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Chapter 7
Are personality and human behaviour determined by genetics and biology (nature) or shaped by one’s upbringing, experiences and environmental factors (nurture).

Mental Health – the capacity of individuals within groups and the environment to interact with one another in ways that promote subjective wellbeing, optimal development and use of mental abilities (cognitive, affective and relational)) and achievement of individual and collective goals consistent with justice.

The emergence of a definition of mental health that encompasses positive constructs, not just the absence of symptoms, is important because it enables mental health and mental illness to be viewed as distinct from each other, and not as two points at the opposite ends of a continuum. The two states are not mutually exclusive.

A person can enjoy mental health regardless of whether or not they are diagnosed with a mental illness if they have a positive sense of self, personal and social support with which to respond to life’s challenges, meaningful relationships with others, access to employment and recreation activities, sufficient financial resources and suitable living arrangements.

For many years the terms mental illness and mental health were used interchangeably when in fact they mean two different things. The use of the term mental health instead of mental illness implies that it should be avoided, hidden or shameful.

Theories of personality Developed to explain human behaviours. For understanding prevention or treatment of mental illness. Each with major shortcomings Biomedical Model – behaviour is influence by physiology, with normal behaviour occurring when the body is in a state of equilibrium, and abnormal behaviour being a consequence of physical pathology. Nervous system disorders (neurotransmitters acetylcholine – Alzheimer’s, dopamine – schizophrenia, noradrenaline – mood disorder, serotonin – mood disorder). Structural changes to the brain, Endocrine or gland dysfunction (postnatal depression), familial (genetic) transmission of mental illness. Constitutional predisposition combined with environmental stress will lead to mental illness.

Psychoanalytic theory – Freud - asserts that behaviour is driven by unconscious processes, and influenced by childhood/developmental conflicts that have either been resolved or remain unresolved. The mind is composed of three forces: the id - the primitive biological force comprising two basic drives, sexual and aggressive. Operates on the pleasure principle and seeks to satisfy life-sustaining needs (food, love, creativity, sexual gratification the ego – the cognitive component of personality which attempts to use realistic means to achieve the desires of the id the superego – the internalised moral standards of the society in which one lives. It can be equated to a conscience. The child goes progresses through stages and failure to satisfy certain needs or stages will result in psychological difficulties that are carried into adulthood. Defence mechanisms (such as repression, denial) are used unconsciously to mediate anxiety.

Behavioural psychology – behaviour is influenced by factors external to the individual. Behaviours are learned depending on whether they are rewarded or not, by association with another event or imitation. Pavlov – conditioning response

Cognitive psychology – perception and thoughts about oneself, one’s individual experience and the environment in influencing behaviour. Behaviour is a result of the interplay of external and internal events. How one thinks about a situation will influence how one behaves in that situation. (eg, a depressed person will selectively choose information that maintains a gloomy perspective). Have shown to contribute in treatment of problem behaviours such as phobias, obsessions and compulsions and depression and schizophrenia.

Humanistic psychology – focuses on the development of a concept of self and the striving of the individual to achieve personal goals. Emphasis on the whole person, human emotions, experience and the meaning of experience, the creative potential of the individual, choice (goals are personally selected), self-realisation and self-actualisation.

Sociological theories – shifts the emphasis from the individual to the broader social forces that influence people. Challenges the notion of individual pathology.

Theories can be interpreted into every day life and so interventions based on the theoriese can also be. However one theory is not right for every situation.

The psychological theories were the basis for the later development of psychiatric nursing theories developed by: Hildegard Pelau (1909-1999) – the “mother of psychiatric nursing”. Developed the Interpersonal Theory of Nursing. The nurse does not perform therapy on the patient, but rather the nurse is the therapy.

Joyce Travelbee (1926-1973) – Human-to-Human relationship model, nurse patient relationship. Emphasis on the emotional and psychological aspects of nursing, such as caring, empathy and rapport.

Phil Barker (1946 - ) – Tidal model – seeks to reveal solutions rather than solve problems. Empowerment of the patient

Nature vs nurture – in the case of schizophrenia, however, heredity accounts for less than 50% of the predictability of the disorder. Genetic inheritance is only a partial influence, with the environment accounting for the rest. Neither nature nor nurture can be considered in isolation from the other.

Bold text== Assignment Questions == Question 1. Mental Status Exam Appearance & Behaviour Beard, Long blonde hair is greasy and matted, Washcloth on head, Clothes are crushed and stained, Thin

Cooperative, Brief and irrelevant replies, Unable to remain seated for a long time, Hyperactive tremor shown by lip movement.

Speech Monotonous tone

Mood & Affect Monotonous tone, Flat – little emotion, Labile – laughing for no apparent reason, Suspicious, Withdrawn, agitated & irritable

Form of thought Believes he can send & receive messages from God. Illogical thinking shown by irrelevant conversation. Disturbance in language

Thought control Delusions of persecution, reference & religious. Obsession that people are coming after him.

Perception Auditory hallucinations

Sensorium and cognition Fully conscious and oriented. Concentration – can’t sit still. Memory - has an aspect. Abstract thought – can handle multiple ideas at once.

Insight Not aware of his illness – he thinks hearing voices is normal

Question 2 & 3

by Raj

Nursing diagnosis

Nursing diagnosis has three parts problems, etiology (cause) and symptoms/defining characters. Therefore, nursing diagnosis is problem related to etiology supported by signs and symptoms. Nursing diagnosis then become the basis for the care plan (Townsend, M.C., 2008, page xxv).

2. Disturbed thought process related to schizophrenia: “It is defined as disruption in cognitive operation and activities (Townsend, M.C. 2008, page108). The following are the nursing diagnosis of Cromac:

•	Impaired ability to reason: Laughs for no apparent reason.

•	Distractibility/altered attention: Moves lips and turn around his head as if someone is talking to him.

•	False believe/delusional thinking: he thinks stranger is talking to him; he believes he can get messages from God through radio & TV; videos have got information about him and he believes his boss is taping his conversation with customer.

•	Inappropriate social behavior: He behaves strangely with customer. He tells customer not to buy certain brand because it has got conversation taped between him and national spy agency. (Townsend, M.C., 2008, page 108)

3. The following are two more Nursing Diagnosis of the Cromac related to Schizophrenia:

	Self Care Deficit: This is an impaired ability to perform or complete activities of daily living. In case of Cromac it is evident by his greasy and matted hair; washcloth on his head; his cloth are crushed and stained. It proves that he has lack of interest in selecting appropriate clothes and maintaining hygiene (Townsend, M. C., 2008, page 111).

	Social Isolation: “Aloneness experienced by the individual and perceived as imposed by others and as a negative or threatened state” is social isolation (Townsend, M.C., 2008, page 105). The following are the defining character shown by Cromac as supportive evidence:

•	Social withdrawn; it is supported by parents report that he hasn’t been to work for week and smoking marijuana.

•	Avoid eye contact; it is his reaction during interview.

Nursing intervention The following are priorities nursing intervention

1.	Pharmacological management. Outcome is complete medication course which brings him in normal state of life relieving all symptoms and episode.

2.	Altered thought process management. Outcome is patient receives and interprets the situation, things and talks as normal human being.

3.	Socialization. Outcome is patient will live, learn and work at a maximum possible level of success as defined by the individual.