Introduction to Mental Health PDF

INTRODUCTION TO MENTAL HEALTH/PSYCHIATRIC NURSING BY BOLARINWA O.S. (RN, RM, RPHN, RMHPN, MSc.) 04-Dec-23 1  Introduction Definition Mental Health can be defined as a suc...

INTRODUCTION TO MENTAL HEALTH/PSYCHIATRIC NURSING BY BOLARINWA O.S. (RN, RM, RPHN, RMHPN, MSc.) 04-Dec-23 1  Introduction Definition Mental Health can be defined as a successful adaptation to stressors from the external and internal environment which is evidenced by thoughts, feelings and behaviours that are age-appropriate and congruent with local and cultural norms. 04-Dec-23 2  It is a successful performance of mental functions shown by productive activities, fulfilling relationships with other people, and the ability to adapt to change and to cope with adversity (APA, 2003). Mental Health is a state of ‘being’ that is relative rather than absolute. 04-Dec-23 3  Robinson (1983) defined mental health as a dynamic state in which thought, feeling, and behaviour that is age-appropriate and congruent with the local and cultural norms is demonstrated. 04-Dec-23 4  Mental Illness Mental Illness is characterized by a maladaptive responses to stressors from the internal and external environment, evidenced by thoughts, feelings & behaviours that are incongruent with the local & cultural norms, and interfere with the individual’s social, occupational and/or physical functioning of an individual. 04-Dec-23 5  Indicators of Mental Health Jahoda (1958) identified Six (6) indicators of mental health: i. A positive attitude toward self: This refers an objective view of self. It involves knowledge & acceptance of strength & limitation. ii. Growth, development, and the ability to achieve self- actualization: Ability to successfully achieve tasks related to each level of development. iii. Integration: Ability to maintain an equilibrium & balance among various life processes. 04-Dec-23 6  Indicators of Mental Health Cont’d iv. Autonomy: Individual’s ability to perform in an independent, self-directed manner. Making choices & accepting responsibility for actions. v. Perception of reality: Ability to perceive the environment accurately without distortion, capacity for empathy & social sensitivity. vi. Environmental mastery: Individual’s ability to achieve a satisfactory role within the group, society, or environment. It also involves being able to love & accept the love of others. 04-Dec-23 7  Characteristics of a Mentally Healthy Person Ability to cope with life’s stresses & disappointment Tolerance and easy-going towards self & others Never underestimates or overestimates his/her abilities and those of others Possesses self-respect Accepts and takes responsibility for own self wrongdoings Satisfaction with self Loves and considers the interest of others 04-Dec-23 8  Characteristics of Mentally Healthy Person Loves and trusts self and others and takes it for granted that others will do the same. Never pushes people around or allowed himself to be pushed around Resolves personal problems or issues as they arise Plans ahead and does not fear the future Welcomes new experiences and ideas Adjust to his environment as required Puts his best effort into what he does 04-Dec-23 9  Characteristics of Mental Illness Marked personality change over time Confused thinking, strange or grandiose ideas Prolonged severe depression, apathy or extreme highs or lows Excessive anxiety, fears or suspiciousness; blaming others Withdrawal from society; friendlessness; abnormal self- centeredness Denial of obvious problems; strange resistance to help Thinking or talking about suicide 1/26/2020 10  Characteristics of Mental Illness Numerous, unexplained physical ailments, marked changes in eating or sleeping patterns. Anger or hostility out of proportion to the situation. Delusions & hallucinations Substance & alcohol abuse Growing inability to cope with problems & daily activities such as job, school, or personal needs. 1/26/2020 11  Symptomatology This is the recognition and study of symptoms and signs of illness which occur in both psychiatric and general medicine. Types include delusion, hallucination, illusion, disorders of speech, etc. 04-Dec-23 12  Delusion This is a false belief held by a mentally ill person despite being proved to be wrong by others. Delusion cannot be corrected by argument. Delusion can be fixed or fleeting It can also be systematized or non-systematized 04-Dec-23 13  Types of Delusion i. Delusion of Persecution: The patient believes there is a plot against him or her. ii. Delusion of Grandeur: He or she believes he possesses great power, wealth, or influence. iii. Delusion of Guilt or unworthiness: The patient believes he is having diseases with which he fouls the environment and has no reason or interest to be alive. iv. Delusion of Control: The patient believes that his thoughts and feelings are being controlled by outside forces. This condition is frequently seen in schizophrenic patients. v. Delusion of reference: The patient believes that unsuspicious/insignificant occurrences refer to him or her in person. 04-Dec-23 14  Types of Delusion vi. Hypochondriacal delusion (Body changes): The patient believes something is wrong in his body. vii. Delusion of Nihilism or state of Nothingness: The patient believes that the world is no longer in existence and that he is dead also. viii. Delusion of Poverty: The patient believes he is extremely poor and worth nothing in money. ix. Delusion of Derealization: The patient believes that things are no longer real and that he has changed or the world has changed. x. Erotomanic Delusion: The patient believes s/he is in love with a celebrity or someone of higher status. 04-Dec-23 15  Hallucination This refers to a false perception without any external stimulus. Types: Auditory hallucination – hearing voices that others could not hear. Very common in schizophrenia and bipolar disorders. Visual hallucination – seeing what others could not see. Common in schizophrenia. Olfactory hallucination – false perception of a smell. Tactile Hallucination – false perception of a movement of an object on or inside the body. Common in depression & somatoform. Gustatory Hallucination – false perception of taste. Common in epilepsy 04-Dec-23 16  Illusion This simply refers to a wrong interpretation or misrepresentation of a real stimulus or object by a patient. E.g. Misrepresenting weavon on a student nurse as snakes. 04-Dec-23 17  Types of Illusions Complete illusion Affective illusion: Occurs in affective disorders Jamais vu: Illusion of unfamiliarity. Common in temporal lobe epilepsy and exhaustion. Déjà vu: Illusion of familiarity Macropsia: Illusion of exaggeration in size Micropsia: Illusion of reduction in size 04-Dec-23 18  Disorders of Thought This affects language and the content of thought in communication. i. Disorders of Thought Possession Thought broadcast Thought extraction Thought echo/sonorization Thought insertion Thought blocking ii. Disorders of Forms of Thought Circumstantiality Targentiality Flight of ideas Loosening associations 04-Dec-23 19  Disorders of Speech Neologism: Invention of new meaningless words. Logorrhea: excessive verbal production Logoclonia: A spastic repetition of syllables. Common in schizophrenia, Alzheimer’s dxs & Parkinson’s dxs. Word salad: a jumble of words and phrases with little obvious connection between them. Mutism: A state of being silent or voiceless. Common in catatonic schizophrenia 04-Dec-23 20  Disorders of Movement Waxy flexibility: Maintaining an abnormal inconvenient posture for a long time. Negativism: Acting out the opposite of what is instructed. Echolalia: Repetition of words or phrases spoken by another person. Common in autism, dementia and schizophrenia Echopraxia: Repetition of movement demonstrated by another person. Common in catatonic schizophrenia Automatic obedience: Following instruction blindly without judgement & resistance. 04-Dec-23 21  Causes of Psychiatric Disorders 04-Dec-23 22 ADMISSION OF PATIENTS IN PSYCHIATRY  Introduction Admission simply refers to the process by which patient(s) entre into the hospital. Admission of patient requiring mental health care, treatment or management differ to some extent compared to other patients. Due to stigma & discrimination associated with mental illnesses, many mentally ill patients & relations often avoid seeking care in psychiatric hospitals/settings. Types of Admission 1. Voluntary admissions Patient believes & knows s/he is mentally sick Patient makes direct application or presentation to the institution for services on his own volition. No coercion in any manner S/he may stay as long as treatment is deemed necessary. Patient can sign out of the hospital at any time provided certified okay. Admission status can be changed to involuntary if mental status examination is poor. 2. Involuntary Admission Indications: Emergency situation (harm to self &/or others) Psychiatric emergencies such as suicide, rape, earthquake or tremor, land slide, volcanic eruption, status epilepticus, etc. Observation & treatment of mentally ill Gravely disable clients: Individuals who are unable to take care of basic personal needs  Types of Involuntary Admission: 1. Emergency/Temporary admission Indications: Psychiatric emergencies e.g. Rape, Suicide/Suicidal attempt, PTSD, Panic attacks, Severe depression, Alcohol overdose, drug abuse, Status epilepticus, Stupor/Catatonic syndrome, etc. Patient who manifests behavior dangerous to self & others Patients are brought in by relatives, friends, police, court or health care professionals, etc. Admission or hospital stay is limited to period of treatment. 2. Mentally Ill Person in Need of Treatment Indications: i. Major psychiatric disorders e.g. Schizophrenia, Bipolar disorders, Major depressive disorder, Mania, etc. ii. Patients who cannot make informed decision iii. Patients likely to harm self & others iv. Patient that cannot perform or fulfill basic personal need for health & safety 3. Involuntary Outpatient Commitment (IOC) Eligibility Criteria: i. History of repeated decompensation requiring involuntary hospitalization ii. Possibility that patient will deteriorate without treatment. iii. Severe & persistent mental illness e.g. Schizophrenia or bipolar disorder iv. Limited awareness of such illness v. Severe mental illness contributing to a risk of becoming homeless, incarcerated, or violent or risk of committing suicide vi. Existence of individualized treatment plan likely to be effective & a service provider who ahs agreed to provide the treatment. Discharge of a Psychiatric Patient 1. Voluntary Discharge Patient leaves the hospital when he feels he is well Patient may leave at any time when certified by physician 2. Certified Discharge Following satisfactory treatment of patient Psychiatrist swears to an affidavit that patient is well enough to be discharged The court grants the discharge permit.  History Taking in Psychiatry Psychiatric assessment requires a comprehensive history taking. This is very vital to: 1. Make diagnosis 2. Identify other co-existing problems 3. Plan treatment/management 4. Estimate prognosis History spans through the entire life-span (pregnancy to adulthood).  Demographic History Name of the patient Age Sex Address Ethnicity Religion Occupation Next of Kin Next of kin Address Phone contact Informant Informant’s Relationship  History of Presenting Problem Nature Severity Onset and course Other relevant problem and symptoms  Family History Enquiries about: Patient’s father, mother, siblings and extended family members. Patient’s spouse and children  Personal History Focus is to identify major stressful events, how patient react to them and impacts on him or her: 1. Maternal health during pregnancy & circumstances around childbirth. Maternal infection in pregnancy, birth trauma, drug and alcohol use in pregnancy, exposure to teratogenic substances (thalidomide, radiations, chemicals, etc.)  Personal History Cont’d 2. Early development Serious & chronic illnesses Maternal/paternal separation: emotional detachment Disease affecting the CNS 3. Educational history Intelligence and achievement Friendship; shyness; leadership role; relation with teacher; etc.  Personal History Cont’d 4. Occupational History Frequent changes of job Lack of job Lack of promotion Frequent quarrels with colleagues 5. Sexual Relationship Success and failure  Personal History Cont’d 6. Social history Housing & living condition Owned or rented Co-occupants relationship Finances etc. 7. Menstrual history Menarche Premenstrual syndrome menopause  Personal History Cont’d 8. Marital history Happy marriage or not. Duration Spouse’s work & personality Previous marriage(s) Any period of separation Plan of future separation/divorce  Personal History Cont’d 9. Forensic history Behavior relating to breaking laws Arrest or detainment Criminal cases or records Penalty of such cases  History of Past Illness Previous history of Medical or Psychiatric illnesses. Directly or indirectly related to present problem.  Personality History Premorbid personality of patient Prevailing mood, character, attitude, habit, etc. Mental Status Examination (MSE) Systematic enquiry into symptoms and signs at the time of interview conducted in an orderly manner. It is expected that the beginner in psychiatry should carry out a complete mental state examination with every patient. Components of MSE are presented on the table below: 1. Appearance and behaviour General appearance Facial expression Posture Movements Social behaviour 2. Speech Rate (Pressured, slow, normal)s Amount Tone (loud, low, normal) 3. Mood Prevailing mood and associated symptoms Variations of mood (elated, depressed, sad, happy, Appropriateness of mood 4. Depersonalization and derealization Disorder of thoughts (Possession, Forms, Contents) thinking Obsessional or compulsive symptoms Delusion 5. Perception Illusions Hallucination (Auditory, Gustatory, Tactile, Olfactory & Visual) 6. Cognitive function Estimate intelligence or Memory Orientation (time, place, person) Attention and concentration (digit, span, serial 7s, 9s, etc) Insight THANK YOU FOR LISTENING