Mental Health Nursing E-Book (eBook)

Front Cover 1
Mental Health Nursing 4
Copyright Page 5
Contents 6
Foreword 8
Preface 10
Contributors 12
1 Preparing for mental health nursing 16
1. The effective nurse 18
Introduction 19
Caring 19
Hope and spirituality 20
Therapeutic Use of Self 21
Empathy and therapeutic use of self 21
Evidence-based practice and therapeutic alliance 22
Self-Awareness 22
Reflection 22
Developing reflective practices 23
Professional Boundaries 23
Self-disclosure 23
Stress and Burnout 24
Stress 24
Burnout syndrome 24
Avoiding burnout syndrome 25
Professional Supportive Relationships 25
Clinical supervision 25
Preceptorship 26
Conclusion 26
References 27
2. The context of practice 30
Introduction 31
The Relationship between Theory and Practice 32
What is a theory? 32
Which theory best guides practice? 32
Nursing theorists 32
Incorporating theory into practice: the personal context 33
The importance of reflection 33
Putting theory into practice: the wider context 34
Demand for evidence-based practice 34
Issues for discussion 34
Changing Beliefs about the Focus of Nursing Practice 35
From dualism to holism 35
Dualism: issues for mental health practice 35
Holism: issues for mental health practice 36
From deficits to strengths 37
From patient to service user: a person with lived experience 39
Distinguishing rehabilitation from recovery 39
Essentials of Recovery-Orientated Practice 40
Personal characteristics of recovery 41
Facilitating self-help and personal responsibility 41
Promoting overall health and wellness 42
Recovery-Orientated Service Provision 42
The community 42
The mental health service 43
Multidisciplinary teams 43
Third-sector organizations 43
Partnerships, participation and empowerment 44
Professional boundaries 45
Conclusion 45
References 46
3. Historical foundations 48
Introduction 49
The Value of Historical Antecedents 49
Past Ideas about Mental Health Problems 51
The ‘humours’ 51
Supernatural influences 52
Greece and Rome 52
The Christian era 53
Mental Health Problems found in Graeco-Roman Sources 54
Mental health problems not found in the ancient literature 55
Historical perspective on schizophrenia 55
‘Hysteria’: a translation error 56
Gender and Healthcare 56
Caring for People with Mental Health Problems 57
Graeco-Roman origins of Western care 57
Eastern medical care 59
Western developments 59
The asylum 59
Doctors and Nurses 60
Ancient Greece and Rome 60
Midwives and nurses 61
Pioneers and Professionalization 62
The USA 63
The UK 63
New Zealand 63
Australia 64
Conclusion 64
References 65
4. The politicolegal context 68
Introduction 69
Historical Landmarks 69
The Current Global Perspective 69
Mental Health Policy 70
Mental Health Legislation 72
Mental Health Act 1983 (amended 2007) 72
Guiding principles 72
Definition of a mental disorder 72
Applications for detention in hospital 73
Holding powers 73
Appropriate medical treatment test 74
Supervised community treatment and community treatment orders 74
Roles 74
Consent to treatment 75
Rights under the Act 75
Advance decisions 76
Mental Capacity Act (2005) 76
Risk Management and the Concept of Dangerousness 78
Managing Behavioural Emergencies 79
Conclusion 83
References 83
5. Professional and ethical issues 86
Introduction 87
Regulation of Professional Practice 87
Nursing Education 88
Standards of Practice 88
Standards 89
Career Pathways 89
Prescribing 89
Reviews of Mental Health Nursing 90
Ethics and Professional Practice 91
Ethical issues in mental health practice 91
Psychiatric diagnosis 91
Mental healthcare and treatment 92
Psychopharmacology 93
Electroconvulsive therapy 93
Seclusion 93
Suicidal behaviour 94
Involuntary treatment 94
Psychological therapy 95
Professional boundaries 96
Confidentiality 96
Conclusion 97
References 97
2 Mental health and wellness 100
6. Mental health and wellness 102
Introduction 103
Incidence and Prevalence of Mental Health Problems 103
Comorbidity 104
Suicidal behaviour 104
Gender Differences 104
Marital Status 105
Disability and Mental Health 106
Misconceptions about Mental Health Problems 107
The media and misconceptions about mental health problems 109
What is Culture? 109
Culture and health beliefs 109
Black and minority ethnic and culturally and linguistically diverse groups 111
Culture and communication style 112
Culture and self-reflection 112
Cultural competence and cultural safety 112
Approaches to Care and Service Delivery 113
Factors that could prevent black and minority ethnic and culturally and linguistically diverse clients using services 113
Model of care delivery 114
Alternative models of care delivery 114
Definition of the problem and diagnosis 114
Structural barriers 114
Gender-appropriate service 114
Incorporating Culturally Safe Practice 115
Conclusion 115
References 116
7. Theories on mental health and ill health 118
Introduction 119
What is Mental Health? 119
Defining mental health 119
‘Mental health’ as a euphemism for ‘mental disorder’ 120
Theories of Personality 121
Biomedical model 121
Critique of the biomedical model 122
Psychoanalytic theory 122
Sigmund Freud (1856–1939) 122
Defence mechanisms 122
Critique of psychoanalytic theory 123
Behavioural psychology 123
Ivan Pavlov (1849–1936) 123
John B Watson (1878–1958) 123
B F Skinner (1904–90) 123
Critique of behaviourism 123
Cognitive psychology 124
Albert Bandura (b. 1925) 124
Aaron T Beck (b. 1921) 124
Martin Seligman (b. 1942) 124
Critique of cognitive psychology 124
Humanistic psychology 124
Charlotte Bühler (1893–1974) 125
Carl Rogers (1902–87) 125
Abraham Maslow (1908–70) 125
Critique of humanistic psychology 125
Sociological models 126
Emile Durkheim (1858–1917) 126
Thomas Szasz (b. 1920) 126
Critique of sociological models 126
From Theory to Practice 127
Theories of psychology, sociology and nursing 128
Hildegard Peplau (1909–99) 129
Joyce Travelbee (1926–73) 129
Phil Barker (b. 1946) 129
Personality and Behaviour: Nature versus Nurture 130
Theoretical perspectives on nature versus nurture 130
Nature or nurture? 130
Nature and nurture 130
Conclusion 131
References 132
8. Mental health across the lifespan 134
Introduction 135
A Lifespan Approach 135
A lifespan approach to nursing practice 135
Mental Health across the Lifespan 136
‘Ideal’ development 136
Stages and theoretical issues in human development 138
Freud 138
Erikson 138
Piaget 139
Moral development 139
Attachment, parenting and family factors 140
Implications for nursing practice 140
Vulnerability, Risk and Resilience 141
Primary Healthcare and Mental Health Promotion 142
Mental Ill Health Prevention and Recovery 143
Childhood 144
Development and theoretical issues 144
Risk factors 145
Prevention and promotion 145
Adolescence 146
Development and theoretical issues 146
Identity 146
Risk factors 147
Prevention and promotion 147
Adulthood 148
Development and theoretical issues 148
Intimacy versus isolation (early adulthood) 148
Generativity versus self-absorption (middle adulthood) 148
Attachment, gender, identity and risk 149
Prevention and promotion 150
Older Adulthood 150
Development and theoretical issues 150
Risk factors 150
Prevention and promotion 151
Conclusion 151
Acknowledgement 152
References 152
9. Crisis and loss 156
Introduction 157
What Constitutes a Crisis? 158
Consequences of a Personal Crisis 158
A Framework for Coping and Adapting to Crisis 158
Events and Perceptions that Can Lead to Personal Crisis 159
Intervening at a Time of Crisis 160
Crisis, Loss and Grief 161
Suicide and Attempted Suicide 161
Griever concerns following suicide 163
Self-Harm 163
Being a Victim of Crime 163
Sudden Death 165
Parental bereavement 165
Sudden death of a partner 166
Attitudes to death 166
Crisis, Loss and Culture 166
Nursing Interventions: Attitudes and Skills 167
Developing enhanced cultural sensitivity 167
Helping service users deal with loss 168
Being there for the service user 168
Allowing the service user to express emotional pain 169
Being sensitive to cultural considerations in death and dying 169
Acknowledging the meaning of death and dying in different cultures 169
Acknowledging difficulties 170
Exploring opportunities for advanced training 170
Conclusion 171
References 173
10. Assessment and diagnosis 176
Introduction 177
Classification Systems 177
Assessment 178
Assessment methods 178
Diaries and personal records 178
Questionnaires and rating scales 179
Direct observation 179
Interviewing 179
The craft of interviewing 180
The interview setting 181
Safety 182
Biopsychosocial Model of Assessment 182
Mental health assessment 183
Identifying key information 183
Example 183
Reason for referral 183
Example 183
Presenting problem 183
Example 184
Example 184
Mental health history 184
Example 185
Medical history 185
Example 185
Drug history 185
Example 185
Psychosocial/relationship history 185
Example 185
Determining risk factors 186
Example 186
Assessment of strengths 186
Collaborative assessment of strengths 186
Mental status examination 187
Example 187
Overview 188
Appearance and behaviour 188
Speech 188
Mood and affect 188
Form of thought 188
Thought content 189
Perception 189
Sensorium and cognition 190
Insight 190
Physical assessment 190
Present and past health status 190
Physical examination 190
Physical functions 191
Laboratory results 191
Spiritual assessment 193
Cultural assessment 193
Triage Assessment 194
Risk of harm to others 197
Risk of harm to self 197
Risk of suicide 197
Risk of absconding 197
Vulnerability to exploitation or abuse 197
Mental Health Assessment and Outcome Measures 199
What to measure? 199
Methods of administering service user outcome measures 199
The Health of the Nation Outcome Scales (HoNOS) 199
Classification of Mental Disorders 200
ICD-10: International Classification of Diseases 200
ICD-10 diagnostic categories 200
DSM-IV TR: Diagnostic and Statistical Manual 200
Multiaxial classification 201
Conclusion 201
References 202
3 Understanding mental health problems 204
11. Learning disabilities 206
Introduction 207
The Language of Learning Disability Services 207
Terminology 207
Systems of classification 208
Causes of Learning Disability and Associated Disorders 209
Services for People With a Learning Disability 209
Service philosophy in learning disability services 210
Prevalence of Dual Diagnosis 210
Falling Through the Cracks 211
Comments on Roy and John’s case studies 212
Acute Assessment 213
Assessment and communication issues 213
Enhancing the assessment process 214
Other pitfalls in the assessment process 216
Acute Nursing Care 216
Facilitating Continuous Care 220
Understanding disability support services 220
Discharge planning 220
Information sharing 221
Person-centred plans 221
Assessment and treatment services for people with dual diagnosis 222
Mental Capacity 223
Conclusion 224
AcknowledgEments 224
Disclaimer 224
References 225
Useful Websites 227
12. Working with children and young people 228
Introduction 229
Diagnosis in Child and Adolescent Mental Healthcare 229
Incidence 230
Mental Health Problems in context 230
Services Available to Children and Young People 231
The Nursing Role 232
Engaging with Children and Young People 232
Children 233
Discussion of case study: Adam 233
Discussion of case study: Tim 234
Discussion of case study: Fiona 235
Skills required 235
Approach taken and outcome achieved 235
Adolescents 236
Psychosis and behaviour issues 237
Discussion of case study: David 237
Depression and suicide 238
Engagement 238
Discussion of case study: Julie 238
Working with Families 239
Confidentiality 239
Medication Adherence 239
Legal Issues 240
Conclusion 240
References 241
13. Mental disorders of older age 242
Introduction 243
Demography of Ageing in the UK 243
Assessment of Older People 244
Ageism in assessment 244
Mental Health Problems in the Older Population 245
Depression 245
Presentation 245
Prevalence 245
Aetiology 245
Assessment 246
Nursing care of people diagnosed with depression 247
Psychotherapeutic support 247
Pharmacotherapy and electroconvulsive therapy 247
Anxiety disorders 248
Suicide 248
Prevalence 248
Substance misuse 248
Delirium 249
Risk factors 250
Schizophrenia 250
Dementia 251
Prevalence 251
Aetiology 251
Clinical features 252
Pharmacological treatment for dementia 252
Psychological interventions and therapies for dementia 253
Comparing delirium, dementia and depression 253
Nursing Care and Treatment of Older People 254
The Nurse–Service User Relationship 254
Maintaining health and function 254
Staff Attitudes 255
Conclusion 256
References 256
14. Schizophrenic disorders 260
Introduction 261
Prevalence 262
Aetiology 262
Biological theories 262
Neuroanatomical abnormalities 262
Genetic predisposition 263
Biochemical theories 263
The stress-diathesis model 263
Diagnostic Criteria 264
Diagnostic and statistical manual of mental disorders 264
A. Characteristic symptoms of schizophrenia 264
B. Social/occupational dysfunction 264
C. Duration 264
D. Excluding other diagnoses 264
Schizophrenia subtypes 265
a. Paranoid type 265
b. Catatonic type 265
c. Disorganized type 265
d. Undifferentiated type 265
e. Residual type 265
Historical Development in Understanding Schizophrenia 266
Contemporary Understanding of Schizophrenia 266
Prodromal phase 266
Acute phase 267
Chronic phase 268
NonpsychopharmAcological Treatment 268
Cognitive behavioural therapy 268
CBT interventions for hallucinations 269
CBT interventions for delusional thinking 269
CBT interventions for stress and stigma 269
Supportive therapy 269
Family intervention 269
Psychopharmacological Intervention 271
Goals of antipsychotic medication administration 272
Adverse effects 273
Weight gain 273
Nursing interventions 273
Parkinsonian effects 273
Nursing interventions 274
Akathisia 274
Nursing interventions 274
Neuroleptic malignant syndrome 274
Nursing interventions 274
Tardive dyskinesia 274
Nursing interventions 274
Acute dystonic reaction (spasm) 274
Nursing interventions 274
Medication adherence 274
Living with Schizophrenia 275
Homelessness 275
Work 275
Labelling and stigma 275
General health 276
Conclusion 277
References 278
15. Mood disorders 282
Introduction 283
Comorbidity 284
Epidemiology and Economic Cost of Mood Disorders 284
Service Response 284
Depression 285
Mild depression 285
Major depression 285
Appearance and behaviour 285
Mood 285
Thinking and speech 286
Thinking about the past, present and future 286
Perception 286
Biological symptoms 286
Aetiology of depression 286
Biopsychosocial model of causation 286
Genetic factors 287
Gene–environment interaction 287
Neurochemical factors 287
Hormone systems and circadian rhythms 287
Gender differences 288
Mania and Bipolar Disorder 288
Appearance and behaviour 289
Mood 289
Thinking and speech 289
Perception 289
Biological symptoms 289
Aetiology of bipolar disorder 290
Genetic factors 290
Neurochemical factors 290
Hormone systems and circadian rhythms 290
Psychosocial factors 290
Dysthymia and Cyclothymia 291
Childbirth and Mood Disorders 291
Postpartum ‘blues’ 291
Postpartum depression 291
Interventions 291
Postpartum psychosis 291
Infant loss 292
Grief and Mood Disorders 292
Older Adults and Mood Disorders 292
Cultural Considerations 293
Medical Conditions and Drug Reactions 293
Medical conditions that cause depression and mania 293
Drug reactions that cause depression and mania 293
Overview of causation 293
Suicide 294
Epidemiology 294
Aetiology of suicide 294
Psychosocial factors 294
Biological factors 294
Nursing interventions for suicide prevention 294
Suicide-prevention contracts and observation 295
Suicide-prevention contracts 295
Constant observation 295
Pharmacology 295
Drugs used in the treatment of depression 295
Antidepressants 295
Selective serotonin-reuptake inhibitors (SSRIs) 296
Side effects 296
Drugs used in the treatment of bipolar disorder 296
Lithium carbonate 296
Other Treatments 296
Psychotherapy 296
Light therapy 297
Electroconvulsive therapy 297
Conclusion 299
References 300
16. Personality disorders 304
Introduction 305
‘Trait’ Versus ‘Disorder’ 305
Classification of Personality Disorders 306
Problems of Diagnosis 307
Epidemiology 310
Aetiology 311
Evolution-based theory of personality 311
Reproduction 312
Survival 312
Homeostasis 312
Assessment 312
Interventions 314
Interactive therapies 315
Pharmacological intervention 315
Therapeutic community 315
Team or triumvirate nursing interventions 316
Working with People Diagnosed with Personality Disorder 316
Conclusion 318
References 320
17. Anxiety disorders 322
Introduction 323
Epidemiology 324
Aetiology 324
Stress theory 325
Biological theories 325
Genetic theories 325
Neurochemical theories 325
Personality/temperament theory 325
Psychoanalytic theory 325
Interpersonal theory 325
Behavioural theory 325
Anxiety and Stress-Related Disorders 326
Panic attacks 326
Nursing interventions 326
During a panic attack 327
After a panic attack 328
Panic disorder 328
Nursing interventions 329
Teaching plan: panic attacks 329
Slow-breathing technique 330
Putting the slow-breathing technique into practice 330
Agoraphobia 330
Types of agoraphobia 330
Social phobia (social anxiety disorder) 330
Specific phobia 331
Nursing and psychological interventions for phobias 332
Graded exposure 332
Prolonged exposure 332
Repeated exposure 332
Focused exposure 332
Practised exposure 333
Adjustment disorder 333
Acute stress disorder 334
Nursing and psychological interventions 334
Debriefing 334
Progressive muscle relaxation 334
Guided imagery 335
Meditation 335
Post-traumatic stress disorder 335
Trauma-focused psychological therapy 335
Generalized anxiety disorder 336
Nursing interventions 336
Problem-solving 336
Obsessive–compulsive disorder 337
Nursing interventions 338
Exposure and response prevention 338
Therapies with Broad Applications 338
Cognitive behavioural therapy 338
Monitoring thoughts and feelings 339
Questioning the evidence, examining alternatives and role reversal 339
Probability 339
Degree of emotion 340
Psychopharmacology 340
Antidepressants 340
Action 341
Selective serotonin-reuptake inhibitors 341
Anti-anxiety medication 341
Nonbenzodiazepine anxiolytics 342
Hypnotics 342
Conclusion 342
References 343
18. Eating disorders 346
Introduction 347
Characteristics of Eating Disorders 348
Anorexia nervosa 348
Bulimia nervosa 349
Unspecified eating disorder 349
Eating disorders in children and adolescents 350
Eating disorders in males 350
Incidence and Prevalence 350
Aetiology and Risk Factors 350
Gender 350
Age 351
History of dieting 351
Social factors 351
Psychological factors 351
Familial factors 352
Genetic and biological factors 352
Medical Complications 352
Cardiovascular effects 352
Electrolyte abnormalities 353
Renal dysfunction 353
Gastrointestinal effects 353
Endocrine effects 353
Musculoskeletal effects 353
Dental and oral effects 353
Skin/integument effects 353
Neurological effects 353
Cognitive changes 353
Comorbidity 354
Assessment 354
Physical assessment 354
Mental state examination 355
Body image assessment 355
Nutritional assessment 355
Disordered eating behaviours and rituals 355
Family assessment 356
Treatment 356
Hospitalization 357
Nutritional rehabilitation 358
Nursing care 359
Therapeutic relationship 360
Normalization of eating patterns 361
Binge eating and purging behaviours 361
Monitoring weight gain 361
Refeeding syndrome 361
Psychotherapeutic techniques and treatments 362
Supportive therapy 362
Goal setting 362
Socratic questioning 362
Cognitive behavioural therapy 363
Interpersonal therapy 363
Motivational enhancement therapy 363
Psychoeducation 363
Family therapy and support 364
Self-help programmes 364
Pharmacotherapy 364
Outcome 366
Conclusion 366
Acknowledgement 367
References 367
19. Substance-related disorders and dual diagnosis 370
Introduction 371
Substance Use and Misuse 372
Epidemiology 372
Pregnant and/or breastfeeding women 372
Pharmacology of Psychoactive Drugs 373
How do Drugs Work? 373
Core Diagnoses for Substance Use 374
Intoxication 374
Hazardous use 375
Harmful use 375
Episodic heavy drinking or ‘binge’ drinking 375
Dependence 375
Assessment and Diagnosis 375
Presentation, setting and history 376
Substance use history 376
Taking a substance use history 376
Observations 377
Tests 378
Mental status examination 378
Laboratory tests 378
Screening tests 378
Interventions 378
Early and brief interventions 378
Motivational interviewing 380
Harm reduction 381
Managing an intoxicated service user 382
Substance withdrawal 382
Alcohol withdrawal 383
Other interventions 384
Dual Diagnosis 384
Clinical significance of dual diagnosis 385
Why do people with a mental disorder use nonprescribed drugs? 385
Assessing substance misuse in a mental health unit 386
Caring for service users with a dual diagnosis 387
Service delivery models for dual diagnosis service users 388
Conclusion 388
References 389
20. Somatoform and dissociative disorders 392
Introduction 393
Somatoform Disorders 393
The process of somatization 395
Epidemiology 396
Aetiology 396
Psychodynamic theory 396
Amplification 397
Interpersonal theory 397
Developmental theory 397
Personality 397
Biological theories 397
Behavioural theory 397
Familial factors 397
Culture 397
Assessment 397
Somatization disorder 398
Hypochondriasis 398
Pain disorder 399
Conversion disorder 399
Body dysmorphic disorder 401
Interventions 402
The therapeutic relationship 403
Reassurance 403
Relief of symptoms 404
Cognitive behavioural therapy 404
Psychopharmacology 404
Support 405
Family involvement 405
Validation 405
Reality therapy 405
Lifestyle interventions 406
Dissociative Disorders 406
Dissociative amnesia 407
Dissociative fugue 407
Dissociative identity disorder 407
Depersonalization disorder 408
Assessment 408
Interventions 408
Conclusion 409
References 409
4 Developing skills for mental health nursing 412
21. Settings for mental healthcare 414
Introduction 415
Historical Overview 416
Therapeutic Communities 417
Principles Governing the Inpatient Therapeutic Milieu 418
Open communication 418
Democratization 418
Reality confrontation 419
Permissiveness 419
Group cohesion 419
Inpatient Mental Health Services 419
Goals of the therapeutic milieu 420
Containment 420
Structure 421
Support 422
Involvement 422
Validation 422
Symptom management 422
Maintaining links with the service user’s family or significant others 422
Developing and maintaining links with the community 423
Criticisms of acute inpatient care 423
Community Care 424
Community Mental Health Services in the UK 425
Primary care 425
Community Mental Health Teams 425
Assertive Outreach Teams 426
Older Persons Services 426
Home Treatment/Crisis Resolution Teams 426
Accident and emergency mental health liaison 427
Child and Adolescent Mental Health Services 427
Early Intervention Service 427
Community Mental Health Service Models 427
The Care Programme Approach 427
Historical development of the CPA process 427
Principles and models underlying mental healthcare in the community 428
Self-determination 428
Normalization 429
Focus on service user strengths 429
Recruiting environmental agencies 430
The strengths model 430
The rehabilitation model 430
The MDT in the community 431
The Future of Mental Health Services in the UK 432
Conclusion 432
References 433
22. Person-centred approaches to managing risk 436
Introduction 437
Communicating with Service Users and Families 437
Therapeutic relationships 438
Empathy 438
Active listening 439
Closed and open-ended questions 439
Reflective listening 439
Paraphrasing 440
Summarizing 440
Body language and touch 440
Influence 440
Transference and counter-transference 441
Boundaries 441
Issues in working with families and carers 442
Skills in Specific Risk Situations 442
Risk assessment and management 442
Managing aggressive behaviour 442
Seclusion 445
Why use seclusion? 445
Service user perspectives on seclusion 445
Nurse perspectives on seclusion 446
Policy perspectives on seclusion 446
Self-harming behaviours and suicide risk 447
Working with the person who self-harms 447
Reasons for self-harming behaviour 448
Providing care and communicating with the person who self-harms 448
Comprehensive assessment of the person who self-harms 448
Interventions for self-harming behaviour 448
Working with the person who is suicidal 449
Reasons for suicidal behaviours 450
Assessing for risk of suicide 450
Caring for and communicating with the person who is suicidal 450
Service user perspectives on being cared for while suicidal 451
Nursing interventions for the person who is suicidal 451
Ethicolegal Issues 453
Service user choice in the therapeutic setting 453
Informed consent 454
Consent must be voluntary 454
Consent must be specific 454
Capacity to give consent 454
Ongoing consent 455
Conclusion 455
References 456
23. Therapeutic interventions 460
Introduction 461
Stress Management 462
Relaxation training 463
Assertiveness training 463
Risk Assessment 465
Risk for violence 465
Self-harm and suicide 465
Crisis intervention 466
Telephone counselling 467
Psychotherapy 467
Individual psychotherapy 467
Brief therapies 468
Motivational interviewing 468
Cognitive behavioural therapy 470
Dialectical behaviour therapy 471
Behaviour Therapy 472
Group Therapy 474
Activity groups 475
Family Therapy 475
Psychoeducation 476
Psychosocial Rehabilitation and Recovery 477
Instilling hope 478
Social skills training 479
Interviewing 480
Care Coordination 481
Electroconvulsive Therapy 481
Conclusion 482
References 483
24. Psychopharmacology and medicines management 488
Introduction 489
Important Pharmacological Principles 489
Important Psychotropic Drugs 490
Anti-anxiety or anxiolytic medications 492
Indications for use 492
Side effects 492
Contraindications/precautions 493
Interactions 493
Service user education 493
Nonbenzodiazepine anti-anxiety drugs 493
Antidepressant drugs 493
Indications for use 494
Side effects 494
Tricyclic antidepressants 494
Monoamine oxidase inhibitors 494
Selective serotonin-reuptake inhibitors 495
Contraindications/precautions 495
Interactions 495
Tricyclics 495
MAOIs 495
SSRIs 495
Service user education 495
Mood stabilizers 495
Indications for use 496
Lithium 496
Antipsychotics 496
Anticonvulsants 496
Side effects 496
Lithium 496
Anticonvulsants 496
Contraindications/precautions 496
Lithium 496
Anticonvulsants 496
Interactions 497
Lithium 497
Anticonvulsants 497
Service user education 497
Lithium 497
Anticonvulsants 497
Antipsychotic or neuroleptic drugs 497
Indications 498
Side effects: traditional antipsychotics 498
Antiparkinsonian medications 500
Side effects: atypical antipsychotics 500
Contraindications/precautions 500
Traditional antipsychotics 500
Atypical antipsychotics: clozapine 501
Interactions 501
Traditional antipsychotics 501
Atypical antipsychotics 501
Smoking 501
Service user education 501
Traditional antipsychotics 501
Atypical antipsychotics 501
PRN (As-Needed) Antipsychotic Drug Administration 501
Medication Concordance 502
Depot Preparation of Antipsychotic Drugs 505
Psychotropic Drug Use in Special Populations 505
Pregnant and lactating women 505
Children 506
Older people 506
Nonmedical Prescribing 506
NMC Standards of Medicines Management 507
Conclusion 507
References 508
25. Physical health 512
Introduction 513
Health Inequalities 513
Comorbidity 515
Role of the Mental Health Nurse 515
Factors Affecting Physical Health 516
Smoking 516
Diet 517
Exercise 517
Medication 517
Drug and alcohol use 518
Physical Health Assessment 518
Structured assessments 518
Pain 518
Dizziness 519
Breathlessness 519
The ABCDE approach 519
Airway 519
Breathing 519
Circulation 520
Disability 521
AVPU 521
Glasgow Coma Scale 521
Blood glucose 522
Exposure/environment 522
Clinical skills 523
Vital signs 523
Sleep 524
Sleep problems 524
Improving sleep 525
Assessing sleep 525
Sexual Health 525
Mental Health and Childbirth 529
Conclusion 531
References 532
Glossary 536
Index 548