History of Psychiatry by Naeem dood ppts

History of psychiatry

1. History of Psychiatry & Psychiatric nursing Noem Dawood Lecturer Dow Institute of Nursing And Midwifery , DUHS. 1

2. Introduction of Teacher and role in Institute Noem Dawood Lecture – DIONAM,DUHS RN, Post RN BSN, MSN, PB, Psych Specialization. In BSN Semester VI- I will teach and facilitates mental health nursing theory as well as clinical rotation in different psychiatric setting at both private and public sectors hospitals of Karachi . 2

3. Learning Objectives How psychiatry has evolved over the ages Pioneers of modern Psychiatry How modern psychiatric treatments developed 3

4. Introduction of the history of mental illness The history of mental illness is probably as old as the origin of mankind. People suffering from mental disorders were mentioned in the holy books of various ancient religions such as Christianity, Islam, Judaism and Buddhism . The term “psychiatry” is a Greek word which literally means “medical treatment of the soul”. It was coined by Dr. Johann Christian Reil In the early 19th century. 4

5. Psychiatry It is branch of medicine that deals with the diagnosis , treatment and prevention mental illness. 5

6. Psychiatric nursing It is a specialized area of nursing practice employing theories of human behavior, as a science and the purposeful use of self as an art in the diagnosis and response to actual or potential mental problem. American Nurses Association 1994. Psychiatric nursing deals with the promotion of mental health, prevention of mental illness, care and rehabilitation of mentally ill individuals both in hospital and community . 6

7. Historical development of psychiatry Period of persecution; In this period, black spirit is considering for cause of mental illness. No treatment is available for mental illness. Period of segregation; In this period, all mentally ill patients are placed in asylum. First asylum – B ethlem asylum” which is in England. Period of Humanitarian; in this period, many asylum are established & physician took interest in mentally ill patient. Period of scientific; After 1856, during this period mental patient is considered & treat as a general patient. Period of prevention; In the 20 th century after 1960 first would wide mental health year celebrate from 1960 – to till period is considered as period of prevention. 10 th OCT. – Would Mental H ealth D ay.

8. Ancient times People of ancient times believed that any sickness indicated displeasure of the gods and in fact was punishment for sins and wrongdoing. Those with mental disorders were viewed as either divine or demonic, depending on their behavior. Later, Aristotle attempted to relate mental disorders to physical disorders and developed his theory that the amounts of blood, water, and yellow and black bile in the body controlled the emotions. These four substances, or humors, corresponded with happiness, calmness, anger, and sadness; imbalances of the four humors were believed to cause mental disorders, so treatment was aimed at restoring balance through bloodletting, starving, and purging.

9. Cont…. In early Christian times, all diseases were again blamed on demons, and the mentally ill were viewed as possessed; priests perform exorcism to rid evil spirits. During the Renaissance, people with mental illness were distinguished from criminals in England; those considered harmless were allowed to wander the countryside and or live in rural communities, but the more “dangerous lunatics” were thrown in prison, chained, and starved. In 1547, the Hospital of St. Mary of Bethlehem was officially declared a hospital for the insane, the first of its kind; by 1775, visitors at the institution were charged a fee for the privilege of viewing and ridiculing the intimates, who were seen as animals, less than human.

10. History of psychiatric nursing In fourth century AD, during the period of Emperor Ashoka , hospitals with 15 beds for mentally ill with two male and two female nurses. In1964-65 Psychiatric nursing was included in curriculum. ( Reddemma K & Nagarajaiah , 2004) For the first time in India, 11 British nurses along with one matron were brought from the UK to work in the mental hospital at Ranchi in the 1930s. Short training courses of three to six months were conducted in Ranchi in 1921, which were recognized by the Royal Medical Psychological Association. During 1948-50 four nurses were sent to the U.K.by Govt. of India for mental health nursing diploma. From 1943, the Chennai Government organized a three months’ psychiatric nursing course (subsequently stopped in 1964), for male nursing students at the Mental Hospital, Chennai (in lieu of midwifery).

11. IMPORTANT MILESTONES 1773 : The first mental hospital in the US was built in Williamsburg, Virginia 1793 : Philip Pinel removed the chains from mentally ill patients confined in Bicetre , a hospital outside Paris i.e. the first revolution in psychiatry 1812 : The first American text book in psychiatry was written by Benjamin Rush, who is referred to as the father of American Psychiatry 1812 : Clifford Beers, an ex- patient of mental hospital wrote the book, “The Mind That found itself” based on his bitter experiences in the hospital

12. Late 18 th century Led to the advent of moral treatment which was characterized by :  Kindness  Compassion  Humane treatment of mentally ill patients

13. Cont…. 1912: Eugene Bleuler , a Swiss psychiatrist coined the term Schizophrenia In 1913 Johns Hopkins University was the first college of nursing in the United States to offer psychiatric nursing as part of its general curriculum. In 1920, The first psychiatric nursing text book, Nursing Mental Diseases was  authored  by Harriet Bailey. The registration of psychiatric nurses was done by 1920 in the UK and degree courses in psychiatric nursing began in the USA . 1927 : Insulin shock treatment was introduced for schizophrenia 1936 : frontal lobotomy was advocated for the management of psychiatric disorder 1938 : Electro Convulsive Therapy (ECT) was used for the treatment of psychoses 1939 : development of psychoanalytical theory by Sigmund Freud led to new concepts in the treatment of mental illness. 1949 : Lithium was first used for the treatment of mania 1952 : Chlorpromazine was introduced which brought about a revolution in psycho-pharmacology In 1961, Psychiatric nursing was included in the basic nursing curriculum by the International Council of Nurses. 1963 : The community Mental Health centers Act was passed

14. 20 TH CENTURY There were two opposing views regarding mental illness:  Biological view stated that mental illness was due to biological causes and could be treated with physical treatments .  Psychological view stated that mental illness was due to factors such as social stresses .

15. HISTORY OF PSYCHIATRIC NURSING Prior to 1860, psychiatric treatment was by custodial care whereby untrained persons controlled mentally ill patients . There was no concept of psychiatric care. Florence Nightingale: Her philosophy of treating a patient as a member of the family and part of the society laid the foundation of psychiatric nursing. She emphasized on:  Holistic care  Therapeutic communication  Sensitivity to human emotions  Development of independence in patients

16. Cont…..  I n 1873, Dr . Edward Cowles, who encouraged Linda Richards, US’ first trained nurse, to start training for mental health nursing.  The first mental health training school for nurses was set up in 1882 at the McLean Hospital.  Effie Taylor combined general and mental health nursing.  Mary Adelaide Nutting emphasized the role of the psychiatric nurse and conceptualized nursing care in terms of:  Diagnosis  Care  Treatment

17. Cont….. Hildegarde E. Peplau : She is known as the Mother of Psychiatric Nursing. She developed the first graduate psychiatric nursing programmer in 1954 at Rutgers University. Her emphasis was on the nurse–patient relationship . First to identify psychiatric nursing as an essential element of general nursing and as a specialty area. First to describe the nurse–patient relationship as the foundation of nursing practice. Her model represented a shift from traditional treatments to interpersonal relational model of practice

18. Cont….. Dr.Hildegard Peplau defined the therapeutic roles that nurses might play in the mental health setting. She described the skills and roles of the psychiatric Nurse in her book “interpersonal relations in Nursing”. It was the first systematic and theoretical frame work developed for Psychiatric nursing .

19. Cont….. Maxwell Jones introduced therapeutic community. The focus began to shift to primary prevention and implementing care and consultation in the community The name psychiatric nursing changed in to mental health nursing.1970’s when it was known as psychosocial nursing .

20. Period of Enlightenment and Creation of Mental Institutions In the 1790s, a period of enlightenment concerning persons with mental illness began. Phillipe Pinel in France and William Tukes in England formulated the concept of asylum as a safe refuge or haven offering protection at institutions where people had been whipped, beaten, or starved just because they were mentally ill ( Gollaher , 1995). In the United States, Dorothea Dix (1802-1887) began a crusade to reform the treatment of mental illness after a visit to Tukes ’ institution in England; she was instrumental in opening 32 state hospitals that offered asylum to the suffering .

21. Sigmund Freud and Treatment of Mental Disorders The period of scientific study and treatment of mental disorders began with Sigmund Freud (1856-1939) and others, such as Emil Kraeplin (1856-1926) and Eugene Bleuler (1857-1939). With these men, the study of psychiatry and the diagnosis and treatment of mental illness started in earnest. Freud challenged society to view human beings objectively; he studied the mind, its disorders, and their treatment as no one had before. Kraeplin began classifying mental disorders according to their symptoms, and Bleuler coined the term  schizophrenia .

22. Development of Psychopharmacology A great leap in the treatment of mental illness began in about 1950 with the development of psychotropic drugs, or drugs used to treat mental illness. Chlorpromazine ( Thorazine ) an antipsychotic drug, and lithium, an  antimanic  agent, were the first drugs to be developed. Over the following 10 years, monoamine oxidase inhibitor antidepressants, haloperidol (Haldol), an antipsychotic; tricyclic antidepressants; and antianxiety agents, called benzodiazepines, were introduced .

23. Principles of psychiatric nursing Allow client opportunity to set own pace in working with problems. Nursing interventions should center on the client as a person, not on control of the symptoms. Symptoms are important, but not as important as the person having them. Recognize your own feelings toward clients and deal with them. Go to the client who needs help the most. Do not allow a situation to develop or continue in which a client becomes the focus of attention in a negative manner. If client behavior is bizarre, base your decision to intervene on whether the client is endangering self or others. Ask for help—do not try to be a hero when dealing with a client who is out of control !

24. Cont…. Avoid highly competitive activities, that is, having one winner and a room full of losers. Make frequent contact with clients—it lets them know they are worth your time and effort. Remember to assess the physical needs of your client. Have patience! Move at the client’s pace and ability. Suggesting , requesting, or asking works better than commanding. Therapeutic thinking is not thinking about or for, but with the client. Be honest so the client can rely on you. Make reality interesting enough that the client prefers it to his or her fantasy. Compliment , reassure, and model appropriate behavior.

25. Theories applied in psychiatric nursing Psychiatric nursing uses theories of human behavior as its scientific framework and requires the use of the self as its art or expression in nursing practice. Some of the theories applied in psychiatric nursing are Hildegard Peplau - Theory of interpersonal relations Psychoanalytic theory Behaviorism Jean Piaget: Theory of Cognitive Stages of Development Humanistic Theories - Abraham Maslow, Carl Rogers

26. Role of a psychiatric nursing Providing a safe therapeutic milieu Working with patients or clients on the real day-to-day problems they face Identifying and caring for the physical aspects of the patient's problems Assuming the role of social agent or parent for the patient in various recreational, occupational, and social situations Conducting psychotherapy Providing leadership and clinical assistance for other nurses and health care workers. 

27. Thank you Noem Dawood [email protected] Phone # [phone]