Foundations of PMHN Theorists/Neurobiology and Philosophical Underpinnings of Psychiatric-Mental Health Nursing

Psychosocial Theories

Theoretical models to explain and/or predict patient responses exist in each of these domains (physiological, psychological, sociocultural, developmental, and spiritual needs of patients)

Psychoanalytical and Neo-Freudian Theorists (5)

Freud: Psychoanalytical

Alfred Adler: Individual psychology

Carl Jung: analytical psychology

Karen Horney: feminine psychology

Harry Stack Sullivan: interpersonal forces

Freud: Psychoanalytical

Unconscious could be accessed through dreams and free association

Id, ego, superego; defense mechanisms;transference and counter transference

Alfred Adler: Individual psychology

Motivating force in life: intolerable sense of inferiority

Principles of mutual respect, choice, responsibility

Carl Jung: Analytical psychology

Extroverted vs. introverted personalities

Harry Stack Sullivan: Interpersonal forces

Importance of human relationships (instinct & drives less important)

Interpersonal relations as the basis for human development & behavior

Humanistic Theorists (3)

Carl Rogers: Client-centered therapy

Frederick S. (Fritz) Perls: Gestalt therapy

Abraham Maslow: Hierarchy of needs

Carl Rogers: Client-centered therapy

Unconditional positive regard (responding positively but truthfully to whatever pt has to say)

Empathy and genuineness

Frederick S. (Fritz) Perls: Gestalt therapy

Anxiety resulting from inability to express natural biologic and psychological desires; repression --> anxiety

Abraham Maslow: Hierarchy of needs

Physiological

Safety

Belongingness/Love

Esteem

Self-actualization

Cognitive Behavioral Theories

Stimulus-Response Theories

Reinforcement Theories

Cognitive Theories

Stimulus-Response Theories (Who and What)

Pavlovian theory: classical conditioning

John B. Watson: behaviorism

Reinforcement Theories (Who and What)

Link between behavior and consequences

Edward L. Thorndike: "stamping in" (reinforcement of positive behavior)

B. F. Skinner: operant conditioning

Cognitive Theories (Who and What)

Theories that emphasize mental processes in development, such as logic and memory

Albert Bandura: social cognitive theory; self-efficacy

Aaron Beck: thinking and feeling; cognitions

Hans Selye Stress Theory

Initial description of the stress response: General Adaptation Syndrome (GAS)

3 Stages of General Adaptation Syndrome (GAS)

1. Alarm: Body reacts to stress (SNS activates)

2. Resistance: Adaption to stress (Flight or flight)

3. Exhaustion: Body resources have been depleted

Social Determinates of Mental Health

Level concerns of poverty, violence, crime, abuse of civil and political rights and freedoms

Threats to personal safety

Economic uncertainty

Health & Social Policy

Access to safe, effective, quality care at all levels

Hildegarde Peplau

Expanded role of psych nurse- outlined the scope of practice, interpersonal relations in nursing- first systematic theoretical framework for psych nursing

Established the first nursing graduate program (Psychiatric Clinical Nurse Specialist) at Columbia University in 1956

Frontal Lobe

A region of the cerebral cortex that has specialized areas for movement, abstract thinking, planning, memory, and judgement

Decreased executive functioning→ poor modulation of impulses→ mood and personality changes

Basil Ganglia

Structures in the forebrain that help to control movement

Defects cause abnormal movement disorders, tremors, twitches

Limbic System

Neural system (including the hippocampus, amygdala, thalamus, and hypothalamus) located below the cerebral hemispheres

Associated with basic emotions, needs, drives, and instincts

Hippocampus

Neural center located in the limbic system; helps storing memories, especially emotional memories

Thalamus

The brain's sensory switchboard for all senses but smell, located on top of the brainstem

Hypothalamus

A neural structure lying below the thalamus; it directs basic human activities: sleep-rest, body temperature and physical drives (hunger, sex); with pituitary gland controls most hormone function

Amygdala

A limbic system structure which is the emotional component to the brain attached to memory; aggression, impulse control

Limbic Midbrain Nuclei

Pleasure center or reward center, chemically reinforces certain behaviors; plays role in biologic basis of addiction

Pineal Gland

Secretes melatonin (sleep) and immune systems responses

Locus Coeruleus

Area of the brainstem that pertains to attention, focus, arousal (excitement), learning

Brain Stem

Responsible for life-sustaining functions

Autonomic Nervous System (ANS)

A set of nerves that carries involuntary and automatic commands that control blood vessels, body organs, and glands

Parasympathetic and Sympathetic

Parasympathetic vs Sympathetic

Parasympathetic (Rest and digest)

Sympathetic (Fight or flight)

Neuroplasticity

The ability within the brain to constantly change both the structure and function of many cells in response to experience or trauma

Neurotransmitters

Small molecules that directly and indirectly control the opening or closingof ion channels

Acetylcholine (ACh)

Enables muscle action, learning, and memory.

In Alzheimer's disease, ACh-producing neurons deteriorate

Dopamine

Influences movement, learning, attention, and emotion

Oversupply linked to schizophrenia

Undersupply linked to tremors and decreases mvmt in Parkinson's

When you hear schizophrenia, think what neurotransmitter?

Dopamine (Too much)

Serotonin

A neurotransmitter that affects mood, hunger, sleep, and arousal

Undersupply linked to depression

Some antidepressants increase serotonin levels

Norepinephrine

Helps control alertness and arousal

Undersupply can depress mood

GABA (gamma-aminobutyric acid)

A major inhibitory neurotransmitter

Undersupply linked to seizures, tremors, and insomnia

Glutamate

A major excitatory neurotransmitter; involved in memory

Oversupply can overstimulate the brain (Migraines/seizures)

Immunology Implications for Psychiatric Illness

Decreased immunity has been associated with grief, bereavement, and depression

Immunological abnormalities have also been associated with alcoholism, autism, and dementia

Mental Health

Emotional and psychological balance in the pursuit of wellness and a meaningful quality of life

What is mental wellness

Purposeful process of individual growth

Integration of experience

Meaningful connection with others, reflecting personally valued goals and strengths that results in being well and living values

Factors that can affect Mental Wellbeing

Poverty, unemployment, underemployment

Trauma

ACEs (Adverse Childhood Experiences)

Lack of education

Stressor

A biological, psychological, social, or chemical factor that causes physical or emotional tension

Psychological adaptation to stress is explained in what two terms?

Anxiety: Associated with feelings of uncertainty and helplessness

Grief: Subjective state of emotional, physical, and social responses to the loss of a valued entity

Adaptive Responses to Stress

Behavior that maintains the integrity of the individual

Viewed as positive and is correlated with a healthy response

Maladaptive Responses to Stress

When behavior disrupts the integrity of the individual

Considered to be negative or unhealthy

Mental Disorders

Health conditions characterized by alterations in thinking, mood, or behavior associated with distress and/or impaired functioning

A mental illness or mental disorder is a syndrome, what is a syndrome?

A set of symptoms that cluster together that may have multiple causes and may represent several different disease states

Public Stigma of Mental Illness

Stereotypes leading to prejudice and discrimination

"Dangerous, unpredictable, unable to function independently, weak."

Recovery from Mental Illness

A process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential

Continuum of Care for Mental Illness

Consists of an integrated system of settings, services, healthcare clinicians, and care levels, spanning illness-to-wellness states

Primary goal is to provide treatment that supports recovery in the LEAST RESTRICTIVE ENVIRONMENT