CU 1 : Mental Health and Mental Illness

I. Concepts of Mental Health and Mental Illness

●​ Mental Health: A state of well-being where an individual realizes their potential, copes with
life’s stresses, works productively, and contributes to the community.
●​ Mental Illness: A condition marked by alterations in thinking, mood, or behavior that causes
distress and impairs daily functioning.
●​ Criteria for Mental Health:
○​ P - positive self-attitude
○​ R - reality perception
○​ A - autonomous behavior
○​ I - integrative capacity
○​ S - self-actualization
○​ E - environmental mastery
●​ Factors Contributing to Mental Illness:
○​ Biologic: Genetics, brain defects, prenatal damage
○​ Individual: Poor health, ineffective coping, low self-esteem
○​ Interpersonal: Family issues, lack of belongingness
○​ Environmental: Poverty, abuse, discrimination

II. Mental Health Care System in the Philippines

●​ Three Levels of Care:

○​ Primary Level – First contact (outpatient care)
○​ Secondary Level – Short hospital visits, psychologist/psychiatrist referrals
○​ Tertiary Level – Specialized psychiatric institutions, rehabilitation
●​ Institutions Providing Mental Health Services:
○​ National Center for Mental Health (NCMH)
○​ Philippine Mental Health Association (PMHA)
○​ Various hospitals and suicide prevention hotlines

III. Psychobiologic Basis of Behavior

●​ Behavior is influenced by:

○​ Genetics
○​ Environment (family, culture)
○​ Biological structures (brain, hormones)
○​
 ●​ Human Behavior Concepts:
○​ Family Dynamics: Decision-making, communication, and problem-solving
○​ Needs and Behavior: Internal motives that drive actions
○​ Conflicts and Frustrations: Emotional stress from unmet desires or opposing wishes
○​ Anxiety: A feeling of apprehension (mild, moderate, severe, panic)

IV. Defense Mechanisms

●​ Adaptive Mechanisms: Healthy coping strategies (anticipation, humor, sublimation)

●​ Narcissistic Defenses: Denial, projection, fantasy (common in children)
●​ Immature Defenses: Regression, suppression, intellectualization (common in adolescents)
●​ Neurotic Defenses: Rationalization, displacement, repression, reaction formation

V. Crisis and Stress Management

●​ Crisis: A situation that overwhelms an individual’s usual coping mechanisms.

●​ Types of Crisis:
1.​ Maturational: Normal life transitions (e.g., puberty, marriage)
2.​ Situational: Unpredictable life events (e.g., job loss, accidents)
3.​ Adventitious: Natural disasters, wars, traumatic experiences
●​ Crisis Stages:
1.​ Denial 3.​ Disorganization
2.​ Increased tension 4.​ Attempts to reorganize

VI. Categories of Psychiatric Disorders (DSM-5)

●​ Schizophrenia Spectrum: Hallucinations, delusions, disorganized thoughts

●​ Mood Disorders:
○​ Depressive Disorders: Persistent sadness, worthlessness
○​ Bipolar Disorder: Mania and depression cycles
●​ Anxiety Disorders: Generalized Anxiety Disorder, panic attacks, phobias
●​ Obsessive-Compulsive Disorders: Repetitive unwanted thoughts (obsessions) and
behaviors (compulsions)
●​ Trauma-Related Disorders: PTSD, Acute Stress Disorder
●​ Personality Disorders: Antisocial, Borderline, Narcissistic
●​ Substance Use Disorders: Alcohol, drug addiction
●​ Neurodevelopmental Disorders: ADHD, Autism Spectrum Disorder
VII. Psychiatric Nursing Principles

●​ Provide patient-centered care

●​ Recognize and manage own feelings towards patients
●​ Prioritize patients with the highest need
●​ Ensure therapeutic communication
●​ Maintain patient safety and reality orientation
 CU 2 Theoretical Basis of Mental Health Practice

I. Psychoanalytic Models

Sigmund Freud (Psychoanalysis)

●​ Personality Theory:
○​ Id – Instinctual drives, pleasure-seeking, impulsive
○​ Ego – Reality principle, problem-solving
○​ Superego – Moral standards, conscience, guilt
●​ Levels of Awareness:
○​ Conscious – Reality-based thoughts
○​ Preconscious – Memories and thoughts that can be recalled
○​ Unconscious – Hidden desires, instincts, repressed thoughts
●​ Psychosexual Stages:
○​ Oral Stage (Birth–1 year) – Focus on sucking, security, trust
○​ Anal Stage (1–3 years) – Toilet training, control, independence
○​ Phallic Stage (3–6 years) – Oedipus/Electra complex, superego development
○​ Latency Stage (6–12 years) – Intellectual development, social skills
○​ Genital Stage (12+ years) – Mature sexual relationships, personal identity
●​ Defense Mechanisms:
○​ Unconscious strategies used to reduce anxiety
○​ Examples: Denial, repression, displacement, rationalization
●​ Transference & Countertransference:
○​ Transference – Client projects feelings onto the therapist
○​ Countertransference – Therapist projects personal feelings onto the client

Neo-Freudian Theories

●​ Anna Freud – Expanded Freud’s work on defense mechanisms

●​ Alfred Adler – Emphasized inferiority complex, social influences on personality
●​ Carl Jung – Developed introversion vs. extroversion, archetypes, and collective
unconscious
●​ Erich Fromm – Studied societal influences on human behavior

II. Interpersonal Relation Models

Harry Stack Sullivan (Interpersonal Theory)

●​ Personality is shaped by interpersonal relationships

●​ Anxiety stems from unsatisfactory relationships
●​ Life Stages:
1.​ Infancy – Need for bodily contact, security
2.​ Childhood – Development of self-esteem, learning interactions
 3.​ Juvenile – Socialization with peers
4.​ Preadolescence – First intimate relationships (best friend)
5.​ Adolescence – Romantic relationships, identity development

Hildegard Peplau (Therapeutic Nurse-Patient Relationship)

●​ Nursing roles: stranger, teacher, guide, counselor, resource person

●​ Phases of Nurse-Patient Relationship:
1.​ Orientation – Building trust, identifying issues
2.​ Identification – Patient expresses feelings, works with nurse
3.​ Exploitation – Using resources for healing
4.​ Resolution – End of nurse-patient relationship, independence

III. Humanistic Theories

Abraham Maslow (Hierarchy of Needs)

●​ Motivations drive behavior, arranged in a pyramid:

1.​ Physiological Needs – Food, water, air, sleep
2.​ Safety Needs – Protection, security
3.​ Love/Belonging – Friendships, relationships
4.​ Esteem Needs – Self-respect, recognition
5.​ Self-Actualization – Personal growth, fulfillment

Carl Rogers (Client-Centered Therapy)

●​ Focused on unconditional positive regard, empathy, active listening

●​ Therapy should center on the client, not the therapist

IV. Developmental Theories

Erik Erikson (Psychosocial Development)

●​ Personality develops through 8 life stages:

1.​ Trust vs. Mistrust (Infancy) – Security, caregiver reliability
2.​ Autonomy vs. Shame/Doubt (Toddler) – Independence, self-control
3.​ Initiative vs. Guilt (Preschool) – Decision-making, conscience
4.​ Industry vs. Inferiority (School Age) – Competence, achievement
5.​ Identity vs. Role Confusion (Adolescence) – Self-identity, belonging
6.​ Intimacy vs. Isolation (Young Adult) – Meaningful relationships
7.​ Generativity vs. Stagnation (Middle Adult) – Productivity, contribution
8.​ Ego Integrity vs. Despair (Maturity) – Acceptance of life, wisdom
V. Cognitive Theories

Jean Piaget (Cognitive Development)

●​ Stages of Cognitive Development:

1.​ Sensorimotor (Birth–2 years) – Object permanence
2.​ Preoperational (2–7 years) – Egocentrism, imagination
3.​ Concrete Operational (7–11 years) – Logical thinking, conservation
4.​ Formal Operational (12+ years) – Abstract reasoning, problem-solving

Lev Vygotsky (Sociocultural Theory)

●​ Cognitive development is influenced by social interactions and culture

●​ Zone of Proximal Development (ZPD) – The gap between what a child can do independently
and what they can achieve with guidance

Information-Processing Theory

●​ Brain functions like a computer:

○​ Attention – Essential for learning
○​ Memory Processing – Moving info from short-term to long-term storage

VI. Stress and Coping Theories

Hans Selye (General Adaptation Syndrome)

●​ Stages of Stress Response:

1.​ Alarm – Fight-or-flight response, adrenaline release
2.​ Resistance – Adaptation to stress, body resources mobilized
3.​ Exhaustion – Resources depleted, risk of illness

Lazarus’ Theory of Stress

●​ Transactional Model: Stress is a reaction to an appraisal of threats vs. coping abilities

●​ Key Concepts:
○​ Primary Appraisal – Evaluating stressor significance
○​ Secondary Appraisal – Assessing available coping resources

Psychoneuroimmunology

●​ Studies interactions between stress, immune function, and mental health

●​ Chronic stress weakens the immune system
 CU 3.1 Nursing Process, Therapeutic Communication, and Therapeutic
Relationships in Psychiatric and Mental Health Nursing Practice

I. Nursing Process in Psychiatric-Mental Health Care

Steps of the Nursing Process

1.​ Assessment – Data collection

○​ Subjective data – Patient’s verbal statements
○​ Objective data – Measurable, observable data
2.​ Diagnosis – Identification of actual or potential mental health problems
3.​ Planning – Setting specific, measurable, attainable, realistic, and time-bound (SMART) goals
4.​ Implementation – Carrying out nursing interventions
5.​ Evaluation – Assessing patient outcomes

Psychosocial Assessment

●​ Purpose: Evaluate a patient's mental and social well-being to provide optimal care.
●​ Components:
○​ Initial information: Demographics, medical history
○​ Presenting problems: Mental health concerns
○​ Family history: Physical and mental health conditions
○​ Risk assessment: Suicide/homicide ideation
○​ Mental health responses: Coping mechanisms
○​ Social and role changes

Mental Status Examination (MSE)

●​ Parallel to the physical exam; evaluates behavior, cognition, and emotion.

●​ Components:
○​ Appearance & Behavior – Grooming, hygiene, motor activity
○​ Thought Processes – Coherence, delusions, hallucinations
○​ Speech Patterns – Tone, volume, clarity
○​ Orientation – Awareness of person, place, time
○​ Memory – Short-term and long-term recall
○​ Cognitive Functioning – Judgment, reasoning, problem-solving

II. Therapeutic Communication

●​ Definition: The exchange of information, thoughts, and emotions to build a trusting

nurse-client relationship.
●​ Modes of Communication:
○​ Verbal – Talking, active listening
 ○​ Non-verbal – Gestures, facial expressions, touch
○​ Written – Notes, records, documentation

Key Factors Affecting Communication

●​ Pace and intonation – Tone and speed of speech

●​ Clarity and brevity – Being precise and concise
●​ Timing and relevance – Addressing patient concerns appropriately
●​ Adaptability – Adjusting communication based on patient needs
●​ Credibility – Establishing trustworthiness

Therapeutic Communication Techniques

Technique Description Example

Active Listening Giving full attention to the Nodding, maintaining eye

patient contact

Clarification Ensuring understanding of the "Can you explain what you

patient's statement mean?"

Reflection Repeating patient's statement "You feel anxious about

to encourage deeper thought tomorrow’s test?"

Silence Allowing time for thought Sitting quietly but attentively

processing

Summarization Reviewing main points "So far, we’ve discussed your

concerns about work and
family."
Non-Therapeutic Communication Techniques

Technique Description Example

Giving false reassurance Providing unrealistic comfort "Everything will be fine."

Advising Telling the patient what to do "You should leave your job if it
stresses you."

Challenging Questioning a patient’s reality "How can you think that?"

Changing the subject Avoiding the patient’s concerns Patient: "I feel depressed."
Nurse: "Let’s talk about your
meals today."

III. Therapeutic Relationship

●​ Definition: A structured professional relationship that promotes the patient’s well-being.

●​ Key Components:
1.​ Trust – Building a sense of safety and reliability
2.​ Genuine Interest – Active participation and attentiveness
3.​ Empathy – Understanding and sharing patient feelings
4.​ Acceptance – Nonjudgmental attitude
5.​ Positive Regard – Encouragement and validation

Types of Nurse-Patient Relationships

Relationship Type Characteristics

Therapeutic Goal-oriented, structured, time-bound

Social Casual, mutual benefits, not health-focused

 Intimate Emotional attachment, not appropriate in
healthcare

Phases of the Nurse-Patient Relationship (Peplau)

1.​ Pre-Interaction Phase – Gathering patient history before meeting

2.​ Introductory Phase – Establishing trust, setting goals, creating a care plan
3.​ Working Phase – Implementing interventions, addressing issues
4.​ Termination Phase – Ending the relationship, evaluating progress

Barriers to a Therapeutic Relationship

●​ Transference – Patient projects feelings from past relationships onto the nurse
●​ Countertransference – Nurse projects personal emotions onto the patient
●​ Resistance – Patient avoids self-exploration or refuses treatment
●​ Boundary Violations – Becoming overly involved or sharing personal details
●​ Encouraging Dependency – Failing to promote patient autonomy