WHAT IS PSYCHIATRIC NURSING?

MENTAL HEALTH GAP ACTION

It is an INTERPERSONAL PROCESS whereby the
professional nurse through the THERPERUTIC 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 MENANING IN THESE EXPERIENCES.
PROGRAMME (mhGAP)
“A state of well-being in which the individual realizes
his or her own abilities, can cope with the normal
stresses of life, can work productively and fruitfully,
and is able to make a contribution to his or her
community.”
-World Health Organization

LEVELS OF CARE World Health Organization, 2008

Scale up services for mental, neurological and
1ST DEGREE (PRIMARY) substance use disorders for countries especially
with low and lower middle incomes
PROMOTIVE PREVENTIVE
R.A. 11036 PHILIPPINE MENTAL
HEALTH ACT OF JUNE 21, 2018
• Mental Health (R.A. 11035 Philippine Mental
Health Act) - Mandates the provision of psychiatric psychosocial
and neurological services in community settings.
• Psychoeducation
• Genetic Counseling
- Safe working environment access to continuing
• Stress Management
education and autonomy in their own practice.
• Anticipatory Guidance
- Additionally, and with some foresight, the Act
2nd DEGREE (SECONDARY)
seeks to integrate Mental Health into the
educational system by promoting Mental Health
• Treatment (Hospitalization or programs in the school and other organizations
Institutionalization)
• Crisis Intervention
• Case Finding
WHAT ARE THE CHARACTERISTICS OF
AN EFFECTIVE PSYCHIATRIC NURSE?
3rd DEGREE (TERTIARY)
• EMPATHY – the ability to see beyond
• Occupational Therapy outward behavior and sense accurately
• Recreational Therapy another person’s experiencing.
• Remotivation Technique • GENUINENESS – ability to use therapeutic
• Bibliotherapy tools appropriately
• UNCONDITIONAL POSITIVE REGARD –
respect for client

Prepared By: Bucoy, Patricia Gabrielle S.

EVOLUTION OF PSYCHIATRIC MENTAL
HEALTH NURSING
ANCIENT TIMES
• Believed that any sickness indicated
displeasure of the Gods
• Punishment for sins and wrongdoing
• Those with mental disorders were viewed as
being either Divine or Demonic, depending
on their behavior
• Individual seen as divine were worshipped
and adored
• Those seen as demonic were ostracized,
punished and burned at the stake
ARISTOTLE (322-382 BC)
• Attempted to relate mental disorders to
physical disorders, and developed his Theory
that amount of blood, water, … and black
bile in the body controlled the emotions
• These four substances, Humors
corresponded with happiness, calmness,
anger, and sadness. Imbalances of the four
humors were believed to cause mental
disorders
• Treatment was aimed at restoring balance
through bloodletting, starving and purging.
Such treatment persisted well into the 19th
century
EARLY CHRISTIAN TIMES (1-1000 AD)
• Primitive Belief and Superstitions were
strong, all diseases were again blamed on
demons, and the mentally ill were viewed as
possessed
• Priests performed exorcisms to rid civil
spirits. When that failed, they used more
severe and brutal measures, such as
incarceration in dungeons, flogging and
starving
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THE RENAISSANCE (1300-1600 CENTURY)
• People with mentally illness were distinguish
from criminal in England
• Those considered harmless were allowed to
wander the countryside or live in rural
communities, but the more “dangerous
lunatics” were thrown in prison, chained and
starve
1547
• The hospital of St. Mary of Bethlehem was
officially declared a hospital for the insane,
the first of its kind
1775
• Visitors at the institution were charged a fee
for the privilege of viewing and ridiculing the
inmates, who were seen as animals, less
than human
PERIOD IN THE COLONIES (LATER THE U.S.)
• The mentally ill were considered EVIL OR
POSSESSED and were punished. Witch hunts
were conducted, and offenders were burned
at the stake.
PERIOD OF ENLIGHTENMENT AND CREATION OF
MENTAL INSTITUTIONS
• 1790’s, a period of enlightenment
concerning persons with mental illness
began
• Philippe Pinel in France and William Tukes
in England formulated the Concept of
Asylum
• The period of enlightenment was short-
lived. Within 100 years after establishment
of the First Asylum
• State hospitals were in trouble
• Attendants were accused of abusing the
residents
• The rural locations of the hospitals were
viewed as isolating patients from their
families and homes, and
• The phase INSANE ASYLUM took on a
negative connotation
ASYLUM
• Concept of Asylum
• A safe refuge or haven offering
protection at institutions, where people
had been whipped, beaten and starved
just because they were mentally ill. With
this movement began the moral
treatment of the mentally ill
• Dorothea Dix in U.S. (1802-1887)
• Began a Crusade to reform the
treatment of Mental Illness after a visit
to Tukes in England
• She was instrumental in opening 32
State Hospitals that offered Asylum to
the suffering
• Dix believed that society was obligated
to those who were mentally ill and
promoted adequate shelter, nutritious
food, and warm clothing
THE PERIOD OF SCIENTIFIC STUDY AND
TREATMENT OF MENTAL DISORDERS: BEGAN WITH
• Sigmund Freud (1856-1939) and others,
such as Emil Kraepelin (1856-1926) and
Eugene Bleuler (1857-1939)
• The Study of Psychiatry and the Diagnosis
and Treatment of Mental Illness started in
earnest
• Freud challenge society to view human
beings objectively. He studies the mind, its
disorders, and their treatment as no one had
before. Many other theorists built on Freud’s
pioneering work
• Kraepelin began classifying mental disorders
according to their symptoms
• Bleuler, coined the term SCHIZOPRENIA
DEVELOPMENT OF
PSYCHOPHARMACOLOGY
1950
• A great leap in the treatment of mental
illness began with the development of
Psychotropic drugs, or drugs used to treat
mental illness
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• CHLORPROMAZINE (THORAZINE)
o An antipsychotic drug
• LITHIUM
o An antimanic agent, were the first
drugs to be developed
AFTER 10 YEARS
• Several psychotropic drugs developed
• MONOAMINE OXIDASE INHIBITOR (MAO
INHIBITOR)
o An antidepressants
• HALOPERIDOL (HALDOL)
o An antipsychotic
• TRICYCLIC
o An antidepressants
• BENZODIAZEPINES
o An antianxiety
• With these drugs it reduces agitation,
psychotic thinking and depression
• Hospital stays were shortened and well
enough to go home
• The level of noise, chaos and violence greatly
diminished in the hospital setting
COMMUNITY MENTAL HEALTH
- 1963: The movement treating those with mental
illness in less restrictive environments
- With the enactment of the Community Mental
Health Centers Act. Through this enactment they
create the DEINSTITUTIONAL
DEINSTITUTIONAL
• A deliberate shift from institutional care in a
state hospital to community facilities
• Function:
- Community Mental Health Center – it
served smaller geographic
catchment, or service, areas that
provided less restrictive treatment
located closer to individual’s homes,
families, and friends
• These centers provided: emergency care,
inpatient care, outpatient service, partial
hospitalization, screening services, and
education
 • Deinstitutionalization, accomplished the • Ability to find meaning in life
release of individual from long-term stays in • Emotional resilience or hardiness
state institutions, the decrease in admissions • Sense of belonging, reality orientation, and
to hospitals and the development of coping or stress management abilities
community-based services as an alternative • Factors include effective communication
to hospital care • Ability to help others, intimacy, and balance
of separateness and connectedness
“REVOLVING DOOR EFFECT”
• Positive effects of deinstitutionalization: it PSYCHOSIS VS NEUROSIS
reduced the number of public hospital beds
by 80%
PSYCHOSIS
• Revolving Door Effect = Repeated Hospital
• Is a severe mental disorder that involves a
Admissions
disruption in the individual’s capacity to
• People with severe and persistent mental
differentiate fantasy from reality
illness may show signs of improvement in a
few days but are not stabilized
NEUROSIS
• Is a maladaptive emotional state resulting
PSYCHIATRIC NURSING OR MENTAL from unresolved unconscious conflicts
HEALTH NURSING
DIFFFERENTATION BETWEEN PSYCHOSIS AND
NEUROSIS
Is the specialty of nursing that cares for people of all
ages with mental illness or mental distress PSYCHOSIS NEUROSIS
Requires Does not usually
I-HEALTH (ACCORDING TO WHO) hospitalization require hospitalization
• Is a state of complete physical, mental and Condition is considered Condition is considered
social well-being, and note merely the major reaction to stress minor reaction to stress
absence of disease or infirmity Reality testing greatly No grave interference
impaired with reality testing;
MENTAL HEALTH Ego remains sound
• A state of emotional, psychological, and Psychotic does not Neurotic feels his
social wellness evidenced by satisfying recognize he is ill suffering and wants to
relationships, effective behavior and coping, get well
positive self-concept, and emotional stability Denies reality and Does not deny reality;
substitute something Merely ignores it
3 FACTORS INFLUENCING A PERSON’S MENTAL else
HEALTH: Conation greatly Conation (action
1. Individual disturbed tendency or impulse
2. Interpersonal toward action) is
3. Social/Cultural disturbed
No secondary gain is Exploits symptoms for a
INDIVIDUAL OR PERSONAL derived by patient from secondary gain
• Factors include a person’s biologic make-up psychosis
• Autonomy and independence Desires and motives are Desires and motives are
• Self-esteem often projected; never externalized (no
• Capacity for growth Distortions of delusions and
• Vitality personality is great hallucinations)
Prepared By: Bucoy, Patricia Gabrielle S.
 Social Functioning is Personality usually • Manifestations:
greatly disturbed remains socially - Avoidance/Passivity
organized - Low Morale
- Lack of Accomplishment/Sense of
STRESS AND STRESSORS Ineffectiveness
- Detachment/Impersonal Response
STRESS - Chronic Complaining
• A state of imbalance between demands - Hostile Reaction to Others
placed on an individual and the individual’s
ability to deal with the demands • There are two (2) different things:
• A condition in which the human system - Under STRESS, one still struggles to
responds to input that has disturbed its cope with pressures. But once
steady state; a feeling of emotional or BURNOUT takes hold, you’re out of
physical tension gas and you’ve given up all hope of
surmounting your obstacles. It is
STRESSOR more commonly experienced as
helplessness/hopelessness
• An input that disturbs the steady state
• Neither positive nor negative but could
have either a positive or negative effect ANXIETY
depending upon how the system processes
it ANXIETY
• A subjective feeling of apprehension, dread,
POSITIVE - EUSTRESS NEGATIVE – DISTRESS or impending doom
Receiving prometon or Loss of job
raise at work FEAR
Starting a new job Injury/Illness • A reaction to a specific anger
Buying a home Death
Marriage Marriage separation ADAPTATION
Taking vacation Retirement • Human being’s response to stress
Holiday seasons
ANXIETY MAYBE DUE TO LOSS/THREAT TO:
• Health/Life
STRESS VS BURNOUT • Needs, Goals, Expectations
• Ability to Perform
STRESS • Self-Control
• A condition in which the human system • Control over one’s life
responds to input that has disturbed its • Status/Prestige
steady state; a feeling of emotional or • Resources
physical tension • Loved Ones
• Freedom/Independence
BURNOUT
• A state of mental or physical, emotional,
and mental exhaustion due to a long-term
involvement in an emotionally demanding
situation or maybe caused by excessive,
prolonged stress

Prepared By: Bucoy, Patricia Gabrielle S.

PROCESS OF ANXIETY § Confident
o COGNITIVE
§ Alertness
STRESSOR
§ Awareness of the
surroundings
ANXIETY § Concentration
§ Accurate perceptions
§ Attentiveness
NEUROCHEMICAL,
§ Logical reasoning & problem
PHYSIOLOGIC, AND EMOTIONAL
solving
REACTIONS
• LEVEL OF ANXIETY
COPING BEHAVIOR MODERATE +2
-PROBLEM – FOCUSED • SYMPTOMS
(Adaptive: recovery & health) o PSYCHOMOTOR
-DEFENSE MECHANISMS § Moderate muscle tension
(Palliative: temporary relief § Increased blood pressure,
pulse & respirations
ANXIETY RELIEF BEHAVIORS § Startle reflex
• Learning and Problem Solving § Slight perspiration
• Escape or Withdrawal – Suicide § Difficulty sitting still for long
• Acting Out – Violence § Periodic slow pacing
• Somatising § Increased rate of speech
• Use of Defense Mechanisms: Adaptive or § Sporadic eye contact
Maladaptive o EMOTIONAL
§ On edge, keyed up
CRISIS SITUATIONS IN RELATION TO THE § Increased irritability
PANDEMIC § Decreased confidence
• Diagnosis of an illness, hospitalization o COGNITIVE
• Losses – job, income § Difficulty in concentrating
• Dying and death § Easily distracted, can focus
• Mental Health Conditions – separation from with assistance
loved ones, isolation, panic, depression, § Narrowed perceptions
suicide § Decreased span of attention
§ Problem solving and
reasoning with effort or
MANIFESTATIONS OF ANXIETY assistance
§ Selective inattention
• LEVEL OF ANXIETY
MILD +1 • LEVEL OF ANXIETY
• SYMPTOMS SEVERE +3
o PSYCHOMOTOR • SYMPTOMS
§ Slight muscle tension o PSYCHOMOTOR
§ Slight fidgeting § Preparation of body for
§ Energetic “flight” or “fight”
§ Good eye contact § Extreme muscle tension
o EMOTIONAL § Increased perspiration
§ Occasional slight irritability
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 §Continuous and rapid pacing,
trembling
§ Loud and rapid speech
EFFECTS OF ANXIETY AND
§ Poor eye contact DESCRIPTIONS OF THE FOUR LEVELS
§ Somatic symptoms OF ANXIETY
o EMOTIONAL
§ Feeling of dread ANXIETY EFFECTS NURSING
o COGNITIVE LEVEL INTERVENTIONS
§ Difficulty focusing even with MILD Increased Use cognitive
assistance alertness; strategies,
§ Ineffective reasoning and enhanced stress-
problem solving learning management
§ Disorientation education and
problem solving
• LEVEL OF ANXIETY MODERATE Ability to Use relaxation
PANIC +4 focus on techniques;
• SYMPTOMS central assists in using
o PSYCHOMOTOR concerns, problem solving
§ Actual flight, fight or difficulty approaches;
immobilization staying teach about
§ Suicide attempts or violence attentive and coping
§ Eyes fixed being able to strategies;
§ Hysterical or mute learn encourage
§ Incoherent verbalization of
o EMOTIONAL feelings
§ Feeling overwhelmed SEVERE Inability to Encourage
o COGNITIVE focus or physical activity
§ Disorganized perceptions problem to stimulate
§ Disorganized or irrational solve, large muscle
reasoning and problem sympathetic groups and to
solving nervous release energy
§ Out of contact with reality system from “fight-
§ Personality disorganization activated flight” response;
structured tasks
or exercise
useful
PANIC Complete Decrease
inability to environmental
focus, stimuli; stay
disintegrated with client;
ability to using quiet
cope; voice, assist
physiological client to
symptoms perform
from “fight- relaxation
flight” breathing
response

Prepared By: Bucoy, Patricia Gabrielle S.

CHARACTERISTICS OF ANXIETY
• Subjective feeling
• Universally seen as unpleasant
• Stressor
• Adaptation
• A form of energy
• Occurs in degrees
EGO DEFENSE MECHANISM
When anxiety becomes overwhelming and too
painful, the ego “protects the individual from
feelings of inadequacy and 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 MECHANISM
Individual’s habitual patterns of dealing with stress
and other problems, they are generally
characteristic of a 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 activities maybe incorporated into coping
mechanism
Pacing, coughing, scratching, finger tapping,
experiencing increased urination and defecation,
increased sexual behavior, fighting, hand wringing,
eating, smoking, cleaning the house, fast driving,
shopping spree including screaming, cursing
DEFENSE MECHANISM
Defense mechanism are more elaborate
Processes and are more likely to arise in the face of
more serious, ongoing stressors
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Defense mechanism 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
IMMATURE DEFENSES
REGRESSION
• Person engages in behaviors appropriate at
an earlier stage of development
INTROJECTION
• When a person completely accepts the
values, opinions, and beliefs of another
person as his own
• Swallows and incorporates
IDENTIFICATION
• Imitates someone
• Superficial
• Integrates or adds to personality
FANTASY
• Gratification of unconscious wishes and
needs by imaginary achievements and
wishful thinking
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
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OTHER DEFENSE MECHANISMS
COMPENSATION
• When the individual makes up for an
imagined or real deficiency in one area 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 like happier by
making jokes and entertaining other people
ALTRUISM OR ALTRUISTIC SURRENDER
• Is a form of projection that at first glance
looks like its opposite: the person attempts
to fulfill his 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 - Academic failure
• Attributing a meaning to an object to accept - Diagnosis of serious illness
an unacceptable taking a more attainable
goal ADVENTITIOUS
• Occurs in response to severe trauma or
CONVERSION natural communities and even nations
• Expressing one’s feelings or conflicts through • Examples:
the body - Floods
- Earthquakes
CRISIS - Wars
- Crimes of violence
State of disequilibrium resulting from a stressful - Rape
event or perceived from a stressful event or a - Murder
perceived threat where the individual’s usual coping - Kidnapping
mechanisms become ineffective in dealing with it - Terroristic acts

Balancing factors:
§ The individual’s perception of the event EVENT
§ Past experiences in coping with stress
§ Established coping strategies PERCEPTION OF EVENT
§ Availability of support persons

TYPES OF CRISIS NOT A STRESSOR

STRESSOR
DEVELOPMENTAL OR MATURATIONAL
COPING
• Occurs in response to a transition from one
stage of maturation to another in the life
cycle (e.g. going forma adolescence to EFFECTIVE INEFFECTIVE
adulthood) COPING
• Examples:
- Beginning school
- Puberty CRISIS
- Graduation
- Marriage
- Birth of a child
CHARACTERISTICS OF CRISIS
- Children leaving home
Crisis occurs in all individuals at one time or another
- Retirement
Crisis is not necessarily pathological; it can provide
SITUATIONAL
stimulus for growth and learning
• Occurs in response to a sudden unexpected
event in an individual’s life. These events
A crisis is time limited and is usually resolved one
generally revolve around experience loss
way or another in a brief period (4 – 6 weeks)
(e.g. death of a loved one)
Ø Successful crisis resolution occurs when
• Examples:
functioning is restored or enhanced through
- Divorce
new learning
- Death
- Job loss
Prepared By: Bucoy, Patricia Gabrielle S.
 Ø Unsuccessful crisis resolution is when CHARACTERISTICS OF CRISIS STATE
functioning is not restored to pre-crisis level,
and the individual experiences decreased • Highly individualized
levels of functioning.
• Self-limiting
• Rarely affects the individual without also
The individual’s perception of the problem
affecting the significant others
determines the crisis
• The person is amenable to suggestions
• Has a growth potential
SYMPTOMS COMMON IN
INDIVIDUALS EXPERIENCING CRISIS SEQUENCE OF CRISIS DEVELOPMENT
PHYSICAL a. Pre crisis period – has emotional equilibrium
• Somatic complaints b. Crisis period – has subjective experience of
• Appetite disturbances upset, failure of usual coping mechanisms,
• Sleep disturbances symptoms experience
• Restlessness c. Post crisis period – resolution of crisis
• Tearfulness
• Irritability CRISIS INTERVENTION
COGNITIVE Is a method of providing assistance to those affected
• Confusion by a crisis, in which the immediate problem is
• Difficulty concentrating resolved and psychological equilibrium is restored
• Racing thoughts
• Inability to make decisions STEPS IN CRISIS INTERVENTION
BEHAVIORAL
1. Assess the situation
• Disorganization 2. Define the event
• Impulsive 3. Assist the client to develop cognitive
• Angry outbursts awareness of the event
• Difficulty carrying out usual role 4. Assist the client in managing feelings
responsibilities 5. Explore with the client the resources
• Withdrawal from social interaction available
6. Assist he client in action planning
EMOTIONAL
• Anxiety
• Anger
• Guilt
• Sadness
• Depression
• Paranoia
• Suspicion
• Helplessness
• Powerlessness

Prepared By: Bucoy, Patricia Gabrielle S.

 TECHNIQUES OF CRISIS
INTERVENTION
• ABREACTION
- A process by which repressed
material, particularly a painful
experience or a conflict is brought
back to consciousness
• CLARIFICATION – questions such as:
- What happened to you?
- What are your thoughts and
feelings?
- Are you experiencing physical
symptoms or changes in your usual
behavior?
- What have you tried to do so far to
resolves the crisis?
• SUGGESTION
• MANIPULATION
• REINFORCEMENT OF BEHAVIORS
• SUPPORT OF DEFENSES
• RAISING SELF-ESTEEM
• EXPLORATION OF SOLUTION
NURSING PROCESS
ASSESSMENT
§ Identify precipitating event of crisis
§ Determine client’s perception of crisis
§ Determine presence of balancing factors
§ Identify the client’s strengths
IMPLEMENTATION FOR THE CLIENT
WHO IS ANGRY AND VIOLENT
1. Intervene early to prevent client acting out
violence
§ Verbal signs
§ Nonverbal signs
2. Use measure to deescalate client’s anger
§ Answer client’s angry questions and
demands
§ Respond to underlying feelings
§ Allow client to vent anger verbally
§ Avoid defending your own behavior
§ Monitor our own body language
§ Provide client control
3. Responds to client’s violent behavior
§ Protect yourself
§ Protect others
§ Follow agency protocol
4. Use principle of violence code
§ Ensure a show of force
§ Designate one team member as a leader
§ Leader stands at the head of the team
§ Leader decides who will take each limb and
head
§ Team acts as on
§ Ensure safety and avoidance of client and
staff injury

NURSING DIAGNOSIS
§ Body image disturbance
§ Caregiver role strain
§ Community coping ineffective Coping
individual ineffective
§ Denial ineffective
§ Family coping potential for growth
§ Grieving dysfunctional
§ Post-trauma response
§ Powerlessness
§ Rape-trauma syndrome
§ Role performance altered
§ Spiritual distress
§ Violence risk for directed at self/others

Prepared By: Bucoy, Patricia Gabrielle S.

 KEY NURSING ASSESSMENT
QUESTIONS

PROVIDES DATA
QUESTIONS
ABOUT
• What happened to
you?
• What are your • Individual’s
thoughts and perception of
feelings? events
• Are you • Cognitive,
experiencing emotional
physical symptoms symptoms about
or changes in your what happened
usual behavior? • Physical behavioral
• Have you ever symptoms
experienced • Past experience
anything similar to with crisis, coping
this in your life? If measure in past
yes, how did you • Individual’s
cope at that time? recognition of
• What do you think strengths
are your personal • Supportive systems
strengths? available in your
• Who do you feel life
supportive or • Use of coping
helpful to you? measures in
• What have you tried present situation
to do so far to help
resolve the crisis?

Prepared By: Bucoy, Patricia Gabrielle S.

 WHAT IS SCHIZOPHRENIA? • Flight of Ideas
- Continuous flow of verbalization
• Causes distorted and bizarre thoughts, from one topic to another
perceptions, emotions, movements, behavior • Associative Looseness
- Fragmented or poorly related
• Cannot be defined as a single illness rather a thoughts or idea
syndrome or disease process with many different NEGATIVE OR SOFT SYMPTOMS
varieties and symptoms
• Alogia
• Can be controlled by medication - Poverty of speech
• Blunted Affect
• Usually diagnosed in late adolescence or early - Restricted range of emotional
adulthood feeling, tone, or mood
• Catatonia
WHEN IS THE PEAK INCIDENCE OF ONSET? - Client seems motionless
• MEN: 15 to 25 years old • Flat Affect
• WOMEN: 25 to 35 years old - Absence of facial expression
• Anhedonia
NOTE: Neurotransmitter of Schizophrenia are - Absence of joy or pleasure
dopamine and serotonin, where dopamine is the • Lack of Volition
happy hormone. When dopamine is high, serotonin - Absence of will, ambition, or drive
should be low. • Apathy
- Feelings if indifference toward
people, activities, or event
SYMPTOMS OF SCHIZOPRENIA
POSITIVE OR HARD SYMPTOMS TYPES OF SCHIZOPRENIA
• Hallucinations PARANOID TYPE
- False sensory perceptions or - Presenting sign is SUSPICIOUS, ideas of
perceptual experiences that do not persecution and delusions
exist in reality - Sees environment as hostile and threatening
• Ideas of Reference
- False impressions DISORGANIZED TYPE
• Delusions - With inappropriate behavior
- Fixed false beliefs - Silly crying, laughing, regression, transient
• Echopraxia hallucinations (auditory)
- Imitation of movements and - Magical thinking
gestures
• Perseveration CATATONIC TYPE
- Persistent adherence to a single idea - With stereotyped position (catatonia) with
or topic waxy flexibility, mutism, bizarre mannerism
- Verbal repetition of a sentence,
word, phrase resisting attempts to UNDIFFERENTIATED TYPE
change the topic - Symptoms of more than one type of
• Ambivalence schizophrenia
- Contradictory beliefs or feelings

Prepared By: Bucoy, Patricia Gabrielle S.

RESIDUAL TYPE
- Characterized by at least one previous,
though not a current episode
- Social withdrawal
- Flat affect
- Looseness of associations
CLINICAL COURSE
• Onset
• Immediate Course
• Long-Term Course
RELATED DISORDER
SCHIZOPHRENIFORM DISORDER
- Symptoms less than 6 months
- Social or occupational functioning may or
may not impaired
SCHIZOAFFECTIVE DISORDER
- Symptoms of psychosis and at the same time
all features of mood disorder either
depression or mania
DELUSIONAL DISORDER
- One or more non bizarre delusions (focus of
delusions is believable psychosocial
functioning is not markedly impaired and
behavior is not obviously odd or bizarre
BRIEF PSYCHOTIC DISORDER
- Sudden offset of at least one psychotic
symptom which last to one day to one night
to one month
SHARED PSYCHOTIC DISORDER (FOLIE A DEUX)
- Two people share similar delusion (in the
context of a close relationship with someone
who has psychotic delusions
Prepared By: Bucoy, Patricia Gabrielle S.
CAUSES OF SCHIZOPHRENIA
GENERIC FACTOR
• Studies have shown:
- Identical twins have 50% risk for
schizophrenia, whereas fraternal
twins have only 15% risk
- Children with biologic parents with
schizophrenia have a 15% risk; the
risk rises to 35% if both parents have
schizophrenia
NOTE: Second child will hit when the parents is
diagnosed with schizophrenia
NEUROANATOMIC AND NEUROCHEMICAL
FACTORS
• Neuroanatomic
- Less brain tissue and cerebrospinal
fluid
- Enlarged ventricles in the brain and
cortical atrophy
- Glucose metabolism and oxygen are
diminished in the frontal cortical
structures of the brain
- Decrease brain function in the frontal
and temporal areas
• Neurochemical
Alteration in the neurotransmitter system.
Neurochemical theories involved the dopamine
and serotonin:
- Excess dopamine as a cause: drugs
increase the dopaminergic system
such as amphetamine and levodopa,
sometime induce a psychotic
reaction similar to schizophrenia
Serotonin
- The leading neurochemical factors
affecting schizophrenia
- Modulates and help to control excess
dopamine, but sometime believed
that excess serotonin itself
contributes to the development of
schizophrenia
IMMUNOVIROLOGIC FACTORS and other psychotic motivation, social
- Exposure to a virus or the body’s immune symptoms withdrawal, and
response to a virus could alter the brain • Have not observable anhedonia (feeling
physiology of people with schizophrenia effect on the of no joy or pleasure
- Cytokines may have role in the development negative signs from life or any
of major psychotic disorders such as activities or
schizophrenia relationships)
- Infections in pregnant women; children born
in crowded areas in cold weather; conditions MAINTENANCE THERAPY
that are hospitable to respiratory ailments - Two antipsychotics are available in depot
injection forms for maintenance therapy:
STRESS Fluphenazine (Prolixin) in decanoate and
- Stress does not cause schizophrenia. enanthate preparations, and Haloperidol
However, it has proven that stress makes (Haldol) in decanoate
symptoms worse when the illness is present - Vehicle for depot injections is sesame oil:
Medications are absorbed slowly over time
DRUG ABUSE into the client’s system
- Drugs (including alcohol, tobacco, and street - Effects: 2-4 weeks eliminating the need for
drugs) themselves do not cause daily oral antipsychotic medication
schizophrenia. However certain drugs can - Duration: 7-28 days for fluphenazine and 4
make symptoms worse/trigger a psychotic weeks for haloperidol
episode if the person already has - These preparations are not suited for the
schizophrenia management of acute episodes of psychosis,
however, very suited for clients requiring
TREATMENT supervised medication compliance over
extended period
PSYCHOPHARMACOLOGY
- Primary medical treatment for schizophrenia SIDE EFFECTS
is psychopharmacology - Side effects are significant and can range
- Antipsychotic medications are also known as from mild discomfort to permanent
Neuroleptics movement disorders
- Not to cure schizophrenia, used only to - Cause two main side effects: Neurologic side
manage the symptoms of the disease effects and non-neurologic side effects
- Older or conventional antipsychotic and
newer or atypical antipsychotics NEUROLOGIC SIDE EFFECTS NON-NEUROLOGIC
SIDE EFFECTS
CONVENTIONAL ATYPICAL • Extrapyramidal side • Weight gain
ANTIPSYCHOTICS ANTIPSYCHOTICS effects – reversible • Sedation
• Dopamine • Both dopamine and movement disorders • Photosensitivity
antagonists serotonin induced by neuroleptic • Anticholinergic
• Actions: target the antagonists medication. Early symptoms:
positive signs of • Actions: not only detection and early - Dry mouth
schizophrenia such diminish positive treatment of EPS is very - Blurred
as delusions, symptoms, they important in promoting vision
hallucinations, also lessen the client’s compliance with - Constipation
disturbed thinking, negative signs of medication. They - Urinary
lack of volition and include: retention
Prepared By: Bucoy, Patricia Gabrielle S.
 - Dystonic reactions - Orthostatic GENERAL APPEARANCE, MOTOR BEHAVIOR AND
- Pseudoparkinsonism hypotension SPEECH
- Akathisia • Appearance may vary widely among
• Tardive dyskinesia: different clients with schizophrenia
- Involuntary
movements OVERALL MOTOR BEHAVIOR ALSO MAY APPEAR
- Irreversible ODD
- Decreasing • Catatonia
medication can - The client may be restless and unable
arrest progression to sit still, exhibit agitation and
• Seizures pacing, or appear unmoving
- Associated with high • Echopraxia
doses of medication - The client may imitate the movement
• Neuroleptic Malignant and gestures of someone whom she
Syndrome or he is observing
- Serious and • Psychomotor retardation
frequently fatal - A general slowing of all movements
- Muscle rigidity, • Waxy Flexibility
fever - Clients with the catatonic type of
- Treated by stopping schizophrenia may exhibit this
the medication
THE CLIENT MAY EXHIBIT UNUSUAL SPEECH
PSYCHOSOCIAL PATTERN
1. Individual and group therapy • Word Salad
- Gives client opportunity for social - Jumbled words and phrases that are
contact and meaningful relationships disconnected or incoherent and
with other people make no sense to the listener
2. Social skills training • Echolalia
- 3 forms of social skills training: - Repetition or imitation of what
a. Basic model someone else says
b. Social problem – solving
model UNUSUAL SPEECH PATTERNS OF CLIENTS WITH
c. Cognitive remediation SCHIZOPHRENIA
model • Clang association
3. Family education and therapy - Are ideas that are related to one
- Family is a factor that improves another based on sound or rhyming
outcomes for the client rather than meaning
- Helps make family members part of • Neologisms
treatment team - Are words invented by the client
• Verbigeration
ASSESSMENT - Is the stereotyped repetition of
words or phrases that may or may
HISTORY not have meaning to the listener
• Previous history of schizophrenia • Echolalia
• Age of onset of schizophrenia - Repetition or imitation of what
• Previous suicide attempts someone else says
• Perception of his or her current situation
Prepared By: Bucoy, Patricia Gabrielle S.
 • Stilted Language
- Is the use of words or phrases that
are flowery, excessive, and pompous
• Perseveration
- Is the persistent adherence to a
single idea or topic and verbal
repetition of a sentence, phrase, or
word, even when another person
attempts 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
THOUGHT 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
Prepared By: Bucoy, Patricia Gabrielle S.
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
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
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
REFERENNCE
- Involve the client’s belief that television
broadcasts, music, or newspaper articles
have special meaning for him or her
SENSORIUM AND INTELLECTUAL
PROCESSES
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 TACTILE HALLUCINATIONS
- Major problem in schizophrenia - Refer to sensations
- Lack of clear sense of where his mind, body, - Often found in client’s undergoing alcohol
and influence end withdrawal
- Depersonalization, derealization, ideas of
reference GUSTATORY HALLUCINATIONS
- Involve a taste lingering in the mouth
SOCIAL ISOLATION - Sense that food tastes like something else
- Inattention to hygiene and grooming
- Preoccupied with delusions and CENESTHETIC HALLUCINATIONS
hallucinations - Involves report that one feels bodily
- Fail to recognize hunger or thirst functions that are usually undetectable

POLYDIPSIA (EXCESSIVE WATER INTAKE) KINESTHETIC HALLUCINATIONS

- Patients with severe and persistent mental - Occur when the client is motionless but
illness reports the sensation of bodily movement
- Long-term therapy with antipsychotic
medications INTERVENTIONS
SLEEP PROBLEMS PROMOTING THE SAFETY OF CLIENT AND OTHERS
- Insomnia - Nurse must approach the client in a non-
threatening manner
HALLUCINATIONS - Nurse must observe for signs of building
- False sensory perceptions, or perceptual agitation or escalating behavior such as
experiences that do not exist in reality increased intensity of pacing, loud talking or
- Can involve the five senses and bodily yelling, and hitting or kicking objects
sensations - Administering medication; moving client to a
quiet, less stimulating environment, and in
TYPES OF HALLUCINATIONS extreme situation, temporarily using
restraints
AUDITORY HALLUCINATIONS
- Involve hearing sounds ESTABLISHING A THERAPEUTIC RELATIONSHIP
- Most often voices, talking to or about the - Trust between client and nurse helps allay
client the fear of a frightened client
- Command Hallucinations – are voices - Nurse must be patient for it takes time
demanding that the client take action, often - Nurse provides explanations that are clear,
to harm self or others direct, and easy to understand
- Nurse must assess carefully the client’s
VISUAL HALLUCINATIONS response to the use of touch
- Involve seeing images that do not exist at all
USING THERAPEUTIC COMMUNICATION
OLFACTORY HALLUCINATIONS - Nurse tries to understand and make sense of
- Involve smell or odor what the client is saying
- Often occur with dementia, seizures, and - Nurse must maintain nonverbal
CVA’s communication with the client, especially
when verbal communication is not very
successful

Prepared By: Bucoy, Patricia Gabrielle S.

 - Presence of nurse can demonstrate the
nurse’s genuine interest and caring to the
client
- Nurse must let the client know when his or
her meaning is not clear
IMPLEMENTING INTERVENTIONS FOR DELUSIONAL
THOUGHTS
- Nurse must avoid openly confronting the
delusion or arguing with the client about it
- Nurse must also avoid reinforcing the
delusional belief by “playing along” with
what client says
- Nurse can help the client minimize the
effects of delusional thinking through
distraction techniques and direct action
IMPLEMENTING INTERVENTIONS FOR
HALLUCINATIONS
- Nurse should focus on what is real and help
shift client’s response toward reality
- Nurse must determine what the client is
experiencing
- Nurse must elicit a description of the content
of the hallucination
- Nurse must infer from client’s behavior that
hallucinations are occurring
- Engage client in a reality-based activity
- Teach client to talk back to the voices
forcefully
CLIENT AND FAMILY TEACHING
• How to manage illness and prevent relapse
• Importance of maintaining prescribed
medication regimen and regular follow up
• Self-care and proper nutrition
• Avoiding alcohol and other drugs
• Teaching social skills through education, role
modeling, and practice
• Counseling and education of
family/significant others about the biologic
causes and clinical course of schizophrenia
and the need for ongoing support
• Importance of maintaining contact with
community and participating in supportive
organizations and care
Prepared By: Bucoy, Patricia Gabrielle S.
RISK FACTORS FOR RELAPSE
HEALTH RISK FACTORS
• Fatigue
• Impaired information processing
• Lack of sleep
• Lack of exercise
• Impaired cause- and effect- reasoning
• Poor nutrition
• Intolerable side effects of medication
ENVIRONMENTAL RISK FACTORS
• Financial difficulties
• Interpersonal difficulties
• Stressful changes in life events
• Housing difficulties
• Poor occupational skills, inability to keep a
job
• Poor social skills, social isolation, loneliness
BEHAVIOR AND EMOTIONAL RISK FACTORS
• Lack of control, aggressive or violent
behavior
• Low self-concept
• Looks and acts differently
• Loss of motivation
• Mood swings
• 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 ling
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
 • Monitor amount of sleepiness or - 1 therapist is equal to 7-10 patients in the
drowsiness. Avoid driving a car or potentially Philippines, however in other countries, 1
dangerous activities until your response time therapist is equal to 10-15 patients
and reflexes seem normal
• If you forget a dose of antipsychotic
medication, take it if the dose is only 3 to 4
hours late. If the missed dose is more than 4
hours late or the next dose is due, omit the
forgotten dose
• If you have difficulty remembering your
medication, use a chart to record doses
when taken or a pill box

SELF CARE AND PROPER NUTRITION

HYGIENE
- Direct the client through the necessary steps
for bathing and shampooing
- Directions should be in clear and short
statements
- Allow ample time for grooming – do not rush
the client
- Encourage to become more independent
when he/she is better oriented to reality

PROPER NUTRITION
- Important in physical and emotional well-
being
- Provide assistance as long as needed then
gradually promote the client’s independence
- Funding available (social worker)

TEACHING SOCIAL SKILLS

• Education, role modeling and practice
• Help the client learn neutral social topics
appropriate to any conversation
• Help excessive greater success in social
interactions
• Eye contact, attentive listening, taking turns
talking

NOTE:
- Empathy is the best attitude of the nurse
with patients with schizophrenia
- For paranoid patients – give daily walks

Prepared By: Bucoy, Patricia Gabrielle S.

 PERSONALITY THEORIES AND
DETERMINANTS OF
PSYCHOPATHOLOGY AS MODELS OF
CARE
NOTE: Herman Rorschach, a Swiss psychoanalyst,
believed that you’re answers, what you saw in the
ink says something about your personality. This is to
determine how people projected their personal
associations onto random shapes. Then he drew
conclusions about the patient’s personality. The
Rorschach test is just one of the methods
psychologists used in an ongoing quest to
understand personality. In goes down to the
question “what makes us who we are?”
PERSONALITY
• Is defined as your distinctive and enduring
characteristic patterns of thinking, feeling,
and behaving
• Psychologists study personality by:
- Trying to understand differences in
specific characteristics
- Looking at how all the various parts
of each person mesh together as a
whole
• There are nine perspectives on personality
theories:
1. Psychobiologic
2. Cognitive
3. Psychosocial
4. Behavioral
5. Psychodynamic/Psychoanalytic
6. Interpersonal
7. Humanistic
8. Psycho-spiritual
9. 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
Prepared By: Bucoy, Patricia Gabrielle S.
• 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
NOTE: Dr. House is one example of a doctor who
firmly stands with psychobiological theory in his
practice. He doesn’t believe that the patient has
schizophrenia so he explored more on the patient’s
psychobiological error and he was able to derive to
another diagnosis.
COGNITIVE THEORY
• It is within the premises of cognitive theory
that thoughts, ideas, and beliefs affects
feelings and behaviors
• It focuses on how a person’s thinking about
a situation or event affects the stimulus and
response
• Cognitive theories address a person’s
thinking about an event or situation as
having an effect on his or her response to a
stimulus (behavior)
NOTE: Clients engage in certain self-statements
based on distorted cognitions. These self-statements
contribute to maladaptation and related behaviors.
PSYCHOSOCIAL THEORY
• Social theories focus on understanding the
influences of and interaction between the
environment, cognition, and a person’s
behavior.
• It states that people influence and are
influenced by their environment, and that a
reciprocal relationship between an
individual and their social environment
exists.
• In summary, environment affects behavior.
An example is Erik Erikson’s stages of
development
NOTE: According to Bandura, the ability of humans
to change their behaviors and interactions in their
social environment can be influenced by observing
others’ behaviors and selecting those observed
behaviors they believe they can and want to change
in themselves.
Trust vs Mistrust: baby needs to figure out if his/her
caretakers can take care of the child. The child needs
to "trust" his/her family
Autonomy vs Shame & Doubt: The child, in this
stage, either builds their confidence or doubts
themself. Self-doubt can come from overprotective
parents
Initiative vs Guilt: The child's parents are major
influences in this stage because the child wants to
learn and if a parent shuts them down the child will
suppress his/her curiosity
Industry vs Inferiority: If the child fails to form new
relationships, he/she develops and inferiority
complex-child will compensate by being a bully
Identity vs Role Confusion: If the teenager does not
find himself/herself they will develop an identity
crisis-won't know who you are throughout your life
and fail Erikson's other stages
Prepared By: Bucoy, Patricia Gabrielle S.
Intimacy vs Isolation: Success leads to strong
relationships, while failure results in loneliness and
isolation
Generativity vs Stagnation: In this stage, adults
generally have kids so that they have someone to
love and care for and also to feel useful
Integrity vs Despair: During their last years of life,
the person looks back on their life to determine if it
was meaningful or not
BEHAVIORAL THEORY
• Behavior is learned. The person becomes
who they are by environmental shaping;
behavior can be observed, described,
recorded, subject to reward and punishment
• Behavioral theory proposes that a person’s
behavior is the result of learning that is a
response to a stimulus
• A person may learn a certain response
(behavior) either to receive a reward or to
avoid a punishment
EXAMPLE: Losing one’s temper with a nagging
spouse might serve as a positive reinforce if the
spouse feels neglected and nags to get any kind of
attention. Nagging, unpleasant thought it might
seem, will likely result in more nagging if it achieves
the objective of gaining a response. The nagging has
been reinforced
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’s trying to deal with reality. Ego
Prepared By: Bucoy, Patricia Gabrielle S.
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.
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
• Hildegard Peplau considered as the mother
of psychiatric nursing. She considers nursing
to be an interpersonal process between
nurse and client
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
NOTE: Abraham Maslow developed a hierarchy of
needs, which progresses from most basic to the
highest level of actualization. This hierarchy
includes: physiological
needs, safety needs, belongingness and love needs,
esteem needs, and the need for self-actualization
PSYCHO-SPIRITUAL 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

Prepared By: Bucoy, Patricia Gabrielle S.