Mental Health Nursing and Psychiatry Concepts

• Mental Health Nursing and Psychiatry covers various topics related to mental health, mental illness, and psychiatric care.
• Includes historical context, legal and ethical considerations, psychopathology, psychopharmacology, and the role of nurses in mental health.
• The concept of mental health includes coping with life stress, realizing abilities, learning, working effectively, and contributing to the community
• Subjective well-being involves cognitive and affective evaluations of one's life, including emotional reactions, satisfaction, and fulfillment.
• It encompasses experiencing positive emotions, low levels of negative emotions, and high life satisfaction.

Mental Illness Concepts

• Concepts connected to mental illness are madness, foolishness, ineptitude, alienation, being unrecoverable and incapable
• Defined as a clinically significant disturbance in cognition, emotional regulation, or behavior that reflects dysfunction in psychological, biological, or developmental processes
• Cultural values, beliefs, language systems, communication methods, and shared practices define a collective identity.
• Mental illness or disturbances are defined relative to social and cultural norms and standards.
• Culture shapes how symptoms, signs, and behaviors are expressed and interpreted.
• Culturally accepted responses to stress or loss and deviant behaviors are not mental illnesses unless linked to dysfunction.
• Biomedicine establishes a standard of expected social behavior based on scientific knowledge, impacting individual behavior.
• Power is not just force but also implicit strategies that normalize behavior.

Stigma

• Derives from Greek, denoting bodily signs indicating something extraordinary or bad about one's moral status.
• Discredits individuals, reducing them to stereotypes, leading to exclusion and discrimination.
• Physical stigmas include undesirable physical characteristics like scars, deformities, or obesity.
• Moral stigmas include socially unacceptable behaviors like alcoholism, prostitution, or homosexuality.
• Tribal stigmas target social groups like gypsies, Jews, or Black people.
• People with mental disorders face stigma, discrimination, and rights violations within and outside healthcare.
• Consequences of stigma include delayed help-seeking, worsening illness, social isolation, and suffering.
• Interventions to reduce stigma, especially for depression, increase willingness to seek help among students with anxiety and depressive symptoms.
• Mental health is linked with well-being.
• Mental illness implies dysfunctionality.
• Culture, power, normalization, and stigma are all interlinked

Mental Health Statistics

• Anxiety disorders are the most prevalent mental health condition.
• Mental illness is the leading cause of disability globally and economic burden
• Severe mental illness can reduce life expectancy by 10-20 years.
• Suicide accounts for 1 in 100 deaths, with 20 attempts per suicide.
• Mental illness affects 8% of children and 14% of adolescents by age 14.
• Suicide is the fourth leading cause of death for those aged 15-24.
• Mental illness costs an estimated $6 trillion annually, making it global political priority

Portugal Mental Health Statistics

• 22.9% of Portuguese people experience a psychiatric disorder.
• Portugal has the second-highest prevalence of psychiatric disorders in Europe, after Northern Ireland.
• 4% of adults have a severe mental disorder, 11.6% moderate, and 7.3% mild.
• Mental and behavioral disorders account for 11.8% of the total disease burden, exceeding oncological diseases but behind cerebrocardiovascular diseases.

Historical Perspective of Concept

• Has evolved with societal changes and scientific understanding; Linked to the concept of health.
• Mental alterations were attributed to supernatural phenomena like spirits and deities. Responses were based on fear and adoration. Treatment involved witchdoctors and religious rituals.
• Hippocrates' medical theory transformed mental illness into an imbalance of humors, though mysticism persisted. Original treatment attempts were made for physical ailments.
• Islamic and Christian medicine sought to treat mental issues. Specific pathologies were considered demonic possessions, leading to exorcisms. People with mental illness were confined to prisons.
• Institutions were created despite a lack of understanding. Included asylums or Manicomios. Poor conditions and experimental treatments caused doubt
• Pinel and Tuke focused study on madness, improved treatment, and better living arrangements for residents. Psychiatry and psychology developed over time

20th Century

• Early 20th-century improvements included psychological theories, increased professional training, treatments, and the emergence of psychotropic drugs. Specialized hospitals were created with optimal conditions.
• The Hospital Júlio de Matos, opened in 1942, was considered one of the most advanced and moderate in the world.
• The first training courses for psychiatric nurses in Portugal (1911), Linda Richards' psychiatric nursing development
• First psychiatric nursing textbook, "Nursing Mental Disease," published in 1920
• Late 20th-century developments included neurophysiological knowledge, investments in psychotropic drugs and psychotherapy, and deinstitutionalization. Social evolution changed representation of mental illness
• There was an increased focus on community treatment and social inclusion, with specialized mental health nursing.

21st Century

• Mental health is seen as public health priority
• Proximity is key with effective care being a mix of therapy and medication
• Peplau's work on "Interpersonal Relations in Nursing" set foundations

Legal, Ethical and Political Framework

• Diagnosis: Determining a disease through symptom study and analysis
• Objectivity done through mindful observations of objective signs and subjective symptoms
• The purpose is the base which to define proper treatment

Syndrome

• Refers to a well-defined set of symptoms, can be the translation of paraogenic modality
• Diagnosis is not required
• Syndromes are diagnosed as disturbances, wrapped in subjectivity

Classification Systems

• Enable cross-cultural communication and definition of psychiatric disturbances
• Boost scientific credit and understanding. Improves the treatment
• Group people into homogenous groups (GDH), therefore productivity becomes easier, creates indicators

American Psychiatric Association DSM-5

• Includes description, symptoms and criteria that diagnoses a myriad of mental disturbances

WHO (World Health Organization) ICD/CID 11

• Permits a systematic collection, analysis, comprehension of data and patterns in dissimilar regions
• Allows for semantic operability and reutilization of data for multiple forms
• Not limited to mental disturbance; Can be used for support

Mental Health Plans and Policies

• There are worldwide health plans like the Comprehensive Mental Health Plan 2013-2030 (WHO), National Health Plan 2030, and World Mental Health Report, that all share statistics plus combat health
• The Coordenação Nacional das Politicas de Saúde Mental supersedes the mental health plan

Law nº35/2023

• Supercedes law nº36/98
• Reference point for mental health in Portugal
• Fundamentals of mental health policy is centering on the person giving them autonomy, subjectivity, and specific needs
• Care should be delivered with the least amount of restriction
• Equal and non discriminatory service
• Equitability of resources
• Incorporates person's well being, health care, residence and working life for all phases

Positive Objective of law nº 35/2023

• Promoting effective ownership of fundamental rights
• To improve populations via mental health implementation that is effective
• Conclude transition and protect rights
• Secure mental health between government areas
• To guarantee affected persons are involved with mental health plans

Knowledge Reinforcement

• Fortify knowledge with scientific proof and promote high mental health practices

Involuntary Treatment

• Treatment against patient's will

Requirements for Involuntary teartment

• A health professional must administer
• Does not take judicial power
• Person maintains legal duties, but temporarily revoked until medical treatment is sorted

Cumlative factors

• Disease is present
• Is required to not be a transfer risk

Must Be Done

• As a means to administer medication that is in line
• Proportional to mental diseases like danger
• Can nominate person to represent
• Must review during a session

Organizational and Functional mental health services - Decreto - Lei nº 113/2021

• Service is regulated by the following model
• Consultive organizations with a national, regional and local scope

Psychiatric Departments Offer:

• Outpatient and community interventions, health promotion, prevention and treatment programs
• Inpatient treatment for people in the acute phase; hospitalization
• Permanent treatment
• Specialized care unit for in-patients

Community mental health teams are responsible for

• Outpatient care and other community interventions
• Each team must minister 50-100,000 inhabitants

Community Mental health Teams Offer:

• External consultation
• Domestic visits
• Intervention with the purpose to promote health, illness literarcy plus psychosoical therapy
• Social intervention
• Cognitive and body intervention

Types of Mental Health Services

• Centers
• Hospital
• Outpatient Service
• Integrated Health Centers

Mental Health Residences Offer

• Independent training apartments
• Moderate support housing

Various Other Services

• Socio-Occupational Units
• Domicliliary Support
• Drug and Alcohol rehabilitation centers

Summary of Mental Health

• Contemporary laws and mental health
• Center towards movements and people
• All aforementioned topics like ECSM

Noções de Psicopatologia (Basics of Psychopathology)

• Neurofisiologia básica (Basic Neurophysiology)
• Includes brain anatomy (cerebro, diencefalo, mesencefalo, pons, cerebelo, bulbo)
• Perturbações do pensamento (Thought Disorders)
• Perturbações do humor (Mood Disorders)
• Perturbações do abuso de substâncias (Substance Abuse Disorders)
• Perturbações do comportamento (Behaviour Disorders)
• Perturbações da personalidade (Personality Disorders)
• Perturbações neuropsiquiátricas (Neuropsychiatric Disorders).

Neurofisiologia básica (Basic Neurophysiology)

• Cérebro (Brain)
• The center of the nervous system.
• Brain controls the rest of the organism.
• Held to the head and and protected by the crânio (cranium) with meninges.
• Neurônios (neurons)
• Possuem longas extensões designadas de axônios e dendritos (axons and dendrites) , connects to others via electrical potential
• Cérebro humano tem 86 mil milhões de neurónios (Human brain has 86 billion neurons)
• Brain can be divided into Prosencéfalo, Mesencéfalo and Rombencéfalo.
• Cérebro sections and functions:
  • CÉREBRO (Conscious) ; DIENCÉFALO (Thalamus and Hypothalamus) ; MESENCÉFALO (Visual and Auditory Stimuli, Motor reflexes); Ponte (Transmits Sensory and Motor Information); BULBO (Regulates Vital autonimic functions), and MEDULA (Spinal health)

Lobos (lobes)

• Frontal: movement activity, attention
• Parietal: Proprioception, Mechanoreceptors, Processing speech
• Descodificação de estímulo visual e auditivo
• Occipital: visual stimulus
• Sistema limbico (Limbic System)
  • Grupo de estruturas relacionadas com relação ao controlo hormonal e endócrino (Group of structures related to hormone control and endocrine)
  • Comportamento, motivação, aprendizagem, processamento de memória a longo prazo, olfato (Behavior, motivation)

Neurotransmissores (Neurotransmitters)

• Substâncias químicas liberadas pelos neurônios (Chemicals released by neurons)
• Regulam funções vitais (regulates vital functions)
  • Ritmo cardíaco (heart rhythm); Frequência respiratória (respiratory frequency); Sono (sleep)
• Aprendizagens (learning); Humor (mood); Medo (fear); Prazer (pleasure); Felicidade (happiness)
  • Estimuladores (stimulators); Adrenalina e noradrenalina (norepinephrine)
  • Inibidores (inhibitors) ; Opióides e GABA (opioids and GABA)
  • Moduladores (modulators); Serotonina and Dopamina (serotonin and dopamine)

Perturbações mentais (Mental Disorders)

• Resultado das alterações do funcionamento dos neurotransmissores (results of alteration of neurotransmissores.
• Perante uma doença mental primeiro deve-se excluir possíveis causas físicas (Before a mental disorder, exclude possible physical causes)
• Uma pessoa que sofre um TCE moderado a grave = a probabilidade de doença mental (if you suffer a TCE illness increases in severity)
• Cérebro and Neurónios -4 front Lobos
• Divides into: -prosencéfalo -Mesencéfalo

Perturbações Do Pensamento (Thought Disorders)

• Perturbações afetam a cognição e se manifestam por alterações na linguagem (language), conteúdo do pensamento e comunicação (content of thought and communication)

Esquizofrenia (Schizophrenia)

• Caracteriza por sintomas psicóticos. Alucinações, delírios (delusions), e discurso desorganizados (disorganized speech)
• Diagnosed with DSM-5
• Presença de, pelo menos, dois sintomas descritos durante o espaço de um mês (Presence of two symptoms)
• Afetar, em grande medida, o funcionamento de uma ou mais áreas da vida pessoal ou social (affect functioning)

Perturbações Do Humor (Mood Disorders)

• Perturbações estão relacionadas com o humor (Mood disorders are related to humor)
• Humor is in relation to states

Depressão (depression)

• As pessoas que sofrem desta perturbação experimentam sentimentos persistentes de tristeza, desesperança e perda de interesse (the constant feeling of despair)
• Causas (causes); Alterações nos neurotransmissores (neurotransmitter); alterações Diagnosis with DSM-5 by doctors

Perturbação bipolar (Bipolar Disorder)

• Perturbações que causa flutuações extremas do humor (mood), energia.
• Divide-se em (divided);
  • Perturbação Bipolar I (Bipolar Disorder I )
• Mania (Maniac); Humor elevado

Perturbações do abuso de substâncias (Substance abuse disorders)

• Drogas
• Alcoolismo (Alcoholism), Caféna
• DSM 5 diagnoses

Abuso substâncias - Alcool (substance abuse - alcohol)

• Substância psicoativa que possui propriedades (psycoactive properties)
• Causa um elevado peso de doença e consequências significativas (significant economical consequences):.

Abstinência (Abstinence)

• Delirium tremens
  • Alteração da perceção do ambiente (Perception of environment);
• Tratamentos (treatment)
  • Psicoterapia(psychotherapy) , Socioterapia (sociotherapy)

PERTURBAÇÕES DO COMPORTAMENTO (Behavior Disorder)

• Obsessive compulsive personality disorder Alterações patológicas do comportamento dos indivíduos. This is described in the Obsessive personality

Anxiedade (Anxiety)

• Diagnosed in DSM-5 Includes -Fobias , -Pânico (panic) . Fatores ambientais.

Perturbações do comportamento alimentar

defined by behavior and food.

• Anorexia Nervosa characterized by incessant urge to low BMI

Types

• DSM 5