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A. Psychoanalytic Model: (Freud¶s Theory)
‡ Personality Components:
ID: ³the demanding child´
: ruled by the Pleasure Principle ±
reflects basic or innate desires such
as pleasure seeking behavior,
aggression and sexual impulse
: seeks instant gratification, causes
impulsive unthinking behavior, and
has no regard for rules or social
convention

SUPEREGO: ³the judge´, ³an
internalized parent´ to bring
behavior under control
: ruled by the Moral Principle
: the part of a person¶s nature that
reflects moral and ethical concepts,
values and parental and social
expectations
: in direct opposition to the id
: weak superego ± delinquent,
criminal, antisocial personality
: may cause inhibition, rigidity or
unbearable guilt
!³the executive´
!guided by the Reality Principle:
delays action until it is practical or
appropriate
: the system of thinking, planning,
problem solving, and deciding
: is in conscious control of the
personality
: the balancing or mediating force
between the id and the superego
: represents mature and adaptive
behavior that allows a person to
function successfully in the world 

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o1 @
! overachievement in one area to
offset real or perceived deficiencies in another area.
Y      
      
   

1  |! expression of an emotional conflict
through the development of a physical symptom,
usually sensorimotor in nature. Y   
    
     
    .
A1 + '! failure to acknowledge an unbearable
condition; failure to admit the reality of a situation or
how one enables the problem to continue. Y  
      
  
  
´1 +": ventilation of intense feelings
towards persons less threatening than the one who
aroused those feelings. Y     

Ë1 +! dealing with emotional conflict by a
temporary alteration in consciousness or identity.
Y    !
     
 
â. : immobilization of a certain portion of the
personality resulting from unsuccessful completion of
tasks in a developmental stage. Y     
"   

ù. +   : modeling actions and opinions of
influential others while searching for identity, or
aspiring to reach a personal, social,or occupational
goal. Y       

#  
    

.  '' '9: separation of the
emotions of a painful event or situation from the facts
involved; acknowledging the facts but not the
emotions. Y        $  
   
>. |: : accepting another person¶s
attitude, beliefs, and values as one¶s own. Y   
    %
like his best friend
10.
|: : unconscious blaming of
unacceptable inclination or thoughts on an external
object. Y  &     
     
  % 

oo1|'9!excusing own behavior to
avoid guilt, responsibility, conflict, anxiety, or loss of
self-respect. Y      
  &  
! 
o1 |   |@: Acting the opposite of
what one thinks or feels. Y      
  '  (   
 

oA1| | !Moving back to a previous
developmental stage to feel safe or have needs met.
Y  )  
& *   
 ! 
o´1|
| ! Excluding emotionally painful or
anxiety-provoking thoughts and feelings from
conscious awareness. Y  +       
+     
,    

oË1|  ! Overt or covert antagonism toward
remembering or processing anxiety - producing
information. Y    
       
  

o 10'@!Exhibiting acceptable behavior to
make up for or negate unacceptable behavior. Y  
    
- &    
    
o10!Substituting a socially
acceptable activity for an impulse that is unacceptable.
Y    -    
      
.)    % 
o1

| !Replacing the desired
gratification with one that is more readily available.
Y  +     
 
o1+! |$negating or undoing
intolerable feelings or thoughts. Y      
 
      
   
  
   

 |+  @ @  

!The individual copes with
stress by engaging in actions rather than
reflecting upon internal beliefs 
'! Involves turning to other
people for support 
@ 0! The individual accepts a
modified form of their original goal 
'|@! Satisfying internal needs
through helping others 
+ ! Refusing to deal with or
encounter unpleasant objects or situations 
@|! Pointing out the funny or ironic
aspects of a situation 

)| : Indirectly
expressing anger
´'  '&'  + 

‡ 1st level: considered normal and involves
conscious efforts at maintaining control over
anxiety by changing the environment or one¶s
perspective: ð ððð ð 


    

ð
‡ 2nd level: involves character changes and
manipulation of relationships with others. May
lead to personality disorders if prolonged or
exaggerated and to difficulties in the interpersonal
areas of work, marriage and parenting:
       

ð 


‡ 3rd level: comprises the repressive defenses
which involve changes in the intrapsychic
process: ð    

ð  
ð   

ð   
ððð

‡ 4th level: seen in the use of the regressive
defenses and involves a return to a state of
helplessness and withdrawal from reality:  
ðð 
ðð
01 0 |'@+ '! Pavlov¶s Theory
( Classical Conditioning); Skinner¶s Theory
( Operant Conditioning)
 
!
- Maladaptive behaviors are learned through
conditioning and continue because they are
rewarding to the person
- Maladaptive behaviors can change/ be changed
without developing insight into underlying causes
by altering the environment
. @(!%/$
 

-Personality develops thru interaction with
significant others: approval or disapproval of
others
-Self-concept / Self-system: ³good me´, ³ bad me
³, and ³ not me ³
-When relationships are uncomfortable
ANXIETY
- Mental Illness: inappropriate interpersonal
relationship and the cause related to past
relationships, inappropriate communication and
current crisis
+1  @+ '!
 
!
-Learned thoughts become the basis for
emotions and behavior
- The amount of perceived control over situations
affects behavior
- Mental Illness is a product of distorted thinking

1 @ @+ '!
 
!
-Focus ia on the ³Here and Now´
-The self is unique and is in search of meaning
and authenticity
- Human needs are organized in heirarchy of
relative order; e.g. Maslow¶s
-Mental Illness is a failure to fully develop one¶s
potential
-Lack of self-awareness and unmet needs
interfere with relationships and feelings of
security
-The fundamental human anxiety is fear of death,
which leads to existential anxiety (concern over
the meaning of one¶s life)
1  
0' @+ '!
 
!
-Mental Illness is a biophysical impairment
influenced by genetics, biochemical alterations,
nervous system function
-Mental Illness can be predisposed however not
only by physiologic factors but by social and
environmental factors as well.
| + |;

<)o@
|' |%1
-³I am what I will´ @|
-Focus of energy: mouth -consistency: trust
-inconsistency:
mistrust

0% 
*"! Listlessness, lethargy, disturbed
feeding (failure to thrive), abnormal crying, social
unresponsiveness

$! Infantile Autism ( Pervasive Developmental
Disorder

@ %1
o@) A '  @ #+0
|
-Focus of energy :elimination -successful choices:
control (autonomy)
-superego development begins
-unsuccessful
choices: shame &
doubt
0% 
*"! Constipation, diarrhea, enuresis,
encopresis, excessive rebellion, excessive conformity

$! Autism, separation anxiety
| + |;
A) $ 
''   %1'

-´I am what I imagine´ -Exploring &
successful
-Focus of energy: relationships with
Genitals parents: initiative
-Unsuccessful
relationships with
parents: guilt

0 |
|0' @! Excessive masturbation,
excessive fears
 
' !attention deficit disorder, psychophysiological
disorders, anxiety disorders, avoidant disorder, overanxious
disorder, childhood onset pervasive disorder

'   +| %1
)o$
 ||
-´I am what I am´
-Work with competency:
-Focus of energy: same Industry
sex friends
-Unable to satisfy family
expectations: Inferiority

0 |
|0' @!withdrawal from peers, low
self-esteem, aggression, short attention span, learning
difficulties
 
' ! Childhood onset pervasive
developmental disorder, anxiety disorders, attention
deficit disorder
 ' +  |' 
o)<$  
-Focus of energy:
Opposite sex -Integrate past with
present roles: roles:
Identity

0 |'
|0' @! Rebelliousness ( lying, stealing,
promiscuity, running away), drug/ alcohol abuse
 
' ! Conduct disorders, eating disorders, affective
disorders, suicide, substance abuse disorders

@ %1
'
o)Ë$
-Capacity for love,
commitment to work &
relationships: Intimacy

0 |
|0' @! Isolation, Impersonal Relationships,
Inconsistent Work History  

' ! Affective Disorders, Suicide, Schizophrenia,
Drug/Alcohol Addiction, Personality disorder

  | %1

Ë) Ë$
-Creative, Productive
concern for others:
Generativity
0 |
|0' @! Self Indulgence; Low Self-esteem  

' ! Affective Disorders, Neurosis, Psychosis,
Psychophysiologic Disororders



   |@' +
+  '
@ 

ºirth- 1 moths ‡ ‡ Recognizes and attaches to
Sensorimotor primary caretaker, develops
simple motor skills, moves
from instant gratification to
coping with anxiety;
‡ Learns about self through
the environment

1 months ± 3 years ‡ ‡ Learns to manipulate
Preoperational environment, after negativism
learns self-control in toilet
training, parallel play
‡ Develops expressive
language and symbolic play
3 ± â years ‡ Preoperational intuitive ‡ Learns symbols
and concepts,
assertiveness
against
environment;
learns sex role
identity

â 12 year ‡ Concrete operational ‡ Sees cause and
effect and draws
conclusions,
develops
allegiance to
friends, uses
energy to
industriously to
create and perform
tasks, shows
competency in
school and with
friends
12 ± 1 years ‡ Formal operational ‡Thinks abstractly,
uses logic and
scientific reason,
masters
independence
through rebellion,
develops firm
sense of self, is
strongly influenced
by peers, develops
sexual maturity,
explores sexual
relationships
1 ± 25 ‡ Develops lasting intimate relationships and
years good work relationships

24 ± 45 ‡ Establishes a family and oversees next
years generation, is productive, shows concern for
others

45 years ± ‡ Sees own life as meaningful, is productive,
death accepts physical changes
‡
|+ | 
| 
‡ | =(* 
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‡3INTERRELATED ºALANCING
FACTORS CONTRIºUTING TO THE
PRODUCTION AND OUTCOME OF A
CRISIS:
- perception of the problem
- situational supports
- coping skills

‡ GOAL OF THERAPY
To help client resolve the problem
and return to his pre-crisis level of
functioning or to a higher level of
functioning in a short period of time (4-â
weeks)

‡ ROLE OF THE NURSE:
to assess the situation quickly and
accurately and to assist the client in a
tentative formulation of his problem.
@@ 
‡ + ! the act of imparting and
exchanging ideas, facts and feelings with
others
‡ |@! verbal and non-verbal
‡  |
  @@ 
 @ !
ö ACKNOWLEDGE THE PATIENT
ö COMMUNICATE ACCEPTANCE TO THE
CLIENT
ö ENCOURAGE THE CLIENT TO EXPRESS
FEELINGS, CONCERNS, ETC
ö INCLUDE OPEN-ENDED STATEMENTS
AND ENCOURAGE DISCUSSION
ö DEAL WITH PATIENT NEED, ³HERE AND
NOW´
ö OFTEN REFLECT COMMON SENSE,
ºASED UPON NURSES¶S EDUCATION
ö ARE ³DOWN-TO-EARTH CHOICES´ NOT
³HIGH SOUNDING´ EDUCATED
STATEMENTS

   |
 
@@  @ 
‡  |@ : establish
climate where client feels cared for and
comfortable
‡   @ 
: sensitivity to
clients¶ current feelings and
communicating this to the client
‡ +
'    : nurse¶s
response is sincere and an expression of
real feelings
‡  | 
: a point of view
that says the client counts and has dignity
‡ '   ' : assume
attitudes of wanting to hear what client
says
‡ + 0+| : social,
physical and emotional limits the nurse
creates
‡ | |@ ! client having
accurate information about how much
time nurse can offer
‡  
: recognizing verbal and non-
verbal patterns of clients¶ immediate
behavior and tension
‡  ' @ : no
³why´ questions
‡| : repeat what client says with
purpose of increasing client¶s awareness of
what he is saying
‡'+: checking accuracy of
communication with each other
‡0 ;| ;: going over what has
been talked about in order to regain focus
‡; |+ @|+ 
''|! giving example/s
‡
|+ |@: teaching
‡ @ 
9| '  

0   
|+ ' : helps
client understand his/ner pattern of thinking
about problems
‡ | 
: understanding conveyed
by nurse of client¶s despair or pain
‡@@|9: way to reinforce important
ideas or points as to check out nurses¶
perceptions 

@@ 0' ; |!
‡CLOSED DISCUSSION
‡ºELITTLING OR ³TALKING DOWN´ TO THE CLIENT
‡SHIFTING RESPONSIºILITY, UNNECESSARILY, TO
OTHERS, SUCH AS THE DOCTOR, HEADNURSE,
ETC.
‡INTELLECTUALIZING IN AºSTRACT LANGUAGE
AºOUT AºSTRACT CONCEPTS TO A CLIENT WITH
VERY CONCRETE NEEDS

„ „ „  
„  „   

„„   „
 „ 

   @
'   |
  @ !
‡' 
‡ 
: yes; uh-hmm; I follow what you said; nodding
‡| : Good morning, Mr. Santos. I see
you¶ve combed your hair
‡ | ' : I¶ll sit with you awhile; I¶ll stay here with
you; I¶m interested in your comfort
‡0|+
: Is there something you¶d like
to talk about? What are you thinking about? Where would
you like to begin?
‡ |  |'' +: Go on; And then; Tell me
about it
‡
'    @ | @  : What
seemed to lead up to«? Was this before or after«?; When
did this happen?
‡@;0 |: You appear tense; Are you
uncomfortable
‡  |+  | 

| 
: Tell
me when you feel anxious., What is happening?, What does
the voice seem to be saying?
‡  | @ 
|: Was this something
like«? Have you had similar experiences?
‡| ! Client: I can¶t sleep. I stay awake all night.
Nurse: You have difficulty sleeping?
‡| ' ! Client: Do you think I should tell the doctor?
Nurse: Do you think you should?
Client: My brother spends all my money and
then has the nerve to ask for more
Nurse: This causes you to feel angry?
‡  : This point seems worth looking at more
closely.; Tell me more about that.; Would you
describe it more fully.; What kind of work«
‡ |@: My name is«; Visiting hours
are«; My purpose in being here is«
‡ ; '|  : I¶m not sure that I follow; What
would you say is the main point of what you
said?
‡
|  | ' : I see no one else in the room;
The sound was a car backfiring.; Your mother
is not here, I¶m a nurse.
‡ +0: Isn¶t that unusual?; Really?; That¶s hard
to believe.
‡ ;  ''+: Tell me whether
my understanding of it agrees with yours; Are
you using this word to convey the idea«?
‡ |0'9 @
' +: Client: I can¶t talk to you or
to anyone. It¶s a waste of time.
Nurse: Is it your feeling that no one
understands?
‡  | ': What are your
feelings in regard to«?; Does this
contribute to your discomfort?
‡ @ 
|' :
Client: I¶m dead.
Nurse: Are you suggesting that you feel
lifeless? Or is it that life seems without
meaning?
‡  ''0|:: Perhaps
you and I can«
‡@@|9: Have I gotten this straight?;
You¶ve said«
‡  | |@' 
' 
 : What could you do to let your anger
out harmlessly?; Next time this comes
up, what might you do to handle it?
NONTHERAPEUTIC TECHNIQUES
‡ | |: Everything will be alright
‡ 

|': That¶s good
‡ | : ! Lets not discuss that
‡ +

|: That¶s bad
‡ | : That¶s right
‡ +| ! I definitely disagree with that
‡ +: I think you should
‡
|0: Now tell me about«
‡ '' : ºut how can you be President of the
Philippines?
‡  : What day is this?
‡ + +6 No one here would lie to you
‡ | @  
': Why do you feel this way
‡ +        |'
| : Who told you that?; What makes you say that?
‡ 0 '' ' 
|  +: Everybody feels low
at times
‡ @; | 
+ @@ : Nice weather we¶re
having
‡ ' |'|  
: Client: I¶m an easter egg
Nurse: What design?
‡ + ': Client: I am nothing
Nurse: Of course you¶re something. Everybody is somebody.
‡  |
| : What you really mean is«; Unconsciously
you are saying«
‡ |+ | ' + 
! Client: I¶d like to
die
Nurse: Did you get any visitors this weekend?
  +|+ | 
,$is an apprehensive anticipation of an
unknown danger.  
is a reaction to an 
, in contrast to 
, which is an emotional response to a
consciously recognized external threat. ºoth
anxiety and fear cause a similar $  
, including    

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A small amount of anxiety is constructive, but too
much can be disabling and overwhelming.
Severity of anxiety is rated as mild, moderate,
severe, or panic. |,$*
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assess cultural factors that may contribute to or
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A reducing environmental stimuli
(lights, noise, activity),
*administering medications as
ordered and observing effects,
*using therapeutic communication
skills to encourage the client to
talk and express feelings,
*recommending physical activities
as outlets for nervous energy and
as distractions from anxiety,
*teaching the client about
diagnoses and treatments.
0' A
  +|+ |


|  |  @ @ 

Phobia ‡ Apprehension, ‡ Avoid confrontation
anxiety, helplessness and humiliation
when confronted with ‡ Do not focus on
phobic situation or getting patient to stop
feared object being afraid
‡ Examples of specific ‡ Systematic
fears: desensitization
Acrophobia ± heights ‡ Relaxation techniques
Claustrophobia ± ‡ General anxiety
closed areas measures
Agoraphobia ± open ‡ May be managed with
spaces antidepressants

Anorexia ‡ Most common in ‡ Monitor clinical status
nervosa females 12-1 years (e.g., weight, intake,
old; characterized by vital signs)
fear of obesity, ‡ ºehavior modification
dramatic weight loss, may help in acute phase
distorted body image, ‡ Family therapy
anemia amenorrhea.
Cathartics and enemas ‡ Support efforts to take
may be used. responsibility for self
‡ Characterized by ‡ Explore issues around
ºulemia sexuality
binge eating and
purging with induced ‡ May be managed with
vomiting antidepressants

|  |  @ @ 

Obsessive ± ‡ Obsession ± ‡ Accept ritualistic
compulsive repetitive, behavior
disorder uncontrollable thoughts ‡ Structure environment
‡Compulsion ± ‡ Provide for physical
repetitive, needs
uncontrollable acts ‡ Offer alternative
e.g., rituals, rigidity, activities, especially
inflexibility using hands
‡ Guide decisions,
minimize choices
‡ Encourage
socialization
‡ Group therapy
‡ Managed with
clomipramine (Anafranil)
Conversion ‡ Physical symptoms ‡ Diagnosis evaluation
hysteria with no organic basis, ‡ Discuss feelings rather
unconscious behavior ± than symptoms
could include ‡ Promote therapeutic
blindness, paralysis, relationship with patient
convulsions without
loss of consciousness, ‡ Avoid secondary gain
stocking and glove
anesthesia, ³la belle
indifference´
NURSING INTERVENTIONS IN
ANXIETY 
 |' @
' 

| 
' 

Assess level of ‡ Look at body language, speech
anxiety patterns, facial expressions, defense
mechanisms and behavior used
‡ Distinguish levels of anxiety

Keep ‡ ºrief orientation to unit of procedures
environmental ‡ Written information to read later, when
stresses/stimulati anxiety is lower
on low when ‡ Pleasant, attractive, uncluttered
anxiety is high environment
‡ Provide privacy, if presence of other
patients is overstimulating
‡ Provide physical care if necessary
‡ Avoid offering many alternatives or
decisions when anxiety is high
  |' @
' 

| 
' 

Assist patient to ‡ Acknowledge anxious behavior
cope with ‡ Always remain with patient
anxiety more ‡ Assist patient to clarity his own thoughts and
effectively feelings
‡ Encourage measures to reduce anxiety, e.g.,
exercise, activities, talking with friends, hobbies
‡ Assist patient to recognize his strengths and
capabilities realistically
‡ Provide therapy to develop more effective
coping and interpersonal skills ± e.g., individual,
group
‡ May need to administer anti-anxiety
medications

Maintain ‡ Use an unhurried approach
accepting and ‡ Acknowledge patient¶s distress and his
helpful attitude concerns about problem
toward patient ‡ Encourage clarification of feelings and
thoughts
‡ Evaluate and manage own anxiety while
working with patient
‡ Recognize the value of defense mechanisms
and realize that patient is attempting to make
the anxiety tolerable in the best way possible
- Do not attempt to remove a defense
mechanism at any time
SOMATIZATION DISORDERS
‡  are $$""
suggestive of physical disorder for w/c there is
no organic basis. $""
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‡  ' | ! "$
 in the normally integrated functions
of ($ "
*%, so that part of one or more of these
functions is lost. The dissociation produces
considerable changes in the person¶s behavior,
feelings and thoughts.
‡ 
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R @ 
'!Clear, concise end rules;
consistency, set limits, confront
R ' ' )  @!successful activities,
approach when not seeking attention,
confront own anger, reinforce strengths
R @ 
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Precautions, therapeutic relationship,role
model relaxation
 +
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‡ : Maladaptive
behavioral changes as a result of
misusing drugs that affect the CNS
‡ **+ 
!
- Abuse of at least one month¶s duration
- Social complications of use
- Psychological dependence
- Pathological pattern
‡ *+(
- Tolerance-tissue adaptation: changes
occur in cells at the nervous system so
that more of the drug is required to
achieve the desired effect
- Withdrawal symptoms: substance
specific syndrome that follows cessation
of or reduction in intake of a substance
that was previously regularly used by an
individual to produce a physiological state
of intoxication. ( 
 =9 
     
 :
‡ *!
- Alcohol = CNS depressant
- ºarbiturates or other sedatives or hypnotics = CNS
depressant
- Cocaine = stimulant psychological dependence
- Amphetamine = stimulant
- Cannabis, Marijuana ± CNS depressant
- Phencyclidine ± PCP, LSD ± hallucinogen ±
psychologically addictive

‡" 
*!
-Clients in all health care settings should be
monitored for alcohol withdrawal ± 1/3 all hospital
admissions involve some type of ETOH use

‡"  
*!
- Consider cocaine use if clients present with
symptoms of weight loss, skin problems,
tachyarrhythmias, seizures or spitting up black
phlegm. Also monitor for cellulitis as a result of
needle use.
‡ ( 
*!
- If history reveals an incidence of blackouts,
insomnia, tremors ± seizures, G-I changes,
fluctuant hypertension, seizures or feelings of low
self-esteem / suicide potential
‡  + ! Alternation in coping
(Substance Abuse) related to excessive
dependency needs
‡  ! Client will abstain from drugs
and develop more appropriate coping
‡ ""!
- Assist client physiological and psychologically to
withdraw
- Teach client about his disease
- Provide nutritional supplement as needed
- Support family getting into therapy
- Treat underlying personality disorder
- Psychotherapy
- Self ± help groups
- Rehabilitation programs
- Antabuse other alternate therapies
-  !
‡ Physical monitor for withdrawal, especially DTs, a
medical emergency
‡ Manipulate behaviors
‡ Impulsiveness
‡ Relationship
‡ Lack of Commitment
@
‡ !
- Flights of ideas ± stream of thought characterized
by rapid association of ideas
- Elated, grandiose mood ± self-satisfied, confident,
aggressive
- Psychomotor Excitement ± Continuous Activity
‡  + ! Excessive activity
related to denial of depression
‡  ! Client will acknowledge
depression and resume moderate level of activity
‡ ""!
- Physical care ± sleeping, eating, rest, etc
- Thought processes
- Inflated self-esteem
- Painful consequences
‡ (4$!
- May be treated as an outpatient if mania is mild
- Hospitalization for acute and delirious
- MEDS: Lithium TTT, Tricyclics, MAO Inhibitors
‡ '"
- Take thorough nursing history - used on a long-term
basis
- Is a salt therefore report if client has history of
cardiovascular or kidney disease
- Therapeutic blood levels: .â ± 1.2 mEg/L
- Signs of toxicity (ºlood level>2.0 mEg/L)
‡ ºlurred vision, increased urination, diarrhea
‡ Irregularity, hypotension, slurred speech, syncope,
vomiting, confusion
‡ ºlackouts, seizures, hyperactive movements,
arrhythmia, circulatory failure
‡ $
- Doxepin (Sinequan) Amitryptyline (Elavil)
Imiprmine (Tofranil)
- Interferes with re-uptake of neurotransmitters
(MAO)
- Side effects: Anticholinergic, weight gain,
orthostatic hypotension
- Nursing Implementations: Give late afternoon or
early evening
‡ @",(*3@5
-Antidepressants
-Isocarboxazid(Marplan); Phenelzine(Nardil)
@)*?("
-Most fatal side effect: Hypertensive crisis: occurs if
mixed with foods containing tyramine
- ": Avoid beer, wine, cheese,
yogurt, sour cream, citrus fruits, bananas,
avocadoes, soy sauce, dried or aged foods.
Affective Disorders
‡  ' | : Characterized by
depressive behavior or elated (Manic) ºehavior or
Fluctuations from one mood to the other.
ö Depressive disorder : Disorder of mood; no
signs of manic behavior
ö ºipolar Disorder : One or more manic episodes
with or without a history of a major depressive
episode
‡ @4+
- Psychologically depressed mood
- Appetite disturbances ± Anorexia or Dfood intake
- Sleep disturbances ± difficulty going to sleep at
night or awakening after 4 -â hours with inability to
return to sleep
- Psychomotor retardation or excitation
- Anxiety
- E self-esteem
- Somatic complaints
- Einterest in sexual activity
- Suicidal thoughts
‡  + ! Alteration in mood and
rate performance related to depression
‡   ! Client will exhibit more
appropriate affect and report some pleasure in life
‡ ""!
- Physical: Monitor I & O, diet, small meals, fluids,
sleep, exercise
- Thought Processes: ºlocking, restate, limit
choices, calm, matter-of-fact, non-judgemental
- Guilt worthlessness: Warm, supportive, repeated
attention, here and now, guilt processes, activities
- Suicide precautions
‡ (4$! Antidepressants, etc,
psychotherapy hospitalization, clinical treatment,
long-term follow up
@(&%+(

+02@(+

@ +

Characterized by psychomotor Characterized by psychomotor
activity (Ĺ emotional support retardation (decreased
and physical activity) emotional and physical
activity)
Associated with the following Associated with the following
signs and symptoms: signs and symptoms:
‡ Restlessness ‡Constipation
‡ Flight of ideas ‡Slowed gait and activity
‡ inability to eat and sleep ‡Inability to make decisions
because of involvement in quickly
more important things ‡Sleep disturbance

Extroverted personality Introverted personality

Initiation of activity Lack of initiative
@ +
| 

Delusional self-confidence Lack of self confidence
(feelings of worthlessness,
inadequacy, and inferiority

Directing hostility onto Internalizing hostility; feeling
environment; aggressively completely at fault; suicidal
finding fault with others; ideation
seeking out and picking on
others sensitive areas;
showing open hostility
Elated mood Melancholy mood

Tendency to dress in bright, Loss of interest in
bizarre colors and color appearance; tendency to
combinations; use of too dress in somber colors; no
much make-up make-up

Apparent unlimited energy Lack of energy; easily
fatigued

Involved in groups; enjoys Withdrawn from groups
being the center of activity
@+
| 
Higher muscle tonus; Low muscle tonus; possibly
possibly appearing younger appearing older than age
than age

Possible increase in sexual Possible lack in sexual
interest interest

' | '  |

‡Treatment for mood disorders, primarily used for
depression but can also be used for mania
‡Nurse¶s role: educative and supportive:
‡Informed consent for ECT
‡NPO from midnight the evening before
‡Ask client to void immediately before TTT
+| !
‡Assist the psychiatrist and anesthesiologist
‡Monitor VS including ECG,ºP and Oxygen
Saturation
|  "!
‡ 
$! administers the electric shock that
induces Grand Mal Seizure
‡ !responsible for administering
all IV medications and oxygen

‡
|+! â-12 treatments can be given
through the entire course
‡ 
 + 
) |  !
‡Restlessness
‡Agitation
‡Confusion
‡Disorientation
‡Mild symptoms of tiredness, nausea and
headache (postanesthesia)
‡Short-term memory loss
%(%($""
(""$
"$1
 9
|  +|+ |
‡  ' | !Disintegrative
life pattern characterized by a thought
disorder, withdrawal from reality, regressive
behavior, poor communication and impaired
interpersonal relationship
‡  $"$** 3$
5

‡ |
|@|  @ 
@!
1. Associative looseness: verbalizations of
disturbed thought patterns. The client
verbalizes successive ideas that appear
to be unrelated to each other.
2. Affect: affect of the person is flat or
inappropriate to the situation. He
demonstrates apathy.
3. Autism: Fantasy and daydreaming are
substituted for reality
4. Ambivalence: coexisting opposite feelings
‡+  | |!At least
one of the following during the
acute phase of the illness:
öºizarre delusions (thought
broadcasting, thought insertion)
öSomatic, grandiose, religious,
persecutory/jealous, delusions
of reference, delusions of
external influences
öIncoherence, loosening of
association, illogical thinking,
poverty of content of speech
(+) deterioration from a previous
level of functioning
‡ 
  9
| !
1. Disorganized: marked incoherence, flat or
silly affect, and extreme social withdrawal
2. Catatonic: marked psychomotor
disturbances which may involve a stupor or
excitement
3. Paranoid: persecutory or grandiose
delusions or hallucinations
4. Undifferentiated: predominant psychotic
symptoms that cannot be classified in any
other area
5. Residual: have experienced an episode of
schizophrenia but whose current clinical
picture does not contain any prominent
psychotic symptoms 

|+!' |
  
| | ' +
0'  | ' 
 !client will learn how to
validate whether or not his thoughts are
reality based 

""!
) 
$!Monitor weight, I & O, monitor
position & possible edema, teach basic
hygiene
)  ((!Clarify pronouns; use
of here and now; visual activities; distraction;
repeated reality orientation
) +3 ,(*5 
3 5!Eye contact; orient; do
not reinforce or agree with client; use of
concrete language; distraction
) 0(!Role model & teach
recognition of emotions
) '? *(!Point out; role
model
) %!Concrete (Limit choice) teach
problem solving
) '??!Trust,
attention, respect, caring, successful
activities 

" %! 
$( 3 "-) 
-6 () (5 
!Modify thought disturbances;
decrease agitated; aggressive behavior;
antiemetics, antipyretics 
(!Anticholinergic: orthostatic
hypotension, tachycardia, dry mouth, weight
gain
,$"(!Restlessness;
Pseudo-parkinsonism, Tardive Dyskinesia

(+(
‡  ' | : Psychotic
disorders in which the predominant symptoms
are delusions, generally persecutory, jealous
or grandiose.
-Characterized by projection, but no active
hallucinations

Nursing diagnosis: Impaired social
interactions related to feelings of mistrust and
suspicions of others.
-Ineffective individual coping related to accept
own feelings and responsibility for actions
secondary to low self-esteem.

Implementation:
-Milieu therapy = Present reality
-Psycho therapy
-Pharmacologic TTT = Major tranquilizers
 @+(
‡  ' | : Psychological or behavior
abnormally associated with transient (reversible) or
permanent dysfunction of the brain. Sometimes referred to
as organic brain syndrome (OºS) and includes Alzheimer¶s
disease
‡ 
3  $5!
- Endocrine dysfunctions
- Nutritional & Deficiency states
- Toxic conditions
- post-traumatic reactions
- Vascular disorders
- Metabolic & Electrolyte abnormalities
- Drugs & Medications
- Infections
- Degenerative & ³Slow Virus´ disease
- Neoplastic disorders 

+ : Alteration in orientation
(Permanent/Temporary) related in structure and/or function
of brain 

! Client will remain oriented to
environment as long as possible 
""!
- Clarification of level of deficit & client¶s ability to learn
- Empathy for client & family
- Prevent further deterioration as much as possible
- Facilitate client¶s acceptance of disability
- Utilize problem ± solving skills on individual basis 
"""(" 
(!
‡ "? ! a client eventually answers a
question but only after giving excessive unnecessary detail.
‡ +!a fixed false belief not based in reality
‡  (! excessive amount and rate of speech
composed to fragmented or unrelated ideas
‡ (!client¶s inaccurate interpretation that
general events are personally directed to him or her, such as
hearing a speech on the news and believing the message
had personal meaning
‡ '! disorganized thinking that jumps
from one idea to another with little or no evident relation
between the thoughts
‡  ? ! wandering off the topic and never
providing the information requested
‡  *? ! stopping abruptly in the middle of
sentence or train of thought; sometimes unable to continue
the idea
‡  *( ! a delusional belief that others can
hear or know what the client is thinking
‡  ! a delusional belief that others are
putting ideas or thoughts into the client¶s head ± that is, the
ideas are not those of the client
‡  2(2! a delusional belief that others are
taking the client¶s thoughts away and the client is powerless
to stop it
‡ 2((! flow of unconnected words that convey no
meaning to the listener

'
 
|  ' 
  9
| !
‡  !ideas that are related to one
another based on sound or rhyming rather than
meaning: ³ I will join the fun and swallow a coin but I
cannot see the sun, I think its my loin´
‡ ": words invented by the client: ³I¶m
scared of µwiggies¶! Are you a µwiggy¶?
‡* : stereotyped repetition of words or
phrases that may or may not have meaning to the
listener: ³I am sick, so are you; so are you; so are
you´
‡ : Client¶s imitation or repetition of what the
nurse says : Nurse: ³Did you sleep well?´ Patient:
³Did you sleep well, sleep well«´
‡('  :Use of words or phrases that are
flowery, excessive, or pompous:´ Now isn¶t it
immensely astonishing that a representative of
Florence Nightingale, a creature of planet earth woud
serve me a glass of sparkling water´ 

%!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: Nurse ³How have you been
sleeping lately?´ Patient: ³I think I know who is out to
get me´ Nurse: ³Where did you put your things?¶
Patient: ³Even at home they¶re out to get me´ Nurse:
³Did you take your medicines this morning?´ Patient:
³No matter where I go I know they¶re out to get me.´ 
((!a combination of jumbled words and
phrases that are disconnected or incoherent and
make no sense to the listener: ³jitter, rude, rice and
sugar, pretty, dance away, bulls eye´
+ '.''. '' 
+ '!False ideas or beliefs accepted as real
by the patient± external contradictory information or
facts cannot alter them
TYPES:
‡ 
$&(+!belief that others
are out to harm
‡(+: Claim to association with
famous people or celebrities, or the belief that he /she
is famous or capable of feats
‡| +: often center around the second
coming of Christ or another significant religious figure
or prophet. Unrelated to his/her religious faith but
comes as part of his/her psychosis
‡"+: generally vague and unrealistic
beliefs about the client¶s health or bodily functions.
Factual information or lab data does not change the
belief. Ex: having worms in the head
‡|+: ideas of reference involve the
client¶s beliefs that television broadcasts, music or
newspaper articles have special meaning for him/ her. 
'' !False sensory perceptions, or
perceptual experiences that do not exist in reality.
Can involve the senses and bodily sensations.( may
be perceived initially as real but later as
hallucinations) 
'': Misperceptions of actual environmental
stimuli ( may be corrected by factual information or
reality) 

  '' !
‡($- most common and may turn into
command hallucinations
‡- second most common
‡$- often occurs with dementia, seizures or
cardiovascular accidents
‡- most often found in patients undergoing
alcohol withdrawal; rarely occurs in schizophrenic
clients (electricity or bugs crawling along the body)
‡$
‡ ! feels bodily functions that are
undetectable like formation of urine by the kidneys or
impulses transmitted by the brain
‡;: patient is motionless but reports the
sensation of bodily movement like floating above the
ground