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
Cuprins
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
Despre autor
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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