NCM 117 – Psychiatric Nursing In the Philippines.
Module 7.0 Psychopathology, Etiology and
Psychodynamics
THE DSM 5
American Psychological Association
THE DSM V
 The Diagnostic and Statistical Manual of Mental
Disorders, Fifth Edition is the 2013 (May 18,
2013) update to the Diagnostic and Statistical
Manual of Mental Disorders, the taxonomic and
diagnostic tool published by the American
Psychiatric Association.
 The Diagnostic and Statistical Manual of Mental
Disorders (DSM) is the handbook used by health
care professionals in the United States and much
of the world as the authoritative guide to the
diagnosis of mental disorders. DSM contains
descriptions, symptoms, and other criteria for
diagnosing mental disorders.
PSYCHOPATHOLOGY, ETIOLOGY &
PSYCHODYNAMICS
DISTURBANCES IN THOUGHT CONTENT/
PROCESSES:
 Schizophrenia and other Psychosis
WHAT IS SCHIZOPHRENIA?
 Schizophrenia is a chronic, severe, debilitating
mental illness characterized by disordered
thoughts, abnormal behaviors, and anti-social
behaviors.
 It is a psychotic disorder, meaning the person
with schizophrenia does not identify with reality
at times.
 WHO IS AFFECTED?
 In the US.
 Schizophrenia affects about 1.1% of the
world'S population
 3.5 million Americans have schizophrenia
 Schizophrenia is most commonly diagnosed
between the ages of 16 to 25
 Schizophrenia can be hereditary (runs in
families)
 It affects men 1.5 times more commonly
than women
 Schizophrenia and its treatment has an
enormous effect on the economy, costing
between $32.5-$65 billion each year
Like most countries of the Western Pacific
region, have a national mental health policy.
However, in comparison to other countries,
it was put into operation relatively recently.
Community care for patients is present, but
as seen in many low and lower middle
income countries, it is limited. www.who.int
 The population of the Philippines is
estimated to be at 100,981,437 (2020).
 There is little epidemiological evidence on
mental disorders in the Philippines;
however, some important data are available.
For example, 14% of a population of 1.4
million Filipinos with disabilities were
identified to have a mental disorder
(Philippines Statistics Authority, 2010).
 The National Statistics Office identified that
mental illness is the third most prevalent
form of morbidity, however the finding that
only 88 cases of mental health problems
were reported for every 100 000 of the
population is likely an underestimate of the
true extent of these issues (DOH, 2005).
 Mental health disorders rank third in the
most common disabilities in the country,
affecting one in every five Filipino adults,
according to the WHO. Furthermore, PHIS-
MS data show that majority of the patients
diagnosed with schizophrenia are of
working age (20 to 44 years); this does not
bode well for Filipinos afflicted with
schizophrenia, as it is most common during
their most productive years.
 Schizophrenia could adversely affect
patients’ lives in terms of work or academic
performance, along with peer and familial
relationships. This deterioration in
performance and relationships could in turn
negatively impact their daily activities, and
even lead those suffering from the disease to
neglect their needs, such as nutrition,
hygiene, and self-care (Manila Standard
Lifestyle, May 21,2018) .
 HOW COMMON IS SCHIZOPHRENIA IN
CHILDREN?
 Schizophrenia in young children is rare. The
National Institute of Mental Health (NIMH)
estimates only 1 in 40,000 children
experience the onset of schizophrenia
symptoms before the age of 13.
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 There are FIVE TYPES OF
SCHIZOPHRENIA. Categorized by the types
of symptoms the person exhibits when they are
assessed:
 Paranoid schizophrenia
 Disorganized schizophrenia
 Catatonic schizophrenia
 Undifferentiated schizophrenia
 Residual schizophrenia
 PARANOID SCHIZOPHRENIA
 Paranoid-type schizophrenia is distinguished
by paranoid behavior, including delusions
and auditory hallucinations.
 Paranoid behavior is exhibited by feelings of
persecution, of being watched, or sometimes
this behavior is associated with a famous or
noteworthy person a celebrity or politician,
or an entity such as a corporation.
 People with paranoid-type schizophrenia
may display anger, anxiety, and hostility.
 The person usually has relatively normal
intellectual functioning and expression of
affect.
 DISORGANIZED SCHIZOPHRENIA
 A person with disorganized-type
schizophrenia will exhibit behaviors that are
disorganized or speech that may be bizarre
or difficult to understand.
 They may display inappropriate emotions
or reactions that do not relate to the situation
at-hand.
 Daily activities such as hygiene, eating, and
working may be disrupted or neglected by
their disorganized thought patterns.
 CATATONIC SCHIZOPHRENIA
 Disturbances of movement mark catatonic-
type schizophrenia.
 People with this type of schizophrenia may
vary between extremes: they may remain
immobile or may move all over the place.
 They may say nothing for hours, or they
may repeat everything you say or do.
 UNDIFFERENTIATED SCHIZOPHRENIA
 Undifferentiated-type schizophrenia is a
classification used when a person exhibits
behaviors which fit into two or more of the
other types of schizophrenia, including
symptoms such as delusions, hallucinations,
disorganized speech or behavior, catatonic
behavior.
 RESIDUAL SCHIZOPHRENIA
 When a person has a past history of at least
one episode of schizophrenia, but the
current has no symptoms (delusions,
hallucinations, disorganized speech or
behavior) they are considered to have
residual-type schizophrenia.
 The person may be in complete remission,
or may at some point resume symptoms.
 WHAT ARE CAUSES OF
SCHIZOPHRENIA?
 Schizophrenia has multiple, intermingled
causes which may differ from person to
person, including:
o Genetics (runs in families)
o Environment
o Brain chemistry
o History of abuse or neglect
 IS SCHIZOPHRENIA HEREDITARY?
 Schizophrenia has a genetic component.
While schizophrenia occurs in only 1% of
the general population, it occurs in 10% of
people with a first-degree relative (parent,
sibling) with the disorder.
 The risk is highest if an identical twin has
schizophrenia. It is also more common in
people with a second-degree relative (aunts,
uncles, cousins, grandparents) with the
disorder.
 SCHIZOPHRENIA SYMPTOMS
 Many people with schizophrenia do not
appear ill. However, many behavioral
changes will cause the person to seem 'off'
as the disease progresses.
 Symptoms include:
o Social withdrawal
o Anxiety
o Delusions
o Hallucinations
o Paranoid feelings or feelings of
persecution
o Loss of appetite or neglecting to eat
o Loss of hygiene
o Symptoms may also be grouped into
categories.
 Positive (More Overtly Psychotic)
Symptoms The "positive," or overtly
psychotic, symptoms are symptoms not seen
in healthy people, include:
o Delusions
o Hallucinations
o Disorganized speech or behavior
o Dysfunctional thinking
o Catatonia or other movement disorders
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  Negative (Deficit) Symptoms "Negative"
symptoms disrupt normal emotions and
behaviors and include:
o Social withdrawal
o "Flat affect," dull or monotonous
speech, and lack of facial expression
o Difficulty expressing emotions
o Lack of self-care
o Inability to feel pleasure (anhedonia)
 Cognitive Symptoms. Cognitive symptoms
may be most difficult to detect and these
include:
o Inability to process information and
make
o decisions
o Difficulty focusing or paying attention
o Problems with memory or learning new
tasks
 Affective (or Mood) Symptoms
o Affective symptoms refer to those which
affect mood.
o Patients with schizophrenia often have
overlapping depression and may have
suicidal thoughts or behaviors.
 Mental health screening and evaluation is an
important part of the diagnosis.
 Many other mental illnesses such as bipolar
disorder, schizoaffective disorder, anxiety
disorders, severe depression, and substance
abuse may mimic symptoms of schizophrenia.
 MD perform an assessment to rule out these
other conditions.
 Antipsychotic medications are the first-line
treatment.
 Medications are often used in combination with
other types of drugs to decrease or control the
symptoms associated with schizophrenia.
 SCHIZOPHRENIA TREATMENT –
MEDICATIONS
 risperidone (Risperdal)
 quetiapine (Seroquel)
 ziprasidone (Geodon)
 aripiprazole (Abilify)
 paliperidone (Invega)
 Mood swings and depression are common in
patients with schizophrenia.
 In addition to antipsychotics, other types of
medications are used.
 MOOD STABILIZERS INCLUDE:
 lithium (Lithobid)
 divalproex (Depakote)
 carbamazepine (Tegretol)
 lamotrigine (Lamictal)
 In addition to antipsychotics, other types of
medications are used.
 ANTIDEPRESSANTS INCLUDE:
 fluoxetine (Prozac)
 sertraline (Zoloft)
 paroxetine (Paxil)
 citalopram (Celexa)
 escitalopram (Lexapro)
 venlafaxine (Effexor)
 desvenlafaxine (Pristiq)
 duloxetine (Cymbalta)
 bupropion (Wellbutrin)
 SCHIZOPHRENIA TREATMENT:
PSYCHOSOCIAL INTERVENTIONS
 Family psycho-education:
o A psychosocial intervention.
o Including family members to support
patients decreases the relapse rate of
psychotic episodes and improves the
outcomes.
o Family relationships are improved.
 Assertive community treatment (ACT):
o use of out-patient support groups.
Support teams including psychiatrists,
nurses, case managers, and other
counselors, meet regularly with the
schizophrenic patient to help reduce the
need for hospitalization or a decline in
their mental status.
 Substance abuse treatment: Many people
with schizophrenia (up to 50%) also have
substance abuse issues that may worsen the
behavioral symptoms of schizophrenia and
need to be addressed for better outcomes.
 Social skills training: a need to relearn how
to appropriately interact in social situations.
o Can reduce drug use, and improve
relationships
 Cognitive behavioral therapy (CBT): Help
patients with schizophrenia change
disruptive or destructive thought patterns,
and enable them to function more optimally.
Help patients "test" the reality of their
thoughts to identify hallucinations or
"voices" and ignore them.
o This type of therapy may not work in
actively psychotic patients, but it can
help others who may have residual
symptoms that medication does not
alleviate.
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  Supported employment: Many people with
schizophrenia have difficulty entering or
reentering the work force due to their
condition. And even connects them with
employers willing to hire people with mental
illness.
 Weight management: Many antipsychotic
and psychiatric drugs cause weight gain as a
side effect.
 WHAT IS THE PROGNOSIS FOR
SCHIZOPHRENIA?
 The prognosis for people with schizophrenia can
vary depending on the amount of support and
treatment the patients receives.
 Many people with schizophrenia are able to
function well and lead normal lives.
 People with schizophrenia have a higher death
rate and higher incidence of substance abuse.
 When medications are taken regularly and the
family is supportive, patients can have better
outcomes.
WHAT IS BIPOLAR DISORDER?
 Bipolar disorder, formerly called manic
depressive, is a mental illness that involves the
sufferer having at least one manic (overly
excited or irritable mood) or nearly manic
(hypomanic) episode.
 The mood swings of this condition can last for
weeks at a time and cause significant work and
relationship problems.
 Affects up to 5% of adults in the United States,
afflicting men and women equally.
 DEPRESSIVE PHASE SYMPTOMS
 The depressive symptoms that may be
experienced in bipolar disorder are those of
any major depressive episode, including
significant sadness, irritability,
hopelessness, and an increase or decrease
in appetite, weight, or sleep.
 Bipolar depression can result in sufferers
wanting, planning, or attempting to kill
themselves or someone else.
 MANIC PHASE SYMPTOMS
 The manic symptoms of bipolar disorder can
include the sufferer having a grossly
excessive sense of well-being or abilities,
racing thoughts, decreased sleep, and
speech that is rapid to the point of being
hard to decipher.
 Manic individuals may also engage in
unwise activities such as excessive sexual
behaviors or spending.
 BIPOLAR I VS. BIPOLAR II
 In order to receive the diagnosis of bipolar I
 disorder, a person must experience at least
one full-blown manic episode in their
lifetime.
 Individuals with bipolar II disorder
experience at least one hypomanic episode,
in that they have symptoms less severe than
fully manic symptoms.
 MIXED FEATURES
 Many people with bipolar disorder also have
mixed features associated with their mood
swings. This involves experiencing
symptoms of depression during manic or
hypomanic episodes.
 CAUSES OF BIPOLAR DISORDER
 Decreases in the activity of different parts
of the brain have been observed when
individuals with bipolar disorder are having
depressive or manic episodes.
 WHO'S AT RISK?
 The symptoms of bipolar disorder tend to
have two peaks of when they begin: between
15 and 25 and from 45-54 years of age.
 Other risk factors:
1. close family history of depression or
bipolar disorder (mood disorder).
2. family history of substance-abuse
disorder.
3. life stressors such as abuse may also
trigger the onset of bipolar disorder.
 DAILY LIFE
 The symptoms of bipolar disorder can
interfere with a person's ability to work,
achieve in school, and maintain
relationships.
 People with this disorder are also at risk for
having other medical and mental-health
problems.
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 BIPOLAR DISORDER AND SUBSTANCE
ABUSE
 Having bipolar disorder can increase the
likelihood of the sufferer developing a
substance-abuse problem from 22% to more
than 50%.
 Some people with bipolar disorder may
drink to numb their manic or depressive
symptoms, a behavior often referred to as
self-medicating.
 FYI: ALCOHOL AND DEPRESSION
 Many people drink alcohol to forget their
worries, but they may be causing themselves
to feel more depressed.
 Heavy drinking can make depression
symptoms worse over time because alcohol
makes your brain less active and may
damage the liver.
 Studies have shown a link between alcohol
use disorders and depression.
 Alcohol itself is a depressant, which means
that it reduces excitability and stimulation.
Just one drink may cause you to feel down.
 Alcohol use can reduce the effectiveness of
antidepressant medications.
 BIPOLAR DISORDER AND SUICIDE
 Up to 10% of people with bipolar disorder
commit suicide, 10 times the risk of people
who have no mental-health disorder.
 Possible signs someone is planning to
commit suicide include giving away
belongings and otherwise putting affairs in
order.
 Anyone who has planned or attempted to
commit suicide should immediately be taken
to the closest hospital ER.
 Suicide Hotlines.
 DIAGNOSING BIPOLAR DISORDER
 Mental-health professionals gather a
detailed history and conduct a mental-status
examination.
 The history will explore the possibility that
the person's symptoms are caused by a
medical condition such as a neurological or
endocrine problem, medication side effect,
or exposure to a toxin.
 The professional will also seek to
distinguish symptoms of bipolar disorder
from other mental-health problems, such as
a substance-use disorder, depression,
anxiety, or schizophrenia.
 MEDICATIONS FOR BIPOLAR
DISORDER
 Medications are an important and effective
part of treating bipolar disorder and include
mood stabilizers, antipsychotics, and
antiseizure medications.
 All these medications have been found to
help even out and prevent the mood swings
suffered by bipolar disordered individuals.
 Antidepressant medication may trigger
mood swings in people with this disorder.
 THERAPY FOR BIPOLAR DISORDER
 Talk therapy (psychotherapy) can
significantly help prevent the recurrence of
depression or mania of bipolar disorder, as
well as decrease the symptoms and problems
caused by those symptoms when they do
occur.
 Cognitive behavioral therapy seeks to help
the individual change ways of thinking from
self-defeating to more productive ways of
thinking.
 Family focused therapy uses mental-health
education, improving communication, and
problem-solving skills for the bipolar-
disordered individual and their family.
 BIPOLAR DISORDER LIFESTYLE TIPS
 As is the case with other mental disorders,
good self-care is an essential part of getting
optimal results from talk therapy and
medications.
 People with bipolar disorder should work on
getting at least eight hours of sleep per
night, exercising regularly, maintaining
good nutrition, and avoiding alcohol or
drug abuse.
 When bipolar-disordered individuals learn
their warning signs for the onset of a manic
or depressive episode, they are more able to
prevent full-blown mood swings.
 FRIENDS AND FAMILY EDUCATION
 Given the important role family members
play in the recovery and long-term progress
of their loved ones with bipolar disorder,
educating family members and helping them
improve communication and problem-
solving skills is an important part of
improving the life of people with this
disorder.
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  WHEN SOMEONE NEEDS HELP
 When a loved one may be suffering from
bipolar disorder, speak openly with them
and seek help from a trusted health-care
professional.
 Educating your loved one that many people
who have this disorder lead highly
productive, satisfying lives with treatment
can go a long way toward helping them
accept help for themselves.
WHAT IS DEPRESSION?
 Everyone feels sad from time to time, if that
occurs most days for more than two weeks, it
could mean that clinical depression is occurring.
 Major depression is a period of sadness,
irritability, or low motivation that occurs with
other symptoms, lasts at least two weeks in a
row, and is severe enough to negatively affect
one's life.
 Depression is not a sign of weakness or a
character flaw. It is a real and treatable medical
illness.
 These PET scans of the brain indicate low
activity in a person suffering from depression
compared to someone who is not depressed.
 EMOTIONAL SYMPTOMS OF
DEPRESSION:
 The most prominent symptoms of
depression are usually a sad or irritable
mood and/or loss of interest in all or most
activities that used to be pleasurable.
 Patients may also experience guilt despite
having done nothing wrong, as well as
feeling worthless, hopeless, and/or have
recurring thoughts of wanting to die, kill, or
otherwise harm themselves, as in cutting or
burning themselves.
 DEPRESSION : PHYSICAL SYMPTOMS
 Depression can sometimes be associated
with physical symptoms.
1. Tiredness and low energy level
2. Trouble sleeping, particularly early
morning waking OR sleeping too much
3. Aches or pains(headaches, muscle
cramps), or digestive problems
(stomachaches, diarrhea, or
constipation) that do not improve even
with pain focused treatment
4. Feeling or seeming slowed down or
agitated.
5. Depression can worsen many other
medical problems, especially those that
cause chronic pain.
 Certain brain chemicals affect pain and
mood, and treating depression tends to
improve the symptoms and outcomes of
many physical illnesses.
 DEPRESSION: APPETITE SYMPTOMS
 Some individuals with depression
experience an increase or decrease in
appetite, which may lead to substantial loss
or gain in weight.
 HOW DEPRESSION CAN IMPACT DAILY
LIFE
 Untreated, symptoms of depression can
negatively impact the sufferer's activities,
relationships, and career.
 Depressed people often have trouble
concentrating and making decisions.
 Stop participating in activities they used to
enjoy, including sex, as well as no longer
spending time with loved ones.
 In severe cases, depression can be fatal as
the result of homicide or suicide.
 SUICIDE: A WARNING SIGN
 People with depression are at risk for trying
to commit suicide.
 Warning signs may include talking about
suicide or dying, threatening to hurt others,
becoming irritable or taking excessive risks,
giving away personal belongings, or
otherwise settling personal affairs.
 Any warning signs for suicide should be
taken very seriously and immediate help
should be sought, either through the closest
emergency room or in discussion with a
suicide hotline.
 WHO IS AT RISK FOR DEVELOPING
DEPRESSION?
 Anyone can develop depression, a family
history of depression is a risk factor for the
illness.
 Eg. being the child or sibling of a depressed
person increases one's risk of developing a
depressive disorder.
 Women are twice as likely as men to have
this condition at some point in their lives.
 How often depression occurs may be
difficult to determine since symptoms of this
illness can vary somewhat based on gender,
age, and ethnic background.
 DEPRESSION: CAUSES
 While it is not clear what specifically causes
depression, a widely accepted theory is a
change in brain structure and chemistry.
o Neurotransmitters are out of balance in
depressed people.
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  Possible causes for the imbalance include
certain medications, alcohol or substance
abuse, hormonal or seasonal changes, or
enduring a traumatic event, like being the
victim of abuse or losing a loved one or a
job.
 SEASONAL DEPRESSION
 If someone has a pattern of feeling
depressed in a particular season, he or she
may have a type of depression called
seasonal affective disorder (SAD).
 Although SAD may occur in any season, it
is most likely to occur fall and winter, when
the daylight hours are shorter.
 Research shows that SAD occurs in 3%-
20% of all people, depending upon where
they live.
 POSTPARTUM DEPRESSION
 "baby blues" afflicts up to 75% of new
mothers. More than 10% of those women
experience more severe and persistent
sadness even if their baby is healthy.
 Postpartum depression, has symptoms that
are very similar to the symptoms of major
depression.
 In postpartum depression, the baby's well-
being may become at risk since a depressed
mother may have trouble enjoying, bonding
with, and caring for her infant.
 In rare instances, the mother may become a
danger to herself or her infant.
 DEPRESSION IN CHILDREN
 Depression afflicts 2% of children in grade
school and about 10% of teens In the United
States.
 It can impair the child or adolescent's
friendships and school performance.
 Symptoms are similar to those in depressed
adults, but depression can be harder to
diagnose in children, partly because they
may revert to earlier behaviors (regress),
seem angry, or engage in risky behaviors.
 DIAGNOSING DEPRESSION
 A specific blood test for depression has yet
to be developed.
 MDs must use the sufferer's description of
their symptoms in order to diagnose this
condition.
 Information gathered as part of the
assessment include information about
medical history, substance abuse, and
medication use since these issues may
contribute to symptoms of depression.
Understanding someone's family medical
and mental-health history can help
determine what he or she is at risk for
developing.
 Discussing moods, behaviors, and daily
activities can help the mental health
professional assess the severity and type of
depression the person is experiencing.
 Gathering all this information is important
to the professional in order to provide the
best treatment.
 TALK THERAPY FOR DEPRESSION
 Different forms of talk therapy
(psychotherapy) can help alleviate
depression that is of mild to moderate
severity.
 CBT cognitive behavioral therapy is to
help the individual alter ways of thinking
and behaving that may lead to depression.
 Interpersonal therapy works with the
depressed person to understand how his or
her ways of interacting with others can
contribute to depression.
 Psychodynamic therapy helps the
depression sufferer understand and come to
terms with how issues from their past may
unconsciously affect their current moods
and actions.
 Studies indicate that most people who are
having their first episode of major
depression need at least six months of
treatment to resolve the depressive
episode.
 DEPRESSION: MEDICATIONS
 Antidepressants, effective for the treatment
of depression.
 Medications affect the levels of brain
chemicals, like serotonin and
norepinephrine.
 May take some weeks to feel the positive
effect of these medications, so it is important
to remain vigilant in taking them and
working with a doctor in the process.
 Studies show that people suffering from
depression tend to get better faster and more
robustly when treated with a combination of
psychotherapy and medication compared to
treatment with either medication or therapy
alone.
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 DEPRESSION: EXERCISE
 Studies show that moderate exercise can be
an important part of alleviating mild to
moderate depression because it causes the
release of chemicals called endorphins
(elevate mood and self-esteem, decrease
stress, increase energy level, and improve
sleep).
 Engaging in just 30 minutes of activity that
elevates heart rate three to four times per
week is enough for anyone to reap the
benefits of exercise.
 LIGHT THERAPY (PHOTOTHERAPY)
 Light therapy, also called phototherapy, can
be an effective treatment for SAD and other
types of depression.
 This form of treatment involves sitting in
front of a medical light box that emits a
specific kind of light for several minutes per
day.
 Phototherapy should only be used when
recommended by a doctor and is often used
with psychotherapy or medication.
 OTHERS:
 ST. JOHN'S WORT FOR
DEPRESSION???
o St. John's wort is an herbal supplement
that has been found to be a potential
help for mild depression, but two large
studies have shown it is ineffective
against moderate or severe depression.
o St. John's wort can interact poorly with
other medications. It is therefore
important to ask a doctor before taking
this or any other supplement.
 PETS FOR DEPRESSION
 While loving pets cannot take the place of
psychotherapy and medication in treating
depression, these family members can be
helpful for many people who suffer from
mild depression.
 Pets relieve stress by providing love and
companionship.
 Research shows that animal-assisted therapy
can also decrease agitation that often goes
with depression.
 THE ROLE OF SOCIAL SUPPORT
 Loneliness often accompanies depression,
having good relationships and social
support can be an important part of recovery
from this illness.
 Support group, either in person or online,
having regular contact with loved ones, or
joining a club can help ward off becoming
socially isolated.
 Spiritual connectedness, either with other
people at a place of worship or just believing
in a power bigger than oneself, can help
decrease depression as well.
 VAGUS NERVE STIMULATION (VNS)
 VNS helps patients who suffer from chronic
treatment-resistant depression that does not
improve with the combination of
psychotherapy and medication.
 VNS requires the surgical insertion of an
electrical device that alleviates depression
by inducing a normal electrical pattern in the
brain by sending electrical pulses through
the vagus nerve in the neck.
 ELECTROCONVULSIVE THERAPY
(ECT)
 ECT is another treatment option for people
who struggle with severe treatment-resistant
depression.
 Administering electric impulses to create a
controlled seizure while the patient is under
sedation.
 ECT helps 80% to 90% of people who
receive it, which is significant given that
most of those individuals would otherwise
continue to suffer.
 While this form of treatment has a history of
stigma attached to it, changes in the way it
was implemented decades ago have
significantly decreased side effects and
improved its effectiveness.
 TRANSCRANIAL MAGNETIC
STIMULATION
 Repetitive rTMS is another option for
people with severe depression that does not
respond adequately to medication and
psychotherapy.
 rTMS, physicians aim electromagnetic
currents at the skull to stimulate a small
electrical current in a part of the brain linked
to depression.
 In contrast to ECT, rTMS does not cause a
seizure and seems to have few side effects.
(However, not many doctors have the
training and experience to implement this
form of treatment).
 GOOD OUTLOOK
 Afflicted with the symptoms of major
depression, one might feel hopeless and
unable to function.
 This condition is quite treatable and as
much as 80% of people with the condition
recover with the help of medication, talk
therapy, or both forms of treatment.
8
  For those who do not improve with those
traditional treatments, interventions like
VNS, ECT, or rTMS can bring significant
relief for many people.
WHAT IS ANXIETY?
 It's natural to worry during stressful times.
 But some people feel tense and anxious day
after day, even with little to worry about.
 When this lasts for 6 months or longer, it may be
generalized anxiety disorder.
 Many people don't know they have it. So they
may miss out on treatments that lead to a better,
happier life.
 SYMPTOMS
 The main symptom is a constant and
exaggerated sense of tension and anxiety.
 Not be able to pinpoint a reason why you
feel tense.
 Worry too much about ordinary things, such
as bills, relationships, or your health. It can
upset your sleep and cloud your thinking.
 May also feel irritable due to poor sleep or
the anxiety itself.
 Physical Symptoms
o Body problems usually come along with
the worry. They can include:
 Muscle tension or pain
 Headaches
 Nausea or diarrhea
 Trembling or twitching
 RISKS:
 People of any age can develop generalized
anxiety disorder, even children.
 Appear gradually, with the first symptoms
most likely to happen between childhood
and middle age.
 Twice as many women as men say they have
it.
 Your troubles will naturally concern you.
 What sets generalized anxiety disorder apart
is the feeling that you can't stop worrying.
You may find it very hard to relax, even
when you do something you enjoy.
 Severe cases can hamper work,
relationships, and daily activities.
 CAUSES:
 Genes passed down through a family may
put some people at a higher risk for anxiety,
but that's not the whole picture.
 Background and experiences also matter.
 Neurotransmitters, as well as a pair of
structures inside the brain called the
amygdalae, seem to be involved.
 DIAGNOSIS:
 No lab test, diagnosis is based on your
description of your symptoms.
 MD may ask: What do you worry about?
How often? Does your anxiety interfere with
any activities?
 It may be generalized anxiety disorder if you
have felt anxious or worried too much for at
least 6 months.
 PSYCHOTHERAPY
 One kind of talk therapy is very effective in
treating anxiety.
 Cognitive Behavioral Therapy.
 A counselor helps you identify your
negative thoughts and actions.
 May do homework, such as writing down
the thoughts that lead to excess worry.
 Learn how to calm yourself.
 ANTI-ANXIETY MEDICINE
 Part of your treatment plan, newer
antidepressant drugs work well to lower
anxiety.
 May take about 4 weeks to feel better.
 MD may prescribe a benzodiazepine during
this time or for a short while. Some drugs
carry a risk of dependence.
 Sometimes, older types of antidepressants
can treat generalized anxiety disorder if your
symptoms include depression or panic.
 May choose options.
 CAUTION:
 Trying a supplement, talk to your MD first
to find out if it's safe.
 Kava, for instance, has been reported to
cause liver damage.
 St. John's wort can affect other medicines,
including antidepressants and birth control
pills.
 WHEN IT’S MORE THAN ANXIETY
 People who have generalized anxiety
disorder may also develop depression,
alcoholism, or drug addiction.
 It's also common for people with GAD to
have another anxiety disorder.
 Include panic disorder, posttraumatic stress
disorder, obsessive-compulsive disorder,
and social phobia.
 PANIC DISORDER
 People with panic disorder have sudden
attacks of terror.
 Symptoms can include a pounding heart,
sweating, dizziness, nausea, or chest pain.
You may think you're having a heart attack,
dying, or losing your mind.
9
  It's one of the most treatable of all anxiety
disorders.
 Panic Attach/ Hypervetillation.
 POSTTRAUMATIC STRESS DISORDER
 Some people develop posttraumatic stress
disorder (PTSD) after living through a
terrifying event.
 Symptoms include vivid flashbacks and a
loss of interest in activities that were once
enjoyable.
 Have trouble being affectionate.
 Feel irritable or even become violent.
 Treatments include medicine and
counseling.
 OBSESSIVE-COMPULSIVE DISORDER
 People with obsessive-compulsive disorder
(OCD) have troubling thoughts they can't
control.
 May feel that they need to repeat rituals,
such as washing their hands or checking that
the door is locked.
 They may get dressed in a certain order or
count objects for no good reason.
 It's often treated with medication and
psychotherapy.
 SOCIAL ANXIETY DISORDER
 People with social phobia feel panicky and
self-conscious in ordinary social situations.
 Symptoms include a sense of dread before
social events and sweating, blushing,
nausea, or trouble talking during the events.
 In severe cases, they may avoid school or
work.
 It can be treated with psychotherapy and
medicine.
 OTHER PHOBIAS
 A phobia is an intense fear of something
that is not likely to cause you any harm.
 Common ones include heights, closed-in
spaces like elevators, dogs, flying, and
water.
 Many people don't seek help because it's
easy to avoid whatever they fear.
 Phobias can be treated.
 Start by talking with your family doctor. If an
anxiety disorder seems likely, he will probably
refer you to a mental health specialist who is
trained in psychotherapy.
 It's important to choose someone you're
comfortable talking to.
WHAT ARE SEXUAL DISORDERS?
 Sexuality is a normal part of human experience.
 The types of sexual behavior that are considered
normal vary greatly within and among different
cultures.
 Defining “normal” sexuality may be
impossible.
 There are wide variations in people’s sexual
behavior, including the frequency of or need for
sexual release.
 Some people desire sexual activity several times
a day, but others are satisfied with infrequent
activity (for example, a few times a year).
 When sexual behavior causes significant
distress for a person or the person's partner or
harms another person, the person may need to be
evaluated by a health care practitioner and
treated.
 Younger people are often reluctant to view older
people as sexually interested, most older people
remain interested in sex and report satisfying sex
lives well into old age.
 Problems such as:
 erectile dysfunction in men,
 pain during sexual intercourse
(dyspareunia),
 painful spasm of vaginal muscles
(vaginismus),
 problems with orgasm in women, affect
people of all ages.
 These problems can be effectively treated with
drugs (most notably those for erectile
dysfunction).
 A person’s attitude toward sexual behavior is
influenced greatly by parents, who can damage
their children’s ability to develop sexual and
emotional intimacy by doing things such as the
following:
 Being emotionally distant
 Punishing children too severely
 Being overtly seductive and exploiting
children sexually
 Being verbally and physically hostile
 Rejecting children
 Being cruel
 SOCIETAL ATTITUDES ABOUT
SEXUALITY AND GENDER
 MASTURBATION
o Once regarded as a perversion and even
a cause of mental disease, masturbation
has now long been recognized as a
normal sexual activity throughout life.
o About 97% of males and 80% of
females have masturbated.
10
 o Males masturbate more frequently than
females.
o Many people continue to masturbate
even when they are involved in a
sexually gratifying relationship.
o Although masturbation is normal and is
often recommended as a safe sex option,
it may cause guilt and psychologic
suffering.
o These feelings can result in considerable
distress and can even affect sexual
performance.
 HOMOSEXUALITY
o As with masturbation, homosexuality,
once considered abnormal by the
medical profession, has not been
considered a disorder for more than four
decades.
o Recognized as a sexual orientation that
is present from childhood.
o An estimated 4 to 5% of adults are
involved exclusively in homosexual
relationships throughout their lives, and
an additional 2 to 5% of people engage
in sex with people of either sex
(bisexuality).
o Adolescents may experiment with same-
sex play, but this experimentation does
not necessarily indicate an enduring
interest in homosexual or bisexual
activity as adults.
o Gay and lesbian people discover that
they are attracted to people of the same
sex,
o Heterosexuals discover that they are
attracted to people of the opposite sex.
o The attraction appears to be the result
of biologic and environmental
influences and is not a matter of
choice.
o The popular term “sexual preference”
makes little sense in matters of sexual
orientation, whether the orientation is
heterosexual, homosexual, or bisexual.
 FREQUENT SEXUAL ACTIVITY
WITH DIFFERENT PARTNERS
o For some heterosexuals and
homosexuals, frequent sexual activity
with different partners is a common
practice throughout life.
o Western cultures, this behavior has
become more acceptable.
o Having multiple sex partners is linked to
the transmission of certain diseases
(such as HIV infection, herpes simplex,
hepatitis, syphilis, gonorrhea, and
cervical cancer) and may also signify
difficulty in forming meaningful, lasting
intimate relationships
 EXTRAMARITAL SEX
o In the US, most people engage in sexual
activity before they are married or
while they are not married. A trend
toward more sexual freedom in
developed countries.
o Most cultures discourage married
people from engaging in sex with
someone other than their spouse. This
behavior occurs frequently despite
social disapproval.
o One objective problem that results is the
possible spread of sexually transmitted
diseases to unsuspecting spouses or sex
partners.
 PARAPHILLIAS
o Disorders of deviant sexuality.
o As defined in the DSM(the clinician’s
diagnostic bible), they involve recurrent
fantasies, urges or behaviors of a sexual
nature that center around children, non-
humans (animals, objects, materials), or
harming others or one’s self.
o Because they are so often associated
with abusive sexual practices that
generate real victims, many people tend
to regard persons who display sexual
deviancies as monsters.
o TYPES OF PARAPHILLIAS:
 Exhibitionism
 Compulsion to display one's
private parts to strangers.
 Like gamblers, pyromaniacs and
other impulse-junkies,
exhibitionists cycle through
periods of increasing tension
that are only relieved by the
‘rush' of exposing themselves
to strangers (occasionally
accompanied by masturbation).
 Fetishism
 Involves having ones sexual
energies fixated on to a
manufactured object, rather than
onto another human being.
11
  Fetish objects are garments such
as shoes, underwear, panties or
bras. They may be made of
particular materials such as
leather or rubber.
 Common for a person with a
fetish to not be able to achieve
orgasm without involving their
fetish object in the sexual act
(e.g., by getting their partner to
wear the fetish object).
 Although not specifically
mentioned in the DSM, persons
who chronically rely on
pornography for sexual arousal
probably qualify as fetishists.
 Frotteurism
 Compulsion to rub ones self
against strangers/ others in a
sexual manner.
 Like exhibitionism and other
impulse control disorders,
frotteurism tends to involve a
cycle of tension buildup that is
relieved by acting out in
‘exciting' ways.
 Pedophilia
 Occurs when a sexually mature
adult fantasizes about or
engages in sexual behavior with
pre-pubescent children.
 Pedophiles tend to have
preferences for male or female
children (but not both)
 Pedophiles commonly
rationalize their deviant
behavior (which may include
fondling only, or actual child-
rape) as being educational and
for the child's benefit.
 May also believe that their child
victim has sexually seduced
them. It is fairly common that
the pedophile will threaten the
child so as to keep their
predatory sexual behavior
secret.
 Because the pedophile often is
the parent or step-parent of the
victim child, or has worked hard
to gain the confidence of the
parents, there are often few
perceived safe people and
places who a child could report
their victimization to anyway.
 Sexual Masochism and Sadism
 Involves persons who engage in
sexual encounters where the
focus is on causing (sadism) or
receiving (masochism) physical
and emotional pain,
embarrassment and humiliation.
 Transvestism (Transvestic
Fetishism)
 Occurs when an otherwise
‘normal' heterosexual male has
fantasies about and/or acts out
dressing up in woman's
clothing.
 Such cross dressing is
commonly experienced as
sexually stimulating.
 Voyeurism ‘peeping tom’
 Behavior involves compulsive
fantasizing about and/or acting
out engaging in spying on
someone (who does not know
they are being observed) in the
act of disrobing.
 This behavior is very common
amongst the general population;
it is not diagnosable as a
disorder unless it becomes a
compulsive part of a person's
sexual routine.
 As exists in most other categories of
disorders, the DSM recognizes a
‘catch-all' Not-Otherwise- Specified
form of paraphillia which can be
diagnosed when other sexually
deviant practices need to be
recorded.
 Examples include chronic
preoccupation with making obscene
telephone calls (phone sex), relating
sexually to only a part of another's
body, dead people, feces and urine,
animals and the like.
 OTHER DISORDER: DISCLAIMER:
SENSITIVE.
12

COGNITIVE DISORDERS
WHAT ARE COGNITIVE DISORDERS?
Alzheimer’s Disease
 This is the most common dementia with around
500,000 sufferers in the UK.
 The disease accounts for 50 to 70% of all
dementia, and one in three over the age of 85 are
thought to have the disease.
 Alzheimer's disease usually affects those in old
age; however the disease can affect those under
65 (early-onset Alzheimer's).
Behavioural Variant Frontotemporal Dementia
 This is a dementia caused by damage to the
frontal or temporal lobes of the brain. The
disease usually presents with behavioural
disturbances (for example stubbornness,
apathy and reduced inhibition) and
predominantly preserved memory.
 Usually affects patients aged 45 to 65, with men
and women equally likely to be affected.
Corticobasal Degeneration
 This is a progressive degenerative disease
which is characterised by movement difficulties
of rigidity, slowing of movement
(bradykinesia) and difficulty in making a limb
follow commands (apraxia).
 Movement symptoms are accompanied by
cognitive difficulties, with both movement and
cognitive symptoms commonly presenting
together after around two years.
 It usually affects patients aged 45 to 70.
Huntington’s Disease
 This is a rare hereditary degenerative disorder of
the brain which affects the movement and the
cognition of sufferers.
 Symptoms often present as a combination of
motor (movement), behavioural (mood) and
cognitive (thinking) disturbances.
 It affects up to 1 in 10,000 people in Europe,
with men and women equally likely to inherit
the disease.
Mild Cognitive Impairment
 This is a problem where memory is affected,
however not at a level which affects daily
functioning (unlike Alzheimer’s disease).
 These memory problems are mild with subtle
changes in day to day memory, language,
attention or visual spatial skills.
 The mild cognitive impairment can stay stable
for many years; however it often progresses to
Alzheimer’s disease.
Progressive Supranuclear Palsy
 This is a neurodegenerative disease associated
with profound slowing of movement, affecting
walking and the eyes, as well as cognitive
difficulties.
 The disease primarily affects those in middle age
and is rare.
INTERVENTIONS:
 Psychosocial models for care of clients are based
on the approach that each client is a unique
person. Even if disease progression blocks the
clients ability to demonstrate these unique
characteristics.
 Focus on care, keeping client’s involved by
relating to theenvironment and other people,
validate feelings and dignity by being
responsive, offering choices and reframing
(offering alternative points of view to explain
events). In contast to medical models of care
that focus on progressive loss of function and
identity.
NURSING INTERVENTION
1. Promoting client safety- protect from injury ,
meet physiologic needs, and manage risks
2. Promote adequate sleep and proper nutrition,
hygiene, and activity- monitor food and fluid
intake, remind to urinate and BM, and balance
between rest and activity, encourage mild
physical activity
3. Structuring the environment and routine-
familiar surroundings and follow routine and
habits (bath and dress) help eliminate
confusions and frustration from diminishing
memory,
4. Provide emotional support- be kind and
respectful, calm and reassuring, use supportive
touch if appropriate
13
  Of children who have anorexia, approximately
25% are MALE and 75% are FEMALE.

5. Promote interaction and involvement- plan

activities geared towards client’s interests,
reminisce with he client about the past, be alert
to client’s non verbal behavior (if non verbal),
employ distraction techniques (time away,
going along, reframe to calm clients who are
agitated, confused and suspicious).

THE PHILIPPINES DOH MEDICATION ACCESS

PROGRAM FOR MENTAL HEALTH LIST OF
ESSENTIAL PSYCHOTROPIC MEDICATIONS
a) First-generation/typical antipsychotics →
chlorpromazine, haloperidol (oral and long-
acting injectable), fluphenazine decanoate
b) Second-generation/atypical antipsychotics →
clozapine, olanzapine, quetiapine, risperidone
c) Antidepressants → fluoxetine, sertraline,
escitalopram
d) Mood stabilisers → lithium carbonate, valproic
acid, carbamazepine, lamotrigine
e) Anticholinergics → biperiden,
diphenhydramine
f) Benzodiazepine → clonazepam
g) Cholinesterase inhibitor → donepezil
h) NMDA receptor antagonist → memantine

N-methyl-D-aspartate
 (NMDA) receptor hypofunction within the brain
is associated with memory and learning
impairments, with psychosis, and ultimately
with excitotoxic brain injury.
 As the brain ages, the NMDA receptor system
becomes progressively hypofunctional,
contributing to decreases in memory and
learning performance.
 In those individuals destined to develop
Alzheimer's disease, other abnormalities (eg,
amyloidopathy and oxidative stress) interact to
increase the NMDA receptor hypofunction
(NRHypo) burden.

EATING DISORDERS:

MEN WOMEN
5% - Anorexia 95% - Anorexia
20% - Bulimia 80% - Bulimia
50% - Binge Eating 50% - Binge Eating

CHILDREN AND TEENS

 95% of eating disorder cases occur in people
ages 12 through 25
14

BE ALERT FOR EATING PATTERNS AND
BELIEFS THAT MAY SIGNAL UNHEALTHY
BEHAVIOR, AS WELL AS PEER PRESSURE
THAT MAY TRIGGER EATING DISORDERS.
RED FLAGS THAT MAY INDICATE AN EATING
DISORDER INCLUDE:
 Skipping meals or making excuses for not eating
 Adopting an overly restrictive vegetarian diet
 Excessive focus on healthy eating
 Making own meals rather than eating what the
family eats
 Withdrawing from normal social activities
 Persistent worry or complaining about being fat
and talk of losing weight
 Frequent checking in the mirror for perceived
flaws
 Repeatedly eating large amounts of sweets or
high-fat foods
 Use of dietary supplements, laxatives or herbal
 products for weight loss
 Excessive exercise
 Calluses on the knuckles from inducing
vomiting
 Problems with loss of tooth enamel that may be
a sign of repeated vomiting
 Leaving during meals to use the toilet
 Eating much more food in a meal or snack than
is considered normal
 Expressing depression, disgust, shame or guilt
about eating habits
 Eating in secret
NURSING MANAGEMENT
Assessment
 Nature and episodes of eating
 Type of disorder (purging or non purging)
 Inappropriate compensatory behaviors
 Self-degradation and depressed mood
 Self-induced vomiting
 Fasting or excessive exercise, erosion of tooth
enamel
 Substance abuse or dependence
 Body mass index, electrolyte status, CBC
 Associated psychiatric disorders
NURSING MANAGEMENT IN EATING
DISORDERS
 Imbalanced nutrition less than body
requirements related to refusal to eat/ drink, self-
induced vomiting, abuse of laxatives/diuretics
evidenced by loss of weight, poor muscle tone
and skin turgor, lanugo, bradychardia,
hypotension, cardiac arrhythmias, pale, dry
mucous membranes.
TREATMENT:
Eating disorders clearly illustrate the close links
between emotional and physical health.
A. anorexia nervosa is to assist patients with
regaining weight to a healthy level;
B. bulimia nervosa interrupting the binge-purge
cycle is key.
C. binge eating disorder it is important to help them
interrupt and stop binges.
 Restoring a person to normal weight or
temporarily ending the binge-purge cycle does
not address the underlying emotional problems
that cause or are made worse by the abnormal
eating behavior.
 Psychotherapy helps individuals with eating
disorders to understand the thoughts, emotions
and behaviors that trigger these disorders.
 Medications have also proven to be effective in
the treatment process.
Because of the serious physical problems caused by
these illnesses, it is important that any
treatment plan for a person with anorexia nervosa,
bulimia nervosa or binge eating disorder
include general medical care, nutritional management
and nutritional counseling. These
measures begin to rebuild physical well-being and
healthy eating practices.
PICA
 Compulsively eat items that have no nutritional
value. Eat relatively harmless items, such as ice.
Eat potentially dangerous items, likes flakes of
dried paint or pieces of metal. May lead to
serious consequences, such as lead poisoning.
 This disorder occurs most often in children and
pregnant women. It’s usually temporary.
15
 Treatment can help you avoid potentially serious
side effects.
 Pica also occurs in people who have intellectual
disabilities. It’s often more severe and long-
lasting in people with severe developmental
disabilities.
 MAY REGULARLY EAT THINGS SUCH
AS:
 Ice
 soap
 Buttons
 clay
 Hai dirt
 Sand paint
 Glue chalk
 The unused remainder of a cigarette
 cigarette ashes
 feces
 WHAT CAUSES PICA?
 There’s no single cause of pica.
 Deficiency in iron, zinc, or another nutrient
may be associated with pica. For example,
anemia, usually from iron deficiency, may
be the underlying cause of pica in pregnant
women.
 Unusual cravings may be a sign that your
body is trying to replenish low nutrient
levels.
 People with certain mental health
conditions, such as schizophrenia and
RUMINATION SYNDROME
obsessive-compulsive disorder (OCD), may
develop pica as a coping mechanism.
 Some people may even enjoy and crave the
textures or flavors of certain nonfood items.
 In some cultures, eating clay is an accepted
behavior. This form of pica is called
geophagia.
 Dieting and malnourishment can both lead
to pica. In these cases, eating nonfood items
may help you feel full.
 HOW IS PICA DIAGNOSED?
 There’s no test for pica. Diagnose condition
based on history and several other factors.
 You should be honest with your doctor
about the nonfood items you’ve eaten. To
develop an accurate diagnosis.
 Hard for MD to determine if you have pica
if you don’t tell them what you’ve been
eating. True for children or people with
intellectual disabilities.
 MD may test your blood to see if you have
low levels of zinc or iron. Help your MD
learn if you have an underlying nutrient
deficiency, such as iron deficiency.
 Nutrient deficiencies may sometimes be
related to pica
 WHAT ARE THE COMPLICATIONS
ASSOCIATED WITH PICA?
 Eating certain nonfood items can sometimes
lead to other serious conditions. Eg:
o poisoning, such as lead poisoning
o parasitic infections
o intestinal blockage
o choking
 TREATMENT FOR PICA:
 Psychological evaluation to determine if you
have OCD or another mental health
condition. Depending on your diagnosis,
they may
 prescribe medications, therapy, or both.
 Until recently, research hasn’t focused on
medications to help people with pica. A
2000 study published in the Journal of
Applied Behavior Analysis Trusted Source
suggested that a simple multivitamin
supplement may be an effective treatment in
some cases.
 If a person with pica has an intellectual
disability or mental health condition,
medications for managing behavioral
problems may also help reduce or eliminate
their desire to eat nonnutritive items
 is a condition in which people repeatedly and
unintentionally spit up (regurgitate) undigested
or partially digested food from the stomach,
rechew it, and then either reswallow it or spit it
out.
 Because the food hasn't yet been digested, it
reportedly tastes normal and isn't acidic, as
vomit is. Rumination typically happens at every
meal, soon after eating.
 It's not clear how many people have this
disorder.
 SYMPTOMS:
 Effortless regurgitation, typically within 10
 minutes of eating
 Abdominal pain or pressure relieved by
regurgitation
 A feeling of fullness
 Bad breath
 Nausea
 Unintentional weight loss
 Rumination syndrome isn't usually
associated with retching.
16

 CAUSES:
 The precise cause of rumination syndrome
isn't clear. Appears to be caused by an
increase in abdominal pressure.
 Frequently confused with bulimia nervosa,
gastroesophageal reflux disease (GERD)
and gastroparesis.
 Linked to a rectal evacuation disorder, in
which poor coordination of pelvic floor
muscles leads to chronic constipation.
 The condition has long been known to occur
in infants and people with developmental
disabilities. It's now clear that the condition
isn't related to age, as it can occur in
children, teens and adults.
 Rumination syndrome is more likely to
occur in people with anxiety, depression or
other psychiatric disorders.
 COMPLICATIONS:
 Untreated, rumination syndrome can
damage the tube between your mouth and
stomach (esophagus).
 Rumination syndrome can also
 cause:
o Unhealthy weight loss
o Malnutrition
o Dental erosion
o Bad breath
o Embarrassment
o Social isolation
 TREATMENT:
 May include – behavioral therapy or
medications.
 Behavioral therapy that involves teaching
people to breathe from the diaphragm is the
usual treatment of choice
AVOIDANT/RESTRICTIVE FOOD INTAKE
DISORDER (ARFID)
 Characterized by restriction of food intake; it
does not include having a distorted body image
or being preoccupied with body image (as
occurs in anorexia nervosa and bulimia
nervosa).
 Typically begins during childhood but may
develop at any age.
 Resemble the picky eating that is common
during childhood—when children refuse to eat
certain foods or foods of a certain color,
consistency, or odor. However, such food
fussiness, unlike avoidant/restrictive food intake
disorder, usually involves only a few food items,
and the child's appetite, overall food intake, and
growth and development are normal.
 Patients may not eat because they lose interest in
eating or because they fear that eating will lead
to harmful consequences such as choking or
 vomiting.
 They may avoid certain foods because of their
sensory characteristics (eg,color, consistency,
odor).
 SYMPTOMS AND SIGNS:
 Avoid eating food and restrict their food
intake to such an extent that they have ≥ 1 of
the following:
 Significant weight loss, in children, failure
to grow as expected
 Significant nutritional deficiency
 Dependence on enteral feeding (eg, via a
feeding tube) or oral nutritional
 supplements
 Markedly disturbed psychosocial
functioning
 Nutritional deficiencies can be life
threatening, and social functioning (eg,
participating in family meals, spending
time with friends in situations where
eating may occur) can be markedly
impaired.
 DIAGNOSIS: CLINICAL CRITERIA FOR
AVOIDANT/RESTRICTIVE FOOD
INTAKE DISORDER INCLUDE THE
FOLLOWING:
 The food restriction leads to significant
weight loss, failure to grow as expected in
children, significant nutritional deficiency,
dependence on nutritional support, and/or
marked disturbance of psychosocial
functioning
 Not caused by unavailability of food, a
cultural practice (eg, religious fasting),
physical illness, medical treatment (eg,
radiation therapy, chemotherapy), or another
eating disorder—particularly anorexia
nervosa or bulimia nervosa
 There is no evidence of a disturbed
perception of body weight or shape.
 However, patients who have a physical
disorder that causes decreased food intake
but who maintain the decreased intake for
much longer than typically expected and to a
degree requiring specific intervention may
be considered to have avoidant/restrictive
food intake disorder.
17
  When patients first present, clinicians must
exclude physical illness as well as other
mental disorders that impair appetite and/or
intake, including other eating disorders,
depression, schizophrenia, and factitious
disorder imposed on another.
SUBSTANCE RELATED DISORDERS:
Defining Substance Use Disorder
 Combines the previous DSM-IV-TR categories
of “substance abuse” and “substance
dependence” into a single disorder, measured
on a diagnostic continuum from mild to severe.
 Each specific substance is addressed as a
separate use disorder, such as alcohol or
stimulants. Other substances include opioids,
sedatives, cocaine, cannabis, amphetamines,
inhalants, and nicotine.
 Addiction is the continued repetition of a
behavior despite adverse consequences, or a
neurological impairment leading to such
behaviors. Addictions can include, but are not
limited to, substance abuse, exercise addiction,
food addiction, sexual addiction, computer
addiction and gambling.
 Classic hallmarks of addiction include
impaired control over substances or behavior,
preoccupation with substance or behavior,
continued use despite consequences, and denial.
 Habits and patterns associated with addiction
are typically characterized by immediate
gratification (short-term reward), coupled with
delayed deleterious effects (long-term costs).
 EPIDEMIOLOGY:
 Substance-related disorders, a category
which includes both substance dependence
and substance abuse, can lead to significant
personal, interpersonal, and societal
problems. Prevalent in individuals aged 18–
25, with a higher occurrence in men than
women, and higher occurrence in urban
residents than rural residents.
 Over 50% of individuals with substance-
related disorders will often have a dual
diagnosis, where they are simultaneously
diagnosed with another psychiatric
diagnosis, the most common being major
depression, dysthymia, personality
disorders, and anxiety disorders.
Most countries have legislation which
makes various drugs and drug-like
substances illegal. Although the legislation
may be justifiable on moral grounds to
some, it can make addiction or dependency a
much more serious issue for the individual.
 Withdrawal from the substances or
associated contaminants can cause
additional health issues, and the individual
becomes vulnerable to both criminal abuse
and legal punishment.
 DSM-5 DIAGNOSTIC CRITERIA:
 Substance use disorder in DSM-5 is set at
two or more criteria from a list of 11.
 Substance use disorder can be diagnosed
with physiological dependence, evidence of
tolerance or withdrawal, or without
physiological dependence.
 In addition, criteria for cannabis and
caffeine withdrawal were added.
 DEFINING GAMBLING DISORDER
 Urge to continuously gamble despite
harmful negative consequences or a desire to
stop. Severe problem gambling may be
diagnosed as clinical pathological gambling
if the gambler meets certain criteria and is
associated with both social and family
costs.
 DSM-5 DIAGNOSTIC CRITERIA
 Re-classified the condition as an addictive
disorder, with sufferers exhibiting many
similarities to those who have substance
addictions. DX, Must have at least four of
the following symptoms in a 12-month
period:
o Needs to gamble with increasing
amounts of money in order to achieve
the desired excitement.
o Is restless or irritable when attempting
to cut down or stop gambling.
o Has made repeated unsuccessful efforts
to control, cut back, or stop gambling.
o Is often preoccupied with gambling
(e.g., having persistent thoughts of
reliving past gambling experiences,
planning the next venture, thinking of
ways to get money with which to
gamble).
o Often gambles when feeling distressed
(e.g., helpless, guilty, anxious,
depressed).
o After losing money gambling, often
returns another day to get even
(“chasing” one’s losses).
18
 o Lies to conceal the extent of
involvement with gambling.
o Has jeopardized or lost a significant
relationship, job, or educational or
career opportunity because of gambling.
o Relies on others for money to relieve
desperate financial situations caused by
gambling.
 ETIOLOGY
 Several theories of substance use and
addiction exist, some of the main ones being
genetic predisposition, the self-medication
theory, a psychological predisposition, and
factors involved with social/economic
development.
 It has long been established that genetic
factors along with social and psychological
factors are contributors to substance use and
addiction. Epidemiological studies estimate
that genetic factors account for 40–60% of
the risk factors for alcoholism.
 Genetic factors may create a predisposition
for substance abuse, which means that an
individual may have a tendency toward
substance abuse. The self-medication
hypothesis suggests that certain individuals
abuse drugs in an attempt to self-medicate
physical, psychological problems, or social
problems. There are strong associations
between poverty and addiction.
 Drug addiction is characterized by strong,
drug-seeking behaviors in which the person
who is addicted persistently craves and
seeks out drugs, despite the knowledge of
harmful consequences.
 Addictive drugs produce a reward, which is
the euphoric feeling resulting from sustained
dopamine concentrations in the synaptic
cleft of neurons in the brain.
 The reward circuit, also referred to as the
mesolimbic system, is characterized by the
interaction of several areas of the brain.
 TREATMENT
 Early treatment of acute withdrawal from
substances often includes medical
detoxification, for physical dependence does
not necessarily address the precedents of
addiction, social factors, psychological
addiction, or the often-complex behavioral
issues that intermingle with addiction.
 Several evidenced-based intervention
programs have emerged, including
behavioral marital therapy, community
reinforcement approaches, cue exposure
therapy, and contingency management
strategies. Most treatment for addictions
involves counseling, step-based programs,
self-help, peer-support, medication, or a
combination of these.
 Twelve-step programs (such as Alcoholics
Anonymous) are a set of guiding principles,
sometimes accepted by members as being
‘spiritual principles’, outlining a course of
action for tackling problems of addiction
including alcoholism, drug addiction, and
compulsion.
 Alcoholics Anonymous is the largest of all
the twelve-step programs (from which all
other twelve-steps programs are derived),
followed by Narcotics Anonymous.
 OTHERS
 COFFEE ADDICTION:
o Caffeine is a central nervous system
stimulant that has the ability to enhance
concentration, increase metabolism, and
boost mood. Whether it comes from
coffee, tea, energy drinks, or soda, many
people feel like they “need” caffeine in
the morning to increase alertness and the
motivation to work.
o More than 90% of adults regularly drink
caffeine, consuming an average of 200
mg of caffeine per day – the equivalent
of two 6-ounce coffees or five 12-ounce
cans of soft drinks.
o In most cases, drinking caffeinated
beverages is a relatively safe, non-
harmful habit; however, when the need
for caffeine crosses the line from a
pleasant pick-me-up to a daily necessity,
it can be indicative of an addiction.
o American Psychiatric Association
(APA) does not currently identify
caffeine addiction as a substance use
disorder; however, it does recognize
caffeine withdrawal as a clinical
condition.
o World Health Organization (WHO)
became the first medical corporation to
formally recognize caffeine addiction as
a clinical disorder in 2012.
o The 5th edition of the Diagnostic and
Statistical Manual of Mental Disorders
does not recognize caffeine addiction as
a substance abuse disorder, but it does
recognize it as a condition for future
study.
19
 DSM-V, PROBLEMATIC CAFFEINE
CONSUMPTION IS CHARACTERIZED BY
AT LEAST THREE OF THE FOLLOWING
CRITERIA:
 A persistent desire or unsuccessful efforts to
cut down or control caffeine use
 Continued caffeine use despite knowledge
of having a persistent or recurrent physical
or psychological problem that is likely to
have been caused or exacerbated by caffeine
 Withdrawal, as manifested by either of the
following:
o The characteristic withdrawal syndrome
for caffeine
o Caffeine (or a closely related substance)
is taken to relieve or avoid withdrawal
symptoms
 Caffeine is often taken in larger amounts or
over a longer period than was intended
 Recurrent caffeine use resulting in a failure
to fulfill major role obligations at work,
school, or home
 Continued caffeine use despite having
persistent or recurrent social or interpersonal
problems caused or exacerbated by the
effects of caffeine
 Tolerance, as defined by either of the
following:
o A need for markedly increased amounts
of caffeine to achieve desired effect
o Markedly diminished effect with
continued use of the same amount of
caffeine
 A great deal of time is spent in activities
necessary to obtain caffeine, use caffeine, or
recover from its effects
 Craving or a strong desire or urge to use
caffeine
 MANAGEMENT:
 Gradually reducing caffeine intake over
several weeks instead of quitting “cold
turkey” can help reduce the severity of
withdrawal symptoms.
 The withdrawal and recovery period from
caffeine is relatively short.
 Most caffeine addiction symptoms can be
resolved in 7-12 days of consumption
reduction.
 During that period, the brain will naturally
decrease the number of adenosine receptors
on each cell, responding to the sudden lack
of caffeine.
 If an individual can decrease intake until it
becomes nothing within a few weeks, the
levels of adenosine receptors in the brain
will reset to their baseline levels, and the
addiction will be broken.
BEER IS AN ALCOHOLIC DRINK
 Typically made from water, barley, hops and
yeast. Compared to wine or hard liquor, beer
usually has the lowest alcohol content by
volume (ABV). Beer’s ABV ranges from about
2 to 12 percent, with the most commonly
consumed beers (Budweiser, Coors Light,
Miller Lite, Corona, Busch, etc.) falling in the
4 to 6 percent range.
 For most people, it takes 3 to 5 beers to be over
the legal driving limit.
 Beer has become synonymous with many
activities in American culture. Drinking games
on college campuses revolve around it, happy
hours are the go-to activity for professionals,
and you’d be hard pressed to find a sporting
event without it.
TOBACCO AND NICOTINE
Tobacco is one of the most widely abused substances
in the world.
 It is highly addictive.
 The Centers for Disease Control and Prevention
estimates that tobacco causes 6 million deaths
Trusted Source per year. This makes tobacco
the leading Trusted Source cause of preventable
death.
Nicotine is the main addictive chemical in tobacco.
 It causes a rush of adrenaline when absorbed in
the bloodstream or inhaled via cigarette smoke.
 Nicotine also triggers an increase in dopamine.
 This is sometimes referred to as the brain’s
“happy” chemical
SMOKING
 The Philippines is one of 15 countries
worldwide with a heavy burden of tobacco-
related ill health. According to World Health
Organization’s 2013 standardized estimate of
smoking prevalence, 35% of men, 6.4% of
women and 20.6% of the Philippines’ population
overall are daily tobacco smokers.
20
SOME PEOPLE CAN SMOKE SOCIALLY OR
OCCASIONALLY, BUT OTHERS BECOME
ADDICTED.
AN ADDICTION MAY BE PRESENT IF THE
PERSON:
 cannot stop smoking or chewing, despite
attempts to quit
 has withdrawal symptoms when they try to quit
(shaky hands, sweating, irritability, or rapid
heart rate)
 must smoke or chew after every meal or after
long periods of time without using, such as after
a movie or work meeting
 needs tobacco products to feel “normal” or
turns to them during times of stress
 gives up activities or won’t attend events where
smoking or tobacco use is not allowed
 continues to smoke despite health problems
 Psychological and behavioral treatments.
Some people who use tobacco have success
with methods such as:
o Hypnotherapy, cognitive-behavioral
therapy (methods help the user change
their thoughts about addiction. They
work to alter feelings or behaviors your
brain associates with tobacco use).
 Treatment for a tobacco addition requires a
combination of methods. Keep in mind that what
works for one person won’t necessarily work for
another. You should talk to you doctor about
what treatments you should try.
DOMESTIC VIOLENCE
THE CYCLE OF DOMESTIC VIOLENCE:

TREATMENTS FOR TOBACCO AND NICOTINE

ADDICTION?
 Addiction can be very difficult to manage.
Many users find that even after nicotine
cravings have passed, the ritual of smoking
can lead to a relapse. There are several
different treatment options for those battling
a tobacco addiction:
 The patch. Known as a nicotine
replacement therapy (NRT). Apply to your
arm or back. The patch delivers low levels
of nicotine to the body. This helps gradually
wean the body off it.
 Nicotine gum. NRT, can help people who
need the oral fixation of smoking or
chewing. People who are quitting smoking
may have the urge to put something into
their mouths. The gum also delivers small
doses of nicotine to help manage cravings.
 Spray or inhaler. Nicotine sprays and
inhalers can help by giving low doses of
nicotine without tobacco use. These are sold
over the counter and are widely available.
The spray is inhaled, sending nicotine into
the lungs.
 Medications. Certain antidepressants or
high blood pressure drugs might be able to
help manage cravings. One medication
that’s commonly used is varenicline
(Chantix). Some doctors prescribe
bupropion (Wellbutrin). This is an
antidepressant that’s used offlabel for
smoking cessation because it can decrease
your desire to smoke.

21

 Domestic violence or domestic abuse has
become a topical issue. The prevalence of sexual
and domestic abuse in the last few years, making
us see that such violations are more common
than we realize.
 Unfortunately, not all victims realize that they
are in abusive relationships. The first step to
getting out of an abusive relationship is to
acknowledge that you are in one.
 Domestic violence is any pattern of behavior
that controls, manipulates, harasses, and harms a
person.
PHYSICAL ABUSE
 One of the most common forms of domestic
violence.
 It involves abusers exerting physical force to
intimidate and strike fear into the hearts of their
victims.
 This type of abuse leaves scars, marks and can
result in a wide variety of chronic diseases.
Some manifestations of physical violence
include:
 Hitting, slapping, biting, choking
 Use of weapons
 Damage of property
 Kidnapping and coercive behavior
 Aggressive behavior
SEXUAL ABUSE
 Movement brought sexual abuse into sharp
focus. Many people who were silent have been
spurred on to share their stories of abuse.
 Crucial to helping arrest sexual offenders and
bring them to justice.
 From workplaces to public places, sexual abuse
happens across all spheres, and even in
marriage. 10-14 percent of married women will
be raped at one point or the other, during their
marriage.
 This abuse is particularly grievous and you
should report any seeming violation of your
space to your superiors or family, depending on
where it occurs. Take up the matter with the
police and proper authorities and movements/
shelters.
 Sexual abuse should never be swept under the
carpet.
EMOTIONAL ABUSE
 Abuser undermines the victim’s self-worth, self-
esteem, and independence. And this is one of the
most common ways abusers inflict woes on their
victims.
 Some examples of emotional abuse are:
 Jealously and throwing tantrums
 Gaslighting to make the victims feel like
they are losing their mind
 Always placing blame on the victim
 Withholding affection and only giving it in
exchange for something
 Making the victim feel like everything is
their fault
 Cutting off family and friends
 There are more signs of emotional abuse in a
relationship. Ultimately, if you are not happy
and do not have any joy or peace while in a
relationship, you should retake a look at it.
VERBAL ABUSE
 Words are powerful, and the wrong words can
create fear and grave emotional abuse. Verbal
abuse is a precursor to some form of physical
abuse and is also a way of demoralizing a
partner.
 Here are a few examples of how verbal abuse
manifests:
 Name-calling
 Threats
 Swearing and continuos humiliation
 Screaming and shouting
 Talking about your body and self-esteem in
derogatory ways
 Laughing at your cherished beliefs
 Once something uses derogatory words to
describe you, that’s a sign that the person
doesn’t respect you. If they mock your body,
personality, or cherished beliefs, then it’s time to
call it quits.
22
SOCIAL ABUSE
 Involves an abuser trying to damage your
relationship with others. Usually, friends,
family, and other vital people in a victim’s life
are cut off systematically.
 It can even go as far as restricting the
movement of a victim. Here are some examples
of social abuse:
 Locking a victim in a house or enclosed
space for hours
 Hiding the victim’s keys and phones
 Asking a victim not to contact friends or
family
 Forbidding the victim from meeting other
people or going to public places
 The ultimate goal of a social abuser is to isolate
you and make a victim feel like an abuser is all
they have. But don’t buy into it. Reach out to
friends and family who have you at heart and
keep them close. It would serve you best to walk
away from anyone who is manifesting signs of
social abuse.
FINANCIAL ABUSE
 A common tactic of many abusers. Some require
that victims seek their consent before making
any purchase.
 At extreme levels, they seize the credit cards of
victims and restrict them from making any
purchases.
 Another way is to prevent the victim from
holding any job that can bring in money.
Instead, they may give the victim only a small
allowance.
 This type of abuse ensures that the victim
depends almost entirely on the abuser for
survival, making it very difficult for the victim
to leave.
TECHNOLOGICAL ABUSE
 In this digital age, this is an increasingly
common form of abuse.
 Abusers take over the accounts of their
partners and control who they interact with.
They block and delete people they do not
like at will.
 Here some common ways abusers use
technology to harras people they are connected
to:
 Firstly, they stalk their victims online,
tracking, and monitoring their every move.
 And it starts with getting access to the
victim’s account. Sometimes, if these
offenders are not privy to passwords, they
resort to hacking.
 They may end up impersonating the victim or
using their accounts for various purposes.
MANAGEMENT/ INTERVENTIONS:
 eight-session psychological intervention delivered
by trained domestic violence and abuse advocates
showed greater reduction in symptoms of
psychological distress, depression and post-
traumatic stress than those who received advocacy
alone.
 Psychological interventions, such as counselling
and cognitive behavioral therapy that are not
adapted to the specific needs of domestic violence
and abuse survivors often fail to meet their needs.
 Advocacy or support is provided by a network of
specialist. Given the contact that advocates have
with women who have recently experienced
[domestic violence and abuse] and their
understanding of the context of abuse, they are a
potential source of psychological support to
survivors who seek help.
 Specialist psychological advocates were trained to
work with common presenting problems including
post-traumatic stress, depression, anxiety, low self-
esteem, anger and managing loss, and received
handouts and self-help resources to use with their
clients.
DISORDERS IN CHILDHOOD AND
ADOLESCENCE
 Like adults, children and adolescents vary in
temperament. Some are shy and reticent; others are
socially exuberant. Some are methodical and
cautious; others are impulsive and careless.
 Whether a child is behaving like a typical child or
has a disorder is determined by the presence of
impairment and the degree of distress related to the
symptoms.
 For example, a 12-year-old girl may be frightened
by the prospect of delivering a book report in front
of her class. This fear would be viewed as social
anxiety disorder only if her fears were severe
enough to cause significant distress and avoidance.
THEMOST COMMON MENTAL DISORDERS OF
CHILDHOOD AND ADOLESCENCE FALL INTO
THE FOLLOWING CATEGORIES:
 ANXIETY DISORDERS are characterized by
fear, worry, or dread that greatly impairs the ability
to function normally and that is disproportionate to
the circumstances at hand.
 Anxiety may result in physical symptoms.
 Diagnosis is clinical.
 Treatment is with behavioral therapy and
drugs.
23
 ACUTE STRESS DISORDER (ASD) and
POST-TRAUMATIC STRESS DISORDER
(PTSD) are reactions to traumatic events.
 The reactions involve intrusive thoughts or
dreams, avoidance of reminders of the event,
and negative effects on mood, cognition,
arousal, and reactivity.
 ASD typically begins immediately after the
trauma and lasts from 3 days to 1 month.
PTSD can be a continuation of ASD or may
manifest up to 6 months after the trauma and
lasts for > 1 month.
 Diagnosis is by clinical criteria.
 Treatment is with behavioral therapy and
sometimes with SSRIs or antiadrenergic
drugs.
 DEPRESSIVE DISORDERS are characterized
by sadness or irritability that is severe or
persistent enough to interfere with functioning
or cause considerable distress.
 Diagnosis is by history and examination.
 Treatment is with antidepressants,
supportive and cognitive behavioral therapy,
or a combination of these modalities.
 Depressive disorders in children and
adolescents include:
o Disruptive mood dysregulation disorder
o Major depressive disorder
o Persistent depressive disorder
(dysthymia)
 OBSESSIVE-COMPULSIVE DISORDER
characterized by obsessions, compulsions, or
both. Obsessions are irresistible, persistent ideas,
images, or impulses to do something.
Compulsions are pathologic urges to act on an
impulse, which, if resisted, result in excessive
anxiety and distress. The obsessions and
compulsions cause great distress and interfere
with academic or social functioning. Diagnosis
is by history. Treatment is with behavioral
therapy and SSRIs.
 Mean age of onset of obsessive-compulsive
disorder (OCD) is 19 to 20 years; about 25%
of cases begin before age 14.
 OCD encompasses several related
disorders, including:
o Body dysmorphic disorder
o Hoarding disorder
o Trichotillomania (hair pulling)
o Skin-picking disorder
o Some children, particularly boys, also
have a tic disorder
 Obsessions are involuntary thoughts,
images, or impulses that occur over and over
again in your mind.
 You don’t want to have these ideas, but you
can’t stop them. Unfortunately, these
obsessive thoughts are often disturbing and
distracting.
 Compulsions are behaviors or rituals that
you feel driven to act out again and again.
(compulsions are performed in an attempt to
make obsessions go away).
 Eg, if you’re afraid of contamination, you
might develop elaborate cleaning rituals (the
relief never lasts). In fact, the obsessive
thoughts usually come back stronger.
 And the compulsive rituals and behaviors
often end up causing anxiety themselves as
they become more demanding and time-
consuming. This is the vicious cycle of OCD
 Most people with OCD fall into one of the
following categories:
o Washers are afraid of contamination.
They usually have cleaning or hand-
washing compulsions.
o Checkers repeatedly check things (oven
turned off, door locked, etc.) that they
associate with harm or danger.
o Doubters and sinners are afraid that if
everything isn’t perfect or done just right
something terrible will happen, or they
will be punished.
o Counters and arrangers are obsessed
with order and symmetry. They may have
superstitions about certain numbers,
colors, or arrangements.
o Hoarders fear that something bad will
happen if they throw anything away. They
compulsively hoard things that they don’t
need or use. They may also suffer from
other disorders, such as depression,
PTSD, compulsive buying, kleptomania,
ADHD, skin picking, or tic disorders.
24
 Hoarding Disorder
o Acquiring possessions provides pleasure
rather than simply satisfying a
compulsion. The items you accrue are
also more likely to have some intrinsic
or emotional value, at least to you.
o Often, you’ll hold on to items in the
belief that they’ll be useful sometime in
the future.
o The distress in Hoarding Disorder stems
more from the consequences of your
hoarding—the clutter and unsafe
environment—along with the anxiety of
having to discard possessions.
 OCD SELF-HELP:
o Tip 1: Identify your triggers
 Create a solid mental picture and
then make a mental note. Tell
yourself, “The window is now
closed,” or “I can see that the oven
is turned off.”
o Tip 2: Learn to resist OCD
compulsions
 This is known as exposure and
response prevention (ERP) and is a
mainstay of professional therapy for
OCD.
 ERP requires you to repeatedly
expose yourself to the source of
your obsession—and then refrain
from the compulsive behavior you’d
usually perform to reduce your
anxiety.
 Building your fear ladder - Think
about your end goal (to be able to
use a public restroom without fear
of contamination, for example, or to
drive to work without stopping to
check if you’ve hit something) and
then break down the steps needed to
reach that goal.
o Tip 3: Challenge obsessive thoughts
 The more unpleasant or distressing
the thought, the more likely you are
to try to repress it. But repressing
thoughts is almost impossible and
trying usually has the opposite
effect, causing the unpleasant
thought to resurface more frequently
and become more bothersome.
o Tip 4: Reach out for support
 The more connected you are to other
people, the less vulnerable you’ll
feel.
 Stay connected to family and
friends.
 Join an OCD support group.
o Tip 5: Manage stress
 Quickly self-soothe and relieve
anxiety symptoms by making use of
one or more of your physical
senses—sight, smell, hearing, touch,
taste—or movement.
 Practice relaxation techniques.
 TREATMENT FOR OCD:
o Cognitive-behavioral therapy is the
most effective treatment for obsessive-
compulsive disorder and generally
involves two components:
o Exposure and response prevention,
which requires repeated exposure to the
source of your obsession, as explained
above.
o Cognitive therapy, which focuses on
the catastrophic thoughts and
exaggerated sense of responsibility you
feel. A big part of cognitive therapy for
OCD is teaching you healthy and
effective ways of responding to
obsessive thoughts, without resorting to
compulsive behavior.
 HOW TO HELP SOMEONE WITH
OCD:
o The way you react to your loved one’s
OCD symptoms can have a big impact
on their outlook and recovery. Negative
comments or criticism can make OCD
worse, while a calm, supportive
environment can help improve the
outcome of treatment.
 Avoid making personal criticisms.
Remember, your loved one’s OCD
behaviors are symptoms, not
character flaws.
 Don’t scold someone with OCD or
tell them to stop performing
rituals. They can’t comply, and the
pressure to stop will only make the
behaviors worse.
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  Be as kind and patient as possible.
Each sufferer needs to overcome
problems at their own pace. Praise
any successful attempt to resist
OCD, and focus attention on
positive elements in the person’s
life.
 Do not play along with your loved
one’s rituals. Going along with
your loved one’s OCD “rules,” or
helping with their compulsions or
rituals will only reinforce the
behavior. Support the person, not
their compulsions.
 Keep communication positive and
clear. Communication is important
so you can find a balance between
supporting your loved one and
standing up to the OCD symptoms
and not further distressing your
loved one.
 Find the humor. Laughing together
over the funny side and absurdity of
some OCD symptoms can help your
loved one become more detached
from the disorder. Just make sure
your loved one feels respected and
in on the joke.
 Don’t let OCD take over family
life. Sit down as a family and decide
how you will work together to
tackle your loved one’s symptoms.
Try to keep family life as normal as
possible and the home a low-stress
environment.
 DISRUPTIVE BEHAVIORAL DISORDERS
(eg, attention-deficit/hyperactivity disorder
[ADHD], conduct disorder, and oppositional
defiant disorder)
 Disruptive behavior disorders (DBD) can
seriously impact a child’s daily life.
 Children with disruptive behavior disorders
show ongoing patterns of uncooperative and
defiant behavior.
 Their responses to authority figures range
from indifference to hostility.
 Their behavior frequently impacts those
around them, including teachers, peers, and
family members.
 The most common types of disruptive
behavior disorders include disruptive
behavior disorder not otherwise specified
(DBD NOS), oppositional defiant disorder
(ODD) and conduct disorder (CD).
 Children with these behavioral disorders can
be stubborn, difficult, disobedient, and
irritable.
 Children with conduct disorder show the
same responses to authority figures as
discussed above, but in addition, they have
a tendency to be physically aggressive and
both actively and intentionally violate
others’ rights.
 The main differences between these
disorders are severity, intensity and
intentionality of behavior exhibited by the
child.
 WHAT SYMPTOMS SHOULD
PARENTS LOOK FOR?
o Children with oppositional defiant
disorder often lose their temper. They
are quick to argue with adults over rules
or requests. They are likely to:
 Be uncooperative
 Argue, even about small and
unimportant things
 Refuse to follow rules
 Deliberately annoy others, and
become easily annoyed by other
people
 Blame others for their mistakes or
misbehavior
 Behave in angry, resentful, spiteful,
and vindictive ways
 Anyone is capable of displaying any of these
behaviors. Children with oppositional
defiant disorder display them more often
than others their age.
 They are likely to be involved in frequent
conflicts with their peers. And they often
face discipline at school.
 Children and teens who have conduct
disorder are likely to:
o Lack respect or regard for others
o Be aggressive toward other people and
animals
o Bully and intimidate others
o Willfully destroy property
o Steal and lie without feeling bad about it
o Be truant frequently
o Run away from home
 Environment. There is an increased risk
for disruptive behavior disorders among
children who were:
o Rejected by their mothers as infants.
o Separated from their parents.
o Recipients of poor foster care.
o Physically, emotionally, or sexually
abused or neglected.
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 HOW ARE DISRUPTIVE BEHAVIOR
DISORDERS TREATED?
o Children with disruptive behavior
disorders often benefit from special
behavioral techniques. These can be
implemented at home and at school.
o Therapeutic approaches typically
include methods for: For younger
children (under age 9), interventions that
help parents more successfully manage
their child’s behaviors are very effective
 Training children to become more
aware of their own anger cues
 Using anger cues as signals to
initiate various coping strategies
 Providing positive reinforcement to
improve self-control
 WHEN SHOULD YOU SEEK HELP
FOR DISRUPTIVE BEHAVIOR
DISORDERS?
o Children with oppositional defiant
disorder or conduct disorder are
challenging to live with. Parents need to
understand that they do not have to deal
with their ODD/CD child alone.
o Interventions such as parent training at
home and behavioral support in the
school can make a difference.
o Parents should not hesitate to ask for
assistance from a mental health
professional.

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