PSYCHIATRIC /MENTAL HEALTH NURSING FOR REGISTERED GENERAL NURSING REGISTERED MIDWIFERY REGISTERED NURSING ASSISTANTS C&P

CHAPTER ONE INTRODUCTION TO CONCEPT OF MENTAL HEALTH / ILLNESS The concepts of mental health and mental illness are culturally defined. Some cultures are quite liberal in the range of behaviors that are considered acceptable, where- as others have very little tolerance for behaviors that deviate from the cultural norms. A study of the history of psychiatric care reveals some shocking truths about past treatment of mentally ill individuals. Many were kept in control by means that were cruel and inhumane. Primitive beliefs regarding mental disturbances took several views. Some thought that an individual with mental illness had been dispossessed of his or her soul and that the only way wellness could be achieved was if the soul returned. Others believed that evil spirits or Supernatural or magical powers had entered the body. The "cure" for these individuals involved a ritualistic exorcism, which often consisted of brutal beatings, starvation, or other torturous means, to purge the body of these unwanted forces. Still others considered that the mentally ill individual may have broken a taboo or sinned against another individual or God, for which Ritualistic purification was required or various types of retribution were demanded. The correlation of mental illness to demonology or witchcraft led to some mentally ill individuals being burned at the start. MENTAL HEALTH(NORMALITY)  The American Psychiatric Association (APA, 2003) defines mental health as “The 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."  Townsend (2009) defines mental health as "the successful adaptation to stressors from the internal or external environment, evidenced by thoughts, feelings, and behaviors that are age appropriate and congruent with local and cultural norms" MENTAL ILLNESS (ABNORMALITY)  APA, 2000, defines mental illness or a mental disorder as "a clinically significant behavioral or psychological syndrome or pattern that occurs in a person and is associated with present distress or disability or with a significantly increased risk of suffering to death.  Townsend (2009) defines mental illness as "maladaptive responses to stressors from the internal or external environment, evidenced by thoughts, feelings, and behaviors that are incongruent with the local and cultural norms, and interfere with the individual's social, occupational, and /or physical functioning”. MENTAL HEALTH AND MENTAL ILLNESS (Normality versus Abnormality) MENTAL HEALTH MENTAL ILLNESS Accept self and others Feels inadequate and has poor self-concept Ability to cope with or tolerate stress Is unable to cope. Exhibits maladaptive behavior Return to normal functioning if temporary disturbed Exhibits dependency needs because of feeling of inadequacy Able to form close and lasting relationships unable to establish a meaningful relationship uses Accept responsibility for actions irresponsible or unable to accept responsibility for actions Optimistic Pessimistic Recognizes limitations(abilities and deficiencies) Does not recognize limitations Able to judge and make decisions Displays poor judgment Able to perceive reality unable to perceive reality Recognizes potentials and talents Does not recognize potentials and talents due to a poor self-concept Able to solve problems himself Avoid problems rather than coping with them or attempting to solve them Takes into consideration societal norms Desires or demands immediate gratification CHARACTERISTICS OF MENTALLY HEALTHY PERSON o An appropriate perception of reality o The ability to accept oneself, others, and human Nature o The ability to manifest spontaneity o The capacity for focusing / concentration on problem- solving o A need for detachment and desire for privacy o Independence, autonomy, and a resistance to enculturation o An intensity of emotional reaction o An identification with humankind o The ability to achieve satisfactory interpersonal relationships o A democratic character structure and strong sense of ethics o Creativeness MENTAL DISORDERS PSYCHOSIS A severe mental condition in which there is disorganization of the personality, deterioration in social functioning, and loss of contact with, or distortion of reality.  There may be evidence of hallucinations and delusional thinking.  Psychosis can occur with or without the presence of organic impairment.  Psychosis is a combination of symptoms resulting in an impaired relationship with reality.  It can be a symptom of serious mental health disorders.  Two types: organic brain syndrome or organic psychosis  functional brain syndrome or functional psychosis  People who are experiencing psychosis may have either hallucinations or delusions. Hallucinations are sensory experiences that occur within the absence of an actual stimulus. For example, a person having an auditory hallucination may hear their mother yelling at them when their mother isn’t around. Or someone having a visual hallucination may see something, like a person in front of them, who isn’t actually there. The person experiencing psychosis may also have thoughts that are contrary to actual evidence. These thoughts are known as delusions. Some people with psychosis may also experience loss of motivation and social withdrawal. It’s important to get medical help right away if you or someone else is experiencing symptoms of psychosis. NEUROSIS Alternate titles: neuroses, psychoneuroses, psychoneurosis Neurosis, plural neuroses, also called psychoneurosis or plural psychoneuroses, mental disorder that causes a sense of distress and deficit in functioning.Neuroses are characterized by anxiety, depression, or other feelings of unhappiness or distress that are out of proportion to the circumstances of a person’s life. They may impair a person’s functioning in virtually any area of his life, relationships, or external affairs, but they are not severe enough to incapacitate the person. Affected patients generally do not suffer from the loss of the sense of reality seen in persons with GENERAL ETIOLOGIES OF MENTAL ILLNESS Host, agent and environmental factors (trilogic factors) are the main causes of mental disability. HOST FACTORS This is the transfer of abnormal genes from parents to off springs (generation to another generation) e.g. chromosomal / genetic abnormality, constitutional factors e.g.  body build,  personality type  Age and sex. ENVIRONMENTAL FACTORS These are factors that precipitate the occurrence of mental disorders e.g.  loss of love one,  properties,  bereavement;  poverty,  divorce,  unemployment,  disappointments in lives,  failure in examinations,  Poor parental upbringing. Etc AGENT FACTORS E.g.  biochemical; lead poisoning, dopamine and serotonin hypothesis  Head injury Brain tumors  Infections  Substance abuse etc. GENERAL NURSING CARE / MANAGEMENTS OF MENTAL DISORDERS A. Physical Care The nurse must; 1. Maintain personal hygiene e.g. grooming and mouth care 2. Promote rest and sleep 3. Ensure elimination i.e. bowel movements 2. Maintain nutrition and fluids requirements 5. Provide protection, safety and security 6. Ensure exercises 7. Encourage minor activities 8. Monitor vital signs; TPR to serve as bases for (and) progress of treatments 9. Assess Patient for Physical Illness and Injuries 10. Serve prescribed medication and monitor its side effects B.Psychological care 1. Establish rapport / good relationship with client 2. Reassure client and family 3. Provide encouragement 4. Orientate patient due to loss of memory and hallucinations 5. Observe client always 6. Address client by his name 7. Listen to patient views and guide him or her 8. Provide emotional support to client 9. Educate client and family members about causes and prevention of mental illness 10. Interview client to assess his mental state / level of reasoning 11. Give psychotherapy /counseling 12. Offer recreational therapy / activities. 13. Help patient to get insight into his condition 14. Allay his fears and anxiety Psychiatric assessment of mentally ill patient A psychiatric assessment, or psychological screening, is the process of gathering information about a person within a psychiatric service, with the purpose of making a diagnosis. The assessment is usually the first stage of a treatment process, but psychiatric assessments may also be used for various legal purposes. The assessment includes social and biographical information, direct observations, and data from specific psychological tests. It is typically carried out by a psychiatrist, but it can be a multi-disciplinary process involving nurses, psychologists, occupational therapist, social workers, and licensed professional counselors. Clinical assessment psychiatric assessment is most commonly carried out for clinical and therapeutic purposes, to establish a diagnosis and formulation of the individual's problems, and to plan their care and treatment. This may be done in a hospital, in an out-patient setting, or as a home-based assessment. Forensic assessment A forensic psychiatric assessment may have a number of purposes. A forensic assessment may be required of an individual who has been charged with a crime, to establish whether the person has the legal competence to stand trial. If a person with a mental illness is convicted of an offense, a forensic report may be required to inform the Court's sentencing decision, as a mental illness at the time of the offense may be a mitigating factor. A forensic assessment may also take the form of a risk assessment, to comment on the relationship between the person's mental illness and the risk of further violent offenses Medico-legal assessment A medico-legal psychiatric assessment is required when a psychiatric report is used as evidence in civil litigation, for example in relation to compensation for work-related stress or after a traumatic event such as an accident. The psychiatric assessment may be requested in order to establish a link between the trauma and the victim's psychological condition, or to determine the extent of psychological harm and the amount of compensation to be awarded to the victim Medico-legal psychiatric assessments are also utilized in the context of child safety and child protection services. A child psychiatrist's assessment can provide information on the psychological impact of abuse or neglect on a child. A child psychiatrist can carry out an assessment of parenting capacity, taking into consideration the mental state of both the child and the parents, and this may be used by child protective services to decide whether a child should be placed in an alternative care arrangement such as foster care. History A standard part of any psychiatric assessment is the obtaining of a body of social, demographic and biographical data known as the history. The standard psychiatric history consists of biographical data (name, age, marital and family contact details, occupation, and first language), the presenting complaint (an account of the onset, nature and development of the individual's current difficulties) and personal history (including birth complications, childhood development, parental care in childhood, educational and employment history, relationship and marital history, and criminal background). The history also includes an enquiry about the individual's current social circumstances, family relationships, current and