Psychiatric Nursing
Health (WHO)
- It is a state of complete physical, mental,
and social well- being and not merely
the absence of disease and infirmity.
Mental Hygiene
 The branch of psychiatry that deals with
the science and practice of maintaining
and restoring mental health, and of
preventing mental disorder through
education, early treatment, and public
health measures.
Mental Hygiene
 Science of maintaining mental health and
preventing disorders to help people function
at their full mental potential
6 techniques to take care of our mental
hygiene by: Edward G. Brown
 Transcend the environment
 Cultivate constructive acceptance
 Visualize the ideal self
 Use positive affirmation
 Practice psychological counterpunching
 Change your internal computer chip
Mental Health
- It is a state of emotional, psychological
and social wellness evidence by
satisfying interpersonal relationships,
effective behavior and coping, a
positive self-concept and emotional
stability.
- It is a psychological state of well-being,
characterized by continuing personal
growth, a sense of purpose in life, self-
acceptance, and positive relations with
others.
- It is the absence of mental illness.
- It is the ability to solve problems, fulfill
one’s capacity for love and work, cope
with crisis without assistance beyond the
support of family and friends, and
maintain a state of well-being by
enjoying life’s setting goals and realistic
limits, and becoming independent,
interdependent, or dependent as the need
arises without permanently losing one’s
independence.
Factors influencing mental health
 Inherited characteristics
 Nurturing childhood
 Life’s circumstances
Ways to maintain mental health
 Good interpersonal communication
 Ego defense mechanisms
 Significant others or support people.
 Involvement in physical activities
Characteristics of Mental Health
 Accepts self and others
 Is able to cope with or tolerate stress
 Can return to normal functioning if
temporarily disturbed
 Is able to form close and lasting
relationship
 Uses sound judgment to make decisions.
 Accepts responsibility for actions
 Is optimistic
 Recognizes limitations (abilities and
deficiencies)
 Can function effectively and
independently
 Is able to distinguish imagined
circumstances from reality
 Is able to develop potential talents to
fullest extent
 Is able to solve problems
 Can delay gratification
 It reflects a person’s approach to life by
communicating emotions, giving and
receiving, working alone as well as with
others, accepting authority, displaying a
sense of humor, and coping successfully
with emotional conflict.
Mental Disorder (APA)
- It is a clinically significant behavioral or
psychological syndrome or pattern that
occurs in an individual and that is
associated with present distress or
disability or with a significantly
increased risk of suffering death, pain,
disability or an important loss of
freedom.
Characteristics of Mental Illness
 Feels inadequate
 Has poor self- concept
 Is unable to cope
 Exhibits maladaptive behavior
 Is unable to establish a meaningful
relationship
 Displays poor judgment
 Is irresponsible or unable to accept
responsibility for actions
 Is pessimistic
 Does not recognize limitations, exhibits
dependency needs because of feelings of
inadequacy.
 Is unable to perceive reality
 Does not recognize potentials and talents
because of poor self-concept.
 Avoids problems rather than coping with
them or attempting to solve them
 Desires or demands immediate
gratification
 It reflects a person’s inability to cope with
stress, resulting in disruption,
disorganization, inappropriate reactions,
unacceptable behavior, and the inability to
respond according to the person’s
expectations and the demands of society.
Psychiatry
 It is the science of curing or healing of the
psyche.
 It is the medical specialty that is derived
from the study, diagnosis, treatment and
prevention of mental disorders.
Psychiatric Nursing
 It is the ‘diagnosis and treatment’ of
human responses to actual and potential
mental health problems.
 It is a specialized area of nursing practice,
employing theories of human behavior as
its science and purposeful use of self as its
art. (ANA)
 It is an interpersonal process that strives to
promote and maintain behavior which
contributes to integrated functioning. (Gail
Stuart)
 It is an interpersonal process whereby the
professional nurse practitioner assists an
individual, family and community to
promote health, to prevent or cope with
the experience of mental illness and
suffering and if necessary to find meaning
in these experiences. (Travelbee)
 Selected nursing interventions that are
commonly used in psychiatric nursing
 Active listening
 Anger control assistance
 Assertiveness training
 Behavior management
 Body image enhancement
 Caregiver support
 Communication enhancement
 Delusion management
 Eating disorders management
 Grief work facilitation
 Hallucination management
 Impulse control training
 Milieu therapy
 Mood management
 Role enhancement
 Sleep enhancement
 Spiritual support
 Substance abuse treatment
 Suicide prevention
 Teaching
Philosophical beliefs related to the effective
practice of Psychiatric Nursing
 The individual had worth and dignity
 The goal of the individual is one of growth,
health, autonomy, and self- actualization.
 Every individual has the potential to change
and the desire to pursue personal goals.
 The person functions as a holistic being that
acts on, interacts with, and reacts to the
environment as a whole person. Each part
affects the total response.
 All people have common, basic, and
necessary human needs.
 All behavior is meaningful
 Behavior consists of perceptions, thoughts,
feelings and actions
 Individuals vary in their coping capacities,
which depend on genetic endowment,
environmental influences, nature and degree
of stress and available resources.
 Illness can be a growth- producing
experience.
 All people have a right to equal opportunity
for adequate care regardless of gender, race,
religion, ethics, sexual orientation, or
cultural background.
 Mental health is a critical and necessary
component of comprehensive health care
services.
 The individual has the right to participate in
decision- making.
Use of Psychiatric –Mental Health Nursing
Skills in Career Opportunities
Obstetric Nursing
 Helping the mother in labor and support
person cope with anxiety or stress during
labor and delivery.
 Providing support to the bereaved parents
in the event of fetal demise, inevitable
abortion, or the birth of an infant with
congenital anomalies.
 Providing support to a mother considering
whether to keep her child or give the child
for adoption.
Forensic Nursing
 Providing services to incarcerated clients
 Acting as consultant to medical and legal
agencies
 Serving as an expert witness in a court
 Providing support for victims of violent
crimes.
Oncologic Nursing
 Helping cancer patients or other
terminally ill individuals on oncologic
units work through the grieving process.
 Providing support groups to families of
terminally ill patients.
Industrial (Occupational Health ) Nursing
 Implementing or participating in industrial
substance abuse programs for employees
and their families.
 Providing crisis intervention during an
industrial accident or the acute onset of a
physical or mental illness
 Teaching stress management
Public Health Nursing
 Assessing the person both physically and
psychologically (e.g. the newly diagnosed
diabetic client may develop a low self-
concept, or the recovering stroke client
may exhibit symptoms of depression due
to slow recovery)
Office Nursing
 Assisting the client by explaining somatic
or emotional concerns during the
assessment process
 Providing support with the problem-
solving process when people call the
office and the physician is unavailable.
 Acting as community resource person
Emergency Room Nurse
 Providing crisis intervention as the need
arises (e.g. during natural disasters,
accidents, or unexpected illnesses causing
increased anxiety, stress or
immobilization)
Roles and functions of mental health and
psychiatric nurse
 The mental health and psychiatric nurse
provides direct care to patients with mental
or emotional disorders, including:
 Promoting self-care and independence.
 Assisting with problem solving to
facilitate activities of daily living.
 Aiding communication and interpersonal
relations
 Helping the client examine behaviors the
test alternatives.
 Teaching about the disorder
 Administering prescribed medications and
treatments
 The nurse is also responsible for
constructing and maintaining a therapeutic
environment.
 Patient and family teaching
 She also coordinates in diverse aspects of
care
 Acting as an advocate on behalf of the
patient and family, she:
 Teaches about rights and responsibilities
 Shares information about self- help groups
 Responsibilities associated with primary
prevention include:
 Teaching principles of mental health
 Teaching how to recognize and reduce
stress
 Promoting effective family functioning
 Participating in community activities
related to mental health promotion.
DSM 5- RELEASED IN 2013 BY APA
 It is the listing of officially recognized
mental disorders.
 Is intended to assist researchers, health
care providers, insurance providers,
regulatory institutions, and other parties
in the medical field in guiding treatment
of mental health issues.
7 Biggest Changes from DSM IV-TR to DSM
5 mood
1. Modification of Artificial Categorization
 The use of multi-axial system to group
disorders into 5 categories is no longer
used
 The categorization has been simplified to
clarify relationships between different
disorders
2. The Autism Spectrum
 The previous categories of autism were
Asperger’s, childhood disintegrative
disorder, and pervasive developmental
disorder are no longer used.
 It is now unified as Autism spectrum
disorder
3. Elimination of Childhood Bipolar Disorder
 In response to an observed trend of
harmful over-diagnosis and over-
treatment of childhood bipolar disorder,
the DSM 5 removes this disorder and
replaces this with Disruptive Mood
Dysregulation Disorder (DMDD), it
does provide a new diagnosis that more
accurately matches a set of symptoms
characterized by extreme temper
outbursts
4. Revisions of ADHD Diagnosis
 DSM 5 broadens the ADHD diagnosis,
allowing for adult-onset and relaxing the
strictness of the criteria to more
accurately reflect new research on this
bipolar. Given that adults have more
developed brains and generally greater
impulse control, adults can now be
diagnosed with ADHD if they have
fewer signs and symptoms than children
do.
5. Increasing Detail on PTSD Diagnosis
 Partly due to the wars in Iraq and
Afghanistan, medical researchers have
gained a great deal more insight into
PTSD in the last 15 years.
The DSM-5 reflects this increased
understanding, adds nuance for children with
PTSD, and describes four main types of
symptoms:
 Arousal
 Avoidance
 Flashbacks
 Negative impacts on thought patterns and
6. Reclassification of Dementia
 In DSM-5, both dementia and the
category of memory/ learning
difficulties called amnestic disorders
have been subsumed into a new
category, neurocognitive Disorder.
 The DSM-5 splits this disorder into 2
broad severities (major and mild) to
encourage early detection and treatment
of these issues
7. Intellectual Disability
 To reflect common language, the issues
previously referred to as “mental
retardation” are now classified as
“intellectual disability”
 It also uses the term Intellectual
Development Disorder.
 The diagnostic criteria for this disorder
has also been updated to more strongly
focus on adaptive functioning, rather
than IQ score
MENTAL HEALTH:
Mental Health- is a state of mental well-being
that enables people to cope with the stresses of
life, realize their abilities, learn well and work
well.
What is the state of mental health globally?
According to WHO it was estimated that 1 out
of every 4 people will be impacted by mental
illness at some point in their lives, 300 million
people worldwide suffer from depression.
What is the current situation of mental health
in the Philippines?
In the Philippines the prevalence of mental
disorders ranged between 11.3% and 11.6% with
an average annual increase of 2.0% increasing
from 7.0 to 12.5 million Filipinos diagnosed
with a mental disorder between 1990 until 2019
underscoring the mental health agenda in the
Phil.
What is mental health in today’s world?
Mental health is a state of mental well-being that
enables people to cope with the stresses of life,
realize their abilities, learn well and work well,
and contribute to their community. It has
intrinsic and instrumental value and is integral to
our well-being.
What is the rate of mental health problems in
the world?
970 million people around the world struggle
with some mental illness and drug abuse, 1 in
every 4 people will be affected by a mental
illness at some point in their lives. 14.3% of
deaths worldwide or approximately 8 million
deaths each year are attributable to mental
disorders.
What state has the most mental illness?
- Montana
Across the US Montana had the highest rate of
mental illness with 25.7% reporting any mental
illness and 6.75 % reporting having a serious
mental illness.
Mental disorders according to WHO- June 8,
2022
1 in every 8 people in the world live with mental
disorder, mental disorders involve significant
disturbances in thinking, emotional regulation or
behavior.
Who is at risk from developing a mental
disorder?
At any one time , a disease set of individual,
family community and structural factors may
combine to protect or undermine mental health.
Although most people are resilient, people who
are exposed to adverse circumstances including
poverty, violence, disability and inequality are at
higher risk. protective and risk factors include
individual psychological and biological factors,
such as emotional skills as well as genetics.
Neurons- are nerve cells that send messages all
over your body to allow you to do everything
from breathing, talking, eating walking, and
thinking.
- It is also called as nerve cells and is the
fundamental units of the brain and the
Nervous system.
- It is a type of cell that receives and send
messages from the body to the brain and
back to the body.
- 86 billion of neurons and 100 billion in
mature brain.
Researchers estimates that the brains
hippocampus which plays a key role in learning,
memory and emotion makes about thousands
new neurons each day throughout adulthood.
Neurotransmitters- are endogenous chemicals
that allo neurons to communicate with each
other throughout the body. They enable the brain
to provide a variety of function through the
process of chemical synaptic transmission, these
endogenous chemicals are integral with shaping
everyday’s life and function.
- body’s chemical messenger, they carry a limited amount of information ready for
messages from one nerve cell across a space to immediate mental use- ( problem solving,
the next nerve, muscle or gland cell. reasoning, learning)
- they relay messages- travel between cells- Why memory is important in psychology?
attaching to specific receptors on target cells.
It is an integral part of human cognition since it
allows individual to recall and draw upon past
events to frame their understanding of the
Types of neurotransmitters:
behavior within the present.
1. Serotonin
Repetition - is a well documented trigger for
2. Dopamine memory formation- the more times something is
repeated the better it is remembered.
3. Glutamate
- set of repeating or doing, saying or writing
4. Acetylcholine something again.
5. GABA- gamma aminobutyric acid Repetitive compulsions are repetitive patterns
and behavior often stemming from unresolved
and deep-rooted emotional pain or past traumas,
Memory - refers to the psychological process of the compulsion to repeat certain behaviors cal
acquiring, storing, retaining, and later retrieving also be caused by a mental illness like OCD
information. (Obsessive Compulsive Disorder).

3 major processes involved in memory? OCD- long lasting disorder in which a person
experiences uncontrollable and recurring
1. Encoding- initial learning of
thoughts (obsession), engages in repetitive
information
behaviors (compulsions) or both. People with
2. Storage- maintaining information over OCD have time consuming symptoms that can
time cause significant distress or interfere with daily
life.
3. Retrieval- ability to access information
when you need it. - is a disorder in which people have recurring
unwanted thoughts, ideas and sensations
(obsessions) and to get rid of the thoughts they
3 types of Memory: feel driven to do something repetitively
(Compulsion)
1. Long term memory- unlimited storage
of information to be maintained for long periods,
even for life ( creates long lasting memories) What is repetition of action called in
2. Short term memory - memory systems Psychology?
in the brain involved in remembering pieces of Repetition of similar actions in similar
information for a short period of time, often up circumstances is the definition of habit. Habit is
to 30 seconds. a result of gradual repetition of actions used over
3. Working memory- type of short term a period of time ( sleeping, eating, drinking are
memory that allows a person to temporarily hold some examples of habits)

Concepts and Patterns of Human behavior
Family Dynamics
- refers to the patterns of interactions among
relatives, their role and relationships and the
various factors that shape their interactions
because family members rely on each other for
emotional, physical, and emotional support, they
are one of the primary sources of relationship
security or stress.
- the processes by which family members
influences, each others thoughts, feelings, and
behavior and the changes in the family
relationships that these processes bring.
5 healthy Family Dynamics
1. Cohesiveness
2. Open communication
3. Parents leading by example
4. Conflict management
5. Setting clear expectations and limits
Patterns of Behavior
Behavior patterns are also described as chains of
behavior, which are multifariously linked from
simpler, smaller segments.
- a complex arrangement of 2 or more responses
that occur in a prescribed order.
Behavior- the way in which one acts or conducts
oneself especially towards others the way in
which a person acts in response to a particular
situation or stimulus.
Different types of Behavioral patterns:
1. Passive aggressive tendencies -
indirectly expressing negative feelings instead of
openly addressing them.
2. Hostility - unfriendly, aggressive
behavior towards people or ideas.
3. Quick tempered
4. Acting on impulse- when you act
quickly with no thought to the consequence
5. Self- sabotage- when people do things
that block their success or prevent them from
accomplishing their goals ( self-medicate with
drugs/alcohol, self-injury)
6. Being attracted to the same sort of
person each time.
Anxiety- feeling of fear, dread and uneasiness
Anxiety disorders are conditions in which you
have anxiety that does not go away and can get
worse over time. The symptoms can interfere
with daily activities such as job performance,
schoolwork, and relationships.
There are several types of anxiety disorders,
including:
1. Generalized anxiety disorder
(GAD). People with GAD worry about ordinary
issues such as health, money, work, and family.
But their worries are excessive, and they have
them almost every day for at least 6 months.
2. Panic disorder. People with panic
disorder have panic attacks. These are sudden,
repeated periods of intense fear when there is no
danger. The attacks come on quickly and can
last several minutes or more.
3. Phobias. People with phobias have an
intense fear of something that poses little or no
actual danger. Their fear may be about spiders,
flying, going to crowded places, or being in
social situations (known as social anxiety).
What causes anxiety disorders?
The cause of anxiety is unknown. Factors such
as genetics, brain biology and chemistry, stress,
and your environment may play a role.
Who is at risk for anxiety disorders?
The risk factors for the different types of anxiety
disorders can vary. For example, GAD and
phobias are more common in women, but social
anxiety affects men and women equally. There
are some general risk factors for all types of
anxiety disorders, including:
1. Certain personality traits, such as being
shy or withdrawn when you are in new
situations or meeting new people
2. Traumatic events in early childhood or
adulthood
3. Family history of anxiety or
other mental disorders
4. Some physical health conditions, such
as thyroid problems or arrhythmia
What are the symptoms of anxiety disorders?
The different types of anxiety disorders can have
different symptoms. But they all have a
combination of:
1. Anxious thoughts or beliefs that are hard
to control. They make you feel restless and tense
and interfere with your daily life. They do not go
away and can get worse over time.
2. Physical symptoms, such as a pounding
or rapid heartbeat, unexplained aches and
pains, dizziness, and shortness of breath
3. Changes in behavior, such as avoiding
everyday activities you used to do
Using caffeine, other substances, and certain
medicines can make your symptoms worse.
What are the treatments for anxiety
disorders?
The main treatments for anxiety disorders are
psychotherapy (talk therapy), medicines, or
both:
1. Psychotherapy can help you recognize
and change troubling emotions, thoughts, and
behaviors. To be effective, it should focus on
your specific anxieties and needs. There are
many types; some of the types used for anxiety
disorders include:
2. Cognitive behavioral therapy
(CBT), which teaches you different ways of
thinking and behaving. It can help you change
how you react to the things that cause you to feel
fear and anxiety. It may include exposure
therapy. This therapy focuses on having you
confront your fears so that you will be able to do
the things that you had been avoiding.
3. Acceptance and commitment
therapy may help with some anxiety disorders.
It uses strategies such as mindfulness and goal
setting to reduce discomfort and anxiety.
4. Medicines to treat anxiety disorders
include anti-anxiety medicines and
certain antidepressants. Some types of medicines
may work better for specific types of anxiety
disorders. (SSRI’s)
5. Support groups and stress management
techniques may also be helpful.
REPUBLIC ACT No. 11036- Metal health act
of the Philippines
An Act Establishing a National Mental Health
Policy for the Purpose of Enhancing the
Delivery of Integrated Mental Health Services,
Promoting and Protecting the Rights of Persons
Utilizing Psychosocial Health Services,
Appropriating Funds Therefor and Other
Purposes
NERVOUS SYSTEM: 1. Cervical -8
2. Thoracic-12
3. Lumbar-5
4. Sacral-5
5. Coccygeal-1
Total of -31

Peripheral nervous system has 2 parts

1. Somatic nervous system
2. Autonomic nervous system

Under peripheral nervous system

Has 2 parts
1. Central Nervous system
3. Peripheral nervous system
Under Central Nervous system
1. Brain
2. Spinal cord
1. Sympathetic nervous system - for
fight,flight and freeze
2. Parasympathetic nervous system - when the
threat is gone all the systems of the body return
back to normal state
Somatic nervous system - responsible to carry
motor and sensory information

Under the Brain

1. Cerebrum
2. Cerebellum
3. Midbrain
Brain-complex organ that controls thought,
4. Diencephalon memory, emotion, touch, motor skills, vision,
breathing, temperature, hunger and every
5. Pons process that regulates our body.
6. Medulla Oblongata PARTS OF THE BRAIN:
Cerebellum - responsible for balance control
Under spinal cord and muscle movement
Midbrain- relay system, transmitting
information necessary for vision and hearing.
- It also plays an important role in motor
movement, pain, and the sleep/wake
cycle. The midbrain, also called the
mesencephalon.
Diencephalon -coordinating with the endocrine
system to release hormones, relaying sensory
and motor signals to the cerebral cortex, and
regulating circadian rhythms (the sleep wake
cycle).
Pons-handles unconscious processes and jobs,
such as your sleep-wake cycle and breathing.
Medulla Oblongata -helps control vital
processes like your heartbeat, breathing and
blood pressure.

Afferent neurons -bringing sensory information

from the outside world into the brain.
Efferent neurons- the nerve fibers responsible
for carrying signals from the brain to the
peripheral nervous system in order to initiate an
action.