Psychiatric Nursing: Mental Health & History

• Psychiatric nursing promotes and maintains behavior contributing to integrated functioning.
• It is a specialized area using human behavior theories and purposeful self.
• It revolves around eight human response processes: activity, cognition, ecological, emotional, interpersonal, perception, psychological, and valuation (ACEE IPPV).

Mental Health Definition

• Mental health is a state of emotional, psychological, and social wellness.
• This is evidenced by:
  • Satisfying interpersonal relationships.
  • Effective behavior and coping.
  • A positive self-concept.
  • Emotional stability (Videbeck, 2012).
• The World Health Organization (WHO) defines mental health as complete physical, mental, and social wellness, not merely the absence of disease.
• Videbeck (2012) describes it as a state of emotional, psychological, and social wellness with satisfying relationships, effective behavior, positive self-concept, and emotional stability.

History of Psychiatric Nursing: Pre-Spanish Regime

• Physical or mental illness was attributed to material and spiritual worlds.
• Treatment involved authentic rituals and ceremonies.
• Filipinos relied on healers like babaylan (shamans) and sorcerers.

Spanish Rule (1565-1898)

• Filipinos attributed mental illness to sorcery or black magic.
• Santiago (1995) mentions mangkukulam (witches) pricking Antigua (voodoo doll) heads with magic pins.
• Manggaway (devil men) were believed to cause mental illness through satanic powers.
• Herbolarios (herbmen) treated the unwell, they were also brought to the church for exorcism.
• Patients were wrapped with mats and whipped.
• Hysteric patients were unexpectedly thrown into the river.
• Mental illness was conceptualized as both biological and psychological.

American Era (1898-1942)

• The concept of mental illness was based on biomedical phenomena.
• Treatments were scientific and mechanistic, emphasizing somatic therapies.
• In the early 1900s, two American physicians treated mentally ill patients at the civil hospital on Calle Iris (Claro M. Recto Avenue).
• In 1904, the insane department at San Lazaro Hospital opened, headed by Dr. Elias Domingo, with Filipino and American nurses in psychiatric nursing care.
• A city sanitarium opened in 1918 to provide psychiatric treatment exclusively for Manila residents.
• The Insular or National Psychopathic Hospital (NPH) opened in Mandaluyong in 1928.
• This was the first facility exclusively for mentally ill patients in the Philippines.
• Manic patients received fever therapy, methazole shock, insulin shock therapy, prolonged narcosis, R1651 hyoscine injections, and hydrotherapy.
• Schizophrenic patients received Lock's sol or insulin injections.
• Patients with general paresis were given fever therapy, tryparsamide, and neo-salversamized serum.
• Epilepsy patients received phenobarbital and magnesium sulfate.

Japanese Occupation (1942-1945)

• NPH remained operational, with patients being taken home by families.
• Patients were confined to small rooms, dying from starvation and lack of medicine.
• Before leaving, the Japanese Imperial Army donated an electroshock apparatus.

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

• Americans returned to the Philippines, initiating growth in the treatment of the mentally ill.
• Efforts focused on rehabilitation, expanding psychiatric facilities, and training personnel.
• The National Psychopathic Hospital (NPH) was renamed the National Mental Hospital (NMH).
• Dr. Jose Fernandez was the officer-in-charge from 1946 to 1961.
• Improved basic services for patients and infrastructure development were needed.
• An infirmary and additional buildings for paying and non-paying patients were constructed.
• The V. Luna General Hospital established a neuropsychiatry service in 1946, electroconclusive therapy, insulin therapy, and narcoanalysis were the initial treatments.
• In 1947, The University of Santo Tomas established departments of, neurology and psychiatry, with Dr. Leopoldo Pardo as chief.
• The Philippine Mental Health Association was founded by Dr. Eduardo Kapf, Toribio Joson, and Manuel Arguelles.
• The University of the East Ramon Magsaysay Memorial Medical Center established a Psychiatry Department (Dr. Jaime Zaguirre) in 1956.
• In 1968 the Philippine General Hospital of the University of the Philippines established a neuropsychiatry section (Dr. Baltazar Reyes, Jr.)
• Treatment for the mentally ill included, psychotherapy and chemotherapy.
• Psychoanalysis gained popularity, being equated with psychiatry.

Psychiatry (1960 to Present)

• Somatic therapy gained prominence in 1960 where drugs were introduced for treating mental disorders.
• Lithium is used for mania.
• Benzodiazepines are used for non-psychotic anxiety.
• Inupramine-like drugs and monoamine oxidase inhibitors are used for depression and severe anxiety.
• Serotonin is a specific reuptake inhibitor used for depression.

Benchmark Period in Psychiatric History

• Enlightenment (1700s)
  • 1754-1826
    • Philippe Pinel believed people could get better
  • 1732-1822
    • William Tuke upheld human dignity.
    • The Asylum movement developed to form hospitals in rural areas
• In 1854-1924 the scientific study began.
  • 1856-1839
    • Sigmund Freud emphasized early life experiences.
  • 1856-1926
    • Emil Kraepelin studied the brain.
  • 1857-1939
    • Eugene Bleuler was optimistic about treatment.

Psychotic Drugs

• Lithium treats mania (1949)
• First antipsychotic medication (1950)
• Monoamine oxidase inhibitors (1952)
• Haloperidol, 1957
• Tricyclic antidepressant (1958), and benzodiazepines (1960).

Mental Disorders

• This can be caused by chemical imbalances, that can be restored
• 13.9% of the world's population has experienced mental health disorders
• As of 2021, per WHO statistics, 71% have a global mental disorder manifested by disorganization and impaired function that arises from various.

Factors Contributing to Mental Illness

• Individual factors: biologic makeup, anxiety, worries/fears, disharmony, loss of meaning
• Interpersonal factors: ineffective communication, dependency/withdrawal, loss of emotional control
• Social and cultural factors: lack of resources, violence, homelessness, poverty, discrimination

Psychotherapeutic Management (Milieu)

• Proactive approach includes the surroundings the, OPD, and home.
• Use of words, styles, and communication skills

Psychopharmacology

• Action, effect, and response to medication.

DSM for Mental Health Disorder

• DSM I (1952): Major Depressive Disorder.
• DSM II (1968): Borderline Personality Disorder, paranoid, mental retardation.
• DSM III (1980): thyroid disease
• DSM IV (1994): marital separation
• DSM V, Axis V includes GAF which is a global assessment of functioning.

Psychiatry Education in the Philippines

• "An Outline in Psychiatric Nursing" was the first textbook.
• Nenita Yasay Davadilla: first psychiatric nurse.
• Magda Carolina Go Vera Llamanzares: first Filipino child psychiatric nurse (1992).
• The First graduate program in psyche was at UP.CN. - MN
• Sotera V, Capellan: first grad. Nurse to head the unit.
• Clinical facilities, NCMH has a, 4,200 bed capacity with 47 hectares.

Continue of Care Treatment Options

• Inpatient hospitalization, outpatient services, residential care, self-help activities, and continuum of care.

Psycho Pathology

• Use of words, drugs, environment, somatic therapies, behavioral conditioning.

Therapeutic Model Theories: Psychoanalytic

• Sigmund Freud emphasized unconscious processes as a basis for motivation.
• Three processes: id (pleasure principle), ego (reality principle), superego (right/wrong).

Developmental Model

• Eric Erikson's model covers the life cycle from birth to death.
• Each stage offers growth opportunities, even up to accepting one's own death.
• Harry Stack Sullivan (1953) looked at interpersonal relationships.
• Cognitive Model: Hildegard Peplau (1952, 1963) had a significant role in applying Sullivan's original concepts regarding interpersonal relationship to nursing practice
• Cognitive-Behavioral Model: Aaron Beck and Albert Ellis focused on thinking and behaving rather than expressing feelings.
• General Adaptation Syndrome (GAS) is a three stage process that includes:
  • Alarm reaction
  • Stage of resistance
  • Stage of exhaustion
• Richard Lazarus focused on the psychological aspects of a person and the environment.

Adjustive Mechanisms

• Adjustive mechanisms include practices used to alleviate anxiety.

Coping Mechanisms

• Coping mechanisms are task-oriented reactions classified by the level of effort utilized to alley anxiety.

Defense Mechanisms

• Defense mechanisms distort reality unconsciously to reduce stress/anxiety.
• Denial: Refusing to admit unacceptable ideas/behaviors to protect oneself.
• Repression: Unconscious forgetting.
• Suppression: Conscious exclusion of anxiety-producing feelings/ideas.
• Rationalization: Making justifications for feelings or behaviors.
• Intellectualization: Using only logical explanations without feelings.
• Dissociation: Unconscious separation of painful feelings from unacceptable situations.
• Identification: Consciously/unconsciously modeling oneself after another.
• Introjection: Unconsciously incorporating others' values/attitudes as one's own.
• Compensation: Covering up weaknesses by overemphasizing/making up desirable traits.
• Sublimation: Channeling instinctual drives into acceptable activities.
• Reaction formation: Conscious behavior is the opposite of unconscious feelings.
• Undoing: Counteracting a transgression or wrongdoing.
• Displacement: Discharging pent-up feelings to a less threatening object.
• Projection: Blaming others for difficulties.
• Conversion: Symbolic expression of intrapsychic conflict through physical symptoms.
• Regression: Unconscious return to an earlier developmental level.
• Splitting: Viewing others/situations as either all good or all bad.

Neuro Anatomy of the Brain

• Dopamine controls complex movements, motivation, cognition, and regulates emotion.
• Serotonin regulates emotions, food intake, sleep, pain control, and sexual behaviors.
• Acetylcholine controls sleep and wakefulness.
• Histamine controls alertness.
• GABA modulates other neurotransmitters.
• Norepinephrine / epinephrine affects attention, learning, memory, and mood.

Neurotransmission

• Neurotransmission involves chemical messengers affecting brain activity.
• Communication occurs via neurotransmitters either exciting or inhibiting brain cells.
• Neurotransmitters perform vital brain functions, and imbalances cause disease or behavioral disorders.
• These are classified into: small amine molecules or peptides.

Neurotransmitter Mental Disorder

• Schizophrenia, shows an ↑ In dopamine.
• Depression, shows an ↓In norepinephrine .
• Depression, shows an ↓In serotonin.
• Alzheimer's disease, shows an ↓In acetylcholine.
• Anxiety and seizures, shows an ↓In GABA.

Psychoimmunology

• Explores how psychological influences affect the nervous system's immune response.
• Efforts link stressors to diseases, with stress impacting immune responses and illnesses.