Chapter 01 Mental Health and Mental Illness Copyright

Chapter 01 Mental Health and Mental Illness Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Mental Health Defined • Complete state of health when physical, mental, and social well-being are intact • Mentally healthy have the ability to adapt to stressors in an acceptable way • A “state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community” (NIMH, 2004) Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Mental Illness Defined • DSM-IV-TR: “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)” • Unable to carry out daily necessities (cooking, bathing, dressing, etc. ) Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Cultural, Ethnic, and Religious Influences • Cultures provide variances in perceiving, coping with, and managing mental health issues • Examples – Turn to faith healers – Deny that a problem exists – View symptoms as punishment for wrongdoing • What makes up a culture? Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Culture • Common heritage and a set of beliefs, norms, values, and behaviors that are unique to each • Cultural identity – Common language – Family customs – Country of origin – Religious and political beliefs – Sexual orientation – Gender Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Other Beliefs • Mental symptoms are related to: witchcraft, demon possessions, or substance abuse – Can be eliminated by remedies such as folk customs, magic, traditional medicines, herbs Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Defining Stress • A condition that results when a threat or challenge to our well-being requires us to adapt or make an adjustment – Distress • Response to a threat or challenge – harmful to one’s health – Eustress • Positive and motivating, shows confidence in the ability to master a challenge or stressor – “Fight or flight” response Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Fight-or-Flight Response • Surge of adrenal hormone epinephrine or adrenalin into the bloodstream. • Provides energy or instant strength to either fight or run away from a danger or threat • Usually reversed to relaxation when the danger has past Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Common Signs & Symptoms of Stress • Physical Symptoms – ^ HR, BP, Resp, palpitations, Abdominal Cramping, N/V, Diarrhea, Headaches, Insomnia • Mental Symptoms – Lack of concentration and memory, inability to make decisions, forgetfulness, confusion • Emotional Symptoms – Anxiety, Nervousness, Irritability, Frustration and worry • Behavioral Symptoms – Fidgeting, Nail-biting, Smoking/Drinking, Yelling, Violence Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Defining Anxiety • Built-in response to a real or perceived threat to our wellbeing • A feeling of apprehension, uneasiness, or uncertainty that occurs in response to a real or perceived threat of an unknown source • Four levels Pg. 6 Table 1. 3 – Mild - Motivated – Moderate – Decreased Attentiveness – Severe – Loses sight of whole picture – Panic – Unaware of reality Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Contributing Factors to Stress and Anxiety • External stressors Pg. 7 Box 1. 2 – Adverse aspects of the environment – Abusive relationship, poverty-level living conditions • Internal stressors – Physical • Chronic illness or terminal condition – Psychological • Continued worry about financial burdens or disasters Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Effect of Stress on Self • Continued stress can eventually pose as a threat to one’s health • We view external circumstances as the cause of our stress, but in reality, we create most of our own stress by choosing to make ourselves miserable and upset • Anticipating the worst possible outcome for situations Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Coping with Stress and Anxiety • Four categories: adaptive, palliative, maladaptive, and dysfunctional. • Positive outcome – Adaptive coping – successful management – Palliative coping – recurrent stressors • Negative outcome – Maladaptive coping – unsuccessful attempts made – Dysfunctional coping – no attempt to solve problem • Discuss examples of both types of coping mechanisms Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Adaptive Coping Strategies • Reframing (restructuring thinking) Pg. 8 Table 1. 4 • Positive self-talk, humor • Assertiveness training • Problem-solving and communication skills • Relaxation techniques, self-care • Support systems • Faith in spiritual power and in yourself Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Psychological Crisis • A state of disorganization during which time usual coping strategies fail • Total inability to control the situation and to function in daily activities • Individual feels helpless and lost • May result from – Unrealistic perception of a threatening event – Lack of a support system – Inadequate coping ability Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Crisis Intervention • Deal with the present situation; early intervention is best • Reduce anxiety level • Help client define the problem • Determine available support • Help client set realistic goals for resolution • Provide support and reassurance • Provide for client’s safety and security Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Case Application 1. 1 • Pg. 10 • How does Nathan’s problem demonstrate a crisis situation? • What is the first step of the interventions to help Nathan? Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Grief and Loss • Grief an emotional process of coping with a loss – May leave the person with a sense of emptiness, hopelessness, and detachment from the meaning that was previously found in life • Loss an actual/perceived change of relationship with lost person or object Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Types of Grief • Anticipatory grief – When expecting a loss in the near future • Conventional grief – Following a loss – Bereavement – adapting to a loss • May take days, weeks, years • Age-related concepts of loss – Pg. 11 Table 1. 5 Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Stages of Grief (Kubler-Ross) • Shock and denial – Want to avoid reality of the loss and act as if nothing has occurred or as though the lost object/person is still present • Anger and pain – Crying, expressions of self-blame, or guilt • Negotiation and bargaining – Attempt to postpone acceptance of loss • Withdrawal and depression – extends beyond 2 weeks • Acceptance and resolution Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Dysfunctional Grief • Failure to cope successfully with loss – Chronic sorrow – Contributing factors to unresolved grief • Socially unacceptable death • Missing person • Multiple losses • Ambivalent feelings toward the lost person • Guilt Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Case Application 1. 2 • Pg. 14 • What feelings might be responsible for Art’s symptoms? • How should the nurse respond to Art? • What stage of the grief process is Art likely experiencing? • What referrals may be appropriate for Art? Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Defining Anger • An emotion triggered in response to threats, insulting situations, or anything that hampers the intended action of an individual • May be directed at an individual, group, or self • Builds into bitterness • People who are easily frustrated angered usually hae a history of being irritable, touchy, and quick-tempered from an early age. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Defining Violence and Abuse • Violence an intense feeling toward an individual that starts with verbal or physical threats and assaults that victimize the person • Abuse compelling destructive action against an individual against his or her will – May be physical, sexual, verbal, emotional, or neglectful Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Managing Anger • Recognize the origin of emotional response – Allows us to be in touch with why we respond as we do • Engage in physical activity – Energy is utilized constructively • Stand up for rights, beliefs, or values – Assertiveness – respect for oneself • Talk with someone who will listen • Learn to forgive Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Question • Tell whether the following statement is true or false. Stress can help people function at optimal levels. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Answer • True • Rationale: Stress is a part of everyday living. Mild stress can motivate and propel people toward accomplishment and success. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Question • Grief that comes when one is expecting a loss in the near future is called A. Conventional grief B. Dysfunctional grief C. Anticipatory grief D. Chronic sorrow Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Answer • C. Anticipatory grief • Rationale: Anticipatory grief is a response in individuals or families that occurs when a loss is expected in the near future. It can be a helpful concept for nurses working with terminally ill patients and patients who are anticipating the loss of a body part or a change in body functioning. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Question • According to Dr. Kubler-Ross, which stage is the first step of the grieving process? A. Anger B. Denial C. Acceptance D. Bargaining Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Answer • B. Denial • Rationale: In the first stage of grief, a person who has experienced a loss wants to avoid the reality of it and may act as if nothing happened. Denial allows a person time to gather coping strategies for the grieving process ahead. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins