1 MDRN 7th Batch November 13, 2005/8-12 Mrs. Lucy Espinosa, RN PSYCHIATRIC NURSING Scope of Psychiatric Nursing: I.

Principles, Concepts and Theories II. Psychodynamics III. Mental Disorders based on DSM IV Revised Symptomatology Defense Mechanism: Example= Phobia–displacement Obsessive Compulsive-undoing Psychopathology including Neurotransmitters and Brain Abnormalities Nursing Diagnosis emphasis in local board Nursing Interventions PRINCIPLES, CONCEPTS and THEORIES Definition of Psychiatric Nursing by the American Nursing Association (ANA):  a specialized area of nursing which emphasizes the theories of human behavior as its scientific aspect and purposeful use of self as its art  it is a SCIENCE because it deals with the use of knowledge, focused on human behavior and understand psychology & sociology Psychodynamic: • it is understanding the motivation behind human behavior • it deals with the whys, reasons and rationale of human behavior whether normal or abnormal (Example: Motivations why a lot of MDs are taking up nursing) • according to Freud, psychiatric/mental cases should be studied from intrauterine stage of growth • according to Leticia Kuan from the stage of courtship of the parents: 2 Types of Courtship 1. Over a stick of cigarette-woman had sex on the night she met the man 2. Bench shining method-advocated by Kuan that involves 2-3 years of courtship • it involves therapeutic nurse-patient relationship (TNPR) and therapeutic nursepatient partnership (TNPP) giving the client a higher sense of autonomy or higher sense of direction Psychopathology: • is understanding the motivation behind abnormal human behavior only • there are 2 roles of psychopathology: 1. Role of Nature-biological & genetic influences 2. Role of Nurture-know psychodynamics (how a person is raised) and environmental influences (early childhood experiences)

2 • Example: Patient with auditory hallucinations (false perceptual disturbance) ↓ -----------------------------------------------------↓ ↓ Nature Nurture ↓ ↓ Genetics and Biological: Environmental influences ↑ dopamine-a neurotransmitter Psychodynamics: history of loss which according to Keltner is a defensive coping mechanism against an overwhelming anxiety: Mild-Moderate=normal Severe=anxiety disorder etiology or cause is part of psychopathology while pathophysiology is abnormal functioning Example: AIDS is caused by HIV virus. How it enters the body? What’s the reason why immune system is low?

 It is an ART because the essential tool used is the Self. • A psychiatric nurse should be a role model, a change agent and employ the Therapeutic Use of the Self (TUS) which is the ability to use one’s person consciously and with full awareness so as to establish relatedness and to structure nursing interventions, ability to use self deliberately and intentionally therapeutically • A nurse should develop Self-awareness which according to Taylor, is the ability to experience genuine feelings of joy, anger and resentment as well as beliefs Example: A male nurse had a fight with his wife. He controlled his feelings, went to work and assigned to 3 patients on physical restraints. One patient while being fed, spewed his food on the male nurse. The latter reacted by kicking the patient resulting to rupture of bladder. As a consequence, he was relieved of his job. To demonstrate self awareness: if only the nurse was truthful to himself, he could ask his supervisor to assign him elsewhere doing difficult duties because he can’t handle the stressful job due to his personal problem. • BQ #1: What is the most difficult part in the therapeutic nurse-patient relationship? a. to remain professional at all times b. to establish trust-patient resistance due to experience c. to exhibit empathy d. self awareness Answer: D, self awareness BQ #2: Factor that strains therapeutic nurse-patient relationship? Answer: Counter transference-you see one person in another person

3 BQ #3: What will you do if you are affected by your patient? Answer: Go to your clinical specialist BQ #4: Client went to assaultive behavior, what should the nurse do? a. Call restraining team - practice in NCMH b. Call doctor - answer as MD c. Give neuroleptics - ideal answer d. Self awareness - local board answer Answer: D, according to Keltner, give the client the right to receive the least restrictive environment 3 Scopes of Psychiatric Nursing Practice: 1. Caring for psychologically ill client in general hospital or medical center  Psychiatric nursing also have specialty areas such as adult and child  Psychiatric nursing liaison is employed in medical centers to handle the psychosocial concern of psychologically ill clients  Role of the nurse is as a facilitator→ bringing out the client’s fears and anxieties 2. Community Mental Health Nursing (CMHN)  The application of the principles of psychiatric care in communities & groups of people  History of CMHN: • Mental Health Nursing started in USA, where big mental institutions provide custodial care (physical care such as feeding and bathing only) of the clients. This resulted to develop Social Breakdown Syndrome, a complication of mental illness (BQ) wherein clients remained apathetic. • Apathy–is a complete absence of feelings or state of indifference in situations where in a normal person can elicit responses. • In 1963, Community Mental Health Nursing was established by enactment of Community Mental Health Act which ordered the closure of big mental institution and the establishment of Community Mental Health Centers. 3. Caring for the Mental Health Consumers in a psychiatric institution 3 Levels of Prevention in CMH Centers: (BQ) Level of Prevention Clients Primary Well Secondary Tertiary Sick Recovered Aspect of Care Promotion of M. H. Prevention of M.I. Crisis Intervention Case Finding Institute Immediate Treatment Follow up Prevent further complications Job placement

a. b. c. a. b. a. b. c.

all are correct but this is more specific BQ #2: To institute immediate treatment is this? a. Knowledge of Self • ability to recognize and use God given talents/potentials and positive points (assets) & accepting negative points (liabilities) turning it into something positive • healthy or normal narcissism is seen in infants & become pathologic if you reach adolescent years • mentally healthy person will strive to avoid his liabilities through enhanced self-awareness by giving an opportunity to do the JOHARI Window by Joe Luft and Harry Ingham • 4 Quadrants of Life or 4 Windows of Life I. Public Self II. the Definition of Mental Health: 1. It is the ability to handle normal stresses of life 3. Blind Spot  Known to self and others  Bad breath area because unknown to self but known to others  Take the risk  It brings anxiety to know the truth III. Private Self IV. Unconscious  Secrets. Primary care b. prevention of illness c. crisis intervention d. promotion of mental health b. It is the ability to see self as others do and must fit in the society or culture where one belongs or lives 6 Concepts/Criteria of Positive Mental Health (according to Marie Jahoda): 1.4 BQ #1: Which of the following aspects of care specifically focus on primary care? a. masks. pretences &  Unknown to self and others hypocrisy  Known to self but unknown to others . Tertiary care Answer: B. Promotion of Mental Health (MH): According to WHO. secondary care because patient is already sick PRIMARY Level of Prevention A. teaching sex education among adolescent & old people Answer: D. It is the ability to maintain an emotional well being 2. Secondary care c.

development and self actualization • is the ability to reach for the highest • Example: Graduating. can’t wait & impulsive b.. SUPEREGO–acts on moral principle and the good conscience • ID=Ego=Superego ID SE Ego Ego SE ID Mentally Healthy (Balanced) Strong ID (Antisocial PD) Strong Superego (Depression) 4. Perceptive Ability –is awareness of our environment Example: A normal mentally well person who feels cold will get a blanket but a psychotic person is oblivious of the climate 3. Mastery of one’s environment • is the ability to adjust and adapt • how you do anything is how you do everything . ID–acts on pleasure. Autonomous Behavior –is the ability to decide wisely 5. Integrative Ability • is the ability to harmonize the 3 Psychic Forces of Sigmund Freud: a. EGO-acts on reality principle. Change in any quadrant affects all the rest of the quadrants b. e.5 • Principles involved in the use of JOHARI Window to enhance self awareness: a. Guts-you should take the risk of blurting deep darkest secret • • 2. Cliché (meaningless phrase) b. Bigger the Q III. as long as it has a professional objective. refocus with empathy done only for 30 minutes 5 Levels of Communication in Johari Window: a. without morals. Gossip c. the one deciding. Bigger the Q I. passing the licensure examinations and going to further studies 6. Ideas and judgment-trying to keep knowledgeable to compensate what is lacking like confidence d. poor communication/interpersonal relationships  How to improve Johari Window? 1) Go into self disclosure by opening up to a friend 2) Feedback mechanism by constructive criticism c. good communication/interpersonal relationships BQ: Can a nurse be self revealing? Answer: Yes. Desirous growth. Feelings-suppress feelings but never dies & come later as…. can wait. can satisfy the needs of ID and restrictions of SE c.

Alzheimer’s–PET shows increased senile plaques and neurofibrillary tangles c. concentration. it causes depression . Prevention of Mental Health: Etiology/General Causes of Mental Disorders I. Position in the family (2nd rank child syndrome)=unpleasant attitude b. sexual libido. Depression-PET and SPECT shows hypofunctioning of the hypothalamus(a small structure of the brain with several blood supply which controls satiety center (thirst and hunger). Cancer c. PET (Pulsitron Emission Tomography) b. sleep and wake cycle. Mental Illness b. Serotonin is proven to be a mood elevator and controls the sleep and wake cycle. Diabetes • Method of transmission: ECG type • Genogram–a multi-generative graphical presentation or schematic diagram of the family tree which includes up to the 3rd generation & take note of the following: a. Cardiovascular d. Biological/Biomedical (BQ) Model  involves organic pathology 4 Causes: 1. Neurotransmitter theory • Neurons has two main parts: the axon and dendrites • The terminal of an axon connects one neuron to another and has synaptic vesicles that stores and releases neurotransmitters • Examples of neurotransmitters: a. Closeness among the family member 2. Schizophrenic–shows decreased blood flow to the frontal lobe 3. learning and decision making causing pseudodementia (false dementia) b. MRI and CT Scan • PET and SPECT are sophisticated/innovative visual imaging techniques which provide the human brain activity by injection of radioisotope into patient’s bloodstream • Examples: a. It should stay at the receptor sites because if there is a reuptake or re-absorption of serotonin by the different synaptic vesicles. Brain abnormality theory • It begun in 1990 in US as decade of the brain • In all forms of mental illness.6 B. Genetic theory • 4 illnesses that is genetic in origin: a. psychiatrist and neurologist appreciate the brain abnormality using diagnostic procedures showing brain activity such as: a. SPECT (Single Photon Emission Computed Tomography) c.

Vitamin B1 deficiency –seen in alcoholics where alcohol interferes with vitamin B1 absorption and thiamine serves as vehicle for glucose. Acetylcholine is a memory neurotransmitter which is decreased on Alzheimer’s d. Increased dopamine–Schizophrenia f. hopelessness poor self concept and low self esteem 2) faulty perception about the future–pessimism 3) faulty perception about the world-sees world as empty  Self Concept –cognitive view about the self (“Pananaw sa pagkatao”)  Self Esteem –affective view about the self (emotional) B. II. Vitamin Deficiency theory a.7 Nclex Q 1: Diet for depressed patients should be high in CHO and low in CHON intake. Increased serotonin-Impulsive 4. Cognitive Model of Anxiety Disorder  Misinterpretation/misperception of danger . banana. Norepinephrine is a fight or flight neurotransmitter which is decreased on depressed patients c. the person 1) has negative perception of self–worthlessness. Low in vitamin C–apathy b. an enzyme precursor of serotonin and banana. Absence of glucose leads to Wernicke’s encephalopathy. a life threatening condition even when the client recovers. Cognitive Model A. chocolate and milk Nclex Q 2: What should be the first food & beverage given to insomniac clients? Answer: Give milk first because it contains L tryptophan. potato and apple skin are rich in potassium which is a vehicle for serotonin b. Decreased GABA–Anxiety e. Low in vitamin D–mania c. dementia of the Korsakoff type ensues (BQ). Cognitive Model of Depression  People who are vulnerable to depression shows a Triad of Depression Self Future World  In depression. Answer: Food & beverages rich in serotonin are oatmeal.

8 November 28, 2005/8-12 Mrs. Lucy Espinosa, RN Continuation of General Causes of Mental Disorders III. Psychosocial Model 2 Main Types: 1. Precipitating-most recent/immediate cause 2. Predisposing-causes that make a person vulnerable to mental illness Factors to consider: A. Age:3 vulnerable ages in life (BQ) connected with mental disorder 1. Adolescent: 17-25 years old-very fragile stage, period of storm and stress, vulnerable to Schizophrenia 2. Menopausal: midlife crisis-empty bird’s nest syndrome 3. Senility: mid 70’s-80’s-most painful part of our life B. Gender 1. Male-express feelings psychophysiologically; prone to schizophrenia 2. Female-express feeling symbolically; prone to depression, anxiety related disorders and somatoform disorders C. Nationality 1. Japanese-high suicide rate 2. Americans-vulnerable to Anxiety Disorder (well worried) 3. Filipinos-vulnerable to Schizophrenia (severely mentally ill) 4. Europeans-vulnerable to Mood Disorder particularly depression because they have everything and could not ask for more D. Intelligent Quotient (IQ) 1. High IQ-higher predisposition to Schizophrenia and Paranoia that started from oral stage because they didn’t develop basic trust & as a compensatory act for lack of social warmth 2. Low IQ-mental retardation to experience psychosis E. Civil Status according to increasing incidence 1. Single-more vulnerable due to absence of support system 2. Widows 3. Separated 4. Married-last to have mental illness F. Four Classification of Body Built/Physique by Krethzner 1. Asthenic (“malapalito”)-80% has slender body with thin bone and oval face; vulnerable to Schizophrenia 2. Athletic (BQ)-has strong muscular development with bony prominence and square face; vulnerable to Anxiety Disorder 3. Pyknic (BQ)-has short & stocky (ex. natives of Baguio); vulnerable to Mood Disorder 4. Dysplastic-combination of the 3 body built and no vulnerability; common among Filipinos

9 G. Classification of Personality according to Temperament by Carl Jung 1. Introvert-very shy & sensitive; vulnerable to Schizophrenia 2. Extrovert-sociable & aggressive; vulnerable to Mood Disorder 3. Ambivert-possesses both qualities of introvert/extrovert; no vulnerability C. Crisis Intervention: BQ: In crisis intervention, one major focus is: a. To offer corrective emotional experiences b. To look into underlying cause c. To restore normal functioning of a person or assist him to pre-crisis level d. To improve social functioning of a person Answer: C 3 Normal Phenomena experienced by people: 1. Stress- a part of being alive; it’s a person & environment interaction; is something objective & can be seen; part of normal adaptation. a. Eutress-normal; motivates a person b. Distress-abnormal/pathological 2. Anxiety-vague unexplainable feelings of apprehension which disturbs the subjective life of a person & his relations with others; the internal state that stress produces 3. Crisis  A minor event that produces stress, “just like a straw that breaks a camel’s back”  minor event→ produces stress→ leading to series of events due to: a. lack of coping resources b. ineffective/dysfunctional coping  comes from a Chinese word “Krinein” which is represented by: a. Face with horrified expression-a problem/danger b. Face with a smile-opportunity  According to WHO, crisis is a psychological time wherein a person handles stress when he finds his old usual coping ways to be ineffective  it differs from stress in that crisis results in a period of severe disorganization due to the failure of individual’s usual coping mechanism &/or lack of their usual resources  Crisis worker is a person who intervenes with crisis; he should be active & directive (BQ); experiences a secure level of decision making & problem solving  the normal duration for a person to resolve a crisis is 4-6 weeks (BQ) but according to Mosby 1-6 weeks because it is self-limiting that goes either into (+) or (-) resolution: 1. Positive resolution-expected with a support system (family)→ crisis become an identified problem→ bringing growth, promoting potential & learning opportunity 2. Negative resolution-results when there’s no support system thus crisis will set in with the preconscious level leading to: a. Psycho-physiologic disorder-when bad experience sets in the subconscious b. Anxiety related disorder c. Psychosis

10 3 Levels of Consciousness (psychoanalytical Theory of Freud): a. Conscious-is the here & now, operates when we are awake, can be compared to the tip of an ice cube in a glass of water, there is the knowledge of the problem thus the aim of crisis worker is to resolve crisis within this level b. Preconscious/Subconscious-watchman of the mind, partly forgotten/partly remembered memories, recalled with vigorous effort c. Unconscious-storage of all painful memories  2 Types of Crisis by Keltner: 1. Maturational/Developmental crisis-more predictable & easier to handle which happens all throughout developmental processes (ex. birth of baby, first day of school, menstruation, vacation) 2. Accidental/Situational crisis-less predictable & hard to manage; could be anticipated threat to one’s self esteem (ex. physical health, accident, disastersnatural & man made) Psychotherapeutic Strategies: Psychotherapeutic Focus Strategies 1. Crisis Intervention Immediate present problem or present situation (ex. death, relationships) 2. Psychotherapy a. Individual (nurse-patient relationship) b. Group (small group meeting) 3. Psychoanalysis Major Goals Restore homeostatic level Normal functioning Normal equilibrium Assist the person to one’s homeostasis (WB Cannon) Offer corrective emotional experiences •

Here & now Conscious Immediate condition of person or the immediate concern Underlying cause Offer long term resolution Unconscious Old scars are unliquidated childhood experience stored in unconscious level

 Nursing Diagnosis: 1. Ineffective coping 2. Risk for injury 3. Risk for violence 4. Family pattern disturbances

2-3 hours  Critical Incident is an event that causes an overwhelming reaction & disrupts normal functioning of a person  5 Steps of CISD: 1. Sharing experiences-involve10-12 persons/participants in circles. Jeff Mitchell  one shot deal (done only once). universality & normalcy). Critical time for a depressed patient is 7-9 months after crisis 3. share their traumatic experiences. Introduction-develop/establish trusting relationship & practice confidentiality. among Filipinos prayers 5. NE & Serotonin are highest during the crisis c. patients undertake suicide 2-3 months after the crisis has abated b. Contingency plan-ex. Restore emotional security & stability Goals for Crisis Intervention: 1. Identify coping styles-acceptance. BQ-Feeling tone of the client B. physical. Psychosocial Processing (PSP) for children-children has shorter attention span: Color your life technique. to lower tension do some breathing exercises 4. Multiple Intervention-in cases where crisis that continually occurs C. facilitator introduces self 2. Prevent Suicide-provide safety of client/family support system because: a. there must be respect & rules must be imposed. behavioral & mental/cognitive reactions. tell clients that it is normal reaction in an abnormal situation (commonality. prevent further violence & decompensation 2. Help the individual to go back to pre-crisis level or homeostatic state Technique in Crisis Intervention: Psychosocial Processing (PSP)  a tool in transforming a victim to become a survivor by providing psychological relief Types of PSP: A. Critical Incident Stress Debriefing (CISD)  pioneered by a fireman. centered on facts & feelings 3. community organization. Assessment-determine the immediate precipitant or patient problem • Intervene during the duration of crisis & not after crisis has abated because this is the time when: a. easier to intervene c.11  Roles of a Nurse in Crisis Intervention: 1. Done in mentally well patients who are experiencing a crisis 2. the client has mental block where decision making & problem solving are shot b. murals & role playing . change is possible d. more effective & prevent ineffective coping styles e. Expect for reactions-emotional. music & art appreciation.

Evening care center: offer administration of hypnosis. Physical structures Therapeutic Meetings: a. In-Patient Service-maximum stay of patient should be 72 hours in ER.12 SECONDARY Level of Prevention  Sick clients of the community  Case Finding: early recognition→ early diagnosis→ early treatment→ recovery 1. Organized activities c. Community meeting-problems of clients encountered in the ward of general interest d. Weekend care center 4. 24 hour Emergency Service includes suicide prevention. Consultation/Education Service Therapeutic Postures: 1. Circle meeting-highlights of the 24 hours b. Brief Psychotic Episode-symptoms lasting from few hours to one month 2. Patient government meeting-officers of the clients discuss issue related to welfare 2. proper sleeping pattern c. sleep hygiene. Small group-personal problems of clients c. Out patient Service (OPS) 2. Uniform attitude . Day care center: 8-5 pm b. Attitude Therapy (BQ)-use of prescribed ways on how to handle clients according to the behavior symptoms they manifest Characteristics of Attitude Therapy: a. equipped with mobile crisis unit (a department of community health center) 5. Consistency to reach the maximum therapeutic value b. music. client is admitted to acute psychiatric unit 3. Schizophreniform Disorder-symptoms lasting 6 months 3. People-client & relatives b. Partial hospitalization a. Schizophrenia-symptoms lasting more than 6 months  Institute immediate treatment TERTIARY Level of Prevention  Recovered clients of the community  Prevent further complications  Provide jobs & shelter to prevent Revolving Door Syndrome Services in a Community Health Center: 1. stress reduction techniques. if not recovered. Therapeutic Community-“Le Fortage Concept”. a milieu therapy by which the total social structure of the treatment unit is involved in the helping process: Elements: a.

Matter of Fact-nurse must be objective. Role Playing for children 6-12 years old C. IQ test which determines the mental development of the patient 4. Case social worker Prepares family case work 5. Psychodrama for adolescent & adult Mental Health Consumers in a Psychiatric Hospital Members of a Psychiatric Team Responsibility 1. Projective Test which reveals the unconscious. consistent. schizoid. No demand for highly assaultive. Activity therapist Provides therapeutic activities . demanding clients b. gives diagnosis and prescribes medicines 2. Active friendliness-nurse must have TLC for withdrawn. Play therapy for children 0-5 years old allowing them the opportunity to express feelings in a safe environment b. conducts mental status examination (MSE). Play therapy for children 5 years and below=a therapeutic procedure by giving children the opportunity to express feelings in a safe environment B. Role therapy for 5-12 years old by mobilizing anger of the child c. antisocial. Passive friendliness for suspicious. fearful clients c. Introduction b. Psychologist Administers and interprets psychological tests A. inner conflicts of the patient B. Remotivation Technique  assist a client to move again→ psychological movement  involves 10-12 participants  to reach the unwounded areas (sports. Sharing the works or jobs  After remotivation therapy: a. clients with rage/furious 3. Psychiatric Nurse Provides nursing care. occupation.13 Types: a. regressed. Sharing the world to live in d. Psychodrama for adolescents and adults 3. Psychiatrist Provides medical care. Facilitates milieu therapy=scientific manipulation of clients environment aimed at producing changes in clients personality. non-judgmental for manipulative. Performs A. nature) of the client  Steps: a. paranoid clients d. manic/elated. Bridge to reality c. Kind firmness (BQ)-gives boring menial tasks internalized hostilities for depressed clients e.

14 January 21. motivates an individual Moderate-give activities Severe-invite client into brisk walking Panic-nurse should stay put only & presence gives assurance to the client 6. Appearance-observe patient from head to foot. Mothering  supervision of feeding & grooming that entails touching the client. 2006/1-5 Mrs. Lucy Espinosa. slow movement & kyphotic=prevent suicide b. Creator of Therapeutic Environment  to produce a warm. Active socializing role-initiating social gatherings. RN Roles of a Psychiatric Nurse: 1. everything was given to them & they didn’t experience any disappointments & frustrations 2. presentations & dancing activities b. downcast eyes. Teacher  Example: Nurse teaches a manic client to wear make-up/clothes properly 3. Observation: to take notice of something which another person might miss a. homelike accepting atmosphere 3 Essential Skills of a Psychiatric Nurse: 1. look at the eyes first (window of the soul) Example: Depressed client-sad facial expression. arms crossed & face sideways Paranoid-refuse to eat because of suspiciousness . Counselor  providing outlet for patient’s anxieties & hostilities  nurse should avoid giving advices. Passive socializing role-staying with mute patients 5. they have been smothered by too much mothering before. Communication 2. Socializing Agent  2 Types: a. Behavior Example: Manic client-too happy. they may react violently Anti-social PD-mothering is CI. droopy posture. suggestions & opinions  nurse should assess the client’s level of anxiety Mild-therapeutic. so the nurse should be assessed first  orchestrating the clinical activities in the area  Example: Schizophrenia/Paranoid-mothering is CI. Technician  know the scientific principle behind nursing procedure  develop systematic ways of doing nursing jobs  Example: Nurse explains to client the importance of turning head to one side after a tonic clonic convulsion during ECT to prevent aspiration pneumonia 4.

Kinesics-is a science of understanding body movement • 3 Forms of Kinesis: 1) Facial expression-the eyes & the corner of the mouth are 2 areas of the face that are least susceptible to control Examples: Bipolar. Quotation marks-used to quote the exact verbatim of the client Example: “may boses. information & attitudes between 2 persons or among a group of persons  clarify or validate first the clients’ feelings & expression before drawing a conclusion  According to Davis. Long dashes-used to complete an incomplete statement Example: “masakit-----meaning the client didn’t say anything else Communication  defined as an exchange of my world of meaning with your world of meaning  is the reciprocal or mutual exchange of ideas.. Verbal-the transmission of a message using spoken or written word 2. Conversation-the manner the patient talks Example: Bipolar-client with pressured speech Depressed-monosyllabic Schizophrenia-incomprehensible responses 3. Non-verbal  actions or behaviors that communicate a message without speaking  listen to what the other person is not saying  more reliable of true feelings because less conscious  reflective of one’s attitude Subtypes of Non-verbal communication: a. it should be per patient’s verbatim  Charting Aides: a. values. Parenthesis-used to validate words preceding the parenthesis Example: “sino sila?” (ang mister ko at babae nya) c. feelings. context (BQ) is the physical setting or constraints where communication took place Types of Communication: 1. Recording & Reporting  Official account of things done  Avoid psychiatric terms. Short dashes-used to validate words which were mumbled by the client Example: “may boses….15 Depressed-refuse to eat because of worthlessness c. beliefs. papatayin ko sila” b. Kinesis-the study of communication through body movement or body language.ingat sila” d. manic-sizing up Schizophrenia-evasive Worried-knitted forehead 2) Eye contact Dimming of lights-looking at a stranger with an 8 feet distance and subsequently averting of our eyes as a sign of respect to the stranger (Hall) .

Paralanguage  refers to how something is said rather than what is said  false language or beyond the language itself (BQ) 2 Forms: 1) Voice quality-tone of voice 2) Non language vocalization-crying.16 Paranoid-poor eye contact Schizophrenia-empty looks Manic-super happy but eyes have no glow Depressed-sad looks. according to Hall. children.5-3 feet as in close friends. Ex. comfort zone is the arm’s length c) Business=4-12 feet as in gatherings. Proxemics  is the study of people’s use of interpersonal space  is the law of space relationship or spatial relationship (BQ) 2 Forms of Proxemics: 1) Territoriality • is the marking off & defending of certain areas as their own • permanent space that we prevent from intrusion 2) Personal Space • is a zone of space surrounding a person that is felt to “belong” to that person • temporary space that we prevent from intrusion • Interpersonal Distance Zones: a) Intimate=6-8 inches as in parents. friends & work situations Persecutory Stance-exhibited by persons who were subjected to persecution (sarcasm or ridicule) by their loved ones d) Public=12 feet and beyond as in concerts & public performances. lovers b) Personal=1. sobbing & moaning Examples: . drooping eyes 3) Gestures: Examples a) Thumb pointing to the pocket-unconsciously telling you to look at his bulging penis b) Repetitive movement-according to Freud. Paranoid clients-nearest distance is 4 feet c. doing repetitively is sexual in nature c) Semi-reclining position with crossed legs & both hands placed at napesuperiority d) Drawing pointed & straight object-phallic personality e) Black-represents penis like black cat at the lap of an old maid f) Hands on top of lap-ready to talk or discuss g) Crossed arms & legs-defensive h) Hands on pocket-ready to fight i) Applying lipstick in front of others-to look at my kissable lips b.

Face to face contact with the client-face client squarely b. she’s unconsciously absorbing the feelings of the client 3. Active Listening  attentiveness to the client in a physical & psychological manner  paying close attention to verbal & non-verbal communication 5 Aspects of Physical Attending according to Kozier: a. Understanding  impart to the client that you understood them by showing empathy (BQ)-entering into the life situation of client by perceiving his current situation or problem or “putting oneself into the client’s shoe”  avoid sympathy because it tends to push client into feelings of hopelessness & worthlessness. according to Keltner. Relatively relaxed position e. genuineness and empathy (entering into the life situation of the person or the objective understanding of how patients feel or how they see their situation) 4 Important Aspects of Therapeutic Communication: 1. Cultural artifacts Example: Wearing mustache & long beard-sign of depression Wearing dark glasses-hiding something Perfume-use mild for intimate contact preferably oil perfume (animalistic) 3. it has 2 elements: pity & condolence-nurse becomes subjective & emotional (introjection). Symbolical-sending flowers to loved ones as an expression of love Therapeutic Communication Definition:  The process in which the nurse consciously utilizes the principles of communication in a goal directed professional framework  According to Kaplan. warmth. Touch-physical act & not always sexual in nature. Maintain eye contact c. touch clients with warning e. Open posture  BQ: The nurse must not interact with crossed arms & legs to the client because it decreases or loses attention on part of nurse & experiences the same feeling or situation from the client 2.17 d. it involves active listening while understanding the client providing insight (awareness as to one’s mental condition) & clarification (encourage the expression of feelings accurately)  Therapeutic communication techniques has to have: respect. so if nurse experienced nape pain. Lean forward toward the client shows interest d. Insight  is the awareness to one’s mental condition .

Close-ended questions  questions answerable by “yes” or “no” . Clarification  asking client to restate. elaborately & specifically Avoid the following Non Therapeutic Techniques: 1. compassionate & trustworthy 4. elaborate or give examples of ideas or feeling  encourage client to express feelings more accurately. judgmental & threatening involving the client to thinking process wherein the client is already preoccupied with hallucinations & delusions  Any question that puts the client to the defensive side  Example: Nurse-“What made you think about that?”  Except for this BQ: Scenario-Patient is standing in front of the window.18  the aim of the nurse is for the client to realize that he has a problem. when answering the board exam so stick with the ideal (Ivory tower of nursing). Don’t worry statements  it gives client false reassurances  it belittles his feelings expressed or connotes that feelings are non valid  Example: Nurse-“You don’t need to worry” 2. Authoritarian remarks  emphasizing the rules & regulations in the clinical area  according to Kaplan. go back to the references  Example: Nurse-“I’m sorry that smoking is not allowed but I understand that it’s difficult. Exploratory statements (How)  Avoid deep probing question by using “how” at a minimum level  the psychiatrist can use how & why because their role is to determine the reason behind the client’s feeling  the nurse role is to allow the expression of client’s feelings 4.” 5. Nurse asked-“Why are you standing in front of the window?” Answer: Nurse uses the nursing process of assessment-SEAS S-afety needs of client E-ncourage to express feelings A-ssist in solving problems S-olving problems=never solve problems for the client. conclusive. forget the real/actual world of nursing. nurse should assist only to avoid parasitic relationship 3. Nurse focus statement  blocks the client’s opportunity to express feelings by grabbing the limelight from the client  Example: Client is telling the nurse about his problems then the nurse relates similar problems of her own 6. Why questions  Don’t use why as a universal rule because it seeks explanation or reasons that are subjective. thus the nurse should be truthful.

it’s the client defensive coping mechanism against overwhelming anxiety.” 5.” 4. Open-ended questions  allowing client to tell his story without constraints .19  these questions can be used only during the orientation phase because the nurse is gathering the demographic data of client or when assessing the safety needs 7. Reflecting  verbalizing stated or implied clients feelings  encourage to listen to one’s feelings first.you’re wrong” 9. Presenting reality or giving correct information  reporting events as they really are  offering a view of what is real & what is not without arguing with the client  Example: Client-“My child. Defending  Attempting to protect someone or something from verbal attack  Example: Nurse-“This hospital has a fine reputation” 10. they said you’re in Cebu but you’re here. Empathy  entering into the life situation of the person  objective understanding of how patient feel or how they see their situation  Example: Nurse-“I understand how you feel today. Disagreeing with the client  opposing the client’s ideas  Example: Nurse-“That’s not true…. these desires are projected thoughts of the client (this is what they want in real) 8. desires & inner conflicts which emanated from a loss. Nurse-“He’s breaking up from you? “What do you feel about this break up?” 2. these desires are serviceable or important to the client c.. Agreement with the client  indicating accord with the client  important to know the psychopathology of hallucinations & delusions a. danger or threat b. Voice out doubts  Expressing uncertainty about the reality of client’s perception & conclusions  Example: Nurse-“I think that is very unusual.” 3. Parroting Therapeutic Communication Techniques: 1. repeat what the client said but turn his statement from declarative to interrogatory  Example: Client-“Ma’am.” Nurse-“I’m the nurse of the clinical area. he’s breaking up from me”. Giving advice  Telling the client what to do  Example: Nurse-“I think what you should do is…” or “What don’t you…” 11.

now that we are divorced (but client is crying)” Nurse-“You said that…. we have been discussing….” 17. Giving recognition (BQ)  Example: Nurse-“I’ve noticed you have combed your hair today.” 14.but I see that you’re crying. you seem upset.” 12. Offering general leads  promotes freedom of response  Example: Nurse-“Where would you like to begin?” 16. Making observation  commenting on what the nurse perceives  Example: Nurse-“I’ve noticed that you are pacing the floor.. differences & perceptions  Example: Nurse-“Was your experience similar to what had happened when you were 7 years old?” 9. Focusing  directing flow of interaction by pursuing a topic until its meaning is clear  Example: Nurse-“You were telling…. Suggesting collaboration (BQ)  offering to work with client toward a goal  making arrangement/agreement with the client  Example: Nurse-“Perhaps you & I can determine the source of your anxiety” 8.20  Example: Nurse-“How can I help you” 6. remarks. Role playing  Example: Nurse-“What will you tell me if I were your boss?” 13.” 7.. Encouraging comparison  asking client to verbalize similarities. Paraphrasing  restating the content of message  Example: Client-“Ma’am. what will you do?” 10. Summarizing  pulling together the salient points of an interaction  reviewing main points & conclusions  Example: Nurse-“For the last 30 minutes. he’s coming back” Nurse-“You mean that you’re going to live together again” 15.” 11. Validation  checking perception of clients verbalizations. Formulating a plan of action (BQ)  Example: Nurse-“Next time you hear voices ordering you to kill. feelings & plans . Confrontation (BQ)  focuses the client’s attention on the resistance by heightening his awareness & inviting an explanation  Example: Client-“This is the only time that I have peace of mind.

. Tell me when you feel anxious. I noticed you had trouble making decision about… 14... A patient says to the nurse.. A patient was admitted to the psychiatric unit after she assaulted her landlord whom he believed was putting bad ideas in her head. Everything will be alright.21  Example: Client-“Something will happen soon. 7. I don’t want to hear about it. Paranoid type says to the nurse. What do you mean by feeling sick inside? 12. When determining if the patient is ready for discharge. 4. But Dr. what would be most appropriate to ask the patient? Answer: What would you do if the situation comes up again? 5. 13. Let’s not talk about that now. 5. Who told you that you were Jesus? 10. 15. XXXXX .? 20. You seem restless. Which of the following response by the nurse would be most appropriate when the patient states during admission interview on the psychiatric unit that she hears voices? Answer: What are the voices telling you….. 17. 3. Do you think I should tell the doctor? 19. Have you had similar experiences? 8. “That guy over there is out to get me and you are one of them. 9. I am listening. A patient who has Schizophrenia. “I want to tell you something but you must not tell anyone else. 3. Do you think you should….” Which of the following responses by the nurse would be therapeutic? Answer: You seem scared…. Give an example of feeling lost. XXXXX N N T T N N T N N T T T T N N T T N T Multiple Choice: 1. Where would you like to begin? 18. 16.” Which of the following responses by the nurse would be appropriate? Answer: I have to reveal anything that would be essential to your treatment 2. just focus on getting…. I think you should…. I hear what you are saying. 11. Go on. I will sit with you for a while. What makes you think the NBI is here? 2. This hospital has a fine reputation. 6. my husband & I are going to see each other soon” Nurse-“What you mean by saying that? Tell me about it” Examination on Therapeutic Communication Techniques: 1. Is there something you would like to talk about? 4. R is very able Psychiatrist.

change client by being the source of change. Consistency can be used therapeutically to contribute to client’s security  Consistency means unchanging.  Example: Social Learning Theory 5. Validate your observation Therapeutic Nurse-Patient Relationship (TNPR)  Is a relationship between the nurse & client and the process. listening and feedback→ Self-awareness→ Self acceptance→ Self understanding-longer process where nurse should know the whys & reasons behind client’s feelings  Example: Psychoanalysis and self disclosure 9. nurse should tell client that it is not accepted 7. change agent by leading a good example or role model. manipulative or anti-social clients 4. Observation must be directed to the motivation of that particular behavior  Know the reason/dynamics behind/pathology 6. Lucy Espinosa. Acceptance: accept client unconditionally but reject maladaptive behavior 2. 2006/1-5 Mrs. nursing needs of clients are met . Relationship with the client should be on the realistic basis  Nurse should be honest and set limits  Example: Client sad bad word.  Anxiety is a normal phenomenon and highly communicable & highly contagious that it can be transferred interpersonally (BQ) 3. RN Principles of Psychiatric Nursing: 1. Reassurance must be given subtly and in a manner acceptable to the client  No false hopes and broken promises  Simple presence shows assurance 8. Unique personal contributions  Example: Client holding “thing” or masturbating. nurse just leave him 10. Change in the client’s behavior is not brought by reason but by emotional experience  According to Mosby. consistency is important because the client can anticipate the nurse decision  Example: confused.22 January 22. Anything which increases the client’s anxiety should be avoided. uniformity or sameness  Consistency & setting limits are building blocks of psychiatric nursing (BQ)  Trust is the essential foundation of psychiatric nursing (BQ)  According to Taylor. Self understanding can be used as a therapeutic tool  Johari’s Window: sharing.

concerns are conveyed with words and congruent body language • confidentiality issues are explained b. Circumstantial responses-client going around the bush BQ: During the orientation phase. Nurse to patient Friend to friend 2. Management of emotions • at the time of admission. 200 or more meanings b. Beginning assessment • intake interviews. Nurse can’t select client Can select friends 4. One word answer-client shows disinterest c. All throughout the relationship Answer: D  Expectations from the client during orientation phase: a. an assessment of client’s needs. Silence-is the commonest among all forms of resistance.Nurse is obliged to meet the nursing Not obliged to meet the needs of a friend needs of client but to a certain degree 4 Phases of Therapeutic Nurse-Client Relationship: 1. Orientation b. introduced/discussed every now and then during the interaction BQ: When do you start the termination phase of TNPR? Answer: Orientation phase BQ: Topics regarding the termination should be discussed in? a. Working d. Building trust • warm.23  BQ: Nursing need-a requirement on the part of the client which nurses are licensed to meet & it must be within the scope of nursing practice TNPR Social Relationship 1. Closeness to client but with limitation There is a degree of intimacy 3. Orientation/Beginning Phase  Aim: To establish trust  The phase when the nurse establishes a contract (30 minutes to 4 days) regarding the duration of the relationship  The phase when the nurse gives a realistic expectation. because all are forms of resistance BQ: What is the difference between tangential & circumstantial?  Steps during Orientation Phase: a. Termination is like a weaning process so it should done gradually. interest. so the nurse should talk about it directly to keep feelings from escalating . Tangential responses-client made a long story but no answer was given d. you expect the client to be? Answer: all of the above. Identifying c. defenses and adaptation styles c. coping strategies. determines the immediate concern/problem/situation but to a broader scope or focus  The phase when the start of introduction of termination. the client typically experience painful emotions.

Identifying Phase  Aim: To maintain trust and relationship  Client will test the nurse’s sincerity  Client may fluctuate between dependence and independence  Example: Client will come late. will never come or will never mind the presence of the nurse BQ: When can you tell the client establish trust? Answer: When the client calls you by your name. the following are utilized except: a. give realistic expectation (orientation phase) Answer: D 4. the client is accepting or acknowledging the relationship 3. identify coping styles d. the client is more likely to recognize the real source of his/her emotions d. the nurse has the responsibility of taking temporary control by offering PRN medications directing the client to a quieter.24 at first. Providing structure • if client loses control of their thoughts. feelings or behavior. remain supportive b. use observation skills c. Providing support like empathy e. the client may displace anger onto the nurse but if supportively confronted about the anger. Working Phase  Aim: to identify coping styles  There is clarification of perceptions and expectations about the relationship  There is further definition of problems and identification of tentative solutions  The client becomes more motivated to take advantage of available resources to resolve problems  The phase that is hardest because trust was already established and client verbalized feelings  Nurse should avoid giving advices instead use communication skills to encourage expression of feelings and interpersonal skills to maintain relationship  The phase when the nurse evaluates. Termination/Resolution Phase  Aim: To prevent separation anxiety  The phase that facilitates healthy closure of the relationship between the nurse and client  The phase summarizes the gains of the relationship and the nurse endorses • . modify plans and handle issues of transference & counter transference BQ: During the working phase. less stimulating place and also includes spending time with him • a major facet of providing structure is limit setting to decrease/stop dysfunctional behavior • limit setting involves pointing out behavior and their negative effect and suggesting alternative behavior 2.

25  Steps: a.. To meet/know the client 2. To introduce 3. Vertical Name of Patient (initials only)……………………. To establish rapport/set a contract  History: started in 1968 by Hildegard Peplau  Purpose: 1. To identify the therapeutic communication techniques that were used 2. student nurse will be able to…………. demonstrate a beginning rapport/trusting relationship with AG or . To describe the symptomatology including the defense mechanism that were exhibited/used by the client 3. Synthesizing what has occurred • Focuses on the more indirect outcomes of the NPR • Clients are encouraged to form other relationships with future counselors and new friends c. Discussion of termination Process Recording  a written record of encounters with clients that are as verbatim as possible and include situations that is actually based on previous experiences  a documentation of the nurse-patient interaction that transpired during the establishment of TNPR  a tool for the nurse to learn about working effectively with clients and establish the setting (interaction with the client)  a learning tool that will facilitate professional growth  usually done during the orientation phase  set the objectives: 1. Nursing inference…………………… CI remarks…………………………. 2. Pavilion…………………………………………… General description (essay form): AG is a 14 y/o female adolescent admitted at Zonta Pavilion. Referrals d. To explain the nursing interventions  Types of Process Recording: 1. Evaluation/Summary progress • Reinforce the changes in and strengths of client • Areas that need more work are outlined b.. Horizontal Name………………………………… P…………………………………….. a. She was wearing a pink hospital gown and was so eager in approaching me…… Learning objective (use SMART): At the end of 30 minutes of nurse-patient interaction.

demonstrate the beginning skills in communication. describe/name/identify the behavioral symptoms including the defense mechanism that were exhibited by AG……………………. Move tissue (Pause) left ..26 b. c. Looking at patient. establish a contract e. In the office. The client sits at the side of desk. The client follows without looking at the nurse. d. use/apply nursing intervention through nursing process Nurse-Patient Interaction Student Nurse Inference/ Analysis & Interpretation N: “Magandang umaga po” Giving introduction made sincerely & coupled with the 5 aspects of physical attending such as…. will be very important in the beginning phase of the relationship Stuart 2000 said that the orientation phase can be challenging to the nurse because resistance will be obviously displayed by the client P: Did not answer. Would you prefer to Has pen in hand. I understand that the client was traumatized by previous incidence Nurse Patient Verbal Non-verbal Verbal Non-verbal Nurse introduced herself and leads the way to the office. Jarvis Other hand flat on or Anita? desk. specify the extent of the relationship f. holding her purse with both hands on her lap.. observation……….. How long were you Writing and looking I don’t know (same as above) feeling so tired? at patient (pause) a week. walking slowly but slightly ahead of the client. the nurse sits in a chair at a desk and opens a folder of paper. (Pause) Anita Looking at the floor be called Mrs. I agree with you. I guess… What happen a Leans toward (Pause) My husband Tears in eyes week ago? patient. just Silence was chosen by the bowed his/her head patient Clinical Instructor Remarks I agree with you in the same manner Taylor said…..

Three Levels of Consciousness based on the Psychoanalytical Theory of Freud: 1. emotional. there is a 3rd portion of human personality which is the Soul or Spirit that remains upon the death of both body and mind. Preconscious/Subconscious  watchman of the mind  partly remembered/forgotten memories  memories that can be recalled to consciousness with some effort and enough cue  Example: “It’s at the tip of my tongue” (BQ) 3. which operates only when awake  material within an individual’s awareness is only one small part of the mind 2. Mind/Psyche-intangible portion. it is compared to a dot  it is a state of awareness. This theory is not accepted by psychiatrist. spiritual and interpersonal well-being of a person  it is the sum total of inherited (genetic) and acquired (environmental) traits (BQ) Two Portions of Human Personality: 1.27 box Trust Fall Activity: emphasizes to develop empathy and trusting relationship Objective: To know that it’s difficult to develop trust and that it’s difficult to be entrusted with a mental patient Trust Walk: Team A (Blindfolded) Team B (Not blindfolded) 1. can be seen and measured 2. social. Conscious  compared to the tip of an ice cube in a glass of water  according to Freud. Gracie: fearful that I might fall Happy PSYCHODYNAMICS Definition: understanding the motivations behind normal and abnormal human behavior Personality:  comes from the word “personane” which means to sound through  according to WHO. it is the sum total of one’s physical. Unconscious  material which is a large part of the mind . can’t be seen or measured Example: IQ of Alfred Binet in 1904 According to parapsychologist. Body/Soma-refers to tangible portion. here and now. intellectual.

Psychoanalysis • Sigmund Freud was the proponent and pioneered by Dr. addresses e) Dropping objects 2) Transference  is the client’s feeling transferred to analyst which maybe (+)/(-) feeling intended to a significant person in the past (client-analyst)  unconscious emotional reaction to a current situation that is actually based on previous experience  if affected by client. phone #s. unliquidated childhood experiences • 4 Steps in Psychoanalysis: 1) Free association  patient in a coach and analyst at the back of patient to prevent resistance in a dimly lit room  in a therapeutic context. sharing of repressed and unresolved memories. continuation of waking hours b) Freudian Slips are slip of the tongue or pen c) Jokes are unconscious intention d) Forgetting well-known names. conflicts. allow patient to say anything that comes to mind  2 things to be analyzed: word and dream analysis  Evidences given by Freud to prove that there is free association/unconscious (BQ): a) Dreams are language of unconscious (unfulfilled). putting/unloading off the chest . wish fulfillment . Santiago in the Philippines • a method of unlocking the unconscious from the past.28  painful memories that could not be naturally recalled  memories. experiences and material that have been repressed and cannot be recalled at will  storage of painful memories-selective recording of painful memories as early as prenatal stage of development  Freud believed that uncovering unconscious material generate an understanding of behavior that enables the individual to make choices about the behavior and thus improve mental health  Three Methods of Recalling Unconscious: a. terminate NPR during orientation phase if a basic RN and during working phase if a therapist then go to a clinical specialist 3) Counter transference is the feeling of the analyst transferred to the client due to empathy (a-c) 4) Catharsis-mental ventilation.

unconscious but predominantly in but predominantly in conscious unconscious Operates in pleasure Operates in reality Operates in moral principle principle principle Untamed. when you are in elementary b. masteral d. Id can’t be modified . BQ: When can we have ID modified? a. never Answer: D. uncultured and Mediator between ID & SE Censor/idealistic/perfectionist uncivilized (BQ). Operates in conscious. Ego-ideal=concept of right. enjoys gratification provided by ID. Conscience=concept of wrong ID Demon Operates in the unconscious BQ: Babies upon birth are purely ID. unconscious preconscious. Hypnosis • Anton Mesmer is the proponent and introduced by Fr. high school c. hallucinations and culturally bounded (BQ: imagination another name for SE) 2. Na Pentothal-truth serum in a process of narcosynthesis 3 Structures of Mind/Psychic Forces EGO SUPEREGO Man Angel Operates in conscious.29 b. baby must have both ID and EGO but ego is mostly affected by the baby’s significant adult. Jaime Bulatao in the Philippines • A process of mesmerism and the suggested technique is mental trance c. EGO evolves within the personality of 2 y/o (old concept) but Leticia Kwan new concept states that upon birth. a stabilizer 1. preconscious. decision making Present from birth until From erection to death resurrection Functions: operates on the Operates on secondary 2 Phases: primary process through process.

Child-moral standards come from parents therefore parents should be role models because children are great imitators. or where everything done repetitively is sexual in nature and its relationship to the development of personality . Psychosexual/Libidinal Theory  Sigmund Freud focused on the 8 stages of psychosexual development  Highlight: focused on libido which is defined as sexual energy. “itch”. Moralistic Theory  Karl Kohlberg focused on the 6 stages of moral development patterns a. Anal (1 ½-3 y ears old)  Child develops ambivalence=co-existing but contrasting feelings  Start formation of superego (BQ)  According to Mosby. Cognitive Theory  Jean Piaget focused on the 4 major stages of cognitive development  Highlight: knowing the world (BQ) 2.30 2 Stages in life Related in Superego Formation: 1. ambivalence refers to independence vs. dependence According to Erikson. Phallic (3-6 years old)  Superego becomes stronger  Child loves parents of opposite sex and hates parents of same sex→ guilt→ SE  The right time to tell an adopted child that he is an adopted  At 7 years old. Shame & Doubt 3. otherwise we develop fixation  Fixation (BQ) is also known as developmental arrest (a stand still in the maturing process)  Example: Stage 1-Basic Trust vs. Interpersonal Theory  Harry Stack Sullivan: pioneered the theory  Highlight: interpersonal relationships and anxiety facilitate development of the self system  Mother and child relationship on the first year of life is the most important because early maternal loss is vulnerable to depression 5. more on the adolescent stage of development Acoording to Freud. takes in everything and it is longer for them to recover emotionally b. is called the age of reason where SE is fully developed Personality Theories: 1. hate 2. refers to love vs. Psychosocial Theory  Eric Erikson focused on the 8 stages of life cycle  Highlight: focus on the different psychosocial crisis & developmental tasks  During the early stage of life. Adolescent-moral standards come from peer group c. Adult-his/her own discernment of what is right and wrong 4. we experienced psychosocial crisis (turning points) which should be resolved before moving on to the next stage. a child should develop this first before moving to Stage 2-Autonomy vs. Basic Mistrust.

Juvenile Era operational Inferiority Formal Identity vs. Developing Pre-conceptual Shame and self-system Stage Doubt Pre-operational: Initiative vs. Adulthood operational Isolation Formal Generativity vs. Infancy Anal or Toddlerhood Phallic or Preschool Latency or School Age Genital or Adolescence Early Adulthood Middle Adulthood Old age Kohlberg’s Stages of Moral Development Pre-conventional: Emphasis Stage 1-might makes right Highlights/Significance: on avoiding punishments (punishment and obedience Children are egocentric & and getting rewards orientation) avoid punishment Stage 2-look out for number Recognition that others one (instrumental and have different points of relativist orientation views but child’s own interest prevails . Early operational Role Diffusion Adolescent Era Formal Intimacy vs. Development of Intuitive Stage Guilt body image and self perception Concrete Industry vs. Despair responsibility for what life is FreudPsychosexual Oral stage vs.31 BQ: People with obsessive compulsive disorder had difficulty during: Answer: Anal phase BQ: Primary narcissism is seen during: Answer: Oral phase BQ: Period when family triangle is one: Answer: Latency Age 0-18 months 1½-3 years 3-6 years 6-12 years 12-18 years 18-25 years 25-45 years 45 years & ↑ Different Stages of Personality Development PiagetEriksonSullivanCognitive Developmental Interpersonal Sensorimotor Trust vs. Maturity operational Isolation Formal Ego integrity Acceptance of operational vs. Need for Mistrust security & trust Pre-operational: Autonomy vs.

Gossiping e. Intra-uterine Stage: 0 to Birth  The start of life focused on the genetic influences and constitutional factors  Highlights: The first trimester of pregnancy is the most important period because the intrauterine environment should be conducive for (+)/pleasant thoughts  Communication should start early: talking to child while in the womb. If oral phase is overly gratified and infant is not weaned from breast to bottle feeding. listening to soft music that stimulates free flow of acetylcholine (Ach-a neurotransmitter for learning and memory)→ more intelligent child II. Chewing or biting: oral-aggressive phase  Highlights: Narcissism is normal in this stage 1. it causes negative residuals such as: a. Talkativeness d. Drug dependency/smoking/gum chewing 2. Oral Phase: Birth to 1 ½ years old  Also called as the Stage of Complete Dependence  Infants should be given skin to skin contact 8 hours/day  Chief Libidinal Areas are: mouth. Alcoholism • Psychopathology of alcoholism: 1) Emotional release 2) Emotional crutch-alcoholics are inadequate and insecure uses alcohol as substitute for the milk bottle • Defense mechanisms: Substitution and Symbolism b. If oral phase is under gratified because (-) maternal-child bonding. it results to no basic trust→ Schizophrenia and Primary Narcissism (Self love) Living up to what people generally expect of one Child is oriented toward maintaining the society norm Fair procedures for interpreting and changing the law when unethical Recognition that some principles and values transcend laws .32 Conventional: Emphasis on social rules and conformity to social norms Stage 3-“good girl” and “nice boy” Stage 4-law and order Post-conventional: Emphasis on moral principles and values Stage 5-social contract and legalistic Stage 6-universal ethical principles Different Phases of Life: I. lips and tongue  Chief Libidinal Activities: 1. Sucking and swallowing: oral-passive phase 2. Over eating c.

give love of understanding. If mother is too lax in imposing rules/no standard at all. Later in adult life. it causes positive residuals. If mother is too rigid/strict/perfectionist when imposing standards or during toilet training. The child shows negativism/resentment by feces retention or “holding it on”. hand washing.33 BQ: According to social learning theory. fixation at the oral phase Answer: A BQ: According to psychosexual theory. alcoholism is: Answer: B III. reliable and responsible • The child becomes overly neat. frequent fixing of bed and washing face 10 times before putting make up 2. Anal Phase: 1 ½ to 3 years old  (+)/(-) reinforcement. definition of urination b. “To hold it on or let it go”  Chief Libidinal Areas: anus and urethra  Chief Libidinal Activities: defecation and micturition  Highlights: 1. defecation and micturition c. unreliable and irresponsible. the term micturition is more scientific . learned behavior b. the child in adult life becomes obedient. The child becomes ambivalent towards the mother but learns to accept mother’s standards by “letting it go”. he will develop obsessive compulsive trait→ obsessive compulsive personality disorder common among males and in USA • Obsession is a repetitive abnormal/irrational thought though he knows that his thought is wrong while Compulsion is a repetitive abnormal act in response to obsession • Obsessive compulsive disorder common among women and is worst than OCPD because social and occupational functions are affected • Example: Wife’s obsessive thought is the husband is a womanizer and her compulsion is to keep counting the pubic hair of her husband whenever he’s late. So. BQ #1: A child at anal phase will find gratification at what activity? a. overly clean and very meticulous (BQ) • When he grows up. alcoholism is: a. defecation and voiding Answer: B. it results to poor impulse control or no self control. he becomes stubborn.

Phallic Phase: 3 to 6 years old  Came from the term phallus=penis. Seeing girls having no penis thinking that they were cut also results to continued threatening or adding up to his fear of being cut. Lucy Espinosa. the child experiences what? Answer: Struggle to hold it on or let it go February 05. give rewards for successful b. girl loves mother b. . also known as the Period of Family Triangle because of a battle among the child. sports activity or giving him toys  This is a very crucial stage because resolution will determine future sexual role. At 3 years old. At 2 years old. at the anal stage. woman or lesbian. father and mother  Chief Libidinal Areas: penis and clitoris  Chief Libidinal Activity: normal infantile masturbation (BQ) which is a universal occurrence due to increase biological and sexual energy  The child develops awareness.34 BQ #2: What will you give a child for success in anal stage? a.  Highlights: According to Freud. whether becoming into a man or homosexual. girl loves the father because father has penis but girl hates mother because of fear that mother may cut the penis (the father) • Castration Fear/Anxiety: a. Penis Envy for girls/Castration Fear or Anxiety for boys • Penis Envy: a. a permanent idea. turn negative to positive by doing constructive outlet such as play. give love and understanding d. The boy saw that his playmates were cut (through circumcision). Postpone circumcision between 3-6 years. It is normal to see a child to experience voyeurism or peeping tom  Sexual is ID so teach the child to sublimation: when you see a child playing with penis. so he will develop the castration complex (BQ). all of the above Answer: C BQ #3: According to Erikson. begins to examine and enjoys holding body and sexual parts. RN Continuation of Different Phases of Life IV. He fears that he will be cut too. 2006/1-5 Mrs. give punishment c. there are 3 Analytical Changes experienced normally by the child in this phase 1.

gone are the battle of Family Triangle  Chief Libidinal Activity: tapering/lowering of the biological and sexual energy (BQ)  The family triangle is gone because the focus of child is already with school  The child introjects (to swallow) teacher’s ego-ideal  Highlights: a.35 b. Latency Phase: 7 to 12 years old  Also refers to as quiet or dormant period where the ID. In the absence of a father. Ego and SE are in equilibrium or stable. it’s not love but more of lust  The period when the child is vulnerable to mental disorders because of problems encountered: According to DSM IV. Oedipal/Electra Situation • Oedipal Situation:  The boy loves mother and hates father. Genital Stage: 13 to 21 years old  The first stormy period because the child is drawn towards and away from parents  The child is fashion conscious. the boy admires attributes of father (according to Kuan. both situations are experienced normally by the child but if it persists beyond adolescent stage it becomes a complex and considered abnormal. the girl will become lesbian • Initially. the boy will become gay. If unresolved. rude tomorrow)  If he/she engaged in live-in relationships. Eventually. If castration complex still exist during adulthood. this leads to the psychopathology of exhibitionism where an exhibitionist is happy when he shocks women because it confirms he has penis 2. identifies with mother and gives up father. • Electra Situation  The girl loves father and hates mother. mirror reflex syndrome and has period of instability (thoughtful today. Social Status . father should spend 10-15 minutes alone with boy) and identifies himself with his father so he gives up mother. Male-21 years old  Highlights: a. 3. Identification • is the unconscious imitation of the feminine or masculine attributes • unconscious attempt to model oneself after a respected person V. The child likes to interact with the peer of the same sex so homosexuality is also normally experienced VI. The child watches TV heroes and imitates what they do so hero worship is normal at this stage b. the age of onset=10-25 years old  Debut is a big celebration because it represents the victory of parents in guiding them: Female-18 years old. Eventually. the age of onset for Schizophrenia=15-22 According to DSM IV-TR.

Oedipal/Electra Reactivation: it is normal to be close with the opposite parent until 17 years old VII. Self deception b. M=50 or gradual  The second stormy period and also known as afternoon of life  The period when mental illness also rises: depression  Problem solving and decision making usually is a failure. Senility: mid 70-80’s according to Kuan  Third stormy period and also known as the twilight years  Most painful period of life  Mental illness may also arise Defense Mechanisms:  are psychological ways of resolving problems (BQ) used by both normal persons to avoid psychosis and by abnormal persons to cope with their mental disorder  the ego uses these mental mechanisms unconsciously to reduce anxiety  According to Taylor.36 A period of transition (too old to be a child. one should avoid using defense mechanism because it leads to: a. too young to be an adult): Who am I?. selection of a mate/partner and psychosexual maturity is attained VIII. woman or lesbian • The sexual preference is based on the experiences during the phallic stage • Dyshomophilia: the guilt and anxiety after a homosexual practice (BQ) c. Gender Identification • Period when you choose to be a man. homosexual. Menopausal: W=47. M=1000 mcg testosterone  Highlights: Midlife crisis and empty nest syndrome BQ: Success of a menopausal stage is? Answer: Guide the next generation BQ: The following are considered normal menopausal signs except: a. Where am I going? • Parents should not be too strict or lax instead establish communication b. Hot flushes c. Psychosis/Psychotic symptoms at times Answer: D IX. Palpitations d. Vaginal Stage  A non specific period and also known as high noon of life  There is direct (+) feelings towards environment  Also vulnerable to Schizophrenia  Highlights: first sexual intimacy (#1 secret). Unreasonableness/irritability b. Ambivalence: Independence versus Dependence d. unmatched sexual desire results to divorce (common in US)  W=6 mcg progesterone. You can’t face the problem realistically • .

Introjection • Ingesting ego structure of another person→ becoming an extension of self . Denial • Failure to accept an unpleasant reality • Primary defense mechanism among alcoholics • Example: A wife continuously sets the table despite the fact that her husband is already dead (BQ) 2. pray it out. failures and frustrations towards others • Initially. Projection • Attributing one’s thoughts. Use problem solving approaches or skills important in growth promoting potential and learning opportunities  2 Types of Coping Mechanism: a. Long term-plan for any eventuality BQ: Defense mechanism for patients with phobia a. eat it out or sex it out) b. feelings. Projection c. One should make use of coping mechanism which are conscious and healthy behaviors (ex. Displacement Answer: C A. Short term: suppression-conscious forgetting b. Immature Defenses: 1.37  Taylor suggested: a. Narcissistic Defenses: 1. Identification • Integrating attributes of an admired person to compensate perceived inadequacy • Unconscious imitation of one idolized attribute of a person or admired attribute of a person • Considered normal as long as it is something normal • It becomes (+) if the idolized attribute is (+) • Examples: A student nurse dresses like her teacher A student nurse acts like her previously admired chief nurse A 5 year old boy asks the barber to have a haircut like his father 2. Denial b. the person denies feelings then blames others • Common defense mechanism among paranoids who manifest persecutory delusions (false beliefs that someone will harm/plot against him) BQ • Example: You are the reason why I failed the examination because you frequently ask me to go with you in the mall B. talk it out.

acceptable and normal as long as it is sublimated c. it is incorporating the ideals & values of another person Common among depressed clients who commit suicide (70%) because depression is a pathological reaction to a loss (BQ) which may be real. to another person or at the world. Bargaining-asking for extension/something in exchange d. Neurotic Defenses: 1. a mother can’t accept marriage of the son because she feels like not part of her life) Considered normal after a real loss when a person underwent the Stages of Grief Process by Elizabeth Kubler Ross completely: a. imagined or symbolic (ex. values) of the admired clinical nurse 3. Denial-shock and disbelief→ few hours to few days only b. Depression-no longer interested with the environment e.38 • • According to Keltner. it results to delusions-false belief that can’t be corrected by explanation) • Example: Minister’s wife daydreamed to become a rock star 5. failed to advance or arrest in developmental stage. Displacement • Emotionally charged situation or object are shifted to a relatively safe substitute situation or object (“pinagdidiskitahan”) • . standstill in the maturing process • Example: Crying on one’s father shoulder when faced a problem C. Anger-mad at God. beliefs. Fixation • Remaining “stuck”. Acceptance-accept the reality of the loss  Allow the person with his own phasing in undergoing the grief process  Sometimes the person can go back from one stage to another  The person must undergo the experience of excruciating pain  An unresolved/incomplete grief process leads to depression • A suicidal person is also a homicidal person (Suicide & Homicide-Siamese twins of Psychiatry)→ extended seaside • Some people commit homicide first before committing suicide • Example: A patient assumes the actions (emphasizes rules & regulations in the ward. Fantasy • Dwelling into one’s imagination • Considered normal if can be recalled back to reality immediately and not excessive (if excessive. Regression • A return to an earlier stage of behavior when stress create problem at present stage where you find security • Example: Assuming a fetal position when sleeping Sticking out the tongue during an embarrassing situation Hiding under the bed (like inside the uterus) Bed wetting (like an amniotic fluid) 4.

Isolation • Separating thoughts and emotions connected with an event to prevent undue anxiety (psychic numbing) • Example: masking sadness by smiling at the funeral of a loved one 5. feelings and events • Unconscious forgetting of painful ideas. Repression • Involuntary exclusion from consciousness anxiety-producing thoughts. what is involve is feeling • Expressing the exact opposite of an unconscious feeling • Unconsciously reverses unacceptable feeling and behaves in exact opposite manner • Common among manic where they show happiness but deep inside they are sad • Example: You say I love you but actually you wanted to kill him 7. somniloquy (sleep talking) 3. Rationalization • Denial + Reason • Justifying behavior by magnifying reasons that are publicly acceptable • Attempts to explain behavior by logical reasoning or makes acceptable excuses for behavior and feelings • If frequently used. Conversion • • . idea or situation • Anything that causes emotional problems and anxiety that are converted into psychological signs and symptoms • Example: somnambulism (sleep walking). events or conflicts • According to Freud. The truth is she didn’t have money to buy it 6. Dissociation • An unconscious separation of painful feelings and emotions within an unacceptable object. Intellectualization • Excessive use of logical reason/explanation to avoid painful situation instead of expressing the true emotions • Also seen among OCD to avoid anxiety 4. Reaction Formation • Over compensation. one become a pathologic liar • Example: Sorry class. I am late because it’s so traffic but the truth is she had a fight with husband • BQ: A woman was window shopping and saw a beautiful dress but did not buy because she said it doesn’t suit her complexion.39 Transferring of feelings to a safer object. most common defense mechanism used but others says rationalization 8. person or situation Common among phobic where anxiety is detached from its original source and attached to a more specific activity 2.

feelings and situations • Conscious/deliberately forgetting or intentionally avoiding discussing something • Example: How is your husband? Answer: Please don’t say bad words 4. Compensation • Exaggerating a trait to mask up feelings of inadequacy and inferiority • Emphasizing assets to fill up inadequacies • Example: A young boy in college wants to be athlete but due to physical built he became a famous fashion designer . Suppression • Voluntary exclusion from consciousness anxiety-producing ideas. Undoing • Engaging in thoughts and actions to cancel out threatening thoughts and actions occurred in the past • Involves a certain act-reverse re-enactment of a particular act • Doing something that is opposite of a previous act with the involvement of guilt feelings • Common among obsessive compulsive disorder • Example: You have driven away your brother and now you accept visitors in your house with open arms 10. Withdrawal • Pathologically isolating self away from others • Example: Mental patients don’t take a bath intentionally so that people won’t get close to them to avoid a relationship. Altruism • Doing good for others with genuine desire. Mature Defenses: 1.40 Expressing unconscious emotional conflicts and anxiety into physical signs and symptoms • Example: Hysterical fainting in funeral 9. Husband left house for a while after a fight with wife • D. not waiting for reward. no guilt feeling • Example: ABS-CBN/GMA Foundation 2. Humor (Fun and Laughter) • Laugh with the patient but not laughing at them • Relaxation increases endorphins 5. Sublimation • Re-channeling socially unacceptable urges into socially acceptable manner • Negative/undesirable things channeled into a desirable/positive • Example: During sexual drive→ do sports instead Anger→ do gross manual outlet such as pulling out weeds in the garden 3.

41 E. Other Defense Mechanisms: 1. Condensation • Fusion of 2 or more ideals of one’s idol into one totality • Example: She sings like Nora Aunor but also includes attribute of her children 2. Substitution • Taking in something in place of the original goal (“panakip butas”) • Example: A girl spurned, so you take her best friend as a substitute 3. Resistance • Instinctive opposition towards criticisms • Ready answer to a negative feedback • Commonest form of resistance-silence • Example: “Kahit ako mataba, hershey’s chocolate naman kinakain ko.” 4. Symbolism • A mental short cut wherein a person attaches meanings to objects, colors, shapes and slogans • Example: black butterfly-funeral; black letter-death; black cat-penis; red shirtlucky

February 11, 2006/1-5 Mrs. Lucy Espinosa, RN MENTAL DISORDERS based on DSM IV-TR prepared by American Psychiatric Association (APA) in 2002 Definition of Terms: 1. Symptomatology-the signs and symptoms of mental disorders 2. Psychopathology-defense mechanisms used Sisa-symbol of insanity in the Philippines Clifford Beers-symbol of insanity in the States St. Dymphna-Patron saint of the insane Signs and Symptoms of Mental Disorders: A. Sensory-Perceptual Disturbances  Sensory stimuli are brought to awareness affecting the 5 senses  Disturbances of Perception: 1. Hallucination-is a false perceptual disturbance without a stimulus a. Hypnagogic-happens when you are about to sleep b. Hypnopompic-happens when you are about to wake up • Types of Hallucinations: a. Gustatory-experienced by patients with seizure disorder b. Olfactory-experience by patients with seizure disorder c. Visual-seen in Delirium tremens due to alcohol and Dementia

42 d. Auditory-common among Schizophrenics (BQ) e. Tactile-as in alcohol withdrawal (BQ) • Reasons why we hallucinate: a. Psychosis-Schizophrenia b. Organic pathology-Seizure Disorder c. Chemical ingestion-when alcohol is taken for 7 days, non-stop & no food then suddenly stop, delirium tremens occurs: According to Taylor, DT occurs 16-36 hours According to Mosby, DT occurs 48-72 hours  Ask patient when was his last drink (BQ) 2. Illusion-is a misinterpretation of a stimulus Example: Seeing small things as small rats because of anxiety to be late BQ: The following are not cognitive disorders except: Autism Delusion Persecution Apathy Answer: D, emotional disturbance

 a. b. c. d.

B. Thought/Cognitive Disturbances  goal directed flow of ideas, symbols & associations initiated by a problem or a task and leading toward a reality-oriented conclusion  Disturbances in content of thought: 1. Delusions-false belief without stimulus which can’t be corrected by evidences a. Persecutory-belief that someone will harm or kill him as in S. Paranoid b. Grandiose-belief of one’s importance, wealth and power c. Somatic-belief of having misplaced organ or have a dreaded disease (Disorganized) d. Nihilistic-belief of non-existence or world is ending 2. Ideas of reference-false belief that behavior of others refers to oneself 3. Thought control-false feeling that one is being controlled by external forces  Disturbances in form of thought: 1. Looseness of associations • disorganized/fragmented flow of thought (“sabog”); no idea is derived seen among schizophrenia • one of the 4 “A’s” of Schizophrenia: autism, ambivalence & affective disturbance (BQ) • Example: Nurses are beautiful, cats are boastful , they are singing 2. Flight of ideas • jumping from one topic to another spontaneously; you can derived an idea • commonly observed among Bipolar patients on manic episode 3. Perseveration

43 repeating the same verbal response to various stimuli; patients can not detach one thought from another seen in schizophrenia • Example: Saying the same thing to different questions; “Sa labas, sa labas, sa labas” 4. Neologism-coining of new words which has meaning to patient Example: Dethilating meaning death machine 5. Blocking-sudden stoppage of thought prominent in severe anxiety 6. Autism-thinking without conscious regard to reality, have their own world 7. Clang Association • words are connected by sounds & not by meaning which include rhyming (poem-like) and punning (injecting witty/clever remark) 8. Echolalia-automatic obedience repeating the same words said by other (BQ) observed in dementia, autism & schizophrenia Example: Nurse says “halika kumain ka” and patient repeats “halika kumain ka” 9. Verbigeration-meaningless repetition of specific words or phrases; constant repetition of same words again & again Example: “pangit, pangit, pangit” 10. Volubility-increased thought seen among manic patients •

C. Behavioral Disturbances  Includes impulses, motivations, wishes, drives, instincts and cravings expressed by motor activity  Behavioral disturbances: 1. Negativism-doing the exact opposite of what was told seen in Schizophrenia 2. Echopraxia-automatic obedience imitating the same act which were done by others seen in disorganized 3. Stereotypy-constant repetition of the same words and acts again and again (“paulit ulit”) even nobody said or did the act seen among autistic patients 4. Catalepsy-state of immobility (“drama of death”); pathological form of withdrawal; does not respond to stimulus Example: Patient don’t eat, drink, move totally close, half close even in painful stimulus 5. Waxy Flexibility (Cerea flexibilitas)-maintaining the same position as positioned by others seen among Catatonic during stupor phase 6. Mannerism-habitual involuntary repetition of acts D. Affective Disturbances  A complex feeling state with psychic, somatic, and behavioral components that is related to affect and mood 1. Mood-inner state of mind expressed through feelings; qualitative & subjective a. Dysphoric-unpleasant

measurable. Apathy-state of indifference in situations wherein a normal person elicits a response (BQ). Euthymic-normal range Mood swings Depress-sadness Euphoria-exaggerated feelings of well being Example: 2 bottles of beer f. external response to varied state of mood. Fear-a feeling of apprehension coming from a more identifiable cause. Paramnesia: falsification of memory. Flat-absence or near absence=scale 1 c.44 b. Anxiety-a feeling of apprehension with a less identifiable cause (nababalisa) manifested like there’s a lump in the throat (daga sa dibdib). d. dementia & intoxicated persons Example: Laughing at first then crying later e. Exaltation-a feeling of being glorified (BQ) Example: You worship me E. Labile-mood swings or fast cycle of emotions seen in mania. complete absence of emotion=scale 0 b. c. acute and easy to manage Example: Fear at site of man g. Ecstacy-feeling of being in heaven. Memory  function by which information stored in the brain is later recalled to consciousness  Disturbances of Memory: 1. may have amnesia because of a traumatic event. quantitative & objective a. Affect-observed expression of emotions. Blunt-severe reduction of emotion=scale 2 seen in post stroke patients  Apathy. Ataraxia-complete absence of anxiety in continuum seen in anti-social PD Example: Drink 1-2 bottles of beer gives you guts Drink 2-3 bottles of beer makes war h. Anterograde amnesia-forgetting recent events (kapapangyari lang-BQ). flat and blunt are seen in Schizophrenia & Depression d. Déjà vu-familiarity with unfamiliar seen in neurotics Example: “parang nakarating na ako dito” . experienced in super sex with someone you love so dearly as in having orgasm 2. e. telling false stories a. Amnesia: partial or total inability to recall past experiences a. seen in dementia Example: Where’s my ball pen? b. Retrograde amnesia-forgetting further events 2. chronic and hard to manage f. Confabulation-fabricating stories to fill gaps in memory because of anterograde amnesia seen in dementia but not in delirium b. Elation-inappropriate joyfulness with delusions of grandeur seen in manic (sobrang saya at yabang) g.

What’s the preventive measure? Answer: Instruct nurse to wipe wet floor for safety of patient I. seen among OCD  Dementia: patient is usually disoriented to person. mother experiences emotional problems like crying. Disorders affecting Children. Before birth-mother takes teratogenic drugs like tetracycline. Mild/Moron • IQ level: 50-69 • Referred to as educable according to WHO • Constitutes the largest segment about 85% • Can reach up to grade 6 . Jamais vu-unfamiliarity with the familiar d. Deja entendu-familiarity with sounds 3. haloperidol and antimanic drugs (lithium carbonate).45 c. place and person b. detailed. place & time (PPT) dementia due to head trauma is permanent symptoms last for more than 30 days  Delirium: patient is usually disoriented to time and place only delirium due to head trauma is temporary symptoms is 30 days lesser disorientation to person is rare BQ: Tata Jose is known to be suffering from dementia was seen out of the clinical area by the nurse. Hypermnesia: exaggerated/excessive recall. What’s the nursing action? a. according to Alfred Binet (1904): Normal=90-110 Borderline=70 Mental Retardation=below 70 Multi-factorial/causal: 1. Hold him gently and guide him back to the clinical area Answer: B BQ: Tata Jose urinated on the floor. during and after birth (less than 18 years old)  Is not a mental illness but children with MR are susceptible to mental illness because of frustrations and failures resulting to depression  A subnormal IQ. After birth-after a traumatic experience→ MR 4 Classification of MR: 1. During birth-hypoxia/anoxia to brain due to prolonged labor→ MR 3. unwanted pregnancy and takes abortive drugs 2. Orient him to time. Infants and Adolescents Mental Retardation (MR):  Is subnormal intellectual functioning which occurs before.

Mainstreaming of children with other regular children Nursing Diagnosis: 1. Severe/Idiots • IQ level: 20-34 • Constitutes about 3% • Needs custodial/physical care 4. Detached professional parent-parents are mechanical in providing care for children 2. Moderate/Imbecile • IQ level: 35-49 • Referred to as trainable • Constitutes about 10% of the entire population of MR • Can reach up to grade 2-4 3. a child psychiatrist  A disturbance in social relatedness with cognitive and language deficit (“may sariling mundo”)  May be due to lack of interpersonal skills (“pakikipag kapwa tao) and disturbed social relation  About 25-50% of AD are suffering from MR and 25% also have seizure disorder  Diagnosis usually at 2-3 years old or 30 months when they already have playmates (BQ) Causes still unknown but multi-factorial: 1. Analysis 3. Implementation: a. Risk for injury Autistic Disorder (AD):  Also called Kanner’s Syndrome founded by Dr. Psychosocial adversity 5.46 Susceptible to mental illness because of parents denies the truth so they force their child to continue studies 2. Leo Kanner. Never push the child. Genetic vulnerability 3. Assess the IQ level of the child by conducting IQ/Psychometric test 2. Facilitate optimal activity d. Altered family pattern/process 2. accept the stage where they are in and don’t force to higher functioning because it may result to more frustrations retreating to fantastic world c. Profound • IQ level: 19 and below • Constitutes about 1% • Needs constant aid and supervision Nursing Interventions for MR patients: 1. Family adversity 4. Emotional support to parents and child b. Societal changes-poverty and child abuse • .

Reality orientation g.47 Mental Retardation 1. Affects both sexes 2. If without MR. Multi-causal/multi-factorial Autistic Disorder 1. There’s generalized delay in development but normal for stage where they are in: a. Gross abnormalities: a. Provide nutritional needs because refusal to eat indicates further regression i. Pronoun reversal where client addresses as you & other as I g. Play with one child only Attention Deficit Hyperactivity Disorder (ADHD):  A condition with the presence of inattention. Need for love and belongingness e. Assess 2. Hyperactivity-the child takes 2-3 minutes for a child not to move . Parents are usually high professional and care given to children is nonconveying of love 4. Implementation: a. Genetics b. Interest in inanimate bright spinning e. High serotonin level c. Emotional outburst to minor stress like head banging c. Unknown cause but with risk factors: a. Family therapy h. hyperactivity and impulsivity in a child for more than 6 months: (BQ) 1. Determine the underlying cause f. Analysis 3. Responds emotionally like a normal 8 years old Nursing Diagnosis: Family pattern disturbance Nursing Interventions for Autistic Patients: 1. Facilitate optimal ability whatever the patient can achieve only (BQ). No eye contact f. above average 3. Pica-eating non nutritive material b. All nursing personnel should be form & consistent c. Safety is a nursing priority: protective care by setting limits b. Peculiar ways of expressing pain 4. Low IQ 3. Cognitive ability is up to grade 2 c. Stereotype behavior like rocking d. Inattention-the child can’t complete an assigned task 2. Chronological age is 18 but mental age is 8 years old b. Seen among first born male 2.greatest nursing responsibility d. Echolalia h. Ignore temper tantrums j.

Parents who are alcoholic and suffering from mental disorders b. Family discord e. Family pattern disturbances 3. Analysis: a. Mild or subtle dysfunction of the frontal lobe responsible for motor regulation and concentration b. Methylphenidate (Ritalin/Concerta): 1) a family of diexydrine 2) given immediately before. Impulsivity-the child hits/maltreats classmates  Onset is before 7 years old Psychopathology: 1. Urban dwellers-small space for the child to express energy & feelings Nursing Interventions for ADHD patients: 1. Provide child training 1) Social Skills training through role playing & instructions by assisting the child in recognizing the impact of one’s behavior to develop empathy on the child 2) Problem Solving Skill training because child misinterprets actions of others (Ex. CNS Stimulant a. Implementation: a. Assessment: assist the child to stop. Teach the child how to borrow things so that he won’t hit others when they object his snatching of things from them) b. Lead poisoning d. Altered parenting c. look & listen before acting done by behavioral cognitive therapy-greatest nursing priority 2. Risk for injury b. Provide parent training-they should be given new ways of understanding the illness and new ways of responding to the illness through: 1) Self Awareness Enhancement (SAE)-develop genuine feelings 2) Teach parents creative Stress Reduction Techniques (SRT) 3) Provide clear limits regarding unwanted behaviors 4) Positive reinforcement like point system or giving reward to the child 5) Mild punishment like time out. Child and sexual abuse c. Hypersensitivity to food additives 2. Broken homes (unstable pattern) d. Role of Nurture (Psychosocial) a. during or after meals because it is an appetite suppressant (BQ) . Role of Nature (Genetics) a. face the wall for 5 minutes 6) Allow child to have discussion of feelings Treatment Modalities: 1. Perinatal insult c.48 3.

RN II. third generation anti-depressants: child had chronic depression→ stress reduction like deep breathing. Delirium-alteration in one’s consciousness 3. hepatotoxic & obsolete 2. What will the client do? Examples: Normal person-I’ll pick it up & return it to owner Antisocial-I’ll open it & maybe there’s money in it Paranoid-I won’t open it & maybe there’s an anthrax Dementia-Can’t judge what to do with the envelope O -Orientation Differences between Delirium and Dementia (BQ): Delirium Dementia Only for a few hours to a month More than a month . 2006/1-5 Mrs. Selective Serotonin Reuptake Inhibitor (SSRI). Amnestic Disorder  with memory loss (most recent) caused by general medical condition. Non stimulant medication: Stratera (Atomozotine)-very expensive 3. modified autogenic techniques 4. place & time R -Reasoning: problem in reasoning because of memory disturbance M -Memory: disturbance in memory causes anxiety on the part of the client A -Attention  Memory-is the foundation of all this cognitive process 3 Main Types of Cognitive Disorder: 1. lack of appetite & hypervigilance or over focused 5) Dose: 10-60 mg BID (8 am & 12 noon) b. mood swing.49 3) given 4-6 hours before retiring because of its side effect-insomnia (BQ) 4) Side Effects: insomnia. Neuroleptics: given on low dose for children who have psychosis March 04. Dementia  characterized by gross cognitive abnormalities  a progressive cognitive impairment which affects I AM JO: I -Insight: awareness of one’s illness A -Abstract thinking or reasoning M -Memory J -Judgment: There’s an envelope on the floor. slow acting. Pemoline (Cylert): a form of amphetamine. toxic agents or carbon monoxide poisoning  Example: inability to learn new activity or information 2. Lucy Espinosa. Cognitive Disorders  all mental illness have organic pathology & with neurotransmitters involved  are formerly called as Organic Brain Disorders which refer to disorders with known cause or Organic Brain Syndrome which are clusters of symptoms with unknown cause (BQ)  these are disorders that affect the client’s PORMA: P -Perception: presence of hallucination which is usually visual O -Orientation: disorientation to person.

Undressing persons and objects 7. Disorientation 4 A’s of Dementia (BQ): 2. Confusion b. a (Ach) production German pathologist who studied the Example: Patient takes paracetamol. Hypoxia-↓ RBC common among pilots. Vascular or Multi-infarct Dementiafound on stroke victims Not good prognosis because mortality Gradual in onset & progressive in course happens within a year Symptoms of Delirium: Symptoms 1. uremia and CHF to offspring Malaria falciparum 2. Neurobiological: create delirium effect 1) ↓ acetylcholine 4. Visual hallucinations & delusions c. Reversible-caused by inflammatory condition (encephalitis). Grabbing at others activities due to destruction of Ach Causes of Delirium: Cause: unknown 1. Aging: age related illness: Central Cholinergic System (CCS). Dementia of Alzheimer’s Type-if detected early & treated with Aricept (Donepezil) that controls destruction of acetylcholine. temporary & reversible No fluctuation b/w lucidness & confusion Chronic. Amnesia-anterograde to retrograde 3.50 With moments of lucidness & confusion Acute. Extreme anxiety & restlessness a. Head trauma: electrolyte imbalance may b. Aphasia-difficulty in naming persons & 4.Chemicals: alcohol neurofibrillary tangles that appears insecticide dense because of aging process pesticide 2) Senile plaques (ameloid deposits) 3. permanent but maybe reversible or irreversible: 1. Precipitating Factors: a. Clouding of consciousness objects (left brain problem) 5.Prescriptive drugs-even within the 1. Apraxia-difficulty in executing motor 8. Irreversible: a. neurotransmitter for memory b. brain of a 50 y/o female then antacid then take steroid for >Findings: having allergy→ avoid poly pharmacy 1) Alzheimer’s tangles now called 2. a >Usual onset:60 y/o as early as 40 system for balance of acetylcholine >discovered by Alois Alzheimer. General Medical Condition like: 2) Genetics-transmitted from parents Pneumonia. Predisposing Factors: therapeutic level will compromise the a. infection or alcoholism 2. Playing with food d. Agnosia-difficulty in recognizing 6. stewardess & with asthma causing anemia where there is less O2 supply and ↓ ACH .

Infections-meningitis e. let the family know that patient has anterograde amnesia and don’t give false hopes b. Assessment: 1. Anxiety 3. Structural-common among boxers because of “punch drunk syndrome” f. the better 3. Interventions: * Facilitate optimal ability of clientgreatest nursing priority 1. Poor judgment & insight 4. Analysis (Nursing Diagnosis): 1. Remove the cause-treat infection. non slippery floor > personality accentuation→ OC > personality change→ regression c. Non specific stressors-frequent stress→ ↑ cortisol→ destroys ACH Nursing Intervention for Delirious Clients: A. withdraw from alcohol drinking & avoid polypharmacy 2. Administer anti-oxidants: Vitamin E. Alteration in Family/Thought Process 3. dim lights & soft music→ induces sleep) 3. Family involvement by: a. Assess B. Management of guilt feelings by allowing family to express their C. Interventions: *Maintain Life-greatest nursing priority or responsibility 1. provide handrails or side rails 2. Provide emotional support and physical comfort 4. Memory loss 2. place & person B. using right judgment. draw curtains. Disoriented to time. well lighted rooms because of the symptom Sundown Syndrome (agnosia and visual hallucinations) which is worst in the evening b. c. Risk for Injury 2. Inability to think abstractly 5. Sensory Perceptual Disturbances 4.51 b. Sensory-common in ICU clients because of frequent stimulation leads to ICU psychosis g. Self Care Deficit C. Metabolic-DM & other metabolic dis. Analysis: 1. Toxic agents-aluminum salts and those who use aluminum foils d. Safety-nursing priority a. carrots & other fresh sources . Disturbance in Sleeping Pattern Nursing Intervention for Demented Clients: A. through nursing care and use environmental manipulation (keep room temperature at most appropriate level. Risk for Injury 2. Short & concrete directions should be given-the easier to understand. Education as to expectations and symptoms. Manage symptoms judiciously.

Flexible activities: a. Pet therapy because pets can give unconditional love 9. small group activities In contrast with Schizophrenics where structured activities is advised because they are failure prone & fearful 5. Encourage self care & teach activities of daily living (ADL) 8. put name on bed d. help them in grooming. Tacrine (Cognex) b. Safety b. Reality orientation: a. give unstructured activities because of their lability b. Provide ID bracelet with alarm (which sounds at 100 meter distance) c. Use of photo albums to facilitate life review therapy (BQ) that will enhance their memory & reduce loneliness 7. don’t disarrange or touch patients things e. don’t say the word “remember” because it’s non therapeutic 6. Medications: a.52 feeling 4. exercise. Wandering due to disorientation. Consistent caregiver-frequent changing of caregiver→ adjustment produces anxiety to patient (BQ) Consistent environment-prevent over stimulation or under stimulation of environment→ not so noisy. Donepezil (Aricept) c. Chart with photo on file d. feeding. crowded and quiet 9. Anti-oxidants: Vitamin E . Alternative outlet for energy 10. place calendar with big letters & # c. boredom & need for exercise a. Reminiscence therapy a. interaction. place a big wall clock with big #s b. restlessness.

Too much: client suffering from elation-vehement energy (manic)  In some instances. Mood Disorders  Based on the Statistics of NCMH: 80% Schizophrenia 10% Substance Related with Psychosis 06% Mood Disorders (Diseases of the Rich) 04% Autistic Diseases  Predominant Feature: Client’s mood or emotions  There are Two Extremes of Emotions: 1. ask co-worker to administer the medicines d. decision making to commit suicide is hard to undertake because they don’t have the psychic energy to do it. some aspects of self care Severe Personal care. feeding.53 d. yard work. the nurse should be on guard because client tends to commit suicide Depressed Elders Depressed Adolescents . ask co-patient about the patient e. thought and activity. Too little: client suffering from depression-despair and lethargy 2. Anti-depressants BQ: You’re new to clinical area and you’re asked to administer medicines to a demented patient but was not sure of his identity. Non-steroidal anti-inflammatory e. indecisiveness. the 1st symptom is psychomotor retardation=slowing down of speech. self destructive thoughts and confusion) are affected due to mood  In severe form of depression. grooming & toiletry Profound Patient is oblivious to surroundings & totally dependent on care givers Terminal Patient is bed bound requiring constant care III. suicide is rare in severe depression because of psychomotor retardation. Metabolic Enhancers & Vasodilators: Hydergine f. client’s thoughts and behaviors (inability to concentrate. pessimism.  Suicide usually occurs when client shows signs of improvement (bright facial improvement or cheerful with no reason). Hence. ambivalence. Likewise. go to the chart and see the picture Answer: C Impairment in the Activities of Daily Living (ADL)based on the Stages of Alzheimer Level of Impairment Patient has difficulty with Mild Balancing checkbooks Preparing complex meals Managing a difficult medication schedule Moderate Simple food preparation. What’s your nursing action? c. household clean up.

54 1. Major Depression • Depression is the predominant feeling of sadness or loneliness which covers the entire life of a person • Types: a) Psychotic depression-with hallucinations & delusions b) Postpartum depression-occurs within 30 days postpartum (BQ) c) Seasonal Affective Disorders (SAD)-occurs during winter & fall common among European countries Depression An abnormal. Ambivalent→ Cry for Help 2. Dysthymia (neurotic depression) • for more than 2 years often than not the client experiences depression • a diagnosis of chronicity and not the severity 2. No warning at all 3. Role of Nature: ↓ in S erotonin (regulates sleep wake cycle & mood)→ oatmeal rich in Serotonin A drenalin D opamine N orepinephrine (also known as noradrenaline) 2. imagined or symbolic From an ambivalent relationship. That is it 2. pathological reaction due to a loss: real. With warning 3. Depressive Disorder-main symptom is depression only 2 Main types of Depressive Disorder: 1. Role of Nurture: • Anger is the universal symptom of distress • Defense mechanism used: Introjection . there’s always guilt feelings→ depression Prolonged Marked by self-blaming Usually endogenous Grief Process A normal response to a normal or real loss From a harmonious relationship Short period: 6-12 weeks 3-6 months in USA 1 year for Filipinos Grief is resolved when client recalls (+) & (-) experiences with the loss without pain or anger Exogenous (it’s reactive coming from environment) Psychopathology of Depression: 1. ↑ lethal method 1. ↓ lethal method Two Types of Mood Disorders: A.

Analysis: a. Have trouble sleeping (insomnia) or too much sleeping (hypersomnia) • In dysthymia. Risk for violence-directed both to self and others b. helpless and hopeless 2. Chronic isolation d. Altered nutrition f. ↓ weight 5. ↑ appetite. ↓ successful suicide U nsuccessful attempts I dentification with the person who had suicide C hronic I llness D rugs: Hypotensive agents because it depletes NE. Prevent suicide: S ingle -in USA=single. ↓ sex libido. living alone & unemployed S upport system -none S uccess -depression S ex -Male: less attempt. ↓ appetite. ↑ successful suicide -Female: more attempt. guilty. Have problems concentrating. the problem is on onset of sleep. has a stronger ID 9 Criteria of Depression: Symptoms exist for more than 2 weeks that meet 4 or 5 of the criteria 1. Feel worthless.55 • • Depressed individuals internalized hostilities→ turned inward to himself→ prone to commit suicide According to Payne. ↑ sex • In psychotic depressed. Feel tired. Cry more easily than usual 8. Assess: 9 Criteria 2. Sleep pattern disturbances 3. Safety of Patient & Relatives (most importantly his loved ones)-a nursing priority because patients commit homicide first then suicide due to introjection b. the problem is on terminal insomnia 4. remembering or making decisions 6. Have physical symptoms such as HA. Implementation: a. Think or talk about suicide 7. Ineffective coping e. Feel restless and unable to sit still Nursing Interventions: 1. stomachache or backaches) without organic origin 9. weak and low in energy & motivation 3. Chronic low self esteem c. Loss of appetite or overeats • In psychotic depressed. Ach & serotonin . in depression the ego capitulates (surrenders) to a strong SE (punitive and rigid) while in mania.

faulting & hopeless Avoid daytime napping c. Treatment Modalities: 1. I can do it. ECT gives a feeling that patient died already and it releases guilt feelings→ patient is freed of sin already  Voltage Used: as low as 90-110 volts  Modified ECT: a. commit suicide 7-9 months after the start of depression Kind firmness-the best attitude therapy. e. Example: hanging 2) Female: uses low lethal method. one on one guarding. don’t leave the patient alone  In the Philippines. 1) Remove hazards 2) Make frequent irregular rounds because during patients lucid intervals they observe your time of rounds 3) Suicide is usually committed early in the morning.  Therapeutic Effect: unknown  According to other theories. ask patient to count seashells. Electroconvulsive Therapy (ECT): a positive treatment alternative given to depressed patients so that he will be amenable to psychopharmacology.56 Example: Reserpine and amphetamine A ge of person or AIDS: 1) Male adolescent-ambivalent. f. Provide a boring task like ask patient to sweep floor. taking poisons  Hanging maybe prevented by: male wall must be waist up while in female wall must be up to shoulder  2 levels of Suicide Prevention in USA: 1) Level I-Undertaken when the client signs a non suicide contract (NSC). use high lethal method L ethality: or likelihood of suicide 1) Male: uses high lethal method. they don’t express their intent. Patient is given Succinylcholine (Anectine). a muscle relaxant (BQ)  After administration. RN rounds every 15 minutes 2) Level II-Client refuses to sign NSC. nurse should have a prepared artificial respiration (O2) because the lung muscle may be paralyzed  Given to manic and patient with grand mal seizures. ask him to recount until he get bored & angry with you because of the boring job. lower standards for them to encounter success because patients are demoralized Cognitive restructuring or reframing-“I am now a survivor.” Because patients always blame themselves (I am the I to be blame). 8 out of 10 suicidal give warnings. d. it’s final. Example: slashing. If he makes a mistake. Then congratulate patient when he’s able to get angry because it’s a success that he’s able to express feeling Remoralization-give simple praises & compliments after doing an activity. it gives a calming effect . not decided yet 2) Elders-increasing & more successful because once they decided. suicide is a “cry for help”.

hard to administer because of dietary restrictions a) No to tyramine rich foods like aged cheese. hyponatremia. constipation. blurring of vision. make an eye contact. bacon & pizza c) No to over ripe fruits & vegetables d) No to caffeine containing food & beverages e) No to poorly refrigerated food f) No to decongestants & asthma tablets g) No to pickles & fermented food . Psychopharmacology: Anti-depressants has a therapeutic effect after 3-4 weeks so watch out for the possibility of suicide once mood changes after 4 weeks of treatment (BQ) a. place & time by performing-Stoop down. Weight gain  Nursing Responsibility after ECT: Orient patient as to person. Tricyclic anti-depressants (TCA)  2 Main types (also used in NCMH): 1) Imipramine HCL (Tofranil) 2) Dotheipin HCL (Prothiaden)  Side Effects: • Cardiac arrhythmia→MI→ Death • Anti-cholinergic effects: nasal congestion. a neurotransmitter  Examples: 1) Tranylcypromine (Parnate) commonly used in USA→ parnate cheese syndrome. Anesthesia  Side Effects: a. dry mouth • Urinary retention (BQ) • Edema • Mania states because TCA acts on NE • Insomnia because TCA acts more on NE  BQ: The patient asks the nurse to allow him go out on pass in the hospital to see his ophthalmologist. cottage & white cheese are good for patients b) No to aged meat like ham. Disorientation d.57 b. What is the nursing action? Answer: Tell patient that blurring is a temporary effect of TCA b. Headache e. Confusion c. Give atropine S04 c. Only fresh. Temporary amnesia b. parmesan & edam cheese because it develops hypertensive crisis manifested by occipital headache. Monoamine oxidase inhibitors (MAOI)  Second generation drug that inhibits destruction of monoamines. it’s 11:00 am & you’re in Pavilion II 2. grasp hand & say “ I’m Ms…your nurse.

great spender. Sertraline (Zoloft). Paroxetine (Seroxat) d. Thioridazine HCL (Melleril)-are antipsychotic drug for anxiety. never go into introspection. Selective serotonin norepinephrine reuptake inhibitors (SSNRI)  Examples: Venlafaxine (Efexor or Effexor). client is evaluative & keeps on comparing.58 2) Phenelzine (Nardil) c. can reach the fullest arc of 2 pendulum parts: mania & depression. sexually promiscuous and result to substance abuse because of sleep pattern disturbances Signs and Symptoms of Mania: 1. no mania because it can’t reach the fullest arc. tension. sleep disturbance & agitation  SSRI & SSNRI are more on anticholinergic effect observe in atypical neuroleptics  SSRI & SSNRI Side Effects: 1) Constipation-↑ fluid intake 2) Temporary blurring of vision 3) Temporary nasal congestion-drink lots of water 4) Dry mouth-in USA. Bipolar II-with hypomania and depression. Excess make up & adornment for female and growing of moustache & beard for male=mask or camouflage of depression • First manifestation of bipolar male patients-mania • First manifestation of bipolar female patients-depression b. Excess in everything a. Hypomania-mild form of mania. Hyperkinesis=more elated→ more tired→ exhaustion→ sudden death which can be explained by the biological mechanism of mania: ↓ SAD ↑ Ne→ hyperkinetic (sobrang likot)→ electrolyte imbalance→ cardiac arrhythmia→ death c. attenuated hypomania 3. Bipolar Disorder-alternate between mania and depression Types: 1. rapid cycling or sometimes it takes days 2. Bipolar I-with episode of mania. Excessive sex with new acquaintances=engage in sexual intimacy with new acquiantances d. hypomania and depression. Selective serotonin reuptake inhibitors (SSRI)  Third generation drug that inhibits reabsorption of serotonin  Examples: Fluoxetine (Prozac). they give hard candies or bubble gum B. Inflated self esteem=”mayabang” . depression.

white or cream curtains & avoid red b. stop them and they will forget about the fight Staff splitting Manipulative & irritable Limit testing-manic patients try to play with your self esteem so nurse should do testing within 30 minutes Monopolizer Flight of ideas Delusions of grandeur 2. 6. voice should be lowered & well modulated 3. 4. wear pale colored clothes c. 8. When demands are frustrated→ hostility→ repressed→ depression  According to Payne: mania=ID stronger while depression=SE Nursing Diagnosis: M ood elated A grandiose delusion N eed to sleep & eat I nappropriate C langing loud & vulgar -Risk for violence -Altered nutrition -Impaired verbal communication Nursing Interventions: 1.59 e. Impaired judgment Have distractibility because of too short attention span (BQ)  Manic patients flatter you as soon as they meet you. Psychopathology of Mania: 1. Find an acceptable outlet for their excessive energy due to ↑ Ne BQ: What therapeutic outlet should a nurse use to manic patients? Answer: Let them join a square dance because there are directions to be followed during the dance 2. Role of Nature (Biological basis): ↓ SADN ↑Ne 2. Excessive spending=great spender f. 5. Feed manic patients with finger foods which they can carry  ↑ CHON and ↑ CHO to compensate for their ↑ energy consumption . Remember that the environment affects their elation  Simplify clients environment by reducing stimuli: a. 7. 3. Role of Nurture (Psychodynamic basis):  Defense mechanism: Denial  Laughing outside but crying inside: Reaction Formation  Internalized hostilities (anger)→ turned outward→ environment→ violence  Elation is a defense against underlying depression (denial)→ appears confident but basically over dependent or outgoing but actually self centered. “hello guys” but will leave you as soon as they meet another person  They go into outburst of song & laughter  Distractibility can be used therapeutically (BQ) because when patients are seen fighting.

Morton salt  Wait for 7-10 days for its therapeutic effect  Patient must be given Haloperidol or Risperdal first while waiting for the effect because patient may die of exhaustion  If patient is in lithium.5 mEq/L and 0.60  Example: cheeseburger  BQ: How to feed a manic patient? Answer: Serve food in the run 4. thyroid H and & tremors I ncrease fluid U nsteady M ania.0 mEq/L • 0. no diuretics (BQ) should be given. Atypical neuroleptics: Olanzepine (Zyprexa)-newest & latest drugs found to have mood stabilizing effect . It is given only if there’s already toxicity  Monitor Na intake of patient: • ↓ Na=↑ LiCO3→ lithium toxicity (hyponatremia & hypokalemia) characterized by: L BM E xcessive thirst & voiding N ausea & vomiting A norexia C onvulsion • ↑ Na=↓ LiC03→ no therapeutic level but don’t ↑ Na intake  Therapeutic level : • Give 3-6 grams of salt & 3000 cc of water • Acute Stage: give 1-1. Carbamazepine (Tegretol) causes Steven-Johnson’s disease b.5-2. Mood stabilizers: Lithium carbonate (Quilonium R in PI or Lithane in USA) L evel I ncontinence T hirst.2 mEq/L for maintenance • Toxic: 1. Valproic acid (Depakene) 3. firm & no demand because manic patients are manipulative  if patient becomes assaultive. ask him to drop it on the floor & not to hand it to you  lesser # of person=lesser stimuli=lesser agitation Treatment Modalities: 1.6-1.3 margin of safety 2. surround him in small circle to prevent assault to a single person or focus anger on one of you  if patient is armed. Beta blockers: Propanolol 4. Use matter-of-fact attitude:  consistent. Anti-convulsants: also found to have mood stabilizing effect a.

Genetic-patients with schizophrenia seem to inherit a predisposition to the disorder B. Regression-dancing like a kid. Brief Psychotic Episode: psychotic symptoms for a few hours to 4 weeks (a month) 2. Role of Nature (Biological theories) 1.61 IV. Role of Nurture (Psychodynamic theories): seeds of mental illness are sown in childhood→ inadequate ego development. Schizophrenia: psychotic symptoms are more than 6 months BQ: Dante is sleepless for 4 days. neuronal loss and brain atrophy (5% brain weight) attributes to the negative symptoms of Schizophrenia 3. What is his diagnosis? Answer: Schizophreniform disorder 4 A’s of Schizophrenia by Eugene Bleuler: 1.→ feelings 2 Prominent Defense Mechanisms used by Schizophrenics: 1. feelings. Affective disturbance--4. Neurostuctural-increased cerebral blood flow in the frontal lobe of the brain. doesn’t eat and dress up for 2 weeks. behavior and perception for more than 6 months: Thoughts-autism. waxy flexibility Psychopathology: A. Schizophreniform: psychotic symptoms reach for 6 months 3. cancer of mental disorders  most devastating & most severe of all mental illness because of wide variety of symptoms Definition: is characterized by a disturbance in thoughts. lack of nurturing attention in the earliest . Biochemical-two big dopaminergic systems are responsible for the wide variety of positive symptoms of Schizophrenia: a. bathes self with urine and trichotillomania (symptom of chronicity) 2. the other distribute dopamine to the spinal cord 2. painting the wall with feces. enlarged ventricles. one dopaminergic system distribute dopamine to the brain b. he doesn’t go to school anymore because he thinks that his classmates are talking at his back. Schizophrenia and other Psychosis  termed as “Sakropenia” in NCMH. Withdrawal-not taking a bath. looseness of association and delusion Feelings-ambivalence and affective disturbance Behavior-regression and withdrawal (going back to childhood) Perception-hallucinations usually auditory Classification: 1. Ambivalence------------. 4 months PTC. Association is loose → thoughts 3. Autism-------------------2.

Paranoid • Most dangerous and hardest to convince that they are sick • Essential Features: a. Onset: 30 years and above. strong association between schizophrenia and low socio-economic status 1. 2. Male d. DSM IV-TR=10-25 years old b. Extreme withdrawal-usually seen at the back of the door or wall. inability to work and lack of a desire to work are all features of schizophrenia 5 Clinical Types of Schizophrenia: 1. Highly critical & sarcastic-avoid competition • Nursing Intervention for Risk of Violence: a. 25% of patients experience a post psychotic depression which is a natural part of schizophrenia that is masked during the acute phase of the illness and some drugs used to treat schizophrenia also produces depression 2. During the Oral phase-failure to establish trusting relationship with mother→ child can’t invest emotional energy outside self→ develops primary narcissism→ if purely anxiety laden home (lots of fighting). no eye contact. highly suspicious because of ↑ Ne b. Unfounded jealousy-example: sewed the vagina of wife c. Depression related to schizophrenia-as the symptoms begin to subside. does environmental scanning before going in a room. Assess b. Relapses • many patients will experience relapse and remission of symptoms throughout their illness • patients most likely to suffer a relapse are those having frequent face to face contact with family who has high expressed emotion index. separated c. well organized & systematized→ persecutory leads to aggression→ a psychiatric emergency case or maybe grandiose brought by experiences of ridicule at home b. Substance abuse-is the most common co-morbid psychiatric condition associated with schizophrenia 4.62 years. child withdraw away from reality. Frequent hallucinations that are usually auditory • Incidence: a. crosses arms & stands sideways. With high IQ-gainly employed but don’t stay in one job for a long time • Symptoms: a. Vulnerability-Stress Model: recognizes that both biological and psychodynamic predisposition to schizophrenia when coupled with stressful life events can precipitate a schizophrenic process 1. During the Phallic phase-failure to develop sexually resulting to confused sexual role and latent homosexuality (closet queen) C. DSM IV=15-25. Presence of one or more delusions that are fixed. Work-lack of work. role of family in the causation. exposed to stressors and those not given antipsychotic medications 3. Single or if married. Nursing Diagnosis: .

holds vagina). silly smiles & giggles like a kid & witch 3. there’s smoke or rat in my stomach) b. Catatonic stupor  waxy flexibility-patient would experience physical discomfort than talk so nurse should prevent edema & cyanosis of lower extremities (BQ)  catalepsy (motoric immobility)-pathologic form of withdrawal b. somatic delusions (ex. Implementation: 1) Distance-client hates too much closeness (BQ). Has disorganized behavior: regressed infantile behavior (ex. never hold complicated instruments around them 4) Solitary activities like painting that will need close concentration to remove delusion-never let patient go into group activities & competitive activities 5) Remotivation Technique: to motivate patient to move again from their fantastic world back to reality so talk about nature. Has disorganized thought: flat affect (apathy-manhid or bato). all undertakings should be gradual (BQ) 3) Never whisper when talking. paints feces on the wall or make feces into meatballs). disorganized or catatonic • Main symptoms are delusions & hallucinations . it should be within the hearing range of the patient. Catatonic excitement-there’s impulsive behavior without external stimulus due to auditory hallucinations about their sexuality  Nursing intervention: to prevent injury 4. nearest distance 4 feet 2) Best attitude therapy: Passive friendliness. politics or religion 6) Feeding-Let the patient to get first his own food tray inside the food cart according to Saunders (BQ) or can give sealed containers if available 2. wait for the non verbal cues of the patient. occupation. Disorganized • Formerly known as Hebephrenic (Goddess of Youth) • More common in women • Worst form of Schizophrenia • Signs and Symptoms: a.63 1) Risk for violence 2) Altered thought process 3) Sensory perceptual alteration 4) Altered nutrition 5) Fluid volume deficit 6) Social Isolation c. “buntis ako”. history or sports and never about family problems. silly behavior (eats vaginal secretion. Undifferentiated • No prominent symptoms of paranoid. Catatonic • 2 Phases of Catatonia: a. never touch them.

64 • Delusions change or vary as compared to paranoid which is fixed or unchangeable 5. Handle them realistically 7. Attitude therapy: Active Friendliness (tender loving care) 2. Individual=nurse-patient relationship b. Proma. Foster trusting and meaningful (one on one) relationship 3. Group=small group meetings where personal problems are discussed 2. it completely blocks the pre-synapse of dopamine but create a hyperdopaminergic activity & also produce Hobonamic acid that gives metallic colored skin & a peculiar odor secreted in saliva. urine & semen. ECT-best for depressed patients 3. stress free & provide support group 5. Typical neuroleptic-cheaper but has more side effects→ ↓ dopaminergic activity. perceptions & behaviors like hallucinations & delusions)→ ↑ dopamine • More with negative symptoms (absence of what should be)→ ↓ dopamine a. Akinesia-absence of movement Nursing Interventions for all types of Schizophrenia except Paranoid: A. Provide support 4. Anhedonia-absence of pleasure d. Avolition-absence of a goal directed or voluntary activity b. not intrusive and highly professional 4. Avoid failure & competition 6. Laractyl) . Interventions: 1. Assess-the symptoms are not due to cognitive disorders or drugs B. Be honest. Accept the patient 2. Analysis-same with paranoid type C. Bridge contact with reality Guidelines in helping all kinds of Patients: 1. Use Psychotherapy a. Alogia-absence of words e. skin. Protect them from embarrassment 5. Activity Therapy 4. Social Therapy-milieu therapy 5. Enhance their self esteem 3. 1) Chlorpromazine (Thorazine. Project environmental self control Treatment Modalities: 1. Psychopharmacotherapy: Anti-psychotics (BQ) or neuroleptics that are formerly known as major tranquilizers or ataractics a. Apathy-absence of feeling c. Structured activity that are stimulating. Residual • No more positive symptoms (presence of unusual thoughts.

Serenace)  Potent but less sedating. dyspnea. given at 8 am & 1 pm  Side Effects: same as a) to d) of chlorpromazine and Extrapyramidal Syndrome (EPS): a) Dystonia • Appears on the first 24 hours characterized as robot like.a life threatening SE where patient develops uncontrollable fever even when given antipyretics. very tense muscle. drooling of saliva due to difficulty & pain in swallowing. protrusion of tongue. limbs & trunk such as: • Involuntary mastication • Involuntary lip smacking • Involuntary rolling of eyes • Involuntary muscle movement • Involuntary protrusion of tongue (worm like protrusion) . continuous stomping of feet in one place (“padyak ng padyak. opisthotonus • Pain all over the body=pain of tongue (“bumaligtad ang dila”)→ blockage of airway→ death • Nursing Responsibility: Give medication immediately as a doctor standing order to allay patient’s anxiety b) Akathisia-motor restlessness. given at 6 pm (usually an hour before sleeping to use it positively)  Side Effects: a) Sedation is considered a SE but is used to help patient go back to a quality of life b) Postural or orthostatic hypotension is a major SE so there is risk for injury and to prevent this SE: • Monitor BP before giving personal grooming • Make sure floor is dry • Let patient sit on bed first & dangle feet before standing up • Let patient do all activities while still up so that he won’t stand again when he’s already lying on the bed c) Photosensitivity-patient should avoid direct contact or exposure to sunlight because they develop sunburn (BQ) d) Metallic colored skin e) Bleeding gums (agranulocytosis) f) Neuroleptic Malignant Syndrome (NMS). oculogyric crisis (rolling of eyeball). ↑ VS→ death 2) Haloperidol (Haldol. convulsions. body rigidity. mask-like face (appears constipated) d) Tardive dyskinesia-an irreversible SE even if medication is given described as an involuntary & repetitious movements of the muscle of the face.65  Sedating but less potent. parang may langgam sa paa”) c) Parkinsonism-pill rolling movement of hands.

45%. if BALC exceeds this dose. societal.06%-0. Atypical neuroleptic-novel. tolerance (gradual increase of the dose to get its desired resultBQ) and withdrawal (physical need)symptoms 2. can still give dopamine to some receptor sites & other selected receptor sites that are lacking with dopamine 1) Clozapine (Clozane in USA. newer.10%-0. what should be your nursing action? Answer: Give medication & refer to MD  Medications for EPS: a) Amantadine (Symmetrel) b) Biperiden (Akineton)-given in USA c) Diphenhydramine (Benadryl) d) Benzotropine (Cogentin) e) Artane-eradicated in hospital because commonly used by drug addicts in patients with parkinsonism because it makes you instantly drunk b.66 BQ: Patient has a tardive dyskinesia.08%→ toxic screening for alcohol in USA (+) Alcohol breath=0. Substance withdrawal Alcohol Related Disorders:  Blood alcohol level concentration: (+) Alcohol breath=0. alcohol reaches the inhibitory center of the brain causing depression of inhibitory center→ uninhibited or heightened spirit (ataraxia)→ more alcohol • . sore throat & fever) 2) Risperidone (Risperdal) 3) Amisulpride (Solian) 4) Quetiapine (Seroquel)-good fo insomniacs 5) Ziprasidone (Zeldox)-from malady to melody 6) Olanzepine (Zyprexa) V. Substance dependence (formerly known as addiction)-a maladaptive pattern of ingesting substances causing compulsions (psychological need). Substance abuse-ingesting substances causing family. there’s a tolerance  Alcohol is the 3rd cause of death in USA  Effects of Alcohol: CNS depressant (BQ) Initially. have selective neuroleptic activity.15%→ toxic screening for alcohol in Philippines Lethal dose=0. Substance related use disorder a. Substance induced disorder a. cravings (subjective desire). Leponex in Philippines)  Considered wonder drug in 90’s  Patients should be subjected to blood examination weekly for 18 weeks then monthly thereafter (BQ)  Side Effects: Agranulocytosis (gum bleeding. expensive but less SE. legal and occupational problems that may go to substance dependence b. Substance intoxication b. Substance Related Disorders 2 Main Types: 1.

uncontrollable marked tremors. Valium for safe sedation with BP precaution • Observe for shock and fever • Place patient in mechanical restraints 2. Hangover: • 4-6 hours after heavy drinking caused by accumulation of acetaldehyde and HCL in the blood • gastritis. During the Acute Phase while patient is confined in the hospital • Ask the patient. Vitamin C to detoxify. visual hallucinations and with delirium (confusion to place and time only) • A fatal condition because patient may die of cerebral edema hence. disorientation. objective and non judgmental • Use confrontational strategy 3. Mouthwash c. unified approach. Shaving set Answer: D. Delirium due to alcohol • According to Mosby. pounding headache. “when was his last drink?” • Give Thiamine or vitamin B1 to prevent dementia (BQ). Detoxify clients through Aversive (to remove) Technique . Rubbing alcohol b. Matter of Fact Attitude: best attitude therapy • It means the use of prescribed attitude-firmly consistent. Alcohol Free Environment • BQ: What can be allowed in the room of an alcoholic? a. Dementia of the Korsakoff’s type: product of chronic alcoholism  Nursing Interventions for Delirium due to Alcohol: 1. Shaving lotion d. paranoia. palpitations. Black out (passing out): anterograde amnesia after heavy drinking (BQ) 3. electric and has no sharps 4.67 intake→ euphoria→ lowering of SE forces→ when it wears off→ shame & guilt→ because of guilt and wants to forget→ will go back to the alcohol resulting to vicious cycle of drinking  Physical consequences of alcohol: 1. Magnesium SO4 to prevent convulsion. tactile hallucinations. seizure or rhum fits and no delirium • the nurse should anticipate the occurrence of withdrawal symptoms by asking for the last time patient drink 4. Acute alcohol withdrawal: • hangover. it requires immediate hospitalization 5. nausea & vomiting • Mgt: Give patient black coffee and let him sleep in a quiet room because alcohol is absorbed & excreted slowly by the body 2. it occurs 48-72 hours • Clouded consciousness.

Help client postpone gratification 4. sha. Re-socialization • Because alcoholics have very poor self esteem. Educate patient & relative 5. Bencis)-given for ADHD d. Explain the procedure c. Reactiven-taken by students who are reviewing e. Confrontational strategies-“You have an alcohol breath again” 2. they should join self help groups using group pressures as the therapist • Alcoholic anonymous (AA)-for recovered alcoholics ALATEEN-for teenage children of recovered alcoholics ALANON-for families of recovered alcoholics because wives are codependents (enjoys being masochist) & enabler (covers up husbands actions)  Defense mechanisms used by alcoholics: denial. Matter-of-Fact: point out consequences of behavior-“I am sorry. Reductyl-relative of amphetamine • produces acute psychotic-like symptoms that closely resemble schizophrenia. Therapeutic Community gives responsibilities Drugs: 1. paranoid • • . What must the nurse do? a. ubas & siopao b. an alcohol sensitizing substance which stabilizes the acetaldehyde and HCL acid • BQ: What does it mean of patient has good understanding about antabuse? If in a party. “speed” • Examples: a. Glass of fruit juice Answer: C 5. Amphetamines-“uppers”. 30 cc red wine c. you won’t be allowed to get out of the clinical area” 3. rationalization and projection  Nursing Diagnosis: Altered family process Ineffective individual coping  Nursing Interventions: 1. what will you order? a. “bato”. Get the patient’s feeling regarding & before detoxifying Answer: C • Give Disulfiram (Antabuse). The next time I smell you having alcohol breath. Phentermine resin (Ionamin)-appetite depressant c.68 A form of behavior modification technique BQ: Peping was ordered to have detoxification. Lifestyle changes 7. 30 cc brandy b. Methamphetamine HCL-shabu. Provide support groups or self help groups like Narcotic Anonymous 6. Conceal the medication b. Dexedrine (Dexis.

sad. Basulca-pure cocaine or coca paste which is sniffed or through IV g. Crack or Rock or Smoked cocaine  an adulterated mixture of cocaine + water + baking soda  produces a crackling sound at boiling point  cheaper.69 • • • • experiences persecutory delusion which is also a predominant symptom of schizophrenia. potent & fast acting and easily available  withdrawal symptom: crashing-difficult to handle because of the emotional pain experienced described as excruciating & agonizing leading to commit suicide or going back to cocaine use. Cocaine-“uppers” • Cocaine was discovered before the advent of anesthesia and coca cola was believed to contain cocaine • Examples: f. Hell-phencyclidine + cocaine i. paranoid withdrawal of amphetamine leads to crashing (withdrawal symptoms of painful. rich clients use ice which is the more expensive kind of amphetamine and crack by poor clients Symptoms of Amphetamine Intoxication: T achycardia E vident weight loss P erspiration & chills P upillary dilatation P sychomotor agitation E levated blood pressure C onvulsion Symptoms of Amphetamine Withdrawal: F atigability I ncreased appetite-a rebound effect V ivid hallucination I nsomnia P sychomotor retardation & agitation • 2. Speedball-cocaine + heroin h. • the cardinal symptom of cocaine use: red excoriated nostril (BQ) because the drug is snorted or sniffed→ vasocongestion→ blood vessel breaks 3. very lonely to the point patient commits suicide in USA. Cannabis (Marijuana)-hallucinogen • the Philippines is the #1 producer of marijuana .

dry mouth No dependence but causes compulsion • • 4. nose is eroded with maggots (“uod”) • Effect: feeling that they can fly. mania. mix with Phenobarbital to prevent status epilepticus • Carbamazepine (Tegretol) is commonly use nowadays for epilepsy. rugby wrap in banana leaves. Bad trip-patient goes into threatening hallucinations (too horrifying. trigeminal neuralgia. more on feelings). Hallucinogens • Lysergic Acid Diethylamide (LSD)-a relative of ecstasy. Sedative & hypnotic-“downer” • Sedatives are given in small amount while hypnotics are given in large amount • Barbiturate are given for a long period of time around 8 months & in large doses then taper gradually because sudden withdrawal causes respiratory depression. apnea. diabetic neuropathy • BQ: What drug causes sudden death when stopped at once? Answer: Barbiturates . cravings for “junk” food. they see monsters) 5. produces tolerance b. Inhalants • Cardinal symptom: smell of a dead necrotic tissue (smell of halitosis) • Vulnerable to respiratory diseases.70 • • taken from an Indian hemp plant: Cannabis sativa 2 Types: a. thinners (it cooks the lungs) & solvents 6. psychosis or sudden death • In NCMH. Good trip-psychedelic & euphoric effect (very. very happy. epileptic patients are given Na dilantin (Phenytoin). erection of penis for a week. no thirst. no hunger pangs • Used in very poor countries. Hashish-leaves soft portion or upper part (very expensive) is pounded to produce a thick resin-like exudates=tetrahydrocannabinol (active ingredient of marijuana) BQ  Effects: 1) Euphoria-mild effect 2) Hallucinations if taken in large amount 3) Perceptual distortions on time & space if moderate amount is taken:  Time passes so slowly (faulty perception)  Thinks distance is wide but in reality it’s close already  Thinks height is still low though it’s high  Perceives sound which are loud as soft Cardinal Symptoms: red eyes. not prohibited in Cambodia b. Marijuana (“damo”)-dried leaves or the upper part of the plant is rolled into cigarette producing a sweet smelling smoke. an anticonvulsant. morning glory seed • Ecstasy Effect: a. sexually active.

↑ Norepinephrine-is an excitatory neurotransmitter responsible for cardiovascular changes during stress & anxiety and prepares body for fight or flight response 2. put baby in mother’s chest after birth & breastfeeding to ↓ birth trauma . palpitation. Caffeine: 250 mg (a cup) • Brewed coffee-100 mg. Chocolate:10-15 mg. Psychodynamic of Anxiety: (Role of nurture) a. synthetic and legal drug to lower withdrawal symptoms (BQ) H eroine & Hydromorphone • Opioid Withdrawal Symptoms (According to occurrence): A nxiety: First stage C old-like or flu-like symptoms: Second stage-lacrimation. According to Otto Rank: anxiety is due to birth trauma where intrauterine environment is the most favorable place to prevent anxiety. expensive. Tea-40 mg. yawning & sneezing A bdominal cramps: LBM N ausea & vomiting 8. the raw material is used as cough suppressant. frequent urination and eventually brain atrophy VI. Anxiety and Other Related Disorders Definition: there is a high level of apprehension and development of behavioral pattern to avoid anxiety (BQ) Chief Predominant Symptom=Anxiety (fear of dying) + depression (prone to suicide) Behavioral Pattern=Rituals & Phobia Psychopathology of Anxiety: 1. ↓ Serotonin c.71 7. Phencyclidine (PCP) or Angel Dust • Hogs because it is elephant tranquilizer • PCP + alcohol→ family violence • Effects: ↑ impulsiveness. it acts also as anti-diarrheal C odeine: used as cough syrup M orphine & M ethadone: imported. Opioid Derivatives-“downer” N arcotics: mixed with analgesics to counteract cancer pain. Psychobiologic aspect of stress & anxiety: (Role of nature) a. Instant coffee-65 mg • Intoxication: rumbling flow of thoughts. unstableness 9. GABA-an inhibitory neurotransmitter associated with relaxation response b.

Panic: +4 or ++++  There’s wild (homicide) & desperate (Suicide) behavior  Dysfunctional coping is used  BQ: During panic level. decision making & problem solving are hard to do  Uses defense mechanism like conversion & make use of maladaptive coping 4. ↑ perceptual field  No need for defense mechanism but only adaptive coping 2. psychological pain. substitute a fantastic world Resides in the castle in the air . Defense mechanism: Repression & Symbolism Levels of Anxiety based on Keltner’s Definition: 1. ↑ motivation. Severe: +3 or +++  There’s scattered focus. mental block. ↑ attention. physical pain. According to Sigmund Freud: anxiety is due to repressed ID→ repressed anger & unreleased sexual drive→ anxiety c. Be alert b. Mild: +1 or +  There’s total focus. keeps on complaining  Can be therapeutic with supervision & used palliative coping (watching TV) 3.72 b. do the following except: a. Stay calm c. Encourage problem solving Answer: C Normal Within the world of reality so there is resolution of crisis Restored homeostasis Aware of reality Anxiety With same amount of stress but resolution of crisis markedly prolonged to Can return to equilibrium Handled by psychiatrist as outpatient Mild symptoms Ignores reality Builds castle in the air Borderline Resolution of crisis is outside of reality & within the reality of world Does not go back to normal equilibrium Psychosis Reality disregarded (disorganized) Deteriorating Handled as inpatient Severe symptoms Denies reality. selective inattention. Moderate: +2 or ++  There’s partial focus.

Assist patient in developing adaptive coping responses-ultimate nurse goal b. danger or catastrophe  Symptoms: a. exercise. constant worry & apprehension occurring for more than 6 months  There is feeling of impending doom. The client is objective. difficulty concentrating. Temporary relief allows the client to return to problem solving Unsuccessful attempts to Anxiety is being ignored by decrease the anxiety going to a movie and then without attempting to solve handled by frantically .73 Defense mechanism: Displacement Undoing Obsessivecompulsive Psychotherapy Anxiolytics Pathological defenses: Projection Introjection ECT Neuroleptic Subtypes of Anxiety Disorder: 1. Generalized Anxiety Disorder (GAD):  Excessive generalized non specific fear. irritability d. feeling keyed up or on edge b. sleep & relaxation 7) Realize that some anxiety is part of living Types of Coping Adaptive Description Solves the problem that is causing the anxiety. restlessness. Teach the client to: 1) Be kind to self & appreciate self 2) Be less critical of self 3) Maintain high self esteem 4) Share feelings when upset or restore self esteem when lowered 5) Identify physiological symptoms of anxiety 6) Manage stress with diet. rest. muscle tension  Nursing Interventions: a. being easily fatigued c. sleep disturbance. rational and productive Normal Use Anxiety about the upcoming examination is reduced by studying effectively & passing the examination with a grade A Anxiety is temporarily reduced by jogging. Effective studying is then possible and a grade of a is still achievable Palliative Maladaptive Temporarily decreases the anxiety but does not solve the problem and anxiety eventually returns.

scrutinized or embarrassed in public c. Misophobia-fear of dirt  Defense Mechanism used: Displacement  Treatment: Behavior Therapy a. type of phobia wherein parents can be legally implicated (USA)→ bring the child to school immediately to avoid fixation (behavior therapy) d. it may be severe. Self exposure treatment 3. Panic Disorder  Panic attacks: a. Systematic desensitization (BQ)-gradual introduction of the feared object b. Flooding (Exposure/Implosive by D. unexpected & with no obvious precipitating factor b. becomes difficult and new A grade of F resulted problems begin to develop Dysfunctional 2. drinking and then Even minimal functioning escaped by passing out. Social phobia-fear of being humiliated. may occur in anticipation of or upon exposure to a trigger  is an attack that lasts for an hour. Simple phobia-fear of specific object or situation like fear of animals. Agoraphobia-fear of being in public or open spaces or situations where escape could be difficult or impossible. lasting for hours after an attack d. reaching a peak in approximately 10 minutes accompanied by: . Wolfe)-sudden introduction of the feared object c. activity or event  Anxiety detached from original source & attached to specific object  Patient knows it is irrational & abnormal but if not entertained produces anxiety  Types: a. usually occur suddenly. Phobic Disorder  Irrational fear of a specific object. Coitophobia-fear of coitus e. worst among the phobias because it results to house bound syndrome b. accompanied by intense fear or discomfort c. fear is due to separation anxiety from leaving the mother. remains A passing grade of C is obtained Is not successful in reducing Anxiety about the anxiety or solving the examination is ignored by problem. flying or heights • Example: School phobia-the most common among all phobias. going out. frightening & incapacitating e.74 the problem→ the anxiety cramming for a few hours.

feeling that one is going crazy d. chest pain. impulses or images that are experienced as intrusive & senseless  Compulsions are repetitive behaviors that are performed in a particular manner in response to an obsession & performed to prevent discomfort & neutralize anxiety . child rearing demands. Acute Stress Disorder (ASD)-resolves within 4 weeks or a month c. receptor hypersensitivity to serotonin or GABA  Nursing Interventions: a. fear of loss of control e. decreased cognitive abilities  Etiology: a. numbness & tingling sensations. Do not touch the patient during the attack 4. Adjustment Disorder-symptoms occur within 3 months but not more than 6 months after an identifiable event like separation. decreased perceptual ability f. choking sensations. Maintain calm demeanor c. Patients often use drugs. more severe than normal stress & grief process but less severe than ASD & PTSD  Normal grief process→ can not adjust→ Adjustment Disorder→ can not adjust→ PTSD→ can not adjust→ Psychosis: Schizophrenia or Depression  Symptoms: a. trembling & diaphoresis b. Provide brown bag for hyperventilation e. Biologic vulnerability-irregularities in synthesis & release of Ne. dizziness & nausea. Exaggerated startle response b. sudden marriage. retirement. Nightmares & flashbacks e. Sleep disturbances c. Speak in short simple sentences d. Normal Stress Reaction-last for a whole day then function is resolved b. Post Traumatic Stress Disorder (PTSD)  is re-experiencing a traumatic event through flashback. carbon dioxide or Na lactate c. DOB. feeling that one is having a heart attack c.75 a. Genetically transmitted b. alcohol or self medicate for distressful symptoms 5. Anger with numbing of other emotions f. nightmares & depression occurring for more than 6 months  Differentiated from: a. Stay with the patient during the attack b. physiologic symptoms: racing heart. Guilt d. Obsessive Compulsive Disorder (OCD)  Obsessions are recurrent & persistent thoughts. ideas. Induced by caffeine.

preconscious and unconscious must function as a unitary whole  during a highly traumatic event→ there is splitting of conscious from preconscious & unconscious to have emotional stability & if splitting does not occur psychosis develops Etiology: 1. Ineffective Coping C. deep breathing exercises. Provide an outlet like relaxation techniques. Analysis or Nursing Diagnosis: 1. Determine if it is really anxiety 2. Dissociative Disorders  there is removal from conscious awareness of painful feelings. fun & humor 6. Allow patients to do their rituals b. Show empathy like “It must be difficult on your part” 7. Sexual & physical abuse in early childhood . Implementation: 1. stress reduction techniques. Assess B. Determine the source of anxiety 4. memories.76  OCD patients recognize that the thoughts are products of their own minds & they know that they are ridiculous or morbid but cannot stop or control them therefore the thoughts become distressful & anxiety provoking  OCD patients perform rituals which are coming from guilt laden conscience to relieve anxiety  Defense Mechanism used: undoing  Nursing Interventions: a. Anger Management VII. Determine own anxiety (on the part of the nurse) 5. Provide a non-stimulating environment 8. Provide alternative that will entail perfections like folding linens d. Determine the level of anxiety 3. Trauma 2. Behavior therapy: also known as exposure treatment where OCD patients are exposed to feared stimuli & then resist the urge to perform rituals Nursing Interventions: A. Anxiety 2. walling off or alteration of one’s consciousness  the conscious. Set limits if it is already affecting physical integrity c. Provide assertiveness technique due to low self esteem making him responsible for his actions & decisions 9. thoughts or aspects of identity  there is removal from consciousness of a highly traumatic event  there is splitting off.

77 Types: 1. recurrent. does not know the 2 alter 2) Eve’s alter 1-good eve (SE) 3) Eve’s alter 2-bad eve (ID) • Treatment: do insight oriented through hypnotherapy • causes staff splitting 4. Somatoform Disorders  formerly known as psychosomatic disorders included in anxiety disorder  are a group of disorders where patient unconsciously manifest bodily signs and symptoms without organic basis (or an adequate medical explanation can not be found)  compared to malingering which is consciously manifesting physical complaints to achieve personal gain (BQ) commonly seen among patients with antisocial personality disorders 5 Specific Somatoform Disorders: 1. Dissociative amnesia-there’s loss of memory of important personal events that are traumatic or painful 2. Dissociative identity disorder • formerly known as multiple or split personality because there is presence of two or more identifiable personalities that take control of the person’s behavior • loss of memory for important personal information • change of personality is dramatic • patients are confined because there are instances that the alter ego will commit suicide • 3 faces of Eve:1) Eve-host. Dissociative fugue • sudden. unexpected travel away from home or work with a loss of memory about the past • confusion about identity or assumption of partial or completely new identity is present • takes one personality only • Purpose of fugue: to carry out what the ego desires but what the SE prohibits meaning ignoring reality 3. Depersonalization • experiences of feeling detached from or an outside observer of one’s body or mental processes • reality testing is intact (oriented to time. person or place) VIII. Somatization Disorder • is characterized by frequent. multiple physical complaints that may warrant medical treatment or even surgical intervention .

78 • defense mechanisms used: repression. Pain Disorder • is characterized by symptoms of pain where there’s only one localized area and site does not change 3. worry of having illness or fear of having serious illness based on misinterpretation of symptoms • fear of getting illness (makukuha)→ fear of having the illness (meron na) ↓ ↓ Obsessive-compulsive disorder hypochondriasis • defense mechanisms used: repression & regression • patients are usually narcissistic • nearest to psychosis 4. Conversion Disorder • is characterized by one physical disability (BQ) which will be on the voluntary muscle or sensory function • example: student has paralysis of the upper arm during examination 5. displacement & denial • patients do doctor shopping for 2 years (Doctor Shopper) • onset is usually before 30 years old • there’s multiple areas of pain 2. Antidepressants 2. Psycho-physiological Disorders  also known as psychosomatic disorder or psychological factor affecting medical condition  are physical diseases in which emotional factors play a very important role Psycho-physiologic disorders Physical diseases Involuntary muscles (smooth muscle) Male expresses physiologically stresses Somatoform disorders Merely physical symptoms Voluntary muscles (those in contact with external world) psycho. Anxiolytics IX. attention & material rewards) Nursing Interventions: 1.Female expresses stresses symbolically . Accept the patient in emotional pain 2. Hypochondriasis • is characterized by somatic preoccupation. Anticipate needs so as not to feed on secondary gains 3. La Belle Indifference (BQ) • is characterized by unconcerned over the physical disability & enjoys being sick because patient has primary (anxiety is relieved) and secondary gain (sympathy. Be non judgmental because they are really suffering from physical distress Medications: 1.

Reduced demands on client 2. Genetics Media violence 2.79 If emotional condition is not treated or resolved. maladaptive & rigid→ causes significant functional impairment or subjective distress→ personality disorders  are disorders wherein the individual does not adjust to life instead exhibits behavioral problems  are inflexibilities to various life situations  clients show deeply ingrained & maladaptive patterns which start as early the time SE formation  client don’t mature. Care for the total person both physical as well as emotional 3. Repression 2. Conversion 3. don’t learn from their experiences and don’t find their behaviors distressing to themselves→ because of others’ reactions or behaviors towards them→ feel distressful→ causing immense emotional pain and discomfort. Displacement 3. Psychopathology: 1. Temperament Substance abuse and affection Disturbed parent-child 3. Chaotic Family dynamics 1. Low frustration tolerance Causes of Conduct Disorder (< 15 years old) Antisocial Disorder (> 15 years old) --------------------------------------------------------------------------------↓ ↓ ↓ Psychological Neurobiological Lower Socio-economic status 1. it may lead to structural damage or life threatening event Defense Mechanisms: 1. verbal is different from the non verbal meaning 4. Lack of parental empathy 2. Anger Management 4. Psycho-physiologic regression No organic pathology or sometimes with a pathology but the somatoform signs and symptoms are inappropriate Defense Mechanisms: 1. Denial Nursing Interventions: Same with anxiety disorder plus the following 1. Faulty ego structure (SE) 3. Personality Disorders  Personality is defined as the totality of emotional & behavioral traits that makes an individual unique→ becomes inflexible. Learned behavior dysfunction chronic interaction) . Displacement 4. Teach client assertiveness training 6. Encourage expression of feeling X. not capable of deep lasting relationship 2. Unstable or inconsistent family pattern (Father is lenient & mother is strict) 3. Product of broken homes-resiliency. Stress Management Technique 5. Projection 2. Neurobiological relationship (rejection and 4. Family uses double blind communication: one message is sent with 2 meanings.

telepathy or 6th sense 3. detached or flat affect Cluster C Behaviors: Anxious Fearful 1. Suspiciousness or paranoid ideation 6. Schizotypal 3. Believes in superstitions. Excessive social anxiety Treatment: Defense Mechanism: Fantasy Treatment: . Borderline 3. Ideas of reference 2. Narcissistic Cluster A: Paranoid (Suspicious) Major Feature: Pervasive distrust and suspiciousness of others Schizoid (Asocial) Major Feature: Pervasive pattern of detachment from social relationships Indicated by 4 or more of Indicated by 4 or more of the following: the following: 1. Recurrent suspicion as to fidelity or sexual partner Defense Mechanism: Projection Treatment: 7. Unusual bodily illusions 4. Deceitfulness-stealing & lying 4. Paranoid 1. Lacks sexual experiences 3. Holds grudges 6. Reacts angrily when he perceives attacks on him 7. Reluctant to confide and 4. Avoidant 2. clairvoyance. Serious violations of rules-running away from home & truancy Classification of Personality Disorders: Cluster A Cluster B Behaviors: Odd Behaviors: Dramatic Eccentric Emotional Erratic 1. Interprets remarks as demeaning or threatening 5.80 --------------------------------------------------------------------------------↓ Behaviors associated with Conduct Disorder 1. Obsessive-compulsive Schizotypal (Eccentric) Major Feature: Pervasive pattern of social & interpersonal deficits Indicated by 5 or more of the following: 1. Aggression to people & animals-cruelty & disrespect 2. Lacks close friends against him 6. Suspects without 1. Schizoid 2. Chooses to be alone loyalty 3. Dependent 3. Histrionic 4. Avoids activities fear that it will be used 5. Cold. circumstantial or metaphorical speech 5. Inappropriate or constricted affect 7. Appears indifferent to praise or criticism 4. Lacks desire. eccentric or peculiar behavior 8. Destruction of property-fire setting 3. Lacks close friends 9. neither sufficient basis enjoys close relationships 2. Antisocial 2. Odd. Doubts trustworthiness or 2. Vague.

Grandiose self importance 2. Envious of others 9. Anti-depressant b. Inappropriate sexually seductive or provocative behavior 3. Recurrent suicidal behavior. gestures. Anti-anxiety agentsa.Frantic efforts to avoid real or imagined abandonment 2. Foster trust by being non intrusive 2. Against societal norms 2.81 1. Lack of remorse or guilt Borderline (Unstable) Main Feature: Pervasive pattern of instability of interpersonal relationships. affect and marked impulsivity Indicated by 5 or more of the following: 1.Unstable and intense interpersonal relationships 3. power. Sense of entitlement 6. Rapid mood shifts and irritability 7. need for admiration and lack of empathy Indicated by 5 or more of the following: 1. Anti-psychotic Diazepam (Valium) b. Anti-psychoticc. Requires excessive admiration 5. Intense and uncontrollable anger 1. Uncomfortable in situations he is not the center of attraction 2. brilliance. Uses physical appearance to draw attention to self 5. threats or selfmutilating 6. Takes advantage of others 7. Dramatic and Narcissistic (Egotistic) Main Feature: Pervasive pattern of grandiosity. Believes that he is special 4. Displays rapidly shifting and shallow emotions 4. Arrogant. beauty or love 3. Behavior Therapy 2. Individual Psychotherapy 1. Preoccupied with fantasies of unlimited success. Individual Psychotherapy 2. Deceitfulness 3. Impulsivity 4. Irresponsible in work and finances 7. Gently encourage participation in social activities Cluster B: Antisocial (Aggressive) Main Feature: Pervasive pattern of disregard for and violation of the rights of others occurring since age 15 years Indicated by 3 or more of the following: 1. Pharmacotherapy: 3. Lacks empathy 8. self image. Irritability and aggressiveness 5. Pharmacotherapy: a. Speech is excessively impressionistic and lacking in detail 6. haughty behaviors or . Psychotherapy 2. Identity disturbance 4. Show empathy 3. Pharmacotherapy: a. Psychostimulant Thioridazine (Melleril) Pimozide (Orap) Nursing Interventions: 1. Impulsivity 5. Anti-psychotic Histrionic (Gregarious) Main Feature: Pervasive pattern of excessive emotionality and attention seeking Indicated by 5 or more of the following: 1. Group Therapy 3. Recklessness 6. Chronic feelings of emptiness 8.

Self help groups 1. . Transient stress related paranoia or dissociative symptoms Cluster C: Avoidant (Withdrawn) Major Feature: Pervasive pattern of social inhibition. Antidepressant (MAOIs) b. mental & interpersonal control Indicated by 4 or more of the following: 1. Exaggerated intimacy with others Defense Defense Mechanism: Mechanism: Splitting-all good Repression and all bad (BQ) Dissociation Treatment: Treatment: Treatment: Treatment: 1.Psychotherapy 1. feelings of inadequacy and hypersensitivity to negative evaluation Indicated by 4 or more of the following: 1. Psychoanalytic1. Antipsychotic 2. objective & non judgmental 2. Antidepressant (Ritalin) b. Antidepressant a. perfectionism. Pharmacotherapy: psychotherapy (Eskalith) Methylphenidate a. setting limits. Behavior Therapy oriented a.3. Anticonvulsant Carbamazepine (Tegretol) Nursing Interventions: 1. Easily influenced by others 8. Pharmacotherapy: 2. Unified Team Approach: consistency among staff & accountability among clients 3. Encourage the use of foam bats 4. Preoccupied with details.82 exaggerated attitudes emotions 7. Lithium Psychostimulant. Antipsychotic Alprazolam (Xanax) d. Matter-of-Fact Approach: firmly consistent. Anti-anxiety c. Journaling 9. Pharmacotherapy: b. Avoids interpersonal Dependent (Submissive) Major Feature: Pervasive and excessive need to be taken care of leading to submissive and clinging behavior and fears of separation Indicated by 5 or more of the following: 1. Pharmacotherapy: 2. Needs excessive amount OCPD (Conforming) Major Feature: Pervasive pattern of preoccupation with orderliness. Benzodiazepine c.

undoing Isolation. Free association 2. Unwilling to get involved with people 3. Feels inept. Over conscientious. Money is hoarded for future 8. Pharmacotherapy: a. intellectualization Treatment: 1. Fear of being criticized or rejected 5. Perfectionist or overly strict standards 3. order. Anorexia Nervosa Definition: an eating disorder that is characterized by voluntary refusal to eat and maintaining body weight. there is no real anorexia and no loss of appetite but often suppress their hunger. Feels helpless when alone 7. Clomipramine (Anafranil) c. Restrains intimate relationship for fear of being shamed or ridiculed 4. Antidepressants c. Group therapy 5. unappealing or inferior 7. Common among adolescent and young adult: 12-18 years old 2. Needs others to assume responsibility 3. Serotonergic agent: Fluoxetine ( ) XI. Insight-oriented therapy 2. lists. scrupulous and inflexible 5. schedules or organization 2. Unable to discard worthless objects 6. Rigidity & stubbornness Treatment: 1. Anti-anxiety agents b. Behavior Therapy: Assertiveness training 3. 90-95% common among females 3. Family therapy 4. Group Therapy 2.83 contact for fear of criticism. disapproval or rejection 2. Non directive therapy 3. Seeks another relationship urgently after another close relationship 8. Mortality Rate: 15-20% . Unrealistically ear of being left alone rules. Serotonergic agents Defense mechanism: Rationalization. Imipramine (Tofranil) b. Feelings of inadequacy 6. Volunteers to do things that are unpleasant to obtain support 6. B-blockers-Atenolol (Tenormin) Treatment: 1. Clonazepam (Klonopin)-a benzodiazepine with anticonvulsant use b. Lacks self confidence 5. Reluctant to engage in new activities of advice & reassurance from others to make decisions 2. Excessive devotion to work excluding leisure 4. Reluctant to delegate work to others 7. Pharmacotherapy: a. a weight phobia and self imposed dieting Incidence: 1. Can’t express disagreement with others for fear of loss of support or approval 4. Eating Disorders 2 Types of Eating Disorders: I. Behavior therapy: Assertiveness training 3. Pharmacotherapy: a. Benzodiazepines c.

History of being a model child: high achiever. Amenorrhea for 3 months 4. Cultural Theory: thinness is valued by society 2. Short term goal: steadily maintain an increase in weight of 2-3 lbs/week e. Prognosis: 21% die of malnutrition and 17-77% recover Psychopathology: 1. Ineffective family and individual coping 4. Measure I and O of client b. Allow client to express their feelings b. Hypothermia 6. Common among adolescents and early adults: 17-23 years old . Altered Nutrition: less than body requirements 2. Stay with client at least 1 ½ -2 hours during and after feeding because they usually induce vomiting c. History of high activity (athletic) & achievement in academics 3. Chronic low self esteem 3. Analysis: 1. favorite of the family→ child conforms to the image→ but because parents control them. Use matter-of-fact attitude because of their manipulative behavior II. Bulimia Nervosa Definition: an eating disorder that is characterized by recurrent binge and purge cycle 2x/week for 3 months Incidence: 1. Physical Aspect a. Never allow the client to leave the table during mealtime d. Emotional Aspect a. child becomes negative→ there is power struggle→ so child tends to control their body weight resulting to anorexia 3. Weight loss of 15% or more of original body weight without apparent reason 2. Schedule client for a session with nutritionist d. Implementation: 1. Distorted body image: child sees self in the mirror as being fat Signs and Symptoms: 1. Assess: Signs and Symptoms B. Altered family processes C. source of family happiness. History of dieting 5. Long term goal: presence of menstruation (BQ)-indicates recovery from anorexia 2. Remove table napkin or tissue paper around the client during meals e. Presence of lanugo Nursing Interventions: A. Weigh client 3x/week at the same time and check if client drinks water before being weighed c.84 4.

Group therapy . Both experience fear of becoming fat and has distorted body image 2. Identify the individual at risk 2. Praise simple accomplishment 3. Low self esteem Differences between Anorexia and Bulimia: Anorexia nervosa Bulimia nervosa Usually found in adolescents Common among college graduates Underweight Above average weight or slightly obese No insight and very hard to treat With insight Primary and Secondary Level of Prevention of eating Disorders: 1. Individual therapy b. erosion of teeth enamel appearing like teeth of rats 4. Recurrent episode of “binge” eating characterized as voracious 20x daily caloric intake in less than 2 hours and a sense of lack of control 2.4% affects men 3. Intense preoccupation with weight and dieting 3. Self induced vomiting producing wounds on throat & fingers. Recurrent inappropriate compensatory behavior in order to prevent weight gain 3. Associated with guilt when full and depression 3. Implementation: 1.85 2. Empathy Similarities between Anorexia and Bulimia: 1. Binge on CHO (↑ serotonin level) done on a secret place 2. Establish a trusting relationship with the client 2. Be alert of the most vulnerable time for onset of symptoms like life changes that involve separation from significant others Treatment of Eating Disorders: 1. Prognosis: good if identified early but tends to be episodic with remissions & relapses Diagnostic Criteria: 1. 1-4. Assess B. The binge eating & compensatory behaviors both occur on average at least 2x a week for 3 months Signs and Symptoms: 1. Educate people about the potential risk of the disorder 3. 0. Analysis: same with anorexia C. Outpatient Therapy a. Family therapy to determine the underlying cause c. Abuse of laxatives and purgatives Nursing Interventions: A.5% affects females.

Cognitive Behavior Technique: 1) Psycho-education: tell client they can manage their own lives 2) Meal Planning: opportunity to plan their own meals 3) Introduction of avoided food 4) Self Monitoring 5) Stimulus Control: self hypnosis 3. Transvestism (Cross dressing)-gratification by wearing the dresses of opposite sex. Sexual expression depends upon the culture and the individual whether it is acceptable or not 5. If it is the sole means of gratification b.86 2. hard to treat. Improve Family Interaction: improve relationships between parents and child XII. Social learning and labeling-learns behavior specifically during adolescence 4. Cultural Theory: depends on where the client is from Classification: 1. If it causes to develop guilt or anxiety . Gender Identity Disorder  Gender identity: a person’s psychological sense of maleness or femaleness  Are disorders characterized by the confusion between the anatomical parts and psychological orientation  Types: a. Cognitive switch-says an infant (1 ½ years old) is neutral but the moment it goes into phallic development then child decides gender (boy or girl) 3. Sexual Disorders Psychopathology: 1. heterosexual relationship with parents is important 7. Inpatient Therapy a. Biological imperative-brain decides whether a person is a man or woman 2. Transexualism-believes that he is trapped in a female body. managed by Behavior Modification-thought stopping b. easier to treat. Hospitalization to a medical unit b. If the sexual act is being used for > 6 months c. Hormonal imbalance 6. Freudian Theory: during the phallic phase. Paraphilias  false sexual intimacy that becomes an abnormality only if it is the only means of gratification  are disorders characterized by specialized sexual fantasies and intense sexual urges & practices  sexual perversion or deviations  4 Criteria to call sexual act as perversion: a. managed by Aversion Therapy-ecstatic experience (pleasant effect of cross dressing) will be coupled with an unpleasant stimuli (ECT) 2. Behavior Modification: token economy (reward system) and (+) reinforcement c.

Sexual sadism-giving pain g. Zoophilia (Bestiality)-animals l. Sexual Desire Disorder 1) Hypoactive-absence of sexual fantasies & desire for sexual activity 2) Sexual Aversion-aversion to & avoidance of genital sexual contact with sexual partner b. Satyriasis-over sex male s. Masturbation-direct stimulation of genitals with hand or fingers p. Frotteurism-use of friction or rubbing d. Sodomy (Screw driver)-inserting penis into the male anus u. Exhibitionism-exposure of one’s genitals to stranger b. Pedophilia-sexual arousal towards children 13 of age & younger e. Sexual masochism-receiving pain f. Klismaphilia-introducing enema into the anus n. Coprophilia-desire to defecate on a partner 1) Coprophagia-eat feces 2) Coprolalia-utterances of obscene words m. Necrophilia-dead people or cadavers j. Sexual Arousal Disorder 1) Female-failure to attain excitement . Voyeurism (peeping tom)-observing naked people or in sexual activity h. Urophilia-desire to urinate on a partner o. If done to a non consenting person like children  Forms of Sexual Deviations: a. Buggery-inserting penis into the female anus 3. Partialism-focuses on one part of the body 1) Cunnilingus-licking the female genitals 2) Fellatio-licking the male genitals 3) Anilingulus-licking the anus k. Nymphomania-over sex female t. Sexual Dysfunctions  Failure to initiate and complete a sexual cycle (excitement-plateau-orgasmresolution)  Types: a.87 d. Soixante neuf-69 or 88 position r. Hypoxyphilia-oxygen deprivation q. Fetishism-sexual focus is on objects c. Telephone Scatologia-obscene phone calling i.

Being willing & able to explore & separate personal values & attitudes from those of clients e. Indications: a. Treatment modality focus on Physical Therapy A. Orgasm Disorder 1) Anorgasmia-absence of female orgasm 2) Male orgasmic disorder-failure to achieve ejaculation 3) Premature Ejaculation-failure of the penis to gain voluntary control d. Major Depressive illness that has not responded to antidepressant medication or in-patients unable to take medication b. Self awareness c. Having skills in communication techniques c. Concrete & comprehensive knowledge of the sexual function & dysfunction b. Definition: induction of a brief & artificial convulsion by passing an electrical current through electrode applied to one or both temples 2. Prevent any sexual activity PHARMACOTHERAPY I. Being comfortable with their own sexual values & expressions d. intervene & evaluate care to promote optimal sexual health f. Never let your own sexual values affect the sexual orientation of your clientdon’t be moralistic & don’t impose your own standard  Nursing Responsibilities: a. Accept the person in great emotional pain b.88 2) Male-failure to attain erection c. Sexual Pain Disorder 1)Dyspareunia-pain during sexual intercourse 2)Vaginismus-continuous contractions of the vaginal wall  Nursing Interventions: a. Bipolar disorder in which the patient has not responded to medication . Becoming proficient in using the nursing process to assess. Electroconvulsive Therapy (ECT) 1. diagnose.

5 to 2 seconds) • Applied uni-temporal. Nursing Considerations: a. Anti-Psychotic Drugs (Neuroleptics or Major Tranquilizers):  Patients are given ECT & drugs so that patient will be amenable to other forms of therapy . Administration: a. Before ECT • Medical history. Medications: Atropine Sulfate-reducing secretions by blocking vagal stimulation Succinylcholine (Anectine)-a muscle relaxant that reduce grand mal seizures Anesthesia with short acting barbiturate b.89 c. Acutely suicidal patients who have not received medication long enough to achieve a therapeutic effect d. Temporary loss of memory for 3 to 6 months B. place & person • Document all treatments 5. turn the patient on his side to prevent swallowing of saliva 4. After ECT • Provide comfort • Remain with the client until alert • Orient patient as to time. complete physical. bi-temporal or frontal for 3 consecutive days/week from 6 to 12 treatments • Patient goes into grand mal seizure • When convulsion subsides & breathing is resumed. Side Effects: a. Hypertension d. Procedure: • Make patient lie with back resting on a pillow to promote hyperextension of the spine preventing fracture of the vertebrae or dislocation • Let patient bite mouth gag • Apply electrode jelly on the temple to ensure complete contact • 2 assistants support shoulder & wrist joints and another one to support the knee • Terminal plugs are inserted into electrodes using 90-110 volts in a split of second (. Weight gain c. Headache b. For elders with history of hypertension & cardiac illness 3. neurological & laboratory examination • Obtain informed consent • NPO after midnight • Check for dentures b.

Impaired Ejaculation 6. nasal (Thorazine. gait or ocular movement occurring 1-2 days a) Opisthotonus . Photosensitivity 5. emotional quieting. Neuroleptic Malignant Syndrome (NMS) Other Side Effects: 1. photophobia. Amenorrhea 3. Laractyl)-sedating effect 2. Extrapyramidal Symptoms: 1st 24 hours will observe the following 1) Dystonia-rigidity in muscles that control posture.90  Used to treat severe mental illness such as Schizophrenia. Anticholinergic 2. Serenace)-highly potent Side Effects: a. Can trigger diabetes & heart disease Classification based on Potency (Keltner): High Potency: Butyrophenone: Haloperidol Less sedating (Haldol. Proma. Laractyl. Haloperidol (Haldol.Prolixin. Psynor) congestion. Postural hypotension-Chlorpromazine b. Jaundice 2. Antiadrenergic 3. Permitil) Thiothixene (Navane) Piperazine: Trifluoperazine (Stelazine) Fluphenazine (Prolixin) Moderate Potency Dibenzoxazepine: Loxapine (Loxitane) Dihydroindolone: Molindone (Moban) Piperazine: Perphenazine (Trilafon) Low Potency Aliphatic: Anti-cholinergic SE: dry mouth. Serenace) More EPS Thioxanthene: Flupentixol (Fluanxol. Extrapyramidal Symptoms (EPS) 5. blurred Chlorpromazine vision. Chlorpromazine (Thorazine. Agranulocytosis 4. Manic Depression and Paranoia  It blocks dopamine receptors  Desired Effects: sedation. psychomotor slowing & alleviating of major symptoms of Schizophrenia Major Categories of Side Effects: 1. mydriasis. Proma. Galactorhea 4. urinary retention Promazine (Promazine. Sparine) Anti-adrenergic SE: hypotension Chlorprothixene (Taractan) Tachycardia Piperidine: Mesoridazine (Serentil) Thioridazine (Mellaril) Typical Anti-psychotic: Cheaper 1.

Alcohol has potentiating effect III. Relative lack of EPS 2. Ziprasidone (Zeldox) II. Olanzepine (Zyprexa) 4. High incidence of life threatening agranulocytosis therefore monitor laboratory weekly for 18 months. Antidepressant  Allows 2-3 weeks for therapeutic effects to kick in  Be careful during this time as symptoms have not yet resolved A. less side effect but expensive 1. monthly thereafter b. sore throat & gum bleeding e. Clozapine (Leponex)-given for 18 weeks Side Effects: a. mask-like face occurring 1-4 weeks 4) Tardive dyskinesia-late appearing involves the muscles of mouth & face a) Blinking of eye b) Protrusion of tongue c) Lip smacking d) Grinding of teeth c. Drowsiness c. Quetiapine (Seroquel) 6. Benzodiazepines: Diazepam (Anxionil. Anticholinergic effects . High rate of seizure c. rigidity & tremors Atypical Anti-psychotic: Newer drug. Amisulpride (Solian) 5. Never give coffee because antagonistic d. Anxiolytic 1. Photosensitivity d. Tricyclic antidepressant: blocks neurotransmitter re-uptake of serotonin. Neuroleptic Malignant Syndrome-uncontrollable fever. Agranulocytosis-fever. norepinephrine & dopamine Welcome Effects: Sedation Improved appetite Side Effects: 1. Trazepam & Valium) Clorazepate (Tranxene) Bromazepam (Lexotan) Alprazolam (Xanor) 2. Risperidone (Risperdal) 3. Habituation b. Hydroxyzine diHCL: Iterax Side Effects: a.91 b) Difficulty talking c) Difficulty swallowing d) Drooling of saliva e) Oculogyric crisis 2) Akathisia-motor restlessness (stomping feet) occurring 1-6 weeks 3) Parkinsonism-pin rolling movement.

an enzyme involved in inactivation of norepinephrine. New: Dothiepin HCL (Prothiaden) B. Headache & dizziness 3. MAO Inhibitor:  Blocks monoamine oxidase. Avoid tyramine rich food: aged cheese (can give white & cheddar cheese) 2. Seroxat)-16x more potent than Prozac .High anti-cholinergic & sedative effect First line of drugs for Panic Disorder Amitriptyline (Elavil)Most cardiotoxic & orthostatic hypotension High anti-cholinergic & sedative effect 2. Hyperthermia 3. Hyperreflexia 2. Fluoxetine (Prozac) 2. refrigerated food & caffeine  If the not allowed food are given. it can cause hypertensive crisis Serotonin Syndrome: potentially lethal consequence of combining serotonin-enhancing psychotropic drugs such as: 1. Do not give banana. NMS C. cold & asthma tablets. Tranylcypromine (Parmate) 2. GIT symptoms: nausea. Decreased libido  Types: 1. Clomipramine + MAOI Signs & Symptoms of Serotonin Syndrome: 1. anti-cholinergic & sedating effects  Side Effects: 1. Blocks alpha 1 adrenergic receptors on peripheral blood vessels causing edema Examples: 1. May increase energy for suicide 5. SSRI + MAOI 2.92 2. Phenelzine (Nardil)  Difficult to administer because client has to change diet: 1. red wine. serotonin & dopamine→ end results increased neurotransmitters 1. Paroxetine (Paxil. beans. Selective Serotonin Re-uptake Inhibitor (SSRI)  Less cardiac side effects. Myoclonus 4. MAOI + L-tryptophan 3. Trigger cardiac arrhythmia 4. Orthostatic hypotension 3. vomiting & diarrhea 2. Old: Imipramine HCL (Tofranil).

Quilonium R)  Narrow therapeutic index (0. Valproic Acid (Depakene) C. calcium channel blocker & ACE inhibitor . Sertraline (Zoloft)-5x more potent than Prozac D. antihistaminic or adrenergic effects  It has a lower potential for drug interaction than other antidepressants & does not exaggerate the effects of alcohol  Example: Venlafaxine (Efexor) IV. Excessive Thirst 5. Anti-Manic (increased norepinephrine)  Peak Effect: 7-10 days so while trying to achieve the peak level. Giddiness 2.2 Meq/L). Anorexia 3. LBM 2. give mannitol B. Convulsion  Signs & Symptoms: 1. Lithium Carbonate (Lithane.6 to 1.93 3. give neuroleptics (Thorazine or Haldol) A. Nausea & Vomiting  Do not give with antacids  Do not give NSAIDs & Diuretics causes lithium toxicity but if there’s toxicity. Tinnitus 3. Convulsion 4.5 to 2 Meq/L)  Hyponatremia: increases lithium Hypernatremia: decreases lithium  Give 3-6 grams of NaCl & 3 L of water  Side Effects: Dry mouth. toxic dose (1. nausea & diarrhea (common) Polyuria & polydipsia occurs in 70% of cases  Major Toxicity: 1. Carbamazepine (Tegretol): drug interaction with antibiotics. Selective Serotonin Norepinephrine Re-uptake Inhibitor (SSNRI)  Few if any anti-cholinergic. Blurred Vision 4.

Master your semester with Scribd & The New York Times

Special offer for students: Only $4.99/month.

Master your semester with Scribd & The New York Times

Cancel anytime.