Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 13 Care of the Psychiatric Patient

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Psychiatric Care Settings Outpatient mental health clinics Long-term psychiatric care facilities Acute psychiatric care facilities Psychiatric rehabilitation facilities

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Assistant’s Duties in a Psychiatric Care Setting Psycho-educational groups—Responsible for making sure patients attend group meetings and supervision during the meetings. ADL groups—Plays an important role in planning and leading these groups. Social skill–building groups—Responsible for helping patients to practice the skills they have learned.

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Assistant’s Duties in a Psychiatric Care Setting (cont) Recreational groups—Gives patients the opportunity to engage in enjoyable activities and socialize with others. Day trips—Responsible for helping to plan activities, encouraging patients to attend, and participating in the activities.

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Therapeutic Environment Promotes interaction between patients and staff members Encourages participation in group activities Conveys a positive, accepting attitude Protects the patient from physical and emotional harm Protects the patient’s dignity and self-esteem

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Therapeutic Environment

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Therapeutic Communication Communication between a health care worker and a patient that is directed at helping the patient express concerns and resolve problems Listening is very important Clear, honest communication is essential for maintaining a therapeutic environment

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Common Therapeutic Communication Techniques

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Workplace Safety Follow the facility’s or unit’s policies Develop trusting relationships with the people you care for Some conditions require: –Restraints –Seclusion

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Psychiatric Treatment Medication Psychotherapy Electroconvulsive therapy

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Four Main Categories of Medications Antidepressants Anxiolytics Mood stabilizers Antipsychotics

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Antidepressants Used to treat clinical depression Fall into several main categories: –Tricyclic antidepressants –Selective serotonin reuptake inhibitors (SSRIs) –Monoamine oxidase inhibitors (MAOIs) –Other antidepressants work by affecting norepinephrine and epinephrine levels

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Anxiolytics Used to treat anxiety disorders (such as obsessive- compulsive disorder, panic attacks, phobias, and PTSD) Commonly used anxiolytic medications –Benzodiazepines –Buspirone

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Mood Stabilizers Used in the treatment of bipolar disorder (manic depression) Lithium is a commonly used mood stabilizer

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Antipsychotics Used to treat psychotic disorders (such as schizophrenia) Can also be used to treat the manic phase of bipolar disorder

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Observations That Should Be Reported Extrapyramidal side effects –Dystonia –Akathisia –Drug-induced parkinsonism –Tardive dyskinesia

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Psychotherapy “Talk therapy” A licensed therapist helps the patient explore feelings, attitudes, thinking, and behavior

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Electroconvulsive Therapy (ECT)

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Common Psychiatric Disorders Anxiety disorders Clinical depression Psychotic depression Bipolar disorder (manic depression) Schizophrenia Personality disorder Substance abuse disorders Eating disorders

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins JIGSAW ACTIVITY STUDENTS WILL BE ASSIGNED TO A GROUP USING NUMBERS IN RANDOM ORDER. EACH GROUP WILL BE GIVEN A “PUZZLE PIECE” AND A MENTAL HEALTH DISORDER THAT IS IN THE TEXT. DURING THE TIME GIVEN EACH GROUP WILL GATHER INFORMATION ABOUT THE DISORDER EITHER FROM THE TEXT, PERSONAL EXPERIENCE, MOVIES, OR OTHER SOURCES AND WRITE THE INFORMATION ON THE PUZZLE PIECE. AT THE END OF THIS TIME, GROUPS WILL EXCHANGE INFORMATION WITH THE PUZZLE PIECE THAT MATCHES WITH THEIR GROUP AND WRITE ANY NEW INFORMATION ON THE PUZZLE PIECE.UNTIL ALL GROUPS HAVE MATCHED THE PIECES TOGETHER TO FORM A “PICTURE” (COMPLETED PUZZLE) OF THE PSYCHIATRIC DISORDERS PAITENTS SUFFER.

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Anxiety Disorders Most common form of mental illness Common anxiety disorders: –Panic disorder –Obsessive-compulsive disorder –Phobia –Post-traumatic stress disorder (PTSD)

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Clinical Depression Characterized by intense feelings of sadness and hopelessness Psychotic depression is severe clinical depression A person may have suicidal ideation

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Bipolar Disorder (Manic Depression) Causes a person to have mood swings Manic phase of the disorder may cause reckless or impulsive behavior Lithium is most commonly used to balance a person’s moods

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Lithium Toxicity Observations to report to the nurse immediately: The person has diarrhea or vomiting The person is having trouble moving in a coordinated way The person complains of ringing in the ears The person has urinary frequency

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Schizophrenia Very disabling form of mental illness A person with schizophrenia: –May have trouble distinguishing real from imaginary –May have hallucinations and delusions –May hear voices –May have disordered thinking and speech –May become unresponsive to others

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Behavioral Effects of Schizophrenia Affect: a person’s facial expression –Flat affect –Inappropriate affect Polydipsia Paranoia

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Personality Disorders Divided into three main categories –Cluster A: defined by odd or eccentric behavior –Cluster B: defined by dramatic, unpredictable, and emotional behavior –Cluster C: defined by fearful or shy behavior

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Common Traits of Personality Disorders They engage in socially unacceptable behaviors. They tend to be very self-centered. They tend to manipulate or exploit others. They do not handle stress well. They tend to blame others for their problems. They often lack insight (in other words, they do not recognize that they have a problem). People with personality disorders are at increased risk for developing other psychiatric disorders, such as eating disorders, substance abuse disorders, anxiety disorders, and depression.

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Substance Abuse Disorders Involve excessive or inappropriate use of drugs (legal or illegal) Can go through withdrawal when receiving treatment for substance abuse

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Eating Disorders Anorexia nervosa Bulimia nervosa

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Who is involved in therapeutic communication? A.Doctor and licensed nurse B.Health care worker and patient C.Licensed nurse and nursing assistant D.Doctor and patient

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer B. Health care worker and patient Therapeutic communication is directed at helping the patient express concerns and resolve problems.

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Tell whether the following statement is true or false. Suddenly stopping therapy with benzodiazepines can be fatal. A.True B.False

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer A. True Abruptly stopping benzodiazepines can cause death. It is important for the patient to take her medication as ordered.

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Question How many different types of personality disorders are there? A.2 B.10 C.3 D.20

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer C. 3 Cluster A personality disorders are those defined by odd or eccentric behavior. Cluster B personality disorders are those defined by dramatic, unpredictable, and emotional behavior. Cluster C personality disorders are those defined by fearful or shy behavior.