Psychiatric Nursing

Ms. Shandz S. de Rosas, R.N.

Psychiatric Nursing
Psychopharmacology

Characteristics Anti-Manic Antipsychotics Anti-Parkinsonian Minor Antidepressants

Tranquilizers
Examples Lithium Haloperidol Dopaminergic Drugs Diazepam (Valium) SSRIs:
Carbonate >Citalopram
Haloperidol Amantadine Chlordiazepoxide (Celexa)
Lithane decanoate (Symmetrel) (Librium)
>Fluoxetine
Lithanate Fluphenazine Levodopa-Carbidopa Alprazolam (Prozac)
(Prolixin) (Sinemet) (Xanax)
Eskalith >Fluvoxamine
Prochlorphe- Levodopa Oxazepam (Serax) (Luvox)
Lithobid razine
(Compazine) Anti-cholinergic Chlorazepate >Paroxetine (Paxil)
Quilonium-R Drugs Dipotassium
Chlorpromazine (Tranxene) >Sertaline (Zoloft)
Carbamezepine (Thorazine) Trihexyphenidyl
(Tegretol) (Artane) NRI:
Molindone >Velafaxine
(Moban) Biperiden (Effexor)
Hydrochloride
Perphenazine (Akineton) Atypical:
(Trilafon) >Buproprion
Benztropine (Wellbutrin)
Thioridazine Mesylate (Cogentin)
(Mellaril) >Nefazodone
Dipenhydramine (Serzone)
Thiotixene Hydrochloride
(Navane) (Benadryl) >Trazodone
(Desyrel)
Trifluoperazine
(Stelazine) >Mirtazapine
(Remeron)
Atypical drugs
>Clozapine TCAs:
>Zyprexa >Amitryptyline
>Seroquel (Elavil)
>Risperdal
>Geodon >Amoxapine
(Asendin)

>Clomipramine
(Anafranil)

>Desipramine
(Norpramin)

>Doxepin
(Sinequan)
>Imipramine
(Tofranil)

>Nortriptyline
(Pamelor)

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Ms. Shandz S. de Rosas, R.N.

>Trimipramine
(Surmontil)

MAOIs:
>Phenelzine
(Nardil)

>Trancyclopramine
(Parnate)

>Isocarboxazid
(Marplan)

Description Controls the Control Control symptoms of Produces Works by

symptoms of symptoms pseudo- sedation, eases modifying the
mania, adequately un parkinsonism in anxiety and activity of the
decreases most patients taking relaxes the relevant
agitation, schizophrenics. antipsychotics muscles. Prevents neurotransmitter
hyperactivity Effective in seizures and pathways. May
in manic reducing helps treatment inhibit the uptake
patients symptoms in alcohol of certain
withdrawal neurotransmitters,
decreasing
depression and its
symptoms
When to Give After meals After meals After meals Before meals
Side Effects >urinary Rapid pulse, dry Slowed CNS Blurred vision, dry
retention, dry mouth, inability activity, mouth,
mouth, to urinate, decreased heart drowsiness,
cracked lips constipation, rate and insomnia, fatigue
EPS respiratory rate and other vague
symptoms.
Adverse Toxicity Neuroleptic Respiratory Agranulocytosis,
Reaction Malignant depression; arrhythmias, bone
Syndrome cardiac arrest; marrow
death depression
Nursing >Monitor >Monitor BP >Avoid vitamin B rich >Limit use, may >Monitor the
Responsibility blood lithium >Advise to wear foods be habit-forming patient’s BP
levels sunscreens >Do not take it within >Do not leave the > Evaluate liver
>Advise >Offer hard 4 hours before patient alone function tests
increased salt candy bedtime >Put the side >Initial
and sodium >Give at the same rails up therapeutic effects
intake time each day at 2-3 weeks; full
>Advise not to therapeutic effects
stop taking the at 3-4 weeks
drug abruptly >Avoid tyramine
containing foods

Psychotherapies

Remotivation therapy
Music therapy
Play therapy
Psychodrama
Milieu therapy
Family therapy

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Ms. Shandz S. de Rosas, R.N.

Psychoanalysis
Hypnotherapy
Humor therapy
Transactional analysis
Behavior modification
Aversion therapy
Token economy
Gestalt therapy

Anxiety Disorders

Anxiety disorders are a group of conditions marked by extreme or pathologic anxiety or

dread. Sufferers experience disturbances of thinking, mood, behavior and physiologic activity. The
anxiety at times may be uncomfortable that they stop doing certain everyday activities to avoid
feeling the dread. Some experience terrible bouts of intense anxiety that immobilize them.

These are thought to result from a combination of genetic, biochemical, neuroanatomic and
psychological factors, coupled with the person’s life experiences. Risk factors include:
a. Female gender
b. Age younger than 45 years
c. Marital separation or divorce
d. History of childhood physical or sexual abuse
e. Low socio-economic status

TYPES OF ANXIETY DISORDERS

Panic Disorder. Represents anxiety in its most severe form. The person experiences recurrent,
unexpected panic attacks that cause intense apprehension and feelings of impending doom. Occurs
suddenly without warning. At some point, around 50% of patients develop severe avoidance,
warranting at times a separate diagnosis of panic disorder with agoraphobia.
Can be caused by a combination of genetic, biochemical and other factors. Has been linked
to migraine, obstructive sleep apnea, mitral valve prolapsed, irritable bowel syndrome, chronic
fatigue syndrome and PMS. Patients usually present with the following symptoms:
a. Palpitations and rapid heart beat
b. Sweating
c. Generalized weakness or trembling
d. Shortness of breath or rapid, shallow breathing
e. Sensations of choking, smothering or a lump in the throat
f. Chest pain or pressure
g. Abdominal pain, nausea, heartburn, diarrhea or other GI symptoms
h. Dizziness, tingling sensations, or light headedness
i. Chills, pallor or flushing
j. Diminished ability to focus or think clearly, even with direction
k. Fidgeting or pacing
l. Rapid speech
m. Exaggerated speech

Panic disorder is highly treatable with a combination of patient teaching, cognitive or

behavioral therapies and relaxation techniques. Teaching the patient about what triggers the
disorder may help him overcome it. Cognitive therapy might also be of help. Behavioral therapy

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Ms. Shandz S. de Rosas, R.N.

typically involves desensitization, or step therapy. Some patient may require antianxiety agents,
sometimes combined with an anti-depressant to control the attacks.

Agoraphobia. It is the intense fear or avoidance of situations or places that may be difficult
or embarrassing to leave, or in which help might not be available. Without treatment, the disorder
might get worse. In extreme cases, the patient becomes a prisoner in his home, to fearful to leave
his “Safe zone”. The exact cause is unknown, but theories include biochemical imbalances and
environmental factors. Treatment usually includes both medication and behavioral therapy. An
anti-depressant ma be prescribed, but the mainstay of treatment is desensitization.

Generalized Anxiety Disorder. A disorder in which anxiety is persistent, overwhelming,

uncontrollable, and out of proportion to stimulus. May range from mild to severe to incapacitating.
Usually emerges slowly, although occasionally triggered by a stressful event. The exact cause is
unknown, but the same factors with the other anxiety disorders are identified. Signs and symptoms
include:
a. Shortness of breath
b. Tachycardia or palpitations
c. Dry mouth
d. Sweating
e. Nausea or diarrhea
f. Inability to relax
g. Muscle tension, aches and spasms
h. Irritability
i. Fatigue
j. Restlessness
k. Trembling
l. Headache
m. Cold clammy hands
n. Insomnia

For patients with mild anxiety, non-pharmacologic methods should be tried first. Relaxation
techniques and biofeedback can decrease arousal. Nursing care would include staying with the
patient most of the time and allowing him to verbalize his feelings.

Post Traumatic Stress Disorder. May occur after someone experiences or witnesses a
serious traumatic event, such as wartime combat, a natural disaster, rape, murder or torture. This is
characterized by persistent and recurrent flashbacks, relieving the event, or nightmares of the
event. Impairments may be mild or severe, affecting nearly every aspect of the patient’s life.
Sufferers are irritable, anxious, fatigued, forgetful, and socially withdrawn.
The disorder may be acute or chronic, and chronicity is determined if the patient has
suffered for more than 6 months. Women are most likely to be affected than men. This is obviously
triggered by a traumatic event but other factors may also develop. Signs and symptoms range from
as simple as anger and impulse control loss until survivor’s guilt. Treatment includes
desensitization, relaxation techniques and psychotherapy. Anti-anxiety agents, MOAIs, SSRIs or
TCAs may be prescribed. Nursing care is focused on providing the patient comfort and helping the
patient adjust successfully.

Acute Stress Disorder. A syndrome of anxiety and behavioral disturbances that occurs
within 4 weeks of an extreme trauma, such as combat, rape or a near death experience. Unlike
PTSD, acute stress disorders usually resolves within 4 weeks. The hallmark of the disease is

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Ms. Shandz S. de Rosas, R.N.

dissociation, which may be accompanied by poor memory or complete amnesia of it. Treatment
usually entails provision of support systems, psychotherapy, behavioral therapy and administration
of anti-anxiety agents, beta blockers or anti-psychotic agents. Nursing care is focused on allowing
the patient to verbalize her feelings and guiding the patient through performance of relaxation
exercises.

Social Phobia. Social phobia, sometimes called social anxiety disorder, refers to a marked
persistent fear or anxiety in a social or performance situation. These people are concerned that
others will see their anxiety symptoms or will judge them to be weak, stupid or crazy. Some even
faint, lose bowel or bladder control or go mentally blank. They are generally associated with
anticipatory anxiety for days or weeks before the event.
The disorder is more common in women, typically starting in childhood or adolescence, and
rarely develops after the age of 25. It is linked with traits of shyness or social inhibition. Studies
suggest that this runs in families. Symptoms include fear of the dreaded event or stimuli, blushing
and other physiologic symptoms. Treatment is focused on desensitization, with accompanied
relaxation techniques and deep breathing exercises. A technique called thought stopping may also
be used. Pharmacologic treatment includes anti-anxiety agents, TCAs, MAOIs, SSRIs, or beta
blockers.

Specific Phobia. Also called as simple phobia, this is characterized by a person experiencing
intense, irrational anxiety when exposed to anticipating a specific feared object or situation. This
feeling may lead into avoidance or a disabling behavior that interferes with activities or even
confines them at home.
Specific phobias are classified into five main groups: natural environment type, animal type,
blood-injection-injury type, situational type and other types. Specific phobias affect about 10% of
the population and are more common in women than in men. The cause is usually unknown but
thought to run in families, caused by traumatic events or anticipated danger about certain
situations or events.
Successful treatment usually involves desensitization or exposure therapy, in which a
companion gradually introduces the patient to what frightens him until the fear begins to fade.
Relaxation and breathing exercises also help. Nursing care focuses on allowing patient verbalization
of feelings, teaching patient assertiveness to help reduce the attacks and thought stopping
technique.

Obsessive-Compulsive Disorder. OCD is characterized by unwanted, recurrent, intrusive

thoughts or images (obsessions), which the person tries to alleviate through repetitive behaviors or
mental acts (compulsions). These acts are done to reduce anxiety or prevent some dreaded event
from happening.
OCD affects around 2% of the general population, sometimes accompanied by major
depressive episodes, other anxiety disorders, substance abuse or personality disorders. OCD tends
to run in families, but is linked to other factors as well. A patient suffering from the disorders
usually present with repetitive hand washing, counting, checking and rechecking whether the door
is locked, social impairment, and the need to achieve perfection.

Somatoform Disorders

Somatoform disorders are a group of psychiatric disorders in which the patient has
persistent somatic complaints that can’t be explained by a physical disorders, substance abuse or
another mental disorder. The symptoms are often linked to psychological factors. Patients with this
disorder don’t feign their symptoms. Instead, they believe their symptoms indicate a real physical

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disorder. Somatization refers to the conversion of an emotional or mental state into a bodily
symptom. Many of these patients go from doctor to doctor in search of a diagnosis and treatments
and these do not afford relief. The precise cause of the existence of such disorder is unknown but
some theorists believe that this is an indication of a patient’s repressed emotions.

Types of Somatoform Disorders

Body Dysmorphic Disorders. In this disorder, the patient is pre-occupied with an imagined
or slight defect in physical appearance. The patient thinks he is hideous or grotesque even though
others assure him that she looks fine; and this leads the patient to think about the perceived
disorder for at least 1 hour a day.
Most often, patients perceive a flaw of the face or head, especially the skin, nose, hair or
ears. Others, however, focus on the shape or size of a particular body part such as the breasts,
genitals, muscles or buttocks. Many patients end up going to cosmetic surgery specialists. The
condition usually start in the late teen age.
The cause of the disorder is usually unknown, but two theories persist: biological and
psychological. Patients pay excessive attention to their appearance and they develop a heightened
perception of it. Signs and symptoms include:
a. Often checks reflection or avoids mirrors
b. Frequently compares appearance with others
c. Tries to cover the defect with clothing or make-up
d. Seeks corrective therapy such as cosmetic surgery and dermatologists
e. Constantly seeks approval from others that they look fine
f. Performs long grooming rituals
g. Picks at skin and squeezes blackheads for hours
h. Measures the body part she thinks is repulsive
i. Anxious and self conscious around peers
j. Avoids social situations where perceived defect may be exposed

The treatment seeks to enhance the patient’s self esteem and reduce her preoccupation
with the flaw and eliminate its harmful effects. Cognitive behavioral therapy is the non-
pharmacologic treatment of choice, combined with thought stopping breaks and implosion therapy.
Nursing intervention is focused on diverting the patient’s focus away from the flaws while trying to
set limits on such behaviors.

Hypochondriasis. Hypochondriasis is marked by the persistent conviction that one has or

is likely to get a serious disease—despite medical evidence and reassurance to the contrary. The
patient does not consciously cause her symptoms and isn’t consciously aware of the benefits they
bring. The disorder can lead to significant psychological distress or impairment in social and
occupational functioning. It affects both men and women, with equal prevalence rates and most
commonly occurs between 20s to 30s.
The exact cause of the disorder is unknown, but some believed it to involve biologically
based hypersensitivity to internal stimuli. The condition is also more common in people who have
had experienced an organic disease, as well as their relatives.
Contributing factors may be any of the following:
a. Death of a loved one
b. Family member or friend with serious illness
c. A history of serious illness
d. Depression or grief in older adults

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Signs and symptoms usually range from specific to general complaints involving a single
body system and reflect a preoccupation with normal body functions. The patient typically describe
the symptom’s location, quality, and duration in minute detail and medical examinations and
assurance do not relieve these concerns. The goal therefore of treatment is to help the patient lead
a productive life despite distressing symptoms and fears.
Individual psychotherapy helps most of the patients. Other treatment includes group
therapy, family therapy, cognitive and behavioral therapy, and pharmacologic therapy using
antidepressants. Nursing interventions focus on helping the patient explore her problems, develop
insights into it and adopt a more acceptable stress coping strategy.

Conversion Disorder. Conversion disorder is marked by the loss or change in voluntary

motor or sensory functioning that suggests a physical illness but has no demonstrable physiologic
basis. The disorder isn’t usually life threatening and is usually of short duration. The symptoms are
not under the patient’s voluntary control and can severely impede the patient’s normal activities.
Affects females than males, with 2 out of 5 rates; more prevalent in rural populations and in
persons with less education and lower socioeconomic status. The disease usually begins in
adolescence or early adulthood and is rarely chronic.
Symptoms arise suddenly—soon after the patient experiences a traumatic conflict he feels
he cannot cope with. Patients with history of histrionic disorder have higher chances of developing
the disease. Many patients with the disorder don’t show concern over the symptoms or their
functional limitations. Called la belle indifference, this apathy is the hallmark of the disorder.
Treatments includes psychotherapy, family therapy, relaxation training, behavior
modification, biofeedback training, or hypnosis. Benzodiazepines have also been proven to be
useful in treating some patients with conversion disorder. Nursing interventions include, but are
not limited to:
a. Establishing supportive nurse-patient relationship using communication techniques
b. Conveying a caring attitude
c. Help patient increase his or her coping abilities, reduce anxiety and enhance self-esteem
d. Help patient develop a more acceptable pattern of behavior in face of stresses

Somatization Disorders. These are disorders characterized by multiple and often vague
physical complaints that suggest a physical disorder but have no physical basis. The symptoms are
typically recurrent. Patients with the disorder may have impairments in occupational, social and
other functioning and may become extremely dependent in their relationships.
The patient may try to manipulate others, even going as far as attempting or threatening
suicide. He usually undergoes repeated medical evaluations which can be potentially damaging and
debilitating. The disorder is thought to be caused by factors such as genetic, biological,
environmental and psychological factors.

DISSOCIATIVE DISORDERS

Dissociative disorders are marked by disruption of the fundamental aspects of waking

consciousness—memory, identity, consciousness, and the general experience and perception of
oneself and the surroundings. The patient uses dissociation as an unconscious defense mechanism
to separate anxiety-provoking feelings and thoughts from the conscious mind.
Normal types of dissociation include daydreams, highway hypnosis, and getting lost in a
book, movie or television program to the point that the person no longer notice the time and
surroundings. They usually result from overwhelming stress caused by a traumatic even that has
been experienced or witnessed or by intolerable psychological conflict. It occurs as the mind
isolates the unacceptable feelings and information.

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Depersonalization. During episodes of depersonalization, self-awareness is altered or lost

temporarily. The sense or depersonalization may be restricted to a single body part, such as a limb
—or it may encompass the whole self. The patient may feel as if the body part or the entire body
has shrunk or grown. Though the condition is rare, it may occur for “normal” people for brief
periods. This is the third most common psychiatric symptom and often follows a life-threatening
danger.
It typically occurs in people who have experienced severe stress, such as combat, violent
crime, accidents or natural disasters. A patient with the condition may report that he feels detached
from his body, as if watching the self from a distance or living a dream. Other symptoms may be:
a. Obsessive rumination
b. Depression
c. Anxiety
d. Fear or going insane
e. Disturbed sense of time
f. Slow recall
g. Physical complaints, such as dizziness
h. Impaired social and occupational functioning

Even without treatment, many patients recover completely. Treatment however may
include psychotherapy, cognitive behavior therapy, hypnosis, and pharmacologic agents. If the
disorder is linked to a traumatic event, the therapy also involve on helping the patient focus on the
event where anxiety has evoked the disorder. Nursing interventions include:
a. Encouraging the patient to recognize that the disorder is a defense mechanism that he is
using to deal with anxiety caused by trauma
b. Help the patient develop behavioral techniques to cope with anxiety
c. Assist the patient in establishing supportive relationships

Dissociative Amnesia. The key feature of dissociative amnesia is a inability to recall

important personal information (usually of a stressful nature) that can’t be explained by ordinary
forgetfulness. The types are as follows:
a. Localized amnesia- the patient can’t remember events that took place during a specific
period of time
b. Selective amnesia- the patient can recall some, but not all of the events during a
circumscribed time period
c. Generalized amnesia- the patient suffers prolonged loss of memory, possibly
encompassing an entire lifetime
d. Continuous amnesia- the patient forgets all events from a given time forward to the
present.
e. Systematized amnesia- the patient’s memory loss is limited to a specific type of
information

Dissociative amnesia probably results from a severe stress associated with a traumatic
experience, major life event, or severe internal conflict. During an amnesiac episode, the patient
may seem even perplexed and disoriented, wandering aimlessly. The patient may be unable to
remember the event that precipitated the episode and usually doesn’t even recognize the inability
to recall information.
Psychotherapy aims to help the patient recognize the traumatic event that triggered the
amnesia and the anxiety it has produced. Filling in memory gaps can be useful in restoring the
continuity of the patient’s identity and sense of self. Nursing interventions include:

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Ms. Shandz S. de Rosas, R.N.

a. Encouraging the patient to verbalize feelings of distress

b. Helping the patient recognize that memory loss is a defense mechanism used to deal
with anxiety and trauma
c. Help the patient deal with anxiety producing experiences.
d. Teach and assist the patient in using reality-based coping strategies under stress rather
than strategies that distort reality

Dissociative Fugue.; Dissociative fugue is marked by sudden, unexpected travel away from
one’s home or workplace, along with an inability to recall one’s part and confusion about one’s
personal identity. Occasionally, the person forms a new identity during a dissociative fugue.
Typically, the new identity is more outgoing and less inhibited than the former one.
The disorder is rare, but most often found among people who have experienced wars,
accidents, violent crimes, and natural disasters. It usually resolves rapidly, and the prognosis for a
complete recovery is good. The treatment of choice is psychotherapy with the aim of helping the
patient recognize the traumatic event that triggered the fugue state and to develop reality-based
strategies for coping with anxiety. Hypnosis may also be used to prompt the patient to recall events
and feelings, and ultimately assist in restoring the memory.
Group therapy may also be of help, and creative therapies such as music, art and
bibliotherapy may be used at times. Nursing interventions include:
a. Monitoring the patient for signs of overt aggression toward self or others
b. Teach the patient effective coping skills
c. Encouragement to use available support system

Dissociative Identity Disorder. Also known as multiple personality disorder, DID is marked
by two or more distinct personalities or sub-personalities (or alters) that recurrently take control
of the patient’s consciousness and behavior. Each identity may exhibit unique behavior patterns,
memories, and social relationships.
In many cases, the primary personality is religious with a strong moral sense, while the sub-
personalities are radically different. They may behave aggressively and lack sexual inhibitions. The
transition from one personality to another is often triggered by stress or a meaningful social or
environmental cue.
Signs and symptoms may include:
a. Lack of recall beyond ordinary forgetfulness
b. Hallucinations, particularly auditory and visual
c. Post-traumatic symptoms
d. Recurrent depressions
e. Sexual dysfunction and difficulty forming intimate relationships
f. Sleep disorders
g. Somatic pain disorders
h. Substance abuse
i. Guilt and shame
j. Suicidal tendencies

The treatment is a long-term process, taking 5 or more years. The goal of therapy is to
integrate all of the patient’s personalities and to prevent the possibility of splitting again.

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PERSONALITY DISORDERS

Paranoid Personality Disorders. Paranoid personality disorder is marked by a distrust of

other people and a constant, unwarranted suspicion that others have sinister motives. Sufferers
play excessive trust in their own knowledge and abilities. Patients with this type of disorder seem
cold and distant, shifting the blame to others and carry long grudges. The specific cause of paranoid
personality disorder is unknown. Some experts believe that the disorder results from negative
childhood experience and a threatening domestic atmosphere.
Signs and symptoms include:
a. Refusal to confide in others
b. Inability to collaborate with others
c. Hypersensitivity
d. Inability to relax
e. Need to be in control
f. Self-righteous
g. Detachment and social isolation
h. Poor self image
i. Sullenness, hostility, coldness and detachment
j. Humorlessness
k. Anger, jealousy and envy
l. Bad temper, hyperactivity and irritability
m. Lack of social support systems

Few patients with the disorder seek treatment on their own. Individual psychotherapy is
preferred over group therapy because of the patient’s suspicious nature. Medications may also be
recommended such as: antipsychotics, SSRIs, anti-anxiety agents. Nursing interventions include:
a. Using a straightforward, honest professional approach
b. Offer persistent, flexible and consistent care
c. Provide supportive, non-judgmental environment in which the patient can safely
explore his feelings
d. Avoid probing in too deeply into the patient’s life
e. Don’t challenge the patient’s beliefs
f. Encourage the patient to participate in the activities.

Schizoid Personality Disorder. The hallmarks of schizoid personality disorder are

detachment, social withdrawal, indifference to others’ feelings, and a restricted emotional range in
interpersonal settings. People with this disorders are commonly described as loners, with solitary
interests and no close friends.
Signs and symptoms usually include:
a. Emotional detachment
b. Inability to experience pleasure
c. Lack of strong emotions and little observable change in mood
d. Indifference to others’ feelings, praise or criticism
e. Avoidance of activities that involve significant interpersonal contact
f. Little desire for or enjoyment of close relationships
g. No desire to be part of a family
h. Strong preference for solitary activities
i. Little or no interest in sexual experiences with another person
j. Lack of close friends or confidants other than immediate family members

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Treatment may be difficult to institute due to the patient’s lack of interests with
relationships with other people. Individual psychotherapy should be short-term, focusing on
solving the patient’s immediate concerns or problems. Nursing interventions include:
a. Respecting the patient’s need for privacy
b. Offer persistent, flexible care
c. Recognize the patient’s need for physical and emotional distance
d. Give the patient plenty of time to express his feelings

Schizotypal Personality Disorder. Schizotypal personality disorder is marked by a

pervasive pattern of social interpersonal deficits, along with acute discomfort with others. People
with this disorder have odd thought and behavioral patterns. Patients also have cognitive or
perceptual disturbances—although these psychotic symptoms aren’t as fully developed as in
schizophrenia. The patient commonly exhibits eccentric behavior and has trouble concentrating for
long periods.
The disorder may have a genetic basis, family, twin and adoption studies show an increased
risk of the condition in people with family history of schizophrenia. Studies show that these people
show a poor regulation of dopamine pathways in the brain. Signs and symptoms include:
a. Odd or eccentric behavior or appearance
b. Inaccurate beliefs that others’ behavior or environmental phenomena are meant to have
an effect on the patient
c. Odd beliefs or magical thinking
d. Unusual perceptual experiences
e. Vague, circumstantial, metaphorical, overly elaborate, or stereotypical speech or
thinking.
f. Unfounded suspicion of being followed, talked about, persecuted or under surveillance
g. Inappropriate or constricted speech
h. Lack of close relationships other than immediate family members
i. Social isolation
j. Excessive social anxiety that doesn’t abate with familiarity
k. Sense of feeling different and not fitting with others easily

Treatment options for a patient with schizotypal personality disorder include individual
psychotherapy, group therapy, cognitive-behavioral therapy, self-help measures, and medications.

Antisocial Personality Disorder. The highlight of personality disorder is chronic antisocial

behavior that violates others’ rights or generally accepted social norms. This disorder predisposed
a person toward criminal behavior. Other features of this disorder include impulsivity,
egocentricity, disregard for the truth, and aggression. The antisocial person can’t tolerate boredom
and frustration. He’s reckless, irritable and unable to maintain consistent, responsible functioning
at work, at school, or as a parent.
Treatment for this disorder include individual psychotherapy and establishing firm but
consistent rules. Group therapy may also be of help, as well as family therapy and use of
medications such as Lithium and beta-adrenergic blockers. Nursing interventions should focus on
using a straight-forward and matter-of-fact approach, reinforcement of positive behaviors.

Borderline Personality Disorder. A disorder of poor regulation of emotions, borderline

personality disorder is marked by a pattern of instability in interpersonal relationships, mood,
behavior, and self-image. Although people with this disorder may experience it in various ways,
most find it hard to distinguish reality from their own misperceptions of the world. The patient

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usually flip-flops in terms of emotions and show impulsivity in decision-making, relationships. They
also have the habit of splitting, and resort to self-destructive behaviors.
The disease may be caused by a dysfunction in the limbic system or frontal lobe, decreased
serotonin activity, increased activity in alpha-2 noradrenergic receptors; prolonged parental
separation, major losses and sexual and physical abuse.
Treatment may be done through individual psychotherapy, group therapy, family therapy,
milieu therapy, alcohol and drug rehabilitation if indicated.

Histrionic Personality Disorder. Histrionic personality disorder is characterized by a

pervasive pattern of excessive emotionally and attention seeking. People with this disorder are
drawn to momentary excitements and fleeting adventures. Charming, dramatic, and expressive,
they can be easily hurt, vain, demanding, capricious, excitable, self-indulgent, and inconsiderate.
The words and feelings they express seem shallow and simulated, not real or deep. People with this
disorder need to be the center of attention at all times. They may even exaggerate their illnesses to
gain attention, interrupt others so they can dominate the conversation and seek constant praise.
The cause of the disorder is usually unknown. A genetic component may be involved, as
hysterical traits are more common in relatives of those with disorder. Treatment of the patient
involves individual psychotherapy. Medications may be administered if needed but is not
encouraged.

EATING DISORDERS

Anorexia Nervosa. Anorexia nervosa is a self-starvation syndrome in which the person

relentlessly pursues thinness—sometimes to the point of fatal emaciation—as she becomes
preoccupied with food and body image. Despite her thinness, she thinks that she’s fat because she
has a distorted body image. Anorexia nervosa has two main forms:
a. The restricting type, in which food intake is limited
b. The binge-eating or purging type, in which the patient also engages in regular binge
eating or purging behaviors including self-induced vomiting or abuse or laxatives,
diuretics or enemas.

Serious medical complications can result from the malnutrition, dehydration and electrolyte
imbalances caused by prolonged starvation, vomiting and laxative abuse. Patients with the disorder
usually present with:
a. Emaciated appearance
b. Skeletal muscle atrophy
c. Loss of fatty tissues
d. Breast tissue atrophy
e. Blotchy or sallow skin
f. Lanugo on the face and body
g. Dryness or loss of scalp hair
h. Hypotension
i. Bradycardia
j. Painless salivary gland enlargement
k. Fatigue
l. Sleep difficulties
m. Cold intolerance
n. Constipation
o. Bowel distention
p. Slow reflexes

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Ms. Shandz S. de Rosas, R.N.

q. Loss of libido
r. Amenorrhea
s. Preoccupation with body size
t. Distorted body image
u. Dissatisfaction with a particular aspect of appearance
v. Low self-esteem
w. Social isolation
x. Ritualism
y. Paradoxical obsession with food
z. Social regression
aa. Feelings of despair, hopelessness and worthlessness
bb. Wearing of oversized clothing
cc. Layering of clothing
dd. Restless activity
ee. Avid exercising
ff. Outstanding academic and athletic performance

Treatment aims to promote weight gain, correct malnutrition, and resolve the underlying
psychological dysfunction. The most effective strategy would be psychotherapy, coupled with ideal
weight restoration. Nursing intervention includes maintaining one-on-one care, specially at meal
times; allowing the patient some control over which foods she wants to take when given choices;
weighing the patient daily and maintaining consistent rules as to food intake.

Bulimia Nervosa. Bulimia nervosa is marked by episodes of binge-eating followed by

feelings of guilt, humiliation, depression, and self-condemnation. Eating binges may occur up to
several times each day. Many sufferers also use measures to prevent weight gain, such as self-
induced vomiting, diuretic or laxative abuse, dieting or fasting.
A typical patient is one who has a normal or nearly normal weight and develops the
condition after a history of extended dieting,
Treatment is similar to that of the patient with anorexia.

SCHIZOPHRENIC DISORDERS

Schizophrenia refers to a group of severe, disabling psychiatric disorders marked by

withdrawal from reality, illogical thinking, possible delusions and hallucinations, and other
emotional, behavioral, or intellectual disturbances. These disturbances may affect everything from
speech, affect, and perception to psychomotor behavior, interpersonal relationships, and sense of
self.

Signs and
Type Characteristics Treatment Nursing Care
Symptoms
Catatonic >Tendency to >May remain mute >ECT, anti-anxiety >Establish presence
remain in a fixed and refuse to move agents >Speak with the
stupor for long about or do ADLs patient, assuming
periods >Bizarre he can hear
>Brief spurts of mannerism >Reinforce reality
extreme excitement >Echolalia, >Be consistent and
echopraxia directive
>Help with ADLs
Paranoid >Prosecutory or >Auditory >Antipsychotic >Build trust and

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grandiose delusion hallucinations drugs rapport

thought content >Unfocused anxiety >Group and >Be brief in patient
>Gender identity >Anger individual contacts
problems >Tendency to argue psychotherapy >Minimize patient
>Stilted formality contact with the
or intensity when staff
interacting with >Don’t touch the
others patient without his
>Possible violence knowledge
>Be calm and
consistent
Disorganized >Marked by >Incoherent, >Neuroleptics >Same as other
incoherent, disorganized >ECT types
disorganized speech > Psychotherapy
speech and >Grossly disorga-
behaviors and by nized behaviors
blunted or >Blunted, silly,
inappropriate superficial, or
affect inappropriate
>Fragmented affect
hallucinations and >Extreme social
delusions with no withdrawal
coherent theme >Hypochondriacal
complaints
Undifferentiated >Presence of >Basic signs and >Follows the same >Same nursing care
schizophrenic symptoms of treatment for other for other subtypes
symptoms in a schizophrenia types
patient who doesn’t without the
fall into the distinguishing
previous categories characteristics of
each subtype

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