1. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 01Mental Health and Mental Illness

2. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Mental Health Defined Complete state of health when physical, mental, and social well-being are intact Mentally healthy have the ability to adapt to stressors in an acceptable way A “state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community” (NIMH, 2004)

3. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Mental Illness Defined DSM-IV-TR: “clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with present distress (e.g., a painful symptom) or disability (impairment in one or more important areas of functioning)” Unable to carry out daily necessities (cooking, bathing, dressing, etc.)

4. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Cultural, Ethnic, and Religious Influences Cultures provide variances in perceiving, coping with, and managing mental health issues Examples –Turn to faith healers –Deny that a problem exists –View symptoms as punishment for wrongdoing What makes up a culture?

5. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Culture Common heritage and a set of beliefs, norms, values, and behaviors that are unique to each Cultural identity –Common language –Family customs –Country of origin –Religious and political beliefs –Sexual orientation –Gender

6. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Other Beliefs Mental symptoms are related to: witchcraft, demon possessions, or substance abuse –Can be eliminated by remedies such as folk customs, magic, traditional medicines, herbs

7. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Defining Stress A condition that results when a threat or challenge to our well-being requires us to adapt or make an adjustment –Distress Response to a threat or challenge – harmful to one’s health –Eustress Positive and motivating, shows confidence in the ability to master a challenge or stressor –“Fight or flight” response

8. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Fight-or-Flight Response Surge of adrenal hormone epinephrine or adrenalin into the bloodstream. Provides energy or instant strength to either fight or run away from a danger or threat Usually reversed to relaxation when the danger has past

9. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Common Signs & Symptoms of Stress Physical Symptoms –^ HR, BP, Resp, palpitations, Abdominal Cramping, N/V, Diarrhea, Headaches, Insomnia Mental Symptoms –Lack of concentration and memory, inability to make decisions, forgetfulness, confusion Emotional Symptoms –Anxiety, Nervousness, Irritability, Frustration and worry Behavioral Symptoms –Fidgeting, Nail-biting, Smoking/Drinking, Yelling, Violence

10. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Defining Anxiety Built-in response to a real or perceived threat to our well-being A feeling of apprehension, uneasiness, or uncertainty that occurs in response to a real or perceived threat of an unknown source Four levelsPg. 6 Table 1.3 –Mild - Motivated –Moderate – Decreased Attentiveness –Severe – Loses sight of whole picture –Panic – Unaware of reality

11. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Contributing Factors to Stress and Anxiety External stressorsPg. 7 Box 1.2 –Adverse aspects of the environment –Abusive relationship, poverty-level living conditions Internal stressors –Physical Chronic illness or terminal condition –Psychological Continued worry about financial burdens or disasters

12. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Effect of Stress on Self Continued stress can eventually pose as a threat to one’s health We view external circumstances as the cause of our stress, but in reality, we create most of our own stress by choosing to make ourselves miserable and upset Anticipating the worst possible outcome for situations

13. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Coping with Stress and Anxiety Four categories: adaptive, palliative, maladaptive, and dysfunctional. Positive outcome –Adaptive coping – successful management –Palliative coping – recurrent stressors Negative outcome –Maladaptive coping – unsuccessful attempts made –Dysfunctional coping – no attempt to solve problem Discuss examples of both types of coping mechanisms

14. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Adaptive Coping Strategies Reframing (restructuring thinking)Pg. 8 Table 1.4 Positive self-talk, humor Assertiveness training Problem-solving and communication skills Relaxation techniques, self-care Support systems Faith in spiritual power and in yourself

15. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Psychological Crisis A state of disorganization during which time usual coping strategies fail Total inability to control the situation and to function in daily activities Individual feels helpless and lost May result from –Unrealistic perception of a threatening event –Lack of a support system –Inadequate coping ability

16. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Crisis Intervention Deal with the present situation; early intervention is best Reduce anxiety level Help client define the problem Determine available support Help client set realistic goals for resolution Provide support and reassurance Provide for client’s safety and security

17. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Case Application 1.1 Pg. 10 How does Nathan’s problem demonstrate a crisis situation? What is the first step of the interventions to help Nathan?

18. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Grief and Loss Griefan emotional process of coping with a loss –May leave the person with a sense of emptiness, hopelessness, and detachment from the meaning that was previously found in life Lossan actual/perceived change of relationship with lost person or object

19. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Types of Grief Anticipatory grief –When expecting a loss in the near future Conventional grief –Following a loss –Bereavement – adapting to a loss May take days, weeks, years Age-related concepts of loss –Pg. 11 Table 1.5

20. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Stages of Grief (Kubler-Ross) Shock and denial –Want to avoid reality of the loss and act as if nothing has occurred or as though the lost object/person is still present Anger and pain –Crying, expressions of self-blame, or guilt Negotiation and bargaining –Attempt to postpone acceptance of loss Withdrawal and depression – extends beyond 2 weeks Acceptance and resolution

21. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Dysfunctional Grief Failure to cope successfully with loss –Chronic sorrow –Contributing factors to unresolved grief Socially unacceptable death Missing person Multiple losses Ambivalent feelings toward the lost person Guilt

22. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Case Application 1.2 Pg. 14 What feelings might be responsible for Art’s symptoms? How should the nurse respond to Art? What stage of the grief process is Art likely experiencing? What referrals may be appropriate for Art?

23. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Defining Anger An emotion triggered in response to threats, insulting situations, or anything that hampers the intended action of an individual May be directed at an individual, group, or self Builds into bitterness People who are easily frustrated and angered usually hae a history of being irritable, touchy, and quick-tempered from an early age.

24. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Defining Violence and Abuse Violencean intense feeling toward an individual that starts with verbal or physical threats and assaults that victimize the person Abusecompelling destructive action against an individual against his or her will –May be physical, sexual, verbal, emotional, or neglectful

25. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Managing Anger Recognize the origin of emotional response –Allows us to be in touch with why we respond as we do Engage in physical activity –Energy is utilized constructively Stand up for rights, beliefs, or values –Assertiveness – respect for oneself Talk with someone who will listen Learn to forgive

26. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Tell whether the following statement is true or false. Stress can help people function at optimal levels.

27. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer True Rationale: Stress is a part of everyday living. Mild stress can motivate and propel people toward accomplishment and success.

28. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Grief that comes when one is expecting a loss in the near future is called A. Conventional grief B. Dysfunctional grief C. Anticipatory grief D. Chronic sorrow

29. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer C. Anticipatory grief Rationale: Anticipatory grief is a response in individuals or families that occurs when a loss is expected in the near future. It can be a helpful concept for nurses working with terminally ill patients and patients who are anticipating the loss of a body part or a change in body functioning.

30. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Question According to Dr. Kubler-Ross, which stage is the first step of the grieving process? A. Anger B. Denial C. Acceptance D. Bargaining

31. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer B. Denial Rationale: In the first stage of grief, a person who has experienced a loss wants to avoid the reality of it and may act as if nothing happened. Denial allows a person time to gather coping strategies for the grieving process ahead.

32. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins