Psychiatric-Mental Health Nursing: Evidence-Based Concepts, Skills, and Practices

Front Matter
	Preface
		Organization of the Eighth Edition
		Changes to the Eighth Edition
		Features
		Photography and Art
		Teaching Learning Package
		Student Resources
	Dedication and Acknowledgments
	Contributors
	Reviewers
ONE: Foundational Concepts in Psychiatric–Mental Health Nursing
	1: Introduction to Psychiatric–Mental Health Nursing
		LEARNING OBJECTIVES
		KEY TERMS
		MENTAL HEALTH
			FIGURE 1.1
			Elements of and Influences on Mental Health
				FIGURE 1.2
			Mental Health as a National Priority
				Checkpoint Questions
		MENTAL ILLNESS
			The Mental Health–Illness Continuum
			Incidence and Prevalence
				TABLE 1.1: Mental Disorders in the United States
			Etiology
				Checkpoint Questions
			Diagnosis
				Five Axes of the DSM
					DSM-IV-TR BOX 1.1: Examples of Axis IV (Psychosocial and Environmental) Problems
					Case Vignette 1.1
						Reflection and Critical Thinking
				Limitations and Criticisms of the DSM
			Prevention and Treatment
				FIGURE 1.3
				Problems in Treating Mental Illness
					COST-RELATED ISSUES.
					STIGMA.
					REVOLVING DOOR TREATMENT.
						FIGURE 1.4
						Checkpoint Questions
				Challenges Remaining
					THE NEW FREEDOM COMMISSION REPORT.
					LIMITED ACCESS TO SERVICES.
				Goals of Care and Methods of Achievement
					FIGURE 1.5
					BEYOND RESPONSE TO RECOVERY.
						Think About It 1.1
					REINTEGRATION INTO SOCIETY.
					MENTAL HEALTH PARITY.
					CULTURALLY COMPETENT CARE.
						FIGURE 1.6
					MEDICATION ADHERENCE.
				Self-Help Movements and Advocacy
					NATIONAL ALLIANCE FOR THE MENTALLY ILL.
						Client-Centered Education 1.1: Managing Drug Therapy
					FAMILY ADVOCACY MOVEMENT.
						TABLE 1.2: Family Adaptation Model
						TABLE 1.3: Client Adaptation Model
					PSYCHIATRIC ADVANCED DIRECTIVES.
						Checkpoint Questions
		PSYCHIATRIC-MENTAL HEALTH NURSING
			Nursing Process and Standards of Care
			Levels of Practice
				FIGURE 1.7
				NURSING SPOTLIGHT 1.1: Psychiatric–Mental Health Nursing’s Phenomena of Concern
				Think About It 1.2
			Guiding Principles
			The Role of the Psychiatric Nurse as a Team Member
			Development of Appropriate Client Care Skills
		Reviewing and Applying Your Knowledge
			Chapter Summary
			Study Questions
		References
		Web Resources
	2: Neuroscience: Biology and Behavior
		LEARNING OBJECTIVES
		KEY TERMS
		NEUROANATOMY AND NEUROPHYSIOLOGY
			Neurons
				FIGURE 2.1
				Neurotransmitters
					Checkpoint Questions
					TYPES OF NEUROTRANSMITTERS.
						TABLE 2.1: Some Neurotransmitters and Their Functions
						BOX 2.1: Neurotransmitters in the Brain
					PROCESS OF NEUROTRANSMISSION.
					FIRST AND SECOND MESSENGERS.
					PSYCHIATRIC NURSING IMPLICATIONS.
						UNDERSTANDING BIOLOGIC FOUNDATIONS 2.1: Neurotransmission
						Think About It 2.1
				Plasticity
					UNDERSTANDING BIOLOGIC FOUNDATIONS 2.2: Major Neurotransmitter Pathways in Mental Health
				Neurogenesis
				Apoptosis
			Central Nervous System
				Spinal Cord
				Brain
					FIGURE 2.2
					ORGANIZATION AND STRUCTURE.
						TABLE 2.2: Organization of the Brain
						Cerebrum.
							FIGURE 2.3
						Diencephalon.
						Cerebellum.
						Brainstem.
						Limbic System.
							FIGURE 2.4
						Basal Ganglia.
							Checkpoint Questions
					BRAIN DEVELOPMENT.
						FIGURE 2.5
						Client-Centered Education 2.1: Encouraging Optimal Learning in Children
						Checkpoint Questions
					NEUROPLASTICITY.
					PSYCHIATRIC NURSING IMPLICATIONS.
						Think About It 2.2
			The Role of Genetics
				Genetics and Psychiatric Disorders
				Interaction Between Genes and Environment
					FIGURE 2.6
				Stress–Diathesis Model
					Checkpoint Questions
		OTHER TOPICS IN NEUROSCIENCE
			Memory, Repetition, and Learning
				FIGURE 2.7
			Circadian Rhythm
				FIGURE 2.8
			Neuroimaging Techniques
				TABLE 2.3: Neuroimaging Techniques
				FIGURE 2.9
			Psychoneuroimmunology
				Checkpoint Questions
		Reviewing and Applying Your Knowledge
			Chapter Summary
			Study Questions
		References
	3: Conceptual Frameworks and Theories
		LEARNING OBJECTIVES
		KEY TERMS
		THEORIES: WHO CARES AND SO WHAT?
			FIGURE 3.1
			Checkpoint Questions
		THEORIES OF HUMAN BEHAVIOR
			Psychoanalytic or Psychodynamic Theory
				General Principles
					TABLE 3.1: Defense Mechanisms
					TABLE 3.2: Freud’s Model of Psychosexual Development
				Critiques
				Nursing Applications
			Behavioral Theory
				Checkpoint Questions
				General Principles
					CONDITIONING.
						FIGURE 3.2
					REINFORCEMENT.
						FIGURE 3.3
					PUNISHMENT.
					GENERALIZATION AND DISCRIMINATION.
					MODELING AND SHAPING.
				Applied Behavior Analysis
					TABLE 3.3: Behavior Modification Techniques
				Nursing Applications
					Think About It 3.1
			Cognitive Theory
				Rational Emotive Theory
					BOX 3.1: Examples of Distorted Beliefs
				Beck’s Cognitive Theory
					TABLE 3.4: Types of Cognitions in Cognitive Therapy
				Cognitive–Behavioral Theory
					TABLE 3.5: Cognitive–Behavioral Techniques
				A Brief Note on Dialectic Behavior Therapy
				Nursing Applications
			Humanistic Theory
				Checkpoint Questions
			Interpersonal Theory
				General Principles
				Hildegard Peplau
			Biophysiologic Theory
				General Principles
				The Stress–Diathesis Model
					FIGURE 3.4
					Checkpoint Questions
			Sociocultural Theory
				FIGURE 3.5
				Cultural Spotlight 3.1: Koro
				Think About It 3.2
		TOWARD A COMPREHENSIVE, MULTIDISCIPLINARY UNDERSTANDING OF PSYCHOPATHOLOGY
			TABLE 3.6: Examples of Risk and Protective Factors
			FIGURE 3.6
			The Emergence of Mental Illness
			Nursing Applications: Assessing Multiple Systems
				Family Characteristics (Microsystem)
				Community Characteristics (Exosystem)
					FIGURE 3.7
			Implications and Criticisms
				Checkpoint Questions
				EVIDENCE-BASED PRACTICE SPOTLIGHT 3.1: Family Functioning and Juvenile Violence
					Reference
		Reviewing and Applying Your Knowledge
			Chapter Summary
			Study Questions
		References
	4: Evidence-Based Practice
		LEARNING OBJECTIVES
		KEY TERMS
		FIGURE 4.1
		SCIENCE
			TABLE 4.1: Scientific Processes
			Principles of the Scientific Method
				Systematic Empiricism
					FIGURE 4.2
				Publicly Verifiable Knowledge
				Empirically Solvable Problems and Testable Theories
			Types of Scientific Evidence
				EVIDENCE-BASED PRACTICE SPOTLIGHT 4.1: Typology of Studies
				Checkpoint Questions
		PSEUDOSCIENCE
			FIGURE 4.3
			EVIDENCE-BASED PRACTICE SPOTLIGHT 4.2: Exemplars of Levels of Study
			Pseudoscience Versus Science
			Myths
			Quackery
				Patterning
				Facilitated Communication
			The Dangers of “Junk Science”
				Multiple Personality Disorder
				Aspartame
					Checkpoint Questions
			The Dangers of Pseudoscience: Attachment Therapy
				Think About It 4.1
		IMPLICATIONS FOR PROFESSIONAL NURSES
			Client-Centered Education 4.1: Combating Quackery and Fraudulent Claims
		THE FUTURE OF MENTAL HEALTH AND PSYCHIATRIC NURSING
		Reviewing and Applying Your Knowledge
			Chapter Summary
			Study Questions
			Critical Thinking Questions
		References
		Web Resources
	5: Legal and Ethical Aspects
		LEARNING OBJECTIVES
		KEY TERMS
		LEGAL ISSUES IN PSYCHIATRIC-MENTAL HEALTH NURSING
			Nurse Practice Acts and the Expanding Role of Nursing
				Case Vignette 5.1
					Reflection and Critical Thinking
			Malpractice
				BOX 5.1: Malpractice Suits Against Nurses
				Think About It 5.1
			Legal Counsel
				Checkpoint Questions
			Basic Rights of Clients Receiving Psychiatric Nursing Care
				BOX 5.2: Federal Bill of Rights for Mental Health Clients
				Informed Consent
					NURSING SPOTLIGHT 5.1: Nursing Care Guidelines to Maintain Legal Rights of Clients
					SPECIAL CONSIDERATIONS IN PSYCHIATRIC SETTINGS.
						FIGURE 5.1
					SUBSTITUTED CONSENT.
				Confidentiality
					HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT.
					RESPONSIBLE RECORD KEEPING.
						FIGURE 5.2
					PRIVILEGED COMMUNICATION.
						Think About It 5.2
			Evolving Legal Rights
				Right to Treatment
				Right to Treatment in the Least Restrictive Environment
				Right to Refuse Treatment
					FIGURE 5.3
				Right to Aftercare
					Checkpoint Questions
			Client Status and Specific Legal Issues
				Voluntary Admissions
					FIGURE 5.4
				Emergency Admissions
				Involuntary Admissions
			Legal Issues and Special Client Populations
				Forensic Clients
					Case Vignette 5.2
						Reflection and Critical Thinking
					COMPETENCY TO STAND TRIAL.
					PLEAS OF INSANITY OR MENTAL ILLNESS.
				Minors
					Checkpoint Questions
		ETHICAL ISSUES IN PSYCHIATRIC-MENTAL HEALTH NURSING
			FIGURE 5.5
			NURSING SPOTLIGHT 5.2: American Nurses Association Code of Ethics for Nurses
			Bioethical Principles in Psychiatric Nursing Practice
				Autonomy
				Beneficence and Paternalism
				Veracity and Fidelity
					Case Vignette 5.3
						Reflection and Critical Thinking
				Justice
					Checkpoint Questions
			Nursing Ethics in Community Mental Health
				FIGURE 5.6
			Boundaries in Ethical Nursing Care
				Case Vignette 5.4
					Reflection and Critical Thinking
		Reviewing and Applying Your Knowledge
			Chapter Summary
			Study Questions
			Critical Thinking Questions
		References
TWO: Client Care Considerations
	6: Culture
		LEARNING OBJECTIVES
		KEY TERMS
		CULTURE
			Changing Demographics and Cultural Awareness
				TABLE 6.1: Trends in U.S. Demographics
				Assimilation
				Implications for Health Care
					Checkpoint Questions
			Culturally Competent Health Care
				BOX 6.1: National Standards for Culturally and Linguistically Appropriate Services (CLAS)
				Cultural Congruence
				Health Literacy
				Models of Transcultural Nursing
					SUNRISE MODEL.
					CULTURAL COMPETENCE IN HEALTH CARE DELIVERY.
						FIGURE 6.1
					CULTURAL COMPETENCE.
						ASSESSMENT TOOL 6.1: Fostering Cultural Self-Awareness
					TRANSCULTURAL ASSESSMENT MODEL.
						Think About It 6.1
				Disparities in Mental Health and Barriers to Effective Treatment
			Variability and Vulnerability
			Ethnopharmacology
				FIGURE 6.2
			Traditional Medicine
			Accessibility
				FIGURE 6.3
			Racial Bias
				BOX 6.2: Diagnosis and Race: The Case of Junius Wilson
			Religious and Spiritual Influences
				Checkpoint Questions
		SOCIOCULTURAL VARIATIONS IN RESPONSE TO MENTAL HEALTH CARE
			Hispanic and Latino(a) Clients
				FIGURE 6.4
			Black Americans
				Case Vignette 6.1
					Reflection and Critical Thinking
				FIGURE 6.5
			Native Americans
				FIGURE 6.6
			Asian and Pacific Islanders
				Cultural Spotlight 6.1: Post-Traumatic Stress Disorder and Culture-Bound Syndromes Among Asian Groups
				FIGURE 6.7
			Middle Eastern Clients
				FIGURE 6.8
			Eastern Europeans
				FIGURE 6.9
				Checkpoint Questions
		CULTURALLY COMPETENT AND CONGRUENT NURSING CARE
			BOX 6.3: Treatment Strategies for Cultural Competence in Mental Health care Delivery
			Essential Skills
				FIGURE 6.10
				Think About It 6.2
			Phases of Transcultural Nursing Knowledge
			Transcultural Assessment
			Building Cultural Awareness
			Cultural Self-Awareness
				Checkpoint Questions
		EVIDENCE-BASED PRACTICE
		Reviewing and Applying Your Knowledge
			Chapter Summary
			Study Questions
			Critical Thinking Questions
		References
	7: Spirituality in Psychiatric Care
		LEARNING OBJECTIVES
		KEY TERMS
		SPIRITUALITY, RELIGION, AND MENTAL HEALTH
			Definitions
				FIGURE 7.1
			Importance of Spirituality and Religion in North America
			Health-Related Attitudes and Philosophies
			Positive Effects of Spirituality and Religion
				Mental Health
					FIGURE 7.2
					Case Vignette 7.1
						Reflection and Critical Thinking
				Critiques and Criticisms of Available Research
			Negative Effects of Religion and Spirituality
			Mental Illness
				FIGURE 7.3
				Checkpoint Questions
		RELIGIOUS AND SPIRITUAL INTERVENTIONS IN MENTAL HEALTH CARE
			Clarifying Values
				FIGURE 7.4
			The Role of Clergy in Mental Health Care
				FIGURE 7.5
			The Role of the Nurse in Mental Health Care
				Think About It 7.1
				Spiritual Assessment
				Spiritual Coping Practices and Interventions
					Therapeutic Communication 7.1: Spiritual Dialogue
						Reflection and Critical Thinking
					NURSING SPOTLIGHT 7.1: NANDA, NOC, and NIC Related to Spirituality
					PRAYER.
						FIGURE 7.6
					BIBLIOTHERAPY WITH SACRED WRITINGS.
					CONTEMPLATION AND MEDITATION.
						FIGURE 7.7
					REPENTANCE AND FORGIVENESS.
					WORSHIP AND RITUALS.
						FIGURE 7.8
					FELLOWSHIP AND ALTRUISTIC SERVICE.
					JOURNAL WRITING.
						Checkpoint Questions
		ETHICAL CONCERNS
		Reviewing and Applying Your Knowledge
			Chapter Summary
			Study Questions
			Critical Thinking Questions
		References
THREE: The Nurse–Client Relationship
	8: Nursing Values, Attitudes, and Self-Awareness
		LEARNING OBJECTIVES
		KEY TERMS
		FIGURE 8.1
		FEAR OF MENTAL ILLNESS: STIGMA AT WORK
			BOX 8.1: Visual Hallucinations in Charles Bonnet Syndrome
		MYTHS AND MENTAL ILLNESS
		UNDERSTANDING MENTAL ILLNESS: CLIENTS IN THEIR OWN WORDS
			Checkpoint Questions
		HURTFUL LANGUAGE
			FIGURE 8.2
			Think About It 8.1
		SITUATIONAL AND DISPOSITIONAL FACTORS IN CLINICAL SETTINGS
			Checkpoint Questions
		LABELING AND SOCIAL PERCEPTION
			Checkpoint Questions
		REALITY AND MENTAL HEALTH CARE: CHALLENGES FOR NURSING
			Recommendations for Working with Clients
				FIGURE 8.3
			Managing Stress and Burnout
				FIGURE 8.4
				BOX 8.2: Managing Work-Related Stress
				Checkpoint Questions
		Reviewing and Applying Your Knowledge
			Chapter Summary
			Study Questions
			Critical Thinking Questions
		References
	9: The Nursing Process in Psychiatric–Mental Health Care
		LEARNING OBJECTIVES
		KEY TERMS
		STEPS OF THE NURSING PROCESS
			FIGURE 9.1
			Assessment
				Interview
					FIGURE 9.2
				Health History
				Mental Status Examination
					NURSING SPOTLIGHT 9.1: Standards of Practice for Psychiatric–Mental Health Nursing
				Psychosocial Assessment
				Physical Examination and Laboratory and Diagnostic Testing
					Checkpoint Questions
			Nursing Diagnosis
				The NANDA Taxonomy
					FIGURE 9.3
				Choosing and Formulating the Nursing Diagnosis
					TABLE 9.1: Writing the Diagnostic Statement: Examples of Incorrect and Correct Diagnoses
				Nursing Diagnosis and Psychiatric Diagnosis
					Checkpoint Questions
			Planning
				Identifying Outcomes
					TABLE 9.2: Examples of SMART Outcome Indicators
				Selecting Interventions
					FIGURE 9.4
				NANDA and the NOC and NIC Taxonomies
					STANDARDIZED CARE PLANS.
					CLINICAL OR CRITICAL PATHWAYS.
						Think About It 9.1
			Implementation
				FIGURE 9.5
				Intervention Strategies for Beginning Practitioners
				Supervision
					FIGURE 9.6
					Checkpoint Questions
			Evaluation
				FIGURE 9.7
		DOCUMENTATION
			TABLE 9.3: Documentation of the Nursing Process
			TABLE 9.4: Comparing Documentation Notes
			FIGURE 9.8
		Reviewing and Applying Your Knowledge
			Chapter Summary
			Study Questions
			Critical Thinking Questions
		References
	10: The Interview and Assessment Process
		LEARNING OBJECTIVES
		KEY TERMS
		PREPARATION
			Self-Awareness
				FIGURE 10.1
				BOX 10.1: Process Recording Format
			Review of the Client’s History
				Think About It 10.1
			Setting Preparation
				FIGURE 10.2
				Checkpoint Questions
		CONTENT OF THE ASSESSMENT
			FIGURE 10.3
			ASSESSMENT TOOL 10.1: PERSONS Acronym for Identifying Major Aspects of Psychiatric–Mental Health Nursing Assessment
			Health History
				Initial Information
					BOX 10.2: Tips for Interviewing Clients With Psychiatric Disorders
				Reason for Seeking Health Care
				Present Illness
				Medications
					FIGURE 10.4
				Drug Allergies
				Substance Use
					Checkpoint Questions
				Past Illnesses
				Family History
				Personal and Social History
				Review of Systems
					Checkpoint Questions
					ASSESSMENT TOOL 10.2: Brief Review of Sleep Patterns
			Physical Examination
				TABLE 10.1: Physical Assessment Findings That May Be Psychiatric or Medical in Origin
				FIGURE 10.5
			Mental Status Examination
				Appearance and Behavior
					FIGURE 10.6
					LEVEL OF CONSCIOUSNESS.
					POSTURE AND MOTOR MOVEMENTS.
						FIGURE 10.7
					DRESS, GROOMING, AND HYGIENE.
				Mood and Affect
					FIGURE 10.8
				Speech and Language
				Thought and Perception
					THOUGHT CONTENT.
						TABLE 10.2: Thought Content Disturbances
					THOUGHT PROCESSES.
					PERCEPTIONS.
					INSIGHT.
					JUDGMENT.
				Cognitive Functions
					ORIENTATION.
					MEMORY.
					ATTENTION/CONCENTRATION.
					INTELLIGENCE.
					ABSTRACT REASONING.
						Think About It 10.2
			Safety Assessments
				Checkpoint Questions
				Suicide Assessment
				Dangerousness to Others and Homicide Assessment
				Victimization Through Abuse or Neglect
			Individualized Needs
				Wellness
				Strengths and Weaknesses
				Cultural Needs
					ASSESSMENT TOOL 10.3: Wellness Evaluation
				Spiritual Assessment
				Coping and Stress Management
					Checkpoint Questions
		RATING SCALES
		SPECIAL CHALLENGES
			Age Group
				FIGURE 10.9
			Communication Challenges
		NURSE’S FOLLOW-UP
		Reviewing and Applying Your Knowledge
			Chapter Summary
			Study Questions
			Critical Thinking Questions
		References
	11: Therapeutic Relationships and Communication
		LEARNING OBJECTIVES
		KEY TERMS
		THERAPEUTIC RELATIONSHIPS
			EVIDENCE-BASED PRACTICE SPOTLIGHT 11.1: The Primacy of the Therapeutic Relationship in Psychiatric Treatment
			Essential Elements
				Trust
					FIGURE 11.1
				Professionalism
					TABLE 11.1: Social Versus Therapeutic Relationships
				Mutual Respect
					FIGURE 11.2
					Think About It 11.1
				Caring
					FIGURE 11.3
				Partnership
					Checkpoint Questions
			Obstacles to Therapeutic Relationships
				Confronting Judgmental Attitudes
					Case Vignette 11.1
						Reflection and Critical Thinking
					Think About It 11.2
				Enhancing Self-Awareness
				Excessive Probing
					FIGURE 11.4
			Phases of the Therapeutic Relationship
				Introductory Phase
					FIGURE 11.5
					Challenging Behaviors 11.1: The Withdrawn Client
				Working (Middle) Phase
					FIGURE 11.6
				Termination Phase
					FIGURE 11.7
					Checkpoint Questions
		THERAPEUTIC COMMUNICATION
			TABLE 11.2: Therapeutic Communication Techniques
			TABLE 11.3: Nontherapeutic Communication Techniques
			Theoretical Framework and Communication Model
				FIGURE 11.8
			Listening
				Therapeutic Communication 11.1: Encouraging Formulation of a Plan
					Reflection and Critical Thinking
			Assertiveness
			Confrontation and Limit Setting
				TABLE 11.4: Examples of Positive Reframing
				Checkpoint Questions
			Self-Disclosure
			Therapeutic Communication in Special Situations
				Clients With Anxiety
					FIGURE 11.9
				Clients With Psychoses
					Challenging Behaviors 11.2: The Angry Client
				Families
					Checkpoint Questions
		Reviewing and Applying Your Knowledge
			Chapter Summary
			Study Questions
			Critical Thinking Questions
		References
	12: Working With the Multidisciplinary Team
		LEARNING OBJECTIVES
		KEY TERMS
		PSYCHOLOGISTS
			Educational Background and Training
				Checkpoint Questions
			The Role of School Psychologists
				FIGURE 12.1
				Individualized Education Programs
				Multidisciplinary Service Coordination Plans in Communities
					FIGURE 12.2
					TEAM COMPOSITION.
					TEAM FUNCTIONING.
						Case Vignette 12.1
			Psychologists, Nurses, and Multidisciplinary Teams
				Checkpoint Questions
		OCCUPATIONAL THERAPISTS
			FIGURE 12.3
			Educational Background and Training
			The Role of Occupational Therapists
				TABLE 12.1: Systems in Sensory Integration
				BOX 12.1: Client Groups That Benefit from Occupational Therapy
			Occupational Therapists, Nurses, and Multidisciplinary Teams
		PROFESSIONAL SOCIAL WORKERS
			Educational Background and Training
				Case Vignette 12.2
			The Role of Social Workers
				FIGURE 12.4
				FIGURE 12.5
				Case Vignette 12.3
			Social Workers, Nurses, and Multidisciplinary Teams
				Checkpoint Questions
		PSYCHIATRISTS
			Educational Background and Training
				FIGURE 12.6
			The Role of Psychiatrists
			Psychiatrists, Nurses, and Multidisciplinary Teams
				Checkpoint Questions
		REGISTERED DIETITIANS
			FIGURE 12.7
			Case Vignette 12.4
			Educational Background and Training
			The Role of Registered Dietitians
				BOX 12.2: Role of the Registered Dietitian in Treatment Plans
			Registered Dietitians, Nurses, and Multidisciplinary Teams
				Case Vignette 12.5
		ART THERAPISTS
			Educational Background and Training
			Role of the Art Therapist
			Art Therapists, Nurses, and Multidisciplinary Teams
		PROFESSIONAL CERTIFIED THERAPEUTIC RECREATION SPECIALISTS
			Educational Background and Training
			The Role of Recreational Therapists
			Recreational Therapists, Nurses, and Multidisciplinary Teams
		BENEFITS OF THE MULTIDISCIPLINARY APPROACH
			FIGURE 12.8
			Think About It 12.1
		Reviewing and Applying Your Knowledge
			Chapter Summary
			Study Questions
		References
FOUR: Conceptual Bases of Treatment
	13: Individual Therapies and Nursing Interventions
		LEARNING OBJECTIVES
		KEY TERMS
		THERAPIES FOR INDIVIDUAL CLIENTS
			FIGURE 13.1
			Goals of Individual Therapy
			Practitioners of Psychotherapy
			Current Trends
			Common Modalities
				TABLE 13.1: Selected Approaches to Psychotherapy
				Psychoanalysis/Psychodynamic Therapies
					Checkpoint Questions
				Cognitive–Behavioral Therapies
					EVIDENCE-BASED PRACTICE SPOTLIGHT 13.1: Cognitive Behavioral Therapy
						References
					Think About It 13.1
					COGNITIVE THERAPY.
						Core Issues.
							TABLE 13.2: Cognitive Distortions
						Treatment Approach.
							TABLE 13.3: Therapeutic Techniques of Cognitive Therapy
					RATIONAL EMOTIVE BEHAVIOR THERAPY.
					DIALECTICAL BEHAVIOR THERAPY.
						FIGURE 13.2
						Checkpoint Questions
				Behavioral Theory
				Client-Centered Therapy
					FIGURE 13.3
				Solution-Focused Therapy
					BOX 13.1: Process of Solution-Focused Therapy
					Checkpoint Questions
			Integrative Approaches to Psychotherapy
			Cultural Considerations in Psychotherapy
				FIGURE 13.4
		PSYCHIATRIC NURSING ROLES AND STRATEGIES FOR INDIVIDUAL CLIENTS
			Basic-Level Psychiatric Nursing Care
				Health Promotion and Health Maintenance
					FIGURE 13.5
				Intake Screening and Evaluation
					FIGURE 13.6
				Case Management
					FIGURE 13.7
				Milieu Therapy
				Promoting Self-Care Activities
					FIGURE 13.8
				Implementing Psychobiologic Interventions
				Health Teaching
				Counseling and Crisis Intervention
				Psychiatric Rehabilitation
			Advanced-Level Therapeutic Nursing Interventions
				FIGURE 13.9
				Think About It 13.2
		Reviewing and Applying Your Knowledge
			Chapter Summary
			Study Questions
			Critical Thinking Questions
		References
	14: Groups and Group Interventions
		LEARNING OBJECTIVES
		KEY TERMS
		GROUP PROCESS
			Characteristics of Groups
			Types of Groups
				FIGURE 14.1
			Group Norms
			Group Leadership
				FIGURE 14.2
				Styles of Group Leadership
					TABLE 14.1: Leadership Styles
				Leadership Qualities for Effective Groups
					BOX 14.1: Role Function Areas for Evaluation of a Group Leader
				Ethical Principles in Group Counseling
					AUTONOMY.
						FIGURE 14.3
					NONMALEFICENCE.
					BENEFICENCE.
					CONFIDENTIALITY.
					INFORMED CONSENT.
				Documentation
					FIGURE 14.4
				Decision Making
				Structuring the Group
					Checkpoint Questions
			Group Roles
				Task Roles
					FIGURE 14.5
				Building and Maintenance Roles
				Individual Roles
					Think About It 14.1
			Group Communication
				TABLE 14.2: Group Communication Techniques
				Latent and Manifest Communication
				Content and Process Communication
				Transference and Countertransference
				Communication Themes
			Stages of Group Development
				Initial Stage
					BOX 14.2: Stages of Group Development
				Working Stage
				Mature Stage
					TABLE 14.3: Common Problems Affecting Group Therapy and Process
				Termination Stage
					Checkpoint Questions
		GROUP THERAPY
			Advantages and Disadvantages
			Therapeutic Factors of Group Therapy
				BOX 14.3: Yalom’s Curative (Therapeutic) Factors
				Instillation of Hope
				Universality
				Imparting of Information
					FIGURE 14.6
				Group Cohesiveness
				Catharsis
				Existential Factors
					Checkpoint Questions
			Types of Therapy Groups
				Psychotherapeutic Groups
					INPATIENT PSYCHOTHERAPEUTIC GROUPS.
						EVIDENCE-BASED PRACTICE SPOTLIGHT 14.1: Reminiscence Therapy for Dementia
							References
					OUTPATIENT PSYCHOTHERAPEUTIC GROUPS.
				Growth Groups
					ENCOUNTER GROUPS.
						FIGURE 14.7
					TRAINING GROUPS.
					COMMUNITY SUPPORT GROUPS.
						TABLE 14.4: Community Support Groups
						Think About It 14.2
		NURSES AND GROUP PROCESS AND THERAPY
			Group Process and Therapy in Nursing Education
			Group Process and Therapy in Nursing Practice
				Historical Perspective
				Contemporary Nursing Groups
					FIGURE 14.8
					EVIDENCE-BASED PRACTICE SPOTLIGHT 14.2: Group Behavior Therapy for Smoking Cessation
						References
		Reviewing and Applying Your Knowledge
			Chapter Summary
			Study Questions
			Critical Thinking Questions
		References
	15: Families and Family Interventions
		LEARNING OBJECTIVES
		KEY TERMS
		FAMILY THEORIES AND MODELS
			FIGURE 15.1
			Family as a System
				FIGURE 15.2
				Checkpoint Questions
			Family Development
				BOX 15.1: Family Development Stages and Tasks
			Role of the Family
			Family and Stress
				FIGURE 15.3
			Strengths Perspective With Families
				Checkpoint Questions
		NURSING ASSESSMENT WITH FAMILIES
			Structural Assessment
				FIGURE 15.4
				ASSESSMENT TOOL 15.1: Components of the Calgary Family Assessment Model
				FIGURE 15.5
			Developmental Assessment
			Functional Assessment
			Cultural Considerations
		NURSING INTERVENTIONS
			Cognitive Interventions
			Affective Interventions
			Behavioral Interventions
				NURSING SPOTLIGHT 15.1: NANDA, NOC, and NIC Labels in Psychiatric Family Care
		FAMILIES OF CLIENTS WITH MENTAL ILLNESS
			Family Burden
				Objective Burden
					FIGURE 15.6
					Case Vignette 15.1
						Reflection and Critical Thinking
					Checkpoint Questions
				Subjective Burden
					Case Vignette 15.2
						Reflection and Critical Thinking
			Iatrogenic Burden
				Confidentiality Issues
				Involuntary Treatment Statutes
				Discrimination
				Burden Attributable to Professionals
					Checkpoint Questions
			Families as a Population at Risk
			Family Consultation
				Components
					FIGURE 15.7
				Nurses as Family Consultants
					Checkpoint Questions
			Family Empowerment
				Therapeutic Communications 15.1: Family Consultation
					Reflection and Critical Thinking
			Family Education
				Components
				Nurses as Family Educators
				Peer-Taught Family Education
			Psychotherapy and Medication
		Reviewing and Applying Your Knowledge
			Chapter Summary
			Study Questions
			Critical Thinking Questions
		References
		Web Resource
	16: Psychopharmacology
		LEARNING OBJECTIVES
		KEY TERMS
		THE FOOD AND DRUG ADMINISTRATION DRUG-APPROVAL PROCESS
			TABLE 16.1: The FDA Drug Testing Protocol for Humans
			Clinical Trials
			Special Considerations with Psychotropic Agents
		PHARMACODYNAMICS
			Neurons and Neurotransmission
				FIGURE 16.1
				Affinity
			Receptor–Pharmacology Spectrum
			Refractoriness
			Efficacy and Potency
			Rule of 5s
			Effect of Medications on Neurons
				TABLE 16.2: Effects of Receptor Antagonism
			Effects of Medications on Synapses
				Checkpoint Questions
		PHARMACOKINETICS
			FIGURE 16.2
			Absorption
				TABLE 16.3: Effects of Psychotropic Medications on Appetite, Gastrointestinal Function, Nutrient Absorption, and Metabolism
			Distribution
				FIGURE 16.3
			Metabolism
			Elimination
				TABLE 16.4: Foods That Contribute to Acid or Alkaline Urine
				TABLE 16.5: Effects of Food and Drug pH on Elimination
				BOX 16.1: Effects of Dietary Substances on Psychotropic Medications
				Checkpoint Questions
		MAJOR CLASSES OF PSYCHOTROPIC DRUGS
			Antidepressants
				FIGURE 16.4
				UNDERSTANDING PSYCHOPHARMACOLOGY 16.1: Antidepressants
				Tricyclic Antidepressants (TCAs)
					Think About It 16.1
				Monoamine Oxidase Inhibitors (MAOIs)
					FIGURE 16.5
				Selective Serotonin Reuptake Inhibitors (SSRIs)
				Other Selective Antidepressants
					SELECTIVE SEROTONIN/NOREPINEPHRINE REUPTAKE INHIBITORS (SNRIS).
					SEROTONIN ANTAGONIST/REUPTAKE INHIBITORS (SARIS).
					SELECTIVE DOPAMINE REUPTAKE INHIBITOR (SDRI).
					ALPHA-2 REUPTAKE INHIBITOR (ARI).
				Drugs for Refractory Depression
					Checkpoint Questions
			Mood Stabilizers
				Lithium Carbonate
					FIGURE 16.6
					UNDERSTANDING PSYCHOPHARMACOLOGY 16.2: Mood Stabilizers
				Anticonvulsants
					Client-Centered Education 16.1: Teaching Points for Clients Taking Lithium
				Medications for Refractory Mania
			Anxiolytics
				Buspirone
				Benzodiazepines
					FIGURE 16.7
					UNDERSTANDING PSYCHOPHARMACOLOGY 16.3: Anxiolytics
				Other Anxiolytics
					Checkpoint Questions
			Antipsychotic (Neuroleptic) Agents
				Typical or Traditional Antipsychotics
					UNDERSTANDING PSYCHOPHARMACOLOGY 16.4: Antipsychotics/Neuroleptics
					TABLE 16.6: Extrapyramidal Motor Side Effects of Antipsychotic Medications
					LOW-POTENCY TYPICAL ANTIPSYCHOTICS.
					HIGH-POTENCY TYPICAL ANTIPSYCHOTICS.
				Atypical Antipsychotics
					TABLE 16.7: Comparisons of Antipsychotic Side Effects Based on Receptor Blockade
					TABLE 16.8: Actions of Atypical Antipsychotic Medications by Receptor Blockade
					FIGURE 16.8
					Checkpoint Questions
			Stimulant and Nonstimulant Cognitive Enhancers
				UNDERSTANDING PSYCHOPHARMACOLOGY 16.5: Stimulants and Cognitive Enhancers
			Memory and Cognition Enhancers
				UNDERSTANDING PSYCHOPHARMACOLOGY 16.6: Cognitive and Memory Enhancers
				Checkpoint Questions
				APPLYING THE NURSING PROCESS: Clients Using Psychopharmacologic Agents
					ASSESSMENT
						Target Symptoms
							ASSESSMENT TOOL 16.1: Brief Psychiatric Rating Scale
						Caffeine Use
							BOX 16.2: Assessing Caffeine Intake
						Nicotine Use
						Polypharmacy
							FIGURE 16.9
					NURSING DIAGNOSIS
					OUTCOME IDENTIFICATION AND PLANNING
						NURSING SPOTLIGHT 16.1: Selected Nursing Diagnoses Pertaining to Drug Effects
						Prescribed and Maximum Dose
						Method of Administration
							BOX 16.3: Decanoate Injections
						Expected Drug Action
						Side Effects
					IMPLEMENTATION
						Promoting Medication Adherence
							ASSESSMENT TOOL 16.2: Abnormal Involuntary Movement Scale
							Factors Contributing to Nonadherence
								Client-Centered Education 16.2: Psychopharmacology Teaching Plan
								Case Vignette 16.1
									Reflection and Critical Thinking
							Nursing Responses
								FIGURE 16.10
						Working With the Family
						Lifespan Considerations
							Pregnancy
								Case Vignette 16.2
									Reflection and Critical Thinking
							Lactation
							Children and Adolescents
							Older Adults
						Pharmacogenetics
						Complementary and Alternative Modalities (CAM)
						Performing Self-Clarification
							Checkpoint Questions
					EVALUATION
		Reviewing and Applying Your Knowledge
			Chapter Summary
			Study Questions
			Critical Thinking Questions
		References
	17: Integrative Therapies
		LEARNING OBJECTIVES
		KEY TERMS
		NCCAM’S CATEGORIES OF PRACTICE
			BOX 17.1: Whole Systems of Medical Practice
			TABLE 17.1: Illustrated Review of Common Integrative Modalities
			Checkpoint Questions
		PSYCHIATRIC CONDITIONS AND INTEGRATIVE THERAPIES
			Anxiety Disorders
				TABLE 17.2: Selected Herbs, Minerals, and Vitamins for Mental Health Use
			Mood Disorders
				EVIDENCE-BASED PRACTICE SPOTLIGHT 17.1: Preferred Music Listening Intervention to Lower Anxiety in Older Adults With Dementia
					Reference
				Light Therapy
				Meditation
					Cultural Spotlight 17.1: Drumming and Chanting
				Herbal and Dietary Supplements
					FIGURE 17.1
					Client-Centered Education 17.1: Mindfulness Meditation
				Other Modalities for Depression
			Schizophrenia and Other Thought Disorders
			Addictive Disorders
				FIGURE 17.2
				FIGURE 17.3
			Cognitive Disorders
				Think About It 17.1
		INTEGRATIVE CARE: INCORPORATING CAM INTO EVIDENCE-BASED NURSING PRACTICE
			Checkpoint Questions
			Importance of Assessment
			Ethical, Legal, and Research-Oriented Obligations
				Case Vignette 17.1
					Reflection and Critical Thinking
		Reviewing and Applying Your Knowledge
			Chapter Summary
			Study Questions
			Critical Thinking Questions
		References
		Web Resources
	18: Somatic Therapies
		LEARNING OBJECTIVES
		KEY TERMS
		ELECTROCONVULSIVE THERAPY
			Pretreatment Evaluation
			Procedure
				FIGURE 18.1
			Indications
			Mechanism of Action
			Side Effects
			Nursing Role and Care
				Checkpoint Questions
		MAGNETIC SEIZURE THERAPY
		PHOTOTHERAPY
			Think About It 18.1
		TRANSCRANIAL MAGNETIC STIMULATION
			UNDERSTANDING BIOLOGIC FOUNDATIONS 18.1: Light Therapy for Seasonal Affective Disorder
			Client-Centered Education 18.1: Seasonal Affective Disorder
			FIGURE 18.2
		VAGUS NERVE STIMULATION
		TRANSCRANIAL DIRECT CURRENT STIMULATION
			Checkpoint Questions
		DEEP BRAIN STIMULATION AND OTHER PSYCHOSURGERIES
			FIGURE 18.3
		Reviewing and Applying Your Knowledge
			Chapter Summary
			Study Questions
			Critical Thinking Questions
		References
FIVE: Settings for Care
	19: Inpatient Care Settings
		LEARNING OBJECTIVES
		KEY TERMS
		INPATIENT CARE CRITERIA AND VARIATIONS
			Levels of Care
				FIGURE 19.1
			Types of Settings
				Psychiatric Units
				Psychiatric Specialty Units
				Nonpsychiatric Units
				Scatter Beds
					Checkpoint Questions
		NURSING ROLES IN INPATIENT CARE MANAGEMENT
			Admission
				FIGURE 19.2
				Types
					BOX 19.1: Types of Involuntary Commitment
				Assessment
			Therapeutic Strategies
				BOX 19.2: Criteria for Establishing a Therapeutic Milieu
				Professional Relationships
				Nurse–Client Contracts
					Checkpoint Questions
				Milieu Management
					Think About It 19.1
					INTERDISCIPLINARY MANAGEMENT.
					FOSTERING SELF-CARE.
						FIGURE 19.3
					CLIENT EDUCATION.
					LIVING SKILLS GROUPS.
					MEDICATION ADMINISTRATION.
						FIGURE 19.4
					WORKING WITH SUPPORT SYSTEMS/FAMILIES.
						Checkpoint Questions
			Documentation and Reporting
			Transfers
			Discharge
				FIGURE 19.5
				Checkpoint Questions
		Reviewing and Applying Your Knowledge
			Chapter Summary
			Study Questions
		References
	20: Community and Home Psychiatric Care
		KEY TERMS
		LEARNING OBJECTIVES
		COMMUNITY MENTAL HEALTH
			Evolution
			Levels of Prevention
				TABLE 20.1: Interventions According to Levels of Prevention
				Primary Prevention
					BOX 20.1: Mental Health Promotion Interventions
				Secondary Prevention
				Tertiary Prevention
					Checkpoint Questions
		COMMUNITY SUPPORT SYSTEMS
			Components of a Community Support System
				BOX 20.2: Essential Components of a Community Support System
			Community Support Programs
				Guiding Principles
				Models of Community Support Programs
				Assertive Community Treatment
				Examples of Programs
					CLUBHOUSE MODEL.
						EVIDENCE-BASED PRACTICE SPOTLIGHT 20.1: Psychiatric Rehabilitation
					FAIRWEATHER LODGE.
					CONSUMER-RUN ALTERNATIVES.
					COMMUNITY WORKER PROGRAMS.
						Checkpoint Questions
				Systems of Care
			Public Policy and Trends
				Chronicity of SPMI
					FIGURE 20.1
				Stalled Resources
				Poverty
				Reinstitutionalization
					BOX 20.3: Community Alternatives to Rehospitalization for Clients With SPMI
				Education
				Psychopharmacology
				Stigma
					Checkpoint Questions
		COMMUNITY PSYCHIATRIC NURSING
			FIGURE 20.2
			Think About It 20.1
		PSYCHIATRIC HOME CARE
			Services
			Principles
				Case Vignette 20.1
					Reflection and Critical Thinking
			Goals
				FIGURE 20.3
			Funding and Eligibility
				BOX 20.4: Common Indications for and Sources of Referral in Psychiatric Home Care
				Checkpoint Questions
			Psychiatric Home Care Nurses
				Think About It 20.2
		Reviewing and Applying Your Knowledge
			Chapter Summary
			Study Questions
			Critical Thinking Questions
		References
	21: Forensic Psychiatric Nursing
		KEY TERMS
		LEARNING OBJECTIVES
		NURSING SPOTLIGHT 21.1: IAFN Subspecialties of Forensic Nursing
		FORENSIC SETTINGS
		FACTORS CONTRIBUTING TO INCARCERATION
			FIGURE 21.1
		ALTERNATIVES TO INCARCERATION
			Checkpoint Questions
		CHARACTERISTICS OF THE FORENSIC POPULATION
			Offenders With Mental Illness
				Cultural Spotlight 21.1: Minority Offenders
			Violent Offenders
			Special Populations
				Juvenile Offenders
					Case Vignette 21.1
						Reflection and Critical Thinking
			Female Offenders
				FIGURE 21.2
				Older Adult Offenders
				Offenders With HIV/AIDS or Hepatitis
				Offenders With Terminal Illness
					Checkpoint Questions
		EFFECTS OF INCARCERATION ON MENTAL HEALTH
			BOX 21.1: Common Stressors to Mental Health in Secure Environments
		CHARACTERISTICS OF FORENSIC PSYCHIATRIC NURSES
			Attitudes
			Skills
				BOX 21.2: Levels of Prevention in Forensic Settings
				NURSING SPOTLIGHT 21.2: ANA Standards for Forensic Nursing
					Standards of Practice for Corrections Nursing
					Standards of Corrections Nursing Professional Performance
				Checkpoint Questions
				APPLYING THE NURSING PROCESS: Forensic Clients
					ASSESSMENT
						FIGURE 21.3
						Content
						Risk of Suicide
					NURSING DIAGNOSIS
					OUTCOME IDENTIFICATION AND PLANNING
						Think About It 21.1
						EVIDENCE-BASED PRACTICE SPOTLIGHT 21.1: Interventions for Suicide Prevention in Incarcerated Populations
							References
					IMPLEMENTATION
						BOX 21.3: Boundary Maintenance Strategies
						Challenging Behaviors 21.1: The Client Who Requests Personal Information
						Promoting Health
							Challenging Behaviors 21.2: The Client Who Gives Compliments and Makes Sexually Explicit Remarks
						Maintaining an Interdisciplinary Approach
						Focusing on the Family
							FIGURE 21.4
						Ensuring Continuity of Care
							FIGURE 21.5
						Acting as Advocate
							FIGURE 21.6
					EVALUATION
		Reviewing and Applying Your Knowledge
			Chapter Summary
			Study Questions
			Critical Thinking Questions
		References
SIX: Psychiatric Disorders
	22: Sleep Disorders
		KEY TERMS
		LEARNING OBJECTIVES
		SLEEP
			Physiology of Sleep
				Sleep Stages
					TABLE 22.1: Characteristics of the Sleep Stages
					NREM SLEEP.
						FIGURE 22.1
					REM SLEEP.
				Sleep-Regulating Processes
					CIRCADIAN RHYTHM.
					HOMEOSTASIS.
			Purposes of Sleep
				UNDERSTANDING BIOLOGIC FOUNDATIONS 22.1: The Suprachiasmatic Nuclei
			Influences on Sleep
				Developmental Changes
					NEWBORNS AND INFANTS.
						FIGURE 22.2
					CHILDREN AND ADOLESCENTS.
						FIGURE 22.3
						Sleep Disorders in Children.
					YOUNG AND MIDDLE ADULTS.
					OLDER ADULTS.
				Sex and Gender
				Race and Ethnicity
				Medical Disorders and Treatments
				Drugs and Chemical Substances
					BOX 22.1: Drugs That Contribute to Disturbed Sleep
		SLEEP DISORDERS
			Signs and Symptoms/Diagnostic Criteria
				Insomnia
					FIGURE 22.4
					TABLE 22.2: Components of Coanitive-Behavioral Theraov for Insomnia
					Therapeutic Communication 22.1: Assessing Sleep Patterns
						Reflection and Critical Thinking
				Sleep-Related Breathing Disorders
					FIGURE 22.5
					DSM-IV-TR BOX 22.1: Sleep Disorders
						Insomnia
						Sleep-Related Breathing Disorder
						Hypersomnia
						Circadian Rhythm Sleep Disorder
				Other Sleep Disorders
					HYPERSOMNIAS.
					CIRCADIAN RHYTHM SLEEP DISORDERS.
					PARASOMNIAS.
					SLEEP-RELATED MOVEMENT DISORDERS.
					NARCOLEPSY.
						Think About It 22.1
			Psychiatric Comorbidity and Sleep
				Mood Disorders
					TABLE 22.3: Antidepressants and Sleep
				Anxiety Disorders
				Attention Deficit/Hyperactivity Disorder
				Schizophrenia
					TABLE 22.4: Antipsychotics and Sleep
				Cognitive Disorders
				Treatment of Sleep Disorders in Clients with Comorbid Psychiatric Disorders
			Interdisciplinary Goals and Treatment
				FIGURE 22.6
				Checkpoint Questions
				Sleep Hygiene
				Hypnotic Drugs
					UNDERSTANDING PSYCHOPHARMACOLOGY BOX 22.1: Drugs Used to Treat Insomnia
				Complementary and Alternative Modalities
					Checkpoint Questions
					APPLYING THE NURSING PROCESS: Sleep Disorders
						ASSESSMENT
							ASSESSMENT TOOL 22.1: Sleep Inventory
							FIGURE 22.7
							ASSESSMENT TOOL 22.2: The Epworth Sleepiness Scale
						NURSING DIAGNOSIS
						OUTCOME IDENTIFICATION AND PLANNING
						IMPLEMENTATION
							UNDERSTANDING NURSING CARE 22.1
							Case in Point 22.1: Agatha’s Story
								Key Assessment Findings
								FIGURE A
								FIGURE B
								FIGURE C.
								EPILOGUE
							FIGURE 22.8
							Client-Centered Education 22.1: Recommended Sleep Hygiene Strategies
						EVALUATION
		Reviewing and Applying Your Knowledge
			Chapter Summary
			Review Questions
			Critical Thinking Questions
		References
		Web Resources
	23: Anxiety Disorders
		KEY TERMS
		LEARNING OBJECTIVES
		ANXIETY
			FIGURE 23.1
			The Continuum of Anxiety
				Effects on Sensation
				Effects on Cognition
				Effects on Verbal Ability
					FIGURE 23.2
			Normal Versus Abnormal Anxiety
				BOX 23.1: Adaptive and Maladaptive Coping Mechanisms for Anxiety
				Checkpoint Questions
		ANXIETY DISORDERS
			Incidence and Prevalence
			Etiology
				Neurobiologic Theories
					FIGURE 23.3
				Psychological Theories
					Checkpoint Questions
			Signs and Symptoms/Diagnostic Criteria
				Generalized Anxiety Disorder
				Phobic Disorders
					Case Vignette 23.1
						Reflection and Critical Thinking
					AGORAPHOBIA.
					SPECIFIC PHOBIA.
					SOCIAL PHOBIA.
				Panic Attacks
					DSM-IV-TR BOX 23.1: Phobic Disorders
						Agoraphobia
						Specific Phobia
						Social Phobia
				Panic Disorder
				Obsessive-Compulsive Disorder
					DSM-IV-TR BOX 23.2: Panic Disorders
						Panic Attack
						Panic Disorder
					FIGURE 23.4
					Case Vignette 23.2
						Reflection and Critical Thinking
				Stress Disorders
					ACUTE STRESS DISORDER.
					POST-TRAUMATIC STRESS DISORDER.
						Checkpoint Questions
						DSM-IV-TR BOX 23.3: Stress Disorders
							Acute Stress Disorder
							Post-Traumatic Stress Disorder
			Comorbidities and Dual Diagnoses
			Differential Diagnosis
				BOX 23.2: Differential Diagnoses for Anxiety Disorders
			Implications and Prognoses
				Think About It 23.1
			Interdisciplinary Goals and Treatment
				Cognitive-Behavioral Therapy
					TABLE 23.1: Selected Cognitive-Behavioral Treatment Strategies for Clients With Anxiety Disorders
					EVIDENCE-BASED PRACTICE SPOTLIGHT 21.1: Interventions for Anxiety Disorders
						References
					BASIC COGNITIVE THERAPY FOR ANXIETY.
						FIGURE 23.5
						Client-Centered Education 23.1: Progressive Relaxation
					SYSTEMATIC DESENSITIZATION AND EXPOSURE TREATMENT.
					RELAXATION TECHNIQUES AND BREATHING RETRAINING.
				Psychopharmacology
					SELECTIVE SEROTONIN REUPTAKE INHIBITORS.
					BENZODIAZEPINES.
					BUSPIRONE.
					BETA BLOCKERS.
						UNDERSTANDING PSYCHOPHARMACOLOGY BOX 23.1: Guidelines for Use of Benzodiazepines
					TRICYCLIC ANTIDEPRESSANTS.
						Checkpoint Questions
						APPLYING THE NURSING PROCESS: Clients With Anxiety Disorders
							ASSESSMENT
							NURSING DIAGNOSIS
							OUTCOME IDENTIFICATION AND PLANNING
							IMPLEMENTATION
								ASSESSMENT TOOL 23.1: Common Findings Associated With Anxiety Disorders
									Cognitive
									Affective
									Physiologic
									Behavioral
								Alleviating Anxiety
									Initiating a Therapeutic Dialogue
									Countering Faulty Thinking
									Managing Hyperventilation
										FIGURE 23.6
										Case in Point 23.1: Ruth’s Story
										Key Assessment Findings
										FIGURE A.
										FIGURE B.
										FIGURE C.
										EPILOGUE
										Therapeutic Communication 23.1: The Client With Generalized Anxiety Disorder
											Reflection and Critical Thinking
									Suggesting Lifestyle Changes
								Teaching Adaptive Coping Strategies
									Teaching Relaxation
									Teaching Problem-Solving Skills
							EVALUATION
		Reviewing and Applying Your Knowledge
			Chapter Summary
			Study Questions
			Critical Thinking Questions
		References
		Web Resources
	24: Somatoform, Dissociative, and Sexual Disorders
		LEARNING OBJECTIVES
		KEY TERMS
		SOMATOFORM DISORDERS
			Incidence and Prevalence
			Etiology
			Signs and Symptoms/Diagnostic Criteria
				DSM-IV-TR BOX 24.1: Somatoform Disorders
					Somatization Disorder
					Undifferentiated Somatoform Disorder
					Conversion Disorder
					Hypochondriasis
					Body Dysmorphic Disorder
				Checkpoint Questions
				Somatization Disorder
				Undifferentiated Somatoform Disorder
				Conversion Disorder
				Hypochondriasis
				Pain Disorder
				Body Dysmorphic Disorder
					FIGURE 24.1
			Comorbidities and Dual Diagnoses
			Implications and Prognosis
			Interdisciplinary Goals and Treatment
				BOX 24.1: Selected Multidiscipfinary Interventions for Clients With Somatoform Disorders
				Individual and Group Psychotherapies
				Psychopharmacology and Somatic Therapies
					EVIDENCE-BASED PRACTICE SPOTLIGHT 24.1: Interventions for Hypochondriasis
						References
					APPLYING THE NURSING PROCESS: Somatoform Disorders
						FIGURE 24.2
						ASSESSMENT
							Mental Status
							Physical Examination
							Social Assessment
								ASSESSMENT TOOL 24.1: Common Mental Status Findings in Somatoform Disorders
									Behavior
									Mood and Affect
									Thought Process and Content
						NURSING DIAGNOSIS
						OUTCOME IDENTIFICATION AND PLANNING
						IMPLEMENTATION
							Case in Point 24.1: Rose and Andrew’s Story
								Key Assessment findings
								EPILOGUE
							Establishing a Trusting Relationship
								EVIDENCE-BASED PRACTICE SPOTLIGHT 24.2: Interventions for Body Dysmorphic Disorder
									References
							Managing Ineffective Coping
								Therapeutic Communication 24.1: Addressing Somatization Disorder
									Reflection and Critical Thinking
							Addressing Powerlessness and Dependency
							Enhancing Self-Esteem
							Reducing Anxiety
								FIGURE 24.3
							Reestablishing Social Activities
							Reestablishing Functional Family Processes
								Think About It 24.1
						EVALUATION
		DISSOCIATIVE DISORDERS
			Cultural Spotlight 24.1: Dissociative Cultural Phenomena
			FIGURE 24.4
			Incidence and Prevalence
			Etiology
			Signs and Symptoms/Diagnostic Criteria
				DSM-IV-TR BOX 24.2: Dissociative Disorders
					Dissociative Fugue
					Dissociative Amnesia
					Depersonalization Disorder
					Dissociative Identity Disorder
			Comorbidities and Dual Diagnoses
				Case Vignette 24.1
					Reflection and Critical Thinking
			Interdisciplinary Goals and Treatment
				Checkpoint Questions
				Individual Therapy
				Group Therapy
				Psychopharmacology
				Art Therapy
					APPLYING THE NURSING PROCESS: Dissociative Disorders
						ASSESSMENT
						NURSING DIAGNOSIS
						OUTCOME IDENTIFICATION AND PLANNING
							ASSESSMENT TOOL 24.2: Inventory for Symptoms of Dissociation
						IMPLEMENTATION
							Therapeutic Communication 24.2: The Client With a Dissociative Disorder
								Reflection and Critical Thinking
							Milieu Management
							Family Education
						EVALUATION
		SEXUAL DISORDERS
			Sexual Dysfunction
			Etiology
			Signs and Symptoms/Diagnostic Criteria
				BOX 24.2: Phases of Sexual Response
				Desire Disorders
				Arousal Disorders
				Orgasmic Disorders
					Case Vignette 24.2
						Reflection and Critical Thinking
				Pain Disorders
					Checkpoint Questions
			Interdisciplinary Goals and Treatments
				TABLE 24.1: Psychological, Physical, and Pharmacologic Causes of Sexual Dysfunction*
				Pharmacologic Therapy
					Think About It 24.2
				Sex Therapy
			Nursing Assessment
				ASSESSMENT TOOL 24.3: Sexual Health History
				FIGURE 24.5
			Nursing Interventions
				Checkpoint Questions
		Paraphilias
			Therapeutic Communication 24.3: Respecting a Client’s Wishes Regarding Sexual Issues
				Reflection and Critical Thinking
			Client-Centered Education 24.1: Fostering Self-Esteem Related to Sexuality
			Checkpoint Questions
		Gender Identity Disorders
			DSM-IV-TR BOX 24.3: Paraphilias
				Exhibitionism
				Fetishism
				Frotteurism
				Pedophilia
				Sexual Masochism
				Sexual Sadism
				Transvestic Fetishism
				Voyeurism
				Paraphilia Not Otherwise Specified
		Compulsive Sexual Behavior
		Reviewing and Applying Your Knowledge
			Chapter Summary
			Study Questions
			Critical Thinking Questions
		References
		Web Resources
	25: Personality Disorders
		LEARNING OBJECTIVES
		KEY TERMS
		PERSONALITY
		OVERVIEW OF PERSONALITY DISORDERS
			Incidence and Prevalence
				Cultural Spotlight 25.1: Care in Diagnosis of Personality Disorders
			Etiology
			Signs and Symptoms/Diagnostic Criteria
				Checkpoint Questions
				Cluster A
					DSM-IV-TR BOX 25.1: Cluster A Personality Disorders
						Paranoid Personality Disorder
						Schizoid Personality Disorder
						Schizotypal Personality Disorder
					PARANOID PERSONALITY DISORDER.
						FIGURE 25.1
					SCHIZOID PERSONALITY DISORDER.
					SCHIZOTYPAL PERSONALITY DISORDER.
						Case in Point 25.1: Margaret’s Story
							Key Assessment Findings
							EPILOGUE
				Cluster B
					ANTISOCIAL PERSONALITY DISORDER.
						FIGURE 25.2
						DSM-IV-TR BOX 25.2: Cluster B Personality Disorders
							Antisocial Personality Disorder
							Borderline Personality Disorder
							Histrionic Personality Disorder
							Narcissistic Personality Disorder
					BORDERLINE PERSONALITY DISORDER.
					HISTRIONIC PERSONALITY DISORDER.
						FIGURE 25.3
					NARCISSISTIC PERSONALITY DISORDER.
				Cluster C
					AVOIDANT PERSONALITY DISORDER.
					DEPENDENT PERSONALITY DISORDER.
						FIGURE 25.4
					OBSESSIVE-COMPULSIVE PERSONALITY DISORDER.
						Checkpoint Questions
			Comorbidities and Dual Diagnoses
				DSM-IV-TR BOX 25.3: Cluster C Personality Disorders
					Avoidant Personality Disorder
					Dependent Personality Disorder
					Obsessive-Compulsive Personality Disorder
			Implications and Prognosis
			Interdisciplinary Goals and Treatment
				FIGURE 25.5
				TABLE 25.1: Goals of Treatment for Specific Personality Disorders
				Psychopharmacology
				Individual Psychotherapy
				Dialectical Behavioral Therapy
				Group Therapy
				Family Education and Therapy
					EVIDENCE-BASED PRACTICE SPOTLIGHT 25.1: Evidence-Based Interventions for Borderline Personality Disorder
						Reference
					EVIDENCE-BASED PRACTICE SPOTLIGHT 25.2: Evidence-Based Interventions for Antisocial Personality Disorder
						Reference
					Case Vignette 25.1
						Reflection and Critical Thinking
					Think About It 25.1
					APPLYING THE NURSING PROCESS: Personality Disorders
						ASSESSMENT
						NURSING DIAGNOSIS
						OUTCOME IDENTIFICATION AND PLANNING
						IMPLEMENTATION
							TABLE 25.2: Recommended Approaches to Personality Types
							Promoting Participation in Treatment
								FIGURE 25.6
								Case in Point 25.2: Gail’s Story
									Key Assessment Findings
									FIGURE A.
									FIGURE B.
									FIGURE C.
								EPILOGUE
							Enlisting the Family in the Treatment Plan
							Improving Coping Skills
							Reducing Inappropriate Behaviors
							Confronting the Client
								Client-Centered Education 25.1: Helping Families When Clients Have Personality Disorders
							Setting Limits
								Therapeutic Communication 25.1: Antisocial Personality Disorder
									Reflection and Critical Thinking
							Providing for Physical Safety
						EVALUATION
					Checkpoint Questions
		NURSE’S SELF-CARE
			FIGURE 25.7
		Reviewing and Applying Your Knowledge
			Chapter Summary
			Study Questions
			Critical Thinking Questions
		References
		Web Resources
	26: Eating Disorders
		LEARNING OBJECTIVES
		KEY TERMS
		EATING DISORDERS: DEFINITION AND TYPES
			FIGURE 26.1
			Incidence and Prevalence
			Etiology
				FIGURE 26.2
				Biologic Theories
				Psychosocial Theories
				Sociocultural Theories
					FIGURE 26.3
				Family-Based Theories
					Checkpoint Questions
			Signs and Symptoms/Diagnostic Criteria
				Anorexia Nervosa
					FIGURE 26.4
					DSM-IV-TR BOX 26.1: Eating Disorders
						Anorexia Nervosa
						Bulimia Nervosa
				Bulimia Nervosa
					FIGURE 26.5
				Other Eating Disorders
			Comorbidities and Dual Diagnoses
				Case Vignette 26.1
					Reflection and Critical Thinking
				Checkpoint Questions
			Implications and Prognosis
			Interdisciplinary Goals and Treatment
				EVIDENCE-BASED PRACTICE SPOTLIGHT 26.1: Interventions for Eating Disorders
				Settings for Care
				Clinical and Dialectical-Pharmacologic Behavioral Therapies
				Family Therapy
				Psychopharmacology
					EVIDENCE-BASED PRACTICE SPOTLIGHT 26.2: Interventions for Anorexia Nervosa
						References
					Checkpoint Questions
					APPLYING THE NURSING PROCESS: Eating Disorders
						ASSESSMENT
							Health History
								Case in Point 26.1: Jody’s Story
									Key Assessment findings
									FIGURE A.
									FIGURE B.
									FIGURE C.
									FIGURE D.
									FIGURE E.
									EPILOGUE
								ASSESSMENT TOOL 26.1: Inventory for Clients With Eating Problems
									Health Perception-Health Management
									Nutrition-Metabolism
									Elimination
									Activity-Exercise
									Sleep-Rest
									Self-Perception-Self-Concept
									Roles Relationships
									Sexuality-Reproduction
									Coping-Stress Tolerance
									Values-Beliefs
								Nutrition
								Elimination
								Reproduction and Hormones
								Activity and Rest
								Psychosocial
									TABLE 26.1: Manifestations of Cognitive Distortions in Clients With Eating Disorders
									Therapeutic Communication 26.1: Moving with Resistance
										Reflection and Critical Thinking
							Physical Examination
								FIGURE 26.6
							Laboratory Testing
							Electrocardiogram Studies
								FIGURE 26.7
						NURSING DIAGNOSIS
						OUTCOME IDENTIFICATION AND PLANNING
						IMPLEMENTATION
							UNDERSTANDING NURSING CARE 26.1
							Checkpoint Questions
							BOX 26.1: Preventing Eating Disorders
							Restoring Nutritional Balance
								FIGURE 26.8
								Think About It 26.1
							Encouraging Realistic Thinking Processes
								Client-Centered Education 26.1: Teaching Points for Clients With Eating Disorders
							Improving Body Image
							Fostering Self-Esteem
							Exploring Feelings of Powerlessness
							Encouraging Effective Coping
								Challenging Behaviors 26.1: The Client With a Distorted Body Image
							Restoring Family Processes
								Enmeshment and Overprotectiveness
								Conflict Avoidance and Rigidity
									Think About It 26.2
						EVALUATION
		Reviewing and Applying Your Knowledge
			Chapter Summary
			Study Questions
			Critical Thinking Questions
		References
		Web Resources
	27: Depressive Disorders
		LEARNING OBJECTIVES
		KEY TERMS
		OVERVIEW OF DEPRESSIVE ILLNESS
			Incidence and Prevalence
			Etiology
				BOX 27.1: Risk Factors for Depression
				Genetic Factors
				Physiologic Factors
					FIGURE 27.1
					BIOGENIC AMINES.
					PSYCHONEUROENDOCRINE AND IMMUNE RELATIONSHIPS.
				Psychological Factors
					LEARNED HELPLESSNESS.
					COGNITIVE FACTORS.
						Checkpoint Questions
			Signs and Symptoms/Diagnostic Criteria
				Major Depressive Disorder
					FIGURE 27.2
				Dysthymic Disorder
					FIGURE 27.3
					DSM-IV-TR BOX 27.1: Depressive Disorders
						Major Depressive Episode
						Dysthymic Disorder
				Postpartum Depression
				Implications and Prognosis
					Case Vignette 27.1
						Reflection and Critical Thinking
			Interdisciplinary Goals and Treatment
				FIGURE 27.4
				Cognitive-Behavioral Therapy
					EVIDENCE-BASED PRACTICE SPOTLIGHT 27.1: Findings From the Sequenced Treatment Alternatives to Relieve Depression (STAR*D)
					FIGURE 27.5
				Psychopharmacology
					UNDERSTANDING BIOLOGIC FOUNDATIONS 27.1: Effects of Antidepressants on Neurotransmitters
					SELECTIVE SEROTONIN REUPTAKE INHIBITORS AND RELATED DRUGS.
					NOVEL (ATYPICAL) ANTIDEPRESSANTS.
					CYCLIC ANTIDEPRESSANTS.
						UNDERSTANDING PSYCHOPHARMACOLOGY BOX 27.1: Symptoms of and Treatment for Serotonin Syndrome
					MONOAMINE OXIDASE INHIBITORS.
						Checkpoint Questions
				Somatic and Integrative Interventions
					UNDERSTANDING PSYCHOPHARMACOLOGY BOX 27.2: Hypertensive Crisis Alert
					APPLYING THE NURSING PROCESS: Depressive Disorders
						ASSESSMENT
							Safety
								Suicide Risk
									Case in Point 27.1: Richard’s Story
										Key Assessment Findings
										EPILOGUE
									ASSESSMENT TOOL 27.1: Scales and Screening Instruments for Depression
								Violence Risk
							Mental Status Examination
							Physiologic Stability
						NURSING DIAGNOSIS
						OUTCOME IDENTIFICATION AND PLANNING
						IMPLEMENTATION
							FIGURE 27.6
							Protecting the Client From Suicide
							Managing the Potential for Violence
							Maintaining Physical Health and Personal Hygiene
								FIGURE 27.7
							Enhancing Thought Processes
							Encouraging Treatment and Medication Adherence
						EVALUATION
		Reviewing and Applying Your Knowledge
			Chapter Summary
			Study Questions
			Critical Thinking Questions
		References
		Web Resources
	28: Bipolar Disorders
		LEARNING OBJECTIVES
		KEY TERMS
		OVERVIEW OF BIPOLAR DISORDERS
			Incidence and Prevalence
			Etiology
				Biologic Foundations
					GENETIC FACTORS.
					NEUROANATOMIC FACTORS.
						UNDERSTANDING BIOLOGIC FOUNDATIONS 28.1: Brain Region Alterations in Bipolar Disorder
					NEUROTRANSMITTERS.
				Psychological Factors
					FIGURE 28.1
					COGNITIVE FACTORS.
					INTERPERSONAL AND SOCIAL RHYTHM MODEL.
				Cognitive Functioning and Bipolar Disorder
					Checkpoint Questions
			Signs and Symptoms/Diagnostic Criteria
				Bipolar I Disorder
					FIGURE 28.2
				Bipolar II Disorder
					DSM-IV-TR BOX 28.1: Bipolar I Disorder
						Manic Episode
						Mixed Episode
					FIGURE 28.3
				Cyclothymic Disorder
				Rapid Cycling
			Implications and Prognosis
			Interdisciplinary Goals and Treatment
				DSM-IV-TR BOX 28.2: Bipolar II Disorder
					Hypomanic Episode
				Psychotherapy
					DSM-IV-TR BOX 28.3: Cyclothymic Disorder
					EVIDENCE-BASED PRACTICE SPOTLIGHT 28.1: Intensive Psychotherapy for Bipolar Depression
						References
					Checkpoint Questions
				Psychopharmacologic Therapy
					MOOD STABILIZERS.
						BOX 28.1: Antidepressants and Bipolar Disorders
						UNDERSTANDING PSYCHOPHARMACOLOGY BOX 28.1: Lithium
						UNDERSTANDING PSYCHOPHARMACOLOGY BOX 28.2: Lithium Toxicity and Associated Serum Levels*
						UNDERSTANDING PSYCHOPHARMACOLOGY BOX 28.3: Divalproex Sodium
					MEDICATIONS FOR REFRACTORY MANIA.
						FIGURE 28.4
						Checkpoint Questions
				Somatic Nonpharmacologic Interventions
					BOX 28.2: Somatic Therapies for Bipolar Illnesses
						Sleep Deprivation
						Transcranial Magnetic Stimulation
						Vagal Nerve Stimulation
					APPLYING THE NURSING PROCESS: Bipolar Mania
						ASSESSMENT
							Safety
							Mental Status Examination
							Physiologic Stability
							Family Issues
								FIGURE 28.5
								EVIDENCE-BASED PRACTICE SPOTLIGHT 28.2: Client Education in Lithium Therapy
									References
								UNDERSTANDING NURSING CARE 28.1
								ASSESSMENT TOOL 28.1: Components and Findings of the MSE in Mania
									Appearance and General Behavior
									Mood and Affect
									Thought Content and Process
									Perceptual Disturbances
									Judgment and Insight
						NURSING DIAGNOSIS
						OUTCOME IDENTIFICATION AND PLANNING
						IMPLEMENTATION
							Managing the Potential for Violence
								Case in Point 28.1: Danielle’s Story
									Key Assessment Findings
									FIGURE A
									FIGURE B
									FIGURE C
									EPILOGUE
							Maintaining Physical Health and Personal Hygiene
								FIGURE 28.6
							Enhancing Thought Processes
								Self-Esteem Issues
								Anxiety and Agitation
							Encouraging Treatment and Medication Adherence
								Think About It 28.1
						EVALUATION
							Client-Centered Education 28.1: Helping a Loved One Who Has Bipolar Disorder
		Reviewing and Applying Your Knowledge
			Chapter Summary
			Study Questions
			Critical Thinking Questions
		References
		Web Resources
	29: Thought Disorders
		LEARNING OBJECTIVES
		KEY TERMS
		SCHIZOPHRENIA AND OTHER THOUGHT DISORDERS
			FIGURE 29.1
			Incidence and Prevalence
			Etiology
				Biologic Theories
					GENETIC INFLUENCES.
					NEUROCHEMICAL AND NEUROANATOMIC CHANGES.
						FIGURE 29.2
						UNDERSTANDING BIOLOGIC FOUNDATIONS 29.1: The Dopamine Hypothesis of Schizophrenia
				Psychosocial Theories
					Checkpoint Questions
			Signs and Symptoms/Diagnostic Criteria
				DSM-IV-TR BOX 29.1: Thought Disorders
					Schizophrenia
					Schizophreniform Disorder
					Schizoaffective Disorder
					Delusional Disorder
					Brief Psychotic Disorder
					Shared Psychotic Disorder (Formerly Called Folie à Deux)
				BOX 29.1: Positive and Negative Symptoms of Schizophrenia
					Positive Symptoms
					Negative Symptoms
				The Disorganization Dimension
					DISORGANIZED SPEECH.
						BOX 29.2: Illustrations of Bizarre and Disorganized Speech
							Loose Associations
							Clanging
							Neologisms
							Word Salad
					DISORGANIZED BEHAVIOR.
						FIGURE 29.3
					INCONGRUOUS AFFECT.
				The Psychotic Dimension
					DELUSIONS.
						Cultural Spotlight 29.1: Delusions, Hallucinations, and Contextual Experience
					HALLUCINATIONS.
						Challenging Behaviors 29.1: Hallucinations
				The Negative Dimension
					FIGURE 29.4
				Other Symptoms
				Subtypes of Schizophrenia
				Water Intoxication
					Checkpoint Questions
			Comorbidities and Dual Diagnoses
			Differential Diagnosis
				BOX 29.3: Differential Diagnoses of Thought Disorders
			Implications and Prognosis
			Interdisciplinary Goals and Treatment
				TABLE 29.1: Clinical Pathway: Schizophrenic Disorder (295.1x, catatonic 295.2x, delusional 297.10, brief reactive psychosis 298.80)
				EVIDENCE-BASED PRACTICE SPOTLIGHT 29.1: Interventions for Schizophrenia
					References
				Checkpoint Questions
				Psychopharmacologic Interventions
					TRADITIONAL (CONVENTIONAL) ANTIPSYCHOTICS.
						UNDERSTANDING PSYCHOPHARMACOLOGY BOX 29.1: Traditional and Atypical Antipsychotic Medications
						FIGURE 29.5
						UNDERSTANDING PSYCHOPHARMACOLOGY BOX 29.2: Medications Used for Side Effects of Antipsychotics
					ATYPICAL (NOVEL) ANTIPSYCHOTICS.
						EVIDENCE-BASED PRACTICE SPOTLIGHT 29.2: Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE)
							References
				Psychosocial Interventions
					MILIEU MANAGEMENT.
					INDIVIDUAL AND GROUP THERAPY.
					COGNITIVE–BEHAVIORAL THERAPY.
					SOCIAL SKILLS TRAINING.
					VOCATIONAL REHABILITATION.
						FIGURE 29.6
						Checkpoint Questions
				Continuum of Care
					DISCHARGE PLANNING.
					CARE IN THE COMMUNITY.
						Think About It 29.1
						APPLYING THE NURSING PROCESS: Schizophrenia and Thought Disorders
							ASSESSMENT
								Mood and Cognitive State
									FIGURE 29.7
								Potential for Violence
								Assessing Social Support
									Challenging Behaviors 29.2: Threatened Aggression
								Knowledge of Illness
							NURSING DIAGNOSIS
							OUTCOME IDENTIFICATION AND PLANNING
								Case in Point 29.1: James’s Story
									Key Assessment Findings
									FIGURE A
									FIGURE B
									FIGURE C
									FIGURE D
									FIGURE E
									EPILOGUE
							IMPLEMENTATION
								UNDERSTANDING NURSING CARE 29.1
								Addressing Disturbed Thought Processes and Sensory Perceptions
									Reinforcing Reality
										Challenging Behaviors 29.3: The Client Who Is Hostile
									Understanding Language Content
									Intervening in Hallucinations
								Managing Violent Behavior
								Enhancing Social Interaction
									Developing Trust
									Initiating Interaction
										FIGURE 29.8
									Modeling Affect
								Promoting Medication Adherence
									Therapeutic Communication 29.1: Disorganized Speech in Schizophrenia
										Reflection and Critical Thinking Questions
								Promoting Improved Coping
									Checkpoint Questions
								Strengthening Family Processes
									FIGURE 29.9
								Educating Clients and Families
								Teaching Symptom Management
							EVALUATION
		Reviewing and Applying Your Knowledge
			Chapter Summary
			Study Questions
			Critical Thinking Questions
		References
		Web Resources
	30: Substance Use Disorders
		KEY TERMS
		LEARNING OBJECTIVES
		SUBSTANCE ABUSE AND DEPENDENCE
			Incidence and Prevalence
				FIGURE 30.1
				BOX 30.1: Key Facts from the 2009 National Household Survey on Drug Abuse
				Alcohol-Related Statistics
				Drug-Related Statistics
				Cultural and Ethnic Variations
					Checkpoint Questions
			Etiology
				Biologic Foundations
				Psychosocial and Behavioral Factors
			Signs and Symptoms/Diagnostic Criteria
				Alcohol-Related Disorders
					FIGURE 30.2
					UNDERSTANDING BIOLOGIC FOUNDATIONS 30.1: Effects of Cocaine on Neurotransmission
					DSM-IV-TR BOX 30.1: Substance-Related Disorders
						Categories
						Criteria
					FIGURE 30.3
					ALCOHOL CONCENTRATION IN THE BODY.
					INTOXICATION.
					BLACKOUTS.
					TOLERANCE.
					WITHDRAWAL.
					COMPLICATIONS.
						FIGURE 30.4
						FIGURE 30.5
						FIGURE 30.6
						Think About It 30.1
				Controlled Substance Disorders
					TABLE 30.1: Commonly Abused Controlled Substances
					STIMULANTS.
						FIGURE 30.7
					CANNABIS.
					HALLUCINOGENS AND PHENCYCLIDINE.
					OPIOIDS.
						FIGURE 30.8
					SEDATIVES, HYPNOTICS, AND ANXIOLYTICS.
						Checkpoint Questions
			Comorbidities and Co-occurring Disorders
				FIGURE 30.9
			Implications and Prognosis
				Perinatal Statistics and Risks
					FIGURE 30.10
				Preventive and Public Health Strategies
					BOX 30.2: Consequences of Cocaine Use During Pregnancy
						Increased Risks to Pregnancy
						Maternal Risks
						Effects on Fetus
						Effects on the Newborn
					Checkpoint Questions
			Interdisciplinary Goals and Treatment
				Detoxification
					BOX 30.3: Principles of Addiction Treatment
					EVIDENCE-BASED PRACTICE SPOTLIGHT 30.1: Evidence-Based Practice Guideline for Detoxification and Substance Abuse Treatment: An Overview of the Psychosocial and Biomedical Issues During Detoxification
						References
					UNDERSTANDING PSYCHOPHARMACOLOGY 30.1: Medications Used for Detoxification
					ALCOHOL.
						ASSESSMENT TOOL 30.1: Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised (CIWA-Ar)
					OPIOIDS AND OTHER DRUGS.
						Checkpoint Questions
				Rehabilitation
					TABLE 30.2: Selected Interdisciplinary Interventions in Rehabilitation
					SELF-HELP GROUPS.
						BOX 30.4: The 12 Steps of Alcoholics Anonymous
					BRIEF INTERVENTION.
				Client-Centered, Culturally Competent Care
					APPLYING THE NURSING PROCESS: Substance Use Disorders
						ASSESSMENT
							UNDERSTANDING NURSING CARE 30.1
							Screening
								Case in Point 30.1: Erica and Paul’s Story
									Key Assessment Findings
									FIGURE A
									FIGURE B
									FIGURE C
									FIGURE D
									EPILOGUE
							Physical Examination
							Psychosocial Assessment
								ASSESSMENT TOOL 30.2: Substance Use Inventory
									Health History Questions
									Physical Examination
						NURSING DIAGNOSIS
							ASSESSMENT TOOL 30.3: The CAGE Questionnaire for Substance Abuse Screening
						OUTCOME IDENTIFICATION AND PLANNING
						IMPLEMENTATION
							Managing Withdrawal
								FIGURE 30.11
							Breaking Through Denial
								TABLE 30.3: Forms of Denial
							Managing Anxiety
							Teaching Effective Coping Strategies
								Therapeutic Communication 30.1: A Cocaine Abuser in Denial
									Reflection and Critical Thinking
							Improving Relationships
							Improving Self-Image
								Case Vignette 30.1
									Reflection and Critical Thinking
							Promoting Healthy Activities
						EVALUATION
						Checkpoint Questions
		IMPAIRED NURSES
		Reviewing and Applying Your Knowledge
			Chapter Summary
			Study Questions
			Critical Thinking Questions
		References
		Web Resources
	31: Cognitive Disorders
		KEY TERMS
		LEARNING OBJECTIVES
		ETIOLOGIC AND DIAGNOSTIC CHALLENGES OF COGNITIVE DISORDERS
			TABLE 31.1: Delirium Versus Dementia
		DELIRIUM
			Incidence and Prevalence
			Etiology
				BOX 31.1: Specific Causes of Delirium
				FIGURE 31.1
				Checkpoint Questions
			Signs and Symptoms/Diagnostic Criteria
				DSM-IV-TR BOX 31.1: Delirium
					Delirium Due to a General Medical Condition
					Substance-Withdrawal Delirium
					Substance-Intoxication Delirium
					Delirium Due to Multiple Etiologies
					Delirium Not Otherwise Specified
				Case Vignette 31.1
					Reflection and Critical Thinking
			Implications and Prognosis
			Interdisciplinary Goals and Treatment
				Medical Interventions
				Environmental Interventions
					FIGURE 31.2
				Cognitive and Psychosocial Interventions
					Checkpoint Questions
					APPLYING THE NURSING PROCESS: Delirium
						ASSESSMENT
							ASSESSMENT TOOL 31.1: Sample Mini-Mental Status Examination Questions
						NURSING DIAGNOSIS
						OUTCOME IDENTIFICATION AND PLANNING
							Think About It 31.1
						IMPLEMENTATION
							Managing Symptoms of Delirium
								FIGURE 31.3
								Challenging Behaviors 31.1: The Client Who Has Acute Confusion
							Providing a Safe Environment
							Assisting With Personal Care
								FIGURE 31.4
							Providing Client and Family Education
						EVALUATION
							Checkpoint Questions
		DEMENTIA
			Incidence and Prevalence
			Signs and Symptoms/Diagnostic Criteria
				DSM-IV-TR BOX 31.2: Dementia
					Dementia of the Alzheimer’s Type
					Vascular Dementia
					Dementia Due to Other General Medical Conditions
				Impaired Learning
				Compromised Ability for Complex Tasks
				Impaired Reasoning
				Compromised Spatial Ability and Orientation
				Language Deficits
					FIGURE 31.5
				Behavioral Problems
					Checkpoint Questions
			Types of Dementia
				TABLE 31.2: Comparative Assessment for Cognitive Disorders
				Alzheimer’s Disease
					ETIOLOGIC FACTORS.
						UNDERSTANDING BIOLOGIC FOUNDATIONS 31.1: Neurologic Alterations in Alzheimer’s Disease
						BOX 31.2: Stages of Alzheimer’s Disease
						Genetics.
						Oxidative Stress.
						Immunology.
						Hormones.
						Inflammation.
						Diet.
					PREVENTIVE FACTORS.
						FIGURE 31.6
				Vascular Dementia
				Lewy Body Disease
				Parkinson’s Disease
					UNDERSTANDING BIOLOGIC FOUNDATIONS 31.2: The Pathophysiology of Parkinson’s Disease
				Huntington’s Disease
				Human Immunodeficiency Virus Dementia
				Frontotemporal Lobar Degeneration
				Creutzfeldt-Jakob Disease
			Implications and Prognosis
			Interdisciplinary Goals and Management
				EVIDENCE-BASED PRACTICE SPOTLIGHT 31.1: Nonpharmacologic Treatment of Dementia-Related Agitation
					References
				Medical and Supportive Interventions
				Psychopharmacologic Interventions
					Think About It 31.2
				Psychosocial Interventions
					EVIDENCE-BASED PRACTICE SPOTLIGHT 31.2: Interventions for Cognitive Disorders
					Checkpoint Questions
					APPLYING THE NURSING PROCESS: Dementia
						ASSESSMENT
							BOX 31.3: Differential Diagnosis for Dementia
							ASSESSMENT TOOL 31.2: Screening Tests for Dementia
							Behavior
								ASSESSMENT TOOL 31.3: Questionnaire for Dementia
									Subjective Data
										Behavioral Changes (Often Asked of the Family)
										Emotional Changes
										Social Changes
										Intellectual Behavior
										Functional Capacity
									Objective Data
										Level of Consciousness
										Appearance
										Attention
										Language
										Memory
										Constructional Ability
										Cortical Function
							Mental Status
								ASSESSMENT TOOL 31.4: Testing for Cognitive Deficits
								FIGURE 31.7
								Perceptual Problems
								Orientation
								Memory
							Family
							Education
						NURSING DIAGNOSES
						OUTCOME IDENTIFICATION AND PLANNING
						IMPLEMENTATION
							Case in Point 31.1: Betty’s Story
								Key Assessment Findings
								FIGURE A.
								FIGURE B.
								FIGURE C.
								FIGURE D.
								FIGURES E AND F.
								FIGURE G.
								Epilogue
							Managing the Client’s Health
							Enhancing Sensory Capabilities
							Meeting the Client’s Physical Needs
							Encouraging Appropriate Behaviors
								Modifying the Environment
									FIGURE 31.8
									Challenging Behaviors 31.2: The Client Who Is Disruptive
									FIGURE 31.9
									Therapeutic Communication 31.1
										A Client with Dementia
										Reflection and Critical Thinking
								Performing Pharmacologic Interventions
								Preserving the Family Unit
									FIGURE 31.10
						EVALUATION
		AMNESTIC DISORDERS
			DSM-IV-TR BOX 31.3: Amnestic Disorders
				Amnestic Disorder Due to a General Medical Condition
				Substance-Induced Persisting Amnestic Disorder
			Checkpoint Questions
		NURSE’S SELF-CARE
		Reviewing and Applying Your Knowledge
			Chapter Summary
			Study Questions
			Critical Thinking Questions
		References
		Web Resources
SEVEN: Psychiatric Emergencies
	32: Anger and Aggression
		LEARNING OBJECTIVES
		KEY TERMS
		DEFINITIONS
		POTENTIAL CONTRIBUTORS TO ANGRY, AGGRESSIVE, OR VIOLENT BEHAVIORS
			Psychiatric Illness
				BOX 32.1: Psychiatric Diagnoses and Patterns of Aggression or Violence
			Medical Conditions
				BOX 32.2: Selected Medical Conditions Associated With Aggression and Violence
			Traumatic Life Events
			Biologic Factors and Temperament
				FIGURE 32.1
			Social–Environmental Factors
				Checkpoint Questions
		HEALTH CARE ENVIRONMENTS AND ANGRY AND AGGRESSIVE CLIENT BEHAVIOR
			Challenging Behaviors 32.1: The Client Who Is Hostile and Profane
			Considerations for Inpatient Settings
				FIGURE 32.2
			Outpatient Factors
		LEGAL ISSUES RELATED TO DANGEROUSNESS AND INTENT
			Checkpoint Questions
		INTERDISCIPLINARY MANAGEMENT OF AGGRESSION AND VIOLENCE
			Verbal Interventions
				FIGURE 32.3
			Limit Setting
				FIGURE 32.4
			Cognitive–Behavioral Interventions
				Guided Discovery
				Anger Management
			Behavior Therapy: Token Economy
				Case Vignette 32.1
					Reflection and Critical Thinking
			Group and Family Therapy
			Prevention of Vapor Lock and Meltdown
			Pharmacologic Intervention
				UNDERSTANDING PSYCHOPHARMACOLOGY 32.1: Typical Medications Used to Treat Aggressive Behavior
				Checkpoint Questions
			Restraint and Seclusion
				Related Controversies
					Think About It 32.1
				Standards in Behavioral Health Care
					BOX 32.3: Summary of Standards for Restraint and Seclusion (R/S)
			Outpatient Management
			A Note on Other Settings
				Checkpoint Questions
				APPLYING THE NURSING PROCESS: Angry, Aggressive, or Violent Behavior
					ASSESSMENT
						BOX 32.4: Risk Factor Profiles for Violent Behavior
					NURSING DIAGNOSIS
					OUTCOME IDENTIFICATION AND PLANNING
					IMPLEMENTATION
						ASSESSMENT TOOL 32.1: Assessment of Violence and Homicidal Ideation
							Violence Assessment
							Assessment of Homicidal Ideation
						Maintaining the Safety of Clients and Staff
						Defusing Anger and Aggression Through Verbal Interventions
							BOX 32.5: Situation-Specific Interventions to Prevent Escalation of Client Aggression
						Setting Limits to Prevent Violent Behavior
						Teaching Anger Management and Coping Skills
							FIGURE 32.5
							Checkpoint Questions
					EVALUATION
		Reviewing and Applying Your Knowledge
			Chapter Summary
			Study Questions
			Critical Thinking Questions
		References
	33: Violence and Abuse
		KEY TERMS
		LEARNING OBJECTIVES
		THE ECOLOGICAL MODEL OF VIOLENCE
			Societal Influences and Macrosystem
				FIGURE 33.1
			Microsystem
			Individual Factors
		PUBLIC HEALTH APPROACH TO VIOLENCE PREVENTION
			Checkpoint Questions
		YOUTH VIOLENCE
			FIGURE 33.2
			Risk and Protective Factors for Youth Violence
				Individual Risk Factors
				Family Risk Factors
				Peer Risk Factors
				Neighborhood Risk Factors
				Protective Factors
					FIGURE 33.3
			Public Health Approach to Youth Violence
			Nurses’ Role in Youth Violence Prevention Efforts
				Checkpoint Questions
		FAMILY VIOLENCE
			Intimate Partner Violence
				Defining the Scope of Intimate Partner Violence
					FIGURE 33.4
				Cost to Children
				Addressing Intimate Partner Violence
					PROBLEMS WITH DETECTION AND SCREENING.
					IMPORTANCE OF SCREENING.
				Nurses’ Role
					ASSESSMENT TOOL 33.1: Intimate Partner Violence Documentation Form
					Checkpoint Questions
			Child Maltreatment
				Effects on Child Functioning
					SOCIAL FUNCTIONING.
					BEHAVIORAL FUNCTIONING.
					EMOTIONAL AND INTELLECTUAL FUNCTIONING.
						BOX 33.1: Child Maltreatment and Post-Traumatic Stress Disorder
						Case Vignette 33.1
					HEALTH AND PHYSICAL FUNCTIONING.
				Nurses’ Role
					FIGURE 33.5
					Checkpoint Questions
			Elder Abuse
				TABLE 33.1: Types of Elder Abuse
				Causes
				Nurses’ Role
					Checkpoint Questions
		RAPE AND SEXUAL ASSAULT
			ASSESSMENT TOOL 33.2: Elder Assessment Instrument (EAI)
			Types of Rape
				Rape by a Stranger
				Date Rape and Acquaintance Rape
				Marital Rape
			Rape Trauma Syndrome
				FIGURE 33.6
			Additional Ramifications of Rape
			Treatment for Survivors of Rape or Sexual Assault
				Case Vignette 33.2
					Reflection and Critical Thinking
				Psychopharmacologic Interventions
				Psychological Interventions
					Checkpoint Questions
					APPLYING THE NURSING PROCESS: Survivors of Rape Trauma
						ASSESSMENT
							Case Vignette 33.3
								Reflection and Critical Thinking
						NURSING DIAGNOSIS, OUTCOME IDENTIFICATION, AND PLANNING
							Think About It 33.1
						IMPLEMENTATION
						EVALUATION
							Case in Point 33.1: Alicia’s Story
								Key Assessment Findings
						EPILOGUE
						Client-Centered Education 33.1: Coping with Rape Trauma Syndrome
		Reviewing and Applying Your Knowledge
			Chapter Summary
			Study Questions
			Critical Thinking Questions
		References
		Web Resources
	34: Suicide and Suicidal Behavior
		KEY TERMS
		LEARNING OBJECTIVES
		SUICIDE
			Incidence and Prevalence
			Suicide Prevention Efforts
				Checkpoint Questions
			Etiology
				Genetic Factors
				Psychological Factors
			Physical Factors
				Case Vignette 34.1
					Reflection and Critical Thinking
				Other Factors
					Checkpoint Questions
			Protective Factors
				APPLYING THE NURSING PROCESS: Suicidal Clients
					ASSESSMENT
						BOX 34.1: Warning Signs of Suicide
						ASSESSMENT TOOL 34.1: Questions to Review Stressors for Suicidal Clients
							Eating
							Sleeping
							Mood
							Health
							Activities
							Coping
						Prior Suicidal Behavior
							BOX 34.2: Is Path Warm?
						Current Suicide Plan
						Lethality Assessment
						Current Resources
							TABLE 34.1: Lethality of Suicide Attempts by Method
							Checkpoint Questions
					NURSING DIAGNOSIS
					OUTCOME IDENTIFICATION AND PLANNING
					IMPLEMENTATION
						Think About It 34.1
						General Overall Guidelines
							Therapeutic Communication 34.1
								The Suicidal Client
								Reflection and Critical Thinking
						Additional Guidelines for Hospitalized Clients
					EVALUATION
		SUICIDE AS A PUBLIC HEALTH PROBLEM
		THOSE LEFT BEHIND
			BOX 34.3: Blueprint for a National Suicide Prevention Strategy
		Reviewing and Applying Your Knowledge
			Chapter Summary
			Study Questions
			Critical Thinking Questions
		References
		Web Resources
	35: Crisis Intervention
		KEY TERMS
		LEARNING OBJECTIVES
		CRISIS
			FIGURE 35.1
			Phases of a Crisis
				FIGURE 35.2
			Types of Crises
				Maturational Crisis
					FIGURE 35.3
				Situational Crisis
					FIGURE 35.4
				Adventitious Crisis
					CRISIS RESPONSES TO TERRORISM.
						FIGURE 35.5
						EVIDENCE-BASED PRACTICE SPOTLIGHT 35.1: Crisis Intervention for People With Severe Mental Illnesses Living in the Community
							Reference
					CRITICAL INCIDENT STRESS DEBRIEFING.
					SELF-CARE FOR PROVIDERS RESPONDING TO ADVENTITIOUS CRISES.
		CRISIS PREVENTION
			FIGURE 35.6
			Checkpoint Questions
		CRISIS INTERVENTION AND STABILIZATION
			Crisis Intervention Versus Traditional Therapies
			Crisis Intervention Across Contexts
			Characteristics and Skills of the Crisis Intervener
				Case Vignette 35.1
					Reflection and Critical Thinking
				Checkpoint Questions
			Team Approach
				Challenging Behaviors 35.1: The Client Who Pits Staff Members Against One Another
			Crisis Groups
				Families in Crisis
					FIGURE 35.7
			Telephone Counseling
				FIGURE 35.8
				Checkpoint Questions
				APPLYING THE NURSING PROCESS: Clients in Crisis
					ASSESSMENT
						FIGURE 35.9
						Evaluating Feelings
							NURSING SPOTLIGHT 35.1: Ten Tips for Crisis Prevention
						Determining Perception of the Event
						Assessing Support Systems
						Assessing Coping Skills
						Determining Potential for Self-Harm
					NURSING DIAGNOSIS
					OUTCOME IDENTIFICATION AND PLANNING
						FIGURE 35.10
					IMPLEMENTATION
						Realizing the Potential for Growth
							Think About It 35.1
						Learning to Ask for Help
						Using Adaptive Coping
						Focusing on Problem Resolution
						Using Information Technology
					EVALUATION
		Reviewing and Applying Your Knowledge
			Chapter Summary
			Study Questions
			Critical Thinking Questions
		References
		Web Resources
EIGHT: Special Populations
	36: Pediatric Clients
		KEY TERMS
		LEARNING OBJECTIVES
		THEORIES OF CHILD DEVELOPMENT
			TABLE 36.1: Overview of Traditional Developmental Theories
			Temperament Theory
				BOX 36.1: Temperaments
			Moral Development Theory
			Cognitive Development Theory
				TABLE 36.2: Piaget’s Theory of Cognitive Development
			Attachment Theory
				FIGURE 36.1
			Contemporary Views of Child Development
				FIGURE 36.2
		MENTAL HEALTH: PROTECTIVE INFLUENCES FOR RESILIENCE
		OVERVIEW OF PEDIATRIC MENTAL ILLNESS
			FIGURE 36.3
			Infrastructure and Availability of Care to Pediatric Populations
			Cultural Barriers to Mental Health Care for Children
			Risk Factors and Etiology
				Biologic Influences
					FIGURE 36.4
				Familial and Societal Influences
				Stressors
					DIVORCE.
						FIGURE 36.5
					CHILD ABUSE.
						Checkpoint Questions
			Evidence-Based Interventions
				EVIDENCE-BASED PRACTICE SPOTLIGHT 36.1: Interventions for Child and Adolescent Disorders
				Prevention and Early Identification
					FIGURE 36.6
				Psychosocial Modalities
					INDIVIDUAL THERAPY.
						Cultural Spotlight 36.1: Considerations for Mental Health Services
					BRIEF PSYCHOTHERAPY.
					PLAY THERAPY.
					FAMILY THERAPY.
					TRAUMA-INFORMED CARE.
						TABLE 36.3: Behaviors and Cognitions Associated With Traumatized Children
					PARENT MANAGEMENT TRAINING AND MULTISYSTEMIC THERAPY.
					GROUP THERAPY.
						FIGURE 36.7
					MILIEU THERAPY.
				Pharmacologic Therapy
				Interdisciplinary Coordination
					TREATMENT SETTINGS AND CONTINUUM OF CARE.
					WRAP-AROUND SERVICES AND SYSTEMS OF CARE.
						Client-Centered Education 36.1: Warnings for Families Considering a Child’s Residential Placement
					COMMUNITY-RELATED FOCI.
					SPECIAL EDUCATION.
						FIGURE 36.8
			General Nursing Care for Pediatric Clients With Psychiatric Disorders
				Assessment
					FAMILY FUNCTIONING.
						FIGURE 36.9
					CURRENT PROBLEM.
					HISTORY.
					MENTAL STATUS EXAMINATION.
						FIGURE 36.10
					PHYSICAL EXAMINATION.
				Interventions
					PROVIDING MEDICATION EDUCATION.
					MEETING FAMILIES’ NEEDS.
					PROMOTING THE RIGHTS OF CHILDREN IN TREATMENT SETTINGS.
						NURSING SPOTLIGHT 36.1: Rights of Pediatric Clients in Health Care Settings
					AVOIDING SECLUSION AND RESTRAINT.
					PROVIDING ADVOCACY.
						Checkpoint Questions
		COMMON PSYCHIATRIC DISORDERS OF CHILDREN AND ADOLESCENTS
		DISRUPTIVE BEHAVIOR DISORDERS
			Attention Deficit/Hyperactivity Disorder
			Etiology
			Signs and Symptoms/Diagnostic Criteria
				DSM-IV-TR BOX 36.1: Attention Deficit/Hyperactivity Disorder
				Comorbidities
			Interdisciplinary Goals and Treatment
				Behavioral Treatment and Other Psychosocial Interventions
				Pharmacologic Therapy
					UNDERSTANDING PSYCHOPHARMACOLOGY 36.1: Methylphenidate (Ritalin, Concerta)
					APPLYING THE NURSING PROCESS: ADHD
						ASSESSMENT
							Case in Point 36.1: Michael’s Story
								Key Assessment Findings
								FIGURE A
								FIGURE B AND C.
								FIGURE D.
							FIGURE E.
							FIGURE F.
							FIGURE G.
							FIGURE H.
							EPILOGUE
								FIGURE I.
						NURSING DIAGNOSIS
						OUTCOME IDENTIFICATION AND PLANNING
						IMPLEMENTATION
							Teaching Social Skills
								FIGURE 36.11
							Educating the Family
								FIGURE 36.12
							Helping Families Cope
							Managing Developmental and Academic Issues
							Improving Self-Esteem
								FIGURE 36.13
						EVALUATION
							Checkpoint Questions
			Oppositional-Defiant Disorder
				DSM-IV-TR BOX 36.2: Oppositional-Defiant Disorder
			Conduct Disorder
				DSM-IV-TR BOX 36.3: Conduct Disorder
				EVIDENCE-BASED PRACTICE SPOTLIGHT 36.2: Parent Management Training and Conduct Disorder
					References
		ADJUSTMENT DISORDERS
			FIGURE 36.14
		ANXIETY DISORDERS
			Obsessive–Compulsive Disorder
			Separation Anxiety Disorder
				FIGURE 36.15
			Phobias
			Social Anxiety Disorder (Social Phobia)
			Generalized Anxiety Disorder
			Post-Traumatic Stress Disorder
				Checkpoint Questions
		MOOD DISORDERS
			Case Vignette 36.1
				Reflection and Critical Thinking
			Depression
			Signs and Symptoms
				BOX 36.2: What Does a Child Have to Be Depressed About?
				Think About It 36.1
			Comorbidities
			Prevention
			Interdisciplinary Goals and Treatment
				Cognitive–Behavioral Therapy and Family Consultation
					FIGURE 36.16
				Pharmacologic Therapy
			Bipolar Disorder
				Signs and Symptoms
				Interdisciplinary Goals and Treatment
					Importance of Early Identification and Treatment
					Pharmacologic Therapy
		AUTISM SPECTRUM DISORDERS
			Signs and Symptoms/Diagnostic Criteria
				DSM-IV-TR BOX 36.4: Autism Spectrum Disorders
					Autistic Disorder
					Asperger’s Disorder
			Autism
				Asperger’s Syndrome
			Interdisciplinary Goals and Treatment
				Checkpoint Questions
		EATING DISORDERS
		SUBSTANCE ABUSE
			BOX 36.3: Signs and Symptoms of Substance Abuse in Adolescents
			Prevention of Drug and Alcohol Abuse
			Interdisciplinary Goals and Treatment
				Therapeutic Communication 36.1: Discussing Peer Pressure and Substance Use With Adolescents
					Reflection and Critical Thinking
		TIC DISORDERS
		TRICHOTILLOMANIA
			FIGURE 36.17
			Checkpoint Questions
		SUICIDE
			Signs
			Prevention
			Interdisciplinary Goals and Treatment
		CHILDREN WITH MEDICAL ILLNESS OR DISABILITY
			FIGURE 36.18
		MENTAL RETARDATION
			FIGURE 36.19
			Checkpoint Questions
		NURSES’ SELF-CARE
			FIGURE 36.20
		Reviewing and Applying Your Knowledge
			Chapter Summary
			Study Questions
			Critical Thinking Questions
		References
		Web Resources
	37: Older Adult Clients
		LEARNING OBJECTIVES
		KEY TERMS
		DEMOGRAPHICS OF AGING AND FUTURE TRENDS
			FIGURE 37.1
		BIOPSYCHOSOCIAL COMPONENTS OF AGING
			FIGURE 37.2
			Biologic Changes
				BOX 37.1: Ten Tips for Healthy Aging
			Risk Factors Affecting Health and Functional Status
				Chronic Illness
				Medications
					UNDERSTANDING BIOLOGIC FOUNDATIONS 37.1: Acetylcholine and Aging
					Checkpoint Questions
			Psychosocial Issues and Influences of Aging
				Retirement
					Client-Centered Education 37.1: Preretirement Planning
				Relocation
					FIGURE 37.3
				Bereavement
					Case Vignette 37.1
						Reflection and Critical Thinking
				Responses to Life Transitions
			Sociopolitical Issues and Influences
				Ageism, Myths, and Prejudices
				Fragmentation of Health Care
					Checkpoint Questions
		OLDER ADULTS WITH PSYCHIATRIC DISORDERS
			TABLE 37.1: Common Psychiatric Conditions in Older Adults
			Sleep Disorders
			Anxiety Disorders
			Somatoform Disorders
			Mood Disorders
				FIGURE 37.4
				Major Depression
				Suicide
				Nursing and Health Care Responses
			Thought Disorders
			Substance Use Disorders
				FIGURE 37.5
			Cognitive Disorders
				Checkpoint Questions
		COMMUNICATING EFFECTIVELY WITH OLDER ADULTS
			BOX 37.2: Useful Communication Skills With Older Adults
			TABLE 37.2: Age-Sensitive Terminology
		CARE OF OLDER ADULTS
			Comprehensive Geriatric Mental Health Assessment
				Think About It 37.1
				Case Vignette 37.2
			Intervention and Treatment
				General Medication Management
				Psychotropic Medication Management
				Electroconvulsive Therapy
				Psychosocial Interventions
					FIGURE 37.6
			Role of Nurses
				Checkpoint Questions
		PROMOTING MENTAL HEALTH AND WELLNESS IN OLDER ADULTS
			Nutrition and Fluids
				Client-Centered Education 37.2: Suggestions About Mental Wellness
				EVIDENCE-BASED PRACTICE SPOTLIGHT 37.1: Interventions to Increase Health Promotion Activities in Older Adults
					References
			Mental and Physical Activities
				FIGURE 37.7
			Support Systems
		Reviewing and Applying Your Knowledge
			Chapter Summary
			Study Questions
			Critical Thinking Questions
		References
	38: Homeless Clients
		LEARNING OBJECTIVES
		KEY TERMS
		DEMOGRAPHICS
			FIGURE 38.1
		HOMELESSNESS AND MENTAL ILLNESS
			Checkpoint Questions
			Contributing Factors
				Deficient Mental Health Care System
					DSM-IV-TR BOX 38.1: Common Diagnoses in Homeless People with Mental Illness
				Functional Abilities and Deficits
				Substance Abuse
					FIGURE 38.2
				Poverty
					FIGURE 38.3
				Inadequate Housing
				High Mobility
					FIGURE 38.4
			Critical Issues Affecting the Homeless Population with Mental Illness
				A Changing Mental Health System
				Barriers to Care
					BOX 38.1: Barriers to Health Care for the Homeless Population
					FIGURE 38.5
				The Shelter System
					FIGURE 38.6
				Health Concerns
					Case Vignette 38.1
						Reflection and Critical Thinking
					FIGURE 38.7
				Criminal Justice System
					Checkpoint Questions
					APPLYING THE NURSING PROCESS: Homelessness
						ASSESSMENT
							BOX 38.2: Stressors of Homelessness That Influence Mental Health
							Think About It 38.1
								BOX 38.3: Communication Suggestions With Homeless Clients Who Have a Mental Illness
						NURSING DIAGNOSIS
						OUTCOME IDENTIFICATION AND PLANNING
						IMPLEMENTATION
							EVIDENCE-BASED PRACTICE SPOTLIGHT 38.1: Meeting the Needs of Homeless People
								Reference
							Forming a Therapeutic Alliance
								Challenging Behaviors 38.1: The Client Lost in the System
							Managing Medications
							Teaching Clients
							Providing Case Management
							Becoming Politically Involved
						EVALUATION
							UNDERSTANDING PSYCHOPHARMACOLOGY 38.1: Medication Management Suggestions for the Homeless Person
		Reviewing and Applying Your Knowledge
			Chapter Summary
			Study Questions
			Critical Thinking Questions
		References
		Web Resources
	39: Clients With Medical Illnesses
		LEARNING OBJECTIVES
		KEY TERMS
		FIGURE 39.1
		MENTAL DISORDER DUE TO A GENERAL MEDICAL CONDITION
			BOX 39.1: Common Medical Disorders Associated With Psychiatric Symptoms
			General Features
			Example: Seizure Disorder (Epilepsy)
				DSM-IV-TR BOX 39.1: Mental Disorders Due to a Medical Condition
					Diagnostic Criteria
					Categories
			Treatment
			Nursing Implications
				Checkpoint Questions
		ADJUSTMENT DISORDERS
			General Features
				DSM-IV-TR BOX 39.2
					Adjustment Disorder
			Reactions to Physical Illness
				BOX 39.2: Factors That Influence Reactions to Illness
			Treatment
			Nursing Implications
				Checkpoint Questions
		MENTAL DISORDER NOT OTHERWISE SPECIFIED DUE TO A GENERAL MEDICAL CONDITION
			FIGURE 39.2
			Cardiovascular Illness
				FIGURE 39.3
				Client Reactions
				Treatment and Nursing Implications
			Pulmonary Illness
				Client Reactions
				Treatment and Nursing Implications
					FIGURE 39.4
					Think About It 38.1
			Reproductive Challenges
				Client Reactions
					FIGURE 39.5
				Treatment and Nursing Implications
					Checkpoint Questions
			Neoplastic Diseases (Cancer)
				Client Reactions
				Treatment and Nursing Implications
					FIGURE 39.6
		NURSING STRATEGIES FOR PSYCHOSOCIAL CARE IN MEDICAL ILLNESS
		Reviewing and Applying Your Knowledge
			Chapter Summary
			Study Questions
			Critical Thinking Questions
		References
		Web Resources
Back Matter
	APPENDIX A: Global Assessment of Functioning (GAF) Scale
	APPENDIX B: DSM-IV-TR Classification: Axes I and II Categories and Codes
		DISORDERS USUALLY FIRST DIAGNOSED IN INFANCY, CHILDHOOD, OR ADOLESCENCE
			Mental Retardation
			Learning Disorders
			Motor Skills Disorder
			Communication Disorders
			Pervasive Developmental Disorders
			Attention-Deficit and Disruptive Behavior Disorders
			Feeding and Eating Disorders of Infancy or Early Childhood
			Tic Disorders
			Elimination Disorders
			Other Disorders of Infancy, Childhood, or Adolescence
		DELIRIUM, DEMENTIA, AND AMNESTIC AND OTHER COGNITIVE DISORDERS
			Delirium
			Dementia
			Amnestic Disorders
			Other Cognitive Disorders
		MENTAL DISORDERS DUE TO A GENERAL MEDICAL CONDITION NOT ELSEWHERE CLASSIFIED
		SUBSTANCE-RELATED DISORDERS
			Alcohol-Related Disorders
				Alcohol Use Disorders
				Alcohol-Induced Disorders
			Amphetamine (or Amphetamine-Like)-Related Disorders
				Amphetamine Use Disorders
				Amphetamine-Induced Disorders
			Caffeine-Related Disorders
				Caffeine-Induced Disorders
			Cannabis-Related Disorders
				Cannabis Use Disorders
			Cannabis-Induced Disorders
			Cocaine-Related Disorders
				Cocaine Use Disorders
				Cocaine-Induced Disorders
			Hallucinogen-Related Disorders
				Hallucinogen-Use Disorders
				Hallucinogen-Induced Disorders
			Inhalant-Related Disorders
				Inhalant Use Disorders
				Inhalant-Induced Disorders
			Nicotine-Related Disorders
				Nicotine Use Disorder
				Nicotine-Induced Disorder
			Opioid-Related Disorders
				Opioid Use Disorders
				Opioid-Induced Disorders
			Phencyclidine (or Phencyclidine-Like)-Related Disorders
				Phencyclidine Use Disorders
				Phencyclidine-Induced Disorders
			Sedative-Hypnotic- or Anxiolytic-Related Disorders
				Sedative-Hypnotic- or Anxiolytic Use Disorders
				Sedative, Hypnotic, or Anxiolytic-Induced Disorders
			Polysubstance-Related Disorder
				Other (or Unknown) Substance-Related Disorders
				Other (or Unknown) Substance Use Disorders
				Other (or Unknown) Substance-Induced Disorders
		SCHIZOPHRENIA AND OTHER PSYCHOTIC DISORDERS
		MOOD DISORDERS
			Depressive Disorders
			Bipolar Disorders
		ANXIETY DISORDERS
		SOMATOFORM DISORDERS
		FACTITIOUS DISORDERS
		DISSOCIATIVE DISORDERS
		SEXUAL AND GENDER IDENTITY DISORDERS
			Sexual Dysfunctions
				Sexual Desire Disorders
				Sexual Arousal Disorders
				Orgasmic Disorders
				Sexual Pain Disorders
				Sexual Dysfunction Due to a General Medical Condition
			Paraphilias
			Gender Identity Disorders
		EATING DISORDERS
		SLEEP DISORDERS
			Primary Sleep Disorders
				Dyssomnias
			Parasomnias
			Sleep Disorders Related to Another Mental Disorder
			Other Sleep Disorders
		IMPULSE-CONTROL DISORDERS NOT ELSEWHERE CLASSIFIED
		ADJUSTMENT DISORDERS
		PERSONALITY DISORDERS
		OTHER CONDITIONS THAT MAY BE A FOCUS OF CLINICAL ATTENTION
			Psychological Factors Affecting Medical Condition
			Medication-Induced Movement Disorders
			Other Medical-Induced Disorder
			Relational Problems
			Problems Related to Abuse or Neglect
			Additional Conditions That May be Focus of Clinical Attention
		ADDITIONAL CODES
	Glossary
		A
		B
		C
		D
		E
		F
		G
		H
		I
		J
		L
		M
		N
		O
		P
		Q
		R
		S
		T
		U
		V
		W
		Y
	Index