NCM 117: CARE OF CLIENTS WITH - Build a relationship of trust

MALADAPTIVE PATTERN OF BEHAVIOR 8. Reassurance

(ACUTE AND CHRONIC) — LECTURE NOTE - Reassure the patient that he/she is in good
hands
PSYCHIATRIC ASSESSMENT - Do not promise them to stay there
As always send mail through the post of c - Don’t give false hope, do not give reasons,
A - Appearanc do not give negative responses
S – Speec 9. Change patient behavior through emotional
M – Memory/moo experience
T – Thought 10.Avoid increase in patient anxiety
P – Perceptio - Do not pre-empt
O – Orientatio - They know how to self-care, pt’s eats very
fast
PSYCHIATRY – it is a branch of medicine that - They have pre-relaxation time
deals with the diagnosis, treatment and 11.Consideration of reason for behavior
prevention of mental illness - Look the calendar if its full moon,
LUNATIC, luna from the moon and how
PSYCHIATRIC NURSING – it is a specialized they respond to the moon
area of nursing practice, employing theories of 12.Necessity of motor and sensory stimulation
human behavior as it is a science, and the - Brain is partially damage entirely it can
purposeful use of self as it is an art, in the affect the motor and sensory stimulation
diagnosis and treatment of human responses to 13. Realistic Nurse-Patient relationship
actual or potential mental health problems - Realistic- sincere with our patients, give
them the treatment management they need
THE BASIC PRINCIPLES IN PSYCHIATRIC - Build on trus
NURSIN
1. Accept patient exactly as they are PSYCHIATRIC NURSING
- Do not compare the patient to yourself - An interpersonal process/relationship
2. Maintain contact with reality whereby the professional nurse practitioner
- 10 questions are asked to the patients; assists on individual, family, or community to
redundantly promote mental health, to prevent or cope
3. Seek validation from patient with experience if mental illness and
- Can ask questions to the patient but DO suffering and if necessary to nd meaning in
NOT ASSUME TO EXTRACT THE EXACT these experiences. (Travelbee
ANSWER - it is a specialized area of nursing practice,
- Record the conversation employing theories of human behaviour as it
4. Self-understanding used as a therapeutic is a science, and the purposeful use of self
tool as it is an art.
- Self-awareness - It is directed towards both preventive and
5. Nurses’ personal contribution corrective impacts upon mental disorders and
- Offering ourselves their sequence and is concerned with the
6. In uence with expectation of behavior promotion of optimal mental health for
- MATTER OF FACT, everything should be society, and the community and those
factual to make it therapeutic individuals who live within it.
7. Consistency and patient security
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 MENTAL HEALT - Biological factors can also be part of the

- Health is a state of wellbeing in which the caus
individual realizes his or her own potential, - Mental disorders are common but treatments
can cope with normal stresses of life, can are available
work productively and fruitfully, and is able
to make a contribution to her or his own NEUROBIOLOGICAL THEOR
community. (WHO - Focus on genetic factors, neuroanatomy,
neurophysiology and biological rhythms as
7 DOMAINS OF HEALT they related to the course of mental
a. Psychologica disorders
b. Emotiona
c. Physica 5 PRINCIPLES OF MIND TO THE BRAIN
d. Educatio RELATIONSHI
e. Social being; adapting to us, manipulate, 1. All mental processes, includes those
interactio conscious and unconscious, result from
f. Spiritual wellbeing; important as in other, operations of the brain. (Behavioral disorders
g. Financia are disturbances of the brain function
- Includes our emotional, psychological, and 2. Genes are important determinants for how
social wellbeing. It affects how we think, feel neurons function and has signi cant control
and act as we cope with life. It also helps over behaviour
determine how we handle stress, relate to 3. Social and developmental factors modify
others and make choice the expression of genes and function of the
- Mental health is important at every stage of neuron
life from childhood and adolescence through 4. Learning creates changes in neuronal
adulthood. connections. Abnormalities in behaviour can
be induced by social conditions
MASLOW'S HIERARCHY OF NEED 5. Counseling and therapy can create long
- Self-actualization; moment of truth, term changes in gene expression. (Group
beginning of your next journe therapy
- Self-estee
- Love and belongingnes IMPORTANCE
- Safety and securit • Recognize genetic factors in mental disorders
- Physical need minimizes the tendency to blame the victim or
- "Self-transcendence famil
• Understanding brain function helps you
MENTAL ILLNES understand how neurobiology and
- Are serious disorders which can affect your psychotherapy converg
thinking, mood, and behaviour. There are
many causes of mental disorders MNEMONICS: ALMOST EVERY CHROMOSOME
- Predisposing and precipitating factor IS LINKE
- Your genes and family history may play a IDENTICAL TWINS 50%
role FRATERNAL TWINS 15
- Life experiences such as stress or a history BROTHER/SISTER 10
of abuse may also matte ONE PARENT 15
BOTH PARENTS 35
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 2ND DEGREE RELATIVES 2 to 3 • Currently, 85% of Americans say nurses'

NO AFFECTED RELATIVES 1 honesty and ethical standards are "very high"
COMMON DIFFERENCES RELATED TO MENTAL or "high", essentially unchanged from the
HEALT 84% who said the same in 2018.
• Male brain is 10% larger than femal • Nurses are consistently rated higher in
• Female has larger corpus callosum honesty and ethics than all other professions
• Female produces more serotonin that Gallup asks about, by a wide margi
• Male has high testosterone levels. • Medical professions in general rate highly in
Americans assessment of honesty anf ethics,
COMMON DISORDERS IN MAL with at least sin in 10 us adults saying
• Autisti medical
• Learning; slow learner
• Substance Abus CONCEPTS OF MENTAL HEALTH AND MENTAL
• Schizoid; split-personalit ILLNES
• Paranoid; A. STATE OF MENTAL HEALTH AND MENTAL
• OC; obsessive compulsiv ILLNESS IN THE COUNTRY AND IN THE
• ADH WORL
• Conduc - The Philippines WHO special initiative for
• Antisocia mental health conducted in the early part of
• Schizotypa 2020 shows that at least 3.6 million Filipinos
• Narcissisti suffer from one kind of mental, neurological
• Dementi and substance use disorder. (DOH, OCT
10,2020)
COMMON DISORDERS IN FEMAL - The COVID pandemic has evoked
• Anxiet overwhelming reactions and emotions from
• Dysthymi people, livelihood affected. Others how to
• Borderline; bipola keep their family safe. We need to take extra
• Dependent; overacting in dependen care now when it comes to mental health
• Schizoaffective disorders; paranoi - Mental health is a human right, it has to be
• Eating; poor eating habits, available for all. Quality, accessible primary
• Histrionic; want to be appealing and dramati health care is the foundation for Universal
• Alzheimer's; "secondary can kill u", health coverage and is urgently required
malnutritio - Mental health should be reality for all, for
COMMON DISORDERS IN BOTH GENDER everyone and everywhere
• Bipola
• Oppositional De an DOH and WHO promote holistic mental health
wellness in light of World Suicide Prevention
Nurses continue to rate highest in honesty, Da
ethic - Ideation; consummated and attemp
- Suicide is very high in Male than Female
GALLUP POLL SOCIAL SERIE - Through the Philippines has consistently
• WASHINGTON, D.C. - For the 18th year in a ranked in the Top 5 of a global optimism
row, Americans rate the honesty and ethics index, the National Center for Mental
of nurses highest among a list of professions Health (NCNH) has reveled a signi cant
that Gallup asks US adults to assess annually increase in monthly hotline calls regarding

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 depression, with numbers rising from 80 calls • Follow up any commitments that you agree to
pre-lockdown to nearly 400.
- Globally, the most vulnerable population is MENTAL HEALTH CARE DELIVERY SYSTEM IN
those aged 15-29 THE PH AND ITS IMPORTANCE AND IMPACT
- Mental health-related deaths are also the TO THE COMMUNIT
second leading causes of fatalities in this - The Philippines has recently passed its rst
age group. These numbers illustrate the need Mental Health Act (Republic Act no 11036).
for more conversations and programs that The Act seeks to establish access to
will break the stigma around mental health comprehensive and integrated mental health
- Most times, Filipinos do not feel comfortable serviced, while protecting the rights of
sharing their mental health challenges for people with mental disorders and their
fear of alienation or prejudice. family members (Lally et al 2019)
- With compassion and understanding for - However, mental health remains poorly
others we can recognize the signs and resourced: only 3-5% of the total health
educate ourselves how to access help. We all budget is spent on mental health and 70%
have a critical role in preventing suicide by of this is spent on hospital care. (WHO AND
socially connecting with affected people and DOH, 2006)
connecting people to mental health services - There is 1 doctor for every 80,000 lipinos
or medical care (WHO AND DOH, 2012); the emigration of
- World Suicide Prevention Da trained specialists to other countries,
particularly english speaking countries,
IT MIGHT HELP TO contributes to this scarcity. This shortage is
• Let them know that you care about them and magni ed in psychiatry where, nationally,
that they are not alone, empathize with them. there are a little over 500 psychiatrists in
You could say something like, “I can’t imagine practice.
how painful this is for you, but I would like to - These gures equate to a severe shortage of
try to understand. mental health specialists in the Philippines
• Be non-judgmental. Don’t criticize or blame
them THE BURDEN OF MENTAL DISORDERS IN THE
• Show that you're listening by repeating PHIL
information they have shared with you. This • There is little epidemiological evidence
can also make sure that you have understood (because the family'll not tell others that a
them properly member has mental disorders) on mental
• Ask about their reasons for living and dying disorders in the Philippines; however, some
and listen to their answers. Try to explore important data are available
their reasons for living in more detail • For example, 14% of a population of 1.4
• Ask if they have felt like this before. If so, million Filipinos with disabilities were
ask how their feelings changed last time identi ed to have a mental disorder
• Reassure them they will not feel this way (Philippines Statistics Authority, 2010)
forever • The 2005 World Health Survey in the
• Encourage them to focus on getting through Philippines identi ed that of 10,075
the day rather than focusing on the future participations, 0.4% had a diagnosis of
• Volunteer to assist them in nding professional schizophrenia and 14.5% had a diagnosis of
help. If need be, offer to keep them company depression.
during their session with a licensed therapist
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 • Between 1984 and 2005, estimates for the - (Medical graduates choose anything but
incidence of suicide in the Philippines have psychiatry
increased from 0.23 to 3.59 per 100k in
males, and from 0.12 to 1.09 per 100k HISTORY OF PSYCHIATRIC NURSIN
females. (Redaniel et al, 2011) Early Histor
• The most recent data from 2016 identi ed an - Insanity associated with sin and demonic
overall suicide rate of 3.2/100k with a possessio
higher rate in males (4.3/100k) than females - Rituals, herbs, ointments and precious stones
(2.0/100k) (WHO, 2018 used to try to extract demon
- Mental illness thought to be incurabl
(Brewed beer can be helpful for anemic, it - Treatment of mentally ill was sometimes
alleviates/promotes restfulness inhumane and bruta

ACCESS TO TREATMEN Middle Age

• Prohibitive economic conditions (poverty) - No actual treatment
and the inaccessibility of mental health - Mentally ill were homeless, begged for food
services limit access to mental healthcare in on the streets, or imprisoned
the Philippines - Charity of religious groups provided food,
• There is a cultural drive to 'save face' when shelter, and ran almshouse
there is a threat to or loss of one's social - Hospital of St. Mary of Bethlehem built in
position, and as such Filipinos may have London, England during the 14th century
dif culty in admitting to mental health - First mental asylum provided safe refuge
problems or seeking help. (Avoiding the for the mentally il
stigma - St. Mary of Bethlehem Hospital in London,
• There is a strong sense of family in the Bedlam (1547) was opened. Cures included ice
Philippines and so, when problems are thought water (hydrotherapy) and bloodletting.
to be socially related, Filipinos will turn to
family and peer networks before seeking The Fifteenth through the Seventeenth
medical help. (Tuliao, 2014 Centurie
- Skepticism was rampant
TREATMENT/MEDICATIO - Conditions of asylums were deplorable
• The most commonly used antipsychotics in - Deprived of heat, sunlight, often chained or
clinical practice are chlorpromazine and cage
haloperidol - Insane were treated like animal
• The most commonly used antidepressants are - thought not to have feeling
escitalopram and uoxetine - were believed to lack understandin
- Men and women not given separate quarter
PSYCHIATRY TRAININ
- Psychiatry remains a less popular speciality First, DO NO HARM, practiced from the 1930s
for medical graduates in the Philippines and to the 1950s, a radical surgery, the lobotomy,
the numbers being trained are inadequate forever changed our understanding and
to meet a growing need. treatment of the mentally ill
- (Not sought after but the world needs this
right now
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 Walter Freeman, who championed lobotomy in - Dynamic concept of psychiatric care

the US, was touring with his “lobotomobile”
demonstrating the procedur ● Emil Kraepelin (1856-1926)
- Classi cation of mental disorder
The Nursing The Eighteenth Centur
● Benjamin Rush (1745-1813) ● Sigmund Freud (1856-1939)
- “Father of American Psychiatry” - Psychoanalysis
- Forerunner in highlighting plight of mentally - Psychosexual theories
ill - Neurosi
- Emphasized moral treatment
- Medical Inquiries and Observations upon ● Carl Gustav Jung (1875- 1961)
the Disease of the Mind (1812) - Founded analytic psychology
- Authoritative work on mental disorders for - Holistically treated individual
several decade
● Harry Stack Sullivan (1892-1949)
● Phillippe Pinel (1745-1826 - Interpersonal theory
- French doctor who was the rst to take the - Emphasized milieu therapy and
chains off and declare that these people multidisciplinary approac
are sick and “a cure must be found
- Advocate for humane patient treatment ● American Psychiatric Association
- Emphasized atmosphere of kindness and - 1952 published Diagnostic and
understanding Statistical Manual of Mental Disorders
- For Pinel “the passions” or emotional (DSM
(moral)* excess were the most frequent
cause of mental illness, insanity, and ● Hildegard Peplau
madness. He described his treatment of the - Published Interpersonal Relations in
mentally sick as “moral” rather than as Nursing: A Conceptual Framework for
“psychological” because he used the word Psychodynamic Nursing (1952)
moral to describe the emotional factors - First theoretical framework for
psychiatric-mental health nursing
● William Tuke (1732-1822) - Therapeutic use of self in psychiatric
- Humanitarian efforts led to the nursing
establishment of York Retrea - She made a major contribution to
nursing science, professional nursing,
The Nineteenth Century: The Evolution of the and, of course, to the psychiatric
Psychiatric Nurs nursing specialty through development of
● Dorothea Lynde Dix (1802-1887) the Interpersonal Relations paradigm, a
- Plight of mentally ill recognized by mid-range theory that has in uenced the
legislative community importance with which the nurse-patient
- Led to establishment of state hospitals relationship is regarded
- Provided mainly custodial car
Historical gures in schizophrenia researc
The Twentieth Century: The Era of Psychiatr • Emil Kraepeli
● Adolph Meyer (1866-1950) - 1883, “Dementia Praecox
- Initiated psychobiological theory

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 - separated schizophrenia from bipolar disorder • Federal Community Mental Health Centers Act
(manic-depressive psychosis) based on the (1963
clinical course of the syndromes • Mental Health Study Act (1995
• Eugene Bleule - In 1955 Congress passed the mental health
- 1911: “Schizophrenia” -1909: Genetic splitting study act to study the problems of mental
of the mind between thought and emotio illness
- Association - The nal report (1961 Action for Mental
- Affec Health is issued by The Joint Commission on
- Ambivalenc Mental Health and Illness)
- Autis - Immediately care be made available to
mentally ill patients in community setting
Advent of somatic therapie - Fully staffed, full-people US time mental
• Hypoglycemic shock (1930s health clinics be accessible to all people living
• Electroshoc in the US
• Psychosurger - Community based aftercare and rehabilitation
• Psychotropic medications (1950s • Philippine Mental Health Law (Republic Act
• Thorazine (chlorpromazine 11036
• Tofranil (imipramine - An act establishing a national mental health
policy for the purpose of enhancing the
History of Therapy ‘Shock’ metho delivery of integrated mental health services,
• Electro-convulsive therapy (ECT) the main promoting and protecting the rights of
indications persons utilizing the psychiatric, neurologic
- resistant depressio and psychosocial health services,
- Catatonic syndrom appropriating funds therefor, and for other
- resistant schizophreni purposes.
• Insulin shock therapy • National Mental Health Polic
- administration of increasing doses of - Service components of NMH
insulin to the development of - Treatmen
hypoglycemic com. - Rehabilitatio
- indications: treatment-resistant - Preventio
schizophreni - Drawbacks in NMH
- lacks adequate guidance and leadershi
The Mental Health Movemen - No mental health policy existed before
• Nation’s attitude towards mentally ill began to the program, the 1987 Mental Health Act,
change which established the central and state
• Authority given to United States Public Health mental health authorities has been
Service addressed mental health services largely non-functional
• Nurse’s role changed from custodial care to - No budgetary estimates or provision
active member of the multidisciplinary tea - No response from psychiatrist
• Mental Health Ac
Legislatio • Mental health health act 198
• National Mental Health Act (1946) • Post mental health service
• Commission on Mental Illness and Health • Present status of mental health service
(1961) established by President Eisenhower • Future of mental health service
• School mental health progra
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 • Community care in mental healt - Acupuncture

• Trust areas of NMH - Massage Therap
- Creating awareness and reducing stigm • Cultural considerations
• Amendments (1975) to the Community Mental - Cultural competency skills
Health Centers Act (1963) - Health disparities
- Least restrictive care • The Future
- Deinstitutionalization - Information technology
- Commitment process - Social changes abroad
• Mental Health Act (1980) - Societal demands
• National Plan for the Chronically Ill (1981) - Access and cost of health car
• Presidents New Freedom Commission on Mental
Health (2002 Trends
● Aneurin Bevan- founder NHS • Managed care
• Evidence-based health care
Therapy • Advanced technologies
• Movement away from long term • Client advocacy group
psychoanalytic therapy
• Short term therapy focused on “here and Concepts of practice
now • Integration of biological knowledge and
concepts
Biological aspects of mental illness • Reacquaintance with care and carin
• Research focused on neurobiology, genetic
studies, and treatment modalities Directions for nursing education
• New medication • Reconceptualize core psychiatric nursing
content
1990s: Decade of the brain • Identify critical clinical competencies
• U.S. Congress declaration based on the • Standardize measurable clinical outcomes
number of Americans affected by brain • Establish a national research agend
disorders
• Increased study of the living brain through Societal changes
advanced technology • Deteriorating social structures
• New psychopharmacologic agents develope • Global AIDS epidemic
• Anti-psychotics given to 68.3% with learning • Increased violence
disabilities A census has revealed that • Inadequate access to health care
antipsychotic medication is given to more than • Rising poverty levels
two thirds of inpatients with learning • Covid Pandemic
disabilities in specialist unit • Global Economic Crisi

The Twenty-First Century: Neuroscience and Health care trends

Genetics • Diverse practice settings
• Information Systems: The Internet and • Intensive community programs
Cyberspace • Home health
- Telemedicine • Mobile crisis units
• Complementary therapies • Therapeutic foster care
- Aromatherapy • Respite car
”

 The Knowledge, skills and attitudes of the

Collaboration of nursing organizations Psychiatric/Mental Health Nurs
• Coalition of Psychiatric Nursing • THERAPEUTIC NURSE-CLIENT RELATIONSHI
• American Psychiatric Nurses Association • Physical dimensio
• International Society of Psychiatric-Mental • Safety dimensio
Health Nurses • Social dimensio
• Alliance of Psychiatric-Mental Health Nurses • Spiritual dimensio
• Association of Child and Adolescent Psychiatric • Provision of treatment modalitie
Nurse • Encouraging self-determinatio
• Provision of informatio
It takes a special form of caring to be a
psychiatric (psych), nurse. People with mental Qualities of Psychiatric Professional Nurs
health issues rely on psych nurses to manage • N - nobility, knowledg
their complex physical and emotional needs. • U - usefulness, understandin
Psych nursing is a ful lling career that offers • R - righteousness, responsibilit
variety and new challenges each day. • S - simplicity, sympath
• E - ef ciency, equanimit
Psych nurses work with children, teens, and
adults of all ages. They are skilled in treating What are the trends of psychiatric nurses
anxiety, depression, bipolar disorder, • Clear insight with high self-understanding
schizophrenia, and substance abuse, to name a (stigmatization and ethical dilemmas are high
few. in psychiatric nursing
• Psychiatric and medical-surgical nursing skills
Also known as psychiatric-mental health nurses and knowledg
(PMHNs) American Psychiatric Nurses • Good and affective communication skills (a
Association, psych nurses provide mental therapeutic relation can only be billed with
health services for individuals and affective communication
communities. They must have good • Competent, punctual, cooperative and cal
communication and relationship skills, exibility,
openness towards diverse lifestyles, and a PSYCHOBIOLOGICAL BASIS OF BEHAVIOR
strong foundation in the basic and behavioral NEUROSCIENCE: BIOLOGY AND BEHAVIO
sciences NEUROANATOMY AND NEUROPHYSIOLOG

Qualities of Mental Health Nurs The Nervous System and How it Works
• Self-awarenes The CNS:
• Self-acceptanc • Brain
• Accepting the patien • Spinal Cord
• Sincere interest on patien • Associated Nerves that control voluntary acts.
• Empathizing with patien
• Reliabilit Division of the Brain Structure:
• Professionalis • Cerebrum– Divided into 2 hemispheres.
• Accountabilit - Corpus Callosum- a pathway connecting the
• Critical thinking abilit 2 hemispheres and coordinates their
functions.

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 - LEFT H. controls the RIGHT side of the - The THALAMUS– Regulates ACTIVITY,
body and is the center for logical reasoning SENSATION and EMOTION.
and analytic functions ei. READING, - The HYPOTHALAMUS– Involved in
WRITING and MATHEMATICAL tasks. TEMPERATURE REGULATION, APPETITE
- RIGHT H. controls the LEFT side of the CONTROL, ENDOCRINE FUNCTION, SEXUAL
body and is the center for CREATIVE DRIVE, and IMPULSIVE BEHAVIOR associated
THINKING, INTUITION, and ARTISTIC with feelings of ANGER, RAGE or
abilities EXCITEMENT
- The HIPPOCAMPUS and AMYGDALA–
• Cerebellum– Located below the Cerebrum. Involved in EMOTIONAL AROUSAL and
- Center for COORDINATION OF MOVEMENTS MEMORY
and POSTURAL ADJUSTMENTS.
- RECEIVES and INTEGRATES information from Disturbances in the Limbic System have been
all areas of the body ei. The muscle, joints, implicated in a variety of Mental Illnesses, ei.
organs and other components of the CNS Memory Loss that accompanies DEMENTIA
and that of poorly controlled emotions and
• Brain Stem– Includes: midbrain, pons, and impulses manifested with PSYCHOTIC or
medulla oblongata. MANIC BEHAVIOR

• THE MEDULLA OBLONGATA– Located at the • FRONTAL LOBES.

top of the spinal cord. - Control the organization of THOUGHT, BODY
- Contains VITAL CENTERS for RESPIRATION MOVEMENT, MEMORIES, EMOTIONS and
and CARDIOVASCULAR functions MORAL BEHAVIOR.
- INTEGRATION of all this information
• THE PONS– Located above the medulla regulates AROUSAL, FOCUSES ATTENTION,
oblongata and in front of the cerebrum, and enables PROBLEM SOLVING and
bridges the gap both functionally and DECISION MAKING.
structural, as a PRIMARY MOTOR PATHWAY. - ABNORMALITIES are associated with
- Measures L: 0.8 inches (2cm), includes most SCHIZOPHRENIA, ADHD and DEMENTIA
of the RETICULAR ACTIVATING(RAS) and the -
EXTRAPYRAMIDAL system (EPS). • THE PARIETAL LOBE.
- The RAS in uences MOTOR ACTIVITY, SLEEP, - Interprets SENSATIONS of TASTE and
CONSCIOUSNESS and AWARENESS. TOUCH and assist in spatial orientation
- The EPS relays information about MOVEMENT
and COORDINATION from the brain to the • THE TEMPORAL LOBE.
spinal nerves. - Center for the senses of SMELL and
- The LOCUS CERULEUS, a small group of HEARING, and for MEMORY and
norepinephrine producing neurons in the brain EMOTIONAL EXPRESSION.
stem, is associated with STRESS, ANXIETY,
and IMPULSIVE BEHAVIOR. • THE OCCIPITAL LOBE.
- Assist in coordinating LANGUAGE
• Limbic System– Located above the brain stem, GENERATION and VISUAL INTERPRETATION,
that includes: Hypothalamus, Thalamus, such as DEPTH PERCEPTION
Amygdala, and Hippocampus.
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 THE NEURO Histamine Neuromodulator Controls

100 B approximated number of brain cells alertness,
forming groups of neurons or nerve cells, gastric
secretions,
arranged in networks.
cardiac
• Neurotransmission- a process whereby stimulations,
neurons communicates information by sending peripheral
electrochemical messages from neuron to allergic
neuron. responses.

• Neotransurmitters- chemical messengers that Acetylcholine Excitatory or Controls sleep

enables messages to cross the synapses Inhibitory and wakefulness
between neurons. cycle, signals
- Aids in transmission of information muscles to
become alert.
throughout the body.
- Either EXCITE or STIMULATE an action in
the cells (EXCITATORY) or stop an action Neuropeptides Neuromodulator Enhance, prolong,
inhibit, or limits
(INHIBITORY
the effects of
THE MAJOR NEUROTRANSMITTER principal
neurotransmitter
TYPE MECHANISM OF PHYSIOLOGIC s.
ACTION EFFECTS

Dopamine Excitatory Control complex Glutamate Excitatory Results to

movements, Neurotoxicity if
motivation, level are too
cognition, high.
regulates
Gamma- Inhibitory Modulates other
emotional
aminobutyric neurotransmitter
responses.
acid (GABA) s.
Norepinephrine Excitatory Causes changes
(Noradrenaline) in attention,
learning and
DOPAMINE.
memory, mood, • Located primarily in the brain stem.
sleep and • Excitatory and is synthesized by Tyrosine.
wakefulness. • Implicated in Schizophrenia and other
Epinephrine Excitatory Controls Fight Psychoses, as well as movement disorders ei.
(Adrenaline) and Flight Parkinson’s Disease.
response.

Serotonin Inhibitory Controls food

NOREPINEPHRINE (NORADRENALINE).
intake, sleep and • Located primarily in the brain stem.
wakefulness, • Most prevalent neurotransmitter in the
temp. regulation, nervous system.
pain control,
• Derivative epinephrine.
sexual behaviors,
regulations of
• Excess, implicated with several anxiety
emotions. disorder.
• De cit, memory loss, social withdrawal, and
depressio
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 SEROTONIN. • Drugs that increase GABA function, ei.

• NT found only in the brain. Benzodiazepines, which is used to treat
• Derived from tryptophan (a dietary aminoacid) anxiety and induce sleep
• Plays an important role in anxiety and mood
disorders and schizophrenia. Concepts and Patterns of Human Behavio
• Contributes to delusions, hallucinations and Humanistic theor
withdrawal behavior (schizo). • HUMANISM.
• Some antidepressants block serotonin • Focuses on a person’s positive qualities, his or
reuptake, leaving it effective longer in the her capacity to change (human potential), and
synapse, thus results to mood improvement. the promotion of self esteem

HISTAMINE. Maslow’s Needs Theory (1908 - 1970

• Role in mental illness still investigated. • Human needs theories propose that all
• Involved in peripheral allergic response. humans have certain basic universal needs an
• Some psychotropic drug block histamine, d that when these are not met con ict is
resulting to weight gain, sedation and likely to occur. ... Later in his life Maslow
hypotension. (1973) proposed self-transcendence as a
need above self-actualization in the hierarchy
ACETYLCHOLINE. of needs
• NT found in the brain, spinal cord and
peripheral nervous system particularly at the Basic Human Need
neuromuscular junction of the of skeletal - Personal Ful llment
muscle. - Distributive Justic
• Derived from dietary choline found in red - Cultural Securit
meat and vegetables, affecting sleep-wake - Identit
cycle and signals muscle to become active. - Freedo
• Alzheimer’s Disease have decreased - Safety and Securit
acetylcholine secreting hormone, and those - Self-estee
with Myasthenia Gravis have reduced - Participatio
acetylcholine receptors (muscle disorder - Belongingnes
whereby impulses fail to pass the myoneural
junction, thus causing muscle weakness) • 10 personal need
- Security… knowing that nancially you will
GLUTAMATE. be okay no matter what happen
• Excitatory amino acid that at high level can - Con dence… being able to press ahead with
have major neurotoxic effect. your life with a strong degree of positivity
• Implicated with brain damage caused by - Choice… not feeling trapped or on the
stroke, hypoglycemia, sustained hypoxia or treadmill of life; the ability to choose brings
ischemia, and other degenerative diseases ei. a sense of freedom
Huntington’s or Alzheimer’s. - Faith… for some it is religion and for others it
may be a strong belief in a moral code
GAMMA- AMINOBUTYRIC ACID. - Legacy… having a pride in what you have
• Major inhibitory NT in the brain. created and/or what you stand for
• Found to modulate other NTs rather than - Making a difference… in whatever you are
provision of direct stimulus. doing, helping others, not being introspective
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 - Sense of belonging/love… We need a strong • Behavior can be changed through conditioning

feeling of connection and to feel loved by with external or environmental conditions or
family and friends stimuli
- Stimulus… Something to get excited about;
hobbies and experiences being a prime BF Skinner: Operant Conditionin
example • American psychologist. Most in uential
- In uencing… being able to in uence matters behaviorist
in a positive way brings empowerment • People learn their behavior from their history
- Variety… this is so important; “all work and or past experiences, those experiences that
no play makes Jack a dull boy” as the saying were repeatedly reinforced
goe • Behavior are those observed, studied,
learned and unlearned.
Carl Rogers (1902 -1987): Client Centered • Behavior can be changed
Therap
• Humanistic American Psychologist who focused 7 principles of Operant Conditioning
on the therapeutic relationship and developed 1. All behaviors are learned.
a new method of client centered therapy 2. Consequences results from behavior –
• Was one of the rst to use client rather than reward and punishment.
the patient 3. Behaviors that is rewarded with reinforcers
• Client Centered therapy focuses on the role tends to recur.
of the patient, rather than the therapist, as 4. Positive reinforcers that follow a behavior
the key towards the healing process. increases the likelihood that the behavior
• Clients do the work of healing, Rogers will recur.
• Therapist takes person centered approach, a 5. Negative reinforcers that are removed after
supportive role, rather than directive or a behavior increase the likelihood that the
expert role behavior will recur.
6. Continuous reinforcement (reward) is the
Behavioral Theorie fastest way to increase that behavior, but
• BEHAVIORISM. Focuses on the contents and do not last long after reward ceases.
operations of the mind. 7. Random intermittent reinforcement
• A school of psychology that focuses on (occasional reward for desired behavior) is
observable behaviors and what one can do slower to produce an increase in behavior,
externally to bring about behavior changes. but behavior continues even if reward
• Behavior can be changed through a system of ceases
rewards and punishments. Eg. An adult
receiving a paycheck is motivated to work Existential Theorie
each day • Behavioral deviation results when a person is
out of touch with himself or herself or the
Ivan Pavlov Classical Conditioning (1849 - environment.
1936 • A person who is alienated feels sad, lonely
• Laboratory experiments with dogs. and feels helpless.
Salivate(response) when they see or smell • Lack of self awareness coupled with harsh
food(stimuli). Ringing of bell (new stimulus). self criticism, prevents the person from
participating in satisfying relationships.
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• Theorists believe that the person is avoiding • People have automatic thoughts that cause
personal responsibility and giving in to the them unhappiness in certain situations
wishes or demands of others
Albert Ellis’ A B C techniques
Aaron Beck (1921-): Cognitive Therap A – activate stimulus or event
• Pioneered the therapy in persons with B– the blank in the person’s mind that he or she
depression must ll in by identifying the automatic thought
• Focuses on immediate thought processing C – excessive inappropriate response
( how a person perceives or interprets his or
her existence and determines how he or she Viktor Frankl Logotherapy (1905 - 1997
feels and behaves • Beliefs on observation of people in the Nazi
• Eg.If a person interprets a situation as Concentration camps, WW2.
dangerous, he or she experiences anxiety and • Curiosity why others survived while others did
tries to escape not, concluded that survivors were able to nd
• Basic emotions of sadness, elation, anxiety, and meaning in their lives even under miserable
anger are reactions to perceptions of loss, conditions.
gain, danger, and wrongdoing by others (Beck • Logos, search for meaning
& Rush, 1995)
Cognitive Therap Frederick Perls’ Gestalt Therap
• Cognitive therapy seeks to help the patient • Emphasizes identifying the person’s feelings
overcome dif culties by identifying and and thoughts in the here and now.
changing dysfunctional thinking, behavior, and • Self awareness leads to self acceptance and
emotional responses responsibility for one’s own thoughts and
• This involves helping patients develop skills for feelings.
modifying beliefs, identifying distorted • Increase client’s self awareness by having
thinking, relating to others in different ways, them write and read letters, keep journals,
and changing behaviors. and perform other activities designed to put
• Treatment is based on collaboration between the past to rest and focus on the present.
patient and therapist and on testing beliefs. • I am I
• Therapy may consist of testing the
assumptions which one makes and identifying William Glasser Reality Therap
how certain of one's usually-unquestioned • Focuses on the person’s behavior and how that
thoughts are distorted, unrealistic and behavior keeps him from achievement of life
unhelpful. goals.
• Once those thoughts have been challenged, • Developed while working with persons with
one's feelings about the subject matter of delinquent behavior, unsuccessful school
those thoughts are more easily subject to performances and those with emotional
chang problems.
• Believed that those who are unsuccessful
Albert Ellis (1913-): Rational Emotive Therap often blame their problems on others, the
• Identi ed 11 irrational beliefs that people use system or society.
to make themselves unhappy. • Need to nd own identities through
• Eg.If I love someone, he or she should love me responsible behavior
back as much

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 Dr. William Glasse When it Present at Emerges Last system

- Born in 1925 in Cleveland, Ohi develops birth after birth to develop,
- Psychiatrist, author founded The William with early becomes
formative internalized
Glasser institut experience after the
- Developed Reality theory and Choice therap s phallic
- Thought to be one of the greatest (oedipal)
stage
educational thinkers of our tim
- Contends that behaviour in school will not
improve until we change the way we work Freud’s Level of Consciousnes
with students ● Three level of consciousnes
• Conscious: what we’re thinking about or
Mental Health Gap Action Program Overview: experiencing at any given moment
Therapeutic Models and its Relevance to • Preconscious: what we can readily call to
Nursing Practic consciousness (memories, knowledge)
• Unconscious: thoughts, desires and impulses
Sigmund Freud ‘s Psychoanalytic Model of which we’re not aware; this is the largest
Personality structur level of consciousness
• Id and Superego
- Conscious, rational part of personality, Harry Stack Sullivan’s Interpersonal Model
charged with keeping peace between (1892 - 1948
superego and i • Interpersonal theory stems from the work of
• Eg Harry Stack Sullivan, who believed that “we
- Reality principl come to treat ourselves as we have been
- Self-preservation activitie treated by our parents
• early relationships and encounters with others,
Id Ego Superego
interpersonal transactions, shape our view of
ourselves and create behavioral tendencies
What it Expresses Mediates Represents that persist over the life span
does sexual and between conscience
aggressive desires of and the
instincts the id and rules of Sullivan’s Psychotherapy Mode
demands of society; • Interpersonal relationship and Milieu therap
the follows
• Nurse focuses on the nurse-patient
superego; internalized
uses moral relationship, the vehicles through which the
defense standards patient becomes health
mechanisms
• Nurse counsel patients by developing
to ward off
unconscious
therapeutic relationshi
anxiety • Anxiety interventions is an important nursing
Hos Entirely partly Partly
rol
conscious it unconscious conscious, conscious, • Nurses use the nurse-patient relationship as a
is partly mostly corrective interpersonal experience for
unconscious unconscious
patient.
o

 Hildegarde Peplau’s Interpersonal Relationship milestones in the mental development of

in Nursing Practice childre
• Emphasized the nurse-client relationship as
the foundation of nursing practice Criticism to the Jean Piaget’s theory of
• The interpersonal model emphasizes the need Cognitive Development
for a partnership between nurse and client as • Piaget concentrated on the universal stages of
opposed to the client passively receiving Cognitive Development and biological
treatment (and the nurse passively acting out maturation. But he failed to consider the
doctor's orders). effect that the social setting and culture
• shared experience - Nurses could facilitate may have on Cognitive Development, as
this through observation, description, advocated by Vygotsky.
formulation, interpretation, validation, and • Several studies have shown that Piaget
interventio underestimated the abilities of children
because his tests were sometimes confusing or
Application of Theory to Areas in Nursing dif cult to understand.
Practice • Piaget carried out his studies with a handful
• Focuses on the interpersonal processes and of participants(i.e small sample size)and in
therapeutic relationship that develops between the early studies he generally used his own
the nurse & client. children. This sample is biased and accordingly
• It requires that the nurse attends to the the results of these studies cannot be
interpersonal processes that occur between generalized to children from different
the nurse and client. cultures
• Interpersonal process is maturing force for
personality. It includes the nurse- client Aaron Beck’s Cognitive Therapy 1921 -
relationship, communication, pattern integration • Negative thoughts, generated by dysfunctional
and the roles of the nurse. beliefs are typically the primary cause of
• Psychodynamic nursing is understanding one’s depressive symptoms.
own behavior to help others identify felt and • the more negative thoughts you experience,
perceived dif culties and to apply principles of the more depressed you will become
human relations to the problems that arise at
all levels of experience Schema
• 3 main dysfunctional belief themes (or
Jean Piaget’s Cognitive Model (1896 - 1980 "schemas") that dominate depressed people's
• Many current views in Psychology are based thinking:
upon Piaget’s theorie - I am defective or inadequate,
• The development of mental abilities occurs as - All of my experiences result in defeats or
we adapt to the changing world around u failures,
• Adaptation involves taking in, processing, - The future is hopeless.
organizing and using new information in ways
which enable us to adjust to changes in the Together, these three themes are described as
environment the Negative Cognitive Triad. When these
• Piaget provided support for the idea that beliefs are present in someone's cognition,
children think differently than adults and his depression is very likely to occur (if it has not
research identi ed several important already occurred)
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Cognitive Behavioral Theory and CB Cognitive therapy is also commonly used alone
• Cognitive Behavioral theories in treating a variety of psychological problems;
• (sometimes called "cognitive theories") are it is especially associated with the treatment
considered to be "cognitive" because they of depression and anxiety, since these
address mental events such as thinking and disorders were the primary focus of Beck’s
feeling. theory and researc
• Cognitive-Behavioral Therapy, or CBT.
• The most dominant and well research formed Stress Model
of psychotherapy available today. Hans Selye’s Stress Adaptation Syndrome
• His pioneering theories are widely used in the • INTERNAL COMPONENT
treatment of clinical depression and various - Internal component: includes neurological &
anxiety disorders. Beck also developed self- physiological responses to stress. Selye
report measures of depression and anxiety, found that when we are under stress for a
notably the Beck Depression Inventory (BDI) long time we go through three phases.
which became one of the most widely used - Alarm Reaction
instruments for measuring depression severity - Stage of Resistance
- Exhaustio
Albert Ellis’ Rational Emotive Therapy (1914
- 2007 • General Adaptation Syndrome (GAS)-
• Dr. Ellis (he had a doctorate but not a medical Reactions that help organism to be mobilized
degree) called his approach rational emotive in reaction to get through situation.
behavior therapy.
• R.E.B.T. Developed in the 1950s, it challenged • Alarm reaction: ght-or- ight reaction with
the deliberate, slow-moving methodology of various neurological / physiological responses.
Sigmund Freud, the prevailing
psychotherapeutic treatment at the time. • Stage of Resistance: arousal state. If
• Where the Freudians maintained that a situation is prolonged, the unusual high level
painstaking exploration of childhood of hormones may setup homeostasis and make
experience was critical to understanding organism vulnerable to disease.
neurosis and curing it, Dr. Ellis believed in
short-term therapy that called on patients to • Exhaustion: Bodily energy falls down -
focus on what was happening in their lives organism exhausted, may collapse.
at the moment and to take immediate action
to change their behavior. Richard Lazarus’ Interactional Model
• “Neurosis,” he said, was “just a high-class word • Emotions result from the cognitive appraisal of
for whining. a situation’s effect on personal well-being
• Cognitive psychotherapy is most associated (done automatically by mind
with the theoretical approaches developed by • All other components of emotion, including
the American psychiatrist Aaron T. Beck and physiological arousal, follow the initial
the American psychologist Albert Ellis. It is cognitive appraisa
often used in combination with behavioral • Intense emotions come from situations whose
techniques, with which it shares the primary outcomes are important to us
aim of ridding patients of their symptoms • Critics argue emotional reactions to a stimulus
rather than providing insight into the or event are virtually instantaneous—too rapid
unconscious or facilitating personal growth. to allow for the process of cognitive appraisal.

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 They suggest that we feel rst and think DISTRESS

later • Negative stress which causes mental agitation.
Prolonged exposure to negative stress can
Stress & Health: The Basic have many harmful effects on individuals. For
• Richard Lazarus (1991 example nancial troubles or heavy workload
- Cognitive Appraisal Approac
• Primary Appraisa THE DSM
- An initial evaluation of whether an event is - The Diagnostic and Statistical Manual of
- irrelevant to yo Mental Disorders, Fifth Edition is the 2013
- relevant but not threatenin (May 18, 2013) update to the Diagnostic and
- stressfu Statistical Manual of Mental Disorders, the
• Secondary Appraisa taxonomic and diagnostic tool published by
- An evaluation of your coping resources & the American Psychiatric Association
options for dealing with the stresso - The Diagnostic and Statistical Manual of
• Other factors Mental Disorders (DSM) is the handbook
used by health care professionals in the
Understanding Stres United States and much of the world as the
Psychoneuroimmunological Mod authoritative guide to the diagnosis of mental
• Psychoneuroimmunology (PNI), also called disorders. DSM contains descriptions,
psycho endo neuroimmunology (PENI), deals symptoms, and other criteria for diagnosing
with the study of the interaction between mental disorders.
psychological processes and the nervous and
immune systems of the human body.
• Until 1970, it was thought among the modern
Western medical community that immune
system function without any in uence from
any other parts or functions of body
• Dr. Robert Ader in 1975 coined the term
Psychoneuroimmunology to show that there
exists a link between the way people think
and about their health

Stress and Coping Style

Eustress & Distress
Proposed by Dr. Hans Selye are the concepts of
“Eustress” , “Distress” and the phenomenon of
“General Adaptation Syndrome”.

EUSTRESS
• Positive stress. Positive stress is a pleasant
form of stress caused by desirable stimuli.
Positive stresses enhances a persons
performance. For example : Excelling in
examination or Job promotion
.

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