MENTAL HEALTH AND PSYCHIATRIC NURSING • Amnesia - inability to recall past events

• Anterograde – immediate
MENTAL HEALTH • Retrograde – distant
• "A state of well-being where a person can realize his • Déjà vu – a subjective feeling that an
or her own abilities to cope with the normal stresses experience which is occurring for the first time has
of life and work productively." (WHO) been experienced before.
• Jamais vu – a feeling that the familiar does not
CRITERIA FOR POSITIVE MENTAL HEALTH seem familiar
• Dementia – immediate forgetfulness
• ________________
• Autonomy OTHER BEHAVIORAL SIGNS & SYMPTOMS
• Perceptive ability • Agitation – anxiety associated with motor
• Integral capacity restlessness
• _________________ • Ambivalence - presence of two opposing feelings
• Mastery of one’s environment at the same time
• Elation (euphoria) - expression of excitement
MENTAL HYGIENE • Mutism – is the refusal to speak
• Study of mental health • Narcolepsy - frequent irresistible urge to sleep with
episodes of cataplexy
• Insomnia – inability to attain enough sleep
THE PSYCHIATRIC SETTING • Hypersomnia – excessive sleep
• Parasomnia – abnormal sleep behavior
Common Behavioral Signs and Symptoms

Disturbances in Perception USE OF APPROPRIATE COMMUNICATION

• Illusion – (+) external stimuli TECHNIQUES
• Hallucination – (-) external stimuli
Disturbances in Thinking COMMUNICATION
• Neologism - pathological coining of new words • ______________ exchange of ideas between or
• Circumstantiality - over inclusion of details among persons
• Word salad - incoherent mixture of words and • Modes:
phrases • VERBAL- written/spoken
• Flight of ideas - shifting of one topic from one • NON-VERBAL- posture, tone of voice and facial
subject to another in a completely unrelated way expression.
• Looseness of Association - shifting of a topic from o Types:
one subject to another in a somewhat related way ▪ Kinesis
• Verbigeration - meaningless repetition of word or ▪ Paralanguage
phrases ▪ Proxemics
• Perseveration - persistence of a response to a ▪ Touch
previous question
• Echolalia - pathological repetition of words of THERAPEUTIC COMMUNICATION
others ▪ A way of interacting in a purposeful manner to
• Stilted language – use of flowery words promote the client’s ability to express his thoughts
• Clang association - the sound of the word gives and feelings openly.
direction to the flow of thought
• Delusion - fixed, false belief which cannot be Essentials:
corrected by appeal or logical reasoning Genuineness
• Grandeur - an exaggerated belief of identity Respect
• Nihilistic - denies the existence of self or part Empathy
of self Attentive listening
• Persecution -belief that he or she is the object Trust & rapport
of environmental attention
• Self-depreciation - worthlessness or Barriers:
hopelessness Belittling
• Somatic - false belief to body function Interrupting / ignoring
Disturbances of Affect Giving advice
• Inappropriate affect - disharmony between the Social response
stimuli and the emotional reaction Changing the subject
• Blunted affect - severe reduction in emotional Approving / disapproving
reaction Moralizing
• Flat affect - absence or near absence of emotional
reaction NURSE-PATIENT RELATIONSHIP
• Apathy - dulled emotional tone (Hildegard Peplau)
• Lability of affect – rapid “mood swings”
Disturbances in Motor Activity Stages:
• Echopraxia - the pathological imitation of posture/ PRE-ORIENTATION
action of others ▪ Begins when the nurse is assigned/chooses a
• Waxy flexibility - maintaining the desired position patient
for long periods of time without discomfort ▪ Anxiety: ______________
• Akinesia – loss of movement ▪ Major task of the nurse: develop self-awarenes
• Ataxia - loss of coordinated movement ▪ Other tasks:
• Automatisms - repeated purposeless behavior ▪ Data gathering
Disturbances in Memory ▪ Planning for first interaction
• Confabulation - filling in of memory gaps
ORIENTATION Identification
▪ Major task: establish trust and rapport • An individual integrates certain aspects of someone
▪ Anxiety: ______________ else's personality into one's own
▪ Establish contract with the patient Intellectualization
▪ Assure confidentiality • An overuse of intellectual concepts by an individual
to avoid expression of feelings
WORKING / THERAPEUTIC Projection
▪ Anxiety: ______________ • "Blaming others"
▪ Major task: identification and resolve problems by Reaction – Formation
reinforcing coping: __________, ________, • Expression of feeling that is the direct opposite of
________ one's real feeling.
▪ Highly individualized Rationalization
▪ More structured • Making justifiable reasons
▪ The longest and most productive Regression
▪ Other tasks: planning and implementation • The turning back to earlier patterns of behavior in
solving personal conflicts.
Problems) Repression
• ________________ • ___________ forgetting
o the development of an emotional attitude Suppression
towards the nurse • ___________ forgetting
o positive or negative Substitution
• Counter transference • Unattainable goal replaced with attainable
o experienced by the nurse / therapist Sublimation
• Unacceptable replaced with socially acceptable
TERMINATION drives
• Reinforce, reward and ____________ Symbolization
• Encourage verbalization • A ___________ threatening object is used to
– Anxiety: Patient represent another
• Summarize the progress Undoing
• Terminate • An attempt to erase an act, thought, feeling, guilt or
desire

STRESS CRISIS AND CRISIS INTERVENTION

• A ___________response of the body to any
demand made upon it. (Hans Selye, 1936)
• Stressors: _________, _________, ____________
Adaptation
• A constant ongoing process that occurs along time
___________, beginning with birth and ending with
death. (Smeltzer, 1992)
Types:
General Adaptation Syndrome (GAS)
• Involves the whole body in response to stress.
Local Adaptation Syndrome (LAS)
CRISIS
• Ineffective individual coping
• A ___________ interruption and disturbance of
one's equilibrium or homeostasis
• Leads to potentially dangerous, self-destructive or
socially unacceptable behavior.
Characteristics:
• Highly-individualized
• Self-limiting: ___________
• Victims: ___________ and submissive
• Affects a person's support system

Types:
DEFENSE MECHANISM Maturational / Developmental
• Are automatic and usually unconscious processes • Expected, predictable and internally motivated
• Pathologic when _______________ • Examples: puberty, adolescence, young adulthood,
• Used by both the healthy and ill marriage, or the aging process.
Situational / Accidental
Commonly used: • Unexpected, unpredictable and externally motivated
Compensation • Example: economic difficulty, illness, accident, rape,
• An attempt to a real or divorce or death
imagined short coming, inferiority, inabilities and Social / Adventitious
weaknesses • Due to acts of ___________
Conversion • Example: natural calamities
• Emotional problems are converted to __________
symptoms
Denial CRISIS INTERVENTION
• Failure to acknowledge an intolerable thought,
feeling, experience or reality Major Goal:
Displacement • Restore the optimum level of functioning (pre-crisis
• The redirection of feelings to a ___________ state)
threatening object.
Fantasy
• Conscious distortion off unconscious feelings or
wishes
Fixation
• "Arrest of maturation"
Introjection
• “Self-blaming
Situations 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. (R.A. ___________
– The Philippine Anti-Rape Law)
ANXIETY
• ___________ response to stress
• An unpleasant emotional state consisting of
psychophysiological responses to anticipation of
unreal or imagined danger, resulting from
unrecognized intrapsychic conflict.

Kinds: Manifestations:
1. ___________ – to prove masculinity
2. ___________ – means of retaliation Physical Cognitive Emotional
3. ___________ – to express erotic feelings Mild Increase in Increased Minimal
VS attentiveness use of
Silent Rape Syndrome
• Maladaptive Pupillary and alertness defenses
• Victim is unable to verbalize dilatation
• Results to anxiety and phobia Diaphoresis
Moderate Vomiting Decreased Use of any
Rape Trauma Syndrome Anorexia perceptive defense
Phases: Nausea ability mechanism
1. Acute / Impact – shock, numbness, _________ Diarrhea / available
2. Repression / Denial – refusal to discuss the event constipation
3. Heightened Anxiety – fear, tension, nightmares Agitation
4. Resolution
Severe Headache Perceptive Defense
BATTERED WIFE SYNDROME Inability to ability is mechanism
• ___________ domestic violence communicate greatly operate
• Men: low self-esteem decreased
• Women: dependence Physical
symptoms Inability to
REPUBLIC ACT 9262: violence against women and become the focus on major
their children focus of issues
attention
CHILD ABUSE
• An act of omission or ___________. Panic Fatigue Personality Defense
disorganizatio mechanis
Abusers: Muscular n m fail
• Abused by their ___________ weakness
• From violent families
• Inadequate parenting skills Nursing Management:
• Socially isolated Priority: ___________
• Emotionally immature Encourage ventilation
• Negative attitude towards the abused Administer medications as ordered
Carefully listen
WARNING SIGNS OF CHILD ABUSE / NEGLECT Environmental stimuli must be controlled
• Child’s use of abusive words
• Hair growth in various lengths
• Inconsistent stories
ANXIETY DISORDERS
• Low self-esteem
• Depression Panic Disorders
Generalized Anxiety
Disorder
• Apathy
• Bruised or swollen genitalia Cause
• Unusual injuries for age and development
• Serious injuries
Level
• Excessive knowledge about sex
Progression
REPUBLIC ACT 7610 (CHILD ABUSE LAW)
o Required reporting of suspected cases to the
Length
nearest authorities within 48 hours
Manifestations
Nursing Interventions:
• Primary concerns:
o Physical injuries
o Psychological trauma PHOBIC DISORDER
• Nurse should display: • Phobia ______________
o S___________ • Most common:
o Attitude (Nonjudgmental) • Social phobia - ________________
o Confidentiality
o Respect SEPARATION ANXIETY DISORDER
o E___________ • Excessive anxiety regarding separation from home
o Dignity or from people to whom the individual has a strong
• Preserve / protect evidences ___________ attachment.
• Intervention: family as a unit • Below 18: ______________
• Children: ___________ therapy • Above 18: ______________
SELECTIVE MUTISM
• Mutism on specific topics. SOMATIC SYMPTOMS AND RELATED DISORDERS
• Mistaken as a language disorder
• Duration: _____________ SOMATIC SYMPTOM DISORDER
• Characterized by physical symptoms that mimic
disease or injury for which there is no identifiable
ANXIETY - RELATE DISORDERS ___________ cause

OBSESSIVE-COMPULSIVE RELATED DISORDERS ILLNESS ANXIETY DISORDER

• An individual presents an unrealistic or exaggerated
physical complaints.
Distinguishing Feature Anxiety relief
• The person becomes, preoccupied with the fear of
developing or having already a disease or illness in
Obsessive Compulsive
Disorder
spite of medical reassurance.
Body Dysymoorphic
Disoder
CONVERSION DISORDER (Functional Neurological
Symptom Disorder)
Hoarding Disorder • A condition in which an anxiety-provoking impulse is
converted unconsciously into functional symptoms.
Trichotillomania / • Classic feature: La belle ___________ (lack of
Trichotillosis
concern or distress)
Excoriation Disorder /
Dermatillomania
PAIN DISORDER
• Chronic pain experienced by a patient in one or
more area
TRAUMA-AND-STRESSOR-RELATED DISORDER • Disables the patient to do ADL
• Often occurs after an accident or during an illness
POST-TRAUMATIC STRESS DISORDER that has caused pain
• Onset: ___________
• Most Common cause: _____________
• Duration: ________________ DISSOCIATIVE DISORDERS
• Hallmarks: ___________ & ________________
DISSOCIATIVE AMNESIA (Psychogenic Amnesia)
ACUTE STRESS DISORDER • Inability to recall ___________ amount of important
(Acute Stress Reaction, Mental Shock, information
Psychological Shock) • Caused by physical / psychological trauma
• Onset: within ___________ • Characterized by:
• Duration: 2 days to 4 weeks – Disorientation
• Causes: – Purposeless wandering
• Experienced directly – Impairment in ability to perform ADL
• Witnessed • Rapid recovery generally occur
• Inexperienced indirectly

Symptoms: DEPERSONALIZATION / DEREALIZATION

• Akinesia DISORDER
• Mutism • Periods of detachment from self or surrounding
• Numbness which may be experienced as "unreal" while
• Symptoms same with PTSD retaining awareness that this is only a feeling and
not a reality.
ADJUSTMENT DISORDER • Feelings of being in a “dream" or "fantasy land"
(Exogenous, Reactive or Situation Depression)
• May be acute or chronic
• More common to ___________ DISSOCIATIVE IDENTITY DISORDER
• Occurrence of two or more personalities within the
Common characteristics: same individual, each of which during sometime in
• depressive symptoms the person's life is able to take control.
• anxiety symptoms
• traumatic stress symptoms
DISORDERS COMMONLY DIAGNOSED TO
REACTIVE ATTACHMENT DISORDER CHILDREN
• Onset: 18-24 months
• Can be:
o Reactive attachment: NEURODEVELOPMENTAL DISORDERS
• Indiscriminate and excessive
attempts to receive comfort and INTELLECTUAL DEVELOPMENTAL DISORDER
affection from any available adult,
even relative strangers • Onset: ___________
• Older children and adolescents – • IQ below ___________
peers • Sub-average intellectual functioning:
o Disinhibited social engagement:
• Extreme reluctance to initiate or
accept comfort and affection, even
from familiar adults, especially
when distressed.
LEVELS: • Loss of function (2 or more):
IQ Capabilities 1. Expressive language
2. Receptive language
Mild • Difficulty adapting to school 3. Social and self-care
• Educable 4. Control over elimination
Moderate • Trainable 5. Play
6. Motor
Severe • Needs complete and close
supervision Drug of choice: ____________
Profound • Minimal capacity for sensorimotor
function PERVASIVE DEVELOPMENT DISORDER NOT
• Needs custodial care OTHERWISE SPECIFIED
• AKA Atypical Personality Development, Atypical
SPECIFIC LEARNING DISORDERS PDD and Atypical Autism
❖ Reading Disorder
❖ Mathematics Disorder ATTENTION DEFICIT HYPERACTIVITY DISORDER
❖ Disorder of Written Expression • Common in boys
❖ Learning Disorder NOS • Diagnosed before age 7
• Triad:
COMMUNICATION DISORDERS
Management:
Types: • Priority: ___________
• Diet: ___________
Difficulty
• DOC: ___________

Language Disorder

Childhood - Onset
MOTOR DISORDERS
Fluency Disorder
Types:
Social Communication
Disorder
Manifestations
Communication
Disorder NOS Developmental Coordination
Disorder
Stereotypic Movement
AUTISM SPECTRUM DISORDER Disorders

Tourette Syndrome

ASPERGER’S DISORDER
• Considered to be on the “high functioning” end of DISRUPTIVE, IMPULSE-CONTROL AND CONDUCT
the spectrum DISORDERS
• Motor development may be delayed
• NO DELAYS OR DIFFICULTIES IN LANGUAGE OPPOSITIONAL DEFIANT DISORDER
OR COGNITIVE DEVELOPMENT. • Pattern of angry / irritable mood, argumentative /
defiant behavior, or vindictiveness
• Lasting at least ___________ months
AUTISM • Manifestations: (at least 4)
• Characterized by: 1. Doesn’t comply with majority
o Impairment in communication skills 2. Deliberately annoy others
o Stereotypical behavior, interests and activities 3. Resentful
• Treatable but not curable 4. Argues often
• More common among boys 5. Blames others
• Diagnosed at age ___________ 6. Frequently loses temper
7. Seeks revenge
Signs and Symptoms: 8. Touchy

Odd play CONDUCT DISORDER

Wants inanimate objects • ___________ delinquents
Not cuddly • Precursor to antisocial personality disorder

Pain insensitive IMPULSE CONTROL DISORDERS NOT OTHERWISE

Likes patterned actitivites SPECIFIED
Acts like deaf
Crying tantrums • Kleptomania
Echolalia
• Pyromania
Diet: _______________
• Intermittent ___________ Disorder
CHILDHOOD DISINTEGRATIVE DISORDER
(___________ Syndrome/ Disintegrative Psychosis)
Manifestations:
• Normal early growth and development up to 2-10
years old
 FEEDING AND EATING DISORDER o blackouts occur
• More common among women. o denial starts
• ___________ - cardinal symptoms of develop
Causes: • ___________ - intoxicated all day
• Psychological factors
– Parental Behavioral problems:
– Individual • Denial
– Sociocultural • Dependency
• Demanding
AVOIDANT/ RESTRICTIVE FOOD INTAKE DISORDER • Destructive
• ___________ Eating Disorder • Domineering

ANOREXIA NERVOSA Alcohol Withdrawal

• Occurs when an individual abruptly stops drinking
Main sign: Morbid fear of gaining weight • Symptoms develop within few hours
Other signs: • Symptoms include:
• Sensitivity to cold temperatures o Careless behavior
• Amenorrhea o Autonomic hyperactivity
• Deliberate self-starvation with weight loss o Unusual perceptions
o Tachycardia
• Denial of hunger o Increased temperature
• Obviously thin but feels fat o Obvious hand tremors
• Lanugo all over the body o Nightmares and insomnia
• Loss of scalp hair
Alcohol Withdrawal Delirium
BULIMIA NERVOSA • AKA ___________ ___________
• Extreme measures to lose weight • Within 48 to 72 hours after the last intake.
o uses diet pills, diuretics or laxatives • Symptoms include:
o purges after eating o Diaphoresis
o extreme exercise o Elevated VS
• Signs of purging o Agitation
o swelling of the cheeks or jaw area o Tremors (seizures)
o cuts and calluses on the back of the hands and o Hyperexcitability to depression
knuckles (___________ sign)
o clear teeth Chronic Problems:
• Peculiar signs • Korsakoff's Psychosis
o Depression o A form of ___________
o loss of interest in activities o Symptoms:
• short-term memory loss
BINGE EATING DISORDER • disorientation
• Eating Disorder NOS • inability to learn new skills
• Eating unusually large amounts of food in a discrete • confabulation
period of time. • Deficiency in vitamin B1 and B12
• Done privately and accompanied by negative • Wernicke's ___________
feelings o An inflammatory hemorrhagic degenerative
• No compensation condition of the brain
o Caused by B1 deficiency

NURSING INTERVENTION: Alcohol Detoxification:

• Reinforce treatment and ___________ prescriptions • Drug of Choice: ___________ (Antabuse)
• Establish a trusting relationship • 3 S’s of detoxification:
• Monitor weight and vital signs o ___________
• Encourage ventilation o Sedation
• Decrease emphasis on foods, eating, weight o Supplementation
• Involve in decision making
• Employ ___________ setting DRUG-RELATED DISORDERS
• Stay with the client after meal
Cocaine-Related Disorders
• Cocaine is a white powdered substance
SUBSTANCE-RELATED DISORDERS • Usually sniffed, snorted, smoked in a pipe or
injected into a vein or subcutaneous tissue.
ALCOHOLISM AND RELATED DISORDERS • Poor man’s cocaine: ___________

ALCOHOLISM Signs of use:

1. _______________ • Cocaine psychosis
2. _______________ • Obvious dilation of the pupils
3. _______________ • Cardiac problems
• Agitation
Progression: • Insomnia
• ___________ • No appetite
o starts with social drinking • Excessive sweating
o tolerance begins to develop • Severe to panic anxiety
• ___________
o alcohol becomes a need Classic Sign: ___________ nasal septum
 o use of prepubertal children (13 years of age or
Cannabis-Related Disorders (Cannabinoids) younger)
• Marijuana o actual sexual act or a fantasy
o ___________ or ___________ • Sadism – inflicting pain
o Mild hallucinogen with some sedative properties • Telephone Scatalogia (sex on phone) - calling
o May lead to psychological dependence someone and making lewd, obscene remarks or
o Plant : cannabis sativa conversation.
o Active component: __________________ • Transvestism – wearing the clothing of a woman
o Routes of use: • Urophilia - urinating on the partner
o Orally (capsules, tablets, on sugar • Voyeurism
cubes) o Act of observing unsuspecting person who is
o With food naked, in the process of disrobing, or engaging
o Smoked in a pipe or rolled as cigarette in sexual activity.
o Onset: _______ o Includes cyber-voyeurism
o Duration: ____________
GENDER DYSPHORIA
Physiologic symptoms : • AKA ___________
• Increased appetite • Persistent discomfort on the assigned sex.
• Nausea and vomiting
• D___________ Nursing Interventions:
• Inability to think clearly • Attitude:
• Ataxia o ___________
• Non-steady gait o Non-judgmental
• Accept his feelings related to sexuality
• H___________ • Have a private area for discussion
• Excitement o Employ limit setting
• Movement problems (reduced coordination) • Intervene to discuss self-esteem issues, anxiety,
• Problems on judgment guilt, and empathy for victims.
• Refer to the correct clinic.
Classic sign: bloodshot eyes

NEUROCOGNITIVE DISORDER
SEXUAL DISORDERS
PERSONALITY DISORDERS
• Sexuality - is the result of biologic, psychological, • ___________ and ___________ patterns of
social and experimental factors that mold an functioning that is stable overtime, and leads to
individual's sexual development, self-concept, body distress or impairment.
image and behavior. • Incidence:
• ___________ of the general population
Phases of Sexual Response Cycle • In all socio-economic classes
• Desire
• Excitement / Arousal Diagnostic Criteria:
• Plateau - “intense moments” • Deviating from culture
• Orgasm (Climax) • Alters ADL
• Resolution phase • Onset: adolescence to early adulthood
• Not associated with other mental illness
• Not associated with other physical illness
SEXUAL DYSFUNCTION DISORDERS
• Sexual Desire Disorders Types
• Sexual Arousal Disorder TYPE A (___________)
• Orgasm Disorders
• Sexual Pain Disorders PARANOID - _____________________
SCHIZOID - _____________________
PARAPHILIA (Sexual Deviation Disorders) SCHIZOTYPAL - _____________________
• Abnormal sexual behaviors
• 6 months + distress or impairment to functioning TYPE B
(Dramatic-Erratic-Egocentric)
Examples:
• __________- - tongue brushing the anus ANTI SOCIAL - _____________________
• Bestiality or Zoophilia - contact with animals BORDERLINE - _____________________
• Coprophilia - smearing feces on the partner HISTRIONIC - _____________________
• Cunnillingus - tongue brushing the vulva NARCISSISTIC - _____________________
• Exhibitionism - exposing one’s genitals to
unsuspecting strangers (usually women or children)
• __________ - inserting the penis into the mouth TYPE C
• Fetishism - inanimate / non-living objects or articles (Anxious / Fearful)
• Frotteurism - Touching or rubbing against the
unsuspecting people. AVOIDANT - ______________
• Masochism DEPENDENT - ______________
• Sexual gratification from experiencing pain OBSESSIVE-COMPULSIVE - ______________
• Necrophilia - use of corpses PASSIVE-AGGRESSIVE - ______________
• _________ - inserting penis into the other parts of
the body
• Pedophilia
SCHIZOPHRENIA COMMON TYPES OF MOOD DISORDERS
• A serious psychiatric disorder Major Depressive Disorder
• One of the most profound disabling illnesses • Lasts at least 2 weeks which impairs _________
• Not a single disease entity • Characterized by depressed mood / loss of pleasure
• "___________ ___________" in most activities
• Characterized by:
o impaired communication Clinical Symptoms of Major Depressive Episode
o loss of contact into reality • Affect is flat
o deterioration from a previous level of • Loss of memory
functioning • Obvious sleep disturbances
• Incidence: • Sad feelings / Social withdrawal
• Men: 15 to 25 • Emotional blunting
• Women: 25 to 35 • Reduced ___________

• Prominent psychotic symptoms, with abnormalities Mania – abnormally and persistently elevated mood
in 1 or more of 5 domains: lasting for 1 week
o Delusions
o Hallucinations Clinical Symptoms of Manic Episode
o Disorganized thinking • Agitation
o Disorganized behavior • Flight of ideas
o Negative symptoms • Increased activity
• Grandiosity
Theories: • High emotions
• Biological • Talkative or pressured to keep talking
• Neuroanatomical and neurodevelopmental • Easy distractibility
• Immunovirological • Reduced sleep

PSYCHOSES RELATED TO SCHIZOPHRENIA Bipolar Disorder

Manifestations
Schizophreniform • Less than ____ months
Disorder • ADL not impaired
• Sudden onset of at least
Brief Psychotic
1 symptom
Disorder
• _____________
Schizoaffective • Psychosis + all features
Disorder of _________ disorder
• 1 or more bizarre
Delusional Disorder delusions
• ADL not impaired
Shared Psychotic • 2 or more people share
Disorder (folie a deux) a similar delusion
• A person’s 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
Dysthymic Disorder
• 2 weeks or more
• Does not alter ADL
Cyclothymic Disorder

NURSING INTERVENTION PRINCIPLES DNOS (Depression Not Otherwise Specified) - lasts

• Priority: Safety for 2 days-2 weeks
• Establish:
o A trusting relationship and provide
Mania Depression
acceptance
o A clear, consistent and open Appearance ___________ ___________
communication
• Set limits DM ___________ ___________
• Decrease environmental stimuli
• Observe for suicidal ideation Attitude Matter of fact Kind firmness
• Administer medications, as ordered therapies

Activity Non-stimulating Monotonous

Never give
MOOD DISORDERS
anything that
Mania Depression requires attention

Biological Hereditary Hereditary Priority NDx Risk for injury: Risk for injury:
Directed at others self-directed
Neurochemical High Low
norepinephrine norepinephrine Nursing Individual Group therapy
and serotonin and serotonin Management therapies Antidepressants
levels levels Lithium ECT
Diet
Psyhoanalytic Defense Rigid superego
mechanism
against
depression
ELECTROCONVULSIVE THERAPY (ECT)
• Exact mechanism is unknown
• Requires a consent

Voltage : volts
Length : .5-2 seconds
Frequency : 6-12 treatments
Interval : hours
Indicator : seizure

Indications of use:
•
• Mania

Contraindications:
• • Unhealed
• Increased ICP fracture
• Cardiac • Retinal
conditions detachment
• TB with history •
of hemorrhage •

Before the procedure:

• Take
• 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:

After the procedure:

• Position
• Check vital signs
• Reorient the client