Professional Documents
Culture Documents
Mental Disorder
Alteration in…… That affects ones:
>
perception self -
awareness
>
Personality Interpersonal Relationships
>
Mood
> Reality Orientation
Behavior
>
Thought
Activities of Daily living ( ADCs)
>
Logic
cognition
>
medications are ∅ a
therapeutic tool
p
Principles:
S sit :
facing the client
0 :
open posture
↳ inhibitions !
no
L :
Lean forward
F
Eye contact
:
↳ most
important principle
R : relaxed
reliable form
p more of communication
NON-VERBAL communication
Paralanguage – Tone Volume Intonation ,
,
Social ( 12ft)
Public ( 15ft)
VERBAL Communication
Sympathy vs. Empathy
Nurse 1: “I feel sorry for you.” Focuses on
→
the nurse
patient
Nurse 1: “It must have been very difficult for you to lose you sister when you needed her most.”
Nurse 2: “I know what it felt like to lose a sister, I lost mine when I was six.”
OFFERING SELF
make them feel that
→
someone is willing
to listen / be
[
there .
SILENCE
↳ am , µ
, , www..my , ,,
•
BROAD OPENING
↳ allows the
patient to direct the conversation
( demands an
explanation ]
1 TOPRANK REVIEW ACADEMY INC – Prof. Kenneth Arzadon, RN, UK-CBT Passer
GENRAL LEAD
“Go on.”
“And then?”
conveys understanding
⑧ RESTATING
of patient 's statement ;
→ ↑ confidence to express /
communicate effectively
1.
→
Client: “I’m-
feeling sick inside.” ↳ could mean a lot of things
>"Pfnnt9VeÑonsiP÷
suicidal
CLIENT: “Life is hard. I want it to be done. There is no rest. I just want to sleep and never wake up.”
NURSE: “I hear you saying things seem hopeless. I wonder if you are planning to kill yourself.”
alternative
PLACING EVENTS IN SEQUENCE → also an
for YYHY ?
“Describe where you were and what you were doing when you collapsed.”
Cognitive Behavioral Therapy
Patterns of patient 's thoughts (thoughts → Behaviors )
[
IDENTIFYING THEMES
@ “What comes into your mind each time you….?”
“What do you do each time you argue with your wife?”
FORMULATING A PLAN →
for px w/ anger
management issues
SUPPORTIVE CONFRONTATION
''I know this isn't easy to do, but I believe you can do it.“
“It would be difficult at first, but you’ll get through it.”
µµµµµm,
"
"
I can see
•
. . .
" "
You seem
•
. . .
''
You sound
"
•
. . .
"
It seems
"
•
. . .
2 TOPRANK REVIEW ACADEMY INC – Prof. Kenneth Arzadon, RN, UK-CBT Passer
?⃝
NURSE-PATIENT RELATIONSHIP
Most Important Element: _________________
Acceptance → nurses can
refuse endorsement !
Purpose: ____________________________________________
To facilitate helping relationship a
Professional Relationship
Elements of a contract:
>
Time Duration Venue , ,
>
Termination
> Patient / Nurses responsibilities
Importance :
/ Introspection
orientation RAPPORT µ
self - awareness
↳ ways to ↑ : good whir mat .
assertive Comm .
attachment
① Resolve issues
Working
Your Past conflict
autobiography /
◦
T C Farmer
@ Determine your own thoughts / beliefs
③ Determine your pre -
conceptions
errand intern
determine feelin sepang
.
.
termination
ORIENTATION
-
-
◦
set the contract w/ the patient
Involve the patient in
planning
°
÷*""*i÷i
%
A-:$
: ÷ :÷ ;€*
Problem: Resistance of the Patient
* *
¥
:
•
WORKING
Nurse’s Responsibility: set good working relationship
→
longest phase of
nurse -
patient
relationship
a
.
×
¢ .
⑧oB⑤¥§
$
Goal: Assertive communication Encourage
verbalization of feeling
#
Problem:
↳
"" " " "" " " "" " "
M" %¥¥¥¥8¥8¥⑧⑧ "
Transference ( RN ) PF> µ
>
A*i%¥{
can
/
Countertransference (
be (t) t)
"
) RN → PT ,
↳ nurses are the ones on the counter "
Intervention:
>
Remind the
px about the contract
>
redirect the emotions
of the px
> Let the verbalize
px to
TERMINATION
Nursing responsibility: Determine the px 's feelings about the termination of relationship
Goal: Evaluate the effectiveness of interventions
Problem: separation Anxiety lsepanx)
↳ this is normal !
↳ could be ( t ) or C- )
contract
Prevention: constantly remind the px about the
Intervention: the power of verbalization
3 TOPRANK REVIEW ACADEMY INC – Prof. Kenneth Arzadon, RN, UK-CBT Passer
FREUD’s STRUCTURAL THEORY OF PERSONALITY
3 components of the mind
Failure of
ego to balance
ID Id vs
superego results
in :
•
pleasure seeking component of the mind >
Anti -
social
•
Seeks immediate gratification > Borderline personality Disorder
EGO >
schizophrenia ( splitting of the mind /soul )
•
Balancer ; Real you °
Ambivalence
SUPEREGO >
Anorexia nervosa
Disorder
>
Obsessive Compulsive
•
Conscience ; Guilt feeling
µgyg
Protect the ego from the
D
Denial Alcoholism
Refusal to accept the truth
-
Identification
-
Introjection
-
Projection
hang
Paranoid
Blaming others
-
Displacement
↳ can be (t) or
f)
"
Kick the cat
hang b abating
phenomenon
"
less
threatening person
acrophobia ( neighs )
or a eg .
( 2 opposing emotions
]
-
Undoing
OCD
Doing something to relieve guilt feelings
-
0Suppression
↳
"
pilot of appetite
-
Conscious forgetting An nervosa suppressing hunger
c)
Repression
-
Unconscious forgetting Amnesia
Dissociation
Multiple Personality Disorder
-
Forgetting w/ change in
identity
Dissociative Fuge
Rationalization
-
Intellectualization [
High functioning
levels of :
↳ "
acknowledges
"
the situation but not the emotions Anxiety
It is God 's will .
Substitution
Unattainable to something that is achievable
easily
-
big to small
0
Compensation
↳ C pacquiao
manny
" "
in other areas
overachieving
-
-
small to big
Sublimation
-
bad to good
ng lalaki ,
"
Pare pareho
"
Lahat
Splitting
-
Borderline personality
-
seeing people
as either good or bad Disorder
4 TOPRANK REVIEW ACADEMY INC – Prof. Kenneth Arzadon, RN, UK-CBT Passer
SYMPTOMATOLOGIES OF MENTAL DISORDER
Disturbances in PERCEPTION
• Illusion misinterpretation of
external stimulus
• Hallucination misinterpretation of
sensory stimulus Management:
▪ Visual (psychedelics) >
marijuana
,%%ation H all
not ↳
uci nation must be recognized
patient m⑤"n9 may be ;
"
It seems
"
first
Do "
.
▪ Tactile (formication)
. .
> alcohol
↳
"
as
withdrawal
▪ Olfactory (Phantosmia) f.
closely associated w/ emotions
> PTSD
/ Posttraumatic stress Disorder
) R ity presentation
eat
↳" I know the voices seem real but I don't hear them ,
let's take a look at the Flowers !
"
D patient
Acknowledge
-
, ,
taste
> metallic
istract the
type of hallucination
most dangerous
the colors
>
hearing
the sound
>
seeing
Disturbances in THOUGHT
reflection
• DELUSION
Could be a
↳
false belief
of past experiences
Management:
▪ Grandiose [ px believes he / she
superior / invulnerable
is
] C larify the content of the delusion "
▪ Persecutory [
.
.
px
will
believes that someone
them
] c. ,
kill / harm
↳ validate ! "
I can see
"
∅ᵈisⁿ
▪ Somatic [
. . .
]
believes that
V ice doubt
PX
→
helps the px have second / reorganized thoughts
he in ill / sick 0
∅ agree
"
↳ "
▪ Nihilistic [
.
. .
believes that
. . .
missing ]
px
Engage in reality based activities
a
-
body part is
↳ ∅ play along
painting gardening
▪ Erotomanic [ px believes that someone
]
.
is in love w/ them
Ideas of Reference )
"
( Referential
"
Delusion
↳
giving meaning to the action
of others .
px eventually answers ]
Circumstantiality [ the
question
provides
unnecessary
details →
Tangentiality [ px didn't
the
answer
question
]
B
"¥¥¥i¥*;↑¥
hx : ask the
Schizophasia [
Clang associations
"
word salad
orange Sky Dirt
, ,
"
]
[ Rhyming of
"
mother has a
words
feather ]
*:
"
due to weather
Echolalia [ repeating ]
words
of others
Palilalia [ ] Repeating
own
one 's
words
a
]
§
1
external emotions
P mood -
internal emotions
Disturbance in Affect
Flat [ ] no emotions
withdrawn Minimal disorder
Rest single
Inappropriate [ 7ie%i¥aIFY]
.
em
schizophrenia
Restrictive [ ] single emotion
paranoid
shift in emotions
La bile [ bipolar
sudden
] disorder
Disturbances in Memory
p inability to recall / remember
Amnesia
%
|
" " " " "" " "
Retrograde a traumatic event
Anterograde [ ∅
a
recall events
traumatic
after
event
]
↳
inability to form new memories
Confabulation true to
making
are
↳ stories that not
losses
fill the gap between memory
5 TOPRANK REVIEW ACADEMY INC – Prof. Kenneth Arzadon, RN, UK-CBT Passer
?⃝
ANXIETY
Neurotransmitter: Gamma aminobutyric acid [ GABA ) ↳ neurotransmitter
inhibitory
( ↑GABA )
Characteristic: Contagious )
' " ↳s ↳
Pregabalin : Anticonvulsant
'
↳
↓ GABA =
KABA
↳
Determine your
own level of anxiety
Anxiety →
↳
>
lorazepam >
Clonazepam
+ alcohol Resp A-
Benzodiazepines
= .
Avoidakoho@Flumazeni1LRomazicorDmWhx.mgt
Nursing education:
Antidote:
LEVELS OF ANXIETY .
acknowledgement
MILD effective
more
Pacing
Paulit -
Wit ( Circumstantiality)
Parasympathetic response redirect the patient
MODERATE ↳ Para : Tae [ Diarrhea
) (t ) Diaphoresis
tinier urination
Dura [ ↑
]
Salivation ]
→ misses few
Coral
anxiety tics
Narrowed perception details
somatic manifestations ↳
Blindness ,
Paralysis
SEVERE ¢ complete a
task
1M
anxiolytic
∅ be redirected
∅ solve a problem
violence , hallucinations
PANIC delusions
,
restrain PRN
g,pg,na,,µ
↓
DSM -5
basis of diagnosis
*ⁿ;*ÑBg%
Compulsion Repetitive actions -
¥ x ¥E↑E¥ ¥É*µ¥ ¥
•¥;?o:%¥¥Q
0E•:• •
.
÷÷÷ !gg¥:B¥!☒
Defense Mechanism: Ritualistic
Purpose ↓ anxiety :
Behaviors
:*:* .
}
Management:
1. Allow px to perform the ritual
2. Adjust the schedule of px
3. Gy limit the rituals
P Displacement !
.
Irrational Fear
[
3 main open spaces !
.
→
Phobia
Specific phobias: all other types of phobias
Claustrophobia Fear of closed spaces i
. to maximum stimulus
2. Systematic Desensitization
↳ spiders
'
.
Gradual exposure
↳ Gradually
to feared object
Arachnophobia : Fear of
place the feared object
1.) Place spider in a bottle to familiar places . .
3) _ . - and so on
6 TOPRANK REVIEW ACADEMY INC – Prof. Kenneth Arzadon, RN, UK-CBT Passer
EATING DISORDERS ] a lack of love / attention
Desire to seek
[ affection / validation ]
Bulimia Nervosa
I *
Perfectionist
↓ food intake ; ↑
> can also
purge activity
Anger Cycle
)
( ma,
sa
ammonia
Bulimia nervosa)
,
Hunger _
psm.is :
>
Self Restricted Diet * '× / week for 3- 4m " !
↓ purge syndrome
>
tatsBinge
-
Compulsive Exercising
> too
many/fast induced
_
"
'
vomiting
↳ Rigorous
Complications : ) Russ /es sign _
scarring 4-
www.agepnmemJ
nx : Distract the client the Knuckles
;
Invite them to
engage in other activites ( walk )
Alopecia [ ↓ "" N ) >
Aware
Encourage client to verbalize during me walk
>
Of the problem
Ritualistic Food Behaviors
>
Anemia (↓ Fe Vit Ba B
9) ( Guilt
feelings → undoing )
,
.
,
)
> mechanism
compensatory
↳ cuts food into small pieces
>
Lanugo ( as
in
an alternative for
thermoregulation
Fat
>
knowledgeable abt . Food
>
∅ refuse to talk abt .
food Complications :
> Tooth
Decay
>
Hypokalemia (¥:¥¥e:)
>
preoccupied w/ eating behaviors
Bleeding "÷÷÷÷÷
>
> Gastric Ulcer Rectal when food has reached
> unaware ,,
NURSING DIAGNOSIS:
- Electrolyte imbalance ☆
↳
nursing priority Easily manageable ;
-
- Altered Nutrition ↳
Long -
term management
colostomy
INTERVENTIONS:
] Plan meals w/ the client
meals
>
Time limit during
⑧ the client after meals
Supervise
>
the bathroom
↳ px
when going to
accompany
PSYCHOTHERAPY:
Self monitoring [ diary
]
> -
Instruct px to keep a
of food intake
emotions / Reflections
& a
journal for
↳ other →
allows the client to associate their food intake & emotion w/ each
1
>
Cognitive Behavioral Therapy
)"""""
EVALUATION: ( 9) BM /
normal
18.5 -
:
24 .
Happy hormones
q
MEDICAL TREATMENT: SSRIs ( selective
↳
snReuptake Inhibitors
safest / best antidepressant
qpaHemof0
PERSONALITY DISORDERS: ↳ personality affects interpersonal relationships
•Bai*
Cluster A
• Paranoid Absence of trust :
:
,
,
/ anting anting / Charms
"
accessories
"
ing
-
↳ Characteristics : Maram
Cluster B
• Borderline Unpredictable mood [ ]
has unstable
: relationships
§
• Antisocial Law Breakers :
their
Cluster C
• Avoidant ∅ Responsibilities :
[• Dependent ∅ ☒ de their
"
oriented
: ,
↳
tanggaplangnangtanggap
back to community
Goal of Management: to help px to go
Establish meaningful relationships
7 TOPRANK REVIEW ACADEMY INC – Prof. Kenneth Arzadon, RN, UK-CBT Passer
Eugene Bleuler
p
:ñm%iiia%ñix
"
[ sohizen splitting
-
DSM
CRITERIA IN THE DIAGNOSIS OF SCHIZOPHRENIA
←
•
2 or more of the following for at least 1 month.
> Hallucinations > Catatonia
↳ lack of movement
>
Delusion >
neg . S / SX
Disturbed
>
thought processes
but
hereditary
no± us '
,
Precipitating [ life
>
-
exp
Threshold
.
=
↑ risk ]
l
protective [ coping
mechanisms ]
↑ serotonin ↑ Dopamine
Neurochemistry: ________________________________________ ,
neumim
Social Causation Hypothesis: ↓ socioeconomic status = ↑ risk
unhealthy foods
°
inaccessible
•
healthcare
Ambivalence [ feelings
opposing
]
2
Associative looseness [∅ ∅
communicate
connect ]
Abnormal affect [ FBIRL ]
@
NEGATIVE Signs of Schizophrenia
↳
:
↳
↑ Serotonin
Disturbances in emotions
Lacks
something
↳ most common in :
flexibility
"
waxy movement
∅
ends in "
Chlorpromazine
"
-
done
,
thioñdazine
°
◦
Olanzapine ◦
risperidone
◦
flu phenazine ↓ °
Quetriapine °
brazed one
Ha Idol ( Haloperidol
° ° °
)
{
•
↑
potency
torpx that
1st gentle
exception
:[%"a%% ] 1st generation
are
hallucinating .
'
MOA : ↓ Dopamine
of ( t )
ism]
SX
Mgt .
SX
④ for elderly
3rd generation ÷
Long Term Injection eg .
Haloperidol
decanoc⊕z
DOPAMINE SYSTEM STABILIZERS " "
DEPOT THERAPY µ µ
,, , mm, ,
↳ ends in -
Zola
◦
Aripiprazole
Brexpiprazole Factors that could affect
◦
non-compliance
MOA : ↑ ↓
/ sensitivity of dopamine receptors
°
Side
effects
↓ balance in dopamine
Inaccessibility
SE
due to
: °
Memory loss
°
8 TOPRANK REVIEW ACADEMY INC – Prof. Kenneth Arzadon, RN, UK-CBT Passer
SIDE EFFECTS OF ↓ ANTIPSYCHOTICS
parasympathetic ] Anticholinergic [ opposite of
Physio >
Psycho
sounder 's 8th edition
Constipation [ fiber]→
"
High "
↑
19000
Agranulocytosis [ ]→ normal 15000
: -
,
stimulates salivation
l
Dry mouth
[ ]
gradually
Orthostatic hypotension reposition
client
the
in breasts
SPF 15 ↑
Photosensitivity [%dE.fi?gEFF-
umbrella
☆
Arrhythmias [%EEF.be ] at
crisis
◦ • ↳
%
"'
spasm of eye muscles
-
Dystonia -
contraction
of neck muscles
Akathisia -
)J
Pseudo parkinsonism
{ :}
parkinson - like manifestations
tremors A Kineton -
biperidin
=
hx Mgt : Altered gait
Benadryl -
diphenhydramine
cogent n
'
mx Mgt :
relaxant
⑧ Prevention ↑ !
:
Hydration
Tardive Dyskinesia
$1
↳ late
difficulty moving
gµ9ue
Protrusion
'
last possible SE of anticholinergic drugs
↳
only appears after 6 months
of treatment Ong ul twisting
↳ the
of drugs in
body
grinding
accumulation
eeth
> Permanent / Irreversible
ip smacking
notify physician
>
>
mx Mgt : Val ben azine ( Ing re 229)
↳ start w/ the lowest dose
9 TOPRANK REVIEW ACADEMY INC – Prof. Kenneth Arzadon, RN, UK-CBT Passer