Kathleen Tusaie & Joyce J. Fitzpatrick 
Advanced Practice Psychiatric Nursing, Second Edition [EPUB ebook] 
Integrating Psychotherapy, Psychopharmacology, and Complementary and Alternative Approaches Across the Life Span

Sokongan

This text reinvigorates the emphasis on the therapeutic relationship that is the core of nursing practice. It also relies on our strong history as therapists and introduces a need for integration of all aspects of care, a true holistic approach that characterizes the nursing perspective…The book should serve as a review for nurses who are studying for certification exams [and is] very useful for coursework in DNP programs as well as the masters programs in psychiatric mental health nursing.


– Grayce M. Sills, Ph D, RN, FAAN

Professor Emerita, Ohio State University

From the Foreword

Now in its second edition, this groundbreaking text and reference continues to be the only resource for APRNs to focus on integrative interventions forindividuals with mental health problems across the lifespan. Combining theory and practice, it provides a clear framework for integratingpsychopharmacology, psychotherapy, and Complementary and Alternative Medicine (CAM) into advanced practice nursing. The second edition is thoroughlyupdated to reflect current research, new classifications in DSM 5, genetic testing, and increased use of telemental health delivery. It builds upon itslifespan focus and updates quick-access pediatric pointers and aging alerts. Additionally, the resource incorporates the 2014 publication of the ANA Scopeand Standards of Practice for Psychiatric Nurses, offers a new focus on QSEN requirements, and responds to the need to reduce health disparities andaddress cultural considerations.


Organized around psychiatric syndromes, the text covers neurobiology, theory and research evidence related to psychopharmacology, psychotherapy, and CAMinterventions. It provides a virtual buffet of clear treatment options in the form of well-designed decision trees and accompanying explanatory narratives.The text also includes a section on such special considerations as substance misuse, medical problems, pregnancy, and forensic issues that often co-occurwith psychiatric syndromes. Concise, clear language and abundant charts, graphs, and algorithms enhance the books’ value in supporting sound clinicalreasoning.


New to the Second Edition:



  • Thoroughly updated, evidence-based content

  • Encompasses new research

  • Presents three completely new chapters on Integrative Management of Impulse Control, Telehealth, and Quality Improvement and Evidence-Based Practice

  • Includes the expertise of new contributors

  • Reflects DSM 5 updates, ANA Standard of Practice for Psychiatric Nurses, and QSEN standards

  • Updates quick-access Pediatric Pointers and Aging Alerts


Key Features:



  • Integrates theory and practice

  • Simplifies complex concepts using clear language while retaining depth of information

  • Supports clinical decision-making skills through easy-to-follow Decision Trees

  • Organized around psychiatric syndromes

  • Edited by internationally acclaimed practitioner/educators

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CONTENTS

Contributors

Foreword to the First Edition
Grayce M. Sills, Ph D, RN, FAAN

Preface

SECTION I. THE DYNAMIC NATURE OF ADVANCED PRACTICE PSYCHIATRIC-MENTAL HEALTH NURSING

1. Theoretical Understandings and Evidence Base for Practice

Joyce J. Fitzpatrick

Overview

Commonly Used Theories in Psychiatric-Mental Health Practice

Psychodynamic Theories

Cognitive Theories

Behavioral Theories

Psychosocial Theories

Developmental Theories

Interpersonal Theories

Humanistic Theories

Biological Theories

General Systems Theory

Change Theories

The Theory of Reasoned Action and Planned Behavior

Transtheoretical Model

Nursing Theories Specific to Psychiatric Nursing

Interrelationship Between Theory and Research

Distinctions Between Research and Evidence-Based Practice

Summary

2. Shared Decision Making: Concordance Between Psychiatric-Mental Health Advanced Practice Registered Nurse and Client

Austyn Snowden and Kathleen R. Tusaie

Overview

Advanced Psychiatric-Mental Health Nursing Practice

Concordance

Background

Knowledge

Health Beliefs

Collaboration

Improving Concordance

Knowledge

Health Beliefs

Collaboration

Summary

Resources

SECTION II. FOUNDATIONS FOR INTEGRATIVE PRACTICE

3. Synergy of Integrative Treatment

Kathleen R. Tusaie

Overview

Rationale for Integrative Treatment

Thinking About the World

Transdiagnostic Syndromes

Effects of Integrative Treatment

Continuum of Treatment Interventions

4. Overview of Psychotherapy

Kathleen R. Delaney and Ricardo Broach

Overview

Psychodynamic Therapy

Applications of Dynamic Principles in Therapy

Dynamic Supportive Therapy

Cognitive Therapy

Interpersonal Therapy

Behavioral Therapy

Theoretical Basis Underlying Change

Techniques of Behavioral Therapy

Positive Psychology

Summary

5. Overview of Psychopharmacology

Debbie Steele, Joan S. Grant, and Norman L. Keltner

Overview

Neuronal Transmission

Dopamine

Norepinephrine

Serotonin

GABA

Glutamate

Acetylcholine

Psychotropic Drugs

History of Antipsychotics

Typical Antipsychotics

Adverse Effects and Typical Antipsychotics

Extrapyramidal Side Effects

Hyperprolactinemia

Increased Negative Symptoms

Neuroleptic Malignant Syndrome

Atypical Antipsychotics

Individual Atypical Antipsychotics

Adverse Effects and Atypical Antipsychotics

Cardiometabolic Syndrome

New Developments

Antidepressants

Selective Monoamine Reuptake Inhibitors

Anti-Anxiety Agents

Bipolar Disorder Medications

Summary

Psychopharmacogenetics

6. Overview of Complementary/Integrative Approaches

Kathleen R. Tusaie and Rosanne Radziewicz

Overview

Types of Complementary/Integrative Interventions

Biologically Based Practices

Specific Herbs and Nutrients Commonly Suggested for Mental Health

Mind–Body Interventions

Relaxation Response

Manipulative and Body-Based Practices

Energy Work

Practice Guidelines

Resources

7. Stages of Treatment

Kathleen R. Tusaie

Overview

Techniques for Developing Therapeutic Relationships

Instilling Hope

Communication Strategies for Following Up on Leads and Instilling Hope

Client Resources

PMH-APRN Resources

Skill and Knowledge

Stages of Treatment

Assessment and Diagnosis

Transitioning to New Topics

Personal Developmental History

Values or Aspirations

Using Self-Report Questionnaires

Synthesizing Information

Risk Formulation

Diagnosis (DSM)

Case Formulation

Advantages and Disadvantages of Split Treatment Delivery (More Than One Provider)

Comparison of Individual and Group Therapy

Further Testing or Referrals

Acute Treatment

Therapeutic Communication Techniques

Stabilization/Maintenance

Termination

Appendix 7.1 Genogram

SECTION III. INTEGRATIVE MANAGEMENT OF SPECIFIC SYNDROMES

8. Integrative Management of Disordered Mood

Kathleen R. Tusaie

Overview

Spectrum of Moods

Etiology

Diathesis

Stress

Summary

Shared Decision Making or Achieving Concordance

Bearing Witness to Suffering

Assessment

Suicidal and Homicidal Thoughts

Diagnosis

Symptoms and Questionnaires

History of Mood Disorder Symptoms

Self-Evaluation

Comorbidity

Insomnia

Collaborative Case Conceptualization

Expected Outcomes

Treatment

Response

Initiating Treatment

Determine Severity of Symptoms and Level of Risk

Low Severity/Low Risk

Complementary/Alternative Approaches

Moderate Severity and Risk

Transcranial Magnetic Stimulation

Psychotherapy

High Level of Severity of Symptoms and Risk

Electroconvulsive Therapy

Vagal Nerve Stimulation

Acute Follow-Up or Continuation

Managing Side Effects

Pharmacotherapy

Maintenance

Primary Prevention

Resources

9. Integrative Management of Anxiety-Related Conditions

Kathryn Johnson and Beth Phoenix

Overview

Anxiety-Related Conditions

The Anxiety Cycle

Physiological Responses

Cognition

Behavioral Responses

Etiology of Anxiety and Anxiety-Related Disorders

Psychological Views of Anxiety

Physiological Factors

Genetic Factors

Prevalence and Impact of Anxiety Conditions

Types of Anxiety Conditions

Assessment

Chief Complaint

Historical Data

Mental State Examination

Concordance and Treatment Planning

Expected Outcomes

Treatment Initiation

Psychotherapy

Cognitive Behavioral Therapies

Other Psychotherapies

Eye Movement Desensitization and Reprocessing

Medications

Benzodiazepines

Antidepressants

Azapirones

Noradrenergic Agents

Anticonvulsants

Second-Generation Antipsychotics

Client Self-Management

Herbal Remedies and Nutritional Supplements

Bibliotherapy and Computer-Assisted CBT

Physical Methods

Special Considerations: Prevention

Resources

10. Integrative Management of Psychotic Symptoms

Marianne Tarraza and Linda Jacobson

Overview

Incidence Prevalence

History

Etiology

Assessment Stages of Schizophrenia

Clinical Assessment

Assessment Scales

Concordance and Shared Decision Making

Expected Outcomes

Suicide and Psychosis

Diagnosis

Differential Diagnoses

Cultural Considerations

Families

Treatment

Medications

Treatment Resistance or Inadequate Response

Managing Side Effects

Neuroleptic Malignant Syndrome

Serotonin Syndrome

Extrapyramidal Side Effects

Tardive Dyskinesia

Abnormal Involuntary Movement Scale

Other Side Effects to Consider

Concerns in Prescribing

Treatment: Psychosocial and Others

Patient Education

Mind–Body Medicine and Schizophrenia

Summary

Resources

11. Integrative Management of Sleep Disturbances

Carol Enderlin, Martha E. Kuhlmann, Melodee Harris, Matthew Hadley, Arlene Sullivan, Karen M. Rose, Anita Mitchell, and Ellyn E. Matthews

Overview

Normal Sleep Architecture

Sleep Across the Life Span

Newborn Period

Infancy

Toddlerhood

School Age

Adolescence

Young and Middle-Aged Adulthood

Older Adulthood

Familial and Genetic Implications

Sleep Disorders

Sleep History and Physical Assessment

General Sleep History

Focused Physical Assessment

Analysis of Sleep Symptoms and Specialized Sleep Screening

Specialized Sleep Screening Tools

Regulation of Sleep

Sleep and Comorbid Psychiatric Disorders

Sleep and Comorbid Medical Disorders

Nursing Decision Trees

Shared Decision Making and Collaborative Treatment Planning

Treatment

Nonpharmacological Treatment of Sleep Disorders

Complementary and Alternative Medicine Modalities

Long-Term Management of Sleep Disorders

Circadian Rhythm Disorders

Narcolepsy

Insomnia

REM Behavior Disorder

Central and Mixed Sleep Apneas

Obstructive Sleep Apnea

RLS and PLM of Sleep

Age-Related Sleep Implications

Summary

Resources

12. Integrative Management of Disordered Eating

Deborah B. Fahs, Robert Krause, and Kathleen R. Tusaie

Overview

Bulimia Nervosa

Epidemiology

Etiology of BN

Assessment

Concordance

Expected Outcomes

Treatment Initiation and Acute Follow-Up

Maintenance

Pharmacotherapy of BN

Prognosis

Bulimia Nervosa Special Considerations

Anorexia Nervosa

Assessment

Etiology

Distinguishing Between Causes and Effects of AN

Sociological and Psychological Factors

Expected Outcomes

Special Considerations

Obesity

Relationship Between Psychiatric Disorders and Obesity

Etiology

Concordance

Assessment

Expected Outcomes

Treatment Initiation and Acute Follow-Up

Pharmacological Interventions

Maintenance/Termination

Resources

13. Integrative Management of Disordered Cognition

Anita Thompson Heisterman

Overview

Classification of Neurocognitive Disorders

General Principles for Assessment of Older Adults

Delirium

Assessment of Delirium

Screening Instruments for Delirium

Shared Decision Making/Achieving Concordance

Outcomes

Treatment of Delirium

Mild Neurocognitive Disorders

Major Neurocognitive Disorders

Etiology

Alzheimer’s Disease

Vascular Disease

Lewy Body Disease

Parkinson’s Disease

Frontotemporal Lobar Degeneration

Other Forms of Neurocognitive Disorders

Substance-Induced Major Cognitive Disorder—Amnestic Confabulatory Type

Clinical Signs and Course of Alzheimer’s Disease (as the Prototype Neurocognitive Disorder)

Early Stage

Intermediate Stage

Late Stage

Shared Decision Making/Achieving Concordance

Assessment

History

Physical

Mental Status Examination

Diagnostic Tools

Differential Diagnosis

Expected Outcomes

Treatment

Acute Follow-Up and Maintenance Treatment

Summary

Resources

14. Integrative Management of Disordered Attention

Marianne Tarraza and Lisa Barry

Overview

Attention Deficit Disorder or Attention Deficit Hyperactivity Disorder

Prevalence

Etiology/Risk Factors

Comorbidity

Autism Spectrum

Etiology

ADHD and the Brain

ADHD and the Role of Neurotransmitters

ADHD and Genetics

ADHD and Environment

Assessment

Broadband Assessments

Narrowband Assessments

Assessment of Medication Adverse Effect

Management

Diagnosis

Psychiatric Comorbidities

Medical Comorbidities

Achieving Concordance

Expected Outcomes

Treatment Initiation

Nonpharmacological Treatments

Behavior Modification

Cognitive Behavioral Therapy

Individual, Family, and Group Therapy

Complementary and Alternative Therapies

Nutritional Interventions

Herbal and Natural Health Products

Vitamins and Minerals

Caffeine

Homeopathy

Exercise

Massage, Meditation, and Yoga

Acupuncture

Osteopathic Manipulative Treatment (OMT) and Chiropractic Manipulation

Electroencephalographic Biofeedback

Playing in Green Spaces

Pharmacological Treatments

Stimulants

Response

Nonstimulants

Follow-Up/Maintenance

Managing Side Effects

Additional Considerations

Cultural Considerations

Autism Spectrum Disorder

Prevalence

Etiology/Risk Factors

Symptoms

Treatment

Management

Special Populations

Resources

15. Integrated Management of Self-Directed Injury

Ann M. Mitchell, Irene Kane, Kirstyn M. Kameg, Kirsti Hetager Stark, and Brayden Kameg

Overview

Definitions

Epidemiology

The CASE Approach to NSSIB/SSIB Assessment

Step 1

Step 2

Step 3

Step 4

Assessment Within the CASE Approach

Assessment Instruments

Relationship Building During Assessment

Integration of Therapeutic Models

Cognitive Behavioral Therapy

Dialectical Behavioral Therapy

Motivational Interviewing

Mindfulness-Based Cognitive Therapy

Future-Oriented Group Training Therapy

Pharmacological Management

Pulling It Together: CASE Approach Care Plan

Continuing Care for the Self-Injurious Individual

Special Considerations

Comorbidities

Autoerotic Asphyxiation (Sexual Masochism Disorder With Asphyxiophilia)

Resources

16. Integrated Management of Other-Directed Violence

Marla Mc Call

Overview

Intimate Partner Violence

Child Abuse

Elder Abuse

Rape

Human Trafficking

Bullying

Violence Toward Health Care Professionals (HCPs)

Types of Violence Toward Health Professionals

Horizontal and Vertical Violence Within Nursing

Effects of Violence on Survivors

Sequelae of IPV

Office Safety Policies

Assessment

Migrant and Refugee Populations

HCPs are at High Risk

Psychiatric Clinicians

Others Most at Risk for Victimization

Assessment of Individual Potential for Violence

Rule Out Medical Reasons First, Then Assess Psychiatric Factors

Risk Assessment Questionnaires

Inpatient

Outpatient

Etiology: Patient Populations at Risk for Perpetrating Violence

General Diagnostic Categories

Delusional Disorders

CD and Antisocial Personality Disorder (APD)

Substance Abuse, Mental Illness, and APD

Low IQ, Head Injury, Chemical Exposures as Risk Factors for Violence

History of Traumatic Childhood Experiences

Neuroendocrine, Genetic, and Hereditary Factors

Expected Outcomes

Concordance in Management of Incidents of Violence

Treatment Initiation, Acute Phase of Violence

Acute Agitation

Follw-Up: Acute Dystonia, Neuroleptic Malignant Syndrome, Allergy

Maintenance Interventions

Antiepileptic Drugs and Other Mood Stabilizers

Antidepressants

General Medication Considerations

Managing Side Effects

Laboratory Studies

Extrapyramidal Side Effects

Blood Dyscrasias

Anticonvulsant Hypersensitivity Syndrome

SIADH, Hyponatremia, Acidosis

Weight Gain, Hyperglycemia, Metabolic Syndrome, Cardiac Events

Elevated Prolactin Level, Hypothyroidism, Renal Problems, Sexual Dysfunction

Movement Disorders

Dietary Measures, Caffeine, Sugar, Vitamins, and Supplements

Caffeine

Micronutrients and Supplements

Refined Foods and Sugar

Exercise, Stress Management, Eastern Healing

Environmental, Cultural, and Milieu Management

Longer Term CBTs and Group Interventions

Pediatric Considerations

CBT and DBT

Pediatric Clinical Case Study

CBT for Perpetrators

Group Mobilization and Social Attitude Transformation

Cognitive Therapy and APD

Therapy Interventions for Parents

Therapeutic Interventions for Children and Adolescents

Complementary/Alternative Therapies

Treatment for PTSD

Therapeutic Milieu Treatment for the Developmentally Delayed Violent Person

Training of Psychiatric Personnel in Violence Management

Basic Elements of Violence-Prevention Training

Know the Physical Environment and Institutional Policies

Critical Incident Stress Management Versus Occupational Health

Legal Issues

Legal Responsibilities

When Legal Action Rather Than Further Treatment Must Be Pursued

Providing Culturally Competent Care

Summary

Resources

17. Integrative Management of Disordered Impulse Control

Lisa L. Salser

Overview

The Process of Impulse Control

Psychoanalytical Perspective

Neuroscience/Developmental Perspective

Cognitive/Behavioral Perspective

Measurement of Impulsivity

Impulsivity Versus Compulsivity

Prevalence and Impact of Impulse Control Problems

Types of Impulse Control Disorders

Oppositional Defiant Disorder

Conduct Disorder

Pyromania

Kleptomania

Intermittent Explosive Disorder

Antisocial Personality Disorder

Summary

Resources

SECTION IV. SPECIAL CONSIDERATIONS

18. Co-Occurring Substance Misuse and Psychiatric Syndromes

Faye Gary, Rita A. Hanuschock, and Ruzica Conic

Overview

Epidemiology

Theory of Addiction

Dopamine Theory

Gateway Hypothesis

Common Liability to Addiction

Genetic Factors

Environmental Factors

Physiological Consequences

Establishing a Diagnosis of SUD

Substances of Abuse

Ethyl Alcohol

Nicotine

Sedatives

Stimulants

Hallucinogens

Narcotics

Determining Appropriate Levels of Care for Treatment of SUDs

Outpatient Treatment

Intensive Outpatient Programs (IOPs)

Partial Hospital Programs

Residential Services

Continuing Care

Treatment-Resistant Patients

Taking a Patient History for Individuals With Suspected Substance Use

Physical Findings in Patients With Substance Use

Laboratory Testing and Findings

Breath Testing

Urine Testing

Sweat Testing

Oral Fluid Testing

Blood Testing

Hair Testing

Special Populations

Adolescents

Elderly

Health Care Workers

Native Americans

Summary

19. Medical Problems and Psychiatric Syndromes

Marianne Tarraza

Overview

Impact of Comorbid Psychiatric Syndromes and Medical Illness

What Is the Cost and Mortality Burden of Comorbidities?

Assessment

Diagnostic Approach

Concordance

Effective Communication Between the Medical Team and the Mental Health Team

Depressive Disorders

Depression and Heart Disease

Depression and Diabetes Mellitus

Depression and HIV Infection/AIDS

Depression and Asthma

Anxiety Disorders

Anxiety Disorders and Diabetes

Anxiety and Asthma

Bipolar Disorder

Bipolar Disorder and Migraine

Bipolar Disorder and Velocardiofacial Syndrome

Bipolar Disorder and Multiple Sclerosis

Bipolar Disorder and Asthma

Bipolar Disorder and Diabetes Mellitus

Bipolar Disorder and Polycystic Ovarian Syndrome

Bipolar Disorder and Obesity

Schizophrenia

Schizophrenia and CVD

Schizophrenia and Diabetes

Parkinson’s Disease

Medical and Psychiatric Comorbidities Related to Pharmacology

The Impact of Common Medications Causing Psychiatric Syndromes

The Impact of Common Psychiatric Medications Causing Medical Comorbidity

Overview of Treatment

Use of Appropriate Medical and Mental Health Screening Tools at First Encounters

Evaluate for Underlying Medical Conditions That May Be Causing Psychiatric Syndromes and Mental Health Conditions That May Be Causing Medical Problems

Use of Medication Reconciliation at All Encounters

Appropriate and Timely Referrals Between Caregivers

Holistic Approach

Management

Summary

20. Pregnancy During Psychiatric Syndromes

Jennifer L. Smith and Carrie R. Cichocki

Overview

Concordance

Principles of Fetal Development and Pharmacology

Anxiety Disorders

Posttraumatic Stress Disorder

Obsessive-Compulsive Disorder

Depression

Bipolar Disorder

Schizophrenia

Substance Use Disorders

Other Considerations for Treatment in the Perinatal Period

Perinatal Loss and Grief

Intimate Partner Violence

Hyperemesis Gravidarum

Special Considerations in the Postpartum Period

Lactation

Summary

21. Forensic Issues and Psychiatric Syndromes

Jeffrey S. Jones

Overview

Corrections

Interpersonal Process

Concept of Nursing Care and the Criminal

Boundaries

Therapy

Antisocial Personality Disorder

Malingering

The Diagnostic Interview

Follow-Up Work

Assessments

Etiology

True Severe and Persistent Mental Illness

Malingering

Antisocial Personality Disorder

Concordance (Shared Decision Making, Planning With Client)

Expected Outcomes

Treatment Initiation

Treatment of Severe and Persistent Chronic Mental Illness

Treatment of Malingering

Treatment of APD

Adjustment Disorders

Special Considerations

Summary

SECTION V. MAINTAINING COMPETENCE AND QUALITY

22. QSEN Competencies: Application to Advanced Practice Mental Health Nursing

Susan E. Phillips, Mary A. Dolansky, and Denise Mathews

Overview

Safety

Patient-Centered Care

Teamwork and Collaboration

Evidence-Based Practice

Quality Improvement

Informatics

A Systems Approach to Meeting QSEN Competencies

23. Telehealth

Patti G. Rodgers

Overview

Technology Guidelines

Telemental Health Models of Care

Practice Guidelines and Technical Standards

The Need for and Uses of Telemental Health

Clinical Considerations in Telemental Health

Special Populations and Telemental Health

Challenges of Telemental Health

The Future of Telemental Health

24. Global Perspectives and the Future of Advanced Practice Psychiatric-Mental Health Nursing

Joyce J. Fitzpatrick

Overview

Global Initiatives in Psychiatric Nursing

Exemplary Psychiatric-Mental Health Nurse: A Global Role Model

Strategies for Global Connections

Professional Self-Development

Interdisciplinary Partnerships

Future Directions for Practice and Research in Psychiatric-Mental Health Nursing

Index

Mengenai Pengarang

Joyce J. Fitzpatrick, Ph D, MBA, RN, FAAN, is Elizabeth Brooks Ford Professor of Nursing, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, where she was Dean from 1982 through 1997. She is also Professor, Department of Geriatrics, Mount Sinai School of Medicine, New York, NY. In 1990, Dr. Fitzpatrick received an honorary doctorate, Doctor of Humane Letters, from her alma mater, Georgetown University. In 2011 she received an honorary doctorate, Doctor of Humane Letters, from the Frontier University of Nursing. She has received numerous honors and awards; she was elected a Fellow in the American Academy of Nursing in 1981 and a Fellow in the National Academies of Practice in 1996. She received the American Journal of Nursing Book of the Year Award 18 times. Dr. Fitzpatrick is widely published in nursing and health care literature with over 300 publications. She served as co-editor of the Annual Review of Nursing Research series, vols. 1-26; she edits the journals Applied Nursing Research, Archives in Psychiatric Nursing, and Nursing Education Perspectives, the official journal of the National League for Nursing. She edited three editions of the classic Encyclopedia of Nursing Research (ENR), and a series of nursing research digests

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