NR 326 Exam 2

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Chamberlain University

NR-326: Mental Health Nursing

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Date

NR 326 Mental Health Nursing Exam 2 Overview

Psychotherapy Overview

Psychotherapy is a cornerstone of mental health nursing, aimed at facilitating emotional and behavioral change. It encompasses a variety of therapeutic approaches, including cognitive therapy, behavioral therapy, and integrative methods like cognitive-behavioral therapy (CBT) and dialectical behavior therapy (DBT). These interventions help patients manage psychological disorders by targeting thoughts, emotions, and behaviors in a structured and supportive environment.

Cognitive Therapy

Cognitive therapy is grounded in the principle that thoughts directly influence emotions and behaviors. The focus is on identifying and reshaping distorted thinking patterns that contribute to psychological distress. This therapy is particularly effective for depression, anxiety disorders, and eating disorders. Clients are guided to reframe and reinterpret life events to decrease emotional suffering (Beck, 2011).

Behavioral Therapy

Behavioral therapy emphasizes that maladaptive behaviors are learned and, therefore, can be unlearned. Foundational theorists such as Pavlov, Watson, and Skinner proposed that behaviors result from past experiences and can be modified through reinforcement and structured interventions.

Key Behavioral Therapy Techniques

Technique	Description	Application in Mental Health
Modeling	Learning by imitating role models	Improves interpersonal skills in clinical settings
Systematic Desensitization	Gradual exposure to anxiety triggers with relaxation	Effective for phobias and anxiety disorders
Aversion Therapy	Pairing undesirable behaviors with unpleasant stimuli	Used in substance abuse or aggression management
Flooding	Intense exposure to feared situations	Reduces phobia-related anxiety
Response Prevention	Blocking compulsive behaviors	Common in obsessive-compulsive disorder (OCD)
Thought Stopping	Interrupting negative thought patterns	Helps control intrusive thoughts
Time-Out	Temporary removal from reinforcing environments	Behavior modification in children and adults
Validation Therapy	Affirming feelings regardless of factual accuracy	Beneficial in neurocognitive disorders

Cognitive-Behavioral Therapy (CBT) and Dialectical Behavior Therapy (DBT)

CBT integrates cognitive and behavioral strategies to demonstrate the dynamic relationship between thoughts, emotions, and behaviors. DBT, a specialized form of CBT, is especially effective for individuals with personality disorders. DBT focuses on mindfulness, emotional regulation, and distress tolerance to enhance coping and interpersonal effectiveness.

Dissociative Disorders

Dissociative disorders involve disruptions in memory, identity, or consciousness, typically stemming from trauma or severe stress.

Disorder	Characteristics
Dissociative Identity Disorder	Presence of two or more distinct personality states, often linked to childhood trauma
Depersonalization-Derealization	Feelings of detachment from self or environment, altering perception
Dissociative Amnesia	Inability to recall important personal information, typically trauma-related

Predisposing Factors: Severe psychological trauma, abuse, and overwhelming stress.
Treatment: Focuses on strengthening coping skills, promoting reality orientation, and psychotherapy interventions (APA, 2013).

Somatic Symptom and Related Disorders

Somatic symptom disorders are characterized by physical symptoms that lack a medical explanation, causing significant emotional distress.

Disorder	Description
Somatic Symptom Disorder	Multiple unexplained physical symptoms disrupting daily life; assessed using PHQ-15
Illness Anxiety Disorder	Preoccupation with serious illness despite reassurance; care-seeking or care-avoidant behaviors; linked to childhood abuse and psychiatric comorbidities
Conversion Disorder	Neurological symptoms such as paralysis or blindness without medical cause; may follow stress; includes pseudocyesis (false pregnancy)
Factitious Disorder	Intentional fabrication of illness to assume the sick role; can be self-imposed or imposed on another (Munchausen by proxy)

Grief and Maladaptive Grieving

Grief is an individual process that can occur before a loss (anticipatory grief) or continue beyond typical timeframes. The Kübler-Ross model outlines five stages: denial, anger, bargaining, depression, and acceptance. Maladaptive grief occurs when an individual becomes “stuck” in certain stages, leading to prolonged distress and impaired functioning.

Neurocognitive Disorders (NCDs)

NCDs involve progressive cognitive decline that interferes with daily functioning, classified as mild or major.

Delirium vs. Dementia

Feature	Delirium (Acute Confusion)	Major NCD (Dementia)
Onset	Sudden	Gradual
Duration	Short-term, often reversible	Chronic, progressive
Causes	Infection, dehydration, medication	Alzheimer’s disease, vascular pathology

Etiological Subtypes of NCD

Subtype	Cause
Alzheimer’s Disease	Neurodegeneration
Vascular NCD	Stroke-related brain damage
Lewy Body Dementia	Protein deposits in the brain
Parkinson’s Disease	Dopaminergic degeneration
Huntington’s Disease	Genetic mutation
HIV-related NCD	Neurological impact of HIV

Defense Mechanisms: Denial, confabulation, and perseveration are often utilized to maintain self-esteem.

Suicide in Mental Health

Suicide is an intentional act of self-harm, frequently associated with psychiatric conditions such as major depression. Over 90% of those who die by suicide have a diagnosable mental disorder. Risk factors include hopelessness, social isolation, trauma, and feelings of guilt.

Comprehensive Suicide Risk Assessment

Assessment Criteria	Key Focus Areas
Suicidal Ideation	Presence of thoughts, plans, and prior attempts
Psychiatric/Medical History	Depression, substance use, chronic illness
Social Connections	Availability of interpersonal support
Symptoms and Diagnosis	Current psychiatric or medical conditions
Risk Indicators	Warning signs, access to means, presence of concrete plans

ATI-Identified Risk Factors

Risk Factor Type	Examples
Gender & Age	Male, older adults
Identity/Occupation	LGBTQ+, military veterans
Comorbid Conditions	Depression, bipolar disorder, schizophrenia
Life Events	Bereavement, job loss, declining health
Biological	Family history, chronic illness
Psychosocial	Hopelessness, interpersonal conflict, trauma
Cultural	High suicide rates in American Indian and Alaskan Native populations
Environmental	Firearm access, unemployment, limited healthcare access

Pharmacological Interventions

Medication Class	Examples	Indications
SSRIs	Citalopram, Fluoxetine, Sertraline	Depression, suicidal ideation
Benzodiazepines	Diazepam, Lorazepam	Anxiety, panic disorders
Mood Stabilizers	Lithium	Bipolar disorder
Second-Generation Antipsychotics	Risperidone, Olanzapine	Schizophrenia, bipolar disorder, adjunct in depression

Electroconvulsive Therapy (ECT)

ECT is indicated for severe depression, schizophrenia, or mania when other interventions fail. Electrical stimulation under anesthesia induces controlled seizures that improve symptoms.

Component	Purpose
Anticholinergics	Reduce secretions
Anesthetics	Prevent discomfort
Methohexital/Propofol	Muscle relaxation

Patient and family education is critical, including pre- and post-procedure care and potential side effects such as confusion, headache, and temporary memory loss.

Depression: Types and Risk Factors

Disorder Type	Characteristics
Major Depressive Disorder	Persistent low mood >2 weeks without mania
Dysthymia	Chronic low-grade depression >2 years
Postpartum Depression	Irritability, fatigue, poor sleep, concerns about infant care

Risk Factors: Hormonal imbalances, neurological changes, medication effects, and learned helplessness.

Bipolar Disorders

Type	Description
Bipolar I	Manic episodes, may alternate with depression
Bipolar II	Hypomanic episodes alternating with major depression
Cyclothymic Disorder	Chronic mood fluctuations not meeting full criteria for bipolar disorder

Manic phases are characterized by impulsivity and hyperactivity, whereas depressive phases involve hopelessness and suicidal ideation.

Trauma and Stress-Related Disorders

Disorder	Key Features
PTSD	Flashbacks, avoidance, hyperarousal, long-term functional impairment
Acute Stress Disorder	Symptoms similar to PTSD, duration 3 days–1 month

Nursing care emphasizes suicide risk assessment, empathy, and facilitating access to therapy and medical support.

Anxiety and Related Disorders

Disorder Type	Characteristics
Phobias	Irrational fears causing avoidance
Panic Disorder	Sudden episodes with palpitations and chest pain
Generalized Anxiety	Excessive worry >6 months, fatigue, poor concentration
Body Dysmorphic Disorder	Obsessive focus on perceived physical flaws

Obsessive-Compulsive Disorder (OCD)

OCD is marked by intrusive thoughts (obsessions) and repetitive behaviors (compulsions) aimed at reducing distress. Management includes psychotherapy and pharmacological interventions, particularly SSRIs.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). Washington, DC: Author.

ATI Nursing Education. (2020). Mental health nursing review module (10th ed.). Assessment Technologies Institute.

Beck, J. S. (2011). Cognitive behavior therapy: Basics and beyond (2nd ed.). Guilford Press.

NR 326 Exam 2

Centers for Disease Control and Prevention. (2022). Preventing suicide. https://www.cdc.gov/suicide/index.html

Townsend, M. C. (2020). Psychiatric mental health nursing: Concepts of care in evidence-based practice (9th & 10th eds.). F.A. Davis.

U.S. Department of Health & Human Services. (2022). Suicide prevention. National Institute of Mental Health. https://www.nimh.nih.gov/health/topics/suicide-prevention