2/25/2013 Dr.Al-Azzam 1 · 2015. 10. 13. · 2/25/2013 Dr.Al-Azzam 16 Reaction Phase: Characteristic reactions: •Fear of returning to the site of the event •Dreams or nightmares

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Lecture Objectives

• Define mental health and mental illness.

• DSM-IV

• Describe physiological and psychological responses to stress.

• Stress management.

• Loss and grief.

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Mental Health

–Is:

A life long process a sense of harmony and balance for the individual, family, friends and community.

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WHO DEFINITION OF MENTAL HEALTH

• a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community

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APA DEFINITION

• The American Psychiatric Association (APA, 2003):

“A state of being that is relative rather than absolute. The successful performance of mental

functions shown by productive activities, fulfilling relationships with other people, and

the ability to adapt to change and to cope with adversity.”

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Townsend Definition

“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.”

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COMPONENTS OF MENTAL HEALTH

• Self-governance

• Growth orientation

• Tolerance of uncertainty

• Self-esteem

• Mastery of Environment

• Reality-orientation

• Stress Management

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Hierarchy Of Needs

MASLOW’S

Safety Needs

Belongingness & Love

Needs

Physiological Needs

Esteem Needs

Self-

Actualization

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Mental Illness

• APA defines mental illness or a mental disorder as:

“A clinically significant behavioral or psychological syndrome or pattern that occurs in an individual and that is associated with present distress (e.g., a painful symptom) or disability (i.e., impairment in one or more important areas of functioning), or with a significantly increased risk of suffering death, pain, disability, or an important loss of freedom…and is not merely an expectable… response to a particular event.”

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• Townsend (2006) defines mental illness as:

“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, and/or physical functioning.”

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STRESS AND COPING

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Stress

• A state of physical and/or psychological arousal

• Often brought about by a perceived threat or challenge

• May be expressed differently by different cultures

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Stress Reaction Phases

1. Acute phase

2. Reaction phase

3. Repair phase

4. Reorientation phase

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Acute Phase

• Lasts minutes, hours or days

• “Fight or flight” response: preparation for physical activity

• Narrowing of focus: decreases ability to think properly

• Emotional reactions: disbelief/consternation/fear/grief

• Rigid behavior: irritability, anger, etc. affects communication

• Panic is rare but if present, requires immediate attention

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Reaction Phase

• Lasts one to six weeks

• Delayed reactions: previously repressed or denied feelings will surface

• May be overwhelming, bringing feelings of powerlessness

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Reaction Phase: Characteristic reactions:

• Fear of returning to the site of the event • Dreams or nightmares • Anxiety, restlessness, insomnia • Muscular tension, tremors and exaggerated startle

response • Increased irritability and isolation, depression • Disturbing thoughts about survival, relief, guilt and

grief • Perceived images of how others suffered in the

disaster, i.e. how they died, how they injured

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Repair Phase

• Lasts one to six months

• Reactions are less intense, and not so overwhelming

– Feelings of hurt continue, but are more manageable

– Renewed interest in everyday life

– Makes plans for the future

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Reorientation Phase

• Approximately six months after a distressing event and continuing

• Heightened stress reactions are substantially reduced – Grief reaction may not be resolved but is accepted

– Most reactions will diminish gradually

• Assessing ongoing needs is important

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Coping with Stress

• Coping is a way to prevent, delay, avoid, or manage stress

• Coping mechanism categories:

– Changing the source of stress

– Changing the view of the situation

– Tolerating the stressor until it passes or becomes less troublesome

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Examples of Coping

• Seeking help from others or offering to help others

• Using natural support systems

• Talking about their experiences and trying to make sense of what happened

• Hiding until the danger has passed

• Seeking information about the welfare of loved ones

• Gathering remaining belongings

Psychological Adaptation to Stress

• Anxiety and grief have been described as two major, primary psychological response patterns to stress.

• A variety of thoughts, feelings, and behaviors are associated with each of these response patterns.

• Adaptation is determined by the extent to which the thoughts, feelings, and behaviors interfere with an individual’s functioning.

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Anxiety

• Anxiety: feeling of apprehension, uneasiness, uncertainty, or dread resulting from real or perceived threat whose actual source is unknown or unrecognized

• Fear: reaction to specific danger

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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.

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Types of Anxiety • Normal

– Motivating force that provides energy to carry out tasks of living

• Acute or state – Anxiety that is precipitated by imminent loss or change that

threatens one’s security (crisis) • Chronic or trait

– Anxiety that persists over time

• Mild

– Occurs in normal everyday living

– Increases perception, improves problem solving

– Manifested by restlessness, irritability, mild tension-relieving behaviors

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Types of Anxiety • Moderate

– Escalation from normal experience

– Decreases productivity (selective inattention) and learning

– Manifested by increased heart rate, perspiration, mild somatic symptoms

• Severe – Greatly reduced perceptual field – Learning and problem solving not possible – Manifested by erratic, uncoordinated, and impulsive

behavior • Panic

– Results in loss of reality focus – Markedly disturbed behavior occurs – Manifested by confusion, shouting, screaming, withdrawal

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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.

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Ego Defense Mechanisms

• Rationalization - Subconscious justifications, excuses or reasoning given to make a behavior seem logical -- "A student fails the final he didn't study for and says... "I couldn't have passed it anyway - that teacher has it in for me."

• Rationalization is included at the beginning of any list of defense mechanisms because it's so frequently recognized as "being defensive".

• Projection - Attempts to banish or "disown" unwanted and disliked thoughts, behaviors, and even "parts of self" by projecting or attributing them to someone else.

• May be as simple as blaming someone else - "He should have let me off on that ticket but that cop was trying to fill his monthly quota."

• Or as complex as seeing and experiencing a repressed or "disowned" part of self in another person - e.g., an excessively passive person marries an excessively angry person - both experience their disowned "part" in the other.

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• Introjection - The opposite of projection - subconsciously "takes in" to self an imprint (or recording) of another person including all their attitudes, messages, prejudices, expressions, even the sound of their voice, etc.

• This is healthy if the imprinted material is helpful advice, warnings, or other lessons from parents and respected others -- unhealthy if shaming messages from parents, hatred, or aggression is turned inward on self.

• Identification - An ability available very early in life that children use to attach themselves to certain qualities, emotions, and attitudes of someone else...especially during the modeling period between eight and thirteen.

• This helps the child further develop the Adult Ego State and the Parent Ego State.

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• Isolation - Separation of memory from emotion...can remember and talk about the trauma but feels no emotion -- the Person talks about the incident as if it is someone else's story.

• Accomplished by talking Third Perceptual Position. • Sublimation - Redirection of impulses into socially acceptable

activities -- normal and healthy, such as when the sexual impulses of adolescence is channeled into sports and competition.

• Displacement - No list of defense mechanisms would be complete without displacement. This defense reduces anxiety or pressure by transferring feelings toward one person to another -- commonly known as "dumping on" someone...e.g., man is mad his boss and kicks the cat when he gets home, or blows up and yells at his family.

• Repression - Painful, frightening, or threatening emotions, memories, impulses or drives that are subconsciously pushed or "stuffed" deep inside.

• It takes a lot of energy to keep material "stuffed"...energy that could be used for more productive living. Healthy if the person does not have the psychological resources available to deal with it.

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• Suppression - Painful, frightening, or threatening emotions, memories, impulses or drives that are consciously pushed or "stuffed" inside.

• It takes a lot of energy to keep material "stuffed"...energy that could be used for more productive living.

• Conversion - Mental conflict converted to a physical symptom... e.g., a soldier on being deployed into battle is conflicted about his desire to serve his country but believes it is wrong to kill for any reason develops paralysis, blindness, or deafness with no medical cause.

• Regression - Giving up current level of development and going back to a prior level... and older child under stress begins wetting the bed or sucking a thumb after a long period without that behavior.

• In extreme cases of PTSD an adult could regress into a child-like ego-state and curl up in a fetal position on the floor unable to communicate.

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• Reaction Formation - Over-compensation for fear of the opposite.

• Two conflicting parts of self -- one is strengthened while the other is repressed...e.g., An overly nice and agreeable person may have a lot of repressed hostility and rage of which they are completely unaware on a conscious level.

• Isolation: Separating a thought or memory from the feeling tone or emotion associated with it. E.g. Without showing any emotion, a young woman describes being attacked and raped.

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• Undoing: Symbolically negating or canceling out an experience that one finds intolerable. E.g. Joe is nervous about his new job and yells at his wife. On his way home he stops and buys her some flowers.

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Loss and Grief

• Loss is a common theme in most disaster settings

• Common reactions to loss: – Denial, numbness or shock

– Bargaining

– Depression

– Anger

– Acceptance

– Reorientation

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Loss and Grief – Signs of Trouble

• Avoiding or minimizing emotions

• Using alcohol or drugs to self-medicate

• Using work or other distractions to avoid feelings

• Hostility and aggression toward others

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Emotional Numbness or Extreme Agitation

• Immediate attention is needed

• Possible referral for professional care

DSM-IV-TR

Diagnostic statistical manual of mental disorders (DSM). The APA’s official classification system

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The five axes of the DSM-IV-TR.

• Axis I Clinical syndromes. (All mental disorders & criteria for rating them except personality disorders/mental retardation, also abuse/neglect)

• Axis II Personality disorders, Mental retardation. (Life long deeply ingrained, inflexible & maladaptive)

• Axis III General medical condition. (Any medical condition that could effect the patients mental state.)

• Axis IV Psychosocial & environmental problems. (Stressful events that have occurred within the previous year)

• Axis V global assessment functioning. (How well the patient performed during the previous year)

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Example of Diagnosis:

• Patient: Johnnie Walker – Axis I: Major depressive Disorder – Axis II: Narcissistic Personality Disorder – some features only

– Axis III: Poor liver functioning, frequent migraines.

– Axis IV: Recently retrenched – Axis V: 65

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