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Lecture 1
Community and Mental Health Nursing-NUR 472
Mental Health and Mental
Illness
Introduction
Maslow's Hierarchy of Needs
Mental Health
 A dynamic process in which a person’s
physical, cognitive, affective, behavioral
and social dimensions interact functionally
with one another and with the
environment.
Mental Health
 “The successful adaptation to stressors
from the internal or external environment,
evidenced by thoughts, feelings, and
behaviors that are age-appropriate and
congruent with local and cultural norms.”
Mental Illness
 Physical, cognitive, affective, behavioral
and social patterns that interact
dysfunctionally with the environment.
Mental Illness
 “Maladaptive responses to stressors from
the internal or external environment,
evidenced by thoughts, feelings, and
behaviors that are incongruent with the
local and cultural norms and interfere with
the individual’s social, occupational, or
physical functioning.”
PHYSICAL AND
PSYCHOLOGIAL
RESPONSES TO STRESS
Physical Responses
 Stress: is “Any factor that threatens the
health of the body or has an adverse
effect on its functioning such as injury,
disease or worry.”
Physical Responses (cont.)
 General Adaptation Syndrome
GAS, is a term used to describe the body's
short-term and long-term reactions to stress
 Alarm reaction stage
 Stage of resistance
 Stage of exhaustion
General adaptation syndrome
 Alarm reaction stage
Is the immediate reaction to a stressor. In the
initial phase of stress, humans exhibit a "fight or
flight" response, which prepares the body for
physical activity. However, this initial response can
also decrease the effectiveness of the immune
system, making persons more susceptible to
illness during this phase.
General adaptation syndrome
 Stage of resistance
During this phase, if the stress continues, the
body adapts to the stressors it is exposed to.
Changes at many levels take place in order to
reduce the effect of the stressor.
General adaptation syndrome
 Stage of exhaustion
The stress has continued for some time. The
body's resistance to the stress may gradually be
reduced, or may collapse quickly. Generally, this
means the immune system, and the body's ability
to resist disease, may be almost totally eliminated.
Patients who experience long-term stress may
succumb to heart attacks or severe infection due
to their reduced immunity.
Psychological Responses
 Anxiety and grief have been described as two
major, primary psychological response patterns
to stress.
Psychological Responses (cont.)
Anxiety
 A diffuse apprehension that is vague in nature
and is associated with feelings of uncertainty
and helplessness
 Extremely common in our society
 Mild anxiety is adaptive and can provide
motivation for survival
Psychological Responses (cont.)
 Four levels of anxiety
 Mild - seldom a problem
 Moderate - perceptual field diminishes
 Severe - perceptual field is so diminished
that concentration centers on one detail only
or on many extraneous details
 Panic - the most intense state
Psychological Responses (cont.)
 Behavioral adaptation responses to
anxiety:
 At the mild level, individuals employ various
coping mechanisms to deal with stress. A few of
these include eating, drinking, sleeping, physical
exercise, smoking, crying, laughing, and talking to
persons with whom they feel comfortable.
Psychological Responses (cont.)
 At the moderate level, the defense mechanisms
for protection, such as
 Rationalization
 Reaction formation: Is a defense mechanism
in which anxiety-producing or unacceptable
emotions and impulses are mastered by
exaggeration (hypertrophy) of the directly
opposing tendency
 Undoing
 Denial
 Isolation
Psychological Responses (cont.)
 Anxiety at the severe level that remains
unresolved over an extended period can
contribute to a number of physiological
disorders--for example, migraine headaches,
irritable bowel syndrome, and cardiac
arrhythmias.
 Extended periods of repressed severe anxiety
can result in psychoneurotic patterns of
behaving--for example, anxiety disorders and
somatoform disorders.
Psychological Responses (cont.)
 Extended periods of functioning at the panic
level of anxiety may result in psychotic behavior;
for example, schizophrenic, schizoaffective, and
delusional disorders.
Psychological Responses (cont.)
Grief
 The subjective state of emotional, physical, and
social responses to the loss of a valued entity;
the loss may be real or perceived.
Psychological Responses (cont.)
 (5 Stages of Grief)
 Denial
 Anger: Sometimes a small part of anger stays
with you throughout the entire illness.
 Fear: This is the most important stage to work
through
 Depression: can cause feelings of inadequacy
and lead to withdrawal and isolation.
 Acceptance
Not everyone goes through these stages in the same order.
Psychological Responses (cont.)
 Anticipatory grief - The experiencing of
the grief process before the actual loss occurs.
-Anticipatory grieving is thought to shorten the
grief response when the loss actually occurs.
 Resolution - Length of the grief process is
entirely individual. It can last from a few weeks
to years.
 Guilt often lengthens the grieving process.
Psychological Responses (cont.)
 Maladaptive grief responses
 Prolonged response
 Delayed/inhibited response: the intentional
postponement of grief. Sometime this is related to
other life events or losses that drain ones ability to
work through the grief process.
 Distorted response: hostility towards a specific
person, and the taking of actions that are selfdestructive.
DSM-IV-TR Multiaxial Evaluation System
 Diagnostic and Statistical Manual of Mental
Disorders, 4th Edition, Text Revision, also
known as DSM-IV-TR, is a manual published by
the American Psychiatric Association (APA) that
includes all currently recognized mental health
disorders.
DSM-IV-TR Multiaxial Evaluation System
 Axis I - Clinical disorders and other conditions
that may be a focus of clinical attention. This is
the top-level diagnosis that usually represents
the acute symptoms that need treatment
 Axis II - Personality disorders and mental
Retardation (These disorders are usually lifelong problems that first arise in childhood)
DSM-IV-TR Multiaxial Evaluation System
 Axis III - General medical or neurological
conditions that may influence a psychiatric
problem. For example, diabetes might cause
extreme fatigue which may lead to a depressive
episode
 Axis IV - Psychosocial and environmental
problems (identifies recent psychosocial
stressors - a death of a loved one, divorce,
losing a job, etc.)
DSM-IV-TR Multiaxial Evaluation System
 Axis V - Identifies the patient's level of function
on a scale of 0-100, (100 is top-level functioning).
Known as the Global Assessment of Functioning
(GAF) Scale, it attempts to quantify a patient's
ability to function in daily life