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BSN 6th Semester Notes

By: Meghraj Chatrani
Subject: Mental Health Nursing
Dated: Sep-5-2024

Unit-1 Mental Health and Mental Illness

Unit-1 Mental Health and Mental Illness

Mental health: Mental health refers to a state of well-being in which an individual can realize
their own potential, cope with the normal stresses of life, work productively, and contribute to
their community. It encompasses emotional, psychological, and social well-being, and influences
how individuals think, feel, and act.

Mental illness: Mental illness refers to a wide range of mental health conditions or disorders that
affect a person’s thinking, mood, behavior, and ability to function. Mental illnesses include
depression, anxiety disorders, schizophrenia, bipolar disorder, and others. They may be caused
by a combination of genetic, biological, environmental, and psychological factors. Treatment
often includes therapy, medication, and support systems.

Mental health nursing: MHN is a specialized field of nursing that focuses on the care of
individuals with mental health disorders. It involves assessing, diagnosing, and treating
individuals with mental illness, providing support, counseling, crisis intervention, and promoting
mental health and well-being.

Psychiatry is a branch of medicine that deals with the diagnosis, treatment, and prevention of
mental, emotional, and behavioral disorders. Psychiatrists are medical doctors who specialize in
mental health and often prescribe medications or provide psychotherapy to help manage mental
health conditions.
Psychiatric nursing: Psychiatric nursing also known as mental health nursing, It involves
assessing, diagnosing, and treating individuals with mental illness, providing support,
counseling, crisis intervention, and promoting mental health and well-being.

7 signs of good Mental Health: 1. Positive Self-Esteem, 2. Resilience: The ability to cope with
and recover from stress, adversity, or trauma., 3. Emotional Regulation, 4. Social Connectivity, 5.
Productivity, 6. Adaptability, 7. Sense of Purpose and Fulfillment
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Unit-2 Tools of psychiatric nursing
A.Therapeutic Communication and therapeutic relationship

Communication: Communication is the process of exchanging information, thoughts, ideas, or

feelings between individuals or groups.

Purposes of communication:

To allow the client to express his thought, feeling, behaviors, and life experiences

• To understand the significance of the clients problems.

• To assist and identify the clients problem areas.
B. Mental Health Examination

Mental status examination (MSE) : Mental status examination (MSE) is an organized,

systemic approach to assessment of an individual’s current psychiatric conditions. Components
of the mental status include (general description, emotional state, thinking, perception and
cognitive function)

Delusion: A fixed, false belief that is not based in reality. A belief that is held despite evidence to
the contrary. E.g: A person believes their partner is cheating on them without any evidence.

Types of delusions: Persecutory Delusion (others are deliberately trying to harm).

E.g: FIA has bugged (infected) my room and intends to kill me.
Grandiose delusion: (person has special power, knowledge, special relationship to a famous
person). E.g: A newly admitted patient told the nurse that he was head of PKISTAN ARMY, and
he was here to save world.

Somatic Delusion: ( unrealistic belief about the health or bodily function, has some physical
defect. E.g: A male client may say that he is pregnant

Religious delusion: (false belief that the person has a special link with God).

Jealousy Delusion: (belief that life partner is not faithful with me).
Phobia: A phobia is a fear of an object or situation causing autonomic hyperactivity and
resulting in avoidance response.

Obsessive-Compulsive Disorder (OCD)

Obsession (repeated thoughts): Obsession are maladaptive persistent pattern of thought, images
or feeling that generate anxiety (e.g., fear of contamination, fear of harm). Compulsions:
Repetitive behaviors or mental acts that the person feels driven to perform in response to an
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obsession (e.g., excessive hand washing, checking). These symptoms significantly interfere with
daily functioning is known as OCD.

Suicidal ideation refers to thoughts, ideas, or plans to harm or kill oneself.

Homicidal ideation refers to thoughts, ideas, or plans to harm or kill others.

Hallucination: Perceptual distortions or a sensory experience that occurs in the absence of any
external stimulus. A perception or sensation that is not based in reality. Can affect any of the
senses (e.g., seeing, hearing, tasting, smelling, or feeling things that are not there)

Illusion: Misinterpretation of real sensory information. Distorted perception of actual stimuli.

Can be corrected with reasoning or clarification. E.g: Seeing a shadow as a person.

C: Self Awareness
Self-awareness is the ability to consciously recognize and understand one’s own emotions,
thoughts, behaviors, and values. In the context of mental health nursing, self-awareness allows
practitioners to reflect on their own feelings and responses, ensuring that personal biases or
emotions do not interfere with providing compassionate and effective care.

Unit-3 Factors affecting mental health and mental illness

Factors are divided in to 2 distinct types; risk factors and protective factors.
Risk factors: Risk factors result to mental declines in a person. Having these factors, chances
are big destruction of mental health. These could be further subdivided in to three; l-Biological
II- Psychological & III- Social.

Protective factors: Protective factors result to increase of positive mental flexibility. Flexible
people can overcome and cope better against negative drive.
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Stress: Stress is a psychological and physiological response to a challenge or threat. It can be
categorized into acute stress (short-term) and chronic stress (long-term). While acute stress may
have adaptive benefits, chronic stress can negatively impact mental health and lead to the
development of mental illnesses.
Adaptation: Adaptation refers to an individual’s ability to adjust their thoughts, behaviors, or
emotions in response to stressors or challenges.

Unit-4 Biopsychosocial Intervention

Anger🤬: Anger is a completely normal, usually healthy, human emotion. But when it gets out of
control and turns destructive, it can lead to problems. The three main approaches are expressing,
suppressing, and calming.

Management of Anger:

Relaxation: Simple relaxation tools, such as deep breathing and relaxing imagery.
Cognitive restructuring: Simply put, this means changing the way of think.

Problem Solving: Finding solution.

Other: Better communication, using humor, counseling, Assertiveness and changing

environment.

Nursing management in Anger :

• Establish Trust and Rapport

• Teach anger management
• If client can not adopt any technique & still out of control then use Physical Restraints
and use of seclusion ( confining in a single room).

Cognitive behavioral therapy CBT: Cognitive behavioral therapy was invented by a

psychiatrist, Aaron Beck, in the 1960s.

It is combination of two therapies.

Cognitive therapy: The aim of cognitive therapy is to change the way the person thinks about
the issue that’s causing concern.

Behavior therapy: The aim of behavior therapy is to teach the person techniques or skills to
alter their behavior.

Importance or application of CBT:

• Manage symptoms of mental illness

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• Prevent a relapse of mental illness symptoms
• Treat a mental illness when medications aren’t a good option
• Learn techniques for coping with stress and to manage emotions.
• Used in MDD, OCD, PTSD, GAD, stress, schizophrenia, hallucination, eating disorders,
etc

Pharmacological management in Anger and other Mental Illness:

Antidepressants:

● Serotonin Reuptake Inhibitors (SSRIs): e.g citalopram

● Norepinephrine Reuptake Inhibitors (NRIs): Atomoxetine

Anticonvulsants: Valproic Acid and carbamezepine

Antipsychotics: haloperidol, risperidone

Anxiolytics: Benzodiazepine
Stimulants: Noradrenaline and Dopamine

Nurse role in pharmacological therapy:

Assessment, prescribed medication administration, education, monitoring and support.

Unit-5 Psychopharmacodynamics
Psychopharmacodynamics: It is the study of the biochemical, physiological, and behavioral
effects of psychoactive drugs. It explores how these drugs interact with the nervous system to
produce their therapeutic and adverse effects.

Unit-6 Personality Disorder

Personality: Personality refers to the unique set of characteristics, patterns of thoughts, feelings,
and behaviors that define an individual and influence how they interact with their environment
and others.

Personality: Personality refers to the enduring characteristics and behavior that comprise a
person’s unique adjustment to life, including major traits, interests, drives, values, self-concept,
abilities, and emotional patterns

Personality disorder: Personality disorder is a mental health condition characterized by

enduring patterns of thought, feeling, and behavior that cause significant distress or impairment
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in a person’s life. These patterns are typically evident by early adulthood and are persistent over
time.

Types of personality disorders:

Cluster A (Odd or Eccentric)

• Paranoid Personality Disorder

• Schizoid Personality Disorder:
• Schizotypal Personality Disorder:

Cluster B (Dramatic, Emotional, or Erratic)

• Antisocial Personality Disorder:

• Borderline Personality Disorder
• Histrionic Personality Disorder:
Cluster C (Anxious or Fearful)

• Avoidant Personality Disorder

• Dependent Personality Disorder
• Obsessive-Compulsive Personality Disorder:.

Antisocial Personality Disorder (ASPD): ASDP is a mental disorder in which a person displays
utter disregard for what is right and wrong and completely ignores the feelings of others around.

Characteristics of ASPD: Disregard for Others, Impulsivity, Deceitfulness (lying), Aggression,

irresponsibility, Lack of Remorse and history of conduct disorder.

Causes of RF of ASDP: Genetic Predisposition, environmental factors (abuse, neglect,

violence), neurobiological factors etc.

Borderline personality disorder BPD: BPD is a mental health condition that affects the way
people feel about themselves and others, making it hard to function in everyday life. It includes a
pattern of unstable, intense relationships, as well as impulsiveness and an unhealthy way of
seeing themselves.

Characteristics of BPD: Unstable Relationships, Unstable Self-Image, self harm, Impulsivity

(Engaging in risky behaviors), Emotional Instability (mood swings), chronic feeling,
uncontroling anger etc

Causes of RF of BPD: Genetic Predisposition, environmental factors (trauma, abuse, neglect,

violence), neurobiological factors et

Treatment of Both ASPD and BPD: treatment involves a combination of therapies, including:

• Psychotherapy: Cognitive-behavioral therapy (CBT) can help individuals with ASPD

and BPD.
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• Medication: for underlying conditions, Such as depression or anxiety. CBT focuses on
mindfulness, emotion regulation, and interpersonal effectiveness.
• Substance Abuse Treatment

Maladaptive behaviors: Maladaptive behaviors are actions or ways of behaving that are
unhelpful or counterproductive in achieving our goals or maintaining our well-being. These
behaviors often result from maladaptive beliefs and can lead to difficulties in our lives and
relationships.
Signs and Symptoms: Substance abuse, Self-harm, Aggression, Avoidance, Compulsive
behavior, impulsive behavior, Difficulty maintaining relationships, Problems at work or school
and Legal issues.

Causes:Maladaptive behaviors can be caused by a variety of factors,

• Mental health disorders: Depression, anxiety, bipolar disorder, or personality disorders

• Others (trauma, cooping mechanism, genetics and environmental factors)
Treatment: Therapy: Cognitive-behavioral therapy (CBT), dialectical behavior therapy (DBT),
and Interpersonal therapy (IPT) are effective for addressing maladaptive behaviors.
Nursing process based on Psychodynamic: (Sigmund Freud): Psychodynamics is a theory
that explores the underlying psychological forces that influence behavior. It emphasizes the
unconscious mind, early childhood experiences, and interpersonal relationships. By
understanding psychodynamics, nurses can gain insights into the underlying causes of
maladaptive behaviors and develop more effective interventions.