PLT College Inc

Institute Of Health Sciences- College of Nursing

Psychiatric Mental Health Nursing

Psych Lecture Series # 2 (Prepared By: Prince Rener V. Pera, RN)

The Nervous System Division Function Abnormal

ities
Divisions: Frontal - Concentration, - Schizo
1. Central Nervous System Lobe abstract thought, phreni
a) Brain information a
b) Spinal Cord storage or memory - ADHD
2. Peripheral Nervous System and motor function - Deme
a) Cranial Nerves - Contains the ntia
b) Spinal Nerves Broca’s Area
- Responsible in
 The function of the Nervous system large for
is to control all motor, sensory, individual’s affect,
cognitive, autonomic and judgment,
behavioural activities personality and
 It has approximately 10 million inhibitions
sensory neurons and 500, 000 motor Parietal - predominantly
neurons that control the muscles Lobe sensory lobe
and the glands - analyses sensory
 contains more than 20 billion nerve information and
cells that link the motor and sensory relays the
pathways, monitor the body’s interpretation of
processes, respond to the internal information
and external environment, maintain Tempora - contains the
homeostasis, and direct all l Lobe auditory receptive
psychological, biologic, and physical area and the
activity through complex chemical Wernicke’s area
and electrical messages. - also contains a
vital area called
Central Nervous System the interpretative
Divisions: area that provides
1. Cerebrum- Consists of 2 integration of
hemispheres that are incompletely somatisation,
separated by the great longitudinal visual and auditory
fissures areas
Sulcus – separates the cerebrum Occipital Responsible for visual
into right and left hemispheres Lobe interpretation
Corpus Callosum- joins the lower
portion of the two hemispheres
 2. Cerebellum- “ Little Brain”
 Responsible for coordination Diagnostic Procedures:
of movements, balance, position Proced Method Result Duratio
sense (awareness of where each ure n
part of body is), and integration of 1. CT Serial X-Rays of Struct 25- 40
Sca brain ural mins
sensory input.
n Imag
 inhibited transmission of
dopamine in this areais associated e
with the lack of smooth muscle 2. MR Radiowaves Struct 45
I from brain ural mins
coordinated movements like
Parkinson’s Disease and Dementia detected from Image
3. Brain Stem magnet
 Connects the pons and the 3. PET Radioactive functi 2-3
cerebellum with the cerebral Sca tracer injected onal hours
n into the
hemisphere; it contains sensory
and motor pathways and serves as bloodstream and
the center for auditory and visual monitored as
reflexes client perform
4. Limbic System activities
 Consists of the thalamus, 4. SPE Same with PET Func 1-2
hypothalamus, amygdale and the CT tional hours
hippocampus
 Controls Memory and Association Areas
emotions 1. Somatosensory AA- This area permits
 Controls also the 4F’s you to determine shape & texture of an
F- eeding object without looking at it
F- ighting 2. Visual AA - receives sensory impulses
F- ornicating from the primary visual area and
F- leeing thalamus. It relates present & past
visual experiences.
Neurotransmitters 3. Auditory AA - It ascertains whether
 Chemical substances manufactured in sound, speech, music or noise.
the neuron that aid in the transmission 4. Wernicke’s Area (Posterior Language)-
of information to and away from the interprets the meaning of speech by
brain recognizing spoken words; it translates
Neuron- basic unit of Nervous System words into thoughts.
a) Sensory Neuron (Afferent Neuron)- 5. Common Integrative Area- integrates
send messages to the CNS sensory interpretations from the
b) Motor Neuron (Efferent Neuron)- association areas & impulses from other
send messages from CNS to areas.
periphery 6. Premotor Area- deals with the learned
c) Association Neuron (Interneurons) motor activities of a complex and
– lie between the motor and sequential nature. it generates nerve
sensory neurons. impulses that cause specific groups of
 muscles to contract in specific sequences.
7. Frontal Eye field Area- sometimes included in the premotor area. It controls voluntary
scanning movements of the eyes- reading this sentence for instance.
8. Language Area- from Broca’s Speech Area, nerve impulses pass to the premotor regions
that control the muscles of the larynx, pharynx and the mouth. The impulses from the
motor area result in specific, coordinated muscle contractions that enables you to
speak.

Neurotrans Chemical Location/ Physiologic Effect Abnormalities

mitter Transmitter Source
Cholinergic Acetylcholine Autonomic Controls sleep, wakefulness Alzheimer’s
Nervous System cycle, and signals muscles to Disease
become alert. Excitatory and (Decreased
inhibitory in nature Acetylcholine)
Monoamine Dopamine Substantia Nigra & Controls complex movements Schizophrenia
System Basal Ganglia (Skeletal muscle tone and some (Increased
aspects of movement), Dopamine)
motivation, cognition, and
regulates emotional response.
Norepinephri Brain Stem, Causes changes in attention, Depression
ne hypothalamus, learning and memory, sleep, (Decreased
postganglionic wakefulness and mood. Has Norepinephrine)
neurons of the been implicated also in
sympathetic maintaining arousal (awakening
nervous system from deep sleep) and dreaming.
Serotonin Brain stem, Controls food intake, sleep and Depression
hypothalamus, wakefulness, temperature (Decreased)
dorsal horn of the regulation, pain control, sexual Schizophrenia
spinal cord behaviour and emotion (Increased)
regulation. Thought also to be
involved in sensory perception
and induction of sleep.
Neuropeptid Endorphin Nerve terminals in Enhances, prolongs, inhibits or
es the spine, brain limits the effect of
stem, thalamus, neurotransmitters
hypothalamus and
pituitary gland
Amino Acid Gamma Spinal Cord, Modulates other Anxiety
Amino cerebellum, basal neurotransmitters. GABA is the (Decreased)
Butyric Acid ganglia, some most common inhibitory
(GABA) and cortical areas neurotransmitter. about half of
Glycine the inhibitory synapses use
GABA and the other half glycine
Glutamate Results in toxicity if too high
and
Aspartate
PSYCHOSOCIAL Assessment
 Idea of the current emotional state, mental capacity, and emotional or
behavioural function
 Used also for planning interventions and for the evaluation of the effectivity of
each interventions employed.
A) History
a) age and developmental stage
b) culture
c) spiritual beliefs
d) previous history
B) General Appearance
a) hygiene and grooming
b) appropriate dress
c) posture
d) eye contact and facial expression
C) Motor Behavior
a) Echopraxia- imitation of one movements of another person
b) Catatonia- motor anomalies in non-organic causes
1. Catatonic Stupor- markedly slowed motor activity
2. Catatonic Rigidity- voluntary assumption of rigid postures
3. Catatonic Posturing- voluntary assumption of inappropriate or bizarre posture
generally maintained for long period of time.
4. Cerea Flexibilitas/ Waxy Flexibility- the person can be molded in a position that is
then maintained
c) Negativism- motiveless resistance to all attempts to be moved or to all instructions
d) Cataplexy- temporary loss of muscle tone and weakness precipitated by a variety of
emotional states; loss of muscle power at times of sudden emotion.
e) Stereotypy- repetitive fixed pattern of physical action or speech; combination of
echolalia and echopraxia.
f) Mannerism- ingrained, habitual involuntary movements
g) Automatism- automatic performance of an act/s generally representative of
unconscious symbolic activity.
h) Hyperactivity/ Hyperkinesis- restless, aggressive, destructive activity often
associated with some underlying organic pathology.
i) Hypoactivity/ Hypokinesis- decreased motor and cognitive activity as in psychomotor
retardation, visible slowing of speech, thought and movements.
D) Speech
1. Pressure of Speech- rapid speech that is difficult to interpret
2. Poverty of Speech- restriction in the amount of speech used; replies maybe
monosyllabic.
3. Dyprosydy- loss of normal speech melody
E) Mood and Affect
Affect- Expression of emotion as observed by others.
 a) Appropriate Affect- Normal condition in which emotional tone (Process/Feeling) is in
harmony with the accompanying idea (Content)
b) Inappropriate Affect- disharmony between the emotional feeling tone and idea,
thought or speech that accompany it.
c) Blunted Affect- severe reduction in the intensity of externalized feeling tone.
d) Flat Affect- absence or near absence of any signs of effective expression, voice is
monotonous, face is immobile, lacks or no expression at all.
e) Labile Affect- rapid and abrupt changes in emotional feeling or tone usually
unrelated to external stimuli.
f) Restricted Affect- Usually serious or somber
g) Apathy – dulled emotional tone.
h) Ambivalence – presence of two opposing feelings.
i) Depersonalization – feeling of strangeness towards one’s self
j) Derealization – feeling of strangeness towards the environment
Mood- Pervasive, sustained emotion, subjectively experienced and reported by the
patient, as well as observed by others.
a) Dysphoric Mood- Unpleasant mood
b) Euthymic Mood- Normal Range of mood
c) Expansive Mood- Expression of one’s feeling without restraint
d) Irritable Mood- Easily annoyed and provoked to anger
e) Elevated Mood- air of confidence and enjoyment
f) Euphoria- intense elation with feelings of grandeur
g) Ecstasy- feelings of intense rupture
h) Depression- psychopathological feeling of sadness
F) Thought Processes and Content
Thought Process-
Content-
a) Circumstantiality- excessive unnecessary details then giving the answer
b) Delusions- Fixed False beliefs not based on reality
 Delusions of Poverty- belief that one is bereft or will be by material possessions
 Somatic Delusions- involves functioning of the body
 Persecutory Delusions- belief that one is harassed, cheated or persecuted
 Delusions of Grandeur- exaggerated conception of one’s importance, power or
identity; belief that someone has a special power.
 Delusions of Self- Accusations- false feelings of remorse or guilt
 Delusions of Control- false feeling that one’s will, thoughts or feeling are being
controlled by external forces
 Religious Delusions- feeling of the client that he is god.
 Nihilistic Delusions- feeling that the world is to end
 Referential Delusions- False feeling that an object is blaming the client for a
certain problem without any factual basis; belief that passages in songs, patterns
of clouds in the sky, comments of passerby refer specially to them.
c) Flight of Ideas- rapid process where patient’s thoughts are fragmented and move
from one unconnected topic to another
 d) Loose Association- stringing together of unrelated topics with a vague connection.
e) Tangential Thinking- wandering off the topic and not providing the information;
failure to reach a goal or stick to the original point.
f) Thought Blocking- stopping abruptly in the middle of a sentence, sometimes unable
to continue the idea.
g) Autistic Thinking- preoccupation with inner private world.
h) Psychosis- inability to distinguish reality from fantasy.
i) Magical Thinking- thinking that is similar to that of the preoccupational stage of
children.
j) Neologism- a word or expression invented by the patient.
k) Word Salad- incoherent mixture of words and phrases
l) Hypochondria- exaggerated concern over one’s health that is not based on real
organic pathology, but rather on unrealistic interpretation of physical signs or
sensation as abnormal
m) Obsession- pathological persistence of an irresistible thought or feeling that can not
be eliminated from consciousness by logical effort, usually associated with anxiety.
n) Phobia- persistent, irrational, exaggerated and invariably pathological dread of some
specific type of stimulus or situation.
o) Mutism- voicelessness without structural abnormalities
p) Echolalia- psychopathological repetition of specific words or phrases of one person
by another; echoing of a sound heard
q) Verbigeration- meaningless repetition of specific words or phrases
r) Clang Association- association of words similar in sound but not in meaning.
s) Perseveration – persistence of a response to a previous question.
t) Derailment- going off the point or subject.
G) Memory
a) Confabulation – filling in memory gap.
b) Amnesia – inability to recall past events.
c) Anterograde amnesia – loss memory of the immediate past.
d) Retrograde amnesia – loss of memory of the distant past.
e) Déjà vu – feeling of having been to place which one has not yet visited.
f) Jamais vu – feeling of not having been to a place which one has visited.

“ Do not look back and grieve over the PAST for it is gone and do not be troubled
about the FUTURE for it is yet to come. Live in the PRESENT,
and make it so beautiful that it will be worth
remembering”- Ida Scott Taylor