MENTAL STATUS EXAMINATION

Client: Unit: Age: Sex: Date: Evaluator:

1. General Overall Appearance:

Appearance?
Well groomed?
Posture / gait?
Bizarre mannerism? (Describe)
Facial Features anything unusual?
Activity of the body (underactive/ overactive)
2. Speech
Tone, inflection, pitch – usual, monotone, appropriate?
Flow of speech?
Relevance?
Association of thoughts (Illogical, incoherent)?
3. Socialization and interpersonal relationship:
Has close friend? Any?
Participation in groups?
Assertiv4eness I others?
Support system provided by family or Friends?
4. Pathological content of thought:
Delusions (e.g. Does anyone control your thoughts?)
Ideas of reference?
Hallucinations? Delusions?
Obsessions? Compulsions?
Suicidal Ideations? Somatic concerns?
5. Intellectual areas:
Insight about current problems?
Judgment? (If there is an earthquake what will you do?)
Accepts responsibility for decisions and actions?
Abstractions (State a proverb and let the patient interpret it)
Orientation to time, place, and person?
Intellectual functioning (count backwards by fives)
Memory (Remote: When were you born?
Recent: What did you have for breakfast?)
General Knowledge (Who is the current president of the Philippines?)
6. Moos Affect:
Depressions? Elations? Agitation? Anxiety?
Suspicious? Labile? Flat affect?
7. Body Image:
How do you describe yourself physically?
8. Ability to cope with stress:
Defense mechanism used? Ineffectively stress?
9. Evaluation of how client reacted to interview and you: (Assessment)
Describe hesitant? Appropriate? Anxious? Hostile?
FORMAT FOR NPI:
(Process Recording No.____)

A. Goals for the day

B. MSE
C. Excerpt of NPI (nurse patient interaction)
D. Problems identified: 1. On the part of the nurse
2. On the part of the patient
D. State goals for the next NPI based on identified problems.

Example:
Client: Mr. X

Coping Mechanism – consist of all coping means used by individual to relief from emotional conflict and
to ward off necessity.

1. PROJECTION – blames others for our own faults, shortcomings and failures 0
2. DENIAL – unconscious refusal to acknowledge reality as they are
3. SUPPRESSION – conscious pushing away from awareness of uncertain ideas unwelcome Ideas,
memories can be recalled
4. REPRESSION – unconscious excluding from field of awareness unbearable ideas and experiences.
5. SYMBOLIZATION – both conscious and unconscious, use symbols for meanings
6. RATIONALIZING – finding logical reason for the things you wanted to do but you can’t
7. IDENTIFICATION – Identify ideas, ideals of person as your own
8. COMPENSATION – developing personality traits or beliefs about ourselves as a means of
compensating for various inadequacy.
9. REGRESSION – a retreat from the present pattern to past level of behavior
10. CONVERSION – process by which an emotional conflict is expressed as a physical symptom.
11. SUBLIMATION – re – channelings of unacceptable drives into acceptable ones.
12. WITHDRAWAL – Isolating self, protective device within the person prevents self from being hurt
13. AGGRESSION – expression of hostility openly or symbolically.
14. TRANFERENCE – transference of emotion from object, set of idea to another
15. RITUALISTIC BEHAVIOR – uniform and repetitive behavior used to control environment and self.
16. UNDOING – CM. against anxiety.
17. REACTION FORMATION – going to the opposite extreme from what one washes to do on afraid
one might do.
18. CONFABULATING – Feeling in gaps of memory by inventing what appears to be suitable
memories or replacements.
19. BLOCKING – disturbance in the rate of speech when a person’s thought and speech are
proceeding at an average rate but are suddenly and completely interrupted
20. DISPLACEMENT
21. INTROJECTION
 NURSING PROCESS
PSYCHIATRIC NURSING PROCESS
ASSESSMENT:
Mental Health Status – for formulation of problem

Methods of Data Gathering.

- Interview patient’s family and psychiatric team
- Observation – “ clinical eye”
- Records

Condition for Effective Interview:

1. Attentiveness
2. Establish rapport – communication technique
3. Freedom for interruption on geographical privacy
4. Psychological privacy – “Mind Set” or “Attention Set”
5. Emotional detachment – don’t be judgmental

Phases of Assessment:
1. Basic Data – Pt’s Profile – reason for hospitalization
- How family perceives
2. Psychological Assessment includes emotional, lifestyle, coping Mechanism, DM, Interaction
pattern, dynamic issue involved

3 types of Dynamic Issues:

a. To be cared and protected
- Dependent person – prone to develop psychotic s/s
b. To be in control
- Anally fixated, obsessive compulsive attitude, conformist / perfectionists
c. To achieve, be secured and be strong
- Self – awareness

3. Social Assessment – family relationship, peer group relationship, cultural background, religious
background, socio-economic status
4. Behavioral Assessment – behavioral manifestations of the patient
5. Medical Assessment

NURSING DIAGNOSIS – identification of patient’s problems based on conclusions about the dynamics of
verbalizations and behaviors.
Example: Anxiety related to marital problem as evidenced by decreased concentration.

- NANDA diagnoses suggest a statement that as three components:

1. Potential or actual problems – identified from the list approved by NANDA
2. Contributing or etiological factor – can include stressors, losses, past experiences,
developmental issues etc.
3. Defining characteristics or behavior – verbal and non-verbal cues tat reflect the actual or
potential problem.
OUTCOME IDENTIFICATION
- Expected outcomes (short or long term)
- Should be directly related to the nursing diagnosis
Example client will verbalize the reality of his current illness

PLANNING – develop plan of care to guide therapeutic intervention and achieve expected outcomes

INTERVENTION / IMPLEMENTATION– consists of all acts deliberately designed to meet the needs and
assist the client to solve to cope with his problem.

EVALUATION – means of evaluating if objectives were met

PROCESS RECORDING – verbatim account of what has occurred before, during and NPI.
-Includes verbal and non – verbal communication or behavior
PURPOSES:
1. Develop understanding of verbal communication
2. Develop understanding of non-verbal cues, action cues, object cues space cues, touch cues
(most fundamental)

Format Inference Remark

N - Therapeutic communication
Technique or non-therapeutic
P - Integration of psyche concepts
-thoughts and feelings

CONTENT OF PROCESS RECORDING:

1. Background information or introductory Data
- Brief discussion on why you have been chosen the patient
- include act. Taking in while patient was in the ward when first seen
- include initial assessment of patient: description
Head to toe – borloloy included, period of silence included
-patient’s reaction to staff and interview

FORMAT FOR PROCESS RECORDING

I. Goas for the day.
II. Description of the client
III. Thoughts and feelings prior to interaction (of the nurse)
IV. MSE
V. NPI
VI. Problems identified on nurse patient
VII. Goals for the following day based on problems gathered

PHASES OF I-I NPR: (nurse – patient relationship)

I. ORIENTATION (initial, beginning)
Objective: Establishment of contract

Elements of contract:
1. Purpose of NPR
 2. Expected goal of NPR
3. Setting/ place
4. Time, duration, Frequency
5. Confidentiality

II. MIDDLE PHASE – working phase

Objective: Maintenance and analysis of the NPR

Therapeutic Tasks:
1. Identification and expiration of different behavior patterns
2. Analysis of client’s mode of conflict resolution
3. Facilitation of client’s self – assessment of growth
4. Address forces that inhibit desired change
5. Create atmosphere offering permission for active experimentation to the test and assess
effectiveness of new behavior
6. Facilitate development of coping skills to deal with anxiety associated with behavioral
changes.

III. TERMINAL PHASE (END)

- Termination of the I –I NPR in a mutually planned and satisfying manner Therapeutic Tasks:
1. Establish reality of separation
2. Review progress of therapy and attainment of goals.
3. Mutually explore feelings of rejection, loss, sadness, and related behavior.

Problems Encountered:
1. ORIENTATION –
a. resistance
b. silence
c. monotone
d. tangential response critic divergent
2. WORKING Phase –
a. transference
b. counter – transference
c. Manipulation
d. acting out
3. TERMINATION PHASE -
a. resistance
b. overdependence

PRE – INTERACTION PHASE - explore our own feelings, analyze our own weaknesses and Strength.
Self – awareness.

COMMUNICATION – exchanged of ideas/ info.

Elements of Communication:
1. Sender
2. Message
3. Receiver
 4. Channel or Mode of Transmission
5. Feedback or response

COMMUNICATION NETWORK
1. intrapersonal – within the self
2. interpersonal – with others
3. Group network
4. Cultural network – communication thru materials and culture.

CHARACTERISTICS OF SUCCESSFU COMMUNICATION

1. Feedback and return response
2. Appropriateness in reply is relevant
3. Efficiency in language used is understood
4. Flexibility – absence of over control on under control

KEYS TO EFFECTIVE COMMUNICATION:

1. Understand own ideas before you try to pass them on.
2. Use the right word at right time at the right place in the right manner to the right person
3. Don’t forget feedback
4. Allow other people to express their own ideas
5. Observe
6. Seek not only to be understood but to understand

COMMUNICATION TECHNIQUES
I. THERAPEUTIC RESPONSES:

1. SILENCE – Lack of verbal communication for therapeutic reason

- allows patient to think
- encourage patients to initiate conversation
TX the art – failure to listen.
2. LISTENING – active process of receiving information and examining ones to the message
received.
Ex. Eye to eye contact
TX value – nurse non – verbally communicate her acceptance to the patient
TX threat – failure to listen.
3. BROAD OPENING – encouraging patient to select topics for discussion
TX value – nurse shows acceptance and value patient’s initiative
TX threat – rejecting responses and the nurse dominating interaction
4. RESTATING – repeating to the patient the main thought he had expressed
TX value – the nurse helps the patients call attention to something important that has been said.
TX threat – nurse let go of something said
5. CLARIFICATION - attempting to put into words vague ideas or clear thoughts of the patients to
enhance the nurses understanding or asking the patients to explain what he means.
6. REFLECTION – directing back with the patient his or her ideas, feelings, questions and content.
Ex. Nakikita ko, malungkot ka.
TX value – validate what the nurse understood and signifies empathy, interest and respect for the
patient.
TX threat- give inappropriate timing of reflections, stereotyping patient’s responses and inappropriate
depth of feelings of reflections.
7. FOCUSING – question or statements that help the patient expand on a topic of important
TX value – allows patients to discuss issues related to his problem and keeps the communication
process goal directed.
TX threat – changing topic and allowing abstractions and generalization.
8. SHARING PERCEPTION – asking the patients to verify the nurse conveys understanding of what he
is thinking and feeling.
TX value – clearing up confusing communication and nurse conveys understanding of the patient.
9. INFORMING- is the skill of into Giving
TX value – helpful in patient’s education about relevant aspects of patient’s wellbeing ad self-
care.
TX value – giving advice
10. SUGGESTING – presentation of alternative ideas for the patients’ common relative to this
problems solving.
TX value – increases pt.’s perceived choices of options
TX threat – giving advice and being judgmental
11. THEME IDENTIFICATION – underlying issues or problems experienced by patient that emerge
repeatedly during the course of NPI.
TX value – allows pt. expiration and understanding of important problems
TX threat – reassuring, giving advice and disapproving
12. HUMOR – discharge of energy thru the comic enjoyment of the imperfect
TX value – socially acceptable form of sublimation
TX threat – indiscriminate use, belittling patient and screen to avoid TX intimacy,

Examples of TX responses:
1. Smiling
2. Leaning forward
3. Open – ended leads

II. NON – THERAPEUTIC RESPONSE:

1. CHANGING THE TOPIC, TANGENTIAL RESPONSE

- Give open- ended leads
- Give feedbacks
2. MORALIZING – approve or disapprove of the pt.’s behavior
Sug. Response – with no.1
3. AGREEING WITH CIENT’S AUTISTIC INVENTIONS
Sug Response – use clarifying responses
4. AGREEING WITH CLIENT’S NEGATIVE VIEW OF SELF
Sug. Response – clarify
5. COMPLEMENTING AND FLATTERING
Sug . Response - clarity
6. GIVING OPINIONS AND ADVICE
Sug . Response – allow patient to consider alternatives
7. SEEKING AGREEMENT FROM CLIENTS WITH NURSES PERSONAL OPINION
Poor response – don’t you think
Sug . Response – Keep personal response to self and give info that would and the client’s orientation
reality.
8. PROBIN OR OFFERING PREMATURE SOLUTION
Sug . Response – Clarification and elicit more data
9. CHANGING CLIENT’S WORDS WITHOUT PRIOR VALIATION
Sug . Response – restating
10. FOLLOWING VAGUE CONTENT AS IF UNDERSTOOD
Sug . Response – clarify
11. QUESTIONING ON DIFFERENT WITHOUT WAITING FOR A REPLY
12. IGNORING CIENT’S QUESTION / COMMENT
Sug . Response – clarify
13. CLOSING OFF EXPLANTION WITH QUESTIONS ANSWERABLE WITH YES OR NO
Sug . Response – open –ended question (who? What? When? )
14. USING CLICHEN’S OR STEREOTYPE EXPRESSIONS
Sug . Response – clarify / restating
15. OVERLOADING – giving too much info at one time
16. UNDERLOADING – Giving too little info at one time
17. SAYING NO WITHOUT SAYING NO
Sug . Response – clarity
18. USING DOUBLE – BIND COMMUNICATION – Sending conflicting message that are incongruent
Sug . Response – take time with the patient
19. PROTNDING DEFECDING, SOMEONE WHILE FALKING WITH THE PATHIN
Response – focus on the feeling tone of the patient and clarity
20. ASKING – WHY – QUESTIONS - assume that he knows what he is done
Sug . Response – clarity
21. COERSION – using force during interaction
22. FOCUSING ON NEGATIVE FEELINGS, THOUGHTS
23. REJECTING CLIENTS BEHAVIOR OR IDEAS
Sug . Response – Client response
24. ACCUSING BELITTLING
Sug response - client Response
25. EVADING A RESPONSE BY ASKING A QUESTION IN RETURN

26. CIRCUMSTANTIALITY - communicating in such a way that the main point is only reach after many
side comments, details and addition “going around the bush”
27. MAKING ASSUMPTIONS WITHOUT CHECKING THEM OUT – acknowledge and accepting what the
patient is doing
28. GIVING FALSE REASSURANCE – clarity

PROCESS RECORDING
NPI
N “Good morning Manong”
P “ Good morning din”
( without looking at me )
N “ I see you are prep. To go
Outside (Pt is tying his shoelaces)
Pt. suddenly stood up
Straight saluted and showed
INFERENCE REMARKS/ANALYSIS
- orienting patient to time of the day - active listening
- pt. acknowledge my greetings
without looking up
- accepting , acknowledging
- you suddenly felt afraid I thought
The patient will hit me, I was
A toothless front.
P “ May BF ka na ba?”
N “ oo , Ikaw? “
P “ Ayoko nang mangambala,
Masakit na masaya (Pt. looks
Suddenly sad)
N “ Hindi ka dapat malungkot
Mabuti ang magmabal kaysa
Hindi.”
Speechless for a few minutes
- Pt. leaned closer to me, I was
Afraid patient’s tone seems to be
Sarcastic
-non-therapeutic response, I should have
Thrown back the question to him
And clarified
- Pt. is taking in symbols
- non-therapeutic, giving advice

OTHER FORMAT:
Nurse Patient/Client Interpretation

PSYCHOPATHOLOGY (THEORIES OF) CONCEPTUAL MODELS

A study of abnormal behavior, its manifestations, meanings and causation

A. PSYCHOANALYTICAL MODEL ( FREUD )y

Key concept:
MI is secondary to unresolved and unconscious childhood conflicts ego is too weak to deal with
anxiety – turns to symptoms.

Symptoms – results as effort to deal with anxiety and are related to unresolved conflicts

Therapeutic Task:
1. Psychoanalysis – uses free association and dream analysis
2. Psychotherapy – therapist – child relationship (TCR)
- Patient is taught to receive or experience things appropriately
a. Transference
b. Counter transference
NI – discern and explore meaning behind human behavior

B. BEHAVIOR MODEL (skinner , Paylov , Watson)

- Behavior is learned then it can be unlearned
- Deviant behavior can perpetuated because it reduces anxiety
Therapeutic Tasks:
1. Desynthesization or Relaxation Technique
- Deep breathing
- Flat lying
2. Assertiveness training – useful when anxiety arises from IPR
- Implies the client’s ability to stand up for his own right without stepping on somebody else’s
toes.
Purpose – increase self-esteem ad self-control
3. A version – refers to the use of a painful stimulus to create an aversion to a stimulus
 Ex. Electric shock
4. Token Economy System – positive reinforcement programs utilized to encourage socially
acceptable behavior in chronically hospitalized patient.
- Reward and punishment system
- Pleasurable experience reinforce the future repetition or desired behavior
C. SOCIAL MODEL – Capean, Szasy
Key Concept: Social and environmental factors create stress which causes anxiety resulting in
symptom formation CM
- Inadequate internal CM – psychopathology

Therapeutic Tasks:
a. Crisis intervention
b. Environmental manipulation
c. Enlistment of support system

D. BIOLOGICAL MODEL – email kraepelin

Key Concept: human behavior is determined by the genetic ad biological make – up of the
individual.
1. MI is organic in origin and is located in the CNS
2. The disease follows a course with characteristic symptoms that can be diagnosed and
classified.
3. Restoration to adaptive MH requires therapy
4. Mi are amenable to physics or somatic treatment
5. MI are within the change of the physician and should be treated following general medical
practice.

Basis of patient care:

1. Continued use of soma therapies
2. The setting is hospital
3. Research into the genetic transmission of mental illness.
4. Research on biochemical and metabolic variables among diagnosed patient.
5. Dominance of the med. Doctor as the leaders of psychiatric treatment team.
- Role of the nurse is on technical aspect.

E. NURSING MODEL – Orlando, Peplau , Orem , Rogers, Roy (nurses)

Key concept:
That the person is a biopsychosiocal entity who responds to stress in an individualized way.
- Behavioral disruptions affects the whole person
Treatment Tasks:
1. Use the nursing process – A, P, I,I

PHILIPPINES PSYCHOPATHOLOGY
Projection – Most common DM used by Filipinos
SYMPTOM FORMATION AND THEIR MEANING – symptoms of any mental illness classified into somatic
and psychogenic in origin
 I. SOMATIC
1. Physiological – bodily and physical manifestation of emotional conflict
- The organs involved are those innervated by the ANS
Ex. Diarrhea, asthma
2. Symbolic Expression – organs involved are under voluntary control of the individual
Ex: Conversion
II. PSYCHIC
A. PERCEPTUAL DISTURBANCES
A.1. ILLUSION – common tactile illusions – most common
Tactile illusions – touch
Olfactory illusions
Gustatory illusions
a.2. HALLUCINATIONS – perceptions of objects, images, sensations that have no
counterpart in reality visual and auditory are common.
Tactile – felt he/ she is caressed
Olfactory – smell something good or bad from self or others
Kinesthetic hallucinations- crawling all over the body
B. THINKING DISTURBANCES
B.1 DELUSION – false set of ideas that seem real to the individual and cannot be
corrected by logic, reason or argument.
a. Delusion of grandeur – Ex. Queen Elizabeth
b. Delusion of Persecution – beliefs and ideas that everybody is out to hurt you.
c. ideas of reference – beliefs and ideas that certain events or situation or
interactions are directly related to self
d. Blocking
B.2. INCOHERENCE – logical thought
B.3. CIRCUMSTANCIANITY – answers that goes around the bush.
B.4. PERSERVRATION – persistent repetition of expression of a single idea in response to
various question.
B.5. PSYCHOMOTOR RETARDATION – serving down of mental physical ability
Choleric – deterioration of movement and speech
B.6. PSYCHOMOTOR EXCITEMENT – nerve static always on the go.
B.7. FLIGHT OF IDEAS- rapid successional ideas in which the goals never reached.
B.8. OBSESSION – Recurrent thought that cannot be dismissed from consciousness
B.9. PHOBIA – intense irrational fear response to an external object or situation.
Hydrophobia – fear of water
Photophobia –fear of light
Zoophobia – fear of animals
Claustrophobia – fear of close crowds
Mysophobia – fear of germs
Acrophobia –fear of height
B.10. AUTISM – persistent indulgence with fantasy, illusion and hallucinations.
B.11. Misidentification – misidentify a person with another.
C. DISTURBANCES OF AFFECT – feeling of emotion
1. FLAT – LACK OF EXPRESSION
2. INAPPROPRIATE – no harmony between thoughts and emotional responses.
3. BLUNT – dullness in emotional response
 EX. Depression, loneliness, apathy/lack of feelings
D. MEMORY
1. AMNESIA – loss of memory for events that occur during a period of themed that may range
from a few hour to a life –time.
2. DÉJÀ VU – firsthand experience may seem to have happened before.
3. JAMOIS VU- being in a familiar situation but believes it is his first time.
4. PARAMNESIA – distortion and fortification of memory in which individual confuses fantasy
with reality.
5. CONFABULATION – filling in gaps in memory

E. CONSCIOUSNESS
1. CONFUSION – disorientation with regard to time, person, place,
2. STUPOR – state of awareness and uncreativeness
3. DREAM STATE – transient clouding of consciousness,
Interpsychie in origin in which the person is aware of his behavior and surrounding and opposite
to his usual pattern.

F. MOTOR BEHAVIOR
1. Psychomotor retardation
2. Psychomotor excitement
3. Agitation – jittery
4. Stereotype – aimless repetition of verbal, intellectual, emotional and motor activities.
5. Posturizing- assumption of unusual posture which is maintained for pronged period of time.
6. Catalepsy – generalized diminished responsiveness characterized by trance – like state.
7. Mannerism – stereotype involuntary movement
8. Negativism – action that are automatic and repetitive
9. Automatism – Actions that are automatic ad repetitive
10. Compulsion – recurrent compelling at which develops as an attempt to relieve obsession,
fears or tension
11. Echopraxia- repeat movement
12. Echolalia
G. SPEECH AND VERABAL BEHAVIOR
1. Blocking
2. Echolalia – repetition of words of another person
3. Verbigeration – meaningless repetition of incoherent words or sentences.
4. Salad – mixture of words and phrase which are incoherent and incomprehensible
5. Logotthea – uncontrollable rapid excessive talking

SCHIZOPHRENIA
- Group of disorders manifested by disturbances in thinking mood and behavior
- Disturbances in thinking – alteration in concepts
Behavior – withdrawn, regressive and bizarre
Mood- ambivalence, loss or empathy with others (emotional and intellectual identification with
others)
History of Schizophrenia
1. Emil Krafplin (1896) – Dementia Pralcox – deteriorating mental condition which is
Incurable.
 2. Eugene Bleuler – coined the word Schizophrenia
Schism – which means split mindedness
Schizo – not deterioration, can be cured with or without defect

Theories of Etiology:
1. Genetic Theory – role of genetics
Kalman – both parents ++ =16%
One of the parents is +=16%
- Monozygotic twins are prone is to develop Schizo
2. Biochemical / Organic – secondary to structural or functional defect in some organ sys.
Ex. Dopamine Hypothesis – Dopamine (Found in basal ganglia which functioned as
neurotransmitter) e.g. antipsychotic drug – increase amount of dopamine at the sypnapsis due
to increase drug.

3. Psychological – common in lower economic status

4. Schizo starts Carly in life especially if there is disturbances m the M-I relationship
- Result – difficulty in relationship with others
A. Adolf Meyer – secondary to poor environmental sanitation disorganized personality and
withdrawal from reality

B. Silvano Aricti – Schizo is a reaction to severely state of anxiety which are deeply rooted in
childhood and further reactivated in adult life.
C. Freud – Schizo secondary weak go-development is impaired Causes of weak ego:
1. Loss / threatened loss of a major source of gratification (person, object, opportunity)
2. Loss / threatened loss of basic acuities
3. Upsurge of erotic hostile feelings
4. Sudden increase in guilt
D. Sullivan – Schizo Secondary to poor M-I relationship Symptoms: Bleur’s 4 A‘s
1. AUTISM – preoccupied with self
- Withdrawal from reality – delusion and hallucination
Disturbances:
1. Thinking disturbances – delusion of grandeur – most common
- Delusion of persecution
2. Perceptual disturbances – Hallucination (without senses (-) usually always
(+))
3. Ideas of reference – everything that happens in rel. To him
4. Depersonalization – strangeness of feeling about the environment and there
Is difficulty in differentiating boundaries about self and env’t?
Idiosyncratic
Erratic
2. AMBIVALENCE – presence of 2 opposing feelings towards one event.
3. ASSOCIATE LOOSENESS – impairment of logical thought progression resulting in confuse, abrupt,
bizarre thinking.
Neologism – coming of new words which he alone understand
Echolalia – repetition of words
Clang association
4. APATHY – absence in the expression of emotion, disturbance in affect.
SECONDARY SYMPTOMS:
Hypochondriacally symptoms – person develops multiple physical symptoms which are not true

Psychopathology
1. Pre – psychotic personality – Schizoid person is shy, withdrawn, and passive with few friends,
daydreaming and introvert.
2. Clinically regarded repression – regressing to level
3. Overuse of projection especially paranoid.
4. The precipitating factors are somatic ad emotional.
CLINICAL TYPES OF SCHIZOPRENIA
Catatonic Type – occurs between ages 15-25, onset is acute, predicated by an emotional disturbing
experience.
a. Catatonic stupor – abandonment of al voluntary motor activity and is characterized by the
following: mutism, negativism, rigidity, wax flexibility, pt. assumes fetal position.
b. Catatonic excitement – exaggerated psychomotor act may develop without any warning Wild
behavior and is unpredictable. Too exhausted and may die.
2. PARANOID – occurs between ages 30-35
1. Extreme suspiciousness, delusions of persecution.
2. Delusions and hallucinations
3. Delusions of omnipotence
3. SIMPLE – Onset is gradual, char. By the following:
1. Treacherous disinvolvement with the environment, apathetic and indifferent
2. No delusion and hallucination
3. Can perform single task but can’t assume mature roles, poor prognosis, deteriorating
4. HEBEPHRENIC – most malignant, very poor prognosis
Chief characteristics of regressive behavior
Disordered thinking
Inappropriate affect
Preoccupied and withdrawn
Visual delusions and hallucinations are prominent.
5. CHRONIC UNDIFFERENTIATED – Unclassified Schizo with mixed emotion
Patient show Schizo without history of psychotic episode.
6. SCHIZOPHRENIA LATET PHASE - Borderline personality
Characteristics: 1. Clear symptoms of Schizo without history of psychotic episodes.
2. NO affective and thought disturbances.
3. Occasional miropsychoti episodes with the following elements
Present: a. hypochondrical symptoms
b. ideas of reference
c. depersonalization
7. ACUTE SCHIZOPHRENIC EPISODES - onset is acute
1. Pronounced mood swings
2. Ideas of reference
3. Impoverished rel.
4. Confusions
5. Anxiety and fear
Can take the appearance of catatonic, paranoid, hebephrenic
8. CHILDHOOD SCHIZOPHENIA – Occurs before onset of puberty
Characteristics: 1. Withdrawal from reality
 2. Autism, mutism
3. Failure to develop separate ego identity for mother
4. Anxiety which is unrevealed and disturbed body image and may have
Illusions and hallucinations.
9. RESIDUAL TYPE – Applied to patient who have experienced been diagnosed and recovered but
exhibits unfavorable signs.
TREATMENT OF SCHIZOPHRENIA
ECT – Electroconvulsive therapy – passing of electrical current to each side of the brain about 60 -100
volts. Indune a grand mal seizure artificially.

THEORIES EXPLAINING EFFECT OF ECT

1. Work by deconditioning new pathway, set aside painful experience
2. Emphasis is upon the unconscious meaning of the patient’s experience at ECT -10 ttt -20-30 session of
ECT.

Nursing Responsibilities:
1. Secure consent
2. NPO after midnight
3. Remove artificial dentures
4. Emptying of the bladder
Pre – op
1. Atropine
2. Sedatives
3. Muscle relaxants – Anatine – avoid paralysis and fracture
Post – op
1. Suctioning
2. Oxygen therapy
PSYCHOTHERAPY
- Refers to certain types of direct relationship between one or more patient and the therapist.
- The therapist provides the patient new life experiences recovery
NURDSING RESPONSIBILITY:
1. Understand the reason for withdrawal and make reality pleasant and free from stress.
2. Anticipate and accept patient’s testing and negative response.
3. Those patients are basically lonely and they crave for attention and companionship they try
different avenues of approach.
4. Watch out for symbolic language:
5. Perception of reality is dependent on reality
6. Prevent aggravation of regressed state.
7. Stimulate patient’s interest in social act and recreation
8. Create corrective family sit. Family ex.
9. Give incentives to behave in proper way.
- Token econ. Sys.
ANTI – PSYCHOTIC DRUGS:
Tranquilizers: Thora zine (Chlorpromazine)
Haloperidol
Haldol
Diazepam
Tranquilizers – no impairment of consciousness
SIDE EFFECTS:
1. A kinetic or hyperkinetic
2. Parkinsonism syndrome – mask life face
- Cogwheel rigidity – shuffling gait.
- Salivation
- Dystonia – rigidity of limb and neck
3. Akathisias- pacing and foot tapping agitation
4. Tardive dyskinesia – excessive blinking, excessive smacking and sucking
5. Hypotension
6. Dry mucous membrane
7. Ocular changes.

AFFECTIVE DISORDER
(Maladaptive Mood state)
- A group of clinical condition whose common and essential feature is a disturbance accompanied
by rel. cognitive, psychomotor, psychophysiological and interpersonal difficulties.

Mood – normal
- Depressed – cyclothymic temperament ( goes in a cycle)
- Elevated

Elevated: Depressed:
- Decreased sleep - loss of energy
- Flight of ideas - difficulty in concentrating
- Grandious ideas - loss of appetite
- Heightened self – esteem - guilt feeling
-Thoughts of death and suicide

CLINICAL TYPES:
1. Manic- depressed illness – bipolar – elation
Unipolar disorder – depression
Degrees of depression:
1. “BLUE” Spell – brought about by disappointment or loss of love one
There is weeping or impulse to cry. Difficulty of concentration in
Very slight and low self – esteem is slight.
Is of short duration.
2. Grief and Mourning – do – however marker or greatly accentuated
- Feeling of sadness is deeper
- Lessening of self – esteem
- Lack of interest in one’s surrounding
- General retardation of motor activities
- Loss of appetite
- Insomnia
- D.M. Ambivalence – greater the bereaved person’s ambivalence the more distressing
Is the period of mourning?
3. Neurotic Depression: Drastic and persistent lowering of sem- esteem due to 2 factors:
1. Long standing insecurities – go is chronically weak which needs bolstering from outside.
 2. If harsh and punitive superego and personal feeling especially of loved one
Superego disapproving producing worthlessness because of guilt.
4. Psychotic Depressive Reaction
Precipitating Factors: Sever blows to security and self – esteem mobilization of extreme feeling of guilt.

Clinical Findings:
1. Mood is extremely melancholy
2. over anxiety
3. Severe self-accusation
4. Appears older man that age.
5. Motor activity is sowed down specifically speech and movement
6. Immobility, mutism and unresponsive to environment.
7. Agitated depression in older patients
8. Delusions are common (severely punished and victim of organic fatal dis.)
- Behavior is weakened and destructive
9. Vegetative signs of depression
- Anorexia
- Weight loss
- Constipation
- Amenorrhea in women
- Insomnia
- “Morning – evening” variation in symptoms – worsen in early mornig hour and slight
Elevation of mood in the afternoon
10. Thoughts of suicide.
Difference with Neurotic Depression to psychotic Depression
N- As day progress patient becomes increasing low spirit
P- “morning -– evening” variation in symptoms
P. Superego is harsh. Punitive immature hostilities are turned inward
D.M. Introjection and identification
5. Depressed phase of Manic- Depressive Psychosis
- Very serious illness of personality involving major impairment of ego function which
Regard to reality testing and revealed testing and revealed by signs of maladjustment to live.

Symptoms of Mania: (opposite of psychotic depressive)

1. Euphoria
2. appears younger than actual age
3. talks rapidly and very responsive to stimuli
4. uses flight of ideas

Degrees of Manic Reaction:

1. Hypomania
a. increase sexual interest
b. eats voraciously
c. decrease sleep
2. Acute mania
a. presence of delusion
b. motor and ideational act is increasingly accelerated
c. weight loss due to high energy with sufficient sleep and nourishment
3. Delirious Mania
a. patients speech incoherent
b. activity is coarsely and wild
c. patient cannot sleep nor eats or drinks life threatening and patient can die
of sheer exhaustion.