NCM 217 FINALS

● Many of the anxiety related disorders are

standalone. Anxiety can be very common and
usual.
● Onset of mental disorder: Uncontrollable anxiety

MALADAPTIVE PATTERNS ANXIETY

NCM 217
TOPIC OUTLINE ● A subjective individual experience characterized by
feelings of apprehension, uneasiness, uncertainty,
I. Anxiety Related Disorders or dread that warns a person of actual or imagined,
II. Obsessive- Compulsive and Related Disorder misperceived or misinterpreted danger
III. Trauma & Stressor Related Disorder ● A normal response to a stressor
IV. Somatic Symptoms and Related Disorders ● Manifested by both psychological & behavioral
V. Dissociative Disorders symptoms
VI. Substance- Related Disorders ● An uncomfortable feeling of dread that is a
VII. Substance- Induced Disorder response to extreme or prolonged periods of stress
VIII. 10 Classification of Psychotic Drugs ● Look beyond what our eyes can see
IX. Schizophrenia Spectrum & Other Psychotic
Disorders STRESS
X. Substance/ Medication- Induced Psychotic
Disorder ● The wear & tear that occurs on the body regardless
XI. Bipolar & Related Disorders of the positive or negative nature of the stimulus
XII. DSM 5 Criteria (stressor)
XIII. Theoretical Influences
XIV. Psychodynamic Theories STRESSOR
XV. Social/ Environmental Theories
XVI. Personality Disorders ● A stimulus that produces a response, creating
XVII. Common Psychiatric Disorders physical & psychological demands on a person
requiring coping & adaptation
LECTURE DATE: 04/11/2023
TYPES OF ANXIETY
CONCEPT MAP ON TRAUMA, ANXIETY, OCD
NORMAL
● Healthy anxiety, mobilizes a person to action
Anxiety OCD Trauma Somatic
Symptom ACUTE
Related ● Precipitated by imminent loss or change that
Disorder threatens sense of security

GAD Excoriation ASD SSD CHRONIC

● Anxiety that an individual has lived for a long time
Panic BDD PTSD Illness Anxiety
GAS-GENERAL ADAPTATION SYNDROME
Agoraphob Hoarding Reactive Conversion (HANS SELYE)
ia Attachme 3 STAGES OF GAS
nt
1. ALARM STAGE
Specific Trichotilloma Factitious D/O ● kinakabahan, nag increase ang rr & bp
phobia nia ● There is a release of cortisol to balance

Social Factitious D/O 2. STAGE OF RESISTANCE

anxiety imposed on
another 3. STAGE OF EXHAUSTION/ADAPTATION

Separation LEVELS OF ANXIETY

anxiety
1. MILD (+1)
ANXIETY RELATED DISORDERS ● positive state of heightened awareness &
sharpened senses, increased problem
solving ability
A. ANXIETY DISORDERS
B. ANXIETY RELATED DISORDERS
2. MODERATE/APPREHENSION LEVEL (+2)
C. GENERALIZED ANXIETY DISORDER
● Focus is on the immediate task only
D. PANIC DISORDER
(tunnel vision)
E. AGORAPHOBIA
● Decreased attention span
F. PHOBIAS
● Ability to learn is still present
G. SOCIAL ANXIETY DISORDER
● Use of palliative coping to alleviate anxiety
H. SEPARATION ANXIETY DISORDER
● relaxation techniques

3. SEVERE / FREE FLOATING (+3)

 ● Creates a feeling that something bad is ● Always anticipates disaster
going to happen or feelings of an ● Worried excessively – major or minor issues
impending doom ● May range from mild nervousness to continuous
● Individual cannot be redirected to a task feelings of dread
● Behavior is geared towards relieving ● Can be very debilitating – makes it difficult to carry
anxiety & not on problem solving out even the most ordinary or simple activities
○ give short explicit directions ● 2x more common in women than in men
○ medications may be given ● There is a social and adl dysfunction that makes it a
○ ensure safety disorder
● It can be debilitating and makes function everyday
4. PANIC (+4) difficult
● Loss of rational thought, helplessness &
terror 1. GENERALIZED ANXIETY DISORDER
● Alteration in sensory perception, complete
physical immobility & muteness. ESSENTIAL FEATURES OF GENERALIZED ANXIETY
● May lead to exhaustion & death DISORDER
○ ensure safety/ decrease ● Excessive anxiety /worry occurring for at least 6
environmental stimuli months
○ do not touch the patient unless ● Difficulty controlling the worry.
really needed ● Presence of at least three associated
○ Give medications symptoms(one for children)
○ Restlessness
LECTURE DATE: 04/19/2023 ○ being easily fatigued
ANXIETY RELATED DISORDERS ○ difficulty concentrating or mind getting
blank
● Formerly known as “NEUROTIC DISORDERS” ○ Irritability
● Use of rigid, repetitive, ineffective behaviors to ○ muscle tension
displace anxiety (phobia, conversion, ○ sleep disturbance
dissociative d/o, hypochondriasis) or to fix it () ● Symptoms cause significant distress/impairment in
● Common DEFENSE MECHANISM used: social/occupational functioning
repression, displacement, & symbolization ● Symptoms not due to a substance and does not
● Reality testing is usually intact occur with mood disorder, psychotic disorder or
● Judgment is typically unimpaired, aware that pervasive developmental disorder
thoughts are irrational but cannot control it.
● Illness is chronic MANAGEMENT
● Anxiety disorders differ from one another in the
types of objects or situations that induce fear, 1. assist client in decreasing anxiety;goal: develop
anxiety or avoidance behavior. adaptive coping responses
● Differ from developmentally normative fear by being a. milieu: recreational activities,
excessive or persisting beyond developmentally b. group therapy : stress mgt,
appropriate periods. problem-solving, self-esteem building
● Many of it developed in childhood and tend to c. behavioral therapy: relaxation training
persist if not treated. d. medications: benzodiazepines (short term
basis only- buspirone(Buspar) (venlafaxine
ANXIETY DISORDER , ssris)
LIZED ANXIETY DISORDER
● Separation Anxiety Disorder 2. PANIC DISORDER
● Selective Mutism
● Specific Phobia ● Core symptom is “panic attack” – overwhelming
● Social Anxiety Disorder fear that occurs out of the blue or w/out warning &
● Panic Disorder for no reason.
● Agoraphobia ● May last for 10 mins to an hour
● Generalized Anxiety Disorder ● Occurrence, intensity, frequency vary but is chronic
● Affects women 3x more than men
TREATMENT APPROACHES ● Onset: late adolescence to early adulthood
● Precipitating factors:
● Multimodal Approach : ○ stressful life experience (unable to
● Pharmacologic graduate, separation)
● Psychosocial (Cognitive behavioral therapy) ○ Panic attacks fade by itself w/out
● Individual psychotherapy intervention
● Family therapy ■ does not seek treatment
■ leads to (3) serious side effects
ANXIETY DISORDERS
ANXIETY RELATED DISORDERS THE 3 SERIOUS SIDE EFFECT ARE THE FF

GENERALIZED ANXIETY DISORDERS ● AVOIDANCE

● GAD, aka FREE-FLOATING ANXIETY ○ Avoids activities, places or situations that
○ Nagwwory everyday for no reason w/o a can trigger attack
trigger, stimulus or ● AGORAPHOBIA
○ A person who anticipates disaster ○ Fear and avoidance of public places
● Persistence of anxiety that hounds everyday ● ANTICIPATORY ANXIETY
existence of the person
 ○ Develops intense anxiety between B. exposure to phobic stimulus almost invariably
episodes evokes an immediate anxiety response
○ May abuse substance to cope, developed C. person recognizes that the fear is excessive or
depression unreasonable
D. phobic situations are avoided or endured with
PANIC DISORDER DIAGNOSTIC CRITERIA intense anxiety/distress
E. the avoidance,anxious anticipation or distress of the
Both (1) and (2) feared stimuli interferes with
● Recurrent and unexpected panic attacks social/occupational functioning
● At least one of the attacks has been followed by a F. in individuals under age 18, the duration is at least 6
month or more of at least one of the following: months
● Persistent concern or worry about the implications G. the anxiety,panic attacks or phobic avoidance is not
of the attack or its consequences better accounted for other mental
● Significant change in the behavior related to the disorders(e.g. OCD,PTSD)
attacks
● Presence/ absence of agoraphobia SUBTYPES FOR SPECIFIC PHOBIAS
● Panic attacks are not due to the effects of a ● Animal Phobia (snakes, spiders)
substance or general medical condition ○ Natural Envt.(storms, water, heights)
● Panic attacks are not better accounted for another ○ Blood, injection, injury
mental disorder (e.g. Specific phobia, OCD,PTSD) ○ Situational
○ others
AGORAPHOBIA ○
DIAGNOSTIC CRITERIA 4. SOCIAL ANXIETY DISORDER

A. Marked fear or anxiety about 2 or more of the ff: A. Marked, persistent fear of social or performance
● Using public transportation situations which he is exposed to unfamiliar people
● Being in an open spaces or to scrutiny by others
● Being in enclosed places. ○ exposure to feared social situation almost
● Standing on line or being in the crowd invariably evokes anxiety
● Being outside of the home alone ○ person recognizes that the fear is
A. Fear is due to thoughts that escape is difficult in the excessive or unreasonable
event of developing panic-like symptoms ○ avoidance of feared social
B. the agoraphobia always provoke fear or anxiety situation/enduring them with intense
C. Situation is always avoided or requires companion, anxiety or distress
endured with intense fear. ○ Aka social anxiety disorder, fear of being
watched, scorned or humiliated in social
situations Excessive self-consciousness
MANAGEMENT
B. Anxiety lasting for 4 weeks
C. Disturbance is causing dysfunction
● Milieu:
D. Disturbance is not better accounted for than any
● Stay With The Client & Remain Calm
other mental conditions.
● Remove The Stimuli/Move The Client To A Less
Stimulating Environment
● Provide Paper Bag If Client Is Hyperventilating SEPARATION ANXIETY DISORDER
● Speak In Short, Simple Sentences;
● Give 1 Direction At A Time A. Developmentally inappropriate and excessive fear
● Do Not Touch or anxiety concerning separation from those to
● Allow Patient To Pace Or Cry whom the individual is attached as evidenced by at
● Teach Relaxation Exercises When Attack Subsides least 3 of the following:
● Medications: Anxiolytics Or Antidepressants (Tcas, ● Separation from home
Ssris[Doc], Maois) ● Worry of separation due to illness, injury,
death
● Worry of getting lost, kidnapped, meeting
3. PHOBIAS accidents
I ● Reluctance to go to school or work due to
● Uncontrollable, persistent & irrational fear of an fear of separation.
object, activity or situation that is out of proportion to ● Refusal to sleep away from major
the stimulus. attachment figure
● Use of DEFENSE MECHANISM : displacement, ● Complains of physical s/s when
symbolization, projection, avoidance separated..
● repressed conflicts are projected to the outside
world & eventually displaced onto an object or
MANAGEMENT
situation.
● Individual Takes extreme measures to avoid source
● Behavior Therapy:
of terror = impairment in social & occupational
● Systematic desensitization
functioning
● Flooding (more rapid than desensitization)
● s/s similar to “panic attack” when exposed
● Self-exposure
● Accept the patient & their fear in a noncritical
(3) MAJOR TYPES OF PHOBIA: attitude
● Teach relaxation activities
SPECIFIC OR SIMPLE PHOBIA ● Medications:
A. marked and persistent fear that is excessive or ● Anxiolytics (alprazolam,clonazepam),
unreasonable due to the presence or TCA(imipramine) MAOI(phenelzine)
anticipation of a specific object or situation
 OBSESSIVE – COMPULSIVE AND
A. OBSESSIVE COMPULSIVE DISORDERS
B. TRICHOTILLOMANIA
C. BODY DYSMORPHIC DISORDER
D. HOARDING DISORDER
RELATED DISORDER
CONSISTS OF (2) COMPONENTS
1. OBSESSIONS
a. Frequently occurring intrusive thoughts,
images, impulses, or emotion that cause a
great deal of anxiety but cannot be
suppressed
● These are intrusive thoughts
creating anxiety
2. COMPULSIONS
a. Uncontrollable urge to do repetitive acts
that alleviate the person’s obsession but
recognizes as unnecessary and
unreasonable
● Urge na di kaya icontrol ng
person, it is an act or urge to act
repetitive actions
● RITUALS
○ are behaviors or repetitive acts a person’s
engages in response to a compulsion =
aimed at reducing stress or divert
unacceptable thoughts
○ There is no pleasure in carrying out rituals
= only temporary relief from anxiety
● Repetitive behavior this represent
the compulsion
● If the person will make this the
person cannot take intrusive
thoughts
OBSESSIVE COMPULSIVE DISORDERS
● Course is variable but progresses over time
○ Acute and progresses overtime esp if there
is a major trigger happen in the future
● DEFENSE MECHANISM used: displacement,
undoing, repression
● An ego-dystonic disorder
○ OCD - exp. Maligo for 4 horus the person
know that this behavior is unacceptable
○ The person doing is not align to what the
person is believes
○ Ego syntonic - obsessive compulsive
personality dso
○ The person believes that their actions are
right, developed since childhood
○ OCPD - perfectionism, collection of many
things, meticulous
○ Ego syntonic because for example their
perfectionism, they tend to rationalize their
actions and they believe that it is right
● Equally present in both men & women
● Onset: women (20-29) ; men (6-15)
● Conscience driven, shy, meticulous, precise about
bodily functions, dress, religious duty & daily routine
● OCD runs in families
- Katapat lng is self awareness and
reflection that its okay to not be perfect
and the world doesn't revolve around that
DIAGNOSTIC CRITERIA FOR OCD
A. Presence of Either obsessions or compulsions or
both
a. Obsessions as defined by 1 and 2
1. recurrent and persistent thoughts,
impulses or images that are
experienced as intrusive and
inappropriate and cause marked
anxiety or distress.
2. The person attempts to ignore or
suppress such thoughts, impulses or
images or try to neutralize them with
some thought or action
b. Compulsions as defined by 1 and 2
1. Repetitive behaviors or mental
acts that the person feels driven
to perform in response to an
obsession or according to rules
that must be applied rigidly
2. The behaviors or mental acts are
aimed at preventing or reducing
distress or preventing some
dreaded event or situation
B. At some point, the person has recognized that the
obsessions or compulsions are excessive and
unreasonable.
C. The obsession or compulsion case marked distress,
are time consuming or significantly interfere with the
person's normal routine, social or occupational
functioning.
D. If another axis I disorder is present, the obsession
or compulsion is not restricted to it.
E. Not caused by substance or general medical
condition
COMMON RITUALS:
● CLEANING
○ Fear of real or imagined germs, dirt,
contamination
○ Repeating
○ Utters names, phrases repeatedly
○ Fear against harm or injury
○ Completing
○ Performs series of complicated tasks in
exact order until done perfectly
○ Fear something will go wrong if not done
perfectly
○ Checking
○ Repeatedly retraces routes, routines
○ Fears harming self or others by missing
something in the routine
○ Locks doors, checks stove
● METICULOUSNESS
○ Extreme neatness and order
○ Exact arrangements of things, furniture,
clothes, etc.
○ Disruption causes massive anxiety
● AVOIDING
○ Stays away from cause of anxiety &
anything related to it
○ Eg. Anxious about chocolate – avoids
anything brown
● HOARDING
○ Less common
○ Constant collection of useless items
○ “need to have things” to avoid anxiety
● SLOWNESS
○ Uncommon, mostly in men
○ Performs things very slowly
 ○ To make sure nothing is missed GENERAL MANAGEMENT FOR OCD
● ARRANGING ● Do not interrupt the act; allow time for completion
○ Arranges things in certain order ○ n limit setting; gradually decrease the
○ Forbidden thoughts time & frequency of rituals
○ Ex; rape victim, the intrusive thought is the
● PRAYING person being rape that it makes a person
○ A need to tell, ask, confess feel dirty the compulsion is taking a bath to
remove the dirt
● TOUCHING ○ Rituals are performed to alleviate their
○ Intrusive thoughts & sexual urges anxiety
● Provide basic needs
● COUNTING ● Ensure safety
○ Excessive religious or moral doubt ● Encourage expression/verbalization of feelings
○ If patient able to verbalize, alleviates their
TRICHOTILLOMANIA feelings
● Psychotherapeutic
● Recurrent pulling out of one’s hair resulting in hair ○ behavioral modification: exposure -
loss. response prevention;
○ Excessive rolling/pulling of hair sometimes ○ Cognitive-Behavioral – thought stopping,
they tend to eat process insight
○ When it forms a mesh like form in the ○ Group therapy – prevent isolation
stomach pt is undergo surgery since it ○ Family therapy – supportive counseling
could obstruct the flow ○ Alternative approach : YOGA meditation
● Repeated attempts to decrease or stop the pulling ● Medications:
its causing significant distress/impairment ○ TCA:clomipramine(Anafranil)-DoC
● Excoriation Disorder (Skin-Picking) ○ SSRIs: fluoxetine,sertraline, fluvoxamine -
○ recurrent skin picking resulting in skin better side effect profiles
lesions ○ MAOIs: given if OCD is accompanied with
○ repeated attempts to decrease or stop panic attacks
picking ○ anxiolytics-anxiety relief but do not relieve
○ its causing areas of dysfunction core symptoms

BODY DYSMORPHIC DISORDER TRAUMA AND STRESSOR RELATED DISORDER

● A preoccupation with 1 or more perceived defects A. POST-TRAUMATIC STRESS

or flaws in physical appearance that are not B. ACUTE STRESS DISORDER
observable or appear slight. C. REACTIVE ATTACHMENT DISORDER
○ They magnify the small defect that
something is pangit tingnan that makes
them to avoid their normal tasks POST-TRAUMATIC STRESS / ACUTE STRESS
● At the course of the disorder, the individual has
performed repetitive behaviors (mirror checking, ● Occurs after experiencing a physically or
excessive grooming, skin picking, reassurance psychologically traumatic event.
seeking) in response to concern. ○ PTSD & ASD are similar with traumatic
● The preoccupation has caused areas of dysfunction experience and flashback, and when
○ Dili na muskwela, work, or other areas flashback occurs it creates anxiety to the
they avoid because of fear person
○ Picture: traumatic event, and re
HOARDING DISORDER experiencing/flashbacks
● Events which threatened the person’s life or
● 1 symptom or 1 ritual someone close to him
● Persistent difficulty discarding or parting with ● Characterized by: persistent frightening thoughts &
possessions regardless of their actual value. memories of the ordeal
○ collections of many things ● Classic sign : “flashbacks”
○ They tend to collect things that the person ● Comorbid disorders: depression & substance abuse
might not even use and is unable to let go ● s/s begin within 3 months of the trauma, course of
for some reasons like: it can be used in the illness varies (some recover after 6mos.)
future or masayangan
○ The problem with hoarding is that it takes Acute Stress Disorder
space and since hoarding is a too much ● has similar s/s to PTSD but is shorter in duration.
collection of things to the point it could S/s appear immediately & lasts 2 days to 4weeks
accumulate overtime
○ Giving up collections gives so much
anxiety to the person PTSD DIAGNOSTIC CRITERIA
● It is due to perceived need to save the items and to
distress associated discarding symptom A. Exposure to traumatic event
● The difficulty in discarding results in the a. Experienced/witnessed actual/threatened
accumulation of possession that congest and clutter death or injury
active living areas.. b. Response involves intense
● Specifies: with excessive acquisition fear,helplessness or horror
○ With good or fair insight B. Persistent re experiencing the traumatic event(1 or
○ With poor insight more):
 a. recurrent & intrusive recollection of event DISSOCIATIVE SYMPTOMS
b. recurrent dreams of the event
c. flashbacks (dissociative reactions) 1. An altered sense of the reality of one’s surroundings
d. intense distress at exposure to symbols of or oneself (e.g., seeing oneself from another’s
the event perspective, being in a daze, time slowing).
e. physiologic reactivity to symbols/cues of 2. Inability to remember an important aspect of the
the event traumatic event(s) (typically due to dissociative
C. Persistent avoidance of stimuli & numbing of amnesia and not to other factors such as head
general responsiveness(3 or more): injury, alcohol, or drugs).
a. efforts to avoid
thoughts,feelings,conversations assoc. AVOIDANCE SYMPTOMS
with trauma
b. efforts to avoid activities,places,people 1. Efforts to avoid distressing memories, thoughts, or
related to trauma feelings about or closely associated with the
c. inability to recall important aspect of the traumatic event(s).
trauma 2. Efforts to avoid external reminders (people, places,
d. markedly diminished interest in significant conversations, activities, objects, situations) that
activities arouse distressing memories, thoughts, or feelings
e. feeling of detachment or estrangement about or closely associated with the traumatic
from others event(s). se.
f. restricted affect
g. sense of foreshortened future AROUSAL SYMPTOMS
D. Persistent symptoms of increased arousal (2 or
more): 1. Sleep disturbance (e.g., difficulty falling or staying
a. difficulty falling/staying asleep asleep, restless sleep).
b. irritability/outbursts of anger 2. Irritable behavior and angry outbursts (with little or
c. difficulty concentrating no provocation), typically expressed as verbal or
d. Hypervigilance physical aggression toward people or objects.
e. exaggerated startle response 3. Hypervigilance.
E. Duration: more than 1 month 4. Problems with concentration.
a. acute: 1-3 months 5. Exaggerated startle response
b. chronic: > 3 months
c. delayed onset: symptoms occur for at least REACTIVE ATTACHMENT DISORDER
6 months post-trauma
F. Significant distress in social/occupational
● A disorder of infancy or early childhood
functioning
characterized by a pattern of markedly disturbed
and developmentally inappropriate attachment
ASD - After traumatic esp 2 days -3 weeks
behaviors in which a child rarely turns preferentially
Traumatic esp appear from onset to More than 4 wks - 6
to an attachment figure for comfort, support,
months or more = PTSD
protection and nurturance.
- RAD common in children, a person with
ACUTE STRESS DISORDER RAD in distress and will not turn to their
attachment figures the person will turn
A. Exposure to actual or threatened death, serious their back and find other to seek comfort
injury or sexual violation. - It could be d/t inconsistent caregivers
B. Presence of 9 or more of the following symptoms ● When distressed, they do not respond more than
from any of the five categories: minimally to comforting efforts of caregivers.
a. Intrusion, ● Age should be at least 9 months and able to form
b. negative mood, selective attachments.
c. Dissociation reactions (flashbacks)
d. avoidance and arousal, (beginning or RAD DIAGNOSTIC CRITERIA
worsening after the traumatic event.)
C. Duration is 3 days to 1 month after trauma
A. consistent pattern of inhibited, emotionally
exposure.
withdrawn behavior toward adult caregivers
D. its causing impairment in social and occupational
manifested by both of the following.
areas.
a. The child rarely or minimally seeks comfort
when distressed.
INTRUSION SYMPTOMS b. 2. The child rarely or minimally responds to
comfort when distressed.
1. Recurrent, involuntary, and intrusive distressing B. A persistent social and emotional disturbance
memories of the traumatic event(s. characterized by at least two of the ff:
2. Recurrent distressing dreams in which the content a. Minimal social and emotional
and/or affect of the dream are related to the event(s responsiveness to others.
3. Dissociative reactions (e.g., flashbacks) in which b. Limited positive affect.
the individual feels or acts as if the traumatic c. Episodes of unexplained irritability,
event(s) were recurring. sadness, or fearfulness that are evident
4. Intense or prolonged psychological distress or even during nonthreatening interactions
marked physiological reactions in response to with adult caregivers.
internal or external cues that symbolize or resemble C. The child has experienced a pattern of extremes of
an aspect of the traumatic event(s). Negative Mood insufficient care as evidenced by at least 1 of the ff:
5. Persistent inability to experience positive emotions
(e.g., inability to experience happiness, satisfaction, MANAGEMENT:
or loving feelings).
 ● Ensure safety (e.g. during flashbacks, illusions)
○ Make sure when the person is having
flashbacks the are in a safe place
● Cognitive restructuring
○ view of self as survivor rather than a victim
● Group therapy (support groups)
○ All victims will share and coping
mechanisms
● Medications (benzodiazepines,lithium,SSRIs, TCAs,
MAOIs, neuroleptics)
Somatic Symptom Disorder, Conversion Disorder
Illness Anxiety Disorder, Factitious Disorder
● The authors of the DSM-5 have proposed that
these disorders be collapsed into one new
diagnosis named complex somatic symptom
disorder. To receive this diagnosis, individuals
must have:
○ Multiple bodily symptoms that are
upsetting, or one severe symptom, for
at least 6 months.
○ They must also worry intensely about
their health, tend to catastrophize their
health, and organize their lives around
their health concerns.
● This new diagnosis may include specifiers to
indicate whether the individual’s symptoms are
most like the DSM-IV-TR diagnoses of
Somatization disorder, Pain disorder, or
Hypochondriasis.
SOMATIC SYMPTOM AND RELATED DISORDERS
A. ILLNESS ANXIETY DISORDER
B. CONVERSION DISORDER
C. FACTITIOUS DISORDER
D. DISSOCIATIVE DISORDERS
● Group of disorders in which people experience
significant PHYSICAL SYMPTOMS for NO
apparent ORGANIC CAUSE.
● Consists of a history of medical complaints
● Characterized by: PHYSICAL COMPLAINTS
● Medical in origin(but cannot be explained) in terms
of:
○ Physical disease
○ Results of substance abuse
○ Another mental disorder
GENERAL SYMPTOMS
● Not consciously producing/controlling their s/s
○ This pl have physical body complaints and
there are not faking it
● They are not faking their symptoms.
○ They don’t have any control with their
symptoms
● Truly experience the symptoms.
● The symptoms pass only when the psychological
factors that led to them are resolved.
● The symptoms can significantly affect daily
functioning.
● Easier diagnosis when psychological factors leading
to the development of symptoms can be identified
clearly or when physical examination proves that
symptoms are not physiologically possible.
SOMATIC SYMPTOM DISORDERS
● Complains of pain
● Characterized by 1 or more somatic symptoms that
are distressing or result in significant disruption of
daily life.
- Diagnostic criteria
● Preoccupation or behavior related to somatic
symptoms associated with health concerns like at
least 1 of the following:
○ persistent thoughts about seriousness of
ones symptoms
○ high level of anxiety over symptoms
○ excessive time and energy devoted to s/s
○ State of being symptomatic last for 6 mos.
ILLNESS ANXIETY DISORDER
● Diff with somatic they complaint of pain if illness
they are having serious illness
● A person who's having a severe headache tends to
seek check up bcz they think they have a tumor?
A. preoccupation with having or acquiring
serious illness
B. Somatic symptoms are not present or if
present are only mild in intensity
C. There is a high level of anxiety about
health and the individual is easily alarmed
about personal health status.
D. Individual performs excessive health
related behaviors (checking of body of
signs of illness)
E. Or maladaptive avoidance ( avoiding
doctors and hospitals.
F. Symptoms may last for 6 months
G. The illness related preoccupation is not
better explained by another mental
disorder, somatic symptom and etc.
CONVERSION DISORDER
● (FUNCTIONAL NEUROLOGICAL SYMPTOM
DISORDER)
● loss or change in physical functioning that cannot
be associated with any organic cause & seems to
be associated with psychological stressors
○ Ex: paralysis - loss of function and is
unable to move
○ Kitakita - loss of eyesight after seeing her
bf with other girl or following a
psychological stress
● Appear symptoms following psychological factors
● One or more symptoms of altered voluntary motor
or sensory function
● Specify:
○ with weakness or paralysis
 ○ with abnormal movement
○ with attacks or seizure ailments. Her mother was accused of
○ with anesthesia or sensory loss causing her illness to gain the attention
of physicians and the media.

Distinctions Between Somatoform Disorders and Related

Syndromes MANAGEMENT

Somatoform Psychosoma Malingering Factitious MEDICATIONS

Disorders tic Disorders Disorders ● no drugs for the direct treatment of conversion
disorder, medications are for anxiety or depression
Subjective Actualy Deliberate Deliberate of that may be associated with conversion disorder.
experience of physical illnes faking of faking
many present with physical physical PSYCHOANALYTIC
physical psychological symptoms to illness to gain ● focuses on the expression of painful emotions and
symptoms, factors avoid an medical
with no seemingly unpleasant attention
memories and on insight into the relationship
organic contributing situation, between these and the conversion symptoms. Also
cause to the illness such as includes hypnosis.
military duty
BEHAVIORAL
● Focus on relieving the person’s anxiety around the
SOMATOFORM initial trauma that caused the conversion symptoms
● subjective experience of many physical symptoms, and on reducing any benefits the person is
with no organic cause receiving from the conversion symptoms.
PSYCHOSOMATIC DISORDER ALTERNATIVE AND COMPLEMENTARY THERAPIES:
● actual. Physical illness, EX. excessive diarrhea ● relaxation techniques, visualization, and
common in indiv who are undergoing stressful biofeedback
events
DISSOCIATIVE DISORDERS
MALINGERING
● deliberate faking of physical symptoms to avoid an
● splitting off of an idea or emotions from one’s
unpleasant situations, such as military duty
consciousness
● feeling of being detached from usual experiences
FACTITIOUS DISORDER
● deliberate faking of physical illness to gain medical
attention and play a sick role TYPES OF DISSOCIATIVE DISORDERS

1. DISSOCIATIVE AMNESIA
FACTITIOUS DISORDER
● 1 or more episodes of sudden inability to
recall important personal information
“MUNCHAUSEN’S SYNDROME”
usually of a traumatic or stressful nature
● A person deliberately fakes an illness specifically to
that is beyond ordinary forgetfulness.
gain medical attention and play a sick role.
a. DA with dissociative fugue
● Its not the person that just faking the symptoms
b. Ex. Rape cases
● That person will fake a symptoms of two another
person
2. DEPERSONALIZATION
● experiences of unreality or being an
IMPOSED ON ANOTHER (DSM-5 CRITERIA) outside observer with respect to one's
thoughts, feelings, sensations.
(Previously Factitious Disorder by Proxy) a. usually after a traumatic
A. Falsification of physical or psychological signs or physical/psychological event
symptoms, or induction of injury or disease, in b. Ex. Perceptual alterations, physical
another, associated with identified deception. numbing
B. The individual presents another individual (victim) to
others as ill, impaired, or injured. 3. DEREALIZATION DISORDER
C. The deceptive behavior is evident even in the a. experiences of unreality with surroundings.
absence of obvious external rewards. b. Ex. Dreamlike, foggy, lifeless or visually
D. The behavior is not better explained by another distorted
mental disorder, such as delusional disorder or
another psychotic disorder. 4. DISSOCIATIVE IDENTITY DISORDER/MULTIPLE
IDENTITY
NOTE: a. presence of 2 or more distinct
● The perpetrator, not the victim, receives this personalities, each with its own pattern of
diagnosis. perceiving, relating & thinking about the
● Specify: environment.
b. personalities do not know about the
○Single episode presence of the other
○Recurrent episodes (two or more events personality/personalities
of falsification of illness and/or induction c. Recurrent gaps in the recall of everyday
of injury) events, important personal information and
● Ex. Jennifer Bush Case (1995) traumatic events
○ endured 200 hospitalizations and 40 d. Causing impairment in areas of functioning
operations to cure her puzzling array of e. Ex. SYbil
 SUBSTANCE USE DISORDERS
MANAGEMENT
● Patterns of symptoms resulting from the use of a
● help the client recognize when dissociation occurs substance that you continue to take despite
● family & group therapy problems due to substance use
● psychotherapy: hypnosis/hypnotherapy ● There is an underlying change in the brain circuit
that persist beyond detoxification
04/19/2023 ○ Brain circuit triggers are changing due to
SUBSTANCE-RELATED DISORDERS drugs
○ Instead of food, music, art or whatever you
A. SUBSTANCE USE DISORDERS do that usually increases your dopamine,
B. SUBSTANCE USE WITHDRAWAL when taking drugs, it will become the
C. ALCOHOLISM reason why your dopamine increases
D. SUBSTANCE RELATED DISORDER ● Exhibited through relapse and intense drug craving
E. SUBSTANCE-INDUCED DISORDERS ● RELAPSE: an attempt to stop using but
still goes back to using
● Mental problems or disorders resulting from the use ● DRUG CRAVING: wanting to use the drug
of 10 classifications of drugs and will have the tendency to increase the
dosage of the drug
10 CLASSIFICATION OF DRUGS
CRITERIA
1. Alcohol
2. Caffeine ● CRITERION A:
3. Cannabis ○ IMPAIRED CONTROL
4. Hallucinogens ○ Instead of you being able to
5. Inhalants control the use of the substance,
6. Opioids it’s like the substance is
7. Sedatives controlling you
8. Hypnotics ○ SOCIAL IMPAIRMENT
9. Stimulants ○ Usually comes out as fights in
10. Tobacco relationships and neglect towards
the family and friends
WHY IS THERE AN ADDICTION? ○ There can be occupational
impairment
● All drugs of abuse target the brain’s pleasure center ➢ The person's work can
○ The pleasure center is often times be affected
activated by good behaviors and promote ○ Risky use - There’s a risk for the person
reinforcement using because they can go to jail

BRAIN REWARD (Dopamine) PATHWAYS ● PHARMACOLOGICAL CRITERIA: tolerance and

● These brain circuits are important for natural withdrawal
rewards such as food, music and art ○ TOLERANCE: the desired dose is
● For example if we eat, we trigger the brain reward markedly increase to achieve the desired
system because we feel good effect
● ALL DRUGS OF ABUSE INCREASE DOPAMINE ○ For example, you will no longer
get drunk with 2 bottles of beer so
you drink 10 to feel drunk OR you
will no longer feel high with 1 tab
of LSD so you take 2

○ WITHDRAWAL: syndrome occurring when

● Typically, dopamine increases in response to
natural rewards such as food. When cocaine is
taken, dopamine increases are exaggerated and
communication is altered
● For food, you can see in the picture how much
dopamine is being produced in the synaptic
junctions
● For cocaine, there is more dopamine
● Instead of receiving activation through adaptive
behaviors, drugs directly activates pathways
neglecting normal activities
○ This can be related to cravings and the
addiction of the drug
blood or tissue concentration of the
substance decline in an individual who
maintained prolonged heavy use
○ For example, you are used to
drinking 2 bottles of alcohol a day
then all of a sudden you stop.
Signs and symptoms of
withdrawal begin to come out.
○ Your blood and tissue has already
begun to be used to that
substance being in your system,
causing physiologic effects.
NOTE:
● Withdrawal will follow when there is cessation or
decline of use after a prolonged heavy use
SUBSTANCE-INDUCED DISORDER
 ● Mental problems that develop in uy people who did
not have mental health problems before using
substances.
● Includes: Intoxication, Withdrawal and
substance/medication induced mental disorders
● Essential feature: development of reversible
substance-specific syndrome due to recent
ingestion of a substance
CRITERIA
Criteria A: clinically significant/problematic changes in
behavior and psychological function associated with
intoxication attributed to drugs, right after subs, use.
Criteria B: symptoms are not attributable to another medical
condition/ mental disorder
Criteria C: Intoxication is common on substance user but
can occur also to non users
COMMON SYMPTOMS OF INTOXICATION
● Disturbances in perception
○ Dili na kaila og tao
○ Ex: ang tingin nila sa poste is mga sexy na
babae
○ For some hallucinogens, they see their
grandmothers as very sexy so there are
addicts who reach to a point of raping their
grandmothers
● Wakefulness
○ 24 hours gising
● Attention
○ Could be low attention span or poor
● Thinking
○ Some could lead to paranoia, overthinking
or depressed thinking so the judgment
becomes poor
● Judgment
○ Could be poor due to clouded thinking
ability
● Psychomotor behavior
○ Don’t allow intoxicated people to drive
● Interpersonal behavior
○ You see the inhibition of an individual once
intoxicated - nawawala
○ Ex: Krimen na nangyayari once a person
takes substance and become intoxicated
SUBSTANCE USE WITHDRAWAL
Features: Development of substance-specific problematic
behavioral change with physiological and cognitive
concomitant due to the cessation/reduction in the prolonged
and heavy use of substance.
NOTE:
- There are people that become normal and the
use of the drug or alcohol or nicotine becomes
part of their life and those who withdraw undergo
changes like becoming hot-headed, can’t focus,
can’t concentrate and some of them will display
physiologic symptoms after they stop taking the
substance. Substance could either be alcohol,
nicotine, or anxiolytics for some.
● Benzodiazepines - classic example of
diazepines that are addicting so this
shouldn’t be taken for a long period of
time. When stopped the anxiety will
shoot up to the highest level
● Significant social and occupational dysfunction
● Not explained by other mental condition
● Withdrawal is associated with substance use
disorder
○ There is large intake of substance already
that leads to withdrawal
ALCOHOLISM
ALCOHOL
● It is the oldest and most widely used drug in the
world. A powerful addictive, central nervous system
depressant. It is created when grains, fruits, or
vegetables are fermented.
● Alcohol’s ill effects are not properly highlighted
since it is legally sold in our country.
ALCOHOLISM
● is the consumption of or preoccupation with
alcoholic beverages to the extent that this behavior
interferes with the alcoholic’s normal personal,
family, social, or work life. Chronic, progressive and
potentially fatal disease
● Larger amount of alcohol and prolonged period of
time of heavy use before you can say the person is
alcoholic.
INTOXICATION
● Use of substances that results in maladaptive
behavior.
● Follow large amount of substance being taken
● People who reach to the point of blacking out as
they have consumed to much
● Can be due to small intake of alcohol but not used
to drinking so intoxication happens
● Maladaptive behavior - di mo ma remember unsa
imong nabuhat due to substance intake
WITHDRAWAL SYNDROME
● refers to the negative psychological and physical
reactions that occur when use of substance ceases
dramatically decreases.
DETOXIFICATION
● is the process of safety withdrawing from a
substance
● Done before when a certain addict or alcohol will be
admitted for a rehabilitation
● Usually with the use of PNSS 1L infused for 6 hours
(depends on the amount of drug that will be flushed
out on the person)
REMISSION
● a state where an alcoholic is no longer showing
symptoms of alcoholism
● Wala nang symptoms of being alcoholic
BINGE DRINKING
● Is simply drinking to get drunk
● Common sa mga sawi
● The aim is to numb the emotion
ALCOHOL DEPENDENCE
● Is when someone continues to drink in spite of
continued social, interpersonal, or legal difficulties
● Di na makalast og day na di makadrink og alcohol
ALCOHOL ABUSE
● Is when drinkers begin to experience a craving for
alcohol, a loss of control of their drinking,
withdrawal symptoms when they are not drinking
and an increased tolerance to alcohol so that they
have to drink more to achieve the same effect.
PHYSICAL DEPENDENCE
● Includes withdrawal symptoms, such as nausea,
sweating, shakiness, and anxiety, when alcohol use
is stopped after a period of heavy drinking
STAGES OF ALCOHOL DEPENDENCE
1. PRE-ALCOHOLIC PHASE: SOCIAL DRINKING
● Response to alcohol “primes” drinker,
psychological relief, release of tension,
seeks occasions when drinking
● Drinking behavior does not stand out
● Time: several months to 2+ years
2. PRODROMAL PHASE: ALCOHOL BECOMES A
NEED; TOLERANCE & DENIAL DEVELOPS
● Evening
○ to promote sleep,
● morning
● To steady the nerves
● Blackouts
○ appear the warning sign
○ Person continues to function but
has no memory of awareness of
what he or she has done
● Alcohol no longer just a beverage but a
“need”
● Habits begin to fail into a definite pattern
● Gross drinking behavior —----- blackouts
—--- gulping and sneaking drinks —-----
chronic hangovers
3. CRUCIAL PHASE: LOSS OF CONTROL OVER
DRINKING
● Drinking stands out
● Drinking requires explanation
● Adopt tactics to regain control
- Deliberate period of abstinence
- Changes in drinking pattern
- Geographical changes
● There could be spontaneous remission
(quit drinking without treatment)
● Life alcohol- centerend and Deteriorating
relationships
4. CHRONIC PHASE: PERSON IS INTOXICATED
EVERYDAY AND DRINKING BECOME
LIFESTYLE
● Morning drinking is common
● Social & workplace functioning gone
● Withdrawal symptoms without
alcohol/Marked physical changes
● Rationalization system fails
● Will likely have continued drinking and
can’t see a way out
● Needs to go rehabilitation if nandito na sa
phase
NOTE:
● Problem is in the Philippines where burying of
alcohol is legal, for them, people will just say
“muundang diay kag inim” they feel that they are
hard headed or it is just their personality that
they don't think that the person has no will to
stop anymore at this place, they are dependent
and the person will never see a way out. That’s
why they are a lot of alcoholic people that are at
risk of suicide.
EFFECTS
IMMEDIATE EFFECTS OF ALCOHOL
● Slurring of speech; non-coordination of motor
function; uninhibited judgment, impaired attention &
memory.
CHRONIC EFFECTS
● Pancreatitis, liver cirrhosis
○ as alcohol is metabolized in the liver
● Hypertension
○ constriction of blood vessels.
● Fetal alcohol syndrome (FAS)
● Thiamine deficiency (peripheral neuropathy)
○ Vit. B deficiency
WERNICKE'S ENCEPHALOPATHY
● a disorder characterized by mental confusion,
○ + ophthalmoplegia - eye movement
disturbances due to paralysis of I or more
extraocular muscles and anisocoria
(unequal see of pupil)
○ + ataxia - gross lack of coordination of
muscle movement. Back-front steps, loss
of balance thus person stands feet apart,
slurred speech
WERNICKE-KORSAKOFF SYNDROME
● is caused by thiamine deficiency in people with
alcoholism since heavy drinkers often eat poorly,
and alcoholism interferes with absorption of
nutrients from the digestive system.
● Thiamin helps produce energy needed to make
neurons function properly. Insufficient thiamin can
lead to damage or death of neurons.
● Thiamin deficiency damages regions of the brain
particularly the thalamus and the mammillary
bodies. Eye movement disorders observed in the
acute phase of the condition are probably due to
damage to other nearby brain regions that make
connections to the nerves controlling eye muscles.
KORSAKOFF PSYCHOSIS
● The chronic stage of Wernicke-Korsakoff
syndrome is distinguished by anterograde
amnesia, a severe memory disorder, which
prevents them from forming lasting memories of
events or information encountered after the onset of
the initial symptoms.
NOTE:
● They commonly experience tactile hallucination,
like there’s a bug crawling under their skin and
amnesia.
● Withdrawal symptoms:
a. MILD TREMULOUSNESS "the shakes" DISULFIRAM
(trembling)
● occurs 3-6 hours after the last drink ● Blocks the oxidation of alcohol at the acetaldehyde
● anxiety, restlessness, irritability, increased stage.
PR & BP ● During alcohol metabolism after disulfiram intake,
● coarse hand tremors, sweating, insomnia, the concentration of acetaldehyde occuring in the
nausea and vomiting. blood may be 5-10 times higher than that found
during metabolism of the same amount of alcohol
b. DELIRIUM TREMENS (DT) alone
● Severe or untreated withdrawal symptoms ● Accumulation of acetaldehyde in the blood
which include hallucinations, seizures, produces a complex of highly unpleasant symptoms
delirium & diaphoresis. (is a potentially referred to as the Disulfiram-alcohol reaction
fatal form of alcohol withdrawal that ● Disulfiram plus even small amounts of alcohol =
can result the problem drinker does not ○ flushing,
receive immediate alcoholism ○ throbbing in head and neck,
treatment) ○ throbbing headache,
● occurs 24 to 72 hours after the last drink ○ respiratory difficulty,
with history of alcohol abuse for more than ○ Nausea,
5 years ○ copious vomiting,
● Safe withdrawal is usually accomplished ○ sweating,
with the administration of diazepam ○ thirst,
(valium) of benzodiazepines, ○ chest pain,
chlordiazepoxide (Librium), or lorazepam ○ palpitation,
(ativan) to suppress the withdrawal ○ Dyspnea
symptoms. ○ Hyperventilation
Note: these medications are only given in ○ Tachycardia
a period of time only as they could develop ○ Hypotension
dependency to the medication which may ○ Syncope
cause and arise new illnesses. ○ Marked uneasiness
○ Weakness
MANAGEMENT of DELIRIUM TREMENS ○ Vertigo
○ Blurred vision
● SEDATION - (Benzodiazepines) is one of the ○ confusion
methods for managing withdrawal symptoms ● Severe reactions:
○ Respiratory depression
● DRYING OUT - a treatment of delirium tremens ○ Cardiovascular collapse
wherein the minimal amount of alcohol is allowed. ○ Arrhythmias
○ Myocardial infarction
MANAGEMENT ○ Acute congestive heart failure
○ Unconsciousness
1. AVERSION THERAPY: disulfiram (Antabuse) ○ Convulsions
● Alcohol-free for hours prior to initiation of ○ Death
treatment ● The duration of the reaction is variable
● Avoid all alcohol products ● From 30-60 mins depending on the
● Ensure that the patient themselves has a amount of alcohol taken while disulfiram
full will to do the treatment.
● This prevents the elimination of SUBSTANCE RELATED DISORDER
acetaldehyde, a chemical the body
produces when breaking down ethanol. SUBSTANCE USE DISORDERS

2. DETOXIFICATION: 1. SUBSTANCE DEPENDENCE

● 3-7 days for withdrawal symptoms ● Characterized by:
● Usually begin 4 to 12 hours after cessation ● Tolerance (is a person’s
or marked reduction of alcohol intake. diminished responses to a drug,
which occurs when the drug is
3. VITAMIN & NUTRITION used repeatedly and the body
● withdrawal symptoms: chlordiazepoxide adopts to the continued presence
(Librium) of the drug),
● As they are deficient in thiamine which ● Withdrawal syndrome
causes not enough nourishment of the ● Inability to stop using the drug
brain ● Continued use despite the
knowledge of the drug causes
4. SUPPORT GROUPS; EX. AA 12 STEPS problems
PROGRAM ● Impaired social/occupational
● Alcoholic Anonymous (AA) functioning
○ International
○ Private group TYPES OF DEPENDENCE
○ Helps people recover from all
types of addiction; starts with 1. PHYSICAL
alcohol but later on it includes 2. PSYCHOLOGICAL
substance abusers: Narcotic
Anonymous (Na) PHASES OF DEPENDENCY
 - Absentee Parents (sobra-sobra
1. PHASE I na ang ginahatag na allowance)
● Euphoria with initial use - “Konsintidor Parents” (the child
● User controls effects by regulating intake na naginom with friends bears a
need to do drinking again in the
2. PHASE II future, idaan sa mother, and the
● Increased craving/psychological mother will cover the situation)
dependence (e.g. dependent on the drug - A wfie of an alcoholic husband
to ally the anxiety) covers the real reason why the
● Development tolerance husband cannot go to work. The
● Change of social group husband will think that it is okay
to drink because their is someone
3. PHASE III (wife) enabling will protect or
● Control over the substance is lost cover his responsibility
● Drugs become the priority - Nurses has the tendency of being
enablers, even though they can
4. PHASE IV still manage to take care of
● Full blown dependency/physical themselves, we still do it for them.
dependence ○ “Recognize dependence but always
● Substance becomes a means of survival promote independence”

SUBSTANCE ABUSE RISK FACTORS

● Failure to fulfill major obligations at work, school or ● BIOLOGIC FACTORS

home ○ Children of alcoholic parents are at higher
● Recurrent substance-related legal problems risk of dependence than are children of
● Recurrent use in hazardous situations (operating nonalcoholic parents
machinery, driving)
● Before they become substance dependent they can ● PSYCHOLOGICAL FACTORS
try to stop using the drug, but when they use the ○ Inconsistency in the parents' behavior,
drug it is in a large amount (abuse) poor role modeling, lack of nurturing pave
the way for the child to adopt a similar
SUBSTANCE-INDUCED DISORDERS style of maladaptive coping, stormy
relationship, and substance abuse.
1. SUBSTANCE INTOXICATION ○ Some people use alcohol as a coping
● Development of substance-specific mechanism or to relieve stress and
syndrome due to a recent ingestion of a tension, increase feelings of power, and
substance the person is “high” decrease psychological pain.

2. SUBSTANCE WITHDRAWAL ● SOCIAL AND ENVIRONMENTAL FACTORS

● Development of substance-specific ○ Culture factors, social attitudes, peer
syndrome due to the cessation or behavior, laws, cost, and availability all
reduction of substance intake influence the initial and continued use of
● Characterized by: substance.
○ Depression
○ Anxiety and craving 10 DIFFERENT CLASSIFICATION OF DRUGS
○ Drive the individual to continue 1. STIMULANTS (AMPHETAMINES, COCAINE,
drug despite significant harm SHABU)
○ Suicide
● Drugs that stimulates or excite the CNS
ETIOLOGY ● Used for Attention Deficit Hyperactive Disorder
○ Ritalin - a little amount of amphetamines to
● Peer Pressure help control the hyperactivity of the child
● Environment ● Produces an intense and immediate feeling of
○ What you saw may influence you to euphoria
consume
● Self-esteem issue EFFECTS / SIGNS OF INTOXICATION AND
○ Low value of the self and the pain that OVERDOSE
recognizing the self
○ They need to make use of the drug ● High or euphoric feeling, Hyperactivity,
because the drug will give them strength, Hypervigilance
confidence, and may forget the emotions ● Talkativeness, Anxiety, Grandiosity
that they having ● Hallucination, Stereotyping or repetitive behavior
● Anger, fighting, impaired judgment
● Co-dependency of the family
○ “Co-dependency” - to become a INTOXICATION:
stand-alone disorder ● Some people experience euphoria, some feel
○ Every addict or alcoholic person there is anger. The personal disposition of the person
always someone at the back who has an before the intoxication affects the effect of the drug
enabling personality on the person.
- Person that would enable the ● You are already mad or sad, if you are intoxicated,
addict to be an addict all of your behavior is towards mad and sad.

COCAINE USES HALLMARK SIGNS:
● Perforated nasal septum (hyperpyrexia,
euphoria, pinpoint pupil) - wound between the
mouth and the nose that doesn’t heal. The nasal
septum comes in contact with the cocaine.
PHYSIOLOGIC EFFECTS
● tachyarrhythmias & hypertension
● Tachycardia, hypertension, dilated pupil
● Perspiration, chills, nausea
● Chest pain, confusion
● Cardiac arrhythmias
WITHDRAWAL SYMPTOMS:
● Marked dysphoria (unhappiness, restlessness)
● Fatigue, vivid and unpleasant dreams
● Insomnia or hypersomnia
● Increase appetite, psychomotor retardation or
agitation
● “Crashing”, depressing symptoms
● Suicidal ideation
2. CANNABIS (MARIJUANA)
● Upper leaves, flowering tops, stems
● Relieving nausea and vomiting in
chemotherapy (legalized in Canada)
● Anorexia and weight loss in AIDS
EFFECTS / SIGNS OF INTOXICATION
Less than 1 min, the peak effects in 20-30 mins, last for 2-3
hours
● High feeling, lowered inhibition
● Relaxation, euphoria
● Increased appetite
MARIJUANA USE HALLMARK SIGN:
● blood-shot eyes
PHYSIOLOGIC EFFECTS:
● Dry mouth
● Hypotension
● Tachycardia
EXCESSIVE USE:
● Delirium
● Psychotic disorders
3. OPIOIDS (STIMULANTS)
● Decreased physiologic and psychological pain
● Common used for cancer patients
● Induced sense of euphoria and well-being
● Morphine, Demerol, Codeine, Methadone, Heroin
EFFECTS / SIGNS OF INTOXICATION
HALLMARK SIGN:
● CLASSIC TRIAD: pinpoint pupil, coma,
respiratory depression
● Apathy, lethargy, impaired judgment
● Psychomotor retardation or agitation
● Dilated pupils. Drowsiness
● Slurred speech, impaired attention, and memory
OVERDOSE:
● Coma, respiratory depression
● Unconsciousness, death
TREATMENT
● Narcan (Naloxone), opioid antagonist or antidote to
overdose or to counter respiratory depression
● Methadone - can be used as a substitute for opioids
or to reduce symptoms; in withdrawal
○ Help client in the detoxification to limit
withdrawal symptoms
4. HALLUCINOGENS
● Distorted perceptions of reality and produce
symptoms similar to psychosis
● Examples: Mescaline, Lysergic Acid diethylamide
(LSD)
● “Designer drugs” such as ecstasy, Phencyclidine
(PCD)
EFFECTS / SIGNS OF INTOXICATION AND
OVERDOSE
● Hallucinations (Usually visual)
● Depersonalization - delusion
● Increase PR, BP, temp, and dilated pupils
INTOXICATION:
cancer ● Anxiety, depression, fear of losing one’s mind
● Paranoid ideation
● Potentially dangerous behavior such as jumping out
of the window in the belief that one can fly
PHYSIOLOGIC SYMPTOMS
● Sweating, tachycardia, palpitations
○ In excessive sweating, there is danger in
dehydration
● Blurred vision, tremors, lack of coordination
TREATMENT
● Isolation from external stimuli
● Use of physical restraints if necessary for the safety
of the patient and others
PHARMACOLOGIC TREATMENT
● Substance abuse management has 2 main
purposes:
● To permit safe withdrawal from alcohol,
sedative/hypnotics Benzodiazepines
● To prevent relapse
COMMON MEDICATIONS
1. VIT. B12 (THIAMINE)
● often prescribed to prevent or treat
Wernicke’s syndrome or Korsakoff’s
syndrome, neurologic conditions that can
result from heavy alcohol use
2. CYANOCOBALAMIN (VIT. B12) & FOLIC ACID
● are often prescribed for clients with
nutritional deficiencies
3. ALCOHOL WITHDRAWAL
● Is usually managed with a benzodiazepine,
an anxiolytic agent, w/c is used to
suppress the symptoms of abstinence. The
most common are diazepam,
chlordiazepoxide & lorazepam
4. METHADONE
 ● A potent synthetic opiate is used as a
substitute for heroin in some maintenance
programs. This is safer because it is legal
& controlled by a physician and available
in tablet form
5. LEVOMETHADYL
● A narcotic analgesic whose only purpose
is the treatment of opiate dependence
6. NALTREXONE
● Opioid antagonist often used to block the
effects of any opiod that might be ingested,
thereby negating the effects of using more
opioids
DUAL DIAGNOSIS
● A person who has both alcohol or drug problem and
emotional and psychiatric problem
● Incidence: 37% = alcohol abuser,30% = drug
abusers
● Other names:
○ MICA - mentally ill, chemical abuser
○ Is already mentally ill before
becoming a chemical abuser
○ CAMI - chemical abuser, mentally ill
○ Is already a chemical abuser
before developing a mental
illness
DIAGNOSTIC PRINCIPLES
1. If the patient's history indicates that psychiatric
problems began prior to the problematic use of
substance, then consider client for DD
2. The symptoms and problems that the client
presents are qualitatively different than usually seen
with problematic use of substances. Differences can
include intensity, frequency, or pattern of problems
3. If the psychiatric problems continue during a
chemical-free interval or 4 weeks after detox. Then
consider a second diagnosis
4. The client has a family history that supports the
psychiatric diagnosis under consideration
5. A history of multiple treatment failures in standard
chemical dependency or mental health treatment
centers
a. Example: a client is admitted due to
psychotic features but already admitted to
rehab 5 times, they will merit dual
diagnosis
6. A person's response to a trial of non-addictive
neuroleptic medications.
a. At first, you thought it is a substance-use
disorder, then the client responds to
antipsychotics or neuroleptics, then you
need to consider.
b. Because if it is substance induce, pag
withdraw ng substance, mawala na dapat
ang symptoms but if di nawala then
binigyan ng antipsychotic tapos nag
responds then consider dual diagnosis.,
TREATMENT
● Ideally both problems should be treated
simultaneously
● First step in treatment must be detoxification
● Patient needs to be in rehab to address substance
abuse and mental problems
● It requires a multimodal, integrated approach that
combines both mental health and chemical
approaches for the simultaneous treatment for both
disorders
○ If the client has comorbid problems, then
dapat sabay ang treatment for both
METHODS INCLUDES
● Individual and group therapy
● Education about drugs and alcohol
○ One of the reasons why they have
structured activities is because the abuser
and the dependent are found to be deviant
to the laws outside the community. They
have the habit of deviating from the laws of
the land
○ They are asked and train to follow rules
and regulations in rehabilitation centers
● Proper nutrition
● Participation in 12 step program
○ This is the principle that is used by NA
(narcotic anonymous) and AA (alcoholic
anonymous)
○ It includes 12 steps that needs to be
followed by recovery addicts
○ Ex. Step 1: We admitted that we are
powerless over alcohol and our lives
become unmanageable
○ So they need to reflect on the step and live
with it. For example - a week. One week
nilang ililive yung first step. So yung first
step is, you need to admit that you are
powerless over the alcohol/drugs meaning
to say you are not in control anymore of
yourself instead you are being controlled.
○ The aim is to follow the 12 steps before
lalabas sa rehabilitation
● Expressive therapies and education
○ Self-help group
○ NA/AA
○ AL-Anon
○ For the family members of the
NA/AA
LECTURE DATE: 05/02/2023
SCHIZOPHRENIA SPECTRUM AND OTHER
PSYCHOTIC DISORDER
A. BRIEF PSYCHOTIC DISORDER
B. SCHIZOPHRENIFORM DISORDER
C. SCHIZOAFFECTIVE DISORDER
D. SUBSTANCE/MEDICATION INDUCED
PSYCHOTIC DISORDER
● These are disorders defined by abnormalities in one
or more of the following five domains: delusions,
hallucinations, disorganized thinking (speech),
grossly disorganized or abnormal motor behavior
(including Catatonia) and negative symptoms
○ Before, was believed that psychosis
(detachment from reality) came from
excess water in the brain, which is why
they drill a hole in the skull and remove the
fluid
○ Dopamine is increased when one is
experiencing positive symptoms
○ Dopamine decreases when drinking
antipsychotics
RISK FACTORS
1. GENETIC FACTORS:
 ○ Focused on the immediate families i.e.
parents, siblings and offspring to see
whether it is genetically transmitted or
inherited.
■ Identical twin affected with 50%
risk
■ Fraternal twin affected with 40%
■ Sibling affected with 15%
2. NEURO ANATOMICAL AND NEUROCHEMICAL
● Studies demonstrated that persons with
schizophrenia have relatively less brain
tissue; that could represent a failure in
development or a subsequent loss of
tissue
● Ct: shown enlarged ventricles in the brain
and certicsl atrophy
● Intrauterine influences i.e. poor nutrition,
tobacco, alcohol and other drugs and
stress are also being studied as possible
causes of the pathology
● Usually diagnosed in late adolescence and
early adulthood. Rarely manifested in
childhood
● Peak onset
○ Men: 15-25
○ Female: 25-35
● Age of onset:
○ Those who develop the illness
earlier show worse outcomes
than those who develop it later
○ Younger clients display a poor
premorbid adjustment, more
prominent (-) signs and more
cognitive impairment than do
older clients
A. Characteristic symptoms
B. Social/occupational dysfunction
○ Work, interpersonal and self-care
functioning is below the level achieved
prior to onset
C. Duration: continuous signs of the disturbance for at
least 6 months
D. Schizoaffective and mood disorders are not present
and are not responsible for the signs and symptoms
E. Not causes by substance abuse or a general
medical disorder
F. If with history of autism spectrum disorder or
communication disorder of childhood onset, the
additional diagnosis of schizophrenia is made only if
prominent delusions or hallucinations in addition to
other required symptoms of Schmitz are also
present for at least one month (or less if
successfully treated)
○ Specify if:
■ With catatonia
○ PHASES
1. PRODROMAL SYMPTOM:
before the acute phase or the
active. Predominantly negative
symptoms
2. RESIDUAL SYMPTOM: after the
acute phase…
● Some criteria for schitz except that the duration
would last only for less than a month
○ Specify if:
■ With marked stressors
■ Without marked stressors
■ With postpartum onset
■ With Catatonia
SCHIZOPHRENIFORM DISORDER
● Schizophreniform disorder is distinguished by its
difference in duration: the total duration of the
illness, including prodromal, active, and residual
phases, is at least 1 month but less than 6 months
SCHIZOAFFECTIVE DISORDER
● Symptoms present but with major depressive/manic
symptoms
● Diagnostic criteria
A. An uninterrupted period of illness during
which there is a major mood episode
(major depressive or manic) concurrent
with Criterion A of schizophrenia
- Note: The major depressive episode
must include Criterion A1: Depressed
mood.
B. Delusions or hallucinations for 2 or more
weeks in the absence of a major mood
episode (depressive or manic) during the
lifetime duration of the illness.
C. Symptoms that meet criteria for a major
mood episode are present for the majority
of the total duration of the active and
residual portions of the illness.
D. The disturbance is not attributable to the
effects of a substance (e.g., a drug of
abuse, a medication) or another medical
condition.
SUBSTANCE/MEDICATION INDUCED PSYCHOTIC
DISORDER
● Symptoms are due to psychoactive substances
● Diagnostic criteria
A. Presence of one or both the following
symptom
1. Delusions
2. Hallucinations
B. there is evidence from the history, physical
examination or laboratory findings of both
1 and 2
● The symptoms In criterion a developed during or
soon after substance intoxication or withdrawal or
after exposure to a medication
NOTE:
● laxatives are not encouraged for those who have
body dysmorphic or eating disorders
LECTURE DATE: 05/09/2023
BIPOLAR AND RELATED DISORDERS

DIFFERENTIAL DIAGNOSTIC A. BIPOLAR I

B. BIPOLAR II
1. Schizotypal personality disorder C. CYCLOTHYMIC DISORDER
● Part of the schizophrenia disorder D. DISRUPTIVE MOOD DYSREGULATION
2. Delusional disorder E. DISORDER
F. MAJOR DEPRESSIVE DISORDER
G. PERSISTENT DEPRESSIVE DISORDER
BRIEF PSYCHOTIC DISORDER
H. (DYSTHYMIA)
I. PREMENSTRUAL DYSPHORIC DISORDER
● Mood disorders
DISORDERS
● Bipolar I
● Bipolar II - person can exp mania and depression
● Cyclothymic disorder
● Substance/medication-induced bipolar
● Bipolar related disorder due to general medical
condition
MANIC EPISODE
● Period of elated or irritable mood for 1 week
● Very talkative, grandiose, decreased need for sleep,
flight of ideas, excessive involvement in activities
that have high potential for problems (e.g. sexual
promiscuity)
○ Sexual promiscuity - iba iba ang sexual
partner
○ Spending spree can spend a big sum
money in a short period of time
● Needs to be hospitalized, homicidal/suicidal;
impairment in social, occupational functioning
HYPOMANIC EPISODE
● Abnormally and persistency elevated, expansive, or
irritable mood and abnormally and persistently
increased activity for 4 consecutive days
● 3 of the ff:
1. Inflated self-esteem or grandiosity
2. Decreased need for sleep
3. More talkative than usual or pressure to
keep talking
4. Flight of ideas or complaints of thoughts
are racing.
5. Distractibility
6. Increase in goal-directed activity (either
socially, at work or school, or sexually) .
7. Excessive involvement in activities that
have a high potential for painful
consequences
DEPRESSIVE EPISODE
● at least 2 weeks depression + 5 SIGECAPS
○ S- Sleep (increased/decreased)
○ I- Interest (decreased) "anhedonia"
○ G- Guilt/ low self-esteem
○ E- Energy (decreased)
○ C- Concentration (decreased)
○ A - Appetite (increased/decreased)
○ P - Psychomotor Activities
(increased/decreased)
○ S - suicidal Ideation
● Marked impairment in social and occupational
functioning.
BIPOLAR I
● It is necessary to meet the following criteria for a
manic episode
● The manic episode may have been preceded by
and may be followed by hypomanic or major
depressive episodes.
● The occurrence of the manic and major depressive
episode(s) is not better explained by schizoaffective
disorder or other mental disorder
NOTE:
● Mania - normal mood - hypomania - dysthymia -
depression
BIPOLAR II
● Criteria have been met for at least one hypomanic
episode and at least one major depressive episode
● periods of depression and hypomania causes
clinically significant distress or impairment in social,
occupational, or other important areas of
functioning.
NOTE:
● Hanggang hypomania lang
CYCLOTHYMIC DISORDER
● adults who experience at least 2 years
● (for children, a full year) of both hypomanic and
depressive periods without ever fulfilling the criteria
for an episode of mania, hypomania, or major
depression.
DSM 5 CRITERIA
DEPRESSIVE DISORDER
● Disruptive mood dysregulation disorder
● Major depressive disorder
● Persistent depressive disorder (dysthymia).
Premenstrual dysphoric disorder
● Substance/medication-induced depressive disorder
● Depressive disorder due to another medical
condition
● Other specified depressive disorder
DISRUPTIVE MOOD DYSREGULATION
DISORDER
● Severe recurrent temper outbursts manifested
verbally (eg. verbal rages, physical aggression
toward people or property) that is out of proportion
in relation to situation
● The temper outbursts are inconsistent with
developmental level
● The temper outburst occur, on average, there or
more times per week
● The mood between temper outbursts is persistently
irritable or anger most of the day, nearly every day,
and is observable by others
MAJOR DEPRESSIVE DISORDER
● at least 2 weeks depression + 5 SIGECAPS
○ S - Sleep (increased/decreased)
○ I - Interest (decreased) "anhedonia"
○ G - Guilt/ low self-esteem
○ E - Energy (decreased)
○ C - Concentration (decreased)
 ○ A - Appetite (increased/decreased) PSYCHODYNAMIC THEORIES
○ P - Psychomotor Activities
(increased/decreased) FREUD
○ S - suicidal Ideation ● hypothesized that depressions stemmed from the
● Marked impairment in social and occupational rage over abandonment of the infant by the
functioning. mother through death, emotional detachment,
or other absence.
PERSISTENT DEPRESSIVE DISORDER EGO
(DYSTHYMIA) ● overpowered by punitive superego. This results in
rigidity, w/ rule-oriented goals that are unrealistic &
A. Depressed mood for most of the day as indicated unattainable, setting the stage for failure.
by either subjective account or observation by ● Always dictates and reminds you
others, for at least 2 years.
SOCIAL/ ENVIRONMENTAL THEORIES
NOTE: ● Circumstances i.e. " ambivalent, abusive, rejecting
● in children and adolescents: duration at least 1 or highly dependent family relationships" can the
year risk for mood disorders.
○ Loss of relationships or an important life
B. Presence while depressed, 2 or more of the role may precede depression. (ex. Loss of
following job)
1. Poor appetite or overeating ○ Physical or sexual abuse can be a factor in
2. Insomnia or hypersomnia depression.
3. Low energy or fatigue ○ Social isolation & severely limited finances
4. Low self esteem are implicated in the depression of senior
5. Poor concentration or difficulty making citizens
decisions
6. Feelings of hopelessness TREATMENT

PREMENSTRUAL DYSPHORIC DISORDER 1. PSYCHOPHARMACOLOGY

● 3 major categories of antidepressants
● Similar to PMS but more serious ○ tricyclic antidepressants (TCAs)
● Causes irritability, depression, or anxiety in the ○ monoamine oxidase inhibitors
week or 2 before the period starts (MAOIs)
● Symptoms usually go 2 to 3 days after the period ○ selective serotonin reuptake
inhibitors (SSRls)
THEORETICAL INFLUENCES ○ atypical antidepressants
BIOLOGIC THEORY 2. ECT
3. PSYCHOTHERAPY
● Genetic: OTHER THERAPIES
a. 1st degree relatives will have 2X risk of
having it in the general population. twins 1. Interpersonal therapy
will have 54% risk 2. Behavioral therapy
3. Psychoanalytic therapy
NEUROCHEMICAL THEORIES 4. Cognitive therapy
5. Family therapy
● influences of neurotransmitters (chemical
messengers) focus on decreasing serotonin & LECTURE DATE: 05/10/2023
norepinephrine as the major biogenic amines PERSONALITY DISORDERS
implicated in mood disorders. PERSONALITY
● serotonin - has many roles in behavior, mood,
activity, aggressiveness & irritability, cognition and ● PERSONALITY. enduring patterns of perceiving,
pain feeling, thinking about and relating to oneself and
environment
NEUROENDOCRINE INFLUENCES
● PERSONALITY TRAIT. aspect of personality that is
● HORMONAL FLUCTUATIONS relatively consistent across time and situation i.e.,
○ Mood disturbances in persons with outgoing, caring, compassionate, exploitive,
endocrine disorders i.e. those of the impulsive
thyroid, adrenal, parathyroid, and pituitary.
○ Postpartum hormone alterations have ● PERSONALITY DISORDER: an enduring pattern of
created serious depressions. thinking, feeling and behaving that is relatively
○ Premenstrual syndrome involves stable over time and the particular personality
symptoms of depression along w/ the features must be evident bt early adulthood
physical symptoms of water retention &
breast swelling. CLASSIFIED UNDER 3 CLUSTERS

HYPOTHALAMIC-PITUITARY-ADRENOCORTICAL ● CLUSTER A PDs

AXIS ○ withdrawn, cold, suspicious or irrational

● Cortisol levels are increased in many depressed ● CLUSTER B PD

people.
 ○ theatrical, emotional and attention-seeking;
their moods are labile and often shallow.
They often have intense interpersonal
conflicts
● CLUSTER C PDs
○ anxious and tensed, often over controlled
WHAT ARE PDs?
● All humans have personality traits
● PDs are collections of traits that have become rigid
and may work to an individual's disadvantage, to
the point that they impair functioning or cause
distress
● These patterns of behavior and thinking have been
present since early adult life and have been
recognizable in the patient for a long time
● All PDs have in common the following
characteristics:
○ A lasting pattern of behavior and internal
experience that is clearly different from the
patient’s culture.
○ This pattern includes: problems with affect,
cognition, control of impulses,
interpersonal relationships
○ Remember the twin hallmark of PDs:
○ early onset (usually by late teens)
○ pervasive nature (disorder’s
features affect multiple aspects of
work, personal and social life)
CLUSTER A
A. PARANOID PERSONALITY DISORDER
B. SCHIZOID PERSONALITY DISORDER
C. SCHIZOTYPAL PERSONALITY DISORDER
PARANOID PERSONALITY DISORDER
● “How little they trust” and “how much they suspect”
others
● Their suspicions are unjustified and they interpret
untoward occurrences as the result of deliberate
intent.
● Tends to harbor resentment for a long time, perhaps
forever.
● Tends to be rigid, cold, calculating, guarded people
who both avoid blame and intimacy.
● This disorder likely creates occupational difficulties
and trouble dealing with superiors and coworkers.
● Men.
SCHIZOID PERSONALITY DISORDER
● They are indifferent to the society of other people.
● Typically lifelong loners who show a restricted
emotional range.
○ Not necessarily lonely, but loners. They
love to be alone. Likes to work in
laboratories, work in their laptops.
● Appears unsociable, cold, and reclusive.
○ No interest in having sex with others.
● They succeed at solitary jobs that others may find
difficult to tolerate.
● May daydream excessively, become attached to
animals, and often do not marry or even form
long-lasting romantic relationships. But they do
retain contact with reality.
● Men.
SCHIZOTYPAL PERSONALITY DISORDER
● Lasting interpersonal deficiencies that severely
reduce their capacity for closeness with others.
○ They do not engage in relationships. Dili
gyud daw naga engage in intimate or
personal relationships.
● Have distorted or eccentric thinking, perceptions
and behaviors, making them odd.
○ Kakaiba sila mag isip sa usual
○ Weird ang connotations sa kanila
● Often feels anxious when with strangers, they have
almost no close friends.
● Suspicious and superstitious.
● Their peculiarities of thought include magical
thinking and belief in telepathy or other unusual
modes of communication.
○ This is their characteristic trait na kaya
ma-fall sila under schizophrenia spectrum
of disorders. They have a kind of
detachment from reality.
● They may talk about sensing a "force" or "presence"
or have speech characterized by vagueness or
unusual use of words.
○ They may eventually develop
schizophrenia.
● Their eccentric ideas and style of thinking place
them at a higher risk for becoming involved with
cults.
● Despite their odd behavior, many marry and work.
GENERAL MANAGEMENT
CLUSTER A
● Cognitive therapy focuses on increasing their sense
of self- efficacy in dealing with difficult situations.
○ So we help them in their sense of self
efficacy, what they are best at doing.
○ We teach them how to cope during
anxiety.
● Psychosocial treatments focus on increasing the
person's awareness of his or her own feeling, as
well as increasing his/her social skills and social
contacts.
○ This may be applicable or done to
paranoid and schizotypal patients but not
sa schizoid personality.
● Traditional neuroleptics such as haloperidol and
thiothixene
○ These are antipsychotics
● Atypical antipsychotics
● Antidepressants
CLUSTER B
A. ANTISOCIAL PERSONALITY DISORDER
B. ANTISOCIAL PERSONALITY DISORDER
C. BORDERLINE PERSONALITY DISORDER
D. HISTRIONIC PERSONALITY DISORDER
E. NARCISSISTIC PERSONALITY DISORDER
● Are known to be dramatic or overly emotional or
unpredictable thinking or behavior
ANTISOCIAL PERSONALITY DISORDER
● They chronically disregard and violate the rights of
other people; they cannot or will conform to the
norms of society.
○ Hallmark: these are people who don't
know how to respect the rights of other
people.
 ○ Like manguha ug gamit ug dili ilaha
whether you like it or not, they're still going
to do it.
● Some are engaging con artists; others graceless
thugs, women may be involved in prostitution; most
have heavy use of illicit drugs.
● They seem superficially charming, many are
aggressive and irritable.
○ They have these charming personality that
they can use to manipulate people, but
most of them are aggressive; madaling
magalit
● Besides substance abuse, there may be fighting,
lying, and criminal behavior.
○ They don't really know how to respect the
rights of other people. They disregard
safety of self or other people and even
they have impulsive behavior
● They occasionally make suicide attempts but their
manipulative interactions makes it difficult to
determine the genuineness of the complaint.
● Before age 15, they must have a history that would
support a diagnosis of Conduct Disorder.
○ People or adolescents having this type of
personality traits or personality patterns
are diagnosed with conduct disorder when
they become 18, that's the time that they
can be diagnosed with Antisocial
Personality Disorder.
○ This type of PD is also the one behind
most of the prisoner
● Men
ANTISOCIAL PERSONALITY DISORDER
● Lower socioeconomic status and runs in families
● Childhood ADHD is a common precursor and
childhood Conduct Disorder is a requirement
● The diagnosis will not be warranted if the behavior
happens in the context of substance abuse
● Never make this diagnosis before age 18 because
children sometimes do not escalate to the full adult
syndrome.
● It is a serious disorder without known effective
treatment. Thus, it is a diagnosis of last resort.
BORDERLINE PERSONALITY DISORDER
● They appear unstable throughout their adult lives.
● Often at the crisis point with regard to their mood,
behavior, or interpersonal relationships.
● Many feel empty and bored, they attach themselves
strongly to others, then become intensely angry or
hostile when they believe they are ignored or
mistreated by those they depend on.
● May impulsively try to harm or mutilate themselves
as expressions of anger, cries for help or attempts
to numb themselves to their emotional pain.
● It runs in families. These people are truly miserable
to the point of having 10% complete suicide.
NOTE:
● Beautiful and talented. Angelina Jolie voluntarily
checked herself into a treatment facility in the
late 1990s. claiming she had experienced both
suicidal and homicidal thoughts. Although she
had no intention of acting on these thoughts. She
realized that she needed help.
HISTRIONIC PERSONALITY DISORDER
● A long-standing pattern of extreme attention
seeking and emotionalism that seeps into all areas
of their lives
● Their interest and topics of conversation focus on
their own desires and activities
● They continually call attention to themselves by
their behavior, including speech,
● Overly concern with physical attractiveness and
express themselves so extravagantly
● Their need for approval can cause them to be
seductive.
● Being insecure and having Iow tor frustration can
spawn temper tantrums.
● Quick to form new friendships and quick to become
demanding.
● They don't think very analytically so they have
difficulty with tasks requiring logical thinking. They
may however succeed in jobs that set a premium on
creativity and imagination
● May run in families. Classic patient is female.
NARCISSISTIC PERSONALITY DISORDER
● A lifelong pattern of grandiosity, a thirst for
admiration, and an absence of empathy
● They regard themselves as unusually special;
self-important individuals who commonly
exaggerate their accomplishments-.
● They have fragile self-esteem and often feel
unworthy, even at times of great personal success,
they may feel fraudulent or undeserving
● They remain overly sensitive to what others think
about them and feel compelled to extract
compliments.
● Often fantasize about wild success and envy those
who have achieved it
● They may choose friends they think can help them
get what they want
● Men.
● Unrealistically positive assumptions about their
self-worth as the result of indulgence and over
evaluation by significant others during childhood.
● Other people with this narcissistic personality
disorder develop the belief that they are unique or
exceptional as a defense against rejection by
important people in their lives
Adolf Hitler
- Not a celebrity, but definitely a famous (or
infamous) person
- There has been speculation about HItler’s
psychiatric profile over the years. In his book,
Hitler:DIagnosis of a Destructive Prophet, author
Fritz Redlich concludes that the genocidal leader
showed strong symptoms of Narcissistic
Personality Disorder
GENERAL MANAGEMENT
ANTISOCIAL
● In psychotherapy focus on helping the person
gain control over his or her anger and
impulsive behaviors by recognizing triggers
and developing alternative coping strategies
● Lithium and the atypical antipsychotics. The
efficacy of these drugs in treating antisocial
personality disorder is not yet clear.
BORDERLINE PD
● Dialectal behavior therapy
○ Reduces depression, anxiety, and
self-stimulating behavior while increasing
interpersonal functioning
○ Antianxiety and antidepressant drugs

HISTRIONIC AND NARCISSISTIC PD
● Cognitive techniques can help these clients
develop more realistic expectations of their
abilities and more sensitivity to the needs of
others
CLUSTER C
A. AVOIDANT PERSONALITY DISORDER
B. DEPENDENT PERSONALITY DISORDER
C. OBSESSIVE-COMPULSIVE PERSONALITY
DISORDER
● Characterized by anxiety, fearful thinking or
behavior
AVOIDANT PERSONALITY DISORDER
● Feels inadequate, are socially inhibited, and overly
sensitive to criticism
○ PLEASERS
● Their sensitivity to criticism and disapproval makes
them eager to please others, which can also lead to
marked social isolation; NOT recognized > Low
self-worth
● They may misinterpret innocent comments as
critical and often refuse to begin a relationship
unless sure of being accepted.
● Avoid occupations that involve social demands
● Other than their family, they have few close friends
● In an interview, they can appear tense and anxious
● Many such patients marry and work although they
may become depressed or anxious if they lose their
support system
DEPENDENT PERSONALITY DISORDER
● Patients feel the need for someone else to take
care of them
● They desperately fear separation, their behavior
becomes so submissive and clinging that it may
result in others’ taking advantage of them or
rejecting them
○ Prone for abuses
● Anxiety blossoms if they are thrust in a position of
leadership; they feel helpless and uncomfortable
when they are alone
○ Always have companion
● Trouble in making decisions, starting projects and
sticking to a job on their own
○ Crushed self-worth
○ Doesn’t believe in themselves
● They tend to belittle themselves and may also
tolerate considerable abuse, even battering
● Women
● E.g. Domestic Abuse
● David Beckham suffers form DPD. Shows
excessive clinginess in his relationsip, a low
self-esteem, inability to cope with certain situations
by himself.
OBSESSIVE-COMPULSIVE PERSONALITY
DISORDER
● Perfectionist, stiff, moralistic, and preoccupied with
orderliness
○ They wanted things to be perfect in
accordance with what they believe is right.
Tends to be anxious kapag may di
masunod sa gusto nila
○ Very high ang standards/moral
● They need to exert interpersonal and mental control
● Many patients with OCPD have no actual
obsessions or compulsions at all
○ OCD - egodystonic
○ PD - egosyntonic
● Their rigid perfectionism often results in
indecisiveness, preoccupation with detail, and
insistence that others do things their way
● Often depressed and it interferes with their
effectiveness
● They are list makers who allocate their own time
poorly, workaholics who must meticulously plan
even their own pleasure
● They resist the authority of others but insist on their
own
● Males. Runs in families
● These people appear to be rigid, stubborn, and
inflexible, especially in right and wrong.
● Steve Jobs - the late CEO of Apple Computer
Corporation suffered from OCPD.
○ According to an article in Slate Magazine,
Jobs’s OCPD is “what made him great”.
MANAGEMENT: DEPENDENT PERSONALITY
DISORDER
● PSYCHODYNAMICS - this is where can know what
are their traumas and pains in the past
○ Free Association
○ Dream Interpretation
● COGNITIVE-BEHAVIORAL THERAPY (CBT) for
dependent personality disorder includes behavioral
techniques designed to increase assertive
behaviors and decrease anxiety, as well as
cognitive techniques designed to challenge clients’
assumptions about the need to rely on others
MANAGEMENT: OBSESSIVE-COMPULSIVE
PERSONALITY DISORDER
● SUPPORTIVE THERAPIES
● BEHAVIORAL THERAPIES CAN DECREASE
THEIR COMPULSIVE BEHAVIORS
● RELAXATION TECHNIQUES
○ OCPD clients oftentimes have a very
strong anxiety, they are highly anxious.
○ We can assist people in this disorder
overcoming the crisis that bring them in for
a treatment such as changing schedules to
overcome anxiety created by changes in
the schedules
○ We can also make use of systematic
desensitization
GENERAL MANAGEMENT FOR
PERSONALITY DISORDER
● Encourage verbalization of feelings/behaviors
○ Ex. “Tell me more”
○ When they verbalize feelings and emotions
its not for the one listening but for the one
talking because they can hear themselves
which gives the person sometime to
process the self
● Encourage to attempt new experiences/situations
● Assist the client in understanding how others view
their behavior
● Decrease irrational beliefs (it’s ok to make mistake
sometimes)
 COGNITIVE RESTRUCTURING TECHNIQUES - Inability to recognize
danger or what poses
● i.e thought-stopping or positive self-talk can also danger/environment risk
enhance self-esteem
CAUSES OF INTELLECTUAL DISABILITY
GENERAL PRINCIPLE OF CARE FOR
PERSONALITY DISORDERS ● HIV/AIDS/rubella infection
● Alcoholic mother
● Acceptance & trust ● Thyroid deficiency
○ As nurses/helpers we need to make sure ● Excessive lead poisoning
that we would be able to accept them ● Damage to the brain
● Be aware of own feelings ● neurological/neurodevelopmental impairment
○ Sometimes it triggers our personal issues. ● Exact gestational age is not reached (premature)
If transference occurs while talking to the ● Opiate intoxication
client, distance a little para makita mo ● Nutritional deficiency (lack in folic acid)
yung sarili mo at yung client who is talking ● Anoxica (absence of oxygen)
to you. ● Toxemia (pregnancy-induced hypertension)
● Consistency & concern; set limits ● Environmental factors
○ Especially for people who are manipulative ● Severe RH incompatibility
(borderline personality disorder)
● Improve social skills LEVEL OF INTELLECTUAL DISABILITY
● Close observation for borderline with suicidal
ideations
Level IQ Implication
PSYCHOPHARMACOLOGY Mild/Moron 51-70 Difficulty adapting to school
Educable - needs assistance
● Lithium - anticonvulsant mood stabilizers; and
*Hindi pwede isabay sa
● Benzodiazepines - used to treat aggression
mainstream school because
there’s a tendency
NOTE: mafrustrate ang child
● Remember: PERSONALITY develops in
RESPONSE TO INHERITED DISPOSITIONS Moderate/ 36-50 Poor awareness of needs of
(Temperament) & ENVIRONMENTAL imbecile others
INFLUENCES (Character) Trainable - needs moderate
supervision
*Don’t expect that they’ll
LECTURE DATE: 05/16/2023 understand the wisdom of
COMMON PSYCHIATRIC DISORDERS why they need to do things.
A. INTELLECTUAL DISABILITY
B. AUTISM SPECTRUM DISORDER Severe/idiot 20-35 Unable to learn academic skills
C. ATTENTION DEFICIT HYPERACTIVITY Poor motor development and
D. DISORDER minimal speech
E. OPPOSITIONAL DEFIANT DISORDER Needs complete and close
F. CONDUCT DISORDER supervision

INTELLECTUAL DISABILITY Profound Below 20 Has minimal capacity for

sensorimotor function
Needs custodial care with a
totally structured environment
● Known as mental retardation
● Significantly subaverage intellectual functioning
(IQ=<70) PRINCIPLES OF NURSING CARE
● Problem of inadequate mental functioning
○ Mental functioning meaning it is not fully ● Protective care
functioning even following age ○ Education of the family - Their involvement
● Onset: 18 is an important factor in the plan of care to
● IQ below 70 promote progress and to minimize the
○ Manifested by sub-average intellectual stress.
functioning in: ○ Para ma aware sila sa capacity ng
○ COMMUNICATION person or magkaroon ng wider patience
○ SELF-CARE ● 3 R's of Mental Retardation Nursing Care
- Person may not be able ○ REPETITION
to take care of self ■ do it over and over again. Do not
○ HOME LIVING expect they’ll get it fully.
- Person may become ○ ROLE MODELING
highly depending on ■ best strategy. show them how to
other people, regardless do it.
of age ○ RESTRUCTURING
○ SOCIAL SKILLS ■ restructuring the household
○ HEALTH AND SAFETY where the client will stay such as
alisin ang breakable para hindi
mastress si client if may masira
● Focus of Education
○ Reading
○ Arithmetic
○ Writing
○ If denial ang parents, they’re putting
pressure sa client.
AUTISM SPECTRUM DISORDER
● Characterized by:
○ Impairment in communication skills (they
lack words to communicate)
○ Presence of stereotyped behavior,
interests and activities
○ Associated with impairment on social
interactions
● Treatable but not curable
○ Symptoms can be alleviated but this is for
life.
● More common among boys
● Usually diagnosed at age 2
● Main problem: Interpersonal functioning
● Most acceptable cause: Biological factors - brain
anoxia, intake of drugs (brought about by problem
during pregnancy, or delivery)
SIGNS AND SYMPTOMS
● Odd play
○ They don't interact with others
● Not cuddly
● Echolalia
● Crying tantrums
○ Not controllable; whatever you give them
they will still cry
○ Oftentimes, when parents don’t
understand what the child undergo,
napapalo sila, hindi lang simpleng palo lalo
na umaabot na ang parents sa limit ng
patience nila
● Head towards anything
● Inanimate object attachment
○ Cling to their favorite object
● Loves to spin objects/self
○ Either pinapaikotnila sa kamay or sila ang
umiikot
● Difficulty interacting with others
● Wants blocks
○ Because they pile
● Acts as deaf
○ Pa bungol2, they don’t listen to you
○ They hear but their attention is on
something they like doing
● Resists normal teaching method/routine changes
○ The reason why hindi sila pwede sa
mainstream schools
○ They want routinary activity
● No fear or danger
○ Especially when out of the streets, you
really have to hold them
● Insensitive to pain
○ You would see a lot of children na kunwari
nadapa or nahulog, and when the child
doesn’t cry they often get praises like “uy
masyadong magaling di talaga umiyak
yung bata”
○ Or pag binigyan ng injection
● No eye contact
○ They have poor eye contact
● Giggling or silly laugh
○ Kahit wala silang kasama
NURSING INTERVENTIONS
● Environment: safe & consistent
○ Away from danger
○ They have to be in the house na hindi sila
basta-basta makalabas
○ The arrangement of the house should be
consistent because changes may cause
anxiety on their part
● Encourage the client to participate for self-care
● Speak calmly when giving instructions
○ Kapag sumisigaw ka o nagagalit ka this
adds up to their anxiety or even to their
misunderstanding or inability to
comprehend things
● Use simple words or phrases
● Repeat instructions as necessary
● Haloperidol - symptomatic relief for hyperactivity,
stereotypical and self-destructive behavior
○ Antipsychotic drugs are also given to some
people who are having range, anger and
self-destructive behavior
ATTENTION DEFICIT HYPERACTIVITY
DISORDER
● Common in boys
● Usually diagnosed before age 7
○ Bakit? Kung sa bahay lang to oftentimes
tinitinggan lang natin na the child is so
comfortable that he can’t stay still, takbo
dito takbo doon. But when the child enters
school (preschool or play school), usually
dito nakikitaan na sila because they don’t
engage on activities provided by the
teacher
● PROBLEMS:
○ Inattention
○ Hyperactivity
○ Impulsivity
SYMPTOMS OF ADHD
● HYPERACTIVITY (6>
○ Is in motion as if "driven by a motor"
○ Cannot stay seate
○ Squirms and fidg
○ Talks too much
○ Runs, jumps and climbs when this is not
permitte
○ Cannot play quietly
● IMPULSIVITY
○ Acts and speaks without thinking
○ May run into the street without looking for
traffic first
○ Has trouble taking turns
○ Cannot wait for things
○ Calls out answers before the question is
complete
○ Interrupts others
INATTENTION (6>)
○ Has a hard time paying attention
daydream
○ Does not seem to listen
○ Is easily distracted from work or play
○ Does not seem to care about details,
makes careless mistakes
○ Does not follow through instructions or
finish tasks
○ Is disorganized
○ Loses a lot of important things
 ○ Does not want to do things that require ● Child training
ongoing mental effort ● Family training
● School and community interactions
ETIOLOGY MODE DEACTIVATION THERAPY
● A treatment approach that focuses on the
CAUSES: INTRANATAL FACTORS underlying compound basic beliefs that influence an
individual’s behavior
NURSING DIAGNOSIS ● A more holistic and effective approach is possible
by addressing the individual’s belief within the
● Potential for injury system.
INDIVIDUAL THERAPY
● It includes conflict resolution, anger control and
PRINCIPLES OF NURSING CARE:
social skills instruction
● Provide nutrition and safety
NURSING MANAGEMENT
● Environment: structured enable appropriate reaction
to the environmental stimuli
1. Limit unacceptable behavior to reduce aggression
● Plan a firm and consistent environment in which
and increase compliance with treatment
limits and standards are set.
2. Development at coping skills and self-esteem
3. Promoting social interaction has proven to be highly
PSYCHOPHARMACOTHERAPY successful
4. Interacting with clients and their families.
DRUG OF CHOICE: Methylphenidate (Ritalin)

OPPOSITIONAL DEFIANT DISORDER DISORDERS COMMONLY DIAGNOSED

CHARACTERISTICS TO ADULTS
Characterized by an enduring pattern of
1. Disobedience
A. EATING DISORDER
1. explosive anger outbursts B. SEXUAL DISORDER
2. argumentativeness C. SEXUAL DYSFUNCTION DISORDER
3. Iow nation tolerÄtce D. GENERAL IDENTITY DISORDER
4. tendency to others quarrels or accidents
EATING DISORDER
CONDUCT DISORDER
● More common among females
● Persistent antisocial behavior of children and
adolescents that significantly impairs their ability to ETIOLOGY
function in the social, academic or occupational
areas. ● PSYCHOLOGICAL FACTORS
● 30-50% of these children are diagnosed w/ ○ Parental factors (domineering parents)
antisocial personality disorder as adults. ○ Parents have a strong personality
that the child may not see
4 CLUSTERED SYMPTOMS OF CONDUCT him/herself as individual but
DISORDER always a product or parang
younger version of his parent
1. AGGRESSION TO PEOPLE AND ANIMALS ○ Individual factors (conflict about growing
● Often bullies, threatens intimidate others up)
● Initiate physical fights, cruel to people and E.g:
animals ○ Not allowed to fly his/her own
● Has forced someone into sexual activity wings or not given a chance
make their own decision or to
2. DESTRUCTION OF PROPERTY explore
● Deliberately engaged in fire setting with ○ Sociocultural factors
the intention of causing damage ○ The environment
● Deliberately destroyed others property
ANOREXIA NERVOSA
3. DECEITFULNESS AND THEFT
● Has broken into someone else house, ● Main sign: Morbid fear of gaining weight
building or car ● The idea of gaining wait is horror for them
● Often lies to obtain goods or favors ● Other s/sx: SAD DOLL
○ Sensitivity to cold temperature
4. SERIOUS VIOLATION OF RULES ○ They do not have enough
● Often stays outside at night despite adipose tissues to make them
prohibition feel warm
● Has run from home overnight at least twice ○ Amenorrhea
while living in a parental home or once ○ Experiencing hormonal
without returning in lengthy period. imbalances
○ Deliberate self-starvation with weight
MANAGEMENT loss
○ Denial of hunger
COGNITIVE - BEHAVIORAL THERAPY ○ Obvious thinness but feels fat
 ○ Lanugo all over the body
- Lanugo is a hours
biofeedback/compensatory
mechanism of the body because
we do not have enough adipose
tissue to balance the temperature
of the body, the hair grows to
keep us warm
○ Loss of scalp hair
BULIMIA NERVOSA
● Extreme measures to lose weight
○ Use diet pills, diuretics or laxatives
○ Purges after eating
○ Extreme exercise
● Sign of purging
○ Swelling of the cheeks or jaw area
○ Cuts and calluses on the back of the
hands and knuckles
○ Teeth that look clear
● Peculiar signs
○ Depression
○ Loss of interests in activities (anhedonia)
FINDINGS
● Weight loss of 15% or more of original body weight
● Amenorrhea
● Social withdrawal and poor family and individual
coping
● History of high activity and achievement in
academics, athletics
○ These children often times are obedient,
achiever in school
● Electrolyte imbalances
● Depression / distorted body image - looking
themselves as very fat despite their weight below
the normal
NURSING DIAGNOSIS
● Body image disturbance
● Ineffective individual coping
NURSING MANAGEMENT
● Establish a trusting relationship
○ These people has their own mindset, they
have a tendceny to follow what they belief
is right
● Monitor vital signs
○ Often times, they manifest impaired vital
signs
● Reinforce:
○ Dietician’s prescription to accomplish
realistic weight gain
○ Treatment plan that establishes privileges
and restrictions based on compliance
■ IF gain weight, allowed to go
home but the child will not be
allowed to go with friends if
he/she wasn’t consumed the
meal
● Decrease emphasis on foods, eating, weight loss or
gain
● Weigh client daily at the same time
○ Every morning, before eating, weigh
patient with their gown only. Inspect the
whole body if they bought something
heavy just to add their weight
● Remain with the client after meal and for 1st four
○ If they consumed the meal, if not assisted
with a nurse, they have the tendency to
purge, initiate vomiting or massive
exercise
● Set limit on time allotted for eating
● Encourage client to express feelings
○ They have unresolved issues. If they
verbalized feelings, they develop insight
why they are having this kind of disorder
● Promote feeling of control by
○ Participation in treatment
○ Independent decision making
■ Given simple choices will help
them go through a long way of
developing their own confidence
of themselves.
SEXUAL DISORDER
● Sexuality - is the result of biological, psychological,
social, and experimental factors that mold an
individual’s sexual development, self-concept, body
image, and behavior.
PHASES OF THE SEXUAL RESPONSE CYCLE
● DESIRE
○ the ability, interest, and willingness to
receive sexual stimulation
○ The ability of an individuals to think to
engage in sex
● EXCITEMENT/ AROUSAL
○ the result of psychological stimulation
○ If may desire pero hindi nagkakaroon ng
excitement or arousal, it may lead to a
disorder
○ Example is fantasizing during the desire
phase and foreplay which involves petting
and fondling of erogenous zones or areas
of the body that are particularly sensitive to
erotic stimulation
● PLATEAU
● ORGASM
○ Formerly termed as climax
○ The shortest stage in the sexual response
cycle
○ Occurs when stimulating proceeds through
the plateau stage to a point where the
body suddenly discharges accumulated
sexual tension
● RESOLUTION PHASE
○ The final phase of sexual response
○ Orgasm and body systems gradually
return to the unaroused state
SEXUAL DYSFUNCTION DISORDER
● SEXUAL DESIRE DISORDER
○ Have a little or no sexual desire or have an
aversion to sexual contact
○ Aversion = the person feels discomfort,
anxiety , or may display symptoms of
vomiting.
○ There si aversion, even just the thought of
having sexual intercourse
● SEXUAL AROUSAL DISORDER
 ○ Individuals cannot complete the
physiologic requirements for sexual Telephone Involves telephoning someone and
intercourse Scatalogia making lewd, obscene remarks or
○ Example: women cannot maintain conversation AKA sex on phone
lubrication, Men cannot maintain an
erection Transvestism Sexual excitement through wearing
the clothing of a woman
● ORGASM DISORDERS
○ Inability to achieve orgasm phase Urophilia Urinating on the partner
○ Example: Premature ejaculation
Voyeurism Act of observing unsuspecting
● SEXUAL PAIN DISORDERS person who is naked, in the process
○ Individuals suffers genital pain of disrobing, or engaging in sexual
(dyspareunia) during the time of sexual activity includes cyber-voyeurism
intercourse
○ Example: Vaginismus
GENERAL IDENTITY DISORDER

● Aka Transexualism
● Believe that they were born as the wrong sex
PARAPHILIA
● Leads to persistent discomfort and feels
(SEXUAL DEVIATION) inappropriate in the role of the assigned sex
○ They are not comfortable with their sex
● A term which generally refers to abnormal sexual
behavior
NURSING MANAGEMENT
● Lasts for 6 months leading to distress or impairment
to functioning
● ATTITUDE:
○ ACCEPTING
Anilingus Tongue brushing the anus ■ We need to accept them as
individuals with disorders
Bestiality or Contact with the animals ○ EMPATHIC
■ These are behaviors that we
Zoophilia
wanted to employ as the
nurses/the therapist, because
Coprophilia Smearing feces on the partner
when you are empathic to them
you understand where they are
Cunnilingus Tongue brushing the vulva coming
○ NON-JUDGEMENTAL
Exhibitionism Involves exposing one’s genitals to
unsuspecting strangers. Victims are ● Accept his feelings related to sexuality
usually women or children. They ○ The person needs to understand na sa
are stimulated by the effect of mature perception towards sexuality of
shocking the victim his/her own. Para hindi siya magiging
judgemental to the client having this
Fellatio Inserting the penis into the mouth disorder.

Fetishism Inanimate / non-living objects or ● Have a private area to discuss fears or concerns
articles about sexuality
○ There are specific areas to talk about fears
Frotteurism Touching or rubbing against the or concerns about sexuality
unsuspecting people. Usually
occurs in crowded places where ● Intervene to discuss self-esteem issues, anxiety,
escape is into the crowd is possible guilt, and empathy for victims
● Employ limit setting
Sexual gratification from ● Referral to the correct clinic
Masochism
experiencing pain involves the acts
of being humiliated beaten,
restrained, or otherwise made to
suffer

Necrophilia Involves the use of corpses

Partialism Inserting the penis into the other

parts of the body

Pedophilia Use of prepubertal children could

be an actual sexual act or a fantasy
child is generally 13 years of age or
younger

Sadism Inflicting pain