Psych module1

Mental Health

A state of (E)emotional, (S)social and (P)sychological wellness as evidenced by: E – Effective behavior and coping; S – Satisfying interpersonal relationships; P – Positive self-concept; E – Emotional stability (WHO).

Mental Illness

A condition that impacts a person's thinking, feeling, or mood and may affect his or her ability to relate to others and function on a daily basis. Each person will have different experiences, even people with the same diagnosis.

Mental Disorder (American Psychiatric Association, 2000)

“A clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with present distress (painful symptom) or disability (impairment in one or more important areas of functioning) or with a significantly increased risk of suffering, death, pain, disability, or an important loss of freedom.”

Factors Influencing Mental Health

Inherited characteristics; social/cultural factors; nurturing during childhood.

Inherited Characteristics

Biological or genetic predispositions that influence an individual’s mental health, such as family history of mental illness, temperament, or neurochemical imbalances.

Social/Cultural Factors

Factors involving the social and cultural environment that influence mental health.

Nurturing During Childhood

The quality of nurturing during childhood, including parenting style, exposure to trauma, and childhood experiences that influence mental health.

Nature

Refers to inherited characteristics — these include biological or genetic predispositions that influence an individual’s mental health, such as family history of mental illness, temperament, or neurochemical imbalances.

Nurture

Refers to social, cultural, and childhood experiences — this encompasses the environment in which a person is raised, including the quality of nurturing during childhood, exposure to trauma, parenting style, and cultural norms.

Nature vs. Nurture

Mental health and illness are not solely caused by either biological (nature) or environmental (nurture) influences — rather, they interact and contribute collectively to the development of mental wellness or disorder.

Components of Mental Health (Johnson, 1997)

Mental health has many components and is influenced by a wide variety of factors.

Maximization of One’s Potential

Oriented toward growth and self-actualization.

Self-Esteem

Has realistic awareness of her abilities and limitations.

Mastery of the Environment

Can deal with and influence the environment.

Autonomy and Independence

Can work interdependently without losing autonomy.

Reality Orientation

Can distinguish the real world from a dream, fact from fantasy.

Tolerance of Life’s Uncertainties

Can face the challenges of day-to-day living with hope and positive outlook in life.

Stress Management

Ability to tolerate anxiety and frustrations.

Factors Contributing to Mental Illness

Individual factors; interpersonal factors; cultural and social factors.

Individual Factors

Include biologic make-up, anxiety, worries and fears, a sense of disharmony in life, and a loss of meaning in one’s life.

Interpersonal Factors

Include ineffective communication, excessive dependency or withdrawal from relationships, and loss of emotional control.

Cultural and Social Factors

Include lack of resources, violence, homelessness, poverty, and discrimination such as racism, classism, ageism, and sexism.

Criteria to Diagnose Mental Disorders

Lack of personal growth; dissatisfaction with one’s characteristics, accomplishments, abilities; ineffective or dissatisfying relationships; dissatisfaction with one’s place in the world; ineffective coping with life’s events.

Lack of Personal Growth

A criterion used to diagnose mental disorders.

Dissatisfaction with One’s Characteristics, Accomplishments, Abilities

A criterion used to diagnose mental disorders.

Ineffective or Dissatifying Relationships

A criterion used to diagnose mental disorders.

Dissatisfaction with One’s Place in the World

A criterion used to diagnose mental disorders.

Ineffective Coping with Life’s Events

A criterion used to diagnose mental disorders.

DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders, 4th Edition – Text Revision)

A taxonomy published by the American Psychiatric Association that describes all the mental disorders with a specific diagnostic criteria.

Purpose of DSM-IV-TR

To provide a standardized nomenclature and language for all mental health professionals; to present defining characteristics or symptoms that differentiate specific diagnoses; to assist in identifying the underlying causes of disorders.

Axis I – Clinical Disorder

Clinical disorder (focus of treatment).

Axis II – Personality Disorder and Mental Retardation

Personality disorder and mental retardation.

Axis III – Medical Conditions

Medical conditions.

Axis IV – Psychosocial and Environmental Problems

Psychosocial and environmental problems.

Axis V – Global Assessment of Functioning (GAF) Score

0–100 score used for global assessment of functioning.

Ancient Times

Displeasure of the gods; punishment for sins and wrongdoings. Thought to be a natural phenomenon – a humanistic approach; imbalances of the four humors.

Early Christian Times (1100)

Evil spirits possessed the body and must be driven out.

Renaissance (1300–1600)

Decline in belief of possession – mental problems were irreversible. Scientific inquiry and humanism.

Period of Enlightenment and Creation of Mental Institutions (18th Century)

A reform movement – chains removed. Need for medical care recognized. First mentally ill patient treated in hospital.

Scientific Study (19th Century)

Research and legislation concerning mental health were enacted. Hospitals for mentally ill were established for long-term custodial care.

Psychopharmacology and Community Mental Health (20th Century)

Start of mental health movement. Large state hospitals, psychoanalysis developed, community centers established. Holistic and short-term care. Return to society emphasized. Prevention-focused.

21st Century

Mental disorders as diagnosable and a serious emotional disturbance impairing daily activities. Leading cause of disability. Emphasis on institutionalization vs. deinstitutionalization. “Revolving door” effect. Community-based care.

Psychiatric Nursing Pertains To

Assessment of behavior, planning and evaluation of care for individuals with mental disorders; promotion of optimal mental health for individuals through early diagnosis, treatment, and rehabilitation; use of therapeutic interactions between the nurse and the individual.

Interpersonal Process

Whereby the nurse, through the therapeutic use of self, assists an individual, family, group, or community to promote mental health; helps prevent mental illness and suffering; participates in the treatment and rehabilitation of the mentally ill; helps find meaning in these experiences.

Travelbee (1970)

Psychiatric nursing is an interpersonal process whereby the professional nurse practitioner assists an individual, family, and community to prevent or cope with the experience of illness and suffering and, if necessary, to find meaning in those experiences.

Mental Health Psychiatric Nursing

A specialized area of nursing that uses the theories of human behavior and the purposeful use of self as its art.

Mental Health Psychiatric Nursing as an Interpersonal Process

Promotes mental health; prevents mental illness; ensures early identification and intervention of emotional problems; provides follow-up care to minimize long-term effects of mental disturbance.

Goal of Psychiatric Nursing: Accept Himself

To help the client accept himself.

Goal of Psychiatric Nursing: Relationship with Other People

To promote relationship with other people.

Goal of Psychiatric Nursing: Independent Functioning

To learn to function independently on a realistic basis

Creator of the Therapeutic Environment

A role of the psychiatric nurse involving the creation of a therapeutic environment.

Technical Nursing Role

A role of the psychiatric nurse involving technical nursing responsibilities.

Therapist

A role of the psychiatric nurse involving therapeutic interventions.

Socializing Agent

A role of the psychiatric nurse involving assistance with social interaction.

Counselor

A role of the psychiatric nurse involving guidance and support

Teacher

A role of the psychiatric nurse involving education and teaching.

Parent Surrogate

A role of the psychiatric nurse involving providing support similar to a parental figure.

Primary Prevention

Goal: Altering causative or risk factors to hinder development of illness; interventions include client and family teaching, stress reduction, and psychosocial support.

Secondary Prevention

Goal: Reducing the effects of mental illness; interventions include screening, crisis intervention, suicide prevention, short-term counseling, and emergency counseling with short-term hospitalization.

Tertiary Prevention

Goal: Minimizing long-term residual effect; interventions include rehabilitation program, vocational training, after-care support, and partial hospitalization options.

Developmental Theories

Theories that explain human growth and development.

Psychosexual Theory by Sigmund Freud

A theory stating that human behavior is motivated by repressed sexual impulses and desires.

Subconscious Thoughts and Feelings

Thoughts and feelings that motivate behavior without conscious awareness.

Freudian Slip

Slips of the tongue that were not accidents or coincidence but rather indicators of subconscious feelings or thoughts that accidentally emerged in casual day-to-day conversation.

Human Personality (Freud)

Was believed to function at three levels of awareness.

Dream Analysis

A primary method used in psychoanalysis that involves discussing a client’s dreams to discover their true meaning and significance.

Dreams (Freud)

Reflect more of the subconscious and have significant meaning (Gabbard, 2000).

Free Association

A method used to gain access to subconscious thoughts and feelings. The therapist tries to uncover the client’s true thoughts and feelings by saying a word and asking the client to respond quickly with the first thing that comes to mind.

Ego Defense Mechanisms

Methods of attempting to protect the self and cope with basic drives or emotionally painful thoughts, feelings, and events. These mechanisms operate at the unconscious level of awareness.

Id

Sexual and aggressive drive; inborn; operates on pleasure principle; primary thinking process is imagery; irrational and not based on reality.

Pleasure Principle

The principle that guides the id to seek immediate gratification.

Primary Thinking Process

Imagery; a characteristic of the id.

Ego

Chief executive officer; operates on reality principle; secondary thinking process is logical and reality-oriented.

Reality Principle

The principle that guides the ego to deal with reality.

Secondary Thinking Process

Logical and reality-oriented thinking process of the ego.

Major Functions of Ego

Adaptation to reality, modulation of anxiety, problem-solving, control and regulation of instinctual drives.

Superego

Conscience and ego-ideal; residue of internalized values and moral training of early childhood.

Conscience

Punishes one for something wrong that was done.

Ego-Ideal

Rewards one for something good that was done.

Oral Stage

Birth–18 months; mouth is the major site of tension and gratification including biting and sucking activities. Id is present at birth.

Anal Stage

1.5–3 years old; anus and surrounding area are the major source of interest. Voluntary sphincter control is the goal. Ego develops gradually.

Phallic Stage

3–5 years old; genital is the focus. Penis envy and Electra complex occur in girls; castration fear and Oedipus complex occur in boys.

Penis Envy

A concept in Freud’s theory involving girls’ feelings related to the male genital organ.

Electra Complex

A concept involving girls during the phallic stage.

Castration Fear

A concept involving boys during the phallic stage.

Oedipus Complex

A concept involving boys during the phallic stage.

Latency Stage

5–11 years old (extended to 13 years old); complexes are resolved. Genital focus is turned to social activities. Formation of superego.

Genital Stage

11–13 years old overlapping with previous stage; development of biologic capacity for orgasm. Starts to appreciate capacity.

Conscious

Functions when the person is awake, aware of himself, his thoughts, feelings, perceptions, and what is going on in the environment.

Pre-Conscious/Subconscious

Ideas and reactions are stored and partially forgotten. Acts as watchman; it prevents unacceptable, disturbing unconscious memories from reaching the conscious mind. Brought into consciousness by recall.

Unconscious

Largest part of the mind. Serves as storage or reservoir of painful memories and experiences which are difficult to recall. Realm of thoughts and feelings that motivate a person even he is totally unaware of them. Can be recalled by psychoanalysis.

Ego Defense Mechanisms

Methods of attempting to protect the self and cope with basic drives or emotionally painful thoughts, feelings, and events.

Functions of Ego Defense Mechanisms

To ward off anxiety; to resolve a conflict; to protect self-esteem; to protect one’s sense of security.

Purpose of Ego Defense Mechanisms

Without defense mechanisms, anxiety might overwhelm, paralyze, and interfere with daily living.

Nature of Ego Defense Mechanisms

Can be therapeutic or pathologic.

Development of Ego Defense Mechanisms

Supposedly in action by 10 years of age.

Level 1: Psychotic Mechanisms

Common to healthy individuals before age 5; includes delusional projection, denial, and distortion.

Delusional Projection, Denial, Distortion

Psychotic mechanisms common to healthy individuals before age 5.

Level 2: Immature Mechanisms

Common in ages 3–15; includes projection, schizoid fantasy, hypochondriasis, passive-aggressive behavior, and acting out.