SCHIZOPHRENIA

Schizoprenia – causes distorted and bizarre thoughts, perceptions, emotions,

movements and behavior. It cannot be defines as a single illness; rather,
schizophrenia is thought of as syndrome or disease process with so many different
varieties and symptoms, much like the varieties of cancer.

Abnormal Involuntary Movement Scale (AIMS) – tool used to screen for

symptoms of movement disorders (side effects of neuroleptic medications).

Akathisia – intense need to move about; characterized by restless movement,

pacing, inability to remain still and the client’s report of inner restlessness.

Alogia – a lack of any real meaning or substance in what the client says.

Anhedonia – having no pleasure or joy in life; losing any sense of pleasure from
activities formerly enjoyed.

Blunted Affect – showing little or a slow-to-respond facial expression; few

observable facial expression.

Catatonia – psychomotor disturbance; either motionless or excessive motor.

Command Hallucinations – disturbed auditory sensory perceptions demanding

that the client take action often to harm self or others, and are considered
dangerous; often referred to as “voices”.

Delusions – a fixed, false belief not based in reality

Depersonalization – feelings of being disconnected from himself or herself; the

client feels detached from his or her behavior.

Dystonia or Dystonic Reaction – extrapyramidal side effect to antipsychotic

mediation; includes acute muscular rigidity and cramping, a stiff or a thick tongue
with difficulty swallowing, and, in severe cases, laryngospasm and respiratory
difficulties; also called dystonic reactions.

Echolalia – repetition or imitation of what someone else says; echoing what is

heard.

Echopraxia – imitation of the movements and gestures of someone an individual is

observing.

Extrapyramidal Side Effects –reversible movements disorders induced by

antipsychotic or neuroleptic medication.

Flat Affect – showing no facial expression

Hallucinations – false sensory perceptions or perceptual experiences that do not
really exist.

Ideas of Reference – client’s inaccurate interpretation that general events are

personally directed to him or her, such as hearing a speech on the news and
believing the message has personal meaning.

Latency of Response – refers to hesitation before the client responds to

questions.

Neuroleptic Malignant Syndrome (NMS) – a potentially fatal, idiosyncratic

reaction to an antipsychotic (or neuroleptic drug).

Neuroleptics – antipshychotic medications.

Polydipsia – excessive water intake.

Pseudoparkinsonism – a type of extrapyramidal side effect of antipsychotic

medication; drug-induced parkinsonism; includes shuffling gait, masklike facies,
muscle stiffness (continuous) or cogwheeling rigidity (ratchet-like movements of
joints), drooling, and akinesia (slowness and difficulty initiating movement).

Psychomotor Retardation – overall slowed movements; a general slowing of all

movements; slow cognitive processing and slow verbal interaction.

Psychosis – cluster of symptoms including delusions, hallucinations, and grossly

disorder thinking and behavior.

Tardive Dyskinesia – a late-onset, irreversible neurologic side effect of

antipsychotic medications; characterized by abnormal, involuntary movements such
as lip smacking, tongue protrusion, chewing, blinking, grimacing, and choreiform
movements of the limbs and feet.

Thought Blocking – stopping abruptly in the middle of a sentence or train of

thought; sometimes client is unable to continue the idea.

Thought Broadcasting – a delusional belief that others can hear or know what the
client is thinking.

Thought Insertion – a delusional belief that others are putting ideas or thoughts
into the client’s head that is, the ideas are not those of the client.

Thought Withdrawal – a delusional belief that others are taking the client’s
thoughts away and the client is powerless to stop it.

Waxy Flexibility – maintenance of posture or position over time even when it is

awkward or uncomfortable.

Word Salad – flow of unconnected words that convey no meaning to the listener.
TYPES OF SCHIZOPHRENIA:

1. Schizophrenia, paranoid type – characterized by persecutory (feeling

victimized or spied on) or grandiose delusions, hallucinations, and,
occasionally, excessive religiosity (delusional religious focus) or hostile and
aggressive behavior

2. Schizophrenia, disorganized type – characterized by grossly

inappropriate or flat affect, incoherence, loose associations, and extremely
disorganized behavior.

3. Schizophrenia, catatonic type – characterized by marked psychomotor

disturbance, either motionless or excessive motor activity. Motor immobility
may be manifested by catalepsy (waxy flexibility) or stupor. Excessive motor
activity is apparently purposeless and is not influenced by external stimuli.
Other features include extreme negativism, mutism, peculiarities of voluntary
movement, echolalia, and echopraxia.

4. Schizophrenia, undifferentiated type – characterized by mixed

schizophrenic symptoms (of other types) along with the disturbances of
thought, affect, and behavior.

Bleuler’s 4 A’s
1. Associative Looseness
2. Affected Disturbances
3. Ambivalence
4. Autism

5. Schizophrenia, residual type – characterized by at least one previous,

though not a current, episode; social withdrawal; flat affect; and looseness of
associations.

Biologic theories
1. Genetic factors
2. Neuroanatomic and neurochemical factors
3. Immunovirologic factors

Side Effects:

Neurologic Side Effects:

 Extrapyramidal Side Effect (acute dystonic reactions, akathisia and
parkinsonism)
  Tradive dyskinesia
 Seizures
 Neuroleptic Malignant Syndrome (NMS)
Nonneurologic side effects:
Weight gain
Sedation
Photosensitivity
Anticholinergic symptoms such as dry mouth, blurred vision, constipation, urinary
retention, and orthostatic hypotension.
POSITIVE OR HARD SYMPTOMS
Ambivalence – (love & hate) holding
seemingly contradictory beliefs or
feelings about the same person, event
or situation
Associative looseness – Fragmented
or poorly related thoughts and ideas.
Delusions – fixed false beliefs that
have no basis in reality.
Echopraxia – imitation of the
movements and gestures of another
person whom the client is observing.
Flight of Ideas – continuous flow of
verbalization in which the person jumps
rapidly from one topic to another.
Hallucinations – false sensory
perceptions or perceptual experiences
hat do not exist in reality.
Ideas of reference – false impressions
that external events have special
meaning for the person.
Perseveration – persistent adherence
to a single idea or topic; verbal
repetition of a sentence. Word or
phrase; resisting attempts to change
the topic.
Conventional Antipsychotics
(dopamine & serotonin antagonist)
Generic name Brand name
Chlorpromazine Thorazine
NEGATIVE OR SOFT SYMPTOMS
Alogia – tendency to speak very little or
convey little substance of meaning
(poverty of content)
Anhedonia – feeling no joy or pleasure
from life or any activities or relationships.
Apathy – feelings of indifference toward
people, activities and events.
Blunted Affect – restricted range of
emotional feeling, tone or mood.
Catatonia – psychologically induced
immobility occasionally marked by periods
of agitation or excitement; the client
seems motionless, as if in a trance
Flat Affect – absence of any facial
expression that would indicate emotions
or mood.
Lack of Volition – absence of will,
ambition, or drive to take action or
accomplish tasks.
Atypical Antipsychotics
(dopamine antagonist)
Generic name Brand name
Clozapine Clozaril
Perphenazine Trilafon Risperidone Risperdal
Fluphenazine Prolixin Olanzapine Zyprexa
Thioridazine Mellaril Quetiapine Seroquel
Mesoridazine Serentil Ziprasidone Geodon
Thiothixene Navane Paliperidone Invega
Haloperidol Haldol aripiprazole abilify
Loxapine Loxitane
Molindone Moban
Perphenazine Etrafon
Trifluoperazine Stelazine

Extrapyramidal side effects – are reversible movement disorders induced by

neuroleptic medication, they include dystonic reactions, Parkinsonism and akathisia.

Dystonic reactions (Acute Dystonia) – includes acute muscular rigidity

and cramping, a stiff or thick tongue with difficulty swallowing and in severe
cases, laryngospasm and respiratory difficulties. Immediate treatment with
anticholinergic drugs such as intramuscular benztropine mesylate (Cogentin)
or intramuscular or intravenous diphenhydramine (Benadryl), usually brings
rapidly relief.
Torticollis – twisted head and neck
Opisthotonus – tightness in the entire body with the head back and an
arched neck
Oculogyric crisis – eyes rolled back in a locked position

Parkinsonism or pseudoparkinsonism – symptoms resemble those of

parkinson’s disease and include a stiff, stooped posture, mask-like facies;
decreased arm swings, a shuffling, festinating gait (with small steps);
cogwheel rigidity (ratchet-like movements of joints) drooling; tremor;
bradycardia; and coarse pill-rolling movements of the thumb and fingers
while at rest. Treated by changing to an antipsychotic mediation that has a
lower incidence of EPS or by adding an oral anticholinergic agent or
amantadine, which is dopamine agonist that increases transmission of
dopamine blocked by the antipsychotic drugs.

Akathisia – reported by the client as an intense need to move about. The

client appears restless or anxious and agitated, often with a rigid posture or
gait and a lack of spontaneous gestures. Akathisia can be treated by a
change in antipsychotic medication or by the addition of an oral agent such
as a beta-blocker, anticholinergic, or benzodiazepine.

Tardive dyskinesia – a late-appearing side effect of anti-psychotic medications, is

characterized by abnormal, involuntary movements such as lip smacking, tongue
protrusion, chewing, blinking, grimacing, and choreifrom movements of the limbs
and feet. TD is irreversible once it has appeared, but decreasing or discontinuing
the medication can arrest the progression. Treatment is Clozapine (Clozaril) a
typical antipsychotic drugs.

AIMS (Abnormal Involuntary Movement Scale) – used to screen for

symptoms of movement disorders. Severity of symptoms is rated from 0-4.
The AIMS can be administered every 3-6 months.

SEIZURES – seizures are an infrequent side effect associated with antipsychotic

medications. Treatment is lowered dosage or a different antipsychotic medication.

Neuroleptic Malignant Syndrome (NMS) – is a serious and frequently condition

seen in those being treated with antipsychotic drugs, it is characterized by muscle
rigidity, high fever, increased muscle enzymes (particularly creatinine
phosphokinase) and leukocytosis (increased leukocytes). NMS is treated by stopping
the medications.
Agranulocytosis – clozapine has the potentially fatal side effect of agranulocytosis
(failure of the bone marrow to produce adequate white blood cells). Agranulocytosis
develops suddenly and is characterized by fever, malaise, ulcerative sore throat and
leukopenia. The drug must discontinued immediately. Clients taking this
antipsychotic must have weekly white blood cell counts for the first 6 months of
clozapine therapy and every 2 weeks thereafter. Clozapine is dispensed every 7-14
days only.

Side Effects Nursing Intervention

Dystonic Reactions Administer medications as ordered;
assess for effectiveness; reassure client
if he or she is frightened.

Tardive dyskinesia Assess using tool such as AIMS; report

occurrence or score increase to
physician.
Neuroleptic Malignant Syndrome
Stop all antipsychotic medications; notify
physician immediately.
Akathisia
Administer medications as ordered;
assess for effectiveness
Extrapyramidal side effects or
neuroleptic-induced parkinsonism Administer medications as ordered;
assess for effectiveness
Seizures
 Stop medication; notify physician;
protect client from injury during seizures;
provide reassurance and privacy for
Sedation client after seizures.

Caution about activities requiring client

Photosensitivity to be fully alert, such as driving a car

Caution client to avoid sun exposure,

advise client when in the sun to wear
Weight gain protective clothing and sun-blocking
lotion.

Encouraged balanced diet with

controlled potions and regular exercise;
focus on minimizing gain.

Anticholinergic symptoms
Dry mouth

Blurred vision

Use ice chips or hard candy for relief

Constipation
Assess side effect, which should improve
with time; report to physician if no
Urinary retention improvement

Increase fluid and dietary fiber intake;

client may need a stool softener if
Orthostatic hypotension unrelieved.

Instruct client to report any frequency or

burning with urination; report to
physician if no improvement over time.

Instruct client to rise slowly from sitting

or lying position; wait to ambulate until
no longer dizzy or light-headed.

Generic (Trade) Name Nursing Intervention

Benztropine (Cogentin) Increase fluid and fiber intake to avoid
Trihexyphenidyl (Artane) constipation; use ice chips or hard candy
Biperiden (Akineton) fro dry mouth; assess for memory
Procyclidine (Kemadrin) impairment (another side effect)

Amantadine (Symmetrel) Use ice chips or hard candy for dry

mouth; assess for worsening psychosis
(an occasional side effect)
Diphenhydramine (Benadryl)
Use ice chips or hard candy for dry
mouth; observe for sedation
Diazepam (Valium)
Observe for sedation; potential for
misuse or abuse
Lorazepam (Ativan)
Observe for sedation; potential for
misuse or abuse
Propranolol (Inderal)
Assess for palpitations, dizziness, cold
hands and feet

Unusual Speech Patterns of Clients with Schizophrenia

Clang associations – are ideas that are related to one another based on sound or
rhyming rather than meaning.
Example: “I will take a pill if I go up the hill but not my name is Jill, I don’t want to
kill.”

Neologisms – are words invented by the client.

Example: “I’m afraid of grittiz. If there are any grittiz here, I will have to leave. Are
you a grittiz?”

Verbigeration – is the stereotyped repetition of words or phrases that may or may

not have meaning to the listener.
Example: “I want to go home, go home, go home.”

Echolalia – is the client’s imitation or repetition of what the nurse says.

Example: Nurse: “Can you tell me how you’re feeling?” Client: “Can you tell me
how you’re feeling, how you’re feeling?”

Stilted language – is use of words or phrases that are flowery, excessive, and
pompous.
Example: “Would you be so kind, as a representative of Florence Nightingale, as to
do me the honor of providing just a wee bit of refreshment, perhaps in the form of
some clear spring water?”

Perseveration – is the persistent adherence to a single idea or topic and verbal

repetition of a sentence, phrases, or word, even when another person attempts to
change the topic.
Example: Nurse “How have you been sleeping lately?” Client “I think people have
been following me.” Nurse “Where do you live?” Client “At my place people have
been following me.” Nurse “What do you like to do in your free time?” Client
“Nothing because people are following me.”

Word salad – is a combination of jumbled words and phrases that are disconnected
or incoherent and make no sense to the listener.
Example: “Corn, potatoes, jump up, play games, grass cupboard.”

TYPES OF DELUSIONS
Persecutory/paranoid delusions – involve the client’s belief that “others” are
planning to harm the client or are spying, following, ridiculing, or belittling the client
in some way. Sometimes the client cannot define who these “others” are.
Example: The client may think that food has been poisoned or that rooms are
bugged with listening devices. Sometimes the “persecutor” is the government, FBI,
or other powerful organization. Occasionally, specific individuals even family
members, may be named as the “persecutor”.

Grandiose delusions – area characterized by the client’s claim to association with

famous people or celebrities, or the client’s belief that he or she is famous or
capable of great feats.
Example: The client may claim to be engaged to a famous movie star or related to
some public figure, such as claiming to be the daughter of the president of the
United States, or he or she may claim to have found a cure for cancer.
Religious delusions – often center around the second coming of Christ or another
significant religious figure or prophet. These religious delusions appear suddenly as
part of the client’s psychosis and are not part of his or her religious faith or that of
others.
Example: Client claims to be the Messiah or some prophet sent from God; believes
that God communicates directly to him or her, or that he or she has a “special”
religious mission in life or special religious powers.

Somatic delusions – are generally vague and unrealistic beliefs about the client’s
health or bodily functions. Factual information or diagnostic testing does not change
these beliefs.
Example: A male client may say that he is pregnant, or a client may report
decaying intestines or worms in the brain.

Referential delusions – or ideas of reference involve the client’s belief that the
television broadcasts, music, or newspaper, articles have special meaning for him or
her.
Example: The client may report that the president was speaking directly to him on
a news broadcast or that special messages are sent through newspaper articles.

TYPES OF HALLUCINATIONS
Auditory hallucinations – the most common type, involve hearing sounds, most
often voices, talking to or about the client. There may be one or multiple voices; a
familiar or unfamiliar person’s voice may be speaking. Command hallucinations
are voices demanding that the client take action, often to harm self or others, and
are considered dangerous.

Visual hallucinations – involve seeing images that do not exist at all, such as
lights or a dead person, or distortions such as seeing a frightening monster instead
of the nurse. They are the second most common type of hallucinations.

Olfactory hallucinations – involve smells or odors. They may be a specific scent

such as urine or feces or a more general scent such as a rotten or rancid odor. In
addition to clients with schizophrenia, this type of hallucination often occurs with
dementia, seizures, or cerebrovascular accidents.
Tactile hallucinations – refer to sensations such as electricity running through the
body or bugs crawling on the skin. Tactile hallucinations are found most often in
clients undergoing alcohol withdrawal; they rarely occur in clients with
schizophrenia.

Gustatory hallucinations – involve a taste lingering in the mouth or the sense

that food tastes like something else. The taste may be metallic or bitter or may be
represented as a specific taste.

Cenesthetic hallucinations – involve the client’s report that he or she feels bodily
functions that are usually undetectable. Examples would be the sensation of urine
forming or impulses being transmitted through the brain.

Kinesthetic hallucinations – occur when the client is motionless but reports the
sensation of bodily movement. Occasionally, the bodily movement is something
unusual, such as floating above the ground.

Implementation for Client with Delusions

Nursing Intervention Rationale
Be sincere and honest when Delusional clients are extremely
communicating with the client. Avoid sensitive about others and can recognize
vague or evasive remarks. insincerity. Evasive comments or
hesitation reinforces mistrust or
delusions.

Be consistent in setting expectations, Clear, consistent limits provide a secure

enforcing rules and so forth. structure for the client.

Do not make promises that you cannot Broken promises reinforce the client’s
keep. mistrust of others.

Probing increases the client’s suspicion

Encourage the client to talk with you, but and interferes with the therapeutic
do not pry for information. relationship.

Explain procedures, and try to be sure When the client has full knowledge of
the client understands the procedures procedures, he or she is less likely to feel
before carrying them out. tricked by the staff.

Give positive feedback form the client’s

successes. Positive feedback for genuine success
enhances the client’s sense of well-being
and helps to make nondelusional reality
a more positive situation for the client.

Recognize the client’s delusions as the Recognizing the client’s perceptions can
client’s perception of the environment. help you understand the feelings he or
she is experiencing.
Initially, do not argue with the client or
try to convince the client that the Logical argument does not dispel
delusions are false or unreal. delusional ideas and can interfere with
the development of trust.
Interact with the client on the basis of
real things; do not dwell on the
delusional material. Interacting about reality is healthy for
the client.
Engage the client in one-to-one activities
at first, then activities in small groups,
and gradually activities in larger groups. A distrustful client can best deal with one
person initially. Gradual introduction of
Recognize and support the client’s others as the client tolerates is less
accomplishments (projects completed, threatening.
responsibilities fulfilled, interactions
initiated). Recognizing the client’s
accomplishments can lessen anxiety and
Show empathy regarding the client’s the need fro delusions as a source of
feelings; reassure the client of your self-esttem.
presence and acceptance.
The client’s delusions can be distressing.
Do not be judgmental or belittle or joke Empathy conveys your caring, interest
about the client’s beliefs. and acceptance of the client.

The client’s delusions and feelings are

Never convey to the client that you not funny to him or her. The client may
accept delusions as reality. not understand or may feel rejected by
attempts at humor.
Directly interject doubt regarding
delusions as soon as the client seems
ready to accept this (e.g., “I find that
hard to believe”). Do not argue but
present a factual account of the situation
as you see it.
Ask the client if he or she can see that
the delusions interfere with or cause
problems in his or her life.
Indicating belief in the delusions
reinforces the delusion (and the client’s
illness)
As the client begins to trust you, he or
she may become willing to doubt the
delusion if you express your doubt.

Discussion of the problems caused by

the delusions is a focus on the present
and is reality based.

Early signs of relapse:

 Impaired cause-and-effect reasoning
 Impaired information processing
 Poor nutrition
 Lack of sleep
 Lack of exercise
 Fatigue
 Poor social skills, social isolation, loneliness
 Interpersonal difficulties
 Lack of control, irritability
 Mood swings
 Ineffective medication management
 Low self-concept
 Looks and acts different
 Hopeless feelings
 Loss of motivation
 Anxiety and worry
 Increased negativity
 Neglecting appearance
 Forgetfulness

Client/Family Education for Schizophrenia:

 How to manage illness and symptoms
 Recognizing early signs of relapse
 Developing a plan to address relapse signs
 Importance of maintaining prescribed medication regimen and regular follow-
up
  Avoiding alcohol and other drugs
 Self-care and proper nutrition
 Teaching social skills through education, role modeling, and practice
 Seeking assistance to avoid or manage stressful situations
 Counseling and education of family/significant others about the biologic
causes and clinical course of schizophrenia and the need for ongoing support
 Importance of maintaining contact with community and participating in
supportive organizations and care

Client Education for Medication Management: Antipsychotic

 Drink sugar-free fluids and eat sugar-free hard candy to ease the
anticholinergic effects of dry mouth
 Avoid calorie-laden beverages and candy because they promote dental
caries, contribute to weight gain, and do little to relieve dry mouth
 Constipation can be prevented or relieved by increasing intake of water and
bulk-forming foods in the diet and by exercising
 Stool softeners are permissible, but laxatives should be avoided
 Use sunscreen to prevent burning. Avoid long periods of time in the sun, and
wear protective clothing. Photosensitivity can cause you to burn easily
 Rising slowly from a lying or sitting position prevents falls from orthostatic
hypotension or dizziness due to a drop in blood pressure. Wait until any
dizziness has subsided before you walk
 Monitor the amount of sleepiness or drowsiness you experience. Avoid driving
car or performing other potentially dangerous activities until your response
time and reflexes seem normal
 If you forget a dose of antipsychotic medication, take it if the dose is only 3-4
hours late. If the missed dose is more than 4 hours late or the next dose is
due, omit the forgotten dose
 If you have difficulty remembering your medication, use a chart to record
doses when taken, or use a pill box labeled with dosage times and/or days of
the week to help you remember when to take medication.

Nursing Intervention for Clients with Schizophrenia:

 Promoting safety of client and others and right to privacy and dignity
 Establishing therapeutic relationship by establishing trust
 Using therapeutic communication (clarifying feelings and statements when
speech and thoughts are disorganized or confused)
 Intervention for delusions:
 o Do not openly confront the delusion or argue with the client
o Establish and maintain reality for the client
o Use distracting techniques
o Teach the client positive self-talk, positive thinking, and to ignore
delusional beliefs
 Interventions for Hallucinations:
o Help present and maintain reality by frequent contact and
communication with client
o Elicit description of hallucination to protect client and others. The
nurse’s understanding of the hallucination helps him or her know how
to calm or reassure the client
o Engage client in reality-based activities such as card playing,
occupational therapy, or listening to music
 Coping with socially inappropriate behaviors:
o Redirect client away from problem situations
o Deal with inappropriate behaviors in a nonjudgmental and matter-of-
fact manner; give factual statements; do not scold
o Reassure others that the client’s inappropriate behaviors or comments
are not his or her fault (without violating client confidentiality)
o Try to reintegrate the client feel punished or shunned for inappropriate
behaviors
o Teach social skills through education, role modeling and practice
 Client and family teaching
 Establishing community support systems and care

CRISIS INTERVENTION

Crisis – is a turning point in an individual’s life that produces an overwhelming

emotional response.

Caplan (1964) Stages of Crisis:

1. The person is exposed to a stressor, experiences anxiety, and tries to cope in
a customary fashion.
2. Anxiety increases when customary coping skills are ineffective.
3. The person makes all possible efforts to deal with the stressor, including
attempts at new methods of coping.
4. When coping attempts fail, the person experiences disequilibrium and
significant distress.

3 Categories of Crises:
 1. Maturational crises, sometimes called Developmental crises – are
predictable events in normal course of life, such as leaving home for the first
time, getting married, having a baby and beginning a career.
2. Situational crises – are unanticipated or sudden events that threaten the
individual’s integrity, such as the death of a loved one, loss of a job, and
physical or emotional illness in the individual or family member.
3. Adventitious crises – sometimes called Social crises, include natural
disasters like floods earthquakes or hurricanes; war; terrorist attacks; riots;
and violent crimes such as rape or murder.

Aguilera (1998) 3 factors that influence whether or not an individual

experiences a crisis:
1. The individual’s perception of the event
2. The availability of emotional supports
3. Availability of adequate coping mechanism

Crisis Intervention Techniques:

1. Directive Interventions – are designed to assess the person’s health status
and promote problem-solving, such as offering the person new information,
knowledge, or meaning raising the person’s self-awareness by providing
feedback about behavior; and directing the person’s behavior by offering
suggestions or courses of action.
2. Supportive Interventions – aim at dealing with person’s needs for
empathetic understanding such as encouraging the person to identify and
discuss feelings, serving as a sounding board for the person, and affirming
the person’s self worth.

Treatment of Mental Disorders and Emotional Problems:

1. Individual Psychotherapy – is a method of bringing about change in a
person by exploring hir or her feelings, attitudes, thinking and behavior. It
involves a one-to-one relationship between the therapist and the client.
2. Group Therapy – clients participate in sessions with a group of people. The
members share a common purpose and are expected to contribute to the
group to benefit others and receive benefit from other in return.
Groups – is a number of persons who gather in a face-to-face setting to
accomplish tasks require cooperation, collaboration, or working together.
Stages of group Development:
 Beginning Stage or Initial Stage – commences as soon as the
group begins to meet. Members introduce themselves, a leader can
be selected, the group purpose is discussed, and rules and
expectations fro group participation are reviewed.
 Working Stage – begins as members begin to focus their attention on
the purpose or task the group is trying to accomplish. Group
 Cohesiveness is the degree to which members work together
cooperatively to accomplish the purpose
 Final Stage or Termination – occurs before the group disbands. The
work of the group is reviewed, with the focus on group
accomplishments, growth of group members, or both depending on the
purpose of the group.
The therapeutic results of group therapy (Yalom, 1995):
 Gaining new information, or learning
 Gaining inspiration or hope
 Interacting with others
 Feeling acceptance and belonging
 Becoming aware that one is not alone and that others share the
same problems
 Gaining insight into one’s problems and behaviors and how they
affect others
 Giving of oneself for the benefit of others (Altruism)
3. Psychotherapy Groups – the goal is for members to learn about their
behavior and to make positive changes in their behavior by interacting and
communicating with others as member of a group. Composed of one or two
therapists as the group leaders.
2 types of Groups:
1. Open Groups – are ongoing and run indefinitely, allowing members to
join or leave the group as they need to.
2. Closed Groups – are structured to keep the same members in the
group for a specified number of sessions.
4. Family Therapy – is a form of group therapy in which the client and his or
her family members participate. The goals include understanding how family
dynamics contribute to the client’s psychopathology, mobilizing the family’s
inherent strengths and functional resources restructuring maladaptive family
behavioral styles, and strengthening family problem-solving behaviors.
5. Education groups – the goal is to provide information to members on a
specific issue – for instance, stress management, medication management, or
assertiveness training.
6. Family Education - NAMI (National Alliance for the Mentally Ill) –
developed a unique 12-week Family to Family Education course taught by
trained family members. NAMI also conducts Provider Education programs
taught by two consumers, two family members, and a mental health
professional who is also a family member or consumer.
7. Support Groups – are organized to help members who share a common
problem to cope with it. Support groups often provide a safe place for group
members to express their feelings of frustration, boredom, or unhappiness
and also to discuss common problems and potential solutions.
 8. Self-Help Groups – members share a common experience, but the group is
not a formal or structured therapy group. Most self-help groups have rule of
confidentiality: whoever is seen at and whatever is said at the meetings
cannot be divulged to others or discussed outside the group.
9. Psychiatric Rehabilitation – involves providing services to people with
severe and persistent mental illness to help them to live in community. These
programs are often called Community Support Service or Community
Support Programs. Psychiatric rehabilitation focuses on client’s strengths,
not just on his or her illness.
(NCCAM) National Center for Complementary and Alternative medicine – is
a federal government agency for scientific research on Complementary and
Alternative Medicine (CAM).

Complementary Medicine – includes therapies used with conventional medicine

practices (the medical model).
Alternative Medicine – include therapies used in place of conventional treatment.
Integrative medicine – combines conventional medical therapy and CAM
therapies that have scientific evidence supporting their safety and effectiveness.

Complementary and Alternative Therapies:

 Alternative medical System – include homeopathic medicine in western
cultures, and traditional Chinese medicine, which includes herbal and
nutritional therapy, restorative physical exercises (yoga, Tai chi), meditation,
acupuncture and remedial massage.
 Mind-body Interventions – include meditation, prayer, mental healing and
creative therapies that use art, music or dance.
 Biologically Based Therapies – use substances found in nature, such as
herbs, food, and vitamins. Dietary supplements, herbal products, medicinal
teas, aromatherapy and a variety of diets are included.
 Manipulative and Body-based Therapies – are based on manipulation or
movement of one or more parts of the body, such as therapeutic massage
and chiropractic or osteopathic manipulation.
 Energy therapies – includes two types of therapy; Biofield therapies,
intended to affect energy fields that are believed to surround and penetrate
the body, such as therapeutic touch, qi gong, and Reiki and Bioelectric-
based therapies involving the unconventional use of electromagnetic fields,
such as pulsed fields, magnetic fields and AC or DC fields.

Psychosocial Interventions – are nursing activities that enhance the client’s

social skills, interpersonal relationships, and communication

Cognitive Therapy – is based on the premise that how a person thinks about or
interprets life experiences determines how he or she will feel or behave. It seeks to
help the person change how he or she thinks about things to bring about an
improvement in mood and behavior.

An understanding of psychosocial theories and treatment modalities can help the

nurse select appropriate and effective intervention strategies to use with the
clients.