Chapter 1

Critical Thinking

1. Examine how family and friends describe people with mental illness. Do you think
their description of mental illness is based on fact or myth? Explain.

They have tendency to harm other people. They can kill. Their description is
based on fact because they know that people with mental illness are not in their
proper way of thinking.

2. Compare the ideas of psychiatric care during the 1800s with those of the 1990s
and
2000s and identify the major political and economic forces that influenced care.

3. Analyze the social, political, and econimic changes that influenced the community
mental health movement.

4. Present anargument for the moral treatment of people with mental disorders.

For example, my father is mentally ill and my mother wants to put him to an
asylum. But me as a daughter, I don’t want him to go there. Because he is a big part
of our family.

5. Trace the history of biologic psychiatry and highlight major ideas and treatments.

Biologic treatments during 1940’s were unsuccessful because of lack of

understanding and knowledge of the biologic basis of mental disorders. The use of
warm baths and, in some instances, ice cold baths produced claming effects for
patients with mental disorders. Baths were applied indiscriminately and used as a
form of restraint, rather than a therapeautic practice. Psychopharmacology
revolutionized the treatment of mental illness and led to an increases number of
patients discharged into the community anfd the eventual focus on the brain as the
key to understanding psychiatric disorders.

Chapter 2
Critical Thinking

1. Examine the concept “syndrome” and explain how a mental disorder syndrome
differs
from a medical disease.

2. Examine the description of people with mental illness in the media, including
television programs, news, and newspapers. Are negative connotations evident?

Yes. Other people especially media, expresses people with mental disorders
as illiterate.

3. Explain the purposes of the five axes of the DSM-IV-TR.

Axis I includes most clinical disorders and other conditions that may be the
focus of clinical attention. Axis II contains personality disorders and mental
retardation. Axis III includes the general medical conditions that must be considered
in the diagnosis and treatment of the primary psychiatric disorders. Axis IV concerns
any psychosocial or environmental problems that may produceadded stress,
confound the diagnosis, or must be considered in the treatment of the primary
psychiatric problem. Axis V provide an estimate of overall funstioning in
psychological, social, and occupational spheres of life.

4. Discus the negative impact of labeling someone with a psychiatric diagnosis.

5. Conduct a literature search on culture bound syndromes and compare the

symptom
patterns and treatment.

Culture-bound syndrome – Behaviors limited to specific cultures that have meaning

within that culture.

Ataque De Nervios
Brain Fag
Falling Out or Blacking Out
Mal de Ojo
Shenjing Shuairo

6. Use the Global Assesment Functioning (GAF) scale to determine current level of
functioning for the following patient scenarios:

a. An 83 y/o person who lives in a nursing home and who is confused and needs
support from nursing staff in activities of daily living.
b. A 16 y/o male refuses to go to school. Stays in his room most of the time, and
talks to people who are not apparent to anyone but him.
c. A 50 y/o person who has returned to work from a recent hospitalization.
Symptoms are minimal.

7. Define the epidemiologic terms Prevalence, Incidence, and Rate.

Prevalence - the number of all new and old cases of a disease or occurrences of an
event during a particular period. Prevalence is expressed as a ratio in which the
number of events is the numerator and the population at risk is the denominator.

Incidence - the number of new cases in a particular period. Incidence is often

expressed as a ratio, in which the number of cases is the numerator and the
population at risk is the denominator.

Rate –

Chapter 3
Critical Thinking

1. Consider the realtionship of self determinism to competence by differentiating

patients who are competent to give consent and those who are incompetent.
Discuss the steps in determining wheter a patient is competent to provide
informed consent for a treatment.

2. Define ompetency to consent to or refuse treatment and relate the definition to

the Self-Determination Act.
3. A patient is involuntarily admitted to a psychiatric unit and refuses all medication.
After being unable to persuade the patient to take prescribed medication, the
nurse documents the patient’s refusal and notifies the prescriber. Should the
nurse attempt to give the medication without patient consent? Support your
answer.

No. I will not give the prescribed medication. The patient refuses but I will let
him/her sign a waver because he/she has the right to refuse.

4. A person who is homeless with a mental illness refuses any treatment. While he is
clearly psychotic and would benefit from treatment, he is not a danger to himself
or others and seems to be able to provide basic needs. His family is desperate for
him to be treated. What are the ethical issues underlying this situation?

5. Discuss the purpose of living wills and health proxies. Discuss their use in
psychiatric-mental health care.

6. Identify the legal and ethical issues underlying the Tarasoff case and mandates to
inform.

If the patient has harmed any person or is about to injure someone, the
professional is mandated by law to report it to authorities. If there are clear
threats of violence toward others, the therapist is mandated to warn potential
victims.

7. Compare the authority and responsibilities of the internal rights protection system
with those of the external advocacy system.

The internal rights protection system operates from within the state mental
health system and consists of special departments or agencies that monitor the
treatment of patients in the system according to the Universal Patient Bill of
Rights and state regulations and laws. The external advocacy system comprises
organizations working outside the state and federal systems to protect the rights
of the mentally disordered or handicapped and includes the american hospital
association, american healthcare association, all of which are involved in setting
standards and licensing procedures.

Chapter4
Critical Thinking

1. Define the continuun of care and discuss the importance of the least
restrictive environment.

The common continuum of care is a comprehensive system of sevices and

programs designed to match the needs of the indicidual with the appropriate
treatment in settings that vary according to levels of sevice, structure, and
intensity of care. The least restrictive Environment states that the unjustified
institutionalization of people with disabilities is discrimination and a violation
of the americans with disabilities. Therefore, treatment is usually delivered in
the community.
2. Differentiate the role of the nurse in each of the following continuum settings:
a. Crisis stabilization
The primary purpose of stabilization is control of precipitating
symptoms through medications, behavioral interventions, and
coordination with other agencies for appropriate after-care. The
major focus of nursing care in a short-term impatient setting is
symptom management.

b. In-home detoxification
The nurse is required to visit the patient daily for meication
monitoring during the patients first week of sobriety.

c. Partial Hospitalization
The interdisciplinary treatment team devises and executes a
comprehensive plan of care encompassing behavioral therapy,
social skills training, basic living skills training, and other forms
of expressive therapy.

d. Assertive community treatment

Concentration of services for high-risk patients within a single
multiservices team enhances continuity and coordination of
care, improving both the quality of care and its cost-
effectiveness. Staffed 24 hours a day for emergency referral.

3. Compare alternative housing arrangements including personal care homes,

therapeutic foster care, and supervised apartments.

Personal care homes operate within houses in the community. Usually 6-10
people live in one house, with a health care attendant providing 24 hour
supervision to assist with medication monitoring or other minor activities.

Board and care homes provide 24 hour supervision and assistance with the
medication, meals ans some self care skills.
Therapeutic foster care is indicated for patients in need of a family-like
environment and a high level of support.

Supervises Apartment setting, Individuals live in their own aparments, usually

alone or with one roomate, and are responsible for all household chores and
self care.