NURS 3300 EXAM 2 STUDY GUIDE-MENTAL
HEALTH SPRING 2019 GRADED A+
Chapter 1: Foundations of Psychiatric –Mental Health Nursing
Factors contributing to mental illness (individual, interpersonal, and social/cultural).
a. Individual, or personal, factors include a person’s biologic makeup, autonomy
and independence, self-esteem, capacity for growth, vitality, ability to find
meaning in life, emotional resilience or hardiness, sense of belonging, reality
orientation, and coping or stress management abilities.
b. Interpersonal, or relationship, factors include effective communication, ability
to help others, intimacy, and a balance of separateness and connectedness.
c. Social/cultural, or environmental, factors include a sense of community, access
to adequate resources, intolerance of violence, support of diversity among
people, mastery of the environment, and a positive, yet realistic, view of one’s
world. Individual, interpersonal, and social/cultural factors
Three purposes of the Diagnostic and Statistical Manual of Mental Disorders,
Fifth Edition (DSM-5).
a. To provide a standardized nomenclature and language for all mental
health professionals
b. To present defining characteristics or symptoms that differentiate
specific diagnoses
c. To assist in identifying the underlying causes of disorders
Historical perspectives of the treatment of mental illness (Examples include mental
disorders were considered either to divine, demonic, or possessed, “bloodletting”,
incarceration in dungeons, witch hunts, insane asylums, and institutionalization
etc.).
a. Individuals seen as divine were worshipped and adored; those seen as demonic
were ostracized, punished, and sometimes burned at the stake. Later, Aristotle
(382–322 BC) attempted to relate mental disorders to physical disorders and
developed his theory that the amounts of blood, water, and yellow and black
bile in the body controlled the emotions. These four substances, or humors,
corresponded with happiness, calmness, anger, and sadness. Imbalances of the
four humors were believed to cause mental disorders; so treatment was aimed at
restoring balance through bloodletting, starving, and purging. Such “treatments”
persisted well into the 19th century (Baly, 1982).
b. In 1547, the Hospital of St. Mary of Bethlehem was officially declared a
hospital for the insane, the first of its kind. By 1775, visitors at the institution
were charged a fee for the privilege of viewing and ridiculing the inmates, who
were seen as animals, less than human
c. In the 1790s, a period of enlightenment concerning persons with mental illness
began. Philippe Pinel in France and William Tuke in England formulated the
concept of asylum as a safe refuge or haven offering protection at institutions
,NURS 3300 EXAM 2 STUDY GUIDE-MENTAL
HEALTH SPRING 2019 GRADED A+
where people had been whipped, beaten, and starved just because they were
mentally ill
What is meant by the term “revolving door effect?”
a. Some believe that deinstitutionalization has had negative as well as
positive effects.
b. the term revolving door effect. Although people with severe and persistent
mental illness have shorter hospital stays, they are admitted to hospitals more
frequently. The continuous flow of clients being admitted and discharged quickly
overwhelms general hospital psychiatric units. In some cities, emergency
department (ED) visits for acutely disturbed persons have increased by 400% to
500%.
c. Shorter, unplanned hospital stays further complicate frequent, repeated hospital
admissions. People with severe and persistent mental illness may show signs of
improvement in a few days but are not stabilized. Thus, they are discharged
into the community without being able to cope with community living.
What is the role of managed care in containing cost for the treatment of mental illness?
a. Managed care is a concept designed to purposely control the balance between the
quality of care provided and the cost of that care. In a managed care system,
people receive care based on need rather than on request.
b. Psychiatric care is costly because of the long-term nature of the disorders. A
single hospital stay can cost $20,000 to $30,000. Also, there are fewer
objective measures of health or illness
c. Mental health care is separated from physical health care in terms of insurance
coverage
d. There are often specific dollar limits or permitted numbers of hospital days in a
calendar year.
e. In addition, many persons with mental illness do not seek care and in fact
avoid treatment. These persons are often homeless or in jail.
f. In the past, insurers had spending caps for mental illness and substance abuse
treatment.
g. In 1996, Congress passed the Mental Health Parity Act, which eliminated
annual and lifetime dollar amounts for mental health care for companies with
more than 50 employees.
What are the Healthy People 2020 Objectives?
a. Reduce the suicide rate
b. Reduce suicide attempts by adolescents
c. Reduce the proportion of adolescents who engage in disordered eating behaviors
in an attempt to control their weight
d. Reduce the proportion of persons who experience major depressive episode
e. Increase the proportion of primary care facilities that provide mental health
treatment onsite or by paid referral
, NURS 3300 EXAM 2 STUDY GUIDE-MENTAL
HEALTH SPRING 2019 GRADED A+
f. Increase the proportion of juvenile residential facilities that screen admissions for
mental health problems Increase the proportion of persons with SMI who are
employed
g. Increase the proportion of adults with mental health disorders who receive
treatment
h. Increase the proportions of persons with co-occurring substance abuse and mental
disorders who receive treatment for both disorders
i. Increase depression screening by primary care providers Increase the number of
homeless adults with mental health problems who receive mental health services
Chapter 2 – Neurobiological Theories and Psychopharmacology
What are the neurotransmitters that play a role in mental illness?
a. Major neurotransmitters have been found to play a role in psychiatric illnesses as
well as in the actions and side effects of psychotropic drugs. Table 2.1 lists the
major neurotransmitters and their actions and effects. Dopamine and serotonin
have received the most attention in terms of the study and treatment of psychiatric
disorders. The following sections discuss the major neurotransmitters associated
with mental disorders.
b. Dopamine Excitatory Controls complex movements, motivation, cognition;
regulates emotional response
c. Norepinephrine (noradrenaline) Excitatory Causes changes in attention, learning
and memory, sleep and wakefulness, mood
d. Epinephrine (adrenaline) Excitatory Controls fight-or-flight response
Serotonin Inhibitory Controls food intake, sleep and wakefulness, temperature
regulation, pain control, sexual behaviors, regulation of emotions
e. Histamine Neuromodulator Controls alertness, gastric secretions,
cardiac stimulation, peripheral allergic responses
f. Acetylcholine Excitatory or inhibitory Controls sleep and wakefulness cycle;
signals muscles to become alert
g. Neuropeptides Neuromodulators Enhance, prolong, inhibit, or limit the effects
of principal neurotransmitters
h. Glutamate Excitatory Results in neurotoxicity if levels are too high
Gamma- aminobutyric acid (GABA) Inhibitory Modulates other
neurotransmitters
What are the neurobiological causes of mental illness?
a. Genetics and Heredity
b. Three types of studies are commonly conducted to investigate the genetic basis
of mental illness:
i. Twin studies are used to compare the rates of certain mental illnesses
or traits in monozygotic (identical) twins, who have an identical
genetic makeup, and dizygotic (fraternal) twins, who have a different
genetic
HEALTH SPRING 2019 GRADED A+
Chapter 1: Foundations of Psychiatric –Mental Health Nursing
Factors contributing to mental illness (individual, interpersonal, and social/cultural).
a. Individual, or personal, factors include a person’s biologic makeup, autonomy
and independence, self-esteem, capacity for growth, vitality, ability to find
meaning in life, emotional resilience or hardiness, sense of belonging, reality
orientation, and coping or stress management abilities.
b. Interpersonal, or relationship, factors include effective communication, ability
to help others, intimacy, and a balance of separateness and connectedness.
c. Social/cultural, or environmental, factors include a sense of community, access
to adequate resources, intolerance of violence, support of diversity among
people, mastery of the environment, and a positive, yet realistic, view of one’s
world. Individual, interpersonal, and social/cultural factors
Three purposes of the Diagnostic and Statistical Manual of Mental Disorders,
Fifth Edition (DSM-5).
a. To provide a standardized nomenclature and language for all mental
health professionals
b. To present defining characteristics or symptoms that differentiate
specific diagnoses
c. To assist in identifying the underlying causes of disorders
Historical perspectives of the treatment of mental illness (Examples include mental
disorders were considered either to divine, demonic, or possessed, “bloodletting”,
incarceration in dungeons, witch hunts, insane asylums, and institutionalization
etc.).
a. Individuals seen as divine were worshipped and adored; those seen as demonic
were ostracized, punished, and sometimes burned at the stake. Later, Aristotle
(382–322 BC) attempted to relate mental disorders to physical disorders and
developed his theory that the amounts of blood, water, and yellow and black
bile in the body controlled the emotions. These four substances, or humors,
corresponded with happiness, calmness, anger, and sadness. Imbalances of the
four humors were believed to cause mental disorders; so treatment was aimed at
restoring balance through bloodletting, starving, and purging. Such “treatments”
persisted well into the 19th century (Baly, 1982).
b. In 1547, the Hospital of St. Mary of Bethlehem was officially declared a
hospital for the insane, the first of its kind. By 1775, visitors at the institution
were charged a fee for the privilege of viewing and ridiculing the inmates, who
were seen as animals, less than human
c. In the 1790s, a period of enlightenment concerning persons with mental illness
began. Philippe Pinel in France and William Tuke in England formulated the
concept of asylum as a safe refuge or haven offering protection at institutions
,NURS 3300 EXAM 2 STUDY GUIDE-MENTAL
HEALTH SPRING 2019 GRADED A+
where people had been whipped, beaten, and starved just because they were
mentally ill
What is meant by the term “revolving door effect?”
a. Some believe that deinstitutionalization has had negative as well as
positive effects.
b. the term revolving door effect. Although people with severe and persistent
mental illness have shorter hospital stays, they are admitted to hospitals more
frequently. The continuous flow of clients being admitted and discharged quickly
overwhelms general hospital psychiatric units. In some cities, emergency
department (ED) visits for acutely disturbed persons have increased by 400% to
500%.
c. Shorter, unplanned hospital stays further complicate frequent, repeated hospital
admissions. People with severe and persistent mental illness may show signs of
improvement in a few days but are not stabilized. Thus, they are discharged
into the community without being able to cope with community living.
What is the role of managed care in containing cost for the treatment of mental illness?
a. Managed care is a concept designed to purposely control the balance between the
quality of care provided and the cost of that care. In a managed care system,
people receive care based on need rather than on request.
b. Psychiatric care is costly because of the long-term nature of the disorders. A
single hospital stay can cost $20,000 to $30,000. Also, there are fewer
objective measures of health or illness
c. Mental health care is separated from physical health care in terms of insurance
coverage
d. There are often specific dollar limits or permitted numbers of hospital days in a
calendar year.
e. In addition, many persons with mental illness do not seek care and in fact
avoid treatment. These persons are often homeless or in jail.
f. In the past, insurers had spending caps for mental illness and substance abuse
treatment.
g. In 1996, Congress passed the Mental Health Parity Act, which eliminated
annual and lifetime dollar amounts for mental health care for companies with
more than 50 employees.
What are the Healthy People 2020 Objectives?
a. Reduce the suicide rate
b. Reduce suicide attempts by adolescents
c. Reduce the proportion of adolescents who engage in disordered eating behaviors
in an attempt to control their weight
d. Reduce the proportion of persons who experience major depressive episode
e. Increase the proportion of primary care facilities that provide mental health
treatment onsite or by paid referral
, NURS 3300 EXAM 2 STUDY GUIDE-MENTAL
HEALTH SPRING 2019 GRADED A+
f. Increase the proportion of juvenile residential facilities that screen admissions for
mental health problems Increase the proportion of persons with SMI who are
employed
g. Increase the proportion of adults with mental health disorders who receive
treatment
h. Increase the proportions of persons with co-occurring substance abuse and mental
disorders who receive treatment for both disorders
i. Increase depression screening by primary care providers Increase the number of
homeless adults with mental health problems who receive mental health services
Chapter 2 – Neurobiological Theories and Psychopharmacology
What are the neurotransmitters that play a role in mental illness?
a. Major neurotransmitters have been found to play a role in psychiatric illnesses as
well as in the actions and side effects of psychotropic drugs. Table 2.1 lists the
major neurotransmitters and their actions and effects. Dopamine and serotonin
have received the most attention in terms of the study and treatment of psychiatric
disorders. The following sections discuss the major neurotransmitters associated
with mental disorders.
b. Dopamine Excitatory Controls complex movements, motivation, cognition;
regulates emotional response
c. Norepinephrine (noradrenaline) Excitatory Causes changes in attention, learning
and memory, sleep and wakefulness, mood
d. Epinephrine (adrenaline) Excitatory Controls fight-or-flight response
Serotonin Inhibitory Controls food intake, sleep and wakefulness, temperature
regulation, pain control, sexual behaviors, regulation of emotions
e. Histamine Neuromodulator Controls alertness, gastric secretions,
cardiac stimulation, peripheral allergic responses
f. Acetylcholine Excitatory or inhibitory Controls sleep and wakefulness cycle;
signals muscles to become alert
g. Neuropeptides Neuromodulators Enhance, prolong, inhibit, or limit the effects
of principal neurotransmitters
h. Glutamate Excitatory Results in neurotoxicity if levels are too high
Gamma- aminobutyric acid (GABA) Inhibitory Modulates other
neurotransmitters
What are the neurobiological causes of mental illness?
a. Genetics and Heredity
b. Three types of studies are commonly conducted to investigate the genetic basis
of mental illness:
i. Twin studies are used to compare the rates of certain mental illnesses
or traits in monozygotic (identical) twins, who have an identical
genetic makeup, and dizygotic (fraternal) twins, who have a different
genetic
