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Psychology
07/07/23 – sir archie

● Psychiatric nursing
○ Nurse-client relationship – it means two way process which there is give and
take. Such as if the nurse will share something the patient should be able to
share also. It is not a therapeutic relationship kapag isa lang ang nag sasalita.
■ It is a series of interaction between the nurse and the client it means
constanct communication. (consistency)
■ goal : positive behavioral change for example this is a change in the
behavior of the client from being uninteractive to interactive, from being
quiet to being able to share.
- Q1: when does the therpeutic relationship begins? Ans: it begins
in orientation phase ito yung unang pag tatagpo with the client.
- Q2: the only tool available for the nurse? Ans: SELF it is because
in psychiatric nursing we give ourselves to the client. It is
important to have SELF-AWARENESS
○ Elements of Nurse Client Relationship
■ T – trust makuha yung tiwala ng client; always protect the trust of the
client once nurse were able to build this rapport.
■ R – Rapport establishing the rapport it means
■ U – unconditional postive regards accept the client for who they are.
(acceptance should be there)
■ S – setting-limits it is because the client is the leader between the
client-nurse relationship.
■ T – therapeutic use of self we will use ourselves towards the client.
(therapeutic communication is used here).
- Q3: when is the trust established? Ans: when the patient starts
sharing to the nurse
○ Therapeutic Behaviors
■ Genuineness – there should be sincerity and honesty
■ Concreteness – ability to identify client’s feelings (we should be
sensitive)
■ Respect – consideration of patient as unique.
○ Phases:
1. Pre interaction/preorientation
a. No contact with the client at this point.
b. Secondary sources which includes the charts, relatives of the
client.
c. The best to conduct the self-awareness
2. interaction/orientation
a. Establish trust
b. Assess client
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c. Mutual agreement
d. Informing about termination
3. Working
a. Longest phase
b. Achieveing goals
c. Sharing facts
d. Resolve the problem
4. Termination
a. Moving towards independence
b. Ending the therapeutic relationship
c. Observe for regressive behaviors.
○ Therapeutic communication (theracomm)
■ Dynamic process of exchange information you adopt what the client says.
■ Verbal and non verbal
○ Theracomm: ELEMENTS
■ sender /encoder – the source of the message
■ Message – actual information being transmitted
■ Reciever – recepient of the message
■ Feedback – recivers of the message
- Barriers – factors inhibits the transfer of
information/communication process
○ Non-verbal communication
■ Proxemics – physical space between the nurse and the patient. (3-6 feet
or one arm and half.)
■ Kinetics – body movement such as rhe gestures, facial expressions, and
mannerisms.
■ Touch – intimate physical touch → but have consent first. Touch the
shoulder part only, palm, do not touch the area that are sensitive.
■ Silence – conveys listening, interest, agreeing, encourages the patient to
talk.
■ Paralanguage – voice quality (tone, inflection) how the message is
delivered. It improves the credibility of what you’re saying.
○ Verbal communication
■ It should be therapeutic, appropriate, simple, adaptive, concise, and
credible
■ Therapeutic techniques MUST DO!!
1. Offering self – let me sit here with you for 5 mins which is
SMART.
- Specific
- Measurable
- Attainable
- Realistic
- Time bounded
2. Active listening – ah huh, yes, no
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3. Exploring – you said hannah was the best, can you describe
her? There is exploration on this example such as si hannah
because the nurse is asking the significant of hannah to the life of
the patient.
4. Broad openings – where would like to begin? By broad opening
we are giving the patient to start the topics that he/she wants to
talk about.
5. Making observations – to start a conversation and conveys that
you are interested to the client as you can also see the small
details. This will increase the self-esteem of the patient as it shows
you are interested.
6. Summarizing – it comes from the root word “summarize”;ex. In
the past 15 minutes we have talked about.. Also It is important to
summarize in the theracomm with the client because you will be
able to know what was discussed and not yet discussed between
the client.
7. Encouraging description of perception
8. Presenting reality
- ex. “I am hearing voices..”
a. EDP: “what are the voices telling you?” – here by
using the encouraging description of perception you are given
the chance to assess the hallucination.
b. PR: “i know that the voice seems real to you, but i
dont hear any voices.” – this is way of presenting reality,
always say the reality to the client
- Recap for no.7 and no.8 as both of the are used when there is illusion
and hallucination: Illusion (with stimuli) vs hallucination
(without stimuli) – difference is the presence of stimuli; ex.
If ilusion if you see the fan as monster which is ang fan
yung stimuli. For hallucination is that nakaka kita ka ng
halimaw pero walang fan.
- Types of hallucination
1. Visual – you see it (vision)
2. Auditory – you can hear it (hearing) – it is
considered dangerous because it has command.
3. Tactile – you can feel it in your skin (feeling)
4. Gustatory – you can taste it (taste) – it is
uncommon among the types of hallucination
9. Seeking clarification – “do you mean?...” also remember when
charting it should be verbatim it means ilagay mo kung ano ang
sinabi ng patiente; if there are words that are unclear always
clarify it with the client.
10. Reflecting – you make the patient answer her own question; let
the patient reflect. Do not answer the problem of the client instead
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assist the patient; this will help the client become more
independent.
11. Restating – rephrase what the patient has said; ensure you dont
use the same word that the client used.
12. General leads – “ go on../Tell me more…”
13. Focusing – “let is look at more closely..” it will let the client feel
that you are interested.
■ Non therapuetic techniques AVOID!!
1. Giving advice – becasue we will not solve the problem of the
client but rather help them
2. Talking about self – it is because we are patient-centered.
3. Telling the client is wrong – it will stimulate dispute and can
result to loss of trust
4. False reassurances – results also to loss of trust due to false
hope. kasi iisipin niya na di totoo mga sinabi mo.
5. Asking why – this implies demands an answer → arouses deep
seated feelings
- Exemption: suicidal → can be direct quesitoning
■ Spheres
1. ID – PLEASURE principles, irrational thoughts; hindi
makdahilanan na iniisip natin; you dont think if its right or wrong.
(increased ID = antisocial)
2. EGO – reality based, this maintains the SANITY.
3. SUPER EGO – it balances the ID, this are the conscience, EGO
IDEAL, this is the moral. (increased Super ego = OCPD)
○ Defense Mechanisms
■ Repression – unconsciously forgetting (di sidaya) – such as traumatic
experiences from childhood, so when get older you forget most of your
childhood becasue of how traumatic the event is.
■ Suppression – conciously forgetting (sadya) – yung utang mo bhie!.
■ Reaction formation – plastic/plastic usually common with people who
has bipolar when you are sad deep inside but you show people that you
are happy.
■ Rationalization – reasoning out or making excuses – convincing yourself
using your own reason.
■ Projection – blaming others
■ Introjecton – blaming self
- Two types of introjection:
1. Blaming yourself
2. Exact replica of other person
■ Compensation – weak on one aspect → but you’ll be strong on another
aspect
■ Denial – unacceptance of the truth. One of the common is when you
cannot move on from your ex..luh siya!
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■ Displacement – chanelling of anxiety – pinagalitan ng nanay tapos nag

dabog ka by shutting the door loud.
■ Regression – going back to the previous developmental stage – by
thumb sucking, umihi sa salawal, or doing fetal position.
■ Undoing – nag huhugas kamay because of guilt feelings. – nag away
kayo ng jowa and dahil may nasabi kang masasakit, then you felt guilty,
so pag uwi mo you bought flowers para maka bawi.
■ Conversion – anxiety → physical symptoms
■ Intellectualization – reasoning (detailed/reference) speaking without
emotions – very detailed explanation with reference.
■ Identification – idolization (certain features) unlike the exact replica only
certain features are followed.
■ Substitution – unavailable → to available
■ Sublimation – unacceptable → to acceptable
○ Crisis
■ Three types of crisis:
1. Maturational/Developmental – predictable and expected
pregnancy, marriage, or something expected.
2. Situational – unpredicatable and unexpected such as different
types of accidents.
3. adventitious/social – calamities/acts of God, hideous crimes
○ Death and dying
■ D – Denial – unacceptance of the truth
■ A – Anger – project/introject
■ B – Bargaining – making unrealistic offers
■ D – Depression – dangerous stage → suicidal (depression) – safety
■ A – Acceptance – moving forward
○ Disturbances in appearance
■ Automatisms – repeated purposes behaviors known that mannerism and
automatism is not the same; Mannerism is more on muscle memory,
meanwhile, Automatism is more on lack of neurotransmitter in the body.
- No enough of the following/unbalanced:
1. Serotonin
2. Dopamine
3. GABA
■ Psychomotor retardation – slowed movements usually seen in
depressed people because you are unmotivated to do something faster
or basically not in the mood to do anything.
■ Waxy flexibility – maintenance of awkward posture; difference of
catatonia it is the maintenance of awkward posture and go back to that
same awkward posture, meanwhile waxy flexibility it stays to the posture
on how you moved the patient, it does not return to the same awkward
posture. In short, para siyang WAX.
Cute si dims :)

■ Echopraxia – purposeless imitation; the patient is mirroring/mirror-like

imitation.
○ Disturbance in communication
■ Mutism
- act of being mute or hindi sila nag sasalita.
■ Negativism
- they always say “NO”.
■ Circumstantiality
- being compared with tangentiality; it is the beating around the
bush; maraming pa ligoy-ligoy not straight to the point but
circumstantiality arrives at the answer; the difference between
tangentiality is that it does not arrive at the answer.
■ Stilted language
- flowery words; common among guys na nangliligaw.
■ Flight of ideas
- somehow related,slightly related, with meaning
■ Loose of association
- without meaning at all, and not related at all.
■ Perseveration
- go back to the same topic over and over again; hindi na naka
move on sa mga topics.
■ Echolalia
- parrot like imitation
■ Palilalia
- stereotyped words/last syllable inuulit nila yung last syllable ang
inuulit nila.
■ Verbigeration
- repetition of the same word over and over; kahit wala siyang
kausap.
■ Coprolalia
- copro (feces)/ lalia (logic/speech) uttering badwords
■ Neologism
- creation of new words
■ Blocking
- sudden cessation of thoughts sudden mental blocking while
talking or discussing.
■ Word salad
- mixture of unrelated words.
■ Clang association
- Rhyming; ito yung mga magaling sa poem
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○ Disturbance in perception
■ Delusion
- fixed false belief
■ Magical thinking
- naniniwala sila sa mahika or magic.
■ Paranoia
- extreme suspiciousness
■ Religiosity
- obssession in religious ideas
■ Phobia
- irrational fear
■ Obsession
- repititive thoughts kapag asa isip mo lang; merong specific goal or
number
■ Compulsion
- repetitive actions kapag ginagawa mo na.
■ Preoccupation
- idea with the intense desire no specific goal but rather no
limitation.
■ thought broadcasting
- others know what i am thinking.
■ Delusions/ideas of reference
- talk of the town/main character; yung feeling mo na patungkol
sayo ang lahat ng bagay.
○ Affect → emotions/expression
■ Inappropriate – incongruent of emotions; usually seen to patient with
schizophrenia; yung masaya ka pero umiiyak incongruency.
■ Blunted – little response
■ Restricted – display one type of expression either happy or sad.
■ Labile mood – these are mood swings or unpredictable
■ Apathy – absence of emotions; no emotions or flat affect only.
■ Ambivalence – opposing feelings; two contradicting feelings.
■ Anhedonia – absence of pleasure
■ Euphoria – feeling of extreme pleasure
○ Stress
■ Stages of stress
1. Stage I – alarm reaction: you have determine that there is stress
2. Stage II – stage of Resistance: you will utilize all resources to
solve the problem
—-----------------------------problem solved—---------------------------------
3. Stage III – stage of Exhaustion: you have utilized all of your
resource but the problem is not solved.
Cute si dims :)

○ Anxiety VS Fear
■ Anxiety
- It is the fear of the unknown
- Levels of anxiety
1. Mild: highest level of thinking or logical thinking; increase
concentration; increased alertness. (problem solving
approach)
2. Moderate: increased irritability, decreased attention span,
selective inattentiveness (relaxation techniques: DBE,
encourage verbalization of feelings.)
- As early as moderate is there should be medication
as it helps to prevent and stop it from being severe.
- Medications:
a. Anxiolytic or benzodiazepines – medication
that has pam/lam.
3. Severe: extreme muscle tension, loud rapid speech,
diffculty of focusing even with assistance, distorted
perception (remain with the client)
4. Panic: suicidal attempts, fixed eyes, hysterical/mute,
incoherence (decrease stimuli, stay with the client, assist in
relaxation techniques, paper bag for hyperventilation)
■ Fear
- Known fear.

Anxiety related disorders

○ Generalized anxiety disorder (GAD)
■ Worry worm (galaw ng galaw) → results to → pacing for no apparent
reason
■ It lasts for 6 months
■ No phobias, no panic attacks, no OC manifestations because if meron
siyang phobia di niya magiging generalized. Same as panic attakcs or
OC.
■ Signs and symptoms:
1. Palpitation
2. Chest pain
3. Headache
4. Insomnia
■ Management
1. Assisst in problem solving – our goal is to make sure patient will
be independent.
2. Teach coping behaviors (assess previous coping behaviors)
3. Drug of choice
a. benzidiazepine/anxiolytic /antianxiety agents “pam/lam”
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○ Panic Disorder
■ Recurrent
■ Unpredictable
■ Panic attacks such as
1. Trembling
2. Racing heat (tachycardia)
3. Chest pain
4. DOB
5. Choking – ito yung feeling na parang na bubulol
6. Numbness
■ Management
1. Assist in problem solving
2. Teaching of coping behaviors for the patient – so that we can built
a new coping mechanism for the patient which can be effective
and modify the ineffectve coping mechanism.
3. Drug of choice
a. Benzodiazipines – if with addiction to benzodiazepines →
substitute → antihistamines
b. Primary: anti allergic reaction
c. Secondary: sedative
d. Other meds: betablocks – nakakapag relax ang beta
blockers and it helps in tachycardia. – “olol”, SSRI’s,
MAOI’s
○ Acute stress Disorders
■ Signs and symptoms are after 2 days to 4 weeks (less than 1 month)
■ Management:
1. Progressive review of the trauma (acceptance)
2. Drug of choice:
a. Benzodiazepines
○ Post traumatic stress disorder (PTSD)
■ Signs and symptoms are more than 4 weeks after acute stress disrder
(more than 1 month)
■ Recurrent flashbacks – there are the intrusive thougths or mga
nakakapag-papagabag na memories.
- Re-experience of trauma happens because of flashback.
■ Defense mechanism: Displacement
■ Signs and symptoms
1. General numbness → somatic (bodily) symptoms
a. Irritability
b. Aggresiveness
c. Depression
d. Anger
e. Social withdrawal
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■ Management:
1. Assist in gaining control over angry impulses (Acceptance)
2. Drug of choice
- SSRI
- During acute attacks: benzodiazepine