JEAN PIAGETS COGNITIVE THEORY Motor activities involving concrete objects results in the development of mental functioning (learning)

) New operation building on already existing ones Increasing integration and coordination Stages of cognitive development are:

LAWRENCE KOHLBERGS MORAL DEVELOPMENT Moral development depends primarily on cognitive development Moral development goes hand in hand with thinking and judgment The Stages of Moral Development are: SUMMARY OF PERSONALITY DEVELOPMENT 1. 2. 3. 4. 5. Development is a continuum Behavior has meaning and is not determined by chance All behaviors should be goal-directed The unconscious plays an active role in determining behavior The early years of life are extremely important for personality development

THEORITICAL FRAMEWORK OF CARE 1. Psychoanalytical Model Behavioral disturbances stems from emotionally painful experiences Repressed feelings leads to unresolved and unconscious conflicts in the mind Defense mechanism develop which produces the disturb symptoms Psychotherapy uncovers the roots of conflict through interviews in the long-term therapy 2. Behavioral Model Behavior can be change through a system of rewards and punishment Response to behavior by therapists should be consistent 3. Cognitive Model Focuses on immediate thought processing-how a person perceives or interprets his or her experience and determines how he or she feels or behaves

4. Gestalt Model Emphasizes identifying the persons feelings and thoughts in the here and now 5. Medical-Biological Model Behavior disturbance is n illness or defect Illness is located in the body, either a neurostructural defect, biochemical alteration, or genetics Disease entities can be diagnosed, classified and labeled Somatic therapies are used which includes: o Electroconvulsive therapies o Psychoneuroimmunology o Psychosurgery o Bright Light Therapy o Transcranial Magnetic Stimulation (TMS) or Repetitive Transcranial Magnetic Stimulation *** INDIVIDUAL PSYCHOTHERAPY A method of bringing about change in a person by exploring his or her feelings, attitudes, thinking and behavior Involves one to one relationship between the therapist and client GROUP PSYCHOTHERAPY Clients participate in a session with a group of people Members share a common purpose and are expected to contribute to the group to benefit others and receive benefit from others in return Examples: o Family therapy o Family education o Education groups o Supports groups o Self-help groups PSYCHOPHARMACOLOGY BASIC PRINCIPLES A medication is selected based on the clients target symptoms Many psychotropic drugs must be given in adequate for a period of time before their full effect is realized The dosage of medication is often adjusted to the lowest dose effective for clients

 Elderly people require lower dosages of medication to produce therapeutic effects and it may take longer for a drug to achieve its full therapeutic effect. Psychotropic drugs are often decrease gradually rather than abruptly discontinued Follow-up care is essential to ensure compliance with the medication regimen, to make needed adjustment in dose and manage side effects Anti-anxiety Drugs Most common drugs are benzodiazepines - Diazepam(Valium), Lorazepam(Ativan), Chlordiazepoxide(Librium), Clorazepate(Tranxene) Buspirone(Buspar) is the first pure anxiolytic drug and acts as a partial agonist at serotonin receptor sites. Barbiturates may also be used for anxiety such as Phenobarbital Propanolol(Inderal) is a beta-blocker effectively interrupts the physiological responses of anxiety Antihistamine Hydroxizine (Iterax, Atarax) has a central cholinergic effect and is good anti-anxiety agent Nursing Intervention Caution client to avoid potentially hazardous activities because of drowsiness Warn the patient of the danger of concurrent use of alcohol and other CNS depressants Avoid abrupt withdrawal Do not give antacids concurrently Do not take medications with meals Watch for adverse reactions Antipsychotic Drugs Classified either by chemical class, potency but more importantly by typicality Low-potency drugs causes more anticholinergic side effects whereas highpotency drugs causes more EPS 1. TYPICAL ANTIPSYCHOTIC DRUGS Traditional drugs effective for positive symptoms but it results in several side effects Examples are: Chlorpromzine (THORAZINE), Thioridazine (MELLARIL), Haloperidol (HALDOL), Fluphenazine (PROLIXIN) 2. ATYPICAL ANTIPSYCHOTIC DRUGS Effective for negative symptoms No endocrine side effects (prolactin increase) Potent anagonists of serotonin Examples are:

o Clozapine (clorazil), risperidone (risperdal), olanzapine (zyprexa), quetiapine (seroquei) 3. DOPAMINE SYSTEM STABILIZER (DSS) DSS are thoughtto balance the dopamine systems by increasing dopamine in brain areas in which dopamine is deficient and decreasing dopamine in brain areas in which dopamine is overactive Only example is: o Aripripazole (abilify) SIDE EFFECTS 1. EXTRAPYRAMIDAL SIDE EFFECTS (EPSE) a. Acute Dystonia - Acute muscular rigidity and cramping, stiff thick tongue with difficulty in swallowing; torticollis, opisthotonus, or oculogyric crisis b. Pseudoparkinsonism - stooped, stiff posture with mask-like face, a festinating gait, cogwheel rigidity, drooling, bradykenesia, pill rolling tremors c. Akathisia - feeling ofinternal restlessness and inability to sit down d. Tardive dyskinesia - Syndrome of permanent involuntary movements of the tongue, facial and neck muscles, upper and lower extremities even truncal musculature - Manifested as tongue-thrusting and protrusion, lipsmaking, blinking, grimacing