MENTAL HEALTH AND PSYCHIATRIC NURSING

COURSE TITLE: MENTAL HEALTH AND PSYCHIATRIC NURSING CHAPTER ONE: ETIOLOGY OF PSYCHIATRIC ILLNESS Student learning objectives At the end of the chapter the student should be able to: a. Discuss the difficulties associated with etiology in psychiatry. b. Discuss the nature vs. nurture controversy c. Classify cause of psychiatric illness d. Explain some specific etiological factors to psychiatric illness Etiology deals with the science or philosophy of causation of disease. It‘s concerned with ascertaining which features of the individual and the environment are relevant and causal and which mechanisms in the body are involved in the illness. Complexity of causes of psychiatric illness Two factors complicate the etiology of psychiatric illness. Etiology or physical illness is usually straight. 1. Causes are often remote in time from the effects that they produce e.g. childhood experiences may predispose to future problems e.g. rape experience making one fail to establish relationships with opposite sex. Fetal distress predisposing to epilepsy in future. 2. A single cause may lead to several effects e.g. Cause Effects Over loving/ -timidity Protecting -easy depression Parents -poor frustration tolerance Also a simple effect may arise from several causes Genetically vulnerability Parental deprivation Depression MENTAL HEALTH AND PSYCHIATRIC NURSING 2 Social events e.g. divorce Childhood experiences e.g. Heredity and environment as influences of behavior and development The differences between individuals or groups is attributable to the above two factors. Heredity is the source of both similarities and differences among individuals. The environmental influences are those that act upon organism at the earlier stages of development within the mother‘s womb and later external environment after birth. Studies on monozygotic twins (identical) reared separately have shown that differences are attributable to the environmental factors e.g. Family environment, School environment, Cultural patterns of the society The similarities are due to the hereditary factors. Hereditary & environmental factors are interdependent factors/forces. Hereditary supplies the potential talent which the favorable environment brings out. It also determines the possible limits of accomplishment for the individual in any given situation. The environment determines how close to these limits of performance any individual can achieve in a given situation. The Nature – Nature controversy The nature (heredity) – nature (environment) debate really concerns the relative importance of heredity & environment. But the general agreement is that human behavior & development is determined by the interaction of the two factors. Therefore, the causation of psychiatric illness is as a result of a complex interaction of a number of factors residing within the individual (Intrinsic factors) and environment (extrinsic factors).Initial attempts to establish a single etiological factor were fruitless. Multiple causation is the rule. The relative importance of intrinsic and extrinsic factors varies according to the:-  Type of illness – schizophremia increases intrinsic  The individual – psychopath – drug abuse. There is a continuous interaction of intrinsic and extrinsic factors to bring about psychiatric illness. NB: - Therefore in many cases, there is no single cause of mental disorders but multiple factors interact to cause the illness. Causes can be put in three classes 3  Predisposing factors-Factors that is usually present early in life.  Precipitating factors-Factors that are present shortly before onset i.e. those factors that induced the illness.  Perpetuating factors-Factors that prolong the course of the disorder. Dysfunctional family patterns. For Example depression might have the following classes of causal factors:  Predisposing factors – genetically susceptibility  Precipitating factor- divorce or loss of a loved one  Perpetuating factors -Poor social support system e.g. poor family support system. Some specific etiological factors 1. Genetical factors These play a predominant role in the causation of psychiatric disorders like major depression, familial alcoholism, personality disorders and mental retardation. Therefore the family history of mental illness is very important in the significance of genetic disorders in the etiology of disease. 2. Physical (or organic) factors These are physical elements e.g. trauma, infections, Syphilis, Viral encephalitis, Meningitis, Malaria (cerebral). Drug withdrawal e.g. alcohol withdrawal (sudden) Delirium Tremens (DTs) that lead to brain damage & subsequently psychiatric illness. A patient with damage to the frontal lobe shows typical psychiatric symptoms/ manifestations – area associated with behavioral functions. Examples of organic psychiatric disorders:- Delirium, Delirium Tremens (DTS), organic hallucinations, dementia, organic anxiety disorder, organic mood disorder, Parkinsonism disease, Huntington‘s chorea etc. 3. Social- economic factors Poverty is the most vital economic factor associated with psychiatric disorder e.g. delinquency (Juvenile) drug/substance abuse disorder, adverse childhood experiences, malnutrition etc. Social factors are also important e.g. functioning of social institutions/ systems of society e.g. family & learning institutions. Problems that can be associated with social factors include suicide, violence, social conflicts, divorce, adverse childhood experiences like rape, teenage pregnancy with its attend ant problems e.g. premature births, abortions etc..The nuclear family has changed greatly e.g. family size and roles other aspects that have affected the family include