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Essentials of Psychiatric Mental Health Nursing, 5th

Edition

Chapter 1
Mental Health and Mental Illness

Copyright 2011 F.A. Davis Company

Essentials of Psychiatric Mental Health Nursing, 5th


Edition

Introduction
 The concepts of mental health and mental illness are culturally defined  Individuals experience both physical and psychological responses to stress

Copyright 2011 F.A. Davis Company

Essentials of Psychiatric Mental Health Nursing, 5th


Edition

Mental Health
Maslow identified  A hierarchy of needs  Self-actualization as fulfillment of one s highest potential

Copyright 2011 F.A. Davis Company

Essentials of Psychiatric Mental Health Nursing, 5th


Edition

Mental Health (cont.)


 Defined as the successful adaptation to stressors from the internal or external environment, evidenced by thoughts, feelings, and behaviors that are age-appropriate and congruent with local and cultural norms

Copyright 2011 F.A. Davis Company

Essentials of Psychiatric Mental Health Nursing, 5th


Edition

Mental Illness
 Defined as maladaptive responses to stressors from the internal or external environment, evidenced by thoughts, feelings, and behaviors that are incongruent with the local and cultural norms and interfere with the individual s social, occupational, or physical functioning

Copyright 2011 F.A. Davis Company

Essentials of Psychiatric Mental Health Nursing, 5th


Edition

Mental Illness (cont.)


 Horwitz described cultural influences that affect how individuals view mental illness, including  Incomprehensibility: the inability of the general population to understand the motivation behind the behavior  Cultural relativity: the normality of behavior is determined by the culture
Copyright 2011 F.A. Davis Company

Essentials of Psychiatric Mental Health Nursing, 5th


Edition

PHYSICAL AND PSYCHOLOGIAL RESPONSES TO STRESS

Copyright 2011 F.A. Davis Company

Essentials of Psychiatric Mental Health Nursing, 5th


Edition

Physical Responses
 Hans Selye defined stress as the state manifested by a specific syndrome which consists of all the nonspecifically induced changes within a biologic system  Fight-or-flight syndrome

Copyright 2011 F.A. Davis Company

Essentials of Psychiatric Mental Health Nursing, 5th


Edition

Physical Responses (cont.)


Selye s general adaptation syndrome  Alarm reaction stage
 Stage of resistance  Stage of exhaustion

Copyright 2011 F.A. Davis Company

Essentials of Psychiatric Mental Health Nursing, 5th


Edition

Physical Responses (cont.)


Fight-or-flight syndrome
 Immediate stress response  Sustained stress response

Copyright 2011 F.A. Davis Company

Essentials of Psychiatric Mental Health Nursing, 5th


Edition

Physical Responses (cont.)


 Sustained physical responses to stress promote susceptibility to diseases of adaptation

Copyright 2011 F.A. Davis Company

Essentials of Psychiatric Mental Health Nursing, 5th


Edition

Psychological Responses
 Anxiety and grief have been described as two major, primary psychological response patterns to stress  A variety of thoughts, feelings, and behaviors are associated with each of these response patterns  Adaptation is determined by the extent to which the thoughts, feelings, and behaviors interfere with an individual s functioning

Copyright 2011 F.A. Davis Company

Essentials of Psychiatric Mental Health Nursing, 5th


Edition

Psychological Responses (cont.)


Anxiety
 A diffuse apprehension that is vague in nature and is associated with feelings of uncertainty and helplessness  Extremely common in our society  Mild anxiety is adaptive and can provide motivation for survival

Copyright 2011 F.A. Davis Company

Essentials of Psychiatric Mental Health Nursing, 5th


Edition

Psychological Responses (cont.)


Peplau s four levels of anxiety
 Mild: seldom a problem  Moderate: perceptual field diminishes  Severe: perceptual field is so diminished that concentration centers on one detail only or on many extraneous details  Panic: the most intense state
Copyright 2011 F.A. Davis Company

Essentials of Psychiatric Mental Health Nursing, 5th


Edition

Psychological Responses (cont.)


Behavioral adaptation responses to anxiety
 At the mild level, individuals employ various coping mechanisms to deal with stress, including
        Eating Drinking Sleeping Physical exercise Smoking Crying Laughing Talking to persons with whom they feel comfortable

Copyright 2011 F.A. Davis Company

Essentials of Psychiatric Mental Health Nursing, 5th


Edition

Psychological Responses (cont.)


 At the mild to moderate level, the ego calls on defense mechanisms for protection, such as
        Compensation Denial Displacement Identification Intellectualization Introjection Isolation Projection        Rationalization Reaction formation Regression Repression Sublimation Suppression Undoing

Copyright 2011 F.A. Davis Company

Essentials of Psychiatric Mental Health Nursing, 5th


Edition

Psychological Responses (cont.)


 Anxiety at the moderate to severe level that remains unresolved over an extended period can contribute to a number of physiological disorders for example, migraine headaches, irritable bowel syndrome, and cardiac arrhythmias.  Extended periods of repressed severe anxiety can result in psychoneurotic patterns of behaving for example, anxiety and somatoform disorders.

Copyright 2011 F.A. Davis Company

Essentials of Psychiatric Mental Health Nursing, 5th


Edition

Psychological Responses (cont.)


 Extended periods of functioning at the panic level of anxiety may result in psychotic behavior for example, schizophrenic, schizoaffective, and delusional disorders.

Copyright 2011 F.A. Davis Company

Essentials of Psychiatric Mental Health Nursing, 5th


Edition

Psychological Responses (cont.)


 Grief: the subjective state of emotional, physical, and social responses to the loss of a valued entity; the loss may be real or perceived.  Elisabeth Kbler-Ross  Five stages of grief  Denial  Anger  Bargaining  Depression  Acceptance
Copyright 2011 F.A. Davis Company

Essentials of Psychiatric Mental Health Nursing, 5th


Edition

Psychological Responses (cont.)


 Anticipatory grief: The experiencing of the grief process before the actual loss occurs.  Resolution: Length of the grief process is entirely individual. It can last from a few weeks to years and it is influenced by a number of factors.
Copyright 2011 F.A. Davis Company

Essentials of Psychiatric Mental Health Nursing, 5th


Edition

Psychological Responses (cont.)


 The experience of guilt for having had a love-hate relationship with the lost entity. Guilt often lengthens the grieving process.  Anticipatory grieving is thought to shorten the grief response when the loss actually occurs.  The length of the grief response is often extended when an individual has experienced a number of recent losses and when he or she is unable to complete one grieving process before another one begins.

Copyright 2011 F.A. Davis Company

Essentials of Psychiatric Mental Health Nursing, 5th


Edition

Psychological Responses (cont.)


 Resolution of the grief response is thought to occur when an individual can look back on the relationship with the lost entity and accept both the pleasures and the disappointments of the association.

Copyright 2011 F.A. Davis Company

Essentials of Psychiatric Mental Health Nursing, 5th


Edition

Psychological Responses (cont.)


 Maladaptive grief responses
 Prolonged response  Delayed/inhibited response  Distorted response

Copyright 2011 F.A. Davis Company

Essentials of Psychiatric Mental Health Nursing, 5th


Edition

DSM-IV-TR Multiaxial Evaluation System


 Axis I: Clinical disorders and other conditions that may be a focus of clinical attention  Axis II: Personality disorders and mental retardation  Axis III: General medical conditions  Axis IV: Psychosocial and environmental problems  Axis V: The measurement of an individual s psychological, social, and occupational functioning on the Global Assessment of Functioning Scale
Copyright 2011 F.A. Davis Company

Essentials of Psychiatric Mental Health Nursing, 5th


Edition

Example of a Psychiatric Diagnosis


     Axis I: 300.4 Dysthymic Disorder Axis II: 301.6 Dependent Personality Disorder Axis III: 244.9 Hypothyroidism Axis IV: Unemployed Axis V: GAF = 65 (current)

Copyright 2011 F.A. Davis Company

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