NCM 217: PSYCHIATRIC NURSING

PRELIMS // 2023

TOPIC 1 & 2 : MENTAL HEALTH AND MENTAL ILLNESS

MENTAL HEALTH AND MENTAL ILLNESS 5 “FREEDOM” THAT MENTALLY PEOPLE

- There is no specific term that could define mental DEMONSTRATE: (ACCORDING TO SATIR)
health or mental illness
- Culturally defined 1. To see, hear what is here, instead of what should be, was or
- Culturally determined will be (reality).

MENTAL HEALTH a. Psychotic patients:

- Experience hallucinations (hear and see
a. SHIELA VIDEBECK what others can’t)
- Is a state of emotional, psychological and social
b. Hallucinations
wellness evidenced by satisfying interpersonal
relationships, effective behavior and coping, positive - There is no stimulus
self-concept and emotional stability. c. Illusions
- A positive or a presence of stimulus
o Emotional d. Nurse’s responsibility:
- Inner feelings - Reorient the patient
o Psychological
- Mind, willfulness, successful performance of mental 2. To say what one feels & thinks, instead of what one ought
functioning (freedom/autonomy)
o State of Social wellness
a. Psychotic patients need to be in a controlled
- Activities in which you spend time with others, fulfilling
environment because they can’t control their own emotions
relationship with others (healthy)
o Effective behavior and coping mechanisms rather than 3. To feel what one feels, instead of what one ought.
using defense mechanism (psychotic patients overuse 4. To ask for what one wants, instead of waiting for permission.
defensive mechanisms such as in denial) 5. To take risks in one’s own behalf, instead of choosing to be
o Positive self-concept only “secure” & not “rocking the boat” (playing safe/not taking
- Self-awareness, self-conscious (who am I, knowing risk).
your own values)
a. Taking risks but also taking responsibility of the risk
o Emotional stability
- Emotional maturity MENTAL ILLNESS (AMERICAN PSYCHIATRIC
ASSOCIATION, 2020)
b. WORLD HEALTH ORGANIZATION (WHO) - A clinically significant behavioral or psychological syndrome
- Is a state of well-being where a person can realize or pattern that occurs in an individual and that is associated
his/her abilities to cope with normal stresses of life & with present distress or disability or with a significantly
work productively. increased risk of suffering death, pain, disability, or an
important loss of freedom.
o Contribution to community
o Productively o Syndrome
- How the person will be able to make - A set of symptoms or disorders
contributions to the community o Distress
- Painful symptoms
c. AMERICAN PSYCHIATRIC ASSOCIATION (APA)
o Disability
- Simultaneous success at working, loving, creating
- Impairment
with capacity for mature and flexible resolution of
▪ Impairment of functioning: self-care, sleep pattern,
conflict between instincts, conscience and reality.
eating pattern, relationships.
o Mastery in all areas of life: Love, work, play
o Puppy Love = Childhood love
PSYCHIATRY
o Hard love = Toxic relationships - Medical specialty dealing with the prevention,
o True love = <3 assessment, diagnosis, treatment and rehabilitation of
o Flexible: Adaptive mental illness.
- From the Greek word means “healer of the spirit”

o Primary goal
- Relief of mental suffering
o Psychotherapy
- Preferred treatment
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PSYCHIATRIC NURSING
American Nursing Association (ANA)
- Is specialized area of nsg practice employing theories
of human behavior as its science and purposeful use
of self as it’s art;
o Therapeutic Use Of Self
- Use ourselves as a tool to help our patient (even by
merely talking with patient)
- An INTERPERSONAL PROCESS that strives to
promote and maintain behavior which contributes to
integrative functioning which may be practiced in a
variety of settings.
o Interpersonal Process
- Patients with mental health problems need most
assistance with interpersonal processes; to help
patients develop a healthy interpersonal relationship.
JOYCE TRAVELBEE: (DEFINITION ADAPTED BY THE
PHILIPPINES)
- An interpersonal process whereby the professional
nurse practitioner assists an individual, family or
community to promote mental health, to prevent or
cope with experience of mental illness and suffering
and if necessary to find meaning in these experiences
- Is the care of patients with morbid thoughts and
feeling states
o Working knowledge of the subject matter
- We based our working knowledge in theories (Human
Theories)
o Emotional maturity
- To care for others
o Creative imagination and enthusiasm
- Full of liveliness; the program should be new
o Inductive reasoning and foresight
- It talks about your discernment, keen, selective
judgement, foresight, vigilant about your behavior
o Pioneer spirit
- Liveliness is still necessary
CONCEPTS OF POSITIVE MENTAL HEALTH
PERSONALITY
- Refers to stable patterns of thoughts, feelings,
behaviors and motivation.
o Ingrained patterns of behavior
o Leads to person’s identity
MAJOR CATEGORIES OF POSITIVE MENTAL
HEALTH
1. Attitude toward the individual self
- Involves aspect related to a person's self-
awareness, acceptance, confidence, level of self-esteem,
sense of personal identification.
- Personal identification: identification in the
group (role in the group, family, community)
2. Growth, Development, & Self- actualization /
Maximization of One’s Potential
- Person’s abilities and potentialities are considered
important
- Mentally healthy individual must always move towards
growth (self-actualization); continually strives to grow
as a person; shouldn’t be satisfied with the status quo
3. Personality Integration/ Integrative Capacity
- The ability to tolerate anxiety and frustration in
stressful situation
o Have tolerance of life’s uncertainties
o Ability to cope
o There is a lesson and blessing in adversities
- Utilization of all processes and attributes in a person
for the unification of personal functioning
o Balance of psychic forces
4. Autonomy and Independence
- The individual’s ability to make his own decision and
react according to his own convictions
o Autonomy includes the capacity to make moral
decisions, and act on them
5. Perception of Reality/Reality Orientation
- This deals with how the person perceive his
environment and other people as well as his reactions
towards them.
o Perception of Reality
6. Mastery of One’s Environment
- Ability to adjust, adapt, and behave appropriately
appropriately in situations and in accordance with
culturally approved standards
7. Stress Management
- The person can tolerate life stresses, experience
feelings of anxiety or grief appropriately and
experience failure without devastation.
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FACTORS THAT AFFECT MENTAL HEALTH DIFFERENCES BETWEEN MENTAL HEALTH AND
MENTAL ILLNESS
1. INDIVIDUAL FACTOR
- Biological make up
- Sense of harmony in life
o Pleasing combination in life and
environment

- Vitality
o Liveliness, enthusiasm, energy of a
Person
o How the person finds meaning in life

- Ability to find meaning in life

- Emotional resilience or hardiness
- Positive identity
o Personal identification (roles)

- Mental Illness:
- Anxiety
- Unrealistic Worries and fears
- Loss of meaning in one’s life
- Inability to distinguish reality from fantasy
- Intolerance of life uncertainties
- Sense of disharmony of life

2. INTERPERSONAL FACTORS
- Effective communication
o NPR: Therapeutic communication CHARACTERISTICS OF AN EMOTIONALLY
techniques MATURED INDIVIDUAL

- Ability to help others ● Does not act immediately on impulse

- Intimacy ● Weighs situations objectively
o Having healthy relationships ● Makes decisions and independent judgments
● Accepts responsibilities for meeting own needs
- Balance of separateness and connection - Emotional maturity
- Mental Illness: - Ability to express own emotions but
o Ineffective communication maintains balance with other people's feelings.
o Excessive dependency
o Withdrawal from relationships GENERAL CRITERIA TO DIAGNOSE MENTAL
o No sense of belongingness ILLNESS
o Inadequate social/ group support
o Loss of emotional control 1. Dissatisfaction with one’s characteristics, abilities &
accomplishments.
3. SOCIAL/ CULTURAL FACTORS
2. Ineffective or unsatisfying interpersonal relationship
- Sense of community
- Access to adequate resources 3. Dissatisfaction with one’s place in the world.
- Intolerance of violence 4. Ineffective coping or adaptation to the event in one's life.
- Support of diversity among people 5. Lack of personal growth.
- Mental Illness:
o Lack of resources
o Violence
o Homelessness
o Poverty
o Unwarranted negative view of the world

- Discrimination i.e. racism, classicism, ageism, sexism

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TOPIC 3: HISTORY AND EVOLUTION OF MENTAL HEALTH CARE

PREHISTORIC/ ANCIENT TIMES PEOPLE’S RESPONSE

- Any sickness indicates displeasure of God
- Punishment for sins and wrongdoing.
- Individuals seen as divine were worshiped & adored.
- Those seen as demonic were ostracized (excluded or
shunned from the group), punished, and sometimes burned at
stake.
TREATMENT
- Tribal Rites
ARISTOTLE (382-322 BC)
- Relate mental disorder to physical disorders & develop his
theory that emotions were controlled by
amount of blood, water, yellow & black bile in the body (which
are considered as emotions).
- Blood: Happiness
- Water: Calmness
- Yellow: Anger (nowadays considered as jealousy)
- Black bile: Sadness
- Imbalances of these 4 were believed to cause
mental disorders.
- The colors are known as humors
A - Assistance
- (Least restrictive); given food and money
B - Banishment
- Cast out into the sea to find “right mind”
C - Confinement
- (Most restrictive); chained & mixed w/ men & women,
old and young, insane w/ criminals, or paupers.
1547
- Hospital of St. Mary of Bethlehem a.k.a “Bedlam” was
officially declared a hospital for the insane, the first of its
kind
- Bedlam means confusion
- Exhibited to the public for ridicule and profit
- Attendants were ringmasters with whips to encourage
patient to perform at Bicetre (France).
1775
- Visitors were charged for a fee for the privilege of viewing and
ridiculing the inmates, who were seen as animals, less than
human
- In US, “colonies” - the mentally ill were considered evil or
possessed or witches and were punished
- Witch hunts were conducted, and offenders were burned at
the stake (Salem, Massachusetts).

TREATMENT PERIOD OF ENLIGHTENED AND CREATION OF

- Aimed at restoring balance through: MENTAL INSTITUTIONS (LATE 18TH – EARLY 19TH
CENTURY)
- Bloodletting 1790’S
- Starving - Began the concern w/ persons of with mental illness
- Purging
* Treatments persisted well in the 19th century PEOPLE
• Philippe Pinel (1745)-1826)
EARLY CHRISTIAN TIMES (1-1000 AD) • William Tuke (1732-1822)
- Early Christians: All diseases were again blamed on demonic • In the US, Dorothea Linde Dix (1802-1887)
possession.
- Priests perform exorcism to get rid of the person of the PHILIPPE PINEL (1745-1826)
evil spirits. When that failed, more severe measures i.e. • Unchaining the men at Bicetre (for men and Salpetriere for
women) (1793)
- Incarceration in dungeon • Released the patients and provided MORAL treatment
- Flogging (whipped)
- Starving, and other brutal treatments were used WILLIAM TUKE (1732-1822)
• Establishing the York Retreatin 1796
RENAISSANCE (1300-1600 AD) • Emphasized social consciousness, moral treatment
- Persons with mental illness were distinguished from criminals
in England IN THE US, DOROTHEA LINDE DIX (1802-1887)
- Harmless were allowed to wander the countryside or lived in • Began a crusade to reform the treatment of mental illness
rural communities • She’s instrumental in opening 32 state hospitals that offered
- “Dangerous Lunatics” were still thrown in prison, chained, and asylum
starved • Believed that society had an obligation to persons who were
- Psychiatric patients were treated as wild animals mentally ill
• Visited york at Tuke institution
• A crusader and a teacher
• During the civil war, served as a superintendent
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SIGNIFICANT CHANGE OVER 10 YEARS, NEW DRUGS ARE INTRODUCED

- The insane were included in the family of man - no longer to (TYPICAL PSYCHOTROPIC DRUGS)
be chained and beaten as animals. The dignity of man was
supplied. Monoamine Oxidase Inhibitor (1952) – Antidepressant
RESULTS: ASYLUM MOVEMENT
- Concept of asylum is considered as a safe refuge/haven o Do not take with cheese
offering protection to people who are mentally ill. o Called MAOI’s

DISADVANTAGE: ASYLUM Haloperidol (Haldol) (1957) – Antipsychotic

- Attendants were accused of abusing the patients,
- Rural location of the hospital was viewed as isolating patients
from family and their homes
- The phrase “insane asylum” took a negative connotation,
rather than being a protective haven.
SCIENTIFIC STUDY OF THE MIND AND MENTAL
ILLNESS (LATE 19TH CENTURY: 1856-1939)
FREUD (1856-1939)
- Psychoanalysis, the unconscious, the importance of early
experience
- Significant Change: Man could be studied, and the study
held promise for treating and curing mental health problems
- Results: The study of the Mind and treatment approaches
to psychiatric conditions flourished
SIGMUND FREUD TREATMENT OF MENTAL
DISORDERS
• Emil Kraepelin (1856-1926)
• Eugene Blueler (1857-1939)
EMIL KRAEPELIN (1856-1926)
- Began classifying mental disorders according to their
symptoms
Tricyclic (1958) – Antidepressants
Benzodiazepines (1960) - Antianxiety agents
Contraindications: Cheese and Processed meat
Effects:
• Reduced agitation, psychotic thinking & depression
• Because of Antidepressant and Antimanic
• Improved the condition of many patients
• Noise, chaos, and agitation diminished
• Hospital stays were shortened
COMMUNITY MENTAL HEALTH
1939 OR UP TO EARLY 1960’S
- Enactment Community Mental Health Centers Act.
- Significant Change: individual do not need to be
hospitalized away from home and community
- Results: Deinstitutionalization
DEINSTITUTIONALIZATION
• 3 components:
o Release
o Diversion from institution/hospital
o Development of alternative community services

EUGENE BLUELER (1857-1939) - A deliberate shift from institutional care in state hospitals to
- Coined the term “Schizophrenia”. community

DEVELOPMENT OF PSYCHOPHARMACOLOGY GOAL

1950 - Decongest mental institutions by 80%
- Mental illness is due to biochemical imbalances - Focused treatment in the community - promotion of
(imbalances of neurotransmitters) thus can be cured and independence
addressed through a pharmacological management
SERVICES OFFERED IN CMHC
SIGNIFICANT CHANGE • Emergency care
- Mental illness → Biochemical Imbalance → Pharmacologic • In-patient care
Cure • Outpatient services
• Partial hospitalization
1ST DRUGS DEVELOPED • Screening services; and
• Thorazine (Chlorpromazine - 1952) - Antipsychotic Drug • Education
(1st gen - known as the neuroleptic drug / major sedative or
major tranquilizer) SERVICES OFFERED IN CMHC
• Diazepam - Minor sedatives - Provide an income for disabled persons
• Imipramine (Tofranil-1959) – Antidepressants
• Lithium (1949) - Very first drug; Antimanic agent o SSI: Supplemental security income
o SSDI: Social security disability income

- Allowing persons with mental illness to be more

independent financially
- States spend less money on care
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21ST CENTURY 1913 John Hopkins

- Deinstitutionalization is viewed by some as having negative
as well as positive effects
- (+) 80% decreased number of hospital beds
- (-) 90% increase in the number of admissions to those beds
- “Revolving Door Effect” has short hospital stays but are
admitted more frequently
1990
- “Decade of the Brain”
- Profound growth of knowledge about the workings of the
brain
- Progress in genetics
- Understanding the causes and treatments
- Was the 1st school of nursing to include a course in
psychiatric nursing in ts curriculum
1950 – National League for Nursing
- The agency w/c accredits nursing program
- Required nursing schools to include an experience in
psychiatric nursing
HARRIET BAILEY (1920)
- Wrote the 1st psychiatric textbook: Nursing Mental Disease
BENJAMIN RUSH
- Father of American Psychiatry

PROBLEMS DOROTHY LYNDE DIX

1. INPATIENT PSYCHIATRIC TREATMENT - Boston teacher who devoted her life to the cause of
- Accounts for majority of spending in mental health in US due building state mental hospitals
to community mental health has never been given financial
base. HILDEGARD E. PEPLAU (1952)
- Wrote Interpersonal Relations in Nursing, a landmark
2. HOMELESSNESS book that described a framework for nursing practice
- Homeless mentally ill are increasing due to the lack of - Based on Sullivan
adequate community resources.
JUNE MELLOW (1968)
1993 - Worked on “Nursing Therapy“
- Access for Community Care & Effective Services & Support
- ACCESS was created, funded by the federal government HISTORICAL DEVELOPMENT OF PSYCHIATRY IN
THE PHILIPPINES
GOAL I. PRE-SPANISH REGIME
- Improve access to comprehensive services across a - Filipinos believed in a world that was equally material and
continuum care spiritual
- Reduces duplication and cost of services - Spirits are psychosocial force that affect behavior
- Improves the efficiency of services programs. - If spiritual world is disobeyed, punishment will be in a form of
bad luck in material world
COMMUNITY-BASED CARE (AFTER
DEINSTITUTIONALIZATION) TREATMENT
- The 2,000 community health centers that were supposed to - Rituals and Ceremonies done by:
be built in 1980 have not materialized • Healers (called babaylan) shaman
• Sorcerer
RESULT
- Community-based system did not accurately anticipate II. SPANISH RULE
the extent of the needs of people with severe and - Filipinos accepted mental illness was caused by sorcery
persistent mental illness
TREATMENT
Despite the flaws in the system, community-based programs • Herbolarios (herbmen)
have positive aspects that make them preferable for treating • Ritual Cleaning in the church
many people with mental illness. Therefore, treatment in the • Use of bitter concoctions of herbs and tree bark
community is a trend that will continue. • Wrap patient in mats and beaten with “buntot pagi”
(stingray)
HISTORY OF PSYCHIATRIC NURSING IN THE • Hot pots placed on head
• Thrown into the river
PHILIPPINES
FLORENCE NIGHTINGALE (1859)
III. EARLY 19TH CENTURY
- Founder of modern nursing noted that client care must
- The organized care and treatment for individuals with
involve psychologic, social & physiologic aspects
mental illness was established at the Hospicio de San Jose
LINDA RICHARDS (1873)
IV. AMERICAN ERA
- 1st American psychiatric nurse promoted better care for
- Early 1900’s
psychiatric clients & directed the 1st school for Mental Health &
- Two American physicians were reported to have provided
Psychiatric Nursing
treatment for mentally ill patients of the Civil Hospital in Calle
Iris (now Claro M. Recto)
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- Americans helped established several treatment centers for

mentally ill

1904
- Insane Department was opened in San Lazaro Hospital
headed by Dr. Elias Domingo (First Filipino Physician in US)

1918
- City Sanitarium was constructed solely for patients residing in
Manila.

V. JAPANESE OCCUPATION
- National Psychopathic Hospital was operational

1941
- Some patients are fetched and taken home while others died
due to starvation and lack of medicine
- Other patients and few employees were executed for alleged
anti-Japanese activities
- Japanese Imperial Army donated electroshock apparatus &
used in lieu of scarcity of medicine

VI. LIBERATION PERIOD AND ERA OF THE

REPUBLIC
- National Psychopathic was renamed National Mental
Hospital and Dr. Jose A. Fernandez as officer in charge
(October 1946 to April 1961)
- Development of more infrastructure (build infirmary for
paying & nonpaying patients

KEY FIGURES IN THE PHILIPPINES

JESUSA BAGAN LARA
- Wrote the 1st textbook entitled “An Outline of
Psychiatric Nursing” in 1973

NENITA YASAY-DAVADILLA
- 1st psychiatric nurse to be sent abroad (University of
Maryland) to obtain MAN under WHO scholarship
program (1968-1970)

MAGDA CAROLINA GO VERA LLAMANZARES

- 1st independent nurse practitioner in child psychiatric
nurse
- Graduated in 1972 from Wayne State University
- With a Master of Child Psychiatric Nursing and
Community Health

SOTERA V. CAPPELAN
- 1st chief nurse at the National Psychopathic Hospital
(now National Center for Mental Health)
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TOPIC 4 & 5: GOALS AND PRINCIPLE OF A PSYCHIATRIC NURSE & NURSE-PATIENT RELATIONSHIP

MOST FUNDAMENTAL GOALS OF PSYCHIATRIC NURSE-PATIENT RELATIONSHIP

NURSING - Series of interactions between nurse and the patient in
• Let/ help patient accept self which the nurse assists the patient to attain positive behavioral
• Improve his relationship with other people change
• Assist patient to function independently in a realistic basis o Factors that enhance nurse-patient relationship:
Environment
BASIC PRINCIPLES OF PSYCHIATRIC NURSING
• All behavior has meaning and meeting the needs of the - Promotes communication
individual
• Accept & respect the client regardless of his behavior COMPONENTS OF A THERAPEUTIC RELATIONSHIP
• Do not accept their maladaptive behavior, but accept them as 1. TRUST
an individual - Built when the client feels confidence in the nurse & the
• Limit or reject inappropriate behavior but not the individual nurse’s presence conveys confidence, integrity, & reliability
• Recognize and accept dependency needs of the client
• Encourage & support expression of feelings TRUSTING BEHAVIORS
• Recognize that the client needs to use his defense 1. Objectivity
mechanisms 2. Caring
3. Interest
MOST IMPORTANT FUNCTIONS OF PSYCHIATRIC 4. Understanding
NURSING 5. Consistent
• Assess emotional need of patient 6. Treats the client as a human being
o Vegetation 7. Suggests without telling
- Resting state of the patient 8. Approachability
9. Listening
• Respond to client’s crisis 10. Keeps promises
• To intervene, reduce panic of disturbed patients 11. Provides schedules of activities
• To make sure patients are safeguarded 12. Honesty
o Use safety measures: 13. Respect
▪ No sharp objects 14. Openness
▪ Materials are safe (patients and nurses 15. Friendly
must be safe) from harm (physical and
psychological harm) 2. CONGRUENCE
- Occurs when words & actions match
• To assess the effects of somatic therapies on the patient - The nurse needs to exhibit congruent behaviors to build trust
o Evaluation part: note if therapies are effective with the client.
o Somatic therapies: medication o Incongruent/Inconsistent behaviors

• “Give a man fish and you feed him for a day. Teach a man
how to fish and you feel him for a lifetime”
• Core Of Psychiatric Nursing: Interpersonal Process
TYPES OF RELATIONSHIPS
1. SOCIAL RELATIONSHIP
- Primarily initiated for the purpose of friendship, socialization,
companionship, and accomplishment of a task
- Communication is usually centered around sharing ideas,
feelings, and experiences and meets the basic needs of people
to interact together
2. INTIMATE RELATIONSHIP
- A healthy intimate relationship involves 2 people who are
emotionally committed to each other and are both concerned
about having their needs met and helping each other do so.
3. THERAPEUTIC RELATIONSHIP
- Focused on the needs, experiences, feelings, & ideas of the
client
- The areas to be worked on are agreed on, and the
outcomes are continually evaluated.
- Making verbal commitments & not following through on
them
- Verbal and nonverbal components of the message do not
match
- Remember:
o Clients with mental disorders often give incongruent
messages because of their illness, the nurse must continue to
provide consistent, congruent messages in return
3. GENUINE INTEREST
- The nurse should be:
o Open & honest
o Display congruent behavior
- Remember:
o Self-disclosure - revealing personal information
about oneself (e.g., biographical data, personal ideas,
thoughts, or feelings), can enhance openness and honesty.
o Should be done after you have established rapport
and trust; you can share past experiences but not personal
information
o Do not share your personal problems especially if
they are not yet resolved.
o Do not share recent painful experiences.
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o Self-disclosure gives hope; allows the patient to PHASES

think that they are not the only ones dealing with 1. ORIENTATION
Problems - Begins when the nurse and client meet and ends when the
o Selective about personal examples client begins to identify problems to examine
- The nurse:
- The nurse must NOT shift emphasis to the nurse’s o Establishes roles,
problems rather than the client’s o Purposes of meeting
o Parameters of subsequent meetings
4. EMPATHY o Identifies the client’s problems
- Ability of the nurse to perceive the meanings and feelings of o Clarifies expectations
the client and to communicate that understanding to the client.
- Remember FUNCTIONS OF THE NURSE
o The nurse needs to understand the difference 1. Before meeting:
between empathy and sympathy (feelings of concern of a. Reads backgrounds materials
compassion shown by one for another). b. Becomes familiar with any medications
c. Gathers necessary paperwork
5. ACCEPTANCE d. Arranges for a quiet, private, comfortable setting
- The nurse who does not get upset or respond negatively to a
client’s outbursts, anger, or acting out conveys acceptance to 2. Nurse consider his or her personal strengths and
the client. limitations
- Do not accept negative behaviors, but accept the client as
person 3. Nurse examine preconceptions about the client
- Ex: A client put his arm around the nurse’s waist a. Ensure that he or she can put them aside and get
to know the real person.
Appropriate response
- Remove his hand and say, “John do not place your hand on 4. Nurse begins to build trust with the client
me. We are working on your relationship with your girlfriend
and that does not require you to touch me. Now, let’s continue.” 5. Appropriate information about the nurse should be
shared
Inappropriate response at this time: name, reason for being on the unit and level
- “John, stop that! What’s gotten into you? I am leaving, and of
maybe I’ll return tomorrow.” schooling
a. Ex.: “Hello, James. My name is Caro Arandia & I
- Remember: will be your student nurse for the next 6 days every
o The nurse must set boundaries for behavior in the Monday to Wednesday. I am a junior nursing student
nurse- client relationship. By being clear & firm, but w/o anger at San Pedro University.”
or judgment, the nurse allows the client to feel intact while still
conveying that the behavior is unacceptable. 6. The nurse needs to listen closely to the client’s history,
perceptions, and misconceptions. Needs to overcome
6. POSITIVE REGARD nervousness and convey feelings of warmth, expertise,
- The unconditional, non-judgmental attitude is known as and understanding.
positive regard and implies respect.
7. Nurse-Client Contracts
MEASURES TO CONVEY POSITIVE REGARD a. Content of the contract:
• Respect by calling the client by name i. Time, place, and length of sessions
• Spending time with the client and ii. When the sessions will terminate
• Listening and responding in an open manner iii. Who will be involved in the tax plan
• Taking the client’s ideas and preferences into account when - Family members? Health care
planning care. team?
• Uses presence or “attending”, which is using nonverbal and iv. Client responsibilities
verbal communication techniques: - Arrive on time, end of time
o Leaning toward the client v. Nurse’s responsibilities
o Maintaining eye contact - Arrive on time, end on time,
o Being relaxed maintain confidentiality at all times,
o Arms resting at sides evaluate progress with client,
document sessions

8. Confidentiality
a. Means respecting the client’s rights to keep private
any information about his or her mental and physical
health and related care.
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b. Also means allowing only those dealing with the
client’s care to have access to the information that the
client divulges
2. WORKING
Tasks Include:
1. Maintaining the relationships
2. Gathering more data
3. Exploring perceptions of reality
4. Developing positive mechanisms
5. Promoting a positive self concept
6. Encouraging verbalization of feelings that facilitate
behavioral change
7. Working through resistance
8. Evaluating progress and redefining goals as appropriate
9. Providing opportunities for the client to practice new
behaviors and
10. Promoting independence
NURSE-CLIENT RELATIONSHIP 2 SUB-PHASES
1. PROBLEM IDENTIFICATION
a. When the client identifies the issues or concerns
causing problems
2. EXPLOITATION
a. The nurse guides the client to examine feelings
and responses and to develop better coping skills
and more positive self image
Remember:
- Again, self-awareness is important so that the nurse can
identify when transference (patient to the nurse) and
countertransference (the nurse to the patient) might occur.
- By being aware of such “hot spots,” the nurse has a better
chance of responding appropriately rather than letting old
unresolved conflicts interfere with the relationship.
3. TERMINATION OR RESOLUTION PHASE
- The final stage in the nurse-client relationship. It begins
when the problems are resolved, and it ends when the
relationship is ended.
- Both nurse and client often have feelings about the ending of
the relationship; the client especially may feel an impending
loss.
- If the client tries to reopen and discuss old resolved issues.
o The nurse must avoid it as if the sessions were
unsuccessful; instead, he/she should identify the
client’s stalling maneuvers and refocus the client on
newly learned behaviors and skills to handle the
problem.
- It is appropriate to tell the client that the nurse enjoyed the
time spent with the client and will remember him/her.
- But it is inappropriate for the nurse to agree to see the client
outside of the therapeutic relationship.
Example:
o Nurse Jones comes to see Mrs. O’Shea for the last
time. Mrs. O’Shea is weeping quietly.
o Mrs. O’Shea: “Oh, Ms. Jones, you have been so
helpful to me. I just know i will go back to my old self
without you here to help me.”
o Nurse Jones: “Mrs. O’Shea, I think we’ve had a very
productive time together. You have learned so many
new ways to help you in having a better relationship
with your children, and I know you will go home and
be able to use those skills. When you come back for
your follow-up visit, I will want to hear all about how
things have changed at home.”
AVOIDING BEHAVIORS THAT DIMINISH THE
THERAPEUTIC RELATIONSHIP
- The nurse has the power over the client by virtue of his or
her professional role. The power can be abused if excessive
familiarity or an intimate relationship occurs, or if confidentiality
is breached.
1. Inappropriate Boundaries
2. Feelings of Sympathy & Encouraging Client
Dependency
3. Non-acceptance and Avoidance
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TOPIC 6 & 7: THERAPEUTIC COMMUNICATION & MSE

COMMUNICATION THERAPEUTIC COMMUNICATION

- The process that people use to exchange information. - The face-to-face process of interacting that focuses on
(Videbeck) advancing the physical and emotional well-being of a
- Used for the transmission of feelings, attitudes, ideas, and patient.
behaviors from one person to another. (Anti-otong) - General purposes:
● Collecting information
COMPONENTS OF COMMUNICATION PROCESS ● Assessing behaviour
● Sender ● Modifying behaviour
● Receiver ● Providing health education
● Message
● Message variable EFFECTIVE COMMUNICATION INFLUENCED BY
a. Confidentiality
EFFECTIVE COMMUNICATION INFLUENCED BY: b. Self-disclosur
● Developmental stage c. Privacy and Respecting Boundaries
● Neurobiological components d. Touch
● Cognitive function
● Psychosocial factors PROXEMICS
● Cultural factors - Study of distance zones between people when they
● Spirituality (Videbeck) communicate
- NOTE: Privacy is desirable but not always possible in
TYPES OF COMMUNICATION therapeutic communication.
I. VERBAL COMMUNICATION
- Consist of the words a person uses to speak to one or PERSONAL SPACE (HALL, 1966)
more listeners. ● Defined space as the following:
- Content o Intimate distance - 6 to 18” (between people)
- The literal words that a person speaks. o Personal distance – 1 1⁄2 to 4 feet (arm’s length)
- Context o Social distance – 4 to 12 feet (used in business)
- Is the envt. in w/c communication occurs & can o Public distance – 12 to 25 feet (entertainer,
include the time & the physical, social, emotional & cultural public speaker)
envt.
TYPES OF TOUCH (KNAPP, 1980)
MAJOR PRINCIPLES OF VERBAL COMMUNICATION REMEMBER:
RAPPORT - Touching a client can be comforting & supportive when it is
● Techniques to encourage rapport welcomed & permitted
○ Warm approach - Nurse should observe the client for cues that show
○ Eye contact and clear, firm voice whether touch is desired or indicated
○ Assertive but not aggressive posture - Pts w/ mental illness have difficulty understanding the
○ Quiet, comfortable environment concept of personal boundaries or knowing when touch is or is
○ Simple, clear explanations based on not appropriate
cognitive function, developmental stage and - In performing personal care, the nurse must verbally
education prepare the client before starting the procedure.
○ Active listening - Paranoid client may interpret touch as a threat & will protect
himself by striking the nurse
II. NON-VERBAL COMMUNICATION
- The behaviour that accompanies verbal content ACTIVE LISTENING AND OBSERVATION
- Process ACTIVE LISTENING
- Denotes all non-verbal messages that the - Refraining from other thoughts & concentrating exclusively
speaker uses to give meaning and context to the message on what the client is saying
- Congruent Message
- Is when content & process agree. ACTIVE OBSERVATION
- Incongruent Message - Observing the speaker’s nonverbal action as he or she
- When the content & process disagree. Communicates

NON VERBAL COMMUNICATION SKILLS

● Behavior that is acted by a person while he is delivering
verbal content(Videbeck)
● Body language or transmission of messages without
using words(Anti-otong)
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WAYS NONVERBAL MESSAGES ACCOMPANY VERBAL CATEGORIES OF FACIAL EXPRESSION

MESSAGES 1. EXPRESSIVE FACE
● Accent - Shows the person’s every thoughts, feelings & needs
– Using flashing eyes or hand movements 2. IMPASSIVE FACE
● Complement - Emotionless, frozen like a mask
– Giving quizzical looks, nodding 3. CONFUSING FACE
● Contradict - Has an expression opposite of what the person is saying
– Rolling eyes to demonstrate that the meaning is the
opposite of what one is saying PHYSICAL APPEARANCE
● Regulate - Reflected in client’s personal hygiene, posture, dress,
– Taking a deep breath to demonstrate readiness to accessories and appropriateness of clothes for season &
speak, using “and uh” to signal the wish to continue speaking weather (Anti-aging)
● Repeat
– Using nonverbal behaviors to augment the verbal EYE CONTACT
message i.e. shrugging after saying, “Who - Direct eye contact suggests involvement
Knows?” - Eye Positioning
● Substitute ● Look up & to the right while thinking - Visual
– Using culturally determined body movements that learners
stand in for words i.e. pumping the arm up & down with a (learn best by seeing things)
closed fist to indicate success ● Look from side to side - Auditory learners (learn
best
BODY LANGUAGE by what they hear)
- Refers to manifestation of feelings or thoughts by way ● Gaze down at their dominant handKinesthetic
of body gestures. learner
- A powerful nonverbal communication tool(Anti-otong) (learn best by doing)
- Gestures, posture, movements, body position POSTURE AND GAIT
(Videbeck) - Manner in which clients carry themselves often reflects
self-concept, mood, and health.
CLOSED BODY POSITION
- Crossed legs or arms, indicate the listener is threatened by Examples:
the interaction and is defensive ● High self esteem – erect posture, active, purposeful
stride
OPEN POSTURE ● Low self esteem – slouched, slow, shuffling stride
- Both feet on the floor, knees parallel hands at the sides or ● Anxiety/anger – rigid, tense or rapid posture & gait
legs crossed only at the ankles(accepting body position) ● Agitation/restlesness/violence- pacing

WAYS TO CONVEY WARMTH, CARING & CALMNESS TONES OF VOICE AND RATE OF SPEECH
● Facing the client directly - Manic or anxious clients may speak at a pressured or rapid
● Turning &leaning the face & body to the client rate
● Maintaining eye contact (avoid staring) - Angry or agitated clients speak loudly
● Nodding to convey validation, acceptance & understanding - Depressed clients speak in a low, passive tone
● Positioning the body to imply an open & natural behavior - Components:
● Presenting a natural, soft smile to communicate warmth o Volume
o Tone
POSITIONING o Pitch
SITTING BESIDE OR ACROSS o Intensity
● Put the client at ease o Emphasis
o Speed
SITTING BEHIND o Pauses
● Creating physical barrier
● Increase the formality of the setting SILENCE
● Decrease the client’s willingness to open up and - Silence or long pauses may indicate many different things
communicate freely - The client may be depressed & struggling to find the energy
to talk.
TYPES OF BODY LANGUAGE - Sometimes the client is thoughtfully considering the question
FACIAL EXPRESSIONS before responding.
- Reveal internal feelings and emotions, reflected in client’s - May seem to be 'lost in his or her own thoughts' and
forehead, lips, mouth and eyes (Anti-aging) not paying attention to the nurse.
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NURSING INTERVENTIONS
● Recognizing the meaning of the behavior
● Reducing the risk of further escalation
● Approaching the client from the side
● Calm, firm, cautious manner
● Responding to eye contact
● Maintaining a comfortable distance
VERBAL COMMUNICATION SKILLS
● Concrete message
- The words are explicit & need no interpretation; the
speaker uses noun than pronoun; clear, direct & easy to
understand
● Abstract message
– Unclear patterns of words that often contain figures
of speech that are difficult to interpret or understand.
● Examples:
o Concrete (clear) message: "Between 5 and 6
pm, Art will be home, so you can pick up the software
he's going to give us."
o Abstract (unclear) message: "You'll have to get it
now."
o Concrete (clear) message: "For you to administer
medications tomorrow, you'll have to understand how
to calculate dosages by the end of today's class."
INTERPRETING SIGNALS OR CUES
CUES
- Are verbal or nonverbal messages that signal key words or
issues for the client
- Cue words introduced by the client can help the nurse to
know what to ask next, how to respond to the client
- Overt cues
- Are clear statements of intent
- Covert cues
- Are vague or hidden messages that need
interpretation and follow-up
THEMES
- A topic around which the client composes his/her words
- It helps the nurse assess the nonverbal behaviors that
accompany the client’s
- Words and build responses on theses cues
- Theme of sadness:
● Theme of loss of control:
o Client: "I had an accident this morning, a
fender bender. I'm OK. I lost my wallet and I
have to go to the bank to cover a check I
wrote last night. I can't get in contact with my
husband at work. I don't know where to
start.“
o Nurse: " sense you feel out of control."
(translating
into feelings)
.● Theme of hopelessness & suicidal ideation:
o Client: Life is hard. I want it to be done.
There is no rest. Sleep, sleep is
good...forever.
o Nurse: I hear your saying things seem
hopeless. I wonder if you are planning to kill
yourself (verbalizing the implied)
OTHER WORD PATTERNS
- Metaphor is used to describe an object or situation by
comparing it to something else familiar.
- Example:
o Client: "My son's bedroom looks like a bomb
went off."
o Nurse: "You're saying your son is not very
neat." (verbalizing the implied)
o Client: "My mind is like mashed potatoes."
o Nurse: "I sense you find it difficult to put
thoughts together." (translating into feelings)
o Client: "You're mixing apples and oranges."
o Nurse: "Where did you get the idea that I'm
talking about two different issues when I
compare your anger at your boss to your coming
home and abusing your wife?" (seeking
clarification)
- Proverbs are old accepted sayings w/ generally
accepted meanings
- Example:
○ Client: "Where there's smoke, there's fire."
○ Nurse: "We have been discussing your belief
that your wife is having an affair because you
have had 12 hangup calls this past week. Help
me understand how you arrived at the
conclusion that these hang-ups indicate your
wife's being unfaithful." (summarizing and
seeking clarification)
- Cliche - an expression that has become trite &
generally conveys a stereotype.
- Example:
○ Client: She has more guts than brain
○ Nurse: Give me one example of how you see
Mary as having more guts than brain (focusing)
- Symbolism is using one object to represent another
- Example:
○ Client: Sally is smart as whip
○ Nurse: Give me one example of how you see
Sally as being smart as a whip (focusing reality).
- Mottos are slogans that people live by.
- Example:
○ The nurse must clarify the client's meaning:
"You have said Semper Fi [the Marine Corps
motto meaning "forever loyal"] at least 5X in the
past 5 minutes, but you say you have had two
children by women other than your wife in the 2
years of your marriage. Who are you being
faithful to?
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THERAPEUTIC COMMUNICATION TECHNIQUES ● Belittling feelings expressed

THERAPEUTIC COMMUNICATION ● Defending
- An interpersonal interaction between the nurse and ● Giving literal responses
clientduring which the nurse focuses on the client’s ● Indicating the existence of an external source
specificneeds to promote an effective exchange of information ● Introducing an unrelated topic
● Making stereotyped comments
General Guidelines: ● Requesting an explanation
Focus on: ● Testing
● Here and now rather than the past ● Using denial
● “What” rather than the “why”
● Description rather than judgment ACCEPTING
Making observations rather than giving inferences - Indicating that nurse has heard and is willing to hear what
● Sharing information and exploring alterations rather client says
than giving actual solutions - E.g. “Yes, I will follow what you said, it’s okay to tell
me, Nodding”
NURSE / PATIENT COMMUNICATION
- Therapeutic Communication - allows the patient to tell their BROAD OPENING
story and to be clearly understood - Allowing client to take initiative in introducing the topic
- Non-therapeutic Communication - prevents the - Using open-ended questions
exchange of clear information or feelings to be expressed ● “What’s new?”
● “Where would you like to begin?”
Common interferences with therapeutic communication ● “What are you thinking about?”
● Nurse’s fear and feelings ● “Is there anything you’d like to talk about?”
● Nurse’s lack of knowledge and insecurity
● Inappropriate responses CONSENSUAL VALIDATION
● Transference and countertransference - Searching for mutual understanding
- Achieving agreement of the interpretation of the event,
THERAPEUTIC COMMUNICATION behavior or issue
● Exploring ● “Tell me if my understanding agrees with yours”
● Focusing ● “Are you using this word to convey that....”
● Formulating a plan of action ● Client: “The atmosphere here is scary”
● General leads ● Nurse: “ Yes, it is like in a dark cellar.”
● Giving information ● Client: “My sister jus passed last year”
● Placing event in time or sequence ● Nurse: “Give me your definition of the word
● Suggesting collaboration ● ‘Passed’?” or “Help understand what passed
● Verbalizing the implied means”
● Voicing doubt
● Using silence CLARIFICATION
● Accepting - Asking patient to restate, elaborate or give examples of ideas
● Giving recognition or feelings
● Making observations ● “What do you mean by ‘feeling sick inside’?”
● Offering self ● “Give me an explanation of being ‘lost’?”
● Reflecting
● Restating ENCOURAGING COMPARISON
● Presenting reality - Asking for similarities and differences
● Redirecting ● “Was it something like....”
● Seeking clarification ● “Have you had similar experiences?”
● Summarizing ● “Tell me about another time you had similar
● Broad openings experience”
● Consensual validation ● “What is one way I look similar/different from your
● Encouraging comparison Daughter?”
● Encouraging expression
● Reassuring ENCOURAGING DESCRIPTION OR PERCEPTION
● Giving approval - Asking client to verbalize what they perceive
● Rejecting ● Client describe their view of an event/experience
● Disapproving ● “What does the voice seem to be saying?”
● Agreeing ● “Tell me when you feel anxious”
● Disagreeing ● “What’s that about?”
● Advising ● “What is happening?”
● Probing and challenging
● Threatening
● Reinforcing
● Interpreting
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ENCOURAGING EXPRESSION OFFERING SELF

- Asking client to appraise the quality of his/her experiences - Making oneself available
● “What are your feelings with regard to...” “Does this - Showing interest and concern
contribute to your distress?” ● “I’ll sit with you for a while.”
● “I’ll stay here with you.”
EXPLORING ● “I’m interested in what you think”
- Delving further into a subject or idea.
● “Tell me more...” PLACING EVENT IN TIME/SEQUENCE
● “Would you describe it more fully?” - Clarifying the relationship of events in time
● “What kind of work?” ● “What seemed to lead up to...?” “Was this before or
after?” “When did this happened?” “What happened
FOCUSING Next?”
- Concentrating on a single, important point
● “Of all the concerns you’ve mentioned, which is PRESENTING REALITY
most - Offering for consideration that which is real
troublesome?” ● “I see no one in the room.”
● “This point seems more worth looking closely” ● “Your mother is not here. I’m your student nurse.”
● Client: “I hate all the doctors” ● “That sound was a car backfiring.
● Nurse: “Who is one doctor you hate?”
● Client: “Everyone hates me” REFLECTING
● Nurse: “Who is the one person who has told you - Directing client actions, thoughts and feelings back to client
he/she hates you? ● Client: “Do you think I should tell the doctor?..”
● Nurse: “Do you think you should?”
FORMULATING A PLAN OF ACTION
- Planning appropriate resolution of a problem RESTATING
- Asking client to consider kinds of behavior likely to be - Repeating the main idea expressed
appropriate in future situations ● Client: “I’m really mad and upset”
● “What could you do to let your anger out ● Nurse: “You’re really mad and upset.”
harmlessly?”
● “Next time this comes up, what might you do to SEEKING INFORMATION
handle it?” - Seeking to make clear that which is not meaning or that
● “How can you tell her you are upset?” which is vague
● “I’m not sure that I follow.”
GENERAL LEADS ● “Have I heard you correctly?”
- Encouraging continuation
● “Go on....” SILENCE
● “And then....” - Gives client time to develop insight
● “Continue”
● “Tell me about it..” SUGGESTING COLLABORATION
● “Tell me about the accident...” - Offering to share, to strive, to work with the client for his/her
benefit
GIVING INFORMATION - Offering to work together w/ the client
- Making available the fact that the client needs ● “Perhaps you and I can discuss & discover the
● “My name is....” triggers for your anxiety.”
● “Visiting hours are...” ● “Let’s go to your room, and I’ll help you find what
● “We are here from Thursday to Saturday, 9am to your looking for.
11am.
● “My purpose of being here is...” SUMMARIZING
- Organizing and summing up that which has gone before
GIVING RECOGNITION ● “You’ve said that...”
- Acknowledging, indicating awareness ● “During the past hour, you and I have discussed..”
● “Hello, Mr.....”
● “I noticed that you’ve combed your hair” “You’ve TRANSLATING INTO FEELINGS
finished - Seeking to verbalize client’s feelings that he/she expresses
your things to do.” only indirectly
● Client: “I’m dead.”
MAKING OBSERVATION ● Nurse: “Lifeless?”
- Verbalizing what the nurse perceives or
● “You appear tense” ● Nurse: “Are you suggesting that you feel lifeless?”
● “Are you uncomfortable when?..” “I notice you are
biting your nails”
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VERBALIZING THE IMPLIED GOALS OF CONDUCTING THE MSE:

- Voicing what the client has hinted at or suggested o To gather baseline data about the client’s level of
● Client: “I can’t talk to you or anyone. It’s a waste of functioning
time.” o Identify actual and potential problems
● Nurse: “Do you feel that no one understands?” o Facilitate making accurate psychiatric and medical
diagnoses.
VOICING DOUBT
- Expressing uncertainty about the reality of the client’s OUTLINE OF THE MENTAL STATUS EXAM
perceptions I. PRE-EXAMINATION
● “Isn’t that unusual?”
● “Really?” GENERAL APPEARANCE
● “That’s hard to believe.” ● Physical characteristics
● Attitude (especially towards the nurse may also be
ASSESSMENT included)
● Collection, organization, analysis of data
● Basis for developing for plan of care Note: look for signs of anxiety (e.g. moist hand, perspiration on
● First step in the nursing process forehead, tense posture)

PURPOSE 1. Apparent Age

- To construct a picture of the client’s current emotional state, 2. Manner of dress (grooming and dress)
mental capacity and behavioral functioning. a) Flamboyant dressing - Manic

FACTORS INFLUENCING ASSESSMENT 3. Cleanliness (hygiene)

● Client Participation/Feedback 4. Eye contact (level of eye contact, pupil dilation &
● Client’s Health Status constriction)
● Client’s Previous Experiences/Misconceptions about a) Intermittent contact
● Health Care ● Tan aw, hawa, tan aw, hawa
● Client’s Ability to Understand b) Occasional and fleeting
● Nurse’s Attitude & Approach ● Fleeting: faster (Tan aw, hawa, tan aw,
hawa)
HOW TO CONDUCT AN INTERVIEW c) Sustained and intense
● ENVIRONMENT ● Directly stares at you (tantalizing eyes)
o Comfortable, private & safe d) No eye contact

● INPUT FROM FAMILY AND FRIENDS 5. Catatonia (rigidity)

o Assessment without the presence of others a) Umbrella term for a psychomotor abnormality
(rigidity)
● HOW TO PHRASE QUESTIONS 6. General state of health and mentation
o Questions need to be clear, simple, and a) Mesomorphic, endomorphic
focused on one specific behavior or b) Appropriate weight for age
symptoms c) Hair (greasy, tangled)
o Use open-ended questions d) Scars on wrist

HISTORY TAKING 7. Peculiarities of appearance (evidence of scars, tattoo and

ASSESSMENT other distinguishing marks)
o Age
o Developmental Stage GENERAL MOBILITY
o Cultural Consideration - Quantitative and qualitative aspect of the client’s motor
o Spiritual beliefs behavior.
o Previous history
1. POSTURE AND GAIT
MENTAL STATUS ASSESSMENT ● Posture - position against gravity either standing or
- Equivalent to physical assessment in the ward sitting (erect
● Gait - walking
MENTAL STATUS EXAMINATION (MSE) ● Erect, slouched, stooped
- A record of data collection process that provides an o Erect - delusional grandeur
overall description of the client’s mental status. ● Does he walk in a stiff, awkward, shuffling manner?
- A cross-section of the patient's psychological life and the sum o Stiff - patients with catatonia
total of the nurse’s observation and impression at the moment. o Shuffling gait - Parkinson’s disease
Mannerisms, tics, unusual gestures,
postures.
o Tics - frequent stretching of head,
winking
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● Catatonia NURSE-PATIENT INTERACTION

● Waxy flexibility (Cerea flexibilitas/chorea flexibilities) ● Cooperative
o Psychomotor symptom for patients with ● Uncooperative
schizophrenia ● Quality
o Decreased response to stimuli o Warm
o Hostile
● Catalepsy vs Cataplexy o Distant
o Catalepsy - freezing action (hypnotized) o Suspicious
o Cataplexy - feels weak and even o Dependent
collapses; sudden loss of muscle tone; o Talkative
common to narcoleptic patients
II. STREAM OF TALK
● Echopraxia - mimicking of action
● Echolalia - mimicking of words A. CHARACTER
● Ataxia - loss of muscle movement - Quantity and rate of production
● Spontaneous - well organized, can elaborate
2. ACTIVITY ● Blocking - sudden stoppage
● Normoactive ● Deliberate - goal oriented, w/pace, cannot elaborate
● Hyperactive ● Pressured - talkative, difficult to interrupt (seen in
● Hypoactive manic patients)
● Psychomotor Retardation ● Aphasia - impairment of language
● Agitated ● Alogia - poverty of speech (seen in patients with
● Compulsion (trichotillomania) - repetitive action dementia)
● Bradykinesia - slow movement, inability to move
● the body swiftly B. ORGANIZATION OF TALK
● Echopraxia - The content of speech
● Stereotypical movement/retardation ● Relevant - makes sense
● Take note of aimless purposeless behaviors ● Irrelevant - (repeat question to establish whether
(automatism) speech is irrelevant or incorrect)
● Incorrect
3. FACIAL EXPRESSION ● Loose Associations/Derailment - mixture of
● Expressive sentence, words or phrases which sounds
● Smiling meaningless
● Tense o He went to the ballpark and bought Frank’s
● Alert beer belly home in a bag of grass seed
● Worried
● Sad ● Word salad - Mixture of words (Schizophrenia)
● Tearful o “Deck the halls with boughs of holly, folly,
● Happy polly, hello Dolly, want a lollipop?”
● Angry
● Suspicious o “Because it makes a twirl in life, my box is
● Ecstatic broken help me blue elephant. Isn’t lettuce
● Frightened brave? I like electrons. Hello, beautiful.”
● Distant
o “Jean jacket racker. Cow stole mine. Run
BEHAVIOR away poster. SIng with a rock. Go go throw.
● Friendly (Attentive/interested Sing with a ring. Moon shines alarm.”
● Embarrassed
● Seductive ● Flight of ideas - topic jumping (mania)
● Impulsive
● Negativistic o Dapat maintindihan mo pa rin ang
● Indifferent/Apathetic phrases/sentence
● Angry/hostile
● Evasive/guarded o “I always liked geography. My last teacher
● Withdrawn in that subject was Professor August A. He
● Defensive was a man with black eyes. I also like black
● Echopraxia eyes. There are also blue and grey eyes and
other sorts, too...”

o “I want some ice cream. Her skin is so soft

and creamy. Have you had the cheesecake
at the restaurant?”
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● Circumstantiality - beating around the bush,
provides a lot of irrelevant information but answers
the question at the end
o Question: “What is your name?
o Response: “Well, sometimes when people
ask me I have to think about whether or not I
will answer because some people think it’s
an odd name even though I don’t really
because my mom gave it to me and I think
you look amazing and your hair is so straight
and I like it.”
o I don’t really because my mom gave it to
me and I think my dad helped
● Tangentiality - patient gets lost with the details
o Always involved a question; Dapat may tinatanong tapos di
maka answer
o Question: What is your name?
o Response: Well, sometimes when people
ask me I have to think about whether or not I
will answer because some people think it’s
an odd name even though I don’t really
because my mom gave it to me and I think
my dad helped but it’s as good a name as
any in my opinion but yeah it’s Tom.
● Echolalia - patient follows the interviewer
● Neologisms - formation of new words
o E.g: “I got so angry I picked up a dish and
threw it at the geshinker.”
● Clang Associations - talks in rhymes (schizo)
● Homonyms - word groups with similar sounds not
necessarily having a logical idea
o Dapat may phrases
o “I got so angry I picked up dish....”
o “You are very cute. A cute mute, who sings
in a suit, while eating his fruit. That boat
hope floats.”
o The train brain rained on me”
o “Here she comes with a cat catch a rat
match.”
o “There’s a mile-long dial trial a while, child.”
● Rhyming - talks in a lyrical manner/poetic manner
● Coprolalia - Compulsive speaking of obscene words.
o E.g. Shit, PI, F*ck
● Glossolalia - phenomenon of people speaking in
tongues/words that are ancient; associated with
religious prayers
● Condensation - Fusion of various concepts into one
● Concrete thinking - ‘literal’
● Emotional/Dramatic - talk like always in a drama
● Bradylalia / Bradyglossia - Abnormal slowness of
the speech
● Verbigeration / Cataplasia - obsessive meaningless
repetition of words and phrases. At times even
numbers and letters; common to autistic patients;
repetition is done even without stimulus
● Perseveration - persistent response to a previous
stimulus/beyond the point of relevance.
o Balik balik ang sentence
III. EMOTIONAL STATE AND REACTIONS
A. MOOD (INNER)
- Persuasive, sustained, internal emotional state
- Answer question: “How do you feel today?”
- Include depth, intensity, duration & fluctuation
- Kinds of Mood:
● Euthymic: Normal mood, absence of depressed or
euphoric mood
● Depression / Depressing: Feeling of sadness or
helplessness, may be accompanied with difficulties of
speech
● Dysphoria: Unpleasant, irritable mood (sapot)
● Euphoria: Bubbly, enthusiastic joyfulness, may be
irritable and has low frustration tolerance (manic
people: always enjoy life but when encounters
problem, they cannot handle it)
● Anhedonia: Loss of interest or pleasure
● Anergia: Abnormal lack of energy/decrease in libido
● Somnolence: Sleepy
● Somnambulism: Sleep walking
B. AFFECT (VISIBLE)
- Objectively defined by the interviewer
- The client’s present emotional responsiveness
- Internal emotional state and may not be congruent with
the mood
- Kinds of Affect:
o Appropriate
o Inappropriate
● Blunted / Restricted - Reduced in intensity
or delayed responses/reaction
● Flat - Absence or near absence of an
emotional expression, may have
monotonous voice, face immobile
● Labile - Rapid shift in emotions unrelated to
external stimuli; Common
● Elated - Extreme feelings of happiness
● Anxious - Tense, worried
● Histrionic - Exaggerated mannerisms,
gestures, theatrical, seductive or highly
excited (papansin, OA)
● Angry - Hostile, resentment, aggression
IV. THOUGHT CONTROL
A. PERCEPTION
- Hallucinations: Altered sensory perception without an
external stimuli; usually false sensory perception without an
external stimuli
● Auditory - False perception of sound; Can hear
voices that aren’t there; Most common (common in
schizophrenic patients)
● Visual - False perception involving sight; Can be in a
form of unformed image or formed images Unformed
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images: flash of lights, ring of fire. Common in drug ● Ideas of Reference

addicts
● Olfactory - False perception of smell; most common
with medical problem or with brain problem
● Gustatory - Common in patients with medical
disorders (problem with temporal lobe)
● Tactile (Kinesthetic) - Perceptions of things in skin
● Somatic - perceptions of things inside the body (e.g.
you feel that you are pregnant)
● Lilliputian - Also known as microptia; objects are
seen small (opposite is macroptia)
● Trailing phenomenon - Common in people taking
hallucinogenic drugs
- Illusions: Misinterpretation of external stimuli; also a false
perception
B. DELUSIONS
- False rigid belief
● Paranoid/Persecutory: others intend to harm or
persecute them
o E.g. “Someone’s watching me...”
o Do not offer food that are already opened;
everything should be sealed
o Your hands should be on the sides
● Grandiose delusion: exaggerated feeling of
importance, power, knowledge
o AKA delusion of grandeur
o Or delusions of reference
o Is the false belief that irrelevant
occurrences or details in the world relate
directly to oneself
o Belief that the world revolves around them
C. DEPERSONALIZATION AND DEREALIZATION
- Common in patients with trauma
- Depersonalization
● Person's subjective sense of being unreal, strange or
unfamiliar
● “It’s not me”
- Derealization
● A subjective sense that the environment is strange or
unreal
● It’s not real.”
D. SUICIDAL/HOMICIDAL/ESCAPE/POTENTIAL
(SHEP)
- Present
- Absent
- Suicidal ideation / Thoughts - A thought or idea of suicide
- Suicide intent / Attempt - Refers to the degree to which the
person intends to act on his suicidal ideations
- Suicidal Threat - Verbalization of an imminent self -
destruction action, which if carried out has a probability of
leading to death.

● Religious delusion: rigid belief on religious subjects E. PREOCCUPATIONS AND RUMINATIONS

o E.g. They believe that they are Jesus. - Preoccupations
o Voluntary attention given to a repetitive thought
● Somatic delusion: there is a rigid belief of o SPO
something’s happening inside their body. - Ruminations
o E.g. I think I have cancer. o Involuntary attention given to intrusive thoughts
o Repetitive or continuous thinking about a particular
● Delusion of Control: someone outside of his body is subject that interferes with other thought process
controlling him; person’s thoughts are being controlled o PTSD, Phobia
by other people or forces - Rituals
o Common in schizophrenic patients o When patients compulsive behavior becomes overly
o 3 aspects: elaborate & stereotyped
● Thought control: Outside person
is controlling his thoughts; F. DEJA VU & JAMAIS VU
○ Someone is controlling me - De Javu - Illusion of visual recognition or familiarity
● Broadcasting: Able to hear others - Jamais Vu - When a familiar situation feels strange or new;
thoughts false feeling of unfamiliarity with a real situation already
○ E.g. They can read your experienced before
mind; Nababasa ko ang
isip mo G. IMPULSE CONTROL
● Insertion: Someone is putting ● Aggression
thoughts into his mind ● Hostility
● Fear
● Delusion of Infidelity/Jealousy/ Othello Syndrome ● Guilt
- person is preoccupied that their partner is being ● Affection
unfaithful ● Sexual feelings
● Erotomanic delusions - More common in women;
delusion that somebody is in love with them V. NEUROVEGETATIVE DYSFUNCTION (BIOLOGICAL
DYSFUNCTION)
● Nihilistic - Their self or part of themself is non- A. SLEEP
existent - Normal
o I’m dead right now but I’m talking to you - Hypersomnia - Too much sleeping (manifestation of atypical
o Cotard syndrome - Belief that they are depression)
immortal. - Interrupted Sleep - Can sleep at any time but wakes up at...
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o MNA: Midnight Awakening; 12 AM D. GENERAL INFORMATION

o EMA: Early morning awakening: 3 AM ● Personal Data
o DFA: Difficulty Falling Asleep ● Current Events
- Insomnia
o Early: Patient has difficulty falling asleep but can E. ABSTRACT THINKING SKILLS
sleep normally or oversleep - Proverbs, Sayings
o Late (terminal) - ability of the pt to go to sleep - Comparisons, similarities, etc.
without the ability to remain asleep (common in - Highly influenced by educational status, age, as well as
depression) cultural background
o Mixed - Combination - Concrete thinking – LITERAL

B. APPETITE F. JUDGEMENT REASONING

- Subjectively defined - Assess patients ability to estimate correctly and form opinions
- Increased concerning external, objective matters
- Decreased - Ask patient hypothetical questions
- Good / Fair / Poor - Assess the soundness of problem-solving
● Polyphagia
● Voracious - e.g. Mukbang G. INSIGHT
● Pica - Eating things that aren’t food - Ability to understand the true cause and meaning of a
● Binge eating situation
● Coprophagia - Feces - Assess: if the client knows the reason for his admission,
knowledge about his illness
C. DIURNAL VARIATION - Patient’s degree of awareness of their illness
- Patient’s mood pattern during the day - Three types:
- May be subjectively reported by the patient o Intellectual - understanding the objective reality of
- Sundowning - Okay in the morning, but when the sun is the situation but without motivation or ability to apply
about to set, the symptoms appear the understanding in a useful concept
- E.g. wala na koy mabuhat maam ani
D. WEIGHT naman
- Normal ko
- Over weight o True Insight - understanding the objective reality of
- Malnourished the situation, coupled with motivation and emotional
- Obese impetus to master the situation
- E.g maningkamot ko nga ma-maayo
E. LIBIDO o Impaired - diminished ability to understand the
- Sexual drive and general energy level objective situation of a reality
- May be subjectively reported by the client
VIII. SUMMARY OF THE MSE
GENERAL SENSORIUM AND INTELLECTUAL STATUS A. DISTURBANCE IN:
A. ORIENTATION ● Presentation
● Time ● Stream of Talk
● Place ● Emotional State and reactions
● Person ● Thought Control
● Situation ● Neurovegetative Dysfunction
● General sensorium and intellectual status
B. MEMORY ● Insight
- Immediate: 3 hours
- Recent: 24 hour recall
- Remote: Months or years
- Confabulation: Fabricate / makes stories to patch up
memory loss; result of brain damage
- Agnosia: Inability to recognize and identify objects or
persons

C. ATTENTION SPAN
- Good: Good attention span correlates to good immediate
recall
- Fair
- Poor