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What were some primitive beliefs about those with mental illnesses?
- soul: was lost & needed to be returned
- Evil: spirits or magical powers entered the body
- Sins: against God or others
- (strong correlation to demonology or witchcraft)
Who's beliefs (in 400 BC) began the movement away from supernatural? What did he associate mental illness with?
Hippocrates; he associated mental illness with irregularity in the 4 body fluids which he called HUMORS (blood, black bile, yellow bile, phlegm)
What was the perspective of mental illness during the middle ages? (500-1500)
- associated with witchcraft
- (islamic countries perceptions changed to actual illness; first asylums for mentally ill)
Who is the father of american psychiatry? Why? Who is Dorthea Dix and what did she do?
- Benjamin Rush: he founded first american hospital for the mentally ill in the 1800s
- Dorthea Dix: founded the state hospital system; the largest resource for mentally ill until community health movement of 1960s; institutionalization
What was Freuds contribution?
- Early 1900s= psychoanalytic movement
- - psychosis and nuerosis caused by psychological trauma
- - viewed mental illness as psychological disorder
- -psychoanalysis and dream interpretation
Who was the first psychiatric nurse? When? When did the national mental health act pass? When did it become a requirement that psychiatric nursing be incorporated into undergrad nursing?
- Linda Richards; In 1873
- In 1946
- (nurse client relationship; knowledge in the somatic therapies)
What does the mental health parity and addiction equity act of 2008 do?
it requires insurance companies to treat mental health on a equal basis with physical illnesses, when policies cover both
What are some of the newer mental health issues in the past decade?
- people in communities with large scale disasters
- older clients with dementia and mood disorders
What are the healthy people 2020 objectives?
- improve mental health through prevention and ensuring access to appropriate quality services
- by 2020 behavioral health tx will surpass medical tx
What are the social influences on mental health care?
- Mental health movement
- National alliance on mental illness (NAMI)
- New freedom commission on mental health
What are the barriers to quality mental health services?
- Communication barriers
- Stigma of mental illness
- ethnic variation in pharmacodynamics
What populations are at risk of mental illness and inadequate care?
- cultural minorities
What is mental health?
the emotional and psychological well being of an individual who has the capacity to interact with others, deal with ordinary stress, and perceive one's surroundings realistically
What is considered "normal" mental health?
- Able to recognize own potential
- Cope with normal stress
- Work productively
- Make contribution to community
- think rationally
- communicate appropriately
What is the most widely accepted explanation for mental illness?
What is Diathesis?
- The Diathesis stress model
- combination of gentic vulnerability and negative environmental stressors
- Diathesis: biologically predisposed
What is the DSM-5?
- the diagnostic and statistical manual of mental disorders, 5th edition
- they are the official guidelines of the american psychiatric association for diagnosing psychiatric disorders
- ( Multiaxial; A-theoretical, descriptive approach, classification of mental disorders; nurses incorporate data fro axis in care)
How can you get a diagnostic evaluation?
look at the history (history evolves) collateral information is useful; observation is often more important than report
What are the diagnostic heirarchies?
- R/O general medical, substance, cognitive disorders first
- simplicity is key
- length of time diagnosis is present
- most treatable first
What are the DSM -IV TR Axes? COME BACK
- Axis I: general anxiety disorder ----------l
- Axis II: borderline personality disorder---l > = 3
- Axis III: Hypertension ---------------------l
By what age did Freud believe that basic character was formed? According to him what major components make up the personality?
by age 5; ID, Ego, Superego
What is the ID? The Ego? The super ego? Why is the freudian theory related to nursing?
- Id: pleasure principle; reflex action; primary process
- Ego: problem solver; reality
- Super-ego: Moral component
- the formation of personality; conscious and unconscious influences; importance of individual talk sessions; attentive listening; transference; counter-transference
What did Erikson contribute?
Influence of social processes om the development of the personality; developmental task at each stage; failure to accomplish tasks results in delayed psychosocial development, and potential psychopathology; the goal is to resolve developmental crises
What did Hildegard peplau contribute?
Psychiatric nursing: care, compassion, advocacy, nurse-client relationship
What is Sullivan's interpersonal Theory? How does sullivan's theory view the nurse's role?
- Purpose of all behavior is to get needs met through interpersonal interactions and to decrease or avoid anxiety
- was the foundation for Hildegard's theory
- the viewed nurse role as: participant/observer, respect for client, unconditional acceptance of client
- and empathy towards client
What are the psychotherapies? What is the focus? What is the therapist like?
- psychodynamic/psychoanalytical; focus: internal experience, defense mechanisms, transference and past relationships, contertransference
- therapist: non-directive
What are defense mechanisms?
(psychoanalytical) They operate at a unconscious level (except suppression) they distort reality to make it less threatening
What are the examples of defense mechanisms?
- reaction formation:
What is psychotherapy? What is the focus? what are the problems? How is the therapist?
- (interpersonal therapy) Focus: interpesonal relationships
- Problems: grief, role disputes, role transition, interpersonal deficit
- therapist: active and directive
What is behavioral learning often called? What is the assumption? What is the focus? goal? techniques? therapist?
- "learning theory"
- Assumption is that all behavior is learned; abnormal behavior is learned foloowing the same principle; if all behavior is learned then all behavior can be unlearned
- Focus: learning more adaptive behavior
- Goal: prediction and control of behavior
- techniques: Operant conditioning, modeling, systematic desensitization, aversion, relaxation, assertiveness
- therapist: active and directive
What are intervention techniques?
- Shaping: reinforcements for attempts at desired behavior
- Modeling: learning new behaviors by imitation
- Contingency contracting: contract drawn up for needed behavior change
- Token economy: tokens awarded for desired behavior; may be exchanged for privileges
What is cognitive therapy? Focus? therapist?
- thoughts come before feelings; thoughts about the world come from our own personal perspectives which may or may not be based on reality;
- Focus: faulty thoughts, cognititions; correcting cognitive distortions, time limited, structured approach
- Therapist: active and directive
What are the different types of cognitive distortions?
- All or nothing thinking:
- Mind reading:
What is cognitive-behavioral therapy?
- test distorted beliefs and change way of thinking; reduce symptoms
- collect and record automatic thoughts.. journal
- identify and challenge cognitive distortions
- -Socratic thinking (??) examine evidence, generate alternatives, decatatrophizing
What is Milieu therapy?
Use of total environment: people setting, structure, and emotional climate all imprtant to healing ; a safe secure environment
What is the definition to stress? According to Roy what is positive adaption?
Roy: + adaption maintains integrity of individual; stabilizes biological process, healthy, returns to equilibrium
What did Hans Selye and Walter cannon find?
- General adaption syndrome; that there is fight, flight, freeze and faint;
- 3 stages: Alarm reaction, resistance, exhaustion
What are examples of the effect mental health can have on physical health?
- Coronary disease
- essential hypertension
- ulcerative colitis
What are the differences between acute and chronic reactions to stress?
- Acute: Uneasiness, sadness, loss of appetite, immune system suppression, increased metabolism, increased energy mobilization cardiovascular tone increased
- Chronic: Anxiety, panic attacks, depression, anorexia, overeating, opportunistic infections, type II diabetes, HTN, fatigue, irritability, angina, heart attack, stroke
What are the differences between positive and negative responses?
- Positive: problem solving, using social support, reframing
- Negative: avoidance, self-blaming, wishful thinking
How is stressed measured?
by the Miller and Rahe Recent Life Changes Questionnaire. ( it is not certain whether stress overload merely predisposes a person to illness or actually precipitates it but there is a link
What are behavioral approches to stress management?
Relaxation techniques: meditation, guided imagery, breathing exercises, biofeedback
What are the cognitive approaches to stress management?
Journal keeping, cognitive reframing, priority setting, use of humor, assertiveness training
What are assorted stress busters?
- limit caffeine
- touch massage