Professional Documents
Culture Documents
Gane
Gane
Neurosis
any long term mental or behavioral d/o in which contact with reality is retained the
condition is recognized by the patient as abnormal. Essentially features anxiety or
behavior exagerrated designed to avoid anxiety
( anxiety d/o ; hysteria to conversion d/o,amnesia,fugue,multiple
personality and depersonalization- dissociative d/o
;oc d/o)
Result of inappropriate early programming(psychoanalysis little value)
Benefits from Behavior Therapy
Psychosis
Mental or behavioral disorder wherein patient looses contact with reality
Presence of delusions, hallucinations,severe thought disturbances,alteration of mood,
poverty of thought and abnormal behavior
(schizophrenia , major disorder of affect ( mania – depression), major paranoid
states and organic mental disorder
Benefits from psychoanalysis and antipsychotics
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
Psychosocial – Erickson
developmental milestones
//delay
0-12mos; TRUST
1-3y AUTONOMY
3-6 INITIATIVE
6-12 INDUSTRY
12-18 IDENTITY
18-25 INTIMACY
25-60 GENERATIVITY
60 and above EGO INTEGRITY
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
• 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 improve 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
INDICATIONS: Selegiline ( Eldepryl)
For management of anti psychotic induced EPS- pseudoparkinsonism
SIDE AND ADVERSE EFFECTS
Anticholinergic Effects Blurring of vision, constipation, 3D’s and
orthostatic hypotension, sorethroat*
Headache, photosensitivity, drowsiness, CHF and halluciantions
Mechanism of
Action
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.
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
SIDE AND ADVERSE EFFECTS
NAVDA Nephrotoxicity*
Fine tremors leading to coarse tremors Cardiac toxicity*
Thirst Hyperthyroidism – Thyroid Crisis*
Nystagmus
CONTRAINDICATIONS AND SPECIAL PRECAUTION
Cardiovascular disease , renal disease, clients on low sodium diet and on diuretic
therapy, brain damage, pregnancy and lactation
NURSING CARE GUIDELINES
V. ANTI ANXIETY
CLASSIFICATION:
BENZODIAZEPINES AZASPIRONES NON-BENZODIAZEPINE
Miscellaneous agents
Alprazolam ( Xanqax)
Chlordiazepoxide ( Librium) Hydroxyzine ( Vistaril)
Clorazepate ( Tranxene) Meprobamate ( Equanil)
Diazepam ( Valium) Buspirone
Lorazepam ( Ativan) (Buspar)
Oxazepam ( Serax)
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.