Mental Health Nursing

2. PSYCHOPATHOLOGY OF MENTAL
DISORDER
R. RUPPA MERCY
M.SC NURSING 1st YEAR

3. DEFINITION:
 Psychopathology is the scientific study of mental
disorders, including efforts to understand their
genetic, biological, psychological, and social causes;
develop classification schemes (nosology) which can
improve treatment planning and treatment outcomes;
understand the course of psychiatric illnesses across
all stages of development; more fully understand the
manifestations of mental disorders; and investigate
potentially effective treatments.

4. HISTORY OF PSYCHOPATHOLOGY:
 sixteenth and seventeenth centuries,
 Early explanations for mental illnesses
were influenced by religious belief and superstition.
 attributed to possessions by evil spirits, demons, and
they so-called "possessions“.

5. HIPPOCRATES:
 The Greek physician Hippocrates was one of the first
to reject the idea that mental disorders were caused
by possession of demons or the devil.
 He believed that mental disorders were due to
diseases originating in the brain and due to
imbalances of fluids in the body.
 In particular: blood, black bile, yellow bile, and
phlegm.

6. PLATO:
 The philosopher Plato would come to argue the mind,
body, and spirit worked as a unit.
 Any imbalance brought to these compositions of the
individual could bring distress or lack of harmony
within the individual.

7. JEAN JACQUES ROUSSEAU
 In the eighteenth century's Romantic Movement, the
idea that healthy parent-child relationships provided
sanity became a prominent idea.
 Philosopher Jean-Jacques Rousseau introduced the
notion that trauma in childhood could have negative
implications later in adulthood.

8. SIGMUND FREUD:
 In the nineteenth century, Austrian
psychoanalyst Sigmund Freud would bring about
psychotherapy and become the father of
psychoanalysis, a clinical method for treating
psychopathology through dialogue between a patient
and a psychoanalyst.
 Talking therapy would originate from his ideas on the
individual's experiences and the natural human
efforts to make sense of the world and life.

9. REVIEW OF STRUCTURE OF
BRAIN

11. THE NERVOUS SYSTEM:
 The brain
Forebrain Mid brain Hind brain
cerebrum mesencephalon pons
diencephalon medulla
cerebellum

12. THE HUMAN BRAIN IS SPLIT UP INTO THREE MAJOR LAYERS:
THE HINDBRAIN, THE MIDBRAIN, AND THE FOREBRAIN.

13. THE FOREBRAIN:
1. cerebrum:
 It consists of two hemispheres divided by CORPUS
CALLOSUM
 Outer shell is called cortex.
 Left hemisphere deals with logic and solving
problems.
 Right hemisphere called “creative” brain associated
with affect, behavior, spatial – perceptual functions.

14. HEMISPHERES:
 EACH HEMISPHERE is divided into four lobes .
 FRONTAL LOBE:
Voluntary body movements for speaking, thinking, judgment,
expression of feelings.
 PARIETAL LOBE:
Perception and interpretation of most sensory information
(includes touch, pain, taste, body positions)
 TEMPORAL LOBE:
Hearing, short term memory; sense of smell; expression of
emotions through connection with limbic system.
 OCCIPITAL LOBE :
Visual reception and interpretation.

15. .THE CORPUS CALLOSUM:
 A thick collection of nerve fibers that connects the
two hemispheres of the brain and is responsible for
the transmission of information from one side of the
brain to the other.
Information transferred includes :
 Sensation
 Memory
 Learned discrimination.

16. DIENCEPHALON:
1. THALAMUS:
 Connects cerebrum with lower brain structures.
 Integrates all sensory input(except smell)
 regulates the pituitary secretion of hormones that
influence
a. metabolism,
b. reproduction,
c. stress response, and
d. urine production .
 maintains fluid balance

17. CONTD…
 maintains temperature regulation by promoting
vasoconstriction and vasodilatation.
 Some involvement with emotion and mood.
2. HYPOTHALAMUS:
 Regulates anterior and posterior lobes of pituitary
gland
 Exerts control over actions of the autonomic nervous
system
 Regulates appetite and temperature

20. LIMBIC SYSTEM
 The part of the brain known as the limbic system
consists of portions of the cerebrum, and the
diencephalon.
 The major component Consists of medially placed
cortical and sub cortical structures and the fiber
tracts connecting them with one another and with the
hypothalamus.
 It is sometimes called the “emotional brain” –
associated with feelings of fear and anxiety; anger
and aggression; love, joy and hope; with sexuality and
social behavior.

22. THE MIDBRAIN
MESENCEPHALON:
 Structures of major importance in the
mesencephalon, or midbrain, include
 nuclei and
 fiber tracts.
 extends from the pons to the hypothalamus.
 Responsible for
 visual (automatically turns away from dangerous
object),
 auditory(turns toward sound heard ) and
 balance(righting) reflexes.( automatically keeping the
head upright and maintaining balance).

23. THE HINDBRAIN
A. PONS:
 The pons is a bulbous structure that lies between the
midbrain and the medulla.
 It composed of large bundles of fibers and forms a
major connection between the cerebellum and the
brainstem.
 It connects cranial nerves V through VIII and centers
for respiration and skeletal muscle tone.

24. CRANIAL NERVES

25. CONTD..
B. MEDULLA
Connects spinal cord and pons and all fiber tracts pass through
it.
The vital centers are contained in the medulla.
Responsible for
 regulation of heart rate,
 blood pressure(diameter of blood vessels)
 Respiration and
 swallowing
 sneezing
 coughing
 vomiting

26. CONTD..
C. CEREBELLUM
 Situated just below the occipital lobes.
 The functions of the cerebellum are concerned with
involuntary movement, such as
 muscular tone
 coordination
 the maintenance of posture and
 equilibrium.

27. NEURONS
 A neuron is a nerve cell that is the basic building
block of the nervous system.
 Neurons are specialized to transmit information
throughout the body both in chemical and electrical
forms.
 Sensory neurons carry information from the sensory
receptor cells throughout the body to the brain.
 Motor neurons transmit information from the brain to
the muscles of the body.
 Interneurons are responsible for communicating
information between different neurons in the body.

28. PARTS OF NEURON

29. SYNAPSES
 Information is transmitted through the body from one
neuron to another. The neurons that transmit the
impulse do not actually touch each other.
 The junction between two neurons is called synapse.
 The small space between the axon terminals of one
neuron and the cell body or dendrites of another is
called the synaptic cleft.
 Neurons conducting impulse towards the synapse are
called presynaptic neurons.
 Neurons conducting impulse away from the synapse
are called postsynaptic neurons.

30. ACTION POTENTIAL
 How do neurons transmit and receive information?
 Neurons transmit information both within the neuron and
from one neuron to the next.
 The dendrites of neurons receive information from sensory
receptors or other neurons.
 This information is then passed down to the cell body and
on to the axon.
 Once the information has arrived at the axon, it travels down
the length of the axon in the form of an electrical signal
known as an action potential.
 An action potential is a part of the process that occurs
during the firing of a neuron.

31. NEUROTRANSMISSION
 Once the electric impulse has reached the end of an
axon, the information must be transmitted across
the synaptic gap to the dendrites of the adjoining
neuron.
 Neurotransmitters are chemical messengers that
are released from the axon terminals to cross the
synaptic gap and reach the receptor sites of other
neurons.
 In a process known as reuptake, these
neurotransmitters attach to the receptor site and
reabsorbed by the neuron to be reused.

32. NEUROTRANSMITTERS:

33. SYNAPTIC TRANSFER:

34. TYPES OF NEUROTRANSMITTERS:

39. ABNORMAL NEUROTRANSMISSION:

40. CAUSES OF ABNORMAL NEUROTRANSMISSION

41. DIAGNOSIS OF IMBALANCE NEUROTRANSMISSION
 Identify the causes
 Identify the symptoms
 Diagnostic tests
 - brain scans
 - live studies
 - brain tissue analysis

43. ADAPTATION AND MALADAPTATION
 ADAPTATION
Adaptation is said to occur when an individual’s
physical or behavioral response to any change in his
or her internal or external environment results in
preservation of individual integrity or timely return
to equilibrium.
 MALADAPTATION
Maladaptation occurs when an individual’s physical
or behavioral response to any change in his or her
internal or external environment results in disruption
of individual integrity or in persistent equilibrium.

44. INDIVIDUAL ADAPTATION

45. INDIVIDUAL ADAPTATION
 The ability to effectively meet social and community
expectations for personal independence, physical
needs, and interpersonal relationships expected for
one's age and cultural group is termed as individual
adaptation.
 An individual’s behavior that interferes with everyday
activities is called maladaptive behavior and it is
undesirable, is socially unacceptable, or interferes
with the acquisition of desired skills or knowledge

46. GROUP ADAPTATION

47. GROUP ADAPTATION
 Group adaptation is a process by which the group
maintains a balance so that it can promote growth of
individual and group members.
 For group to adapt successfully there must be
A. Good communication
B. Mutual respect
C. Adequate resources available
D. Previous experiences with stressors.

48. MALADAPTIVE PROCESS
1. Crisis: “a state of disequilibrium resulting from the
interaction of an event with the individual or family’s
coping mechanisms, which are inadequate to meet the
demands of the situation, combined with the
individual’s or family’s perception of the meaning of the
event”.
- TAYLOR, 1982
“ A crisis situation is the result of a person’s perception
and emotional response to a loss or threat of loss of self
– esteem from events”.

49. TYPES OF CRISIS
1. Situational crisis/external crisis/coincidental crisis:
 Eg. Death of a loved ones
 An accident
 Loss of employment
2. Maturational crisis/developmental crisis/internal
crisis
 Maturational crisis involves how an individual will
perceive themselves, their role and their status.
 Eg. Adolescence
 marriage

50. CONTD…
3. Socio – cultural crisis:
It arises from the cultural values that are embedded in
the social structure.
Eg. Discrimination
Between race and robbery
4. Crisis resulting from traumatic stress:
Crisis resulting when unexpected external stress over
which the individual has little or no control. Eg. Rape,
robbery
5. Crisis resulting from psychopathology:
Preexisting psychopathology has been instrumental in
precipitating the crisis. Eg. Neurosis.

51. CONTD…
6. Adventitious crisis/community crisis:
it is accidental, uncommon, unanticipated results in
multiple losses may be because of environmental
changes. Eg. Natural disorders like floods, earthquakes.
7. Psychiatric emergencies:
Crisis occurs when general functioning is impaired and
the individual is incompetent to assume personal
responsibility.

52. 2. STRESS
 The non - specific response of the body to any
demand placed upon it
- Hans selye
 It can be positive such as when it helps you avoid
danger or meet a deadline. but when stress lasts for a
long time, it may harm your health.

53. STRESS PROCESS
Any event or thought
Specific hormone is released
Make brain more alert
Muscles to tense
Increase in pulse
Short term – avoid danger long term - harmful

54. TYPES OF STRESS
 Acute stress
 Chronic stress
 Eustress
 distress

55. TYPES
 ACUTE STRESS:
Goes away quickly
Helps managing dangerous situation
All people have it.
 CHRONIC STRESS:
Lasts for longer period
Goes for a week or months
When we don’t realize it is a problem
Don’t find ways to manage stress it may lead to health
problems.

56.  EUSTRESS:
Eustress or positive stress occurs when your level of
stress is high enough to motivate you to move into
action to get things accomplished.
 DISTRESS:
Distress are negative stress occurs when your level of
stress is either too high or too low and your body and
mind begin to respond negatively to the stressors.

59.  Disaster is defined by WHO as “ a severe disruption,
ecological and psychological, which greatly exceeds
the coping capacity of the affected community.
 It can be natural and man – made, psychological
reaction may be either adaptive or maladaptive.
3. DISASTER

60. ETIOLOGY: BIO – PSYCHO – SOCIAL
FACTORS
 Cause of mental illness can be chronologically divided
into 3 groups:
PRE – DISPOSING FACTORS:
 These occurs before the onset of the disease or before
psychopathology have appeared.
 Genetic factors
 Biological factors
 Psychological factors

61. CONTD…
PRECIPITATING FACTORS:
 These are events that occur shortly before the onset
of disorders and appear to have induced it.
 Physical factors
 Physiological factors
 Psychological factors
 Social factors.

62. CONTD…
 PERPETUATING FACTORS:
 These are factors that prolong the course of a
disorder after it has been provoked. It is extremely
vital to consider these factors while planning
treatment.

63. ADAPTIVE COPING MECHANISMS
 Awareness
 Relaxation

64.  Meditation
 Interpersonal communication with caring others

65.  Problem solving
 Pets

66. CONTD..
 music

67. DEFENCE MECHANISM
Behavior used to protect oneself from unpleasant
emotions or situations known as defense mechanism.
This process is usually unconscious.
HEALTHY:
Helps to develop new acceptable behavior.
Change external environment positively.
Can modify needs.
UNHEALTHY:
Escape from the reality.

68. TYPES
COMPENSATION:
counter balancing weakness by strength.
DENIAL:
Individual is not ready to accept painful emotions or
situations.
Eg. Individuals continue to smoke cigarettes even
though they have been told of the health risks involved.

69. CONTD…
DISPLACEMENT:
The transfer of negative emotion from one person or
thing to an unrelated person or thing.
IDENTIFICATION:
An attempt to increase self – worth by acquiring certain
attributes and characteristics of an individual one
admires.
Eg. A teenage girl emulates the mannerisms and style of
dress of a popular female rock star.

70. INTELLECTUALIZATION:
Individual will ignore or avoid the emotional aspect of a
person.
Eg. A young professor receives a letter from his fiancée
breaking of their engagement. He shows no expression
when discussing this with his best friend. Instead he
analyses his fiancée's behavior and tries to reason why the
relationship failed.
CONTD…

71. CONTD…
 INTROJECTION:
Integrating the beliefs and values of another individual
into one’s own ego structure.
Eg. A psychiatric client claims to be the son of god,
drapes himself in sheet and blanket, “performs
miracles” on the other clients, refuses to respond unless
addressed as JESUS CHRIST.
ISOLATION:
Separating a thought or memory from the feeling tone,
or emotion associated with it.
Eg. A young women describes being attacked and raped,
without showing any emotions

72. CONTD…
PROJECTION:
When you project your impulses, behavior and thoughts
onto someone else.
Eg. Sue feels a strong sexual attraction to her track
coach and tells her friend, “he’s coming on to me!”
RATIONALIZATION:
Is the substitution of a safe & reasonable explanation
for the true cause of behavior. It occurs when we tell an
element of truth but deny the larger truth of the matter.
Eg. A student who cheats on a test may say: “I only
cheated on a few question, I know most of the answers.”

73. CONTD…
REACTION FORMATION:
Converting of unwanted or dangerous thoughts to the exact
opposite thought.
Eg. Jane hates nursing. She attended nursing school to please
her parents. During career day, she speaks to prospective
students about the excellence of nursing as a career.
REGRESSION:
when someone is under a lot of stress, they return to
behavior from an earlier stage of development. Also known
as back journey.
EG. A lady regressed into adolescent starts to walk, talk or
dress like as her younger self. When a person is confronted to
some loss may be back journey to a stage which had been
more pleasant & successful in his lifetime.

74. CONTD..
REPRESSION:
Involuntary forgetting of unpleasant feelings and experiences
from one’s own awareness.
Eg. An accident victim can remember nothing about his
accident.
SUBLIMATION:
Consciously or unconsciously channeling drives into
acceptable activities.
Eg. Sport is an example of putting our emotions into
something constructive.

75. CONTD…
SUPPRESSION:
The voluntary blocking of unpleasant feelings and
experiences from one’s awareness.
Eg. Scarlett O Hara says, “I don’t want to think about
that now. I’ll think about that tomorrow.
UNDOING:
Symbolically negating or canceling out an experience
that one finds intolerable.
Eg. A man spills some salt on the table, then sprinkles
some over his left shoulder to “prevent bad luck”.

76. CONTD..
WITHDRAWAL:
Escaping from the situation.
Eg. Fear of rejection in making friends.
DAY – DREAMING:
Thinking to deviate from stress or problem.
SOMATIZATION:
The person’s negative feelings are transferred into
physical symptoms.
HUMOR:
Focusing on funny aspects of a painful situation.

77. STRESS MANAGEMENT:

78. TO RECAPITULATE. . .