Principles and Concepts of Mental Health Nursing

Health is a state of complete physical, mental, social and spiritual well-being and not merely the absence
of disease or infirmity. Both physical and mental healths are interdependent. A nurse who is responsible
for total health care of a person must take care of both physical and emotional needs; therefore she should
develop a basic understanding and skill in psychiatric nursing to achieve total health care.
PSYCHIATRY
It is a branch of medicine that deals with the diagnosis, treatment and prevention of mental illness.
PSYCHIATRIC NURSING
According to American Nurses Association, 1994:
It is a specialized area of nursing practice, employing theories of human behavior as it is a science, and
the purposeful use of self as it is an art, in the diagnosis and treatment of human responses to actual or
potential mental health
problems. Thus psychiatric nursing deals with the
promotion ofmental health, prevention of mental
illness, care and rehabilitation of mentally ill individuals both in hospital and community.
Mental health nursing is concerned with the prevention, treatment and nursing care of people of
all ages who are suffering from mental illness and its effects. Despite steady and continuing
improvements in health care and living conditions in many countries of the world, extended life
expectancy and improved economic growth have brought an increase in the numbers of people who are
suffering from mental illness (WHO 1998).

CLASSIFICATION OF MENTAL DISORDERS

CLASSIFICATION OF MENTAL DISORDERS
Classification is a process by which complex
phenomena are organized into categories, classes
or ranks so as to bring together those things that
most resemble each other and to separate those
that differ.
Like any growing branch of medicine, psychiatry
has seen rapid changes in classification
to keep up with a conglomeration of growing
research data dealing with epidemiology, symptomatology,
prognostic factors, treatment methods
and new theories for causation of psychiatric
disorders.
At present there are two major classifications
in psychiatry, namely, ICDlO (1992)and DSMIV
(1994).
I. ICDlO (International Statistical Classification of
Disease and Related Health Problems) -1992
This is WHO's classification for all diseases and
related health problems. The chapter 'F' classifies
psychiatric disorders as mental and behavioral
disorders and codes them on an alphanumeric
system from FOOto F99.
The main categories in ICDlO
FOO-F09 Organic, including symptomatic,
mental disorders
FOO Dementia in Alzheimer's disease
FOl Vascular dementia
F04 Organic amnestic syndrome
FOS Delirium
F06 Other mental disorders due to brain
damage and dysfunction and to
physical disease
F07 Personality and behavioral disorders
due to brain disease, damage and
dysfunction
F10-Fl9 Mental and behavior disorders due
to psychoactive substance use
FlO Mental and behavioral disorders due
to use of alcohol
Fl 1 Mental and behavioral disorders due
to use of opioids
F12 Mental and behavioral disorders due
to use of cannabinoids
F13
F14
Fl6
F20-F29
F20
F20.0
F20.1
F20.2
F20.3
F20.4
F20.5
F20.6
F21
F22
F23
F24
F25
F30-F39
F30
F31
F32
F33
F34
F40-F49
F40
F41
F42
F43
Mental and behavioral disorders due
to use of sedatives or hypnotics
Mental and behavioral disorders due
to use of cocaine
Mental and behavioral disorders due
to use of hallucinogens
Schizophrenia, schizotypal and
delusional disorders
Schizophrenia
paranoid schizophrenia
hebephrenic schizophrenia
catatonic schizophrenia
undifferentiated schizophrenia
post-schizophrenic depression
residual schizophrenia
simple schizophrenia
Schizotypal disorder
Persistent delusional disorders
Acute and transient psychotic disorders
Induced delusional disorders
Schizoaffective disorders
Mood (affective) disorders
Manic episode
Bipolar affective disorder
Depressive episode
Recurrent depressive disorder
Persistent mood disorder
Neurotic, stress-related and somatoform
disorders
Phobic anxiety disorders
Other anxiety disorders
Obsessive-compulsive disorder
Reaction to severe stress, and adjustment
disorders
Dissociative (conversion) disorders
Somatoform disorders
F44
F45
F50-F59 Behavioral syndromes associated
with physiological disturbances and
physical factors
FSO Eating disorders
F51 Non-organic sleep disorders
F52 Sexual dysfunction, not caused by
organic disorder or disease
F60-F69
F60
F60.0
F60.1
F60.2
F60.3
F60.4
F60.5
F60.6
F60.7
F61
F62
F63
F64
F65
F70-F79
F70
F71
F72
F73
F80-F89
F80
F81
F82
F83
F84
F90-F98
F90
F91
F93
F94
F95
Disorders of adult personality and
behavior
Specific personality disorders
paranoid personality disorder
schizoid personality disorder
dissocial personality disorder
emotionally unstable personality disorder
histrionic personality disorder
anankastic personality disorder
anxious personality disorder
dependent personality disorder
Mixed and other personality disorders
Enduring personality changes, not
attributable to brain damage and
disease
Habit and impulse disorders
Gender identity disorders
Disorders of sexual preference
Mental retardation
Mild mental retardation
Moderate mental retardation
Severe mental retardation
Profound mental retardation
Disorders of psychological development
Specific developmental disorders of
speech and language
Specific developmental disorders of
scholastic skills
Specific developmental disorder of
motor function
Mixed specific developmental disorders
Pervasive developmental disorders
Behavioral and emotional disorders
with onset usually occurring in childhood
and adolescence
Hyperkinetic disorders
Conduct disorders
Emotional disorders with onset specific
to childhood
Disorders of social functioning with
onset specificto childhood and adolescence
Tic disorders
F98 Other behavioral and emotional disorders
with onset usually occurring in
childhood and adolescence
F99 Unspecified mental disorder

II. DSMIV (Diagnostic and Statistical Manual)-1994

This is the classification of mental disorders by
the American Psychiatric Association (APA). The
pattern adopted by DSM IV is of multiaxial
systems.
A multiaxial system that evaluates patients
along several versatiles contains five axes. Axis I
and II make up the entire classification which
contains more than 300 specific disorders.
The five axes of DSM IV are
AXISI: Clinical psychiatric diagnosis
This includes all
mental disorders (except personality disorders and
mental retardation).
AXISII: Personality disorder and mental retar
Dation.
These disorders usually begin in childhood or adolescence
and persist in a stable form into adult life.
AXISIII:General medical conditions
These include any current general medical condition that is potentially relevant to the understanding or
management of the individual’s mental disorder.
AXISIV:Psychosocial and environmental problems
These are problems that may affect the diagnosis, treatment, and prognosis of mental disorders named on
axes I and II. These include problems related to primary support group, social environment, education,
occupation, housing, economics, access to health care services, interaction with the legal system or crime,
and other types of psychosocial and environmental problems.
AXISV: Global assessment of functioning in current and past one year.
This
allows the clinician to rate the individual’s overall
functioning on the Global Assessment of Functioning
(GAF) Scale. This scale represents in global terms a
single measure of the individual’s psychological, social, and occupational functioning.
Ill. Indian Classification
In India Neki (1963),Wig and Singer (1967),Vahia
(1961) and Varma (1971)have attempted some modifications of ICD8 to suit Indian conditions.
They are broadly grouped as follows:
A. Psychosis
j,
Functional Affective
a. Schizophrenia a. Mania
Simple schizophrenia b. Depression
Hebephrenic schizophrenia
Catatonic schizophrenia
Paranoid schizophrenia
B. Neurosis
• Anxiety neurosis
• Depressive neurosis
• Hysterical neurosis
• Obsessive compulsive neurosis
• Phobic Neurosis
C. Special disorders
Childhood disorders
• conduct disorders
• emotional disorders
Personality disorders
• sociopath
• psychopath
Substance abuse
• alcohol abuse
• drugabuse
Psycho physiological disorders
• asthma
• psoriasis
Mental retardation
• Mild

PERSONALITY DEVELOPMENT
INTRODUCTION:
The word personality is derived from the Greek term
persona. It was used originally to describe the theatrical mask worn by some dramatic actors at the time.
DEFINITION OF PERSONALITY

"Personality refers to deeply ingrained patterns

- of behavior, which include the way one relates to,
perceives, and thinks about the environment and
one self".
'--American Psychiatric Association (APA) 1987

The totality of emotional and behavioral characteristicS

that are particular to a specific person and that remain somewhat stable and predictable over time.

PSYCHOSOCIAL FACTORS INFLUENCING

PERSONALITY
development occurs in response to a number
of biological and psychological influences, including
(but not limited to) heredity, temperament, experiential
learning, and social interaction.
I. Role of Heredity
At conception when the egg cell of the female is
fertilized by the sperm cell of the male, each new
human being receives a genetic inheritance that
provides potentialities for development and
behavioral traits throughout a lifetime.
The principal raw materials of personality -
physique, intelligence and temperament are the
result of heredity. How they will develop will
depend on environmental influences. Many
aspects of human behavior and development
ranging from physical characteristics such as
height, weight, eye and skin color, the complex
patterns of social and intellectual behavior, are
influenced by a person's genetic endowment.
II. Environmental Factors
1. Family
• Among environmental factors, the most
important is the family environment. The
reaction of the family environment towards
an individual, and the role ofparents, are very
important in the molding of personality.
Parents serve as a model whom the child
imitates, and their influence is considerable
on the child. Parents influence the development
of a child's personality in a wide variety
ofways. Children learn the moral values, code
of conduct, social norms and methods of
interacting with others from parents.
• On the whole friendly and tolerant fathers
help children to have greater emotional
stabilityand selfconfidence.Domineering and
rigid fathers will only foster the development
of submissive and frightened dependent
children.
• Over-protective mothers will influence
children in the direction of dependence and a
total disregard for others. Nagging mothers
will cause children to be shy, submissive and
emotionally unstable.
• Besides the role of the parents, the atmosphere
in the family is greatly influencing. A peaceful
and loving atmosphere results in children
being orderly, peace-loving and very affectionate.
Without undue strain they develop mature and pleasant personalities. In a family
where there is tension, constant quarrels and
incompatibility among parents, the child is
likely to develop strong feelings of insecurity
and inferiority.
• Birth order: This is another familial factor that
can have an important influence on
personality development. Every child has a
unique position in the family, such as the
eldest, youngest, second or third. Thisposition
has a definite influence on personality. The
eldest child is very often overburdened with
responsibility, hence he grows up to be very
independent, while the youngest being the
baby of the family is petted and spoilt. The
common view of an only child would be that
he will be pampered and spoilt.
2. Physique
An individual's size, strength and general
appearance determines to a large extent the way
in which he behaves towards others and how
others react towards him. An individual with an
imposing body-build and a healthy appearance
definitely influences those around him. Even if
he has not proved himself,yet he gains recognition
and status through his physical appearance.
Contrary to this is the small lean person; even if
he has some merits, these are over-lookedbecause
of his physique. People are apt to judge him
according to his appearance.
3. Endocrine Glands
• The secretions of endocrine glands affect
physical growth, emotional growth and
mental growth. These will have an impact on
the total personality of an individual.
• The thyroid gland secretes a hormone called
thyroxin, and the main function of this
hormone is regulation of body metabolism. If
the thyroid gland is under-active, the result is
usually mental dullness, inactivity, depression,
fatigue and poor appetite. Hyper secretion
of these glands leads to extreme over-activity.
• The parathyroid gland regulates calcium
metabolism. Excitabilityof the nervous system
is directlydependent on the amount ofcalcium
in the blood. Deficient working of this gland
leads to the development of an irritable,
distracted, nervous and a tense person.
• Similarly other glands namely pituitary, the
adrenal and the gonads have their tremendous
impact on various personality traits.
30 A Guide to Mental Health and Psychiatric Nursing
mature and pleasant personalities. In a family
where there is tension, constant quarrels and
incompatibility among parents, the child is
likely to develop strong feelings of insecurity
and inferiority.
• Birth order: This is another familial factor that
can have an important influence on
personality development. Every child has a
unique position in the family, such as the
eldest, youngest, second or third. Thisposition
has a definite influence on personality. The
eldest child is very often overburdened with
responsibility, hence he grows up to be very
independent, while the youngest being the
baby of the family is petted and spoilt. The
common view of an only child would be that
he will be pampered and spoilt.
2. Physique
An individual's size, strength and general
appearance determines to a large extent the way
in which he behaves towards others and how
others react towards him. An individual with an
imposing body-build and a healthy appearance
definitely influences those around him. Even if
he has not proved himself,yet he gains recognition
and status through his physical appearance.
Contrary to this is the small lean person; even if
he has some merits, these are over-lookedbecause
of his physique. People are apt to judge him
according to his appearance.
3. EndocrineGlands
• The secretions of endocrine glands affect
physical growth, emotional growth and
mental growth. These will have an impact on
the total personality of an individual.
• The thyroid gland secretes a hormone called
thyroxin, and the main function of this
hormone is regulation ofbody metabolism. If
the thyroid gland is under-active, the result is
usually mental dullness, inactivity, depression,
fatigue and poor appetite. Hypersecretion
of these glands leads to extreme overactivity.
4. School
• The children spend much of their time in the
schools and hence it can play a very large part
in the formation of the personality of the child.
• Thefollowing factors ofschoolwill have direct
role on child personality:
• the friendships and acquaintances which
are made among the children themselves
• the type of curriculum in the schools,
which affects the habitual responses of
children
• well-furnished laboratories, adequate
playground, etc.
Anurturant school atmosphere that provides
for all-round development, consistency,
structure, warmth and responsiveness, can do
a great deal to help children develop a
favorable personality and cope with changing
life circumstances.
5. Teacher
A teacher is the most important person in the
school who can help in modifying children's
personalities. He is the most powerful source of
stimulation for the child. If he/she possesses
desirable personal and social modes or reactions,
he will inculcate them among his students. On
the other hand, effects of prejudicial treatment on
the part of teachers can make the child lose self-confidence
and develop low self-esteem.
6. Peer Group
Developmental psychologists believe that interactions
with peers are critical to many of the social skills and advances that occur during childhood.
Peer group refers to other children of the same
age who study with or play with the child. Peer
group is much more influential than siblings or
parents.
Even at preschool age, playmates are highly
influential. Children imitate peers and try to be
likethem in many respects. The peer group serves
as an important reference group in shaping
personality traits and characteristics of the
growing child. As the child grows up peers
become progressively more influential in molding
the child's self concept. Children learn many
forms ofbehavior, some socially appropriate and
others socially undesirable, from their peers.
For example, by striving to be accepted and
liked by their peers, they gain new insights into
the meaning of friendship. Through give and take
with peers, they learn the importance of sharing,
reciprocity and cooperation. Bytrying to get peers
to understand their thoughts and feelings, they
learn to communicate more effectively.Within the
peer group, children also learn sex-rolenorms. In
general, boys become rougher, boisterous, more
compulsive, and form larger groups, while girls
tend to formmore intimate,more exclusivegroups.
Feelings of masculine superiority, sex bias and
other attitudes and behavior develop with gender
identification.
7. Sibling Relationships
The number of siblings as well as their sex
and age has a considerable influence on the
development of both favorable and unfavorable
personality traits like cooperativeness, sharing,
aggressiveness, jealousy, etc. Although sibling
rivalry is common, older siblings invariably teach
the infant a great deal and they can even function
as a source of security. On the other hand,
unhealthy comparisons can also develop, for
instance, an athletic child who is favored by an
athletic father over a less active sibling, may suffer
from an inferiority complex or develop low self-esteem.
8. MassMedia
Mass media includes films, television, radio,
printed literature, etc. Mass media has a
considerable impact on attitudes, values, beliefs
and behavior patterns. Baron and Bryne (1986)
have shown that individuals, especially children,
imitate specific aggressive acts of models. They
have proposed that human personality formation
is a result of modeling and imitating the behavior
of significant others. Many abnormal forms of
behavior can be learned by imitating models from
the mass media.
9. Culture
Culture influences personality because every
culture has a set of ethical and moral values,
beliefs .and norms which considerably shapes
behavior. Cross-cultural studies have pointed out
the importance of cultural environment in
shaping our personality. Individuals of certain
cultures are more generous, open-hearted and
warm whereas individuals of some other cultures
are suspicious, introverted and self-centered. It
has also been found that certain cultural
communities are more prone to develop certain
abnormal behaviors as compared to others,
probably due to the influence of geographical,
dietary, hormonal or genetic influences within
the community.