NCMB317 LECTURE:
01
Concepts of Mental Health and Mental Illness
Bachelor of Science in Nursing 3YB
Professor: Donato Mirador MAN, RN
CONCEPTS OF MENTAL HEALTH AND MENTAL ILLNESS
Mental Health Care Delivery System in the Philippines
Three Levels of care in the Health Care System
1) Primary - The primary health care tier serves as a patient's
first point of contact with a health professional who can
provide outpatient medical care
2) Secondary - The secondary health care includes referrals
to psychologists and psychiatrists where short hospital
visits and consultation-liaison services to other medical
departments are made. Services includes assessment,
counselling, and/or prescription drugs
3) Tertiary - The tertiary health care includes referrals to
psychiatric institutions if the mental illness needs
specialized care and more severe mental illness would
require more rehabilitation. In the Philippines, most
psychiatrists are in private practice, although some work in
government institutions such as in the National Center for
Mental Health.
Institutions and other mental health services in the
Philippines
- Both private and public groups maintain mental health
facilities and institutions in the Philippines but access to
them remains uneven throughout the country.
- Most facilities are located in the National Capital
Region (NCR) and other major cities in the country, thus
favoring individuals who live near these urban areas.
National Center for Mental Health (NCMH)
- National Center for Mental Health originally named Insular
Psychopathic Hospital, was established in 1925 under the
Public Works Act 3258. At the time, the City Sanitarium and
San Lazaro Hospital were the only primary institutions that
catered for the needs of the mentally ill, however, due to
the large volume of patients pouring in; there was a need to
build another institution that could provide for the needs of
mentally ill patients. It is located in Mandaluyong City in a
64-hectare site.
- The institution officially opened on December 17, 1928,
accepting 379 patients who were all crowding in San
Lazaro Hospital. In 1930, the bed capacity was increased
to 800, although the total number of patients was over
836. Two pavilions were added to increase the bed
capacity to 1,600. By 1935, the City Sanitarium closed, and
leaving NCMH with 1,646 patients to serve.
- Aside from being a hospital, NCMH is authorized by the
Department of Health as a Special Research Training
Center. According to the NCMH website, the hospital is
"mandated to render a comprehensive (preventive,
promotive, curative and rehabilitative) range of quality
mental health services nationwide". Aside from this, NCMH
also offers a 4-year psychiatric residency-training program
for doctors and a 2-year psychiatric nursing program for
nurses specializing in psychiatric care. There are also
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Prelim Week
affiliation programs that cater to students from the fields of
psychology, pharmacy, and nursing, among others.
- NCMH currently occupies 46.7 hectares of land, with 35
pavilions/cottages, and 52 wards, as well as facilities such
as medical infirmary, library, chapel, conference rooms,
tennis court, basketball court, multi-purpose hall and
dormitories. NCMH has a bed capacity of 4,600 and serves
an average of 3,000 in-patients on a daily basis, in addition
to 56, 000 outpatients per year. Most patients come from
Metro Manila and nearby regions III and IV. They also serve
patients from other regions, often-forensic cases referred
by the courts. Subsidy for treatments is given to 87% of the
inpatients, which belong to classes C and D. The institution
received its ISO 9001:2008 certification on December 2,
2015
Philippine Mental Health Association, Inc.
- The Philippine Mental Health Association, or PMHA, is "a
private, non-stock, non-profit organization dedicated to the
promotion of mental health and prevention of mental
disorders. Its headquarters is located in Quezon City with
nine chapters all over the Philippines:
• PMHA Bacolod-Negros Occidental,
• PMHA Baguio-Benguet,
• PMHA Cabanatuan-Nueva Ecija
• PMHA Cagayan de Oro-Misamis Oriental
• PMHA Cebu,
• PMHA Dagupan-Pangasinan
• PMHA Davao
• PMHA Dumaguete-Negros Oriental
• PMHA Lipa-Batangas.
- It was established on January 15, 1950 with Dr. Manuel
Arguelles as president due to the call for assessment of
mental health problems induced by WW II. At present, their
programs range from Education and Information Services
(EIS), Clinical and Diagnostic Services (CDS), and
Intervention Services (IS).
- The PMHA provides guidance and educational programs for
the youth through collaborating with various private and
public schools and colleges in the country. They also
organize seminars and workshops for youth mental health
through their EIS arm.
- The Association officially expanded its services to the adult
population in 1960. They now provide psychiatric,
psychological, and counseling services to all sectors of
society under CDS.[19] They also launched Rehabilitation
Care Services in 1962 to assist in the recovery and
reintegration of patients into the community.
- The Association's IS arm has two centers: the Center for
Children and Youth (CCY) and the Adult Work Center
(AWC). The CCY provides various kinds of therapy sessions
and counseling along with special education for those with
learning disorders and mental retardation. The AWC
 PSYCHIATRIC NURSING LECTURE: WK1 – CONCEPTS OF MENTAL HEALTH AND MENTAL ILLNESS
provides life skills training and family programs to assist
mental health patients in their recovery and therapy.
Other Institutions
- Most major hospitals (both public and private) In
the National Capital Region (NCR), have a psychiatric
department which caters to the need of people with mental
illness.
a) The Medical City
b) Philippine General Hospital (PGH)
c) Manila Doctors Hospital (MDH)
d) University of the East Ramon Magsaysay Memorial
Medical Center (UERMMMC)
Note: Webbline provides a list of mental health care facilities
that can be found in the provinces and in NCR.
Suicide Prevention Hotlines in the Philippines
- Those who are in need of immediate assistance may opt to
call a suicide hotline:
• Natasha Goulbourn Foundation (NGF). The NGF
suicide hotline can be reached at (02) 804-HOPE (4673),
0917 558 HOPE (4673) or 2919 (toll-free for GLOBE and
TM subscribers).
• Manila Lifeline Centre (MLC). The MLC can be
reached at (02) 8969191 or 0917 854 9191.
Importance of Mental Health in the community
1) Belonging. Community provides a sense of belonging — a
group that one can identify as being a part of. A true sense
of belonging includes the ability to feel that one is a part of
the community that will embrace and appreciate a
person’s unique qualities.
2) Support. Community provide support in times of difficult
situations. Knowing there are people, GO’s or NGO’s in the
community who support you can help one feel safe and
cared for, safe resulting to a positive outlook on life.
3) Purpose. In community, people fill different roles. These
roles can give one a sense of purpose through bettering
other people’s lives. Having purpose, and helping others,
helps give meaning to life.
Global & Regional Perspective on Mental Health
Mental Health Act (Republic Act No. 11036)
- The Law proposes a mental health policy that aims to:
a) Enhance the delivery of mental health services
b) Promote mental health services
c) Provide accessible mental health care – Mental health
services are proposed to be accessible from large-scale
hospitals down to the barangay level.
d) Promote and protect the rights of the individuals
utilizing psychiatric, neurologic and psychosocial health
services
Mental Health Gap Action Programmed (mhGAP) training
- MhGAP is a WHO program, launched in 2008, to scale up
care for MNS disorders
• Mental disorders
• Neurological disorders
• Substance abuse disorders
- The program asserts that, with proper care, psychosocial
assistance and medications, millions of people around the
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world could be treated for psychoses, epilepsy,
depression, and suicide can be prevented, thus they may
live a normal life.
- To meet this goal is to train non-specialist care to address
the unmet needs of people with priority MNS conditions.
- The mhGAP training is a collaboration between the World
Health Organization, the Department of Health, and local
government units to strengthen the mental health services
in local communities in the Philippines. Over a few years,
non-specialized health workers in all 18 regions in the
country have participated in the training, empowering them
to make decisions and manage mental health patients
close to where it is most needed. Leon is one of the first
municipalities to have a comprehensive community-based
mental health program in the country.
Psychobiologic Bases of Behavior
Biology and Behavior
- Behavior is determined by biology. There is a genetic basis
to all behaviors. Most behavior has an adaptive or
evolutionary function. Behaviors have their origins in
specific locations of the brain.
- In order to understand human behavior, it is necessary to
include animal studies.
- Biology is 100% involved in all the variance in what we think,
what we feel, and how we behave
Concepts and Patterns of Human Behavior
Family Dynamics
- Family dynamics are all about the functioning of a family in
a good and bad situation. It also includes the ways of
decision-making, problem solving, or even sharing their
feelings. Thus, it helps individuals to judge themselves as
well as the outside world.
- Types of Family Structures & Family Dynamics
1) Nuclear family
2) Single Parents
3) Extended Family
4) Childless Family
5) Grandparent Family
6) Stepfamily
Concepts of Human behavior
Needs and Behavior
- Needs are internal motives that energize, direct and
sustain behavior. They generate strivings necessary for the
maintenance of life as in physiological needs and for the
promotion of growth and wellbeing as in psychological and
implicit needs.
- According to humanist psychologist Abraham Maslow, to
our actions are motivated in order to achieve certain needs.
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- Individual’s morality and high ideals: An individual’s

moral standards, code of ethics and high ideals may
become a source of frustration.
- Level of aspirations: Conflict between one’s
aspirations to one’s capability to achieve it may lead
to frustration
Anxiety & anxiety responses
- Anxiety - A vague unpleasant feeling of apprehension. An
emotional response to unknown and non-specific danger
or threat. Anxiety motivates a person to take action, to
solve a problem or to resolve a crisis.
- Anxiety is considered normal when it is appropriate to the
situation
- Anxiety becomes abnormal when it is excessive, chronic
and results to impairment in the individual’s major
functioning. Individual usually shows unusual behaviors.
- Examples:
• Panic without reason
Conflicts and Frustrations
• Irrational fear of objects
- Conflict is a painful emotional state that results from a
• Uncontrollable repetitive actions
tension between opposed and contradictory wishes as
Types of Anxiety
defined by Douglas and Holland.
- Conflict is a state of tension brought by the presence in the 1) Mild anxiety
individual of two or more opposing desires as defined by - Perception – increased/widens
Barney and Lehner. - Behavioral changes: Alert/ aware, energetic, attention
- Sources of Conflict at home environment increased
a) Faulty upbringing at home, - Physiological changes: Slight discomfort, restlessness,
b) Unhealthy relationships, GI butterflies and difficulty Sleeping.
c) Overprotection. - Coping: Adaptive Tasked or defense oriented
- Sources of Conflict in the school environment - Nursing management
a) Unpleasant school or college environment, • Listen
b) role of teachers, • Focus on problem solving
c) faulty method of teaching, • Engage in goal directed activities
d) denial of opportunities for self-expression 2) Moderate anxiety
e) Classmates are some of the sources of conflict. - Perception: Decreased / narrowed and Selective
- Sources of Conflict in occupational environment inattention
a) Improper working environment - Behavioral Changes: Difficulty in concentration, easily
b) dissatisfaction with the working conditions distracted, attention span decreased and pacing
c) unsatisfactory relationships - Physiological Changes: Clammy hands, diaphoresis,
- Frustration means emotional tension resulting from the muscle tension, GI distress, headache, dry mouth and
blocking of a desire or need (Good, 1959). According to frequent urination
Barney and Lehner (1953), frustration refers to failure to - Coping: Palliative - use of any defense mechanism
satisfy a basic need because of either condition in the available
individual or external obstacles. - Nursing Management:
- Causes of Frustration • Refocus attention
1) External factors • Supervise client in solving problems and learning
- Physical factors: Natural calamities, new things.
floods, droughts, earthquakes, fire and accidents • Speak in short, simple and easy to understand
cause frustration in an individual. sentence.
- Social and societal factors: Societal norms and • Administer oral anxiolytic
values impose certain obstacle in meeting the 3) Severe anxiety
individual needs, which leads to frustration - Perception: distorted perception
- Economic and financial factors: Unemployment and - Behavioral
lack of money causes frustration in an individual. • Inability to reason abstractly
2) Internal factors • In ability to make decision
- Physical abnormality or defects. • Inability to solve a problem
- Conflicting desires or aims: When a person has • Impaired judgment
conflicting desires, he develops frustration. • Confused and disoriented

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• Difficulty focusing even with assistance a) Tasked oriented (direct problem solving)
- Signs and symptoms becomes the focus of attention b) Defense oriented (regulate response to stress
• Increased BP, RR, CR through the use of defense mechanism)
• Chest pain 3) Defense Mechanisms
• Severe headache - Also called ego defense mechanism /protective
• Nausea/ Vomiting defense. It is defined as patterns of behaving or thinking
• Diarrhea used by an individual to protect himself from
• Tremors threatening aspects of his own environment or from his
own feeling of anxiety.
• Dilated pupils
- Purposes:
• Coping: Maladaptive - Excessive use of defense
a) Maintain a sense of being in control of the situation
mechanisms
b) Lessen discomfort
- Nursing Management:
c) Deal with stress
• Decrease anxiety
d) Decrease anxiety
• Relaxation technique
- Types of Defense Mechanisms
• Reduce environmental stimuli a) Normal and adaptive mechanism
• Stay or walk with person who is upset - Persons who use these mechanisms are viewed
• Attentive listening as having virtues
• Administer intramuscular anxiolytics - Enhances the user a feeling of mastery and
4) Panic anxiety pleasure.
- Perception: Disorganized • Anticipation – planning ahead for a realistic
- Behavioral: expectation
• Immobilized • Compensation – making up for imagined
• Hysterical or mute handicapped or deficiency
• Disorganized thinking • Compromise – reciprocal give and take
• Irrational reasoning necessary in many relationships
• Feeling overwhelmed and out of control - Suicidal • Sublimation – most constructive mechanism
• Maybe out of contact with reality – rechanneling socially unacceptable
(Hallucination/Delusion) behavior to a socially acceptable one
- Physiological • Humor - seeing the lighter side of the situation
• Same w/ severe anxiety b) Narcissistic Defense Mechanisms
• SOB - Most primitive mechanism
• Hyperventilation - Usually used by children
- Coping: Dysfunctional: use of defense mechanisms fail - Person who uses these defenses eliminate the need to
- Nursing Management cope with reality
• Provide safety • Denial – refusal to accept reality
• Reduce environmental stimuli • Projection – blaming others for unacceptable deeds
• Continuously talk with the person or thoughts
• Use touch judiciously • Fantasy – gratification of wishes through imagination
• Remain with the person (Panic can last from 5 – 30 c) Immature Defense Mechanism
minutes) - Seen in adolescence and some non-psychotic
Adaptation and Coping Mechanisms individual.
1) Adaptation - Lessen distress and anxiety provoking situations
- The physical or behavioral characteristic of an organism - People who excessively use these defenses are seen as
that helps an organism to survive better in the socially undesirable in that they are immature, difficult
surrounding environment. to deal with, and seriously out of touch to reality
- Levels of Adaptation: • Conversion – transferring emotional conflict into
a) Adaptive - Facing and finding solution to the physical symptoms
situation • Malingering - Fabrication of an ailments
b) Less Adaptive - Use defense mechanisms • Fixation – psychosocial development ceased to
temporarily advance
c) Maladaptive - Use defense mechanisms excessively • Regression – returning to an earlier developmental
d) Dysfunctional - Defense mechanism is ineffective. stage
ADL and social functions are affected • Identification – unconscious attempt to change
2) Coping oneself to resemble admired person
- Involves any effort to decrease the stress response • Introjection – a type of identification in which the
- Coping mechanism can be constructive or destructive individual incorporates the traits or values of
- Constructive coping mechanism when it is: another to self.
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• Intellectualization – Excessive reasoning to obscure
real feeling
• Suppression – Conscious or voluntary forgetting of
unacceptable or painful Ideas, thoughts or feelings
• Isolation – Person blocks feelings associated with
unpleasant experience
o Physical isolation - Physical withdrawal from
people to prevent further hurt or damage to one’s
security
o Emotional isolation - The process of separating
an unacceptable feelings, ideas or impulses from
one’s thought
d) Neurotic Defense Mechanisms
- Seen in obsessive-compulsive, hysterical individual,
and adults under stress.
- Have short-term advantage in coping
- When used as one’s primary style of coping the world, it
can cause long term problems in relationships and in
enjoying life.
• Displacement – releasing anger in a less threatening
way
• Dissociation – blocking off anxiety provoking event
from the conscious mind. Example amnesia
• Substitution – taking something in place of the
original goal
• Rationalization - justifying one’s behavior to make
unacceptable feelings and behavior acceptable
• Reaction formation - acting out behaviors opposite
to what one really feels
• Repression – involuntary or unconscious forgetting
unacceptable thoughts from conscious mind
• Undoing – engaging in a behavior that is considered
to be opposite of a previous unacceptable
behavior
- Underlying Causes of Anxiety
1) Interpersonal Factor
• Fear of interpersonal rejection
• Traumatic or dysfunctional relationship
2) Behavioral Factor
• Exposure to early negative life circumstances
• Learned response to frustration
3) Psychoanalytic Factor
• Conflict between the ID and the Superego
Crisis
- Occurs when the EVENT that is causing the ANXIETY is
overwhelming and the usual coping patterns are
suspended.
- Many life’s events can evoke a crisis such as:
• Man-made disasters
• Interpersonal events
• Natural disasters
• Traumatic experience
- Types of Crisis
1) Maturational crisis
- Normal part of growth and development
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- Ex: leaving home for the first time, completing
school, getting married, having a baby, beginning a
career, accepting adult responsibility
- Successful resolution of a crisis allows a person to
develop positive characteristics
2) Situational crisis
- Unpredicted or sudden events that threaten the
individual’s integrity
- Ex. death of a loved one, loss of a job/job promotion,
illness of a member of the family, migration, high
school/college graduation
3) Adventitious crisis
- Unexpected unusual events that can affect an
individual or a multitude of people
- a social crisis, which includes:
• Natural disasters such as floods, typhoon,
earthquakes, forest fires, hurricane, tsunami
• national disasters such as racial discriminations,
kidnapping, riots, war or terrorism
• violent crimes such as rape, murder and assault
and battery
- Stages of Crisis
1) Denial - initial reaction (shock & disbelief)
2) Increased tension - the person recognizes the
presence of a crisis, still functional
3) Disorganization - the person is preoccupied with the
crisis, and functioning is affected.
4) Attempts to reorganize - the individual mobilizes
previous coping mechanisms or acquire new ways of
coping
Mental Health and Mental Illness
- Mental health and mental illness are difficult to define
precisely. People who can carry out their roles in society
and whose behavior is appropriate and adaptive are viewed
as healthy.
- Conversely, those who fail to fulfill roles and carry out
responsibilities or whose behavior is inappropriate are
viewed as ill.
- The culture of any society strongly influences its values and
beliefs, and this in turn affects how that society defines
health and illness. What one society may view as
acceptable and appropriate, another society may see as
maladaptive and inappropriate.
Mental health
- The World Health Organization defines mental health as a
state of well-being in which every individual realizes his or
her potential, can cope with the normal stresses of life, can
work productively and fruitfully and can contribute to his or
her community
- Criteria of a Mental Health
• P – Positive attitude toward self – you have a strong
sense of identity and believe you're capable of rising to
whatever challenges that comes your way. Negative
self-concept – you have an inaccurate perceptions of
yourself and believe you’re incapable of doing things as
others do and uncertain of achieving your goal.
 PSYCHIATRIC NURSING LECTURE: WK1 – CONCEPTS OF MENTAL HEALTH AND MENTAL ILLNESS
• R – Reality perception – The ability to view the world not
being too pessimistic or optimistic
• A – Autonomous behavior – the ability to function
independently.
• I – Integrative capacity – ability to handle of manage
any adverse or difficult situations.
o Resilience ability to adjust in a healthy manner in
any difficult situations
o Hardiness ability to resist illness even under stress/
ability
o Self-efficacy ability to succeed in specific situations
or accomplish a task.
o Resourceful ability to problem solved and believing
that you can cope in any adverse or difficult
situations
• S – Self-actualization and personal growth – ability to be
motivated to realize one's full potential and make use of
these potentials to achieve goals.
• E – Environmental mastery – ability to meet the
demands of any situations and being able to adapt to
changing circumstances.
Mental illness
- Mental Illness is a health conditions marked by alterations
in thinking, mood or behavior that causes distress and/or
impair individual’s major functioning:
a) Occupational functioning
- unable to perform ADL,
- role performance
- unable to work or go to school
b) Emotional functioning
- unable to express feelings effectively and
assertively
• project/suppress feelings
• aggressively express feelings
• destroying things/properties
• yelling or hurting others
c) Psychological functioning
- unable to think abstractly
- unable to think rationally (committing suicide)
- unable to cope with stress
- unable to solve problems effectively
d) Social functioning
- unable to develop a satisfying relationship with
others
- unable to involve self in community activities or
organizations.
e) Spiritual functioning
- Spirituality involves the essence of person’s being
and his/her beliefs about the meaning of life and
the purpose of life
- faith in God is a primary source of comfort and
help in times of stress and difficult situations and
serve as a primary coping device
- Criteria of Mental Illness
• L – Lack of personal growth
• I – Ineffective coping with one’s life events
– Ineffective or non-satisfying relationship
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– Inability to meet own needs
• D – Dissatisfaction with one’s characteristics, abilities,
and accomplishments. Dissatisfaction with one’s place
in the world.
Factors Contributing to Mental Illness
- Mental illness is common. About one in five adults has a
mental illness in any given year. Mental illness can begin at
any age, from childhood through later adult years, but most
cases begin earlier in life.
- The effects of mental illness can be temporary or long
lasting. A person can have more than one mental health
disorder at the same time. For example, one can have
depression and a substance use disorder simultaneously.
- There are many factors that influences the development of
mental illness which includes the following
Biologic Factors
1) Genetic Factor. Mental illnesses sometimes run in families,
suggesting that people who have a family member with a
mental illness may be somewhat more likely to develop one
themselves.
2) Neurostructural Factor. Infections: Certain infections have
been linked to brain damage and the development of mental
illness or the worsening of its symptoms. For example, a
condition known as pediatric autoimmune neuropsychiatric
disorder (PANDA) associated with
the Streptococcus bacteria has been linked to the
development of obsessive-compulsive disorder and other
mental illnesses in children.
3) Brain defects or injury: Defects in or injury to certain areas
of the brain have also been linked to some mental illnesses.
4) Prenatal damage: Some evidence suggests that a disruption
of early fetal brain development or trauma that occurs at the
time of birth -- for example, loss of oxygen to the brain -- may
be a factor in the development of certain conditions, such
as autism spectrum disorder.
5) Brain chemistry. Neurotransmitters are naturally
occurring brain chemicals that carry signals to other parts
of the brain and body. When the neural networks involving
these chemicals are impaired, the function of nerve
receptors and nerve systems change, leading to
depression and other emotional disorders.
Individual Factors (PAIN)
• P- Poor physical health
• A – Any kind of loss (loss of meaning in one’s life)
• I – Ineffective coping and inability to distinguish reality from
fantasy
• N - Negative view of self
Interpersonal Factor (FAIL)
• F- Faulty family interaction & nurturing during childhood
• Absence of sense of belongingness
• Ineffective communication & interaction (withdrawal from
relationship)
• L-Loss of emotional control
Environmental Factor (PAIN)
• P- Poverty, homelessness and presence of discrimination
• A - Abuse and violence
 PSYCHIATRIC NURSING LECTURE: WK1 – CONCEPTS OF MENTAL HEALTH AND MENTAL ILLNESS
• I – Inability to make use of support and community
resources
• N -Negative view of the world
Risk factors
Certain factors may increase the risk of developing a mental
illness, which includes the following:
1) A history of mental illness in a blood relative, such as a
parent or sibling
2) Stressful life situations, such as financial problems, a
loved one's death or a divorce
3) An ongoing (chronic) medical condition, such as diabetes
4) Brain damage as a result of a serious injury (traumatic
brain injury), such as a violent blow to the head
5) Traumatic experiences, such as military combat or assault
6) Use of alcohol or recreational drugs
7) A childhood history of abuse or neglect
8) Few friends or few healthy relationships
9) A previous mental illness
Complications of Mental Illness
- Mental illness is a leading cause of disability. Untreated
mental illness can cause severe emotional, behavioral and
physical health problems.
- Complications sometimes linked to mental illness
includes:
1) Unhappiness and decreased enjoyment of life
2) Family conflicts
3) Relationship difficulties
4) Social isolation
5) Problems with tobacco, alcohol and other drugs
6) Missed work or school, or other problems related to
work or school
7) Legal and financial problems
8) Poverty and homelessness
9) Self-harm and harm to others, including suicide or
homicide
10) Weakened immune system, so your body has a hard
time resisting infections
11) Heart disease and other medical conditions
Classification of Mental Illness
1) Psychosis. It is characterized by loss of reality testing,
altered thought process ad presence of psychotic
manifestation such as hallucination and delusions
2) Neurosis. It is refers to a class of functional mental
disorder involving distress but not delusion or hallucination,
where behavior is not outside socially acceptable norms. It
is also known as psychoneurosis or neurotic disorder. No
loss of reality testing
3) Functional. It is characterized by unknown underlying
cause or has no clear-cut etiologic factor to account for
the impairment because it is difficult to investigate brain
function during life.
4) Organic. It is a disturbance caused by injury or disease
affecting brain tissues as well as by chemical or hormonal
abnormalities. Exposure to toxic materials, neurological
impairment, or abnormal changes associated with aging
can also cause these disorders
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The Diagnostic Statistical Manual of Mental Disorders 5th
Edition (DSM-5)
Purposes
1) To enable physicians or other clinicians to reliably
diagnose patients who present a mental disorder
2) To outline treatment pathways for the diagnosis and the
likely outcome
The following list describes the main types (often-called
classes or categories) of psychiatric disorders according
to the DSM 5:
1) Bipolar and Related Disorders. This group includes
disorders in which episodes of mania (periods of excessive
excitement, activity, and energy) alternate with periods of
depression
2) Depressive Disorders. These include disorders
characterized by feelings of extreme sadness and
worthlessness, along with reduced interest in previously
enjoyable activities. Examples include major depressive
disorder and premenstrual dysphoric disorder (PMDD),
which is more severe than the more widely known
premenstrual syndrome (PMS). PMS is not classified as a
psychiatric disorder.
3) Schizophrenia Spectrum and Other Psychotic
Disorders. Psychotic disorders cause detachment from
reality. People with these diagnoses experience delusions,
hallucinations, and disorganized thinking and
speech. Schizophrenia is probably the best known of these
illnesses, although detachment from reality can
sometimes affect people with other psychiatric disorders.
4) Anxiety Disorders. Anxiety involves focusing on bad or
dangerous things that could happen and worrying fearfully
and excessively about them. Anxiety disorders
include generalized anxiety disorder (GAD), panic disorder,
and phobias (extreme or irrational fears of specific things,
such as heights).
5) Obsessive-Compulsive and Related Disorders. People with
these disorders experience repeated and unwanted urges,
thoughts, or images (obsessions) and feel driven to taking
repeated actions in response to them (compulsions).
Examples include obsessive-compulsive disorder (OCD),
hoarding disorder, and hair-pulling
disorder (trichotillomania).
6) Trauma- and Stressor-Related Disorders. These psychiatric
disorders develop during or after stressful or traumatic life
events. Examples include posttraumatic stress
disorder (PTSD) and acute stress disorder.
7) Dissociative Disorders. These are disorders in which a
person’s sense of self is disrupted, such as dissociative
identity disorder and dissociative amnesia.
8) Somatic Symptom and Related Disorders. A person with
one of these disorders may have distressing and
incapacitating physical symptoms with no clear medical
cause. (“Somatic” means “of the body.”) Examples include
illness anxiety disorder, somatic symptom disorder
(previously known as hypochondriasis), and factitious
disorder.
9) Personality Disorders. A personality disorder involves a
lasting pattern of emotional instability and unhealthy
behaviors that seriously disrupt daily living and
 PSYCHIATRIC NURSING LECTURE: WK1 – CONCEPTS OF MENTAL HEALTH AND MENTAL ILLNESS

relationships. Examples include borderline, antisocial, Control over behavior Impulse control disorder
and narcissistic personality disorders. • Can recognize and act on & aggressive behavior
10) Eating and Feeding Disorders. These psychiatric disorders cues to existing limits • Shows repetitive and
are disturbances related to eating, such as anorexia • Can respond to the rules, persistent pattern of
nervosa, bulimia nervosa, and binge eating disorder. routines, and customs of aggressive conduct in
11) Elimination Disorders. Psychiatric disorders in this group any group to which he or which the basic rights of
relate to the inappropriate elimination (release) of urine or she belongs others are violated
stool by accident or on purpose. Bedwetting (enuresis) is Appraisal of reality Schizophrenia &
an example. • Accurate picture of what psychotic disorders
12) Sleep-Wake Disorders. These are severe sleep disorders, is happening around the • Shows bizarre
including insomnia disorder, nightmare disorder, sleep individual delusions, such as
apnea, and restless legs syndrome. • Good sense of the delusion of being
13) Sexual Dysfunctions. These disorders of sexual response consequences, both controlled
include such diagnoses as premature ejaculation, erectile good and bad, that will • Has auditory
disorder, and female orgasmic disorder. follow his or her acts hallucinations
14) Paraphilic Disorders. Many sexual-interest disorders are • Can see the difference • Manifests delusions with
included in this group. Examples include sexual sadism between the “as if” and persecutory or jealous
disorder, voyeuristic disorder, and pedophilic disorder. “for real” in situations content
15) Gender Dysphoria. These disorders stem from the distress Effectiveness in work Adjustment disorder with
that goes with a person's stated desire to be a different
• Within limits set by work (or Academic)
gender. The diagnostic criteria in this group differ Inhibition
abilities, can do well in
somewhat among children, adolescents, and adults.
tasks attempted • Shows inhibition in work
16) Neurocognitive Disorders. These psychiatric disorders
• When meeting mild or academic functioning
affect people’s ability to think and reason. The disorders in
failure, persist until whereas previously
this group include delirium as well as disorders of thinking
determines whether or there was adequate
and reasoning caused by such conditions or diseases as
not he or she can do the performance
traumatic brain injury or Alzheimer's disease.
job
17) Neurodevelopmental Disorders. The many psychiatric
A healthy self-concept Dependent personality
disorders in this group usually begin in infancy or
childhood, often before a child starts school. Examples • Sees self as approaching disorder
include attention-deficit/hyperactivity disorder (ADHD),
individual ideas, as • Passively allows others
autism spectrum disorder, and learning disorders. capable of meeting to assume responsibility
18) Substance-Related and Addictive Disorders. People with demands for major areas of life
these diagnoses have problems associated with excessive • Has reasonable degree because of inability to
of self-confidence that function independently
use of alcohol, opioids (for example, oxycodone and
morphine), recreational drugs, hallucinogens, and six other helps in being • Lacks self-confidence
types of drugs. This group also includes gambling disorder resourceful under stress (e.g. sees self as
19) Disruptive, Impulse-Control, and Conduct Disorders helpless or stupid)
People with these disorders show symptoms of difficulty Satisfying relationships Borderline personality
with emotional and behavioral self-control. Examples • Experiences satisfaction disorder
include kleptomania (repeated stealing) and intermittent and stability in • Shows pattern of
explosive disorder relationships unstable and intense
20) Other Mental Disorders. This group includes psychiatric • Socially integrated and interpersonal
disorders that are due to other medical conditions or that can rely on social relationships
don't meet all the requirements for any of the other supports • Has chronic feeling of
psychiatric disorder groups emptiness
Effective coping strategies Substance dependents
Mental Health versus Mental Illness • Uses stress reduction • Repeatedly self-
Signs of Mental Health Signs of Mental Illness strategies that address administered
Happiness Major Depressive Episode the problem issue, threat substances despite
• Finds life enjoyable • Losses interest or (e.g. problem solving, significant substance-
• Can see in objects, pleasure in all or almost cognitive restructuring) related problems (e.g.
people, and activities all usual activities and • Using coping strategies threat to job, family and
their responsibilities for pastimes in a healthy way that social relationships)
meeting his or her needs • Describes mood as does not cause harm to
depressed, sad, self and others
hopeless, discouraged
or “down in the dumps”

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Coping and Defense Mechanisms k) Rationalization – justifying one’s behavior to make

Coping Mechanisms unacceptable feelings and behavior acceptable
- involves any effort to decrease the stress response. Coping • Sour Graping - implies that what is sincerely wanted
mechanism can be constructive or destructive is not worth trying after all
1) Constructive coping mechanism when it is tasked • Sweet Lemon - implies that a person tries to
oriented (direct problem solving) or defense oriented convince himself/herself that what he/she has is
(regulate response to protect oneself) exactly what he want
2) Destructive coping mechanisms often cause a mental l) Reaction Formation – acting out behaviors opposite to
health disorder because the person avoids the problem. what one really feels.
Defense Mechanism m) Regression – returning to an earlier developmental
- It is a pattern of behaving or thinking use d by individual to stage
protect self from threatening aspect s of the environment n) Repression – involuntary or unconscious forgetting
and from her/his own feeling of anxiety. It serve as a coping unacceptable thoughts from conscious mind
mechanism or protective defense. Although all individuals o) Suppression – conscious or voluntary forgetting of
may, in times of severe emotional stress, use many of the unacceptable or painful ideas, thoughts or feelings
behaviors listed below, it is the repetitive use of these p) Symbolism – conscious use of idea or object to
behaviors in most situations that is indicative of problems. represent another actual event or Object
- Defenses mechanisms are used as: q) Undoing – engaging in a behavior that is considered to
1) Protection of self-security be opposite of a previous unacceptable behavior,
2) Promotion of self-esteem thought or feeling
3) Resolve mental conflict
4) Reduce anxiety
Types of Defense Mechanisms
1) Commonly Used Normal Defense Mechanisms that
may help an individual deal with reality.
a) Compensation – making up for imagined handicapped
or deficiency
b) Compromise – reciprocal give and take necessary in
many relationships
c) Identification – unconscious attempt to change oneself
to resemble an admired person
d) Sublimation – re-channeling socially unacceptable
behavior to a socially acceptable one
e) Substitution – taking something in place of the original
goal or desire
2) Compensatory Defense Mechanisms
a) Conversion – transferring emotional conflict into
physical symptoms
b) Denial– unacceptance of reality
c) Displacement – releasing anger in a least threatening
way
d) Dissociation – blocking off of an anxiety provoking event
from the conscious mind
e) Fantasy – gratification by imaginary achievements and
wishful thinking
f) Fixation – psychosocial development ceased to
advance
g) Intellectualization – excessive reasoning to avoid real
feeling
h) Introjection – a type of identification in which the
individual incorporates the traits or values of another to
self
i) Isolation – person blocks feelings associated with
unpleasant experience
j) Projection – transferring one’s internal feelings,
thoughts, and unacceptable ideas and traits to
someone else

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