REFRESHER: PSYCHIATRIC NURSING

LECTURER: PROFESSOR ARCHIE ALVIZ

NURSE-CLIENT RELATIONSHIP ② CONCRETENESS

⇒ A two-way process of series of interaction between the
nurse and the client → CONTINUOUS and CONSISTENT
- GOAL: positive behavioral change (there should be
noticeable change in behavior)
- Ability to identify a client's feelings. BE SENSITIVE!!
③ RESPECT
- Consideration of patient as a unique being
PHASES OF THERAPEUTIC RELATIONSHIP

❓ WHEN DOES THE THERAPEUTIC ❓ ① PRE-INTERACTION / PRE-ORIENTATION

- No contact
RELATIONSHIP BEGIN? - Data: secondary sources
- Conduct and build SELF-AWARENESS before having

LO
Orientation Phase. nurse-patient interaction

❓ WHAT IS THE ONLY TOOL AVAILABLE FOR ❓ ② ORIENTATION

- Establish trust and goals
THE NURSE? - Assess client’s needs
- Establish mutual agreement or contract (inform about
SELF. Hence, it is important to conduct self-awareness prior termination)
exposure to psychiatric patients because it makes an
individual know his strengths and weaknesses.
③ WORKING
- Longest phase

IL
Nurses cannot offer themselves to their patient if they are

① TRUST
-
not holistic.

ELEMENTS OF THERAPEUTIC RELATIONSHIP

The patient will not share their thoughts unless you

-
-

-
Achieving goals and sharing facts
Resolve problems

④ TERMINATION
Moving towards independence
regressive behaviors)
(observe for
R
gain his/her trust
- Once you have gained their trust → PROTECT!!! THERAPEUTIC COMMUNICATION
○ DO NOT LIE as it destroys the relationship.
- Trust is established when the patient begins sharing
⇒ Dynamic process of exchanging communication
or engaging in conversation with the nurse.
- Composed of verbal and non-verbal communication
AR

(used simultaneously)
② RAPPORT
- Allows the patient to warm up to the nurse.
ELEMENTS OF THERAPEUTIC COMMUNICATION
- Trust is earned by establishing rapport.
① SENDER / ENCODER
③ UNCONDITIONAL POSITIVE REGARD (ACCEPTANCE) - Source of the message
- Accept the client regardless of who they are.
② MESSAGE
④ SETTING LIMITS - Information being transmitted
- The nurse is the leader of the nurse-client
relationship. ③ RECEIVER / DECODER
C

○ Set the direction and boundaries - Recipient of the message

⑤ THERAPEUTIC USE OF SELF ④ FEEDBACK

- Nurse as a tool - Receiver’s response
- Uses therapeutic communication

THERAPEUTIC BEHAVIORS
💡 BARRIERS 💡
⇒ Characteristics a nurse must have in order to handle clients ⇒ Factors that inhibits the transfer of information or
properly communication process
● Examples: environment, age, language barrier, etc.
① GENUINENESS
- Sincerity and honesty (reality based)
 REFRESHER: PSYCHIATRIC NURSING
LECTURER: PROFESSOR ARCHIE ALVIZ

TYPES OF COMMUNICATION TECHNIQUES - Example: “I noticed you have combed your hair
NON-VERBAL COMMUNICATION today.”
A. Proxemics
- Physical space between the nurse and the client (3-6 F. Summarizing
ft [one arm and half]) - Organizing and summing up that which has gone
before.
B. Kinetics - Example: “In the past 15 minutes, we have talked
- Body movements (gestures, facial expressions, about…”
mannerisms)
- Enhances a person’s speech G. Seeking clarification
- Striving to explain that which is vague or

LO
C. Touch incomprehensible and searching for mutual
- Intimate physical touch (invasive) understanding of what has been said facilitates and
- Requires consent increases understanding for both client and nurse.
- Conveys empathy and concern - Example: “Do you mean?...”

D. Silence H. Encouraging description of perception

- Listening, agreeing - Asking the client to verbalize what he or she
- Conveys interest perceives
- Encourages the patient to talk - Usually used when the patient has illusions (with
stimuli) or hallucinations (without stimuli)

IL
E. Paralanguage
-
-
Voice quality (tone, inflection)
How the message is delivered

VERBAL COMMUNICATION
⇒ Should always be therapeutic, appropriate, simple,
-

-
-
DO NOT ENCOURAGE description when the patient
is hostile, angry
ENCOURAGE description when the patient is calm
Example: “What are the voices telling you?”

I. Presenting reality
R
adaptive, concise, and credible. - Usually used when the patient has illusions or
hallucinations
① THERAPEUTIC TECHNIQUES: MUST DO - USE when the patient is angry.
A. Offering self - Example: “I know that the voices seem real to you,
- Making oneself available but there are no voices here.”
AR

- Primary tool for therapeutic communication

-
-
It should be SMART
Example: “Let me sit here with you for 5 minutes”
💡 HALLUCINATIONS 💡
Types
B. Active listening ● Visual
- Simple response ● Auditory –– most dangerous → command
- Examples: “ah huh”, “no”, “yes” ● Tactile
● Gustatory
C. Exploring
- Delving further into subject or an idea J. Reflecting
C

- Example: “You said Hannah was the best, can you - Directing client actions, thoughts, and feelings back to
describe her?” client
- Assist the client in answering the question, LET them
D. Broad opening think and answer → facilitates INDEPENDENCE
- Allowing the client to take the initiative in introducing a - Example:
topic. Patient: “Iiwan ko na ba ang aking asawa?”
- Example: “Where would you like to begin?” Nurse: “Sa tingin mo, mas makakabuti ba
sayo kung iiwan mo siya?”
E. Making observations
- Verbalizing what the nurse perceives K. Restating
- Good way to start a conversation - Repeating the main idea expressed by rephrasing it.
- Lets the client feel that you are really caring or - Example:
showing concern Patient: “I feel blue.”
Nurse: “Are you depressed?”
 REFRESHER: PSYCHIATRIC NURSING
LECTURER: PROFESSOR ARCHIE ALVIZ

L. General leads
DEFENSE MECHANISMS
- Giving encouragement to continue
- Examples: “Go on,” “Tell me more,” “And then” ● Unconsciously forgetting (HINDI
SADYA) anxiety-provoking
M. Focusing thoughts from awareness.
- Concentrating on a single point ● Commonly seen in patients with
- Lets the client understand and feel that you are Repression severe traumatic experiences
interested. (e.g. childhood traumas)
○ Hypnotherapy can bring
- Example: “Let us look at it more closely.”
back those memories into
consciousness
② NON-THERAPEUTIC TECHNIQUES: AVOID

LO
A. Giving advice ● Consciously forgetting (SADYA)
- Telling the client what to do Suppression unacceptable thoughts.
- Let the client solve the problem, nurses are just there ● Example: low exam score
to guide them.
● Acting the opposite of what one
Reaction thinks or feels. (KAPLASTIKAN)
B. Talking about self
Formation ● Common in Bipolar Disorder (to
- Should be patient-centered mask depression) patients
- The patient should tell more about his or her self
rather than the nurse ● Attempting to justify unacceptable
Rationalization needs (reasoning out or making

IL
C. Telling the client is wrong
- Arouses dispute leading to argument resulting to loss
of trust

D. False reassurances
- Not based from reality
Projection
●
excuses)

Attributing
unacceptable
thoughts to
others)
one's
feelings
own
and
others (blaming
R
- Can cause the loss of trust Types
- Example: “Kapag sinunod mo ang sinabi ko, lalabas ① Blaming yourself
ka na bukas.” ○ Example: “I failed an exam
because I didn’t listen”
E. Asking why Introjection ② Becoming an exact replica
AR

- It demands an answer which may arouse deep seated ○ Accepting another person’s
feelings, memories attitudes, beliefs, and values
- Exemption: Suicidal patients as one’s own (imitates
○ Direct questioning since time is of the behavior)
essence
● Modeling actions and opinions of
influential others while searching
SPHERES for identity, or aspiring to reach a
Identification personal, social, or occupational
① ID –– pleasure principle goal (idolization or copying certain
- Irrational impulses features)
● Example: copying BTS members
C

- ID > SUPEREGO → antisocial personality disorder

styling

② EGO –– reality principle ● Attempting to make up for or

- Maintains sanity Compensation offset deficiency
- Distorted ego → illusion, hallucination, and delusion ● Weak on one aspect but strong
on another aspect
③ SUPEREGO –– conscience principle
- Ego ideal Denial ● Failure to acknowledge an
unbearable condition
- SUPEREGO > ID → obsessive compulsive
(unacceptance of truth)
personality disorder
● Channeling of anxiety
Displacement ● Ventilation of intense feelings to a
less threatening person than the
one who aroused those feelings.
 REFRESHER: PSYCHIATRIC NURSING
LECTURER: PROFESSOR ARCHIE ALVIZ

- Examples: unexpected pregnancy, sudden death,

● Moving back to a previous
developmental stage to feel safe accident
Regression or have needs met.
● Example: thumb sucking, fetal ③ ADVENTITIOUS / SOCIAL
position, peed on his underwear - Calamities or acts of God, and hideous crimes
- Examples: earthquakes, tsunamis, rape, abuse,
● Exhibiting acceptable behavior to murder
make up for or negate
Undoing unacceptable behavior
● Example: Buying flower for your DEATH AND DYING
wife because you have an
argument ① DENIAL

LO
- Unacceptance of the truth
● Expression of an emotional
Conversion conflict through the development
of a physical symptom, usually ② ANGER
sensorimotor in nature. - Projection or introjection

Types
① Reasoning out with references
○ Reasoning in a detailed
manner (has reference)
○ Example: Mother: “‘Wag kang
③ BARGAINING
- Making unrealistic offers
- Example: “Lord, ako na lang magkasakit, huwag lang
siya.”

IL
Intellectualization lalabas dudugo ang ilong
mo.” Child: “Epistaxis is
caused by…”

② Speaking without emotion

○ Uses mind to cover
individual’s vulnerability.
an
④ DEPRESSION
-

-
Most dangerous stage → HIGH RISK of suicide,
feelings of unworthiness, hopelessness and loss of
warmth.
Priority is SAFETY.
R
⑤ ACCEPTANCE
● Replacing the desired gratification
with one that is more readily - Moving forward → moving on
available
Substitution ● Example: He wants to pursue Every person has a different pace or time frame per stage.
med school, however, his family This may be due to their surroundings or how severe the
AR

does not have enough resources. problem is.

Hence, he took nursing since it is
med-related.
DISTURBANCES IN APPEARANCE
● Substituting a socially acceptable
activity for an impulse that is A. AUTOMATISMS
unacceptable. - Repeated purposeless behavior
Sublimation ● Example: Leon wanted to punch

💡 💡
Kion, but instead of punching
Kion, he punched his pillow. AUTOMATISMS VS MANNERISMS VS TICKS

● Polarized views of self and others Automatism is more on neurotransmitter problems.

C

Splitting arise due to intolerable conflicting Mannerism is more of a muscle memory.

emotions Tick is more on nerve and motor problems.
● All good or all bad

B. PSYCHOMOTOR RETARDATION
CRISIS - Slowed movements
- Common in depression
① MATURATIONAL / DEVELOPMENTAL
- Predictable and expected C. WAXY FLEXIBILITY
- Examples: pregnancy, marriage, bills, natural death - Maintenance of an awkward posture.
- There is NO return to the previous position whenever
② SITUATIONAL you try to move the patient, rather it adapts its new
- Unpredictable and unexpected position.
 REFRESHER: PSYCHIATRIC NURSING
LECTURER: PROFESSOR ARCHIE ALVIZ

D. CATATONIA K. PALILALIA
- Maintenance of an awkward posture. - Repetition of stereotype words or the last syllable
- There is RETURN to the previous position whenever - Example: “WATER -ter -ter -ter”
you move the patient.
L. VERBIGERATION
E. ECHOPRAXIA - Repetition of the same word over and over again
- Purposeless imitation of movement (mirror-like) whether WITH or WITHOUT companion
- Example: “Maganda ako, maganda ako, maganda
DISTURBANCES IN COMMUNICATION ako.”

A. MUTISM M. COPROLALIA

LO
- Act of being mute - Copro (feces); lalia (logic or speech); shit or trash talk
- Silent and does not respond to questions - Involuntary outburst of obscene words or socially
inappropriate and derogatory remarks
B. NEGATIVISM
- They always say NO N. NEOLOGISM
- Neo (new); gism (speech)
C. CIRCUMSTANTIALITY - Invention of new words that only he/she can
- Eventually answers a question but only after giving understand.
excessive unnecessary detail.
Jargons are not neologisms.

IL
D. TANGENTIALITY
- Wandering from one topic to another, not giving the
required information.

E. STILTED LANGUAGE
- Use of words or phrases that are flowery, excessive,
O. BLOCKING
-
-
Sudden cessation of thoughts
Mental block

P. CLANG ASSOCIATION
R
and pompous. - Ideas that are related to one another based on sound
- Men are poetic than women or rhyming rather than meaning.
- Example: “Kapag ako ang kaharap mo, walang apir
F. FLIGHT OF IDEAS apir… bagsakan na ng career.”
- Excessive amount and rate of speech composed of
AR

fragmented or slightly related ideas but has meaning DISTURBANCES IN PERCEPTION

- Nurse can understand the point of the patient even
though the sentence structure is bad.
- Example: “Tanim palay gulay saing pamilya masaya”
G. LOOSE ASSOCIATIONS
- Fragmented or unrelated statements but has NO
meaning
- Nurse cannot understand the point of the patient.
- Example: “Paglabas ko kanina sa bahay, yung hotdog
C
⇒ Perception –– the way you perceive things
A. DELUSIONS
- Fixed false beliefs.
Types
● Paranoid –– belief that others are talking about him
● Persecutory / Persecution –– belief that others are

na may salamin, at yung alak ng rice cooker planning to harm him.

nagkaroon ng sasakyan.” ● Grandeur –– claim to associate with famous people
or claims that he is famous
H. WORD SALAD
- Mixture of unrelated words; jumbled words with no B. MAGICAL THINKING
sense. - Belief that thoughts or behavior have control over
- Example: “Sabon, kape, tubig, ref, banana chips” specific situation or people; belief in non-existent
phenomenon
I. PERSEVERATION - Believes in magic
- Persevere the topic; goes back to the same topic - Imaginary friend
- Cannot move on from the topic
C. PARANOIA
J. ECHOLALIA - Extreme suspiciousness
- Imitation of what others say (parrot-like imitation). - Being suspicious of others
 REFRESHER: PSYCHIATRIC NURSING
LECTURER: PROFESSOR ARCHIE ALVIZ

D. RELIGIOSITY E. APATHY / FLAT AFFECT

- Obsession in religious ideas - Absence of emotions or expressions
- They are something powerful or ultimate being
F. AMBIVALENCE
E. PHOBIA - Opposing feelings
- Irrational fear - Example: Happy but nervous

F. OBSESSION G. ANHEDONIA
- Repetitive thoughts - Lack of pleasure
- Has target or goal number - Other emotions are present EXCEPT pleasure
- Example: “I need to wash my hands 10x”

LO
H. EUPHORIA
G. COMPULSION - Feeling of extreme pleasure
- Repetitive actions - Common in drunk individuals
- Example: washes his hands 10x
STRESS
H. PREOCCUPATION
- Idea with intense desire
- Higher form of obsession STAGES OF STRESS
- No target goal or number
① STAGE 1: ALARM REACTION
- The only thing that he thinks throughout the day

IL
-

-
-
Example: sexually preoccupied, stalkers

I. THOUGHT BROADCASTING
Other knows what I am thinking → SUSPICION
Common in Paranoid Disorders
-
-
You have determined that there is stress (stressor)
Example: The PNLE is near, you feel nervous.

② STAGE 2: STAGE OF RESISTANCE

- Period wherein you will utilize all resources to solve
the problem
R
- Example: You enrolled in TRA, you reviewed every
J. IDEAS OF REFERENCE
night
- Belief that broadcasts have special meaning for him.
- GOAL: PROBLEM SOLVED; if not, STAGE 3.
- “Talk of the town” or “main character energy”

③ STAGE 3: STAGE OF EXHAUSTION

AFFECT
- You have utilized all of your resources but the
AR

problem is not solved.

⇒ Emotions or expressions. - Example: During the PNLE, you did your best but end
up failing the boards
A. INAPPROPRIATE AFFECT
- Incongruent → the emotion does not match the ANXIETY RELATED DISORDERS
situation
- Commonly seen in Schizophrenia
- Example: You failed an exam but you are happy
ANXIETY VS FEAR
B. BLUNTED AFFECT ANXIETY
C

- Minimal or little response - Fear of the unknown

- The emotion is right but subtle.
- Example: You passed the boards and you said, “Ah, LEVELS OF ANXIETY
okay.” ● Mild
○ Highest level of thinking → logical thinking
C. RESTRICTED AFFECT ○ Increased concentration and alertness
- Display one type of expression ○ Widened perceptual field
- Example: If the outcome is positive or negative: “Yay!” ○ “Good anxiety”

🟩
○ Management:
D. LABILE MOOD Problem solving approach
- Unpredictable shifts of emotions (mood swings)
- Common in Bipolar disorder ● Moderate
- Example: From happy to sad. ○ Increased irritability, decreased attention
span → selective inattentiveness
 REFRESHER: PSYCHIATRIC NURSING
LECTURER: PROFESSOR ARCHIE ALVIZ

🟩
○ Management: ○ Let them solve the problem, you are just

🟩
Relaxation techniques (DBE) there to GUIDE.

🟩
Encourage verbalization of feelings ● Teach coping behaviors
Medications ○ Assess previous coping behaviors
● Anxiolytics or ■ Continue: effective
Benzodiazepines (-pam or ■ Modify: ineffective
-lam) ● Medications:
○ DOC: Benzodiazepines / Anxiolytics ––
Medications are given as early as moderate anxiety to prevent -pam, -lam
further anxiety because prevention is better than cure. ● Cognitive behavioral therapy

LO
● Severe PANIC DISORDER
○ High level of anxiety ⇒ Recurrent and unpredictable
○ Characterized by extreme muscle tension - Characterized by panic attacks
○ Loud rapid speech
○ Difficulty of focusing even with assistance
🟨
CLINICAL MANIFESTATIONS
○ Distorted perception
🟨
Trembling (cephalocaudal)

🟩
○ Management:
🟨
Racing heart (Tachycardia)
Remain with the client as physical
🟨
Chest pain
presence can greatly decrease
🟨
Difficulty of breathing
anxiety.
🟨
Choking sensations

IL
● Panic
○
○
○
○
Highest level of anxiety; EMERGENCY!
Suicidal attempts
Fixed eyes, hysterical or mute, incoherence

🟩
Management:
Decrease stimuli by removing the
🟩
🟩
Numbness

MANAGEMENT
Assist in problem solvings
Teach coping behaviors –– to develop new coping
behaviors
R
🟩
patient from the source of anxiety.
🟩
○ Assess previous coping behaviors

🟩
Stay with the client Medications:

🟩
Assist in relaxation techniques ○ DOC: Benzodiazepines
Give brown paper bag (must be at ■ If with ADDICTION to
the bedside) to alleviate Benzodiazepines, USE
AR

hyperventilation antihistamines.
● Primary effect: anti-allergic
FEAR reaction
- Fear of the known and specific ● Secondary effect:
sedative or depressant
GENERALIZED ANXIETY DISORDER effect (to relax the patient)
⇒ “Worry worm” → chronic pacing, restless ○ Beta blockers –– blocks sympathetic
- No apparent reason nervous system causing relaxation
- Lasts for 6 months ■ It manages chest pain and racing
heart
C

CRITERIA ○ MAOIs and SSRIs –– balances

● No phobias → phobic disorder neurotransmitters to have a more stable
● No panic attacks → panic disorder mood and decrease anxiety
● No obsessive-compulsive manifestations → OCD
ACUTE STRESS DISORDER

🟨
CLINICAL MANIFESTATIONS ⇒ Acute

🟨
Palpitations (SNS response) - 2 days to 4 weeks only or less than a month
Chest pain → chronic anxiety can contribute and

🟨
progress into heart conditions

🟨
Insomnia –– inability to maintain and fall asleep
🟨
CLINICAL MANIFESTATIONS
Headache
🟨
Palpitations

🟨
Headache
MANAGEMENT
🟨
Tachycardia
● Assist in problem solving Insomnia
 REFRESHER: PSYCHIATRIC NURSING
LECTURER: PROFESSOR ARCHIE ALVIZ

🟨 Chest pain THREE MAIN TYPES

① AGORAPHOBIA
MANAGEMENT - Fear of open public spaces
● Progressive review of the trauma - Example: When in a public place, they always stay
○ Recall the past event together with the near the exit.
patient in order to have acceptance
■ If there is no acceptance, prolonged
or extended anxiety may result.
💡 HOW TO KNOW IF IMPROVING 💡
● Medication:
The client is able to go outside.
○ DOC: Benzodiazepines

LO
If not treated, it might progress and lead to PTSD. ② SOCIAL PHOBIA
- Fear of talking or interact to others
POST-TRAUMATIC STRESS DISORDER
③ SIMPLE / SPECIFIC PHOBIA
⇒ Signs and symptoms are more than 4 weeks
- Fear of specific objects, animals, environment or
- Characteristics:
situation
○ Recurrent flashbacks → intrusive thoughts
- Example: hydrophobia, claustrophobia
(unsettling memories)
○ Reexperiencing of the trauma

🟩
MANAGEMENT
○ Defense mechanism: Displacement
Systematic desensitization –– gradual exposure to

IL
CLINICAL MANIFESTATIONS
● Starts with general numbing to somatic (bodily)

🟨
symptoms:

🟨
🟨
🟨
Irritability
Aggressiveness
Depression
🟩
the fear objects
Flooding –– sudden exposure to the feared object

🟩
○ Is it effective? No, since it might cause
trauma wherein it may lead to PTSD
○ Contraindicated in patients with heart
diseases.
R
Breathing exercise –– Deep breathing exercise
🟨
Anger

🟩
(DBE) helps minimize anxiety
Social Withdrawal
Thought stopping –– diversional activity
■ To manage, let them join group
○ Example: The use of rubber band (making a
therapy.
star, double star or bahay ni Tarzan) as form
● May let them know that
of therapy, wherein the psychiatrist will
AR

there are also other people

advise patient to make 20 stars when there
who are experiencing what

🟩
is an anxiety attack
they have been through
Guided imagery –– conditioning (picturing happy
and let them feel that there
thoughts or pleasant situations).
is still hope.

OBSESSIVE-COMPULSIVE DISORDER
🟩
MANAGEMENT
Assist in gaining control over angry impulses → ⇒ They are aware that they have the disease.
- Characteristics
🟩
ACCEPTANCE
Medications ○ Obsession –– persistent thoughts
○ Compulsion –– persistent action
C

○ DOC: SSRI
○ DOC during acute attacks: Benzodiazepine
■ If with benzodiazepine addiction → These characteristics become a disorder when it starts to
antihistamine affect your ability to function–– ADLs.
○ Beta Blockers

🟩
MANAGEMENT
PHOBIC DISORDER Aversion therapy –– inflict punishment when they fail
to follow the limits (setting time-frame)
⇒ Persistent irrational fear
○ Example: You are only allowed to wash your
- Fear is unreasonably proportion to the actual danger
hands at a scheduled time. Failure to follow

🟩
the allotted time will result in punishment.
CAUSE
Medication:
● Past events
○ DOC: SSRI –– blocks reuptake of of
● Imbalance of neurotransmitter (dopamine, serotonin,
serotonin
GABA)
 REFRESHER: PSYCHIATRIC NURSING
LECTURER: PROFESSOR ARCHIE ALVIZ

■ Alteration of certain - With intact reality

neurotransmitters (serotonin and
dopamine) is proven to be more
effective than using
benzodiazepines.
■ Since OCD is a life-long treatment,
prevention of addiction is a must,
hence the recommendation to use
- Has periods of hyperactivity, depression, and suicidal
tendency
③ MANIC DISORDER
- Fluctuation between mania to normal
- Has periods of hyperactivity and no intact reality

🟩
SSRI. ④ MAJOR DEPRESSIVE DISORDER
Give time for ritualistic behavior UNLESS dangerous - Fluctuation between major depression to normal
○ Obsession and compulsion cannot not be - Has periods of depression and suicidal tendency

LO
ultimately eliminated but it can be normalize,
in which patient is able to function properly in ⑤ CYCLOTHYMIA
daily life - Bipolar-like disorder
○ If dangerous and uncontrollable, give - Fluctuation between hypomania to hypodepression

🟩
medication. - Has periods of hyperactivity and depression
Diversional activities –– especially if compulsion is - With intact reality and no suicidal tendency
dangerous
○ When giving diversional activities, it should ⑥ DYSTHYMIA
be related to the patient’s obsession and - Minor depression
compulsion. - Fluctuation between hypodepression to normal

IL
🟩
🟩
■ Example: The client has OCD in
washing hands, let the client do the
laundry or wash the dishes.
Cognitive Behavioral Therapy –– used for patients
who have obsessive thoughts only, which may help in
changing their perspective
-
-
Has periods of depression
With no suicidal tendency

MAJOR
DEPRESSION
BIPOLAR II
R
SLRC: Important in caring for OCD Problem Overdependence → Mask of depression
○ SL: Set limits loss
○ R: Reality based
○ C: Consistent Defense Introjection Reaction formation
Mechanism
AR

MOOD DISORDERS
Signs and Negative symptoms: ● Hyperactivity
symptoms ● Anhedonia ● Manipulative
● Hypomania ––hyperactive but intact reality ● Psychomotor ● Inattentive
● Mania –– hyperactive but NO intact reality retardation
● Hypodepression –– depressed but NOT suicidal
● Major depression –– depressed but suicidal Attitude Kind firmness but Matter-of-fact
Therapy with limits (present reality)
TYPES Activity ● Counting diverts High energy to
attention deplete energy:
● Writing ● Breaking leaves
C

(journaling, ● Modeling clay to

poems) relieve
manipulation
● Walking
because they
are hyperactive
and to exhaust
them to have a
proper sleeping
① BIPOLAR I pattern.
- Fluctuation between mania to major depression
- Has periods of hyperactivity, depression, suicidal Therapy ● Group therapy ● Solitary therapy
tendency, and no intact reality ● Non-competitive to prevent
play manipulation of
② BIPOLAR II other people
- Fluctuation between hypomania to major depression
 REFRESHER: PSYCHIATRIC NURSING
LECTURER: PROFESSOR ARCHIE ALVIZ

📝
Nursing Diagnosis
● Noncompetitive
play Potential for injury directed to others and self
● Finger foods

🟩
Management
WOF Suicide → Nutrition

🟩
PRIORITY: safety ○ Sealed foods

🟩
Safety
When giving medications, let them open the wrapper.
SCHIZOPHRENIA
ANTIPSYCHOTIC MEDICATIONS
⇒ Increase dopamine
⇒ To decrease dopamine

LO
- DSM V: no subtypes
- Therapeutic effect: 3-4 weeks.
- DSM IV: has subtypes

SIDE EFFECTS
CLASSIFICATION
① EXTRAPYRAMIDAL SYMPTOMS
① CATATONIC - Includes:
- Abnormal motor behavior ○ Dystonia
- Defense Mechanism: Repression ■ Clinical manifestation: Acute

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muscular rigidity & spasm

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Clinical Manifestations
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Torticollis

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Catatonic
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Oculogyric crisis

IL
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Waxy flexibility
Mutism
Negativism

Nursing Diagnosis
Impaired motor activity
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Opisthotonus
Laryngeal spasm

Tardive dyskinesia

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■ Clinical manifestation:

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Tongue protrusion
R
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Lip smacking

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Management
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Blinking

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Circulation: passive range of motion exercises Grimacing
Nutrition: feeding
○ In severe cases, NGT. ○ Pseudoparkinsonism
AR

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■ Clinical manifestation:
② DISORGANIZED
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Tremors (pin-rolling)
- Bizarre behavior
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Bradykinesia
- Defense Mechanism: regression
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Mask like face

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Festinating gait

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Clinical Manifestations
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Slurred speech
Bizarre thoughts, movement, and speech Drooling

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Nursing Diagnosis ○ Akathisia
Impaired Social Functioning
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■ Clinical manifestation
C

Restless

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Management
ADL assistance
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Management
Antidote: Anticholinergic(ABC)
③ PARANOID ○ Akineton, Artane
- Suspiciousness and ideas of reference ○ Benadryl
- Defense Mechanism: projection ○ Cogentin

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Clinical Manifestations ② NEUROLEPTIC MALIGNANT SYNDROME

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Delusion - Life-threatening

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Hallucinations
Flight of ideas
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Clinical Manifestations
Wide fluctuations of BP
○ Management:
 REFRESHER: PSYCHIATRIC NURSING
LECTURER: PROFESSOR ARCHIE ALVIZ

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STOP medication - Grandiosity
Notify physician - Need constant admiration from others
- Exaggerated sense of being important
PERSONALITY DISORDERS

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MANAGEMENT
Medication:
CLUSTER A: ECCENTRIC ○ Anticonvulsants
○ Lithium (for manic symptoms)
① PARANOID
○ MAOIs
- Extreme suspiciousness and distrust

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All cluster B have manic symptoms

LO
PARANOID PERSONALITY DISORDER VS
PARANOID SCHIZOPHRENIA CLUSTER C: ANXIOUS AND FEARFUL
① AVOIDANT
1. PPD is caused by experiences whereas PS is - “I avoid because I hate criticism”
caused by increased dopamine . - Low self esteem
2. PPD individuals are not psychotic, while PS
- Avoid responsibility
patients are psychotic.

② DEPENDENT
② SCHIZOID - “I can’t live if living is without you”
- Social withdrawal, aloof or loner - Does not want to be alone
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IL Problem in Maintaining relationship

③ SCHIZOTYPAL
- Bizarre behavior
Silly laughing
Magical thinking (mildly psychotic)
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Submissive
Overreliance → only dependent in partner

③ OBSESSIVE-COMPULSIVE PERSONALITY DISORDER

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Perfectionist
Rigid and inflexible
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MANAGEMENT
Medications: 💡 OCD VS OCPD 💡
○ Antidepressants
○ For schizotypal only: low dose antipsychotic 3. OCD is an anxiety related disorder, whereas OCPD
is a personality disorder.
AR

because they are mildly psychotic

4. Individuals with OCD are aware that they have the
disease, while individuals with OCPD are unaware.
CLUSTER B: DRAMATIC / ERRATIC 5. In OCD patients, they have real compulsion and
① ANTISOCIAL obsession. On the other hand, OCPD patients have
- No guilt, no remorse, disregard laws and rules, no no real compulsion and obsession, simply they are
extreme perfectionists.
conscience
- Id is dominant

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- Example: perform animal cruelty MANAGEMENT
- If below 18 years old, it is called conduct disorder. Medication:
○ Benzodiazepines
C

② BORDERLINE ○ Anxiolytics
- Suicidal tendencies
- Manipulation through body mutilation (self-destructive
behaviors)
- Fear of being alone

Give immediately antidepressants to prevent suicide

③ HISTRIONIC
- “I love the attention”
- Seductive, dramatic, and excessively emotional

④ NARCISSISTIC
- “I love myself”