PSYCHIATRIC NURSINGPSYCHIATRIC NURSINGConcept of Mental Health Concept of Mental Health

and illnessand illness

Dr. Naiema Gaber ElsayedDr. Naiema Gaber Elsayed

Lecture objectivesLecture objectives

Define Mental HealthDefine Mental Health Define Mental Illness and Identify the Define Mental Illness and Identify the

Population at RiskPopulation at Risk Define Psychiatric NursingDefine Psychiatric Nursing Determine the Nurse’s Role in Psychiatric Determine the Nurse’s Role in Psychiatric

NursingNursing Identify the Common terminology used in Identify the Common terminology used in

psychiatric and mental therapypsychiatric and mental therapy

What is Mental Health?What is Mental Health?

World Health Organization:

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

Mental Health/Illness ContinuumMental Health/Illness Continuum

StressStress

Mental HealthMental Health Mental Illness Mental Illness

ADAPTIVEADAPTIVE MALADAPTIVE MALADAPTIVE

Healthy Healthy NeurosisNeurosis PsychosisPsychosis

* Reality Oriented* Reality Oriented *Denies Reality *Denies Reality

**Positive self-conceptPositive self-concept

*Emotional stable*Emotional stable•

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FUNDAMENTAL CONCEPTSFUNDAMENTAL CONCEPTS

MENTAL HEALTH Is a state of emotional, Is a state of emotional,

psychological, and social wellness psychological, and social wellness evidenced by:evidenced by:

Satisfying interpersonal Satisfying interpersonal relationshipsrelationships

Effective behavior and copingEffective behavior and copingPositive self-conceptPositive self-conceptEmotional stabilityEmotional stabilitySelf-awarenessSelf-awareness

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Who has mental health?Who has mental health?

We all fall short to some extent.We all fall short to some extent.

Therefore, advocates of mental health believe Therefore, advocates of mental health believe that a broad range of mental health services that a broad range of mental health services should be available to general population, not should be available to general population, not just seriously mentally ill.just seriously mentally ill.

They believe that prevention and education, as They believe that prevention and education, as well as treatment, are important.well as treatment, are important.

MentalMental IllnessIllness

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

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What is mental illness?What is mental illness? Is it a disease, like diabetes or smallpox?

Is it a form of deviant behavior—like being disobedient, choosing to dress differently.

It is manifested by disorganization and It is manifested by disorganization and impairment of functions that arises from impairment of functions that arises from various causes such as psychological, various causes such as psychological, neurobiological and genetic factorsneurobiological and genetic factors

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What causes mental illness?What causes mental illness?

Psychological Psychological such as: early development, such as: early development, cognitive styles, personal identity)cognitive styles, personal identity)

Biological as Biological as Genetics, Neurochemisty, Viral Genetics, Neurochemisty, Viral causationcausation

Sociological “Sociological “environmental/social |environmental/social |causationcausation”: as Poor living conditions and ”: as Poor living conditions and dangerous neighborhoodsdangerous neighborhoods

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Factors Affecting Mental HealthFactors Affecting Mental Health

Mastering the EnvironmentMastering the Environment Reality orientationReality orientation Stress Management Stress Management Maximizing One’s Potential Maximizing One’s Potential Autonomy and IndependenceAutonomy and Independence Tolerating One’s UncertaintiesTolerating One’s Uncertainties Self-esteemSelf-esteem

““MRS MATS”MRS MATS”

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The Classification of Mental Illness:The Classification of Mental Illness:

The NeurosesThe Neuroses usually the patient retains insight and orientation; they usually the patient retains insight and orientation; they

experience deep distress and may commit suicide as experience deep distress and may commit suicide as depressiondepression

The PsychosesThe Psychoses(the patient is disorientated, deluded, and lacking in (the patient is disorientated, deluded, and lacking in

insightinsight) e.g. Schizophrenia, puerperal psychosis ) e.g. Schizophrenia, puerperal psychosis

The DementiasThe Dementias

Progressive deterioration with loss of recent memory and Progressive deterioration with loss of recent memory and deterioration of a normal personality,deterioration of a normal personality,

They may be primary or more commonly secondary to They may be primary or more commonly secondary to another condition e.g. alcohol, strokeanother condition e.g. alcohol, stroke

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Etiology mental illnessEtiology mental illness

InheritanceInheritance-Genetics/Intra-uterine environment Schizophrenia,Huntington’s

InfectionsInfections--HIV,Syphilis,CJD

Drug AbuseDrug Abuse

Alcohol,Heroin etc

TraumaTrauma/head injury

Biochemistry/Biochemistry/metabolicmetabolic

Porphyria,Diabetes

VascularVascular--CVA

Neurological Neurological diseasesdiseases

MS,Brain tumour

UpbringingUpbringing

Mothering,education,parenting

Nutrition/PCM

Classification of Mental IllnessesClassification of Mental Illnesses

The Diagnostic and Statistical Manual of The Diagnostic and Statistical Manual of Mental Disorders, 4Mental Disorders, 4thth Edition, Text Revision Edition, Text Revision (DSM-IV-TR).(DSM-IV-TR).

Diagnostic criteria are listed for each of the Diagnostic criteria are listed for each of the psychiatric disorders.psychiatric disorders.

A multiaxial system- people are evaluated A multiaxial system- people are evaluated from multiple aspects or points of function.from multiple aspects or points of function.

DSM-IV-TR Multiaxial Evaluation SystemDSM-IV-TR Multiaxial Evaluation System

Axis IAxis I -- Clinical disorders and other conditions Clinical disorders and other conditions that may be a focus of clinical attentionthat may be a focus of clinical attention

Axis IIAxis II -- Personality disorders and mental Personality disorders and mental retardationretardation

Axis IIIAxis III -- General medical conditions General medical conditions Axis IVAxis IV -- Psychosocial and environmental Psychosocial and environmental

problemsproblems Axis VAxis V -- The measurement of an individual’s The measurement of an individual’s

psychological, social, and occupational psychological, social, and occupational functioning on the GAF Scalefunctioning on the GAF Scale

Population at Risk for Mental Population at Risk for Mental IllnessIllness

1.1. Familiar or genetic predisposition to Familiar or genetic predisposition to mental illnessmental illness

2.2. Poor access to health carePoor access to health care

3.3. Misusing substanceMisusing substance

4.4. Undergoing lifestyle changesUndergoing lifestyle changes

5.5. Victims of violenceVictims of violence

6.6. Elderly poorElderly poor

Community Mental Community Mental Health Services Health Services

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Treatment and CareTreatment and Care

Hospital Care

Community Care

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Preventive NetworksPreventive NetworksChurch, Family, Home, Friends, Church, Family, Home, Friends,

Work Work

Psychiatric NursingPsychiatric Nursing

Psychiatric nursingPsychiatric nursing or or mental health mental health nursingnursing is the specialty of is the specialty of nursing that cares that cares for people of all ages with for people of all ages with mental illness or or mental distress.mental distress.

An An interpersonal processinterpersonal process that promotes that promotes and maintains behavior that contributes to and maintains behavior that contributes to integrated functioningintegrated functioning

What do psychiatric nurses do?What do psychiatric nurses do? Ensure safety and securityEnsure safety and security Care for biophysical needsCare for biophysical needs

ADL’sADL’s Nutrition, exerciseNutrition, exercise Medication managementMedication management

Assist in creating a healthy social worldAssist in creating a healthy social world increase self-awareness by:increase self-awareness by:

* Discussion,* Discussion,*Experience*Experience* Role play* Role play

Nursing Approach/Model Nursing Approach/Model Components:Components:

1.1. Nurse-Client Interactive RelationshipNurse-Client Interactive Relationship –– mutuality, collaboration, and problem-solving; mutuality, collaboration, and problem-solving; tools: tools: communication and nurse-client communication and nurse-client relationshiprelationship

2.2. Environmental ManagementEnvironmental Management – provide – provide therapeutictherapeutic environment by serving as environment by serving as advocates advocates and role models, by offering social support and by and role models, by offering social support and by engaging clients in collaborative problem-solving engaging clients in collaborative problem-solving of here-and-now problems of daily livingof here-and-now problems of daily living

3.3. Nursing ProcessNursing Process

Common terminology used in Common terminology used in psychiatric and mental therapypsychiatric and mental therapy

Dynamics of Human BehaviorDynamics of Human Behavior

BehaviorBehavior – the way an individual reacts to a certain – the way an individual reacts to a certain stimulusstimulus

ConflictConflict – situation arising from the presence of two – situation arising from the presence of two opposing drivesopposing drives

Need Need - organismic condition that requires a certain - organismic condition that requires a certain activityactivity

Stress Stress – life events in which a demanding situation – life events in which a demanding situation taxes a person’s resources as coping mechanismstaxes a person’s resources as coping mechanisms

AdaptationAdaptation – process of interacting with the – process of interacting with the environment to maintain homeostatic equilibriumenvironment to maintain homeostatic equilibrium

MaladaptatioMaladaptation – ineffective coping n – ineffective coping

Dynamics of Human Behavior Dynamics of Human Behavior cont.cont.

PersonalityPersonality – integration of systems and – integration of systems and habits representing an individuals habits representing an individuals characteristic and adjustment to his characteristic and adjustment to his environment expressed through behaviorenvironment expressed through behavior

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PersonalityPersonality

Each human being is Each human being is uniqueunique

We all have different We all have different personalitiespersonalities

My personality My personality reflects genetic reflects genetic inheritance and inheritance and EnvironmentEnvironment

3 divisions of the mind3 divisions of the mind

Conscious – focused on awarenessConscious – focused on awareness

Subconscious – recalled at willSubconscious – recalled at will

Unconscious – never recalled / largest partUnconscious – never recalled / largest part

Learning – change in behavior through – insight , Learning – change in behavior through – insight , relearning and remotivationrelearning and remotivation

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BehaviorBehavior

SUPER-EGO

EGO

ID

The Parent

The Adult

The Child

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The Subconscious MindThe Subconscious Mind

The Conscious

The Subconscious

Common Behavioral Signs and Common Behavioral Signs and SymptomsSymptoms

1)1) Disturbances in perceptionDisturbances in perception Illusion: Illusion: Misinterpretation of an actual Misinterpretation of an actual

external stimuliexternal stimuli

Hallucinations : FHallucinations : False sensory perception alse sensory perception in the absence of external stimuliin the absence of external stimuli

2)2) Disturbances in thinking and speechDisturbances in thinking and speech

Word salad Word salad – incoherent mixture of words and – incoherent mixture of words and phrases with no logical sequence.phrases with no logical sequence.

Verbigeration Verbigeration – meaningless repetition of – meaningless repetition of words and phrases.words and phrases.

Perseveration Perseveration – persistence of a response to a – persistence of a response to a previous question.previous question.

Echolalia –Echolalia – pathological repetition of words of pathological repetition of words of othersothers

Aphasia Aphasia – speech difficulty and disturbance– speech difficulty and disturbanceExpressive , receptive or globalExpressive , receptive or global

Flight of ideas- Flight of ideas- shifting of one topic from one shifting of one topic from one subject to another in a somewhat related way.subject to another in a somewhat related way.

Looseness of associationLooseness of association-incoherent ,illogical -incoherent ,illogical flow of thoughts (unrelated way)flow of thoughts (unrelated way)

Clang association Clang association – sound of word gives – sound of word gives direction to the flow of thought.direction to the flow of thought.

Delusion Delusion – persistent false belief,rigidly held– persistent false belief,rigidly held Delusions of grandeur- Delusions of grandeur- special /important in a wayspecial /important in a way Persecutory-threatenedPersecutory-threatened

Magical thinking – Magical thinking – primitive thought process primitive thought process thoughts alone can change events.thoughts alone can change events.

Autistic thinking Autistic thinking – regressive thought – regressive thought process-subjective interpretations not validated process-subjective interpretations not validated with objective realitywith objective reality

3)3) Disturbances of affect (imotion)Disturbances of affect (imotion) Inappropriate Inappropriate – disharmony between the – disharmony between the

stimuli and the emotional reaction.stimuli and the emotional reaction.

Blunted affect Blunted affect – severe reduction in emotional – severe reduction in emotional reaction.reaction.

Flat affect Flat affect – absence or near absence of – absence or near absence of emotional reaction.emotional reaction.

Apathy –Apathy – dulled emotional tone. dulled emotional tone.

Depersonalization – feeling of strangeness from one’s self Common.

DerealizationDerealization – feeling of strangeness towards

environment.

Agnosia Agnosia – lack of sensory stimuli integration

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

4)4) Disturbances in motor activityDisturbances in motor activity Echopraxia Echopraxia – imitation of posture of others– imitation of posture of others Waxy flexibility Waxy flexibility – maintaining position for a – maintaining position for a

long period of timelong period of time Ataxia Ataxia – loss of balance– loss of balance AkathesiaAkathesia – extreme restlessness – extreme restlessness Dystonia-Dystonia- uncoordinated spastic movements of the uncoordinated spastic movements of the

bodybody Tardive dyskenisia Tardive dyskenisia – involuntary twitching or – involuntary twitching or

muscle movementsmuscle movements ApraxiaApraxia – involuntary un-purposeful movements – involuntary un-purposeful movements

5)5) Disturbances in memoryDisturbances in memory ConfabulationConfabulation – filling of memory gaps – filling of memory gaps

Amnesia Amnesia – memory loss (inability to recall – memory loss (inability to recall past events)past events)

RetrogradeRetrograde-distant past-distant past Anterograde Anterograde – immediate past– immediate past Anomia Anomia – lack of memory of items– lack of memory of items

summarysummary MENTAL HEALTH is balance in a persons internal MENTAL HEALTH is balance in a persons internal

life and adaptation to realitylife and adaptation to reality

MENTAL ILLNESS is a state of imbalance MENTAL ILLNESS is a state of imbalance characterized by a disturbance in a persons thoughts, characterized by a disturbance in a persons thoughts, feelings and behaviorfeelings and behavior

Familiar, genetic predisposition, PovertyFamiliar, genetic predisposition, Poverty and abuses are major risk factorsand abuses are major risk factors

Psychiatric nursing Psychiatric nursing – interpersonal process – interpersonal process whereby the professional nurse practitioner whereby the professional nurse practitioner assist clients to achieve psychosocial well assist clients to achieve psychosocial well being through the therapeutic use of self(art) being through the therapeutic use of self(art) and nursing theories (science).and nursing theories (science).

Core of psych nursing Core of psych nursing – interpersonal process – interpersonal process – human to human relationship(both for – human to human relationship(both for

mentally healthy and illmentally healthy and ill

Community Mental Health Community Mental Health Services Services

1- curativecurative services as hospital and communitycommunity care.

2- preventive services preventive services as Church, Family, Home, Friends, Work.

Feedback questionsFeedback questions

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