Psychiatric Nursing

Mental Health

• Mental health is a state of well-being where a person can realize their abilities to cope with normal life stresses and work productively (WHO).
• Criteria for mental health include:
  • Self-awareness: recognizing thoughts, feelings, and weaknesses, and experiencing genuine feelings.
  • Autonomy: ability to function independently and with others.
  • Perceptive ability: awareness of stimuli, reality orientation, and integral capacity.
  • Self-actuation: ability to adapt to life changes, cooperate, and be satisfied in every endeavor.

Mental Illness

• Mental illness is a state of imbalance characterized by a disturbance in thoughts, feelings, and behavior.
• Factors increasing the risk of mental illness include:
  • Genetic predisposition
  • Trauma
  • Stress
  • Lack of social support

Mental Hygiene

• Mental hygiene is the science of maintaining mental health and preventing the development of psychosis, neurosis, or other mental disorders.

The Biological Basis of Behavior

• Neurons are the "messengers" of the nervous system, unique in shape and function.
• Well-known neurotransmitters include:
  • Acetylcholine (ACh): involved in arousal and attention, loss of which leads to Alzheimer's disease.
  • Dopamine: affects neurons associated with voluntary movement, involved in learning, memory, and emotions, and loss of which leads to Parkinson's disease.
  • Serotonin: sets an emotional tone, low levels of which are associated with depression.
  • Endorphins: reduce pain by inhibiting or "turning down" neurons that transmit pain information.

Therapeutic Modalities, Psychosocial Skills, and Nursing Strategies

• Psycho-analytic theory by Sigmund Freud:
  • Id: the primitive and instinctual part of the mind, containing sexual and aggressive drives and hidden memories.
  • Ego: the realistic part that mediates between the desires of the Id and the demands of reality.
  • Superego: the moral component, which develops last and functions as a policeman to check the unlawful activities of the Id.
• Freud's psychosexual stages of development:
  • Oral stage (birth to 1 ½ years): mouth, lips, and tongue, sucking, biting, and chewing.
  • Anal stage (1 ½ to 3 years): anus, bowel retention, and elimination toilet training.
  • Phallic stage (3 to 6 years): genitals, identifying with same-sex parent to learn gender role and sense of morality.
  • Latency stage (6 years to puberty): latency, preferring own-sex company, and hating the opposite sex.
  • Genital stage (puberty to adulthood): genitals, cognitively and socially developed.

Verbal Communication Skills

• Therapeutic communication techniques:
  • Using concrete messages that are explicit and easy to understand.
  • Avoiding non-therapeutic communication that cuts off interaction.
  • Interpreting signals or cues.
  • Finding cues through active listening.
• When to terminate therapy:
  • Goals have been met.
  • Patient is emotionally stable.
  • Patient is independent and can cope with separation anxiety, fear, and loss.

Defense Mechanisms

• Positive defense mechanisms:
  • Compensation: making up for weaknesses by developing strength in other areas.
  • Substitution: replacing an unachievable goal with an achievable one.
  • Displacement: redirecting emotions to a more acceptable target.
• Negative defense mechanisms:
  • Repression: unconscious forgetting of unpleasant experiences.
  • Projection: placing blame on others for one's own difficulties.
  • Rationalization: justifying failures and unacceptable behaviors with excuses.
  • Regression: reverting to childish behavior under stress.
  • Fantasy: imaginary gratification of frustrated desires.
  • Identification: attempting to increase self-worth by adopting traits of another.
  • Transference: unconsciously identifying with another person.
  • Conversion: converting emotional conflicts into physical symptoms.
  • Intellectualization: using logic to avoid expressing actual emotions.
  • Dissociation: involuntary suppression of mental function to express forbidden impulses.
  • Introjection: unconsciously adopting the thoughts or traits of others.
  • Denial: refusing to face reality to avoid anxiety.