Presented by: Dave Jay S. Manriquez, RN. PSYCHIATRIC NURSING Introduction • MENTAL HEALTH – balance in a persons internal life and adaptation to reality • Mental ILL Health – state of imbalance characterized by a disturbance in a persons thoughts, feelings and behavior Psychiatric nursing • interpersonal process whereby the professional nurse practitioner ,through the therapeutic use of self (art) and nursing theories (science), assist clients to achieve psychosocial well being. • Core : interpersonal process Related Terms • Mental hygiene – measures to promote mental health , prevent mental illness and suffering and facilitate rehabilitation – Main tool: therapeutic use of self – It requires self-awareness • Methods to increase self-awareness: – Introspection – Discussion – Experience – Role play • Assessment (psychosocial processes ) – Appearance , behavior or mood – Speech , thought content and thought process – Sensorium – Insight and judgment – Family relationships and work habits – Level of growth and development Common Behavioral Signs and Symptoms Disturbances in perception • Illusion – misinterpretation of an actual external stimuli • Hallucinations – false sensory perception in the absence of external stimuli Disturbances in thinking and speech • neologism – coining of words that people do not understand • Circumstantiality – over inclusion of inappropriate thoughts and details • Word salad – incoherent mixture of words and phrases with no logical sequence • Verbigeration – meaningless repetition of words and phrases • Perseveration – persistence of a response to a previous question • Echolalia – pathological repetition of words of others • Aphasia – speech difficulty and disturbance – Expressive , receptive or global • Flight of ideas- shifting of one topic from one subject to another in a somewhat related way • Looseness of association-incoherent illogical flow of thoughts (unrelated way) • Clang association – sound of word gives direction to the flow of thought • Delusion – persistent false belief, rigidly held – Delusions of grandeur: special /important in a way – Persecutory: threatened – Ideas of reference: situation/events involve them – Somatic: body reacting in a particular way – Jealous: thinking that their partner is unfaithful – Erotomanic: person, usually of high status, is in love with the client – Religious: illogical ideas about God and religion exhibited by extreme or extraneous behavior – Mixed: combination of above without a predominant theme • Magical thinking – primitive thought process thoughts alone can change events • Autistic thinking – regressive thought process; subjective interpretations not validated with objective reality • Dereism – unorganized thinking Disturbances of affect • Inappropriate – disharmony between the stimuli and the emotional reaction • Blunted affect – severe reduction in emotional reaction • Flat affect – absence or near absence of emotional reaction • Apathy – dulled emotional tone • Depersonalization – feeling of strangeness from one’s self • Derealization – feeling of strangeness towards environment • Agnosia – lack of sensory stimuli integration Disturbances in motor activity • Echopraxia – imitation of posture of others • Waxy flexibility – maintaining position for a long period of time • Ataxia – loss of balance • Akathesia – extreme restlessness • Dystonia- uncoordinated spastic movements of the body • Tardive dyskinesia – involuntary twitching or muscle movements • Apraxia – involuntary unpurposeful movements Disturbances in memory • Confabulation – filling of memory gaps • Déjà vu – something unfamiliar seems familiar • Jamais vu- something familiar seems unfamiliar • Amnesia – memory loss (inability to recall past events) – Retrograde-distant past – Anterograde – immediate past – Anomia – lack of memory of items Dynamics of Human Behavior • Behavior – the way an individual reacts to a certain stimulus • Conflict – situation arising from the presence of two opposing drives • Need - organismic condition that requires a certain activity Dynamics of Human Behavior • Personality – totality of emotional and behavioral traits that characterize the person in day to day living under ordinary conditions; it is relatively stable and predictable. FORMATION OF PERSONALITY • TEMPERAMENT – biological-genetic template that interacts with our environment. – a set of in-built dispositions we are born with – mostly unalterable – our nature. • CHARACTER – the outcome of the process of socialization, the acts and imprints of our environment and nurture on our psyche during the formative years (0-6 years and in adolescence). – the set of all acquired characteristics we posses, often judged in a cultural-social context. • Sometimes the interplay of all these factors results in an abnormal personality THEORIES OF PERSONALITY DEVELOPMENT Freud’s PSYCHOSEXUAL THEORY • Libido – inner drive • Parts of body –focus of gratification • Unsuccessful resolution - fixation • Structures of personality – Id: pleasure principle-instinct – Ego: controls action and perception –reality principle – Superego: moral behavior - conscience • 0-18 m0s ;oral – mouth – trust and discriminating • 18 mos. – 3 years ; anal – bowels – holding on or letting go – Negativism and toilet training age • 3 -6 years phallic ; genitals –exploration and discovery ( inc. sexual tension) – Gender identification and genital awareness – Oedipus and Electra complex – Castration anxiety and penis envy • 6-12 years – latency (quiet stage) sexual energy diverted to play. Institution of superego: control of instinctual impulses • 12 – young adult – genital ; reawakening of sexual drives –relationships – Sexual maturation – Sexual identity ,ability to love and work Eric Erickson’s PSYCHOSOCIAL THEORY • 0-12mos • 1-3y • 3-6 • 6-12 • 12-18 • 18-25 • 25-60 • 60 and above • TRUST vs. MISTRUST • AUTONOMY vs. SHAME & DOUBT • INDUSTRY vs. INFERIORITY • INITIATIVE vs. GUILT • IDENTITY vs. IDENTITY CONFUSION • INTIMACY vs. ISOLATION • EGO INTEGRITY vs. STAGNATION • GENERATIVITY vs. DESPAIR INFANCY • CONSISTENT MATERNAL –CHILD INTERACTION – TRUST • INNER FEELING OF SELF WORTH • HOPE TODDLER • ALLOW EXPLORATION • PROVIDE FOR SAFETY • “NO, NO” – NEGATIVISM • OFFER CHOICES / REVERSE PSYCHOLOGY • TOILET TRAINING – 18 MOS.-BOWEL – DAYTIME BLADDER: 2 yo – NIGHTIME BLADDER: 3 yo • REWARD W/ PRAISE AND AFFECTION • INDEPENDENCE PRE-SCHOOL • PROVIDE PLAY MATERIALS • SATISFY CURIOSITY • TEACH AND REINFORCE(HYGIENE,SOCIAL BEHAVIOR) • SIBLING RIVALRY • WILLPOWER SCHOOL AGE • HOW TO DO THINGS WELL-SUPPORT EFFORTS • CHUMS AND HOBBIES • NEEDS TO EXCEL/ACCOMPLISH • NEED FOR PRIVACY AND PEER INTERACTION • COMPETENCE ADOLESCENCE • MAKE DECISION,EMANCIPATION FROM PARENTS • BODY IMAGE CHANGES • NEED TO CONFORM BUT KEEP INDIVIDUALITY • SELF - AWARENESS YOUNG ADULT • COMMITMENT AND FIDELITY • RESPONSIBILITY • ACHIEVEMENT OF INDEPENDENCE MIDDLE ADULTHOOD • SUPPORT-PERIOD OF ROLE TRANSITIONS • MIDLIFE CRISIS • ADJUSTMENT AND COMPROMISE • MOST PRODUCTIVE AND CREATIVE • ALTRUISM LATE ADULTHOOD • SELF ACCEPTANCE • SELF WORTH • WISDOM Jean Piaget’s COGNITIVE THEORY 0-2 SENSORIMOTOR • REFLEXES • IMITATIVE REPETITIVE BEHAVIOR • SENSE OF OBJECT PERMANENCE AND SELF SEPARATE FROM ENVT. • TRIAL AND ERROR RESULTS IN PROBLEM SOLVING 2-7Y PRE-OPERATIONAL • SELF-CENTERED,EGOCENTRIC • CANNOT CONCEPTUALIZE OTHER’S VIEW • ANIMISTIC THINKING • IMAGINARY PLAYMATE – SYMBOLIC MENTAL REPRESENTATION – CREATIVITY • 2-4 PRE-CONCEPTUAL (PRE-LOGICAL) • 4-7 INTUITIVE (UNDERSTANDING OF ROLES) 7-12Y CONCRETE OPERATIONAL • LOGICAL CONCRETE THOUGHT • INDUCTIVE REASONING (SPECIFIC TO GENERAL) • CAN RELATE, PROBLEM SOLVING ABILITY • REASONING AND SELF-REGULATION 12-ABOVE: FORMAL OPERATIONAL THOUGHT • Abstract thinking • Separation of fantasy and fact • Reality oriented • Deductive reasoning • Apply scientific method Havighurst’s DEVELOPMENTAL TASKS • Baby to early childhood – Right from wrong and Conscience • Late childhood – Physical skills, wholesome attitude, social roles – Conscience morality and values – Fundamental skills in academics – Personal independence • Adolescence – Sexual social roles – Relationships – Independence and ideology • Early adulthood – Career – Selecting a mate – Finding Civic or social responsibility • Middle age – Achieving Civic or social responsibility – Adjusting to changes – Satisfactory career performance – Adjusting to aging parents – Adjusting to parental roles • Old age – Adjusting to changes – Establishing satisfactory living arrangements and affiliations Kohlberg’s MORAL DEVELOPMENT/ THINKING/ JUDGEMENT • PRE-CONVENTIONAL (0-6) – PUNISHMENT AND OBEDIENCE – OBEDIENCE TO RULES TO AVOID PUNISHMENT • CONVENTIONAL ( 6-12 ) – MUTUAL INTERPERSONAL EXPECTATIONS,RELATIONSHIPS AND CONFORMITY – SOCIAL SYSTEM AND CONSCIENCE MAINTENANCE – BEING GOOD IS IMPORTANT SELF RESPECT OR CONSCIENCE • POST –CONVENTIONAL (12 – 18 Y) – PRIOR RIGHT OR SOCIAL CONTRACT – UNIVERSAL ETHICAL PRINCIPLE – ABIDE FOR COMMON GOOD – RATIONAL PERSON-VALIDITY OF PRINCIPLES-AND BECOME COMMITTED TO THEM – INNER CONTROL OF BEHAVIOR UNDERSTANDING THE EQUALITY OF HUMAN RIGHTS AND DIGNITY OF HUMAN BEINGS AS INDIVIDUALS Harry Stack Sullivan’s INTERPERSONAL THEORY INFANCY • NEED FOR SECURITY-INFANT LEARNS TO RELY ON OTHERS TO GRATIFY NEEDS AND SATISFY WISHES, DEVELOPS A SENSE OF BASIC TRUST, SECURITY AND SELF WORTH WHEN THIS OCCURS TODDLERHOOD / EARLY CHILDHOOD • CHILD LEARNS TO COMMUNICATE NEEDS THROUGH USE OF WORDS AND ACCEPTANCE OF DELAYED GRATIFICATION AND INTERFERENCE OF WISH FULFILLMENT PRE-SCHOOL • DEVELOPMENT OF BODY IMAGE AND SELF-PERCEPTION • ORGANIZES AND USES EXPERIENCES IN TERMS OF APPROVAL AND DISAPPROVAL RECEIVED • BEGINS USING SELCTIVE INATTENTION AND DISASSOCIATES THOSE EXPERIENCES THAT CAUSE PHYSICAL OR EMOTIONAL DISCOMFORT AND PAIN SCHOOL AGE • THE PERIOD OF LEARNING TO FORM SATISFYING RELATIONSHIPS WITH PEERS-USES COMPETITION,COMPROMISE AND COOPERATION • THE PRE-ADOLESCENT LEARNS TO RELATE TO PEERS OF THE SAME SEX ADOLESCENCE • LEARNS INDEPENDENCE AND HOW TO ESTABLISH SATISFACTORY RELATIONSHIPS WITH MEMBERS OF THE OPPOSITE SEX YOUNG ADULTHOOD • BECOMES ECONOMICALLY, INTELLECTUALLY AND EMOTIONALLY SELF SUFICIENT LATER ADULTHOOD • LEARNS TO BE INTERDEPENDENT AND ASSUMES RESPONSIBILITY FOR OTHERS SENESCENCE • DEVELOPS AN ACCEPTANCE OF RESPONSIBILITY FOR WHAT LIFE IS AND WAS AND OF ITS PLACE IN THE FLOW OF HISTORY TREATMENT MODALITIES REMOTIVATION THERAPY • TREATMENT MODALITY THAT PROMOTES EXPRESSION OF FEELINGS THROUGH INTERACTION FACILITATED BY DISCUSSION OF NEUTRAL TOPICS • STEPS : climate of acceptance creating bridge to reality sharing the world we live in appreciation of works of the world climate of appreciation MUSIC THERAPY • Involves use of music to facilitate expression of feelings, relaxation and outlet of tension PLAY THERAPY • enables patient to experience intense emotion in a safe environment with the use of play • children express themselves more easily in play. revealing as reflection of child’s situation in the family • provide toys and materials – facilitate interaction – observe and help child resolve problems through play Group therapy • Treatment modality involving three or more patients with a therapist to relieve emotional difficulties, increase self – esteem, develop insight , LEARN NEW ADAPTIVE WAYS TO COPE WITH STRESS and improve behavior with others