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Mercedes A Perez-Millan MSN, ARNP
INTRODUCTION TO PSYCHIATRIC
NURSING
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Mental Health???????
MENTAL ILLNESS
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Seven Signs of Mental Health
HappinessControl over behavior
Appraisal of realityEffectiveness in work
Healthy self-conceptSatisfying relationships(give and receive love)
Effective coping strategies
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Traits of Mental Health
Ability tooDeal with conflicting emotionsoLive without undue fear, guilt, or
anxiety
oTake responsibility for one's ownactions
oThink clearly
oNegotiate each developmental task
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Prevalence of Psychiatric Disorders
USAThe Department of Health and Human Servicesand the National Institute of Mental Health
(2004) provide the following statistics:
57.7 million Americans have a mental illness. That is26.2 per cent of Americans 18 or older.
Four of the ten leading causes of disability include:major depression, bipolar disorder, schizophrenia andobsessive compulsive disorder.
The economic burden of mental illness in the USA,
exceeds $ 170 billion.
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National Institute of Mental Health
2002 USA StatisticsAffective Disorders- 9.5 pre-cent. 18.8 millionSuicide- 29,350 people committed suicideSchizophrenia- 1.1 percent, 2.2 millionAnxiety disorders- 13.3 percent, 19.1 million
Eating disorders- 2- 5 percent of populationADHD- 4.1 percent of youth ages 9 to 17Substance abuse- 11.3 percent of the population
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Theories of Mental Illness
PSYCHOBIOLOGICAL
PSYCHOLOGICAL
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PSYCHOBIOLOGICAL
Genetic
Other Biological Influences
The Role of the Environment
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PSYCHOBIOLOGICAL
Overview of the Brain
Forebrain
CerebrumoFrontal lobe- Voluntary movement, language,
executive function
oParietal lobe- Sensory impulses, tactile sensations
oTemporal lobe- Memory, emotions, taste, smell,auditory
oOccipital lobe- Vision, visual perception
DiencephalonsoThalamus- Pathway of motor & sensory impulses
oHypothalamus- Regulates hormonal functioning
PSYCHOBIOLOGICAL
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PSYCHOBIOLOGICAL
Overview of the Brain (cont.)
MIDBRAIN
Mesencephalon- Processes visual &auditory information
HINDBRAIN
Pons- Visceral & somatic motor controlMedulla- Autonomic functioning of major
organs
Cerebellum- Modulates movement
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PSYCHOBIOLOGICALNEURON
CONDUCTION OF ELECTRICAL IMPULSES
NEUROTRANSMITTERS
RECEPTORS
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PSYCHOBIOLOGICALNEUROTRANSMITTER
CHEMICAL MESSANGERSRELEASED AT PRESYNAPTIC NEURONDIFFUSES ACROSS SYNAPSE TO POST
SYNAPSE
ATTACHES TO SPECIALIZED RECEPTORSINHIBITS OR STIMULATESRELEASED AND THEN DESTROYED OR
TAKEN BACK FOR RECYCLING
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Dopamine DA Schizophrenia, ManiaParkinsons, Depression
Norepinephrine NE ManiaDepression
Serotonin 5-HT AnxietyDepression
Gamma-amino- GABA Reduction ofbuturic acid anxiety
Anxiety
Acetyl-Choline Ach DepressionAlzheimers
PSYCHOBIOLOGICALNeurotransmitter/ Receptor/ Disorder
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PSYCHOLOGICAL
Freud's Psychoanalytic TheoryoConscious, preconscious, unconscious
oId, ego, superego
oDefense mechanisms and Anxiety
oTheories of personality
PSYCHOLOGICAL
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PSYCHOLOGICALPSYCHOANALYTICAL EGO FUNCTIONS
1.
1.REALITY TESTING
2.SENSE OF REALITY
3.JUDGEMENT
4.IMPULSE CONTROL
5.THOUGHT PROCESS
6.ARISE
1.
1.DEFENSIVE FUNCTIONING
2.OBJECT RELATIONS
3.AUTONOMOUS FUNCTIONING
4.STIMULOUS BARRIER
5.MASTERY COMPETENCE
6.SYNTHETIC INTEGRATIVE
FUNCTIONING
EGO
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PSYCHOLOGICAL
FreudPsychosexual Stages of Development
Oral (0-18mosAnal (18mos-3yrs)Phallic (3-6yrs.)
Latency (6-12yrs)Genital (13-20yrs)
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PSYCHOLOGICAL
ERIKSON
Psychosocial Stages of Development
Trust vs Mistrust
Autonomy vs Shame and Doubt
Initiative vs Guilt
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PSYCHOLOGICAL
ERIKSON (cont)
Industry vs Inferiority
Identity vs Role Confusion
Intimacy vs Isolation
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PSYCHOLOGICAL
ERIKSON (cont)
Generativity vs Stagnation
Ego Integrity vs Despair
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Maslows Hierarchy of Needs
6. Self-Transcendent Needs 5.Self- Actualization Needs
4. Esteem Needs
3. Love and Belonging Needs 2. Safety Needs 1.Physiological Needs
Emphasis on human potential and clients strengths
Establishes what is most important in sequences ofnursing actions Sets PrioritiesVarcarolis p. 20-21
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Psychiatric Mental Health Nursing and the
Nursing Process
1. Assessment 2. Nursing Diagnosis
6. Evaluation 3. Outcome Identification
4. Planning
5. Implementation
Factors Affecting Mental Health
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Factors Affecting Mental Health
and Nursing Assessment
Support systemsFamily influencesDevelopmental events
Cultural beliefs and valuesHealth practices
Negative influences
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PSYCHIATRIC ASSESSMENT
Construct databaseoMental status examination (MSE)
oPsychosocial assessment
oPhysical examination
oHistory taking
oInterviews
oStandardized rating scales
Verifying the data
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DIAGNOSIS OF PSYCHIATRIC
ILLNESS
Medical- DSM-IV-TV (Diagnostic andStatistical Classification of Mental Disorders)
Nursing- NANDA (North American NursingDiagnosis Association)
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DSM-IV-TR
Mental disorders are considered a
manifestation of a
BehavioralPsychologicalBiologicaldysfunction of the individual
DSM- IV- TR MULTI-AXIAL
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DSM- IV- TRMULTI-AXIAL
CLASSIFICATION
Axis I- All major psychiatric disordersAxis II- Personality disorders; Mental
retardationAxis III- Current medical conditions that are
relevant to the mental disorder
Axis IV- Psychosocial and environmentalproblems
Axis V- Global Assessment of Function(GAF)
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Therapeutic Approaches
PsychoanalysisShort term psychotherapyCognitive TherapyBehavior TherapyoModeling
oOperant Conditioning
oSystemic desensitization
oAversion Therapy
Milieu Therapy
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CULTURAL BIASES
Consider cultural differences that influencehealth
Be accepting of changing families
Be open, consider differences in order toprovide sensitive, competent care
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GOALS and Interventions of
Psychiatric Care Directed to
Anxiety+
Reality testing+
Self esteem =
Level of functioning and manage diseaseprocess