Psychiatric Nursing: History and Concepts

• Psychiatric Nursing is an interpersonal process enhancing behaviors that contribute to integrated functioning.
• It is a specialized nursing area using human behavior theories as its science, and self use as its art.
• Psychiatric Nursing is organized around activity, cognition, ecological, emotional, interpersonal, perception, physiologic, and valuation human response processes.
• Wellness, according to the WHO, is a state of complete physical, mental, and social well-being, not just the absence of disease.
• Emotional, psychological, and social wellness is shown through satisfying relationships, effective behavior and coping, positive self-concept, and emotional stability.

Pre-Spanish Regime

• Mental illness was believed to be rooted in the spiritual and material realms.
• Treatments involved rituals and ceremonies.
• Filipinos depended on healers like babaylans (shamans) and healing sorcerers.
• It was believed that mental illness was caused by sorcery acts.
• Santiago (1995) mentioned mangkukulam (witches) using magic pins on voodoo dolls.
• Manggagaway (devil men) refers to satanic powers causing mental illness.
• Herbolarios (herb men) treated unwell individuals, who were also taken to church for purification or exorcism.
• Patients could be wrapped in mats and whipped with bamboo or stingray tails.
• Hysterical patients faced unexpected river plunges.
• Mental illness recognition as biological and psychological entities emerged during the early nineteenth century.
• After the Spanish naval, Hospicio de San Jose was established.
• Authorities sought confinement for mentally ill sailors there.

American Era (1898-1942)

• Biomedical aspects formed the foundation for understanding mental illness.
• Scientific and mechanistic treatments, with somatic therapies, highlighted psychiatric illness's biological aspects.
• Centers were created in the Philippines for those with mental illnesses.
• In the early 1900s, two US physicians offered care for mentally ill individuals at Civil Hospital (Calle Iris).
• In 1904, the Insane Department at San Lazaro Hospital was established for patients led by Dr. Elias Domingo and cared for by American and Filipino nurses trained in psychiatric care.
• The City Sanitarium was established in 1918 to give psychiatric care only to Manila residents.
• The Insular or National Psychopathic Hospital (NPH), established in Mandaluyong during 1928, exclusively treated mentally ill patients in the Philippines.
• Fever therapy, metrazole shock, insulin shock therapy, prolonged narcosis, hyoscine injections and hydrotherapy were used to treat manic patients.
• Lock's sol or insulin injections were treatment given to Schizophrenic patients
• Patients with syphilitic dementia (general paresis) had fever therapy, tryparsamide, and neo-salversamized serum.
• Epilepsy patients were treated with phenobarbital, magnesium sulfate, spinal drainage, and a ketogenic diet.
• Depressed patients received Lock's Sol, barbiturates, and electroshock treatments.

Japanese Occupation (1942-1945)

• The NPH sustained its operations during the Japanese Occupation.
• Many individuals were taken home by their families.
• Patients suffered confinement, starvation, and medicine shortages.
• The Japanese Imperial Army donated an electroshock apparatus before departing the NPH, marking a significant advancement in treatment.
• Electroshock treatment became a key method.
• Self-denial practices and local medicinal plants utilization were adopted.

Liberation Period and Era of the Republic (1945-1960)

• With Americans' return to the Philippines, growth began in the treatment of mental health.
• The immediate needs included psychiatric rehabilitation, expansion plus training of essential hospital personnel.
• Return of the Americans to the Philippines to improve training in psychiatry for medical staff plus patient care
• The National Psychopathic Hospital (NPH) had a name change to National Mental Hospital (NMH).
• Dr. Jose Fernandez served as officer-in-charge from October 1946 to April 1961.
• Enhanced basic patient services plus facilities development was sought, including a new infirmary for both paying and nonpaying patients.
• The V. Luna General Hospital gave services to the Armed Forces, creating a neuropsychiatry service.
• Electroconvulsive therapy and narco analysis were the first treatment approaches.

Other Historical Facts

• In 1947, the University of Santo Tomas had a Neurology and Psychiatry Department led by Dr. Leopoldo Pardo and the Philippine Mental Health Association was created by Dr. Eduardo Krapf, Toribio Joson, and Manuel Arguelles
• The University of the East Ramon Magsaysay Memorial Medical Center founded a Department of Psychiatry in 1956, with Dr. Jaime Zaguirre.
• During 1968, the Philippine General Hospital under the University of the Philippines established a Neuropsychiatry Section with Dr. Baltazar Reyes, Jr..
• Psychotherapy as well as chemotherapy were used for treatment.
• Psychoanalysis became increasingly well-known, with a lot of public equating it to psychiatry.
• Even with dominance in psychoanalytic ways of treatment, biological factors remain strong
• Beginning 1960, Somatic therapy became favored.
• Lithium was introduced to treat mania
• Benzodiazepines were introduced to treat non-psychotic anxiety
• Monoamine oxidase inhibitors were introduced to treat depression
• Serotonin plus norepinephrine reuptake inhibitors were used for depression near the end of the 20th century.
• The Enlightenment period of the 1700s saw Philippe Pinel (1754-1826) advocate for patient betterment.
• William Tuke (1732-1822) highlighted human dignity.
• This period also saw Asylums develop to be hospitals in rural areas
• Benchmark studies of the mind, during the 1870's showed that Sigmund Freud (1856-1939) put emphasis on early life.
• Emil Kraepelin (1856-1926) studied the brain
• Eugene Bleuler (1857-1939) remained optimistic about treatment.
• In the 1950s psychotropic drugs were discovered like: lithium-mania treatment (1949), 1st anti-psychotic (1950), monoamine oxidase inhibitors (1952), haloperidol (1957), tricyclic antidepressant (1958), and benzodiazepines (1960).
• Mental disorders occur from chemical imbalances and can be restored.
• Statistics from WHO in 2021 showed global anxiety disorders at 71%b, with 13.9% of the world's population dealing with mental health disorders.
• Mental disorders involve impairment of function due to psychological, genetic, or neurobiological reasons.
• Biological makeup, worry, and fears are factors to mental illness.

Psychiatric Education and Key Figures

• Disharmony in life and loss of one's sense of purpose can determine mental illness.
• Excessive dependency or withdrawal can impact relationships and emotions
• Violence and lack of key resources has a high-correlation
• Milieu management proactively adapts surroundings and promotes effective communication.
• Mental health is assessed with DSM for major depressive disorder, borderline personality disorder, and thyroid disease, among other things
• V codes help evaluate functionality via hallucination influence (2000).
• Psychiatry education began with a psyche nsg outline in 1967 including the board exam in 1978.
• Nenita Yasay Davadilla distinguished as the first psyche nurse from MAN at the University of Maryland
• Magda Carolina Go Vera Llamanzares distinguished as first Filipino child psychiatric nurse at Wayne State University in 1992
• The first graduate degree happened at UP, CN, and MN
• Sotera V. Capellan (1928-1959) was the first graduate nurse to head the unit
• The NCMH has 4,200 beds on 47 hectares
• Treatment can range from in-patient rehab to self-help activites
• Use of words, substance abuse, and behavioral conditioning are aspects of psycho pathology
• Psychodynamic factors can influence behavior
• Personality includes id, ego, and superego principles.
• Eric Erikson presented a life cycle approach to development
• Harry Stack Sullivan (1953) examined relationships.
• Hildegard Peplau (1952-1963) applied concepts to nursing regarding anxiety and insecurity
• Aaron Beck and Albert Ellis developed models to focus on thinking rather than expressing
• Hans Selye (1956) described General Adaption Syndrome to manage stress
• Richard Lazarus studied psychological stress
• Advanced mechanisms alleviate anxiety and include coping and defense aspects
• Task-oriented reactions are classified as conscious reaction
• Defense mechanisms include denial, repression, suppression, rationalization, intellectualization, dissociation, and introjection, just to name a few.
• Neuroanatomical considerations include dopamine, serotonin, acetylcholine, histamine, and GABA
• Neurotransmission plays an influence

Additional Facts

• The reuptake of neurotransmitters is key for cell communication
• Neurotransmitters can lead to disorders in their absence
• Amino molecules help with neurotransmitters
• It is important to note: increasing dopamine results in schizophrenia.
• It is also important to note: decreasing norepinephrine, serotonin, and acetylcholine results in depression an ALzeimer's
• Psycho Neuro Immunology explores the psychological infulences on the nervous system and there response to stressors.
• Communication is influence and is an exchange of information and includes personal experiences like gender or cultural diversity.
• Communication is in the form of verbal, or use of written, and electronic resources.
• Therapeutic communication and includes verbal and non-verbal interaction, is plan and directed around the patients needs.
• Nurse need to build on trust, empathy, and self-awereness
• The Johari Window is a great way to improve and visual framework for better interpersonal communication
• The NP1 is a great way to assess the patients concerns by select appropriate means for the patient and evaluate the results.
• Provide a basic and therapeutics approach
• Communication includes a ore Orientation, Orientation, and Termination stages
• The last stages are the Working stage which leads to the Termination stage in all communications.
• One need to be aware and know you're own short coming which can interfere such as: fears, and not giving time for attention.
• There are many ways to deal with situation include observation and assessments.
• One important thing to remember is your own mental and emotional state
• Not communicating with patients at their level and not knowing the cultural differences is an overal no-no
• With Non-Therapeutic Communication, this includes communication that makes the patient not comfortable
• It is important to note the need in each patient.
• These sessions usually start with individual therapy and can extend to group therapy or other form like a couples
• There is also what is know as miliea therapy which is basically a type of therapy that can help with coping.
• Dance, art, and even reading news is a therapy.
• It is important to motivate the patient at all times.
• Play therapy is a great method for parent to express openly, be mindful to give calm and focus.
• If the patient is in need, than Electroconvulsive therapy (ECT) may be needed

Antipsychotic Drugs and Their Implications

• Strong Antipsychotics: Clozapine can cause neutropenia.
• FDA-approved Antipsychotics : Quetiapine, is for schizophrenia, acute manic episodes, and major depressive disorder.
• Long-term Antipsyhotics: Aripiprazole, for maintenance is used for mental health conditions
• Cognitive and behavioral and phycoeducational helps with conditions like anxiety or depression.
• Remember that one should be very direct on what the needs and the state of mind of the patient especially is she or is under the use of drugs.
• Another known disorder is schizoaffective disorder

Schizophrenia

• It's important to know that if a patient has schizophrenia that they have all the key + signs
• 1. There must be delusional
• 2. Disorganized in the way they communicate
• 3. There also 3 other lesser known symptoms: a negative affect, canonic, disorganized.
• There also the levels on how to proceed basic Interventions.
• You must know what the patient is talking about
• There are may therapeutic method, it is important to ask the right questions in the right matter.
• There also certain side effects that the medications can give.
• Extra Pyramidal Syndrome is more known and and be aware as part of Extra Pyramidal
• In some case certain medicine can cause cause more damage that there worth and there important to be able to identify that .
• There are many known reason to why the mental and physical health of someone can be at risked.
• Remember nursing responsibility and treatment can is available