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Give a brief, chronological overview of mental health
- Primitive belief strong correlation r/t witchcraft
- Hippocrates (father of medicine) in 400BC moving away from supernatural and assoc mental health with the four bodily fluids
- Middle ages back to witchcraft
- Islamic countries first to create asylums
How did Benjamin Rush and Dorothea Dix contribute to mental health?
- Benjamin rush is the father of american psychiatry and created the first american hospital for the mentally ill in the 1800s in Philadelphia
- Dorothea Dix believed mental illness could be cured in the right environment, created the state hospital system and institutionalization which was the largest resource for the mentally ill until the 1960s
How did Freud contribute to mental health?
- Psychoanalytic movement of the early 1990s
- Psychosis and neurosis caused by psychological trauma
- Viewed mental illness as psychological disorder
- Psycoanalysis and dream interpretation
How did Linda Richards contribute to mental health and nursing education?
- Linda Richards was the first psychiatric nurse in 1873 and started the first school of psychiatric nursing
- 1946 passed the National mental health act for graduate level nursing education
- 1955 it was added into undergrad nursing curriculum
Describe the Mental Health Parity and Addiction Equity Act
- Requires insurance companies to treat mental health on an equal basis with physical illness when policies cover both
Describe the Healthy People 20/20 objectives for mental health
Improve mental health through prevention and ensuring access to appropriate, quality service
Describe the NAMI and New Freedom Commission on Mental Health's social influence on mental health care?
- National alliance on mental illness (NAMI) is a consumer education resource
- New Freedom commission is a research group making recommendations for mental health delivery
What are some barriers to quality mental health services?
- communication barriers (including language)
- stigma of mental illness
- ethnic variations in pharmacodynamics
What populations are vulnerable to mental illness and inadequate care?
- cultural minorities
- vulnerable populations
What are some new ways communities can be educated on mental health?
- Mental health first aide course
- Smartphone apps
Describe "mental health"
- Able to recognize own potential
- Cope with normal stress
- Work productively
- Make contributions to community
- Think rationally
- Communicate appropriately
Describe the mental health continuum
- Moves from mild to psychosis
- Psychophysiogic factors affecting medical conditions fall between mild and moderate
- Anxiety disorders, dissociative disorders, somatoform disorders, personality disorders and eating disorders fall between moderate and severe
- Depressive disorders, bipolar disorders, schizoprenic disorders, and cognitive disorders fall between severe and psychisis
- As a continuum, you can move between any stage
What is the diathesis-stress model?
- diathesis is a biological predisposition where stress is from environmental stress or trauma
- Together, this is the most accepted explanation for mental illness
What is the DSM V and what are the approaches?
- Official guidelines of the APA for diagnosing psychiatric disorders. Outline expected s/s for each disorder
- It can no theory or treatment attached
- It is multi axial (I-V)
Describe the DSM V TR Axes
- Axis I: clinical psychiatric diagnosis/major clinical symptoms
- Axis II: Personality disorders and mental retardation
- Axis III: physical disorders or illness
- Axis IV: psychosocial or environmental stressors
- Axis V: global assessment of functions (GAF) is a numeric scale used to see if someone has low enough function for inpatient care (20-30 for inpatient care)
What is Freud's psychoanalytic theory?
- Freud believed that a person's basic character was formed by age 5
- he organized the structure of the personality into the three major components
- Id: pleasure principle, reflex reaction, primary process
- Ego: problem solver, reality tester, uses defense mechanisms
- Super-ego: moral component
How does Freud's psychoanalytic theory apply to nursing?
- Importance of individual talk sessions
- attentive listening skills
- Transference: client puts thoughts, feelings, etc for another person onto health care provider. can be positive or negative
- Countertransference: health care provider puts thoughts, feelings, etc of another person onto the client
Describe Erikson's theory
- Erikson's theory of developmental stages through lifespan
- tasks/crisis at each stage
- Failure to accomplish task results in delayed Psychosocial development and potential psychopathology
- Goal is to resolve the developmental crisis
What is Hildegard Peplau's theory?
- Nurse theorist that believed the 1 on 1 relationship was the key component to healing
- Care, compassion, advocacy, nurse/client relationship
- Founder of process recordings
What is Sullivan's Interpersonal Theory? How does it apply to nursing?
- Purpose of all behavior is to get needs met through interpersonal interactions and to decrease or avoid anxiety
- This was the foundation of Peplau's nursing theory for the role of the nurse in the relationship
What is the focus of Psychoanalysis?
- Internal experience
- Defense mechanisms
- Transference and past relationships
- The therapist is non-directive
What are defense mechanisms? What is the goal of defense mechanisms?
Defense mechanisms operate on an unconscious level (except suppression) to distort reality to make it less threatening
Describe the different defense mechanisms
- Compensation: overachievment in one area to offset real or perceived deficiency in another area
- Displacement:ventilation of intense feelings towards persons less threatening than the person who aroused those feelings
- Rationalization:Excusing own behavior to avoid guilt, responsibility, conflict, anxiety, or loss of self-respect
- Identification: Modeling actions and opinions of influential others, while searching for identity, or aspiring to reach a personal, social, or occupational goal.
- Intellectualization: reduces anxiety by thinking about events in a cold, clinical way
- Projection:Unconscious blaming of unacceptable inclinations or thoughts on an external object
- Sublimation:Replacing the desired gratification with one that is more readily available
- Suppression: Conscious choice to put situation/stress aside for time being
- Undoing: Exhibiting acceptable behavior to make up for or negate unacceptable behavior
- Denial:Failure to acknowledge an unbearable condition; failure to admit the reality of a situation, or how one enables the problem to continue
- Regression:moving back to a previous developmental stage in order to feel safe or have needs met
- Reaction formation: acting the opposite of what one feels or thinks
- Isolation: Attempting to avoid a painful thought or feeling by objectifying and emotionally detaching oneself from the feeling
- Repression: (cornerstone of all defense mechanisms) excluding emotionally painful or anxiety-provoking thoughts and feelings from conscious awareness
- Introjection: Accepting another person's attitudes, beliefs or values as one's own
- Dissociation: dealing with emotional conflict by a temporary alteration in consciousness or identity
- Resistance:Overt or covert antagonism toward remembering or processing anxiety-producing information
- Conversion:Expression of an emotional conflict through the development of a physical symptom, usually sensorimotor in nature
- Fixation: immobilization of a portion of a personality resulting from unsuccessful completion of tasks at a developmental stage
What is interpersonal therapy?
- Focus on interpersonal relationships
- Problems of grief, role disputes, role transition, interpersonal deficits
- Therapists are active and directive
What is behavioral therapy?
- Often called learning theory
- Assumption is that all behavior is learned
- Therefore, abnormal behavior can be unlearned
- Goal is prediction and control of behavior with a focus on learning more adaptive behaviors
- -operant conditioning
- -synthetic desensitization
- -aversion therapy
- Therapist is active and directive
What are intervention techniques?
- Shaping: reinforcements for attempts at desired behavior
- modeling: learning new behavior by imitation
- Contingency contracting: contract drawn up and needed for behavior change
- Token economy: token awarded for desired behavior, which may be exchanged for privileges
What is the focus of cognitive therapy?
- Focus on faulty thoughts and cognition
- Correcting cognitive distortions
- Time limited, structured approach
- Therapist is active and directive
Describe cognitive therapy
- Thoughts come before feelings and actions
- Our thoughts may not portray reality correctly, requiring reframing
- Magnification: negatives are magnified
- Minimization: minimize the positives
- Mind reading
What is Mileu Therapy?
- Safe, secure environment
- Use of total environment for therapy
- People, setting, structure, and emotional climate are all important
- Clients own the environment and peers are powerful
Describe Roy's theory in reaction to stress
- Roy's theory is based on a person's adaptation to stress
- positive adaptations maintain the integrity of the individual
- Healthy responses return to equilibrium and stabilize biological health
What do Hans Selye and Water Cannon believe about stress
- General adaptation syndrome: GAS
- Fight, flight, freeze, faint
- There are 3 stages: alarm reaction, resistance, and exhaustion
How can mental health effect physical health?
Can cause asthma, cancer, coronary disease, essential HTN, ulcerative colitis
What are some 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 or overeating, opportunistic infections, type II DM, fatigue and irritability, angina, MI, CVA
How can stress be rated on a scale?
- Self assessment by the Miller and Rahe Recent Life change Questionnaire
- There is a link between the level of stress and illness
Describe some approaches to stress management
- Behavioral approaches:
- -guided imagery
- -breathing exercises
- - biofeedback
- Cognitive approaches:
- -journal keeping
- -cognitive reframing
- -priority settings
- -use of humor
- -assertiveness training