Introduction to Psychiatric Nursing

Introduction to Psychiatric Nursing

• Psychiatric nursing focuses on the care of individuals with mental health conditions.
• Mental health is a state of emotional, psychological, and social wellness.
• Defining mental health is challenging as societal norms influence the definition.
• Key characteristics of mental health include satisfying interpersonal relationships, effective coping mechanisms, positive self-image, and emotional stability.

Mental Health Factors

• Factors influencing mental health are multifaceted and interact.
• They are categorized as individual, interpersonal, and sociocultural.

Individual/Personal Factors

• Biological makeup, including genetics, plays a role in mental health.
• Autonomy, independence, self-esteem, and capacity for growth are also influential.
• Vitality, ability to find meaning in life, emotional resilience, and hardiness are key personal factors.
• Sense of belonging and reality orientation are significant.
• Coping mechanisms and stress management skills also impact mental well-being.

Interpersonal/Relationship Factors

• Effective communication is essential for healthy relationships.
• Ability to support others and maintain intimacy is critical.
• Balance between separateness and connectedness within relationships is vital.

Sociocultural/Environmental Factors

• Sense of community and access to adequate resources are vital.
• Tolerance of violence and acceptance of diversity are crucial for mental well-being.
• Mastery of the surroundings and a positive outlook on the world are important.

Mental Illness

• Defining mental illness is challenging; it is based on socially acceptable behavior.
• Mental disorders affect mood, behavior, and thinking, often leading to distress and impaired functioning.

Aspects of Mental Illness

• Mood: Pervasive and sustained feeling.
• Behavior: Observable reactions to internal and external environments.
• Cognition: Mental processes of gaining knowledge and understanding.

Dissatisfaction Associated with Mental Illness

• Dissatisfaction with oneself is common in mental illness.
• Dissatisfaction in relationships is another key aspect.
• Ineffective coping mechanisms contribute to the challenge.

Factors Affecting Mental Illness

• Individual factors, such as biological makeup and personal experiences, strongly influence mental illness.
• Interpersonal factors, including communication, relationships, and social support, affect how a person responds to and cope with mental illness.
• Sociocultural factors, such as societal expectations and access to resources, significantly impact a person's mental well-being.

Individual/Personal Factors (Mental Illness)

• Biological makeup, including genetics, is important.
• Intolerable or unrealistic worries and fears contribute to mental illness.
• Inability to distinguish reality from fantasy or illusions can impact mental health.
• Intolerance of uncertainty is a risk factor.
• Sense of disharmony and loss of meaning in life are factors.

Interpersonal/Relationship Factors (Mental Illness)

• Ineffective communication, excessive dependency, or withdrawal from relationships are potential challenges.
• Lack of a sense of belonging and inadequate social support contribute to mental health problems.
• Loss of emotional control can increase the risk of mental illness.

Sociocultural/Environmental Factors (Mental Illness)

• Lack of vital resources such as finances or social support systems.
• Experiences of violence and trauma can have profound effects.
• Homelessness is a high risk factor.
• A negative view of the world or discrimination (stigma, racism, classism, ageism, sexism) is detrimental.

DSM-5-TR

• The DSM-5-TR is the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision.
• It is the standard reference for psychiatric diagnoses.
• It is published by the American Psychiatric Association (APA).

DSM-5-TR Purposes

• To provide a standardized nomenclature for mental health professionals.
• To establish characteristics and symptoms for diagnoses to support differentiation.
• To aid in identifying underlying causes of disorders.

Parasomnias

• Parasomnias are abnormal events during sleep, such as sleepwalking and sleep terrors.
• Non-rapid eye movement (NREM) sleep arousal disorders frequently occur in the first third of the sleep cycle.
• Sleepwalking involves getting out of bed during sleep and walking around.
• Sleep terrors entail a sudden awakening with intense fear and signs of autonomic arousal.
• Amnesia about the episodes is common.

Theories of Mental Health

• Neurobiological theories focus on the biological aspects, including the nervous system, neurotransmitters, and brain structure and function.
• Psychosocial theories focus on psychological and social factors.

Neurobiological Theories

• Neurobiological theories examine neurological and biological concepts, studying the nervous system's structure, function, and biochemical interactions.
• The nervous system is divided into the central and peripheral nervous systems.
• The CNS consists of the brain and spinal cord, and contains relay neurons (interneurons).
• The PNS comprises cranial nerves, spinal nerves, peripheral nerves, sensory neurons and motor neurons.
• Nerve cells include neurons (structural units involved in electrical signaling) and glial cells (support cells in the nervous system).

Neurobiological Theories (Brain Parts)

• Cerebrum: Divided into four lobes (Frontal, Parietal, Temporal, and Occipital). Some functions are distinct, others are integrated. The corpus callosum connects the two hemispheres to coordinate functions.
• Cerebellum: Located below the cerebrum; coordinates movements and postural adjustments.
• Brainstem: Includes the midbrain, pons, medulla oblongata, and nuclei for cranial nerves III-XII. Crucial for vital functions.
• Medulla Oblongata: Located at the top of the spinal cord, controlling vital functions including respiration and cardiovascular functions.
• Pons: Located above the medulla; bridges the gap between structures, serving as a primary motor pathway.
• Midbrain: Connects the pons and cerebellum to the cerebrum. Includes the reticular activating system (regulating consciousness/awareness) and extrapyramidal system (relaying movement information).
• Limbic System: Located above the brain stem, managing emotions and memory; includes the thalamus, hypothalamus, hippocampus, and amygdala.

Neurobiological Theories (Neurotransmitters)

• Neurotransmitters are chemical messengers in the nervous system.
• Neurons communicate via electrochemical signals.
• After use, neurotransmitters are reabsorbed, metabolized, or diffuse, maintaining neuronal homeostasis.

Neurotransmitters (Excitatory)

• Dopamine: Primarily in the brain stem, affecting complex movements, motivation, and emotional responses; vital role in schizophrenia and Parkinson's disease.
• Epinephrine/Adrenaline: Involved in the fight-or-flight response, significantly impacting alertness, learning, and memory.
• Norepinephrine/Noradrenaline: Also important for attention, learning, memory, sleep, and wakefulness. Linked to several anxiety disorders, and mental health conditions.
• Glutamate: Implicated in brain damage (stroke, hypoglycemia, hypoxia/ischemia) and various degenerative diseases (Huntington’s, Alzheimer’s).

Neurotransmitters (Inhibitory/Neuromodulators)

• Serotonin: Regulates food intake, sleep, wakefulness, temperature, pain, and emotions.
• Gamma-aminobutyric acid (GABA): Major inhibitory neurotransmitter in the brain, affecting anxiety and sleep.
• Acetylcholine: Found in the brain, spinal cord, and peripheral nervous system, involved in muscle function, learning, and memory; implicated in Alzheimer’s and Myasthenia Gravis.
• Histamine: Controls alertness, gastric secretions, cardiac stimulation, and allergic responses.
• Neuropeptides: Modify or modulate the effects of other neurotransmitters.

Psychosocial Theories

• Psychosocial theories combine psychological concepts with societal interactions to understand mental health.
• These theories emphasize the individual's development within their social environment.
• Notable theorists include Sigmund Freud, Erik Erikson, Jean Piaget, and Hildegard Peplau.

Sigmund Freud

• Known as the father of psychoanalysis, he developed theories about the structure of personality (id, ego, superego). He posited that human behavior stems from unconscious desires, and explored levels of awareness (conscious, preconscious, unconscious).
• Key concepts include the Oedipus/Electra complexes, defense mechanisms (e.g., repression, projection, reaction formation), and stages of psychosexual development: oral, anal, phallic (Oedipal), latency, and genital.

Erik Erikson

• Extended Freud's work.
• Focused on psychosocial development across the entire lifespan.
• Described eight psychosocial stages of development, where individuals face unique tasks at each stage. Completion of these tasks is critical for successful development.

Jean Piaget

• Explained cognitive development in stages, asserting that biological maturation and experience shape cognitive abilities.

Hildegard Peplau

• Expanded on Sullivan’s interpersonal theory to create a framework for therapeutic relationships between nurses and patients.
• Identified four stages (orientation, identification, exploitation, and resolution) in interpersonal relationships and various roles nurses may take on during these stages.
• She defined levels of anxiety (mild, moderate, severe, panic) to understand the patient's experience and understand the nature of their response to a psychic threat.

This quiz explores the fundamentals of psychiatric nursing, a field dedicated to caring for individuals with mental health conditions. It covers various aspects of mental health, including influential factors and key characteristics. Test your knowledge on individual and sociocultural elements affecting mental well-being.