mental health

• Axis 1: The presenting problems
• eg: BPD (bi-polar disorder), or Schitzophrenia

• Axis 2: the chronic or long-term problems that are not going to be corrected
• eg: mental retardation, personality disorders

• Axis 3: general medical conditions
• eg: DM, HTN, COPD, hypothyroidism

• Axis 4: current stressors...the "why now"
• eg: divorce, death in the family, recent medical dx...

• Axis 5: Global Assessment of Functioning (GAF) score
• eg: 40 (current) 65 (last year)

• GAF= Global Assessment of Functioning= overall assessment within 10 ranges of
• 1) severity of symptoms OR
• 2) level of functioning
• -if discrepancy exists GAF reflects worse of the 2, don't give benefit of the doubt!
• -if second GAF scale # is used it should be labeled w/ time period...eg 45 (current) 60 (past year)

• 1) orientation
• 2) working
• 3) termination

leader: set up atmosphere of respect, confidentiality, and trust

group: get to konw one another, issues of joining a group, acceptance, rejection, sexual attratction, posistion in the gorup

leader: encourage members to cooperate w/ each other and handle conflict, keep group focused on therapeutic goals of individual members

group: issues of leadership, power and control, develops functional norms (eg. sit in circle, come on time), and a sense of group identity, grapples w/ completing a task, developing competance and trust

• -Roles:
• -become sensitive to the roles clients assign to you (transference)

Trust Development- consistency is key w/ actions and words

leader: acknowledge the contributions of each member and the experience as a whole

group: prepare for the seperation and for the future, endings, loss, loneliness, death, saying goodbye (tendancy to avoid goodbyes by not showing up, making vague future plans, etc)

feeling hopeful about one's life

feeling that one is not alone

sharing info

• giving appropriate help to other members
• eg: "I've spent all this time talking about me. Lou needs to talk about his visit w/ his dad, let's focus on him"

releasing feelings and emotions, like a cleansing

coming to understand what life is about

• A= Activating Event +
• B= Beliefs, or aotomatic thoughts =
• C= Consequences, feelings

- a pt. w/ psychosocial difficulties haas negavive Beliefs that cause neg. Consequences. W/ CBT we want to change their Beliefs to positive/adaptive ones

• -daily mood charting
• -tracking pleasant events
• -homework
• -learning behavioral skills
• -examining and changing neg. thoughts

• -med education
• -sexuality
• -dual-diagnosis
• -multifamily
• -symptom management
• -stress management
• -community
• -self-care

• -same as the RN +
• -psychotherapy
• -family therapy

• -age of onset 14-16 yrs
• -50% co-morbidity w/ OCD
• -main diffs from bulemia=
• 1) refusal to attain or maintain minimal body weight for age and height, pt. <85% of normal BMI
• 2) perceptual distrubances (pt. sees themself as fat- doesn't know there is a problem)pt. ego-cyntonic (they feel like they're fine)
• 3) Amenorrhea-after menarche, females miss at least 3 consecutive periods or befre menarche the menstral cycle is delayed
• -concern about weight often increases as weight decreases

• -age of onset 18-24yo
• -pt usually w/in normal weight range
• -pt. recognizes there is a problem but feels helpless to correct it
• -pt. feels sense of relief after purging, release of tension and anxiety, depression follows episode (post-binge remorse or guilt)

• -hematology: anemia, leukopenia
• -chemistry: incr. BUN, hypercholeserolemia, metabolic alkalosis (incr. serum bicarb), hypochloremia, hypokalemia, metabolic acidosis
• -EKG: sinus brady, dysrhythmias (can lead to cardiac arrest)

• -metabolic alkalosis- d/t loss of stomach acid
• -metabolic acidosis- d/t diarrhea
• -hypokalemia, hyponatremia, hypochloremia
• -elevated serum amylase