusions.

19. 7. Describe the symptoms of anxiety, depression, and schizophrenia
REMEMBER:
Many signs of mental illness are simply extreme behaviors most people experience some of the time. Recognizing this might make it easier to understand mentally ill residents.

20. Transparency 20-2: Mental Diagnosis 1

21. Transparency 20-3: Mental Diagnosis 2

22. Transparency 20-4: Mental Diagnosis 3

23. Define the following term:
Psychotherapy
a method of treating mental illness that involves talking about one’s problems with mental health professionals.

24. 8. Explain how mental illness is treated
Mental illness can be treated. Common treatments include the following:
Medication
Psychotherapy
Electroconvulsive (shock) treatment—generally used only when other treatments have not been successful
Psychosurgery, a kind of brain surgery, may improve chronic mental disorders

25. 8. Explain how mental illness is treated
REMEMBER:
Residents with mental illness have the right to participate in the planning of their care just as any other resident.
Their private information must also be kept confidential, just as the information of any other resident.

26. 9. Explain your role in caring for residents who are mentally ill
The NA’s role in caring for residents who are mentally ill includes the following:
Observe residents for changes. Document and report.
Support the resident and family and friends.
Encourage residents to do as much for themselves as possible.

27. 10. Identify important observations that should be made and reported
Report any of the following:
Changes in ability
Positive or negative mood changes (withdrawal)
Behavior changes
Comments about hurting self or others (including jokes)
Failure to take medication or medication errors
Real or imagined physical symptoms
Events, situations, or people that upset or excite residents

28. Define the following term:
Substance abuse
the use of legal or illegal drugs, cigarettes, or alcohol in a way that is harmful to the abuser or to others.

29. Transparency 20-5: Signs of Substance Abuse
Changes in personality, moodiness, strange behavior, disruption of routines
Irritability
Changes in physical appearance
Smell of cigarettes, liquor, or other substances
Reduced sense of smell
Unexplained changes in vital signs
Loss of appetite
Inability to function normally
Need for money
Confusion/forgetfulness
Blackouts or memory loss
Frequent accidents
Problems with family and friends

30. 11. List the signs of substance abuse
REMEMBER:
Illegal drugs are not the only substances that are abused. Even over-the-counter medications can be abused if too many are taken.

31. 11. List the signs of substance abuse
Think about this question:
What substances commonly found in the home could be abused?

32. 11. List the signs of substance abuse
REMEMBER:
Residents who do not have doctors’ orders against drinking alcohol and who live in a facility where alcoholic beverages are allowed may drink alcohol if they wish to do so. NAs should not make judgments or gossip.

33. Chapter Exam 1. A person who is mentally healthy
(A) Can’t adapt to change very easily
(B) Is unlikely to care for him or herself
(C) Has a hard time taking responsibility for decisions
(D) Deals with stressful situations
2. Which if the following statements is a fallacy (a false belief) about mental illness?
(A) People with mental illness can control their symptoms.
(B) Mental illness is a disease like any physical illness.
(C) Mentally healthy persons can control their emotions.
(D) Mental illness affects a person’s ability to function.

34. Chapter Exam (cont’d.) 3. Mental illness can be made worse by
(A) Eating a diet heavy on meat
(B) A strong sense of self-respect
(C) Strong family support
(D) Substance abuse
4. One guideline for communicating with mentally ill residents is to
(A) Talk to adults like they are children if they do not understand what is being said.
(B) Maintain eye contact and listen closely.
(C) Stand really close to the resident.
(D) Argue with residents if what they are saying is not true.

35. Chapter Exam (cont’d.)
5. Which of the following is true of defense mechanisms?
(A) They are a type of mental illness.
(B) Anyone who uses them is likely to become mentally ill at some point.
(C) People who are mentally ill do not use them.
(D) They help a person cope with stress.
6. Telling your co-worker “Let’s throw spitballs at our boss” is an example of which kind of defense mechanism?
(A) Displacement
(B) Regression
(C) Rationalization
(D) Projection

36. Chapter Exam (cont’d.)
7. A co-worker gets the promotion that you have wanted for a long time. When your friend asks you if you’re upset, you say, “No, not at all.” This is an example of
(A) Denial
(B) Displacement
(C) Regression
(D) Projection
8. Signs of clinical depression include
(A) Hair loss
(B) Hyperactivity
(C) Intense, sudden chest pain
(D) Irritability

37. Chapter Exam (cont’d.) 9. A ______ is an intense form of anxiety.
(A) Phobia
(B) Coping mechanism
(C) Fallacy
(D) Situation response
10. Which of the following is a good way to for a nursing assistant to care for a mentally ill resident?
(A) Do everything for the resident.
(B) Give the resident his or her medication.
(C) Support the resident and his or her family and friends.
(D) Encourage the resident to stop being mentally ill and just get better.

38. Chapter Exam (cont’d.)
11. Which of the following statements about observing mentally ill residents is true?
(A) An NA does not need to report a comment about suicide if it is a joke.
(B) An NA needs to report changes in personality.
(C) Withdrawal does not need to be reported.
(D) An NA does not need to report an imagined physical symptom.
12. Which of the following is a common set of treatments for mental illness?
(A) Electroconvulsive (shock) therapy and psychosurgery
(B) Medication and psychotherapy
(C) Psychotherapy and psychosurgery
(D) Medication and Electroconvulsive (shock) therapy

39. Chapter Exam (cont’d.)
13. A resident has been acting a little strangely lately. She gets upset very easily and her eyes are always red. She does not eat much, and sometimes you can smell alcohol on her breath, even in the morning. What should you do?
(A) Confront the resident about what you have noticed.
(B) Call Alcoholics Anonymous.
(C) Report your observations to the nurse.
(D) Tell the facility’s chaplain.