1 maladaptive patterns of behavior


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1 maladaptive patterns of behavior

  2. 2. Distribution of diagnosis across mental health facilities in the philippines DISORDERS OUTPATIENT FACILITIES COMMUNITY IN-PATIENTS MENTAL HOSPITAL Schizophreni a 57% 63% 71% Mood Disorder 19% 24% 18% Substance Abuse 8% 6% 5% Neurotic Disorder 6% 1% 2% Personality Disorder 3% 2% 0% Others 7% 4% 4%
  3. 3. Psychiatric Nursing O - O O O O Interpersonal process whereby the professional nurse practitioner through the therapeutic use of self, * assist an individual, family, group or community to: 1. Promote mental health, 2. Prevent mental illness and suffering, 3. Participate in the treatment and rehabilitation of the mentally ill. • and if necessary find meaning in these experiences.
  4. 4. Psychiatric Nursing - Is both a science and an art
  5. 5. HEALTH O State of complete physical, mental, and social wellness, not merely the absence of disease or infirmity…..(WHO)
  6. 6. Mental Health O A state of complete physical, mental, and social wellness, not merely the absence of disease or infirmity (WHO). Criteria: a. Satisfying interpersonal relationship; b. Effective behavior and coping; c. Positive self – concept; and d. Emotional stability
  7. 7. Factors Influencing a person’s Mental Health O Individual or personal – biologic make-up, autonomy and independence, capacity for growth, vitality, ability to find meaning in life, sense of belonging, reality orientation and coping or stress management abilities
  8. 8. Factors influencing a person’s Mental health O Interpersonal, or relationship – effective communication, ability to help others, intimacy and a balance of separateness and connectedness. O Social/cultural, or environmental – sense of community, success to adequate resources, intolerance of violence, support of diversity among people, mastery of the environment, and a positive, yet realistic, view of one’s world
  9. 9. Mental Illness is a mental or behavioral pattern or anomaly that causes distress or disabili ty, and which is not developmentally or sociall y normative…. wikipedia O
  10. 10. Criteria to diagnose Mental Disorders O Dissatisfaction with one’s characteristics, abilities, and accomplishments; O Ineffective or unsatisfying relationships; O Dissatisfaction with one’s place in the world; O Ineffective coping with life events; and O Lack of personal growth
  11. 11. Factors  Individual – biologic make – up, intolerable or unrealistic worries or fears, inability to distinguish reality from fantasy, intolerance of life’s uncertainties, a sense of disharmony in life, and a loss of meaning in one’s life.
  12. 12. Factor s O Interpersonal - - ineffective communication, excessive dependency on or withdrawal from relationships, no sense of belonging, inadequate social support, and loss of emotional control.
  13. 13. O Social/cultural factors – lack of resources, violence, homelessness, poverty, an unwarranted negative view of the world, and discrimination such as stigma, racism, classism, ageism, and sexism
  14. 14. DSM-IV (DIAGNOSTIC AND STATISITCAL MANUAL OF MENTAL DISORDERS) O published by the American Psychiatric Association (APA), provides a common language and standard criteria for the classification of mental disorders.
  15. 15. Purposes of DSM-IV-TR O To provide standardized nomenclature and language for all mental health professionals O To present defining characteristics or symptoms that differentiate specific diagnoses. O To assist in identifying the underlying causes of disorders
  16. 16. The DSM-IV organizes each psychiatric diagnosis into five dimensions (axes) relating to different aspects of disorder or disability: Axis I: All psychological diagnostic categories except mental retardation and personality disorder Axis II: reporting of Personality disorders and mental retardation Axis III: General medical condition; acute medical conditions and physical disorders Axis IV: Psychosocial and environmental factors contributing to the disorder Axis V: Global Assessment of Functioning or Children's Global Assessment Scale for children and teens under the age of 18
  18. 18. ANCIENT TIMES - Punishments for sins and wrong doing Viewed as either divine or demonic, depending on their behavior Aristotle (383-322 BC) – relate disorders to physical disorders and his theory that amounts of blood, water and yellow and black bile in the body controlled the emotions (corresponds with happiness, calmness, anger and sadness). O Treatment: blood-letting, starving, and purging (till 19th century)
  19. 19.  Early Christian Times (1-1000 AD) - Mentally ill were viewed as possessed - Tx: Priests performed exorcism. When failed they used more severe and brutal measures such as incarceration in dungeons, flogging and starving
  20. 20.  Rennaisance (1300-1600) - Distinguished from criminals  1547 – Hospital of St. Mary of Bethlehem was officially declared as hospital for the insane.  1775 – Charged for a fee for a privilege of viewing and ridiculing the inmates who were seen as animal rather than human.
  21. 21. Benchmark Period in Psychiatric History PERIOD KEY PEOPLE OR DEVELOPMEN TS SIGNIFICANT CHANGE IN THINKING RESULT/S Enlightenment • Philippe Pinel • Insane no longer • Asylum move , - 1790 (1745- 1826) treated as less ment • William Tuke than human developed (1732 – 1822) • Human dignity upheld
  22. 22. “ To consider madness incurable…is constantly refuted by the most authentic facts” Philippe Pinel, Dec. 11, 1794
  23. 23. Asylum (Sanctuary)
  24. 24. O Dorothea Dix O (1802-1887)- one of the first major reformers in the United States, was instrumental in developing the concept of asylum.
  25. 25. PERIOD Scientific Study (1870’s) KEY PEOPLE OR DEVELOPMENTS s • Sigmund Freud (1856-1939) – emphasized the importance of early life experiences; studied the mind, its disorders and their treatment • Emil Kraepelin (1856 – 1926)- Studied the brain; classify mental illness according to their symptoms • Eugene Bleuler (1857 – 1939); was optimistic about treatment; coined the term SIGNIFICANT CHANGE IN THINKING RESULT/S • Mental • Study of the Illness could mind and be studied treatment approaches to psychiatric conditions flourished • Decade of the brain can be traced back to Kraepelin’s thinking.
  26. 26. PERIOD KEY PEOPLE OR SIGNIFICANT DEVELOPMENTS CHANGE IN THINKING g RESULT/S Psychotropic Drugs – 1950’s • Lithium (1949) • First antipsychotic (1950) • Monoamine oxidase inhibitors (MAOI’s) 1952 • Haloperidol (1957) • Tricyclic antidepressant s (TCAs) 1958 • Benzodiazepin es (1960) • If some mental disorders are caused by chemical imbalances then chemicals could restore the balance; people would no longer need to be confined • A destigmatizatio n of mental illness occurred; parents and others not blame; term least restrictive environment evolved from this discovery
  27. 27. PERIOD KEY PEOPLE OR DEVELOPMEN TS SIGNIFICANT CHANGE IN THINKING RESULT/S Community Mental Health , 1960s Community Mental Health Centers Act (1963) Individuals do  Advantage: not need to be Intervention in hospitalized familiar away from family sorroundings and community, has helped many people have the people, is less right to be expensive treated in their • Disadvantages: own community  Homelessness linked to disinstitutionaliza tion; many people “slip through the cracks” of the system
  28. 28. PERIOD Decade of the Brain KEY PEOPLE OR DEVELOPMEN TS SIGNIFICANT CHANGE IN THINKING RESULT/S • Congression • If we can • An increase al Mandate understand in funding for the brain, we brain can help research millions of lead to new people treatment suffering strategies; from mental has disorders. increased our understandin g of mental disorders
  29. 29. Six Major Periods of Mental Ilness Treatment in Philippine History 1. Pre-Spanish Regime - During this period, believed in a world that is equally material and spiritual. - Relied on healers called babylan (shaman) and sorcerer healing. - Rituals and ceremonies
  30. 30. 2. Spanish Rule - Filipinos accepted that mental illness was caused by an act of sorcery (mangkukulam or witches and manggagaway or the devil men) Treatment: - Herbmen (herbolarios) - Brought to church for exorcism or ritual cleaning
  31. 31. Early Nineteenth Century - Organized care and treatment for individuals with mental illness was established at the Hospicio de San Jose - Spanish naval authorities requested for a place of confinement for their mentally ill sailors.
  32. 32. The American Era - Two Americans provided treatment for mentally ill patients of the Civil Hospitals located in Calle Iris (now known as Claro M Recto Avenue) - In 1904, the insane department was opened at the San Lazaro Hospital. - The first physician to attain formal training in psychiatry in the US is Dr. Elias Domingo.
  33. 33. Japanese Occupation - World War II - National Psychopathic Hospital continued to operate - The Japanese Army donated an electroshock apparatus to the hospital.
  34. 34. The Liberation Period and the Era of the Republic - The National Psychopathic Hospital was renamed National Mental Hospital, with Dr. Jose A. Fernandez designated as officer in charge from Oct 1946 to April 1961
  35. 35. Present Day Psychiatry O The use of SOMATIC Therapies became most popular.
  36. 36. Psychiatric Nursing Education: THREE FIRSTS  Linda Richard – the first American Psychiatric Nurse  Nursing Mental Disease – the first psychiatric nursing book wrote by Harriet Bailey  Hildegard Peplau – first psychiatric nursing theorist
  37. 37. Development of Psychiatric Education in the Philippines  An Outline of Psychiatric Nursing – the first textbook wrote by Jesusa Bagan Lara in 1973  Nenita Yasay-Davadilla – the first psychiatric nurse to be sent abroad to obtain MSN under WHO scholarship program.  Magda Carolina Go Vera Llamanzares – first Filipino child psychiatric nurse  Sotera Capellan – the first chief nurse of a Mental Hospital
  38. 38. Role of Mental Health Nurse  Ward manager- creates a therapeutic environment  Socializing agent- assists the patient to feel comfortable with others  Counselor- Listens to the patient’s verbalization  Parent surrogate- assists the patient in the performance of ADL
  39. 39. Role  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
  40. 40. Role  Therapist- explores the patient’s 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 living.  Stranger- Offering the client the same acceptance and courtesy that the nurse would do to any strangers.
  41. 41. Essential Qualities  Empathy – ability to see beyond outward behavior and sense accurately another person’s inner experiencing.  Genuineness- ability to use therapeutic tools appropriately.  Unconditional positive regard - respect
  42. 42. Decision Tree for Continuum of Care
  43. 43. Continuum of Care O A complete range of programs and services that treats the whole person from wellness to illness to recovery within the community Green and Lyndon, 1998
  44. 44. Decision Tree for Continuum of Care
  45. 45. Parameters in Decision Tree O Safety requirements O Intensity of supervision needed O Severity of symptoms O Level of functioning O Type of treatment needed