TO THE STUDENT
READING AND REVIEW TOOLS
Objectives introduce the chapter topics.
Key Terms are listed with page number references, and selected difficult medical, nursing, or scientific terms are accompanied by simple phonetic pronunciations. Key terms are considered essential to understanding chapter content and are defined within the chapter. Key terms are boldfaced in the narrative and are briefly defined in the text, with complete definitions in the Glossary.
Each chapter ends with (1) Key Points that reiterate the chapter objectives and serve as a useful review of concepts, (2) Additional Learning Resources, and (3) Critical Thinking Questions
Complete References at the end of each chapter cite evidence-informed information and provide resources for enhancing knowledge.
CHAPTER FEATURES
Case Studies contain critical thinking questions to help you develop problem-solving skills.
Critical Thinking Boxes contain thought-provoking scenarios and critical thinking questions.
Cultural Considerations address the mental health needs of culturally diverse patients.
Medication Alert boxes identify the risks and possible adverse reactions of psychotherapeutic medications.
Sample Patient Care Plans are multidisciplinary and address how members of the health care team work collaboratively to meet patient needs.
EVOLVE RESOURCES
Be sure to visit your textbook’s Evolve website (http://evolve. elsevier.com/Canada/Morrison-Valfre/) for a Study Guide, an Audio Glossary, Review Questions, and more!
Canada is a country of immigrants. English is my fifth language. I am grateful to my daughter, Shelly Bard, for her help with this book.
Boris Bard
Much appreciation to Professor Lisa-Marie Forcier for her assistance with research and clinical scenarios and for her dedication to battling the stigma of mental illness
Eric MacMullin
No text is written alone. The continued support of my husband, Adolph; of my friend Marian McCollum; and of other colleagues has provided the energy to complete this project when my own energy was low. The guidance, expertise, and encouragement from my editors Nancy O’Brien, Becky Leenhouts, and Mike Sheets are much appreciated. I also thank all the health care providers who so freely share their time and expertise with those who want to learn more about the dynamic and complex nature of human behaviour.
Michelle Morrison-Valfre
The product you are holding in your hands or viewing on your screen exists as a result of a great deal of work, research, and review. Although authors tend to get the most obvious credit (after all, it is our names that appear on the cover), a text of this nature would be entirely impossible if not for the work of many dedicated publishing professionals.
Although we have worked diligently to “Canadianize” the venerable Morrison-Valfre text, many other unsung heroes have toiled away to make this text as valuable to you, the reader, as humanly possible. Although it would be almost impossible to list them all, there are three individuals we would like to thank specifically.
Content Strategist/Acquisitions person extraordinaire Roberta Spinosa-Millman recognized the need for a specifically Canadian, fundamental text that addresses how we—as Canadians— approach, treat, and recognize mental health. Roberta pulled together three very different authors/mental health practitioners and set the foundation for us to work together to produce what we consider to be an excellent text and reference. Thank you, Roberta, for the dual opportunities of producing a text of this nature and of allowing us the honour to work together.
Somehow balancing Zen-like patience along with a subtle ability to kindly motivate and direct, Content Development Specialist Martina van de Velde worked extensively to ensure that our efforts were consistent and relevant. Many, many thanks to her for her collaboration, professionalism, and kindness. Again, for the times we did not get chapters completed on time, missed a deadline, or simply forgot, we offer apologies and, in equal measure, sincere admiration.
Finally, our “almost at the finish line” copy editor, Jerri Hurlbutt, who has a keen eye for detail, word, and idea flow and for use of reference and Internet-accessible information, took a sometimes rough draft and turned it into something of equal measures of accuracy and art. Jerri has also motivated and inspired us with her efficiency and work ethic. We simply cannot imagine this final product without Jerri’s input and direction.
There are many, many others who were involved in getting this text from our brains into your hands, and to those far-too-anonymous people, we also give our sincere thanks. Sales staff, printers, clerical workers, technicians, and others have all played a vital role in making this text available.
Boris Bard Eric MacMullin
Jacqueline Williamson
UNIT I Mental Health Care: Past and Present
1 The History of Mental Health Care, 2
Early Years, 3
Ancient Societies, 3
Greece and Rome, 3
Middle Ages, 4
The Renaissance, 5
The Reformation, 5
Seventeenth Century, 5
Eighteenth Century, 5
Nineteenth Century, 6
Twentieth Century, 7
Psychoanalysis, 7
Influences of War, 7
Introduction of Psychotherapeutic Medications, 8
Adult Community Mental Health Programs, 8
Twenty-First Century, 8
2 Current Mental Health Care Systems, 10
Mental Health Care in Canada, 10
Mental Health Care in Industrialized Countries, 11 Norway, 11
The United Kingdom, 11 Australia, 11
The United States, 11 Care Settings, 12
Inpatient Care, 12
Outpatient Care, 12
Delivery of Community Mental Health Services, 13
Community Care Settings, 14
Advocacy, 15 Therapy, 15
Crisis Intervention, 15
The Multidisciplinary Mental Health Care Team, 15 Care Team, 16
Patient and Family, 16
Patient Populations, 16
Impact of Mental Illness, 18
Incidence of Mental Illness in Canada, 18
Economic Issues, 18
Social Issues, 18
3 Ethical and Legal Issues, 21 Values and Morals, 22
Acquiring Values, 22
Values Clarification, 22 Rights, 23
Patient Rights, 23 Care Provider Rights, 23
Ethics, 23
Ethical Principles, 23
Codes of Ethics, 24
Ethical Conflict, 24
Laws and the Legal System, 25
General Concepts, 25
Legal Concepts in Health Care, 25
Laws and Mental Health Care, 26
Patient–Caregiver Relationship, 26
Adult Psychiatric Admissions, 26 Areas of Potential Liability, 26
Patient Restraint, 27 Care Providers’ Responsibilities, 28
The Reasonable and Prudent Caregiver Principle, 28
4 Sociocultural Issues, 31
The Nature of Culture, 31 Characteristics of Culture, 32 Influences of Culture, 33
Health and Illness Beliefs, 33
Cultural Assessment, 35 Communication, 35 Environmental Control, 36 Space, Territory, and Time, 37
Social Organization, 37 Biological Factors, 38 Culture and Mental Health Care, 38
5 Theories and Therapies, 41
Historical Theories, 42 Darwin’s Theory, 42
Psychoanalytical Theories, 42
Psychoanalytical Therapies, 44
Transference and Countertransference, 44
Analytical Psychotherapy, 44
Other Theories, 45
Developmental Theories and Therapies, 45
Cognitive Development, 45
Psychosocial Development, 46
Behavioural Theories and Therapies, 46 B.F. Skinner, 47
Other Behavioural Therapies, 48
Humanistic Theories and Therapies, 48
Perls and Gestalt Therapy, 48
Maslow’s Influence, 48
Rogers’s Patient-Centred Therapy, 49
Current Humanistic Therapies, 49
Systems Theories, 49
Cognitive Theories and Therapies, 50
Cognitive Restructuring Therapies, 50 Coping Skills Therapies, 50
Problem-Solving Therapies, 50
Reality Therapy, 50
Sociocultural Theories, 51
Mental Illness as Myth, 51
Biobehavioural Theories, 51
Homeostasis, 51
Stress Adaptation Theory, 51
Psychobiology, 52
Psychoneuroimmunology, 53
Nursing Theories, 53
Psychotherapies, 53
Individual Therapies, 53
Group Therapies, 53
Online Therapy, 54
Somatic Therapies, 54
Brain Stimulation Therapies, 54 Pharmacotherapy, 55 Future Developments, 55
6 Complementary and Alternative Therapies, 58 Definition of Terms, 59 Allopathic Medicine, 59 Complementary Medicine, 59
Alternative Medicine, 59
Integrative Medicine, 59 Holistic Care, 59
Health Canada’s Licensed Natural Health Products Database, 59
Body-Based CAM Therapies, 60
Whole Medical Systems, 60
Biologically Based Therapies, 61
Body-Based Practices, 62
Energy-Based CAM Therapies, 62
Mind-Body Medicine, 62
Energy Medicine, 64
Technology-Based CAM Applications, 65
CAM Approaches to Mental Health Care, 65
CAM Mental Health Therapies, 65 Words of Caution, 66
Adverse Effects, 66 Implications for Care Providers, 66
7 Psychotherapeutic Medication Therapy, 68 How Psychotherapeutic Medication Therapy Works, 69 Classifications of Psychotherapeutic Medications, 70
Antianxiety Medications, 71
Antidepressant Medications, 72
Mood-Stabilizer Medications, 73
Antipsychotic (Neuroleptic) Medications, 74
Signs and Symptoms, 76
Patient Care Guidelines, 76 Assessment, 77 Coordination, 77
Medication Administration, 77 Monitoring and Evaluating, 78 Patient Teaching, 78
Special Considerations, 78 Adverse Reactions, 78 Nonadherence, 78 Informed Consent, 79
UNIT II The Caregiver’s Therapeutic Skills
8 Principles and Skills of Mental Health Care, 82 Principles of Mental Health Care, 83 The Mentally Healthy Adult, 83 Mental Health Care Practice, 83 Do No Harm, 83
Accept Each Patient as a Whole Person, 83 Develop Mutual Trust, 84 Explore Behaviours and Emotions, 84 Encourage Responsibility, 85 Encourage Effective Adaptation, 86 Provide Consistency, 88 Skills for Mental Health Care, 89 Self-Awareness, 89 Caring, 89 Insight, 90 Risk Taking and Failure, 90 Acceptance, 90 Boundaries and Overinvolvement, 90 Commitment, 91 Positive Outlook, 92 Nurturing Yourself, 92
9 Mental Health Assessment Skills, 95
Mental Health Treatment Plan, 95
DSM-5 Diagnosis, 96 Nursing (Therapeutic) Process, 96 About Assessment, 97 Data Collection, 97 Assessment Process, 98 The Patient at Risk, 100 Obtaining a History, 100 Effective Interviews, 100 Physical Assessment, 101 Mental Status Assessment, 102 General Description, 102 Emotional State, 102 Experiences, 102 Thinking, 103 Sensorium and Cognition, 104
10 Therapeutic Communication, 107 Theories of Communication, 108 Ruesch’s Theory, 108 Transactional Analysis, 108
Neurolinguistic Programming, 109 Characteristics of Communication, 109 Types of Communication, 109 Process of Communication, 109 Factors That Influence Communication, 110
Levels of Communication, 110
Verbal Communication, 110
Nonverbal Communication, 111
Intercultural Communication, 111
Intercultural Differences, 111
Therapeutic Communication Skills, 112
Listening Skills, 112
Interacting Skills, 112
Nontherapeutic Communication, 114
Barriers to Communication, 114
Nontherapeutic Messages, 114 Problems With Communication, 114 Communicating With Mentally Troubled Patients, 117
Assessing Communication, 117
11 The Therapeutic Relationship, 120 Dynamics of the Therapeutic Relationship, 120 Trust, 121 Empathy, 121 Autonomy, 121 Caring, 122 Hope, 122 Characteristics of the Therapeutic Relationship, 123 Acceptance, 123 Rapport, 123
Genuineness, 123
Therapeutic Use of Self, 124 Phases of the Therapeutic Relationship, 124 Preparation Phase, 124
Orientation Phase, 125 Working Phase, 125 Termination Phase, 126
Roles of the Care Provider, 126 Change Agent, 126 Teacher, 126 Technician, 127 Therapist, 127 Problems Encountered in the Therapeutic Relationship, 127 Environmental Problems, 127 Problems With Care Providers, 127 Problems With Patients, 128
12 The Therapeutic Environment, 131 Use of the Inpatient Setting, 132 Crisis Stabilization, 132
Acute Care and Treatment, 132
The Chronically Mentally Ill Population, 132 Goals of a Therapeutic Environment, 133 Help Patients Meet Needs, 133
Teach Psychosocial (Adaptive) Skills, 133 The Therapeutic Environment and Patient Needs, 134
Physiological Needs, 134
Safety and Security Needs, 135
Love and Belonging Needs, 136
Self-Esteem Needs, 137 Self-Actualization Needs, 137 Variables of the Therapeutic Environment, 138
Admission and Discharge, 138 Adherence, 138
UNIT III Mental Health Challenges Across the Lifespan
13 Challenges of Childhood, 142
Normal Childhood Development, 143 Common Behavioural Challenges of Childhood, 143 Mental Health Challenges of Childhood, 145 Environmental Issues, 145 Homelessness, 145 Abuse and Neglect, 147 Problems With Parent–Child Interaction, 148 Parent–Child Conflicts, 148 Emotional Challenges, 148 Anxiety, 148 Depression, 149
Somatoform Disorders, 149
Post-Traumatic Stress Disorder, 149 Behavioural Challenges, 149 Children and Violence, 149 Children and Electronic Media, 150 Attention-Deficit/Hyperactivity Disorder, 150 Disruptive Behavioural (Conduct) Disorder, 151 Challenges With Eating and Elimination, 152 Eating Disorders, 152 Elimination Disorders, 152 Developmental Challenges, 153 Intellectual Development Disorder, 153 Learning Disorders, 153 Communication Disorders, 154 Pervasive Developmental Disorders, 154 Autism, 154 Schizophrenia, 155 Therapeutic Actions, 155 Meet Basic Needs, 155 Provide Opportunities, 156 Encourage Self-Care and Independence, 156
14 Challenges of Adolescence, 160 Adolescent Growth and Development, 161 Physical Development, 161
Psychosocial Development, 161 Common Challenges of Adolescence, 162 Internal (Developmental) Challenges, 162 External (Environmental) Challenges, 162 Teens and Electronic Media, 165
Mental Health Challenges of Adolescence, 165 Behavioural Disorders, 165 Emotional Disorders, 166
Mood Disorders, 167 Eating Disorders, 167
Chemical Dependency, 168
Personality Disorders, 169
Sexual Disorders, 169
Psychosis, 170 Suicide, 170
Therapeutic Interventions, 171
Surveillance and Limit Setting, 171
Building Self-Esteem, 171
Skill Development, 171
15 Challenges of Adulthood, 174
Adult Growth and Development, 174
Common Challenges of Adulthood, 176
Internal (Developmental) Challenges, 176
External (Environmental) Challenges, 178
Mental Health Challenges of Adults, 180
Therapeutic Interventions, 180
Health Care Interventions, 180
Preventing Mental Illness, 180
16 Challenges of Late Adulthood, 183 Overview of Aging, 183 Facts and Myths of Aging, 184
Physical Health Changes, 185
Mental Health Changes, 185 Research and Aging, 185
Common Challenges of Older Persons, 186
Physical Adaptations, 187
Health Care Services, 187
Psychosocial Adaptations, 188
Mental Health Challenges of Older Persons, 190
Elder Abuse, 191
Dementia, Depression, and Delirium, 191
Therapeutic Interventions, 192
Age-Related Interventions, 192
Mentally Ill Older Persons, 192
Mental Health Promotion and Prevention, 193
17 Cognitive Impairment, Alzheimer’s Disease, and Dementia, 196
Confusion Has Many Faces, 196
Normal Changes in Cognition, 196
The Three “D’s” of Confusion, 197 Medications and the Older Population, 197
Patients With Delirium, 197
Finding the Cause, 199
Treating Delirium, 200
Patients With Dementia, 200 Symptoms of Dementia, 200 Gentle Persuasive Approach, 201 Dementia Care, 201
Causes of Dementia, 202
Alzheimer’s Disease, 202 Symptoms and Course, 202
After the Diagnosis, 204 Principles of Management, 204
Therapeutic Interventions, 205 Assessment, 205
Interventions for Patients Living With Alzheimer’s Disease, 205 Caregiver Support, 207
UNIT IV Patients With Psychological Challenges
18 Managing Anxiety, 211
Continuum of Anxiety Responses, 212
Types of Anxiety, 212
Types of Anxiety Responses, 212
Coping Methods, 212 Defence Mechanisms, 213 Crisis, 213
Self-Awareness and Anxiety, 215
Theories Relating to Anxiety, 215 Biological Models, 215 Psychodynamic Model, 215 Interpersonal Model, 216 Behavioural Model, 216 Other Models, 216
Anxiety Throughout the Life Cycle, 216 Anxiety in Childhood, 216 Anxiety in Adolescence, 217 Anxiety in Adulthood, 217 Anxiety in Older Persons, 217 Anxiety Disorders, 217 Separation Anxiety Disorder, 218 Selective Mutism, 218 Specific Phobia, 218 Social Anxiety Disorder, 218 Panic Disorders, 218 Agoraphobia, 219
Generalized Anxiety Disorder (GAD), 219
Obsessive-Compulsive and Related Disorders, 219
Obsessive-Compulsive Disorder (OCD), 219
Body Dysmorphic Disorder, 220 Hoarding Disorder, 221
Hair-Pulling Disorder (Trichotillomania), 221 Excoriation Disorder (Skin Picking), 221 Substance-/Medication-Induced ObsessiveCompulsive and Related Disorder, 221 Obsessive-Compulsive and Related Disorder Due to Another Medical Condition, 221 Other Specified Obsessive-Compulsive and Related Disorder, 221
Unspecified Obsessive-Compulsive and Related Disorder, 221
Trauma- and Stressor-Related Disorder, 221
Reactive Attachment Disorder, 221
Disinhibited Social Engagement Disorder, 222
Post-Traumatic Stress Disorder (PTSD), 222
Acute Stress Disorder, 222
Adjustment Disorder, 223
Other Specific Trauma- and Stressor-Related Disorder, 223
Unspecific Trauma- and Stressor-Related Disorder, 223
Therapeutic Interventions, 223
19 Illness and Hospitalization, 227
The Nature of Illness, 228
Stages of the Illness Experience, 228
Effects of Illness, 229
The Hospitalization Experience, 230
Situational Crisis, 230
Psychiatric Hospitalization, 231
Therapeutic Interventions, 231
Psychosocial Care, 232
Pain Management, 234
Discharge Planning, 234
20 Loss and Grief, 236
The Nature of Loss, 236
Characteristics of Loss, 237
Loss Behaviours Throughout the Life Cycle, 237
The Nature of Grief and Mourning, 238
The Grieving Process, 238
Stages of the Grieving Process, 238
The Dying Process, 240
Age Differences and Dying, 240
Terminal Illness, 240
Cultural Factors, Dying, and Mourning, 241
Stages of Dying, 241
Therapeutic Interventions, 242
Hospice Care, 242
Meeting the Needs of Dying Patients, 243
Loss, Grief, and Mental Health, 243
21 Depression and Other Mood Disorders, 247
Continuum of Emotional Responses, 248
Theories Relating to Emotions and Their Disorders, 248
Biological Evidence, 248
Other Theories, 248
Emotions Throughout the Life Cycle, 249
Emotions in Childhood, 249
Emotions in Adolescence, 249
Emotions in Adulthood, 250
Emotions in Older Persons, 250
Characteristics of Mood Disorders, 250
Depressive Disorders, 250
Disruptive Mood Dysregulation Disorder, 250
Major Depressive Disorder, 251
Major Depressive Disorder With Specifiers, 251
Persistent Depressive Disorder (Dysthymia), 252
Premenstrual Dysphoric Disorder, 252
Substance-/Medication-Induced Depressive Disorder, 252
Depressive Disorder Due to Another Medical Condition, 252
Other Specified Depressive Disorder, 253
Unspecified Depressive Disorder, 253
Bipolar and Related Disorders, 253
Bipolar I Disorder, 253
Bipolar II Disorder, 254
Cyclothymic Disorder, 254
Substance-/Medical-Induced Bipolar and Related Disorder, 254
Bipolar and Related Disorder Due to Another Medical Condition, 254
Other Specified Bipolar and Related Disorder, 254
Unspecified Bipolar and Related Disorder, 254
Therapeutic Interventions, 254
Treatment and Therapy, 255
Medication Therapies, 256
Nursing (Therapeutic) Process, 259
22 Physical Challenges, Psychological Sources, 262
Role of Emotions in Health, 263
Anxiety and Stress, 263
Childhood Sources, 264
Common Psychophysical Challenges, 264
Theories of Psychophysical Disorders, 264
Somatic Symptom and Related Disorders, 265
Cultural Influences, 265
Somatic Symptom Disorder, 266
Illness Anxiety Disorder, 266
Conversion Disorder, 267
Psychological Factors Affecting Other Medical Conditions, 268
Other Specified Somatic Symptom and Related Disorder, 268
Unspecified Somatic Symptom and Related Disorder, 268
Factitious Disorder, 268
Other Conditions That May Be a Focus of Clinical Attention, 269
Malingering, 269
Implications for Care Providers, 269
23 Eating and Sleeping Disorders, 272
Feeding and Eating Disorders, 273
Pica, 274
Rumination Disorder, 274
Avoidant/Restrictive Food Intake Disorder, 274
Anorexia Nervosa, 274
Bulimia Nervosa, 276
Binge Eating Disorder, 277
Obesity, 277
Guidelines for Intervention, 279
Sleep–Wake Disorders, 280
Insomnia Disorder, 281
Hypersomnolence Disorder, 281
Narcolepsy, 282
Breathing-Related Sleep Disorders, 282
Circadian Rhythm Sleep–Wake Disorder, 282
Parasomnias, 283
Other Sleep Disorders, 283
Guidelines for Intervention, 283
24 Dissociative Disorders, 286
Continuum of Self-Concept Responses, 287
The Healthy Personality, 287
Self-Concept Throughout the Life Cycle, 287
Self-Concept in Childhood, 287
Self-Concept in Adolescence, 287
Self-Concept in Adulthood, 288
Self-Concept in Older Adulthood, 288
Dissociative Disorders, 288 Characteristics, 288
Depersonalization/Derealization Disorder, 289
Dissociative Amnesia and Dissociative Amnesia With Fugue, 289
Dissociative Identity Disorder, 291 Trance, 291
Other Specified Dissociative Disorders, 291
Therapeutic Interventions, 291 Treatments and Therapies, 292
UNIT V Patients With Psychosocial Challenges
25 Anger and Aggression, 297
Anger and Aggression in Society, 299
Gender Aggression, 299
Aggression Throughout the Life Cycle, 299
Scope of the Problem Today, 300
Theories of Anger and Aggression, 300
Biological Theories, 300
Psychosocial Theories, 300
Sociocultural Theories, 301
The Cycle of Assault, 301
Trigger Stage, 301
Escalation Stage, 301
Crisis Stage, 302
Recovery Stage, 302
Depression Stage, 302
Disruptive, Impulse-Control, and Conduct Disorders, 302
Oppositional Defiant Disorder, 302
Intermittent Explosive Disorder, 303
Conduct Disorder, 303
Antisocial Personality Disorder, 303
Pyromania, 303
Kleptomania, 303
Guidelines for Intervention, 304
Assessing Anger and Aggression, 304
Therapeutic Interventions, 304
26 Outward-Focused Emotions: Violence, 310 Social Factors and Violence, 311 Theories of Violence, 312 Abuse, Neglect, and Exploitation Within the Family, 312 Domestic Violence, 313 Intimate Partner Abuse, 313 Abuse During Pregnancy, 314 Child Abuse, 314 Adolescent Abuse, 317 Elder Abuse, 318 Sexual Abuse, 318 Abuse, Neglect, and Exploitation Within the Community, 318
Violence Against Health Care Workers, 318 Violence, Trauma, and Crime, 318 Group Abuse, 319
Mental Health Disorders Relating to Violence, 320
Post-Traumatic Stress Disorder, 320 Rape-Trauma Syndrome, 320 Therapeutic Interventions, 321 Special Assessments, 321 Treating Victims of Violence, 321 Preventing Violence in Your Life, 321
27 Inward-Focused Emotions: Suicide, 327 Continuum of Behavioural Responses, 328 Myths About Suicide, 328 Impact of Suicide on Society, 328 Cultural Factors, 328 Social Factors, 329 Dynamics of Suicide, 330 Characteristics of Suicide, 330 Categories of Motivation, 331 Theories About Suicide, 332 New Biological Evidence, 332 Effects of Suicide on Others, 332 Suicide Throughout the Life Cycle, 333 Suicide and Children, 333 Suicide and Adolescents, 333 Suicide and Adults, 333 Suicide and Older Persons, 334 Therapeutic Interventions, 335 Assessment of Suicidal Potential, 335 Therapeutic Interventions for Suicidal Patients, 336
28 Substance-Related Disorders and Addictive Disorders, 340
The Role of Chemical Substances in Society, 341 Substance Use and Age, 341 Scope of the Problem Today, 343 Categories of Abused Substances, 343 Severity of Impact and Legality, 343 Alcohol, 343 Caffeine, 346 Cannabis, 346 Hallucinogens, 347
Inhalants, 347
Opioids (Narcotics), 348
Sedatives (Hypnotics or Anxiolytics), 349
Stimulants, 349
Tobacco (Nicotine), 350
Other Medications, 351
Characteristics of Substance Use and Abuse, 351
Stages of Addiction, 351
Substance-Related Disorders and Addictive Disorder, 352
Similarity Between Addiction and Other Disorders, 352
Three Main Malfunctions Leading to Addiction, 352
Guidelines for Intervention, 353 Assessment, 353
Treatments and Therapies, 354
Relapse, 356
Nursing/Therapeutic Process, 356
29 Sexuality and Sexual Disorders, 360
The Continuum of Sexual Responses, 361
Self-Awareness and Sexuality, 361
Sexuality Throughout the Life Cycle, 362
Sexuality in Childhood, 362
Sexuality in Adolescence, 362
Sexuality in Adulthood, 363
Sexuality in Older Adulthood, 363
Sexuality and Disability, 363
Sexual Orientation, 363
Gender Identity, 364
Gender Identity Terminology, 364
Paraphilic Disorders, 365
Other Specified Paraphilic Disorders, 365
Unspecified Paraphilic Disorder, 365
Therapeutic Approach, 366
Sexual Dysfunctions, 366
Gender Dysphoria, 366
Pornography, 367
Therapeutic Interventions, 367
Psychosexual Assessment, 368
Nursing/Therapeutic Process, 368
30 Personality Disorders, 372
Continuum of Social Responses, 373
Personality Throughout the Life Cycle, 373
Personality in Childhood, 373
Personality in Adolescence, 373
Personality in Adulthood, 374
Personality in Older Adulthood, 374
Theories Relating to Personality Disorders, 374
Biological Theories, 374
Psychoanalytical Theories, 374
Behavioural Theories, 374
Sociocultural Theories, 375
Personality Disorders, 375
Eccentric Cluster, 376
Erratic Cluster, 377
Psychopaths and Sociopaths, 378
Fearful Cluster, 379
Therapeutic Interventions, 379
Treatment and Therapy, 379
Nursing (Therapeutic) Process, 380
31 Brain Function, Schizophrenia, and Other Psychoses, 383
A Few Facts About Our Brains, 384
Brain Function, 384
Normal Brain Function, 385
Abnormal Brain Function, 386
Psychosis, 388
The Schizophrenia Spectrum, 388
Delusional Disorder, 388
Brief Psychotic Disorder, 388
Schizophreniform Disorder, 388
Schizophrenia, 388
Schizoaffective Disorder, 391
Substance/Medication-Induced Psychotic Disorder, 391
Psychotic Disorder Due to a Medical Condition, 391
Catatonia Associated With a Mental Disorder, 391
Other Specified Schizophrenia Spectrum and Other Psychotic Disorder, 393
Unspecified Schizophrenia Spectrum and Other Psychotic Disorder, 393
Therapeutic Interventions, 393
Treatments and Therapies, 393
Nursing (Therapeutic) Process, 394
Special Considerations, 395
Nursing Responsibilities, 399
32 Chronic Mental Health Disorders, 402
Scope of Mental Illness, 403
Public Policy and Mental Health, 403
Effects of Deinstitutionalization, 403
Experience of Chronic Mental Illness, 403
Meeting Basic Needs, 403
Access to Health Care, 403
Characteristics of Chronic Mental Illness, 404
Behavioural Characteristics, 405
Physical Characteristics, 405
Psychological Characteristics, 405
Special Populations, 405
Children and Adolescents Living With Chronic Mental Illness, 406
Older Persons Living With Chronic Mental Illness, 406
Persons With Multiple Disorders, 406
Providing Care for People Who Are Chronically Mentally Ill, 406
Inpatient Settings, 406
Outpatient Settings, 407
Psychiatric Rehabilitation, 407
Therapeutic Interventions, 407
Treatments and Therapies, 407
Nursing (Therapeutic) Process, 408
33 Challenges for the Future, 414
Changes in Mental Health Care, 414 Change in Settings, 415 Challenges Created by the Canadian Health Care System, 415
Long-Acting Injectables, 416 Homelessness, 416
The Canadian Charter of Rights and Freedoms, 417 Cultural Influences, 417
The Mental Health Care Team, 418 Team Members, 418
Mental Health Care Delivery Settings, 418 Change and Mental Health Patients, 418 Competency, 418
Empowerment of Patients, 418 Obligations of Patients, 419
Obligations of Care Providers, 419 Providers of Care, 419 Expanded Role for Nurses, 420 Making Change in the Health Care System, 420 The Change Process, 421 Other Challenges, 422 The Challenge to Care, 422 A Look to the Future, 422 Appendix
A. Mental Status Assessment at a Glance, 424
B. A Simple Assessment of Tardive Dyskinesia Symptoms, 425
C. Canadian Standards for Psychiatric-Mental Health Nursing, 426 Glossary, 429 Index, 441
