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MENTAL HEALTH "A state of well-being where a person can realize his or her own abilities to cope with

h the normal stresses of life and work productively." (WHO) A balance in persons internal life and adaptation to reality. A state of well-being in which a person is able to realize his potentials. Criteria for Mental Health: Self-awareness Ability to: recognize ones thoughts feelings, asset potentials and weakness. experience genuine feelings as anger, happiness, resentment Leads to self-acceptance, self-understanding in order to understand others Autonomy: ability to function independently and function with others Perceptive ability Awareness of stimuli, reality orientation. Orientation to: Time, Place, Person Integral capacity: Ability to harmonize psychic forces (id, ego, super ego). Self-actuation Ability to adopt to life changes, happy to work with others Satisfaction in every endeavor Genuine cooperation Mastery of ones environment: Awareness of the changes around him

MENTAL HYGIENE A science that deals with: Promotive, Preventive, Curative, Rehabilitative aspects of care. MENTAL DISORDER A medically diagnosable illness which results in significant impairment of one's cognitive, affective or relational abilities and is equivalent to mental illness. MENTAL ILLNESS A state in which an individual shows deficit in functioning and is unable to maintain personal relationship. A state of imbalance characterized by a disturbance in a persons thoughts, feelings and behavior Factors that increase the risk: Crises, Abuses, Poverty

Psychiatric Nursing: Lecture Aid

Lester R. L. Lintao

Criteria for Mental Disorder / Mental Illness: Dissatisfaction with: ones characteristics, abilities and accomplishments ones place in the world Ineffective: interpersonal relationship coping or adaptation to the events in ones life PSYCHIATRIC NURSING An interpersonal process Concerned with all the aspects of care Both a Science and an Art Science uses different theories Art - therapeutic use of self Clientele: Individual, family and the community Both mentally healthy and mentally ill Main tool of the nurse: Therapeutic use of self Characteristics of a Good Psychiatric Nurse: Empathy Genuineness Congruence Unconditional positive regard

THE PSYCHIATRIC SETTING Admitting a Client in the Psychiatric Setting Areas to be assessed: Health perception Orientation Metabolic pattern Elimination pattern Cognitive pattern: Judgment, Insight, Memory Activity and exercise pattern Thought process Sleep-rest pattern

Psychiatric Nursing: Lecture Aid

Lester R. L. Lintao

COMMON BEHAVIORAL SIGNS AND SYMPTOMS Disturbance in Perception Illusion - misperception of an actual external stimuli Hallucination - false sensory perception in the absence of external stimuli
Management: Acknowledge the feelings Reorient to reality Provide distractions

Neologism - pathological coining of new words Circumstantiality - excessive inclusion of details Word salad - incoherent mixture of words and phrases Flight of ideas - shifting of one topic from one subject to another in a somewhat related way Looseness of Association - shifting of a topic from one subject to another in a completely unrelated way Verbigeration - meaningless repetition of word or phrases Perseveration - persistence of a response to a previous question Echolalia - pathological repetition of words of others Stilted language use of flowery words Clang association - the sound of the word gives direction to the flow of thought Delusion fixed, false belief which cannot be corrected by appeal or logical reasoning Grandeur - an exaggerated belief of identity Nihilistic - the client denies the existence of self or part of self Persecution - belief that he or she is the object of environmental attention and being singled out for harassment Self-depreciation - worthlessness or hopelessness Somatic - false belief to body function

Disturbances of Affect Inappropriate affect - disharmony between the stimuli and the emotional reaction Blunted affect - severe reduction in emotional reaction Flat affect - absence or near absence of emotional reaction Apathy - dulled emotional tone Lability of affect rapid mood swings

Psychiatric Nursing: Lecture Aid

Lester R. L. Lintao

Disturbances in Motor Activity Echopraxia - the pathological imitation of posture/action of others Waxy flexibility - maintaining the desired position for long periods of time without discomfort Akinesia - loss of movement Bradykinesia - slowness of all voluntary movement including speech Ataxia - loss of coordinated movement Automatism - repeated purposeless behavior Disturbances in Memory Confabulation - filling in of memory gaps Amnesia - inability to recall past events Anterograde - immediate past Retrograde - distant past Dj vu - a subjective feeling that an experience which is occurring for the first time has been experienced before Jamais vu a feeling that the familiar does not seem familiar Dementia gradual deterioration of intellectual functioning results in decreased capacity to perform ADL Other behavioral signs & symptoms Agitation a state of anxiety associated with motor restlessness Agnosia - inability to recognize and interpret sensory stimuli Akathisia - a feeling of muscular quivering, an urge to move about constantly and an inability to sit still Ambivalence - presence of two opposing feelings at the same time Delirium - refers to acute change or disturbance in a person's: LOC, cognition, emotion , perception Derealization - feeling of strangeness towards the environment Dysthymia - persistent state of sadness Elation (euphoria)- feeling of expression of excitement Mutism refusal to speak Narcolepsy - sleep disorder characterized by frequent irresistible urge to sleep with episodes of cataplexy (sudden loss of muscle power) Insomnia inability to attain enough sleep Hypersomnia excessive sleep Parasomnia abnormal sleep behavior

Psychiatric Nursing: Lecture Aid

Lester R. L. Lintao

USE OF APPROPRIATE COMMUNICATION TECHNIQUES Communication: reciprocal exchange of ideas between or among persons Modes: Verbal - written/spoken Non-verbal - posture, tone of voice, facial expression Types of Non-verbal communication: Kinesis body movement eye contact gestures Paralanguage voice quality non-language vocalization (crying, sobbing, moaning) Proxemics law of space relationship Touch physical act Cultural artifacts Meta communication based on role expectations hidden meaning of words Elements:

g Messa



Therapeutic Communication: a way of interacting in a purposeful manner to promote the clients ability to express his / her thoughts and feelings openly. Essentials for a Therapeutic Communication: Genuineness E GR A T Respect Empathy Attentive listening Trust (rapport)

Psychiatric Nursing: Lecture Aid

Lester R. L. Lintao

Barriers to Therapeutic Communication Belittling Interrupting / ignoring Giving advice Social response Changing the subject Approving / disapproving Moralizing NURSE PATIENT RELATIONSHIP

Hildegard Peplau Phase Anxiety Tasks Pre-Interaction Phase Nurse Major task: develop self-awareness begins when the includes all of what the nurse thinks and does nurse is before interacting with the patient assigned/chooses a data gathering, planning for first interaction patient patient is excluded as an active participant Orientation phase Patient Major task: establish trust and rapport when the nurse conduct initial interview patient interacts establish contract with the patient for the first time learn about the patient and his initial concerns and needs encourage the patient to feel comfortable with the meeting manage present emotions of the patient provide support and empathy of the patients feelings assure confidentiality

Psychiatric Nursing: Lecture Aid

Lester R. L. Lintao

Phase Anxiety Tasks Working / None Major task: identification and resolution of the Therapeutic Phase patient's problems it is highly planning and implementation individualized Teach more structured Learn than the Change orientation phase the longest and most productive Problems: phase Transference limit setting must the development of an emotional be employed attitude towards the nurse positive or negative Counter transference experienced by the nurse / therapist Termination Phase Patient Reinforce and reward change and strength of patient Encourage expression of feelings about termination of the relationship Summarize the progress Terminate the relationship without giving promises

THEORIES OF HUMAN DYNAMICS Psychosexual Development: Sigmund Freud Levels of Consciousness and the Psychic Forces

Psychiatric Nursing: Lecture Aid

Lester R. L. Lintao

Ego (Reality)

Superego (Moral)

Id (Pleasure)



Libido - the instinctual drives Regression and fixation are common terms in this theory. Gave prominence to sexual feelings: defined "sex" as anything that gives gratification Stages: Oral Stage (0-2 years) The area of gratification is the mouth Pleasures: sucking activities like fingers, toes or nipples Dissatisfaction: resurface at a later age overeating, smoking, nail-biting Nursing Implication: Provide oral stimulation by giving pacifiers Breastfeeding may provide more stimulation Do not discourage thumb sucking Anal Stage (2-4 years) Children's attention is focused on the anal region. Pleasure: elimination Covers the ideal age for "toilet training" (2 1/2 years) 2 concepts: Holding on Letting go

Psychiatric Nursing: Lecture Aid

Lester R. L. Lintao

Possible problems: Compulsive need to be clean and orderly Frugality and stinginess Greed Insistence on doing things at one's own rate at the expense of others Rigid training Excessive messiness and disorderly habits Nursing Implication: Help children achieve bowel and bladder control without undue emphasis on its importance. Phallic Stage (4-6 years) Pleasure: genital region activities associated with stroking and manipulating their sex organs Oedipus complex Electra complex Concept: Onset of normal homosexuality Nursing implications: Accept child's sexual interest Help the parents answer child's questions about birth or sexual differences Latency Stage (6 to 12 years) Period of calmness / stable period. Many of the disturbing behaviors are buried in the subconscious mind Their energies are absorbed by the concerns in school, peers, sports and other recreational activities Nursing Implication: Help the child have positive experiences Genital Stage (12 years & up) Oedipal feelings are reactivated toward opposite sex The person is on his/her way in establishing a satisfying life of his/her own Nursing Implication: Provide appropriate opportunities for the child to relate with opposite sex Allow child to verbalize feelings about new relationships

Psychiatric Nursing: Lecture Aid

Lester R. L. Lintao

Psychosocial Development Theory: Erik Erikson Childhood is very important in personality development. Rejected Freud's attempt to describe personality solely on the basis of sexuality believed that social factors greatly affect felt that personality continued to develop beyond five years of age. Period of Life Infant 0-18 months (Hope) Trust vs. Mistrust Toddler 18 mos. to 3 years (Willpower) Autonomy vs. Shame/Doubt Preschool 3 to 6 years (Purpose) Family Primary Person Maternal person Positive Resolution o Reliance on the caregiver o Development of trust in the environment Negative Resolution o Fear, anxiety and suspicion o Lack of care, both physical & psychological by caretaker leads to mistrust of environment o Loss of self-esteem o Sense of external control may produce self-doubt in others

Paternal person

o Sense of self-worth o Assertion of choice and will o Environment encourages independence, leading to sense of pride o The ability to learn to initiate activities, to enjoy achievement and competence

Initiative vs. Guilt Schooler Neighbors/ o Learning the value of 6 to 12 yrs. School work (Competence) o Acquiring skills and tools of technology Industry vs. o Competence helps to Inferiority order life and make things work Adolescent Peer group o Experiments with 12 to 18 yrs, various roles in (Fidelity) developing mature individuality Identity vs. Role confusion
Psychiatric Nursing: Lecture Aid

o The inability to control newly developed power o Realization of potential failure leads to fear of punishment and guilt o Repeated frustrations and failures lead to feelings of inadequacy and inferiority that may affect their view of life

o Pressures and demands may lead to confusion about self

Lester R. L. Lintao


Period of Primary Positive Resolution Life Person Young Adult Partners o A commitment to in 18 to 24 yrs. others (Love) friendship o Close heterosexual relationship and Intimacy vs. procreation Isolation Middle Partner o The care and concern Adult for the next 24 to 54 generation yrs. o Widening interest in (Care) work and ideas Generativity vs. Selfabsorption Late Adult, 54 yrs. to death, (Wisdom) Integrity vs. Despair

Negative Resolution o Withdrawal from such intimacy, isolation, selfabsorption and alienation from others

o Self-indulgence and resulting psychological impoverishment

Mankind o Acceptance of ones life o Realization of the inevitability of death o Feeling of dignity and meaning of existence

o Disappointment of ones life and desperate fear of death

Cognitive Development Theory: Jean Piaget Stages: Sensorimotor (0-2 years) Reflex to complex Begins to organize visual images and control motor responses Coordinates sensory impressions Pre-verbal stage Preoperational Stage (2-7 years) Transitional period Egocentric and irreversible thinking Words become symbols for objects symbolic thinking Formation of ideas of categorization Lack of ability to go back and rethink a process or concept. Mental image the symbolic process which are evident in plays Construction of verbal schemas preconcepts
Psychiatric Nursing: Lecture Aid Lester R. L. Lintao 11

Concrete Operations (7 11 years) Thinking appears to be stabilized o ability to think of the possible consequences of actions Logical implications Formal Operations (11 years to adulthood) Full patterns of thinking Ability to use logic and symbolic processes o mathematical and scientific reasoning Combinatorial thinking - multidimensional approach o hypothetic or hypothetico-deductive reasoning

Moral Development Theory: Laurence Kohlberg Level One (Preconventional Morality) Childrens judgments are based on external criteria. Standards of right and wrong are absolute and laid down by authority. Level Two (Conventional Morality) Childrens judgments are based on the norms and expectations of the group. Stage 1 Behavior is based on the desire to avoid severe physical punishment by a superior power. Right or wrong is based on consequences to him. Punishment = wrong act

Stage 2 Actions are based largely on satisfying ones own personal needs. Stage 3 Good behavior is that which pleases others and judgments are based on intentions. Children conform to rules to win the approval of others and to maintain good relationships. Stage 4 What is right is what is accepted.

Psychiatric Nursing: Lecture Aid

Lester R. L. Lintao


Level Three (Post Conventional Morality) The individual recognizes the arbitrariness of social and legal conventions. The individual attempts to define moral values that are separate from group norms.

Stage 5 Behavior recognizes the laws as arbitrary and changeable. For aspects of life not governed by laws, right and wrong are personal decisions based on agreement and contracts. Stage 6 Morality is based on respect for others rather than on personal desires. The individual conforms to both social standards and to internalized ideals to avoid selfcondemnation rather than to avoid social censure. Other Theories

Behavioral Model (Ivan Pavlov, John Watson, B. F. Skinner) Behavior is: a response to a stimulus from the environment learned and retained by positive reinforcement Interpersonal Model (Harry Stack Sullivan) Focused on the role of the environment and interpersonal relations as the most significant influences on a individuals development Anxiety is communicated interpersonally Human Motivational Need Model. (Abraham Maslow) Hierarchy of needs in order of importance Primary needs (physiologic) need to be met prior to dealing with higher level needs Psychobiologic Model Focus is in mental illness as a biophysical impairment. Human behavior is influenced by genetics, biochemical alterations and function of brain and CNS. The stress response is a neuroendocrine response

PSYCHOTHERAPY A process in which a person enters into a contract to interact with a therapist to relieve symptoms, resolve problems in living and seek personal growth

Psychiatric Nursing: Lecture Aid

Lester R. L. Lintao


INDIVIDUAL THERAPY: Is a confidential relationship between client and therapist. Hypnotherapy: Involves various methods and techniques to induce a trance state where the patient becomes submissive to instructions Humor therapy: Use of humor to facilitate expression of feelings and to enhance interaction Psychoanalysis: Focuses on the exploration of the unconscious, to facilitate identification of the patient's defenses

GROUP THERAPY minimum number : 3 Ideal number :8-10 Advantages: decreases o isolation o dependence develops o coping skills o interpersonal learning o opportunities for helping others o ability to listen to other members Remotivation Therapy: Promotes expression of feeling through interaction facilitated by discussion of neutral topics Family therapy: A method in which family members gain: o insight into the problems o improve communication o improve functioning of individual members as well as the family as a whole. o It focuses on the total family as an interactional system Milieu Therapy A therapeutic environment is organized to: o encourage and assist the client to control problematic behavior o function within the range of social norms Play therapy Effective for children suffering from maladjustment or behavior disorder. The child is usually placed in a play room Purpose - to discover the causes of the child's conflict through observation of his play and to interpret it to the child.
Psychiatric Nursing: Lecture Aid Lester R. L. Lintao 14

Recreational therapy Uses activities which vitalize the patient's interest and help him / her to relax and feel refreshed. Example: Playing baseball may be prescribed for as a means of expressing hostility in a group. Occupational therapy: Uses any mental or physical activity prescribed or guided to aid an individual's recovery from a disease or injury. Musical therapy Involves music which allows the child or adolescent to express herself or himself. Also effective with those who have difficulty communicating. Art therapy: Clients are encouraged to express their feelings or emotions by painting, drawing or sculpture. Psychodrama therapy: Patients dramatizes their emotional problems in a group setting.

BEHAVIOR MODIFICATION THERAPY A mode of treatment that focuses on modifying observable (overt) and quantifiable behavior Systematic manipulation of the environment and variables thought to be functionally related to the behaviors. Limit Setting o Therapist gives an advanced warning of the limit and the consequences will follow if the client does not adhere to the limit. o The consequences should occur immediately after the client has exceeded the limit o Consistency must occur with all personnel. o Purposes: o Minimizes manipulation and splitting of the staff. o Provides a framework for the client to function in and enable a client to learn to make requests. Systematic Desensitization o Clients are exposed slowly to a feared object or a thing that inhibits anxious responses and taught ways to relax. o Effective in treating phobias.
Psychiatric Nursing: Lecture Aid Lester R. L. Lintao 15

Implosive therapy o The clients are exposed abruptly to intense forms of anxiety producers, either in imagination or in real life Cognitive Behavior therapy o Uses confrontation as a means of helping the clients restructure or rearrange irrational beliefs, maladaptive thinking, perception-, and behaviors. o Used for depression and adjustment difficulties. Biofeedback o Teaches the clients to control or change aspects of their internal environment. Aversion therapy o Uses unpleasant or noxious stimuli to change inappropriate behavior. o Examples o Antabuse to treat alcoholics Assertiveness Training o Clients are encouraged and taught how to appropriately relate to others Token-economy: Utilizes the principle of rewarding desired behavior to facilitate change.

ELECTROCONVULSIVE THERAPY (ECT) Exact mechanism is unknown Requires a consent Voltage : Length : Frequency : Interval : Indicator : 70-150 volts .5-2 seconds 6-12 treatments 48 hours tonic-clonic seizure

Indications of use: Depression Mania Contraindications: Fever Increased ICP Cardiac conditions TB with history of hemorrhage

Catatonic schizophrenia

Unhealed fracture Retinal detachment Pregnancy Osteoporosis

Psychiatric Nursing: Lecture Aid

Lester R. L. Lintao


Before the procedure: Take vital signs Diagnostic procedures o X-ray o ECG o EEG Drugs given o Atropine sulfate (decrease secretions) o Anectine (Succinylcholine) (relax muscles) o Methohexital Na (Brevital) (anesthetic) During the procedure: Observe for tonic-clonic seizure Priority: Airway After the procedure: Position Check vital signs Reorient the client Watch out for complications: o Memory loss o Headache o Apnea o Respiratory depression o Fracture

BASIC CONCEPTS ON PSYCHOPHARMACOLOGY MAJOR TRANQUILIZERS/ ANTIPSYCHOTICS Indication: Schizophrenia and Other Psychosis Desired effect: control of symptoms Best taken after meals MOA: Block selected dopamine receptors decrease dopamine symptoms Types Examples Typical Haloperidol Mellaril Thorazine EPS Treats (+) symptoms only Atypical Risperdal Seroquel Clozaril Expensive Less available More agranulocytosis
Lester R. L. Lintao 17



Psychiatric Nursing: Lecture Aid


Cheaper Less or no EPS More available For both (-) & (+) symptoms Before 1990s After 1990s

Side effects Blurred vision Dry mouth Tachycardia, palpitation, constipation, urinary retention Side effects Photosensitivity Orthostatic hypotension Extra Pyramidal Symptoms o Pseudoparkinsonism o pill-rolling tremors mask-like face o cog-wheel rigidity o propulsive gait o Akathisia - restless leg syndrome o Dystonia - defect in muscle tone Side effects Neuroleptic Malignant Syndrome (NMS) Muscle rigidity + high grade fever

Nursing Action Avoid driving Give sugarless gum Monitor & report Nursing Action Dont expose skin to sunlight Monitor BP Advise gradual change in position Discontinue the next dose Report at once Give antidote: Anticholinergics Akineton Artane Benadryl Cogentin Dopaminergics: L- Dopa Espequel Sporadel Nursing Action Withhold the next dose Notify the physician Cooling measures

Adverse effect: report promptly Tardive dyskinesia - lip smacking Agranulocytosis o Assess for: Fever Sore throat Lab data: WBC count Hepatotoxicity o Assess for ALT & AST

Psychiatric Nursing: Lecture Aid

Lester R. L. Lintao


MINOR TRANQUILIZERS/ ANXIOLYTICS Common indication: Anxiety disorders Desired Effect: Decreased anxiety, adequate sleep Have sedative effects Examples: (XL VASET) Xanax (Alprazolam) Librium (Chlordiazepoxide ) Valium (Diazepam) Ativan (Lorazepam) Serax (Oxazepam) Esquanile Tranxene (Chlorazepate Dipotassium) Nursing Implications: Best taken before meals Advise to avoid driving Administer it separately with any drug Anxiolytics + Alcohol = severe hypotension / hypersedation Another anxiolytic = respiratory depression death Other drugs = CNS depression Stimulants = less effective

ANTIDEPRESSANTS Desired effects: increased appetite, adequate sleep Tricyclic Antidepressants Examples: Imipramine (Tofranil)

Amitriptyline (Elavil)

Nursing Implications: Best given after meals Effectivity: after 2-3 weeks Check the BP, it causes hypotension Check the heart rate, it causes cardiac arrythmias Monitor I & O Monitor for signs of increased IOP

Psychiatric Nursing: Lecture Aid

Lester R. L. Lintao


MAO INHIBITORS Indication: refractory depression Examples: Tranylcypromine (Parnate) Phenelzine (Nardil) Isocarboxazid (Marplan)


Nursing Implications: Best taken after meals Report headache; it indicates hypertensive crisis Avoid tyramine containing foods like: Avocado Banana Cheddar and aged cheese Soysauce Preserved foods Effectivity: 2-3 weeks Monitor the BP There should be at least a two-week interval when shifting from one antidepressant to another Selective Serotonin Reuptake Inhibitors Fluoxetine (Prozac) Paroxetine (Paxil) Fluvoxamine (Luvox) Celatopram (Celexa) Sertraline (Zoloft) Nursing Implications: Avoid the use of: Diazepam Tryptophan Alcohol Monitor PTT, PT Never give to pregnant / lactating mothers.

ANTI-MANIC AGENT Examples: Lithium Citrate (Cibalith S)

Lithium Carbonate (Eskalith, Lithane, Lithobid)

Psychiatric Nursing: Lecture Aid

Lester R. L. Lintao


Nursing implications: Never give to pregnant mothers Best taken after meals Increase intake of: fluids (3 L /day) sodium (3 gm/day) Avoid activities that increase perspiration Effectivity: 10-14 days Antipsychotic is administered during the first 2 weeks Level (mEq/L) Status .5 1.5 Therapeutic S/Sx Nursing Interventions Monitor Increase sodium & fluid intake D/C next dose Report *IV NSS D/C next dose Report *MANNITOL (antidote)



Vomiting Anorexia Nausea Diarrhea Abdominal cramps 2.0 and above Fatally toxic Lethargy (Altered LOC) 1.7 1.9 Toxic

D/C next dose Report *Dialysis

STRESS A nonspecific response of the body to any demand made upon it. (Hans Selye, 1936) A state produced by a change in the environment that is perceived as challenging, threatening or damaging to the persons dynamic equilibrium. (Smeltzer, 1992) Adaptation A constant ongoing process that occurs along time continuum, beginning with birth and ending with death. (Smeltzer, 1992) A continuous process of seeking harmony in an environment.

Psychiatric Nursing: Lecture Aid

Lester R. L. Lintao


Types of Adaptation: General Adaptation Syndrome (GAS) Involves the whole body in response to stress. Compared to life process as it focuses on the wear and tear of the body tissues. Phases: Alarm o Acute phase of the syndrome o Characterized as the flight and fight reaction o Defensive by nature but self-limiting o If stress is intense, it may lead to death Resistance o Characterized as the state of adaptation o Person moves back to homeostasis Exhaustion o Result of a prolonged exposure to stress and adaptive mechanisms can no longer persist. Local Adaptation Syndrome Refers to inflammatory response and repair processes that occur at the local site of tissue injury. Eustress - positive stress Distress - negative stress and damaging stress CRISIS AND CRISIS INTERVENTION A situation that occurs when an individual's habitual coping ability becomes ineffective to meet the demands of a situation. A serious interruption and disturbance of one's equilibrium or homeostasis Leads to potentially dangerous, self-destructive or socially unacceptable behavior. Characteristics Highly-individualized Self-limiting: 4-6 weeks Person affected becomes passive and submissive Affects a persons support system

Psychiatric Nursing: Lecture Aid

Lester R. L. Lintao


Type Maturational / Developmental

Situational / Accidental

Description expected, predictable and internally motivated Unexpected, unpredictable and externally motivated

Example Puberty, adolescence, young adulthood, marriage, or the aging process. Economic difficulty, illness, accident, rape, divorce or death

Social / Adventitious Due to acts of nature

Natural calamities



CRISIS INTERVENTION Major Goal: Restore the maximum level of functioning (pre-crisis state) It is an active but temporary entry into the life situation of an individual or a family during a period of stress. A way of entering into the situation to help them mobilize their resources and to decrease the effect of stress.

Domestic Violence Requiring Crisis Intervention: RAPE Nonconsensual sexual penetration of an individual, obtained by force or threat, or in cases in which the victim is not capable of consent.

Psychiatric Nursing: Lecture Aid

Lester R. L. Lintao


Kinds of Rape Power to prove masculinity Anger means of retaliation Sadistic to express erotic feelings Silent Rape Syndrome A maladaptive reaction to rape The victim: o fails to disclose information about the rape o is unable to resolve feelings about the sexual assault o Results to increase anxiety and may develop a sudden phobic reaction. Rape Trauma Syndrome (RTS) Refers to a group of signs and symptoms experienced by a victim in reaction to rape Phases: Acute / Impact shock, numbness, disbelief Repression / Denial refusal to discuss the event Heightened Anxiety fear, tension, nightmares Stage of Resolution

BATTERED WIFE SYNDROME (BWS) A form of cyclic domestic violence Men: low self-esteem Women: Dependent personality disorder

(taken from the book of Shiela Videbeck) Characteristics of Abusive Husbands: They usually come from violent families They are immature, dependent and non-assertive They have strong feelings of inadequacy

Psychiatric Nursing: Lecture Aid

Lester R. L. Lintao


CHILD ABUSE An act of omission of responsibility or commission in which intentional harm is inflicted on a child. Components of Omission: Child abandonment leaving the child physically Child neglect - lack of provision of those things which are necessary for the child's growth and development Types of Commission: Physical Abuse - is an intentional physical harm inflicted on a child by a parent or other person. Emotional abuse - insult and undermining one's confidence Sexual abuse - in the form of sexual contact

Characteristics of Abusive Parents: They come from violent families They were also abused by their parents They have inadequate parenting skills They are socially isolated because they don't trust anyone They are emotionally immature They have negative attitude towards the management of the abused Warning signs of Child Abuse / Neglect: Childs excessive knowledge on sex and abusive words Hair growth in various lengths Inconsistent stories from the child and parent/s Low self-esteem Depression Apathy Bruised or swollen genitalia; tears or bruising of rectum or vagina Unusual injuries for the childs age and development Serious injuries (fractures, burns, lacerations) Evidence of old injuries not reported

Assessment, Planning and Nursing Actions for Crisis Primary concerns: o Physical injuries o Alleviation of psychological trauma
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Nurse should display: o Sensitivity o Attitude (Nonjudgmental) o Confidentiality o Respect o Empathy o Dignity Evidences are important: o stained clothing o fingernail scrapings o mouth or anal smears containing semen Intervention focuses on family as a unit If the victim is a child: Play and art therapy DEFENSE MECHANISM These are automatic and usually unconscious processes or act by the individuals to: o reduce or cope anxiety or fear o resolve emotional or mental conflict o protect one's self-esteem o protect one's sense of security Becomes pathologic when overused Used by both mentally healthy and mentally-ill individuals Common Defense Mechanisms Used: Compensation o An attempt to overcome a real or imagined short coming, inferiority, inabilities and weaknesses. o A blind woman becomes proficient in playing piano. Conversion o Emotional problems are converted to physical symptoms o A student unprepared for a report suffered headache the day she is supposed to deliver her report. Denial o Failure to acknowledge an intolerable thought, feeling, experience or reality o After being admitted to the CCU because of an AMI, a middle-aged man insists that he is in the hospital for just a diagnostic work-up.

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Displacement o The redirection of feelings to a less threatening object o After an argument with his father, a boy goes to the room and kicked his door. Fantasy o Conscious distortion of unconscious feelings or wishes o A boy who is being bullied by his friends wished he had the power of Wolverine. Fixation o An unhealthy mechanism which is an arrest of maturation at certain stages of development

Introjection o Symbolic assimilation or taking into oneself a love/hatred object. Derived from the word "introject" which literally means to take into or ingest o Common to depressed clients o Self-blaming Identification o An individual integrates certain aspects of someone else's personality into one's own o A young school teacher adopts his former mentor's teaching style when conducting class sessions Intellectualization o An overuse of intellectual concepts by an individual to avoid expression of feelings o A man who was asked to share a memorable experience about his grandmother who died discussed the stages of death and dying by Elizabeth Kubler Ross. Projection o Attributing to others one's unconscious wishes/fears o Literally, this means to "throw off or to blame others o A student who failed a subject blames his failure on poor teaching. Reaction Formation (AKA overcompensation) o Expression of feeling that is the direct opposite of one's real feeling. o A student who dislikes one of her classmates may act or show concern toward her.
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Rationalization o An individual finds a justifiable cause and acceptable reasons just to be saved from an embarrassing and anxiety producing thoughts or situations. Regression o The turning back to earlier patterns of behavior in solving personal conflicts o Commonly seen to schizophrenic patients o A person who becomes ill in the face of disappointment has regressed to a form of childish behavior. Repression o The involuntary or unconscious forgetting of unpleasant ideas or impulses. Suppression o Permits the individual to store away or consciously forget the unpleasant, painful and unacceptable thoughts, desires, experiences and impulses. o "I'll think it about tomorrow", "I'd rather go now", "Can we change the topic?" o A boy walked out from the group and said "I have to go now", when he was asked what happened to their relationship with his girlfriend. Substitution o Replacing the desired unattainable goal with one that is attainable o After failing the board exam 3 times, a woman worked as a nursing aide just to be in the hospital. Sublimation o The redirection of unacceptable instinctual drive with one that is socially acceptable o Instead of harming his mother, a man expressed his anger by composing a song. Symbolization o A less threatening object is used to represent another o Missing her husband, a woman finds comfort in hugging her son who looks like his father. Undoing o An attempt to erase an act, thought, feeling, guilt or desire o A man gives his wife a bunch of roses after their argument last night.

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ANXIETY Subjective response to stress Vague sense of impending doom An unpleasant emotional state consisting of psychophysiological responses to anticipation of unreal or imagined danger, resulting from unrecognized intrapsychic conflict. Signs and symptoms: Physical Mild Increase in VS Pupillary dilatation Diaphoresis Physical Moderate Anorexia Nausea Vomiting Agitation Diarrhea / constipation Severe Headache Inability to communicate Physical symptoms becomes the focus of attention Panic Fatigue Muscular weakness Nursing Diagnoses: Ineffective individual coping Anxiety Nursing Management: Prioritize safety Encourage the client to verbalize feelings Administer medications, as ordered Carefully listen to the client Environmental stimuli must be controlled
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Cognitive Emotional Increased Minimal use of defense attentiveness and mechanism alertness Cognitive Emotional Decreased Use of defense perceptive ability mechanism

Perceptive ability Defense mechanisms is greatly operate decreased Inability to focus on major events

Personality disorganization

Defense mechanism fail

ANXIETY DISORDERS Panic Disorder A sudden surge of overwhelming anxiety and fear May include terror, sense of unreality or fear of loosing control Attack: 1 minute to 1 hour Phobic Disorder Phobia is an irrational, unrealistic or exaggerated fear of a specific object, activity, or situation that in reality presents little or no danger. Examples: Acrophobia heights Agoraphobia - open places and of being alone in public places Algophobia pain Arachnophobia - spiders (arachnoids) Claustrophobia - enclosed place Monophobia - being alone Pathophobia disease Social phobia - criticism, humiliation or embarrassment. Thanatophobia - crowds Generalized Anxiety Disorder (GAD) Involves anxiety and worry that is excessive and unrelenting. May alter ADL Clients may experience: fatigue, irritability, restlessness, muscle tension, sleep disturbance Obsessive Compulsive Disorder An anxiety disorder characterized by uncontrollable, unwanted thoughts and repetitive, ritualized behaviors. Post-Traumatic Stress Disorder (PTSD) A delayed reaction of the person who has been involved or exposed to traumatic events. Symptoms: intense psychological distress feeling of detachment or estrangement from others insomnia decreased concentration avoidance of thoughts and feelings recurrent distressing dreams inability to recall an important aspect of the trauma
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Nursing Interventions Modify environment safe Approach: kind-firmness Nonjudgmental and calm attitude Allow agreeable time for rituals Give medications as ordered Execute therapeutic modalities - biofeedback, change of the scenery, therapeutic touch, hypnosis, massage or relaxation exercises Desensitization ANXIETY RELATED DISORDERS Somatoform Disorders (Briquets Syndrome) Characterized by physical symptoms that mimic disease or injury for which there is no identifiable physical cause Clients: express emotional turmoil or conflict through physical symptoms usually seek repeated medical attention Associated with anxiety and depression Somatization Disorder (Briquets Disease) A disorder applied to patients who chronically and persistently complain of varied physical symptoms that have no identifiable physical origin Conversion Disorder A condition in which an anxiety-provoking impulse is converted unconsciously into functional symptoms. Classic feature: Labelle indifference (lack of concern or distress) Examples: Paralysis, blindness, loss of touch or pain sensation, dyspnea, seizures or convulsions Hypochondriasis An individual presents an unrealistic or exaggerated physical complaints. The person becomes, preoccupied with the fear of developing or having already a disease or illness in spite of medical reassurance. Body Dysmorphic Disorder Preoccupation with an imagined defect in his or her appearance. Slight physical abnormality = excessive concern / anxiety

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Dissociative Disorders Conditions that involve disruptions or breakdowns of memory, awareness, identity and/or perception Dissociative Amnesia Inability to recall extensive amount of important information Caused by trauma Characterized by: Disorientation Purposeless wandering Impairment in ability to perform ADL Rapid recovery generally occur Depersonalization Disorder Periods of detachment from self or surrounding which may be experienced as "unreal" while retaining awareness that this is only a feeling and not a reality Dissociative Identity Disorder Occurrence of two or more personalities within the same individual, each of which during sometime in the person's life is able to take control. Nursing Interventions: Professional attention Education of family Resolution of primary cause Supportive therapies Offer support and empathy Nonjudgmental attitude Administer medications, as ordered Listen attentively

PERSONALITY DISORDERS Pervasive and inflexible patterns of functioning that is stable overtime, and leads to distress or impairment. 10% to 13% of the general population Types of Personality Disorders: Eccentric Personality Disorder (Type A) Paranoid (Suspicious and distrustful) Persons who display pervasive and long stand suspiciousness More common in men
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Schizoid (Socially distant and detached) Pattern of detachment from social relationship Chooses solitary activities Topics are inanimate objects and ideas Schizotypal (Odd and eccentric) mild schizophrenia Acute discomfort in close relationships Cognitive or perceptual distortion Dramatic-Erratic Personality Disorder (Type B) Antisocial (aggressive and manipulative) Pattern of disregard for the violation of the rights of others Low self-esteem Borderline (destructive and unstable) Characterized by patterns of instability in relationships, self image and mood Self-mutilating behavior More common in women Histrionic (emotional and dramatic) Excessive emotionally and attention-seeking behaviors that are dramatic and egocentric Exaggerated expression of emotion Overreaction to minor events Narcissistic (boastful / superiority complex) Grandiosity and need for constant admiration Exploitation of others for fulfillment of own desire Anxious or Fearful Personality Disorder (Type C) Avoidant (inferiority complex) Social inhibition Feelings of inadequacy and sensitivity Low self-esteem Social withdrawal in spite of a desire for affection and acceptance Dependent (submissive) Submissive clinging behavior related to excessive need to be cared for by others Lack of self-confidence Perceive self as helpless and stupid Obsessive-Compulsive (perfectionist) Preoccupied with orderliness, perfectionism, inflexibility, need to be in control Formal and serious interpersonal relationship Judgmental of self and others

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Lester R. L. Lintao


Passive-Aggressive Intentional inefficiency Passive resistance to demands for adequate performance in both occupational and social functioning Nursing Diagnosis: Ineffective individual coping Self-esteem disturbance Nursing Care: Avoid client attempts to manipulate Set limits and boundaries Consistency is essential Clear communication Deal with frustration Specific treatment of symptoms

DISORDERS COMMONLY DIAGNOSED TO CHILDREN AUTISM Characterized by: impairment in communication skills presence of stereotyped behavior, interests and activities. Associated with impairment on social interactions Treatable but not curable More common among boys Usually diagnosed at age 2 Main problem: Interpersonal functioning Most acceptable cause: Biological factors - brain anoxia, intake of drugs Signs and Symptoms Odd play Not cuddly Echolalia Crying tantrums Head towards anything Inanimate object attachment Loves to spin objects / self Difficulty interacting with others

Wants blocks Acts as deaf Resists normal teaching method / routine changes No fear of danger Insensitive to pain No eye contact Giggling or silly laughing

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Nursing Interventions Environment: safe consistent Encourage the client to participate for self-care Promote communication Speak calmly when giving instructions Use simple words or phrases Repeat instructions as necessary. Haloperidol - symptomatic relief for hyperactivity, stereotypical and selfdestructive behavior MENTAL RETARDATION Not a mental illness. Onset: 18 IQ below 70 Manifested by sub-average intellectual functioning in: Communication Social skills Self-care Health and safety Home living Causes HIV/ AIDS / rubella Neurological / neurodevelopmental impairment infection Exact gestational age is not reached Alcoholic mother (premature) Thyroid deficiency Excessive lead poisoning Opiate intoxication Nutritional deficiency (lack in Folic Acid) Damage to the brain Anoxia Toxemia (pregnancy-induced hypertension) Environmental factors Severe RH incompatibility Levels Mild/moron IQ 51-70 o o Moderate/Imbecile 36-50 o o Severe/Idiot 20-35 o o o Profound Below o 20 o Implication Difficulty adapting to school Educable needs assistance Poor awareness of needs of others Trainable needs moderate supervision Unable to learn academic skills Poor motor development and minimal speech Needs complete and close supervision Has minimal capacity for sensorimotor function Needs custodial care with a totally structured environment
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Psychiatric Nursing: Lecture Aid

Principles of Nursing Care Protective care Education of the family Their involvement is an important factor in the plan of care to promote progress and to minimize the stress. Repetition Role modeling Restructuring Focus of Education Reading Arithmetic Writing ATTENTION DEFICIT HYPERACTIVITY DISORDER Common in boys Usually diagnosed before age 7 Problems: Inattention Hyperactivity Impulsivity Causes: Abuse of the child Drug exposure Hypoperfusion (brain) Developmental problems Neurologic impairment Pre-natal trauma Early malnutrition Signs and Symptoms Obstinacy Negativism Egocentrism Fighting syndrome Aggressiveness Tolerance is low Nursing Diagnosis - Potential for injury

Difficulty concentrating Excessive talking Fidgeting Interrupt/intrudes on others Child exhibits hyperactivity Indulges in destructive behavior Temper tantrums

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Lester R. L. Lintao


Nursing interventions: Provide nutrition and safety Provide an environment that: is calm is structured enables appropriate reaction to the environmental stimuli Plan a firm and consistent care in which limits and standards are set. Parent education Pharmacology: Methylphenidate (Ritalin) Dexedrine Cyclert

DISORDERS COMMONLY DIAGNOSED TO ADOLESCENTS AND ADULTS EATING DISORDERS More common among females. Causes: Psychological factors Parental factors (domineering parents) Individual factors (conflict about growing up) Sociocultural factors Anorexia Nervosa Main sign: Morbid fear of gaining weight Other signs: Sensitivity to cold temperatures Denial of hunger Amenorrhea Obvious thinness but feels fat Deliberate self-starvation with Lanugo all over the body weight loss Loss of scalp hair Bulimia Nervosa Extreme measures to lose weight uses diet pills, diuretics or laxatives purges after eating extreme exercise Signs of purging swelling of the cheeks or jaw area cuts and calluses on the back of the hands and knuckles (Russels sign) teeth that look clear

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Peculiar signs depression loss of interest in activities Findings: (for both) Weight loss of 15% or more of original body weight Amenorrhea Social withdrawal and poor family and individual coping History of high activity and achievement in academics, athletics Electrolyte imbalance Depression / distorted body image Nursing Diagnosis: Body image disturbance Ineffective individual coping Nursing Interventions: Reinforce treatment plans and dietary prescriptions Establish a trusting relationship Monitor weight and vital signs Encourage client to express feelings Decrease emphasis on foods, eating, weight Involve in decision-making Employ limit setting Stay with the client after meal and for 1st four hours

SUBSTANCE-RELATED DISORDERS Alcoholism A chronic disease or a disorder characterized by excessive alcohol intake and interference in the individuals health, interpersonal relationship and economic functioning. (WHO) Considered to be present when there is .1% or 10 ml for every 1000 ml of blood Signs of use: .1-.2% - low coordination .2-.3% - presence of ataxia, tremors, irritability, stupor .3 and above - unconsciousness

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Progression: Pre-alcoholic starts with social drinking tolerance begins to develop Prodromal alcohol becomes a need blackouts occur denial starts Crucial - cardinal symptoms of alcoholism develops Chronic - the person becomes intoxicated all day Outcome: Brain damage Alcoholic hallucinosis Death Behavioral problems: Denial Dependency Demanding

Destructive Domineering

Alcohol Withdrawal Occurs when an individual abruptly stops drinking Symptoms develop within few hours Symptoms include: Careless behavior Autonomic hyperactivity Unusual perceptions (illusions, hallucinations) Tachycardia (impending delirium tremens) Increased temperature Obvious hand tremors Nightmares and insomnia Alcohol Withdrawal Delirium AKA delirium tremens Experienced within 48 to 72 hours after the last intake: Symptoms include Diaphoresis Elevated VS Agitation Tremors (seizures) Hyperexcitability to depression
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Chronic Problems: Korsakoff's Psychosis A form of amnesia Characterized by short-term memory loss disorientation inability to learn new skills confabulation Deficiency in B1 and B12. Wernicke's Encephalopathy An inflammatory hemorrhagic degenerative condition of the brain caused by B1 deficiency Symptoms include: double vision involuntary and rapid eye movements lack of muscular coordination decreased mental function Nursing Diagnosis: Ineffective individual coping Principles of Nursing Care: Monitor vital signs Well-lighted room Diet as tolerated Administration of glucose Vitamins Alcohol Detoxification: Drug of Choice: Disulfiram (Antabuse) - delays the metabolism of alcohol Avoid alcohol-containing products 3 Ss of detoxification: Safety Sedation Supplementation (Vitamin B complex, Vitamin C)

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DRUG-RELATED DISORDERS Cocaine-Related Disorders (Stimulants) Cocaine is a white powdered stimulant substance Usually sniffed, snorted, smoked in a pipe or injected into a vein or subcutaneous tissue. Poor mans cocaine: Shabu (sha-boo) Signs of use: Cocaine psychosis Obvious dilation of the pupils Cardiac problems Agitation Insomnia No appetite Excessive sweating Severe to panic anxiety Classic sign: Perforated nasal septum Can cause a sudden heart attack even in healthy young people.

Cannabis-Related Disorders (Cannabinoids) Marijuana Can act as stimulant or depressant and is often considered to be a mild hallucinogen with some sedative properties Is not physically addicting but may lead to psychological dependence Plant : cannabis sativa Active component is Tetrahydocannabinol Routes of use: Orally (capsules, tablets, on sugar cubes) With food Smoked in a pipe or rolled as cigarette. Acts within 15 minutes Effects lasts approximately 2 to 4 hours Physiologic symptoms include Increased appetite Hypothermia Nausea and vomiting Excitement Drowsiness Movement problems (reduced coordination) Inability to think clearly Problems on judgment Ataxia Non-steady gait
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Classic sign: bloodshot eyes In large doses, it may cause: Hallucination Suicidal ideations Delusions of invulnerability Long-term Goals: Community resources Other coping means aside from denial Personal responsibility (behavioral contract) Isolation Nutrition Group therapy

SEXUAL DISORDERS Sexuality - is the result of biologic, psychological, social and experimental factors that mold an individual's sexual development, self-concept, body image and behavior. Phases of the Sexual Response Cycle Desire - the ability, interest and willingness to receive sexual stimulation Excitement / Arousal Result of psychological stimulation Example is fantasizing during the desire phase and foreplay which involves petting and fondling of erogenous zones or areas of the body that are particularly sensitive to erotic stimulation. Plateau intense moments Orgasm formerly termed as climax the shortest stage in the sexual response cycle occurs when stimulation proceeds through the plateau stage to a point where the body suddenly discharges accumulated sexual tension Resolution the final phase of sexual response organs and body systems gradually return to the unaroused state Sexual Dysfunction Disorders Sexual Desire Disorders: Individuals who have little or no sexual desire or have an aversion to sexual contact.

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Sexual Arousal Disorder: Individuals cannot complete the physiologic requirements for sexual intercourse Examples Women cannot maintain lubrication Men cannot maintain an erection Orgasm Disorders: Inability to achieve orgasm phase Example: Premature ejaculation Sexual Pain Disorders: Individuals suffer genital pain (dyspareunias) Example: Vaginismus Paraphilia (Sexual Deviation) A term which generally refers to abnormal sexual behavior Lasts for 6 months leading to distress or impairment to functioning. Examples: Anilingus Bestiality or Zoophilia Coprophilia Cunnillingus Exhibitionism
Fellatio Fetishism Frotteurism

tongue brushing the anus contact with animals smearing feces on the partner tongue brushing the vulva Involves exposing ones genitals to unsuspecting strangers (usually women or children) inserting the penis into the mouth inanimate / non-living objects or articles Touching or rubbing against the unsuspecting people. Usually occurs in crowded places where escape is into the crowd is possible. Sexual gratification from experiencing pain Involves the use of corpses Inserting the penis into the other parts of the body Use of prepubertal children (13 years of age or younger) in an actual sexual act or a fantasy Sexual gratification from inflicting pain Involves telephoning someone and making lewd, obscene remarks or conversation. Sexual excitement through wearing the clothing of a woman urinating on the partner Act of observing unsuspecting person who is naked, in the process of disrobing, or engaging in sexual activity Includes cyber-voyeurism

Masochism Necrophilia Partialism Pedophilia Sadism Telephone Scatalogia (AKA sex on phone) Transvestism Urophilia Voyeurism

Psychiatric Nursing: Lecture Aid

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Gender Identity Disorder AKA Transexualism They believe that they were born as the wrong sex Leads to persistent discomfort and feels inappropriate in the role of the assigned sex. Nursing Interventions: Attitude: Accepting Empathic Accept his feelings related to sexuality Have a private area to discuss fears or concerns about sexuality Intervene to discuss self-esteem issues, anxiety, guilt, and empathy for victims. Employ limit setting. Referral to the correct clinic.

SCHIZOPHRENIA AND OTHER PSYCHOSES SCHIZOPHRENIA A serious psychiatric disorder One of the most profound disabling illnesses Not a single disease entity but a combination of disorders "split mind" Characterized by: impaired communication loss of contact into reality deterioration from a previous level of functioning Nursing Diagnosis: Altered thought process Theories Biological Neuroanatomic and neurochemical Immunovirological Manifestations: Eugen Bleuler Associative looseness Autism Affective disturbance Ambivalence

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Positive symptoms: Ambivalence Associative Looseness Delusions Echopraxia Negative symptoms: Alogia Anhedonia Apathy Avolition

Flight of ideasHallucinations Ideas of reference Perseveration

Blunted affect Catatonia Flat affect

Types Disorganized Prognosis: Poor Defense Mechanism: Regression Paranoid Prognosis: Good Defense Mechanism: Projection

Distinguishing features Peculiar / bizarre behavior Incoherence Stereotyping

Nursing Interventions Assist with ADL Encourage activity Present reality

Hallucinations Ideas of reference Delusion of persecution Suspiciousness

Catatonic Prognosis: Good Defense Mechanism: Repression

Wax flexibility Stupor Negativism mutism, rigidity, lack of response

Priority: safety of others Deal with the HID Offer sealed foods / unopened medicines Never displace outbursts of emotions Explain procedures in simple ways Never argue with the patient Priority: nutrition & circulation Provide distraction Encourage activity

Undifferentiated Patients whose manifestation cannot be easily fitted into one or the other type Residual Patients with minimal symptoms

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Nursing Intervention Principles: Establish: a trusting relationship and provide acceptance a clear, consistent and open communication Set limits Decrease environmental stimuli Observe for suicidal ideation Administer medications, as ordered. PSYCHOSES RELATED TO SCHIZOPHRENIA Schizophreniform Disorder Schizoaffective Disorder Delusional Disorder Brief Psychotic Disorder Shared Psychotic Disorder (folie a deux) Client presents symptoms of schizophrenia for less than 6 moths ADL may not be altered Client presents symptoms of psychosis and all features of a mood disorder (depression / mania) Client has 1 or more bizarre delusions ADL not impaired Client experiences sudden onset of at least 1 psychotic symptom Lasts from 1 day to 1 month 2 people share a similar delusion

MOOD DISORDERS Theories: Biological Neurochemical Neuroendocrine Psyhoanalytic Defense mechanism against depression Mania Hereditary High norepinephrine and serotonin levels Depression Hereditary Low norepinephrine and serotonin levels Elevated glucocorticoid Elevated TSH Rigid superego

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Lester R. L. Lintao


Common Types of Mood Disorders Major Depressive Disorder Lasts at least 2 weeks which impairs ADL Characterized by depressed mood / loss of pleasure in most activities Clinical Symptoms of Major Depressive Episode Affect is flat Loss of memory Obvious sleep disturbances Sad feelings / Social withdrawal Emotional blunting Reduced appetite Mania abnormally and persistently elevated mood lasting for 1 week Clinical Symptoms of Manic Episode Agitation Flight of ideas Increased activity Grandiosity High emotions Talkative or pressured to keep talking Easy distractibility Reduced need for help Bipolar Disorder A persons mood cycles between mania and depression for 1 week Bipolar I Disorder one or more of symptoms of manic episode accompanied by major depressive episode Bipolar II Disorder one or more symptoms of major depressive episode with hypomania Related disorders: Dysthymic Disorder Lesser severe than major depression No symptoms such as impaired communication, delusions and hallucinations Cyclothymic Disorder DNOS (Depression Not Otherwise Specified) - lasts for 2 days-2 weeks

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Appearance DM Attitude therapies Activity

Mania Elated Projection Matter of fact Non-stimulating Never give anything that requires attention Risk for injury: Directed at others Individual therapies Lithium Diet

Depression Sad Introjection Kind firmness Monotonous

Priority NDx Nursing Management

Risk for injury: self-directed Group therapy Antidepressants ECT

SUICIDE thought or act of taking ones own life ultimate form of self-destruction "cry for help reunion wish or fantasy progressive failure to adapt feelings of anger or hostility a way to end feelings of hopelessness and helplessness an attempt "to save face" or seek a release to a better life Risk Factors Sex (more female attempts suicide but more male commits suicide) Use of drugs / alcohol Identification with a dead family member Chronic Illness (e.g. Cancer) Irrational thinking Depression/Dependent personality Age (18-25 and 40) Lethality of previous attempt/Losses Nursing Diagnosis: Risk for injury-Self directed Nursing care: Safe environment Always take overt or covert threats or attempts seriously Ventilation of feelings Encourage activities Monitor closely (one-on-one, 24/7) Empathy (show acceptance & appreciation)
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CONDITION COMMONLY DIAGNOSED IN THE ELDERLY Alzheimers Disease A chronic, progressive degenerative cognitive disorder. Marked by Dementia Main Pathology: presence of senile plaques - destroys neurons (decreased acethylcholline) Signs and Symptoms: Dementia Cognitive disturbances o Aphasia deterioration of language function o Apraxia impaired motor function o Agnosia inability to recognize objects / people Executive functioning - loss of abstract thinking 3 PHASES: Forgetfulness - difficulty of remembering appointments Advance - difficulty of remembering past events but not recent events Terminal - death occurs in 1 year Nursing Diagnosis: Altered thought processes Nursing Care: Priority: safety & security Always reorient the client (clock & calendar) Use color instead of numbers & letters Consistency 1 nurse to lessen confusion DEATH AND DYING DEATH/D YING: Elizabeth Kubler-Ross Stages: Denial - "NO NOT ME" Anger - "WHY ME" Bargaining - "IF ONLY" Depression - Stage of silence Acceptance - "YES, IT'S ME" Nursing Diagnosis: Ineffective individual coping

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Nursing Care: Listen to clients verbalizations Offer your presence always Value the clients beliefs and recognize your own beliefs Emotional and family support *** END ***

Psychiatric Nursing: Lecture Aid

Lester R. L. Lintao