Lecture Aid: Mental Health and Psychiatric Nursing Lester R. L.

Lintao 1

MENTAL HEALTH

· "A state of well-being where a person can realize his or her own abilities to cope with the normal stresses of
life and work productively." (WHO)

CRITERIA FOR POSITIVE MENTAL HEALTH

· ________________
· Autonomy
· Perceptive ability
· Integral capacity
· _________________
· Mastery of one’s environment

MENTAL HYGIENE
· Study of mental health

USE OF APPROPRIATE COMMUNICATION TECHNIQUES

COMMUNICATION
• ______________ exchange of ideas between or among persons
• Modes:
· VERBAL- written/spoken
· NON-VERBAL- posture, tone of voice and facial expression.
o Types:
▪ Kinesis
▪ Paralanguage
▪ Proxemics
▪ Touch

THERAPEUTIC COMMUNICATION
▪ A way of interacting in a purposeful manner to promote the client’s ability to express his
thoughts and feelings openly.

Essentials:
Genuineness
Respect
Empathy
Attentive listening
Trust & rapport

Barriers:
Belittling
Interrupting / ignoring
Giving advice
Social response
Changing the subject
Approving / disapproving
Moralizing

NURSE-PATIENT RELATIONSHIP
(Hildegard Peplau)

Stages:
PRE-ORIENTATION
▪ Begins when the nurse is assigned/chooses a patient
▪ Anxiety: ______________
▪ Major task of the nurse: develop self-awareness
▪ Other tasks:
▪ Data gathering
▪ Planning for first interaction

ORIENTATION
 Lecture Aid: Mental Health and Psychiatric Nursing Lester R. L. Lintao 2

▪ Major task: establish trust and rapport

▪ Anxiety: ______________
▪ Establish contract with the patient
▪ Assure confidentiality

WORKING / THERAPEUTIC
▪ Anxiety: ______________
▪ Major task: identification and resolve problems by reinforcing coping: __________,
________, ________
▪ Highly individualized
▪ More structured
▪ The longest and most productive
▪ Other tasks: planning and implementation

Problems)
• ________________
o the development of an emotional attitude towards the nurse
o positive or negative
• Counter transference
o experienced by the nurse / therapist

TERMINATION
• Reinforce, reward and ____________
• Encourage verbalization
– Anxiety: Patient
· Summarize the progress
· Terminate

STRESS
· 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:
I. Physical
A. General Adaptation Syndrome
B. Local Adaptation Syndrome

II. Psychological (Defense Mechanism)

DEFENSE MECHANISM
• Are automatic and usually unconscious processes
• Pathologic when _______________
• Used by both the healthy and ill

Commonly used:
Compensation
· An attempt to a real or imagined short coming, inferiority, inabilities and weaknesses
Conversion
· Emotional problems are converted to __________ symptoms
Denial
· Failure to acknowledge an intolerable thought, feeling, experience or reality
Displacement
· The redirection of feelings to a ___________ threatening object.
Fantasy
· Conscious distortion off unconscious feelings or wishes
Fixation
· "Arrest of maturation"
Introjection
· “Self-blaming
 Lecture Aid: Mental Health and Psychiatric Nursing Lester R. L. Lintao 3

Identification
· An individual integrates certain aspects of someone else's personality into one's own
Intellectualization
· An overuse of intellectual concepts by an individual to avoid expression of feelings
Projection
· "Blaming others"
Reaction – Formation
· Expression of feeling that is the direct opposite of one's real feeling.
Rationalization
· Making justifiable reasons
Regression
· The turning back to earlier patterns of behavior in solving personal conflicts.
Repression
· ___________ forgetting
Suppression
· ___________ forgetting
Substitution
· Unattainable goal replaced with attainable
Sublimation
· Unacceptable replaced with socially acceptable drives
Symbolization
· A ___________ threatening object is used to represent another
Undoing
· An attempt to erase an act, thought, feeling, guilt or desire

CRISIS AND CRISIS INTERVENTION

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:
Maturational / Developmental
• Expected, predictable and internally motivated
• Examples: puberty, adolescence, young adulthood, marriage, or the aging process.
Situational / Accidental
• Unexpected, unpredictable and externally motivated
• Example: economic difficulty, illness, accident, rape, divorce or death
Social / Adventitious
• Due to acts of ___________
• Example: natural calamities

ANXIETY
· ___________ response to stress
· An unpleasant emotional state
consisting of psychophysiological responses.

Manifestations:
Physical Cognitive Emotional
Mild Increase in VS Increased attentiveness and Minimal use of defenses
Pupillary dilatation alertness
Diaphoresis

Moder Vomiting Decreased perceptive ability Use of any defense mechanism

 Lecture Aid: Mental Health and Psychiatric Nursing Lester R. L. Lintao 4

ate Anorexia available

Nausea
Diarrhea / constipation
Agitation
Severe Headache Perceptive ability is greatly Defense mechanism operate
Inability to communicate decreased

Physical symptoms become the Inability to focus on major

focus of attention issues

Panic Fatigue Personality disorganization Defense mechanism fail

Muscular weakness

Nursing Management:
Priority: ___________
Encourage ventilation
Administer medications as ordered
Carefully listen
Environmental stimuli must be controlled

ANXIETY DISORDERS
Panic Disorder Generalized Anxiety Disorder

Cause
Level

Progression

Length

Manifestations

PHOBIC DISORDER
• Phobia ______________
• Most common:
• Social phobia - ________________

SEPARATION ANXIETY DISORDER

• Excessive anxiety regarding
separation from home or from people to whom the individual has a strong ___________ attachment.
• Below 18: ______________
• Above 18: ______________

SELECTIVE MUTISM
• Mutism on specific topics.
• Mistaken as a language disorder
• Duration: _____________

ANXIETY - RELATED DISORDERS

OBSESSIVE-COMPULSIVE RELATED DISORDERS

 Lecture Aid: Mental Health and Psychiatric Nursing Lester R. L. Lintao 5

Distinguishing Feature Anxiety relief

Obsessive Compulsive
Disorder
Body Dysymorphic Disoder

Hoarding Disorder
Trichotillomania /
Trichotillosis
Excoriation Disorder /
Dermatillomania

TRAUMA-AND-STRESSOR-RELATED DISORDER

POST-TRAUMATIC STRESS DISORDER

• Onset: ___________
• Most Common cause:
_____________
• Duration: ________________
• Hallmarks: ___________ &
________________

ACUTE STRESS DISORDER

(Acute Stress Reaction, Mental Shock, Psychological Shock)
• Onset: within ___________
• Duration: 2 days to 4 weeks
• Causes:
• Experienced directly
• Witnessed
• Inexperienced indirectly

Symptoms:
• Akinesia
• Mutism
• Numbness
• Symptoms same with PTSD

ADJUSTMENT DISORDER
(Exogenous, Reactive or Situation Depression)
• May be acute or chronic
• More common to ___________

Common characteristics:
• depressive symptoms
• anxiety symptoms
• traumatic stress symptoms

REACTIVE ATTACHMENT DISORDER

• Onset: 18-24 months
• Can be:
o Reactive attachment:
▪ Extreme reluctance to initiate or
accept comfort and affection, even from familiar adults, especially when distressed.
o Disinhibited social engagement:
▪ Indiscriminate and excessive attempts
to receive comfort and affection from any available adult, even relative strangers
▪ Older children and adolescents –
peers
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SOMATIC SYMPTOMS AND RELATED DISORDERS

SOMATIC SYMPTOM DISORDER

• Characterized by physical symptoms
that mimic disease or injury for which there is no identifiable ___________ cause

ILLNESS ANXIETY DISORDER

• An individual presents an unrealistic
or exaggerated physical complaints.
• The person becomes, preoccupied
with the fear of developing or having already a disease or illness in spite of medical reassurance.

CONVERSION DISORDER (Functional Neurological Symptom Disorder)

• Anxiety-provoking impulse is
converted ___________ into functional symptoms.
• Classic feature: La belle
___________ (lack of concern or distress)

PAIN DISORDER
• Chronic pain experienced by a patient
in one or more area
• Alters ADL
• Often occurs after an accident or
during an illness that has caused pain

DISSOCIATIVE DISORDERS

DISSOCIATIVE AMNESIA (Psychogenic Amnesia)

• Inability to recall ___________
amount of important information
• Caused by physical / psychological
trauma
· Rapid recovery generally occur

DEPERSONALIZATION / DEREALIZATION DISORDER

• Periods of detachment from self or
surrounding which may be experienced as "unreal"
• Reality is intact
• Escape to “dream" or "fantasy land"

DISSOCIATIVE IDENTITY DISORDER

· Occurrence of two or more
personalities within the same individual
· Each of which during sometime in the
person's life is able to take control.

DISORDERS COMMONLY DIAGNOSED TO CHILDREN

NEURODEVELOPMENTAL DISORDERS

INTELLECTUAL DEVELOPMENTAL DISORDER

• Onset: ___________
• IQ below ___________
• Sub-average intellectual functioning

LEVELS:
 Lecture Aid: Mental Health and Psychiatric Nursing Lester R. L. Lintao 7

IQ Capabilities

Mild • Difficulty
adapting to school
• Educable
Moderate • Trainable

Severe • Needs
complete and close supervision
Profound • Minimal capacity for sensorimotor function
• Needs custodial care

SPECIFIC LEARNING DISORDERS

❖ Reading Disorder
❖ Mathematics Disorder
❖ Disorder of Written Expression
❖ Learning Disorder NOS

COMMUNICATION DISORDERS

Types:
Difficulty

Language Disorder

Speech Sound Disorder

Childhood - Onset Fluency
Disorder
Social Communication Disorder

AUTISM SPECTRUM DISORDER

ASPERGER’S DISORDER
• Age: _________________
• Predisposing factor: _________________
• Hallmark: _________________
• Motor development may be delayed

AUTISM
• Treatable but not curable
• Hallmark: Stereotypical behavior
• Gender: _______________
• Age: ___________
• Language pattern: _________________
• Diagnostic: _________________
• Diet: _______________

CHILDHOOD DISINTEGRATIVE DISORDER (___________ Syndrome/ Disintegrative Psychosis)

• Age: ________________
• Loss of function (2 or more):
1. Expressive language
2. Receptive language
3. Social and self-care
4. Control over elimination
5. Play
6. Motor
• Drug of choice: ____________

PERVASIVE DEVELOPMENT DISORDER NOT OTHERWISE SPECIFIED

 Lecture Aid: Mental Health and Psychiatric Nursing Lester R. L. Lintao 8

• AKA Atypical Personality Development, Atypical PDD and Atypical Autism

ATTENTION DEFICIT HYPERACTIVITY DISORDER

• Gender: ________________
• Age: ________________
• Triad: ________________, ________________, ________________
• Management:
• Priority: ___________
• Diet: ___________
• DOC: ___________

MOTOR DISORDERS

Types:
Manifestations
Developmental
Coordination Disorder
Stereotypic Movement
Disorders
Tourette Syndrome

DISRUPTIVE, IMPULSE-CONTROL AND CONDUCT DISORDERS

OPPOSITIONAL DEFIANT DISORDER

• Pattern of angry / irritable mood, argumentative / defiant behavior, or vindictiveness
• Lasting at least ___________ months

CONDUCT DISORDER
• ___________ delinquents
• Precursor to antisocial personality disorder

IMPULSE CONTROL DISORDERS NOT OTHERWISE SPECIFIED

• Kleptomania
• Pyromania
• Intermittent ___________ Disorder

FEEDING AND EATING DISORDER

• More common among women.

Causes:
• Psychological factors
– Parental
– Individual
– Sociocultural

AVOIDANT/ RESTRICTIVE FOOD INTAKE DISORDER

• ___________ Eating Disorder

ANOREXIA NERVOSA

Main sign: Morbid fear of gaining weight

Other signs:
• Sensitivity to cold
• Amenorrhea
• Deliberate self-starvation
 Lecture Aid: Mental Health and Psychiatric Nursing Lester R. L. Lintao 9

• Denial of hunger
• Obviously thin but feels fat
• Lanugo all over the body
• Loss of scalp hair

BULIMIA NERVOSA
• Extreme measures to lose weight
o uses diet pills, diuretics or laxatives
o purges after eating
o swelling of the cheeks or jaw area
o cuts and calluses on the back of the hands and knuckles (___________ sign)
o clear teeth
o extreme exercise
• Peculiar signs
o Depression
o loss of interest in activities

• Pathognomonic: __________________

BINGE EATING DISORDER (Eating Disorder NOS)

• Eating unusually large amounts of food in a discrete period of time.
• Done privately and accompanied by negative feelings
• No compensation

NURSING INTERVENTION:
• Reinforce treatment and ___________ prescriptions
• Establish a trusting relationship
• Monitor weight and vital signs
• Encourage ventilation
• Decrease emphasis on foods, eating, weight
• Involve in decision making
• Employ ___________ setting
• Stay with the client after meal

SUBSTANCE-RELATED DISORDERS

ALCOHOLISM AND RELATED DISORDERS

ALCOHOLISM
1._______________
2._______________
3._______________

Progression:
• ___________
o starts with social drinking
o tolerance begins to develop
• ___________
o alcohol becomes a need
o blackouts occur
o denial starts
• ___________ - cardinal symptoms of develop
• ___________ - intoxicated all day

Behavioral problems:
• Denial
• Dependency
• Demanding
• Destructive
 Lecture Aid: Mental Health and Psychiatric Nursing Lester R. L. Lintao 10

• Domineering

Alcohol Withdrawal
• Occurs when an individual abruptly stops drinking
• Symptoms develop within few hours

Alcohol Withdrawal Delirium

• AKA ___________ ___________
• Within 48 to 72 hours after the last intake.

Chronic Problems:
• Korsakoff's Psychosis
o A form of ___________
o Deficiency in vitamin B1 and B12
· Wernicke's ___________
o An inflammatory hemorrhagic degenerative condition of the brain
o Caused by B1 deficiency

Alcohol Detoxification:
• Drug of Choice: ___________ (Antabuse)
• 3 S’s of detoxification:
o ___________
o Sedation
o Supplementation

DRUG-RELATED DISORDERS

Cocaine-Related Disorders
• Cocaine is a white powdered substance
• Usually sniffed, snorted, smoked in a pipe or injected into a vein or subcutaneous tissue.
• Poor man’s cocaine: ___________
• Classic Sign: ___________ nasal septum

Cannabis-Related Disorders (Cannabinoids)

• Marijuana
o ___________ or ___________
o Mild hallucinogen with some sedative properties
o May lead to psychological dependence
o Plant : cannabis sativa
o Active component: __________________
o Routes:
o Oral
o Smoked
o Onset: _______
o Duration: ____________
o Classic sign: bloodshot eyes

SEXUAL DISORDERS

· Sexuality - is the result of biologic, psychological, social and experimental factors that mold an individual's
sexual development, self-concept, body image and behavior.

SEXUAL DYSFUNCTION DISORDERS

• Sexual Desire Disorders
• Sexual Arousal Disorder
• Orgasm Disorders
• Sexual Pain Disorders

PARAPHILIA (Sexual Deviation Disorders)

· Abnormal sexual behaviors
· 6 months + distress or impairment to functioning
 Lecture Aid: Mental Health and Psychiatric Nursing Lester R. L. Lintao 11

Examples:
• Anilingus- tongue brushing the anus
• Bestiality or Zoophilia - contact with animals
• Coprophilia - smearing feces on the partner
• Cunnillingus - tongue brushing the vulva
• Exhibitionism - exposing one’s genitals to unsuspecting strangers (usually women or children)
• Felatio - inserting the penis into the mouth
• Fetishism - inanimate / non-living objects or articles
• Frotteurism - Touching or rubbing against the unsuspecting people.
• Masochism
• Sexual gratification from experiencing pain
• Necrophilia - use of corpses
• Partialism - inserting penis into the other parts of the body
• Pedophilia
o use of prepubertal children (13 years of age or younger)
o actual sexual act or a fantasy
• Sadism – inflicting pain
• Telephone Scatalogia (sex on phone) - calling someone and making lewd, obscene remarks or
conversation.
• Transvestism – wearing the clothing of a woman
• Urophilia - urinating on the partner
• Voyeurism
o Act of observing unsuspecting person who is naked, in the process of disrobing, or engaging in sexual
activity.
o Includes cyber-voyeurism

GENDER DYSPHORIA
• AKA ___________
• Persistent discomfort on the assigned sex.

Nursing Interventions:
· Attitude:
o ___________
o Non-judgmental
· Accept his feelings related to sexuality
· Have a private area for discussion
o Employ limit setting
· Intervene to discuss self-esteem issues, anxiety, guilt, and empathy for victims.
· Refer to the correct clinic.

NEUROCOGNITIVE DISORDER

PERSONALITY DISORDERS
• ___________ and ___________ patterns of functioning that is stable overtime, and leads to distress or
impairment.
• Incidence:
• ___________ of the general population
• In all socio-economic classes

Diagnostic Criteria:
· Deviating from culture
· Alters ADL
· Onset: adolescence to early adulthood
· Not associated with other mental illness
· Not associated with other physical illness

Types
TYPE A (___________)
PARANOID - _____________________
SCHIZOID - _____________________
SCHIZOTYPAL - _____________________
 Lecture Aid: Mental Health and Psychiatric Nursing Lester R. L. Lintao 12

TYPE B
(Dramatic-Erratic-Egocentric)
ANTI SOCIAL - _____________________
BORDERLINE - _____________________
HISTRIONIC - _____________________
NARCISSISTIC - _____________________

TYPE C
(Anxious / Fearful)

AVOIDANT - ______________
DEPENDENT - ______________
OBSESSIVE-COMPULSIVE - ______________
PASSIVE-AGGRESSIVE - ______________

SCHIZOPHRENIA
• Not a single disease entity
• "___________ ___________"
• Characterized by:
o impaired communication
o Altered reality
o deterioration from a previous level of functioning
· Incidence:
· Men: 15 to 25
· Women: 25 to 35

• Prominent psychotic symptoms (1 or more for 6 months)

o Delusions
o Hallucinations
o Disorganized thinking
o Disorganized behavior
o Negative symptoms

• Defense mechanism: __________________

Theories:
• Biological
• Neuroanatomical and neurodevelopmental
• Immunovirological

PSYCHOSES RELATED TO SCHIZOPHRENIA

Manifestations
• Less than ____ months
Schizophreniform Disorder
• ADL not impaired
• Sudden onset of at least 1 symptom
Brief Psychotic Disorder • _____________

Schizoaffective Disorder • Psychosis + all features of _________ disorder

• 1 or more bizarre delusions

Delusional Disorder • ADL not impaired

Shared Psychotic Disorder (folie a deux) • 2 or more people share a similar delusion

NURSING INTERVENTION PRINCIPLES

• Priority: Safety
• Establish:
o A trusting relationship and provide acceptance
 Lecture Aid: Mental Health and Psychiatric Nursing Lester R. L. Lintao 13

o A clear, consistent and open communication

• Set limits
• Decrease environmental stimuli
• Observe for suicidal ideation
• Administer medications, as ordered

MOOD DISORDERS
Mania Depression
Biological Hereditary Hereditary
Neurochemica High Low norepinephrine and serotonin levels
l norepinephrine
and serotonin
levels
Psyhoanalytic Defense Rigid superego
mechanism
against
depression

COMMON TYPES OF MOOD DISORDERS

Major Depressive Disorder

• At least 2 weeks which impairs _________
• Characterized by depressed mood / loss of pleasure in most activities

Clinical Symptoms of Major Depressive Episode

• Affect is flat
• Loss of memory
• Obvious sleep disturbances
• Sad feelings / Social withdrawal
• Emotional blunting
• Reduced ___________

Mania – abnormally and persistently elevated mood lasting for 1 week

Clinical Symptoms of Manic Episode

• Agitation
• Flight of ideas
• Increased activity
• Grandiosity
• High emotions
• Talkative or pressured to keep talking
• Easy distractibility
• Reduced sleep

Bipolar Disorder
• A person’s mood cycles between mania and depression for 1 week

Bipolar I Disorder
Bipolar II Disorder

Dysthymic Disorder
• 2 weeks or more
• Does not alter ADL

Cyclothymic Disorder

DNOS (Depression Not Otherwise Specified) - lasts for 2 days-2 weeks

 Lecture Aid: Mental Health and Psychiatric Nursing Lester R. L. Lintao 14

  Mania Depression
Appearance ___________ ___________
DM ___________ ___________
Priority NDx Risk for injury: Risk for injury: self-directed
Directed at others
Nursing Management Individual therapies Group therapy
Lithium Antidepressants
Diet ECT