Theoretical Bases For Psychiatric Mental Health Nursing

Prior to 19th century is believes that mental illness was viewed in terms of possession by evil spirits and supernatural forces. Before 19th century People who are mentally ill are secluded in the form of punishment

• The asylum (mental institution) were built
• Shelter was developed After 19th century Advent moral treatment and management in psychiatry
• Team approach
• Case management
• Collaborative approach – psychiatric nurse carrying home visiting, nursing diagnosis & nursing process
• Refer to psychiatrist, psychotherapist, behavior cognitive therapist Concept of deinstitutionalization and community-based care
• Institutions were unhealthy for the mentally ill
• Civil rights of people were addressed
• Mentally ill clients from the institutions are place back into the community
• Early case findings, diagnosis, and crisis intervention, could minimize the incidence and severity of mental illness

The theoretical bases for psychiatric mental health nursing provides framework to organise our thinking about the manifestation, development and treatment of mental disorders. It enhances direct assessment, suggest causes and interventions/ management. Theoretical bases related to mental illness includes the following:

1. Neurobiological
2. Psychoanalytic
3. Social/ social cultural
4. Cognitive
5. Genetics

Neurobiological

Central nervous system

The central nervous system includes the brain and spinal cord, which are made up of the neurons. Neurons normally don’t reproduce or replace themselves, so when they become damaged or die they cannot be replaced by the body. Examples of neurodegenerative diseases include Parkinson’s, Alzheimer’s, and Huntington’s disease. Neurodegenerative disease is a range of conditions which primarily affect the neurons in the human brain. Neurodegenerative diseases are incurable and debilitating conditions that result in progressive degeneration and / or death of nerve cells. Neurodegenerative process lead to cognitive and affective impairment such as Alzheimer’s disease and other dementias, Parkinson’s disease and related disorders.

Neurochemical processes

A neurotransmitter transmits (carries) a chemical message from one neuron to another in the brain and the entire nervous system. Neurotransmitter is a brain chemical that lets brain cells communicate with each other and these allows the brain to function properly. The two type of Neurotransmitter and receptors includes:

• Excitory transmitters eg norephinephrine, dopamine, acetylcholine and serotonin
• Inhibitory transmitter’s eg amino acid

Abnormal concentrations of these substances are associated with impulsivity and mental disorders such as depression, anxiety, addictive disorders, and schizophrenia. Many studies have linked low levels of the neurotransmitter. Low level of serotonin for example may lead to depression, impulsive and aggressive forms of behavior, violence, and even suicide.

Neuroendocrine

Neuroendocrine involves the interaction between the nervous system and the hormones of the endocrine glands. The nervous and endocrine systems often act together to regulate the physiologic processes of the human body. These includes hypothalamus, pituitary gland, thyroid glands, gonads, and pancreas. Abnormalities in the neuroendocrine will contribute to functional psychosis, phobias, bipolar disorder, depressive and anxiety disorder.

Psychoneuroimmunology Psychoneuroimmunology is a branch of medicine that study the interactions between psychological factors, the central nervous system, and immune function as moderated by the neuroendocrine system. These conditions may include infection, tumours and head injury. Such abnormalities may contribute to affective disorders and panic disorders Psychoanalytic Sigmund Freud (1856 – 1939) – an Austrian is the founder of psychoanalytic theory. He coined that things that happen to people during childhood can contribute to the way they later function as adults. He theorised that, there are three different parts of the mind which is:

Unconscious mind (ID)

• Preconscious mind (SUPEREGO)
• Conscious mind (EGO) Level of conciousness using Iceberg as the Metaphor
• The Id represents the individual’s innate drives and desires. Unwanted and uncomfortable thoughts hidden from awareness e.g anger, aggression, sexual impulses are kept hidden from consciousness by defense mechanism.

The superego is thought to reflect morality and internalized moral concepts of acceptable behaviour and thoughts. The Ego is the integration of perception, memory, and defense mechanisms used to resolved conflict and promote psychological function. The Ego serves to balance the instinctual drives of the Id with the stringent rules and taboo behaviour imposed by the superego and reality

Freud explained human psyche and its problems resulting from unconscious conflicts originating from childhood experiences. Psychoanalytic theory demonstrated the significant role of anxiety in maladaptive behaviour. Nurses ought to be aware of client’s defense mechanisms against instinctual demands and anxiety. Anxiety may be reduced before the defenses can be disengaged. Social/ social cultural Social theories reflect significant interactions that govern developmental milestones that influence adaptation across life span.

Erik Ericson theory (1963) believed that personality development continues over the life span through 8 stages.

1. Infancy: trust and mistrust
2. Early childhood: autonomy vs shame, doubt
3. Preschool: Initiative vs guilt
4. Middle childhood: Industry vs inferiority
5. Adolescence: Identity vs. Identity confusion
6. Young adulthood: Intimacy vs isolation
7. Middle age: Generative vs stagnation
8. Old age: Integrity vs despair

Each stage focuses on challenges and achievements of each developmental stage and their impact on resolving the next stage. Each stage involves a turning point where one develops normally and able to adapt to his environment. Healthy development involves adjusting the demand of the particular crisis that characterizes each stage in the lifespan. On the other hand, a crisis in personality may occur that may result in a specific conflict. If the conflict is not satisfactorily resolved, the person will continue to struggle and the social and emotional development will be impairing. The crisis emerges in a predetermine order according to maturation.

However, there is no real evidence that this stages unfold in the sequence that is propose. Successful resolution of each crisis requires balancing a positive trait and a corresponding negative trait for example trust and mistrust stage. While healthy people will trust their surroundings, they also need to be vigilance and learn some mistrust to prepare for dangerous happening. Cognitive The person’s perceptions and interpretations influence subsequent biological and behavioral responses. Cognitive theorists attribute mental health problems to the defeatist and distorted attitudes or thinking of the person and rely on restructuring of such thinking to get rid of problems. Impairment addressed. Genetics The genetic makeup of a person can be acquired from his parents.

The genetic significance includes schizophrenia, manic depressive psychosis, depression, epilepsy and mental sub normality:

• Schizophrenia: If one of your parents has schizophrenia, chance of having the disease is 13 percent
• Bipolar Affective Disorder: If one of your parents has bipolar disorder, chance of having the disease is 15 percent.
• Depressive Disorder: If one of your parents or a sibling has major depression, risk increases by 20 to 30 percent
• Alzheimer’s disease: 25 – 50% of close relatives
• Substance abuse disorders: e.g. alcoholism in monozygotic twins, biological parent Etiology of mental illness