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PSYCHIATRIC NURSING

MOOD DISORDERS
2 neurotransmitters affected: 1. Serotonin A vasoconstrictor, liberated by blood platelets, that inhibits gastric secretion and stimulates smooth muscle; present in relatively high concentrations in some areas of the central nervous system (hypothalamus, basal ganglia), and occurring in many peripheral tissues and cells and in carcinoid tumors. 2. Norepinephrine - a catecholamine hormone of which the natural form is D, although the L form has some activity; the base is considered to be the postganglionic adrenergic mediator, acting on ) and * receptors; it is stored in chromaffin granules in the adrenal medulla, in much smaller amounts than epinephrine, and secreted in response to hypotension and physical stress; in contrast to epinephrine it has little effect on bronchial smooth muscle, metabolic processes, and cardiac output, but has strong vasoconstrictive effects and is used pharmacologically as a vasopressor, primarily as the bitartrate salt. 5 hydroxyindole acetic acid (5HAA) responsible for breaking down serotonin into smaller particles Major depressive disorders decreased serotonin, decreased norepinephrine Mania increased serotonin, increased norepinephrine Serotonin is an inhibitory neurotransmitter Nor epinephrine is an excitatory neurotransmitter Depressed patients have the attitude or emotion that they want to kill themselves but manic patients have the energy to kill themselves Pinocytosis - the adenosine monophosphate ADP ATP Mood Disorders - withdrawal, affective problems, affects cognition, affect and psychomotor of the patient - Definition : disturbances in feelings, thinking and behavior - A group of mental disorders involving a disturbance of mood, accompanied by either a full or partial manic or depressive syndrome that is not due to any other mental disorder. Mood refers to a prolonged emotion that colors the whole psychic life; it generally involves either depression or elation DEPRESSION 1. Refers to an emotional state of sadness, discouragement, decrease selfesteem and hopelessness and helplessness 2. Key Features of Major Depressive Disorder There must be two weeks of maladaptive functioning. At least 5 of the following should be present: a. Depressed mood * b. Recurrent thoughts of death or suicidal ideation *

Inability to experience pleasure (anhedonia) Feelings of worthlessness Sleep disturbance Appetite disturbance Eating too much binge eating g. Diminished ability to concentrate Adult diminished ability to concentrate in the morning, more in the afternoon Children more in the morning, less in the afternoon h. Psychomotor Disturbance i. Fatigue or loss of energy Dapat present ni silang duha gyud c. d. e. f. 3. Anti Depressants (Side effect: Cardiotoxic) a. TCA Drugs: o Trimipramine (Surmontil) o Clomipramine (Anafranil) o Amitryptiline (Elavil) o Amoxapine (Ascendin) o Doxepin (Sinequan) o Desipramine (Norpramin) o Imipramine (Tofranil) o Nortriptyline (Aventylpamelor) o MAprotiline o PROtryptiline TCA Overdose o Coma o Convulsion and respiratory depression o Ataxia - An inability to coordinate muscle activity during voluntary movement o Agitation - depression with excitement and restlessness o Stupor - A state of impaired consciousness in which the individual shows a marked diminution in reactivity to environmental stimuli and can be aroused only by continual stimulation o SEdation b. SSRI Has the least side effects Drugs o Fluvoxamine (Luvox) an SSRI that is drug of choice for OC Disorder o Flouxetine (Prozac) a drug of choice for bulimia nervosa (sign of bulimic patient: RUSSEL sign callouses and scar over the knuckles of their hands) o Paroxetine (Paxil) also used to treat panic attacks o Sertraline (Zoloft) causes sexual dysfunction o Citalopram (Celexa) o Escitalopram (Lexapro) Side Effects o Weight loss o Headache

o Insomnia o Sexual Dysfunction c. MAOI Side effect: Hypertensive Crisis This will take effect 2 to 4 weeks Drugs: o (PArnate) tranylcyclopramine for severe reactive or endogenous depression o (MArplan) isocarboxazid o (NArdil) Phelzine most effective and most sedative; for cocaine abuse and panic attacks o (MAnerix) Moclobemide Side Effects: (Hypertensive Reactions) o Headache (occipital) o Palpitations o Photophobia and dilated pupils o Nausea o Neck stiffness/soreness o Sweating Tyramine Rich Foods o Beans, bananas o Avocados o Yeast, Yogurt o Cheese except cottage cheese, American cheese and white cheese because they do not undergo processing o Chicken liver o Chocolate o Pickles o Smoked salmon o Soy sauce o ***All processed and fermented foods are tyramine rich Tyramine Rich Beverages o Beer o Chianti red wine o Coffee o Tea d. AAD (Atypical Anti Depressant) Drugs: o BUpropion (Wellbutrin) o MIrtazipine (Remeron) o VEnlafaxine (Effexor) o NEfazodone (Serzone) Side Effects: o Dizziness for SSRI o Alters results of SGOT, SGPT o Weight gain for atypical depressants e. Herbal Remedies Drugs: o St. Johns Wort (Hypericum perforatum) first drug of choice o Gingko Biloba increase your mental acuity f. Electroconvulsive Therapy

For severely depressed patients Drugs: o Anectine muscle relaxant; it is used to avoid spasms and fracture o Brevital a short acting anesthesia; also used to induce light coma o Atropine Sulfate anti cholinergic drug; is used to decrease secretions and avoid aspiration; causes dry mouth Principles: o Electric Current (70 to 150 volts) o 0.5 to 2 seconds duration o It produces a grand mal seizure or tonic-clonic seizure 30 to 60 seconds o Minimum of 6 and maximum of 12 per person in the entire life o 3 to 4 times per week o Interval: 36 hours between the first and second treatment 4. Dysthymia - if the person does not meet the DSM for Depression MANIA 1. It is an emotional state characterized by: a. high optimism b. increased energy c. elation d. exaggerated sense of importance and invincibility

2. Key Features A distinct period of abnormal and persistent elevated, expansive or irritable mood that lasts at least 1 week and at least three of the criteria: a. Decreased need for sleep b. Flight of Ideas rapid shifting of thoughts c. Increase in goal directed activities d. Excessive involvement in pleasurable activities e. Distractibility f. Very talkative/Pressured speech g. Inflated self-esteem or Grandiosity 3. Mood Stabilizers a. Lithium Ion causes lithium toxicity the peak blood level : 1 to 3 hours Clinical Response: 7 to 10 days Contraindication: Cardiovascular disease Therapeutic Level: 0.5 to 1.5 mEq/L Lithium is a salt: so we should increase salt about 2mg/day (lithium is a salt and sodium is a salt, and there is a chloride to react to them. But lithium can not be excreted by the body system, so I fake pa nato ang lithium para ma excrete sya sa liver) and water up to 2 to 3 liters

If mu reach na ug 1.6 mEq/L, stop the medicine or drug holiday Side Effects: o Nausea o Polyuria o Polydipsia excessive thirst o Dry mouth o Diarrhea o Drowsiness 2-3 mEq/L side effects o Tinnitus - Noises (ringing, whistling, hissing, roaring, booming) in the ears o Blurred vision o Large output of dilute urines (normal spec grav = 1.010 to 1.030) kung dilute urine, increased specific gravity o Ataxia uncoordinated purposeful movement o Giddiness or drowsiness or sillyness Antidotes: o Urea o Mannitol o Aminophylline o Hemodialysis what to do before hemodialysis: palpate for the thrill and auscultate for the bruit Kung peritoneal dialysis, warm the dialysate At serum levels above 3 mEq/L o Multiple organs syndrome and organ systems syndrome leading to coma and death b. Carbamazepine Anti convulsive Causes blood dyscrasia (agranulocytosis) o Manifestations are the following: Sore throat Mouth sores Decreased WBC which is < 3000 mm3 (Lukopenia) so dapat mag CBC After 48 hours, there will be fever and malaise c. Valproic Acid (Depakene) Disadvantages: o Transient hair loss o Tremors o Dose related thrombocytopenia o Weight gain o Gastro-intestinal upset 4. Interventions: a. Restrain the patient or give immediately the Haldol b. If patient resist Haldol, restrain the patient c. High caloric, hand-held foods

5. Cyclothymia if the person does not meet the DSM for Mania *** Additional Notes *** Shifting from MAOI to SSRI = 14 days Shifting from SSRI to MAOI = 5 weeks If they belong to the same cluster, same day ihatag. TCA should never be added with alcohol because it will lead to respiratory depression, which would lead to coma and subsequently death. There is a chemical reaction between those two. Meditation should never be used for patients who are very anxious when thoughts of suicide occur, dapat iredirect ang energy. WE dont care about the past state of the person, but the present state of the person. Multi-Infarct Dementia hypoxic destruction of brain cells Huntingtons Disease o hyperkinesis causing choreiform movements o be able to know that the person has this disease at the age of 20 years old o dancing without music o at the age of 30 ang death or 10 years after occurrence Creutzfeldt Jakob Syndrome/Mad Cow Disease an infectious particle called prion Autosomal Recessive 25% are affected among the children Autosomal Dominant 50% are affected among the children

GRIEF AND LOSS


Grief - an emotional response - subjective emotions and affect (subjective means you only know you are grieving, others do not know; mourning when others know that you are grieving, outward expression of emotion) - normal response to the experience of loss Grieving or Bereavement - the process by which the person experiences the grief Mourning - outward expression of grief or emotion TYPES OF GRIEVING 1. Anticipatory Grieving - people facing an imminent loss begin to grapple (struggle, fight, wrestle) 2. Complicated Grieving/Dysfunctional Grieving - response outside the norm - occurring when a person is void of emotion - grieves for prolonged periods - expression of grief that seem disproportionate to the event - they have a bizarre behavior - grieved for a long period of time 3. Disenfranchised Grief - grief over a loss that is not or cannot be acknowledged openly, mourned publicly, or supported socially

3 categories of circumstances in disenfranchised grief: A relationship has no legitimacy The loss itself is not recognized The grieve is not recognized

THEORIES OF GRIEVING: 1. Phases of Grieving by Elizabeth-Kubler Ross a. Denial Not me b. Anger Why me c. Bargaining Yes me, but d. Depression Yes me e. Acceptance My time is close, its alright **Blaming others during anger stage **Loss becomes acute depression **If the person is in shock denial **Adapting to the loss acceptance 2. John Bowlbys Phases of Grieving a. Numbness b. Emotional yearning c. Cognitive disorganization d. Cognitive reorganization 3. John Harveys Phases of Grieving a. Shock, outcry and denial b. Intrusion of thoughts, distractions and obsessive review of the loss c. Confiding in others to emote and cognitively restructure account of loss 4. Schwindt Rodebaugh and Valentines Phases of Grieving a. Shock, disbelief and denial b. Feeling i. Anguish, guilt, sadness, anger, lack of concentration, sleep disturbances, appetite changes, fatigue, general discomfort c. Dealing i. Adapting to the loss d. Healing i. Integration of loss as part of life; acute anguish dissipated; loss may or may not be forgotten or accepted

SEXUAL DISORDERS
I. SEXUAL DYSFUNCTION 1. Sexual Desire Disorders a. aversion to sexual contact b. Phallic Stage Oedipal Complex son close to mother Electra Complex daughter close to father Oral 0 to 18 months Anal 18 months to 3 years old Phallic 3 to 6 years Latency 6 to 12 years

Genital 12 to 18 years old 2. Sexual Arousal Disorder a. Cannot maintain a physiological requirement for sex b. Some causes: Patient my be taking anti-psychotic, anti depressants and anti hypertensive drugs 3. Orgasmic Disorder - Unable to achieve orgasm 4. Sexual Pain Disorder a. Dyspareunia o Genital pain in men or women associated with sexual contact b. Vaginismus o Involuntary constriction of the perineal and outer vaginal muscles c. Priapism o Prolonged and painful erection of the penis for 24 hours II. PARAPHILIA sexual instinct is expressed in ways that are socially unaccepted or are biologically undesirable 1. Exhibitionism exposing ones genitals to unsuspecting strangers make use of supportive confrontation to a patient masturbating publicly if you enter the room, and the patient is masturbating privately, ignore and provide privacy 2. Fetishism using non-living objects 3. Transvestic Fetishism/Cross Dresser sexual gratification through wearing the clothing of the opposite sex normal kung mga 6 years old, but kung more than 6 years old na, dili na normal 4. Frotteurism/Frot/Frottage touching or rubbing against a non consenting individual 5. Pedophilia sexual activity with the child or children, generally 13 years old or younger 6. Klismaphilia use of enemas to achieve orgasm 7. Sexual Masochism act of being humiliated, beaten, restrained or otherwise made to suffer

8. Hypoxyphilia hypoxy means decreased oxygen auto-erotic asphyxia self-strangulation oxygen deprivation is used to sexually satisfy oneself life-threatening 9. Sexual Sadism psychological or physical suffering of the victim is sexually exciting to the person 10. 11. 12. 13. 14. 15. 16. 17. 18. Plushophilia sexual gratification with the use of stuffed toys Onanism masturbate using a pillow Emetophilia vomitus Hybristophilia killing or committing crimes Coprophilia feces Voyeurism/Peeping Tom observing an unsuspecting person who is naked, disrobing or having sexual intercourse sex spy Zoophilia having sex with animals sexual contact with animals Infantilism desire to be treated as an infant and be dressed in diapers Necrophilia person is using corpses to meet sexual needs Scatalogia obscene telephone calls to attain sexual arousal example: cybersex

III. GENDER IDENTITY DISORDER discomfort with ones sex or the gender role of that sex IV. SEXUAL ADDICTION Obsessive-compulsive sexual behavior that causes severe stress Sex is a more important priority It began with masturbation paraphilia pornography homosexual, heterosexual, bisexual, or orgy (group sex) *** Additional Notes ***

Never place a masochist and sadist in one room Never put in one room an exhibitionist and a voyeur

SOMATOFORM DISORDERS
Somatoform/Psychosomatic psycho meaning mind; somatic meaning body physical symptoms for which no known organic cause or physiological mechanism CAUSES OF SOMATOFORM DISORDER: 1. Primary Gains - benefits from self 2. Secondary Gains - internal or external benefits received from others because one is sick - Example: attention from family members - Example: as well as comfort measures 3. Alexithymia - difficulty identifying and expressing feelings - unconsciously wanting attention from others 4. Malingering - refers to intentional production of false or grossly exaggerated physical or psychological symptoms - motivated by external incentives 5. Factitious Disorder/Munchausens Syndrome - feigns physical/psychological symptoms to oneself solely to gain attention 6. Munchausens by Proxy - person inflicts illness or injury on someone else to gain the attention - to be a hero for saving the victim TYPES OF SOMATOFORM DISORDERS 1. Somatization Disorder - patient has many physical complains - history of at least 4 physical complains - transference of mental experiences into bodily symptoms 2. Pain Disorder - pain in one or more areas of the body severe enough to seek treatment - they are considered to be doctor shoppers 3. Conversion Disorder - characterized by: o sensory dysfunction (muteness, blindness, deafness, loss of tactile sense) o motor dysfunction (aphasia, paralysis, seizures) - the main basis is the presence of La belle Indifference o seeming unconcern with a fairly dramatic symptom o beautiful indifference 4. Body Dysmorphic Disorder - preoccupation with a defect in appearance 5. Hypochondriasis - unrealistic fear of having a serious illness

SCHIZOPHRENIA
it is a type of psychosis mental disturbances that feature withdrawal, affective problems and interrupted thought processes 2 neurotransmitters affected: 1. Dopamine - increased 2. Serotonin - increased 5 MAJOR TYPES OF SCHIZOPHRENIA 1. Catatonic Type - marked by stupor (waxy flexibility) - peculiar movements (stereotypy) - excessive motor activity (stereotypy) - extreme negativism (when they select to do so; such as inability or failure to execute orders) - echolalia (senseless copying of words) - echopraxia (senseless copying of actions) - motoric immobility (same as marked by stupor or waxy flexibility) 2. Undifferentiated - person has pronounced hallucinations and delusions - disorganized thought processes and behavior 3. Paranoid - they have one or more systematic delusions - frequent auditory hallucinations 4. Disorganized - they have confusion or loose of associations - disorganized thought - disorganized speech - disorganized behavior - flat or inappropriate affect 5. Residual - absence of pronounced delusions, hallucinations, confusion or looseness of association - found in chromosome number 6, 12, 19, 21 TWO TYPES OF SCHIZOPHRENIA 1. Type I/Positive - bizarre behavior - hallucinations - abnormal thought form - ambivalence (The coexistence of antithetical attitudes or emotions toward a given person or thing, or idea, as in the simultaneous feeling and expression of love and hate toward the same person) - delusions - develops over a short period of time because this is brought about by increased dopamine 2. Type II/Negative - Alogia (no logic) - affective flattening - anhedonia - attention impairment - avolition (no motivation)

asocial behavior anergia (no energy) causes: o increased VBR (ventricular brain ratio) o decreased Cerebral Blood Flow o Reduction in brain weight (why? Mass of brain is 1,500gms)

DELUSIONS
Refers to fixed false belief DIFFERENT TYPE OF DELUSIONS 1. Somatic Delusions - injury or illness regarding their body 2. Nihilistic delusions - world is ending or that they are dying 3. Persecutory Delusions - being threatened or spied on **Bouffee Delirante - When there is violence and agitation 4. Religious delusions - having special healing powers 5. Sexual Delusions - others know about their intimate activities 6. Delusion of Reference - when you believe that the TV is talking about me - so called because there is a referent material which is the television and radio 7. Delusion of Influence - you believe that you can control other peoples thoughts 8. Paranoid Delusions - extreme suspiciousness - They all think that I am a homosexual **Othello Syndrome when there is morbid or pathological jealousy **Anaclitic Depression when the child aged 6 to 30 months, is separated from the mother (by Rene Spitz) 9. Grandiose Delusions - you claim an identity - believing that you are God, 2nd Virgin Mary, etc ANTI-PSYCHOTIC/NEUROLEPTIC DRUGS 1. Typical/Traditional a. High Potency i. Stelazine ii. HAldol iii. Navane iv. Trilafon v. PROlixin b. Moderate Potency i. MOban ii. LOxitane iii. SErentil c. Low Potency - has the worst side effects, causes photosensitivity

i. THOrazine oldest anti psychotic ii. MEllaril iii. TAractan **Gedankenlautwerden echo de la pense - thought echo 2. Atypical - Clozapine same as carbamazepine that causes blood dyscrasias - Risperidone - Olanzapine easily melts in your mouth so dapat mag drink ka direcho water kay kung mag melt sa imong mouth kay ma change na iyang effect - Pimozide - Sertindole - Ziprasidone - Quetiapine 3. New Generation/Dopamine System Stabilizer - Aripiprazole (Abilify) medicine of the century Extrapyramidal System Side Effects: a. Acute Dystonic Reaction head and neck muscle spasm; it is an emergency case; because this one causes bronchospasm and will occlude the airway; so refer immediately the patient to the physician, and order for Benadryl i. Torticolis neck spasm/wry or stiff neck ii. Opisthotonus severe arching of the back iii. Oculogyrocrisis rolling movement of the eyes Antidotes: a. Diphenhydramine (Benadryl) b. Benztropine (Cogentin) b. PseudoParkinsonism i. Rigid, mask-like facial expressions, shuffling gait, finger and hand tremors (4 to 6 beats per second) Antidotes: a. Parsidol b. Benadryl c. Akineton d. Artane e. Cogentin f. Kemadrin Other Antidotes: c. Akathisia i. Restlessness and agitation ii. Fidget or rock repetitively iii. Motor restlessness d. Tardive Dyskinesia i. The most irreversible ii. Early signs: tongue movement or increased blinking iii. Late signs: protrusion of the tongue and sialorrhea (excessive salivation); increased mouth movement (Rabbit syndrome) iv. Treatment Stop the drug Most irreversible

Most fatal side effect of anti psychotics: NEUROLEPTIC MALIGNANT SYNDROME ANTICHOLINERGIC-LIKE SIDE EFFECTS AND PERIPHERAL NERVOUS SYTEM-LIKE SIDE EFFECTS 1. Blurred vision, photosensitivity * a. Blurred vision i. Foremost goal: SAFETY ii. Nursing Intervention: advise the patient to avoid driving and operating machineries b. Photosensitivity i. Advise the patient to make use of sunscreen (long sleeves, white beamed hat) 2. Orthostatic Hypotension * a. Parameter: i. Systolic Pressure: 20 mmHg ii. Diastolic Pressure: 5-15 mmHg b. Nursing intervention: Advise the patient to rise up slowly 3. Urinary Retention a. Length and Size of catheter for females: Length 3 to 4 inches ; Size Fr 12 to 14 i. Length of urethra 1.5 to 2.5 inches b. Length and Size of catheter for males: Length 6 to 9 inches ; Size Fr 16 to 18 i. Length of urethra 5.5 to 6.25 inches c. Catheterize as per doctors order 4. Nasal Congestion a. Foremost Responsibility: give over the counter decongestants 5. Decreased Sweating/Anhidrosis a. If you cover the patient, it would result to Neuroleptic Malignant Syndrome b. Foremost Nursing Intervention: Provide ventilation 6. Urinary Hesitation a. Foremost Nursing Intervention: Stimulate the patient to void i. Make a swishing sound ii. Pour warm water over perineum iii. Turn on the faucet 7. Sedation a. Foremost Nursing Intervention: Safety b. Do not promote the sedation effect, Wake up and start the day early 8. Constipation a. Fiber: 25 to 35 grms b. Water: 2 to 3 liters 9. Mydriasis dilated pupils a. Stop the administration of the drug if patient is suffering mydriasis 10. Elevated Body Temperature a. Nursing Intervention: Cooling measures (ex. TSB, lessening of blanket, lessening of clothing) 11. Dry Mouth * a. What to do: Offer patient with sugarless gums and candies, oral hygiene, ice chips, sips of water b. If we keep on giving ice chips may lead to fluid volume excess, so be very careful

*Common sa board exam

ANXIETY RELATED DISORDERS


Neurotransmitters affected: 1. GABA (Gamma-Amino-Butyric Acid) GENERALIZED ANXIETY DISORDER 1. DSM IV Criteria a. Decreased ability to concentrate b. Disturbed sleep c. At least 6 months of excessive worry and anxiety d. Muscle tension e. Easily fatigued 2. Nursing Interventions: a. Cognitive Therapy i. We make use of thought stopping b. Behavioral Therapy i. Rewards ACUTE STRESS DISORDER 1. Last for 2 to 4 weeks if it progresses to more than 4 weeks, post traumatic stress disorder na (acute kung within 6 months) 2. The person experienced, witnessed, or was confronted with an event that involved actual or threatened death to self or others, responding in fear, horror/hopelessness 3. Three or more of the following dissociative symptoms: a. Derealization b. Depersonalization detached from mental or bodily processes i. Depersonalization Disorder believing that you dont have a heart; believing that you dont have a skin where in fact it is intact c. Amnesia for an important aspect of the trauma Suppression d. Reduced awareness of surrounding (in a daze) e. Sense of numbing, detachment, or absence of emotional response

POST TRAUMATIC STRESS DISORDER 1. DSM IV Criteria a. Onset i. Acute: within 6 months after the event ii. Delayed: 6 months or more b. Duration i. Acute: 1 to 3 months ii. Chronic: 3 months or more c. Exposure to traumatic event involving threat of death/injury to self or others d. Re-experiencing or reliving the traumatic event: i. Flashbacks ii. Hallucinations iii. Illusions

iv. Distressing thoughts or dreams 2. Interventions: a. Psychotherapy i. Hypnosis ii. Interpretation of dreams iii. Pseudohypnosis iv. Free association b. Family Therapy c. Vocational Rehabilitation d. Group Therapy i. Minimum of 6 and maximum of 10 members ii. It should be homogenous they must have one theme (ex. Rape victims, Alcoholics) e. Relaxation Techniques i. Breathing techniques ii. Aromatherapy iii. Color Therapy PANIC DISORDER 1. Recurrent episodes of panic attacks 2. At least one of the attacks has been followed by one month (or more) of the following: a. Persistent concern about having additional attacks b. Worry about consequences (going crazy, having a heart attack, losing control) c. Significant change in behavior 3. Nursing Intervention a. Cognitive-behavioral Therapy b. Behavioral Therapy c. Breathing Techniques d. Relaxation Techniques PHOBIC DISORDER 1. Irrational Fear 2. Phobia comes from the Ancient Greek word for fear (fobos) a. Kolpophobia fear of vagina b. Medorthophobia fear of penis c. Blennophobia slimes d. Homilophobia sermons 3. Phobic Disorders are intense irrational fear responses to an external object, activity or situation 4. Nursing Intervention: a. Behavioral Therapy i. Systematic desensitization/Flooding gradual exposure of the patient to the feared object (Desensitization); abrupt exposure (flooding) ii. Deep muscle relaxation iii. Re-breathing techniques iv. Self-hypnosis b. Cognitive Therapy i. Recognition of irrational beliefs ii. Stopping of irrational beliefs iii. Replacing of irrational thoughts with new thoughts

OBSESSIVE-COMPULSIVE DISORDER 1. DSM IV Criteria a. Obsessions (persistent ideas) i. Intrusive, inappropriate, recurrent and persistent thoughts ii. What does this do to a person: 1. Produces anxiety b. Compulsion i. Uncontrollable urge to perform an act repetitively ii. Neutralizes anxiety iii. Ritualistic behavior c. Recognition that obsessions or compulsions are unreasonable or excessive d. Obsessions or compulsions cause distress, are time-consuming, and interfere with usual daily functioning 2. Nursing Intervention: a. Behavioral Therapy i. Convey awareness for the need for the ritual but set limits ii. Exposure in vivo and response preventions DISSOCIATIVE DISORDER 1. Alterations in conscious awareness a. Periods of forgetfulness (done consciously) b. Memory loss for stressful events (done consciously) 2. Types of Dissociative Disorder a. Dissociative Fugue i. Episodes of suddenly leaving the home or place of work ii. May assume a new identity b. Dissociative Amnesia i. Client cannot remember important personal information usually of a stressful nature such as birthdate, age, address, etc. c. Dissociative Identity Disorder (Multiple Personality Disorder) i. Client displays two or more distinct personalities d. Depersonalization Disorder i. Persistent or recurrent feeling of being detached from his or her mental process ii. You do believe that you do not have a brain, heart, etc. ANTI-ANXIETY DRUGS (ANXIOLITICS) 1. Non-Benzodiazepines a. Buproprion (Buspar) b. Propanolol ( c. Meprobamate (Miltown) d. Clomipramine e. SSRI 2. Benzodiazepines/Minor Tranquilizers a. Chlrodiazepoxide oldest; discovered 1960 b. Chlorazipate c. Clonazepam d. Lorazepam e. Oxazepam f. Alprazolam g. Diazepam (Valium) 2nd oldest; discovered 1962

Has A Major Reaction With the Following: 1. Succinylcholine Chloride 2. Alcohol 3. Tricyclic Antidrepressant 4. MAOI 5. Antacids 6. Disulfiram (antabuse) given to patients who are alcoholic 7. Nefazodone 8. Phenytoin (Dilantin) a. Avoid restrictive closings *** Additional Notes *** Overdeveloped id antisocial persons Overdeveloped ego paranoid persons Blunt Affect minimized emotional response Labile shifting emotional response Flight of Ideas shifting of ideas Ambivalence opposing emotion done at the same time Palilalia Hi..hi..hi Coprolalia obscene words Perseveration Phenomenon same answer to different questions Verbigeration Delutional Thinking thought process Hallucination sensory perception Schizo functional Alzheimers organic; occurs at 6th decade of life Tourette syndrome multiple motor plus verbal tics; best medicine is Clonidine (Catapres)

SUBSTANCE RELATED DISORDERS


CENTRAL NERVOUS SYSTEM DOWNERS (Psychodepressants) 1. Produce their effects by stimulating inhibitory neurotransmitter Gamma Aminobutyric Acid (GABA) or altering excitatory neurotransmitters (Dopamine and Nor Epinephrine) 2. Different Downers: a. Chloral hydrate b. Barbiturates c. Benzodiazepines d. Gluthetimide e. Methaqualone f. Tranquilizers g. Narcotics i. Codeine ii. Heroine iii. Hydromorphone iv. Opium v. Morphine vi. Meperidine vii. Methadone 3. Short Term Effects of Narcotics

a. b. c. d. e. f. g.

Constipation Restlessness Nausea Urinary Problems Drowsiness Euphoria Loss of pain sensations

CENTRAL NERVOUS SYSTEM UPPERS (Psychostimulants) 1. Increases the release of dopamine and nor epinephrine from pre-synaptic neurons and preventing their re-uptake. 2. Uppers: a. Nicotine b. Methelphenidate c. Phenmetrazine d. Amphetamines e. Caffeine i. 4 cups of coffee in a day is classified an upper; 500 to 600 mg is also significant for you to experience the increasing effect of the upper ii. Signs and symptoms: 1. Anxiety 2. Arrhythmias 3. Depression 4. Insomnia 5. Tachycardia f. Cocaine i. Short-term Cocaine Effects 1. Increased blood pressure 2. Constricted blood vessels 3. Dilated pupils 4. Decreased appetite 5. Increased energy 6. Increased heart rate 7. Increased temperature 8. Mental Alertness PSYCHEDELIC - Producing distorted sensory perceptions and feelings or altered states of awareness or sometimes states resembling psychosis 1. Cannabinoids a. Marijuana (Cannabis sativa) i. Blood shot eyess b. Hashish i. Hash c. Hashish Oil i. Hash oil d. Tetra-Hydro-Cannabinol (THC) 2. Hallucinogens (Psychotomimetic) a. Phencyclidine Piperidine (PCP) i. Angel dust, horse tranquilizer, or peace pill ii. Cardinal Signs: 1. Blank stare 2. Ataxia

3. Muscle rigidity b. Phencyclidine Piperidine Analogues (PCPy) c. Amphetamine Variants i. 2, 5-Dimethoxy-4-methylamphetamine d. Lisergic Acid Diethylamide (LSD) 3. Mescaline a. Derived from cactus plants (Peyote) 4. Psilocybin (Psilocybe mexicana) a. AKA magic mushroom RAVE AND TECHNO DRUGS / DATE RAPE DRUGS 1. Ecstasy (MDMA) a. 3,4 methylenedioxymethamphetamine (MDMA) b. AKA: Adam c. Dose: 100-150 mg d. Signs: i. Euphoria ii. Increased energy iii. Increased self-confidence iv. Increased sociability 2. Drugs frequently used to facilitate a sexual assault (rape): a. Flunitrazepam i. Fast-acting benzodiazepene b. Gamma-hydroxybutyrate (GHB) i. Effects: Rapidly produce sexual urges

CHILDHOOD DISORDERS
ADHD 1. There must be the presence of the following: a. Hyperactivity b. Impulsivity c. Destructibility 2. Causes: a. Prenetal exposure to lead, alcohol, nicotine, cocaine b. Increased dopamine c. Brain damage 3. Characteristics of ADHD: a. Fidgeting and squirming constantly b. Having trouble paying attention to details c. Having trouble concentrating to one activity at a time d. Having trouble waiting for turn e. Impulsively blurting out answers to questions f. Talking constantly even at inappropriate times g. Making careless mistakes in school work h. Running around in a disruptive way when required to be seated or quiet i. Being easily distracted by things going on around them j. Often displacing school assignment, books and toys k. Seeming not to listen even when addressed directly 4. Treatment: a. Diet: i. Megavitamin Therapy

ii. Sugar-Controlled Diets (no to chocolates because they are polysaccharides) b. Psychopharmacology: CNS UPPERS/STIMULANTS (We are after the paradoxical effect) to be given in the morning because they cause insomnia;, right after breakfast: post cebum because it causes loss of appetite) i. Dextro-amphetamine (Dexedrine) ii. Amphetamine Compound (Adderall) iii. Methylphenidate (Ritalinn) iv. Pemoline (Cylert) the last drug of choice because it causes liver damage c. Side Effects i. Weight loss ii. Insomnia iii. Loss of appetite d. Interventions: i. Ensuring the childs safety and that of others (foremost nursing intervention) ii. Improve role performance iii. Simplifying instructions/directions iv. Structure daily routine v. Provide support and education to the family vi. Seat the child in action zones vii. Make sure you are assessing knowledge and not attention span **Psych book by Norman Keltner CONDUCT DISORDERS 1. Persistent antisocial behavior in children and adolescents below 18 years old (pag above 18 years old, Anti social personality disorder) 2. Causes: a. Coercive, ineffective, or inconsistent parenting (main reason) 3. Symptoms: a. Serious violation of rules b. Aggression to people and animals c. Destruction to property d. Deceitfulness and theft 4. Classification of Conduct Disorder: a. Mild i. Minor harm to others ii. Lying, truancy, staying out late without permission b. Moderate i. Does an amount of harm to others ii. Vandalism and theft c. Severe i. Many conduct problems with considerable harm to others ii. Forced sex, cruelty to animals, use of weapons, burglary, robbery 5. Nursing Intervention: a. Decreasing violence and increasing compliance with treatment b. Set consistent limits c. Improving coping skills and self-esteem d. Educate and support the family

OPPOSITIONAL DEFIANT DISORDER 1. Enduring pattern of uncooperative, defiant and hostile behavior without major anti-social violation MENTAL RETARDATION 1. Causes a. Downs Syndrome/Trisomy 21/Mongolism foremost cause b. Simian Crease Transverse palmar or plantar crease c. Goldssteins Sign Wide or great distance between the great toe and the adjoining toe d. Brushfields Spots e. Oriental Eyes epicanthic fold f. Fragile X i. Inherited cause of mental retardation 1. Macro-orchidism 2. High-arched palate 3. Mitral Valve Prolapse 4. Hyperextensible Joints g. Hypotonia 2. Classification a. Mild i. IQ 55-70 ii. Educable mentally retarded b. Moderate i. IQ 40-54 ii. Trainable c. Severe i. IQ 25-39 ii. Sight words and survival skills d. Profound i. IQ less than 25 ii. Require pervasive services and pervasive support COGNITIVE DELAYS 1. Use as many senses as possible 2. Example: - See the red ball - Sit on the red square - Add red color to the drawing - Eat a red tomato TOOLS TO MEASURE INTELLIGENCE 1. 1 to 42 months a. Bayley Scales of Infant Development 2. 3 to 7 years a. Wechsler Preschool and Primary Scale of Intelligence-Revised 3. 2.5 years to Adult a. Stanford-Binet Intelligence Test, 4th Edition 4. 6 to 16 years a. Wechsler Intelligence Scale for Children, 3rd Edition

PERSONALITY DISORDER

CLUSTER A 1. Odd and Eccentric 2. Who belongs to this cluster? a. Paranoid Personality Disorder i. Holds grudges towards other people ii. Interpret remarks as demeaning or threatening iii. Doubts trustworthiness of others iv. Suspicious in others v. Fear of confiding in others vi. Fear personal information will be used against them vii. Become angry and threatening when they perceive they are attacked by others b. Schizoid Personality Disorder i. Chooses to be alone ii. Avoids activities iii. Appears cold and detached iv. Lacks desire for close relationships and friends v. Lacks sexual experiences c. Schizotypal Personality Disorder will progress to Schizophrenia; pag naa na cyay hallucination, delusion and illusion i. Blunted or inappropriate affect ii. Vague, stereotypical, overelaborate speech iii. Ideas of Reference iv. Peculiar thinking v. Suspiciousness vi. Few close relationships vii. Uncomfortable in social situations viii. Magical thinking or odd belief ix. Eccentric appearance or behavior CLUSTER B 1. Dramatic, Erratic and Emotional 2. Who belongs to this cluster? a. Borderline Personality Disorder i. Unstable and intense interpersonal relationship ii. Frantic avoidance of abandonment; real or imagined iii. Self-mutilating behaviors iv. Chronic feelings of emptiness v. Rapid mood shifts vi. Impulsivity vii. Problems with anger viii. Transient dissociative and paranoid symptoms ix. Suicidal behavior b. Histrionic Personality Disorder i. Needs to be the center of attention ii. Uses physical appearance to become the center of attention iii. Uses speech to impress others but is lacking in depth iv. Displays sexually seductive or provocative behaviors v. Dramatic expression of emotion vi. Easily influenced by others vii. Exaggerates degree of intimacy with others viii. Shallow, rapidly shifting emotions (labile affect) c. Antisocial Personality Disorder i. Engages in illegal activities ii. Violates rights of others

iii. Irresponsible in work and with finances iv. Lack of guilt or remorse v. Impulsiveness vi. Aggressive behavior vii. Recklessness d. Narcissistic Personality Disorder i. Believes he or she is special ii. Envious of others or others are envious of him or her iii. Sense of entitlement iv. Takes advantage of others for own benefit v. Needs to be admired vi. Fantasies of unlimited power, brilliance or success vii. Lacks empathy viii. Arrogant ix. Grandiose self importance CLUSTER C 1. Anxious/Fearful 2. Who belongs to this cluster? a. Avoidant Personality Disorder i. Those people who dont take risks ii. No to risk b. Dependent Personality Disorder i. They need others c. Obsessive-Compulsive Personality Disorder i. Perfectionism that interferes with task completion *** Additional Notes *** Somniloquy sleep talking Soliloquy self talking