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