PSYCHIATRIC NURSING Concept of Mental Health and illness

1. PSYCHIATRIC NURSINGConcept of Mental Health and illness Dr. Naiema Gaber Elsayed

2. Lecture objectives • Define Mental Health • Define Mental Illness and Identify the Population at Risk • Define Psychiatric Nursing • Determine the Nurse’s Role in Psychiatric Nursing • Identify the Common terminology used in psychiatric and mental therapy

3. 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.”

4. Mental Health/Illness Continuum Stress Mental Health Mental Illness ADAPTIVE MALADAPTIVE Healthy NeurosisPsychosis * Reality Oriented *Denies Reality *Positive self-concept *Emotional stable

5. 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

6. 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.

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

8. 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 impairment of functions that arises from various causes such as psychological, neurobiological and genetic factors

9. 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

10. Factors Affecting Mental Health • Mastering the Environment • Reality orientation • Stress Management • Maximizing One’s Potential • Autonomy and Independence • Tolerating One’s Uncertainties • Self-esteem “MRS MATS”

11. The Classification of Mental Illness:The 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

12. Etiology mental illness Drug Abuse Alcohol,Heroin etc Inheritance-Genetics/Intra-uterine environment Schizophrenia,Huntington’s Upbringing Mothering,education,parenting Neurological diseases MS,Braintumour Trauma/head injury Biochemistry/metabolic Porphyria,Diabetes Infections-HIV,Syphilis,CJD Vascular-CVA Nutrition/PCM

13. 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.

14. 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 individual’s psychological, social, and occupational functioning on the GAF Scale

15. Population at Risk for Mental Illness • Familiar or genetic predisposition to mental illness • Poor access to health care • Misusing substance • Undergoing lifestyle changes • Victims of violence • Elderly poor

16. Community Mental Health Services

17. Treatment and Care Hospital Care Community Care

18. Preventive NetworksChurch, Family, Home, Friends, Work

19. 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

20. What do psychiatric nurses do? • Ensure safety and security • Care for biophysical needs • ADL’s • Nutrition, exercise • Medication management • Assist in creating a healthy social world • increase self-awareness by: * Discussion, *Experience * Role play

21. 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

22. Common terminology used in psychiatric and mental therapy

23. 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 person’s resources as coping mechanisms • Adaptation – process of interacting with the environment to maintain homeostatic equilibrium • Maladaptation – ineffective coping

24. Dynamics of Human Behavior cont. • Personality – integration of systems and habits representing an individuals characteristic and adjustment to his environment expressed through behavior

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

26. 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

27. Behavior The Parent SUPER-EGO EGO The Adult ID The Child

28. The Subconscious Mind The Conscious The Subconscious

29. 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

30. 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

31. 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,rigidlyheld • Delusions of grandeur- special /important in a way • Persecutory-threatened

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

33. 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.

34. Depersonalization – feeling of strangeness • from one’s self Common. • Derealization – feeling of strangeness towards environment. • Agnosia– lack of sensory stimuli integration • examples of affect are sadness, fear, joy, and anger.

35. 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

36. 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

37. 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

38. 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

39. Community Mental Health Services 1- curative services as hospital and community care. 2- preventive services as Church, Family, Home, Friends, Work.

40. Feedback questions