Abarquez, Amil, Auza, Son

PSYCHIATRIC NURSING
(November 13, 2021) I. Mental health
A. Is the ability of a person to ADJUST /
cope up to whatever stress
CHAPTER 1 encountered everyday
B. Criteria: Self-acceptance
Psychiatric Nursing - It is an C. Example: Breakup - accept first in
interpersonal process whereby the nurse order to adjust and cope with the
uses therapeutic self in assisting an breakup
individual, family or community
II. Mental Illness
Note: In board exams if there are questions A. Disturbance of person’s thought,
pertaining to definition of psychiatric nursing” the best
thinking, feelings and behavior
answer is anything involving “interpersonal process”
B. Risk Factors
1. Poverty
*interpersonal process- you need to know
2. Abuse
how to talk and communicate with
3. Hereditary
psychiatric clients, with the most therapeutic
C. Disturbance of thought: Mentally ill
tool: therapeutic self
people have high dopamine levels in
the brain that causes these symptoms
*When you become therapeutic, you can
such as hallucinations and so, they
manipulate. When you show that you can
claim to have “third eye” - so accept
understand the person and he/she feels
that they see images that no one sees
that you understand them, trust is made and
D. Disturbance of feelings: drastic mood
so, the patient will most likely adhere and
changes such as sudden agitation
follow
and anger
E. Disturbance of behavior: e.g. seeking
attention and other mannerisms

Answer: A
Rationale: The other answers are not Answer: B. Heredity
appropriate as the “Senior nurse” has Rationale: Predisposing Factor means
instructed you. non-modifiable risk factor. Precipitating
factor means modifiable. While Abuse is the
 Abarquez, Amil, Auza, Son
most common precipitating factor, in this
case it is the predisposing factor.
MAJOR PSYCHOTIC SIGNS AND
SYMPTOMS
A. Altered Sensory Perception
a. Hallucination - no external stimuli
(e.g. demonyo sa gild w/o stimuli - a
demon will appear without a stimuli -
out of nowhere -)
b. Illusion- with external stimuli
(e.g. looking at seatmate at R side
and it became ot*n huhu) - seatmate
as stimuli
Question: Lucy was staring at the mango
tree, and suddenly it turned into a demon.
What is the best nursing diagnosis?
Answer: Altered sensory perception.
B. Altered Thought Process (beliefs)
- Thought translates to speech, so
altered speech also indicates altered
thought process
1. Delusion - false belief
a. Grandeur - mamayabang
(not real)
b. Persecution - feels like
someone is going to harm
you (FBI - Russell Crowe in
Beautiful Mind)
c. Control - claims being
possessed (e.g. I am an alien
from Pluto, the real me is in
space)
d. Religion - Religion is
founded on mental illness
(e.g. I talked to God, I saw
Mother Mary)
e. Ideas of reference -
Everything one perceives
relates to one’s own destiny
(e.g. you feel like the sun is
sending signals to your brain,
you listen to the radio and
you believe that the
broadcaster is talking to you,
two classmates talking and
you feel like they are talking
trash about you)
2. Echolalia - repeat words of others
(e.g. autistic children,
schizophrenics)
3. Word Salad - mixture of words (e.g.
hello! Burgundy cebu ger2)
4. Neologism - coining of new words.
Ex. Truthiness, gay language
5. Alogia - poverty of speech,
reduction in the amount of speech,
difficulty formulating thought. (E.g
Are you married? Uhhh, kuan,
kanang)
6. Circumstantiality - add
unnecessary details but relevant
detail is achieved (paikot-ikot) e.g.
What is your opinion on Death
Penalty? Accdg to Webster's
definition…. Accdg to the
constitution…. So my opinion on the
death penalty is...
7. Tangentiality - Digress from one
topic to another topic - with
tangentiality, unlike circumstantiality,
it doesn’t answer the question being
asked.
8. Clang Association - Rhymes,
similarity of sound and not content
9. Dissociation - Detached from
normal function - Detached
10. Flight of Ideas - Shift from 1 topic to
another (relate) - common in bipolar
manic patients.
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11. Loose of Association - sequence E. Memory Disturbances

of unrelated ideas (can’t relate) 1. Amnesia - forgetfulness
common in schizophrenia a. Anterograde - forgetting of
the recent/ immediate past
C. Inappropriate Affect (short term), common in
*40-50% of psychia questions belong here Alzheimer's
1. Blunted Affect - delayed response; e.g. Ate dinner at 6 pm, but
there is facial expression (shows reported that the nurse did
signs of improvement) not feed him/her at 7 pm
2. Flat Affect - more delayed response b. Retrograde - Forgetting of
with NO facial expression and the distant past. - long term
sometimes no response (to report as 2. Confabulation - creation of fantasy
need to change or change dose of to fill in gaps e.g. upon narrating a
antipsychotic medication) story, a detail is forgotten, so they
3. Apathy - no emotion or feelings make up other stories (fill gaps) to
4. Anhedonia - inability to experience protect their self-esteem / ego.
pleasure (killjoy) - di ka enjoy og
activities such as movies, laag, etc.
5. Ambivalence - opposing feelings
(e.g. the patient wants to die but
doesn’t want to die, “Nurse, I hate
you! It’s just that I hate you, but I
love you, but I hate you.”) - way
klaro
6. Labile - sudden mood swing (e.g.
crying then laughing at the same
time) monitor depressed patients, as
they might commit suicide when this
is displayed Answer: B
Rationale: Because holding the curtain is
D. Impaired Motor the stimuli (Illusion needs stimuli)
1. Echopraxia - repeat movements
(e.g. patient repeats movement of
the nurse)
2. Waxy Flexibility - The ability to hold
position for a very long period of
time. As a nurse, PROMOTE
CIRCULATION as priority
intervention by asking open-ended
questions so when they talk, they
move, inducing circulation; rephrase
when no response.

Answer: C
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Rationale: Curtain 2. Displacement - Shift emotion to less

threat (idamay ang imong kalagot or
other feelings to wrong things or
people - like if a parent is mad at
you, you displace your anger to your
younger sibling etc.)
3. Projection - Assimilate self to others
(nakikita mo sarili mo sa ibang tao;
e.g. blaming others - thieves get
mad at other people who also steal,
because they see themselves in
them)
Answer: D 4. Substitution - replace unattainable
Rationale: You need to present reality, goal to something attainable (e.g.
however you must prioritize the broken up with ex, aim for something
interpersonal relationships and the use of attainable by accepting the breakup
therapeutic self. Therefore it is most and finding someone else)
appropriate to say D. To present reality, you 5. Sublimation - channel unacceptable
need to be therapeutic, a better way to say behavior towards something
the letter C is “I understand that you are acceptable (e.g. A person selling
seeing the devil, however for me I do not shabu, prays the rosary - the illegal
see anything here, this is a curtain.” action is channeled through prayer)
Note: Present reality in the right time, in the 6. Symbolization - used to represent
right manner. another - (e.g people may seem
smarter if they speak English,
CHAPTER 2 however they only speak English to
pretend they are smart. Or someone
I. Ego Defense Mechanisms dressed expensively, however they
A. Protect SELF against anxiety are actually not rich.)
B. Normal reaction 7. Undoing - attempt to erase a wrong
C. Automatic act to protect self-esteem (e.g Giving
flowers to your wife even if you were
Note: They will always provide ego defense shouting and being angry at her
mechanisms questions in the board exams. prior)
8. Repression - involuntary forgetting;
unintended, usually happens when
1. Denial - Failure to accept reality you make yourself busy to forget
(Not to be mistaken with what happened (e.g. Studying while
suppression. For example a gay going through a break-up)
person would rather not disclose 9. Suppression - voluntary forgetting;
their sexuality - that is suppression intended (e.g You are still
not denial.) heartbroken, so you purposely
unfollow your ex on FB so you
cannot remember him/her, to move
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on easily) - repress, suppress,
substitute!
10. Identification - conscious patterning
of behavior; intended (e.g you adapt
a role model or behavior from
another person that you admire
purposefully/ consciously. Like you
adapt the behavior of a teacher you
admire. Same views, values and that
is something you want to achieve)
11. Introjection - unconscious
patterning of behavior; we have
behaviors that we adapt from others
because we are exposed to them
frequently, but we are not aware of it
(e.g. you get undesired behaviors
from the people that are around you
- hindi sinasadya)
12. Rationalization - justify
unacceptable behavior. Excuses
(e.g. “Why did you fail the NLE?”
“Failed NLE because bobo yung
teacher” - Making an excuse rather
than analyzing why (like in
intellectualization))
13. Intellectualization - Explain things
in DETAIL, based on books or
studies (e.g “Why did you fail the
board exam” “Failed the NLE
because some questions used were
not from the book reference that I
used.” To describe in detail why, and
analyze why. As opposed to
rationalization where it was just an
excuse.)
14. Regression - reversion to earlier
stage of development to decrease
anxiety (e.g. unconsciously doing
fetal positions while standing up or
laying down during times of anxiety)
15. Compensation - weakness in one
area through gratification in another
area (e.g. person does not worry
having low grades, because partner
is attractive (compensation))
16. Acting Out - performing extreme
behavior in order to express thought
or feelings (Over exaggeration, like
over-acting, throwing phone, or
ventilating through shouting or
swearing)
Answer: D
Rationale: Denial is you cannot accept, and
acting with exaggeration, constant denying.
If denial it should be “That's not true! He did
not abuse me, he is the best father in the
world.”. The statement above does not
indicate any denying, rather is lying.
CHAPTER 3
Schizophrenia
Note: Compromises 50% of Mental Illness
● Split of Mind - nawawala ka sa
sariling pag-isip
● Impaired Reality - (e.g when you
look at the curtain, but it looks like a
ghost. Or when you listen to music,
instead of hearing a song, you hear
voices that you should die.)
Eugene Bleuler’s: (4A’s) (OUTDATED
DEFINITION OF SCHIZOPHRENIA)
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● Autism
● Ambivalence
● Associative Looseness CLASSIFICATION OF SCHIZOPHRENIC
● Affect is not appropriateness SYMPTOMS (Most Updated as of
November 2021)
Causes of Schizophrenia
Class 1. Positive Class 2. Negative
● 1% of Population (1% of Filipinos Symptoms Absent Symptoms
have schizophrenia) to a Mentally Can be present to
● Decrease brain (frontal) Healthy Individual. a mentally healthy
● Biologic - Increase Dopamine individual
○ Norepinephrine (high - Major and Hard
hyper), serotonin Symptoms Minor and Soft
Symptoms
(high-happiness,
low-depressed), GABA Hallucination Avolution
(anxiety)
Illusion Anergia
○ If there is a question
regarding “what is the Delusion Asocial
biologic cause of
schizophrenia” it is basically Echopraxia Anhedonia
(You cannot
asking “What is the main appreciate pleasure.
neurotransmitter that causes Ayaw mo sa party,
schizophrenia?” - In this ayaw mo sa yummy
question basically it is food, ayaw mo sa
sex)
dopamine. Antipsychotics are
given to reduce dopamine
● Freud (Psychoanalytic Theory) - Insomnia Apathy (lack of
Weak ego (e.g. experienced child interest, enthusiasm,
or concern)
abuse, they did not feel that they
were loved), leads to vulnerable Ambivalence Alogia (Yes, or no, or
breakdown (e.g. mabuang kung limited verbalization,
or poverty of speech)
gibuwagan rag uyab)
● Social factors (most common) - e.g. Bizarre Behavior Affect is inappropriate
Single parent mothers - blunt, flat, no
● Vitamin Deficiency - B1 B6 B12 C response at all
(that’s why people in poverty Poor hygiene
develop schizophrenia due to
malnutrition) Pacing/rocking
● Organic factors - Trauma, Stroke, (common sign of a
person with anxiety)
Viral, Bacterial (alters balance and
function of the brain) - (In third world Regression
countries, Typhoid Fever can cause
Odd posture
psychosis and schizophrenia)
● Environment infection
● Autoimmune
 Abarquez, Amil, Auza, Son

DSM 5 Criteria for Schizophrenia “poisoned”, open, prepare and serve

(Important)
Note: No need to manifest all to be classified as
schizophrenic. Patients should manifest
symptoms in 2 criterias or more to confirm
Schizophrenia. At least 1 symptom must be
MAJOR.
it in front of the patient
- Safety
Catatonic Schizophrenia
● Excitement - Hyperactive, talkative
● Stupor - waxy Flexibility, mute
(However they are listening)

MAJOR:
Nursing diagnosis: Impaired Motor (Again
1. Hallucinations
remember to prioritize diagnosis based on
2. Delusions
question/scenario)
3. Disorganized Speech
Defense Mechanism - Repression
MINOR:
4. Disorganized or catatonic behavior
Priority Care:
(hyper and waxy flexibility)
● Circulation
5. Negative symptoms (blunt and flat
● Nutrition
affect)
Disorganized Schizophrenia
Paranoid Schizophrenia
Disorganized thought and behavior
- Suspicious, Delusions, Hostile &
● Mumbling (talk)
Aggressive (to protect themselves)
- Do not touch (assault) - If you want
Nursing Diagnosis: Poor social interaction
to touch, you must inform them why
Defense Mechanism - regression
such as (I will take your blood
Priority care:
pressure sir/ma’am)
- Physiologic Needs (they might eat in
- Maintain Distance (Proxemics): talk
trash bins, etc.)
to the patient through a table as a
- Safety (they might harm others and /
safe distance
or themselves)

Nursing Diagnosis - Risk for injury directed

to others (However remember, you must
adapt to the situation. E.g if the patient
refuses to eat, the nursing diagnosis is Risk
for Imbalanced Nutrition)

Defense Mechanism - Projection (gawain

nila nakikita sa iba)

Priority care:
- Nutrition: if patient does not want to
eat, serve sealed foods to ensure
the patient that they are not Answer: C
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Rationale: The concern of the patient at this -First sign of NMS: High
time is that the nurses are spraying poison fever (> 38.5), diaphoresis
on the food tray upon removing it from the - Altered LOC (Restless,
cart. So you have to address that specific Stupor, Coma etc), Muscle
concern of the patient and so, let the patient Problems
remove his own tray inside the cart. - Report immediately and
provide an antidote.
● Can give with anxiolytics
(Anxiolytics and antipsychotics
can be given together)

Atypical Antipsychotics
● “Pine” & “Done” Suffix
● Newest antipsychotics
● Can cause EPS, but lower risk than
typical.
● Better than typical, as it can manage
Answer: A. both positive and negative
Rationale: Eliminate D, as it contraindicates symptoms of schizophrenia.
the question asked. Eliminate C as client is ● Toxic/Adverse effects:
stupor, exhibiting waxy flexibility; eliminate B ○ Agranulocytosis - the bone
as it is not the priority concern. marrow is suppressed, in
producing WBC -> Risk for
Chapter 4 infection)
■ Report when patient
ANTIPSYCHOTICS / NEUROLEPTICS is having sore throat
■ Avoid going to
Typical Antipsychotics crowded places
● “Zine” & HALOPERIDOL ■ Routine CBC every
● Old month, as WBC may
● For POSITIVE symptoms only and drop
not negative symptoms ■ Do not give drug
● High chance of EPS - (high when patient has
incidence of Extrapyramidal dementia or
symptoms - however this is a side alzheimer’s as their
effect, and not a toxic side effect. So condition will
although they have manifestations of degenerate faster
EPS, we do not stop the (give anxiolytics
antipsychotics, but rather provide instead)
medications that help in relieving ○ Leukopenia
EPS) ○ Neuroleptic Malignant
● Toxic/Adverse - NMS (Neuroleptic Syndrome - MOST TOXIC
Malignant Syndrome) (Stop the ● Don’t give with dementia
medication) Signs of NMS: Ziprasidone
 Abarquez, Amil, Auza, Son

● Low BP, Wide QT Intervals Dysphagia (due to the

presence of neck rigidity),
What is the best and most effective pupillary paralysis
antipsychotic drug? d. Akathisia - “kati”; feeling of
Clozapine (Board Exam), Risperadone in having ants under the pants
the Philippines -> restlessness, irritability,
agitation (e.g. inability to sit
All Antipsychotics (APs) common side still)
effects:
1. Photosensitivity - caution upon Anti-EPS / anticholinergic drug
going under the sun (sunscreen at 1. Cogentin
least 30 spf, shades, sweater, cap , 2. Benadryl
umbrella) 3. Akineton
2. Dry mouth and Constipation - 4. Artane
exercise, high fiber diet, encourage These cause muscle relaxation
sugar-free candy -> promotes (muscle-relaxants) to combat tremors and
salivation movement for EP.
3. Increased Weight
4. Decrease in BP, especially Antipsychotic given through IM: -
Ziprasidone
5. GI irritants - to prevent upset, take ● Decanoate
drug with or after meals ● Given once a month (ever 4 weeks)
6. Extrapyramidal syndrome (EPS) - ● Priority intervention: Allow the
symptoms of Parkinson’s caused by patient to sit down for a while
low dopamine due to the drug (decrease BP, orthostatic
(non-toxic) hypotension)
a. Tardive Dyskinesia
(Symptoms derive from the CHAPTER 5
mouth) - lip problem MOOD DISORDERS
(smacking), tongue twitching This is a critical topic to learn
b. Pseudo-Parkinson’s - First Occurs in highly functional people
sign is tremors (reversible
through anticholinergics as Mood Swings - Types
standing order, which causes 1. UNIPOLAR - Depression
muscle relaxation), Second 2. BIPOLAR - Depression & Mania
sign - rigidity
(non-reversible) Third sign - Moods (between normal (N), depressed (D),
Bradykenesia Fourth sign - and bipolar B)
Akinesia, bradykinesia / slow
walking, akinesia / cannot
walk (severe)
c. Dystonia - common
symptoms (affect neck &
eyes):
 Abarquez, Amil, Auza, Son

● Low Self-Esteem (unworthy)

Prevention of Suicide:
A. Increase their self-esteem
a. Identify their worth
B. Determine plan of suicide
a. Non-therapeutic approach
b. Direct statement - “do you
plan on committing suicide?”
c. What, where, when, how
Magulo ang utak, they are not able to
Causes of mood disorders:
verbalize, but they can answer questions.
1. Loss - Number 1 cause of mood
They want to die, but they don’t want to die -
disorders
they ask for help.
2. Biologic (through neurotransmitters:
serotonin - happy, norepi - hyper,
Types of Depression
dopamine - emotion)
1. Major Depression: HIGHLY suicidal,
3. Substance Abuse - alcohol as most
acute, usually lasts for 2 weeks or
common substance (going to bars
more
diverts attention from being
2. Dysthymic Depression - HIGHLY
depressed because people around
suicidal, chronic, di mahalata,
are active and happy); do not let
usually lasts for 2 years or more,
person drink alcohol as it
mild symptoms
intensifies level of depression and
3. Seasonal
can lead to suicide, as alcohol is a
4. Atypical
depressant
5. Melancholic
4. Physical / Sexual Abuse
6. Born at the end of March
5. Chronic Illness
7. Premenstrual Dysphoric Disorder
8. Postpartum Depresion: Postpartum
MAJOR DEPRESSION
blues (1 week after birth),
Characteristics of Depression:
postpartum depression (1 month),
● Hopelessness & Helplessness (Most
postpartum psychosis (1 year
common characteristics of
beyond)
depression)
● Sadness (normal), isolation (normal)
SUICIDE
and loneliness (normal) -> However
● Self destructive
if these symptoms are
● Cry for help
overwhelming (Such as
● Ambivalence - they want to die, but
overwhelming sadness) can lead to
they don’t want to die
depression.
● Altered appetite & Sleep (stress
Best intervention: be with the suicidal
eating / starving, insomnia / too
person / keep with the patient
much sleep)
● Slow
 Abarquez, Amil, Auza, Son
Types of Suicide
● Threat (e.g If you leave me! I will go
far away and you will never see me
again!) - No gesturing of a suicide
● Gesture (e.g. If you are going to
leave me, I will push this knife
towards my wrist, or pull the trigger)
● Attempt (e.g When you shot
yourself, but survived)
● Complete (e.g attempted suicide
and actually died successfully)
● Plan: How the patient will commit
suicide
● Ideation: No plan yet, but thought of
it (I want to join my friend in heaven)
SUICIDE RISKS
S - Sex: female (attempt), male (complete)
due to lakas ng loob
A - Age: 18-27 & > 40 has the highest risk
D - Depression
P - Prior attempts
E - Etoh (or drug dependent)
R - Rational thought (loss) or psychosis
S - Social support (lacking)
O - Organized Plan
N - No Spouse
S - Sickness/Stress
SIGNS
1. Sudden Mood Change
2. Give prized belongings
3. Verbalize
4. Will
5. Low Self-Esteem
SAFETY (Best management for suicidal
patient)
1. Stay (Stay with patient as much as
possible)
2. Unscheduled rounds (Don't schedule
your rounds, as the patient will know
when the nurse is not available)
3. Remove pointed objects
4. Verbalize
Note: They will always choose the fastest
way to die.
ANTI-DEPRESSANTS
4 Rules:
1. High suicide risk - less than 2 weeks
(increase energy, but cannot yet
manage the depression - this energy
can be used for suicide)
2. Slow onset & slow taper off - wait
for 2-4 weeks before the patient can
feel the response, tapers off slowly
(do not abruptly stop)
3. Never mix, but replacing / changing
is allowed: wait for the half-life of 2
weeks before changing to another
antidepressant.
a. SSRI w/ St. John’s wort -
serotonin syndrome (as the
wort also contain serotonin)
b. MAOIs w/ any
Antidepressants - contains
serotonin and dopamine
4. All psyche drugs
a. Decrease BP - orthostatic
hypotension
b. Increase weight
c. Hepatotoxic
SSRIs: Selective Serotonin Reuptake
Inhibitors (most common
antidepressants) (increases serotonin)
● “Ine” (e.g. fluoxetine, sertraline,
paroxetine, fluvoxamine) & “pram”
(escitalopram, citalopram)
(remember -ine not -pine)
● Sexual dysfunction (low libido),
delayed ejaculation
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● Do not mix with MAOIs, St. John’s & ● “CAAN” Calcium, Antacids,
Tramadol Acetaminophen, NSAIDs
● Can mix with benzodiazepines can I - increased Suicide Risk
be mixed typical antipsychotics
● Serotonin Syndrome “SRI”
(overdose of serotonin) BIPOLAR
○ S - Sweaty, Hot Fever
○ R- Rigidity, restless, tremors Bipolar 1 - History of Mania (more on manic
and agitation episodes)
○ I - Increased HR (vital signs) Bipolar 2 - No History of Mania (more
depression episodes)
TCAs: Tricyclic Antidepressants
(increases secretion of norepinephrine - Cyclothymia (lasts for 2 Years) - chronic,
hyper) minimal form of Bipolar Disorder
● “Pramine” & “Tryptyline” ● Hypomania
● Anticholinergic side effects ● Depression
○ Blurred vision/Photophobia ● Mania
○ Urinary retention
(Imipramine) MANIA: Common Characteristics
○ Dry mouth ● Manipulative (Most common)
○ Constipation ● Threat / Danger/ Impulsive -
○ Sedation cannot control emotions
● Amitriptyline - Orthostatic ● Hyperactive/Happy/Euphoria
Hypotension ● Insomnia
● Talkative - Flight of ideas, pressured
MAOIs: Monoamine Oxidase Inhibitors speech (fast speech)
(increases norepinephrine, serotonin ● Racing Thought - many things go
and dopamine) inside their head, causing insomnia
● Tranylcypromine ● Colorful - Clothing choices are
● Phenelzine colorful and bright
● Isocarboxazid ● Extravagant (Grandiosity)
● Selegiline ● Sexually Provocative

Nursing considerations (patient teaching) for Defense Mechanism: Reaction Formation

MAOIs medication: - “plastikay” (e.g. “I miss you, friend!” -
intention is to borrow money)
M - Massive Hypertension risk (serotonin
syndrome) BIPOLAR Types
A - Avoid foods rich in tyramine to prevent
hypertensive crisis (e.g. wine & cheese - Bipolar 1
[swiss, cheddar, aged, mozzarella], soy, - Major low (depression) &
soya, beer, sausage, salami, fermented & Major High (Mania)
dry fruits, no chocolates) - Bipolar 2
O - OTC Leads to Hypertensive crisis - Major low (Depression)
 Abarquez, Amil, Auza, Son
* Hypomanic (less high)
- Cyclothymia
- Hypomania & Dysthymia
Defense Mechanism
Reaction Formation - They actually
act the opposite of what they perceive to do.
Management of Mania
1. Safety - they can be very impulsive,
and thus poses danger (e.g the
patient lifted the chair and is about to
throw it across the ward)
2. Nutrition - High Calories, Finger
food (due to hyperactivity, food
should be able to be carried by
fingers while they move such as
burgers, chicken because they are
always on the move)
3. Matter of Fact - always present the
facts to the patients (e.g. The client
demands to eat lunch at 10 am
instead of 12nn -> Nurse tells patient
“Your lunch will be served at 12nn” )
4. Set Limits - be firm and consistent
5. Anti-manic Agents - lithium
carbonate (drug of choice)
6. Group therapy - support group
(7-10 members)
a. Leader - delegate to
members (different leader
everyday; nurse is NOT
included); some members
have recovered and are
included to inspire those that
are not recovered
b. Nurse - facilitator (maintains
a therapeutic environment)
Antimanic Agents
Drug of Choice: Lithium Carbonate
Other drugs: Valproic acid, carbamazepine,
antipsychotics
- Check kidney function first and
ensure that the patient does not
have a kidney problem first, as
lithium carbonate is nephrotoxic.
- Check Creatinine and Urine Output
Lithium Carbonate Toxicity
L - Level over 1.5 is toxic (normal level is
0.5 - 1.5) (if below 0.5, it means patient is
in Manic phase -> Give medication)
I - Increase fluids, regulate Na+ (135-145
mEql normal) - if low sodium, indicates
toxicity ; must take 2-3 g /day (3 g and
above, increased sodium reduces effects
of lithium)
T - Toxic Signs: Diarrhea (first sign),
Thirst, Polyurea, Vomiting
H - Hold NSAIDs; decrease renal blood
flow as it further impairs kidney function
Patient teaching
- Avoid activities that lead to
excessive perspiration, as more
sodium is lost - low sodium levels,
leading to lithium carbonate toxicity
- Diuretics are antidotes, decreasing
effectiveness of lithium; only
administer when toxicity happens
Normal Side Effects of Lithium
Carbonate:
● Tremors: Fine hand tremors
(expected findings)
● GI: headache, nausea, vomiting
● Depression: monitor for suicidal
ideations
ECT - Electroconvulsive Therapy
Note: If it cannot be relieved by medications,
ECT is another option for the patient.
Indications:
- Depression
- Mania
 Abarquez, Amil, Auza, Son

- Catatonic Excitement 3. Orient - Orient once awake - when

Note: May be done to pregnant women with patient is awake
no complications (antidepressants cross the 4. Monitor - Continue monitoring V/S
placental barrier, and are teratogenic) so
ECT is the preferred treatment, use less
than 100 volts

Contraindications:
- Increased ICP (stroke, brain tumor)
- Others (Delay ECT): Fever,
Hypertension, Fracture (It could
further worsen fracture), Present of
Cardiac & Respi Problem

Preparation
- Same with pre-op or general Answer: A
anesthesia procedures (NPO, Rationale: question is most common side
consent, removal of dentures and effect AFTER ECT -> answer which makes
nail polish, etc.) most sense in relation to the question is A
(patient forget events PRIOR to ECT)
Side Effects:
- Temporary memory loss __________________________________
- Headache
- Asleep DAY 2
- Muscle Weakness (succinylcholine) ANXIETY DISORDERS

Pre-ECT medications: Different Levels of Anxiety

1. Atropine sulfate - addresses safety Note: In the board exam you will be given a scenario
by preventing aspiration during and and you would have to identify what type or level of
anxiety the patient has.
after ECT
2. Succinylcholine - muscle relaxant Mild / Alertness
(monitor respiratory depression - Power - Pupil Dilate
3. Methohexital sodium - anesthetic perception (adrenaline
(super alert), rush), High VS,
agent
High Learning Butterfly
- Daily tension Tummy
Note: Patients are asleep before ECT due (normal), Cope (masakit tiyan
to the medications given; patient must not (can easily pero hindi
feel the ECT confront) natatae)

Moderate / GI symptoms -
Management: Order of priority 1-5
Apprehension LBM, constipation
1. Airway - Side lying position, or - Low perception - Brain is
administer O2 (hindi ka connected to
2. Safety - Lower bed and raise side masyadong aware the Gi through
with what is
rails
 Abarquez, Amil, Auza, Son

happening around vagus nerve -> occurs when it prolonged or

them), stressed brain occurs for a long unmanaged,
- Selective -> affected GI time resulting
inattention - Abnormal GI -> emergency)
(preoccupied brain
mo sa ibang stressed brain
bagay-bagay - e.g. since connected
crossing the street by vagus nerve Common denominator: Inability to adjust or
while thinking about cope with the stressors in life
something else)
- Low learning,
What is Anxiety Disorder?
can cope
*your brain keeps ● Subjective response to threat
on thinking of ● Note: (fear related to the unknown)
multiple solutions to ● Causes:
a single problem, 1. Decreased GABA:
and that is why you Gamma-aminobutyric acid
have low a. (Major, primary
awareness to what neurotransmitter
is around you
blocking nerve
Severe/Fight or impulses in the brain;
Flight/Free low levels of this
Floating Anxiety - Nervous neurotransmitter
- Impending (Palpitation) causes anxiety)
doom, Dyspnea/Hyper 2. Familial
- Cannot cope ventilation
3. Social
- Pupil
constriction, 4. Life experiences
tunnel vision ● More of subjective; you will only
(confused, no know when a person is experiencing
awareness of anxiety when he/she tells you
what is (subjective) or objective on severe /
around)2 high / panic level of anxiety
Panic / ++++ exhaustion, (objective)
Disorganized can collapse
- Danger Pupil - dilate Practice board question:
(self/others) - (hypothalamus to Mario has been experiencing insomnia
gulo ang utak adrenal gland:
compensate! since his son died 2 months ago.
mo, death Epinephrine is released A. Mild
- Doom - dilatation happens as
- Cannot cope compensatory B. Moderate
- Goal (decrease mechanism) C. Severe
anxiety into a D. Panic
Heart & lungs
manageable
symptoms (cardiac
level) Answer: C
arrhythmia
progresses to vtach Rationale: Insomnia is an indication of “not
*we cannot prolong
/ svp / cardiac coping”. Because Mario has been
panic experience,
arrest when experiencing “since” his son died 2 months
as suicide or death
ago, that means he hasn’t resolved his lack
 Abarquez, Amil, Auza, Son

of coping skills (insomnia). Eliminate A & B.

Beta Blocker Palpitations due to
Mario would have died a day after his son’s (order) nervousness,
death if he was experiencing panic anxiety, *PRIORITY
so eliminate D. (severe-panic) Note: This can lead
to arrhythmias,
Gerald, 30 years old, has been experiencing therefore Beta
headaches for a month, ever since his Blockers should be
administered
boyfriend had another boyfriend.
A. Mild
B. Moderate Anxiolytics/ Decrease Anxiety
C. Severe Benzodiazepines
D. Panic Zepam/Zolam, Note: Best
BLT management for
decreasing anxiety.
Answer: The headaches lasted for a month, *EMERGENCY
indicating lack of coping MANAGEMENT ANTIDOTE for
(severe-panic) toxicity: Flumazinil
ANXIETY MANAGEMENT
Note: Management of anxiety should be based on the
level of anxiety as presented by the board exam. Countertransference: When you feel what
Understand the situation, discern the level of anxiety, the patient feels (e.g. mas nagalit ka sa ex
and provide the intervention based on updated ng bestfriend mo kaysa sa bestfriend mo
guidelines. after sharing her feelings)
Safety Decrease stimuli,
*PRIORITY rest command, Are we allowed to restrain a patient
Note: Most important to restraint without a doctor’s order? If so, how long
address for all
psychiatric patients thereafter do we need to obtain a
doctor’s order?
Relaxation Deep breathing, +
imagery We are allowed to restrain a patient when
Verbalization Mild/Moderate - necessary, even if there is no doctor's order.
therapeutic (allow However, we need to OBTAIN a doctor's
them to talk and order after restraining IMMEDIATELY
give this moment (Previous source, was within 24 hours
to them) - “tell me (DSM IV), however now the updates is
how you feel?” immediately)
“What are your
concerns at this
time?” BENZODIAZEPINES
- (-) zepam / (-) zolam
Severe/Panic - Common S/E:
direct statements, - dizziness, clumsiness
and questions - Hangover symptoms (Board Exam)
answerable by yes - Nausea, Headache, Vomiting
or no - “Are you
okay? Sit down.
Calm down.” LIBRIUM
 Abarquez, Amil, Auza, Son
TRANXENE
Buspirone (Buspare)
- While all anxiolytics cause dizziness,
Buspirone does not cause dizziness,
so they can do concentration
activities (like driving etc.)
BENZODIAZEPINE Antidote: FLUMAZENIL
Types of Anxiety Disorders
- OCD
- GAD
- PTSD
- Phobia
OCD
Note: Commonly asked in the board exams
○ Obsession - Persistent intrusive
thought - There is a thought that is
intrusive that you don't want to think
about, however the thought is
persistent in your mind. Causes
high level of anxiety
○ Compulsion (as coping
mechanism) - Uncontrolled RITUAL
- Ritual meaning a repetitive
behavior that cannot be controlled.
The uncontrolled ritual leads to
decreased level of anxiety to divert
the intrusive/persistent thought
(obsession)
○ Goal of Treatment:
Limit, Control, Decrease
Note: You do not stop the
compulsion as it can contribute to the
higher level of anxiety. So the goal should
be towards limiting or controlling, but not to
stop.
○ Management:
■ Behavior Modification Therapy
■ Psychotherapy - explore ways on
how the patient can ventilate or
verbalize feelings in order to
extract matters the disturbs the
mind of the patient
■ Medication - Drug of choice for
OCD is Clomipramine
(AnaFranil) (Tricyclic
Antidepressant)
Note: Board exam, if no Clomipramine,
use the next SSRI (Selective Serotonin
Reuptake Inhibitors - Drugs that end
with “ine/pram”)
Most common side effect: Sexual
Inactivity (Delayed ejaculation)
Question: The patient missed the group
therapy at 8:30 am because she was
washing her hands from 8:00 to 8:30 am.
What should the nurse advise her next?
Answer: Let the patient wash her hands at
an earlier time so that she will not miss the
group therapy.
Question: A mother reports to the nurse
that her child performs hand washing 30x a
day. Upon thorough assessment by the
nurse, they learned that the child has red,
dry, cracked, and scaly skin. What is the
MOST appropriate goal of treatment?
A. Limit hand washing.
B. Encourage the child to verbalize
feelings.
C. Provide adequate skin care.
D. Decrease hand washing a day.
Rationale: Remember to address the goal
to address the problem.
 Abarquez, Amil, Auza, Son

○ Flooding (exposure to a fake

GENERALIZED ANXIETY DISORDER scene) - “prank” ; make a
(GAD) situation similar to the
Note: One of the most difficult disorders to diagnose patient’s traumatic
due to those having GAD being highly functional.
experience. Once the patient
● Excessive Worry (worries too much on panics, make the patient
small things) realize that the situation is
● Last for 6 Months (If symptoms lasts just a “prank” (not real), and
for 6 months or more, then it is an that the real traumatic event
indicator for GAD) happened long ago.
○ Tension - Confused,
Increased VS, Restless, PHOBIA
Irritable, Tremors, Slurred ● Irrational Fear of Specific object
Speech, Headache ● Major Types
● Recommended pharmacologic ○ Agoraphobia - panic attacks
management: antihypertensive + in public (in libraries,
antidepressant - to feel calm and avoid expressways, malls, etc.)
BP from increasing caused by anger ○ Social Phobia - Fear of
situations in which one might
POST TRAUMATIC STRESS DISORDER be embarrassed or criticized:
(PTSD) fear of making a fool of
Note: Related to a previous traumatic experience
(happened over 3-6 months ago)
oneself.
● Flashback - relive i. Xenophobia: Fear of
events/re-experience - Panic, strangers
palpitation ○ Simple phobia - cause of
○ Note: In board exams, they will use phobia is a specific object
the word “flashback” to indicate (e.g. eggplants, spiders,
PTSD related questions. darkness, dirt, closed spaces
● Nightmares etc.)
● Conversion - type of somatoform Scenario: You're in a public market, and
wherein you feel like you are you drop your eggs, and people look at you,
paralyzed or blind, but you are not making you panic, is this agoraphobia or
(emotional stress becomes a physical social phobia?
symptom w/ no actual physiologic
cause as a way of the mind to cope Answer: Social phobia - although this
with the stress) occurred in a public setting, the cause of the
● Depression - PTSD can lead to panic attack was due to the people looking
depression at the person dropping the egg, and is then
● Management: fearing of being embarrassed and criticized.
○ Cognitive Therapy -
presenting reality; challenges ● Management
and corrects the wrong ○ Systematic Desensitization
belief; (systematic process)
 Abarquez, Amil, Auza, Son
i. Show a picture of the
fear (draw it first, or
have it in black and
white before showing
a colored image ->
remember to be
systematic!)
ii. Video (But make sure
to start with gentler
videos - eg. start with
small animation of
green snake before
lastly showing a large
anaconda video)
iii. Exposure
● To maintain patient composure and
prevent panic attacks during
systematic desensitization:
○ Always encourage the
patient to do deep breathing
and relaxation techniques
after each step of the
desensitization process
(most important)
Types of Phobias:
● Acrophobia - Fear of heights
● Astraphobia - Fear of electrical
storms
● Claustrophobia - Fear of closed
spaces
● Hematophobia - Fear of blood
● Hydrophobia - Fear of water
● Monophobia - Fear of being alone
● Mysophobia - Fear of dirt or germs
● Nyctophobia - Fear of darkness
● Pyrophobia - Fear of fires
● Social Phobia - Fear of situations in
which one might be embarrassed or
criticized; fear of making a fool of
oneself
● Xenophobia: Fear of strangers
● Zoophobia - Fear of Animals
Eating Disorder
Types:
● Anorexia Nervosa
● Bulimia Nervosa
Causes:
Which among the causes of eating disorder
is the most common cause of eating
disorder?
● BELONGING TO A STRICT FAMILY -
increases likelihood of the child being
a perfectionist :(((( huhuhu ))))):
Other Causes of Eating Disorders
● Genetics / Heredity
● Social Factors
● Media
Common Characteristics of BOTH
Disorders
● Obsession with their weight - they feel
like they are obese, but are actually
thin, malnourished and underweight
● Obsession with food - they are hungry,
but they don’t want to eat, as they
have a very high discipline of not
wanting to eat
● Highly Perfectionist - they need to
finish what they are doing and meet
deadlines, so they don’t eat
● Known to abuse laxatives/diuretics -
usually hides these pills or laxatives
● Manifest abdominal problems
● Depression - leads to suicidal ideation
Distinct characteristics in ANOREXIA
Nervosa
● Odd or weird behavior (Common in
Nursing Boards) -
○ This includes claiming that
they have eaten however
they are hiding their food or
threw it in the trash.
○ Slow Eating
 Abarquez, Amil, Auza, Son

● Poor Nutrition - - Self-esteem Disturbance

○ as evidenced in decrease of - Ineffective Coping
weight (thin) ->
○ prone to hypothermia
○ Lanugo is developed for Nursing Management
some as compensation for 1. Address the nutrition (make sure
hypothermia the patient eats the food that is
● Skin (Dry) served, and stay with the patient
● Hair - Brown and brittle with many split while they are eating for 1-2 hours
ends after eating food) - if more severe,
● Absence of menstruation provide IV nutrition) First
(amenorrhea) - caused by intervention/Priority
malnutrition. 2. Behavior Modification - Set limits
● Purges (However less common in by being firm and consistent (for
anorexia) -> Therefore, monitor them example they must eat at 12pm, and
an hour after meals as they may visit they must finish the food that is
the CR and purge their food. served)
3. Cognitive Behavioral Therapy -
Distinct Characteristics of BULIMIA Challenges and corrects wrong
Nervosa beliefs (Note: Do not confront
● Excessive eating whether or not they have an eating
● Purging - Vomiting after eating disorder as they will be defensive
○ Possible complications: and can deny.)
i. Stained teeth 4. Involve the patient with meal
ii. Erosion of the plans - ensure that they consume
teeth/enamel due to food that they like/ favorite foods that
constant exposure to are nutritious! (not just cake or
gastric acids from fishbol).
emesis a. Note: Do not allow the patient’s
● Usually in the nursing exam, the family to bring food for the patient
as it should be between the patient
weight of the patient is normal
and the nurse to plan the meals.
(sometimes there is a slight decrease)
as opposed to anorexia where the 5. Weigh patient, same time each day
patient is underweight. 6. Monitor the patient while eating and
● Performs intense exercise 1-2 hours after as they will purge.

Nursing Diagnosis of Anorexia and

Bulimia Nervosa: ---------------------------------------------------------
● Most common diagnosis:
- Imbalanced/Altered Nutrition: CHILDHOOD DEVELOPMENTAL
Less than Body DISORDERS
Requirements - Priority.
● Other Diagnosis ● ADHD - Attention Deficit Hyperactive
- Body Image Disturbance Disorder
 Abarquez, Amil, Auza, Son

● Autism ● A preschooler is not dumb; slow

● MR - Mental Retardation learning may indicate poor nutrition
(75% of the food that we eat is
Note: These questions can appear in Psychiatric consumed by the brain)
Nursing or Pediatric Nursing
● PH - one of the high incidents of
anemia among children
Note: You can prevent developmental disorders
Management of ADHD
Causes
● SAFETY - Priority management
Pregnancy Complications - most
● Behavioral Therapy - Aims to improve
common developmental disorders
inappropriate behavior to appropriate
(such as Pregnancy Induced Hypertension
-> can impede blood flow to the baby -> less behavior
O2 supply to brain) ● Nutrition - high caloric food (chicken,
Heredity burgers yum) due to hyperactivity;
Stress, Nutrition, Environment they need these foods for energy
(pollution) since child is hyperactive
● Play - safe and age appropriate
Note: Incidences of autism for example are actually ● CNS Stimulant (To improve Focus) -
higher from rich families that can afford food with Ritalin, Methamphetamines
higher cholesterol/processed foods, and alcohol
(teratogenic factors)
Question: What type of play is not
appropriate with a child having ADHD?
ADHD - Attention Deficit Hyperactivity
A. Hopscotch
Disorder
B. Swimming
● Impulsive - lack of self-control;
C. Skateboarding
becomes destructive (mainit ang ulo,
D. Mountain climbing - not safe
throws toys when mad)
● Hyperactive - fidgeting - there is a
AUTISM
part of their body that they frequently
● Poor Social Interaction
use/fidget
○ Unresponsive - although you
● Inattention - easily distracted; tend to
may talk to them, they do not
have low grades but are not dumb
respond
● Most common among boys: in 3
○ Not Cuddly
children, 2 are boys and 1 is a girl
○ ECHOLALIA - they repeat
● Usually diagnosed at 7 years old,
the words they hear from
naturally resolves at 12-13 years old
others, together with the tone
● When you look at their notebook, first
and sound
page to succeeding pages show
○ Spin objects - Toy (Blocks)
drawings, instead of taking notes due
○ Intimate with Inanimate
to lack of attention
objects
● May have problems with
○ Loves music
attitude/behavior - palaaway sila - may
○ Tantrums (head bang) -
present oppositional defiance
● Common among boys (higher
disorder (but not all)
incidence)
 Abarquez, Amil, Auza, Son

● Usually diagnosed and confirmed at

moron Educable
3 years old No
● NO round objects such as balls, the supervision
tendency is that balls roll away,
causing temper tantrums. Moderate/ 30-49 Grade 1-2
● Give toys such as hollow blocks Imbecile Basic Training
(e.g. how to eat
using spoon and
Causes fork,
handwashing)
1. Pregnancy Complications - most
Less
common developmental disorders Supervision
(such as Pregnancy Induced Hypertension
-> can impede blood flow to the baby -> less Severe/ 20-29 Toddler
O2 supply to brain) Idiot Supervision
2. Heredity Mental age: 1-3
3. Stress, Nutrition, Environment years old
(Toddler)
(pollution)
Profound Below 20 Custodial
Management for Autism Care
● Address SAFETY due to Mental ability
hyperactivity and tantrums (e.g. of an infant
(e.g. can say 1-2
provide helmets / pads when the words only,
child head bangs) cannot walk)
● Nutrition - children tend to be chubby
because they are rich Management for Mental Retardation
● Behavior Modifications - model ● SAFETY - same care for a child with
appropriate behaviors autism
● Repetition ● Nutrition
● Role modeling ● Behavior Modification
● Refer with available resources ● Repetition
○ You cannot let the child join ● Role Modeling
in a regular school; refer ● Referral to available resources
them in special schools or ---------------------------------------------------------
training centers (SPED)
DOMESTIC VIOLENCE
Note: You can prevent developmental ● Rape
disorders ● Child Abuse
● Battered Wife
● Elderly Abuse
MENTAL RETARDATION / LEARNING
DISABILITY (DSM V) RAPE
● RA 8353 - The Anti-Rape Law of
LEVEL IQ TASK 1997 defined as “forcible insertion of
the penis/ other objects into the
Mild/ 50-70 Grade 5-6 mouth, anus and vagina”
 Abarquez, Amil, Auza, Son

Types: ● RA 7610 - Report to Police, Social

1. Acquaintances - someone you know Worker or Barangay within 48
2. Incest - relative hours
3. Statutory (Rape w/ Consent below ● Common cause of child abuse in the
18 years old) Philippines is NEGLECT due to
4. Blitz poverty (This may differ to textbooks
5. Accessory (Can’t give consent) - like in the states where the most
such as someone who is common abuse is physical or
unconscious or comatose emotional abuse)
6. Date
7. Confidential (Unreported) Types of Child abuse
- Emotional Abuse
- Physical Abuse
RAPE TRAUMA MANAGEMENT
SYNDROME - Sexual Abuse
- Neglect (Most common in PH)
Disorganized Preserve
- After Rape Evidence Signs of Child Abuse:
(Intervention 1. Injuries at various stages of
immediately after) -
healing
such as do not
change the 2. Aloof - not comfortable or shy in
patient’s clothes interacting with the health care team
until after 3. Unequal hair length (gi-kulata)
investigation 4. Nightmares
5. Depression - Powerlessness (they
Shock, Disbelief, Safety- stay with
cannot do anything, they cannot
Numbness patient
protect themselves)
Anxiety (Fear of Document 6. Knowledge w/ sex - due to his/her
Death) (Accurate and experience of having sex with the
Complete) - Details abuser
may be needed for
future litigation *NLE: Presents this issue in SITUATIONS. Read as
report many board exam questions as possible to
improve common sense.
Denial (No Proper Referral
feelings/emotion) (supervisor, police)
Management
Note: report case ● Talk to the victim ALONE when
first to the assessing
supervisor, as it is ● SAFETY
the supervisor’s ○ Report (police, barangay,
responsibility to child services such as
refer the case to
DSWD)
medico-legal)
○ Where to go (nearest
neighbor who can protect the
child)
CHILD ABUSE
 Abarquez, Amil, Auza, Son

○ Shelter (get the child from

the family for safety) Characteristics of an abuser (abusive)
● Family Therapy 1. Low self-esteem / high insecurity
○ Observe behavior of the 2. Belong to violent family - observe
family, make sure that you how the person treats the mother
wear your uniform as your 3. Abused
presence as a nurse reminds 4. Immaturity - fights over the simplest
them of the things that they things
need to do or have to abide
● Play Therapy ---------------------------------------------------------
○ Divert - give interesting toys
that can immediately and PERSONALITY DISORDERS
temporarily divert the child ● Different view of self and others - they
from the bad experience view themselves as always correct and
others as always wrong
BATTERED WIFE SYNDROME ● Not flexible - behavior/attitude is not
flexible; they cannot change this distinct
Phases: behavior
1. Tension Building - Verbal, No ● Poor social interaction - people do not
Physical Injury/ Harm like them because of how they interact
2. Battery Incident - Physical Injury with others (masamang ugali)
a. Ask for help - Denial (i was
hurt because it was my fault) CLUSTERS
= due to co-dependence Cluster A
b. Co-Dependence - takes - Weird (Odd/eccentric Behavior)
responsibility for the action of - Schizoid
abuser - Schizotypal
c. Dependence - tolerance of - Paranoid
abuse for the sake of Cluster B
children or financial - Wild (erratic)
dependence
3. Honeymoon - Undoing (defense Cluster C
mechanism); abuser compensates - Worried (anxious)
through providing luxury things while
victim still hopes that abuser will Cluster A (all are paranoid)
change Paranoid
- Accusatory
Note: The risk for harm is higher when the victim Schizoid
leaves the abusive relationship / family, because the
- Aloof (Isolate - they like to work
abuser’s ego is affected and so, the abuser will find
the victim and further cause harm.
alone and are uncomfortable with
groups), Last to catch up w/ fashion
*The mind can define true love in a mature - Paranoia
mind at 25 years old. Schizotypal
 Abarquez, Amil, Auza, Son
- Awkward (Magical Thinking - they
think that they have superpowers or
third eye). Ideas of Reference
- Want social relationships, but are
awkward due to their thinking
-- - - - - - - -
Cluster B (Wild and Erratic Behaviors)
● Antisocial
● Borderline
● Histrionic
● Narcissistic
Antisocial Disorder
● Over 18 years old, with history of
conduct disorder (genetic)
● Break laws - habitual
● No remorse or conscience
● Charming (but evil)
Borderline Personality Disorder
*most common type of personality disorder, with
highest incidences among women
● Self-mutilating - when they can’t
have what they want, they hurt
themselves (most common)
● Manipulative - all wants should be
followed, and arguments happen
when these are not given; they lie
just to manipulate
● Projection - always blames you for
the argument, but it is hers/his
● Intense Relationship - masakit sa
ulo, very possessive, grabe
magmahal
● Splitting - I love you, I can’t live w/o
you, but does the opposite and
hangs out with others
● Fear of Abandonment
● Unsuccessful Behaviors
Histrionic Personality Disorder (PD)
● Attention seeking behavior - the
way they talk, move, dress
● Manipulative - they want their wants
& interests followed
● Shallow Relationships
● Dramatic - maarte due to attention
seeking behaviors
Narcissistic Personality Disorder (PD)
● Grandiose Self-Image
● Love of self - major exaggeration of
achievements
● Pretentious
● Entitled
● Lacks empathy
● Fragile (but inflated) self-esteem
● Vulnerable to criticisms
Management for Cluster B
Can’t handle negative emotions from
Self-Evaluation
● Dialectical behavioral therapy
○ Targets specific thoughts and
behaviors
○ Helpful for Borderline
-- - - - - - - -
CLUSTER C (Anxious and worried)
● Avoidant - cowardly
● Obsessive compulsive -
compulsive
● Dependent - clingy
*Genetic association: ANXIETY disorders
Avoidant PD (“cowardly”)
 Abarquez, Amil, Auza, Son

● Low self-esteem - they feel like ● Difficulty making decisions, and

they do not belong or achieve the blames the other person when
criteria of the group he/she is not satisfied with the
● Shy decision
● Timid ● Abusive relationship
● Socially inhibited
● Hypersensitive to rejection - they Management for Cluster C
would rather be alone than be ● Social Skills Training
rejected ● Anxiety Management - allow to
They feel like they do not meet the social verbalize feelings
criteria of a group and so, they become ● Group Therapy (7-10 persons)
avoidant ○ Safe place to engage in
social interactions
Obsessive Compulsive PD
● Inflexible —-- END —--
● Rigid
● Obsessed with:
○ Perfection
○ Rules
○ Details
● OCD (ritualistic behavior): ego
DYSTONIC - you don’t want to think
about it, but the thought is
persistent, ego is NOT in harmony of
the self (DISHARMONY OF THE
EGO)
○ Anxiety occurs because of
the persistent thought that is
unwanted
● OCD (personality disorder): ego
SYNTONIC - ego meets its desired
goals of the self: is satisfied when
there is perfection, rules are followed
and details are seen (in HARMONY
WITH THE EGO)
○ They experience anxiety
when the criteria/ goal is not
met, or ego is not satisfied

Dependent PD
● Clingy
● Overly dependent
● Fear separation/ rejection
● Lacks self-confidence