PSYCHIATRIC NURSING Concept of Mental Health and illness

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PSYCHIATRIC NURSINGConcept of Mental Health and
illness

• Dr. Naiema Gaber Elsayed

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Lecture objectives

• Define Mental Health
• Define Mental Illness and Identify the
  Population at Risk
• Define Psychiatric Nursing
• Determine the Nurses Role in Psychiatric Nursing
• Identify the Common terminology used in
  psychiatric and mental therapy

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What is Mental Health?

• World Health Organization
• "Mental health is a state of well-being where a
  person can realize his or her abilites to cope
  with normal stresses of life and work
  productively.

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Mental Health/Illness Continuum

• Stress
• Mental Health Mental Illness
• ADAPTIVE MALADAPTIVE
• Healthy Neurosis Psychosis
• Reality Oriented Denies Reality
• Positive self-concept
• Emotional stable

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FUNDAMENTAL CONCEPTS

• MENTAL HEALTH
• Is a state of emotional, psychological, and
  social wellness evidenced by
• Satisfying interpersonal relationships
• Effective behavior and coping
• Positive self-concept
• Emotional stability
• Self-awareness

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Who has mental health?

• We all fall short to some extent.
• Therefore, advocates of mental health believe
  that a broad range of mental health services
  should be available to general population, not
  just seriously mentally ill.
• They believe that prevention and education, as
  well as treatment, are important.

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Mental Illness

• A mental disorder or condition manifested by
  disorganization and impairment of functions that
  arises from various causes such as psychological,
  neurobiological and genetic factors.

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What is mental illness?

• Is it a disease, like diabetes or smallpox?
• Is it a form of deviant behaviorlike being
  disobedient, choosing to dress differently.
• It is manifested by disorganization and
  impairment of functions that arises from various
  causes such as psychological, neurobiological and
  genetic factors

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What causes mental illness?

• Psychological such as early development,
  cognitive styles, personal identity)
• Biological as Genetics, Neurochemisty, Viral
  causation
• Sociological environmental/social causation
  as Poor living conditions and dangerous
  neighborhoods

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• Factors Affecting Mental Health
• Mastering the Environment
• Reality orientation
• Stress Management
• Maximizing Ones Potential
• Autonomy and Independence
• Tolerating Ones Uncertainties
• Self-esteem
• MRS MATS

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The Classification of Mental
IllnessThe Neuroses usually the patient
retains insight and orientation they experience
deep distress and may commit suicide as
depressionThe Psychoses(the patient is
disorientated, deluded, and lacking in insight)
e.g. Schizophrenia, puerperal psychosis The
DementiasProgressive deterioration with loss of
recent memory and deterioration of a normal
personality,They may be primary or more commonly
secondary to another condition e.g. alcohol,
stroke
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Etiology mental illness
Drug Abuse Alcohol,Heroin etc
Inheritance-Genetics/Intra-uterine environment
Schizophrenia,Huntingtons
Upbringing Mothering,education,parenting
Neurological diseases MS,Brain tumour
Trauma/head injury
Biochemistry/metabolic Porphyria,Diabetes
Infections-HIV,Syphilis,CJD
Vascular-CVA
Nutrition/PCM
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Classification of Mental Illnesses

• The Diagnostic and Statistical Manual of Mental
  Disorders, 4th Edition, Text Revision
  (DSM-IV-TR).
• Diagnostic criteria are listed for each of the
  psychiatric disorders.
• A multiaxial system- people are evaluated from
  multiple aspects or points of function.

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DSM-IV-TR Multiaxial Evaluation System

• Axis I - Clinical disorders and other conditions
  that may be a focus of clinical attention
• Axis II - Personality disorders and mental
  retardation
• Axis III - General medical conditions
• Axis IV - Psychosocial and environmental problems
• Axis V - The measurement of an individuals
  psychological, social, and occupational
  functioning on the GAF Scale

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Population at Risk for Mental Illness

1. Familiar or genetic predisposition to mental
   illness
2. Poor access to health care
3. Misusing substance
4. Undergoing lifestyle changes
5. Victims of violence
6. Elderly poor

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• Community Mental Health Services

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Treatment and Care
Hospital Care
Community Care
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Preventive NetworksChurch, Family, Home,
Friends, Work
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Psychiatric Nursing

• Psychiatric nursing or mental health nursing is
  the specialty of nursing that cares for people of
  all ages with mental illness or mental distress.
• An interpersonal process that promotes and
  maintains behavior that contributes to integrated
  functioning

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What do psychiatric nurses do?

• Ensure safety and security
• Care for biophysical needs
• ADLs
• Nutrition, exercise
• Medication management
• Assist in creating a healthy social world
• increase self-awareness by
• Discussion,
• Experience
• Role play

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Nursing Approach/Model

• Components
• Nurse-Client Interactive Relationship
  mutuality, collaboration, and problem-solving
  tools communication and nurse-client
  relationship
• Environmental Management provide therapeutic
  environment by serving as advocates and role
  models, by offering social support and by
  engaging clients in collaborative problem-solving
  of here-and-now problems of daily living
• Nursing Process

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Common terminology used in psychiatric and mental
therapy
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Dynamics of Human Behavior

• Behavior the way an individual reacts to a
  certain stimulus
• Conflict situation arising from the presence of
  two opposing drives
• Need - organismic condition that requires a
  certain activity
• Stress life events in which a demanding
  situation taxes a persons resources as coping
  mechanisms
• Adaptation process of interacting with the
  environment to maintain homeostatic equilibrium
• Maladaptation ineffective coping

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Dynamics of Human Behavior cont.

• Personality integration of systems and habits
  representing an individuals characteristic and
  adjustment to his environment expressed through
  behavior

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Personality

• Each human being is unique
• We all have different personalities
• My personality reflects genetic inheritance and
  Environment

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3 divisions of the mind

• Conscious focused on awareness
• Subconscious recalled at will
• Unconscious never recalled / largest part
• Learning change in behavior through insight ,
  relearning and remotivation

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Behavior
The Parent
SUPER-EGO
EGO
The Adult
ID
The Child
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The Subconscious Mind
The Conscious
The Subconscious
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Common Behavioral Signs and Symptoms

• Disturbances in perception
• Illusion Misinterpretation of an actual
  external stimuli
• Hallucinations False sensory perception in the
  absence of external stimuli

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• Disturbances in thinking and speech
• Word salad incoherent mixture of words and
  phrases with no logical sequence.
• Verbigeration meaningless repetition of words
  and phrases.
• Perseveration persistence of a response to a
  previous question.
• Echolalia pathological repetition of words of
  others
• Aphasia speech difficulty and disturbance
• Expressive , receptive or global

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• Flight of ideas- shifting of one topic from one
  subject to another in a somewhat related way.
• Looseness of association-incoherent ,illogical
  flow of thoughts (unrelated way)
• Clang association sound of word gives direction
  to the flow of thought.
• Delusion persistent false belief,rigidly held
• Delusions of grandeur- special /important in a
  way
• Persecutory-threatened

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• Magical thinking primitive thought process
  thoughts alone can change events.
• Autistic thinking regressive thought
  process-subjective interpretations not validated
  with objective reality

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• Disturbances of affect (imotion)
• Inappropriate disharmony between the stimuli
  and the emotional reaction.
• Blunted affect severe reduction in emotional
  reaction.
• Flat affect absence or near absence of
  emotional reaction.
• Apathy dulled emotional tone.

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• Depersonalization feeling of strangeness
• from ones self Common.
• Derealization feeling of strangeness towards
  environment.
• Agnosia lack of sensory stimuli integration

• examples of affect are sadness, fear, joy, and
  anger.

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• Disturbances in motor activity
• Echopraxia imitation of posture of others
• Waxy flexibility maintaining position for a
  long period of time
• Ataxia loss of balance
• Akathesia extreme restlessness
• Dystonia- uncoordinated spastic movements of the
  body
• Tardive dyskenisia involuntary twitching or
  muscle movements
• Apraxia involuntary un-purposeful movements

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• Disturbances in memory
• Confabulation filling of memory gaps
• Amnesia memory loss (inability to recall past
  events)
• Retrograde-distant past
• Anterograde immediate past
• Anomia lack of memory of items

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summary

• MENTAL HEALTH is balance in a persons internal
  life and adaptation to reality
• MENTAL ILLNESS is a state of imbalance
  characterized by a disturbance in a persons
  thoughts, feelings and behavior
• Familiar, genetic predisposition, Poverty
• and abuses are major risk factors

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• Psychiatric nursing interpersonal process
  whereby the professional nurse practitioner
  assist clients to achieve psychosocial well being
  through the therapeutic use of self(art) and
  nursing theories (science).
• Core of psych nursing interpersonal process
  human to human relationship(both for
• mentally healthy and ill

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• Community Mental Health Services

1- curative services as hospital and community
care. 2- preventive services as Church, Family,
Home, Friends, Work.
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Feedback questions
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