NCM 117J

(MALADAPTIVE
PATTERN OF BEHAVIOR)
OVERVIEW OF PSYCHIATRIC MENTAL HEALTH NU RSIN G
MODULE 1/7

PREPARED BY:
MARY RUTH V. ENRIQUEZ, RN MAN
 EVOLUTION OF PSYCHIATRIC MENTAL
HEALTH NURSING PRACTICE
Ancient Times:
Believed that any sickness indicated displeasure of the Gods.
Punishment for sins and wrongdoing.
Those with mental disorders were viewed as being either Divine or Demonic, depending on their behavior.
Individual seen as divine were worshipped and adored;
Those seen as demonic were ostracized, punished and burned at the stake.
Insanity was associated with demonic possession
Healer extract unseen spirits through rituals using herbs, ointments and precious stones
Mental illness perceived as incurable, and treatment of the insane was sometimes inhuman and brutal.
 Aristotle (322-382 BC):
Attempted to relate mental disorders to physical disorders, and developed
his Theory that amount of blood, water, yellow and black bile in the body
controlled the emotions.
These four substances, Humors corresponded with happiness, calmness,
anger, and sadness. Imbalances of the four humors were believed to cause
mental disorders.
Treatment : was aimed @ restoring balance through blood letting, starving
and purging. Such treatment persisted well into the 19th century.
Early Christian Times (1- 1000 AD):
Primitive belief and Superstitions were strong, all diseases were
again blamed on demons, and the mentally ill were viewed as
possessed.
Priests performed exorcisms to rid evil spirits. When that failed,
they used more severe and brutal measures, such as incarceration
in dungeons, flogging and starving.
The renaissance (1300-1600 century):
People with mentally illness were
distinguish from criminals in England.
Those considered harmless were allowed
to wander the countryside or live in rural
communities, but the more “dangerous
lunatics” were thrown in prison, chained
and starve.
1547: the hospital of St. Mary of Bethlehem was officially declared a hospital for the insane, the
first of its kind.

1775: visitors at the institution were charged a fee for the privilege of viewing and ridiculing the
inmates, who were seen as animals, less than human

During the same period in the Colonies (later the U.S), the mentally ill were
considered evil or possessed and were punished. Witch hunts were conducted, and offenders were
burned at the stake.
Period of Enlightenment and Creation
of Mental Institutions:
1790’s, a period of enlightenment concerning persons with mental illness
began.
Philippe Pinel in France and William Tukes in England formulated the
Concept of Asylum
The period of enlightenment was short-lived. Within 100 years after
establishment of the First Asylum, state hospitals were in trouble. Attendants were
accused of abusing the residents, the rural locations of the hospitals were viewed
as isolating patients from their families and homes, and the phase INSANE ASYLUM
took on a negative connotation.
Concept of Asylum: a safe refuge or haven offering protection at institutions, where
people had been whipped, beaten and starved just because they were mentally ill. With this
movement began the moral treatment of the mentally ill.

Dorothea Dix in U.S (1802- 1887), began a Crusade to reform the treatment of Mental Illness
after a visit to Tukes in England. She was instrumental in opening 32 State Hospitals that offered
Asylum to the suffering.
Dix believed that society was obligated to those who were mentally ill and promoted adequate
shelter, nutritious food, and warm clothing.
The Period of Scientific Study and
Treatment of Mental Disorders: began with
Sigmund Freud (1856-1939) and others, such as Emil Kraepelin (1856-
1926) and Eugene Bleuler (1857- 1939).
The Study of Psychiatry and the Diagnosis and Treatment of mental
illness started in earnest.
Freud challenge society to view human beings objectively. He
studied the mind, its disorders, and their treatment as no one had
before. Many other theorists built on Freud’s pioneering work.
Kraepelin began classifying mental disorders according to their
symptoms.
Bleuler, coined the term SCHIZOPPRENIA.
Development of Psychopharmacology:
1950 = a great leap in the treatment of mental illness
began with the development of Psychotropic drugs, or drugs
used to treat mental illness.
CHLORPROMAZINE (THORAZINE) = an
antipsychotic drug.
LITHIUM = an antimanic agent, were the first drugs to be
developed.
After 10 years = several psychotropic drugs developed.
MONOAMINE OXIDASE INHIBITOR(MAO INHIBITOR) = antidepressants

HALOPERIDOL (HALDOL) =an antipsychotic

TRICYCLIC = an antidepressants
BENZODIAZEPINES = antianxiety
 With these drugs it reduce agitation,
 Psychotic thinking and depression.
Hospital stays were shortened and
well enough to go home.
 The level of noise, chaos and violence
Greatly diminished in the hospital setting
Community Mental Health
In 1963 = the movement treating those with mental illness in less restrictive environments.
With the enactment of the Community Mental Health Centers Act. Through this
enactment they create the DEINSTITUTIONAL
DEINSTITUTIONAL: a deliberate shift from institutional care in a state hospital to community
facilities.
Function: Community Mental Health Center - it served smaller geographic catchment, or service,
areas that provided less restrictive treatment located closer to individuals homes, families, and
friends.
These centers provided: emergency care, inpatient care, outpatient service, partial hospitalization,
screening services, and education.
Deinstitutionalization, accomplished the release of individual from long-term stays in state
institutions, the decrease in admissions to hospitals and the development of community-based
services as an alternatives to hospital care.
DEINSTITUTIONAL
Revolving Door Effect
Positive effects of deinstitutionalization: it reduced the
number of public hospital beds by 80%, the number of
admissions to those beds correspondingly, increased by
90%; such findings have led to the term “REVOLVING
DOOR EFFECT”
Revolving Door Effect = repeated hospital
admissions.
People with severe and persistent mental illness may
show signs of improvement in a few days but are not
stabilized. Thus, they are discharged into the community
without being able to cope with community living.
MENTAL HEALTH AND MENTAL
ILLNESS
 Mental Health
Mental Health : a state of emotional, psychological, and
social wellness evidenced by satisfying relationships,
effective behavior and coping, positive self- concept, and
emotional stability.
3 FACTORS INFLUENCING A
PERSON’S MENTAL HEALTH:

INDIVIDUAL
INTERPERSONAL
SOCIAL /CULTURAL
INDIVIDUAL or Personal
factors include a person’s biologic make-
up, autonomy and independence, self-
esteem, capacity for growth, vitality, ability
to find meaning in life, emotional
resilience or hardiness, sense of belonging,
reality orientation, and coping or stress
management abilities.
INTERPERSONAL or
relationship
factors include effective communication, ability
to help others, intimacy, and balance of
separateness and connectedness.
SOCIAL/CULTURAL, or
Environmental
factors include a sense of community, access or 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 Illness /Mental Disorder, (American
Psychiatric Association(APA), 2000)
Defined by DSM-IV-TR (Diagnostic and Statistical of Manual of Mental
Disorder 4th edition, Text Revision)
 as a clinically significant behavioral or psychological syndrome or
pattern that occurs in an individual and that is associated with present
distress (e.g. a painful symptom) or disability ( impairment in one or
more important areas of functioning) or with a significantly increased
risk of suffering death, pain, disability, or an important loss of freedom.
General Criteria to diagnose Mental Disorders include:
Dissatisfaction with one’s characteristics, abilities, and
accomplishments
Ineffective or unsatisfying relationships
Dissatisfaction with one’s place in the world
Ineffective coping with life events
Lack personal growth
Deviant (error/ wrong doings) behavior does not necessarily
indicate a mental disorders
Factors Contributing to Mental
Illness:
Individual factors
Interpersonal factors
Social/cultural factors
INDIVIDUAL FACTORS:
Biologic make-up
Intolerable or unrealistic worries or fears
Inability to distinguish reality from fantasy
Intolerance of life’s uncertainties
Loss of meaning in one’s life
INTERPERSONAL FACTORS:
Ineffective communication
Excessive dependency on or
withdrawal from relationships
No sense of belonging
Inadequate social support
Loss of emotional control
SOCIAL/CULTURAL FACTORS:
Lack of resources
Violence
Homeless
Poverty
Unwarranted negative view of the world
Discrimination such as stigma (social
unacceptable), racism, classism, ageism,
and sexism.
 Multiaxial Classification System:
Involves assessment on a several axes, or domains of information, allows the practitioner to
identify all the factors that relate to a person’s condition.

4 Classification of Multiaxial:
AXIS I: is for identifying all major psychiatric disorders except Mental Retardation and
Personality disorders.
Ex. Depression, schizophrenia, anxiety, and substance abuse.
AXIS II: is for reporting Mental Retardation and personality disorders as well as prominent
maladaptive personality features and defense mechanism.
Ex. Childhood personality disorders, paranoid personality disorder, antisocial personality
disorder.
 Classification of Multiaxial:
AXIS III : is reporting for current Medical Conditions that are potentially relevant to understanding or managing the
person’s mental disorder as well as medical conditions that might contribute to understanding the person.
AXIS IV: reporting psychosocial and environmental problems that may affect the diagnosis, treatment, and prognosis of
mental disorders.
Includes: problem with the primary support group
The social environment
Education
Occupation
Housing
economics
Access to health care, and the legal system.
Ex. Crisis level
 Classification of Multiaxial:
AXIS V: presents a Global Assessment of functioning, which rates the person’s overall
psychological functioning on a scale of 0 to 100.
This represents the clinician’s assessment of the person’s current level of functioning; the clinician
also may give a score for prior functioning
Ex. Highest Global Assessment of Functioning in past year or 6 months ago.
All clients admitted to a hospital for Psychiatric treatment will have a Multiaxis diagnosis from the
DSM-IV-TR.
Although student nurses do not use DSM-IV-TR to diagnose client , they will find it a helpful
resources to understand the reason for the admission and to begin building knowledge about the
nature of psychiatric illness.
The Mental Health Nurse’s Role
1. Creator of a Therapeutic environment/ Milieu: the nurse provides the
opportunities for clients to experience acceptance in social relationship.
2. Social agent: the nurse helps individuals or group to plan and participate in parties.
The nurse helps clients participate successfully in group activities.
3. Counselor: when clients need someone to listen with understanding and sympathy
while they talk about troublesome problems. EMPATHIC LISTENING.
4. Teacher: the nurse helps clients learn to function in more socially acceptable ways. ex.
Helps a client learn new game, dance steps or song.
5. Mother Surrogate/Parent Surrogate: the nurse gives emotional support and
understanding or when she performs a mothering activity such as feeding a client.
The Mental Health Nurse’s Role
6. Technical Nursing Role/Technician: the traditional role of the
nurse includes those technical aspects involved in pouring and administering
medications, carrying out medical and surgical treatments, observing and
recording client behavior, and taking vital signs.
7. The Nurse as Therapist: the role of the nurse therapist is carefully
explained to all levels of the professional staff and to all clients in the clinical
situation.
The nurse works collaboratively with other Mental Health Professionals in
the situation and confers regularly with those responsible for developing the
treatment plans for the client with whom she is working.
The Mental Health Nurse’s Role
8. Ward Manager: delegates nursing activities to ancillary workers and other nurses, and
supervises and evaluate their performance.
Coordinate the client’s activities
Determine staffing
Sees adequate supplies, cleanliness and orderliness in the ward.
9. Researcher: nurses often use research to improve client care.
Research based on theory
Improve practice and quality care
Evidence base ( techniques)
Essential Qualities of an Effective
Psychiatric Nurse:
1.Respect for Client:
Taking the time and energy to listen
Giving privacy during treatment and examination
Allows client to make choices, do not humiliate them
Being honest about to stay
2. Availability:
Creating a nurturing healing milieu
Assisting suffering clients to meet their basic human needs
Essential Qualities of an Effective
Psychiatric Nurse:
4. Spontaneity: being natural and care for individual differences.
5. Hope: client have the capacity for growth and change.
6. Accepting: means refraining from judging and rejecting a client
7. Vision of the profession: sense of purpose, openness to gratifying, experience,
mastery.
8. Accountability: professional integrity that the will have the best problem resolving
assistance possible.
Interdisciplinary Team
Regardless of the treatment setting, rehabilitation program, or population, an interdisciplinary
(multidisciplinary) team approach is most useful in dealing with multifaceted problems of
clients with mental illness.
Different members of the interdisciplinary team include:
1. Pharmacist :the registered pharmacist is a member of the interdisciplinary team when
medications, management of side effects, and/or interactions with nonpsychiatric medication
are complex. Clients with refractory symptoms may also benefit from the pharmacist’s
knowledge of chemical structure and actions of medications.
Interdisciplinary Team
2. Psychiatrist : is a physician certified in psychiatry by the American Board of Psychiatry
and Neurology.
Which requires a 3 year residency.
2 years of clinical practice, and completion of an examination
The primary function of psychiatrist is diagnosis of mental disorders and prescription of
medication treatments.

3. Psychologist : the clinical psychologist has a doctorate (Ph.D) in clinical psychology

and is prepared to practice therapy, conduct research, and interpret psychological tests.
May also participate in the design of therapy programs for groups of individuals.
Interdisciplinary Team
4. Psychiatric Nurse : the registered nurse gains experience in working with clients
with psychiatric disorders after graduation from accredited program of nursing and
completion of the licensure examination.
The nurse has a solid foundation in health promotion, illness prevention, and rehabilitation in
all areas, allowing him or her to view the client holistically.
The nurse is also an essential team member in evaluating the effectiveness of medical
treatment, particularly medications.
Registered Nurses who obtain Master’s degrees in Mental Health may be certified as Clinical
Specialists or licensed as advanced practitioners, depending on individual State Nurse Practice
Acts.
Advanced Practice Nurses are certified to prescribed drugs in many states.
Interdisciplinary Team
5. Psychiatric Social Worker: are prepared at the Master’s level, and they are
licensed in some states.
Social workers may practice therapy and often have the primary responsibility for working
with families, community support, and referral.
6. Occupational Therapist: may have an Associate degree ( Certified Occupational
Therapy Assistant) or a Baccalaureate degree (Certified Occupational Therapist).
Occupational therapy focuses on the functional abilities of the client and ways to improve
client functioning, such as working with arts and crafts and focusing on psychomotor skills.
Interdisciplinary Team
7. Recreational Therapist: complete a baccalaureate degree, but in some instances
persons with experience fulfill these roles.
The recreation therapist helps the client to achieve a balance of work and play in his or her life
and provides activities that promote constructive use of leisure or unstructured time.
8. Vocational Rehabilitation Specialist : includes determining client’s interest and
abilities and matching them with vocational choices.
Clients are also assisted in job-seeking and job-retention skills as well as in pursuit of further
education, if that is needed and desired.
Can be prepared at the baccalaureate or master’s level and may have different levels of
autonomy and program supervision based on their education.