The purpose of the DSM-5 is to facilitate healthcare providers’ diagnosis of mental disorders and development of individualized treatment plans (APA, 2013). The DSM-5 bases disorders on a continuum from mental health to mental illness. A mental disorder is defined in the DSM-5 as a syndrome characterized by clinically significant disturbance in the individual’s cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning (APA, 2013, p. 20). The definition also reflects the high level of disability or distress in occupational or other life activities that results from the mental disorder. Some healthcare providers feel that the DSM-5’s categorical classifications limit its use because individuals may not fit neatly into one specific category. Regardless, the DSM-5 serves as a guideline to assist practitioners in making sound clinical decisions. Diagnosis does not always imply etiology; therefore, using the DSM-5 to predict behavior or response to treatment is inappropriate (APA, 2013).
By 1880, researchers had developed seven classifications of mental illness: mania, melancholia, monomania, paresis, dementia, dipsomania, and epilepsy (APA, n.d.). By 1918, the need for uniformity in diagnoses drove the Committee on Statistics of the American Medico-Psychological Association, which later became the American Psychiatric Association (APA, 2013), to develop the first Statistical Manual for the Use of Institutions for the Insane . The purpose of this document was to gather statistical information from institutions regarding 22 known disorders. Following World War II, US Army psychiatrists expanded the diagnostic categories to better incorporate the types of problems veterans experienced as a result of combat (APA, n.d.). In 1952, the APA published the first edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) . Since then, the APA has published new editions of the DSM every 5 to 10 years. In 2013, the APA released the fifth edition of the DSM, the most recent version (APA, 2013). The DSM-5 is the result of a 12-year revision process involving hundreds of professionals, field trials to demonstrate the reliability of the data, and public and professional review and comment (APA, 2013).
THEORIES RELATED TO PSYCHIATRIC AND MENTAL HEALTH NURSING
Mental health professionals base their work on assessments, behaviors, and theories. These are often described as explanations or hypotheses and tested for relevance and Freud’s psychoanalytic theory Sigmund Freud, referred to as the father of psychoanalysis , revolutionized thinking about mental disorders (Townsend, 2019). His theories of personality structure, level of awareness, anxiety, the role of defense mechanisms, and stages of psychosexual development revolutionized the psychiatric world (Townsend, 2019). Although Freud started as a biological Erikson’s theory on the stages of human development Erik Erikson, a developmental psychologist, emphasized the role of the psychosocial environment and expanded on Freud’s psychoanalytic theory. The Eight Stages of Man, is organized by Harry Stack Sullivan’s interpersonal theory Interpersonal theories are the cornerstone of mental health nursing. Harry Stack Sullivan, an American-born psychiatrist, identified personality as an observable behavior within interpersonal relationships, which led to the development of his interpersonal theory. Sullivan believed that anxiety or painful feelings arise from insecurities or the inability to meet biological needs. All behaviors are designed to help individuals through interpersonal interactions by decreasing anxiety. Individuals are unaware that they act out behaviors to decrease anxiety and therapy can help the patient gain personal insight into these insecurities. He was the first to use the term participant Hildegard Peplau’s theory of interpersonal relations Hildegard Peplau, sometimes referred to as the mother of psychiatric nursing , published the theory of interpersonal relations in 1952, which became a foundation for modern psychiatric and mental health nursing (Townsend, 2019). The goal of interpersonal therapy is to reduce or eliminate psychiatric symptoms by improving interpersonal functioning (Sadock, & Ruiz, 2015). Sullivan’s work greatly influenced Peplau. She developed the first systematic framework for psychiatric nursing, focusing on the nurse-patient relationship. Peplau established the foundation of professional practice for psychiatric nurses and continued working on psychiatric nursing theory and advancement of nursing practice throughout her career. She was the first nurse to identify mental health nursing as a specialty area with specific ideologies and principles, and the first to age and developmental conflicts: 1. Basic trust versus mistrust. 2. Autonomy versus shame and doubt. 3. Initiative versus guilt. 4. Industry versus inferiority.
soundness. In mental health, theories are often borrowed from other disciplines and inspire treatments for the practice of psychiatric nursing.
scientist, he changed his approach to conversational therapy. He concluded that talking about difficult issues involving intense emotions had the potential to heal problems that could cause mental illnesses. This led Freud to develop his psychoanalytic theory (https://pmhealthnp.com/pmhnp-topics/sigmund-freud- psychoanalytic-theory/).
5. Identity versus role confusion. 6. Intimacy versus isolation. 7. Generativity versus stagnation. 8. Ego integrity versus despair.
Analysis of behavior using Erikson’s framework helps nurses to identify long term successful resolution of psychosocial development across the lifespan.
observer , which refers to the idea that therapists must be part of the therapeutic session. Sullivan insisted that healthcare professionals should interact with patients as authentic human beings through mutual respect, unconditional acceptance, and empathy. Sullivan developed the concept of psychotherapeutic environments characterized by accepting the patient and the situation, which has become an invaluable treatment tool. Even today, many group psychotherapies, family therapies, and training programs use Sullivan’s design of an accepting atmosphere (Halter, 2018). describe the nurse-patient relationship as the foundation for nursing practice (Boyd, 2018). Peplau created a major shift from a care model focused on medical treatment to one based on the interpersonal relationship between nurses and patients. She further proposed that nurses are both participants and observers in the therapeutic treatment of patients. Her theory recognizes the ability to feel in oneself the feelings experienced by another ; she identified this as empathetic linkage (Boyd, 2018). Another key concept, according to Peplau, is anxiety, which is an energy that arises when present expectations are not met (Boyd, 2018). Throughout her career, Peplau’s goal was for nurses to care for the person and the illness.
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