UNIT-5.(MENTAL DISORDER AND NURSING INTERVENTION) Unit-5. (Mental Disorders and Nursing Interventions)

(a).Psycho-Pathophysiology Of Human Behaviour.

*Behavior is everything i.e. from conception to death it does everything. It consists of 3 items.

1. Connection (Primary Mental Function)

*It includes thinking, judgment and recognition.

2. Affection

*There is an emotional component, which includes happiness, sorrow, fear and anger.

3.Connation (psychomotor activity)

*ADL (Activities of Daily Living)

*Behavior helps a person to be aware of and understand himself and the environment.

*Psychiatric nursing is a branch of nursing that deals with the care of psychiatric patients with abnormal behavior.

(b).ETIOLOGICAL THEORIES [Genetics, Biochemical, Psychological]

★WHAT CAUSES OF MENTAL DISORDER OR CAUSES OF ABNORMAL BEHAVIOR

(Causes of mental disorder or causes of abnormal behaviour.)

*Biological factors

• Genetics (heredity) Chromosomal abnormalities affect the development of the fetus.Mongolism and Down syndrome etc. If mental illness occurs in family members, other family members are likely to develop it.

•Biochemical factor

Biochemical abnormalities within the brain cause psychological disorders. Disturbance in neurotransmitters like dopamine, serotonin, norepinephrine etc. causes some mental disorders.

•Physical factor

A healthy body makes a healthy mind. A person’s physical condition directly affects mental health. Severe malnutrition affects the physical and mental growth of an infant. Mental disorders occur due to some physical factors.

• Brain structure abnormalities Mental illness occurs due to damage in the structure and function of the brain. Brain injury is more likely to cause mental health problems.
• Infections and tumors Infections and tumors can develop mental disorders. Infections can cause broad spectrum psychiatric symptoms such as delirium, psychotic and mood disorders.

•Physiological factors

Mental illness can develop due to reasons like pregnancy, child birth, fever, menopause, puberty etc.

*Psychological factor

•Faulty child-parent relationship

This type of relationship affects the behavior of the child.

Neglect

Anxiety and low self-esteem are seen in a person when they are neglected by parents or other family members.

•Strict discipline

Due to strict discipline, fear develops and mental health is affected.

Trauma

Severe psychological trauma such as emotional, physical and sexual abuse can result in altered mental health.

• Stress Stress develops when study, job and marital life fail to adjust and when a loved one is lost.

** Social and Cultural Factors

•Unemployment

• Insecurity

•Poverty

•Alcoholism

•Prostitution

•Job loss

•Broken Home

•Urbanization

•Violence

• Divorce

•Family conflict

(C).CLASSIFICATION MENTAL DISORDERS

(C).(Classification of Mental Disorders)

There are currently 2 major classifications of mental disorders.

(1). ICD-10 (International Classification of Diseases-10 (1992).

(2).DSM IV (Diagnostic Statistical Manual Classification-IV (1994).

(1).ICD-10 (International Classification of Diseases-10)

Useful for classifying and monitoring causes of injury and death, and maintaining information for health analysis, such as studies of trends in mortality and morbidity.

*ICD is published by “WHO”.

*ICD-10 is the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD). Which is given by WHO.

• Classification of Mental and Behavioral Disorders is included in Chapter (V)5 of ICD-10. *Chapter ‘F’ classifies mental disorders and codes them on an alphanumeric system from F00 to F99.

★F00 -FO9 includes organic, symptomatic mental disorder.

•F00 : Dementia in Alzheimer’s disease

•F01 : Vascular dementia

•F02 : Dementia in other diseases

•F03 : Unspecified dementia

•F04 : Organic amnestic syndrome

•FO5 : Delirium

★F10-F19 are coded for mental and behavioral disorders caused by psychoactive substances.

•F10 : Mental and behavioral disorders due to alcohol abuse.

•F11 : Mental and behavioral disorders caused by opioids.

•F12 : Mental and Behavioral Disorders Caused by Cannabinoids.

•F13 : Mental and behavioral disorders caused by sedatives or hypnotics.

•F14 : Mental and behavioral disorders caused by cocaine.

•F15 : Mental and behavioral disorders caused by stimulants.

•F16 : Mental and behavioral disorders caused by hallucinogens.

★F20-F29 codes for schizophrenia, schizotypal and delusional disorder.

•F20 : Schizophrenia

•F20.0 : Paranoid schizophrenia

•F20.1  : Hebifrenic schizophrenia

•F20.2 : Catatonic schizophrenia

•F20.3 : Undifferentiated schizophrenia

•F20.4 : Post-schizophrenic depression

•F21 : Schizotypal disorder

•F22 : Persistent delusional disorder

•F23 : Acute transient psychotic disorder

•F24 : Induce delusional disorder

•F25 : Schizo affective disorder

•F28 : Other non organic psychotic disorders

★F30-39 codes for mood disorder.

•F30 : Mania

•F31 : Bipolar disorder

•F32 : Depressive episode

•F33 : Recurrent depressive episode

•F34 : Persistent mood disorder

•F38 : Other mood disorder

★F40-F49 codes for neurotic, stress related and somatoform disorders.

•F40: Phobic anxiety disorders

•F41 : Other anxiety disorders

•F42 : Obsessive compulsive disorders

•F44 : Dissociative disorders

•F45 : Somatoform disorders

•F48 : Other neurotic disorders

★F50-F59 code behavioral disorders associated with physiological disturbances.

•F50 : Eating disorder

•F51 : Non organic sleep disorders

•F52 : Sexual Dysfunction

•F55 : Non Dependence Producing Substance Abuse

★F60-69 codes for adult personality and behavioral disorders.

•F60 : Specific personality disorders

•F60.0 : Paranoid personality disorders

•F60.1 : Schizoid personality disorders

•F60.2 : Dissociative personality disorders

•F60.3 : Emotionally unstable personality

•F60.4 : Histrionic personality disorders

•F60.5 : Anastatic personality disorders

•F60.6 : Anxious personality disorders

•F60.7 : Dependent personality disorders

•F61 : Mixed and other personalities

•F62 : Enduring Personality Changes,

•F63 : Habit and impulse disorders

•F64 : Gender identity disorders

★F70-79 codes for mental retardation.

•F70 : Mild mental retardation

•F71 : Moderate mental retardation

•F72 : Severe mental retardation

•F73 : Profound mental retardation

•F78 : Other mental retardation

★F80-89 codes for psychological developmental disorder.

•F80 : Specific developmental disorder of speech

• F81 : Specific developmental disorder of scholastic skills

•F82 : Specific developmental disorders of motor function

•F83 : Mixed specific developmental disorder

•F84 : Pervasive developmental disorder

•F88 : Other disorders of psychological development

★F90-F99 codes for behavioral and emotional disorders occurring in childhood and adolescence.

•F90 : Hyperkinetic disorders

•F91 : Conduct disorders

•F92 : Emotional disorders of childhood

•F95 : Tic disorders

•F99 : Unspecified mental disorders

(2).DSM(Diagnostic Statistical Manual) Classification

DSM (Diagnostic and Statistical Manual). It is a handbook used by health care professionals in the United States and most of the world.

The DSM is published by the American Psychiatric Association (APA).

*The pattern adopted by DSM-IV is that of a multiaxial system.

*DSM-IV has 5 Axis.

•AXIS-I : Clinical Psychiatric Diagnosis

•AXIS-II : Personality Disorder and Mental Retardation

•AXIS-III : General Medical Condition

AXIS-IV: Psycho-Social and Environmental Problems AXIS-V: Global Assessment of Current and Past 1 Year Function