1. Lecture 1 Community and Mental Health Nursing-NUR 472 Mental Health and Mental Illness

2. Introduction

3. Maslow's Hierarchy of Needs

4. Mental Health  A dynamic process in which a person’s physical, cognitive, affective, behavioral and social dimensions interact functionally with one another and with the environment.

5. Mental Health  “ The successful adaptation to stressors from the internal or external environment, evidenced by thoughts, feelings, and behaviors that are age-appropriate and congruent with local and cultural norms. ”

6. Mental Illness  Physical, cognitive, affective, behavioral and social patterns that interact dysfunctionally with the environment.

7. Mental Illness  “ Maladaptive responses to stressors from the internal or external environment, evidenced by thoughts, feelings, and behaviors that are incongruent with the local and cultural norms and interfere with the individual ’ s social, occupational, or physical functioning. ”

8. PHYSICAL AND PSYCHOLOGIAL RESPONSES TO STRESS

9. Physical Responses  Stress: is “ Any factor that threatens the health of the body or has an adverse effect on its functioning such as injury, disease or worry. ”

10. Physical Responses (cont.)  General Adaptation Syndrome GAS, is a term used to describe the body's short-term and long-term reactions to stress  Alarm reaction stage  Stage of resistance  Stage of exhaustion

11. General adaptation syndrome  Alarm reaction stage Is the immediate reaction to a stressor. In the initial phase of stress, humans exhibit a "fight or flight" response, which prepares the body for physical activity. However, this initial response can also decrease the effectiveness of the immune system, making persons more susceptible to illness during this phase.

12. General adaptation syndrome  Stage of resistance During this phase, if the stress continues, the body adapts to the stressors it is exposed to. Changes at many levels take place in order to reduce the effect of the stressor.

13. General adaptation syndrome  Stage of exhaustion The stress has continued for some time. The body's resistance to the stress may gradually be reduced, or may collapse quickly. Generally, this means the immune system, and the body's ability to resist disease, may be almost totally eliminated. Patients who experience long-term stress may succumb to heart attacks or severe infection due to their reduced immunity.

14. Psychological Responses  Anxiety and grief have been described as two major, primary psychological response patterns to stress.

15. Psychological Responses (cont.) Anxiety  A diffuse apprehension that is vague in nature and is associated with feelings of uncertainty and helplessness  Extremely common in our society  Mild anxiety is adaptive and can provide motivation for survival

16. Psychological Responses (cont.)  Four levels of anxiety  Mild - seldom a problem  Moderate - perceptual field diminishes  Severe - perceptual field is so diminished that concentration centers on one detail only or on many extraneous details  Panic - the most intense state

17. Psychological Responses (cont.)  Behavioral adaptation responses to anxiety:  At the mild level, individuals employ various coping mechanisms to deal with stress. A few of these include eating, drinking, sleeping, physical exercise, smoking, crying, laughing, and talking to persons with whom they feel comfortable.

18. Psychological Responses (cont.)  At the moderate level, the defense mechanisms for protection, such as  Rationalization  Reaction formation: Is a defense mechanism in which anxiety-producing or unacceptable emotions and impulses are mastered by exaggeration (hypertrophy) of the directly opposing tendency  Undoing  Denial  Isolation

19. Psychological Responses (cont.)  Anxiety at the severe level that remains unresolved over an extended period can contribute to a number of physiological disorders--for example, migraine headaches, irritable bowel syndrome, and cardiac arrhythmias.  Extended periods of repressed severe anxiety can result in psychoneurotic patterns of behaving--for example, anxiety disorders and somatoform disorders.

20. Psychological Responses (cont.)  Extended periods of functioning at the panic level of anxiety may result in psychotic behavior; for example, schizophrenic, schizoaffective, and delusional disorders.

21. Psychological Responses (cont.) Grief  The subjective state of emotional, physical, and social responses to the loss of a valued entity; the loss may be real or perceived.

22. Psychological Responses (cont.)  (5 Stages of Grief)  Denial  Anger: Sometimes a small part of anger stays with you throughout the entire illness.  Fear: This is the most important stage to work through  Depression: can cause feelings of inadequacy and lead to withdrawal and isolation.  Acceptance Not everyone goes through these stages in the same order.

23. Psychological Responses (cont.)  Anticipatory grief - The experiencing of the grief process before the actual loss occurs. -Anticipatory grieving is thought to shorten the grief response when the loss actually occurs.  Resolution - Length of the grief process is entirely individual. It can last from a few weeks to years.  Guilt often lengthens the grieving process.

24. Psychological Responses (cont.)  Maladaptive grief responses  Prolonged response  Delayed/inhibited response: the intentional postponement of grief. Sometime this is related to other life events or losses that drain ones ability to work through the grief process.  Distorted response: hostility towards a specific person, and the taking of actions that are self- destructive.

25. DSM-IV-TR Multiaxial Evaluation System  Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision, also known as DSM-IV-TR, is a manual published by the American Psychiatric Association (APA) that includes all currently recognized mental health disorders.

26. DSM-IV-TR Multiaxial Evaluation System  Axis I - Clinical disorders and other conditions that may be a focus of clinical attention. This is the top-level diagnosis that usually represents the acute symptoms that need treatment  Axis II - Personality disorders and mental Retardation (These disorders are usually life- long problems that first arise in childhood)

27. DSM-IV-TR Multiaxial Evaluation System  Axis III - General medical or neurological conditions that may influence a psychiatric problem. For example, diabetes might cause extreme fatigue which may lead to a depressive episode  Axis IV - Psychosocial and environmental problems (identifies recent psychosocial stressors - a death of a loved one, divorce, losing a job, etc.)

28. DSM-IV-TR Multiaxial Evaluation System  Axis V - Identifies the patient's level of function on a scale of 0-100, (100 is top-level functioning). Known as the Global Assessment of Functioning (GAF) Scale, it attempts to quantify a patient's ability to function in daily life