N424_Ordered_Combined

Dialectical Behavioral Therapy (DBT) is a type of CBT that emphasizes:

• Gradual behavioral change.
• Acceptance and validation.
• A balance of acceptance and change, influenced by mindfulness and Zen meditation.

It is particularly effective for borderline personality disorder, mood disorders, eating disorders, substance use disorders, and suicidal ideation.

• Display of two or more separate, distinct personalities

The primary screening tools for PTSD include the Primary Care PTSD Screen and the PTSD Checklist.

Screening tools for dissociative disorders include the Dissociative Disorders Interview Schedule, Somatoform Dissociation Questionnaire, and Dissociative Experience Scale.

Assessments for dissociative disorders should include:

1. Physical assessment
2. EEG to rule out TBI, epilepsy, and substance abuse
3. Mental Status Examination (MSE)
4. Assessing recent/remote memory for gaps
5. Evaluating family and occupational stressors, and occurrence of stressful events
6. Assessing for depression, mood shifts, and anxiety

Key time periods for screening PTSD include:

• At first visit for new patients
• Within 60 days of deployment
• 30 days after return from deployment
• 3-6 months after return from deployment
• Annually

Additionally, screening is done when clinically indicated and during the Post-Deployment Health Assessment and Periodic Health Assessment.

Trauma-informed care is a care management approach that recognizes the impact of trauma on individuals. Key components include:

• Addressing emotional, psychological, and physiological needs
• Creating a safe, non-threatening environment
• Establishing a therapeutic relationship and encouraging clients to share their feelings.

Strategies to reduce anxiety include:

1. Music therapy
2. Guided imagery
3. Massage
4. Breathing techniques
5. Age-appropriate strategies involving caregivers as needed.

Support for clients with dissociative disorders includes:

• Encouraging independence and decision-making when they are ready
• Using grounding techniques to help them stay connected to the present.

Client education strategies to manage anxiety include:

• Verbalizing negative feelings and progress at their own pace
• Avoiding overwhelming clients with too much information about past stressful events.

Common medications include antidepressants such as SSRIs, SNRIs, mirtazapine, and amitriptyline, which can decrease depressive and anxious symptoms.

Prazosin is a centrally-acting alpha agonist that decreases hypervigilance and insomnia in individuals with PTSD.

Propranolol is a beta-adrenergic blocker that decreases elevated vital signs and physical manifestations of anxiety, panic, hypervigilance, and insomnia.

Medications might not be prescribed unless there are specific findings of depression and/or anxiety, in which case the same medications used for ASD and PTSD may be prescribed.

The primary goal of CBT is to change distorted thought processes and negative thoughts to improve emotional regulation and develop personal coping strategies.

Prolonged exposure therapy involves relaxation techniques combined with exposure to anxiety-provoking stimuli. Repeated exposure leads to a decreased anxiety response over time, whether the exposure is imagined or practiced.

Psychodynamic psychotherapy focuses on connecting to both conscious and unconscious thought processes to understand and resolve emotional conflicts.

EMDR therapy is contraindicated for individuals with serious mental illness (SMI), suicidal ideation (SI), substance use disorder (SUD), detached retina, or glaucoma.

Biofeedback aims to increase awareness and gain control over reactions to triggers, helping individuals manage their physiological responses.

The patient's motor activity is unremarkable for tics, tremors, or EPS symptoms, but she is pacing and gesturing broadly.

The patient's speech is described as pressured and hyperverbal.

The patient reports her mood as 'Amazing'.

The patient's affect is described as expansive.

Abstinence refers to refraining from the use of substances.

Recovery is when an individual no longer engages in using substances.

Compulsivity is the persistent reinitiation of a habitual act despite the potential for adverse consequences.

A compelling desire for previously experienced positive or euphoric effects of a psychoactive substance.

The body's physical need for a specific substance, where cessation of use can result in specific withdrawal syndrome.

The process of safely and effectively withdrawing an individual from an addictive substance.

• Available support
• Family influences
• Developmental events
• Personality states and traits
• Demographic and geographical locations
• Psychosocial stressors
• Inadequate parenting
• Spirituality; religious influences
• Poverty
• Cultural and subcultural beliefs and values
• Health practices and beliefs
• Hormonal influences
• Biological influences
• Inherited factors

• Rational thinking
• Effective coping
• Resiliency
• Self-control
• Self-awareness
• Developmentally on task
• Spiritual satisfaction
• Happiness and joy
• Self-care
• Positive self concept
• Learning and productivity
• Effective communication
• Meaningful relationships

Mental health is a state of mental well-being that enables individuals to cope with life's stresses, realize their abilities, learn and work effectively, and contribute to their community. It holds both intrinsic and instrumental value and is essential for overall well-being.

A mental illness is a medical condition that disrupts a person's thinking, feeling, mood, and ability to relate to others, leading to significant dysfunction and an inability to cope with ordinary life demands.

The four quadrants are:

1. Optimal Mental Health with Mental Illness
2. Optimal Mental Health without Mental Illness
3. Poor Mental Health with Mental Illness
4. Poor Mental Health without a Mental Illness

People with serious mental illness (SMI) generally die 10-20 years earlier than the general population.

Key themes include:

1. Anxiety, fear, distress, stress
2. Coping Resources
3. Safety
4. Trauma Informed Care
5. Suffering
6. Hope

The DSM-5 is intended to diagnose and classify disorders based on specific criteria, providing expected assessment findings to assist in planning, implementing, and evaluating care.

1. Assessment: Recognize cues and gather data.
2. Analysis: Analyze cues and prioritize hypotheses.
3. Planning: Generate solutions and set nursing goals.
4. Implementation: Take actions and perform nursing interventions.
5. Evaluation: Evaluate outcomes and assess the effectiveness of interventions.

The key factors impacting recovery from mental illness include:

1. Public Stigma: The negative attitudes and beliefs held by society towards individuals with mental health issues.

2. Self-Stigma: The internalization of public stigma by individuals, leading to feelings of shame and reduced self-esteem.

3. Institutional Stigma: The policies and practices within organizations that discriminate against individuals with mental health issues.

1. Implicit Bias: Occurs outside of one's conscious awareness, influencing attitudes and behaviors unconsciously.

2. Explicit Bias: Involves intentional discrimination and negative behaviors displayed towards individuals based on their mental health status.

It is important to rule out a physical cause for the anxiety symptoms.

Anxiety can be a side effect of medication or can be substance-induced or due to withdrawal from substances.

The GAD-7 measures the severity of anxiety and includes items that describe the diagnostic features of Generalized Anxiety Disorder (GAD).

The Hamilton Rating Scale for Anxiety measures the severity of anxiety through 14 items that describe both psychic and somatic symptoms.

The Fear Questionnaire assesses the presence and impact of phobias.

The Yale-Brown Obsessive Compulsive Scale rates the severity and intensity of obsessive and compulsive behaviors in children and adolescents aged 6-17.

The Hoarding Scale Self-Report assesses the severity of compulsive hoarding.

The Panic Disorder Severity Scale is a self-report scale that measures the severity of panic attacks and panic disorder symptoms.

• Excessive anxiety when separated from an emotional attachment.
• Fear of permanent separation.
• Disruption of Activities of Daily Living (ADLs) and normal routine.
• May include physical manifestations.

• Involves avoidance of places/situations that trigger anxiety.
• Fears are often disproportionate to actual risks.
• Can significantly disrupt daily life and functioning.

• Characterized by excessive fear of embarrassment or poor performance in social situations.
• Leads to difficulty in public speaking or participating socially.
• May include physical manifestations such as sweating or trembling.

The stereotype that people with personality disorders are abusive is a harmful generalization that stigmatizes individuals with these conditions, ignoring the complexity of their experiences and behaviors.

Anxiety is often inaccurately stereotyped as being synonymous with shyness and quietness, which overlooks the diverse ways anxiety can manifest in individuals.

A common misconception is that OCD is merely about being very organized, which trivializes the serious and debilitating nature of the disorder.

A harmful stereotype is that hallucinations and delusions are the only symptoms of psychotic disorders, ignoring other significant symptoms such as disorganized thinking and emotional disturbances.

The stereotype that all individuals with borderline or histrionic personality disorders are female perpetuates gender bias and fails to recognize that these disorders can affect any gender.

The stereotype that all narcissists and antisocial individuals are male reinforces gender biases and overlooks the fact that these disorders can also affect females.

The stereotype that mental illness is primarily a 'white girl problem' is a harmful generalization that ignores the prevalence and impact of mental health issues across diverse populations.

The purpose of the nurse-patient relationship is to further the personal development of the patient.

The four components of the nurse-patient relationship are:

1. Two people
2. Professional expertise
3. Client needs
4. Responsible use of words for a productive process

• Happens prior to meeting the patient
• Identify feelings and clarify how they may affect care

• Assessment of the patient
• Listening to needs, goals, and strengths
• Establishing boundaries
• Engaging in mutual goal planning

1. Identification phase: Nurse and patient identify problems and develop trust.
2. Exploitation phase: Patient engages in working toward goals and implementation of intervention.

The Resolution Phase, where the relationship comes to an end.

Therapeutic neutrality involves the nurse being aware of their own beliefs while acknowledging that multiple views exist. The focus should be on the patient's perspective and desires, rather than the nurse's own opinions, to encourage open communication.

Centering allows the nurse to acknowledge their own feelings, creating a neutral framework for interaction. This helps in maintaining focus on the patient and fosters a supportive environment for communication.

Empathy is crucial as it validates the patient experience and is recognized as a significant factor in facilitating change and learning. Additionally, nonverbal communication in expressing empathy has twice the impact compared to verbal communication.

Active listening goes beyond just hearing words; it involves demonstrating genuine interest in what is being said through both verbal and nonverbal cues, ensuring the patient feels understood and valued.

Unconditional positive regard is crucial for developing a therapeutic relationship as it involves meeting patients in a positive, accepting manner, treating them with dignity and respect, and suspending judgment or approval regardless of their history, symptoms, or behaviors.

Nonverbal communication can convey active interest through:

1. Physical proximity (when safe)
2. Good eye contact
3. Leaning slightly forward
4. Facing the person to communicate a positive attitude

The therapeutic alliance is achieved when the patient can freely discuss their concerns and needs. It is based on the trust established by the nurse with the patient through the therapeutic relationship.

A strong therapeutic alliance leads to better patient outcomes, including:

1. Increased likelihood of adhering to treatment plans
2. Continued engagement in treatment

Establish rapport is the first step in building a therapeutic relationship with a patient.

Review physical status and obtain baseline vital signs (VS) to understand the patient's current health status.

The purpose of performing a mental status exam (MSE) is to assess the patient's cognitive function and emotional state.

Assess for risk factors affecting patient safety or the safety of others.

Identify mutual goals for treatment to ensure that both the patient and healthcare provider are aligned in their objectives.

Formulate a plan of care as the final step in the initial assessment process to address the patient's needs and goals.

The key components of verbal communication include:

1. Vocabulary - Use of appropriate language, avoiding medical jargon, and considering language barriers.
2. Clarity/Brevity - Providing the shortest and most straightforward explanations to enhance understanding.
3. Timing and Relevance - Assessing the receiver's readiness for communication based on their emotional state.
4. Pacing - Adjusting the rate of speech to convey the right impression.
5. Tone - Utilizing tone to express acceptance, judgement, and preferences.

The main aspects of nonverbal communication include:

• Body Language - Gestures and posture that convey messages.
• Eye Contact - Indicates attention and engagement.
• Proximity - The physical distance maintained during interaction.
• Body Movements - Movements that can express emotions or reactions.
• Timing - The timing of nonverbal cues in relation to verbal communication.
• Touch - The use of physical contact to convey support or empathy.
• Appearance - How one's appearance can influence perceptions.
• Smells - The impact of scents in communication contexts.
  Nonverbal communication varies greatly across cultures and is essential for establishing and maintaining relationships.

The primary purpose of a therapeutic relationship is goal-directed to meet the needs and goals of the patient, whereas a social relationship is for enjoyment, pleasure, and to meet mutual needs.

In a social relationship, the role is that of a friend, while in a therapeutic relationship, the role is that of a counselor, educator, or caregiver.

In social relationships, the power is equal, whereas in therapeutic relationships, the nurse has power and authority, leading to unequal access to information and resources.

Social relationships may be lifelong, while therapeutic relationships are limited to episodes of care.

Therapeutic relationships use careful, purposeful, and professional language, while social relationships use casual or colloquial language with shared confidences and intimate disclosures.

Sharing in social relationships is mutual and equal, while in therapeutic relationships, it is one-sided and focused on the patient, with the patient sharing more than the nurse.

Activities in social relationships are spontaneous and based on interests and values, while in therapeutic relationships, they are specific to meeting patient goals and guided by ethical standards.

Reciprocity in social relationships is equal between both parties, whereas in therapeutic relationships, it is unequal, with the nurse acting for the benefit of the patient without expectation of return.

A broad opening is a technique used to invite the patient to share their thoughts and feelings, such as asking, 'What brings you in today?'.

A nurse can offer themselves by introducing their role and expressing willingness to help, for example, 'I'm the nurse caring for you today. Please let me know how I can help'.

Neutrality involves maintaining an unbiased stance while encouraging the patient to share sensitive information, such as saying, 'You shared that you've had several abortions and prefer not to use birth control. Tell me more about that.'

Feelings can be translated by reflecting the patient's emotions, for instance, 'It sounds like you felt sad and disappointed when you didn't get the job.'

Silence allows time and space for self-reflection, giving the patient an opportunity to think and process their feelings.

Observing involves noticing non-verbal cues from the patient, such as saying, 'I noticed you were crying' or 'Your posture looks very tense'.

Exploring encourages deeper discussion by prompting the patient to elaborate, such as asking, 'Tell me more about that'.

Paraphrasing involves summarizing the patient's statement in the nurse's own words to ensure understanding and validate the patient's feelings.

Reframing is a technique that helps the patient view their situation differently, for example, 'I know you described your choice to quit your job as "wimping out", but maybe it was an example of you taking care of yourself.'

Planning involves discussing future steps with the patient, such as asking, 'You said you'd like to find a new job. What steps are you planning to take to accomplish this goal?'.

Social responding involves casual interactions, often using phrases like 'That's normal' or 'It's for your own good.' In contrast, therapeutic responses are more focused on the patient's needs and feelings, aiming to foster understanding and healing.

Giving advice in a therapeutic context means directly telling the patient what to do, often using phrases like 'If I were you...'. This approach can undermine the patient's autonomy and may not be conducive to their healing process.

Challenging involves directly questioning a patient's thoughts or behaviors, such as asking 'Why did you ...?'. This can help the patient reflect on their actions but must be done sensitively to avoid defensiveness.

Judging refers to responses that suggest the nurse or clinician has rendered a verdict on the patient's thoughts or actions. This can create a barrier to open communication and trust between the patient and clinician.

An example of devaluing is saying, "Everyone gets nervous," which minimizes the individual's feelings.

False reassurances involve statements like, "Now that you’re in treatment, staying off drugs will be much easier," which may not reflect the individual's reality.

Asking "Why did you do that?" can be problematic as it may put the individual on the defensive and hinder open communication.

Transference occurs when the patient transfers feelings to the nurse that were originally formed toward a person from the patient's past.

Countertransference refers to the nurse's behavioral and emotional response to the patient, which can be influenced by the nurse's own past experiences and feelings.

The nurse must acknowledge and reflect on their feelings, and it is important to bracket or set aside personal reactions to maintain a therapeutic relationship.

1. Speak briefly and allow adequate time for responses, as some individuals may need more time.

2. Ensure basic needs are met, such as hunger, thirst, and temperature.

3. When unsure of what to say, say nothing; silence can be a powerful tool.

4. Focus on feelings when in doubt.

5. Keep the focus on the patient by demonstrating a caring attitude, being open, direct, truthful, and sincere.

6. Show reliability and use empathy to build trust.

7. Practice active listening by using nonverbal cues to convey interest.

Boundaries are essential to maintain a safe and professional nurse-patient relationship. They help to establish clear roles, protect patient confidentiality, and ensure that the care provided is ethical and respectful.

A boundary violation occurs when an action or behavior oversteps normal professional boundaries to meet the nurse's needs. Examples include:

• Strong feelings about a patient: Favoring a patient, swapping assignments, or giving special attention.
• Off-hours contact: Contacting a patient after discharge.
• Giving gifts: Providing gifts to patients.
• Keeping secrets: Maintaining secrets with a patient.

Maintaining boundaries in therapeutic relationships is crucial for several reasons:

1. Professionalism: It establishes a professional environment that fosters trust and respect.
2. Focus on the Patient: Keeping the focus on the patient ensures that their needs are prioritized.
3. Prevention of Misunderstandings: Clear boundaries help prevent misunderstandings and inappropriate behavior.
4. Self-Care: It protects the mental health of the professional by limiting emotional involvement.
5. Testing Boundaries: Patients may test boundaries, and maintaining them helps reinforce the therapeutic framework.

The cycle begins with Unmet Need/Goal, leading to Anxiety. This anxiety causes Frustration, which then escalates to Anger, ultimately resulting in Aggression. This aggression can circle back to the top, indicating that unmet needs can perpetuate the cycle.

• Changes in mood
• Increased movement (pacing, rocking)
• Eye movement (scanning, watchful)
• Disorganized behavior

• Lips tighten
• Eyebrows lower
• Chin drops
• Stare at target

• Clenched fists
• Rapid breathing
• Possible cessation of body movement

1. Respect personal space
2. Avoid provocative behavior
3. Establish verbal contact
4. Be concise
5. Identify wants and feelings
6. Listen closely to what the patient is saying
7. Agree to agree or disagree
8. Set clear limits and lay down the law
9. Offer choices and optimism
10. Debrief the patient and staff

The recommended posture for a nurse is to be relaxed, with hands open and in front of the body, while minimizing movement such as fidgeting or excessive gestures.

A nurse should maintain a calm voice and avoid escalating the volume during interactions with patients.

The nurse should position themselves at a 45-degree angle to the patient, ensuring they do not block exits while also making sure the patient is not positioned between the nurse and the door.

To promote patient growth

The goal of a therapeutic nursing interaction is to promote patient insight and behavioral change directed toward patient growth.

The nurse should focus on acknowledging the patient's actions and encouraging alternative behaviors to ensure safety and address the immediate risk of harm.

The purpose of the preorientation phase is to identify personal attitudes and beliefs that may affect how care is delivered to the patient.

The nurse should help the patient clarify the meaning of the relationship. This approach allows the patient to explore his feelings in a safe environment and understand the nature of his attachment.

Transference is a phenomenon where a patient unconsciously displaces feelings about a person from their past onto the nurse, affecting the nurse-patient relationship.

The nurse should clarify the meaning of the nurse-patient relationship based on the present situation to help the patient understand their feelings and the dynamics of the relationship.

• Complex
• Confusing
• Multi-faceted
• Theories help explain complicated, natural phenomena and can be tested and confirmed using the scientific method.

1. Physiological Needs: Breathing, food, water, shelter, clothing, sleep.
2. Safety and Security: Health, employment, property, family and social ability.
3. Love and Belonging: Friendship, family, intimacy, sense of connection.
4. Self-Esteem: Confidence, achievement, respect of others, the need to be a unique individual.
5. Self-Actualization: Morality, creativity, spontaneity, acceptance, experience purpose, meaning and inner potential.

Maslow's Hierarchy of Needs suggests that individuals must satisfy lower-level needs (like physiological and safety needs) before they can address higher-level needs (like love, esteem, and self-actualization). This framework implies that unmet basic needs can hinder mental health and well-being, as individuals may struggle to achieve self-actualization without first feeling secure and connected.

The three parts of the personality are Id, Ego, and Superego.

The Psychoanalytic Theory was developed by Sigmund Freud.

Psychodynamic Theory emphasizes that human behavior is influenced by childhood experiences and involves contributions from multiple theorists.

A key debate in Psychodynamic Theory is Nature vs Nurture.

Interpersonal Theory emphasizes that human behavior is shaped by our interpersonal relationships and social experiences.

The key figures in Behavioral Theory include:

1. John Watson: Focused on child development and the role of the environment.
2. Ivan Pavlov: Known for classical conditioning.
3. B.F. Skinner: Developed the concept of operant conditioning.

Sullivan's Interpersonal Developmental Stages span from birth to age 21, highlighting the importance of interpersonal relationships during this critical period of development.

A psychiatric emergency is a crisis in which an individual's general functioning is severely impaired, rendering them incompetent or unable to assume personal responsibility for their behavior.

• Exposure to precipitating stressor
• Anxiety escalates

• Defense responses fail
• Anxiety further escalates
• Functioning becomes disorganized
• Trial-and-error attempts to resolve anxiety

• Trial-and-error attempts fail
• Anxiety escalates to severe/panic levels
• Behavior becomes flight/withdrawal

• Overwhelming anxiety/panic
• Can lead to anguish, apprehension, feelings of powerlessness, dissociation, depression, confusion, violence

This type of crisis is precipitated by normal life-cycle transitions that overwhelm the client.

Cognitive Theory suggests that human behavior is influenced by an individual's thought process, where thinking leads to certain emotions. It can be used to explore maladaptive thought patterns and challenge biases.

The key figures associated with Humanistic Theory include Abraham Maslow, Carl Rogers, and James F.T. Bugental.

Humanistic Theory is based on the belief that people are innately good, and that mental or social illness causes deviations from this inherent goodness.

The Biopsychosocial Model Theory, developed by George L. Engel, posits that mental health disorders are a malfunction within the body, influenced by biological, psychological, and social factors. It emphasizes the interconnectedness of these domains in understanding health and illness.

The three components of the Biopsychosocial Model are:

1. Biological: Includes factors like genetics, tissue pathology, inflammation, and drug effects.
2. Psychological: Encompasses beliefs, thoughts, feelings, and coping mechanisms.
3. Social: Involves family, community, financial resources, and cultural influences.

The overlap in the Biopsychosocial Model represents Whole Person Health, which includes concepts like neurotags, empathy, and validation. This highlights the importance of considering all three domains (biological, psychological, and social) for a comprehensive understanding of health.

The key developmental theories include those proposed by Piaget, Kohlberg, Freud, and Erikson. These theories focus on distinct stages of social, emotional, and cognitive development from childhood through adulthood.

Erik Erikson's Stages of Psychosocial Development outline stages from birth to death, each with specific tasks or goals that ideally should be achieved. This framework helps nurses identify the development of personality throughout a person's life.

Trust vs Mistrust

Will

Initiative vs Guilt

5-13 years

Fidelity

Intimacy vs Isolation

Care

Integrity vs Despair

Cognitive Behavioral Therapy (CBT) focuses on the relationship between core beliefs, thoughts, feelings, and behaviors. It emphasizes that changing negative thought patterns can lead to changes in feelings and behaviors.

Dialectical Behavioral Therapy (DBT) was developed by Marsha Linehan.

The 'Wise Mind' in DBT is the synthesis of two opposites: Reasonable Mind (facts and logic without emotions) and Emotion Mind (emotions controlling thinking and behavior without reason).

Psychoanalytic therapy examines the unconscious mind and how it influences an individual's thoughts, feelings, or behaviors.

Behavioral therapy focuses on modifying a client's maladaptive behaviors and patterns, encouraging adaptive behaviors instead.

Cognitive therapy posits that problems can stem from an individual's past but are guided and maintained by what is happening in the present.

Cognitive Behavioral therapy considers how a client's feelings influence their behaviors or thoughts and uses both cognitive and behavioral approaches to decrease anxiety.

Biological therapy involves treatment that alters the individual's psychological functioning, which can be pharmacological or brain-stimulating therapy.

The goal of Individual therapy is to reduce or eliminate clients' manifestations to promote well-being, allowing them to continue with daily life.

Group therapy is a psychosocial therapy where multiple clients meet with a therapist to share ideas and insights for improving coping skills.

Family therapy focuses on working as a unit, addressing the family as a whole rather than just the individuals.

Milieu therapy aims to control the environment to assist the client in preventing self-destructive or maladaptive behaviors.

• Be familiar with types of therapies used in your workplace
• Assist with appropriate interventions and teaching
• Collect initial assessment data
• Recognize need for therapy
• Use therapeutic communication

• Ethics: Systematic principles that govern behavior, often codified in professional guidelines.
• Morals: Personal beliefs about right and wrong, shaped by culture and society.
• Values: Core beliefs or standards that guide behavior and decision-making.
• Rights: Entitlements or permissions granted to individuals, often protected by law.

The core ethical principles include:

1. Autonomy: Respecting a patient's right to make their own decisions.
2. Beneficence: Acting in the best interest of the patient.
3. Nonmaleficence: Avoiding harm to the patient.
4. Justice: Ensuring fairness in treatment and resource distribution.
5. Veracity: Commitment to truthfulness and honesty in communication.

Key issues include:

• Informed Consent: Ensuring patients understand treatment options and risks.
• Confidentiality: Protecting patient privacy and sensitive information.
• Duty to Warn: Legal obligation to inform potential victims of threats.
• Restraint and Seclusion: Ethical considerations in the use of physical restraints.

• Statutory Law: Laws enacted by legislative bodies, such as statutes and regulations.
• Common Law: Law developed through court decisions and judicial interpretations, based on precedents.

Individuals with a mental health diagnosis have the same civil rights as others, including:

• Humane treatment
• Voting rights
• Driver's license
• Due process of law

Individuals receiving mental health care have additional specific rights, including:

• Informed consent and the right to refuse treatment
• Confidentiality
• Participation in and review of a written treatment plan with discharge follow-up
• Communication with others outside the facility
• Interpretive services as necessary
• Respect, dignity, and freedom from discrimination
• Freedom from harm (appropriate use of seclusion/restraints)
• Psychiatric advance directive
• Least restrictive interventions

The key components of informed consent include:

1. Knowledge: The patient must have decision-making capacity and adequate information about the treatment.
2. Competency: The patient must be competent to understand the information provided.
3. Free Will: The patient must voluntarily choose to participate in the treatment without coercion.

Note: No diagnosis or symptom automatically negates the ability to give consent.

A patient’s right to refuse treatment can be overridden in cases where immediate intervention is necessary to prevent:

• Death or serious harm to self or others
• Deterioration of the patient's clinical state

Providers such as MDs, DOs, and ARNPs are responsible for obtaining informed consent from patients before treatment, ensuring that patients are fully informed about their treatment options and the associated risks and benefits.

Evidence supports the long-term benefits of involuntary medication, particularly in conditions such as:

• Schizophrenia
• Bipolar disorder

This suggests that involuntary treatment can be crucial for stabilizing patients who may not be able to make informed decisions about their care.

Capacity is a clinical determination that assesses whether an individual can make healthcare decisions, which is fluid and specific to time and decision. It involves the patient's ability to:

• Communicate a consistent choice
• Understand relevant information
• Appreciate the situation and consequences
• Reason about treatment options

Competence, on the other hand, is a legal concept determined by a court. It does not fluctuate and incompetent individuals do not have the legal right to make decisions. A declaration of incompetence must be reversed by the court. Evidence considered for competence includes:

• Presence of mental illness
• Impaired judgment
• Significant interference with reasoning ability due to mental illness

The term 'Least Restrictive Alternative' refers to the principle that psychiatric care should be provided in the least restrictive environment possible, which can include options such as:

1. Locked or unlocked units
2. Inpatient or outpatient care
3. Use of seclusion or restraints

This approach aims to respect the rights and freedoms of individuals while ensuring their safety and well-being.

In 1976, a significant Supreme Court ruling established that individuals could not be hospitalized against their will without due process, marking a shift towards respecting the rights of patients in mental health settings.

HIPAA is a federal law that protects the privacy and security of Protected Health Information (PHI) by regulating its collection, storage, and disclosure by 'covered entities'.

A nurse must:

1. Understand federal and state laws related to healthcare settings.
2. Only discuss patient information with others who provide care.
3. Obtain patient consent before sharing information with others.

The 'duty to warn' requires healthcare professionals, including nurses, to protect third parties if a patient poses a serious threat to another person, as established in the Tarasoff v Regents of the University of California case in 1976.

Healthcare professionals are required to report any suspected child or elder abuse to the appropriate authorities as part of mandatory reporting laws.

• Document clearly and objectively
• Focus on just the facts
• Example: The patient picked up a chair, held it over their head, and yelled, "I want to go home".

• What the staff did in response to the behavior
• Include timelines and extent of response
• Example: The nurse immediately called for help and told the patient to "Please put the chair down. You're scaring us". Other staff directed patients to their rooms. The nurse continued to engage the patient by stating, "I want to help you get home, too. Would you like to sit down and discuss how to do that?" The patient then set the chair down and engaged in conversation with the nurse.

• Document the exact time the provider was notified about a change in the patient's condition.
• Example: A call was placed to Dr. Brain at 1400 to report a change in patient's condition.

• Document the time and dosage of medication given.
• Example: PRN Olanzapine 5 mg was given for acute agitation.

Informal admission is the least restrictive form of admission for treatment.

Voluntary admission is when the client or guardian chooses admission to obtain treatment, while involuntary admission occurs when the client enters the facility against their will for an indefinite amount of time.

Temporary emergency admission is for clients who are admitted for emergent care due to their inability to make decisions regarding their care.

Involuntary admission is based on the need for psychiatric treatment, risk of harm to self or others, or inability to provide self-care (grave disability).

Long-term involuntary admission is similar to temporary commitment but must be imposed by the courts and typically lasts between 60-180 days, whereas temporary emergency admission is usually shorter and based on immediate need.

• Conflict between two or more courses of action
• No clear-cut answer to the dilemma
• Requires the use of ethical principles to resolve the issue

• ANA Code of Ethics for Nurses
• AHA Patient Care Partnership
• Nurse Practice Act (state specific)
• Facility resources: policies, ethics committee, attorneys, colleagues

Autonomy refers to respecting an individual's right to make their own decisions. For example, a nurse helps a client explore alternatives rather than giving direct advice when the client struggles with decision-making.

Beneficence is the quality of doing good. An example is when a nurse assists a newly admitted client with a psychotic disorder to feel safe in the mental health facility environment.

Fidelity involves loyalty and keeping promises to individuals. For instance, a nurse remains with a client during a conversation with their guardian as requested by the client.

Justice refers to fair and equal treatment for all individuals. An example is a nurse leading a discussion in a treatment team meeting about whether two clients who broke the same rule were treated equally.

Non-maleficence means never doing harm to any individual. For example, a nurse may withhold a prescribed medication after a client reports severe side effects, ensuring no further harm while consulting for an alternative treatment.

Veracity is the principle of honesty when dealing with individuals. For instance, if a client questions a nurse about a conversation, the nurse should respond truthfully about the discussion's intent to help the client.

Utilitarianism promotes actions that produce the most good (happiness) for the most people.

Kantianism suggests that decisions and actions are bound by a sense of duty.

Divine Command Ethics focuses on actions that are commanded by God.

Natural Law Theory emphasizes human knowledge of the difference between good and evil to guide decision making.

Ethical Egoism bases decisions on what is best for the individual making the decision.

Seclusion and restraint should be prescribed for the shortest possible time and only after less restrictive measures fail, such as:

1. Verbal interventions
2. Diversion and redirection
3. Calm, quiet environment
4. PRN medications

Seclusion and restraint are used for the physical protection of the patient or those around the patient. They should not be used for:

• Staff convenience
• Punishment
• Patients who are extremely unstable (mentally or physically)
• Patients who cannot tolerate decreased stimulation of seclusion
• Patients who are suicidal

The four types of restraints are:

Documentation must include:

1. Precipitating events/behaviors
2. Alternative actions taken prior to initiation
3. Signs of injury
4. Proper application
5. Vital signs and pain
6. Time initiated
7. Current behavior, needs being met, VS
8. Hygiene and elimination
9. Physical and psychological status and comfort
10. Readiness to discharge

A provider must write an order for seclusion or restraint. They can initiate it emergently but must have the order within 15 minutes.

A provider must reassess the patient every 24 hours.

Documentation should include:

• Signs of injury
• Vital signs and pain
• Physical and psychological status and comfort
• Readiness to discharge

A tort is a civil wrong-doing where one party claims wrongful conduct on the part of another and seeks compensation. It can be either intentional or unintentional.

Intentional torts involve willful actions that damage a person's property or violate their rights. Examples include:

1. False imprisonment: Confinement without legal grounds.
2. Assault: Making a threat to a client's person.
3. Battery: Touching a person in a harmful or offensive way.

Unintentional torts involve actions or inactions that cause unintended harm due to failing to fulfill one's duty. Key examples include:

1. Negligence: Failing to provide adequate care.
2. Malpractice: Professional conduct that does not meet the standard of competence, resulting in provable damages to the patient.

Autonomy is demonstrated as the patient is given the right to make their own choices regarding their food intake.

Beneficence is illustrated as the action is taken to protect the patient and others from harm.

Fidelity is shown as the nurse keeps their promise to the client, maintaining trust in the therapeutic relationship.

Nonmaleficence is involved as the nurse acts to prevent harm to the patient by withholding the medication that caused a reaction.

Autonomy is reflected as the patient is empowered to make decisions about their own care and activities.

A patient experiencing delusions and psychosis who assaulted another person would be appropriate for involuntary admission due to the immediate risk they pose to others.

A patient with severe depression who attempted suicide 6 months ago is at risk for involuntary admission due to their history of self-harm.

A client experiencing mania with psychotic features may require involuntary admission if they are a danger to themselves or others due to their condition.

A patient with bipolar disorder who appears agitated and is quickly pacing the halls may be considered for involuntary admission if their behavior poses a risk to themselves or others.

Categories of crises include:

1. Developmental Crises: Occur during life transitions (e.g., adolescence, retirement).
2. Situational Crises: Arise from unexpected events (e.g., job loss, natural disasters).
3. Existential Crises: Involve questions about life purpose and identity.
4. Environmental Crises: Result from external factors affecting a community (e.g., war, economic downturn).

Crisis interventions can include:

• Immediate Support: Providing emotional support and safety.
• Problem-Solving: Assisting individuals in finding solutions to their crises.
• Referral: Connecting individuals to additional resources or services.

Nurses play a crucial role in crisis response by:

1. Assessment: Evaluating the patient's mental and physical state during a crisis.
2. Intervention: Implementing immediate care strategies to stabilize the patient.
3. Support: Providing emotional support and reassurance to patients and families.
4. Coordination: Collaborating with other healthcare professionals and services for comprehensive care.
5. Education: Informing patients and families about coping strategies and available resources.

Types of violence include:

1. Physical Violence: Inflicting bodily harm (e.g., hitting, choking).
2. Emotional/Psychological Violence: Causing mental harm (e.g., threats, manipulation).
3. Sexual Violence: Non-consensual sexual acts (e.g., rape, sexual harassment).
4. Domestic Violence: Violence occurring within intimate relationships.
5. Community Violence: Violence occurring in public spaces (e.g., gang violence).

Sexual assault can be categorized as:

• Acquaintance Rape: Assault by someone known to the victim.
• Stranger Rape: Assault by an unknown individual.
• Marital Rape: Non-consensual sexual acts within marriage.

Interventions for patients who are violent or have experienced violence include:

1. De-escalation Techniques: Using verbal and non-verbal communication to calm the patient.
2. Safety Planning: Developing a plan to ensure the safety of the patient and others.
3. Therapeutic Communication: Engaging in supportive dialogue to help the patient express feelings.
4. Crisis Counseling: Providing immediate psychological support and coping strategies.
5. Referral to Specialized Services: Connecting patients with mental health professionals or support groups.

Important factors for a nurse's self-awareness and self-care include:

1. Emotional Awareness: Recognizing personal feelings and reactions to crises.
2. Stress Management: Implementing techniques to manage stress (e.g., mindfulness, exercise).
3. Support Systems: Utilizing peer support and professional counseling when needed.
4. Boundaries: Establishing clear boundaries to maintain professional and personal well-being.
5. Continuous Education: Engaging in training and workshops on crisis management and self-care strategies.

Three factors determine this:

1. The individual's perception of the event
2. The availability of situational support
3. The availability of adequate coping mechanisms

A crisis is an acute, time-limited event (approximately 4-6 weeks) that cannot be managed with the client's normal coping mechanisms. It is personal in nature, representing a struggle for equilibrium and adaptation, and can result in either psychological deterioration or growth. Characteristics of a crisis include:

1. Sudden event with little or no time to prepare
2. Perceived as overwhelming or life-threatening
3. Loss or decrease in communication with others
4. Sense of displacement
5. Actual or perceived loss
6. Precipitated by specific, identifiable events

A dispositional crisis is a response to an external situational stressor, such as a divorce or job change.

A crisis of anticipated life transitions, also known as maturational developmental crises, involves normal life-cycle transitions that may be anticipated but can leave the individual feeling a lack of control, requiring new coping mechanisms.

A crisis resulting from traumatic stress, termed adventitious, is triggered by an unexpected external stressor that leaves the individual feeling emotionally overwhelmed and defeated, with little or no control over the situation.

A crisis reflecting psychopathology is an emotional crisis influenced or triggered by pre-existing psychopathology, such as personality disorders, bipolar disorders, or schizophrenia.

The primary goal of crisis intervention is the resolution of the individual's immediate crisis and restoration to at least the level of functioning that existed before the crisis period, or possibly to a higher level of functioning.

1. Assessment: Evaluate the situation and the individual's needs.
2. Planning of Therapeutic Intervention: Develop a strategy to address the crisis.
3. Intervention: Implement the planned therapeutic actions.
4. Evaluation of Crisis Resolution and Anticipatory Planning: Assess the effectiveness of the intervention and plan for future needs.

The nurse should focus on managing anxiety and other mood symptoms associated with the crisis by providing support, reassurance, and therapeutic interventions to help stabilize the client's emotional state.

Nurses can assist clients by:

• Teaching coping strategies tailored to the individual's needs.
• Encouraging problem-solving techniques.
• Promoting mindfulness and relaxation exercises.
• Supporting the development of a support network.

Crisis counseling aims to provide brief, solution-based therapy that instills hope in clients, helping them to navigate their crisis and develop a plan for moving forward.

Nurses can:

• Identify and connect clients with community resources.
• Facilitate support group participation.
• Encourage family involvement in the care process.
• Provide information on mental health services available.

1. Gather information about precipitating stressors and resulting crisis.
2. Assess mental and physical status, including suicidal ideation (SI), homicidal ideation (HI), anger, aggression, and substance use.
3. Evaluate the adequacy of support systems and the individual's perception of personal strengths and limitations.
4. Consider cultural or religious needs.
5. Differentiate between risk factors and protective factors.
6. Identify nursing diagnoses such as ineffective coping, anxiety (severe to panic), disturbed thought process, risk for self- or other-directed violence, and fear.

The first step is to gather assessment data.

The RN should consider the urgency/emergency of the situation and the identified diagnosis.

Interventions should account for the type of crisis, the individual's strengths, their desired choices, and the available resources.

The goal is to plan for a return to, or increase in, the precrisis level of functioning.

The key actions include:

1. Implement actions identified in the planning phase.
2. Use a reality-oriented approach.
3. Demonstrate unconditional acceptance, active listening, and attention to immediate needs.
4. Clarify the problem by helping the individual determine what they believe precipitated the crisis.
5. Set firm limits on aggressive/destructive behaviors and establish boundaries while maintaining consistency.
6. Acknowledge feelings of guilt, helplessness, and powerlessness.
7. Guide the individual through a problem-solving process.

The key objectives to reassess include:

1. Positive behavioral changes
2. Development of more adaptive coping mechanisms
3. Individual's belief in their ability to respond with healthy adaptation in the future
4. Growth or gained insight
5. Ability to describe a future plan-of-action

During the evaluation phase, a summary of what has occurred during the intervention should be discussed with the individual.

A plan of action is developed for the individual to deal with the stressor should it reoccur.

1. Benzodiazepines (short-term):

   • Alprazolam
   • Diazepam
   • Oxazepam

2. Antidepressants (longer term):

   • Paroxetine
   • Bupropion
   • Fluoxetine

1. Primary care: Identify potential problems, coping mechanisms, and lifestyle changes.

2. Secondary care: Identify interventions that promote safety.

3. Tertiary care: Provide support during recovery from severe crisis, including outpatient clinics, rehab centers, crisis stabilization centers, short-term residential services, and workshops.

• Affect: Anxious, tense, frowning
• Behavior: Intense demeanor, no eye contact, hypersensitive, defensive response
• Communication: Low talking through clenched teeth, yelling/shouting
• Physical Signs: Flushed face, clenched fists
• Emotional Control: Lack of control or overcontrolled emotions
• Nature of Anger: Normal emotional response to frustration; can be positive if expressed healthily, negative if suppressed or expressed aggressively; often a secondary emotion related to other disorders (e.g., depression, anxiety, PTSD).

• Pacing, restless
• Threatening body language
• Verbal or physical threats
• Threats of homicide or suicide
• Loud voice
• Argumentative
• Destruction of property
• Posturing
• Suspiciousness

Inappropriately expressed anger can escalate into aggression, resulting in verbal or physical attacks.

Aggressive individuals may have feelings of inadequacy, insecurity, guilt, fear, and rejection.

Violence is a goal-directed act with the intent of harming a specific person or object.

• History of aggression, poor impulse control, violence
• Poor coping skills, limited support
• Comorbidities
• Living in a violent environment
• Limit setting in milieu

• Depression
• Substance use
• Bipolar disorder
• PTSD
• Alzheimer's disease
• Individuals who are easily overwhelmed/marginal coping skills
• Psychotic delusions/command hallucinations

1. Respond quickly; remain calm and in control.
2. Encourage verbal expression of emotion and use therapeutic communication.
3. Describe options clearly and offer choice.
4. Reassure that staff are present to prevent loss of control.

Set limits:

• Be calm and direct.
• Use physical activity to deescalate behaviors.
• Inform client of consequences of behaviors.
• Use pharmacological interventions if no response to calm limit-setting.
• Plan for a "show of force" if appropriate.

1. Atypical Antipsychotics: Olanzapine, Ziprasidone
2. Typical Antipsychotic: Haloperidol (greater side effect potential)
3. Antidepressants
4. Mood Stabilizers
5. Sedative/Hypnotics: Benzodiazepines

• Self-Regulation: Clients identify how they will manage their behavior during aggression cycles.
• Stressors: Clients identify stressors that may have contributed to the incident.
• Discussion: Encourage clients to discuss the incident from their perspective.

• Effectiveness of Interventions: Assess how well the interventions worked during the incident.
• Documentation: Document the entire incident thoroughly for future reference.

Abuse is the maltreatment of one person by another, involving the purposeful use of force that results in physical and/or psychological injuries or death.

1 in 4 women and 1 in 10 men have reported being victims of sexual violence and/or physical violence and/or stalking by an intimate partner.

Adverse childhood experiences (ACEs) have a major impact on health and well-being throughout life.

No, abuse affects all populations equally, regardless of race, religion, economic class, age, and educational background.

Many abusers were themselves victims of abuse as children.

1. Physical: Involves physical pain or harm, such as shaken baby syndrome, strangling, striking, kicking, or pushing.

2. Sexual: Involves sexual contact without consent.

3. Emotional: Includes behaviors that minimize an individual's feelings of self-worth, such as humiliation, threatening, or intimidating.

4. Neglect: Refers to the failure to provide necessary physical care, emotional care, education, or medical care.

5. Economic: Involves the failure to provide for the needs of a vulnerable person when means are available.

Nurses must prepare to deal with various types of violence including:

1. Violence between family members: This includes Intimate Partner Violence (IPV), abuse against children, or vulnerable adults.
2. Mass-casualty events: These can be human-made or natural disasters.
3. Violence against individuals with mental illness: This includes the potential for harm from individuals with mental health conditions.

Additionally, a history of violence and criminal activity is the most significant predictor of future violence.

• Low self-esteem
• Feelings of helplessness, hopelessness, powerlessness, guilt, shame
• May protect the perpetrator and accept responsibility for the abuse
• Possible denial of the severity of the abuse and situation

• May control victims with threats and intimidation
• Often an extreme disciplinarian who uses corporal punishment
• Exhibits poor impulse control and violent outbursts
• Perceives the victim as bad
• Experiences low self-esteem and feelings of worthlessness, possibly with substance use disorder (SUD)
• Has difficulty assuming adult roles
• May have a history of abuse

• Perpetrator: Exhibits minor anger and physical abuse.
• Victim: Feels tense and tends to accept blame.

• Tension becomes unbearable, leading to serious abuse.
• The victim may try to cover up injuries or seek help.

• The perpetrator becomes loving and promises to change, expressing remorse for their behavior.
• The victim wants to believe in the possibility of change and hopes for a better future.

• These periods continue with increasingly shorter durations.
• Emotions during these phases increase in intensity.

• More likely to be female partners, but male partners can also be vulnerable.
• Attempting to leave the relationship.
• Pregnancy.
• Older adults who are vulnerable.
• Family groups are often targeted.
• Violence is most aimed at family and friends, not strangers.
• Abuse toward a child is a significant risk factor, especially if:
  • The child is under 4.
  • The perpetrator perceives the child as different.

1. Conduct a thorough history
2. Provide privacy
3. Be direct, honest, and professional
4. Use accessible language
5. Employ therapeutic communication:
   • Understanding and attentive
   • Use open-ended questions
6. Inform the client if a referral must be made and explain the process

• Unusual bruising in areas such as the abdomen, back, and buttocks
• Bruising at various stages of healing
• Burns or bite marks
• Fractures with unusual features
• Assess the mechanism of injury to see if it matches the history provided

• Respiratory distress
• Bulging fontanels
• Increase in head circumference

Mandatory reporting ensures that healthcare professionals report suspected abuse to the appropriate authorities, which can help protect clients and facilitate access to necessary resources and support.

Nurses can provide support by offering basic care, developing a safety plan, and educating clients about available resources and coping strategies.

Maslow's hierarchy helps nurses understand the client's needs, prioritizing safety and basic physiological needs before addressing higher-level psychological and social needs.

Nurses should know about support groups, case management services, and options for family relocation to help clients find safety and support.

Skills such as problem-solving, stress management, and knowledge of community resources are essential for helping clients navigate their situations effectively.

The school nurse should consider the following potential issues:

1. Sexual Abuse - The refusal to change and participate in physical activities may indicate discomfort related to past trauma.
2. Emotional Neglect - Lack of support or attention from caregivers could lead to withdrawal and refusal to engage in activities.
3. Physical Neglect - Inadequate care or supervision may result in physical symptoms affecting her ability to participate.
4. Emotional Abuse - Psychological harm from caregivers could manifest in behavioral changes and refusal to engage in normal activities.

People may stay in abusive relationships due to a variety of factors, including:

1. Fear of retaliation or escalation of violence.
2. Emotional attachment to the abuser, including love or dependency.
3. Financial dependence on the abuser, making it difficult to leave.
4. Isolation from friends and family, leading to a lack of support.
5. Low self-esteem and feelings of worthlessness, believing they deserve the abuse.
6. Cultural or societal pressures that stigmatize leaving a relationship.
7. Hope for change, believing the abuser will improve or that the relationship can be salvaged.

To gather more information if partner violence is suspected, consider the following steps:

1. Create a safe environment for the individual to talk.
2. Ask open-ended questions to encourage sharing without pressure.
3. Listen actively and validate their feelings without judgment.
4. Observe physical signs of abuse, such as injuries or changes in behavior.
5. Inquire about their support system and if they feel safe at home.
6. Provide information about local resources and support services.
7. Respect their autonomy and decisions regarding their situation.

Common biases regarding abuse, abusers, and victims may include:

• Victim-blaming, assuming victims are responsible for the abuse.
• Stereotyping abusers as only certain types of people, ignoring the complexity of their backgrounds.
• Minimizing the impact of emotional or psychological abuse compared to physical abuse.
• Assuming all victims can easily leave an abusive situation without understanding the barriers they face.
• Believing that abuse only occurs in certain demographics, overlooking its prevalence across all social, economic, and cultural groups.

Resources that can be offered to patients suspected of being victims of violence include:

• Hotlines for immediate support, such as the National Domestic Violence Hotline.
• Local shelters that provide safe housing and support services.
• Counseling services for emotional support and recovery.
• Legal assistance for restraining orders or legal advice.
• Support groups for sharing experiences and finding community.
• Educational materials on recognizing abuse and understanding rights.
• Safety planning resources to help them prepare for leaving an abusive situation safely.

Forms of sexual assault include:

1. Pressured or forced sexual contact - talk or actions
2. Inappropriate touching
3. Female Genital Mutilation (FGM)
4. Incest
5. Sex trafficking
6. Rape

Anyone can be a victim or perpetrator of sexual assault, including:

• Children
• Vulnerable adults

Survivors of sexual violence can suffer:

• Long-term emotional trauma
• Severe psychological effects

Examples of sexual violence include:

• Denial of emergency contraception
• Measures to prevent STIs
• Organized rape during war/conflict
• Sexual homicide

The common substances include:

• GHB
• Flunitrazepam (Rohypnol)
• Ketamine
• Alcohol

Key considerations include:

1. Self-awareness: Maintain empathy, objectivity, and nonjudgment.
2. Initial and ongoing assessment: Evaluate anxiety, coping mechanisms, and support.
3. Private environment: Ensure confidentiality and comfort.
4. SANE: Involve Sexual Assault Nurse Examiners when possible.
5. Informed consent: Always obtain consent before proceeding with assessments.

The types of rape identified include:

• Stranger rape
• Marital rape
• Date rape
• Acquaintance rape

A critical aspect is to ensure a private environment to provide comfort and confidentiality during the assessment process.

Rape is characterized as a crime of violence, involving aggression, anger, and power dynamics.

A sustained and maladaptive response to sexual assault.

Initial emotional reactions can be expressed or controlled reactions.

Emotions can include embarrassment, revenge, guilt, anger, fear, anxiety, and denial, which can persist and become maladaptive.

Acute Stress Disorder appears within 3 days of the trauma and persists for no more than one month.

PTSD persists beyond one month and includes reliving the event, hyperarousal, avoidance, fears, phobias, difficulty in daily functioning, and somatic responses.

A compound rape reaction involves experiencing additional disorders such as mental health disorders (e.g., depression, anxiety, substance-use disorders) and physical disorders (e.g., manifestations of prior physical illness, gastrointestinal issues, headaches, fatigue).

Signs of a silent rape reaction include:

1. The survivor does not report or inform anyone of the sexual assault.
2. Abrupt changes in relationships.
3. Nightmares.
4. Increased anxiety.
5. Marked change in sexual behaviors.
6. Sudden onset of phobia.

Victims may experience sleep disturbances, depression, anxiety, depersonalization, dissociation, flashbacks, or nightmares.

Barriers include shame, self-blame, and fear of retaliation.

Victims are encouraged to seek support or counseling to aid in their recovery process.

Victim-blaming is a common societal issue that affects victims, often leading to further psychological distress.

Safety - allow patients to feel physically and emotionally safe.

By being straightforward and honest with patients.

It involves having trauma support persons who have shared lived-experience with the patients.

It makes patients active participants in their own care, enhancing their sense of control and involvement.

It involves acknowledging the patient's strengths and helping them feel capable and in control.

It requires being aware of biases and stereotypes, and being mindful of language used with patients.

Assume every patient has experienced trauma.

By remembering that the patient is in control of their own body and being sensitive to their needs.

It helps to create a safe environment and fosters trust between the patient and provider.

It facilitates open dialogue, helps build trust, and allows patients to express their feelings and concerns.

By involving them in decision-making processes and respecting their choices and preferences.

It helps to reduce anxiety and fosters a sense of control and trust in the healthcare process.

The mental status examination is used to assess a patient's cognitive, emotional, and psychological functioning, which aids in early identification and better management of mental illness, ultimately improving patient outcomes.

The key components of the mental status examination include:

1. Appearance - Observations about the patient's physical appearance and grooming.
2. Behavior - Assessment of the patient's behavior and interactions.
3. Speech - Evaluation of the patient's speech patterns, including rate and volume.
4. Mood and Affect - Assessment of the patient's emotional state and expression.
5. Thought Process - Evaluation of the patient's thought patterns and coherence.
6. Cognition - Assessment of orientation, attention, memory, and insight.
7. Insight and Judgment - Evaluation of the patient's understanding of their condition and decision-making abilities.

The mental status examination can improve patient outcomes by:

1. Early Identification - Detecting mental health issues at an early stage.
2. Tailored Interventions - Informing appropriate treatment plans based on the patient's specific needs.
3. Monitoring Progress - Allowing for ongoing assessment of the patient's mental health status.
4. Enhanced Communication - Facilitating better communication between healthcare providers and patients regarding mental health.

The MSE is a structured assessment used to evaluate a patient's current mental state, providing a snapshot of their condition at the time of the assessment. It is a standard part of the psychiatric interview and offers information about diagnosis, treatment, and response to treatment.

Information during the MSE is obtained through observation and formal questioning, collecting both subjective and objective data.

The patient is a well-nourished, 50-year-old female who appears her stated age, is clean, and well-groomed.

The patient shows no acute distress, is laughing and smiling inappropriately, is flirtatious with staff, and is difficult to redirect at times.

The patient's thought process is characterized by flight of ideas.

The patient expresses a grandiose delusion stating, 'I am God's messenger, sent here to cure the world.'

The patient endorses auditory hallucinations and appears to be actively responding to internal stimuli.

The patient is alert and oriented to self.

The patient shows poor cognition as evidenced by an inability to maintain focus or concentration.

The patient demonstrates poor insight, as indicated by her declining medication.

The key components of a mental status examination include:

Facial expressions to assess include:

• Smiling
• Scowling
• Blushing

In Major Depressive Disorder (MDD), individuals often exhibit poor grooming and poor hygiene as symptoms of their condition.

Physical signs associated with Anorexia Nervosa (AN) include:

• Lanugo (fine hair growth)
• Large or baggy clothing to conceal weight loss

Visible signs that may indicate Substance Use Disorder (SUD) include:

• Visible needle marks
• Bruising
• Pupil size changes

In individuals experiencing Mania, one might observe:

• Excessive make-up
• Brightly colored clothes

Common grooming issues in individuals with Dementia include:

• Poor grooming
• Food on clothing
• Body odor

Individuals with Schizophrenia Spectrum Disorders (SSD) may experience negative symptoms, which can include poor grooming and hygiene.

Behaviors associated with an agitated state include lip smacking, scanning, and clenched fists.

Common behaviors in individuals with anxiety include pacing, wringing hands, and rocking.

Apprehensive individuals may display behaviors such as being watchful and socially withdrawn.

Ritualistic behavior is characterized by repeated actions such as looking, turning, and stepping.

Demanding individuals often exhibit behaviors such as making demands of staff.

A withdrawn individual tends to avoid or not seek social interactions.

In Major Depressive Disorder (MDD), individuals often appear withdrawn.

Behaviors associated with mania include being demanding, provocative, seductive, and flirtatious.

Individuals with OCD often display repetitive and ritualistic behaviors.

Typical behaviors in Generalized Anxiety Disorder (GAD) include fidgeting and pacing.

Schizotypal Personality Disorder is characterized by odd and eccentric behavior.

Individuals with Antisocial Personality Disorder often exhibit calm, manipulative, and demanding behavior.

• Gait: Shuffling, Limping, Speed
• Involuntary Movement: Tics, Twitches, Tremors
• Echopraxia: Imitation of Movements Made by Another Person
• Ataxia: Muscular Incoordination
• Apraxia: Inability to Perform Tasks or Movements (Speaking, Eating, Writing)
• Dystonia: Involuntary Muscle Movements (Spasms in Legs, Face, Arms, Neck)
• Hyperactivity & Hypoactivity
• Stereotypic Movements: Repetitive, Nonfunctional, Involuntary Movements

• MDD: Psychomotor Retardation
• Mania: Psychomotor Agitation
• Obsessive Compulsive Disorder (OCD): Stereotype
• Stimulant Intoxication: Psychomotor Agitation, Fidgeting, Pacing
• Autism Spectrum Disorder (ASD): Stereotype
• Medical Side Effects: Tremors, Restlessness, Muscle Spasms

• Hyperverbal: Excessive talking
• Minimal: Very few words
• Mute: No speech at all

• Depression: Soft, monotone, with latency
• Anxiety: Increased quantity, rapid, pressured
• Mania: Pressured and loud
• SSD (Social Communication Disorder): Increased latency, decreased quantity

Echolalia is the repetition of words or phrases spoken by another person, often observed in certain mental health conditions.

'Word salad' refers to a group of words randomly put together, lacking coherent meaning, often seen in severe mental health disorders.

Prosody reflects emotion in speech, indicating the speaker's feelings and can be crucial in assessing mental health conditions.

Anhedonia is the inability to feel pleasure. It is significant in mood assessment as it is a key symptom of Major Depressive Disorder (MDD), indicating a profound impact on an individual's emotional well-being.

Dysphoria is characterized by a profound sense of unease or dissatisfaction, while euthymic mood refers to a state of mood that is in the 'normal' range. Understanding these differences is crucial for accurate mood assessment.

In mania, individuals typically exhibit elevated, expansive, and labile moods. These characteristics are important for diagnosing mood disorders and understanding the patient's emotional state.

Individuals with Borderline Personality Disorder (BPD) often experience affective instability, lability, and anxiety. Recognizing these traits is essential for effective treatment and support.

A blunted affect in schizophrenia indicates a significant reduction in emotional expression. This symptom is crucial for diagnosing the disorder and understanding the patient's emotional experience.

Thought blocking refers to an incomplete train of thought where an individual suddenly stops speaking, often unable to continue their thought process. This can indicate underlying mental health issues.

Circumstantial thinking is characterized by a delay in reaching the main point of a conversation due to the inclusion of unnecessary details. This can make communication less effective and may indicate certain mental health conditions.

Flight of ideas involves racing thoughts that rapidly switch topics, creating a nearly continuous flow of accelerated speech. This symptom is often associated with mania and can affect the clarity of communication.

Loose associations occur when ideas shift from one unrelated topic to another without any obvious connections. The speaker is often unaware of the disconnect, which can be indicative of certain mental health disorders.

Tangential thinking is the inability to get to the point of a story, where the speaker introduces multiple unrelated topics and eventually loses the original topic. This can hinder effective communication and understanding.

Perseveration is the persistent repetition of the same word or ideas in response to different questions. This can indicate cognitive difficulties and may be observed in various mental health conditions.

Neologism refers to the creation of new, invented words that are meaningless to others but hold symbolic meaning for the speaker. This can be a sign of disordered thinking often seen in certain mental health disorders.

• Grandiose: Unrealistic sense of self-importance
• Delusions: False belief held despite proof it is false
• Thought Broadcasting: Belief that thoughts are being sent out to others
• Thought Insertion: Belief that thoughts are not one's own
• Somatic Delusions: Related to the body
• Suicidal Ideation/Homicidal Ideation
• Ideas of Reference: Belief that an event is specifically related to the patient
• Paranoia

• Schizophrenia: Characterized by delusions
• Psychosis: Involves delusions
• OCD: Features obsessions and compulsions
• Obsessive Compulsive Personality Disorder: Preoccupation with rules, order, or organization
• Post Traumatic Stress Disorder (PTSD): Involves recurrent and distressing thoughts and memories
• Paranoid Personality Disorder: Involves preoccupation and suspicion
• Schizotypal Personality Disorder: Characterized by suspicion and paranoia

• Auditory: Hearing sounds or voices that are not present.
• Visual: Seeing things that are not there.
• Olfactory: Smelling odors that have no source.
• Gustatory: Tasting things that are not present.
• Tactile: Feeling sensations on the skin that are not real.

Derealization is a dissociative symptom where an individual feels detached from their surroundings, as if they are observing the environment rather than experiencing it directly.

Depersonalization is a feeling where one's own reality is temporarily lost, often described as feeling like one is in a dream state, detached from oneself.

These symptoms can indicate serious conditions such as:

• Alcohol withdrawal: Can lead to hallucinations.
• Schizophrenia: Often characterized by hallucinations.
• PTSD: May involve derealization and depersonalization.

Additionally, there may be medical causes for these symptoms, including encephalitis, autoimmune diseases, or tumors.

The key components to assess are:

1. Person: Does the patient know who they are and who the people around them are?
2. Place: Does the patient know where they are and behave accordingly?
3. Time: Can the patient state the approximate date and time?
4. Situation: Does the patient understand the situation and the purpose of the interview?
5. Level of Consciousness: Is the patient sedated, groggy, drowsy, or in a coma?

Assessing a patient's orientation is important because:

• It helps identify delirium, which is characterized by disorientation to situation, time, and place.
• It can indicate intoxication, which may also lead to disorientation.
• Understanding a patient's orientation aids in determining their cognitive function and overall mental health status.

The components of cognition assessment include:

1. Recent Memory: Ability to recall recent events.
2. Remote Memory: Ability to recall important historical and childhood events.
3. Recall: Ability to recall 3 unrelated words.
4. Abstract Thinking: Consider developmental stage and ability to interpret proverbs; assess if figures of speech are taken literally.
5. General Fund of Knowledge: Ability to name 5 presidents, cities, major events, and sports teams.

Cognition assessment is important because it helps identify various mental health conditions:

• Delirium: Associated with poor concentration.
• Dementia: Characterized by memory impairment and poor abstract thinking.
• Intoxication: Leads to decreased alertness and poor concentration.
• Major Depressive Disorder (MDD): Results in poor concentration.
• Mania/Hypomania: Causes distractibility and poor concentration.
• Wernicke Korsakoff Syndrome: Associated with poor short-term memory.

Insight refers to the understanding of the actual cause or nature of a situation, particularly the patient's awareness of their symptoms, illness, or limitations.

The levels of patient insight include:

1. Fair - Acknowledges depressive symptoms but declines treatment.
2. Denies illness - Blames symptoms on others or external factors.
3. Minimizes illness - Considers symptoms manageable.
4. Partial awareness - Aware of illness but unable to apply this knowledge effectively.
5. Lack of insight - No insight whatsoever.

Judgment refers to the current ability to assess a situation and act appropriately, including how a patient solves problems or makes decisions.

Judgment impairment can be classified as:

1. Impaired - In the context of intoxication.
2. Poor - In the context of schizophrenia, psychosis, and dementia.
3. Good - The patient is aware and makes decisions that do not endanger themselves or others.

Remaining neutral and avoiding judgement during the MSE is crucial because it helps to create a safe environment for the patient, encourages open communication, and ensures that the assessment is objective and free from bias or stigma.

The MSE does not include the patient's history or past mental states, which is significant because it focuses solely on the patient's current mental state, allowing for an accurate assessment of their present condition without the influence of past experiences.

Descriptions in the MSE should be as descriptive as possible, avoiding vague terms like 'normal' or 'WDL'. Instead, they should be qualified with 'As Evidenced By (AEB)' to provide specific observations and details about the patient's mental state.

The suicide risk assessment may be conducted in tandem with the MSE, as both evaluations are essential for understanding the patient's current mental state and determining any immediate risks to their safety.

Anxiety is a feeling of worry, nervousness, or unease about something with an uncertain outcome. Anxiety-related disorders include various conditions characterized by excessive fear or anxiety, such as Generalized Anxiety Disorder, Panic Disorder, and Social Anxiety Disorder.

Pharmacological treatments for anxiety disorders typically include:

1. Antidepressants (e.g., SSRIs, SNRIs)
2. Benzodiazepines (for short-term relief)
3. Buspirone (an anxiolytic)
4. Beta-blockers (for physical symptoms)
5. Antihistamines (for mild anxiety)

These medications help manage symptoms and improve overall functioning.

Non-pharmacological treatments for anxiety disorders include:

1. Cognitive Behavioral Therapy (CBT)
2. Mindfulness and Meditation
3. Exercise
4. Support Groups
5. Relaxation Techniques (e.g., deep breathing, progressive muscle relaxation)
6. Lifestyle Changes (e.g., diet, sleep hygiene)

These approaches focus on coping strategies and behavioral changes to reduce anxiety symptoms.

Key components of nursing assessment for clients with anxiety disorders include:

1. Patient History (including family history of anxiety)
2. Symptom Assessment (frequency, duration, and intensity of anxiety symptoms)
3. Physical Examination (to rule out medical causes)
4. Mental Status Examination (to assess cognitive function and mood)
5. Risk Assessment (for self-harm or harm to others)

These components help in formulating an effective care plan.

Nursing interventions for clients with anxiety disorders include:

1. Establishing a Therapeutic Relationship
2. Providing Education about anxiety and treatment options
3. Encouraging Relaxation Techniques
4. Monitoring Medication Effects and side effects
5. Facilitating Support Groups or therapy sessions
6. Developing Coping Strategies with the client

These interventions aim to support the client in managing their anxiety effectively.

Common physical manifestations of anxiety include:

• Headaches
• Nausea and vomiting (N/V)
• Sleep disturbances

The levels of anxiety and their characteristics are as follows:

Elevated or persistent anxiety can lead to:

• Behavior changes
• Impairment of function
• Development of anxiety disorders, which can be persistent and disabling

Anxiety is characterized by feelings of discomfort, apprehension, and dread, typically related to the anticipation of danger.

Anxiety disorders are the most common psychiatric disorder, affecting up to 20% of adults.

The median onset of anxiety is around 11 years old.

Women are more likely to experience anxiety disorders than men.

Anxiety involves both physical and psychological responses.

The source of anxiety is often nonspecific or unknown.

Fear or anxiety when separated from an individual to whom one is emotionally attached.

Irrational fear of a certain object or situation, such as zoophobia (fear of animals) or acrophobia (fear of heights).

Extreme fear of places where one feels vulnerable or unsafe.

Excessive fear of social or performance situations, particularly the fear of being judged by the public.

Recurrent panic attacks that can lead to significant distress or impairment.

Uncontrollable, excessive worry that lasts at least 6 months.

Common symptoms of panic attacks include:

• Sweating, trembling, shaking
• Chest pain, shortness of breath
• Palpitations
• Nausea, gastrointestinal upset
• Dizziness, chills, hot flashes
• Numbness, tingling
• Depersonalization
• Fear of dying

Panic attacks last for a discrete period, but the exact duration can vary from a few minutes to longer, depending on the individual.

A common psychological experience associated with panic attacks is a feeling of impending doom.

Panic attacks are not classified as a disorder but may occur with a variety of anxiety disorders, other mental health disorders, or medical conditions.

Agoraphobia is characterized by the avoidance of situations that may trigger panic attacks, leading individuals to avoid places where escape might be difficult or help unavailable.

The fundamental features of OCD are intrusive thoughts of unrealistic obsessions and compulsive behaviors that are attempts to control these thoughts.

Hoarding Disorder is characterized by difficulty parting with possessions, which results in extreme stress and functional impairment.

Body Dysmorphic Disorder involves a preoccupation with perceived flaws or defects in physical appearance, leading to significant distress and impairment.

Obsessions are characterized by:

1. Intrusive: They jump into the mind with no warning, causing stress and distress, and cannot be expelled through logic or reasoning.
2. Recurrent: They occur repeatedly throughout the day and are time-consuming.
3. Unwanted: They consist of distressing thoughts and images.

Compulsions can be categorized into:

1. Repetitive, ritualistic thoughts or behaviors: These are performed to prevent or reduce distress or to avert a dreaded event or situation.
2. Behavioral (observable): Examples include washing hands, making lists, tapping, and checking and re-checking.
3. Mental: These include activities like praying and counting.

It relieves anxiety

Females are more affected than males for all anxiety disorders and obsessive-compulsive disorders, except for hoarding disorder, where males are more affected than females.

Risk factors include a family history of anxiety disorders and a history of trauma.

• Involves an intense fear of a specific object or experience.
• Fear can be triggered by merely thinking about the phobia.

• Characterized by panic attacks lasting 15-30 minutes.
• Symptoms include:
  • Palpitations
  • Shortness of breath (SOB)
  • Choking/smothering sensation
  • Chest pain
  • Nausea/Vomiting (N/V)
  • Depersonalization
  • Fear of dying/insanity
  • Chills/hot flashes
• May lead to behavior changes and fixation on future attacks.

• Involves uncontrollable, excessive worry for most days over a period of 6 months.
• Causes significant impairment in functioning across work, home, and social life.
• Physical manifestations include:
  • Restlessness
  • Muscle tension
  • Avoidance of stress
  • Increased time/effort for daily tasks
  • Procrastination
  • Sleep disturbances

• Attempts to suppress persistent, anxiety-producing thoughts/urges through compulsive/obsessive behaviors.
• Obsessions/compulsions are time-consuming and result in social/occupational impairment.

• Obsessive desire to save items regardless of value.
• Extreme stress at the thought of discarding items.
• Results in social/occupational impairment and unsafe living conditions.

• Perceived physical defect/flaw that produces anxiety.
• Can lead to social/occupational impairment.
• Attempts to conceal flaw and practices repetitive behaviors (e.g., mirror checking or comparing to others) due to anxiety.

• Provide safety and comfort during assessment and at times of crisis (e.g., panic attacks).
• Keep the individual focused on the present.
• Assess for comorbidities and substance use disorders (SUD).
• Use relaxation techniques to help manage anxiety.
• Instill hope and enhance self-esteem.
• Identify maladaptive defense mechanisms.
• Implement milieu therapy which includes:
  • Supportive and structured environment.
  • Monitoring for self-harm and suicidal ideation (SI).
  • Engaging in daily activities that foster sharing, resilience, and cooperation.
  • Utilizing therapeutic communication and shared decision-making.
• Identify counseling, group therapy, and community resources for additional support.

SSRIs are the first-line treatment for anxiety and obsessive-compulsive disorders. Examples include sertraline and paroxetine.

SNRIs can also be effective treatments for anxiety and obsessive-compulsive disorders. Examples include venlafaxine and duloxetine.

Antianxiety medications include:

1. Benzodiazepines - used short-term as needed (PRN).
2. Buspirone - used for long-term treatment.
3. Beta-blockers and antihistamines - used PRN for anxiety symptoms.

Mood stabilizers can be used either as monotherapy or as an adjuvant treatment. Examples include lamotrigine and valproic acid.

The primary goal of CBT is to decrease the anxiety response by changing cognitive distortions through cognitive reframing, which involves identifying negative thoughts, examining their causes, and developing supportive ideas to replace negative self-talk.

Key educational points include:

1. Monitor for manifestations of anxiety.
2. Notify the provider of worsening symptoms.
3. Consult the provider before changing medication doses.
4. Evaluate coping mechanisms and introduce stress relief techniques.

The goal of relaxation training is to control pain, tension, and anxiety through different techniques.

Modeling involves demonstrating appropriate behavior in a stressful situation, with the goal for the patient to imitate that behavior.

Systematic desensitization involves mastering relaxation techniques and then gradually exposing the client to an anxiety-producing stimulus, using relaxation to overcome the resulting anxiety.

Flooding is a technique that involves exposure to a great deal of undesirable stimulus to turn off the anxiety response, and it is particularly useful for treating phobias.

The purpose of response prevention is to prevent the client from performing compulsive behavior, with the goal of diminishing anxiety.

Thought stopping teaches the client to say 'stop' when negative thoughts or compulsions arise and to substitute a positive thought in its place.

Generalized Anxiety Disorder (GAD) is characterized by excessive worry about various aspects of life, including academic performance and personal relationships, along with symptoms like irritability and insomnia.

Common medications include:

Key points for patient education include:

1. Dosage and Administration: Explain the prescribed dosage and how to take the medication.
2. Potential Side Effects: Inform about common side effects and when to seek help.
3. Avoiding Alcohol: Advise against alcohol consumption while on these medications.
4. Regular Follow-ups: Emphasize the importance of regular follow-up appointments to monitor progress.
5. Discontinuation: Discuss the proper way to discontinue medication to avoid withdrawal symptoms.

Common side effects include:

Examples of anxiolytics include:

1. Buspirone
2. Benzodiazepines such as:
   • Lorazepam
   • Alprazolam
   • Clonazepam

Medications used include:

• Anxiolytics (e.g., Buspirone, Benzodiazepines)
• Centrally acting alpha-blockers (e.g., Prazosin)
• Anticonvulsants (e.g., Gabapentin, Pregabalin)
• Antidepressants:
  • SSRIs
  • SNRIs
  • TCAs
  • MAOIs
  • Mirtazapine, Trazodone
• Beta blockers (e.g., Propranolol)

1. Benzodiazepines: Lorazepam, alprazolam, clonazepam, diazepam, chlordiazepoxide, clorazepate, oxazepam
2. Atypical Anxiolytic/Nonbarbiturate Anxiolytic: Buspirone
3. Selected Antidepressants:
   • SSRIs: paroxetine, sertraline, fluoxetine, citalopram, escitalopram, fluvoxamine
   • SNRIs: venlafaxine, duloxetine, desvenlafaxine
4. Other Antidepressants:
   • TCAs: amitriptyline, imipramine, clomipramine
   • MAOIs: phenelzine
   • Mirtazapine
   • Trazodone
5. Other Medications: propranolol, prazosin, gabapentin, pregabalin
6. Antihistamines: hydroxyzine pamoate, hydroxyzine HCl

The major classes of antidepressants include:

1. SSRIs (Selective Serotonin Reuptake Inhibitors):

   • Paroxetine
   • Sertraline
   • Fluoxetine
   • Escitalopram
   • Fluvoxamine

2. SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors):

   • Venlafaxine

3. TCAs (Tricyclic Antidepressants):

   • Amitriptyline
   • Imipramine

4. MAOIs (Monoamine Oxidase Inhibitors):

   • Phenelzine

5. NaSSAs (Noradrenergic and Specific Serotonergic Antidepressants):

   • Mirtazapine

Other medications include:

• Propranolol (beta blocker)
• Prazosin (centrally acting alpha-blocker)
• Clonidine (centrally acting alpha 2 agonist)

The prototype medication for benzodiazepines is alprazolam.

The primary purpose of benzodiazepines is to enhance inhibitory effects of GABA in the central nervous system (CNS), providing rapid relief from anxiety following administration.

Benzodiazepines are used for:

1. Short-term treatment for Generalized Anxiety Disorder (GAD) and panic disorder.
2. Seizure disorders.
3. Insomnia.
4. Muscle spasm.
5. Alcohol withdrawal.
6. Induction of anesthesia.
7. Amnesic prior to surgery or procedures.

Important nursing administration considerations include:

1. Tapering the medication over several weeks following long-term use.
2. Taking the medication with food if gastrointestinal upset occurs.

Client education should include:

• Take medication as prescribed and do not alter dosing.
• Avoid abrupt discontinuation to prevent withdrawal symptoms.
• Be aware of the potential for abuse; keep medication in a secure place.
• Notify the provider if indications of withdrawal occur.

When taking benzodiazepines, avoid:

• CNS depressants as they can cause respiratory depression.
• Alcohol, barbiturates, and opioids.
• Engaging in hazardous activities or driving due to potential impairment.

• CNS depression: Sedation, lightheadedness, ataxia, decreased cognitive function.
  • Anterograde amnesia: Difficulty recalling events after dosing.
  • Acute toxicity: CNS depression, respiratory depression, severe hypotension, cardiac arrest.

• Observe for manifestations such as sedation and lightheadedness.
• Contact the provider if symptoms occur.
• Avoid hazardous activities and other CNS depressants.

1. Perform gastric lavage followed by activated charcoal for oral toxicity.
2. Administer Flumazenil as an overdose treatment.
3. Monitor vital signs and ensure availability of resuscitation equipment.

• High risk in pregnancy: Can cause fetal abnormalities and withdrawal in newborns.
• Controlled substance.
• Contraindicated in sleep apnea, respiratory depression, and glaucoma.
• Use cautiously in those with liver disease and a history of substance use disorder.
• Assess fall risk for older adults.

Buspirone binds to serotonin and dopamine receptors, although its exact antianxiety mechanism is unknown.

Buspirone is primarily used for the treatment of Generalized Anxiety Disorder (GAD).

Common side effects include dizziness, nausea, headache, lightheadedness, and agitation. It does not interfere with daily activities.

Caution should be exercised when prescribing buspirone during pregnancy and breastfeeding, and it should be used cautiously in patients with renal or liver disease. It is contraindicated for concurrent use with MAOIs.

Buspirone should be administered at the same time daily, may be taken with meals, and it typically takes 4 or more weeks to achieve full effects.

Concurrent use of erythromycin, ketoconazole, St. John's wort, and grapefruit juice can increase the effects of buspirone and are contraindicated.

SSRIs selectively inhibit serotonin reuptake, increasing serotonin at the neuronal junction.

SSRIs are first-line treatment for:

1. Panic disorders
2. Trauma- and stressor-related disorders
3. Generalized Anxiety Disorder (GAD)
4. Obsessive-Compulsive Disorder (OCD)
5. Social Anxiety Disorder
6. Post-Traumatic Stress Disorder (PTSD)
7. Depressive disorders
8. Adjustment disorders
9. Associated manifestations of dissociative disorders

1. SSRIs may be taken with food.
2. To minimize sleep disturbances, they should be taken in the morning.
3. They should be taken daily.

1. Higher risk in pregnancy; other SSRIs are lower risk.
2. Contraindicated with TCA or MAOI use.
3. Alcohol should be avoided.
4. Use caution in individuals with liver/kidney dysfunction, seizure disorders, or history of GI bleeding.
5. Caution in those with bipolar disorder.

Early adverse effects include nausea, diaphoresis, tremor, fatigue, and drowsiness. Clients should be educated to report these effects, take the medication as prescribed, and be cautious with driving as these effects should subside over time.

Later adverse effects (after 5+ weeks) include sexual dysfunction (impotence, delayed/absent orgasm/ejaculation), weight gain, and headache. Management options include dose change, medication holiday, dose reduction, or addition of bupropion. Clients should be educated to report any sexual dysfunction.

Clients should monitor their weight as they may experience weight loss early in therapy and weight gain with long-term treatment. It is important to exercise regularly and follow a well-balanced diet.