Professional Documents
Culture Documents
Disturbances of affect
Inappropriate – disharmony between the stimuli and the emotional reaction
Blunted affect – severe reduction in emotional reaction
Flat affect – absence or near absence of emotional reaction
Apathy – dulled emotional tone
Depersonalization – feeling of strangeness from one’s self
Derealization – feeling of strangeness towards environment
Agnosia – lack of sensory stimuli integration
Disturbances in memory
Confabulation – filling of memory gaps
Déjà vu – 2nd time-like feeling
Jamais vu- not having been to the place one has been before
Amnesia – memory loss (inability to recall past events)
Retrograde-distant past
Anterograde – immediate past
Anomia – lack of memory of items
Dynamics of Human Behavior
Personality – integration of systems and habits representing anindividuals characteristic
adjustment to his environment expressed through behavior
Individualistic, unique, predictable(stability and consistency)
Determinants: psychological,cultural, biological ( not inhereted) and familial
Analysis
Potential support systems or stressors
Potential risk factor
Satisfaction of human needs
– Physiological(oxygen , fluids, nutrition, temp.,elimination,shelter,rest,sex)
– Safety and security(physical and psychological)
– Love and belongingness
– Self esteem
– Self –actualization
3 divisions of the mind
Conscious – focussed on awareness
Subconscious – recalled at will
Unconscious – never recalled / largest part
Learning – change in behavior through – insight , relearning and remotivation
0-2 SENSORIMOTOR
REFLEXIVE
IMITATIVE REPETITIVE BEHAVIOR
SENSE OF OBJECT PERMANENCE AND SELF SEPARATE FROM ENVT.
TRIAL AND ERROR RESULTS IN PROBLEM SOLVING
2-7Y PRE-OPERATIONAL
SELF-CENTERED,EGOCENTRIC
CANNOT CONCEPTUALIZE OTHER’S VIEW
ANIMISTIC THINKING
IMAGINARY PLAYMATE – SYMBOLIC MENTAL REPRESENTATION – CREATIVITY
2-4 PRE-CONCEPTUAL (PRE-LOGICAL)
4-7 INTUITIVE (UNDERSTANDING OF ROLES)
7-12Y CONCRETE OPERATIONAL
LOGICAL CONCRETE THOUGHT
INDUCTIVE RESAONING (SPECIFIC TO GENERAL)
CAN RELATE ,PROBLEM SOLVING ABILITY
REASONING AND SELF-REGULATION
12-ABOVE FORMAL OPERATIONAL THOUGHT
Abstract thinking
Separation of fantasy and fact
Reality oriented
Deductive reasoning
Apply scientific method
PRE-CONVENTIONAL (0-6)
– PUNISHMENT AND OBEDIENCE
– OBEDIENCE TO RULES TO AVOID PUNISHMENT
CONVENTIONAL ( 6-12 )
– MUTUAL INTERPERSONAL EXPECTATIONS,RELATIONSHIPS AND CONFORMITY
– SOCIAL SYSTEM AND CONSCIENCE MAINTENANCE
– BEING GOOD IS IMPORTANT SELF RESPECT OR CONSCIENCE
POST –CONVENTIONAL (12 – 18 Y)
PRIOR RIGHT OR SOCIAL CONTRACT
UNIVERSAL ETHICAL PRINCIPLE
ABIDE FOR COMMON GOOD
RATIONAL PERSON-VALIDITY OF PRINCIPLES-AND BECOME COMMITTED TO THEM
INNER CONTROL OF BEHAVIOR UNDERSTANDING THE EQUALITY OF HUMAN
RIGHTS AND DIGNITY OF HUMAN BEINGS AS INDIVIDUALS
DEFENSE MECHANISMS
• unconscious intrapsychic adoptive efforts to resolve emotional conflict and cope with anxiety
• automatic
• pathology is determined by the frequency of use
PHASES
• PRE-INTERACTION – SELF – AWARENESS
• ORIENTATION PHASE – DEVELOP A MUTUALLY ACCEPTABLE CONTACT
• WORKING – IDENTIFICATION AND RESOLUTION OF THE PATIENT’S PROBLEMS
• TERMINATION – ASSIST PATIENT TO REVIEW WHAT HE HAS LEARNED AND
TRANSFER HIS LEARNING TO HIS REL. W/ OTHERS
WHEN TO TERMINATE NPR
• GOALS ACCOMPLISHED
• EMOTIONALLY STABLE
• GREATER INDEPENDENCE
• ABLE TO COPE WITH ANXIETY, LOSS , FEAR AND SEPARATION
COMMON PROBLEMS - NPR
• TRANSFERENCE – DEVELOPMENT OF EMOTIONAL ATTITUDE + OR – TOWARDS THE
NURSE
• RESISTANCE – DEVELOPMNET OF AMBIVALENT FEELINGS TOWARDS SELF –
EXPLORATION
• COUNTER – TRANS FERENCE – TRANSFERENCE AS EXPERIENCED BY THE NURSE
PRINCIPLES OF CARE
• ACCPETS PATIENT AS UNIQUE WITH INHERENT VALUE AND WORTH
• PATIENT IS VIEWED AS HOLISTIC HUMAN BEINGS WITH INTERDEPENDENT AND
INTERRELATED NEEDS
• FOCUS ON STRENGTHS AND ASSETS
• NON – JUDGEMENTAL ASSISTANCE TOWARDS COPING
• EXPLORE THE PATIENTS BEHAVIOR AND THE NEED IT IS DESIGNED TO MEET AND
THE MESSAGE IT IS COMMUNICATING
LEVELS OF INTERVENTION
• PRIMARY – INTERVENTIONS AIMED AT THE PROMOTION OF MENTAL HEALTH AND
LOWERING THE RATE OF CASES BY ALTERING THE STRESSORS
• SECONDARY – INTERVENTIONS THAT LIMIT THE SEVERITY OF THE DISORDER
– CASE FINDING AND PROMPT Tx
• TERTIARY – REDUCING THE DISABILITY AFTER A DISORDER
– PREVENTION OF COMPLICATION AND ACTIVE PROGRAM OF REHABILITATION
CHARACTERISTICS OF A PSYCHIATRIC NURSE-major roles of a nurse - socializing agent
and patient advocate
• EMPATHY- ability to see beyond outward behavior and sense accurately another persons
inner experience
• GENUINENESS/CONGRUENCE – ability to use therapeutic tools appropriately
• UNCONDITIONAL POSITIVE REGARD - respect
THERAPEUTIC COMMUNICATION
• CLARIFICATION
• LIMIT SETTING
• EMPATHETIC / ENCOURAGE EXPRESSION
• ANSWERS NEEDS
• REFLECTIVE AND INSIGHTFUL
THERAPEUTIC COMMUNICATION
• FOCUS ON FEELING TONE ,NEEDS ,MOTIVATION
• MUST HAVE CONSISTENCY AND IS NON JUDGEMENTAL
• CRITERIA OF SUCCESSFUL COMMUNICATION – FEEDBACK , APPROPRIATENESS,
FLEXIBILITY AND EFFICIENCY
TECHNIQUES OF COMMUNICATION
• TO INITIATE A CONVERSATION –
– giving broad openings
– giving recognition / acknowledgement
• TO ESTABLISH RAPPORT
– GIVING INFORMATION
– USE OF SILENCE
• TO GATHER INFORMATION
– FOCUSING
– VALIDATING
– REFLECTING
– RESTATING
• TO CLOSE A CONVERSATION
– summarizing
TYPES OF PSYCHOTHERAPIES
REMOTIVATION THERAPY
• TREATMENT MODALITY THAT PROMOTES EXPRESSION OF FEELINGS THROUGH
INTERACTION FACILITATED BY DISCUSSION OF NEUTRAL TOPICS
• STEPS :
climate of acceptance
creating bridge to reality
sharing the world we live in
appreciation of works of the world
climate of appreciation
MUSIC THERAPY
• INVOLVES USE OF MUSIC TPO FACILITATE EXPRESSION OF FEELINGS,FACILITATE
RELAXATION AND OUTLET OF TENSION
PLAY THERAPY
enables patient to experience intense emotion in a safe environment with the use of play
children express themselves more easily in play. revealing as reflection of child’s situation
in the family
provide toys and materials – facilitate interaction – observe and help child resolve
problems through play
Group therapy
• Treatment modality involving three or more patients with a therapist to relieve emotional
difficulties, increase self – esteem, develop insight , LEARN NEW ADAPTIVE WAYS TO
COPE WITH STRESS and impr ove behavior with others( RELATIONSHIP WITH OTHERS
CAN BE WORKED THROUGH)
• IDEAL 8 – 10 MEMBERS
MILIEU THERAPY
• CONSISTS OF TREATMENT BY MEANS OF CONTROLLED MODIFICATION OF THE
PATIENTS ENVIRONMENT , FACILITATE POSITIVE BEHAVIORAL CHANGE
• INCREASE PATIENTS AWARENESS OF FEELINGS, INCREASE SENSE OF
RESPONSIBILITY AND HELP ETURN TO COMMUNITY
• clients plan social and group interaction
• token programs , open wards and self medication
FAMILY THERAPY
• A METHOD OF PSYCHOTHERAPY WHICH FOCUSES ON THE TOTAL FAMILY AS AN
INTERACTIONAL SYSTEM
• PROBLEM IS A FAMILY PROBLEM
• focus on sick members behavior as source of trouble / symptom serve a function for the family
• members develop sense of identity
• points out function of the sick member for the rest of the family
PSYCHOANALYTIC
• focuses on the exploration of the unconscious, to facilitate identification of the patients
defenses
• ANXIETY RESULTS BETWEEN CONFLICTS OF ID AND EGO(DEFENSE MECHANISMS
FORM TO WARD OFF)
• BECOMES AWARE OF UNCONSCIOUS THOUGHTS AND FELINGS.UNDERSTAND
ANXIETY AND DEFENSES
HYPNOTHERAPY
• VARIOUS METHODS AND TECHNIQUES TO INDUCE A TRANCE STATE WHERE
PATIENT BECOMES SUBMISSIVE TO INSTRUCTIONS
BEHAVIOR MODIFICATION
A THERAPEUTIC INTERVENTION INVOLVOING THE APPLICATION OF LEARNING
PRINCIPLES IN ORDER TO CHANGE MAL-ADAPTIVE BEHAVIOR
PSYCHOLOGICAL PROBLEMS ARE A RESULT OF LEARNING
DEFICIENCIES CAN BE CORRECTED THROUGH LEARNING
• OPERANT CONDITIONING
– USE OF REWARDS TO EINFORCE POSITIVE BEHAVIOR
– PERCEIVED AND SELF REINFORCEMENT BECOMES MORE IMPORTANT THAN
EXTERNAL
• DESENSITIZATION
– SLOW ADJUSTMENT OR EXPOSURE TO FEARED OBJECTS(USED IN PHOBIAS)
– PERIODIC EXPOSURE,UNTIL UNDESIRABLE BEHAVIOR DISAPPEARS OR LESSENS
•AVERSION THERAPY - EXAMPLE OF BEHAVIOR MODIFICATION IN WHICH PAINFUL
STIMULUS IS INTRODUCED TO BRING ABOUT AN AVOIDANCE OF ANOTHER
STIMULUS WITH THE END VIEW OF FACILITATING BEHAVIORAL CHANGE
OTHER THERAPIES
TOKEN ECONOMY-REWARDING DESIRED BEHAVIOR
COGNITIVE THERAPY – SHORT TERM STRUCTURED THERAPY –ORIENTED TOWARDS
PRESENT PROBLEMS ABD SOLUTIONS – AMIN FOCUS OF DEPRESSIVE DISORDERS
HUMOR THERAPY – TO FACILITATE EXPRESSION AND ENHANCE INTERACTION
ACTIVITY THERAPY – GROUP INTERACTION WHILE WORKING ON A TASK TOGETHER
PSYHCHOPHARMACOLOGIC AGENTS
I. ANTI-PSYCHOTICS
SUB-CLASSIFICATIONS
PHENOTHIAZINES NON-PHENOTHIAZINES
INDICATION
- formerly called major tranquilizers / neuroleptics. used to
relieve psychotic symptoms( delusions , hallucinations
and looseness of association)of schjizophrenia, mania and psychotic
depression and organic mental disorders
- acute management of agitation and hyperactivity
ANTICHOLINERGIC EFFECTS
(EPS)EXTRAPYRAMIDAL SYMPTOMS
– PSEUDOPARKINSONISM-tremor , mask like facies drooling , restlesssness
– AKATHISIA- restlessness,and anxiety
– DYSTONIA-grimacing , torticollis ,oculogyric crisis, intermittent muscle spasms
- TARDIVE DYSKINESIA-lip smaking and tongue and mouth
SEIZURES
HEPATOTOXICITY*
ORTHOSTATIC HYPOTENSION
PHOTOSENSITIVITY and HYPERSENSITIVITY
ENDOCRINE DISORDERS
DYSCRASIAS *
AGRANULOCYTOSIS – sorethroat,chills,fever,malaise
LEUKOPENIA
BP and temperature
K – monitor blood levels
Seizures, NMS and EPS
L.F.T.’s
CBC with differential
medical management :
NMS – Bromocriptine or Amantadine( dopamine agonist) and
Dantrolene (Dantrium) muscular relaxant
Dystonia – Diphenhydramine,Benztropine , Diazepam, Lorazepam
Pseudoparkinsonism – Antiparkinsonian, Anticholinergic
Akathisia – Anticholinergic, Benzodiazepines, Beta-blockers,Clonidine
Tardive dyskinesia – early referral-dose reduction , no anticholinergics
CLASSIFICATIONS
2 TYPES :
Trihexypheiedil ( Artane)
Biperiden Hydrochloride ( Akineton)
Benztropine Mesylate ( Cogentin)
Diphenhydramine Hydrochloride
(Benadryl)
Misc. agent
Selegiline
INDICATIONS: For ( Eldepryl)
management of anti psychotic induced EPS- pseudoparkinsonism
COMMON TYPES
Tranylcypromine (Parnate)
Isocarboxazid ( Marplan)
Phenelzine (Nardil)
Mechanism of
Action
Ritalin ( Methylphenidate)
Amphetamine ( Benzedrine)
INDICATIONS
effective in management and treatment of depression and related mood and depressive disorders
such as:
Obsessive compulsive ,Eating d/o,Obesity,Bipolar disorder,Panic d/o
SIDE EFFECTS AND ADVERSE REACTIONS:
C- anti-depressants
H- decreased signs and symptoms of depression(increased appetite and sleep
E – p.c.
K-
Monitor BP, HR and
ECG
Monitor BP and food
items
EXAMPLES
Carbamazepine (Tegretol )
MOA
Exact mechanism unknown , alters the level of norepinephrine and other neurotransmitters
INDICATIONS
• Treatment of acute mania and for prophylaxis of recurrent manic and depressive episodes in
bipolar disorder
V. ANTI ANXIETY
CLASSIFICATION:
MOA: depresses Reticular Activating system and reduces anxiety by stimulating the action of an inhibitory
neurotransmitter called GABA
INDICATIONS; treatment of anxiety disorders and for short term relief of symptoms of
Anxiety; selective medications effective for skeletal muscle relaxation, pre
and post-op sedation, seizure control.