- reduce attention to other

TREATMENT:
 Benzodiazepines
 SSRI Antidepressant
PANIC DISORDER  TCA
-extreme, overwhelming form of anxiety often experienced when an individual is  Clonidine (Catapres-Antihypertensive)-Sublingual
placed in a real or perceived life-threatening situations.  Propanolol Dec. palpitation
-duration of 15-30 minutes
-no effect on benzodiazepine MANAGEMENT:
 Cognitive behavioral Techniques
FOUR OR MORE OF THE FOLLOWING SYMPTOMS:  Deep breathing and relaxation
 Palpitations
 Sweating NURSING INTERVENTION:
 Tremors  Provide a safe environment and ensure privacy
 Shortness of breath  Use therapeutic communication
 Sense of suffocation  Manage anxiety
 Chill  Provide client and family education
 Chest pain
 Abdominal distress
 Nausea PHOBIAS
 Dizziness
 Paresthesia (tingling or numb feeling) -intense, illogical, persistent fear of a specific object or social situation that
 Hot flushes causes extreme distress and interferes with normal functioning
-person may never have had contact with the object
DIAGNOSIS -a person feels powerless to stop it
 Recurrent, unexpected panic attacks, followed by at least 1 month of
persistent concern or worry, -“Philia”Gustong gusto
 Happen in 15% in people with depression -Ex: Firophilia- like fire
 Peaks in late adolescence and mid 30’s
3 CATEGORIES
CLINICAL COURSE:
1. AGORAPHOBIA
 Can lead to AVOIDANCE BEHAVIOR
2. SPECIFIC PHOBIA
 Developed AGORAPHOBIA (fear of the market place or fear being
3. SOUND ANXIETY/ PHOBIA
outside)
-fear of judgement (fear of mistake that other will judge them)
PRIMARY GAIN
-is the relief of anxiety achieved by performing the specific anxiety-driven
behavior.
-reduce anxiety
-Ex: stay in the house AVOIDANCE BEHAVIOR

SECONDARY GAIN
-attention receive from others as a result of these behaviors
 TREATMENT:
1. DRUGS (Benzodiazepines)
2. Behavior Therapy
-SYSTEMIC DESENSITIZATION (Onti onti I expose sa fear)
-FLOODING (done by clinical therapist- not nurse)

GENERALIZE ANXIETY DISORDER (GAD)

-Characterized by at least 6 months of persistive and excessive worry and

anxiety (unable to control)
-not usually diagnosed by psychiatrist
-diagnose physician -give the ff. medication treatment
3 or more of the following symptoms:
-Uneasiness
-Irritability
-dizziness
-muscle tension
CATEGORY OF SPECIFIC PHOBIAS -fatigue
1. NATURAL ENVIRONMENT -difficulty thinking
a) Astrophobia (fear of aliens/ stars, lightning and space) -sleep alteration
b) Hydrophobia (fear of water)
c) Dendrophobia (fear of trees) TREATMENT
2. BLOOD INJECTION PHOBIAS (MUTILATION/MEDICAL -Buspirone -treat GAD (Anxiolytics -Dec. Symptoms of Anxiety)
TREATMENT) -SSRI
a) Trypanophobia (fear of needles)
b) Dentophobia (fear of dentists)
c) Hemophobia (fear of blood)
OCD (OBSESSIVE-COMPULSIVE DISORDER)
3. SITUATIONAL PHOBIA
a) Claustrophobia (fear of closed space) OBSESSION- recurrent, persistent, intrusive, and unwanted thoughts, images,
b) Aerophobia (fear of flying/airplane) or impulses that cause marked anxiety, that interfere with interpersonal, social,
c) Glossophobia (fear of public speaking) or occupational function.
4. ANIMAL PHOBIA COMPULSION -ritualistic or repetitive behaviors or mental acts that a person
a) Batrachophobia (fear of amphibians like frogs, toads carries continuously in an attempt to neutralize anxiety.
b) Cynophobia (fear of dogs)
c) Equinophobia (fear of horse) COMMON COMPULSIVE
ONSET AND CLINICAL COURSE  Checking Rituals
-usually occur in childhood adolescence  County Rituals
-Lifelong 80% of the time  Washing/ Scrubbing
-Peak age is middle adolescence  Praying and chanting
-The course of social phobia is often continuous although may become less  Touchy, rubbing/ tapping
severe  Ordering
 Aggressive urges
 appearance such as thinking
OCD
- repetitive meaningless actions that are difficult to conquer
-used to alleviate anxiety or to prevent terrible thoughts.
-diagnosed only when these thoughts images and impulses consume the
person, or when they are compelled to act on the behaviors to the point at which
they interfere with personal, social, and occupational functions.

ONSET AND CLINICAL COURSE:

-start in childhood especially in males, for females begins 20s 7. HOARDING DISORDER
-equally disturbed for both sexes -Progressive, debilitating, compulsive disorder only recently diagnosed
on its own
RELATED DISORDER OF OCD -Excessive acquisition of animals or apparently useless things, cluttered
EXCORIATION living spaces that become inhabitable, and significant distress and
TRICHOTILLOMANIA impairment for the individual.
ONYCHOPHAGIA 8. KLEPTOMANIA
OMNIOMANIA -Compulsive stealing, reward seeking behavior
BODY IDENTITY DISORDER -Common in females with frequent comorbid diagnosis of depression
BODY DYSMORPHIC DISORDER and substance use
HOARDING DISORDER TREATMENT FOR OCD
-Medication
1. EXCORIATION -Behavior Therapy
-dermatiliomania a. Exposure
-categorized as self-soothing behavior b. Response prevention

SCHIZOPHRENIA

 Is not a single disease rather it is thought of as a syndrome or as a

disease process with many varieties and symptoms.
2. TRICHOTILLOMANIA  Usually diagnosed in late adolescence or early adulthood.
-Chronic repetitive hair pulling  The peak incidence of onset is 15 to 25 years of age for men and 25 to
-Self soothing behavior that can cause distress and impairment 35 years of age for women.
3. ONYCHOPHAGIA  Prevalence is estimated at 1% of the total population.
-chronic nail biting  Symptoms are divided into two major categories
4. ONIOMANIA POSITIVE (HARD SYMPTOMS/ SIGNS)
-Compulsive buying NEGATIVE (SOFT SYMPTOMS/ SIGNS)
-Acquisition type of reward behavior
5. BODY IDENTITY DISORDER NEGATIVE SYMPTOMS OF SCHIZOPHRENIA
-Term given to people who feel “overcomplete” or alternated from a part 5 A’S
of their body and desire amputation. ALOGIA(reduction in quantity of words spoken),
-Amputee identity disorder, apotemnophilia “Amputation love” AVOLITION (reduced goal-directed activity due to decreased motivation),
6. BODY DYSMORPHIC DISORDER (BBD) ASOCIALITY (lack of motivation to engage in social interaction)
-preoccupation with an imagined or exaggerated defect in physical ANHEDONIA (reduced experience of pleasure)
APATHY (lack of interest/concern)
BLUNTED AFFECT- decreased ability to express emotion through your facial
expressions, tone of voice, and physical movements
CATATONIA - disrupts a person's awareness of the world around them.
FLAT AFFECT- no emotional expression
INATTENTION- lack of attention; distraction.
ONSET
 May be abrupt or insidious
 Diagnosis of schizophrenia is made when the person begins to display
more actively positive symptoms of delusions, hallucination, and
disordered thinking (psychosis)
 Those who develop the illness earlier show worse outcomes that those
who develop it later
 Younger clients display a poorer pre-morbid adjustment than do older
clients
 Those who experience a gradual onset tend to have a poorer-immediate
and long-term course than those who experience an acute and sudden
onset.
 Approximately one third to one half relapse within 1 year an acute
episode.
IMMEDIATE TERM COURSE
 TWO CLINICAL PATTERNS EMERGE
1. The client experiences ongoing psychosis and never fully recovers,
although may shift in severity over time.
2. The client experiences episodes of psychotic symptoms that alternate
with episodes of relatively complete recovery from the psychosis.
LONG TERM COURSE
 The intensity of psychosis tends to diminished with age.
 The disease becomes less disruptive to the persons life and easier to
manage but rarely can the clients overcome the effects of many years
dysfunction.
 Many clients have difficulty functioning in the community and few lead
fully independent lives.
 Antipsychotic medications play a crucial role in the course of the
disease and individual outcomes.
OTHER RELATED DISORDER
1. SCHIZOAFFECTIVE DISORDER
 Mixture of psychotic and mood symptoms
 Psychosis characterized by both affective and schizophrenic
symptoms with substantial loss of occupational and social
functioning
 The symptoms may occur simultaneously or may alternate
between psychotic and mood disorder symptoms
 Long-term outcomes for the Bipolar type of schizoaffective
disorder-similar for those for bipolar disorder
 Outcomes for the Depressed type of Schizoaffective disorder-
similar to those for schizophrenia.
2. SCHIZOPHRENIFORM DISORDER
 Displays symptoms that are typical with schizophrenia and lasts
at least 1 month but no longer than 6 months.
3. CATATONIA
 -Characterized by marked psychomotor disturbances and either
excessive motor activity or virtual immobility and motionless
 -Cataplexy (waxy flexibility)/ stupor- headbang
 Excessive motor activity is apparently purposeful and not
influenced by external stimuli
 Include negativism, mutism, peculiar movements, echolalia, or
echopraxia.
 It can occur with schcizophrenia, mood disorders or other
psychotic disorders.
4. DELUSIONAL DISORDER
 The client has one or more non-bizarre delusions that is the
focus of the delusion is believable
 May be persecutory, erotomatic, grandiose, jealous or somatic
in content.
 Psychosocial functioning is not markedly impaired and behavior
is not obviously odd or bizarre.
5. BRIEF PSYCHOTIC DISORDER
• Includes all psychotic disturbances that less than 1 month
and are not related to a mood disorder, a general medical
condition, or a substance-induced disorder
-At least one of the following psychotic disorders:
-Delusions
-Hallucinations
-Disorganized speech
-Grossly disorganized or catatonic behavior.
6. SHARED PSYCHOTIC DISORDER
 Two people share a similar delusion
 The person with this diagnosis develops this delusion in the
context of a close relationshiops with someone who has
psychotic delusions, most commonly siblings, parents and child
or partners.
 The more submissive or suggestible person may rapidly
improve if separated from the dominant person.
7. SCHIZOTYPAL PERSONALITY DISORDER
 Involves odd, eccentric behaviors including transient psychotic
symptoms
 Person with this personality disorder may eventually be
diagnosed with schizophrenia.

ETIOLOGY
GENETIC FACTORS
NEUROANATOMIC AND NEUROCHEMICAL FACTORS
-less brain tissue and CSF (90-200 ml normal value)
-diminished glucose metabolism and oxygen in the frontal and temporal areas
-Low glucose Frontal- Negative Symptoms
-Low glucose Temporal- Positive Symptoms

-intrauterine influences
-Excess dopamine and serotonin