INTRODUCTION TO PSYCHIATRIC NURSING

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INTRODUCTION TO PSYCHIATRIC NURSING
Mercedes A Perez-Millan MSN, ARNP
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Mental Health
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MENTAL ILLNESS
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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

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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

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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.

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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

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Theories of Mental Illness

• PSYCHOBIOLOGICAL
• PSYCHOLOGICAL

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PSYCHOBIOLOGICAL

• Genetic
• Other Biological Influences
• The Role of the Environment

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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

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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

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PSYCHOBIOLOGICAL NEURON

• CONDUCTION OF ELECTRICAL IMPULSES
• NEUROTRANSMITTERS
• RECEPTORS

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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

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PSYCHOBIOLOGICALNeurotransmitter/ Receptor/
Disorder

• Dopamine DA Schizophrenia, Mania
• Parkinsons, Depression
• Norepinephrine NE Mania
• Depression
• Serotonin 5-HT Anxiety
• Depression
• Gamma-amino- GABA Reduction of
• buturic acid anxiety
• Anxiety
• Acetyl-Choline Ach Depression
• Alzheimers

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PSYCHOLOGICAL

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

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PSYCHOLOGICALPSYCHOANALYTICAL EGO FUNCTIONS
SELF ESTEEM
EGO

• REALITY TESTING
• SENSE OF REALITY
• JUDGEMENT
• IMPULSE CONTROL
• THOUGHT PROCESS
• ARISE

• DEFENSIVE FUNCTIONING
• OBJECT RELATIONS
• AUTONOMOUS FUNCTIONING
• STIMULOUS BARRIER
• MASTERY COMPETENCE
• SYNTHETIC INTEGRATIVE FUNCTIONING

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PSYCHOLOGICAL

• Freud
• Psychosexual Stages of Development
• Oral (0-18mos
• Anal (18mos-3yrs)
• Phallic (3-6yrs.)
• Latency (6-12yrs)
• Genital (13-20yrs)

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PSYCHOLOGICAL

• ERIKSON
• Psychosocial Stages of Development
• Trust vs Mistrust
• Autonomy vs Shame and Doubt
• Initiative vs Guilt

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PSYCHOLOGICAL

• ERIKSON (cont)
• Industry vs Inferiority
• Identity vs Role Confusion
• Intimacy vs Isolation

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PSYCHOLOGICAL

• ERIKSON (cont)
• Generativity vs Stagnation
• Ego Integrity vs
  Despair

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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

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Psychiatric Mental Health Nursing and the
Nursing Process

• 1. Assessment 2. Nursing Diagnosis
• 6. Evaluation 3. Outcome
  Identification
• 4. Planning
• 5. Implementation

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Factors Affecting Mental Health and Nursing
Assessment

• Support systems
• Family influences
• Developmental events
• Cultural beliefs and values
• Health practices
• Negative influences

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PSYCHIATRIC ASSESSMENT

• Construct database
• Mental status examination (MSE)
• Psychosocial assessment
• Physical examination
• History taking
• Interviews
• Standardized rating scales
• Verifying the data

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DIAGNOSIS OF PSYCHIATRIC ILLNESS

• Medical- DSM-IV-TV (Diagnostic and
  Statistical Classification of Mental
  Disorders)
• Nursing- NANDA (North American Nursing
  Diagnosis Association)

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DSM-IV-TR

• Mental disorders are considered a manifestation
  of a
• Behavioral
• Psychological
• Biological
• dysfunction of the individual

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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)

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Therapeutic Approaches

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

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CULTURAL BIASES

• Consider cultural differences that influence
  health
• Be accepting of changing families
• Be open, consider differences in
  order to provide sensitive, competent care

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GOALS and Interventions ofPsychiatric Care
Directed to

• Anxiety
• Reality testing
• Self esteem
• Level of functioning and manage disease process