LECTURE # 1
DESCRIPTION OF PACKETS AND Hx OF PSYCHIATRY AND PSYCHIATRIC
NURSING
■ Greece Seems to be earliest civilization to care for mentally ill
■ Many times mentally ill treated like animals
■ Modern psychiatric divided into 4 bench marks, (periods)
I.
1790s – 1950s – caring (period of enlightenment), Tuke from England and Pineal from
France establish asylums in Europe
Dorothia Dix initiated humane treatment of mentally ill in the USA
II.
1850s – 1950s – period of attempted “curing”
Freud developed concept of id, ego and superego, introduced concept of neutrality, felt
unresolved subconscious were the cause of mental illness, allowed pts to free associate,
began description of ego defense mechanisms , Rationalization, somatization etc..
Described five phases of psychosexual development, also described innate drives –
sexual and aggressive.
Kraeplin – first person to classify mental illnesses
Bluelar – coined term schizophrenia
Harriet Bailey wrote first psyc nursing book
1882 McLean hospital first hospital in US to train psychiatric nurses
Erickson – eight stages of man (review on your own)
Maslow – Hierarchy of needs, very important to nurses to asses triage needs
Piaget – cognitive development, 4 stages, sensorimotor, preoperational, concrete
operations and formal operations
Skinner and Pavlov studied behavior and learning theory
In addition to the theorists of the era physical treatments were also attempted
Insulin coma therapy, ECT, frontal lobotomies, hydrotherapy
III.
Period 3 – 1950s development of chemical treatment for mental illness thorazine first
anti-psychotic, lithium discovered in Europe 1st mood stabilizer Isoniazid used to treat
T.B. found to have mood elevating properties lead to discovery of MAO inhibitor anti
depressants
IV.
Period 4 – 1960s discharge pts to the community, as meds worked pts could be d/c
Also mental institutions were getting known as places of pt abuse leading to
deinstitutionalization, this created other problems ie. homelessness, med non-compliance,
jail for mentally ill.
Current psychiatric treatment still revolves around the use of meds, but it is known that
for non-psychotic pts the talk therapy also works.
Review of brain
■ Frontal lobe particularly the pre-frontal lobe is what makes us
human in that it gives us the ability to plan, make decisions in addition to enjoying
music art and other humanities. No other animal has this ability.
■ Temporal lobe responsible for language, memory, emotion. Processes sense of smell
■ Parietal lobe process info obtained by senses except sense of smell
■ Occipital lobe process vision
Brain also organized into functional systems
■ Extra pyramidal system – coordinates involuntary muscle movement, i.e. muscle tone,
reflexes, posture, site of extra pyramidal side effects of anti-psychotics
■ Limbic system – usually described as emotional center of brain, contains Amygdala,
thalamus, hypothalamus, and hippocampus which deals with memory
Most psychiatric meds affect neurotransmitters in the brain. These transmitters are dopamine,
norepinephrine (adrenalin), serotonin, acetylcholine, GABA, glutamate, endorphins (body
natural pain killers.)
Review nerve cell anatomy
1990s considered the decade of the brain because of major medication advancedment and new
techniques that allowed more accurate brain imaging while the person was alive.
■ Cats scan – 3d x-ray
■ MRI allows study of magnetic field of tissues
■ Pet scan positron emission tomography
■ Spect scans
Meds that were invented during the 1980s and 90s were more receptor specific thus having fewer
side effects, i.e. clozaril, zyprexa antipsychotic that has few extrapyramidal symptoms
(involuntary trembling and other movement problems).
M. Mangino
Disk #2