MODULE 1

Foundation of Psychiatric Nursing

Lesson 1 - Terminologies in Psychiatric Nursing
Mental Health - is a state of balance between the individual and the surrounding world,
a state of harmony between oneself and others, and a co- existence between the reality
of the self and that of the others.

Mental Illness - are clinically significant conditions characterized by alterations in

thinking, mood (emotions), behavior associated with personal distress and impaired
functioning.

Psychiatry - It is a branch of medicine that deals with the diagnosis, treatment and
prevention of mental illness.

Psychiatric Nursing - 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 .

Perception - is the meaningful organization of sensory data and their interpretation in

the light of one’s past experience.

Hyper aesthesia - Increased intensity of sensations, seen in intense emotions and

hypochondriacally (chronic anxiety) personalities. In hyper aesthesia sounds appear
louder, colors brighter, and pain unbearable.

Illusions - Misperceptions or misinterpretations of real external sensory stimuli: e.g.

Shadows may be misperceived as frightening figures. In a fading light rope is
misperceived as a snake.

Hallucinations - Perception in the absence of real external stimuli; experienced as true

perception coming from the external world (not within the mind). E.g. Hearing a voice of
someone when actually nobody is speaking within the hearing distance. (Causes:
Intense emotions, Suggestion, Disorders of sense organs, Sensory deprivation,
Disorders of CNS - epilepsy, Psychiatric disorders)

Auditory hallucinations (Voice, sound, noise) - is a form of hallucination that

involves perceiving sounds without auditory stimulus seen in Psychosis. Three types:
Elementary – noises, bells or undifferentiated whispers; in organic states: Partly
organized- music and completely organized- hallucinatory voices schizophrenia-
persecutory in nature

Types of auditory hallucination:

Second-person hallucinations - voice speaking to the person addressing him as
“you”.

Third-person hallucinations - voice talking about the person as “he” or “she”.

Thought echo - hearing one’s own thoughts being spoken aloud; the voice may come
from inside or outside the head.

Visual hallucination - is the seeing of things that are not there. (Elementary- flashes of
light:

Partly organized- patterns - Completely organized- people, animals, objects.)

Olfactory hallucinations - is the phenomenon of smelling odors that are not really
present. The most common odors are unpleasant smells such as rotting flesh, vomit,
urine, faces, smoke, etc.

Gustatory hallucination - is the perception of taste without a stimulus. Seen in

depression

Tactile hallucinations - Hallucination of touch or surface sensation. Three types:

superficial, kinesthetic (movement of body parts) and visceral (severe pain of separation
of internal organ, twitching etc.).

Formication (type of tactile hallucination) - is the sensation of insects crawling

underneath the skin and is frequently associated with prolonged cocaine use.

Somatic Hallucination - False sensation of things occurring / moving in or to the body,

most often visceral in origin.

Imperative hallucination - Voices giving instructions to patients, who may or may not
feel obliged to carry them out.

Command / commentary hallucinations - The subject hears voices that comment on,
command, or describe the subject's actions or behavior. The person feels obliged to
obey.

Lilliputian hallucinations - A type of visual hallucination. Commonly seen in certain

neurological diseases. Here the object appears either smaller or larger than they
actually are. (micropsia, macropsia). It is seen in Alice in wonderland syndrome.

Scenic hallucinations - hallucinations in which whole scenes are hallucinated like a

cinema film; more common in psychiatric disorders associated with epilepsy. Type of
visual hallucination.
Autoscopy (phantom mirror image) - The person sees himself and knows that it is he.
Sometimes seen in normal subjects when they are depressed or emotionally disturbed.
Commonly seen in borderline disorders and psychosis.

Negative Autoscopy - the patient looks in the mirror and sees no image; in organic
states. Although the sufferer's image may be seen by others, he or she claims not to
see it.

Internal Autoscopy - the subject sees his own internal organs.

Extracampine hallucinations - a hallucination which is outside the limits of the sensory

field. They are hallucinations beyond the possible sensory field. e.g., 'seeing' somebody
standing behind you.

Hypnagogic hallucinations - hallucinations when falling asleep. Hypnopompic

hallucinations: hallucinations when waking from sleep. It can be any type such as
auditory, visual etc.

Mood congruent hallucination - Hallucination in which content is consistent with either

a depressed or manic mood.

Mood incongruent hallucination - Hallucination in which content is not consistent with

either a depressed or manic mood. eg. Depressed voices in depression, self-inflated
worth or power in mania.

Pseudo hallucination - seen in Attention seeking personalities, hysteria.

Derealisation - A subjective sense that the environment is strange and unreal.

Depersonalization - a person’s subjective sense of being unreal, strange and

unfamiliar.

Abnormalities of Possession of thought. (Source of water)

Abnormalities in the stream of thought. (Flow of river)

Abnormalities in the content of thought. (Water, mud etc.)

Abnormalities of Form of thought. (Liquid form of water)

Obsessions - Repetitive ideas, images, feelings or urges insistently entering person’s

mind despite resistance. They are unwanted, distressful and recognized as senseless
and irrational. Obsessions are frequently followed by compelling actions (compulsions).
Common obsessional Contents - dirt/ contamination / cleaning, orderliness,
doubts/checking/counting, aggressive impulses/inappropriate acts, Ruminations:
internal debates in which arguments for and against even the simplest everyday actions
.
Thought alienation - Thoughts are under the control of outside forces and are
participating in it. The types of alienation are;

Thought Insertion - Delusion that some of person’s thoughts being put into the mind by
an external force (other people, certain agency) and these thoughts are recognized as
foreign.

Thought Withdrawal - Delusion that some of person’s thoughts being taken out of the
mind against his will by outside forces. Usually associated with thought blocking. The
experience is passive.

Thought Broadcasting - Delusion that others can read or hear the person’s thoughts,
as they are broadcast over the air, radio or some other unusual way. The experience is
passive.

Dysmorphophobia - A type of overvalued idea where the patient believes one aspect
of his body is abnormal/deformed or imperfect. It is also called as Body dysmorphic
disorder (BDD)

Volubility - abundant or pressured talking. Seen in mania (tachylogia (excessive

speech), verbomania (use of more words)

Flight of ideas -The thoughts follow each other rapidly and there is no general direction
of thinking, seen in mania /excited schizophrenics. Flight of ideas describes excessive
speech at a rapid rate that involves fragmented or unrelated ideas. It is common in
mania. It has also been described in schizophrenia and ADHD.

Pressure of thoughts - Rapid abundant varying thoughts associated with pressure of

speech and flight of ideas.

Poverty of thoughts - Few, slow, unvaried thoughts associated with poverty of speech.
Thought block: Sudden cessation of thought flow with complete emptying of the mind
not caused by an external influence.

Circumstantiality - A pattern of thinking and communication that is demonstrated by

the speaker’s inclusion of many irrelevant and unnecessary details in his speech before
he is able to come to the point. Seen in epileptic personality, obsessional personality
and dementia.

Derailment - Direction of thought is lost and the thought goes away from the intended
theme.
 Tangentiality - It is a form of derailment. Replying to a question in an oblique,
tangential or even irrelevant manner. Wandering from the topic and never returning to it
or providing the information requested. E.g. In answer to the question "Where are you
from?” a response "My dog is from England. They have good fish and chips there. Fish
breathe through gills. “

Thought blocking (thought derivation, snapping off) - sudden arrest of train of

thoughts leaving a “blank”. A new thought may begin after the pause. With no recall of
what was being said or going to be said. Seen in F-20, also in anxious or exhausted
states.

Preservation - It is the repetition of a particular response (such as a word, phrase, or

gesture) regardless of the absence or cessation of a stimulus. It is usually caused by a
brain injury or other organic disorder.

Overvalued Ideas - abnormal beliefs, unique to the individual which dominates his life.
Worry- subjective sense of tension or uneasiness.

Phobias - persistent, pathological, unrealistic fear of an object, situation

Somatic symptoms - bodily complains which are varied in anatomical location and are
usually are not associated with any pathology

Religious preoccupation - seen in OCD

Excessive day dreaming - Schizotypal personality (odd and eccentric people with less
relationship)

Homicidal Ideas-F-20, ASP (Anti-social personality)

Philosophical and Magical ideas

Depressive cognition - ideas of worthlessness, helplessness, hopelessness

Suicidal ideas DSH (Deliberate self-harm)

Inflated self-esteem - mania, narcissistic personality (excessive self-admiration,

disregard for others' feelings etc.)

Delusions - Fixed false beliefs which are not shared by others, are out of keeping with
one’s educational, social and cultural background and are unshakable in the face of
evidence to the contrary.

Primary Delusion - (Autochthonous Delusion) - That which appear suddenly and with
full conviction, but without any previous events leading up to it. Seen in Schizophrenia.
Secondary Delusions - Derived from preceding morbid experience.

Delusional Mood - The experience of change of mood often with anxiety prior to
delusion.

Delusional Perception - in the initial stage of delusion the person make new
perceptions with familiar stimuli such as doubting familiar situations.

Grandiose delusion - Delusion of exaggerated self-importance, power or identity.

Persecutory (paranoid) delusion - Delusion of being persecuted (cheated, mistreated,

etc.)

Delusion of Control/influence - The thoughts, feelings of the patient is controlled by

external forces.

Delusion of jealousy/infidelity - Delusion that a loved person (wife/husband) is

unfaithful (infidelity delusion)

Delusion of Guilt/self-accusation - belief that one is sinner and responsible for the
ruin of family of someone else.

Somatic Delusion - Belief involving functioning of the body. E.g. my brain is melting.

Nihilistic delusion - Delusion of nonexistence of self, part of the body, belongings,

others or the world. Seen in major depression.

Delusion of reference - Delusion that some events and others behavior refer to
oneself.

Delusions of love (‘fantasy lover’, ‘erotomania’) - Delusion that someone, (usually

inaccessible, high social class person) is deeply in love with the patient.
Somatic Passivity: Passive recipient of bodily sensations imposed from outside forces.

Passivity phenomena - also may occur as part of delusions such as our impulses,
actions and feelings are controlled by some external force. Connected with somatic
hallucination.

Delusions of Replacement (Capgras Syndrome) - a belief that important people in

one's life have been replaced by impostors.

Mood-Congruent Delusion - Delusional content has association to mood: - in

depressed mood: delusion of self - accusation.

Mood-Incongruent Delusions - Delusional content has no association to mood, e.g.

patient with elevated mood has delusion of thought insertion.
Systematized Delusion - Delusion united by a single event or theme e.g. delusion of
jealousy/thematically well connected with each other.

Bizarre Delusion - Totally odd and strange delusional belief, e.g. delusion that person’s
acts are controlled by stars.

Loosening of Association - (Loose Association) a thought disorder in which series of

ideas are presented with loosely connected. A manifestation of a thought disorder
whereby the patient's responses to the interviewer's questions are not logically
connected to those that occur before or after. Example: I sang out for my mother ……
for this to hell I went…how long road…is

Neologism - Use of newly coined term, word, or phrase that has not yet been accepted
into mainstream language. E.g. what do you know about him?

Autistic thinking - Thinking not in accordance with consensus reality and emphasizes
preoccupation with inner experience.

Verbigeration - senseless repetition of some words or phrases over and over again.
Peter paid plenty for piping. Plenty for piping paid Peter.”

Word Salad - Meaningless and incoherent mixture of words of phrases. Eg. “It was
shockingly not of the best quality I have known all such evildoers coming out of doors
with the best of intentions!”

Feeling - A positive or negative reaction to some experience

Emotion - A stirred up state due to physiological changes which occurs as a response

to some event and which tends to maintain or abolish the causative event.

Mood - The pervasive feeling tone which is sustained (lasts for a length of time) and
colors the total experience of the person.

Affect - The outward objective expression of the immediate cross sectional emotion at a
given time.

Euthymia - A normal mood state, neither depressed nor manic.

Perplexity - A state of puzzled bewilderment.

Anxiety - Feeling of apprehension accompanied by autonomic symptoms (such as

muscles tension, perspiration and tachycardia), caused by anticipation of danger.

Free-floating anxiety - Diffuse, unfocused anxiety, not attached to a specific danger.

Fear - Anxiety caused by realistic consciously recognized danger.

Panic - Acute, self-limiting, episodic intense attack of anxiety associated with

overwhelming dread and autonomic symptoms.

Phobia - irrational exaggerated fear and avoidance of a specific object, situation or

activity.

Agoraphobia - patients rigidly avoids situations in which it would be difficult to obtain

help.

Social phobia - Intense and excessive fear of being observed by other people E.g:
eating or drinking in public or talking to the other member of sex.

Specific phobia - irrational fear of a specific object or stimulus.

Acrophobia - fear of heights.

Arachnophobia - fear of spiders.

Claustrophobia - fear of closed spaces.

Gamophobia - fear of marriage.

Hemophobia / Haematophobia - fear of blood.

Zoophobia - fear of animals.

Insectophobia - Fear of insects.

Hydrophobia - fear of water.

Astraphobia - fear of thunderstorms.

Agitation - severe feeling of inner tension associated with motor restlessness.

Irritable mood - easily annoyed and provoked to anger.

Dysphoria - mixture feelings of sadness and apprehension.

Depressed mood - feeling of sadness, pessimism and a sense of loneliness.

Anhedonia - lack of pleasure in acts which are normally pleasurable. Eg. Games,
watching movies etc.
Diurnal variation - a variation in the severity of symptoms (mood) depending on the
time of the day.

Grief - Subjective feeling of loss. Sadness appropriate to a real loss (e.g. death of a
relative)

Guilt - unpleasant emotion secondary to doing what is perceived as wrong.

Shame: unpleasant emotion secondary to failure to live up to self-expectations.

Ambivalent Mood - coexistence of two opposing emotional tones towards the same
object in the same person at the same time.

Alexithymia - inability to, or difficulty in, expressing one’s own emotions.

Elevated Mood - a mood more cheerful than usual. The types are as follows;

Euphoria (Stage I) - mild elevation in which feeling of elevated mood with optimism and
self-satisfaction not keeping with ongoing events. Usually seen in hypomania.

Elation (stage II) - (Moderate elevation) – a feeling of confidence and enjoyment, along
with increased Positive mental attitude (PMA). –a feature of manic illness.

Exaltation (stage III) - (severe elevation): intense elation with delusions of grandeur,
seen in severe mania.

Ecstasy (Stage IV) - (very severe elevation): a sense of extreme well-being associated
with a feeling of rapture, bliss and grace. Typically seen in delirious and stuporous
mania.

Expansive Mood - expression of euphoria with an overestimation of self-importance.

Grandiosity - feeling and thinking of great importance (in identity or ability).

Constricted Affect - significant reduction in the normal emotional responses.

Flat affect - absence of emotional expression.

Apathy - lack of emotion, interest or concern, associated with detachment.

Labile Affect - rapid, abrupt changes in emotions in the same setting, unrelated to
external stimuli.

La Belle Indifference - A condition in which the person is unconcerned with symptoms

caused by a conversion disorder. Lack of emotion or concern for the perceptions by
others of one's disability, usually seen in persons with conversion disorder.
Inappropriate Affect - disharmony between emotions and the idea, thought, or speech,
accompanying it.

Cyclothymia - There is cyclical mood variation to a lesser degree than in bipolar

disorder.

Dysthymia - Mild chronic depression.

Echolalia - Meaningless imitation of words or phrases made by others.

Verbigeration - Repetition of words of phases while unable to articulate the next word
in the sentence. Similar to preservation but no significance of stimuli.

Pressure of Speech - rapid, uninterrupted speech that is increased in amount.

Tendency to speak rapidly and frenziedly.

Mutism - inability to speak.

Elective Mutism - refusal to speak in certain circumstances.

Poverty of Speech - restricted amount of speech.

Stuttering (Stammering) - frequent repetition or prolongation of a sound or syllable,

leading to markedly impaired speech fluency.

Cluttering - dysrhythmic rapid and jerky speech.

Clang Associations (Rhyming) - association of word similar in sound but not in

meaning (e.g. That boat hope floats” or “The train brain rained on me.)

Word Salad - incoherent mixture of words and phrases.

Dysphasia - impairment in producing or understanding speech.

Dysarthria - difficulty in articulation (production of appropriate sound) and speech

production.

Sensory Aphasia - nonsensical fluent speech due to damage to Wernicke’s area (a

part of cerebral cortex that deals with sensory speech processing such as
comprehension).

Motor Aphasia - impairment in the ability to formulate fluent speech due to lesion
affecting Broca’s area (a part of cerebral cortex that deals with motor speech
processing).
Coprolalia - forced vocalization/repetition of obscene words or phrases.

Palilalia - is characterized by the repetition of a word or phrase; i.e., the subject

continues to repeat a word or phrase after once having said. It is a perseveratory
phenomenon.

Alogia - lack of speech output.

Psychomotor Retardation - Slowed mental and motor activities.

Stupor - A state in which a person does not react to the surroundings: (mute, immobile
and unresponsive).

Catatonic Stupor - Stupor with rigid posturing.

Psychomotor Agitation - Restlessness with psychological tension. (Patient is not fully

aware of restlessness.)

Catatonic Excitement - Marked agitation, impulsivity and aggression without external

provocation.

Chorea - sudden involuntary movement of several muscle groups with the resultant
action appearing like part of voluntary movement.

Aggression - Verbal or physical hostile behavior, with rage and anger.

Akathisia - Inability to keep sitting still, due to a compelling subjective feeling of

restlessness.

Dyskinesia - Restless movement of group of muscles (face, neck, hands).

Dystonia - Painful severe muscle spasm.

Torticollis - Contraction of neck muscles.

Tics - Sudden repeated involuntary muscle twisting. E.g. repeated blinking, grimacing.

Compulsions - Compelling repeated irrational action associated with obsessions. E.g.

repeated hand washing.

Echopraxia - Imitative repetition of movement of somebody.

Stereotypies - Purposeless repetitive involuntary movements. E.g. Foot tapping, thigh

rocking.
Mannerism - Odd goal-directed movements. E.g. repeated hand movement resembling
a military salute.

Waxy Flexibility - Patient’s limbs may be moved like wax, holding position for long
period of time before returning to previous position. People allowing themselves to be
placed in postures by others, and then maintaining those postures for long periods even
if they are obviously uncomfortable. This occurs in catatonic schizophrenia.

Automatic obedience - the patient carries out every instruction regardless of the
consequences. Perseveration: is a senseless repetition of a goal-directed action, a
particular response, such as a word, phrase, or gesture which has already served its
purpose (beyond their relevance).

Dyspraxia - inability to carryout complex motor tasks, although the component motor
movements are preserved.

Ambitendency - a motor symptom of schizophrenia in which there is an alternating

mixture of automatic obedience and negativism.

Trichotillomania - a condition characterized by an overwhelming urge to pluck out

specific hairs.

Pyromania - is an impulse control disorder in which individuals repeatedly fail to resist

impulses to deliberately start fires, in order to relieve tension or for instant gratification.

Dipsomania - uncontrollable craving for alcohol or compulsive drinking of alcohol.

Kleptomania - a disorder in which the individual impulsively steals things other than
personal use or financial gain.

Negativism - an apparently motiveless resistance to all commands and attempts to be

moved or doing just the opposite.

https://www.slideshare.net/JohnykuttyJoseph/terminologies-in-psychiatric-nursing
LESSON 2 - History of Psychiatry and Psychiatric Nursing
Psychiatry - is a branch of medicine that deals with the diagnosis, treatment and
prevention mental illness

Psychiatric Nursing - is a specialized area of nursing practice employing theories of

human behavior, as a science and the purposeful use of self as an art in the diagnosis
and response to actual or potential mental health problems (American Nurses
Association 1994)

Psychiatric nursing deals with the promotion of mental health, prevention of mental
illness, care and rehabilitation of mentally ill individuals both in hospital and community.

History of Psychiatry Primitive beliefs regarding mental illness:

Individual had been dispossessed of his/her soul Mgt: Returning the soul to the client
Broken a taboo or sinned against another individual or god Mgt: Ritualistic purification

Evil spirits or super natural/magical powers entered the body

Mgt: Exorcism (prayer, noise making)Brutal beating, starvation, Burning, amputated and
tortured Oral preparation of a purgative made from sheep dung and wine Trephining (A
circular opening made on the skull by means of crude stone instruments to let out evil
spirits)

Development of Psychiatry

Pythagoras (BC): developed the concept that the brain is the seat of intellectual activity

Hippocrates (BC): described mental illness as hysteria, mania and depression Plato (
BC) identified the relationship between mind and body. Asclepiades, who is referred to
as the father of psychiatry, made use of simple hygienic measures, diet bath, massage
in place of mechanical restraints.

Aristotle, a Greek philosopher, emphasized on the release of repressed emotions for

the effective treatment of mental illness. He suggested catharsis and music therapy for
the patient with melancholia St. Augustine who believed that although God acted
directly in human affairs, people were responsible for their own actions

Renaissance in Europe (AD): it was believed that demons were the cause of
hallucinations, delusions and sexual activity Mgt: Torture and even death

Important Milestones 1773: The first mental hospital in the US was built in
Williamsburg, Virginia1793: Philip Pinel removed the chains from mentally ill patients
confined in Bicetre, a hospital outside Paris i.e. the first revolution in psychiatry1812:
The first American text book in psychiatry was written by Benjamin Rush, who is
referred to as the father of American Psychiatry

1812: Clifford Beers, an ex- patient of mental hospital wrote the book, “The Mind That
found Itself” based on his bitter experiences in the hospital1912: Eugene Bleuler, a
Swiss psychiatrist coined the term Schizophrenia The Indian Lunacy Act passed1927:
Insulin shock treatment was introduced for schizophrenia1936: frontal lobotomy was
advocated for the management of psychiatric disorders

1938: Electro Convulsive Therapy (ECT) was used for the treatment of psychoses

1939: development of psychoanalytical theory by Sigmund Freud led to new concepts in

the treatment of mental illness.1946: The Bhore committee presented the situation with
regard to mental health services. Based on the recommendations 5 hospitals were set
up at Amirtsar, Hyderabad, Srinagar, Jamnagar and New Delhi

1949: Lithium was first used for the treatment of mania

1952: Chlorpromazine was introduced which brought about a revolution in psycho-

pharmacology1963: The community Mental Health centres Act was passed1978: The
Alma –Ata declaration of ‘Health for all by 2000 AD’ posed a major challenge to Indian
mental health professionals.

1981: Community psychiatric centres were setup experiment with primary mental health
approach at Raipur Rani, Chandigarh and Sakalwara, Bangalore.1982: The Central
Council of India accepted the national Mental Health Policy and brought out the National
Mental Health programme in India.1987: The Indian Mental Health Act was passed

1990: The Govt.of India formed an Action Group at Delhi to pool the opinions of mental
health experts about the National Mental health program NIMHANS Bangalore has
taken up the leadership in orienting heath care professionals about the mental health
programs of our country

Development of Modern Psychiatric Nursing

1872: First training school for nurses based on the Nightingale system was established
by the New England Hospital for women and children, Linda Richards the first Nurse to
graduate from the one-year course, developed 12 training schools in the USA

1882: first school to prepare nurses to care for the mentally ill was opened at Mc Lean
Hospital in Waverly Two-year program was started but few psychological skills were
addressed and much importance was given to custodial care such as personal hygiene,
nutrition, medication etc1913: John Hopkins became the first school of nursing to
include a fully developed course for psychiatry nursing in the curriculum
1943: Psy. Nsg course was started for male nurses

1946: Health survey committee’s report recommended preparation of nursing personnel

in Psy. Nsg also. The existing institutions like mental hospitals in Bangalore and Ranchi
should start training

1952: Dr.Hildegard Peplau defined the therapeutic roles that nurses might play in the
mental health setting. She described the skills and roles of the psy. Nurse in her book
“interpersonal relations in Nursing” . It was the first systematic and theoretical frame
work developed for Psy. Nsg.

1953: Maxwell Jones introduced therapeutic community.

1956: one-year post certificate course in psy. nsg was started at NIMHANS,
Bangalore1960: The focus began to shift to primary prevention and implementing care
and consultation in the communityThe name psychiatric nursing changed in to mental
health nursing. 1970’s when it was known as psychosocial nursing.

1963: Journal of Psy. Nsg and Mental Health services was published.

1964: Mudaliar committee felt the need for preparing large number of Psy. Nurses and
recommended inclusion of Psychiatry in the nursing curriculum.1965: The Indian
Nursing Council included psy. Nsg as a compulsory course in B.Sc. Nsg program 1973:
Standards of psychiatric and mental health nursing practice were enunciated to provide
a means of improving the quality care

1975: Psy. Nsg was offered as an elective subject in M.Sc. Nursing at the RAK College
of Nsg, New Delhi.

1980: Scientific advances in the area of psychobiology, brain imaging techniques,

knowledge about neurotransmitters and neuronal receptors, molecular genetics related
psychiatry etc. emerged. These contributed to the shift from psychodynamic models to
more balanced psychobiological models of psychiatric care.

1986: The Indian Nursing Council made psy. nsg a component of General nursing and
Midwifery course1990: During these years’ integration of neuro sciences into holistic
biopsychosocial practice of psychiatric nursing occurred1994: The above mentioned
changes led to the revision of standards of psychiatric and mental health nsg.

https://slideplayer.com/slide/6654367/
LESSON 3 – Evolution of Mental Health Psychiatric Nursing
Complimentary therapies - unconventional therapies that encompasses a spectrum of
practices and beliefs, including herbs, visual imagery, acupunctures, and massage
therapy.

Decade of brain - proclamation by the state Congress that explains mental illness as a
disease of the brain. It underscores the significance of technological advances in
neurobiology and genetics and their impact on understanding mental illness.

Deinstitutionalization - caring for people outside the hospital who have been
previously hospitalized for an extended period, caring for people in the community
rather than in a state facility.

Mental Health Movement - a movement that begun more than 25 years ago that
focuses on humane treatment of the mentally ill, initially advocating their release from
state institutions to community mental health centers.

Moral treatment - humane treatment of the mentally ill; for example, releasing clients
from mechanical restraints and improving physical care.

Psychotropic - various pharmacologic agents, such as antidepressants and

antipsychotic, ant manic and antianxiety agents used to affect behavior, mood and
feelings.

Neurobiology - biology of the nervous system, particularly the brain.

Neuroscience - the science and study of the central nervous system.

Insanity - was associated with demonic possession.

Healers - extract unseen spirits through rituals using herbs, ointments and precious
stones.

Mental illness - was perceived as incurable, and treatment of the insane was
sometimes inhumane and brutal.

Mentally ill people:

Often imprisoned or forced to live in streets and beg for food.

For more humane treatment, they depend on charity of religious groups, who dispenses
alms or food or other donations to the needy or poor and ran almshouses and general
hospitals.
First mental asylum: St. Mary of Bethlehem

Built in London, England during the 14th Century.

Conceived as a sanctuary or refuge for the destitute and afflicted.

Model for similar institutions elsewhere.

Continued skepticism about the curability of mental illness.

Asylums became the repositories for prolonged enclosure of the mentally ill.

Insane people were treated more like animals than humans.

Inhabitants were poorly clothed and fed; often chained and caged, and deprived of heat
and sunlight.

The insane was no longer treated as less than human.

The concept of asylum developed from the humane efforts of Pinel and Tuke.

Emphasized the need for pleasant surroundings and diversional and moral treatment of
the mentally ill.

Treatment include (considered controversial): bloodletting and the administration of cold

and hot baths, harsh purgatives, and emetics.

Considers inducement of fright or shock would cause the mentally ill to regain their
insanity.

Invented the tranquilizer chair and the Gyrator.

Tranquilizer chair- the mentally ill’s extremities is strapped down and this reduces motor
and pulse rates; thought to produce calming effect.

Gyrator- a form of shock therapy consisting of a rotating, swinging platform onto which
the person was strapped and moved at high speed; Thought to increase cerebral
circulation.

Author of the first American treatise on Psychiatry: Medical Inquiries and Observations
upon the Disease of the Mind.

Advocated kindness and moral treatment.

Greatest impact came after he was placed in charge of Bicerte Hospital.

Proved that releasing the insane from chains and providing moral treatment improved
their prospect.

William Tuke (1732-1822)

Began a 4-yaer dynasty that advocated humane treatment of the mentally ill.

Franz Anton Mesmer (1734- 1815)

Renewed the art of suggestive healing that stemmed from the ancient use of trances,
which became the basis of hypnosis.

U.S. and other European Countries began a movement that championed reformation of
ideas in establishing state hospitals.

1772 - First psychiatric hospital in America in Williamsburg, Virginia.

1817 - Mclean Asylum in Massachusetts became the first US institution to provide

humane treatment for the mentally ill.

Humane treatment- emphasized an environment of understanding and promoted a

sense of contentment and mental and physical health.

Increased concerns and sensitivity to the needs of the mentally ill generated a need for
better-educated attendants to care for severely disturbed clients.

A retired school teacher from Massachusetts.

Led crusade that brought attention of these conditions to the public and legislature.

The result is an improvement in standards of care for the mentally ill which led to
proliferation of state hospitals.

The first American Psychiatric Nurse

Graduate of New England Hospital for Women

Developed nursing care in state hospitals and also directed a school of psychiatric
Nursing in Mclean Psychiatric Asylum in 1880.

Her efforts resulted to the development of school for nurses in more than 30 asylums

Exploration of the reasons for mental disease accelerated with contributions from
numerous theorists and researchers who laid the foundation for understanding and
demystifying mental illness.
Initiated psychobiological theory and dynamic concept of psychiatric care.

Theory centered on treatment rather than disease and integrated biochemical, genetic,
psycho social, and environmental stresses on mental illness.

Had been treated for mental illness.

Contributed to preventive care though his classic work, A Mind That Found Itself,
published in 1908.

Played a major role in establishing Mental Health Movement in New Haven,

Connecticut, in 1908 and promoting the early detection of mental illness.

Devised a classification of mental disorders.

Shifted from an emphasis on research in the path biological laboratory to the

observation and research in conditions known as praecox dementia and mania.

Coined the term schizophrenia and included its characteristics the four as: apathy,
associative looseness, autism, and ambivalence.

Development of psychoanalysis, psychosexual theories, and neurosis.

Psychoanalysis- a method that serves as the basis for treatment and a theory for
personality development.

Founded analytic psychology.

Proposed and originated the concepts extroverted and introverted personality.

Integrated spiritual concepts, reasoning, ancestral emotional trends, and mysticism, and
the creative notion of human beings.

Objected to Freud’s notions that neurosis and personality development were based on
biological drives.

Her theory suggested that neuroses stem from cultural factors and impaired
interpersonal relationships.

Postulated the Hypothesis of interpersonal theory and the development of

multidisciplinary approaches to psychiatric and milieu therapy.

He surmised that anxiety could be reduced through a meaningful interpersonal

relationship that stresses the process of effective communication.

A deliberate shift from institutional care in state hospitals to community facilities.

Community mental health centers: provides less restrictive treatment located closer to
homes, families and friends.

Declared by the US Congress as the Decade of the Brain Increase in brain research;
increased interest in biologic explanations for mental disorders. Significant changes in
public awareness which enabled clinicians to address relatively complex topics with
patients and families. Nursing responded by significant augmentation of psychobiologic
content in academic nursing programs and a torrent of continuing education programs.

“Nursing Mental Diseases” Written by Harriet Bailey in 1920 in 1937, psychiatric nursing
became a part of the curriculum of general nursing programs.

Hildegard Peplau Developed a model for psychiatric nursing practice wrote the book
“Interpersonal Relationship in Nursing” (1952), heavily influenced by Harry Stack
Sullivan. Emphasizes the interpersonal dimension of practice. Wrote a history of
psychiatric nursing Single most important figure in psychiatric nursing

The Diagnostic and Statistical Manual of Mental Disorders (DSM): outlines the signs
and symptoms required in order for clinicians to assign a specific diagnosis to a patient.
Has been published in six editions since its inception in 1952

Axis I: Clinical disorders (e.g., schizophrenia, major depression, bipolar disorder) Axis
II: Personality or developmental disorders (e.g., paranoid and borderline personality
disorders, mental retardation) Axis III: General medical conditions that relate to axis I
or II or have bearing on treatment (e.g., neoplasms, endocrine disorders) Axis IV:
Severity of psychosocial stressors (e.g., divorce, housing, educational issues) Axis V:
Global assessment of functioning, on a scale of 0 to 100 (e.g., score of 30 means that
the patient’s behavior is highly influenced by delusions and hallucinations)

Was established thru Public Works Act 3258

Was first known as Insular Psychopathic Hospital, situated on a hilly piece of land in
Barrio Mauway, Mandaluyong, Rizal and was formally opened on December 17, 1928.

Later known as National Mental Hospital

November 12, 1986: was given its present name National Center for Mental Health thru
Memorandum Circular No. 48 of the Office of the President.

January 30, 1987: categorized as Special Research Training Center and Hospital
under the DOH

Today: Bed capacity: 4,200

Daily average in-patients: 3, 400 ◦ 46.7 hectares ◦ 35 pavilions/ cottages ◦ 52 wards

Personnel: 1,993 ◦ Doctors: 116 ◦ Nurses: 375 ◦ Administrative staff: 651 ◦ Medical

Ancillary Personnel: 196

A special training and research hospital mandated to render a comprehensive

(preventive, promotive, curative and rehabilitative) range of quality mental health
services nationwide. Gives and creates venues for quality mental health education,
training and research geared towards hospital and community mental health services
nationwide.

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