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A. Psychiatric Nursing • • • B. Main Tool Mental health Primary purpose is to promote mental health Not curable, only to reduce the symptoms : IPR (Interpersonal Relationship) Nurse: self-awareness to
Client, individual, family, environment minimize weakness, maximize strength C. Focus of Psyche :
Human Behavior - Leads to identification of feelings - Responses to the environment, changes are meaningful : Therapeutic use of self acquired thru self-
D. Tool Used By The Nurse awareness E. Levels Of Prevention:
3 Levels Of Prevention: 1.) Primary Promote mental health (Healthy) • Remove factors before they can cause illness Ex. Stress reduction Health Teachings/Community Teachings/Community Demographics Support System Accident Prevention 2.) Secondary • Lessen the duration of mental illness (ill) Ex. Suicide Prevention Crisis Intervention/ Treatment & Diagnosis Providing Psychotherapy & Milieu Therapy 3.) Tertiary • Function to become independent Ex. Rehabilitation Centers/ Al anon Relapse Avoidance F. Stages Of Interaction 1st Stage: Orientation Assessment Establishment of Trust
Created by Niňa E. Tubio
2nd Stage: Working Problem Solving
Tell Patient of Termination Discussion Stage: Termination Set contract Patient is mostly cooperative Evaluation Goodbye Patient is resistant of RN) I. MENTAL HEALTH ----- A state of mind 6 Concepts In Mental Health: 1. Self-Awareness 2. Self-Actualization –Self-fulfillment or self-realization 3. Perception Of Reality 4. Autonomous Behavior: – Independence, decision-making ability 5. Adaptation : Use of Adaptive Defense Mechanisms Compensation Rationalization Identification Fantasy Substitution Sublimation
3rd Summarize Say Grief-Anger (Focus Pt. violent/suicidal
6. Integrative Capacity - Time to evaluate frustrations - Ability to solve conflicts: *Conflict—presence of 2 goals resolved through
a. Double Approach = 2 + goals b. Double Avoidance = 2 goals c. Approach-Avoidance = (+) & (-) outcome Ex. Developmental Task
II. PERSONALITY DEVELOPMENT: *Our beliefs & thoughts influence our feelings & consequently manifests as behavior. BELIEFS BEHAVIOR Create the
Created by Niňa E. Tubio 2
Different Inputs/Factors * Per sonare ------- “to sound through”--- The sum total of traits w/c are unique
III. THEORIES ON PERSONALITY DEVELOPMENT: 1. SIGMUND FREUD - Father of Psychoanalysis
Psychoanalysis – Uses the principle of free association (Talk of anything that comes to mind & correlate w/ the behavior) - As the treatment for the unconscious mind - The role of the unconscious w/c has conflicts-----results to maladaptive behaviors (Dr. Karen Horney- detractor of Freud’s’ Penis Envy - “ALL BEHAVIOR HAS MEANING” Different Theories Of Sigmund Freud: A. 3 STRUCTURE OF THE PERSONALITY
D IMPULSIVE Part WANT TO
Operates on “PLEASURE PRINCIPLE” Instinctual drive: “Eat, urinate, have Avoidance of pain, All “I” Ex. Babies are all ID: “I want it, I want
UPEREGO SHOULD NOT MALL VOICE OF GOD
“CONSCIENCE” Higher self, ideal ego Tells you what is right or wrong The censoring part, the moral values What makes you a perfectionist, rigid & Ex. I should not eat yet….. Function: 1. Inhibit the ID impulse
GO XECUTIVE Arbiter
Operates on “REALITY PRINCIPLE” In touch with reality The self, self-identity
Created by Niňa E. Tubio
Develops 6 months Functions: 1. Higher Functions: memory, orientation, decision-maker 2. Integrator of Personality: mediator bet. the Id & Superego between self & environment 3. It will tolerate frustrations 4. Solve conflicts Ex. “I can wait for what I want” 5. Uses Defense Mechanism---to maintain balance (PRN only) 6. Directs motor skills 7. Evaluate the environment 8. Reduces anxiety *The ability to tolerate frustration based on the balance of the 3 functions: Imbalance -----Maladaptive Behavior 1. ID EGO SUPEREGO ID 2. SUPEREGO
EGO SUPEREGO is Characteristic of: OBSESSIVEANOREXIA PERFECTIONIST,
ID is dominant; needs a superego (conscience) dominant; needs an ID Characteristic of: MANIC COMPULSIVE ANTISOCIAL (Serial-killer) NERVOSA NARCISSISTIC RIGID 3. ID EGO If there’s Weakened EGO SUPEREGO
Impaired Reality Perception Characteristic of: SCHIZOPHRENIA
THE THEORY OF LIBIDO LIBIDO - Sexual energy for survival • Man’s sexual desires & urges • Personal-----libidal striving w/c focuses on gratification
Created by Niňa E. Tubio
Helpless----------------needs to develop sense of trust. Ego & Superego -----all resides in the unconscious & operates on different levels of the mind Except the ego when dealing with reality----resides on the ---conscious Repression – Unconscious forgetting of an anxietyprovoking event THE PSYCHOSEXUAL THEORY Suppression – Conscious forgetting of an anxiety-provoking event (voluntary) E. Birth Trauma (the cause of 1st D. not kept warm Residuals Developed : Behavior: Overeating Narcissisti c Stems from being deprived & 3 Maladaptive Created by Niňa E. not given milk/water. Tubio Regressi on Going to an earlier developme Fixation Stopping in a certain5 stage of Developm . Dreams. STAGES OF PSYCHOSEXUAL DEVELOPMENT 1. recalled voluntarily CONSCIOUS PRE-CONSCIOUS (Sub-conscious) UNCONSCIOUS anxiety) *The ID. THE THEORY OF DREAMS • Resides in the unconscious THE THEORY ON LEVELS OF AWARENESS 3 Levels of Awareness: > Highest level of Awareness > Contains all experiences that can be > “Tip Of The Tongue”. ORAL STAGE 0 – 18 months “ Survival” All ID Cry. suck mouth Biting. sense of security After 6 months.C. Thumb sucking & Nail biting-----------------all normal in infancy Dependent. EGO develops------Development of Self-Concept Maternal Deprivation results if there’s no feeding. accidents. Deja Vu > Experiences that partly forgotten & partly remembered > Forgotten > Experiences that cannot be recalled Ex. anxieties & phobias > Where traumatic experiences are stored (Repression) Ex.
SCHOOLER Focus: Genitals------Penis only Development of Gender Identity Masculine/Feminine Created by Niňa E. Over-talkative Gossiping Chewing gums Smoking & Drinking alcohol 2. (Antisocial) PHALLIC STAGE 3 years – 6 years old SE Anal P HALLIC ENIS ARENT RE . Rigid. Collectors & Residuals Developed: Hoarders Problems: Strict Toilet Training Too much punishment w/ Toilet-training result to a child who is: Good mother Successful Bad mother Clean Organized Obedient Dirty Disorganized Disobedient SE SE Anal Retentive Expulsive (Obsessive-Compulsive) 3. Righteous. Tubio Sense of Being 6 . ANAL STAGE 18 months – 3 years old -------the 1st to developed Focus on Elimination -----Bowel -----Bladder (Bedwetting) Toilet training Temper Tantrums---Normal---Ignore as long as no harm is present: If (+) harm---set limits SUPEREGO is being formed(begins)---------------Mother as the superego Sense of Autonomy Develops------manifested through Negativism (No) Stubbornness Concerns: Punishment Cleanliness Habit-training Stage Perfectionist.
GENITAL STAGE 12 years and above energy) Focus: Genitals Emergence of LUST The Heterosexual Stage Sense of Identity AMBIVALENCE: Child (Gising na ulit ang sexual G Adult ENITAL ISING Struggle for independence from parents Problems: Conflicts & Frustrations dominates 2. Promiscuity. LATENCY STAGE 6 to 12 years old (School Age) ang libido) (“Log tu” tulog Focus: School & Peer The Homosexual Stage-----------Identify with the same sex------Best friend Areas on school & social competition--------------form the sense of group success Sense of Industry Fear: School Phobia-------------Separation-Anxiety A R W EADING ITING ITHMETIC Sublimation – placing sexual energies (feelings) toward more productive endeavors Residuals Developed: School Dropout 5. Sense of Initiative Genital Exhibitionism/Masturbation Imaginative With a friend Explorative “Why” Residuals Developed: Sexual Deviation Sibling Rivalry is normal Development of Complexes----child attachment to opposite sex Oedipus Complex (boy loves mommy) Electra Complex (girl loves daddy) Both complexes Identification To parent of the (Role Identification) resolved thru Identification (girl imitates mommy) Girls“Penis Envy” same sex Identification (boy imitates daddy) 4.Psychosocial Theory Of Development Created by Niňa E. Alcoholism ERIK ERICKSON------. Residuals Developed: Drug Addiction. Tubio 7 .
Restrictions) Anger To Self Family 6-12 years (School) Laten t Inferiority (Social Loner) (School Dropout) School “Who Am I” based on beliefs. Tubio Intimacy (Commitment) Generativity (Productivity) “Sharing” Isolation (Relationships/Jo bs on Temporary Basis) Stagnation (Selfish. Considered the “Social Factors” Man as a Social Being Person play different roles & as we play them.No” “My” Independe nce “Teach The Child” Parents 3 – 6 years (PreSchooler) Phalli c Guilt (Denial. we achieve something PSYCHOSOCIAL STAGES OF DEVELOPMENT Freud Stage 0-18 months (Infancy) 18 months – 3 years (Toddler) Oral (+) Trust ( Friendly/ Affectionate) (Self-Confidence) Autonomy (SelfDetermination) (Independence) Initiative (Responsible) (Role Identification) Initiate the 1st step Industry (Competition) (Cooperative) “Sx of High SelfEsteem” (-) Mistrust (Withdrawn/Susp icious) Shame & Doubt (Overtly Compliant) Factor Significa nt Person Mother Feeding Anal Toilet Training “No. SelfCentered) “No Learning” Love Husband/ Wife Children Parenting “Sharing beliefs w/ Children Grandchil dren 8 . selects & become who you are along w/ your peers Peers (Major factor in the dev’t of beliefs Teacher Peer 12 – 20 years (Adolescen ce) Genit al Identity (Self-Actualized) (Self-Direction) Role Confusion (Identity Crisis) Opposite Sex 20-25 years (Young Adult) 25-45 years (Middle Adult) Created by Niňa E.
Unworthy) (Fear of Death) Husband/ Wife Best friend Reflection Paranoia = Stems from the development of mistrust Exercise: Newly admitted Patient:----Develop 1st ----Trust ----Develop/teach autonomy since pts.ESTEEM LOVE & BELONGINGNESS SAFETY & SECURITY Created by Niňa E.esteem: Give Improvement of Self Task SELF-ACTUALIZATION SELF. color.perceive. they still believed its existence • 2nd Stage : Pre-Operational 2.7 years old • Egocentric----does not feel what adults feel • Animistic Thinking -------cartoons are powerful • Imitates other people • Pre-Conceptual 2-4 y/o -----Use of language to talk • Intuitive Stage 4 -7 y/o-----Unidimentional classification/characteristics (Child can fix toys according to size. JEAN PIAGET-------Theory Of Cognitive Development Four Stages Of Cognitive Development 1st Stage : Sensorimotor 0. ABRAHAM MASLOW’S HIERARCHY OF NEEDS > Continuous > Low self. height--1 at a time only : Concrete Operational 7 – 12 years old • Logical • Concept of Cause & Effect : Formal Operation • Idealistic • Abstract Thinking 12 years old & above 3rd Stage 4th Stage 4.hear) Adapt through the use of reflexes & motor skill Concept of Object Permanence ----even if they cannot see the object. Tubio 9 .children” 45 & Above (Late Adult) Ego Integrity (Worthiness) (Completeness) Despair (Hopeless. Are dependent with self-care deficit 3.2 years old • Preverbal • Recognizing environment by the use of senses (baby can see.
Early Adolescence--. Superiority Concept HARRY STACK SULLIVAN-----Theory Of Interpersonal Relationships 9.9-12 y/o Best Friend Depends on group success 5. OTTO RANK------Theory Of Birth Trauma Birth Trauma---------Manifested Through----------Separation Anxiety Birth Trauma --------the 1st cause of Anxiety CARL JUNG------Theory Of Libido 7. Late Adolescence------18-22 y/o Created by Niňa E.0-18 months Mouth 2. Theory Of Libido-------derived from an energy level 6. 8. Childhood------------18 months. ADOLF MEYER--------Psychobiology Theory Concept of the mind & body as one entity ALFRED ADLER------Individual Psychology Unique Man born with a weakness but overcomes it through Compensation Inferiority Vs.12-18 y/o Emergence of Lust Attraction to opposite sex-----bases: physical appearance 6. Infancy--------------. Theory of Interpersonal Relationships Mother & Child developed IPR during infancy------if lacking------anxiety Builder Of Self-Esteem Motivation Stages: 1.6 y/o Egocentric/Gender Identity 3. Juvenile----------------6-9 y/o Competitive 4.BASIC PHYSIOLOGICAL NEEDS 5. Pre-Adolescence-----. Tubio 10 .
Development of lasting relationship----based on security 7. Tubio Involuntary Movements (AUTONOMIC) 11 . then it can be unlearned Good Behavior Reward Repeated behavior Bad Behavior Punishment Extinguishes behavior / extinction IV.F. B. SKINNER Unconditioned Response (salivation) ---------------------OPERANT CONDITIONING MODEL If all behavior is learned. Language Occipital Lobe = Vision Temporal Lobe = Hearing. PSYCHOPHARMACOLOGY Positive reinforcement Negative reinforcement Anatomy: Frontal Lobe = Personality. BEHAVIORAL MODELS A. Adulthood-----------------22 y/o & above Achievements Focus on emotional & sexual maturity 10. Judgment. Smell Parietal Lobe = Touch How do you interact with your environment? S I M ENSORY NTEGRATION OTOR -----1st ------seeing ------2nd------analyze ------3rd------action Voluntary Movements (SOMATIC)SNS ANS Created by Niňa E. IVAN PAVLOV ------------------CLASSICAL CONDITIONING MODEL “All behavior is learned” through CLASSICAL CONDITIONING Unconditioned stimulus (food) Conditioned stimulus (bell) B. Learning.
psychotic C-cholinergic D. Tubio 12 . DEFENSE MECHANISMS Mental mechanisms Coping Mechanisms from stress Patterns of adjustment Affects/Interferes with ADL--------harm to self or others Operates on the unconscious level Processes on the Ego---------to reduce anxiety--------maintain selfesteem Results to > Adaptive/ Maladaptive > Distort reality > Self-deception Created by Niňa E.depressants Effect is ANTI V.Brain (Alert) Sympathetic Parasympathetic (Relax) Spinal cord RR Motor Nerves GI moist mouth ♥ HR ↑ ↑ ↓ ↓ ↓ dry mouth constipation ↓ retention ↑ diarrhea Ach frequency GU ↑ Acetylcholine – “on” switch of muscle (transmits message to the muscle) Acetylcholine Neuro Epinephrine/ Synapse Vasodilatation Transmitter Norepinephrine Pupils Midriasis Blood Vessel Vasoconstriction BP Increased Myotic Decreased Muscle Fiber Anti-Cholinergic/ Anti-Parasympathetic sympathetic Sympathetic Drug Classifications: A.anxiety P.
Acting like a child Unconscious forgetting of anxiety provoking concept (Selective forgetting) Illogical reasoning for a socially unacceptable trait (Giving rational reasons) • Uses “because” • Most common defense mechanism used Ex. social & occupational role (Models a certain behavior) Unconsciously imitating another person Attribute to others one’s unacceptable trait Mechanism) Ex. you shout to your Failure to acknowledge an unacceptable trait or situation or reality Ex. persona. Anger repressed & converted to physical symptoms 13 Sublimation Substitution Conversion Created by Niňa E. Tubio . “I don’t want to talk about it” Excessive energies put towards more productive endeavors Redirect feelings (anger) to a socially acceptable behavior Replacing a difficult goal with an accessible one Repression.DEFENSE MECHANISMS Displacement Transfer of feelings to less threatening object/person rather than the one who provoked it • Unacceptable Ex. Show true feeling then feels guilty after doing it Assuming trait. “I drink the beer in the ref rather than waste it” Doing opposite of the intention (Hypocrites) subordinate” Denial Regression Repression Rationalization Reaction-Formation Undoing Doing opposite of what you have done (Action & then amends) Ex. “Not me but them” (Scapegoat Identification Projection Introjection Suppression Assume another’s trait as your own (Taken into oneself) Ex. “ Boss shouts at you. “Not only you. “I am not an alcoholic” Returning to an earlier developmental stage (earlier pattern of behavior) Ex. Me too” Conscious forgetting of an anxiety-provoking concept (Voluntary forgetting) Intentional forgetting to an unpleasant experience Ex.
Fugue new place 3. numbness & motor paralysis Compensation Solve conflicts by manifesting physical symptoms Overachieving in one area to cover defective part or weakness To overcome inferiority & excel in other aspect of personality Use of imagination/daydreaming Separating your feelings from the situation Arrest of maturation/Persistence of one stage of development Give meaning to objects Psychological flight from self Ex. Amnesia. Depersonalization Unreality to oneself With altered sense of self 5. Dissociation not otherwise classified Sleep talking---somniloquism Sleepwalking--somnambulism Amok aggression --New identity in a Created by Niňa E. Tubio 14 .Ex. Rape or traumatic experiences Unconscious separation of certain parts or functions of personality Fantasy Isolation Fixation Symbolism Dissociation Alteration in--------Memory Identity Consciousness To reduce/avoid anxiety Categories: 1. Psychogenic Amnesia------loss of memory 2. Multiple Personality Dissociative identity disorder 2 or more personalities 4.
No reality 3. leaning forward Exploring questions Who. CONCEPT OF NEUROSES & PSYCHOSES Neuroses 1. when. Reality is present 3. Ego in the unconscious 4. establish eye contact.” NON-THERAPEUTIC • Ignoring patient’s feelings or emotions “Don’t worry be happy” False Reassurance “Everything’s going to be fine” Ignoring the client • • • • • • Changing the subject • • • • Asking “why?” Putting client on the defensive Making value-based judgments Prejudicial. Ego in the conscious 4. Tubio 15 .VI. Haldol THERAPEUTIC COMMUNICATION TECHNIQUES THERAPEUTIC • Offering Self “I’ll sit with you” “I’ll stay with you” Silence (giving patient time to think) Making observations “You seem sad” Active Listening Nodding. I’m listening. Thorazine. use of adjectives “Nice weather today” Flattery “You are the most beautiful …” Advising “You should do this. where. Disturbance of the mind 2. Ativan VII. how Broad Opening “How are you today?” “How are things going today?” General leads “Go on. what. Valium. THERAPEUTIC COMMUNICATION Tx: Psychoses 1.” Nurse: “You’re sad?” Refocusing “ We were talking about the exam….” “In my opinion…” Commanding client • • • • • • Created by Niňa E. Delusion Tx: Minor Tranquilizer Ex.” “ And then what else?” Restating Client: “I’m sad. Maladaptive emotional state 2. Behavior is Core Symptom: Hallucination. Major Tranquilizer Ex. Behavior is socially acceptable appropriate Core Symptom: Anxiety Illusion.
Vague sense of impending doom .A feeling of uneasiness---------vague apprehension------uncertainty Different with Fear – afraid of what you know .Presence of an external danger A.• Focusing “Tell me more about this…” • Arguing with the patient • Clarification “What do you mean by plooplank?” • Do not impose your opinion CONCEPTS & DISORDERS VIII. Tubio P D S 16 . ASSESSMENT: Level of Anxiety 0 = Ataraxia------absence of anxiety----------uncommon---------present only in clients on shabu/drug addicts P E R C E P T U A L F I E L D MILD PANIC MODERATE SEVERE Mild +1 Moderate +2 Severe +3 Panic +4 Created by Niňa E. ANXIETY .Present is the anticipation of danger .Afraid of the unknown .
“You seem anxious” *An emergency Words are usually enough to SNS Activation Manage mild anxiety NURSING DIAGNOSES: Ineffective Individual Coping Powerlessness Impaired Skin Integrity PLANNING/ IMPLEMENTATION: ↓ level of anxiety ↓ level of environmental stimuli Relaxation techniques (Psychophysiology) EVALUATION: Effective individual coping B.Widened Perceptual Field acing on’t know what to do uicide Increased motivation RN meds on’t know what to say afety Restless irective Enhance learning capacity Selective Inattention Free-floating anxiety Increased Hearing Presence of Physical Sx muscle tension DON’T TOUCH client Problem-Solving present Narrowing of attention Respiratory alkalosis* * Good: Client more aware *Breathe into bag * Bad: Contagious Disorganized Level * Normal anxiety r/t everyday tension Terror/Threat USE THERAPEUTIC COMM Apathy Ex.) PANIC DISORDER • • • 15-30 minutes escalation of the SNS Sudden: Happens w/o warning With or W/O agoraphobia 2 Types: Agoraphobia Sign of Panic Disorder Created by Niňa E.) GENERALIZED ANXIETY DISORDER • • • • • • • • 6 months excessive worrying Restless Concentration difficulty Sleep problems Palpitations Feeling of being at the edge of seat Easy fatigability Patient knows what the problem is 2. Tubio Fear of open spaces > Outstanding 17 . DISORDERS ASSOCIATED WITH ANXIETY 1.
) Major Sign: DOCTOR HOPPING Favorite pastime of people suffering Nervous System CONVERSION La belle difference (Emotional detachment) Loss of Sensory/Motor Fx S &Sx real HYPOCHONDRIASIS Minor discomfort interpreted as major illness BODY DYSMORPHIC DISORDER Illusion of structural defects S &Sx not real NURSING FOCUS: Client’s Feelings (↓anxiety leads to ↓symptoms) Created by Niňa E.Intentional that (Conscious) *Primary gain – the result you get when you manifest certain behavior ↓ anxiety (Ex. from mother) Physiology: ANXIETY “I am sick” Malingering (Pretending) Somatoform (Unconscious) 5.Social Phobia - Fear of public 3.No organic basis .Pretending to be sick .) MALINGERING . Tubio 18 .) POST TRAUMATIC STRESS DISORDER (PTSD) Trauma Disasters Rape War Others Victims (not forever) Survivors Flashbacks : > 1 month Nightmares 4. Escape from Teacher) *Secondary gain = ↑ Attention ( Ex.) SOMATOFORM DISORDERS Unconscious Not pretending but no organic basis SOMATOFORM (unconscious) Affects the 3 system Psychosomatic Disorders (Real pain/ real Sx.
Tubio 19 .) OBSESSIVE-COMPULSIVE DISORDER (OCD) Physiology: Beliefs/Thoughts reflect into feelings Factors: If disturbed thoughts Obsession (Persistent Thoughts) (Root of Anxiety) Anxiety Anxiety Do something to relieve anxiety Action : Compulsion Persistent Behavior & Action Created by Niňa E.) PSYCHOSOMATIC DISORDERS Psycho physiologic Real illness.6. real Sx & pain with organic basis Physiology: ↑ ANXIETY SNS PNS ↑BP Hypertension Vasoconstrictio n Bronchoconstrictio n Cerebral Artery Migraine Left Gastric Artery Asthma Decreased O2 supply----cells die Breakdown of mucosal lining----ulceration Stress ulcer 7.
Trauma in past related to feared Ex. Counter transference-----Rn feels something for patient EATING DISORDERS ANOREXIA NERVOSA & BULIMIA NERVOSA ANOREXIA Diet. diet Underweight. 2. Eat…induce vomiting Normal weight Irregular menstruation Knows the Problem But 20 . Tire will cause burning Ex.) PHOBIA Irrational fear Etiology: object Intervention: REMOVE stimulus (object of fear) to ↓ anxiety (Immediate intervention) Increased stimuli = ↑ anxiety Decreased stimuli = ↓ anxiety Belief Object will hurt patient Avoidance: Interferes w/ ADL Tx: BEHAVIORAL THERAPY: Systematic Desensitization . < 85% of body weight 3 months amenorrhea Failure To Recognize Created by Niňa E. Interferes with ADLs 2. Tubio Prior knowledge Experience Ex. 4. Feelings Scared Behavior 1.↓ anxiety Reasons when compulsion becomes negative: 1. BULIMIA Eating Pattern Weight Menstruation Knowledge Eat. diet. 3. IX. Harms self & others 8.gradual exposure to feared object Individual Therapy Hypnosis--------------------Relaxed state Free Association----------Ideas shared to psychoanalyst Catharsis--------------------Free to express feelings Transference---------------Patient feels something for psychoanalyst 5.
Anti-depressant RELATED DISORDERS: 1. COMORBID PSYCHIATRIC DISORDERS COMMON IN CLIENTS WITH EATING DISORDER X.Establish nutrition pattern . BINGE EATING DISORDER .Characterized by morning anorexia .Recurrent episodes of binge eating . PERSONALITY DISORDERS Cluster A Created by Niňa E.No regular use of appropriate compensatory behaviors 2. Accompany in the toilet Body Image Disturbance .Teach stress management.Evening hyperphagia (Consuming 50% of daily calories after last evening meal) .Risk for metabolic alkalosis NURSING ALERT • Most fatal complication: ARRHYTHMIAS MANAGEMENT: Priority: DEFICIT Restore fluid & electrolyte balance Anorexic & bulimic clients are at risk for FLUID VOLUME Collaborate with client re: menu through use of CONTRACT to ensure cooperation • Priority: Target weight gain & Monitor eating pattern & weight • • Nsg Dx: N. Tubio 21 . NIGHT EATING SYNDROME (NES) .Problem Ashamed & Embarrassed NURSING CONSIDERATIONS Bulimic induces vomiting & tends to abuse laxatives Assess for: Dental caries Wounded knuckles Vomiting . Stay with client for 1 hour after meals to ensure client eats food & does not induce vomiting. Journal keeping .Nightime awakenings (at least once a night) 3.I.
dramatic Manipulative “I love myself” Insensitive. ↓ Self-esteem Have a talent but no confidence “Can’t live without you” ↓ Self-Esteem Poor decision-making skills NARCISSISTIC Cluster C AVOIDANT DEPENDENT OBSESSIVE-COMPULSIVE Organized Constancy in Environment Perfectionists------Provide time to do rituals OTHER CATEGORIES: PASSIVE-AGGRESSIVE DEPRESSIVE in a variety of context NURSING INTERVENTION TO ALL: Created by Niňa E. Do not care about people & believes he Detachment from social relationships Avoids activities & group more concerned with things No enjoyment: Limited range of emotional expression in interpersonal settings PARANOID SCHIZOTYPAL Cluster B ANTISOCIAL Suspicious Violent Acute discomfort in relationships Eccentric behavior Breaks the law Usually charming. steals. drug addicts-drives fast-unsafe sex-thrill Are slick talkers BORDERLINE Loves to split groups “My life is an empty glass” Likes to keep spares (-) (+) Afraid of being alone suicidal fill Manipulative friends Self-mutilation Splitting Superficial Relationships Labile affect (sudden change of mood) seeker HISTRIONIC Attention-Seeking Excited. lie As Adults.SCHIZOID can stand on his own Avoids people. Tubio Always says “yes” but resistance is hidden Pattern of depressive cognitions & behaviors Improve Interpersonal Relationships 22 . were usually cruel to animals. Arrogant Self-absorbed Exaggerated Avoid people & groups Fears criticism. witty As kids.
Runs in families. THEORIES OF CAUSATION: > Stress Diathesis Model . genetic component (biological) > Unknown > Physiological Finding: ↑Dopamine in schizophrenic clients Physiology: ACH “ON” switch D “OFF” switch ACH ↑ACH ↑ACH ↑Dopamine D D Parkinso n’s ↓Dopamine ACH ↓ACH Schizophr enia Antipsychotic agents → ↓Dopamine Client manifest Parkinson-like symptoms known as ACH ↓Dopamine D ↑ACH Give ANTICHOLINERGICS to treat EPS Except Tardive Dyskinesia EXTRA PYRAMIDAL SIDE EFFECTS (Voluntary mov’t of the skeletal muscles) (↓D & ↑ACH) A kathisia (restlessness. Tubio to balance Schizophrenia . inability to stay still)* Most common A kinesia ( muscle rigidity) D ystonia ----earliest sign (1-5 days) Characteristic Features: • Torticullis (wry neck) • Oculogyric crisis (fixed stare) • Opisthotonus ( arched back) T ardive Dyskinesia (irreversible effects) d/t ↑ Adenosine Triphosphate • Lip smacking • Tongue protrusion • Cheek puffing N euroleptic Malignant Syndrome or NMS • Hyperthermia. SCHIZOPHRENIA EGO Disintegration Impaired Reality Perception Famous example: John Forbes Nash.Stressful living pushes person to escape into fantasy “Far better to be king in your fantasy world” idea > Genetic Vulnerability . Jr.Build Trust XI. 23 Anti-Psychotic & AntiCholinergic Both given to Created by Niňa E.
ACH ANTICHOLINER GICS A kineton A rtane D DOPAMINERGI CS Parlodel Larodop a OTHER SIDE EFFECTS OF ANTIPSYCHOTIC MEDICATIONS: Photosensitivity Teach patient to use sunscreen. Trapped in own world SSOCIATIVE LOOSENESS Unrelated ideas 1. wide-brimmed hat when going out • Agranulocytosis (↑ monocytes. Blunt Pull between 2 opposing forces (incomplete) Created by Niňa E. rashes. ↑ lymphatic) Teach client to report SORE THROAT (1st sign of Blood Dyscrasia) Hypersensitive Reactions Ex. Opacity of the lens. retinitis Pruritus. dermatosis. Tubio 24 . Inappropriate emotion) 3. Allergy ↓ Epinephrine ------Hypotension Endocrine-------------M = Gynecomastia F = Enlargement of breast & ↑ libido Arrythmia Blurring of vision. THE NURSING PROCESS: ASSESSMENT: 4 A’s Types Of Affect • A FFECT MBIVALENCE UTISM Self-absorbed. Appropriate External manifestation (feelings & 2. Flat (none) 4. eczema. dermatitis & hyperpigmentation A.
Consistent Approach • Ambivalence (sad but smiles) • Waxy • Flat affect • Scared/Withdrawn/Viol flexibility • Disorganized ent • “No” (Rebel) speech/manner • Negativism (flight of ideas) N.Illusion. Created by Niňa E. Tubio • Hebephrenic 1. TYPES OF SCHIZOPHRENIA Orientation 2. Keep door open (giggling) 2. Develop Trust: C. One-to-one interaction SCHIZOPHRENIA 3.I. Short but frequent visits 4.I. Don’t touch patient 3. 1. Establish Eye 25 .4 THINGS TO ASSESS IN SCHIZOPHRENIC PATIENTS Assess Nsg Dx Content of Thought Disturbed Thought Processes Hallucinations/ Illusions Disturbed Sensory Perception Suspicious Risk for OtherDirected Violence Present Reality Provide Safety Minimize/ Eliminate risk for otherdirected violence Suicidal Risk for SelfDirected Violence Present Reality Provide Safety Minimize/ Eliminate risk for selfdirected violence Planning/ Implement ation Evaluation Present Reality Provide Safety Present Reality Provide Safety Improved Thought Processes Improved Sensory Perception B. Delusion) NEGATIVE Hypoactive Withdrawn Quiet Flat Affect Apathy PARANOID Poverty of • Uses Projection words Problems with: • Mistrust-------Suspicious N. Foods in sealed container DISORGANIZED Meals wrapped CATATONIC • Inappropriate affect 5. SYMPTOMS S & Sx OF SCHIZOPHRENIA 2 Types POSITIVE Hyperactive Sociable Talkative Restless Queen of the World Flight of ideas (Hallucinattion.
• • • RESIDUAL No more (+) or (-) Sx Social Withdrawal Withdrawn UNCLASSIFIED or UNDIFFERENTI ATED • Mixed classification s • Cannot be classified D. The home of the brave. moving one unconnected topic to another “The sun is shining. Here is the bag.New topics Vs. no rhyme Rhyming words Created by Niňa E. The brave little Indian boy. Tubio 26 .” . THOUGHT PROCESS DISTURBANCE FLIGHT OF IDEAS Fragmented thoughts. AMBIVALENCE forces ECHOLALIA ECHOPRAXIA WORD SALAD CLANG ASSOCIATION Feeling of being pulled between 2 opposing I repeat what you say (Word Repetition) I repeat what you do (Action Repetition) Just mixing of words. The mouse is on the mat. LOOSE ASSOCIATIONS -Stringing together of unrelated topics with a vague connection “I am going home.
false beliefs * NURSE Persecutory “The FBI is after me” Grandeur “I am queen of the world” Ideas of Reference “They are talking about me.NEOLOGISM can use CLARIFICATION DELUSIONS Newly created words-------Fixed. auditory. IMPORTANT: Also ask what the voices are saying because 10% of schizophrenic clients are CKNOWLEDGMENT “I know the voices are real to you…” EALITY ORIENTATION----------Present reality “But I don’t hear them. visual. tactile.” CONCRETE THINKING words & phrases proverb Inability to conceptualize the meaning of * Test by asking client to tell the meaning of a P HALLUCINATIONS ILLUSIONS ilosopo roverb False sensory perceptions. without stimulus (-) for visual. auditory Believes that he has magical power MAGICAL THINKING MANAGEMENT TECHNIQUE H A R ALLUCINATIONS Auditory hallucinations are common. tactile Misinterpretations of real external stimuli (+) for stimuli.” D Created by Niňa E. Tubio IVERSION “Let’s go to the garden.” IRECTIVE 27 .
AUTISM Trapped in own world/ live in a fantasy world Unresponsive to people Echolalia Poor eye contact Cannot express feelings verbally----root of self-directed violence/self-mutilation Boys > Girls Autistic-savant (gifted) . ALZHEIMER nomia gnosia phasia praxia Don’t know name of object Problem with senses (smell. touch) Can’t say it Can’t do it A away place. DISORDERS OF THE CHILD 1." Mngt: ECT Therapy XIII.XII. + Perseveration this is what I want to do….about 1% of all autistics ASSESSMENT: ABC’s APPEARANCE Created by Niňa E. taste . Tubio Flat affect 28 . New Identity issociative Identity Disorder Multiple Personality issociative Amnesia Don’t know who/where I am epersonalization Believe that they are not persons “I want to talk about something. anymore D issociative Fugue Takes a new personality from a far New Place. hear.
OC.Consistent movement Neat. Tubio ID dominant: Mother & RN will act as SUPEREGO may grow up to be ANTISOCIAL may not be antisocial 7 years old & below 6 months & above Must appear in 2 (home & school) 29 . ATTENTION DEFICIT & HYPERACTIVITY DISORDER (ADHD) Cannot focus on anything Can progress to Conduct Disorder----to---Antisocial Behavior---Future Criminal ID dominant Residual ADHD Onset: Duration: Settings: Created by Niňa E. improved social interaction. music. Risk for Injury PLANNING/ IMPLEMENTATION: Use Maslow’s Hierarchy of Needs Promote constancy & safety EXPRESSIVE THERAPY----uses art. poetry Purpose: ↓ risk for injury. able to express feelings EVALUATION: Enhanced Communication Improved Social Interaction Safety 2. literature. Wants constancy BEHAVIOR Repetitive Ritualistic COMMUNICATION Echolalia attention Incomprehensible/Difficulty communicating * Can’t cry for help. usually hurts self to get *Talk slowly to autistic child Nsg Dx: turned it inward Impaired Verbal Communication Impaired Social Interaction ------cannot form IPR Self-mutilation ------cannot express anger.
ASSESSMENT: APPEARANCE BEHAVIOR Usually dirty Clumsy Hyperactive Impatient. Tubio 30 .bath Chedule ----Time for everything et limits afety Medical Mgt: RITALIN EVALUATION: Minimize risk for injury ↓ Glucose Improved social interaction ↑ Glucose Safety ↓ Frontal lobe ↑ Frontal lobe ↓ judgment ↑ judgment S/Sx of ADHD Ritalin ( a stimulant) 3. MENTAL RETARDATION Levels Of Mental Retardation: Profound Normal 20 Severe 35 50 Moderate 70 Mild Borderline 90 IQ 110 Created by Niňa E. Easily Distracted Talkative.play. Blurts out in class COMMUNICATION Nx Dx: Risk for Injury Impaired Social Interaction PLANNING/ IMPLEMENTATION MILIEU THERAPY S Tructure ----Provide place to study.eat.
Don’t brush BANTAY BATA 163 XV. CHILD ABUSE teeth) B Burns Bruises Bone Fractures (Bungi) Body of Evidence should not be lost ( Don’t bathe child.Happy (dominant) & Sad Too self-actualize Created by Niňa E. Mental age is 2-7 y/o------------Preoperational Stage Mild: 50-70 Can go to school. Mental age is 7-12 y/o XIV. BIPOLAR 2 poles-----. MOOD DISORDERS A.Profound: the Client Severe: <20 Thinks like an INFANT---Cannot be trained-----Stay with 20-35 Moderate: 35-50 Can be trained. Tubio 31 .
g. MANIA Created by Niňa E.BIPOLAR I MANIC TYPE an episode BIPOLAR II MANIC-DEPRESSIVE TYPE BIPOLAR I USUAL PROFILE: Female Usually 20 years old & above Under stress Obese DRUG OF CHOICE: work ASSESSMENT: Lithium ( for mania) * Mania is not a Dx but of bipolar disorder ↓ NE ------Takes 2-4 weeks to Use Maslow’s Hierarchy of Needs 3 Or More Signs Confirms Disorder: G F S P E E D MANAGEMENT: grandiose. Tubio 32 . watering plants. heavy make-up. loud voice ↓ Self -esteem Caregiver Role: Train / Safety Impulsive so ensure safety Impaired Social Interaction Lock doors & windows Place in room with low Risk For Injury/ Other-Directed stimulus Violence Not with other manics or Manic clients usually ↓ Eat ↓ Sleep Hyperactive masturbate because of ↑ Sex worrying Finger foods Private room ↓ anxiety “Tell pt.g.g. it is not allowed” What are appropriate tasks? No competition or group games. ↑ risk activities flight of ideas sleeplessness pressured speech exaggerated SE extraneous stimuli (easily distracted) distractibility ↓ Self -Actualized Manifested by Defensiveness & Compensation ↑Self Esteem by giving TASK Compensation: S/Sx: flamboyant. sweeping the floor to put energies to productive endeavors Avoid activities with fine motor skills e. sports e. basketball-------------↑ Anxiety Gross motor skills e. sewing Escort outdoors Punching bag------“Displacement” B.
vomiting. fine hand N 3 Signs of Lithium ausea. Tubio 33 . Needs a mood stabilizing agents-----. Creatinine) Only 90% absorb by iidneys kidneys remors.drug of choice If level is near 2. diarrhea a ( ↑ sodium intake to correct FVD) (Na: 135-145 mEq/L) H ydration l/day I U 3 ncrease “PUPU” M outh. dry * * Lithium absorbs water Created by Niňa E.LITHIUM & GROUP THERAPY ↑ NE LITHIUM .3 mEq/L Ataxia Mental Confusion L evel : 0.5.5 mEq/ dL Toxicity I ncrease urination T Kiidneys Check first before beginning therapy (BUN.5 – 1.
Give Antidepressants 2. DEPRESSION ↓ Serotonin If unresponsive to drugs------. atropine sulfate------dry mouth barbiturates succinycholine Chloride-----To relax muscles . If Drugs not working----Electroconvulsive Therapy (ECT) Pre-ECT: N A B S Post-ECT: Side-lying position---Lateral Created by Niňa E.ECT Therapy THE GRIEF PROCESS Denial Anger Bargaining Depression 2 wks or more is a sign of MAJOR CLINICAL DEPRESSION Acceptance ASSESSMENT 5 4 3 ↓ Self – Actualization ↓ Self –esteem Give Simple TASK Withdrawn Stay with client 2 Risk for self-directed violence 1 ↕ eat ↕ sleep hypoactive ↓ sex Be sensitive to client’s needs MANAGEMENT OF DEPRESSED PATIENT: 1.C. Tubio 34 npo for 6 hrs.
Tubio irect Question/Approach “Do you plan to commit suicide?” rregular nterval Visit frequently but should not be predictable 35 . Terminal MANAGEMENT OF SUICIDAL PATIENT: Suicide Area: Hospital Majority happens on a weekend from 1-3 AM Sunday Weekend----less personnel D I Created by Niňa E. Dizziness Temporary Memory loss (distinct Sx) Rn reorient LEAD TO: SUICIDE SUICIDAL CUES Verbal “I won’t be a problem anymore” “This is my last day on earth” Non Verbal Gives away valuables Sudden change in mood ALONE SUICIDE TRIAD: LOSS OF SPOUSE JOB Who Will Commit Suicide? s A D P Ex--------Male (more successful) ------Female (hesitant) Ge-------15-24 y/o or above 45 y/o epression atient with previous attempts will try again E thanol (ETOH) Alcoholics R irrational S lacks social support O rganized plan----greater risk N o family S ickness.S/E: Headache.
Tubio 36 . Nervous • • Tremors Give DOWNERS 2.E Most suicides are done in the early morning & ndorsement during endorsement arly AM Close Surveillance XVI. Depressed • • Sits down on chair Give UPPERS DOW NERS Asleep Bradypnea Bradycardia Pupils constrict Hypotension Coma Asleep Weight Gain *Constipation * GU Retention UPPERS EUPHORI A Awake Psychological sense of well-being Tachycardia Tachypnea Pupils dilate Dry mouth Hypertension Seizures Weight loss (Thin) *Diarrhea Alcohol Barbiturates Opiates Narcotic Marijuana Morph Code Hero INE Coma Bradypnea Cocaine Hallucinogen Amphetamines STOP UPPERS Antidote: NARCAN (narcotic antagonists) Alcohol Overdose Morphine Overdose Tremors Fatigue Crash Syndrome Created by Niňa E. SUBSTANCE ABUSE Types of ADDICT: 1.
Awake.Depressed Suicide OVERDOSE vs. Identify if drug is Upper or 2. Check Effect 3. Downer Check for opposite effect & 2.A way of escape from problems . D restless ENIAL EPENDENCE b. WITHDRAWAL WITHDRAWAL ↑ HR ↑ BP ↑ RR ↑seizures ↓ HR ↓ BP ↓ RR LOC (coma) OVERDOSE Alcohol ↓ HR ↓ BP ↓ RR LOC (coma) Cocaine ↑ HR ↑ BP ↑ RR ↑seizures Narcan (Naloxone HCl) Narcotics Withdrawal Sx of WITHDRAWAL: Sx Of OVERDOSE to 2 Types: 1. tachycardia. happy----socializing . Sx of Withdrawal Narcotic Antagonist: Drug of choice for Overdose Drug of choice for Valium (Diazepam) Methadone Detoxification ALCOHOLISM (for seizures) Drug of choice for Narcotics Alcohol Abuse .D/T peer pressure Etiology: Theory of Intergenerational Transmission (child imitating parents) Physiology: ALCOHOL BLOCKOUT CONFABULATIO N Awake but unaware Inventing stories to increase selfesteem “I am not an alcoholic” “I can’t live without you” a. Know if drug is Upper or Downer 1. Psychological Carving CODEPENDECY tolerated by the body Created by Niňa E. Physical – tremors. Tubio ENABLING or Significant other tolerates abuser Increased Drinking 37 Tolerance .
Tubio 38 . DEFICIENCY(Thiamine) Monitor for: WERNICKE’S ENCELOPATHY (motor problems) KORSAKOFF’S Provide well-lit room to avoid OMPLICATIONS SNS stimulation Within 24-72˚ of withdrawal D ELIRIUM TREMORS Tremors.g. Alcoholics Created by Niňa E.MANAGEMENT A B C VOIDs ALCOHOL VERSION THERAPY LCOHOLICS ANONYMOUS NTABUSE (Disulfiram) Ask 1st the time of last alcohol intake before giving Anatabuse: There should be a 12 – HOUR INTERVAL NEVER take alcohol with antabuse OR ELSE Nausea & Vomiting Problems of Alcoholics: 1 VIT. GROUP THERAPY Nurse as organizer Nurse as facilitator e.Withdrawal with MD Supervision Role of the Nurse: Alcohol CHECK belongings for: Mouthwash Elixir (alcohol-based) ASK TIME of last alcohol intake to monitor delirium SELF-HELP vs. Illusions F THERAPY: 1. Hallucinations. & ORMICATION AMILY THERAPY Feeling of “bugs crawling under the skin” DETOXIFICATION .
XII. Tubio 39 . P H A R M A M O M E N T S ANTI-ANXIETY AGENTS V L A S T alium ibrium tivan erax ranxene M iltown E quanil V istaril A tarax I B uspar nderal (Used also for Alcohol Withdrawal) “VLAST ME VAIB” THE AUTONOMIC NERVOUS SYSTEM (2 Neurotransmitters) Epinephrine/ Norepinephrine excite the SNS Gamma aminobutyric acid (GABA) (Stops) inhibits SNS ANTI-ANXIETY AGENTS ANXIETY E/ NE ANTI CHOLINERGIC Constipation Retention Dry mouth Blurred vision *Effects of GABA: Drowsiness Orthostatic Hypotension *Contraindicati ons No coffee No alcohol Do not drive GABA If ABRUPT Withdrawal: Rebound phenomenon Within 1 wk Seizures ANTI-ANXIETY AGENTS ↑ GABA WITHDRAWAL Recommended: Gradual Withdrawal Tapered dose D E P E N D E N C E RELAXED To prevent Orthostatic Hypotension: S it D angle S tand gradually Created by Niňa E.
All Medications Taken On Full Stomach-------except Anti-Anxiety ANTI-DEPRESSANTS sendin orpramin ofranil inequan rozac (ssri) A nafranil A N T S A ventyl V ivactil E lavil P P axil ↑ Serotonin ↓ Serotonin Give ANTIDEPRESSANTS ------------------taken on full stomach ↑ Serotonin S afest S ide effects low R I to 4 wks Selective Serotonin Reuptake Inhibitors ↑ Serotonin & NE T wo to 4 wks wo neurotransmitters C A * Higher incidence of side effects Tricyclic ↑ Serotonin. NE & Dopamine M ono A mine O xidase I inhibitors *2-6 wks effect MAO destroys serotonin. ↓MAO will With MAOIs . AVOID TYRAMINE-RICH FOODS or else HYPERTENSIVE CRISIS Diaphoresis Tyramine rich foods: A vocado foods ged cheese B eer foods F ernented P ickles reserved MONOAMINE OXIDASE INHIBITORS ( MAOIs) M N P PLAN DIL NATE Marplan Nardil 40 Created by Niňa E. Tubio .
Tubio Major Neuroleptics (ANTIThorazine Haldol Serenace Mellaril Trilafon Proloxin Modecate Clozaril 41 .AR ANTI-PARKINSON AGENTS “CAPABLES” C ogentin A rtane P arlodel ldedpryl A kineton ymmetrel 2 CLASSIFICATION B enadryl L arodopa E S ANTICHOLINERGICS ABC A kineton. Artane B enadryl C ogentin DOPAMINERGICS PLSE P arlodel L arodopa S ymmetrel E ldepryl ANTI-PSYCHOTICS rolixin S tellazine S erentil T horazine T rilafon SNS Effect-------2-4 wks C lozaril M ellaril H aldol P TRANQUILIZERS • Produces emotional relaxation/calmness 2 Types Minor Anxiolytics (ANTI-AXIETY) PSYCHOTIC) Valium Anxionil Ativan Tranxene Xanax Serax Librium Equanil Created by Niňa E.
Produces Drug Tolerance VLASTMEVAIB ANXIETY E/NE Anticholinergic S/E Constipation Dry mouth Blurred vision SSTTCMHP SCHIZOPHREN D Always ON EPS/E Akathisia Akinesia Dystonia Tardive Dyskinesia NMS Ach MANIA NE ANTI-ANXIETY ↑GABA ANTIPSYCHOTICS ↓D L I N ausea T H S/E Drowsy X alcohol X coffee X drive eqpmt Orthostatic Hypotension gradual D Anticholinergic Dopaminergic ABC PLSE Constipation retention K I U N M Vomiting Diarrhea a ↑ Diarrhea Frequency RELAXED SSRI PPZ ↑ Serotonin only Anticholinergic S/E Constipation Retention Male Erectile Dysfuncion ↑ Serotonin TCA /NE ANTSAVE ANTI-DEPRESSANTS ↑ all Health Teaching To All: Drug Compliance NO to Tyramine or else HYPERTENSIVE CRISIS MAOIs MNP ↓Serotonin DEPRESSI Created by Niňa E.Miltown Action: ↓ Anxiety CNS Depressant Risperdal ↓ Dopamine Produces EPS Acts on Limbic system Responsible for alertness S/E: Habit-forming. Tubio 42 .
Somatoform Disorder (DSM-IV) Temporal & Other Requireme nts Onset <30 y of age Exclusions By Other Psychiatric Illness Not specified Somatoform Disorder (DSM-IV) Somatization Disorder General Description History of many physical complaints. not better accounted for by other mental disorder Not explained by medical condition or pathophysiologic mechanism Not intentionally produced or feigned. substance effect. not explained by other neurologic or medical condition. or culturally sanctioned behavior and/or experience Symptoms Associated affecting voluntary psychologic motor and/or al factors sensory function suggesting neurologic and/or medical condition Pain Disorder Pain is predominant focus. panic of bodily disorder. 1 pseudoneurologic Other Exclusions Not explained by general medical condition or substance effect Undifferentia One or more ted physical somatoform complaints disorder Conversion Disorder Duration >6 Not accounted mo for by another mental disorder Not limited to pain or sexual dysfunction. Tubio 43 .Table 1. major Created by Niňa E. not exclusively during course of somatization disorder. not restricted to circumscribed concern about appearance Hypochondri asis Preoccupation Duration >6 Not exclusively with fear of having mo during obsessive or idea that one compulsive has serious disorder (OCD). anxiety. 4 pain sites or functions: 2 nonpain GI. disease based on generalized misinterpretation anxiety. severe enough to warrant clinical attention Psychologic al factors in important role Not better Not specified accounted for by mood. does not meet criteria for dyspareunia Not of delusional intensity. 1 sexual or reproductive. or psychotic disorder.
Created by Niňa E. the symptoms must cause clinically significant distress or impairment in social. separation anxiety. or other areas of functioning.—To qualify for this category of diagnoses. occupational.symptoms. persistent fear and idea despite medical evaluation and reassurance Body Dysmorphic disorder Preoccupation with imagined defect in appearance or excessive concern about slight physical anomaly Somatoform symptoms Not applicable depressive episode. Tubio 44 . or other somatoform disorder Not better Not specified accounted for by other mental disorder Somatoform disorder. not otherwise specified Can be <6 Does not meet mo duration criteria for any other somatoform disorder Not specified Note.