ANXIETY – subjective emotional occurring when ego is threatened and provoked by unknown.

Type of crisis – resolve after 4 weeks

Developmental
- A parent has been failed to
accomplish the developmental
stages of the child. The
psychoanalytic theory of Erick
Erickson.
Existential Situational
- They feel that they are not living life to the - These include accidents and natural
fullest; they think they don’t have any disasters.
direction in life and don’t know how to
continue with their life.
Mostly sa mga aged person.

ANXIETY FEAR
>There is an external stimuli or internal >Represents danger
>Normal >External stimuli or cause can be physical
>Unavoidable >Afraid of what you know
>Afraid of the unknown >External danger
>uneasiness >outcome define
>no object >has an object same as phobia

Levels and Manifestation of Anxiety

MILD ANXIETY MODERATE ANXIETY SEVERE ANXIETY PANIC ANXIETY
Psychological: Psychological: Psychological: Psychological:
Wide perceptual field: Narrowed perceptual field: Perceptual field: can’t Focus on self cannot process
Irritability immediate task, selectively established connection of environmental stimuli,
Attentive and alert attentive, can’t connect details distorted perceptions,
Motivation is increased thoughts and events Doesn’t respond to doesn’t recognize potential
independently. redirection, awe, cries, danger, and can’t
Physical: Use of automatisms horror communicate verbally.
Butterfly in the stomach (mannerisms) Physical symptoms may Delusions and hallucinations.
Difficulty to sleep develop.
Restlessness Physical: Physical:
Fidgeting Muscle tension, diaphoresis, Physical: May bolt or run
Nausea high pitched sound and faster Severe headache, N/V, immobile
Sweaty rate of speech. Gi problem, diarrhea, trembling, vertigo, Experience inability to move
Shaky urination tachycardia, chest pain or speak.
Nervous worst of all
MANAGEMENT: -Ex: loss of loved ones. You victim of a crime
> Job interview, class >refocusing client with are hyperventilating. Or flight, fright, freeze or mute
performances, oral imagery, speak short, simple maratol naka don’t know
recitation. Subside after easy to understand. what to do.
the problem is solved >relaxation technique MANAGEMENT:
>helping client to identifying a MANAGEMENT: >Remain with the client 5-30
way of controlling it >Ensure client’s safety, talk minutes
with them, and walk with >Ensure that she’s safe with
them. you
>Keep talking
> Put in a non-stimulating
place.

Adaptive
Opposite to dysfunctional.
Attempting to solve the
problem, lvl of anxiety
maybe lessen or subside.
(win-win).
*Naka adopt ang patient sa
technique so na solve sya.
Coping with anxiety
Dysfunctional
No attempt to find a
solution, so level of anxiety
is still there and may
proceed to the higher level
of anxiety. (lose-lose)
*Wala nangitag paagi ang
nurse nga ma solve ang
problem so dli sya
masolutionan.
Maladaptive
Opposite to palliative. No
attempt to find a solution
but the lvl of anxiety will be
lessen, or it will subside.
(lose-win)
Helps only for short term
but will cause oroblem in
the long term.
Ex. Escape and avoidance
Stress eating
Overspending
Palliative
There is an attempt to solve
but there's an instance that
it will not resolve (win-lose)
Nangita kag paagi pero
namatay ang patient
Reducing pain without
curing the cause of pain

Anxiety reducing Technique and Intervention

Cognitive behavior Systematic desensitization Progressive relaxation
Positive aspect, optimism. To dec lvl Same to therapeutic modalities, Visual imagery that allows relaxation
of anxiety. reality situation. in response to stress and anxiety.
Turning negativity into positive Remember: 1st. Informed consent or
mindset permission. Ipa balik2 nimo until
*practice internal dialogue or self-talk mawagtang imo fear

Melieu therapy, effective for patient

who has phobia. Conquer situations or
things to which she's afraid of.

Positive and Negative Behaviors- It is an adaptive or defense mechanism of people with anxiety to reduce level of
discomfort.

POSITIVE NEGATIVE
Would be able to adapt the situation using imagery Converting it into maladaptive behaviors, tension
technique is refocusing the attention to something else, headache, usually it reduces the efficiency of the immune
breathe slowly. system.

3 stages of stress

ALARM RESISTANCE EXHAUSTION

*First time the person >Body fight backs >Body is tired
experiences the stress. >Trying to deal with the anxiety >Immune is weak prone to getting sick
*Upset because of the news >cope with the problem >DEPRESSION
*Overthinking >Agitation >I DON’T CARE ANYMORE
>ANXIETY >Mu sukol sila
>ANGER
TR:
Anxiolytics
First line is SSRI

BENZODIAZEPINE –they are CNS depressants meaning they could act to slow the body and the brain.
Effects if taken: reduce anxiety, promote sleeps, relaxes muscle, and prevents seizure, alcohol withdrawal.
*Should be taken at the same specific time or stress of if indicated.
*Absorbed readily after oral ingestion but is slower in IM administration.
*Can cause withdrawal syndrome
*GABA inhibitory
*Could cause early sedation, low VITAL SIGNS. dugay mawala sa lawas it takes 2 weeks to tapered but dali ra mo effect
*No more alcohol

Antianxiety medication Sedative-hypnotic

AlpraZOLAM (XANAX) EstaZOLAM (Prosom)
Chlordiazepoxide (Librium) FluraZEPAM (Dalmane)
ClonaZEPAM (Klonopin) TemaZEPAM (Halcion)
DiazePAM (Valium) QuaZEPAM (Doral)
LorazePAM (Ativan)
OxazePAM (Serax

Most common benzodiazepines used

Diazepam (Valium) Lorazepam (Ativan) Clonazepam (Klonopin)
First line of agents for status First line of agents for status For anticonvulsant
epilepticus epilepticus
Best benzo Best benzo

Non benzodiazepine

Anti-anxiety
Buspirone (buspar) Proponolol (Inderal) Clonidine
it takes 2-4 weeks before mo effect
ang tambal
Lesser risk and fewer side effects.
No interaction with alcohol or CNS
depressants but not effective for
alcohol withdraw
Hazardous to take with MAOI
Avoid with grapefruit

Overdose to Opioids – treats it with NALOXONE

Overdose to Benzo – treatment is FLUMAZENIL

RAPE – violence and humiliation through sexual means. Intercourse without its consent
Complete Physical Assessment – should be done before the victim has showered, change clothes. PRESERVED EVIDENCE

Sexual Sadists Exploitive predators Inadequate men Rapist

Aroused by pain Objects of gratification Obsessed and fantasies Anger
Objectify women about sex

Nursing Interventions
1. Safety and Security – remain with them
2. Treat injuries
3. Prophylactic for STD
4. Give control back to the patient
5. Obtain consent collection of nails, hair samples or photographs of the wounds

Individual therapy Group therapy Grounding therapy

Focus on restoring the victims sense Groups with the same situational Orienting the patient to the real or to
of control, relieving feelings of crisis to relate. the present. Used when a person
helplessness experience dissociation or flashbacks.

CHILD ABUSE – maltreatment or intentional injury of a child

Form of physical abuse, neglect or failure to prevent harm, emotional care, abandonment, sexual assault, overt torture
or maiming.

TYPES OF CHILD ABUSE

PHYSICAL
Scars, fractures, multiples
bruise during physical
assessment.
*They don’t show any reaction
upon assessment due to
immunity.
SEXUAL
Incest, rape, sodomy (oral
or anal copulation)
exposing the adult’s
genital to the child
NEGLECT
Malicious or ignorant
withholding of physical,
emotional or educational
support
PSYCHOLOGICAL
Blaming, screaming,
constant family discord,
alcoholism, drug abuse or
prostitution.

ASSESSMENT – WARNING SIGNS NURSING INTERVENTIONS

1. Serious injury 1. Ensure safety and well-being
2. Delay or no treatment 2. Full psychiatric evaluation
3. Child or parent giving inconsistent history of the injury 3. Establish trust and communication
4. UTI TEARS OF VAGINA OR RECTUM 4. Play therapy 3-12 years old
5. Evidence of old injuries note reported or can’t be explained. 5. Contact/refer to a social worker

ELDER ABUSE – maltreatment of older adults by family or caregivers

Common in elderly with multiple or chronic mental and physical health or if dependent with a family member.

PHYSICAL PSYCOSOCIAL NEGLECT MATERIAL SELF-NEGLECT

- frequent Isolation, Poor hygiene, lacking Unpaid bills, sudden sale Memory loss,
injuries, fear or helplessness needed medications, of property, bank unresponsiveness,
anxiety towards withdrawal anger dirty smelly activity, changes to will, inability to ADL,
family members environment, rashes, more on about wandering, refuses
lacking clothing valuables, money and medical attention.
property.
TYPES OF ANXIETY DISORDERS

A. PANIC - rapid intense escalating fear and anxiety that last for 15-30 minutes.
Feeling of: Emotional fear, severe panic attack, and sweating, palpitations, and tremors shortness of breath.
Diagnosed: recurrent unexpected panic attack followed by 1 months of persistent worry over future attacks.

Avoidance behavior is a result of:

1. Primary gain- relief of anxiety by performing anxiety
2. Secondary gain- attention received from others as a result of these behaviors

B. PHOBIAS – illogical intense and persistent fear of specific object or situation. Exposure to the object, animal or
situation or when thinking that they will exposed to the trigger
Astraphobia - fear of thunder and lightning
Agoraphobia –fear or anxiety of places from which escape is difficult Autophobia - fear of being alone
Specific Phobia –fear or anxiety caused by an object Claustrophobia - fear of confined or crowded
Social Phobia –fear or anxiety cause by social or performance situations spaces
which leads the person to panic and become incapacitated (unable to Hemophobia - fear of blood
move or perform) Hydrophobia - fear of water
Acrophobia - fear of heights ophidiophobia - fear of snakes
Arachnophobia - fear of spiders Zoophobia - fear of animals
TR: Therapy: behavior therapy, systematic desensitization, flooding rapid desensitization direct confrontation with a
phobia

C. GENERALIZED ANXIETY DISORDER – worry that interfere with daily lives, feeling on edge worries focus on everyday
things such as job responsibilities, family health, or minor matters such as chores, repairs or appointments.
D. SOCIAL ANXIETY DIRORDER- SOCIAL POBUA - Afraid being embarrassed, humiliated rejected or looked down on in
social interactions. Fear of public speaking, meeting new people, eating or drinking in public. That last for six months
E. SEPARATION ANXIETY DISORDER - Fearful of separation with those whom she is attached. Losing someone close to
him, refuse to sleep might dream about someone living him.
Children: 4 weels
Adults: six months

TR: SSRI, Cognitive behavioral therapy- turn negativity to positive thinking

TREATMENT MODALITIES
Milieu therapy Individual Group therapy Cognitive therapies Behavioral
psychotherapy therapies
Called therapeutic Stages: orientation, Basic concepts
community or Defined as the working, termination Automatic thought Behavioral
environmental method of sharing
achieving change Client participate in Techniques: recognizing
Goal: manipulate in person exploring sessions with a group of the automatic thought
therapeutic hospital that his feeling people and schemas modifying
can be carried to other One on one rs with Formal structure and is thought, generating
aspects of his life. the therapist and led by a professional alternatives, daily record
the client. of dysfunctional though
Management 24 hrs and cognitive rehearsal,
Administer medication
Assist clients
SCHIZOPHRENIA - psychiatric condition that has a major impact on persons thinking, feelings and behavior
*Beliefs that doesn’t align with reality
*Diagnosed in late adolescence or early adulthood 15 to 25

Neurosis – aware of what is happening or his/her mental conditions (ego-dystonic)

Psychosis – not aware of his mental condition, there is a detachment, Magical thinking, illusions, and
hallucinations (Ego-syntonic)
POSTIVIE NEGATIVE
DSM-V Criteria
Ambivalence Alogia
Delusion
Associative looseness Anhedonia
Hallucination
Delusions Apathy
Disorganized speech
Echopraxia Blunted affect
Grossly disorganized
Flight of ideas Catatonia
Negative symptoms (psychomotor)
Hallucinations Avoliation

PERSONALITY DISORDER

Schizoid Schizotypal
*no interest in relationship, seclusive to self, loner, *eccentric magical thinking, odd beliefs, aloof,
gamers malignant, scientist, can transition to schizophrenia.
*Crazy scientist

PSYCHOTIC DISORDER
Brief psychotic disorder Schizophreniform Schizophrenia Schizo+affective
0 to 1month 1 to less than 6 more than 6 months Psychotic +mood symptoms
*with or without months manifest two of the
obvious stressor, * 2 or more 5 symptoms Primary- schizo at least 2 weeks
postpartum onset symptoms of DHDGN (Delusions, without the other one. Presence of
*presence of one or for 4 weeks Hallucination, SIGECAPS
more DHDGN *could lead to Disorganize, Negative Secondary- bipolar, depressed
*ages 20 or 30’s schizophrenia or behavior)
*cause by postpartum schizophreniform Examples:
or extreme life stress Schizoaffective disorder, depressed
type
Major depressive disorder with
psychotic features
Schizoaffective disorder, bipolar type
Bipolar disorder with psychotic
features

3. DELUSIONAL DISORDER – bizarre or non-bizarre delusions for at least one month

Non bizarre – happens in real life (being followed, having an infection, deceives by one’s spouse)
Bizarre - doesn’t align with reality
*1 month
* 2 or more DHDGN
4. SHARED PSYCHOSIS: folie a deux, falret syndrome
*contagious, infectious insanity
*occurs in long term relationships
*DHDGN

5. SUBSTANCE MEDICATION INDUCED PSYCHOTIC DISORDER

*hallucinations or delusions after substance use or during withdrawal
*resolved after drug is cleared
*last for weeks if caused by amphetamine or cocaine

TR:
1. Psychopharmacology: antipsychotic – also called tranquilizer or neuroleptics

TYPICAL – FIRST KNOWN developed in 1950

HIGH POTENCY
Treats the inability to sit still, uncontrollable shaking and difficulty in walking
Prolixin FluphenaZINE Haldol Haloperidol
*Long acting injectable prolixin last for 2-3 weeks *Alone or combination with benzodiazepine
lorazepam is used to aggressive or psychiatric
patients stay in control.
2- 4 weeks interval longer

LOWPOTENCY
Cause sedation and poor muscle strength
ThioridaZINE Chlorpomazine
*Children with severe behavioral problems *First developed antipsychotic introduced in 1950

ATYPICAL ANTIPSYCHOTICS
*introduced in 1990
*reduced or no risk for
*treats negative and cognitive symptoms

Clozapine Risperidone Olanzapine Ziprasidone

*First truly new *The most frequently
antipsychotics prescribed
S.E: agranulocytosis, S.E: Orthostatic
seizure, excessive hypotension, sedation,
salivatation insomnia, headache at
higher dosage. Can cause
EPSE
*Injectable form and
proven effective in
treating acute mania and
bipolar
S.E: Similar to risperidone
S.E: Cardiac dysrhythmic
contraindicated with
patient who has history
of myocardial infarction
or heart failure

NEW GENERATION ANTISYCHOTICS

Ariprazole introduced in 2002
>dopamine stabilizers
> control symptoms without side effects
SIDE EFFECTS OF ANTIPSYCHOTICS
Side effects Manifestations Consideration
(extrapyramidal side
effects)
Sedation Drowsiness Patient’s safety. Administer bedtime,
avoid driving
Effects of hormone Decreased libido, amenorrhea, weight gain, Explain, weight client every other day
sexual dysfunction
Dystonia muscle rigidity, oculogyric crisis, torticollis, Occurs 1st week receiving Haldol
writer’s clamp, opisthosomas TR: Benadryl, benzo
Akathisia restlessness, fidgeting, jitty feelings and Most common EPSE poorly to treatment
nervousness inability to sit still *major reason patient stops taking meds.
TR: propranolol
akinesia: absence of movement
bradykinesia: slow movement
Tardive dyskinesia involuntary movement, lip smacking tongue Late appearing: 6 months or more
protrusion, chewing blinking, grimace *stops with sleeping
*reappear all the time
*decreasing or discontinuing can arrest
progression
Induce pseudo- Tremors, shuffling gait, drooling, cogwheel 1-5 days, most in women and dehydrated
parkinsonism rigidity, stiff, stoop posture, mask like face, arm clients
swing TR: change it to amantadine

Bradycardia: coarse pill-rolling

Orthostatic On standing patient experience drop in BP Rise slowly, hold med if there is rise by
hypotension 30bpm per 30mmhg
Neuroleptic malignant fever, sweating, muscle rigidity, tremors, Occurs with high potency antipsychotics
syndrome impaired ventilation, leukocytosis, 2 weeks if therapy after increase dosage,
should not be reinstituted for 2 weeks
Immediately discontinue all drugs

TR: Dantrole, bromocriptine

Antipsychotics
Anticholinergic Constipation, dry mouth, blurred vision, Freq sips of water, sugary candy or
Effect orthostatic hypotension, urinary retention gums, do not drive, foods high in
and nasal congestion, then tachycardia. fiber, be alert for narrow glaucoma.

Agranulocytosis Fever, malaise, ulcerative sore throat, Emergency and develops abruptly,
leucopenia do weekly cbc, discontinue drug
immediately when cbc drops 50% or
<3,000, need reverse isolation
Seizure Uncontrollably jerking of the body, repeated Occurs in clozapine may have to
contraction and relaxation technique discontinue clozapine.

PRODROMAL
*Early stage not recognized until
diagnosed
*withdrawal, isolation, anxiety,
difficulty concentrating, poor
hygiene, sleep problems,
irritability.
PHASES OF SCHIZOPHRENIA
ACTIVE
*Obvious for 2 years
*Hallucinations, paranoid
delusions, lack of eye contact, flat
affect, changes to motor behavior,
confused.
RESIDUAL
*Resemble symptoms in
prodromal phase and some of
active phase remain.
Lack of emotion, social withdrawal,
eccentric behavior, illogical
thinking, conceptual
disorganizations, frank violations.
PERSONALITY DISORDER – way of thinking and behaving. They become inflexible and maladaptive and significantly
interfere with a person function. 1 year if diagnosed before age of 18
Personality disorder is ego syntonic: No self-awareness. They don’t know they have problem.
* 10 to 13 occurs more on low socioeconomic groups and unstable
*45% they have coexisting personality disorder

CLUSTER A – ODD and ECCENTRIC they tend to involve thinking and behavior that appears unusual or eccentric to
others. This often leads to social problems.

Paranoid Schizoid Schizotypal

mistrust and suspicions of
others tend to always cynical or
pessimistic view of the world,
reality testing is intact
TR: serious straightforward
approach
gamers, detached from social
relationships, excessive reclusiveness,
no motivation for relationships, blunt
affect, hides in work
*unable to feel pleasure, wants to be
alone
TR: assist client to find case manager
scientist they have magical thinking, type
of schizo could turn into schizophrenia
*suspicious
*They believe they have special power
*dress in unusual ways
TR: develop self-care skills, social skills
training

CLUSTER B – DRAMATIC, EMOTIONAL OR ERRATIC

Borderline personality Histrionic Narcissistic Antisocial

disorder
*Unstable mood,
negative self-image
border between neurotic
and psychotic
*high risk for non-suicidal
self-injury (cutting,
tattooing)
*bad or good
*suicidal behaviors
*reckless and impulsive
*Highly attention seeking
*seductive, craves center of
attentions, sexually
promiscuous concerned with
appearances.
*self-entitled, lacking
empathy, grandiose,
exaggerate their
accomplishment.
Self-importance
Excessive need for
admiration
conduct personality disorder
*no regard for others, tend to
be criminal, violet or
sociopaths.
*manipulative
*childhood histories or abuse,
violence, cruelty to other
animals, enuresis.

CLUSTER C – ANXIOUS AND FEARFUL avoids or clings to people

OCD Avoidant personality disorder Dependent personality disorder
*Ego-dystonic *Hypersensitive to criticism *Rely on other people for emotional
*They know they have problem so *Low self esteem support and validation
they Dislike it. *Desire rs but extreme anxiety *Always in rs
*focus on details and order *Nervous, they have interest but they *Tolerate abusive rs.
*Perfectionist are afraid to initiate *Can’t decide for themselves.
*wanting to be in control

OCPD - overly rigid with order, control, perfectionist

>over kaayu, if dli nya mabuhat hunahuna nya mo buto iyang brain
SAS

BIPOLAR DISORDER – changes in a person’s mood, energy and ability to function

Manic- abnormally happy
Hypomanic- overly depressed
Mood episodes: intense emotional states 3. CALCIUM CHANNEL BLOCKERS

*Does who have not responded to lithium

1. BIPOLAR I - experience manic episode, worse of them all
or anticonvulsant will not likely to
*Manic episode last one week. Highly spirited or irritable most of the days
respond to these meds.
1. Decreased need for sleep (energetic than usual)
*calcium channel blocker
2. Faster speech
*treat bipolar patient that have
3. Racing thoughts, changing ideas when speaking
hypertension, supraventricular
4. Distractibility, increased activity, reckless/
arrhythmias, pregnant because
*Hypomanic – last for 4 days in a row. Not really reckless
teratogenic is much lower risk.
2. BIPOLAR II
Kindling- occurs after severe withdrawal
*A person should have at least one major depressive episode and 1
syndrome usually in alcohol.
hypomanic
*Return to normal after mood episodes
Meds: Verapamil, NimodiPINE, NifediPINE
*Have other mental illness anxiety, substance abuse

3. CYCLOTHYMIC – milder, mood swings

Emotional upside down but less severe than bipolar 1 or 2
*At least 2 years, have never stopped for more than 2 months.

TR: MOOD STABILIZERS – lithium, valporic acid, carbamazepine, lamictal, antipsychotics, oxcarbazepine

1. LITHIUM – most toxic

Blood level checked once a month
Lithium blood is taken 8-12 hours after the last dosage. No antidote for lithium poisoning
Take effect 1-3 weeks for symptoms to subside
Osmotic diuretics mannitol (diamox) or carbonic: decreases lithium levels by increasing secretions. For lithium toxicity

MILD TO MODERATE MODERATE-SEVERE SEVERE

1.5-2 meq/L 2-3meq/L >3meq/L
Diarrhea, vomiting, coarse hand Hyperactive deep tendon reflexes, Seizure, organ failure, renal failure,
tremors, lack of coordination vertigo, slurred speech, nystagmus, peripheral vascular collapse, coma,
tinnitus death

2. ANTICONVULSANTS – treatment for mania through improved mood stability of those with epilepsy. Used for those
who were resistance to use lithium treatment. It relaxes the brain to prevent seizure
Valporic Acid (Depakene, Lamotrigine(Lamictal) Carbamezapine (Tegretol) Oxcarbazepine
Divalproex) It delays the onset of mood Can cause decrease of Does not have serious
Commonly used drugs for episodes serum levels of other adverse reactions
bipolar anticonvulsants and oral
S.E: Stevens-Johnsons contraceptives Therapeutic serum level:
*1-2 weeks syndrome (serious rashes 15-35 mcg/mL
*can be used with lithium could cause death S.E could cause lethal
and antipsychotics overdose, not for pregnant,
S.E: GI prob, diabetes
thrombocytopenia, hepatic
failure
DEPRESSION – Feelings of sadness, guilt, hopelessness, social withdrawal, lack of energy, low motivation, sleep
problems, thoughts of suicide, and self-esteem lack of motivation. Goes on for 1 week
> Cyclical meaning it come and go, it also has future episodes.
CAUSES: changes in hormones, genetics.
>Decrease of interest

Neurobiological Cognitive behavioral Psychoanalytical

High familial and genetic patterns
imbalance of the neurotransmitter
norephi and sero
Low level of tryptophan
loss of someone or something that has
sentimental value (reinforcement
theory: reward or punishment)
Cognitive triad: Negative view of set
of the world and of the future
Arouse from withdrawal of maternal
love and support during the oral phase
and later experience loss.
Impairment of social relationship,
abundance, rejection from fam
members or from childhood.

CRITERIA: five or more of the following presents in 2 weeks Agitation or retardation

Depressed mood every day or feelings of sadness (dysphoria) Anergia
Lack of pleasure or interest (anhedonia) Guilty
Weight loss, weight gain or decrease or increase in appetite Indecisive
Insomnia Suicidal ideation

A. MAJOR DEPRESSIVE DISORDER (clinical depression) – last for 6 months to year or more
Low serotonin, norepinephrine, dopamine
>very sad, discourage, anxious, hopeless, very serious
>2 weeks of a sad mood or lack of interest
A. 5 out of 9 symptoms SIGECAPS
Sleep B. Significant distress to daily life
Interest C. not due to substance abuse
Guilt D. no medical condition
Energy E. Not manic or hypomanic
Concentration
Appetite
Psychomotor activity
Suicidal ideation

B. PERSISTENT DEPRESSIVE DISORDER – 2 years without remission.

C. PREMENSTRUAL DYSPHORIC DISORDER – 1 year
> Menarche beginning.
>5 symptoms during the week before menstruation

C. BEREAVEMENT EXCLUSIONS- depressive symptoms last for 2 months following the death of a loved one

D. DYSTHYMIA - persistent depressive disorder for 2 years or more

Mild symptoms for long period
Changes in appetite or sleep, esteem, concentration, hopelessness for
 POSSIBLE NURSING DIAGNOSES FOR DEPRESSION
Mood disturbances: Educate about depression and TR, observe
and document, administer antidepressants.
Dysfunctional Grieving: Encourage verbalization of thought and
feelings, foster communication between families.
Risk for Self-directed violence: maintain a safe environment,
Initiate suicide precautions, risk suicide, ventilation of feelings
Disturbed thought process
Impaired social interactions: participation in groups and social
activities, physical activities
Social Isolation: Encourage participation in groups and activities
Self-Esteem disturbances: Engage in simple task, praise
accomplishment
Self-care deficit: Assist client in assuming responsibility for
hygiene and grooming, give step-by step process
Imbalance nutrition less than body req: Small frequent meal
and fluids, monitor food intake, sit down with the client during
eating and encourage
Chronic low self-esteem: Engage in simple task, assist in
identification of strength,
Disturbed Sleep pattern: Provide rest period after activities,
reduce stimulants in the evening, encourage to stay out of bed
during the day, relaxation.

TR:
1. Non pharmacologic – psychotherapy
2. ECT
3. ANTIDEPRESSANTS

FIRST LINE: SSRI selective serotonin reuptake inhibitors

*effective that has fewer side effects
*indicated for bulimia, obesity, OCD, depression.

Prozac (fluoxetine) Zoloft (sertraline) Paxil (paroxetine)

Approved for bulimia, PDD, promote Treatment for depression, PTSD and Depressive relapse, teratogenic.
smoking cessation, Major depression. social anxiety
Long life, less likely to cause
withdrawal syndrome

Side effects:
1. Serotonin syndrome if mixed with TCA
2. St. John Wort (Herbal)
3. SSRI+MAOI = fetal
4. Mental changes
5. Discontinue first for 2 weeks then proceed to the next line.

SECOND LINE: TCA tricyclic acid

*overdose is an issue since it takes time to achieve the therapeutic result. 2-4 weeks
*avoid TCA using other CNS depressant
*drugs that have anticholinergic properties are not allowed
*mixed with MAOI fatal
*sunblock is required can cause photosensitivity
PHYSOSTIGMINE (ANTILIRIUM) - antidote for TCA toxicity

Tofranil (imipramine) Nortryptiline (aventyl) Elavil (Amitryptiline) Sinequan (Doxepin)

Depression, enuresis, Nerve pain, nocturnal Most toxic Depression and anxiety,
improve mood, sleep, enuresis, depression insomia
spetite and energy
THIRD LINE: MAOI Monoamine Oxidase Inhibitors
*Administered to hospitalized patients or to individuals to can be supervised.
*not much used because fatal
*interaction with tyramine foods could be fatal.
NOTE: undergo diagnosis of HR (ECG)
Consistent monitoring VS. Increased VS, so anti-hypertensive is given.

Avoid:
14 days interval between drugs TCA and SSRI
Potentiates alcohol and their medications
Hypertensive crisis- happens when taken with tyramine foods + MAOI
Tyramine foods- high protein foods, beverages dairy products fruits and vegies, meats, chocolate

Parnate Tranylcypromine Marplan Isocarboxazid Nardil Phenelzine

Depression by restoring the balance of Depression by restoring the balance of Depression by restoring the balance of
neurotransmitters in the brain. neurotransmitters in the brain. neurotransmitters in the brain.

ECT – ELECTROCONVULSIVE
Administration of electric shock (70-150V)
Through electrodes in the temple for 0.2 – 9.0 seconds
Producing 30-60 seconds of grand mal seizure

Seizure more than 180 seconds is unfavorable and terminated with diazepam or a benzodiazepine.
Action: alters endocrine system
Side effects: temporary memory loss, confusion, headache
Contraindication: Intracranial hemorrhage, acute MI, severe hypertension

Pre-treatment care: signed informed consent, NPO 6-8hrs, dentures, void, baseline v/s.
Premeds: atropine sulfate to decrease secretion and to counteract ECT
Methoxital (brevital) short acting barbiturates CNS depressant, including coma
Succinylcholine (Anectine) muscle relaxant maintaining IV line and bite-block

Post treatment care: place patient to side to prevent aspiration, oxygenation and maintain quiet environment.
Orientation of time, place, and person.
Anterograde amnesia: can’t recall new information or after treatment
Retrograde: can’t recall events before the treatment
 TRAUMA AND STRESS
When a person experiences a distressing event or series of events, such as abuse, a bad accident, rape or other sexual
violence, combat, or a natural disaster, they may have an emotional response called trauma.

A. POST-TRAUMATIC STRESS DISORDER PTSD - a person witness an extraordinarily terrifying and potentially deadly
event.
Experience: horror, helplessness, serious injury or threat a serious injury or death.
Common in: combat, natural man made disasters, sexual terrorist attacks, serious accidents or illnesses, sexual or
physical assault, and various forms of abuse.
Diagnosis – at least 5 months after the trauma

PTSD symptoms for 1 month

1. Re-experience symptom (dreams, or walling recollections and flashbacks, bad dreams, frightening thoughts)
2. One avoidance symptom (staying away from places, avoiding thoughts)
3. Two arousal and reactivity symptoms (easily startled, tense on the edge, difficult sleeping, angry outburst)
Two cognition and mood symptom (trouble remembering trauma, negative thoughts, distorted feeling or guilt)

B. ACUTE STRESS DISORDER - Severe anxiety and other symptoms for 1 month after exposure to an extreme traumatic
stressor death, accident or a person experience, witnessed or were confronted with an event like: death, serious injury.

C. ADJUSTMENT DISORDER- development of emotional or behavioral symptoms in response to stressors within 3mths
Positive stressor: wedding or new home, winning lotto, jackpot, business is booming
Negative: death, break up, loss of job
Symptoms:
Marked distress that is in excess of what would be expected
Significant impairment in social
Once stressor has ended, the symptoms do not persist for more than an additional of 6 months of it could be PTSD

TR:
Cognitive therapy
Exposure therapy for PTSD
Eye movement desensitization and reprocessing- guided eye movement
Psychopharmacology- antidepp and anti-anxiety
OCD OBSESSIVE COMPULSIVE DISORDER
The person knows these thoughts are excessive or unreasonable but believes he or she has no control over
them. Unwanted thoughts, images or impulses.
EGO DYSTONIC
obsessions over germs or cleanliness
compulsion are ritualistic, repetitive behaviors to relieve OCD
interfere with daily lives

Common obsessions
*Contamination, safety, worrying about forgetting something, double checking, worrying about straight
objects,

Common compulsions
*Checking rituals, chanting or praying, washing and scrubbing, orderliness, hoarding, counting.

Treatment: behavioral therapy

Exposure- involves assisting the client that he/she avoids
Response prevention- involves delaying or avoiding performance
BDD BODY DYSMORPHIC DISORDER BDD
*Imperfections about the physical appearance
ritualistic behavior
Spends: 1 to 8 hours the mirror
Treatment: ssri, tca, neuroleptics, lithium, MAOI, psychotherapy

HOARDING Person’s irrational, persistent difficulty in discarding or parting with possessions regardless of their value.

Stress about throwing the items

Distrust about other touching their objects

TRICHO TRICHOTILLOMANIA
Hair pulling disorder, head, eyelashes, eyebrows, beards underarms, scalp most common.
Pulling is her coping mechanism
Develop around 9 to 13 years old

EXCORIATION
Skin-picking disorder, rubbing its skin until it bleeds without knowing.

Treatment:
1. Antipsychotics, antianxiety, antidepressants
2. Habitat reversal training- new hobbies or a stress ball
3. Stimulus control- changes into the environment to prevent from skin pricking, wearing gloves or band
aids
 SOMATIC SYMPTOM AND RELATED DISORDERS AND DISSOCIATIVE DISORDERS

Somatic symptoms disorders

Somatization Somatic symptom disorder

Mental experience and states into bodily symptoms More bodily pain including neurologic problem, G.I complaints,
sexual symptoms. Not traceable to physical cause or substance
abuse.

Other somatic symptom disorders

Illness Anxiety Disorder
(hypochondriasis)
*Concern that they have serious
disease, minor complaints are
very serious. Doctor shopping.
Conversion disorder/ functional
neurological symptom disorder:
*neurological symptoms can’t be trace
back to medical care
*weakness or paralysis, abnormal
movement, blindness, hearing loss. Loss
of sensation or numbness, seizures
Other specific symptoms
Occur for less than 6 months or may
involve called pseudocysts – false
belief woman have that they are
pregnant for a long time.

Malingering Munchausen by proxy Factitious

Intentional production of false or
excessively exaggerated physical
sx.
All of these will never be happy if
they have a negative result.
Inflict illness or injury on someone rather
than self to gain attention to medical
personal or to be a hero of the victim.
*Intentionally produces fakes or
psychological symptoms to gain
attention inflict injury to self.
*uncommon but occurs with medical
health workers
*to assume the role of caregiver

Dissociative disorder
Dissociative identity Dissociative amnesia Depersonalization disorder Derealization
disorder/ multiple *difficulty remembering *Detachment from actions, *Feeling or unreality or
personality disorder important info about feelings, thoughts and detachment from or
*Personality states self sensations as if they are unfamiliarity with the world,
*gaps in memory about *last over minutes watching a movie. inanimate object or all
everyday events, hours, days months or *I am no one I have no self. surroundings. She’s a fog,
personal information years, dream, bubble.
and or past traumatic
events

Average onset: 16 -20 (problem with life starts)

TR: psychotherapy, hypnotherapy, adjunctive therapy. Act or movement therapy connect with parts of their mind

Dissociative fugue: unexpected travel away from work and home with a loss of memory from traveling. Confusion about
identity
Mapping- identify different personalities, relationship between them are explored.
 EATING DISORDERS
Behavioral conditions characterized by severe persistent disturbances in eating behavior.

ANOREXIA NERVOSA BULIMIA NERVOSA BINGE EATING

Refusal to maintain body weight Eating a large amount of food, rapidly Lose control over his eating
BMI: 17kg and secretly for 2 hours. Sense of lack Not followed by laxatives
Intense fear of gaining weight even over eating during episodes. Doing these Large amount of foods for 2 hours
though underweight twice a week for 3 months. Eating even though full
Denial of seriousness current low Fast eating, eating alone or in secret
body weight Prevent weight gain: purging, use of Ashamed or guilty about eating
Amenorrhea for 3 cycles laxatives, self-induced vomiting, enema, 2 weeks for 6 months at least
diuretic, fasting, and excessive exercise. Or once a week over the last 3
Ages of onset: 14 to 18 more months.
conscious with their body women Age of onset: 15-24
TR: SSRI Prozac, ant seizure,
S/S: topiramate and Vyvyan’s and ADHD
S/S: Binge eating followed by purging:
Refuses to eat binge-purging cycle
Plays with foods eat small amount Loss of teeth enamel esp. posterior front
Dry skin teeth
Absent menses Calluses on dorsum of fingers or scars on
Hypothermia, hypotension, dorsum of hand
bradycardia Russell’s sign: Reddened knuckles
Enlarged parotid gland
Increased peristalsis, rectal bleeding or
constipation

Paraphilias

Exhibitionism- exposing genitals to stranger

Voyeurism- mamuso, manyakis, peeping
Fetishism- use of nonliving objects by the person
Pedophilia- sexual act involve child
Transvestism fetishism- crosses dressing
Frotteurism- rubbing/touching against non-consenting person
Sexual masochism- beaten, receive pain
Sexual sadism- inflict pain
Zoophilia- sexual relation to animals
Necrophilia- from cadavers
Coprophilia- defecated the partner
Coprophagia- desire to eat feces
Telephone scatologia- phone sex, wordings
Computer scatologia- sexual through comp
 Substance Abuse – using drugs

Polysubstance Abuse – more than one substance combined illegal or prescription.

Substance dependence – persistent use of alcohol or other psychoactive drugs. Can cause addiction and withdrawal
symptoms when drug is used or stopped completely
Tolerance – response to a drug that occurs with repeated use
Withdrawal –persistent desire or successful efforts to cut down or control use.

Classic theory- view addiction as a disease chronic and progressive

Psychodynamic theory- ego as structure of personality that regulates thinking and control, not functioning well in
addiction
Social Learning and Conditional theory – Offers substance as a reward

ALCOHOL
Alcoholism- most abused drugs. A CNS depressant. 80% absorbed in small intestine and 20% stomach

Blood Alcohol Level: 100-150 mg/dL

0.15% - legal definition of intoxication
0.40% - coma, respiratory depression and death occurs

Effect: sedation, decreased inhibition, relaxation, decreased coordination, impaired judgement, slurred speech, sexual
dysfunction.
Overdose: BAL: 0.40%stupor, cardiac arrest, coma BAL: 0.50% death
Withdrawal syndrome: anorexia, irritability, nausea, tremors, insomnia, tachycardia increased V.S, hallucination,
delirium, tremens.

Side effects:

Delirium Tremens
Wernickles encephalopathy
Korsakoff’s syndrome
most serious from alcohol withdrawal, 6 hours from last drink and life is
threatening. Seizure confusion, disorientation Drug of choice: benzodiazepine
acute reversible neurological condition associated with thiamine deficiency or VIT
B1
Most serious form ataxia, leads to nystagmus and diplopia
chronic irreversible disorder: confusion, memory loss, learning deficit and
confabulation.

Peripheral neuropathy vitamin b deficiency

Alcohol myopathy muscle pain, swelling and reddish tinged urine

Sexual dysfuncion interferes with normal sex

Alcoholic cardiomyopathy congestive heart failure

Cirrhosis HPN, ascites, esophageal varices

Alcoholic management
Recovery begins but does not end with abstinence

Substance Expected Dependence Behavior-related to overdose Withdrawal Syndrome

OPIATES Euphoria, pinpoint constricted Unconscious , respiratory Watery eyes, dilated pupils,
(heroin, pupils. Nausea, constipation, slurred depression, cardiac arrest, coma anxiety, yawning, vomit.
morphine, speech and death 8-12hours after last dose
codeine,
opium,
methadone)
Amphetamines Euphoria, insomnia, hyperactivity, Restlessness Depression and fatigue.
hyper alertness, fine tremors, May lead to psychotic
dilated pupils behavior and suicide
2-4 days from last dose
Hallucinogen Distorted perception, grandiosity, Panic and psychosis Bad trip and flashbacks
hallucination, illusion, dilated pupils,
hypertension, and increased
salivation
Cocaine “most Grandiosity, pressured speech, Seizure, respi dep, cardiac Severe craving, depression,
addictive drug tachycardia, hypertension and arrhythmia, delirium fatigue and anxiety
known to man” diaphoresis
Marijuana Red eyes relaxation mild euphoria, Psychosis Anxiety, restlessness, lack
loss of inhibition, dry mouth, of appetite, sweating,
paranoid malaise, nausea
Phencyclidine Euphoria, perceptual distortion, Drowsiness, stupor, grand mal NONE
PCP violence, antisocial behavior, seizure and death
increased salivation and nystagmus

BENZODIAZEPINES - Alcohol withdrawal and use to suppress the symptoms of abstinence

DISULFIRAM ANTABUSE Help to deter clients from drinking. Severe reactions happen: flushing, throbbing headache,
dizziness, N/V
METHADONE – substitute for heroin in some maintenance
LEVOMETHADYL – narcotic analgesics used to treat opiate dependence
NALTREXONE (REVA) opioid, antagonist treat overdose
CLONIDINE CATAPRES – treat hypertension given to client wit opiate dependence to suppress some withdrawal

Al-anon family group: support services for adults who abuse alcohol
Alcoholic anonymous – help member overcome their addiction to alcohol
Dual diasgnosis.org – access to resources for people with mental illness and substance abuse
NEUROLOGICAL DEVELOPMENT – manifest early in development before the child enters grade school, produce
impairments of personal, social, academic, or occupational functioning.

A. INTELLECTUAL DISABILITY – mental retardation

Below average intelligence or mental ability, lack of skills necessary for day to day living, can still do and learn new skills
but they learn them more slowly. Primary limitations (potty training)

Intellectual functioning also known as IQ- ability to learn, reason make decision and solve problems
Adaptive behavior- life skills for everyday life. Communicate effectively, interact with others and take care of one selves

Symptoms:
>rolling over, sitting up, crawling or walking late
>talking late or trouble talking
>slow to master potty training, dressing and feeding self
>difficulty remembering thing
>tantrums
>difficulty with problem solving or logical thinking

Conceptual area Social area Practical area

memory, reading, writing in math thoughts and feelings, interpersonal Personal care, health and safety,
skills, social judgement money management, task org.

Average IQ is 100 range of 85-115

Disable if less than 70-75
Mental retardation diagnosed between ages 18 years old

Mild 52-69 Moderate 36-51 Severe 20-35 Profound 19 or below

Minimal to no assistance.
Can live independently with
minimum level of support.
>educable able to person 6th
grade
>walking delay
>delay developmental
milestones
Trainable, able to perform 2nd
grade level with moderate
supervision
>can attend to their own
personal care
Requires daily assistance Requires 24 hours care
with self-care activities Vocational task with
and safety supervision supervision
*Little or no
communication Sugo-sugoon.
*No schooling but can be
train a simple vocational
task

TYPES OF SUPPORT NEEDED

Intermittent Limited Extensive Pervasive

occasional support support such as a day program ongoing, daily high level support for all activities,
needed in sheltered workshop extensive nursing care
B. ATTENTION DEFICIT HYPERACTIVITY DISORDER- inattentiveness, over activity and impulsiveness. Boys common
Inattention, hyperactivity, impulsiveness
Impairment of social relationship
Dec of attention span
Onset: 5 to 7 years old toddlers, roam around, safety precaution
Nutritional status- foods that easily hand carried
Avoid highly caffeinated or chocolates

Onset and clinical course

Begins in preschool or school, problem much younger age
As infants they are fussy and temperamental and have poor sleeping pattern, always on the go into everything

INATTENTIVE BEHAVIORS HYPERACTIVE IMPULSIVE BEHVAIORS

Misses details Fidgets leaves seat
Careless mistakes Runs or climb excessively
Difficulty sustaining attention, don’t listen, don’t do Can’t play quietly
chores or homework, no organization, avoid task Always on the go
requiring mental effort Talk excessively
Blurts out answer
Interrupt
Can’t wait for turn

TR:
Psychopharmacology: methylphenidate (ritalin)- reduce hyperactivity, mood lability, impulsivity
Therapeutic play 7 to 12 years old

C. AUTISM SPECTRUM DISORDER ASD

Symptoms Manifestations
Autism No later than 3 years of age
No eye to eye contact Social communication deficit, social interaction, repetitive behavior
Maturity of cognitive aspect No or little eye contact makes few expressions towards other. No gestures
Loves to engage object for communication, any mood or emotional affect.
Promote safety, tantrums bang his head Hand flapping, body twisting or head banging
Echolalia 80% starts in infancy
Hand flapping 20% normal growth and development until 2 or 3 years of age
Rocking on body genetic, or relative link
goal of TR: reduce behavioral symp and to promote learning

Asperger’s disorder – autism however there is no language and cognitive delays involved.
Rett’s disorder - Impairments in language and coordination, and repetitive movements, slower growth, tantrums
Opposite Defiant Disorder – disobedience, argumentative, exploitive angry outburst. 3rd common psychiatric preschool.
Conduct Disorder – serious violations
Separation anxiety disorder – separation from mother or caregiver