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EXAM STUDY GUIDE
Mental
Health Final
Exam
LATEST MENTAL HEALTH FINAL
EXAM STUDY GUIDE
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Diagnostic Classes of Substance Abuse
• Intoxication: use of a substance that results in maladaptive behavior
• Withdrawal syndrome: refers to the negative psychological and physical reactions that
occur when use of a substance ceases or dramatically decreases
• Detoxification: the process of safely withdrawing from a substance
• Substance abuse: drug is used outside the medical or social norm despite
negative consequences
• Substance dependence: problem associated with addiction
Alcoholism
• First episode of intoxication → continuing problems with alcohol → first blackout →
continued drinking → development of tolerance → tolerance break → continued drinking →
functioning becoming affected → periods of abstinence/temporary controlled drinking →
escalation of alcohol intake → more problems → subsequent crisis → continuation of cycle
• Related disorders: gambling, caffeine and tobacco additions
• CNS depressant: relaxation/loss of inhibitions
1. Slurred speech, unsteady gait, lack of coordination, and impaired
attention, concentration, memory, and judgment
2. Aggressive behavior or display inappropriate sexual behavior; the person who
is intoxicated may experience a blackout
• Treatment of an alcohol overdose: gastric lavage or dialysis to remove the drug and support of
respiratory and cardiovascular functioning in an intensive care unit
• Symptoms of withdrawal
1. Onset within 4 to 12 hours after cessation or marked reduction of alcohol
intake; peaking on second day; complete in about 5 days
2. Severe or untreated withdrawal may progress to transient hallucinations, seizures,
or delirium (DTs)
3. Benzodiazepines for safe withdrawal
Substance Abuse Treatment
• Concept: medical illnesses, chronic, progressive, characterized by remissions and relapses
• Treatment models: Hazelden Clinic model and 12-step program of Alcoholics Anonymous
• Individual, group counseling
• Treatment settings
• Pharmacologic treatment: safe withdrawal; prevent relapse
• Medications help manage withdrawal or cravings, but is not a specific treatment for
substance abuse
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Alcohol Intoxication and Overdose
• An overdose, or excessive alcohol intake in a short period, can result in
vomiting, unconsciousness, and respiratory depression
• This combination can cause aspiration pneumonia or pulmonary obstruction
• Alcohol-induced hypotension: can lead to cardiovascular shock and death
• Treatment: similar to that for any central nervous system depressant—gastric lavage or
dialysis to remove the drug, and support of respiratory and cardiovascular functioning in an
intensive
care unit
• The administration of central nervous system stimulants is contraindicated
Physiological Effects of Alcoholism/Long Term (Box 19.1)
• Cardiac myopathy
• Wernicke encephalopathy: an acute neurological condition characterized by a clinical triad
of ophthalmoparesis with nystagmus, ataxia, and confusion
• Korsakoff psychosis: a late complication of persistent Wernicke encephalopathy and results
in memory deficits, confusion, and behavioral changes
• Pancreatitis
• Esophagitis
• Hepatitis
• Cirrhosis
• Leukopenia
• Thrombocytopenia
• Ascites
Alcohol Withdrawal and Detoxification
• Symptoms of withdrawal usually begin 4 to 12 hours after cessation or marked reduction
of alcohol intake.
• Symptoms: coarse hand tremors, sweating, elevated pulse and blood pressure,
insomnia, anxiety, and nausea or vomiting
• Severe or untreated withdrawal may progress to transient hallucinations, seizures, or
delirium, called delirium tremens
• Alcohol withdrawal usually peaks on the second day and is over in about 5 days; withdrawal
may take 1 to 2 weeks
• Safe withdrawal is usually accomplished with the administration of benzodiazepines, such
as lorazepam (Ativan), chlordiazepoxide (Librium), or diazepam (Valium), to suppress the
withdrawal symptoms
• Total scores less than 8 indicate mild withdrawal, scores from 8 to 15 indicate moderate
withdrawal (marked arousal), and scores greater than 15 indicate severe withdrawal
(Clinical
Institute Withdrawal Assessment of Alcohol Scale)
Disulfiram (Antabuse)
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• Use: aversion therapy for alcoholism
• Never give to a patient that is intoxicated or without their consent
• Mechanism of action: inhibition of enzyme involved with alcohol metabolism
• Adverse reaction with alcohol ingestion
• Side effects: fatigue, drowsiness, halitosis, tremor, impotence
• Drug interactions: with phenytoin, isoniazid, warfarin, barbiturates, long-acting benzodiazepines
• Client teaching: avoidance of alcohol, including common products that may contain it (will
cause same symptoms if the client has taken it with alcohol)
1) Shaving cream, deodorant, OTC cough preparations, vanilla extract
Elder Considerations
• Approximately 30% to 60% of elders in treatment began drinking abusively after age 60
• Risk factors for late-onset substance include chronic illness that causes pain, long-term use of
prescription medication (sedative-hypnotics, anxiolytics), life stress, loss, social isolation,
grief,
depression, and an abundance of discretionary time and money
• Physical problems associated with substance abuse develop more quickly in elders
Types of Therapy Groups
• Psychotherapy Group: the goal of a psychotherapy group is for members to learn about their
behavior and to make positive changes in their behavior by interacting and communicating
with others as a member of a group
1) Open groups are ongoing and run indefinitely, allowing members to join or leave
the group as they need to
2) Closed groups are structured to keep the same members in the group for a
specified number of sessions
• Family Therapy: the goals include understanding how family dynamics contribute to the client’s
psychopathology, mobilizing the family’s inherent strengths and functional resources,
restructuring maladaptive family behavioral styles, and strengthening family problem-solving
behavior
• Family Education: the curriculum focuses on schizophrenia, bipolar disorder, clinical depression,
panic disorder, and obsessive–compulsive disorder
• Education Groups: the goal is to provide information to members on a specific issue—
for instance, stress management, medication management, or assertiveness training
• Support Groups: are organized to help members who share a common problem cope with it
• Self-Help Groups: members share a common experience, but the group is not a formal
or structured therapy group (no identifiable leader)
Therapeutic Techniques (Table 6.1)
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EXAM STUDY GUIDE
Mental
Health Final
Exam
LATEST MENTAL HEALTH FINAL
EXAM STUDY GUIDE
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Distribution
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1
Diagnostic Classes of Substance Abuse
• Intoxication: use of a substance that results in maladaptive behavior
• Withdrawal syndrome: refers to the negative psychological and physical reactions that
occur when use of a substance ceases or dramatically decreases
• Detoxification: the process of safely withdrawing from a substance
• Substance abuse: drug is used outside the medical or social norm despite
negative consequences
• Substance dependence: problem associated with addiction
Alcoholism
• First episode of intoxication → continuing problems with alcohol → first blackout →
continued drinking → development of tolerance → tolerance break → continued drinking →
functioning becoming affected → periods of abstinence/temporary controlled drinking →
escalation of alcohol intake → more problems → subsequent crisis → continuation of cycle
• Related disorders: gambling, caffeine and tobacco additions
• CNS depressant: relaxation/loss of inhibitions
1. Slurred speech, unsteady gait, lack of coordination, and impaired
attention, concentration, memory, and judgment
2. Aggressive behavior or display inappropriate sexual behavior; the person who
is intoxicated may experience a blackout
• Treatment of an alcohol overdose: gastric lavage or dialysis to remove the drug and support of
respiratory and cardiovascular functioning in an intensive care unit
• Symptoms of withdrawal
1. Onset within 4 to 12 hours after cessation or marked reduction of alcohol
intake; peaking on second day; complete in about 5 days
2. Severe or untreated withdrawal may progress to transient hallucinations, seizures,
or delirium (DTs)
3. Benzodiazepines for safe withdrawal
Substance Abuse Treatment
• Concept: medical illnesses, chronic, progressive, characterized by remissions and relapses
• Treatment models: Hazelden Clinic model and 12-step program of Alcoholics Anonymous
• Individual, group counseling
• Treatment settings
• Pharmacologic treatment: safe withdrawal; prevent relapse
• Medications help manage withdrawal or cravings, but is not a specific treatment for
substance abuse
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2
Alcohol Intoxication and Overdose
• An overdose, or excessive alcohol intake in a short period, can result in
vomiting, unconsciousness, and respiratory depression
• This combination can cause aspiration pneumonia or pulmonary obstruction
• Alcohol-induced hypotension: can lead to cardiovascular shock and death
• Treatment: similar to that for any central nervous system depressant—gastric lavage or
dialysis to remove the drug, and support of respiratory and cardiovascular functioning in an
intensive
care unit
• The administration of central nervous system stimulants is contraindicated
Physiological Effects of Alcoholism/Long Term (Box 19.1)
• Cardiac myopathy
• Wernicke encephalopathy: an acute neurological condition characterized by a clinical triad
of ophthalmoparesis with nystagmus, ataxia, and confusion
• Korsakoff psychosis: a late complication of persistent Wernicke encephalopathy and results
in memory deficits, confusion, and behavioral changes
• Pancreatitis
• Esophagitis
• Hepatitis
• Cirrhosis
• Leukopenia
• Thrombocytopenia
• Ascites
Alcohol Withdrawal and Detoxification
• Symptoms of withdrawal usually begin 4 to 12 hours after cessation or marked reduction
of alcohol intake.
• Symptoms: coarse hand tremors, sweating, elevated pulse and blood pressure,
insomnia, anxiety, and nausea or vomiting
• Severe or untreated withdrawal may progress to transient hallucinations, seizures, or
delirium, called delirium tremens
• Alcohol withdrawal usually peaks on the second day and is over in about 5 days; withdrawal
may take 1 to 2 weeks
• Safe withdrawal is usually accomplished with the administration of benzodiazepines, such
as lorazepam (Ativan), chlordiazepoxide (Librium), or diazepam (Valium), to suppress the
withdrawal symptoms
• Total scores less than 8 indicate mild withdrawal, scores from 8 to 15 indicate moderate
withdrawal (marked arousal), and scores greater than 15 indicate severe withdrawal
(Clinical
Institute Withdrawal Assessment of Alcohol Scale)
Disulfiram (Antabuse)
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3
• Use: aversion therapy for alcoholism
• Never give to a patient that is intoxicated or without their consent
• Mechanism of action: inhibition of enzyme involved with alcohol metabolism
• Adverse reaction with alcohol ingestion
• Side effects: fatigue, drowsiness, halitosis, tremor, impotence
• Drug interactions: with phenytoin, isoniazid, warfarin, barbiturates, long-acting benzodiazepines
• Client teaching: avoidance of alcohol, including common products that may contain it (will
cause same symptoms if the client has taken it with alcohol)
1) Shaving cream, deodorant, OTC cough preparations, vanilla extract
Elder Considerations
• Approximately 30% to 60% of elders in treatment began drinking abusively after age 60
• Risk factors for late-onset substance include chronic illness that causes pain, long-term use of
prescription medication (sedative-hypnotics, anxiolytics), life stress, loss, social isolation,
grief,
depression, and an abundance of discretionary time and money
• Physical problems associated with substance abuse develop more quickly in elders
Types of Therapy Groups
• Psychotherapy Group: the goal of a psychotherapy group is for members to learn about their
behavior and to make positive changes in their behavior by interacting and communicating
with others as a member of a group
1) Open groups are ongoing and run indefinitely, allowing members to join or leave
the group as they need to
2) Closed groups are structured to keep the same members in the group for a
specified number of sessions
• Family Therapy: the goals include understanding how family dynamics contribute to the client’s
psychopathology, mobilizing the family’s inherent strengths and functional resources,
restructuring maladaptive family behavioral styles, and strengthening family problem-solving
behavior
• Family Education: the curriculum focuses on schizophrenia, bipolar disorder, clinical depression,
panic disorder, and obsessive–compulsive disorder
• Education Groups: the goal is to provide information to members on a specific issue—
for instance, stress management, medication management, or assertiveness training
• Support Groups: are organized to help members who share a common problem cope with it
• Self-Help Groups: members share a common experience, but the group is not a formal
or structured therapy group (no identifiable leader)
Therapeutic Techniques (Table 6.1)
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