Care of Clients With Maladaptive Patterns of Behavior1

ptive
a la d a
it h M
n t s w av io r
f C li e f B e h
re o n s o
Ca Patt e r
NCM 105
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MENTAL HEALTH & MENTAL ILLNESS
• MENTAL HEALTH – is a state of emotional,

psychological, and social wellness evidenced
by satisfying interpersonal relationships,
effective behavior and coping, positive self-
concept, and emotional stability.
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Factors affecting a person’s Mental Health
• Individual
• Interpersonal/Relationships
• Social/Cultural
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MENTAL HEALTH & MENTAL ILLNESS
• MENTAL ILLNESS – a clinically significant

behavioral or psychological syndrome or
pattern that occurs in an individual and that is
associated with present distress or disability
or with a significantly increased risk of
suffering death, pain, disability, or an
important loss of freedom.
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Diagnostic & Statistical Manual of Mental
Disorders (DSM-5)
• Describes all mental disorders, outlining
specific diagnostic criteria for each based on
clinical experience and research.
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Historical Perspective of the Treatment of
Mental Illness
• Ancient Times
1. Aristotle (382-322BC)
2. Early Christian Times (1-1000 AD)
3. Renaissance (1300-1600) – Hospital of St.
Mary of Bethlehem
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Period of Enlightenment and Creation of
Mental Institutions
• Asylum – a safe refuge or haven offering
protection at institutions where people had
been whipped, beaten, and starved just
because they were mentally ill. (1970)
• Dorothea Dix (1802-1887)
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Development of Psychopharmacology
• 1950 – development of Psychotropic Drugs
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Move toward Community Mental Health
• 1963 – Deinstitutionalization – a deliberate

shift from institutional care in state hospital to
community facilities.
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Mental Illness in the 21 Centuryst
• ACCESS – Access to Community Care and

Effective Services and Support
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Psychiatric Nursing Practice
• Linda Richards (1873) “THE MENTALLY SICK
SHOULD BE AT LEAST AS WELL CARED FOR AS
THE PHYSICALLY SICK”
• Hildegard Peplau - importance of nurse-client-
relationship
• June Mellow – meeting the needs and
strengths of the client
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STUDENT Concerns
• What if I say the wrong thing?
• What I will be doing?
• What if no one will talk to me?
• Am I prying when I ask personal questions?
• How will I handle bizarre or inappropriate
behavior?
• Etc…
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PYSCHOSOCIAL THEORIES & THERAPIES
• Psychoanalytic
• Developmental
• Interpersonal
• Humanistic
• Behavioral
• Existential
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Psychoanalytic Theories
• Father of Pyschoanalysis
• Supports the notion that all human behavior is
caused and can be explained
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Psychoanalytic Theories
• Behavior motivated by subconscious Thoughts
and Feelings
• Emotions that exist

• Can recall with some effort
• Repressed memories
• “Freudian Slip”
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Freud’s Dream Analysis
• Dream Analysis – is a primary method used in
psychoanalysis, involves discussing a client’s
dream to discover their true meaning and
significance.
• Free Association – is used to gain access to
subconscious thoughts or feelings
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Ego Defense Mechanisms
• Are methods of attempting to protect the self
and cope with basic drives or emotionally
painful thoughts, feelings, or events.
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Transference & Countertransference
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DEVELOPMENTAL THEORY
• Erik Erikson
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COGNITIVE STAGES OF DEVELOPMENT
• Jean Piaget
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INTERPERSONAL THEORIES
• Harry Stack Sullivan
• He believed that one’s personality involves
more than individual characteristics,
particularly how one interacts with others.
• Hildegard Peplau
1. Phases of nurse-patient relationship
2. Role of the Nurse in therapeutic relationship
3. 4 levels of anxiety
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HUMANISTIC THEORIES
• Humanism – focuses on a person’s positive
qualities, his or her capacity to change and the
promotion of self-esteem.
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HUMANISTIC THEORIES
• Humanism – focuses on a person’s positive
qualities, his or her capacity to change and the
promotion of self-esteem.
• Carl Roger – Client Centered Therapy focuses
on the role of the client, rather than the
therapist, as the key to the healing process.
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BEHAVIORAL THEORIES
• Behaviorism – a school of psychology that
focuses on observable behaviors and what
one can do externally to bring about behavior
change.
• Behavior can be changed through a system of
rewards and punishments.
1. Ivan Pavlov
2. BF Skinner
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EXISTENTIAL THEORIES
• Existential theorist believe that behavioral
deviations result when a person is out of
touch with himself or herself or the
environment.
• Existential Therapies
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CRISIS INTERVENTION
• Crisis is a turning point in an individual’s life
that produces an overwhelming emotional
response.
• Three Categories
1. Maturational
2. Situational
3. Adventitious
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TREATMENT MODALITIES
1. Individual Psychotherapy – a method of
bringing about change in person by exploring
his or her feelings.
2. Groups – is a number of person’s in a face-to-
face setting to accomplish tasks that require
cooperation, collaboration, or working
together.
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TREATMENT MODALITIES
3. Group Therapy
• Psychotherapy Group
• Family Therapy
• Family Education
• Education Group
• Support Groups
• Self-help Groups
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LEGAL AND ETHICAL ISSUES
• Rights of clients and related issues
• Involuntary Hospitalization
• Release from the hospital
• Conservatorship
• Least restrictive environment
• Confidentiality
• Duty to warn 3rd party
• Insanity defense
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• Nursing liability
1. Tort – is a wrongful act that results in injury,
loss, or damage.
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• Ethical Issues
1. Utilitarianism – the act is right if its
consequences yield happiness or pleasure to
the greatest number of people
2. Deontology – puts focus on the rightness or
wrongness of actions
3. Moral Principles
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Module 2
1. Establishing a therapeutic relationship
2. Establishing therapeutic communication
3. A client’s response to illness
4. Conducting a psychiatric-mental health nursing
assessment
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Components of a
Therapeutic Relationship
• Trust
• Genuine Interest
• Empathy
• Acceptance
• Positive Regard
• Self-awareness & Therapeutic Use of Self
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Types of Relationships
1. Social Relationship
2. Intimate Relationship
3. Therapeutic Relationship
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Establishing the Therapeutic Relationship
• PHASES
1. Orientation Phase – begins when the nurse
and client meet and ends when the client
begins to identify problems to examine.
The nurse establishes roles, the purpose of
meeting, and the parameters of subsequent
meetings; identifies the client’s problems and
clarifies expectations.
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• PHASES
1. Orientation Phase – the nurse begins to build trust
with the client.
• Nurse-Client Contracts
a. Time, place and length of session
b. When sessions will terminate
c. Who will be involved in the treatment plan
d. Client responsibilities
e. Nurse’s responsibilities
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• PHASES
1. Orientation Phase
• Confidentiality
• Self-disclosure
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• PHASES
2. Working Phase
• Problem identification
• Exploitation
3. Termination Phase – begins when the problem is

resolved, and it ends when the relationship is
ended
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Therapeutic Communication
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• Communication?
• Verbal & Non-Verbal
• Context & Content
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• It is an interpersonal interaction between the
nurse and client during which the nurse
focuses n the client’s specific needs to
promote an effective exchange of information.
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• Privacy & Respecting Boundaries
 Proxemics – is the study of distance zones
between people during communication.
1. Intimate Zone
2. Personal Zone
3. Social Zone
4. Public Zone
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• Touch
5 types of TOUCH:
1. Functional-professional touch
2. Social-polite touch
3. Friendship-warmth touch
4. Love-intimacy touch
5. Sexual-arousal touch
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• Active Listening & Observation
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• Verbal Communication Skills
1. Using concrete messages VS abstract
messages
2. Using therapeutic Communication
Techniques
3. Interpreting signals or cues (overt/covert)
4. Metaphor, Proverbs, Cliche
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• Nonverbal Communication Skills
• Facial Expression
 Expressive face
 Impassive face
 Confusing facial expression
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• Body Language
• Vocal Cues
• Eye Contact
• Silence
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Client’s Response to Illness
• Individual Factors
1. Age, Growth and Development
2. Genetics & Biologic Factors
3. Physical Health & Health Practices
4. Response to Drugs
5. Self-efficacy
6. Hardiness
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• Individual Factors
7. Resilience & Resourcefulness
8. Spirituality
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• Interpersonal Factors
1. Sense of Belonging
2. Social Networks & Social Support
3. Family Support
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ASSESSMENT
• Content of the Assessment
1. History
- background assessment include the client’s
history, age and development stage, cultural
and spiritual beliefs.
- the history of the client, as well as his or her
family, may provide some insight into the
client’s current situation.
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ASSESSMENT
2. General Appearance & Motor Behavior
- Automatisms
- Psychomotor retardation
- Waxy flexibility
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ASSESSMENT
3. Mood & Affect
- Blunted
- Broad
- Flat
- Inappropriate
- Restricted
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ASSESSMENT
4. Thought Process & Content
- Circumstantial thinking - Tangential thinking
- Delusion - Thought blocking
- Flight of ideas - Thought broadcasting
- Ideas of reference - Thought insertion
- Loose associations - Thought withdrawal
- Word salad
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ASSESSMENT
5. Sensorium & Intellectual Processes
 Orientation
 Memory
 Ability to concentrate
 Abstract thinking
 Concrete thinking
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ASSESSMENT
6. Sensory-Perceptual Alteration
 Hallucinations
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ASSESSMENT
7. Judgment & Insight
8. Self-concept
9. Roles & Relationships
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ASSESSMENT
• Data Analysis
• Psychological Test
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MODULE 3
1. Nursing management for a client experiencing anger,

hostility and aggression
2. Nursing management for client experiencing abuse and
violence
3. Nursing management for client experiencing grief and loss
4. Nursing management for a client experiencing anxiety,
anxiety disorders and stress-related illness.
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Definition of Terms
• ANGER – a normal human emotion, is a strong,
uncomfortable, emotional response to a real or
perceived provocation.
• HOSTILITY – (verbal aggression) an emotion
expressed through verbal abuse, lack of
cooperation, violation of rules or norms, or
threatening behavior.
• PHYSICAL AGGRESSION – is a behavior in which a
person attacks or injures other person or property.
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Onset and Clinical Course
• ANGER
1. can be both negative & positive
response/reaction
2. Catharsis
3. Anger suppression VS outburst
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Onset and Clinical Course
• HOSTILITY & AGGRESSION
1. Sudden & unexpected behavior
2. Stages/Phases
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Related Disorder
• Influence of Media
• Paranoid delusions
• Anger on depressed person
• Intermittent explosive disorder
• Acting out
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Etiology
• Neurobiologic Theories
1. Serotonin
2. Dopamine & Norepinephrine
3. Structural damages
• Psychosocial Theories
1. Temper tantrums
2. Impulse control
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Cultural Considerations
• Culture influences
• Bias influences
• Bouffee delirante
• Amok
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Treatment
• Focus on underlying or co-morbid psychiatric
diagnosis
• Lithium
• Carbamazepine (tegretol)
• Valproate (depakote)
• Atypical antipsychotic
• Benzodiazepines
• Rapid tranquilizers
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Treatment
• Seclusion / restraints
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Application of the Nursing Process
• Assessment
1. Be aware of the factors that influences
aggression
2. History of violent or aggressive behavior
• Data Analysis
• Outcome identification
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• Intervention
1. Engaging in dialogue
2. Managing the environment
3. Managing Aggressive Behavior
5 Phases
Triggering, Escalation, Crisis, Recovery &
Postcrisis
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Triggering
• Non-threatening and calm approach
• Use clear, simple and short statements
• Allow client time
• Medications
• Relaxation technique and physical activity
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Escalation
• Nurse must control the situation
• Give direction in calm and firm voice
• Show of force
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Crisis
• Clients becomes physically aggressive
• Nurse must take charge of the situation
• Use of seclusions and restraints
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Recovery
• Encourage talking
• The nurse must help the client to be relax
• Explore alternatives to aggressive behavior
• Debriefing session with the staff
• Confidentiality
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Postcrisis
• Client is removed from seclusion or restrains
• Discuss clients behavior in a calm manner
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• Evaluation
1. The goal is to teach angry, hostile and
potentially aggressive clients to express their
feelings verbally and safely without threats or
harm to others or destruction of property.
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Abuse & Violence
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Characteristics of Violent Families
• Family Violence – the home, which is normally
a safe haven of love and protection, may be
the most dangerous place for victims.
• Abuse of Power and Control
• Alcohol & Other Drug Abuse
• Intergeneration Transmission Process
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Abuse & Violence
• Cultural considerations
• Spouse or partner abuse – the mistreat or
misuse of one person by another in the
context of an intimate relationship.
1. Psychological abuse
2. Physical abuse
3. Sexual abuse
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Abuse & Violence
• Clinical Picture
• Cycle of Abuse and Violence
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Cycle of Abuse and Violence
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Abuse and Violence
• Assessment
1. Safe
• Treatment & intervention
1. Restraining order
2. Stalking
3. Individual psychotherapy or counseling,
group therapy, support or self-help groups
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Child Abuse
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Types of Child Abuse
• Physical Abuse
• Sexual Abuse
• Neglect
• Psychological Abuse
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Clinical Picture
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Child Abuse
• Assessment
1. The key to recognize when the child’s
behavior is outside what is normally
expected for his or her age and
developmental stage
2. Responsibility of reporting abuse-related
cases
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Child Abuse
• Treatment & Intervention
1. Ensure safety and well-being
2. Psychiatric evaluation
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Elder Abuse
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Clinical Picture
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Elder Abuse
• Assessment
1. Relieving caregiver’s stress
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Rape & Sexual Assault
• Rape – is the perpetration of an act of sexual
intercourse with a female against her will and
without her consent
• Date Rape
• Male Rape
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Rape & Sexual Assault
• Dynamics of Rape
• Assessment
1. Support from family
2. Give her the right to decide if possible
3. Prophylactic Treatment
4. Provide counseling
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Psychiatric Disorders related to
Abuse & Violence
• Posttraumatic Stress Disorder (PTSD) –
disturbing pattern of behavior demonstrated
by someone who has experienced a traumatic
event
1. Cluster of Symptoms: reliving
The event, avoiding reminders of
The event, and being on guard or
Experiencing hyperarousal
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Abuse & Violence
• Posttraumatic Stress Disorder (PTSD)
2. Symptoms occur 3 months or more afterv the
trauma
3. Can occur at any age
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Abuse & Violence
• Dissociative Disorders – Dissociation is a
subconscious defense mechanism
that helps a person protect his or
her emotional self from
recognizing the full effects of
some horrific or traumatic event
by allowing the mind to forget or
remove itself from the painful
situation or memory. KLCBesario
Abuse & Violence
• Types Dissociative Disorders
1. Dissociative Amnesia
2. Dissociative Fugue
3. Dissociative Identity Disorder
4. Depersonalization Disorder
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Abuse & Violence
1. Cognitive Behavioral Therapy
• Application of the Nursing Process
1. Assessment
2. Data Analysis
3. Outcome Identification
4. Intervention
5. Evalaution
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Grief & Loss
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Definition of Terms
• Grief – refers to subjective emotions and
affect that are a normal response to the
experience of loss
• Grieving/Bereavement – refers to the process
by which a person experiences the grief
• Mourning – is the outward expression of grief.
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Types of Losses
• Physiologic Loss
• Safety Loss
• Loss of Security & a Sense of Belongingness
• Loss of Self-esteem
• Loss related to Self-Actualization
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The Grieving Process
• Kubler-Ross Stages of Grieving
1. Denial
2. Anger
3. Bargaining
4. Depression
5. Acceptance
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• John Bowlby – attachment behaviors
1. Experiencing numbness and denying the loss
2. Emotionally yearning for the lost loved one and
protesting the permanence of the loss
3. Experiencing cognitive disorganization and
emotional despair with difficulty functioning in
the everyday world
4. Reorganizing & reintegrating the sense of self to
pull life back together
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• John Harvey
1. Shock, outcry, and denial
2. Intrusion of thoughts, distractions and
obsessive review of the loss
3. Confiding in others as a way to emote and to
cognitively restructure an account of the loss
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• Rodebaugh & Colleagues
1. Reeling
2. Feelings
3. Dealing
4. Healing
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Task of the Grieving Process
• Undoing psychosocial bonds to the loved one
and eventually creating new ties
• Adding new roles, skills and behaviors and
revising old ones into a “new identity and
sense of self”
• Pursuing a healthy lifestyle that includes
people and activities
• Integrating the loss into life
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Dimensions of Grieving
• Cognitive Responses to Grief
1. Questioning and Trying to Make Sense of the
Loss
2. Attempting to Keep the Lost One Present
• Emotional Response to Grief
1. Anger, sadness, and anxiety
2. Feelings of hatred and revenge are also
common responses
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Dimensions of Grieving
• Spiritual Responses to Grief
• Behavioral Responses to Grief
1. Easiest to observe
• Physiologic Response to Grief
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Cultural Consideration
• Universal Reactions to Loss
1. Culture-Specific Rituals (Acculturation)
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Nurse’s Role
• Encourage the client to discover and use what
is effective and meaningful for them
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Disenfranchised Grief
• 3 categories of circumstances can result in
disenfrachised grief:
1. A relationship has no legitimacy
2. The loss itself is not recognized
3. The griever is not recognized
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Complicated Grieving
• Characteristics of Susceptibility
1. Low self esteem
2. Low trust in others
3. Previous psychiatric disorder
4. Previous suicide threats or attempts
5. Absent or unhelpful family members
6. Ambivalent, dependent or insecure
attachment
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Complicated Grieving
• Risk Factors leading to Vulnerability
1. Death of a spouse or child
2. Death of parent
3. Suden, unexpected and untimely death
4. Multiple deaths
5. Death by suicide or murder
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• Assessment
1. Observing what the person is thinking, how
the person feels, what the person’s values
and belies are, how the person is acting and
what is happening in the person’s body
2. The use of effective communication
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• Assessment
3 critical components in assessment:
1. Adequate perception regarding loss
2. Adequate support while grieving for the loss
3. Adequate coping behaviors during the
process
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• Assessment
3. Perception of loss
Assessment begins with exploration of the
clients perception of the loss.
• Data Analysis & Planning
• Outcome Identified
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• Intervention
1. The nurse’s guidance helps the client examine
and make changes.
2. Exploring the client’s perception and meaning of
the loss
3. Adaptive Denial
4. Use of effective communication skills
5. Give the client opportunity to compare and
contrast ways in which he/she has coped
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• Intervention
6. Encourage the client to still take care of
himself/herself
• Evaluation
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Anxiety & Stress-Related Illness
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Anxiety
• Is a vague feeling of dread or apprehension
• It is a response to external or internal stimuli
that can have behavioral, emotional, cognitive
and physical symptoms
• Unavoidable in life and can serve many
positive functions
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Anxiety Disorder
• Comprise a group of conditions that share a
key feature of excessive anxiety with ensuring
behavioral, emotional, cognitive, and
physiologic responses
• Can demonstrate unusual behaviors
• Experience significant distress overtime,
impairs their daily routine, social lives and
occupational functioning
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Anxiety as a Response to Stress
• Stress – the wear and tear that life causes on
the body.
• It occurs when a person has difficultly dealing
with life situations, problems and goals
• General Adaption Syndrome
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Anxiety as a Response to Stress
• 3 stages of reaction to stress:
1. Alarm Reaction Stage
2. Resistance Stage
3. Exhaustion Stage
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Levels of Anxiety
• Mild
• Moderate
• Severe
• Panic
• When working with an anxious patient, the

nurse must be aware of his/her own anxiety
level.
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Overview of Anxiety Disorder
• These are diagnosed when anxiety no longer
functions as a signal of danger or a motivation
for needed change
• Types:
1. Agoraphobia 5. GAD
2. Panic disorder
3. Specific phobia
4. Social phobia
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Related Disorders
• Anxiety disorder due to a general medical
condition
• Substance induced anxiety disorder
• Separation anxiety disorder
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Etiology
• Biologic Theories
1. Genetic Theories
• Hereditary/Heritability
2. Neurochemical
• GABA, norepinephrine, serotonin
3. Psychodynamic
• Defense Mechanism
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Treatment
• Combination of medication and therapy
• Positive reframing
• Decatastrophizing
• Assertive training
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Elder Consideration
• Associated with another condition
• Agoraphobia and GAD the most common late-
life anxiety disorder
• Treatment - SSRI
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Panic disorder
• Is composed of discrete episodes of panic
attack
• Panicking without stimulus
• Avoidance behavior
• Agoraphobia – Primary & Secondary
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Panic disorder
• Treatment
1. Cognitive-behavioral techniques
2. Relaxation techniques
3. medications
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• Assessment
1. Automatisms 7. Self-blame
2. Depersonalization
3. Derealization
4. Disorganized thoughts
5. Confused and disoriented
6. Judgment is suspended
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• Data Analysis
• Outcome Identification
• Intervention
1. Promoting safety & comfort
2. Managing Anxiety
3. Providing client and family education
• Evaluation
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Phobias
• Illogical, intense, persistent fear of a specific
object or social situation that causes extreme
distress and interferes with normal
functioning.
• 3 categories of phobias
1. Agoraphobia
2. Specific phobia
3. Social phobia
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Treatment
• Behavioral therapy
1. systematic desensitization – the therapist
progressively exposes the client to the
threatening object in a safe setting until the
client’s anxiety decreases.
2. Flooding – form of rapid desensitization. The
goal is to get rid of the clients phobia in 1 or 2
sessions.
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Obsessive-Compulsive Disorder
• Obsession – are recurrent, persistent, intrusive
and unwanted thoughts, images or impulses
that causes marked anxiety and interfere with
clients function.
• Compulsion – are ritualistic or repetitive
behaviors or mental acts that a person carries
out continuously in an attempt to neutralize
anxiety.
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Obsessive-Compulsive Disorder
• It can be manifested through many behaviors,
all of which are repetitive, meaningless and
difficult to conquer.
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Treatment
• Behavior Therapy
1. Exposure
2. Response prevention
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• Assessment
• Data Analysis
• Intervention
1. Using therapeutic communication
2. Teaching relaxation & behavioral techniques
3. Completing a daily routine
4. Providing education
• Evaluation
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• GAD
• PTSD
• Acute stress disorder
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Psychopharmacology
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Psychopharmacology
• The study of the use of medications in treating mental
disorders.
• This includes an understanding of:
1. Protein binding (how available the medication is to the
body)
2. Half-life (how long the medication stays in the body)
3. Polymorphic genes (genes which vary widely from
person to person)
4. Drug-to-drug interactions (how medications affect one
another)
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Psychopharmacology
• The scientific study of the effects drugs have
on mood, sensation, thinking, and behavior.
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Neurotransmitter
• Psychoactive drugs exert their sensory and
behavioral effects almost entirely by acting
on neurotransmitters and by modifying one or
more aspects of synaptic transmission.
• Neurotransmitters can be viewed as chemicals
through which neurons primarily
communicate; psychoactive drugs affect the
mind by altering this communication.
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Drugs may act by:
1. Serving as a precursor for the neurotransmitter
2. Inhibiting neurotransmitter synthesis
3. Preventing storage of neurotransmitter in the
presynaptic vesicle
4. stimulating or inhibiting neurotransmitter
release
5. stimulating or blocking post-synaptic receptors
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Drugs may act by:
6. Stimulating autoreceptors, inhibiting
neurotransmitter release
7. Blocking autoreceptors, increasing
neurotransmitter release
8. Inhibiting neurotransmission breakdown
9. Blocking neurotransmitter reuptake by the
presynaptic neuron.
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Critical Focus of Psychopharmacology
1. Drugs can alter the secretion of many hormones

2. Hormones may alter the behavioral responses to
drugs
3. Hormones themselves sometimes have
psychoactive properties
4. The secretion of some hormones, especially
those dependent on the pituitary gland, is
controlled by neurotransmitter systems in the
brain.
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Anti Anxiety
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Review: Neurochemicals
• During Anxiety:
1. Gamma-aminobutyric Acid – function as the
body’s natural anti-anxiety.
2. Norepinephrine – triggers or increases the
level of anxiety
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Anti anxiety/Anxiolytics
• Medication that inhibits anxiety
• 2 classifications:
1. Benzodiazepines
2. Nonbenzodiazepines
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1. Benzodiazepines
• Benzodiazepines enhance the effect of
the neurotransmitter gamma amino-butyroc
acid (GABA) at the GABA Receptor
• Resulting in sedative, hypnotic (sleep-
inducing), anxiolytic (antianxiety), anticonvuls
ant, and muscle relaxant properties.
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1.Benzodiazepines
• Very Fast (onset) – Diazepam (Valium)
• Fast – Chlorazepate (Tranxene)
• Intermediate – Alprazolam (Xanax),
Chlordiazepoxide (Librium), Clonazepam
(Klonopin)
• Moderately slow – Lorazepam (Ativan),
Oxazepam (Serax)
KLCBesario
1. Benzodiazepines
• Side Effects:
• Dizziness, clumsiness, sedations, headache,
fatigue, sexual dysfunction, blurred vision,
dry throat and mouth, constipation, high
potential for abuse and dependence
KLCBesario
1. Benzodiazepines
• Nursing Implications:
 Avoid alcohol & antihistamines
 Avoid potentially hazardous activities like driving
 Rise slowly from lying or sitting position
 Use sugar free beverages or hard candy
 Drink adequate fluids
 Take only as prescribe, don’t stop abruptly
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2. Nonbenzodiazepines
• Very Slow – Buspirone (BuSpar)
• Rapid – Meprobamate (Miltown, Equanil)
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Antidepressants
• Review: Neurochemicals
1. Serotonin – level is low during depression
state
2. Norepinephrine – is also low
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Antidepressants
• broad group of drugs that are used in the
treatment of depression.
• Although they do not cure depression, they
are usually effective at improving mood and
relieving symptoms such as restlessness,
anxiety, sleep problems, and suicidal thoughts.
KLCBesario
Antidepressants
• Major Categories
1. Cyclic Antidepressants
2. Monoamine oxidase inhibitors (MAOI’s)
3. Selective serotonin reuptake inhibitors
(SSRI’s)
4. Atypical antidepressants
KLCBesario
Cyclic Antidepressants (TCA’s)
• Oldest antidepressants
• Different degree of efficacy in blocking the
activity of norepinephrine and serotonin or
increasing the sensitivity of postsynaptic
receptor sites
• They have a lot of side effects
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• Example of Drugs
1. Amitriptyline (Elavil)
2. Amoxapine (Asendin)
3. Doxepin (Sinequan)
4. Imipramine (Tofranil)
5. Desipramine (Normpramine)
6. Nortriptyline (Pamelor)
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• Side Effects
 blurred vision, dry mouth, constipation,
weight gain or loss, low blood pressure on
standing, rash, hives, and increased heart rate
 Should be used cautiously in patients with
seizures since they can increase the risk of
seizures
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• Side Effects
 may worsen urinary retention (difficulty
urinating) and narrow angle glaucoma.
 Abnormal heart rhythms and sexual
dysfunction have also been associated with
tricyclic antidepressants.
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• Side Effects
 If tricyclic antidepressants are discontinued
abruptly, withdrawal symptoms may occur.
 Withdrawal symptoms may occur when even a
few doses are missed. Therefore, the dose of
antidepressant should be reduced gradually
when therapy is discontinued.
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• Nursing Implications
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Monoamine Oxidase Inhibitors (MAOI’s)
• This type of drugs are used infrequently due

to its potentially fatal side effect
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Monoamine Oxidase Inhibitors (MAOI’s)
• Drug:
1. Isocarboxazid (Marplan)
2. Phenelzine (Nardil)
3. Tranylcypromine (Parnate)
KLCBesario
Selective Serotonin Reuptake Inhibitors
(SSRI’s)
• Newest category of antidepressants
• block or delay the re-absorption of serotonin,
by the original (presynaptic) nerves it was
released from. This effect increases the levels
of serotonin in the synapses
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Selective Serotonin Reuptake Inhibitors
(SSRI’s)
• Drugs
1. Flouxetine (Prozac)
2. Sertraline (Zoloft)
3. Citalopram (Celexa)
4. Escitalopram (Lexapro)
KLCBesario
Atypical Antidepressants
• These drugs are used when the client has an
inadequate response to or side effects from
SSRI.
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Atypical Antidepressants
• Drugs
1. Venlafaxine (Effexor)
2. Duloxetine (Cymbalta)
3. Bupropion (Wellbutrin)
4. Nefazodone (Serzone)
5. Mirtazapine (Remeron)
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Antipyschotic/Neurolyptics
• Are used to treat symptoms of psychosis,
such as delusions and hallucinations
• These drug worked by blocking receptors of
the neurotransmitter dopamine
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• Drugs
1. Chlorpromazine (Thorazine)
2. Haloperidol (Haldol)
3. Clozapine
4. Risperidone
5. Olanzapine
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• Side Effects
1. Extrapyramidal symptoms – serious
neurologic symptoms
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Maladaptive Patterns of Behavior
1. Nursing management for a client with schizophrenia
2. Nursing management for a client with mood disorders\
3. Nursing management for a client with personality disorder
4. Nursing management for a client with history of substance
abuse
KLCBesario
Schizophrenia
• Causes distorted and bizarre thoughts,
perceptions, emotions, movements, and
behavior.
• It cannot be defined as a single illness
• Diagnosed in late adolescence or early
adulthood (15-25 years old-Men) (25-35 years
old-Women)
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Schizophrenia
• 2 Major Categories of Symptoms:
1. Positive or Hard Symptoms
• Ambivalence
• Associative looseness
• Delusions
• Echopraxia
• Flight of Ideas
• Hallucinations
• Ideas of Reference
• Perseveration
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Schizophrenia
• 2 Major Categories of Symptoms:
2. Negative or Soft Symptoms
• Alogia
• Anhedonia
• Apathy
• Blunted Affect
• Catanonia
• Flat Affect
• Lack of Volition
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Schizophrenia
• Types of Schizophrenia
1. Schizophrenia, Paranoid Type
2. Schizophrenia, Disorganized Type
3. Schizophrenia, Catatonic Type
4. Schizophrenia, Undifferentiated Type
5. Schizophrenia, Residual Type
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Schizophrenia
• Onset
1. May be abrupt or insidious
2. The diagnosis is usually made when the
person begins to display more actively
positive symptoms
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Schizophrenia
• Related Disorders
1. Schizophreniform disorder
2. Schizoaffectice disorder
3. Delusional disorder
4. Brief psychotic disorder
5. Shared psychotic disorder
KLCBesario
Schizophrenia
• Etiology
 Resulted from dysfunctional relationships in
early life & adolescence
 Resulted from dysfunctional parenting or
family dynamics
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Schizophrenia
• Biologic Theories
1. Genetic Factors – transmitted or inherited
2. Neuroanatomic & Neurochemical Factors –
less brain tissue and cerebrospinal fluid.
Enlarged ventricles in the brain and cotical
atrophy. Excess Dopamine and Serotonin
3. Immunovirologic Factors
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Schizophrenia
• Treatment
1. Psychopharmacology (Thorazine)
2. Antipsychotic depot injections (Fluphenazine
& Haloperidol)
• Side effects – EPS
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Schizophrenia
• Extrapyramidal Side Effects
1. Dystonic Reactions
2. Pseudoparkinsonism
3. Akathisia
4. Tardive dyskinesia (AIMS)
5. Neuroleptic Malignant Syndrome
KLCBesario
Schizophrenia
• Psychosocial Treatment
1. Individual & Group therapy
2. Family Education & Therapy
KLCBesario
Schizophrenia
1. Assessment
2. History
3. General Appearance, Motor Behavior, and
Speech
4. Mood and Affect
5. Thought Process & Content
6. Delusion
KLCBesario
Schizophrenia
7. Sensorium& Intellectual Processes
8. Judgment & Insight
9. Self-concept
10. Roles & Relationship
11. Physiologic & Self-Care Consideration
KLCBesario
Schizophrenia
• Data Analysis
• Intervention
• Evaluation
KLCBesario

Care of Clients With Maladaptive Patterns of Behavior1

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Care of Clients With Maladaptive Patterns of Behavior1

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ptive

• MENTAL HEALTH – is a state of emotional,

• MENTAL ILLNESS – a clinically significant

• 1950 – development of Psychotropic Drugs

• 1963 – Deinstitutionalization – a deliberate

• ACCESS – Access to Community Care and

• Emotions that exist

3. Termination Phase – begins when the problem is

1. Nursing management for a client experiencing anger,

• When working with an anxious patient, the

1. Drugs can alter the secretion of many hormones

• This type of drugs are used infrequently due

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