fandrews@tcc.

edu
804-305-8649

Health: A state of complete physical, mental, and social

well-being
World Health Organization, WHO

Able to recognize own potential

Cope with normal stress

Work productively

Make contribution to
community

Successful adaptation to stressors from the internal or external

environment, evidenced by thoughts, feelings & behaviors that are age
appropriate & congruent w/local & cultural norms
Successful performance of mental function, resulting in productive
activities, fulfilling relationships, & the ability to adapt to change and
cope with adversity
Implies mastery and contentment in love, work, play, spirituality &
relationships
Includes: self-governance, progress towards self-realization, tolerance
of unknown, self-esteem, reality orientation, stress management and
mastery of environment

Ability to

Think rationally
Communicate appropriately
Learn
Grow emotionally
Be resilient
Have a healthy self-esteem

Considered clinically significant when

marked by

Patients distress
Disability or
Risk of disability or
Loss of freedom
Is culturally defined

A clinically significant behavioral or

psychological syndrome experienced by a
person, marked by distress, disability, or the
risk of suffering, disability, or loss of
freedom (APA, 2007)

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Diathesis biological predisposition

Stress environmental stress or trauma
Most accepted explanation for mental
illness

Combination of genetic vulnerability and negative

environmental stressors

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Biological-genetics, age, sex, enzymes, neurotransmitters, nutrition, health

Psychological-coping skills, intelligence, morale, self-concept, personality,
affect
Social-job, money, stress, relations, education, politics, loss
Cultural-religion, coping methods, support

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Dissatisfaction with ones characteristics,

abilities, & accomplishments
Ineffective or unsatisfying interpersonal
relationships
Dissatisfaction with ones place in the world
Ineffective coping
Impaired reality testing

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 Eating

disorders
Attention deficit
Autism
Alzheimers disease
Schizophrenia
Mood disorders
Anxiety disorders

An authoritative volume
that defines and
classifies mental
disorders in order to
improve diagnoses,
treatment, and research.
**Does not define mental health

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APAs Diagnostic and Statistical Manual of

Mental Disorders (1st published 1952)
Official classification system
Offers a common language to
communicate
Names of illnesses are augmented by
description of Dx criteria

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Categories are descriptions, not explanations

Its categories imply sharp dividing lines between

normal and abnormal behaviors

Many psychiatric categories lack an empirical

foundation

Diagnoses are not based on a body of research on

children

Criteria may not apply uniformly to all cultures

DSM-5 has moved to a nonaxial

documentation of diagnosis (formerly Axes I, II
and III), with separate notations for important
psychosocial and contextual factors (formerly
Axis IV) and disability (formerly Axis V) (2013,
p. 16).
The GAF scale was removed from the DSM-5
because of perceived lack of reliability and
poor clinical utility (APA, 2013).
The APA (2013) recommended the WHODAS
2.0 as a preferred measure for use in
assessing clients functioning.
WORLD HEALTH ORGANIZATION DISABILITY
ASSESSMENT SCHEDULE 2.0
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International Classification of Disease

Clinical descriptions of mental and behavior

disorders

Divided into 10 disease classifications

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The North American Nursing Diagnosis

Association International (NANDA-I)
describes a nursing diagnosis as a clinical
judgment about individual, family, or
community responses to actual or potential
health problems and life processes.
**Do not confuse with Medical diagnoses**

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Basic Level

Advanced Practice

Each has clearly defined roles

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The diagnosis and treatment of human

responses to actual or potential mental
health problems
A specialized area of nursing practice that
employs theories of human behavior as its
science & purposeful use of self as its art.
It is directed toward both preventive &
corrective impacts on mental disorders & their
sequelae & is concerned with the promotion of
optimal mental health for society, community
& individual within it

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Communicating that mental illnesses are

brain disorders

Advocating for people with mental illness

Eliminating stigma and discrimination

Improving access to treatment services

Facilitating accountability to mental health

consumers

Integrating mental illness into community life

Mental health is fundamental to a healthy

life
Mental disorders are real health conditions
with enormous consequences
Effective treatments for mental disorders
are available
A range of treatment options is available
for most mental disorders
Those with mental disorders or symptoms
should seek treatment because it can help

As the aged population increases, the incidence

of chronic illnesses and disabilities requiring
mental healthcare will also rise

By 2020, violence and self-injury are predicted

to be major worldwide disabilities
The burden of psychiatric illness is immense
and expected to grow
The more mental health services provided, the
more professionals will be needed

Provide a therapeutic milieu

Working with here & now problems of clients
Using surrogate parent role
Caring for the somatic aspects of clients
health problems
Teaching factors r/t emotional health
Acting as social agent
Providing leadership to other personnel
Conducting psychotherapy
Engaging in social & community action r/t MH

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Basic: counseling, milieu rx,

education, promotion of self-care,
case management, client advocacy,
health promotion & maintenance
Advanced: All of the above,
psychotherapy,
medication prescription, consultation,
private practice

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Conceptual Frameworks and Theories

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Means of organizing & explaining a complex

body of knowledge r/t human behavior
Gives direction to practice
CM assists practitioners to function rationally &
allows for evaluation of effectiveness
Organization facilitates research; They lead to
the collection of relevant data, which leads to
expansion of knowledge in the field

Provide a world view about how the world works

Promote interventions consistent with tenets of

the theories to help people experiencing
psychiatric disorders
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Theory: one persons or groups beliefs

about how something happens or works
Theories contain sets of systematically
related assumptions built upon elements
called concepts
Theory describes relationships
between concepts/phenomenon
Hypothesis: prediction about two or more
concepts in a theory

Theories

Psychoanalytic
Behavior
Cognitive
Cognitive
behavior
Humanistic
Interpersonal
Biophysiological
Sociocultural

Rx Approaches

Classical Psychoanalysis
Psychodynamic &
Psychoanalytic
Psychotherapy
Short term Psychotherapy
Interpersonal
Psychotherapy
Cognitive Therapy
Behavioral Therapy
Modeling
Operant Conditioning
Systematic Desensitization
Aversion Therapy
Milieu Therapy

Theorists: Freud ; laterHorney, Klein,

Adler, Erikson, and Jung

General principles:
Unconscious
Repression
Defense mechanisms
Transference
Countertransference
No empirical evidence; unresearchable

Transference
Positive or negative feelings and thoughts clients
have toward the service provider, which may
hamper or move forward the process of therapy

Countertransference
Feelings and thoughts that service providers have
toward the client, which can be destructive or
disruptive to therapy

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Defense mechanisms and anxiety

Operate on unconscious level
Deny, falsify, or distort reality to make it less
threatening
Experiences during the early stages of life
determine an individual's lifetime adjustment
patterns and personality traits.

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conscious-memories that remain w/in

awareness; under control of ego; easily retrieved
events
preconscious-memories that may have been
forgotten or are not in awareness; partially under
control of superego; helps to suppress unpleasant
or nonessential memories from conscious
unconscious-largest, repressed memories;
retrieved only thru therapy; may emerge in
dreams

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 personality:

3 components

id-locus of instinctual drives; impulsive

& irrational; operates on pleasure
principle
ego-rational self; develops between 4-6
mos; operates on reality principle;
mediator
superego-perfection principle; develops
between 3-6 yrs; composed of ego-ideal
& conscience

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libido-psychic energy originating in id

cathexis-id invests energy into an object to
achieve gratification
anticathexis-use of energy by ego &
superego to control id impulses

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Oral: birth-18 mos

Anal: 18 mos-3 yrs
Phallic: 3-6 yrs
Latency: 6-12 yrs
Genital: 13-20 yrs

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8 Stages of Man

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Eight stages of development

Personality continues to develop through old age

Failures at one stage can be rectified at

another stage

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Developmental model is important

part of nursing assessment
Helps determine what types of
interventions are most likely to be
effective

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Trust vs mistrust: birth-18 mos

Autonomy vs shame & doubt: 18 mos-3
yrs
Initiative vs guilt: 3-6 yrs
Industry vs inferiority: 6-12 yrs
Identity vs role confusion: 12-20 yrs
Intimacy vs isolation: 20-30 yrs
Generativity vs stagnation: 30-65 yrs
Ego integrity vs despair: 65-death

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Theorists: Guthrie, Pavlov, Watson; Skinner,

Thorndike; Bandura, Beck, Lewin, Tolman

General principles:
Conditioning (respondent; operant)
Reinforcement
Punishment
Generalization and discrimination
Modeling and shaping
Applied behavior analysis
Lots of empirical evidence

Behavior
modification
tokenism

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Focused on behavior; all behavior is learned

Behavior has consequences (reward or
punishment)
Rewarded behavior tends to recur
+ reinforcement increases frequency of
behavior
Strategies: behavior modification, token
economy, systematic desensitization

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Theorists: Beck, Meichenbaum, Ellis

General principles:

Cognitions
Functional analysis of behavior (ABCD)
Cognitive restructuring
Cognitive relabeling
Systematic rational restructuring
Rational problem solving
Lots of empirical evidence
Gold standard

Several theorists: Maslow, Rogers, Szasz, Perls

General principles:
Recognizes importance of learning
Recognizes psychological processes, such as
creativity, hope, love, self-fulfillment, personal
growth, values, and meaning
Concerned with human beings, their
potentialities, and personal growth
Positive view of human nature
No empirical evidence

Anxiety
good me; bad me;
not me

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Theorist: Sullivan

General principles:
Emphasizes interpersonal socialization of human
beings throughout developmental stages
Important role of early childhood in shaping
human beings and their self-concept
Concerned with anxiety-arousing aspects of
interpersonal relationships
No empirical evidence

Individual behavior & personality

development are result of IPR
Anxiety-a feeling of emotional discomfort;
all behavior is aimed at relieving
Anxiety arises because of inability to satisfy
needs

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General principles consider:

The effects of social and cultural
influences on an individual
The impact of social influences, such
as social class and marriage, on
mental health
The impact of cultural and ethnic
factors as they relate to mental
health and mental illness

Theorists: Cicchetti, Bronfenbrenner

General principles:

Both individual and environmental characteristics

influence the person, his or her family, the
community, and the greater sociocultural arena
The broader contexts of development and
functioning are included
Informed by genetic and neurophysiologic variables
Certain contextual characteristics and events may
enhance or hinder a persons development and
adaptation

Family characteristics (microsystem)

Poverty; family, employment, or residential
instability; child-care burden; parental stress; and
social isolation

Community characteristics (exosystem)

Cohesive neighborhoods with strong support
services (e.g., churches, community policing
partnerships) can help mitigate the effects of
community violence

Sensorimotor: birth-2
yrs
Preoperational: 2-6 yrs
Concrete operational: 612 yrs
Formal operations: 1215+

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General principles:
Sometime erroneously called Medical Model
Proposes that psychopathology results from
some physiologic condition, primarily a
deviation in the CNS
Therapeutic processes focus on somatic
treatments and are moving more toward
psychosocial therapies

Genetics
Temperament
Development
Brain circuitry
Human biology at molecular level
Environment

Neurological, chemical, genetic etiologies of

disease
Abnormal behavior is part of a disease
process or a defect
Usually locates defect in limbic system or
CNS
Strategies: meds, nutrition, hydration, ECT

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