Reviewers v

Preface vii

Acknowledgments ix

Unit I Introduction to Mental Health and Mental Illness

Chapter 1 Mental Health and Mental Illness 1

Defining Mental Health and Mental Illness 2

Mental Health 2

Mental Illness 2

Cultural, Ethnic, and Religious Influence? 2

Cultural Heritage-Beliefs, Norms, and Values 3

Factors that Affect Mental Health 3

Stress and Anxiety 5

Grief and Loss 9

Chapter 2 The Delivery of Mental Health Care 18

Historical Advancement of Mental Health Care 19

Early Civilizations 19

The Beginning of Change 19

Twentieth Century Progress 20

Community-Based Care 20

Current Issues in Mental Health Care 21

Access to Care: Cultural Disparities 21

Legal and Ethical Considerations in Mental Health Care 23

Client Rights 24

Use of Seclusion and Restraint 26

Nurse Accountability 27

Practice Settings for Mental Health Care 27

Inpatient Psychiatric Settings 27

Outpatient Mental Health Settings 28

Nonpsychiatric Health Care Facilities 28

Chapter 3 Theories of Personality Development 38

Personality 39

Individual Needs and Behavior 39

Temperament 40

Theories of Personality Development 40

Sigmund Freud (Psychoanalytic Theory) 40

Erik Erikson (Psychosocial Developmental Theory) 43

Jean Piaget (Cognitive Development Related to Personality) 47

Lawrence Kohlberg (Theory of Moral Development) 48

Harry S. Sullivan (Theory of Interpersonal Development) 48

Hildegard Peplau (Psychodynamic Nursing) 48

Murray Bowen (Family Systems Theory) 49

Other Theories 50

Unit II Mental Health Care

Chapter 4 Treatment of Mental Illness 55

Establishing a Therapeutic Milieu 56

Treatment Team 57

Interdisciplinary Team Members 57

Role of the Nurse 59

Types of Therapy 60

Psychotherapy 60

Group Therapy 62

Biomedical Therapy 62

Electroconvulsive Therapy 62

Other Type, of Therapy 63

Pharmacological Agents and Mental Illness 63

Symptom Categories of Psychiatric Disorders 64

Classification of Psychotropic Drug Agents 64

Action of Psychotropic Drags on Neurotransmitters 64

Psychotropic Drug Agents and the Older Client 65

Chapter 5 Establishing and Maintaining a Therapeutic Relationship 70

The Therapeutic Relationship 71

Important Characteristics for Establishing a Nurse-Client Relationship 71

Phases of a Therapeutic Relationship 72

Professional Boundaries 73

Response to Difficult Client Behaviors 74

Manipulation 75

Violence or Aggression 75

Altered Thought Process (Hallucinations, Illusions, Delusions) 75

Sexually Inappropriate Behaviors or Aggression 76

Chapter 6 Dynamics of Anger, Violence, and Crises 81

Dynamics of Anger and Aggression 82

Defining Anger 82

Trait Anger 82

Expressing Anger and Resentment 82

Unrestrained Anger and Violence 83

Influencing Factors for Violence 83

Managing Anger 86

Crisis and Intervention 88

Types of Crises 88

Crisis Intervention 89

Suicide 90

Risk Factors 90

Risk Assessment and Intervention 91

Steps for Prevention 91

Unit III Fundamental Nursing Roles in Mental Health Nursing

Chapter 7 Communication in Mental Health Nursing 95

Communication in Mental Health Nursing 96

Speech Patterns Common to Clients with Mental Illness 96

Therapeutic Communication 97

Verbal Communication 97

Nonverbal Communication Techniques 98

Active Listening 99

Nontherapeutic Communication 99

Chapter 8 The Nursing Process in Mental Health Nursing 105

Understanding the Nursing Process for Mental Health Nursing 106

Psychosocial Assessment 106

Subjective Data 107

Objective Data 108

Nursing Diagnosis 108

Planning Expected Outcomes 109

Implementation of Nursing Interventions 109

Evaluation 111

Sample Application of the Nursing Process 112

Client Situation 112

Nursing Assessment 112

Unit IV Specific Psychiatric Disorders

Chapter 9 Anxiety Disorders 117

Types of Anxiety Disorders 118

Generalized Anxiety Disorder 118

Panic Disorder 119

Specific Phobia 121

Social Anxiety Disorder (Social Phobia) 122

Posttraumatic Stress Disorder (Trauma and Stressor-Related Disorders) 123

Obsessive-Compulsive Disorder 125

Treatment of Anxiety Disorders 126

Antianxiety Agents 127

Application of the Nursing Process to the Client with an Anxiety Disorder 129

Nursing Assessment 129

Nursing Diagnosis 131

Expected Outcomes 131

Nursing Interventions 131

Evaluation 132

Chapter 10 Mood Disorders 136

Introduction 137

Mood and Affect Defined 137

Depressive Disorders 137

Major Depressive Disorder 137

Persistent Depressive Disorder (Dysthymia) 139

Bipolar and Related Disorders 140

Signs and Symptoms 140

Incidence and Etiology 141

Cyclothymic Disorder 142

Treatment of Depressive Disorders 142

Antidepressants 143

Treatment of Bipolar and Related Disorders 146

Application of the Nursing Process 149

Assessment 149

Selected Nursing Diagnoses 150

Expected Outcomes 151

Nursing Interventions 151

Specific Interventions for a Suicidal Client 152

Evaluation 153

Chapter 11 Psychotic Disorders 158

Introduction to Psychotic Disorders 159

Psychosis 159

Types of Psychotic Disorders 161

Schizophrenia 161

Treatment of Psychotic Disorders 165

Antipsychotic Drug Agents 166

Autiparkinson Drug Agents 171

Psychotropic Drugs and the Older Client 171

Application of the Nursing Process 172

Assessment 172

Selected Nursing Diagnoses 173

Expected Outcomes 173

Interventions 173

Evaluation 175

Chapter 12 Personality Disorders 181

Introduction 182

Types of Personality Disorders 182

Cluster A Personality Disorders 182

Cluster B Personality Disorders 185

Cluster C Personality Disorders 191

Treatment of Personality Disorders 193

Application of the Nursing Process 194

Assessment 194

Selected Nursing Diagnoses 195

Expected Outcomes 195

Interventions 195

Evaluation 196

Chapter 13 Somatic Symptom and Related Disorders 201

Introduction 202

Types of Somatic Disorders 202

Somatic Symptom Disorder 202

Illness Anxiety Disorder (Formerly Hypochondriasis) 204

Conversion Disorder (Functional Neurologic Symptom Disorder) 205

Factitious Disorder 206

Application of the Nursing Process 207

Nursing Assessment 207

Selected Nursing Diagnosis 208

Expected Outcomes 208

Interventions 209

Evaluation 210

Chapter 14 Dissociative Disorders 215

Introduction 216

Types of Dissociative Disorders 216

Dissociative Amnesia 216

Dissociative Amnesia with Dissociative Fugue 217

Dissociative Identity Disorder 218

Depersonalization/Derealization Disorder 220

Treatment of Dissociative Disorders 220

Application of the Nursing Process 221

Nursing Assessment 221

Nursing Diagnoses 221

Expected Outcomes 222

Nursing Interventions 222

Evaluation 223

Chapter 15 Substance-Related Disorders 227

Substance Use, Abuse, and Addiction 228

Substance Abuse 228

Addiction 228

Phases of Substance Dependency 229

Classes of Substances 230

Theoretical Approaches to Substance Use and Abuse 231

Codependence: A Family Disease 232

Substance-Induced Disorders 233

Substance Intoxication 233

Substance Withdrawal 234

Substance-Specific Use Disorders 234

Alcohol- Use Disorder 241

Cannabis-Use Disorder 242

Hallucinogen-Use Disorder 242

Inhalant-Related Disorders 245

Opioid-Related Disorders 245

Stimulant-Use Disorder 246

Caffeine-Use Disorder 247

Nicotine-Use Disorder 248

Sedative-, Hypnotic-, or Anxiolytic-Use Disorders 248

Substance Abuse by Health Care Professionals 249

Treatment of Substance-Related Disorders 250

Detoxification 251

Treatment Programs 251

Application of the Nursing Process 251

Assessment 251

Selected Nursing Diagnosis 253

Expected Outcomes 253

Interventions 255

Evaluation 258

Chapter 16 Eating Disorders 263

Introduction 264

Types of Eating Disorders 264

Anorexia Nervosa 264

Bulimia Nervosa 267

Binge-Eating Disorder 269

Treatment of Eating Disorders 270

Application of the Nursing Process 271

Assessment 271

Selected Nursing Diagnoses 271

Expected Outcomes 272

Interventions 272

Evaluation 272

Chapter 17 Sexual Disorders 278

Introduction 279

Types of Sexual Disorders 279

Sexual Dysfunction Disorders 279

Paraphilic Disorders 282

Gender Dysphoria Disorder 284

Treatment of Sexual Disorders 286

Application of Nursing Process to the Client with a Sexual Disorder 286

Assessment 286

Selected Nursing Diagnoses 286

Expected Outcomes 286

Interventions 287

Evaluation 287

Unit V Age-Specific Disorder and Issuer

Chapter 18 Disorders and Issues of Children and Adolescents 291

Introduction 292

Types of Mental Disorders in Children and Adolescents 292

Neurodevelopmental Disorders 292

Language and Communication Disorders 294

Speech Sound Disorder 294

Autism Spectrum Disorder 295

Attention Deficit/Hyperactivity Disorder 296

Specific Learning Disorders 299

Disruptive, Impulse-Control, and Conduct Disorders 300

Oppositional-Defiant Disorder 300

Intermittent Explosive Disorder 300

Conduct Disorder 302

Anxiety Disorders 302

Separation Anxiety Disorder 302

Tic Disorder (Tourette's Disorder) 303

Elimination Disorders 304

Signs and Symptoms 304

Incidence and Etiology 304

Treatment of Child and Adolescent Disorders 304

Neurodevelopmental Disorders 305

Learning and Communication Disorders 305

Anxiety Disorders 305

Elimination Disorders 305

Application of the Nursing Process 306

Assessment 306

Selected Nursing Diagnoses 306

Expected Outcomes 306

Interventions 307

Evaluation 307

Chapter 19 Disorders and Issues of the Older Adult 312

Introduction 313

Mental Health Care for Older Adults 313

Psychosocial Issues Related to Aging 313

Impaired Cognitive Functioning 314

Types of Mental Disorders in the Older Adult 314

Delirium 314

Dementia 315

Treatment of Neuroeognitive Disorders in the Older Adult 322

Application of the Nursing Process for Delirium 324

Assessment 324

Selected Nursing Diagnoses 324

Expected Outcomes 324

Interventions 324

Evaluation 326

Application of the Nursing Process for Dementia 326

Assessment 326

Selected Nursing Diagnoses 327

Expected Outcomes 327

Interventions 327

Evaluation 329

Appendices

Appendix A DSM 5 Classification of Mental Disorders 333

Appendix B Nanda-I Nursing Diagnoses Most Frequently Used in Mental Health and Psychiatric Settings 342

Appendix C Anxiety Scale (Sample) 348

Appendix D Answers to Student Worksheet 349

Glossary 363

Index 375