NCM117J PSYCHIATRIC

WHAT IS PSYCHIATRIC NURSING? WHAT ARE THE ROLES AND FUNCTIONS OF A

• It is an INTERPERSONAL PROCESS whereby the
professional nurse through the therapeutic use of
self, assist an individual, family or group/
community to promote mental health, to prevent
mental illness and suffering, to participate in
treatment and rehabilitation of the mentally ill and
to find meaning in these experiences.
LEVELS OF CARE
1st primary – promotive
preventive
2nd secondary – treatment (hospitalization or
institutionalization)
crisis intervention
case finding
3rd tertiary – occupational therapy
recreational therapy
remotivation technique
bibliotherapy
MENTAL HEALTH GAP ACTION PROGRAMME
(mhGAP)
PSYCHIATRIC NURSE?
• Creates a therapeutic environment
• Assist the patient to feel comfortable with others
• Listen to the client’s verbalization
• Assist the client in the performance of activities of
daily living
• Enables the client and his relatives to know their
rights and responsibilities
• Assist the client to learn more adaptive ways of
coping
ANXIETY AND OTHER RELATED DISORDERS
PSYCHOSIS
• Is a severe mental disorder that involves a
disruption in the individuals capacity to
differentiate fantasy form reality
NEUROSIS
• Is a maladaptive emotional resulting from
unresolved unconscious conflicts.

• A state of well-being in which the individual Differentiation of Neurosis and Psychosis

realizes his or her own abilities can cope with the
NEUROSIS PSYCHOSIS
normal stresses of life can work productively and
Does not usually require Requires hospitalization
fruitfully and is able to make a contribution to his
hospitalization
or her community.
Condition is considered Condition is considered major
• WHO, 2008. Scale up services for mental
minor reaction to stress reaction to stress
neurological and substance use disorders for
No gave interference with Reality testing greatly
countries especially with low and lower middle
reality testing, ego remains impaired
incomes
sound
R.A 11036 Phil MH Act Neurotic feels his suffering Psychotic does not recognize
• June 21, 2018 and wants to get well he is ill
• Mandates the revision of psychiatric, psychosocial
and neurological services in the community
ANXIETY
settings
• Safe for working environment access to continuing ➢ Anxiety – a subjective feeling of apprehension
education and autonomy in their own practice dread or impending doom
• additionally, and with some foresight act seeks to ➢ Fear – a reaction to a specific anger
integrate MH into the educational system by ➢ Stress – a state of imbalance between demands
promoting MH programs into the school and other placed on an individual and the individual ability
organizations to deal with the demands.
o Stress - condition in which the human
WHAT ARE THE CHARACTERISTICS OF AN
system responds to input that has disturbed
EFFECTIVE PSYCHIATRIC NURSE?
its steady state, a feeling of the emotional or
• EMPATHY - the ability to see beyond outward physical tension.
behavior and sense accurately another person’s o Stressor - an input that disturbs the steady
experiencing state.
• GENUINENESS - ability to use a therapeutic ▪ Neither positive nor negative but
appropriately could have either a positive or
• UNCONDITIONAL POSITIVE REGARD – respect negative effect depending upon how
for client the system processes it.
o Adaptation - human beings respond to stress

Stress and Stressors

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Positive - EUSTRESS Negative - DISTRESS • Defense mechanisms ------------ palliative,

• Receiving promotion or • Loss of job temporary relief
raise at work. • Injury or illness
• Starting a new job • Death
• Buying a home • Marriage Anxiety Relief Behaviors
• Marriage separation 1. Learning and problem solving
• Taking vacation • Retirement 2. Escape or withdrawal-suicide
• Holiday seasons 3. Acting-out violence
4. Somatizing
Burnout – a state of mental or physical exhaustion, 5. Use of defense mechanism: adaptive or
maybe caused by excessive, prolonged stress. maladaptive

BURNOUT Crisis situations in relation to the pandemic

• Manifestations
o Avoidance/ passivity
o Low morale
o Lack of accomplishment/ sense
infectiveness
o Detachment/ impersonal response
o Chronic complaining
o Hostile reaction to others
Stress VS Burnout
Stress – a condition in which the human system responds
to input that has disturbed its steady state: a feeling of
emotional or physical tension.
Burnout - is a state of physical emotional and mental
exhaustion due to a long-term involvement in an
emotional demanding situation.
There are 2 different things:
Under stress, one still struggles to cope with
pressure but once burnout takes hold you're out of the
gas and you've given up all hope of surmounting your
obstacle it is more commonly experienced as
hopelessness or hopelessness.
Anxiety maybe due to loss or threat to:
• Health/ life
• Needs, goals, expectations
• Ability to perform
• Self control
• Control over one’s life
• Status/ prestige
• Resources
• Loved ones
• Freedom/ independence
Process of Anxiety
Stressor ------- Anxiety --------------- Neurochemical,
Physical, and
Emotional reactions
Coping behavior
• Problem-focused ------------ adaptive, recovery and
health
▪ Diagnosis of an illness, hospitalization
▪ Losses – job, income
▪ Dying and death
▪ Mental health conditions – separation from loved
of
ones, isolation, panic, depression, suicide
Characteristics of anxiety
▪ subjective feeling
▪ universally seen as unpleasant
▪ stressor
▪ adaptation
▪ a form of energy
▪ occurs in degrees.
EGO DEFENSE MECHANISMS
When anxiety becomes overwhelming and painful
the ego “protects the individual from feeling of
inadequacy on worthlessness”, by unconsciously
blocking the anxiety causing impulses or distorting them
into a more acceptable and less threatening form.
Relieves tension and anxiety but not solving the problem.
COPING MECHANISMS
Individual’s habitual pattern of feeling with stress and
other problems they are generally characteristic of each
person dealing with stress and problems on an
unconscious and conscious level.
▪ Turning to others for support
▪ Physical movement and sustained action to release
tension and provide relief, repetitive.
▪ Defense mechanism are more likely to arise in the
▪ Processes and more likely to arise in the face of
more serious, ongoing stressors.
▪ Defense mechanisms don’t operate in tandem.
NARCISSISTIC DEFENSES
▪ Denial – when emotional conflict is blocked from
awareness and the individual refuses to recognize
its existence because it is too much for the person
to handle at the moment. Failure to accept a
painful truth.
▪ Projection – tendency to see one’s unacceptable
desires or traits in other people. Throwing off.

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IMMATURE DEFENSES
▪ Regression – person engages in behaviors
appropriate at an earlier stage of development.
▪ Introjection – when a person completely accepts
the values, opinion, and beliefs of another person
as his own. Swallows and incorporates.
o Identification – initiates someone’s;
superficial integrate or adds to personality.
▪ Fantasy – gratification of unconscious wishes and
needs by imaginary achievements and wishful.
▪ Displacement – redirecting emotions or impulse to
a safer substitute wherein with whom originally is
unacceptable for some reasons.
▪ Intellectualization – when an individual strips
emotion from a difficult memory or threatening
impulse when talking about it or responding to it
and the individual approach situations at cognitive
level. Excessive use of reasoning.
▪ Rationalization – when an individual
unconsciously makes reasonable explanations or
excuses to justify unacceptable thoughts, feelings
or behaviors: using a reason not a real reason to
justify.
▪ Reaction formation / overcompensation – an
individual who behaves in an exactly the opposite
manner from his true feelings, desires or thoughts.
▪ Repression – threatening thoughts, feelings, ideas
that are anxiety provoking are involuntarily
pushed into the unconscious, which cannot be
remembered at will.
MATURE DEFENSES
▪ Suppression – when an individual consciously and
voluntarily excludes from awareness those ideas,
feelings and situations that are causing discomfort
and anxiety; deliberate effort to forget.
▪ Sublimation – when an individual transforms an
unacceptable impulse, whether it be sex, anger,
fear, or whatever, into a socially acceptable even
productive form rechanneling the unacceptable.
OTHER DEFENSE MECHANISMS
▪ Compensation – when an individual makes up for
an imagined or real deficiency in one are by
emphasizing capabilities in another to maintain
self-respect and self-esteem; to cover for
inadequacy.
▪ Identification – when an individual internalizes the
characteristics, values, or opinions of another
person.
▪ Humor – even if you are sad, you make life happier
by making jokes and entertaining other people.
▪ Altruism or altruistic surrender – is a form of
projection that at first looks like its opposite: the
person attempts to fulfill hid or her own needs
vicariously, through other people.
▪ Sour graping – when someone puts something
down in a negative way or makes it out to be
unimportant solely because it is unattainable to
them.
• Somatization – convert anxiety to physical
symptoms.
• Dissociation – a form of repression; something
related to self.
• Isolation – separation of feelings from thoughts.
• Fixation – unable to outgrow.
• Undoing – repairing something to make-up.
• Symbolization – attributing a meaning to an object
to accept an unacceptable taking a more attainable
goal.
• Conversion – expressing one’s feelings or conflicts
thru the body.
EGO DEFENSE
EXAMPLE
MECHANISMS
Woman experiences blindness after
Conversion
witnessing a robbery.
Denial Woman denies that her marriage is failing
Male victim of car-jacking exhibits symptoms
Dissociation
of traumatic amnesia the next day.
Teenager dresses, walks, and talks like his
Identification
favourite basketball player.
Man who was late for work blames wife for
Projection
not setting the alarm clock.
Student states he didn't make the golf team
Rationalization
because he was sick.
Reaction- Man who dislikes his mother-in-law is very
formation polite and courteous toward her.
Student who failed a test states she isn't ready
Suppression
to talk about her grade.
An engagement ring symbolizes love and a
Symbolization
commitment to another person.
CRISIS
• State of disequilibrium resulting from stressful
event or perceived threat working individuals
useful coping mechanisms becomes ineffective in
dealing with it
• Balancing Factors:
o The individual’s perception of the event
o Past experience in coping with stress
o Established coping strategies
o Availability of support persons
TYPES
• Developmental or maturational
o Occurs in response to a transition from one
stage of maturation to another in the life
cycle (e.g., going from adolescence to
adulthood)
• Situational
o Occurs in response to a sudden unexpected
event in an individual's life, this events
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generally revolve around experience loss. • POST CRISIS PERIOD – resolution of crisis
(e.g., dead of a love one)
CRISIS INTERVENTION
• Adventitious
o Occurs in response to severe trauma or • Is a method of providing assistance to those
natural disaster this crisis can affect affected by a crisis in which the immediate
individuals’ communities and even nations program is resolved and psychological equilibrium
is restored
EVENT
Steps in crisis Intervention
• Perception of event
o Not a stressor 1. Assess the situation
o Stressor 2. Define the event
▪ Coping 3. Assist the client to develop cognitive awareness of
• Effective the event
• Ineffective coping 4. Assist the client in managing feelings
o Crisis 5. Explore with the client the resources available
6. Assist client in action planning
CHARACTERISTICS
TECHNIQUES OF CRISIS INTERVENTION
• Crisis occurs in all individuals at one time or
another • ABREACTION - process by which repressed
• crisis is not necessarily pathological; it can provide material particularly a painful experience or a
stimulus for growth and learning conflict is brought back to consciousness
• A crisis is time 4 usually resolved one way or • CLARIFICATION – questions such as:
another in a brief period. (4-6 weeks) o What happened to you?
o Successful crisis resolution occurs when o What are your thoughts and feelings?
functioning is restored or enhanced through o Are you experiencing physical symptoms or
new .learning changes in your usual behavior?
o Unsuccessful crisis resolution is when o What have you tried to do so far to resolve
functioning is not restored to pre-crisis level the crisis?
and the individual experiences decreased • Suggestion
levels of functioning. • Manipulation
• Reinforcement of behavior
SYMPTOMS COMMON IN INDIVIDUALS
• Support of defenses
EXPERIENCING CRISIS
• Raising self-esteem
• PHYSICAL – somatic complains, appetite • Exploration of solution
disturbances, sleep disturbances, restlessness,
NURSING PROCESS
tearfulness, irritability
• COGNITIVE – confusion, difficulty concentrating, A. Assessment
racing thoughts and inability to make decisions a. Identify precipitating event of crisis
• BEHAVIORAL – disorganization, impulsive, angry b. Determine client’s perception of crisis
outburst, difficulty carrying out usual role c. Determined presence of balancing factors
responsibilities, withdrawal from social interaction d. Identify clients’ strengths
• EMOTIONAL – anxiety, anger, guilt, sadness, B. Nursing diagnosis
depression paranoia, suspicion, helplessness, a. Body image disturbance
powerlessness b. Caregiver role strain
c. Community coping ineffective
CHARACTERISTICS OF CRISIS STATE
d. Coping individual ineffective
• Highly individualized e. Denial ineffective
• Self-limiting f. Family coping potential for growth
• Rarely affects the individual without also affecting g. Grieving dysfunctional
the significant others h. Post trauma response
• the person is amenable to suggestion i. Powerlessness
• has a growth potential j. Rape trauma syndrome
k. Role performance altered
SEQUENCE OF CRISIS DEVELOPMENT
l. Spiritual distress
• PRE CRISIS-PERIOD – Has emotional equilibrium
• CRISIS PERIOD – has subjective experience of IMPLEMENTATION FOR THE CLIENT WHO IS
upset, failure of usual coping mechanisms, ANGRY AND VIOLENT
symptoms experience.

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1. Intervene early or prevent client acting out PERSEVERATION - persistent adherence to a single idea
violence or topic; verbal repetition of a sentence, word, phrase
a. Verbal signs resisting attempts to change the topic.
b. Nonverbal signs
AMBIVALENCE - contradictory beliefs or feelings.
2. Use measure to deescalate client’s anger
a. Answer client angrys question and FLIGHT OF IDEAS - continuous flow of verbalization
demands from one topic to another.
b. Responds to underlying feelings ASSOCIATIVE LOOSENESS - fragmented or poorly
c. Allow client to vent anger verbally related thoughts or ideas.
d. Avoid defending your own behavior
e. Monitor our own body language
3. Responds to client’s violent behavior ALOGIA – poverty of speech
a. Protect yourself
b. Protect others BLUNTED AFFECT – restricted range of emotional
c. Follow agency protocol feeling, tone or mood.
4. Use principle of violence code CATATONIA – client seems motionless.
a. Ensure a show of force
FLAT AFFECT – absence of facial expression.
b. Designate one team member as a leader
c. Leader stands at the head of the team ANHEDONIA – absence of joy or pleasure.
d. Leader decides who will take each limb
LACK OF VOLITION – absence of will, ambition or drive.
and head
e. Team acts as one APATHY – feelings if indifference toward people,
f. Ensure safety and avoidance of client and activities or event.
staff injury
TYPES OF SCHIZOPHRENIA
WHAT IS SCHIZOPHRENIA? PARANOID TYPE - presenting sign is SUSPICIOUS ideas
of persecution and delusions; sees environment as hostile
▪ Causes distorted and bizarre thoughts, perception
and threatening.
emotion, movements and behavior.
▪ Cannot be defined as a single illness rather a DISORGANIZED TYPE - with inappropriate behavior;
syndrome or disease process with many different silly, crying, laughing, regression, transient hallucination
varieties and symptoms. (auditory)
▪ Can be controlled by medication.
CATATONIC TYPE - with stereotype position (catatonia)
▪ Usually diagnosed in late adolescence or early
with waxy flexibility, mutism, bizarre mannerism.
adulthood.
UNINDIFFERENTIATED TYPE - symptoms of more than
When is the peak incidence of onset?
one type of schizophrenia.
▪ Men: 15 to 25 years
RESIDUAL TYPE - characterized by at least once
▪ Women: 25 to 35 years
previous though not a current episode; social withdrawal
SCHIZOPHRENIA “is” SCHIZOPHRENIA “is not” flat affect and looseness of association.
a brain disease with concrete a “split personality”
CLINICAL COURSE
and specific symptoms due to
physical and biochemical Related Disorders
changes in the brain.
an illness that strikes young caused by childhood • SCHIZOPHRENIFORM DISORDER – symptoms
people in their prime trauma, bad parenting or less than six months social or occupational
poverty functioning may or may not impaired.
almost always treatable with the result of any action or • SCHIZOAFFECTIVE DISORDER – symptoms of
medication personal failure by the
psychosis and at the same time all features of
individual
mood disorder either depression or mania.
more common than most people
think • DELUSIONAL DISORDER – one or more non
bizarre delusion's (focus of delusions is believable
psychosocial functioning is not markedly impaired
HALLUCINATIONS - false sensory perception or
and behavior is not obviously odd or bizarre.
perceptual experiences that do not exist in reality.
• BRIEF PSYCHOTIC DISORDER – sudden upset of
IDEAS OF REFERENCE - false impressions. at least one psychotic symptom which last one day
to one night to one month.
DELUSIONS - fix false beliefs.
• SHARED PSYCHTIC DISORDER (FOLIE A DEUX)
ECHOPRAXIA - imitation of movements and gestures. - two people share similar delusion (in the context

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of a close relationship with someone who has
psychotic delution).
CAUSES OF SCHIZOPHRENIA
▪ Genetic factor
▪ Neuroanatomic and neurochemical factors
▪ Immunovirologic factors
▪ Stress
▪ Drug abuse
CULTURAL CONSIDERATIONS
“Culture-bound” syndrome = psychotic behavior
observed in countries or among particular ethnic groups.
Ethnicity – maybe a factor in the way person responds to
psychotropic meds.
TREATMENT
▪ Primary medical treatment for schizophrenia is
psychopharmacology.
▪ antipsychotic medications are also known as
neuroleptics.
▪ not to cure schizophrenia used only to manage the
symptoms of the disease.
▪ Older or conventional anti-psychotic and newer or
atypical antipsychotics.
▪ Dopamine and serotonin antagonist
PSYCHOSOCIAL
1. Individual and group therapy
2. social skills training
3. family education and therapy
ASSESSMENT
History [Previous history of schizophrenia] [age of
onset of schizophrenia] [previous suicide attempts] [
perception of his or her current situation]
General appearance, motor behavior and speech
[Appearance may vary widely among different clients
with schizophrenia]
Overall motor behavior also may appear odd:
CATATONIA – the client may be restless and unable to
sit still exhibit agitation and pacing or appear unmoving.
ECHOPRAXIA – the client may imitate the movements
and gestures of someone whom she or he is observing.
PSYCHOMOTOR RETARDATION – general slowing of
all movements.
WAXY FLEXIBILITY - client with catatonic type of
schizophrenia may exhibit this.
The client may exhibit unusual speech pattern:
WORD SALAD – jumbled words and phrases that are
disconnected or incoherent and make no sense to the
listener.
ECHOLALIA - repetition or imitation of what someone
else says.
Unusual speech patterns of clients with schizophrenia
CLANG ASSOCIATION – are ideas that are related to one
another based on sound or rhythmic rather than
meaning.
NEOLOGISMS – are words invented by the client.
VERBIGERATION – the stereotype repetition of words or
phrases that may or may not have meaning to the
listener.
ECHOLALIA – repetition or imitation of what someone
else say.
STILTED LANGUAGE – is the use of words or phrases
that are flowery excessive and prompous.
PERSEVERATION – the persistent adherence to a single
idea or topic and verbal repetition of a sentence phrase
or word even when another person tends to change the
topic.
WORD SALAD - jumbled words and phrases that are
disconnected or incoherent and make no sense to the
listener.
Mood and Affect
Flat effect- no facial expression
Blunted effect- few observable facial expression
Anhedonia- The client may report feeling depressed and
having no pleasure or joy in life.
THOUGH PROCESS AND CONTENT
Schizophrenia often is referred to as a thought disorder.
❖ Thought Blocking - Clients may suddenly stop
talking in the middle of sentence and remain silent
for several seconds to 1 minute.
❖ Thought broadcasting - They believe others can
hear their thoughts.
❖ Thought withdrawal- they believe that others are
taking their thoughts.
❖ Thought insertion- that others are placing thoughts
in their mind against their will.
Alogia- describes the lack of any real meaning or
substance in what the client says.
DELUSIONS - fixed false beliefs with no basis in reality
What are the types of delusions?
Persecutory/paranoid delusions- involve the client’s
beliefs that “others” are planning to harm the client or
are spying them. Sometimes the client cannot define who
these “others” are.
Grandiose delusions- characterized by the client’s claim
to association with famous people or celebrities, or the
client’s belief that he or she is famous.
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Religious delusions- often center around the second
coming of Christ or another significant religious figure or
prophet. These religious delusions appear suddenly as
part of the client’s psychosis and are not part of his or her
religious faith.
INTERVENTIONS
Somatic delusions- are generally vague and unrealistic
beliefs about the client’s health or bodily functions.
Factual information or diagnostic testing does not change
these beliefs.
Referential delusions or ideas of reference- involve the
client’s belief that television broadcasts, music, or
newspaper articles have special meaning for him or her.
SENSORIUM AND INTELLECTUAL PROCESSES
HALLUCINATIONS - false sensory perceptions, or
perceptual experiences that do not exist in reality. It can
involve the five senses and bodily sensations.
Types of Hallucinations
• AUDITORY HALLUCINATIONS - involve hearing
sounds; most often voices, talking to or about the
client.
Command hallucinations – are voices demanding
that the client take action, often to harm self or
others.
• VISUAL HALLUCINATION - involve seeing images
that do not exist at all.
• OLFACTORY HALLUCINATIONS - involve smell
or odor; often occur with dementia, seizures, and
CVA’s.
• TACTILE HALLUCINATIONS - refer to sensations;
often found in clients undergoing alcohol
withdrawal.
• GUSTATORY HALLUCINATIONS - involve a taste
lingering in the mouth; sense that food tastes like
something else.
• CENESTHETIC ALLUCINATIONS - involves
report that one feels bodily functions that are
usually undetectable.
• KINESTHETIC HALLUCINATIONS - occur when
the client is motionless but reports the sensation of
bodily movement.
• DEPERSONALIZATION - most extreme form of
disorientation; client feels detached from his
behavior.
• JUDGEMENT - ability to interpret the
environment correctly, frequently impaired in the
client with schizophrenia.
• DETERIORATION OF SELF-CONCEPT - major
problem in schizophrenia; lack of clear sense of
where his mind, body, and influence end;
depersonalization, derealization, ideas of
reference.
• SOCIAL ISOLATION – inattention to hygiene and
grooming; preoccupied with delusions and
hallucinations; fail to recognize hunger or thirst.
• POLYDIPSIA (excessive water intake) - Patients
with severe and persistent mental illness; long-
term therapy with antipsychotic medications.
• SLEEP PROBLEMS – insomnia.
▪ Promoting the safety of client and others.
o Nurse must approach the client in a non-
threatening manner.
o Nurse must observe for signs of building
agitation or escalating behavior such as
increased intensity of pacing, loud talking or
yelling, and hitting or kicking objects.
o Administering medication; moving client to
a quiet, less stimulating environment and in
extreme situations, temporarily using
restraints.
▪ Establishing a therapeutic relationship.
o Trust between client and nurse helps allay
the fear of a frightened client.
o Nurse must be patient for it takes time.
o Nurse provides explanations that are clear,
direct and easy to understand.
o Nurse must assess carefully the client’s
response to the use of touch.
▪ Using therapeutic communication.
o Nurse tries to understand and make sense of
what the client is saying.
o Nurse must maintain nonverbal
communication with the client, especially
when verbal communication is not very
successful.
o Presence of nurse can demonstrate the
nurse’s genuine interest and caring to the
client.
o Nurse must let the client know when his or
her meaning is not clear.
▪ Implementing interventions for delusional
thoughts.
o Nurse must avoid openly confronting the
delusion or arguing with the client about it.
o Nurse must also avoid reinforcing the
delusional belief by “playing along” with
what client says.
o Nurse can help the client minimize the
effects of delusional thinking through
distraction techniques and direct action.
▪ Implementing interventions for hallucinations.
o Nurse should focus on what is real and help.
o shift client’s response toward reality.
o Nurse must determine what the client is
experiencing.
o Nurse must elicit a description of the content
of the hallucination.
o Nurse must infer from client’s behavior that
hallucinations are occurring.
o Engage client in a reality-based activity.
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o Teach client to talk back to the voices - Monitor amount of sleepiness or drowsiness .
forcefully. Avoid driving a car or potentially dangerous
activities until your response time and reflexes
Client and family Teaching
seem normal.
▪ How to manage illness and prevent relapse - If you forget a dose of antipsychotic medication,
▪ Importance of maintaining prescribed medication take it if the dose is only 3 to 4 hours late. If the
regimen and regular follow up. missed dose is more than 4 hours late or the next
▪ Self-Care and proper nutrition dose is due, omit the forgotten dose.
▪ Avoiding Alcohol and other drugs - If you have difficulty remembering your
▪ Teaching social skills through education, role medication, use a chart to record doses when taken
modeling and practice or a pill box
▪ Counseling and education of family/significant
Self-care and proper nutrition
others about the biologic causes and clinical course
of schizophrenia and the need for ongoing support - HYGIENE
▪ Importance of maintaining contact with o Direct the client through the necessary steps
community and participating in supportive for bathing, shampooing…
organizations and care. o Directions should be in clear and short
statements.
RISK FACTORS FOR RELAPSE
o Allow ample time for grooming – do not rush
• HEALTH RISK FACTORS the client.
o Fatigue o Encourage to become more independent
o Impaired information processing when he/she is better oriented to reality.
o Lack of sleep - PROPER NUTRITION
o Lack of exercise o Important in physical and emotional well-
o Impaired cause-and effect-reasoning being
o Poor nutrition o Aid as long as needed then gradually
o Intolerable side effects of medication promote the client’s independence.
• ENVIRONMENTAL RISK FACTORS o Funding available (social worker)
o Financial difficulties - TEACHING SOCIAL SKILLS
o Interpersonal difficulties o Education, role modeling and practice
o Stressful changes in life events o Help the client learn neutral social topics
o Housing difficulties appropriate to any conversation.
o Poor occupational skills, inability to keep a o Help experience greater success in social
job. interaction.
o Poor social skills, social isolation, loneliness o Eye contact, attentive listening, taking turns
• BEHAVIORAL AND EMOTIONAL RISK FACTORS talking.
o Lack of control, aggressive or violent
behavior
o Low self-concept
o Looks and acts differently.
o Loss of motivation
o Mood swings
o Poor medication and symptom management
Client Teaching and Medication Management
- Drink sugar free fluids and eat sugar-free hard
candy to ease the anticholinergic effects of dry
mouth.
- Prevent constipation by increasing water intake
and bulk forming foods in the diet.
- Stool softeners are permissible, but laxatives
should be avoided
- Use sunscreen to prevent burning. Avoid long
periods of time in the sun and wear protective
clothing.
- Rising slowly from a lying or sitting position will
prevent falls from orthostatic hypotension or
dizziness due to a drop in blood pressure.

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PSYCHOSOCIAL THEORY
Personality Theories and
• Social theories focus on understanding the
Determinants of Psychopathology as influences of and interaction between the
environment, cognition, and a person’s

Models of Care behavior.

• It states that people influence and are
influenced by their environment, and that a
Personality
reciprocal relationship between an individual
- Is defined as your distinctive and enduring and their social environment exists.
characteristic patterns of thinking, feeling, and • In summary, environment affects behavior. An
behaving. example is Erik Erikson’s stages of
- Psychologists study personality by:
o Trying to understand differences in
specific characteristics.
o Looking at how all the various parts of
each person mesh together as a whole
- There are nine perspectives on personality
theories:
o Psychobiologic
o Cognitive
o Behavioral
o Psychodynamic/ Psychoanalytic
o Interpersonal
o Humanistic
o Psycho-spiritual
o Eclectic

PSYCHOBIOLOGIC THEORY
• Psychobiology, as a field of study, is focused on
the science of the brain’s anatomy and
physiology.
• Influenced by biochemical alteration, genetics,
mental illness as biophysical impairment
• Thoughts, sensations, joys, and aches are
activities of the 100 billion neurons in brain
tissues. Neuroscientist can almost read
people’s thoughts from blood flow of their
brains as well as if the person is thinking of a
place/face or looking at a bottle/shoe
• Meds are utilized to correct biochemical
imbalances in the brain
development.
COGNITIVE THEORY
• It is within the premises of cognitive theory that BEHAVIORAL THEORY
thoughts, ideas, and beliefs affects feelings and
behaviors • Behavior is learned. The person becomes who
• It focus on how a person’s thinking about a they are by environmental shaping; behavior
situation or event affects the stimulus and can be observed, described, recorded, subject
response. to reward and punishment.
• Cognitive theories address a person’s thinking • Behavioral theory proposes that a person’s
about an event or situation as having an effect behavior is the result of learning that is a
on his or her response to a stimulus (behavior). response to a stimulus.

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NCM117J PSYCHIATRIC

• A person may learn a certain response • Hildegard Peplau considered as the mother of
(behavior) either to receive a reward or to avoid psychiatric nursing. She considers nursing to
a punishment. be an interpersonal process between nurse and
client.

PSYCHODYNAMIC/ PSYCHOANALYTIC
THEORY
• It is a psychological model in which behavior is
explained in terms of past experiences and
motivational forces; actions are viewed as
stemming from inherited instincts, biological
drives, and attempts to resolve conflicts
between personal needs and social
requirements.
• Sigmund Freud believed that our personality is
largely shaped by our enduring conflict
between our impulses to do whatever we feel
like, and our restraint to control these urges
between our pleasure-seeking urges and our
inner social control over them. Actions are
believed to be motivated by emotions and
thoughts.
• Freud believe that anxiety comes from the part
of the ego getting all stressed out about losing
control over the id and superego, so he
proposed that our ego used a series of defense
mechanisms as a method of reducing anxiety.
Sigmund Freud theorizes that our mind is divided
into three interacting parts the id, the ego, and the
superego that provide the battleground for this
internal conflict that shaped our personalities. Think
of it as like an iceberg, its mostly hidden and that big
under water chunk is your id your unconscious
primitive and instinctive self, Freud thought the id
was all about sex and aggression the so-called
pleasure principle of immediate gratification. To him
infants were all id, such as were babies freak out
when they don't get a snack immediately instead of
just taking a deep breath for a second. Eventually
kids develop the ego that is largely conscious
component that is trying to deal with reality. Ego
works in how the id gets what it wants in a
reasonable, timely way. The final is the superego that
represents the real but also the ideal.
HUMANISTIC THEORY
• It focuses on the present and the “here & now”
with nothing to do with the past
• Humanistic theory moved traditional concepts
of mental health and illness from a focus on
illness, determinism, the unconscious, and
reductionism to a focus on health.
• Humanistic theories reflected the theoretical
shift toward a more holistic, interpersonal,
positive perspective.
PSYCHOSPIRITUAL THEORY
• Spirituality is the human quality that gives
meaning and sense of purpose to an
individual’s existence. Spirituality exists within
each individual regardless of belief system and
serves as a force for interconnectedness
between the self and others, the environment,
and a higher power.
• Earliest practices focused on including spiritual
treatment because insanity was considered a
disruption of mind and spirit
• Reeves and Reynolds note that the large
volume of contemporary research (more than
60 studies) demonstrating the value of
spirituality for both medical and psychiatric
patients is influencing this change.
ECLECTIC THEORY
• This model selects, combines, and incorporates
the diverse techniques from several theories
• Utilizes more than one personality theories and
determinants of psychopathology as models of
care and joins those models into an integrated
approach increasing the parameters involved

INTERPERSONAL THEORY
• Psychologists believe that unsatisfactory
interpersonal relations primarily cause
maladaptive behavior.
• Sullivan believed that poor relationships cause
anxiety, which serves as the basis for all
emotional problems.
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