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INTRODUCTION TO PSYCHIATRIC NURSING

Mercedes A Perez-Millan MSN, ARNP

Mental Health ???????

MENTAL ILLNESS

Seven Signs of Mental Health

Happiness Control over behavior Appraisal of reality Effectiveness in work Healthy self-concept Satisfying relationships
(give and receive love)

Effective coping strategies

Traits of Mental Health

Ability to
oDeal with conflicting emotions oLive without undue fear, guilt, or anxiety oTake responsibility for one's own actions oThink clearly oNegotiate each developmental task

Prevalence of Psychiatric Disorders USA


The Department of Health and Human Services and the National Institute of Mental Health (2004) provide the following statistics:

57.7 million Americans have a mental illness. That is


26.2 per cent of Americans 18 or older.

Four of the ten leading causes of disability include:


major depression, bipolar disorder, schizophrenia and obsessive compulsive disorder.

The economic burden of mental illness in the USA,


exceeds $ 170 billion.

National Institute of Mental Health 2002 USA Statistics

Affective Disorders- 9.5 pre-cent. 18.8 million Suicide- 29,350 people committed suicide Schizophrenia- 1.1 percent, 2.2 million Anxiety disorders- 13.3 percent, 19.1 million Eating disorders- 2- 5 percent of population ADHD- 4.1 percent of youth ages 9 to 17 Substance abuse- 11.3 percent of the population

Theories of Mental Illness


PSYCHOBIOLOGICAL

PSYCHOLOGICAL

PSYCHOBIOLOGICAL

Genetic
Other Biological Influences The Role of the Environment

PSYCHOBIOLOGICAL
Overview of the Brain
Forebrain

Cerebrum
o Frontal lobe- Voluntary movement, language, executive function o Parietal lobe- Sensory impulses, tactile sensations o Temporal lobe- Memory, emotions, taste, smell, auditory

Diencephalons

o Occipital lobe- Vision, visual perception


o Thalamus- Pathway of motor & sensory impulses

o Hypothalamus- Regulates hormonal functioning

PSYCHOBIOLOGICAL
Overview of the Brain (cont.)
MIDBRAIN

Mesencephalon- Processes visual &


auditory information

HINDBRAIN

Pons- Visceral & somatic motor control Medulla- Autonomic functioning of major Cerebellum- Modulates movement
organs

PSYCHOBIOLOGICALNEURON

CONDUCTION OF ELECTRICAL IMPULSES NEUROTRANSMITTERS RECEPTORS

PSYCHOBIOLOGICALNEUROT
RANSMITTER

CHEMICAL MESSANGERS RELEASED AT PRESYNAPTIC NEURON DIFFUSES ACROSS SYNAPSE TO POST

ATTACHES TO SPECIALIZED RECEPTORS INHIBITS OR STIMULATES RELEASED AND THEN DESTROYED OR


TAKEN BACK FOR RECYCLING

SYNAPSE

PSYCHOBIOLOGICALNeurotrans
mitter/ Receptor/ Disorder

Dopamine DA Schizophrenia, Mania


Parkinsons, Depression

Norepinephrine NE Mania
Depression

Serotonin 5-HT Anxiety


Depression

Gamma-amino- GABA Reduction of


buturic acid anxiety Anxiety Acetyl-Choline Ach Depression Alzheimers

PSYCHOLOGICAL

Freud's Psychoanalytic Theory


oConscious, preconscious, unconscious

oId, ego, superego


oDefense mechanisms and Anxiety oTheories of personality

PSYCHOLOGICALPSYCHOANALYTI
CAL EGO FUNCTIONS

EGO

1.
1. REALITY

1.
TESTING
1. DEFENSIVE

FUNCTIONING

2.SENSE OF REALITY

2.OBJECT RELATIONS

3.JUDGEMENT
4.IMPULSE CONTROL 5.THOUGHT PROCESS 6.ARISE

3.AUTONOMOUS FUNCTIONING
4.STIMULOUS BARRIER 5.MASTERY COMPETENCE 6.SYNTHETIC INTEGRATIVE FUNCTIONING

PSYCHOLOGICAL
Freud

Psychosexual Stages of Development

Oral (0-18mos Anal (18mos-3yrs) Phallic (3-6yrs.) Latency (6-12yrs) Genital (13-20yrs)

PSYCHOLOGICAL
ERIKSON Psychosocial Stages of Development Trust vs Mistrust

Autonomy vs Shame and Doubt

Initiative vs Guilt

PSYCHOLOGICAL
ERIKSON (cont) Industry vs Inferiority

Identity vs Role Confusion

Intimacy vs Isolation

PSYCHOLOGICAL
ERIKSON (cont) Generativity vs Stagnation

Ego Integrity vs Despair

Maslows Hierarchy of Needs


6. Self-Transcendent Needs 5. Self- Actualization Needs 4. Esteem Needs 3. Love and Belonging Needs 2. Safety Needs 1. Physiological Needs

Emphasis on human potential and clients strengths Establishes what is most important in sequences of
nursing actions Sets Priorities Varcarolis p. 20-21

Psychiatric Mental Health Nursing and the Nursing Process


1. Assessment 2. Nursing Diagnosis

6. Evaluation 3. Outcome Identification

4. Planning 5. Implementation

Factors Affecting Mental Health and Nursing Assessment

Support systems

Family influences Developmental events Cultural beliefs and values Health practices Negative influences

PSYCHIATRIC ASSESSMENT

Construct database
oMental status examination (MSE) oPsychosocial assessment

oPhysical examination
oHistory taking oInterviews oStandardized rating scales

Verifying the data

DIAGNOSIS OF PSYCHIATRIC
ILLNESS

Medical- DSM-IV-TV (Diagnostic and


Statistical Classification of Mental Disorders)

Nursing- NANDA (North American Nursing


Diagnosis Association)

DSM-IV-TR
Mental disorders are considered a manifestation of a

Behavioral Psychological Biological

dysfunction of the individual

DSM- IV- TR MULTI-AXIAL CLASSIFICATION

Axis I- All major psychiatric disorders Axis II- Personality disorders; Mental Axis III- Current medical conditions that are Axis IV- Psychosocial and environmental
relevant to the mental disorder
problems retardation

Axis V- Global Assessment of Function


(GAF)

Therapeutic Approaches

Psychoanalysis Short term psychotherapy Cognitive Therapy Behavior Therapy


oModeling oOperant Conditioning oSystemic desensitization oAversion Therapy Milieu Therapy

CULTURAL BIASES

Consider cultural differences that influence


health

Be accepting of changing families Be open, consider differences in order to


provide sensitive, competent care

GOALS and Interventions of Psychiatric Care Directed to

Anxiety
+ +

Reality testing
Self esteem = Level of functioning and manage disease
process

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