This document provides an overview of psychiatric nursing and mental health topics. It defines mental health and discusses factors that influence it such as family, development, and culture. It then describes signs and symptoms of mental illness, theories of mental illness including psychobiological and psychological perspectives, and approaches to treatment like therapy and medication. Assessment in psychiatric nursing including tools like the DSM-IV are discussed. The role of the nurse in caring for patients with mental illness by addressing factors like anxiety, reality, and self-esteem to improve functioning is also summarized.

1. INTRODUCTION TO
PSYCHIATRIC NURSING

2. INTRODUCTION TO PSYCHIATRIC NURSING

3. Mental Health
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MENTAL ILLNESS

4. Mental Health
 Mental Health dose not mean mere
absence of mental illness. It is a sense of
wellbeing an individual feels. There should
be some positive qualities in every human
being that enables him to live happily in
society. Successful performance of mental
function.
 Mental health and physical health are
interrelated and interdependent. As the
saying goes, A sound mind in a sound
body’. Mental and physical health are the
two sides of a coin.

5. MENTAL HEALTH

6. Definition of Mental Health
WHO defines MH as ‘’ the capacity of an
individual to form harmonious relationships
with others and to participate in, or
contribute constructively to, changes in the
social environment.
Meninger defines mental health as’’ the
adjustment of human beings to the world
an to each other with a maximum of
effectiveness and happiness.

7. 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
 He is productive

8. The Signs and symptoms of
Mental Illness
General behavior
Sleep Disturbance
Loss of appetite and
refusal of food.
Personal appearance
Lack of interest
In sex
Personal relationship: have strained
interpersonal relationship (WD& aloof)

9. The Signs and symptoms of
Mental Illness
 Interest in work, Hobbies, and surroundings
 Behavior : overactive and restless and
assault others, dull, slow his activity.
 Disturbance in thinking can be evident from
his talk.
irrelevant talk, meaningless,
incoherent talk

10.  Thought block. Thought insertion,
Thought withdrawal, Thought
broadcasting and thought being
controlled by an outside force. There
are diagnostic of schizophrenia.
 Disorder of the content of thought
(Delusions) is a false fixed belief.
 Types of delusions:
 Delusions of persecution
 (paranoid delusion)
 Delusions of Grandiose
 Delusions of jealousy or infidelity; his
spouse is unfaithful and is having extra
marital affairs

13.  Delusions of control (passivity
phenomenon), his thinking, actions, and
feelings are all not his own but are being
controlled by some external agencies.
 Nihilistic delusions, the false belief that
the world is going to end or his body
parts are missing.
 Hypochondriacal delusions false belief
that he has some incurable disease.
 Ideas of references: the person has a
false idea that people around talk
about him and make fun of him.

15. Disturbance of perception
 Illusion: is a perceptual disturbance, the
misinterpretation of a real sensory
stimulus.
 Hallucination: is a false perception
which occurs without an external
stimulus.
1. Auditory hallucination
2. Visual hallucination
3. Olfactory hallucination
4. Gustatory hallucination
5. Tactile hallucination

17. Mentally ILL

18. Disturbance of Memory
 Amnesia: means total loss of memory for a
certain period of a person waking life.
 Dysamnesia (paramnesia): is the failure of
the memory to recall events that happened
minutes or hours ago. Cause by damage of
the hypocampus&mammillary
body of the brain…alcoholic
Dementia..simplex encephalitis.

19. Organic Memory Impairment
 Inability to recall events accurately.
Dementia
 Consciousness: complete loss of
awareness,
- Confusion
- disorientation

20. Hispanic girl

21. Disturbance of Affect or Mood
 Elation of extreme happiness
 Depression: a state of dejection,
hopelessness, extreme sadness and
misery.
 Anxiety: it is a vague fear in the
absence of immediate danger.
 Inappropriate affect: reacts with the
wrong emotion to a particular event.
 Apathy:
 Incongruous affect:

22. Disturbance in Motor Activities
 Catalepsy: a general term for immobile
 Waxy flexibility: the person can be
molded into a position …maintained
 Negativism: Motiveless resistance to all
attempts to be moved
 Stupor: lack of reaction
 Echopraxia: Pathological imitation of
movements of one person to another.
 Posturing: Voluntary assumption of
bizarre posture and maintaining it for
long periods of time.

23. Disturbance in Motor Activities
 Catatonia: Motor anomalies in non
organic disorder
 Catatonic excitement, marked by
agitation and seemingly pointless
movement.
Catatonic rigidity, in which the person
assumes a rigid position
 Akinesia, or absence of physical
movement
 Stereotypy: repetitive fixed pattern of
physical action or speech.

24. Disturbance in Motor Activities
 Mutism: voicelessness without structural
abnormalities

25. Disturbance in form of thought
1. Neologism:
2. Word salad: incoherent mixture of words
3. Circumstantiality
4. Perseveration - Persistent repetition of words
or ideas.
5. Semantic paraphasia - Substitution of
inappropriate word. e.g. "I slipped on the coat,
on the ice I mean, and broke my book
6. Tangentiality - Replying to questions in an
oblique, tangential or irrelevant manner. e.g.:
Q: "What city are you from?
7. Flight of idea
8. Echololia 9. Blocking

26. 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

27. 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.

28. 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

29. Theories of Mental Illness
PSYCHOBIOLOGICAL
PSYCHOLOGICAL

30. PSYCHOBIOLOGICAL
Genetic
Other Biological Influences
The Role of the Environment

31. 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

32. PSYCHOBIOLOGICAL
Overview of the Brain
Forebrain
Diencephalons
Thalamus- Pathway of motor &
sensory impulses
Hypothalamus- Regulates hormonal
functioning
Limbic system- Modulates emotions

33. 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

35. PSYCHOBIOLOGICAL
NEURON
 CONDUCTION OF ELECTRICAL IMPULSES
 NEUROTRANSMITTERS
 RECEPTORS

36. 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

37.  Dopamine DA Schizophrenia, Mania
Parkinson’s, Depression
 Norepinephrine NE Mania
Depression
 Serotonin 5-HT Anxiety
Depression
 Gamma-amino- GABA Reduction of
buturic acid anxiety
Anxiety
 Acetyl-Choline Ach Depression
Alzheimer’s
PSYCHOBIOLOGICAL
Neurotransmitter/ Receptor/ Disorder

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

39. PSYCHOLOGICAL
PSYCHOANALYTICAL “EGO FUNCTIONS”
1. REALITY TESTING
2. SENSE OF REALITY
3. JUDGEMENT
4. IMPULSE CONTROL
5. THOUGHT PROCESS
6. ARISE
7. DEFENSIVE FUNCTIONING
8. OBJECT RELATIONS
9. AUTONOMOUS FUNCTIONING
10. STIMULOUS BARRIER
11. MASTERY COMPETENCE
12. SYNTHETIC INTEGRATIVE
FUNCTIONING
EGO

40. PSYCHOLOGICAL
Freud
“Psychosexual Stages of Development”
 Oral (0-18mos
 Anal (18mos-3yrs)
 Phallic (3-6yrs.)
 Latency (6-12yrs)
 Genital (13-20yrs)

41. PSYCHOLOGICAL
ERIKSON
“Psychosocial Stages of Development”
Trust vs Mistrust
Autonomy vs Shame and Doubt
Initiative vs Guilt

42. PSYCHOLOGICAL
ERIKSON (cont)
Industry vs Inferiority
Identity vs Role Confusion
Intimacy vs Isolation

43. PSYCHOLOGICAL
ERIKSON (cont)
Generativity vs Stagnation
Ego Integrity vs Despair

44. Maslow’s 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 client’s strengths
 Establishes what is most important in sequences of
nursing actions “ Sets Priorities” Varcarolis p. 20-21

45. Psychiatric Mental Health Nursing
and the Nursing Process
1. Assessment 2. Nursing Diagnosis
6. Evaluation 3. Outcome Identification
4. Planning
5. Implementation

46. Factors Affecting Mental Health
and Nursing Assessment
Support systems
Family influences
Developmental events
Cultural beliefs and values
Health practices
Negative influences

47. PSYCHIATRIC ASSESSMENT
Construct database
Mental status examination (MSE)
Psychosocial assessment
Physical examination
History taking
Interviews
Standardized rating scales
Verifying the data

48. DIAGNOSIS OF PSYCHIATRIC
ILLNESS
 Medical- DSM-IV-TV (Diagnostic and
Statistical Classification of Mental
Disorders)
 Nursing- NANDA (North American Nursing
Diagnosis Association)

49. DSM-IV-TR
Mental disorders are considered a
manifestation of a
Behavioral
Psychological
Biological
dysfunction of the individual

50. 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)

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

52. CULTURAL BIASES
 Consider cultural differences that influence
health
 Be accepting of changing families
 Be open, consider differences in
order to provide sensitive, competent care

53. GOALS and Interventions of
Psychiatric Care Directed to…
 Anxiety
+
 Reality testing
+
 Self esteem =
 Level of functioning and manage disease
process