Professional Documents
Culture Documents
Mental Health
A state of emotional, psychological and social wellness evidenced by: a. Satisfying interpersonal relationships b. Effective behavior and coping c. Positive self concept d. Emotional stability
Mental Illness
disharmony Is a sense of _____________ with the aspects of living that may be _________________ to the individual, distressing family, friends, and community.
APA (2000)
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.
5. Perceptions of Reality how one perceives ________ & envt, people 6. Mastery of Ones Environment
ability to _________, _________, adapt adjust and _________ appropriately according behave to culturally approved standards
& how he ________ to them reacts
Historical Review
Primitive: mentally ill possessed by demons as punishment for sin. Treatments: trephine skull operations starving beating abandoning in forests to be devoured by animals burning at stake
Romans bleeding, purging, sulfur baths Gheel in Belgium start of Gheel colony by St. Dymphna
Reformation Era
To almshouses, jails, dungeons favorite therapeutic procedures: purging and bleedings Bethlehem Royal Hospital in London (Bedlam: by King Henry VII) Pinel, Phillippe and William Tukes freed chained insane patients, started humane treatment
Period of Enlightenment and Creation of Mental Institutions Formulated the concept of asylum
Development in the US
1773 Eastern Lunatic Asylum in Williamsburg, Virginia 1783 Dr. Benjamin Rush: Father of American Psychiatry, organized first lectures
Human treatment of the mentally ill Invented the tranquilizer chair Gyrator
Development in the US
________________________: Dr. Edward S. Cowles organized first course 1882, McLean Asylum, Waverly, Mass Dorothea Lynde Dix: aroused legislative action to establish & enlarge hospitals in US; d/t inhumane practices and filthy cells, jails & poorhouses
Other Developments
________________________: (French) Jean Martin Charcot Psychotherapy Emil Kraeplin ____________________: (German) Classification of mental disorders Sigmund Freud: Psychoanalysis, Psychosexual theory and neurosis
th 20
Century Developments
ECT
1946 US National Mental Health Act of ____: research and training, improvement, expansion of community health services Deinstitutionalization: shift from the community institution to the ___________
Development of Psychopharmacology
In the 1950s the development of psychotropic drugs were used to treat mental illness. Chlorpromazine (Thorzine), an antipsychotic drug, and lithium, an anti-manic agent, were the first drugs to be developed. 10 years later, monoamine oxidase inhibitors, haloperidol (Haldol), an antipsychotic; tricyclic antidepressants; and antianxiety agents (benzodiazepines), were introduced. Because of these new drugs, hospital stays were shortened, and many people were well enough to go home.
Psychoanalysis
A form of psychodynamic psychotherapy therapist and client in which the ___________________ conscious explore the clients ____________ unconscious and _______________ conflicts coping and ___________ patterns
Founders of Psychoanalysis
Father of SIGMUND FREUD: ___________________ Psychoanalysis
Further explained the ANNA FREUD: ______________________ _______________________________ defense mechanisms
classified VAILLANT: ___________ the defense mechanisms in a hierarchy from _____________ to healthy psychotic
Primary Drives
Eros
Drive towards life Instincts concerned with self preservation or survival of the fittest
Thanatos
Drive towards death Aggression or hate which can be directed inward or outward
Personality
Personality characteristic traits that are generally predictable in their influence on ____________, ____________, cognitive affective and behavioral patterns expressed through ______________ behavior Factors Influencing Personality:
1. hereditary 2. environment 3. training
A. Levels of Consciousness
1. Conscious
1. Functions when awake 2. Here and now 3. Easy recall of past experiences
A. Levels of Consciousness
2. Subconscious
1. Ideas and reactions are stored and partially forgotten 2. Prevents unacceptable disturbing memories from reaching conscious mind 3. Tip of the tongue experiences
A. Levels of Consciousness
3. Unconscious - greatest influence on personality - storehouse of memories, feelings throughout life - memories are not recalled - dreams, slip of the tongue, unexplained behavior
A. Levels of Consciousness
1. Conscious 2. Subconscious 3. Unconscious
ID
Primarily a sexual and aggressive drive The first structure to develop in the personality
Developed during infancy
EGO
CEO of the mind. Toddler period Mediates between the Id and Super Ego thus maintaining a reality orientation for the person.. Reality principle. Secondary process thinking which is
logically oriented in time and distinguishes between reality and fantasy.
Partially under conscious control. What happens when ego cant mediate against the unconscious drives?
SUPER EGO
Our conscience 2 main functions- reward and punishment.
Rewards good behavior and punishes bad behavior by creating guilt.. A residue of internalized values and moral training or early childhood..
Pre-school age Overly strict super ego may lead to extremes of guilt and anxiety
Pleasure Principle
Reality Principle
EGO
ID/
SUPEREGO
Resolving Conflicts
Stimulus Drive Response Resolution
Resolving Conflicts
Stimulus Drive Response Resolution
Eats ice cream and feels satisfied momentarily. May become stimulus for guilt.
Resolving Conflicts
Stimulus Drive Response Resolution
Does not eat. May become stimulus for sad or angry feelings.
Resolving Conflicts
Stimulus Drive Response Resolution
Drive is reduced.
Pavlov
Classic conditioning (Behavior theory)
Application to Nursing
Classic conditioning to initiate a behavior Operant conditioning to ensure the behavior is repeated
Psychosexual Theory
By Sigmund Freud
Stages of Development
Oral Anal Phallic Latency Prepuberty & Adolescence Genital Birth 18 mos. 18 mos 3 years 3 5 years 6 12 years 12 15 years
15 years - adult
Fixation
Arrest of maturation at an earlier level of psychosocial development. It is behavior that should have been outgrown.
Fixation : passivity, gullibility, & dependence, the use of sarcasm, & the devt of orally focused habits (smoking and drinking)
Major Char:
Reality principle, fear of loss of object loved, approval & disapproval, Beginning superego development
Fixation: rel. to anal retentiveness (stinginess, rigid thought patterns, OCD) Or anal expulsiveness char (messiness, destructivenss, cruelty)
Toilet Training
Toilet Training
Major Char:
Major Char:
Major Char:
Application to Nursing
Anxiety has an important role in maladaptive behavior. Nurses must understand the role of unconscious conflict in the motivation of behavior. Nurses must be aware of the clients defense mechanisms.
Major Char:
Other Possible Personality Traits
Heterosexual relationships
Inability to negotiate this stage could result in difficulties in becoming emotionally and financially independent, lack of strong personal identity and future goals, and inability to form satisfying intimate relationships
Psychosocial Theories
Erik Erikson
Focused on personality development across the life span while focusing on social and psychological development in life stages. Erikson believed that psychosocial growth occurs in sequential stages, and each stage is dependent on the completion of the previous stage/life task.
Application to Nursing
Facilitate adaptive resolution of various developmental crises or tasks by using the nursing process to assess the clients level of functioning and subsequent planning. Provides basis for client centered nursing interventions.
Trust vs. Mistrust (infant) Autonomy vs. Shame and Doubt (toddler) Initiative vs. Guilt (preschool) Industry vs. Inferiority (school age) Identity vs. Role confusion (adolescence) Intimacy vs. Isolation (young adult) Generativity vs. Stagnation (middle adult) Ego integrity vs. Despair (maturity)
IV. Industry vs. Sense of competence Inferiority Completion of projects (6 to 12 years) Pleasure in efforts and effectiveness Ability to cooperate and compromise Identification with admired others Joy of involvement in the world and with others Balance of work and play
Feeling unworthy and inadequate Poor work history (quitting, being fired, lack of promotions, absentism, lack of productivity) Inadequate problem solving skills Manipulating others / violating others rights Lack of friends of the same sex OR Overly high achieving / perfectionist Reluctance to try new things for fear of failing Feeling unable to gain love or affection unless totally successful Being a workaholic
Cognitive Theories
Jean Piaget
Sensorimotor (birth to 2 years): The child develops a sense of self as separate from the environment and the concept of object permanence. Begins to form mental images. Preoperational (2-6 years): Child begins to express himself with language, understands the meaning of symbolic gestures, and begins to classify objects.
Concrete operations (6-12 years): Child begins to apply logical thinking, understands reversibility, is increasingly social and able to apply rules Thinking is still concrete. Formal operations (12 to 15 years and beyond): Child learns to think and reason in abstract terms, further develops logical thinking and reasoning, and achieves cognitive maturity.
Application to Nursing
Helps nurses recognize impaired development and prove a relationship that facilitates the persons accomplishment of developmental tasks. Enables early childhood interventions
The importance and significance of interpersonal relationships in ones life Personality is manifested only in a persons interaction with another person or with a group Developed the first therapeutic community or milieu with young men with schizophrenia in 1929.
Stages
Infancy
Development of self concept Learn to trust others
Childhood
Accept influence of others
Juvenile
Peer relations
Preadolescence
Form friendships with same sex peers
Early adolescence
More independent Establish relationship with opposite sex
Late adolescence
Develop enduring relationship with opposite sex
Milieu therapy is used in the acute care setting; one of the nurses primary roles is to provide safety and protection while promoting social interaction
Application to Nursing
Used to strengthen support systems Foster interpersonal relationships Strengthens clients belief systems Facilitates faith, hope and life
Acute anxiety
Positive state of heightened awareness and sharpened senses Learn new behaviors and solve problems. Person can take in all available stimuli (perceptual field).
Moderate anxiety
Decreased perceptual field (focus on immediate task only) Learn behavior only with assistance Ideal anxiety state for teaching a client regarding health concerns such as diabetes
Humanistic Theories
Maslows Hierarchy of needs
Physiologic needs, need to be met first. Safety and security needs Love and belonging needs Esteem needs Self-actualization,
The need for beauty, truth, and justice. Few people actually become self-actualized.
Remember, traumatic life experiences or compromised health can cause a person to regress to a lower level of motivation!
Application to Nursing
Useful in organizing curricula and in assessing and giving care Emphasis on physiologic needs as the priority when life and physical integrity are in jeopardy
Neurobiological Theories
All behaviors are a reflection of brain function All thought processes represent a range of functions mediated by nerve cells in the brain Cognitive and emotional dysregulation result from multiple causes (trauma, genetics, nutrition etc) that cause neurotransmitter disturbances in the brain.
Application to Nursing
Provide the basis of target sites for pharmacological and psychotherapeutic interventions that mitigate symptoms of various psychiatric disorders
PSYCHIATRIC NURSING
Interpersonal process whereby the professional nurse practitioner through the use of self, assist an individual, family, group or community to promote mental health, to prevent mental illness and suffering, to participate in the treatment and rehabilitation of the mentally ill and if necessary to find meaning in these experiences. It is both Science and an Art.
Science in Psychiatric Nursing. The use of different theories in the practice of nursing, serves as the science of psychiatric nursing. Art in Psychiatric Nursing. The therapeutic use of self is considered as the art of psychiatric nursing.
Mental Hygiene.
It is the science that deals with measures to promote mental health, prevent mental illness and suffering and facilitate rehabilitation.
Genuineness
Sense of openness, realness and lack of defensiveness. It conveys congruence between verbal and non verbal behaviors
Warmth
Imparts consistency , kindness, patience, and caring for the client
Empathy
Experiencing clients feelings as though they were his own but the nurse does not totally lose her identity Sympathy is feeling or sharing the identical concerns of another. It interferes with formation of therapeutic relationship
Acceptance
Tolerance and appreciation of the client as a human being regardless of race, gender, culture, religion
Leadership
Problem solving and decision making
Patient advocate enables the patient and his relatives to know their rights and responsibilities Teacher assists the patient to learn more adaptive ways of coping Technician facilitates the performance of nursing procedures
Therapist explores the patients needs, problems and concerns through varied therapeutic means Reality base enables the patient to distinguish objective reality and subjective reality Healthy role model acts as a symbol of health by serving as an example of healthful livings
The nurse views the patient as a Holistic human being with interdependent and interrelated needs The nurse accepts the patient as a unique human being with inherent value and worth exactly as he is. The nurse should focus on the patients behavior non-judgmentally, while assisting the patient to learn more adaptive ways of coping
The nurse should explore the patients behavior for the need it is designed to meet and the message it is communicating The nurse has the potential for establishing a nurse-patient relationship with most if not all patients The quality of the nurse-patient relationship determines the degree of change that can occur in the patients behavior.
Primary
Interventions aimed at the promotion of mental health and lowering the rate of cases by altering the stressors Examples: Health education Information dissemination Counseling
Secondary
Intervention that limit the severity of a disorder Two components
Case finding Prompt treatment Examples: Crisis intervention, Administration of medications
Tertiary
Interventions aimed at reducing the disability after a disorder Two components
Prevention of complication Active program of rehabilitation Examples: Alcoholic anonymous, Occupational therapy
Altered Genes Brain exposed to internal and external demands Brain attempts to cope Successful Unsuccessful
Mental Health
Mental Illness
Defense Mechanisms
They are psychological strategies used individuals (and by extension--groups of individuals and even entire nations at times) to cope with reality and to maintain his/her self -image intact.
A defense mechanism becomes pathological when it is used persistently and leads to maladaptive behavior that will eventually threaten the physical and/or mental health of the individual. There are psychological defenses that are: a. Almost always pathological b. Immature c. Neurotic d. Mature defense mechanisms
B ehavioral and General Appearance E motion: Mood and Affect S peech T though content and Process
P erceptual Disturbances I mpulse Control C ognition and Sensorium K nowledge, Insight and Judgment
Diagnostic Exams
Neurometrics
Measures the electrophysiology of the brain especially increased or decreased beta, alpha, theta and delta waves
Magnetic Resonance Imaging Distinguishes gray and white matter in 3 dimensions Identifies structural abnormalities