PRINCIPLES AND CONCEPTS OF MENTAL HEALTH

UNIT 2
PRINCIPLES AND CONCEPTS OF
MENTAL HEALTH
Textbook of Psychiatric & Mental Health Nursing
Authors
Bharat Pareek
Sandeep Arya
Prepared by:- Meenakshi
www.visionbookspublisher.com 1

LEARNING OBJECTIVES
EXPLAIN THE
CLASSIFICATION OF
MENTAL DISORDERS
EXPLAIN THE
PSYCHODYNAMICS OF
MALADAPTIVE
BEHAVIOR
DISCUSS THE
ETIOLOGICAL FACTORS,
PSYCHOPATHOLOGICAL
OF MENTAL DISORDERS
EXPLAIN THE PRINCIPLES
AND STANDARDS OF
MENTAL HEALTH
NURSING
DESCRIBE THE
CONCEPTUAL MODELS OF
MENTAL HEALTH
NURSING

CHAPTER OUTLINE
*CLASSIFICATION OF MENTAL DISORDERS
*PERSONALITY
*THEORIES OF DEVELOPMENT OF PERSONALITY
*DEFENSE MECHANISM
*PSYCHOPATHOLOGY OF MENTAL ILLNESS
*PRINCIPLES OF MENTAL HEALTH & MENTAL HEALTH NURSING
*STANDARDS OF MENTAL HEALTH NURSING

CLASSIFICATION OF MENTAL DISORDERS
ICD-10 ICD-10
F0: Organic, including symptomatic,
mental disorders.
F1: Mental and behavioral disorders
due to use of psychoactive substances.
F2: Schizophrenia, schizotypal and
delusional disorders.
F3: Mood [affective] disorders.
F4: Neurotic, stress-related and
somatoform disorders.
F5: Behavioral syndromes associated
with physiological disturbances and
physical factors.
F6: Disorders of personality and
behavior in adult persons.
F7: Mental retardation.
F8: Disorders of psychological
development.
F9: Behavioral and emotional
disorders with onset usually occurring
in childhood and adolescence.
In addition, a group of "unspecified
mental disorders".

DSM-IV
•Axis I: Clinical Disorders (all mental disorders except Personality Disorders
and Mental Retardation).
•Axis II: Personality Disorders and Mental Retardation.
•Axis III: General Medical Conditions (must be connected to a Mental
Disorder).
•Axis IV: Psychosocial and Environmental Problems (for example limited
social support network).
•Axis V: Global Assessment of Functioning (Psychological, social and
job-related functions are evaluated on a continuum between mental health
and extreme mental disorder).

PERSONALITY
“THE SUM OF ACTIVITIES THAT
CAN BE DISCOVERED BY
ACTUAL OBSERVATION OVER A
LONG ENOUGH PERIOD OF
TIME TO GIVE RELIABLE
INFORMATION”

CHIEF CHARACTERISTICS OF PERSONALITY
PERSONALITY IS WHAT ONE IS.
PERSONALITY OF EACH INDIVIDUAL IS UNIQUE.
PERSONALITY IS DYNAMIC AND NOT STATIC.
PERSONALITY FUNCTIONS AS A UNIFIED WHOLE.
PERSONALITY IS THE PRODUCT OF BOTH HEREDITY AND
ENVT.
PERSONALITY IS CONTINUALLY ADJUSTING ITSELF TO
ENVT.
IN RARE CASE PERSONALITY INFLUENCES THE
ENVIRONMENTS.
PERSONALITY IS ALWAYS STRIVING FOR CERTAIN ENDS.

ELEMENTS OF PERSONALITY
PHYSICAL
APPEARANCE
INTELLIGENCE
EMOTIONALLY
SOCIABILITY
CHARACTER

MARK OF BALANCED PERSONALITY
GOOD
PHYSICAL
APPEARANCE.
EMOTIONAL
STABILITY
HIGH
INTELLECTUA
L ABILITY
HIGH DEGREE
OF SOCIAL
ADJUSTMENT
HIGH MORAL
CHARACTER.
COOL
TEMPERAMEN
T
GOOD
DIRECTEDNESS
HIGH
ADJUSTABILIT
Y

THEORIES OF PERSONALITY DEVELOPMENT
FREUD’S THEORY OF PSYCHOSEXUAL DEVELOPMENT OF PERSONALITY
THE ORAL STAGE
• Age Range: Birth to 1 Year
• Erogenous Zone: Mouth
THE ANAL STAGE
• Age Range: 1 to 3 years
• Erogenous Zone: Bowel and Bladder Control
THE PHALLIC STAGE
• Age Range: 3 to 6 Years
• Erogenous Zone: Genitals
THE LATENT PERIOD
• Age Range: 6 to Puberty
• Erogenous Zone: Sexual Feelings Are Inactive

•ERICKSON’S THEORY OF PSYCHO SOCIAL DEVELOPMENT

STAGE BASIC
CONFLICT
IMP.
EVENTS
OUTCOME
Infancy
(birth to 18
months)
Trust vs.
Mistrust
Feeding Children develop a sense of trust when caregivers provide reliabilty, care, and
affection. A lack of this will lead to mistrust.
Early
Childhood
(2 to 3 years)
Autonomy
vs. Shame and
Doubt
Toilet Training Children need to develop a sense of personal control over physical skills and a sense of
independence. Success leads to feelings of autonomy, failure results in feelings of shame
and doubt.
Preschool
(3 to 5 years)
Initiative vs. Guilt Exploration Children need to begin asserting control and power over the environment. Success in
this stage leads to a sense of purpose. Children who try to exert too much power
experience disapproval, resulting in a sense of guilt.
School Age
(6 to 11 years)
Industry
vs. Inferiority
School Children need to cope with new social and academic demands. Success leads to a sense
of competence, while failure results in feelings of inferiority.

STAGE BASIC
CONFLICT
IMPORTANT
EVENTS
OUTCOME
Adolescence
(12 to 18 years)
Identity
vs. Role
Confusion
Social Relationships Teens need to develop a sense of self and personal identity. Success
leads to an ability to stay true to yourself, while failure leads to role
confusion and a weak sense of self.
Young
Adulthood
(19 to 40 years)
Intimacy
vs. Isolation
Relationships Young adults need to form intimate, loving relationships with other
people. Success leads to strong relationships, while failure results in
loneliness and isolation.
Middle
Adulthood
(40 to 65 years)
Generativity
vs. Stagnation
Work and
Parenthood
Adults need to create or nurture things that will outlast them, often by
having children or creating a positive change that benefits other
people. Success leads to feelings of usefulness and accomplishment,
while failure results in shallow involvement in the world.
Maturity
(65 to death)
Ego Integrity
vs. Despair
Reflection on Life Older adults need to look back on life and feel a sense of fulfillment.
Success at this stage leads to feelings of wisdom, while failure results
in regret, bitterness, and despair.

•PERSONALITY THEORY OF INTELLECTUAL DEVELOPMENT (JEAN PIAGET)

SENSORY MOTOR PERIOD (0 – 24 MONTHS)
STAGE-AGE CHARACTERISTIC BEHAVIOR
Reflexive Stage
(0-2 months)
Simple reflex activity such as grasping, sucking.
Primary Circular
Reactions(2-4 months)
Reflexive behaviors occur in stereotyped repetition such as opening and closing fingers
repetitively.
Secondary Circular Reactions
(4-8 months)
Repetition of change actions to reproduce interesting consequences such as kicking one’s feet to
more a mobile suspended over the crib.
Coordination of Secondary
Reactions
(8-12 months)
Responses become coordinated into more complex sequences. Actions take on an “intentional”
character such as the infant reaches behind a screen to obtain a hidden object.
Tertiary Circular Reactions
(12-18 months)
Discovery of new ways to produce the same consequence or obtain the same goal such as the
infant may pull a pillow toward him in an attempt to get a toy resting on it.

Invention of New Means Through
Mental Combination
(18-24 months)
Evidence of an internal representational system. Symbolizing the problem-solving sequence before
actually responding. Deferred imitation.
THE PREOPERATIONAL PERIOD (2-7 YEARS)
Preoperational Phase
(2-4 years)
Intuitive Phase
(4-7 years)
Increased use of verbal representation but speech is egocentric. The beginnings of symbolic rather
than simple motor play. Can think about something without the object being present by use of
language.
Speech becomes more social, less egocentric. The child has an intuitive grasp of logical concepts in
some areas. However, there is still a tendency to focus attention on one aspect of an object while
ignoring others.

PERIOD OF CONCRETE OPERATIONS
STAGE-AGE
CHARACTERISTIC BEHAVIOR
(7-12 YEARS) Evidence for organized, logical thought. There is the ability to perform multiple
classification tasks, order objects in a logical sequence, and comprehend the principle of
conservation.
PERIOD OF FORMAL OPERATIONS
(12 years and onwards) Thought becomes more abstract, incorporating the principles of formal logic. The
ability to generate abstract propositions, multiple hypotheses and their possible
outcomes is evident.

•PERSONALITY THEORY OF MORAL DEVELOPMENT
(LAWRENCE KOHLBERG (1971)

I. PRE CONVENTIONAL LEVEL
Stage 0: Egocentric judgment
Stage 0: Egocentric judgment
Stage 2: The instrumental relativist
orientation
II. CONVENTIONAL LEVEL
Stage 3: The interpersonal
concordance
Stage 4: The "law and order"
orientation.
III. POST-CONVENTIONAL LEVEL
Stage 5: The social-contract legalistic
orientation
Stage 6: The universal ethical-principle
orientation

KLEIN:- OBJECT RELATION THEORY
•Object relations theory places less emphasis on biologically based
drives and more importance on consistent patterns of interpersonal
relationship.
•Object relations theory tends to be more maternal, stressing the
intimacy and nurturing of the mother.
•Object relations theorists generally see human contact and relatedness-
not sexual pleasure- as a prime motive of human behavior.

DEFENSE MECHANISM
The term "defense mechanism" is often thought
to refer to a definitive singular term for
personality traits which arise due to loss or
traumatic experiences, but more accurately
refers to several types of reactions which were
identified. Defense mechanisms are sometimes
confused with coping strategies

STRUCTURAL MODEL OF PSYCHOANALYTICAL
THEORY: THE ID, EGO, AND SUPEREGO

Id: A selfish, primitive,
childish, pleasure-oriented
part of the personality with no
ability to delay gratification.
Superego : Internalized
societal and parental standards
of "good" and "bad", "right"
and "wrong" behavior.
Ego: The moderator between the id
and superego which seeks
compromises to pacify both. It can
be viewed as our "sense of time and
place“.

VAILLANT'S CATEGORIZATION OF DEFENSE
MECHANISMS
LEVEL 1 PATHOLOGICAL
❖Delusional Projection
❖Denial
❖Distortion
❖Splitting
❖Extreme projection

LEVEL 2 IMMATURE
❖Acting out
❖Fantasy
❖Idealization
❖Passive aggression
❖Projection
❖Projective identification

LEVEL 3 NEUROTIC
❖Displacement
❖Dissociation
❖Compartmentalization
❖Hypochondriasis
❖Intellectualization
❖Regression
❖Repression

LEVEL 4 MATURE
❖Altruism
❖Anticipation
❖Humor
❖Identification
❖Introjection
❖Sublimation
❖Assertiveness

MALADAPTIVE BEHAVIORS
MALADAPTIVE BEHAVIORS REFER TO
TYPES OF BEHAVIORS THAT INHIBIT A
PERSON’S ABILITY TO ADJUST TO
PARTICULAR SITUATIONS. IT IS A TYPES OF
BEHAVIORS THAT INHIBIT A PERSON’S
ABILITY TO ADJUST TO PARTICULAR
SITUATIONS.

MALADAPTIVE BEHAVIOR USED BY INDIVIDUAL
OR GROUP DURING CRISIS, STRESS AND DISASTER
•STEREOTYPICAL BEHAVIOR
•RITUALISTIC BEHAVIOR SELF-INJURIOUS BEHAVIOR
•AGGRESSION
•TRANSITION DIFFICULTIES
•RUNNING
•AVOIDANCE
•ANGER

STRESS MANAGEMENT

CRISIS
PERCEPTION OR EXPERIENCING
OF AN EVENT OR SITUATION AS
AN INTOLERABLE DIFFICULTY
THAT EXCEEDS THE PERSON’S
CURRENT RESOURCES AND
COPING MECHANISMS

DISASTER AND ITS MANAGEMENT
SERIOUS DISRUPTION OF THE FUNCTIONING OF A
COMMUNITY OR A SOCIETY. DISASTERS INVOLVE
WIDESPREAD HUMAN, MATERIAL, ECONOMIC OR
ENVIRONMENTAL IMPACTS, WHICH EXCEED THE
ABILITY OF THE AFFECTED COMMUNITY OR SOCIETY
TO COPE USING ITS OWN RESOURCES

TYPES OF DISASTERS
❖NATURAL DISASTERS
❖ENVIRONMENTAL EMERGENCIES
❖COMPLEX EMERGENCIES
❖PANDEMIC EMERGENCIES

MAJOR ASPECTS OF DISASTER MANAGEMENT
❖DISASTER PREPAREDNESS
❖DISASTER RESPONSE
❖DISASTER RECOVERY

PARTS OF THE BRAIN AND THEIR FUNCTIONS
The brain is made of three main parts: the forebrain, midbrain, and
hindbrain. The forebrain consists of the cerebrum, thalamus, and
hypothalamus (part of the limbic system). The midbrain consists of the
tectum and tegmentum. The hindbrain is made of the cerebellum, pons
and medulla. Often the midbrain, pons, and medulla are referred to
together as the brainstem.

CEREBRUM
•The cerebrum is the largest portion of the brain, and contains tools
which are responsible for most of the brain's function. The cerebrum is
divided into a right and left hemisphere which are connected by axons
that relay messages from one to the other.

CEREBELLUM
This is commonly referred to as "the little brain," and is considered to be
older than the cerebrum on the evolutionary scale. The cerebellum
controls essential body functions such as balance, posture and
coordination, allowing humans to move properly and maintain their
structure.

LIMBIC SYSTEM
•The limbic system contains glands which help relay emotions. Many
hormonal responses that the body generates are initiated in this area.
The limbic system includes the amygdala, hippocampus,
hypothalamus and thalamus.

BRAIN STEM
All basic life functions originate in the brain stem, including heartbeat,
blood pressure and breathing. In humans, this area contains the medulla,
midbrain and pons. This is commonly referred to as the simplest part of
the brain, as most creatures on the evolutionary scale have some form of
brain creation that resembles the brain stem.

NEUROTRANSMITTERS
•GLUTAMATE: Used at the great majority of fast excitatory synapses in the
brain and spinal cord. It is also used at most synapses that are "modifiable", i.e.
capable of increasing or decreasing in strength.
•GABA: Used at the great majority of fast inhibitory synapses in virtually every
part of the brain. Many sedative/tranquilizing drugs act by enhancing the effects
of GABA.

SEROTONIN: Is a monoamine neurotransmitter. Most is produced by
and found in the intestine (approximately 90%), and the remainder
in central nervous system neurons. It functions to regulate appetite,
sleep, memory and learning, temperature, mood, behavior, muscle
contraction, and function of the cardiovascular system and endocrine
system.

Nor-epinephrine which focuses on the central nervous system, based on patients
sleep patterns, focus and alertness. It is synthesized from tyrosine.
Epinephrine which is also synthesized from tyrosine takes part in controlling the
adrenal glands. It plays a role in sleep, with one’s ability to stay become alert, and
the fight-or-flight response.

BIOLOGICAL RHYTHM
❑Exogenous biological rhythms
❑Endogenous Biological Rhythms
CHARACTERISTICS OF TRUE BIOLOGICAL CLOCK
❖Endogenous
❖Temperature independent
❖Reset ability
❖Internal monitor

PSYCHOPATHOLOGY OF MENTAL ILLNESS
•GENETICS
•HERITABILITY
•INFECTIOUS INFLUENCES
•PANDAS

PRINCIPLES OF MENTAL HEALTH NURSING
•Care with dignity and humanity
•Accountability
•Safety
•Patient centered and self-determination
•Confidentiality
•Competency
•Collaboration

PRINCIPLE OF MENTAL HEALTH CARE
•Promotion of Mental Health and Prevention of Mental Disorders
•Access to Basic Mental Health Care
•Mental Health Assessments in Accordance with Internationally Accepted Principles
•Provision of the Least Restrictive Type of Mental Health Care
•Self-Determination
•Availability of Review Procedure
•Respect of the Rule of Law

ANA STANDARDS OF MENTAL HEALTH NURSING
•Standard I - Assessment
•Standard II - Diagnosis
•Standard III - Outcome Identification
•Standard IV - Planning
•Standard V - Implementation
•Standard Va – Counseling
•Standard Vb - Milieu Therapy
•Standard Vc - Promotion of Self-Care Activities

•Standard Vd - Psychobiological Interventions
•Standard Ve - Health Teaching
•Standard Vf - Case Management
•Standard Vg - Health Promotion and Health Maintenance

CONCEPTUAL MODEL IN MENTAL HEALTH
NURSING
•PSYCHOANALYTICAL MODEL
•INTERPERSONAL MODEL
•SOCIAL MODEL
•EXISTENTIAL MODEL
•SUPPORTIVE THERAPY MODEL
•MEDICAL MODEL

CHAPTER SUMMARY
The classification of mental disorders, also known as psychiatric nosology or
taxonomy, is a key aspect of psychiatry. There are currently two widely
established systems for classifying mental disorders ie: International
Classification of Diseases (ICD-10) produced by the World Health Organization
(WHO) and the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV)
produced by the American Psychiatric Association (APA).
Personality is the dynamic organization with within the individual of those
psycho-physical systems that determine his unique adjustment to his
environments. Freud proposed three structures of the psyche or personality: Id,
ego and superego. Psychoanalysts trace disrupted behavior in the adult to earlier
developmental stages.

PRINCIPLES AND CONCEPTS OF MENTAL HEALTH

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