Psychiatric Mental Health Nursing Notes

Foundations of Psychiatric Mental Health Nursing

Introduction and Overview

  • This session covers eight chapters regarding Psychiatric Mental Health Nursing.
  • A recording and supplementary resources will be shared via email, including quizzes and exam expectations.

Chapter 1: Understanding Mental Health

Definition of Mental Health

  • Mental health lacks a universal definition.
  • Influenced by three components:
    • Individual Factors: Unique biological and psychological makeup.
    • Interpersonal Relationships: Quality and effectiveness of social interactions.
    • Sociocultural Factors: Relevant views influenced by societal and cultural beliefs, including stigma and discrimination.
  • Dynamic and subject to change based on experiences and environments.

Mental Illness vs. Mental Health

  • Mental illness includes disorders affecting mood, behavior, and thinking.
  • Distinction: Everyone has emotional states, but mental illnesses often cause
    • Significant distress
    • Impaired functioning

Contributing Factors to Mental Illness

  • Factors are not limited to individual, interpersonal, and sociocultural aspects:
    • Individual: Genetics, unreasonable fears or worries.
    • Interpersonal: Poor communication, lack of social support.
    • Sociocultural: Negative worldview, discrimination (stigma, racism, classism).

The DSM-5

  • Diagnostic and Statistical Manual of Mental Disorders, 5th Edition.
    • Published by the American Psychiatric Association.
    • Functions:
    • Standardizes mental illness nomenclature.
    • Describes characteristics and symptoms of mental disorders.
    • Aids in identifying causes of disorders.
  • Often referred to as the "bible" of psychiatry.

Historical Perspectives on Mental Illness

  • Historical views have varied, ranging from divine punishment to supernatural explanations.
  • Notably, the community mental health movement began with Community Mental Health Act of 1963.
    • Initiated deinstitutionalization and changes in commitment laws.

Current Mental Health Statistics

  • Approximately 51.5 million adults in the U.S. suffer from mental illness, with only 23 million receiving treatment.
  • About 11 million children diagnosed with mental disorders.
  • Economic burden of mental illness higher than all types of cancer combined.
  • Mental illness is the leading cause of disability for ages 15-44 in the U.S. and Canada.
  • Only one in four adults and one in five adolescents receive treatment.

Rotational Door Effect

  • Due to deinstitutionalization, patients often experience a cycle of admittance and discharge without adequate follow-up care, leading to rehospitalization.
  • Emergency departments frequently manage patients needing inpatient care due to limited resources.

Key Issues in Mental Health Treatment

  • Individuals with mental illness and substance abuse disorders face significant barriers to treatment, notably within the unhoused community.
  • Population of unhoused individuals often experiences a cycle of mental illness and inadequate social support.

Healthy People 2030 Goals

  • Reduce suicide rates.
  • Increase treatment access for youth and adults with mental health disorders.
  • Improve community support services to enhance treatment access.

Chapter 2: Neurobiological Theories and Psychopharmacology

Importance of Psychopharmacology

  • Essential for understanding treatment mechanisms, requiring foundational knowledge of pharmacology.

Neurobiological Structures to Know

  • Limbic System: includes thalamus, hypothalamus, hippocampus, amygdala.
    • Important for emotional arousal and memory.

Neurotransmitters

  • Excitatory:
    • Dopamine: Effects on mood and cognitive function.
    • Norepinephrine: Linked to alertness and response to stress.
    • Glutamate: Primary excitatory neurotransmitter.
  • Inhibitory:
    • Serotonin: Affects mood, sleep, and emotional regulation.
    • GABA: Major inhibitory neurotransmitter that modulates excitability.
  • Acetylcholine: Involved in arousal and muscle control.

Brain Imaging Techniques

  • CT scans, MRIs, PET scans, SPECT scans.
  • Limitations include cost and patient intolerance.

Causes of Mental Illness

  • Genetics, immune response, and potential viral factors contribute to mental health disorders.

Role of Nurses in Research and Education

  • Nurses must inform patients and families about potential new treatments and encourage participation in research.

Principles of Psychopharmacology

  • Efficacy: Maximum therapeutic effect.
  • Potency: Required amount to achieve effect.
  • Half-life: Time for half of the drug to clear the body.
  • Off-label use: Effectiveness in conditions not originally approved in testing.

Drug Classifications in Psychopharmacology

  • Antipsychotics:
    • First Generation: Conventional, focused on dopamine blockade.
    • Second Generation: Atypical, varied mechanism of action.
    • Third Generation: Dopamine system stabilizers.

Side Effects of Antipsychotics

  • EPS Symptoms include acute dystonia, tardive dyskinesia, neuroleptic malignant syndrome (NMS).
  • Additional effects: Weight gain, metabolic syndrome, cardiovascular risks.

Antidepressant Medications

  • Types include tricyclics, SSRIs, MAOIs, and atypical antidepressants.
  • Side Effects: Vary based on the class; SSRIs linked with serotonin syndrome, a potentially fatal condition.

Mood Stabilizers

  • Lithium: Must monitor therapeutic levels closely (0.6-1.2 mEq/L) to avoid toxicity.
  • Other medications: anticonvulsants also used.

Anxiety Medications

  • Primarily benzodiazepines and buspirone, monitor for dependence and side effects.

Chapter 3: Psychosocial Theories and Therapy

Psychosocial Theories

  • Overview of prominent theorists: Freud, Erikson, Sullivan, and Peplau.
    • Highlight the importance of interpersonal relationships and development stages.
    • Roles of anxiety in behavior and mental health outcomes.

Crisis Intervention

  • Four stages of crisis response and intervention techniques.
  • Importance of early assessment and intervention in crises.

Chapter 4: Treatment Settings and Therapeutic Programs

Inpatient Treatment

  • Focus on rapid assessment and stabilization, began discharge planning upon admission.

Residential Settings

  • Group homes and assisted living environments. Increasing emphasis on community-based care for long-term recovery.

Chapter 5: Therapeutic Communication

Importance

  • Therapeutic communication techniques essential for establishing rapport and understanding patient needs.

Components of Therapeutic Communication

  • Trust, genuine interest, empathy, acceptance, and positive regard.

Techniques

  • Active listening, clarifying, questioning types, and recognizing both verbal and non-verbal communication.

Chapter 6: Patient Response to Illness

Individual Factors

  • Personal beliefs, coping mechanisms, support systems, and background impact recovery and response to illness.

Cultural Considerations

  • Acknowledge diversity in health practices and beliefs.

Chapter 7: Mental Health Assessment

Purpose

  • Conduct psychosocial assessments for formulation of a care plan addressing emotional state, functionality, and support needs.

Key Assessment Domains

  • Evaluate history, appearance, mood, behavior, process of thought, judgment, insight, and risk assessments.

Interview Techniques

  • Combine open-ended questions with focused clarification regarding the patient’s perception and experience of their condition.