1. PSYCHIATRIC NURSING Concept of Mental Health and illness
Dr. Naiema Gaber Elsayed
Overview:

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 Neurosis Psychosis
* 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. Mental Illness
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 depression The Psychoses (the patient is disorientated, deluded, and lacking in insight) e.g. Schizophrenia, puerperal psychosis The Dementias Progressive 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,Brain tumour
There are several well known factors which determine mental illness
Infections -Syphilis, HIV
Trauma-post head injury
Neoplasms-Brain tumours may present with personality change and mental distress
Genetics-Huntington’s chorea and dementia
Vascular-post stroke or intermittent arterial embolism
Drug abuse-Korsakoff’s psychosis in chronic alcoholics
but often there is no obvious cause
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
It is increasingly recognised that mental illness is a chronic and relapsing condition and that treatment may,in consequence be for months, years or even for life.
Previously many patients spent weary years in long-stay care-the mental asylums. They became institutionalised. There was no effective therapy and they were simply looked after in a simple routine, the worst of their symptoms often “burned out’ but by that time they had lost all contact with family, friends ,work etc.
Now many more patients can be cared for in the community after discharge from hospital. They may never need hospital admission or attend day hospital as part of therapy. Community care is expensive in the professional time and effort to look after patients in a social setting rather than an institution. There are more demands upon friends, family and social services but the results are much better. Long term medication, supervised therapy and intense rehabilitation all play their part.
Medication:Anti-depressants, anti-psychotics, anxiolytics, mood stabilisers
Electro-convulsive therapy (ECT)
Psychotherapy-individuala nd group,Psychoanalysis
Psychosurgery-Prefrontal leucotomy, temporal lobe surgery
Community Care

18. Preventive Networks Church, Family, Home, Friends, Work
Mental illness is preventable, mental illness can be effectively treated
The social networks are important in
Primary prevention;
Having a home, being married, having work, friends,beliefs
-a positive self image
Secondary prevention;
early diagnosis,effective treatment, community support
Tertiary prevention;
long term management and care in the community

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
Personality will be reflected in behaviour and predilection to a particular mental state.
E.g. Introvert/Extrovert
Practical men and Visionaries
Idle and industrious
Thinkers and Doers
It is possible to do a Personality inventory and classify human beings quite accurately into their predominant personality type and to predict their preferred mode of behaviour in a particular set of circumstances

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
Why do we behave as we do-the range of human behaviour from Ape to Angel?
Is this a consequence of our innate personality, the situation in which we are with its pressures for uniformity or expectation.(Doctors are expected to stay calm and assert authority in very frightening situations), or previous experience and our own free choice?
To what extent are we influenced by our subconscious mind and by the great stories, ideas and myths of the world? E.g. Good versus Evil
Sigmund Freud,( ) a man whose ideas still ring controversially and passionately round the world suggested that there are three components in our make -up.
The super-ego (The parent figure) the ideal behaviour we strive for, rational, kindly, moral,thoughtful, logical, just ,fair……..
The ego (The adult figure) reality, a bit messy, trying to make sense of things, sometimes doing evil by mistake when trying to do good, frail and making mistakes but trying again.
The Id (the child) the uncontrolled fun loving primitive, full of lusts and instincts, demanding instant gratification, selfish, poor attention span ID
The Child

28. The Subconscious Mind The Conscious The Subconscious
It is postulated that when confronted with stressful and painful situations or of deep feelings coming from the id of which we may feel deeply ashamed, we place /push these “off limits” thoughts and ideas into our subconscious in an attempt to forget not only about them but also that we have ever experienced them.
The subconscious mind and its feelings, ideas and problems may surface when we are confronted with a situation, which has resemblance, perhaps, to a previous unhappy and unresolved problem. This produces deep distress and sometimes further inappropriate behaviour. This may manifest in frank mental illness-depression, anxiety, delusion and psychosis
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. Verbigeration – meaningless repetition of words and phrases.
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. Delusion – persistent false belief,rigidly held
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,rigidly held
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 Familiar, genetic predisposition, Poverty
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

41. WHO Website http://www.who.int/whr/2001/main/en/contents.htm
World Health reports 2001
Mental health,New understanding, New hope