Psychiatric Mental Health Nursing PDF

PSYCHIATRIC MENTAL HEALTH Prof. Alexis O. Zaño Jr, RN, MSN, JD. NURSING  EVOLUTION OF PSYCHIATRIC CARE AND MENTAL HEALTH IN THE PHILIPPINES The evolution of psychiatric Care in the Philippines can be better appreciated by considering its highlights through the historical in...

PSYCHIATRIC MENTAL HEALTH Prof. Alexis O. Zaño Jr, RN, MSN, JD. NURSING  EVOLUTION OF PSYCHIATRIC CARE AND MENTAL HEALTH IN THE PHILIPPINES The evolution of psychiatric Care in the Philippines can be better appreciated by considering its highlights through the historical interludes, from the Pre-Spanish period, Spanish periods, the American regime, the Japanese occupation, and the eventual American liberation.  THE PRE-SPANISH ERA Preceding the Spanish era, there was not much information available regarding the phenomenon of mental illness, more so how it was managed. All maladies psychiatric or otherwise were simply believed to be instigated by natural and supernatural occurrences.  THE SPANISH ERA During almost four centuries of the Spanish ruling, from 1521 to 1898, mental illness and conditions manifesting with aberrant thinking and behavior were attributed to religious factors and supernatural forces. Individuals who were referred as having a mental illness were thought to have offended or displeased deities; having incensed witches or mangkukulam who would get back at them by casting wicked chants and incantations or pricking mystic dolls with a needle; and devilmen or manggagaway who would make them mentally ill by praying to the dark forces.  THE SPANISH ERA Management-wise, these supposed mentally ill individuals were brought to churches for purification and exorcism. Alternatively, they were brought to folk healers or herbolarios who would subject them to physical and psychological distress in an attempt to chase off their mental illness. The first ever institutional care of the mentally ill originated at the turn of the 19th century in Hospicio de San Jose, the first Roman Catholic social welfare institution in the country founded in 1782 which also operated as a foster care agency to orphans, the abandoned, those with special needs, and the elderly.  THE AMERICAN REGIME It was during the American regime, from 1898 to 1946, when mental disability began to be recognized just as any other medical illness. Thus, an advocacy towards a more humane approach towards the mentally ill was fostered. Such paradigm shift reflected the transitions concurrently ensuing in the Western countries. As a result, a good number of hospitals were established. November 1904 marked the establishment of the country’s first ever hospital unit specifically dedicated for the mentally ill, the Insane Department of San Lazaro Hospital, under the newly created Bureau of Health.  THE AMERICAN REGIME On December 18, 1928, the first hospital exclusively dedicated for the treatment of patients afflicted with mental and nervous disorders was formally opened and inaugurated. It was called the Insular Psychopathic Hospital, a 64-hectare estate which was constructed through a substantial government appropriation. In 1910, the Philippine General Hospital was opened during which two American physicians, Almond T. Gough and Samuel Tretze, began to teach psychiatry to the medical students who rotated for their clinical practicum at the Insane Department of San Lazaro Hospital and the Insular Psychopathic Hospital.  THE AMERICAN REGIME During those times, common modes of treatment for the mentally ill involved empirical somatic therapies. For instance, for patients who are having a manic episode, they would use fever therapy (fever induction through protein injections or the bite of malaria-infected mosquitoes); metrazol shock (chemical shock induction through camphor oil injection; insulin shock inducing a hypoglycemic coma) For general paretics or brain syphilis, which was thought to be functional in nature at that time, they would employ fever therapy; or administer tryparsamide or neo-salversamized serum giving intravenous mercury preparations. Psychotherapeutic strategies were generally still not implemented at that time. Nonetheless, adjunctive therapeutic approaches such as occupational and recreational therapies were already in effect.  THE JAPANESE OCCUPATION With the eruption of World War II in December 1941, the progress of psychiatry in the country was placed into a halt. Majority of the families of mentally ill patients felt compelled to bring them home despite the continued operation of the National Psychopathic Hospital. Still, the remaining inpatients were herded in small rooms and subsisted on limited food and medicine supplies given that the Japanese imperial army would make use of the patient rooms in the said hospital to stock their supplies. Treatment-wise, electroconvulsive therapy became the foremost therapeutic modality using antiquated Japanese apparatus, followed by the use of local medicinal herbs.  THE ERA OF LIBERATION Following the widespread emotional impressions brought about by the casualties of the war was the increased awareness and appreciation of the discipline of psychiatry. Subsequent to the end of World War II, there was an extensive expansion and rehabilitation of the existing psychiatric facilities together with the subsequent training of the workforce. In July 1946, the National Psychopathic Hospital was renamed National Mental Hospital (NMH) and with financial aid from its benefactors, a new structure for paying patients was constructed together with a few other charity sections.  MENTAL HEALTH AND MENTAL ILLNESS The World Health Organization (WHO, 2014) describes health as "a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity. Mental health is a state of well-being in which each individual is able to realize his or her own potential, cope with the normal stresses of life, work productively, and make a contribution to the community.  Mental illness refers to all psychiatric disorders that have definable diagnoses. These disorders are manifested in significant dysfunctions that may be related to developmental, biological, or psychological disturbances in mental functioning. According to the US Department Health and Human Services (HHS), in 2014: > One in five American adults experienced a mental health issue. > One in ten young people experienced a period of major depression. > One in twenty-five Americans lived with a serious mental illness such as schizophrenia, bipolar disorder, or major depression. > Suicide was the l0th leading cause of death in the United States. M ENTAL HEALTH CONTINUUM MENTAL HEALTH CONTINUUM RISK AND PROTECTIVE FACTORS  PERCEPTIONS OF MENTAL HEALTH AND MENTAL ILLNESS Mental refers to the brain, the most complex part of the body, responsible for the higher thought processes that set us apart from all other creatures. Physical refers to the workings of the brain - the synaptic connections, the areas of functioning, the spinal innervations and connections- are. One problem with this distinction is that it implies that psychiatric disorders are "all in the head." Most damaging is the belief that these disorders are under personal control and indistinguishable from a choice to engage in bad behavior. These beliefs support the stigma to which people with mental illness are often subjected. Stigma, the belief that the overall person is flawed, is characterized by social shunning, disgrace, and shame.  PSYCHIATRIC - MENTAL HEALTH NURSING Psychiatric-mental health nursing is the nursing specialty that is dedicated to promoting mental health through the assessment, diagnosis, and treatment of behavioral problems, mental disorders, and comorbid conditions across the lifespan (American Nurses Association et al., 2014). Psychiatric-mental health nurses assist people who are in crisis or who are experiencing life problems, as well as those with long-term mental illness.  DSM-5 The Diagnostic and Statistical Manual (DSM) is a publication of the American Psychiatric Association (APA). First published in 1952, the latest 2013 edition describes criteria for 157 disorders. The development of the DSM-5 was influenced by clinical field trials conducted by psychiatrists, psychiatric-mental health advanced practice registered nurses, psychologists, licensed clinical social workers, licensed counselors, and licensed marriage and family therapists.  LIST OF DISORDERS CATEGORIES IN THE DSM-5 1. Neurodevelopmental Disorders 13. Sexual Dysfunctions 2. Schizophrenia Spectrum Disorders 14. Gender Dysphoria 3. Bipolar and Related Disorders 15. Disruptive, Impulse Control, and Conduct 4. Depressive Disorders Disorders 5. Anxiety Disorders 6. Obsessive-Compulsive Disorders 16. Substance-Related and Addictive Disorders 7. Trauma and Stressor-Related 17. Neurocognitive Disorders 8. Dissociative Disorders 18. Personality Disorders 9. Somatic Symptom Disorders 19. Paraphilic Disorders 10. Feeding and Eating Disorders 20. Other Disorders 11. Elimination Disorders 12. Sleep-Wake Disorders  A common misconception is that a classification of mental disorders classifies people, when the DSM actually classifies disorders. For this reason, the DSM avoid the use of labels such as "a schizophrenic" or "an alcoholic” Viewing the person as a person and not an illness requires more accurate terms such as "an individual with schizophrenia" or my patient has major depression.