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 Deal with conflicting emotions Live without undue fear, guilt, or anxiety Take responsibility for one's own actions Think clearly Negotiate 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 The

Biological Influences

Role of the Environment

PSYCHOBIOLOGICAL
Overview of the Brain
Forebrain
Cerebrum Frontal lobe- Voluntary movement, language, executive function Parietal lobe- Sensory impulses, tactile sensations Temporal lobe- Memory, emotions, taste, smell, auditory Occipital lobe- Vision, visual perception Diencephalons Thalamus- Pathway of motor & sensory impulses Hypothalamus- Regulates hormonal functioning Limbic system- Modulates emotions

PSYCHOBIOLOGICAL
Overview of the Brain (cont.)
MIDBRAIN Mesencephalon- Processes visual & auditory information

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

PSYCHOBIOLOGICAL
NEURON

CONDUCTION OF ELECTRICAL IMPULSES NEUROTRANSMITTERS RECEPTORS

PSYCHOBIOLOGICAL
NEUROTRANSMITTER

CHEMICAL MESSANGERS RELEASED AT PRESYNAPTIC NEURON DIFFUSES ACROSS SYNAPSE TO POST SYNAPSE ATTACHES TO SPECIALIZED RECEPTORS INHIBITS OR STIMULATES RELEASED AND THEN DESTROYED OR TAKEN BACK FOR RECYCLING

PSYCHOBIOLOGICAL
Neurotransmitter/ Receptor/ Disorder

Dopamine

DA

Schizophrenia, Mania Parkinsons, Depression Mania Depression

Norepinephrine

NE

Serotonin

5-HT

Anxiety Depression
Reduction of anxiety Anxiety Depression Alzheimers

Gamma-aminobuturic acid

GABA

Acetyl-Choline

Ach

PSYCHOLOGICAL
Freud's Psychoanalytic Theory
Conscious, preconscious, unconscious Id, ego, superego Defense mechanisms and Anxiety Theories of personality

PSYCHOLOGICAL
PSYCHOANALYTICAL EGO FUNCTIONS

EGO

1. 2. 3. 4. 5. 6.

REALITY TESTING SENSE OF REALITY JUDGEMENT IMPULSE CONTROL THOUGHT PROCESS ARISE

7. 8. 9. 10. 11. 12.

DEFENSIVE FUNCTIONING OBJECT RELATIONS AUTONOMOUS FUNCTIONING STIMULOUS BARRIER MASTERY COMPETENCE 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 Mental status examination (MSE) Psychosocial assessment

Physical examination
History taking Interviews Standardized 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 retardation Axis III- Current medical conditions that are relevant to the mental disorder Axis IV- Psychosocial and environmental problems Axis V- Global Assessment of Function (GAF)

Therapeutic Approaches
Psychoanalysis Short term psychotherapy Cognitive Therapy Behavior Therapy Modeling Operant Conditioning Systemic desensitization Aversion Therapy Milieu Therapy Individual, group and family 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