MALADAPTIVE PATTERNS OF

BEHAVIOR

WILMA O. RIVADENERA, RN,MAN

Distribution of diagnosis across mental health facilities in the philippines

DISORDERS

OUT-PATIENT

FACILITIES

COMMUNITY IN-

PATIENTS

MENTAL HOSPITAL

Schizophrenia

57% 63% 71%

Mood Disorder

19% 24% 18%

Substance Abuse

8% 6% 5%

Neurotic Disorder

6% 1% 2%

Personality Disorder

3% 2% 0%

Others 7% 4% 4%

Psychiatric NursingO - Interpersonal process whereby the

professional nurse practitioner through the therapeutic use of self, * assist an individual, family, group or community to:

O 1. Promote mental health, O 2. Prevent mental illness and suffering, O 3. Participate in the treatment and

rehabilitation of the mentally ill.O • and if necessary find meaning in

these experiences.

Psychiatric Nursing

- Is both a science and an art

HEALTHOState of complete physical,

mental, and social wellness, not merely the absence of disease or infirmity…..(WHO)

Mental Health

O A state of complete physical, mental, and social wellness, not merely the absence of disease or infirmity (WHO).

Criteria:a. Satisfying interpersonal

relationship;b. Effective behavior and coping;c. Positive self – concept; andd. Emotional stability

Factors Influencing a person’s Mental Health

O Individual or personal – biologic make-up, autonomy and independence, capacity for growth, vitality, ability to find meaning in life, sense of belonging, reality orientation and coping or stress management abilities

Factors influencing a person’s Mental health

OInterpersonal, or relationship – effective communication, ability to help others, intimacy and a balance of separateness and connectedness.

OSocial/cultural, or environmental – sense of community, success to adequate resources, intolerance of violence, support of diversity among people, mastery of the environment, and a positive, yet realistic, view of one’s world

Mental IllnessO  is a mental or 

behavioral pattern or anomaly that

causes distress or disability, and which is not developmentally or socially normative…. wikipedia

Criteria to diagnose Mental Disorders

ODissatisfaction with one’s characteristics, abilities, and accomplishments;

O Ineffective or unsatisfying relationships;

ODissatisfaction with one’s place in the world;

O Ineffective coping with life events; and OLack of personal growth

Factors Individual – biologic make – up,

intolerable or unrealistic worries or fears, inability to distinguish reality from fantasy, intolerance of life’s uncertainties, a sense of disharmony in life, and a loss of meaning in one’s life.

Factors

OInterpersonal - - ineffective communication, excessive dependency on or withdrawal from relationships, no sense of belonging, inadequate social support, and loss of emotional control.

OSocial/cultural factors – lack of resources, violence, homelessness, poverty, an unwarranted negative view of the world, and discrimination such as stigma, racism, classism, ageism, and sexism

DSM-IV(DIAGNOSTIC AND STATISITCAL

MANUAL OF MENTAL DISORDERS)

Opublished by the American Psychiatric Association (APA), provides a common language and standard criteria for the classification of mental disorders.

Purposes of DSM-IV-TR

O To provide standardized nomenclature and language for all mental health professionals

O To present defining characteristics or symptoms that differentiate specific diagnoses.

O To assist in identifying the underlying causes of disorders

The DSM-IV organizes each psychiatric diagnosis into five dimensions (axes) relating to different aspects of disorder or disability:Axis I: All psychological diagnostic categories except mental retardation and personality disorderAxis II: reporting of Personality disorders and mental retardationAxis III: General medical condition; acute medical conditions and physical disordersAxis IV: Psychosocial and environmental factors contributing to the disorderAxis V: Global Assessment of Functioning or Children's Global Assessment Scale for children and teens under the age of 18

BENCHMARK IN PSYCHIATRIC NURSING

ANCIENT TIMES

- Punishments for sins and wrong doing- Viewed as either divine or demonic, depending on

their behavior 

Aristotle (383-322 BC) – relate disorders to physical disorders and his theory that amounts of blood, water and yellow and black bile in the body controlled the emotions (corresponds with happiness, calmness, anger and sadness).

O Treatment: blood-letting, starving, and purging (till 19th century)

 

Early Christian Times (1-1000 AD)

 - Mentally ill were viewed as

possessed- Tx: Priests performed exorcism.

When failed they used more severe and brutal measures such as incarceration in dungeons, flogging and starving

 

Rennaisance (1300-1600)  

- Distinguished from criminals 

1547 – Hospital of St. Mary of Bethlehem was officially declared as hospital for the insane.

  1775 – Charged for a fee for a privilege of

viewing and ridiculing the inmates who were seen as animal rather than human.

Benchmark Period in Psychiatric History

PERIOD KEY PEOPLE OR

DEVELOPMENTS

SIGNIFICANT CHANGE IN THINKING

RESULT/S

Enlightenment , - 1790

• Philippe Pinel (1745- 1826)

• William Tuke (1732 – 1822)

• Insane no longer treated as less than human

• Human dignity upheld

• Asylum move ment developed

“ To consider madness incurable…is constantly refuted by the most authentic facts”

Philippe Pinel, Dec. 11, 1794

Asylum (Sanctuary)

O Dorothea

DixO (1802-1887)- one of

the first major reformers in the United States, was instrumental in developing the concept of asylum.

sPERIOD KEY PEOPLE OR

DEVELOPMENTSSIGNIFICANT CHANGE IN THINKING

RESULT/S

Scientific Study(1870’s)

• Sigmund Freud (1856-1939) – emphasized the importance of early life experiences; studied the mind, its disorders and their treatment

• Emil Kraepelin (1856 – 1926)- Studied the brain; classify mental illness according to their symptoms

• Eugene Bleuler (1857 – 1939); was optimistic about treatment; coined the term Schizophrenia

• Mental Illness could be studied

• Study of the mind and treatment approaches to psychiatric conditions flourished

• Decade of the brain can be traced back to Kraepelin’s thinking.

gPERIOD KEY PEOPLE OR DEVELOPMENTS

SIGNIFICANT CHANGE IN THINKING

RESULT/S

Psychotropic Drugs – 1950’s

• Lithium (1949)

• First antipsychotic (1950)

• Monoamine oxidase inhibitors (MAOI’s) 1952

• Haloperidol (1957)

• Tricyclic antidepressants (TCAs) 1958

• Benzodiazepines (1960)

• If some mental disorders are caused by chemical imbalances then chemicals could restore the balance; people would no longer need to be confined

• A destigmatization of mental illness occurred; parents and others not blame; term least restrictive environment evolved from this discovery

PERIOD KEY PEOPLE OR DEVELOPMENTS

SIGNIFICANT CHANGE IN THINKING

RESULT/S

Community Mental Health , 1960s

Community Mental Health Centers Act (1963)

Individuals do not need to be hospitalized away from family and community, people have the right to be treated in their own community

Advantage: Intervention in familiar sorroundings has helped many people, is less expensive

• Disadvantages:

Homelessness linked to disinstitutionalization; many people “slip through the cracks” of the system

PERIOD KEY PEOPLE OR

DEVELOPMENTS

SIGNIFICANT CHANGE

IN THINKING

RESULT/S

Decade of the Brain

• Congressional Mandate

• If we can understand the brain, we can help millions of people suffering from mental disorders.

• An increase in funding for brain research lead to new treatment strategies; has increased our understanding of mental disorders

Six Major Periods of Mental Ilness Treatment in Philippine History

1. Pre-Spanish Regime- During this period, believed in a world that is equally material and spiritual.- Relied on healers called babylan

(shaman) and sorcerer healing. - Rituals and ceremonies

2. Spanish Rule- Filipinos accepted that mental illness

was caused by an act of sorcery (mangkukulam or witches and manggagaway or the devil men)

Treatment: - Herbmen (herbolarios)- Brought to church for exorcism or

ritual cleaning

Early Nineteenth Century- Organized care and treatment for

individuals with mental illness was established at the Hospicio de San Jose

- Spanish naval authorities requested for a place of confinement for their mentally ill sailors.

The American Era- Two Americans provided treatment

for mentally ill patients of the Civil Hospitals located in Calle Iris (now known as Claro M Recto Avenue)

- In 1904, the insane department was opened at the San Lazaro Hospital.

- The first physician to attain formal training in psychiatry in the US is Dr. Elias Domingo.

Japanese Occupation- World War II- National Psychopathic Hospital

continued to operate- The Japanese Army donated an

electroshock apparatus to the hospital.

The Liberation Period and the Era of the Republic- The National Psychopathic Hospital was renamed National Mental Hospital, with Dr. Jose A. Fernandez designated as officer in charge from Oct 1946 to April 1961

Present Day Psychiatry

OThe use of SOMATIC Therapies became most popular.

Psychiatric Nursing Education: THREE FIRSTS Linda Richard – the first American

Psychiatric NurseNursing Mental Disease – the first

psychiatric nursing book wrote by Harriet Bailey

Hildegard Peplau – first psychiatric nursing theorist

Development of Psychiatric Education in the Philippines

An Outline of Psychiatric Nursing – the first textbook wrote by Jesusa Bagan Lara in 1973

Nenita Yasay-Davadilla – the first psychiatric nurse to be sent abroad to obtain MSN under WHO scholarship program.

Magda Carolina Go Vera Llamanzares – first Filipino child psychiatric nurse

Sotera Capellan – the first chief nurse of a Mental Hospital

Role of Mental Health Nurse

Ward manager- creates a therapeutic environment

Socializing agent- assists the patient to feel comfortable with others

Counselor- Listens to the patient’s verbalization

Parent surrogate- assists the patient in the performance of ADL

Role Patient advocate- enables the

patient and his relatives to know their rights and responsibilities

Teacher- assists the patient to learn more adaptive ways of coping

Technician- facilitates the performance of nursing procedures

Role Therapist- explores the patient’s

needs, problems and concerns through varied therapeutic means.

Reality base- enables the patient to distinguish objective reality and subjective reality.

Healthy role model-acts as a symbol of health by serving as an example of healthful living.

Stranger- Offering the client the same acceptance and courtesy that the nurse would do to any strangers.

Essential Qualities Empathy – ability to see beyond outward

behavior and sense accurately another person’s inner experiencing.

Genuineness- ability to use therapeutic tools appropriately.

Unconditional positive regard - respect

Decision Tree for Continuum of

Care

Continuum of Care

O A complete range of programs and services that treats the whole person from wellness to illness to recovery within the community

Green and Lyndon, 1998

Decision Tree for Continuum of Care

Parameters in Decision Tree

O Safety requirementsO Intensity of supervision neededO Severity of symptomsO Level of functioningO Type of treatment needed