What is Chemical Neurotransmission

This is the process linking the discharge of a neurotransmitter by one neuron and the binding of the neurotransmitter molecule to a receptor on another neuron. The process of chemical neurotransmission is affected by most drugs used in psychiatry. Older antipsychotics, but not the serotonin-dopamine antagonists, are believed to exert their effects mainly by blocking dopamine type 2 (D₂) receptors; virtually all antidepressants are believed to exert their effects by increasing the amount of serotonin or norepinephrine, or both, in the synaptic cleft; and almost all benzodiazepine anxiolytics are believed to exert their effects on the GABA_A receptors that are linked to chloride ion channels. (Sadock, 2007)

What is the psychopathologic role of Dopamine?

Observations that drugs that block dopamine receptors (e.g., haloperidol) have antipsychotic activity and drugs that stimulate dopamine activity (e.g., amphetamine) can induce psychotic symptoms in nonschizophrenic persons when given in sufficiently high doses. The dopamine hypothesis of schizophrenia grew from this premise. The dopamine hypothesis remains the leading neurochemical hypothesis for schizophrenia, but room is being made for a role for serotonin, based on the therapeutic success of the serotonin-dopamine antagonists. A recent series of studies showed that plasma concentrations of HVA, in fact, are reduced in many patients with schizophrenia who respond to antipsychotic drugs.

Moreover, Dopamine may also be involved in the pathophysiology of mood disorders. Dopamine activity may be low in depression and high in mania. Amphetamines, which potentiate dopamine activity, are highly effective antidepressants. The observation that levodopa (Larodopa) can cause mania and psychosis in some patients with parkinsonian side effects also supports the hypothesis. Some studies have found low levels of dopamine metabolites in depressed patients.

What is the psychopathologic role of Norepinephrine?

What the relative roles of serotonin and norepinephrine are in the pathophysiology of depression is still unclear. However, THE biogenic amine hypothesis of mood disorders was based on the observation that the some antidepressants are effective in alleviating the symptoms of depression. Drugs that affect both neurotransmitters are effective, and drugs that affect primarily norepinephrine—for example, desipramine (Norpramin)—and drugs that affect primarily serotonin—for example, fluoxetine—are also effective.

What is the psychopathologic role of Serotonin?

The chief involvement of serotonin with a psychopathological condition is with depression. This hypothesis is simply that depression is associated with too little serotonin and that mania is associated with too much serotonin. The permissive hypothesis postulates that low levels of serotonin permit abnormal levels of norepinephrine to cause depression or mania. With the success of SSRIs and buspirone, which are effective antianxiety agents, the theory of anxiety needed room for a role for serotonin. Similarly, schizophrenia was previously thought to result from an imbalance of dopamine, but since the therapeutic success of the serotonin-dopamine antagonists, schizophrenia is now thought to result from misregulation of both dopamine and serotonin function.

What is the psychopathologic role of Acetylcholine?

Acetylcholine is commonly linked to dementia of the Alzheimer's type and other dementias. Anticholinergic agents can impair learning and memory in healthy people. Acetylcholine may also be involved in mood and sleep disorders.

What is the psychopathologic role of GABA?

The GABAergic system is known to be linked with benzodiazepines and its potential role in the pathophysiology of anxiety disorders. Many of the standard anticonvulsants also have their effects on the GABA system; therefore, researchers in epilepsy also are actively studying the GABA system.

Myths and Facts about Mental Illness

Throughout the ages, mental illness has been misunderstood. It has been associated with demonic possession, the evil eye, and lunar influences among other things. Although, the etiology and dynamics of mental illness are more understood at present, there are still myths that are widely believed at present. Some of these myths and the corresponding facts are presented below:

1. Myth: Mental illness is the polar opposite of mental health.

Fact: Mental health and mental illness are not polar opposites. Instead, they may be thought of as points on a continuum. As such, mental health and mental illness are dynamic states. One’s mental status is not fixed; rather, it could move from one point of the continuum to another. As points on a continuum, there is no demarcation line that distinctively indicates where mental health ends and mental illness begins. There is no universally agreed cut-off point between what is considered as normal behavior and the behavior associated with mental illness. What is considered abnormal behavior differs between cultures, social groups within the same culture, and even different social situations.

2. Myth: Mental illness is a weakness or defect in character and sufferers can get better simply by willing themselves to get well.

Fact: Mental illnesses are real illnesses. They are as real as diabetes and heart disease. Just like many other real illnesses, they require and respond well to treatment. Persons with mental illness cannot will themselves to get well. As nurses, it is important for us to realize this so that we do not blame our clients when they do not get well.

3. Myth: Mental illness is purely mental.

Fact: Studies of the brain show that there is much "physical" in "mental" disorders. For example, the brain chemistry of a person with major depression is different from that of a non-depressed person.

Many people see mental and physical as separate functions when, in fact, mental functions (e.g., memory) are physical as well. Mental functions are carried out by the brain. Likewise, mental disorders are reflected in physical changes in the brain.

4. Myth: Mental illness is the result of bad parenting.

Fact: Most experts agree that a genetic susceptibility, combined with other risk factors, leads to a psychiatric disorder. In other words, mental illnesses have a physical cause.

The blame placed on parents may cause these parents to feel guilty for their children’s mental illness. There is already enough burden placed on the family when one of its members becomes mentally ill. Let us not add to that burden by pointing an accusing finger on the parents or other family members.

5. Myth: Mental illness is a disease of adults.

Fact: About half of mental disorders begin before age 14. Around 20% of the world’s children and adolescents are estimated to have mental disorders or problems (WHO 2010b).

6. Myth: Only a small percentage of the population has mental illness.

Fact: Hundreds of millions of people worldwide are affected by mental, behavioral, neurological and substance use disorders. For example, estimates made by the WHO in 2002 showed that 154 million people globally suffer from depression and 25 million people from schizophrenia; 91 million people are affected by alcohol use disorders and 15 million by drug use disorders. About 24 million suffer from Alzheimer and other dementias (WHO, 2010a).

7. Myth: As long as the person consults a health professional, mental illness is readily diagnosed.

Fact: One in four patients visiting a health service has at least one mental, neurological or behavioral disorder but most of these disorders are neither diagnosed nor treated (WHO, 2010a). One factor that may lead to misdiagnosis is the fact that many mental disorders also have physical manifestations (e.g. insomnia, fatigue, weight loss/gain). When a person presents with physical manifestations, it is very possible that health professionals focus on these physical manifestations without realizing that these are just symptoms of a mental disorder.

8. Myth: Because mental illness is ‘mental’, it produces less disability compared to diseases that affect the body.

Fact: Major depression is the leading cause of disability (measured by the number of years lived with a disabling condition) worldwide among persons age five and older. When measured in terms of Disability Adjusted Life Years (DALYs) i.e., years of healthy life lost to premature death or disability, major depression ranked second only to ischemic heart disease in magnitude of disease burden in established market economies. Schizophrenia, bipolar disorder, obsessive-compulsive disorder, panic disorder, and post-traumatic stress disorder also contributed significantly to the total burden of illness attributable to mental disorders (Murray and Lopez, 1996).

9. Myth: Mental illness is not fatal.

Fact: About 800,000 people die by suicide every year. More than half of the persons who commit suicide are between the ages of 15 and 44. Mental disorders are one of the causes of suicide (WHO 2010b).

10. Myth: There is no treatment for mental illness.

Fact: Cost-effective treatments exist for most disorders and, if correctly applied, could enable most of those affected to become functioning members of society.

11. Myth: People with a severe mental illness, such as schizophrenia, are usually dangerous and violent.

Fact: Statistics show that the incidence of violence in people who have a brain disorder is not much higher than it is in the general population. People with a mental illness are more likely to be victims, not perpetrators of violence. It has been calculated that the lifetime risk of persons with an illness such as schizophrenia seriously harming or killing another is just .005%, while the risk of these persons killing themselves is nearly 10% (New South Wales Mental Health Sentinel Review Committee, 2003).

12. Myth: It is best to keep persons with mental illness isolated from the rest of the society.

Fact: Treatments could enable most of those affected to become functioning members of society in their homes, work places, and the community.

13. Myth: Once mental illness occurs, it will be there for the rest of one’s life.

Fact: Some people have only one episode of mental illness and recover fully. For others, episodes of mental illness occur with periods of wellness between episodes. Complete recovery is possible for most persons with mental illness especially if they receive help early. Some people may require long-term or lifelong treatment to manage their illness. For a minority of those with mental illness, episodes of illness will occur and, without medication and effective management, leave little room for recovery.

14. Myth: There are enough resources to manage mental illness.

Fact: Most middle and low-income countries devote less than 1% of their health expenditure to mental health. Consequently mental health policies, legislation, community care facilities, and treatments for people with mental illness are not given the priority they deserve. For example, low-income countries have .05 psychiatrists and .16 psychiatric nurses per 100,000 population (WHO, 2010b). Translating this to whole numbers, this is equivalent to five psychiatrists and 16 psychiatric nurses per ten million population.

Bullets: History of Psych Nursing

PERIOD OF ENLIGHTENMENT

· Philippe Pinel – France

· William Tuke – England

· Asylum – a physical location or a state of mind

· Terms for Mental Illness: madness, lunacy, insanity, feeblemindedness, idiocy

· Dorothea Dix – USA: opened 32 state asylums

· Eastern Lunatic Asylum (Williamsburg, Virginia, 1773) – first asylum in the USA

· Four concepts of asylum: Patients, Professionals, Patients, Public

· Linda Richards – 1^st American psych nurse

PERIOD OF SCIENTIFIC STUDY

· Sigmund Freud – changed the world’s view on mental illness

· Emil Kraeplin – contributed to the classification of mental disorders

· Eugene Bleuler – “Schizophrenia”

· Humans could be studied and that study held promise for treating MI

PERIOD OF PSYCHOTROPIC DRUGS

· Development of antipsychotics (1^st-Chlorpromazine) and antidepressants (1^st – Imipramine)

· Mental Illness caused by biochemical imbalances

COMMUNITY MENTAL HEALTH

· Destroyed the state hospital system

· Individuals do not need to be hospitalized away from home or community

· People have the right to be treated in the community

· Opened whole range of opportunities for psychiatric nurses from intrainstitutional to extrainstitutional

DEINSTITUTIONALIZATION

· Refers to depopulating of state mental hospitals

· Conflict: 33% of the homeless have mental illness

Welcome to the Malingering Nurse

Mental Health and Psychiatric Nursing is a field that is, to a lot, very interesting. Fortunately, I am one of those who love this field and I am excited to work on with this blog that would cater to students, reviewees, and even the laymen who have an affinity to learning the intricate world of psychiatric nursing. This blog will feature concepts drawn from my book and explain it in the simplest possible manner. Worksheets will also be provided and techniques on how to easily recall psych concepts will be given. Much is to be said about how to go around with this blog yet much is also left unknown and are still due to be discovered. Therefore, I will leave you with this short message.

I would like to welcome all of you to -The Malingering Nurse-