Pdf

1. 1
Mental Health Nursing For Nurse_Level_IV
Shimelis.T
(Lecturer)

2. Evaluation method:
Quiz
Attendance
 participation
Assignment
Written Final exam
05/10/2025 2

3. 3
Learning objective
At the end of this course, the students will be able to:
 Know the historical overview of psychiatric nursing development
 Understand basic principles of Mental health (psychiatric ) nursing
 Discuss the definition of psychiatry, mental health, and mental illness
 Differentiate mental health and mental illness
 Explain therapeutic communication
 Etiology of mental disorder
 Sign and symptom of mental disorder
 Principle of management

4. 4
Introduction to psychiatry
 It is the branch of medicine that concerned with the study
of
mental illness
emotional disturbance
abnormal behavior
 Is concerned with the prevention, diagnosis and
treatment of mental illness

5. 5
Health and mental health
Health
• is defined as a complete
– Physical
– Mental
– Social, spritual well-being
– and not merely the absence of
disease and infirmity
(weakness)
Mental health
• is defined as a state of well-being in
an individual’s
– emotional
– social and
– psychological aspect throughout
one’s life

6. 6
Mental health…
 The World Health Organization (WHO) describes mental health
as "a state of well-being in which the individual…
realizes his or her own abilities
 can copy with the normal stresses of life
can work productively and fruitfully
able to make a contribution to his or her community’’
 Mental Health is not just the absence of mental illness

7. Mental Illness
 Mental illness is characterized by:
Dissatisfaction with ones characteristic, abilities or
accomplishments
Ineffective or unsatisfying relationship
Dissatisfaction with ones place in the world
Ineffective coping with life events
Lack of personal growth
7

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Definition of a psychiatric disorder
 Psychiatric disorder is disturbance of
1. Cognition (thought)
2. Conation (action)
3. Affect (feeling)
Or any disequilibrium between the three

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History of psychiatry
 The early Babylonian, Chinese and Egyptian civilization
viewed mental illness as
o possession
o Used exorcism, which sometimes involved
Beatings
restraints
starvation to drive evil spirits from their victim

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Hippocrates
 Hippocrates (460-377 BC)- A Greece physician, believed that the
human body was filled with four basic substances, called humours,
which are in balance when a person is healthy
 blood
 lymph
 bile and
 phlegm(mucus)
 To Hippocrates, diseases resulted from an imbalance of these humours

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Cont..
 Hippocrates (400BC)
o Classified mental illness – mania, melancholia
o Suggested more human treatment –
 Rest
 Bathing
 exercise and dieting
 Aristotle (384 to 322 BCE) believed that mental illness occurred when
the soul was subjected to changes in temperature and the emotions

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Cont..
 20th
century
– Disease classification and rebirth of biological psychiatry
– Advance in discovery of medication
– Discovery of relationship between illness and specific
neurotransmitter
• E.g. increase in NE and serotonin seemed to help depressed
• patients medications that block the transmission of dopamine
provided relief from hallucination and paranoia

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Second half 20th Century
 These period Psychopharmacology became part of psychiatry with the
discovery of the first neurotransmitter by Otto Loewi, Acetylcholine!
 Radiology and image diagnosis was first used as a psychiatric tool in
1980
 The 1st
discovery of chlorpromazine in the treatment of Schizophrenia
in 1952
 Imipramin in 1957
 SSRI’S since 1988
 lithium carbonate revolutionized treatment of Bipolar Disorder, in 1948

14. 14
Ethiopian psychiatric history
 The Amanuel Mental Hospital
Built by the Italians
The built for general purpose when the country was
occupied
After independent it was converted to a mental care
institution, appropriate for the isolation of ‘serious
mentally ill’
Few beds for mentally ill patient

15. Ethiopian psychiatric history
In the 1960s
 Introduction of psychiatry in the curriculum of the new
medical faculty
 Training of Ethiopian psychiatrists started in different
European countries
 Return of psychiatrists from abroad
 Also psychiatric nurse training started for decentralizing the
service to people who can’t afford transport to Addis Ababa
15

16. Problems encountered in the development of MHS
 Negative attitudes:- still describe mental illness to individual’s wrong
doings
 Inaccessibilities of services (scarcity)
 Limited knowledge of spectrum of mental disorders
 Centralization
 Shortage of human resources
16

17. Problems Cont’d
 Limited scope of management skills
 Lack of proper planning, monitoring and evaluation
 Lack of basic statistics
 Shortage of essential drugs
 Lack of national mental health policy
17

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Misconception (Myth) of mental illness in
Ethiopia
• Causation
o Possession
o Witchcraft
o Evil eye or demons
o Sin
o Poisoning
o Result of punishment from
God
• Treatment
o Holy water
o Sheiks & priests
o Herbalists
o Exorcisms

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CONT..
The profession
– Results in mental illness
– Can read the mind
Patients
– Dangerous & feared
– Are not treatable & can’t work
– Fools, unattainable, don’t feel pain
– Can’t possess a property, don’t have equal rights

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…
 Myth: Mental illness only affects a few people
 Fact: Mental illness is common. It affects people of all ages,
educational and high/low income levels and cultures
 Myth: Mental illness is caused by a personal weakness
 Fact:
 A mental illness is not a character flaw
 It is caused by genetic, biological, social and environmental factors
 Seeking and accepting help is a sign of strength

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….
 Myth: People with a mental illness never get better.
 Fact: With the right kind of help, most people do recover and
lead healthy, productive and satisfying lives.
 Myth: People with a mental illness can “pull themselves out of
it”.
 Fact: A mental illness is not caused by personal weakness and is
not “cured” by personal strength

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…
 Myth: People with a mental illness are violent
 Fact:
 People with a mental illness are no more violent or dangerous than the
rest of the population
 People with a mental illness are more likely to harm themselves or to be
harmed than they are to hurt other people
 Myth: People with a mental illness should be kept in hospital
 Fact:
 With appropriate treatment and support, people with mental illness can
live successfully in the community
 In fact, the majority of people with a mental illness live independently in
the community

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Etiology of mental disorders
 Unknown or not well understood.
 Caused by combination and interaction of several factors
 Single cause may lead to several effect
 Complex and ambiguous
 The Bio-Psycho-social model is so far the most plausible
approach to the problem

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Cont..
 Stressful life events
 unemployment, the death of a loved one
 economic problems
 loneliness
 infertility, marital conflict
 Violence and trauma
 Difficult family background- People who have had an unhappy childhood because
of violence or emotional neglect are more likely to suffer mental
 Brain diseases
 Heredity or genes
 Medical problems

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Factor influencing mental health
 Major Factor influencing mental health is three “P”
1. predisposing factors
2. Precipitating factors
3. Perpetuating factors
 Predisposing factors are increase susceptibility to psychiatric disorder
and present over a long period of time. Eg ;- age, gender, genetics

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Cont…
 Precipitating factors are trigger occurrence of illness
-are events that precede clinical onset, (Environmental factors,
physical illness)
 Problem with family interaction
 Problem in interpersonal r/ship
 Living circumstances /immigration
 Occupational loss
 Physical illness

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Cont…
Perpetuating factors are factors that prolong the course
of a disorder and delay recovery from illness
– Secondary demoralization and withdrawal from social activities
– Substance use/abuse
– Lack of social support
– Chronic physical illness

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Prevalence of mental disorder
 Common to all countries
 25% of the world’s population will develop mental illness at
some stage in their lives
 450million people suffer from mental disorder

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Management of mental disorder
Mainly of three types
– Biological- mainly medication, ECT
– Psychological
– social

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Principles of mental health Nursing
 Patient is accepted exactly as he/she is
 Reassurance should be given in a subtle and acceptable manner
 Unnecessary increase in patients anxiety should be avoided
 Maintain realistic nurse-patient relationship
 Avoid physical and verbal forces as much as possible

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Cont…
• If client behavior is bizarre, base your decision to intervene on
whether the client is endangering self or others.
• Ask for help—do not try to be a hero when dealing with a client
who is out of control!
• Avoid highly competitive activities, that is, having one winner
and a room full of losers
• Be honest so the client can rely on you
• Reassure the clients

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Mental health nursing
Therapeutic communication

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INTRODUCTION
 The nurse-client relationship is the foundation on which
psychiatric nursing is established
 The therapeutic interpersonal relationship is the process by which
nurses provide care for clients in need of psychosocial
intervention

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Cont..
 Mental health providers need to know how to gain trust and
gather information from the patient
 The patient's family, friends and relevant social relations, and to
involve them in an effective treatment plan
 Therapeutic use of self is the instrument for delivery of care to
clients in need of psychosocial intervention
 Interpersonal communication techniques are the “tools” of
psychosocial intervention

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THERAPEUTIC NURSE-CLIENT RELATIONSHIP
Therapeutic relationships are
goal- oriented
directed at learning and growth promotion

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Cont…
 Therapeutic Use of Self - ability to use one’s personality
consciously and in full awareness in an attempt to establish relatedness
and to structure nursing interventions
 Nurses must possess self-awareness, self-understanding, and a
philosophical belief about life, death, and the overall human condition
for effective therapeutic use of self

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Cont…
Requirements for Therapeutic Relationship
Rapport
Trust
Respect
Genuineness
Empathy

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THERAPEUTIC COMMUNICATION TECHNIQUES
o Using silence - allows client to take control of the discussion, if
he or she so desires
o Accepting - conveys positive regard
o Giving recognition - acknowledging, indicating awareness
o Offering self - making oneself available
o Giving broad openings - allows client to select the topic

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Cont…
 Encouraging comparison - asking client to compare similarities and
differences in ideas, experiences, or interpersonal relationships
 Restating - lets client know whether an expressed statement has or has not
been understood
 Reflecting - directs questions or feelings back to client so that they may be
recognized and accepted
 Focusing - taking notice of a single idea or even a single word
 Exploring - delving further into a subject, idea, experience, or relationship

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Definition of different terminology in psychiatry
(Sign and Symptom)

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Learning Objectives
• To help you identify
– What sign and symptoms are in psychiatry
– Sign and symptom of
• Emotion
• speech
• Perception
• Thought
• Motor activity
• Cognition

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Sign
 Observation and objective findings elicited by clinician
 E.g. patient’s constricted affect or psychomotor retardation

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Symptoms
 The subjective experiences described by the patient
 Often expressed as the chief complaint
 E.g. depressed mood or lack of energy

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Syndrome
 A group of signs and symptoms that together make up a recognizable
condition
 More ambiguous than a specific disorder or disease
 Symptoms are more likely to indicate mental disorder if they
 occur together
 persistent
 interfere with the function of the individual

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Sign and symptoms
 Over 350 terms are used to describe the sign and symptoms in psychiatric
illness
 Becoming an expert in recognizing specific signs and symptoms allows the
clinicians to-
 Understandably communicate with other clinicians
 Accurately make a diagnosis
 Effectively manage treatment
 Reliably predict a prognosis
 Thoroughly explore pathophysiology, causes and psychodynamic issues

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Abnormalities related to emotion
 Emotion is a complex feeling state with physiological changes
occurring as a response to some event and behavior component
that is related to affect and mood
 Emotion has two parts
– Mood is the inside feeling of a person and is relatively long
lasting
– Affect is the outward and observed expression of one’s feeling
and is mostly short lived

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Affect
 Affect should be assessed in terms of:-
– Stability (stable , labile)
– Appropriate (to the content of speech and circumstances)
– Intensity (flat, blunted, constricted)
– Affect can be ( sad, happy, euphoric, irritable, anxious, neutral,
fearful, angry, pleasant)

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Affect
 Appropriate affect
– Condition in which the emotional tone is in harmony with the
accompanying idea, thought or speech
 Inappropriate affect
– Disharmony between the emotional feeling tone and the idea,
thought or speech
– E.g. laughing when discussing the death of a loved one
– Mostly seen in severe psychiatric disorder

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Affect
 Restricted or constricted affect
– Reduction in intensity of feeling tone
– Less severe than blunted affect but clearly reduced
– Limited range of expressed emotion
– Little variability of expression during the interview

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Affect
 Blunted affect
– Disturbance in affect manifested by severe reduction in intensity
of externalized feeling tone
– The individual’s facial expression varies little
– There are few physical gestures of emotion
– Eye contact is either minimal or the patient seems to stare at the
interviewer
– The patient speaks in monotonous tone with little vocal
inflection
– The person’s face seems to have little muscle tone

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Affect
 Flat affect
– Is more severe form of blunted affect with essentially no
affective expression
– The interviewer may feel as if he is conversing with inanimate
object
– If he is told that his mother died or if he is told that he win
lottery the response will be the same
– No expression of sadness at the news of the death of his
mother

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Affect
 Labile affect
– Refer to abrupt, rapid and repeated shifts of type and intensity
of emotion
– Unrelated to external stimuli
– It is not proportionate to the expected response
– There is emotional incontinence

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Mood
 A pervasive and sustained emotion subjectively experienced and
reported by a patient
 E.g. depression, elation, anger

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Mood
 Euthemic mood:- normal range of mood, implying absence of
depression or elevated mood
 Alexythymia:- a person’s inability to describe or difficulty in
describing or being aware of emotions or mood

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Mood
 Irritable mood:- a state in which a person is easily annoyed and
provoked to anger
 Mood swings(labile mood):- oscillations (fluctuation) of mood
between euphoria and depression
 Elated/Expansive mood:-is characterized by excessive
happiness, frequently with an overestimation of their significance
or importance

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Mood
• Hypomania:- mood abnormality with the qualitative characters
of mania but less intense
• Mania:- mood state characterized by elation, agitation,
hyperactivity, hyper sexuality and accelerated thinking and
speaking
• Depression: psychopathological feeling of sadness

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Mood
 Anhedonia:- loss of interest in and withdrawal from all regular
and pleasurable activities, often associated with depression
 Suicidal ideation:- thoughts of wanting to end one’s own life
 Dysphoric mood:- an unpleasant mood

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Speech disorders
 Pressure of speech- rapid and increased in amount
 poverty of speech- restrictions in amount
 Non-spontaneous- no self initiation
 Mutism - complete loss of speech
 Neologism - new words that are constructed by the patient or
ordinary words that are used in a new way

59. Disorders of Perception
 Perception: is the process of becoming aware of what is presented through
sense organs
Disorders of perception can be divided into sensory distortions and sensory
deceptions
 Sensory distortions
• There is a constant real perceptual object which is perceived in a distorted way
 Sensory deceptions
• A new perception occurs that may or may not be in response to an external
object
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60. Sensory distortions
 These are changes in perception that are the result of a change in
the
 Intensity
o Eg. (hyperacusis or hypoacusis)
 the spatial form of the perception
o Eg. (micropsia or macropsia)
60

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Sensory deceptions
 These can be divided into two forms
– Illusions - misinterpretations of stimuli arising from an
external object
– Stimuli from a perceived object are combined with a mental
image to produce a false perception e.g., misinterpreting
shadows as threatening

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Disorder of perception
 Hallucinations –
 is perception experienced in the absence of actual stimuli
 may occur in all the sensory modalities
 A false perception which is not a sensory distortion or a
misinterpretation, but which occurs at the same time as real perceptions
 Come from ‘within’, but subject reacts to them as true perceptions
coming from ‘without’

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Forms of hallucination
• Auditory hallucination is hearing a voice which does not exist
– Common in schizophrenia
• Visual hallucination is seeing things which don’t exist
• Olfactory – smelling things which don’t exist uncommon
• Gustatory-. is the experience of strange taste in the mouth. uncommon
• Tactile is sense of touch without existing stimulus, e.g. insect crawling on
the body
– Visual and tactile hallucination are common in delirium, alcohol
withdrawal or other medical condition

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Perceptual disorders
 Derealization: refers to the experience of the patient that
everything in his surrounding appears to have changed and is
strange
 Depersonalization: Sensation of unreality concerning oneself, or
parts of oneself

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Thought disorder
 Thinking: the ability to process information in once mind in both
content and form
 When a logical sequence occurs thinking is normal
 Disorders of thinking occur in the following forms:
 Forms of thought
 Content of thought

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Specific disturbances in form of thought
 Form of thought: refers to how ideas are connected and related
to each other
 Neologism:- new word created by a patient, often by combining
syllables of other words
 Circumstantialities:- indirect speech that is delayed in reaching
the point but eventually gets from original point to desired goal;
characterized by an over inclusion of unnecessary details

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Cont..
 Tangentiality:- inability to have goal-directed associations of
thought; speaker never gets from desired point to desired goal
 clang association:-Association or speech directed by the sound of
a word rather than by its meaning
 Flight of ideas:- rapid continuous verbalizations or plays on
words produce constant shifting from one idea to another

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Cont..
 Loosening of association:-refers to lack of connection between ideas as
occurs in schizophrenia; when severe speech may be incoherent
 Perseveration: is the tendency to focus on a specific idea or content
without the ability to move on to other topics
 Thought block: refers to the experience of the patient characterized by
sudden blankness, and or emptiness, and the patient losses track of his/her
own thought
 Echolalia:- pathological repeating of words of one person by another;
tends to be repetitive and persistent

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Delusion
 A delusion is a false belief or conviction that cannot be changed
by rational arguments or evidence
 As a pathology, it is distinct from a belief based on false or
incomplete information
 They are of particular diagnostic importance in psychotic
disorders and particularly in schizophrenia, manic episode and
psychotic depression

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delusion
 A false belief based on incorrect inference about external reality
 Firmly sustained despite what almost everybody else believes
 The belief is not ordinarily accepted by other members of the
person’s culture or subculture

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Types of delusion
 Grandiose delusions: refers to the patient’s belief that he is great or
important
 Delusions of jealousy (infidelity): refers to the person’s belief that
the spouse or partner is being unfaithful
 Persecutory delusions: refers to the patient’s belief that people or
organizations are trying to inflict harm on him, damage his
reputation, or make him insane

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Types of delusion
• Nihilistic delusion: denial of existence of their body, their mind,
their loved ones and the world around
• Delusion of guilt and worthlessness: refers to the patient’s belief
that he/she is sinner and is not worthy to live
• Erotomania: Delusional belief, more common in women than in
men, that someone is deeply in love with them

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Types of delusion
 Delusion of reference: concerned with ideas that objects, events or actions
of people have special significance for the person
– Example, gesture by somebody is believed to be directed specifically to the patient
 Delusion of being controlled: belief that personal actions,
impulses, or thoughts are being controlled by an outside agency

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Types of delusion
 Thought withdrawal: refers to the patient’s experience that his ideas are
mysteriously removed
 The patient may complain that his political enemies remove his ideas for
their own personal ambitious
 Thought broadcasting: refers to the patient’s experience that his/her ideas
are shared by others without telling him/her
 Thought insertion:-Delusion that thoughts are being implanted in one's
mind by other people or forces

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Motor/ behavior abnormalities
 Tics - irregular, involuntary & repeated movements involving a
group of muscles
 Mannerism - repeated movements that appear to have some
functional significance to a given person, but used out of context
& inappropriately e.g. saluting
 Stereotypes - repeated movements that are regular and without
obvious significance e.g. rocking to and fro

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Cont..
 Negativism - doing the opposite of what was asked to do
 Echopraxia - imitation of the others act
 Echolalia – imitation of others speech
 Waxy flexibility - maintenance of once body part in
uncomfortable position for a long

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Disturbance of attention and concentration
 Attention is the ability to focus on something
 Concentration is the ability to maintain that focus
 Attention and concentration can be impaired in many of
psychiatric conditions, and physical illness

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Cont..
 Judgment: the ability to make sound decisions in the interest of
self and others
 Insight: - is a correct awareness of one’s own mental and
physical condition

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THANK YOU