Mental Health Concepts

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Mental Health Concepts

• Medical-Surgical Nursing
• Unit 9
• Beth Meyer

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Mental Health

• Ones ability to cope with and adjust to the
  recurrent stresses of everyday life

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• Inherited characteristics
• Childhood nurturing
• Positive-negative influences in life

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Mental Illness

• Evidenced by pattern of behaviors that is
  conspicuous, threatening and disruptive of
  relationships or that deviates significantly from
  behavior that is considered socially and
  culturally acceptable

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What is normal?

• One out of every 8 people in the U.S. need mental
  health services

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Brief History of Mental Illness

• Greco-Roman Era - Hippocrates believed mental
  illness had natural causes
• Lunacy- thought troubled minds were due to the
  moon
• Dark Ages Early Christians believed mental
  illness was punishment for sins, possession

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• 18th and 19th Century
• Asylums

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• 1940s and 1950s
• ECT
• Now
• The future.

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Where are the mentally ill now?
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Mental Health Continuum

• Mental Health Mental Illness
• Adaptive Maladaptive

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Personality

• Relatively consistent sort of attitudes and
  behaviors particular to an individual

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Sigmund Freud

• 1856-1939
• Freudian slip
• Believed that all behavior is set in the
  unconscious
• Psychosexual stages

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Freuds Components of Personality

• Id- concerned with gratification if it feels
  good, do it!
• Ego- balance to id now, wait a minute brings
  back to reality
• Superego- the conscience determines what is
  right or wrong

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Self-concept

• Perceptions and values of a person and how that
  person behaves or interacts

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Adaptation and Coping

• Adjustment or coping mechanisms used by everyone
  on a daily basis
• Good or bad
• Healthy if helps person to meet personal goals
• Unhealthy if causes to distort reality

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Defense Mechanisms

• Protects against stressful situations
• Frequently on unconscious level

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Types of Defense Mechanisms

• Compensation try to cover up a weakness by
  showing greater strengths or excellence in
  another area
• Conversion emotional stress unconsciously
  converted into physical complaints

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• Denial refuses to see what is obvious to
  everyone else
• Displacement feelings towards an object are
  distorted and transferred to less threatening
  object
• Dissociation painful ideas, situations, or
  feelings separated from awareness

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• Projection justifies own behavior and feelings
  or permitting them to blame their short comings
  on other people or objects
• Rationalization allows one to do what he/she
  wants to when it should not be done

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• Reaction formation overcompensation deny
  unacceptable feelings and impulses by adopting
  conscious behaviors that appear to contradict the
  thoughts
• Regression retreat to earlier, less stressful
  time
• Repression most common forget due to too
  painful to remember

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STRESS

• Nonspecific response of the body to any demand
  made of it
• How do you respond to stress?

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Anxiety!!!!!

• Mild
• Moderate
• Severe
• Panic

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Illness Behaviors

• Illness
• Crisis
• Crisis intervention

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Improvement of Mental Health
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Assessment of Emotional Status

• History and data collection
• Affect external manifestation of inner feelings
  or emotions usually demonstrated in facial
  expressions
• Flat affect no facial expressions

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Nursing Diagnosis for Mental Health
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Care of the Psychiatric Patient

• What is normal?
• neurosis
• psychosis
• Diagnostic and Statistical Manual of Psychiatric
  Disorders, IV-TR
• Baker Act

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Organic Mental Disorders

• Delirium
• Sundowning syndrome
• Dementia

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Though Process Disorders

• Schizophrenia
• Disorganized
• Paranoid
• Catatonic
• Undifferentiated
• Residual

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Major Mood Disorders

• Depression
• Bipolar disorder

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Anxiety Disorders

• Anxiety
• panic disorders
• specific phobias
• social phobia
• Obsessive-compulsive disorder
• Post-traumatic Stress Disorder

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Suicide
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Personality Disorders

• Antisocial personality disorders

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Sexual Disorders

• Sexual dysfunctions
• Paraphilias
• Gender identity disorder

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Psychophysiologic Disorders

• Psychosomatic
• Psychophysical illness

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Eating Disorders

• Anorexia nervosa
• Bulimia nervosa

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Treatment for Mental Illness

• Psychotherapy
• Electroconvulsive therapy ECT
• Pharmacology

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Traditional Antipsychotic Drugs for Schizophrenia

• Thorazine 50-800 mg qd
• Mellaril 50-800 mg qd
• Stelazine 2-80 mg qd
• Trilafon 8-64 mg qd
• Prolixin 2-40 mg qd
• Haldol 1- 15 mg qd

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Atypical drugs for Schizophrenia

• Risperdal 4 6 mg qd
• Zyprexa 10- 20 mg qd
• Seroquil 300-400 mg qd
• Clozaril 200-400 mg qd

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Side Effects

• Extrapyramidal side effects (EPS)
• pseudoparkinsonism drooling, shuffled gait,
  stiff or stooped posture
• dystonia contractions of tongue, neck, face
  and back. May become permanent
• akathesia restless movement
• tardive dyskinesia protruding,rolling tongue,
  smacking

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EPS Treatment

• Cogentin 1-3 mg bid
• Artane 2-5 mg tid
• Benadryl 25-50 mg tid/qid

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Other Side Effects

• Hypotension and orthostatic hypotension
• Tachycardia
• Agranulocytosis
• Neuroleptic malignant syndrome

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Antimanic Drugs for Bipolar Disorder

• Lithium 300-600 mg tid
• Lithium ER 300 mg bid
• Side Effects H/A, dry mouth, polyurea,
  hypotension, hyponatremia, muscle weakness
• WNL Blood range 0.5-1.4mEq/L
• Toxicity can occur at 1.5 mEq/L

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Anticonvulsant for Bipolar Disorder

• Depakote - 15-60 mg/Kg/day
• given bid,tid or qid
• Side Effects
• visual disturbances, rash, diarrhea, light
  colored stool, jaundice, thrombocytopenia

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Antidepressants

• Selective serotonin re-uptake inhibitors
• Atypical antidepressants
• Tricyclic antidepressants
• MAO inhibitors

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• SSRIs
• Prozac 20-40 mg qd
• Luvox 50-300 mg qd
• Paxil 20-50 mg qd
• Zoloft 25-50 mg qd
• Effexor 75-225 mg qd
• Serzone 300-600 mg qd
• Celexa 10-40 mg qd

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SSRI Side Effects

• Rash
• Anxiety
• Weight loss
• Tremors
• Dizziness
• Altered libido
• Serotonin syndrome

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Atypical Antidepressants

• Wellbutrin 300 mg qd
• Desyrel 150-200 mg qd
• Remeron 15-30 mg qd

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Side Effects

• Wellbutrin seizures, sedation, insomnia,
  tremors, dry mouth, increased appetite
• Desyrel agrnulocytosis, thrombocytopenia,
  leukopenia, nightmares, paralytic ileus,
  hypo/hyper tension, palpatations
• Remeron same as Desyrel

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Tricyclic Antidepressants

• Elavil 100-200 mg qd
• Pamelor 75-150 mg qd
• Tofranil 100-200 mg qd
• Sinequan 100 200 mg qd
• Side Effects
• Same as Desyrel

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MAO Inhibitors

• Marplan 20-30 mg qd
• Nardil 45-75 mg qd
• Parnate 20-30 mg qd
• Side Effects
• hypertensive crisis secondary to ingestion of
  foods containing tyramine (cheeses, wine, chopped
  liver, Chinese food), figs, OTC cold medicines,
  yeast rolls, chocolate. Never combine with other
  antidepressants

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Benzodiazepines for Anxiety

• Klonopin 0.5 1.5 mg qd
• Valium 2 - 10 mg bid,
• tid, qid
• Ativan 2-6 mg
• (10 mg/day max)
• Xanax 0.25- 0.5 mg tid
• (4mg/day max)

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Side Effects

• Sedation
• Dizziness
• Hypotension
• Loss of coordination
• Can develop increased tolerance
• Physical dependency