Mental health Defined as " Successful performance of mental functions, resulting in the ability to engage in productive activities, enjoy fulfilling relationships, and change or cope with adversity." Mental illness Defined as " clinically significant behavior or psychological syndrome experienced by a person and marked by distress, disability, or the risk of suffering disability, or loss of freedom." The diagnostic entities manual of mental disorders (DSM-5) The current official guidebook for categorizing and diagnosing psychiatric mental health disorders in the United States. Mental disorders ...a mental or bodily condition marked primarily by sufficient disorganization of personality, mind, and emotions to seriously impair the normal psychological functioning of the individual—called also mental illness Myths and misconceptions One myth is that to be mentally ill is to be different and odd. Another misconception is that to be mentally healthy, a person must be logical and rational. Resiliency ...the ability to recover from or adjust easily to misfortune and change. Epidemiology ...the quantitative study of the distribution of disorder in human population Prevalence rate ...the proportion of a population with a mental disorder at a given time Biologically based mental illness ...a mental disorder caused by neurotransmitter dysfunction, abnormal brain structure, inherited genetic factors or other biological causes. Psycho biological disorder ...biologically influenced mental illness. examples are Schizophrenia, Bipolar Disorder, major depression, OCD, posttraumatic disorders and autism Distress ...painful symptom Disability ...impairment in one or more important areas of functioning. Stigma ...an attribute that is deeply discrediting where a person is reduced from a whole person to a tainted, discounted one Stigmatizing ...attitudes toward the mentally ill can have harmful effects on an individual and family, especially if the diagnosis is made on the basis of insufficient evidence and proves faulty. Cultural - related syndromes ...appear to be more influenced by culture alone and are not seen in all areas of the world. Running amok ...someone runs around engaging in furious almost indiscriminate violent behavior. Pibloktoq ...an uncontrollable desire to tear off ones clothing and expose oneself to severe winter weather; it is a recognized form of psychological disorder in parts of Greenland, Alaska, and Arctic regions of Canada Anorexia nerosa ...a psychobiological disorder that entails voluntary starvation. DSM IV-TR *classifies mental disorders. * Establishes criteria for classification of mental disorders. * Evaluates individuals from numerous cultural/ethnic groups. * Uses multiaxial system for diagnoses. Multiaxial Diagnostic System Axis 1: mental disorder(s), focus of treatment. Axis 2: personality disorder(s) and mental retardation. Axis 3: general medical conditions; relevant to Axis 1 diagnosis. Axis 4: psychosocial and environmental problems. Axis 5: global Assessment of Functioning (GAF). 7 signs of Mental Health page 12 Table 12-1 1. Happiness. 2. Control over behavior. 3. Appraisal of reality. 4. Effectiveness in work. 5. Healthy self-concept. 6. Satisfying relationship. 7. Effective coping strategies. Factors affecting severity and progress of Mental Illness 1. Support systems. 2. family influence. 3. Developmental events. 4. cultural beliefs and values. 5. health practices. 6. negative influences. Axis I Clinical disorders/ focus of attention Axis II Personality disorders and MR Axis III General Medical Conditions Axis IV Psychological and environmental problems Axis V Global Assessment of Functioning GAF- Global Assessment of Functioning DSM-IV-TR Axis V. Global Assessment of Functioning (GAF) Score, Psychiatrically hospitalized persons usually score 50 or below Akathesia The inability to remain still, motor restlessness, and anxiety Dystonia is a condition of abnormal muscle tone that causes the impairment of voluntary muscle movement Dyskinesia the distortion or impairment of voluntary movement such as in a tic or spasm Postural Hypotension Sudden but temporary drop in blood pressure when rising from a reclining or seated position (unusually low blood pressure upon standing) Anticholinergic Side Effect Blurred vision- usually subsides after a few weeks Dry eyes- fluids given Constipation- high fiber diet Dry mouth- Sugar free gum or candy Tachycardia Urinary hesitancy or retention (Very common) Hypotension Photophobia- Sun glassess Parkinsonism a degenerative disorder of the central nervous system characterized by tremor and impaired muscular coordination, Termor, shiffling gait, drooling and slooped posture Oculogyric Crisis attack of involuntary deviation and fixation of the eyeballs, usually in the upward position. It may last for several minutes or hours and may occur as an extrapyramidal side effect of some antipsychotic medications. Opisthotonos tetanic heightening of entire body, head and belly up Torticollis an abnormal condition in which the head is inclined to one side as a result of the contraction of muscles on that side of the neck Hypertensive crisis condition seen as increase blood pressure that cause the heart rate and breathing to increase photosensitivity quality of being photosensitive; abnormal sensitivity of the skin to ultraviolet light Agranulocytosis symptoms include sore throat, fever, malaise, and mouth sores. It is a rare occurrence, but a possibility the nurse should be aware of. Any flulike symptoms should be carefully evaluated.Onset: During the first 12 weeks of therapy, occurs suddenly Tardive Dyskinesa is a persistent EPS that usually appears after prolonged treatment and persists even after the medication has been discontinued. TDK consists of involuntary tonic muscular contractions that typically involve the tongue, fingers, toes, neck, trunk, or pelvis. This potentially serious EPS is most frequently seen in women and older patients and affects up to 50% of individuals receiving long-term, high-dose therapy. Cogwheeling Antipsychotic meds which create a racheting effect of the muscle. jerky, ratchet like resistance to passive movement as mm alternately tense and relax define mental health State of well being in which the individual realizes his/ her own abilities, can cope with the normal stresses of life, can work productively and fruitfully and can contribute to the community. mental Ilness denotes clinicallysignificantbehavorial or psychological patterns that occur in. an individual that causes distress or disability in the person's life.Disorders manifest as inappropriate behavioral patterns that result from the distortions and discomfort experienced in the mind of the individual.Thinking errors and misconception often lead to irrational and unrealistic processing. stress a condition that results when a threat or challenge to ones well-being requires the person to adjust or adapt to the enviroment. Distress negative stress and demands an exhausting type of energy. (ex. student who is disqualified from the football team because of poor grades resulting in a feeling of low self- worth Eustress positive and motivating, as shown by one's confidence in the ability to master a challenge or stressor.(ex. football player who stress about an upcoming football game challenges him to play better.) Acute stressor constitutes the reaction to an immediate threat, commonly called [fightor-flight response] chronic stress situation is ongoing or continues such as chronic illness of family member or job related responsibilities stress reaction the physical response to the stressor , or the stress reaction, is triggered by the arousal of the autonomic nervous system. physical stress symptoms increased blood pressure and heart rate. heart palpitations increased respirations abdominal cramping headaches insomnia mental stress symptoms lack of concentration and memory inability to make decisions confusion forgetfulness emotional stress symptoms anxiety nervousness irritability frustration and worry behavioral stress symptoms fidgety movements nail- biting smoking and drinking yelling throwing things anxiety ... mild level of anxiety is a natural and motivating toward productivity with an improved sense of well- being. if anxiety is not improved it becomes moderate moderate level of anxiety become uncomfortable and difficult to tolerate for extended periods. if anxiety not controlled it becomes severe severe level of anxiety is physically and emotionally exhausting. the individual is desperate for a way to relieve the mental and emotional turmoil.if steps are not taken to decrease this severe level than a state of panic may develop. panic level of stress possibly leading to hysteria, suicide attempts, or violence adaption syndrome (fight or flight) 1. Alarm stage- sympathetic nervous system neurons rapidly release norepinephrine. 2. Stage of Resistance- neuro endocrine hormones, although temporarily excessive endavor to compensate for the physiologic changes of the alarm stage. 3. Stage of Exhaustion- it occurs when one or more adaptive or resistive mechanisms are no longer able to protect the person experiencing a stressor. Coping strategies Adaptive coping-rational and productive way of resolving a problem to reduce anxiety. Palliative coping- copying strategy that temperaily relieves the anxiety but the problem still exists and must be dealt with at a later time. Maladaptive coping- unsuccessful attempts to decrease anxiety without attempting to solve the problem allowing anxiety to continue. Dysfunctional coping- the individual who does not attempt to reduce the anxiety or solve the problem. reframing is a way of restructuring our thinking about stressful events into one that is less disturbing and over which we can have some control. (ex. by changing our views to a more realistic expectation we can pursue a solution more clearly. Advanced Practice Registered Nurse, Psychiatric Mental Health A licensed RN with a master of science or Doctor of Nursing practice in Psychiatric nursing. Basic Level Registered Nurse, RN Any nurse with basic training, a diploma, associate degree, or baccalaureate degree in nursing., completed nursing program, state licesure and qualified to work in most any general or speciality area. Clinical Epidemiology broad term that addresses what happens after patients are seen by providers Co-morbid Condition A condition that occurs along with another disorder. Diagnostic And Statistical Manual Of Mental Disorders, Fourth Edition, DSM 4 A classification of mental disorders that includes descriptions of diagnostic categories. The DSM 4 is the most widely accepted system of classifying abnormal behaviors used in the United States today. Electronic Health Care, E H C The provision of health care through methods which are not face-to-face but rather through an electronic medium. Epidemiology The quantitative study of the distribution of mental disorders in human populations. Evidence-Based Practice Care based on the collection, interpretation, and integration of valid, important, and applicable patient-reported, clinician-observed, and research-derived evidence. Incidence Refers to the number of new cases of mental disorders in a healthy population within a given period of time. For example, the number of New York City adolescents who were diagnosed with major depression between 2000 and 2010. Mental Health Continuum A conceptual line used to represent levels of mental health and mental illness that vary from person to person and vary for a particular person over time. Mental Illness A clinically significant behavioral or psychological syndrome marked by the patient's distress, disability, or the risk of suffering disability or loss of freedom. Nursing Intervention Classification, N I C A listing of research-based nursing intervention labels that provide standardization of expected nursing interventions. Nursing Outcomes Classification, N O C A classification system which defines and describes patient outcomes to nursing interventions. Phenomena Of Concern The central interests of a particular discipline. In nursing they are commonly considered to be person, health, environment, and nursing. Prevalence Describes the total number of cases, new and existing, in a given population during a specific period of time. Example: the number of adolescents who screen positive for major depression in New York City schools between 2000 and 2010 Psychiatric Mental Health Nursing, P M H N This specialty area in nursing and core mental health profession promotes mental health through the nursing process in the treatment of mental health problems and psychiatric Psychiatry's Definition Of Mental Health Evolves over time and is shaped by the prevailing culture and societal values. Reflects changes in cultural norms, society's expectations, and political climates. Registered Nurse-Psychiatric Mental Health, R N, P M H A nursing graduate who possess a diploma, AA, or BA and chooses to work in the specialty of psychiatric mental health nursing. Resilience The ability to adapt and cope, which helps people to face tragedies, loss, trauma, and severe stress. Global Assessment of Functioning A 0 to 100 rating of a person, with more severe disorders indicated by lower numbers and more effective functioning by higher numbers Electronic Health Record A long-term accumulation of a patient's health care information from a many different of providers. 10 Fundamental Components of the Recovery process Self directed, Individule and person centered, Empowering, Holistic, Nonlinear, Strength Bases, Peer supported, Respect, Responsibility, Hope. Diathesis-Stress Model Suggests that a person may be predisposed for a mental disorder that remains unexpressed until triggered by stress or trauma. This is the most accepted explanition for mental illness. Mental Health Consumer Groups of people with mental illnesses. Decade of the Brain •1990 - 2000 by Pres. George H. W. Bush •Years dedicated to new studies & to make legislation/general public aware of advances that were made in neuroscience/brain research Traits of Mental Health Think rationally, most of the time. Communicate appropriately. Learn - frontal lobe working properly. Grow emotionally. Resilient. Healthy self-esteem. Mental Health a state of well-being in which each individual is able to realize his or her own potential, cope with the normal stresses of life, work productively and fruitfully, and make a contribution to the community. Culture-Bound Syndromes Occur in specific sociocultural contexts and are easily recognized by people in those cultures. Running Amok a culture-bound syndrome of Southeast Asia, in which a person, usually a male, runs around engaging in furious, almost indiscriminate violent behavior. Pibloktoq an uncontrollable desire to tear off one's clothing and expose oneself to severe winter weather, is a recognized psychological disorder in parts of Greenland, Alaska, and the Artic regions Recovery The fact that some people, even those with the most serious illnesses, such as schizophrenia, will recover. A consumer-focused process, in which people are able to live, work, learn, and participate fully in their communities. Why is it important to recognize & treat mental illnesses early? Because with each "episode", the risk goes up 50% that they will have another episode Diathesis A biological predisposition to a disorder. Also known as vulnerability. A diathesis only causes abnormal behavior when it is combined with a stress or challenging experience. National Alliance on Mental Health (NAMI) •1979 - Formed by people w/ mental illness & their families. •1980's - Group began resisting traditional "paternalistic" mental health care providers who dictated care & treatment New Freedom Commission on Mental Health 2003 - Release of recommendations for mental health care in America. Called for a streamlined system. Advocated for Early diagnosis and treatment, New expectation for principles of recovery, Increased assistance in helping people find housing & work. Parity functional equality Epidemiologists Identify high-risk groups, and high-risk factors associated with illness onset, duration, & recurrence. Examples of high-risk groups associated w/ illness onset, duration, & recurrence. •Kids facing traumatic experiences at young age. •Genetic predisposition Examples of high-risk factors associated w/ illness onset, duration, & recurrence are. •Old treatments •Poverty •Isolation In the DSM 4, mental disorders are MANIFESTATIONS of a dysfunction of an individual's. behavior, psychology, and biology. In the D S M 4, mental disorders are ASSOCIATED with? Distress or painful symptom. Disability of important areas of function. High risk of suffering death, pain, disability, or loss of freedom. The D S M 4 classifies what? the disorder not the person. Axis 1 Mental disorder that is the focus of treatment; refers to a collection of s/s that together constitute a particular disorder. Example: Major depressive disorder Axis 2 Personality disorders & mental retardation. Example: Dependent personality disorder Axis 3 General medical conditions relevant to the mental disorder on Axis 1. Example: Diabetes Axis 4 Psychosocial & environmental problems. Example: relationship failing, job loss, finances. 300 to 500 means high stress. Axis 5 The Global Assessment of Functioning Score, or G A F Score. Example: 31; unable to work or respond to family & friends. The Main Personality Disorders are Obsessive-Compulsive, Narcissistic, Histrinic, Paranoid, Boarderline, Dependent, Schizoid, Anxious or Avoidant, Schizotypal, and Antisocial. Nursing Intervention any treatment based upon clinical judgment and knowledge that a nurse performs to enhance patient/client outcomes I C D-10 International classification of diseases •Clinical descriptions of mental & behavior disorders •Divided into 10 disease categories Nursing Diagnosis This is a clinical judgment about individual, family, or community responses to actual or potential health problem/life processes. It provides the basis for selection of nursing interventions to achieve outcomes for which the nurse is accountable. A well defined nursing diagnosis provides the framework for Identifying appropriate nursing interventions for dealing w/ the patients reaction to the disorder Basic Level Psych RN interventions •Health teaching andmaintenance •Milieu therapy •Pharmacological, biological & integrative therapies Psych nurse advanced practice interventions Basic interventions plus Med Rx's and treatment, hospital admitting, Psychotherapy, Consultation-sharing clinical expertise with nurses or other health care professionals to enhance the treatment of patients Case Management Coordinate patient care provided to individuals, their families, and significant other on a continuum and to provide efficient transitions to services that may be needed after discharge at home, in clinics, or other health care facilities. Community nursing centers Centered on low cost by providing care in established community buildings. The focus is on wellness and ease of accessible within the community. Serves low-income and uninsured people as long as they can secure funding. Cultural Competence Sensitivity to different cultural views reguarding health, illness, and response to treatment. Patient Advocate an individuale who speaks for the patient and protects their rights Stigma a powerfully negative label that greatly changes a person's self-concept and social identity