mosby items and derived items © 2005, 2001 by mosby, inc. family mental health nursing by nataliya...

Mosby items and derived items © 2005, 2001 by Mosby, Inc.

Family Mental Family Mental Health NursingHealth Nursing

By Nataliya Haliyash,

MD,PhD,MSN

Ternopil State Medical University

Institute of Nursing


Historical evolution of Historical evolution of mental health care.mental health care.

Mental Mental Illnesses Include:

•Autism Spectrum Disorders,

•Attention Deficit/Hyperactivity Disorder,

•Bipolar Disorder,

•Borderline Personality Disorder,

•Dissociate Disorders,

•Eating disorders,

•Depression,


Introduction to Mental Illness

• Obsessive Compulsive Disorder (OCD),

• Panic Disorder,

• Post Traumatic Stress Disorder,

• Panic Disorder,

• Substance Abuse Disorder

• Schizophrenia,

• Seasonal Affective Disorder,

• Suicide,

• and Tourette’s Syndrome


Introduction to Mental Introduction to Mental IllnessIllness• All cultures have had problems with

mental illnesses.

• Mental illnesses can affect any age, race, religion, or income. Mental illnesses are not the result of personal weakness, lack of character or poor upbringing.

• In many cultures those with a mental illness were considered the bottom of society and were often locked away in jails, back rooms, abused in Asylums and used for entertainment.


The History of Mental Illnesses• The History of Mental Illness In the 1600s Native

American shamans would summoned powers from the beyond to treat the mentally ill.

• Those with a mental illness were often said to be involved with witchcraft and were demonically possessed.

• Those suffering from a mental illness were commonly referred to as lunatics- mania lunatics and melancholy lunatics

• Barbaric treatments included ice baths, making the person vomit, and bleeding the victim of all their “bad blood”

• In the 1700s Cotton Mather, a Puritan clergyman, separated from the overused and common witchcraft and possession theories and tried to find a more logical explanation.


History (Cont.)History (Cont.)

• In the 1800s Benjamin Rush wrote the first American textbook of psychiatry and by 1843 there were only around 24 hospitals in the United States dedicated to treating mental illness. →→

• In the 1900s Clifford Beers, manic depressive himself, wrote his life experiences as a mental patient in The Mind That Found Itself.

• In the 1900s ideas pertaining to Mental Illnesses started to bloom. Sigmund Freud came to America to lecture on the topic of psychoanalysis.

• In 1918 as ruled by The American Psychoanalytic Association only those who had actually completed medical school could train in psycho analytics.


Different Treatments• Starting in the 1930s doctors began trying different

procedures to help their patients. They tried insulin for schizophrenia in 1930 and from 1936 to around the 1950s used the Frontal Lobotomy.

• The Frontal Lobotomy was performed as such: • “-To induce sedation, inflict two quick shocks to the head.• -Roll back one of the patients’ eyelids.• -Insert a device, 2/3 the size of a pencil, through the

upper eyelid into the patients’ head.• -Guided by the markings indicating depth, tap the device

with a hammer into the patients’ head/ frontal lobe.• -After the appropriate depth is achieved, manipulate the

device back and forth in a swiping motion within the patient’s head.”

http://www.toddlertime.com/advocacy/hospitals/Asylum/history-asylum.htm


Stepping Away From the Lobotomy

• In the 1940s they started to use Electrotherapy to treat mental illness.

• Then came the medication. The first medication was called chlorpromazine, next came haloperidol, and lithium. In 1989 they introduced the first serotonin dopamine antagonist.

• Today medications include Zoloft, Risperdal, Zyprexa, Seroquel, Tegretol, Lamictal, Topamax, Klonopin , Xanax , Valium , and many more.


People living and deceased with Mental Illness

• There are many famous people today and in the past that suffer/ed from Mental Illness.

• The names may surprise you because they seem so “normal” and some you may remember from the news and magazines.


Scientific :

• Scientific Dr. Kay Jamison

• No longer suffers from manic depression

• Professor of Psychiatry at the John Hopkins School of Medicine as well as the co-author of the standard medical text taught there

• Wrote An Unquiet Mind


Academic :• Academic William James was born in

New York City on January 11, 1842.

• Suffered from Depression, battling it for most of his life.

• Published many books on philosophy and lectured on various other topics concerning psychology, spiritualism, and philosophy.

• Ex: "Philosophical Conceptions and Practical Results“, "Man's Religious Appetites“, and "Their Satisfaction through Philosophy“


Cultural:• Drew Carey born May,23, 1958

in Cleveland, Ohio • Suffers from Depression • He is an actor, writer and

director.

• Jim Carrey was born January,17, 1962

• Diagnosed with clinical depression

• He is an actor best know for his lead role in Ace Ventura Pet Detective


Cultural (Cont.)• Sheryl Crow was born February 11

1962

• Suffers from Depression

• She is a nine-time Grammy Award winning singer-songwriter and activist

• Truman Capote was born September 30 1924 in New Orleans, Louisiana and died August 25 1984

• Suffered from clinical depression

• Writer who wrote Breakfast at Tiffanys and In Cold Blood


Athletic :

• Lionel Aldridge

• Football Player was born in February, 14, 1941

• Played for the Green Bay Packers in the 1960’s

• Battled Schizophrenia


Public Service/Social Justice:

• Abraham Lincoln, 16th President of the United States born in February,12,1809

• suffered from periods of deep depression.

• Theodore Roosevelt- 26th President of the United States born in 1858 in New York

• suffered from Bipolar disorder


Mental Health is a worldwide problem

• At any one time 300-400 million people in the world have a significant mental illness i.e. 5%


FactsFacts• Mental illness is a major contributor to the Global Burden

of Disease• Mental illness accounts for 12% of the disease burden of

the world• Mental illness is an increasing problem in prevalence

and severity• The % of Disability Lost Years from Mental illness is

increasing– In 1990 - 10% of all DALY’s– In 2000 - 12% of all DALY’s– In 2020 - 15% of all DALY’s

• Mental illness can be treated effectively• Mental illness can be prevented


FactsFacts

• Mental illness is common: 6 in 10 women and 4 in 10 men in Western Europe and North America will have a significant mental illness during their lifetime

• Mental illness can affect any one of us

• Mental illness occurs in all societies and cultures


FactsFacts• Nearly 1 in 3 Americans experience a mental

disorder, or over 75 million people, in any given year recently.

• Half of all lifetime cases of mental illness begin around age 14.

• Racial and ethnic minorities are less likely to have access to mental health care services and often receive a poorer quality of care.

• 24 % of state prisoners and 21 % of local jail prisoners have a recent history of mental health disorder.

• For more information on Mental Health visit Nami National Alliance on Mental Illness @ http://www.nami.org/


The Rates by Category

Women Men BothAny Anxiety

Disorder23.4% 14.3% 19.1%

Any Mood Disorder

11.6% 7.7% 9.7%

Any Impulse-Control

Disorder

9.3% 11.7% 10.5%

Any Substance Disorder

11.6% 15.4% 13.4%

Any Disorder 34.7% 29.9% 32.4%


The Rates by Category (Cont.)

• As we can see, women are at a significantly greater risk for any anxiety disorder (more than double the risk for a specific phobia, like a fear of spiders, for panic disorder, and for post-traumatic stress disorder).

• They are also at slightly more risk for a mood disorder — especially for depression, where their rate is nearly double that of men’s risk for depression.


The Rates by Category (Cont.)

• Men are at greater risk for impulse-control disorders, but no disorder significantly stands out except conduct disorder (more than 4 times the risk).

• Men are at more risk for substance disorders across the board as well, with more than twice the risk for alcoholism and three times the risk for drug abuse.


Treatment and Care

Hospital Care

Community Care


Treatment and Care• It is increasingly recognized that mental

illness is a chronic and relapsing condition and that treatment may in consequence be for months, years or even for life.

• Previously many patients spent weary years in long-stay care-the mental asylums. They became institutionalized. There was no effective therapy and they were simply looked after in a simple routine, the worst of their symptoms often “burned out’ but by that time they had lost all contact with family, friends ,work etc.


Treatment and Care• Now many more patients can be cared for

in the community after discharge from hospital. They may never need hospital admission or attend day hospital as part of therapy. Community care is expensive in the professional time and effort to look after patients in a social setting rather than an institution. There are more demands upon friends, family and social services but the results are much better. Long term medication, supervised therapy and intense rehabilitation all play their part.


Treatment and Care

• Medication: Anti-depressants, anti-psychotics, anxiolytics, mood stabilisers

• Electro-convulsive therapy (ECT)

• Psychotherapy-individuala nd group,Psychoanalysis

• Psychosurgery-Prefrontal leucotomy, temporal lobe surgery


Preventive NetworksChurch,Family, Home, Friends, Work


Preventive Networks (Cont.)

• The social networks are important in:

• Primary prevention:– Having a home,

– being married,

– having work,

– friends,beliefs

– a positive self image

• Secondary prevention:

– early diagnosis,

– effective treatment,

– community support

• Tertiary prevention;– long term

management and care in the community


The Mental Health Act

Compulsory Psychiatric Treatment

Criminal responsibility

Power of attorney


The Mental Health Act (Cont.)

• A gravely mentally ill person may no longer be responsible for their actions.

• They may be a danger to themselves-suicide or to others-homicide

• It may be necessary to admit such a person, compulsorily - under legal section - to hospital for treatment and care. This is a major step and has to be closely guarded against abuse for to deprive a fellow human being of his/her liberty, perhaps for long periods and force treatment upon an unwilling patient denies an essential human right.


The Mental Health Act (Cont.)

• In criminal cases a decision needs to be made if the criminal ,at the time of the deed was in full understanding of the situation and appreciated the gravity of the offence. Very roughly would he/she have still done this action at this time if a policeman had been standing beside him.

• Elderly demented patients may no longer be able to manage their own affairs and it may be necessary for the state or a responsible person to take over this task-the power of attorney.

• In each case the psychiatric voice is crucial


Mental Handicap/learning disability

The mind of a young child in the body of an adult


Mental Handicap/ Learning Disability (Cont.)

• Mental handicap or learning disability is about those people in the lowest 3% of the IQ curve.

• The incidence of severe Mental Handicap is 3 per 1,000 (IQ < 50) and may be the consequence of genetic abnormality, chromosome disorders or severe brain damage.

• Moderate handicap (IQ 50-70) is more common among poor deprived populations; with effective parenting, education and care such people can learn to live and live well; without this they will decline into a quasi animal state with associated behavioural problems and frank mental illness


Mental Handicap/ Learning Disability (Cont.)

• People with learning disability often have other congenital problems-cardiac, orthopaedic, neurological, ophthalmic.

• The cause of much mental handicap is unknown The setting up of registers of mentally handicapped people enables the effective provision of health, social and educational services determined by and tailored to their needs.


Canst thou not minister to a mind diseased,

Pluck from the memory a rooted sorrow,

Raze out the written troubles of the brain,

And with some sweet oblivious antidote

Cleanse the stuff’d bosom of that perilous stuff

Which weighs upon the heart?

Macbeth


The end

Q & A &

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