PSYCH NOTES

y Man is an integrated whole (physical, mental,

emotional, social, spiritual)

o PRIMARY preventive, promotive o SECONDARY diagnostic, curative o TERTIARY - rehabilitative

y ERIC BURN PARENT-ADULT-CHILD

o PARENT demanding, authoritative, all-knowing o ADULT most matured, most compromising, sensitive, perceptive o CHILD child-like, childish

y Man is continuously evolving in the health-illness

continuum

y COPING effortful, conscious, reality-focused y DEFENSE MECHANISM unconscious, helps

temporarily, blocks reality

y JOHARI WINDOW self-awareness

Known to self Unknown to self Known to others ARENA BLIND SPOT Unknown to FACADE UNKNOWN others y JAHODA CRITERIA OF MENTALLY HEALTHY SELF o INCREASING SELF-AWARENESS o PERSONAL AUTONOMY  Psychoanalytical (Freud): Anal/muscle training o PERCEPTION OF REALITY o DEGREE OF GROWTH AND DEVELOPMENT TOWARDS SELF-ACTUALIZATION  Self-actualized at peace, not easily affected, sense of accomplishment and contentment o BALANCE OF PSYCHIC FORCES id, ego, superego o MASTERY OF THE ENVIRONMENT harmony of love, work and play

y EGO DEVELOPMENT (ID pleasure seeker; EGO

realistic; SUPEREGO future-oriented) o STAGES OF EGO DEVELOPMENT  PRE-SYMBIOTIC PHASE earliest development; infancy: recriprocation  SELF-DIFFERENTIATION toddlerhood: I am different.  WHOLE-SELF DIFFERENTIATION late school age  SELF-INDIVIDUATION I am unique; search for independence

y FRAMEWORK OF MHN PROCESS

Nurse

Patient Nurse-Patient Relationship

y MODELS AND PERSPECTIVES OF MI CAUSATION

o BIOLOGICAL/MEDICAL chemical imbalances, neurotransmitter, genetics o PSYCHOANALYTICAL unconscious, child-rearing practices, traumatic experience; ALL BEHAVIOR IS MEANINGFUL o BEHAVIORAL learning theory, conditioning, LEARN-UNLEARN  PAVLOV classical conditioning  WATSON social learning  SKINNER operant conditioning  BANDURA o COGNITIVE faulty cognition, mindset, negativism, learned helplessness o HUMANISTIC Maslow, Roger o EXISTENTIAL meaning in life; EVERYTHING HAS A MEANING o PSYCHOSOCIOCULTURAL o PHENOMENOLOGICAL

o NURSE:  Is mentally healthy  Has a good personality  Has mastery of growth and development  Mastery of models and perspectives of mental illness (MI) causation o PATIENT:  INSIGHT ability to realize there is something wrong and is seeking for help  Support system  Environmental factors  Socioeconomic factors Client types Individual Family Community ADP I Primary Secondary Tertiary E (Scopes of MHN practice)

Nursing process

THERAPEUTIC COMMUNICATION

y In developed countries, about half of hospital beds

are occupied by MI patients though only account for 2% of total hospital admission

y CHARACTERISTICS OF THERAPEUTIC
COMMUNICATION o Purposeful, goal-oriented, deliberate o Pre-requisites of NPR:  Trust/rapport  Accepting attitude  Nonjudgmental  Objectivity  Mature emotional involvement  Empathy/sympathy o Characterized by stages/phases  Pre-interaction, pre-orientation, pre-introduction phase establish trust and rapport; contract setting (introduction, schedules [days, time, duration, interval, dates], goal/purpose, focus, confidentiality, set of expectations, collaborative effort, setting)  Working phase  Termination/evaluation phase discharge planning (check up/consultation, home medications, stigma, job/placement/occupation)

y In the Philippines, there are 750,000 MI with only 300

qualified psychiatrists

y 3.4M human crimes filed in court are drug-related y Drug prevalence for women tripled from 1%-3.3% y Drug use in children doubled from 10.9% to 19.7% y Family constitutes 06% engaged in drugs (followed by
peers, neighbors) trafficking MENTAL RETARDATION

y ME NTAL RETARDATION mental deficiency,

nonrehabilitative; intervention: HABILITATION (highest potential) DEGREE TERMS PERFOR MA IQ Mild Subnormal Borderline 12 and 75-80 up Moderate Moron Educable 7-12 55-70 Severe Embecile Trainable 5-7 35-50 Profound Idiot Custodial 3 yrs 25 or and below below y INTERVENTION FOR MENTALLY RETARDED o Total acceptance by the family o Home environment is better than institutionalization o Behavioral techniques were proven to be workable for them o Mastery training

y THERAPEUTIC COMMUNICATION TECHNIQUES

o Direct VS indirect o Overt VS covert o Denotative VS connotative o Explicit VS implicit o Manifest VS latent o Demonstrated VS hidden MENTAL HEALTH DATA

y CAUSES OF MENTAL RETARDATION

o Abnormality of sex chromosomes o CNS malformation o Parental age (Mother <18 or >35) o Consanguinity o Birth trauma o Blood grouping (Rh incompatibility) o Recessive traits o Maternal infection (German measles) o Teratogenic factors o Metabolic disorder

y 1% of any defined population suffers at any given

time from severe MI

y 10% will be affected in their lives y 30% of all mental illnesses coming to the attention of
general practitioner is primarily MI

y 20% of all illnesses is secondary to MI y 10 to 30 thousand of any given population is metally

retarded (MR)

y 4 thousand are moderately to profoundly affected y After 65 years of age, likelihood of developing MI
increases

PSYCHOPATHOGENIC DISORDERS

y ANXIETY DISORDERS
o PANIC ATTACK a discrete period of intense fear or discomfort, in which at least 4 of the following symptoms developed abruptly and reached peak within 10 minutes:  Palpitations, pounding heart, or accelerated HR  Sweating  Trembling or shaking  Sensations of shortness of breath or smothering  Feeling of choking  Chest pain or discomfort  Nausea or abdominal distress  Feeling dizzy, unsteady, lightheaded, or faint  Derealization (feelings of unreality) or depersonalization (being detached from oneself)  Fear of losing control or going crazy  Fear of dying  Paresthesias (numbness or tingling sensations)  Chills or hot flushes o AGORAPHOBIA anxiety about being in places from which escape might be difficult (or embarrassing) or in which help may not be available o PANIC DISORDER presence of recurrent unexpected panic attacks with at least one of the attacks has been followed by 1 month of one or more of:  Persistent concern about having additional attacks  Worry about the implications of the attack or its consequences  Significant change in behavior related to the attacks o SIMPLE/SPECIFIC PHOBIA (1) a marked and persistent fear that is excessive or unreasonable, cued by the presence or anticipation of a specific object or situation, (2) exposure to the phobic stimulus almost invariably provokes an immediate anxiety response, (3) person recognizes that the fear is excessive or unreasonable;,(4) phobic situation is avoided or else ids endured with intense anxiety or distress o SOCIAL PHOBIA (1) a marked and persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or

to possible scrutiny by others, (2) exposure to the feared social situation almost invariably provokes anxiety, (3) person recognizes that the fear is excessive or unreasonable o OBSESSIVE-COMPULSIVE DISORDER [A] OBSESSIONS: (1) recurrent and persistent thoughts, impulses, or images that are experienced, at some time during the disturbance, as intrusive and inappropriate and that caused marked anxiety or distress, (2) the thoughts, impulses, or images are not simply excessive worries about real-life problems, (3) the person attempts to ignore or suppress such thoughts, impulses, or images, or to neutralize them with some other thought or action; [B] COMPULSIONS: (1) repetitive behaviors that the person feels driven to perform in response to an obsession, (2) the behaviors or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation; however, these behaviors are not connected in a realistic way; [C] at some point, person recognizes that the fear is excessive or unreasonable; [D] obsessions or compulsions cause marked distress, are time consuming (more than 1 hour a day) o POST-TRAUMATIC STRESS DISORDER [A] the person has been exposed to a traumatic event in which both of the following were present (1) the person experienced, witnessed, or was confronted with an even or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others, (2) the person s response involved intense fear, helplessness, or horror; [B] traumatic event is persistently reexperienced ; [C] persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness; [D] persistent symptoms of increased arousal; [E] duration of the disturbance (B, C, and D) is more than 1 month

y PERSONALITY DISORDERS
o CLUSTER A  PARANOID PERSONALITY DISORDER a pervasive distrust and suspiciousness of others such that their motives are interpreted as malevolent, beginning by early adulthood and present in a variety of contexts

 SCHIZOID PERSONALITY DISORDER a pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings beginning by early adulthood and present in a variety of contexts as indicated by 4 or more of the following: (1) neither desires nor enjoys close relationships, including being part of a family, (2) almost always chooses solitary activities, (3) has little, if any, interest in having sexual experiences with another person, (4) takes pleasure in a few, if any, activities, (5) lacks close friends or confidants other than first-degree relatives, (6) appears indifferent to the praise or criticism of other, (7) shows emotional coldness, detachment, or flattened affectivity  SCHIZOTYPAL PERSONALITY DISORDER - a pervasive pattern of social and interpersonal deficits marked by acute discomfort with, and reduced capacity for, close relationships as well as by cognitive or perceptual distortions and eccentricities of behavior, beginning by early adulthood and present in a variety of contexts as indicated by 5 or more of the following: (1) ideas of reference, (2) odd beliefs of magical thinking that influences behavior and is inconsistent with subcultural norms, (3) unusual perceptual experiences, including bodily illusions, (4) odd thinking and speech, (5) suspiciousness or paranoid ideation, (6) inappropriate or constricted affect, (7) behavior or appearance that is odd, eccentric, or peculiar, (8) lack of close friends or confidants other than first-degree relatives, (9) excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears rather than negative judgments about self o CLUSTER B  ANTISOCIAL PERSONALITY DISORDER [A] a pervasive pattern of disregard for and violation of the rights of others occurring since age 15 years, as indicated by 3 or more of the following: (1) failure to conform to social norms with respect to lawful behaviors, (2) deceitfulness, (3) impulsivity or failure to plan ahead, (4) irritability and aggressiveness, (5) reckless disregard for safety of

self or others, (6) consistent irresponsibility, (7) lack of remorse; [B] individual is at least age 18 years; [C] there is evidence of conduct disorder with onset before age 15 years  BORDERLINE PERSONALITY DISORDER a pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following: (1) frantic efforts to avoid real or imagined abandonment, (2) a pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation, (3) identity disturbance, (4) impulsivity in at least 2 areas that are potentially self-damaging, (5) recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior, (6) affective instability due to a marked reactivity of mood, (7) chronic feelings of emptiness, (8) inappropriate, intense anger or difficulty controlling anger, (9) transient, stress-related paranoid ideation or severe dissociative symptoms  HISTRIONIC PERSONALITY DISORDER a pervasive pattern of excessive emotionality and attention seeking, beginning by early adulthood and present in a variety of contexts, as indicated by five or more of the following: (1) uncomfortable in situations in which he or she is not the center of attraction, (2) interaction with others is often characterized by inappropriate sexually seductive or provocative behavior, (3) displays rapidly shifting and shallow expression of emotions, (4) consistently uses physical appearance to draw attention to self, (5) has a style of speech that is excessively impressionistic and lacking in detail, (6) shows self-dramatization, theatrically, and exaggerated expression of emotion, (7) is suggestible i.e. easily influenced by others or circumstances, (8) considers relationships to be more intimate than they actually are  NARCISSISTIC PERSONALITY DISORDER a pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy, beginning by early adulthood and

present in a variety of contexts, as indicated by five (or more) of the following: (1) has a grandiose sense of self-importance, (2) is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love, (3) believes that he or she is special and unique and can only be understood by, or should associate with, other special or highstatus people, (4) requires excessive admiration, (5) has a sense of entitlement, (6) is interpersonally exploitative, (7) lacks empathy, (8) is often envious of others or believes that others are envious of him or her, (9) shows arrogant, haughty behaviors or attitudes o CLUSTER C  AVOIDANT PERSONALITY DISORDER a pervasive pattern of social inhibition, feelings of inadequacy, and hypersensitivity to negative evaluation, beginning by early adulthood and present in a variety of contexts, as indicated by 4 or more of the following: (1) avoids occupational activities that involve significant interpersonal contact because of fears of criticism, disapproval, or rejection, (2) unwilling to get involved with people unless certain of being liked, (3) shows restraint within intimate relationships because of the fear of being shamed or ridiculed, (4) preoccupied with being criticized or rejected in social situations, (5) inhibited in new interpersonal situations because of feelings of inadequacy, (6) views self as socially inept, personally unappealing, or inferior to others, (7) is unusually reluctant to take personal risks or to engage in any new activities because they may prove embarrassing  DEPENDENT PERSONALITY DISORDER a pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation, beginning by early adulthood and present in a variety of contexts, as indicated by 5 or more of the following: (1) has difficulty making everyday decisions without an excessive amount of advice and reassurance from others, (2) needs others to assume responsibility for most major areas of his or her life, (3) has difficulty expressing disagreement with others because of fear of loss of support or approval, (4) has

difficulty initiating projects or doing things on his or her own, (5) goes to excessive lengths to obtain nurturance and support from others, to the point of volunteering to do things that are unpleasant, (6) feels uncomfortable or helpless when alone because of exaggerated fears of being unable to care for himself or herself, (7) urgently seeks another relationship as a source of care and support when a close relationship ends, (8) unrealistically preoccupied with fears of being left to take care of himself or herself  OBSESSIVE-COMPULSIVE PERSONALITY DISORDER a pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency, beginning by early adulthood and present in a variety of contexts, as indicated by 4 or more of the following: (1) is preoccupied with details, rules lists, order, organization, or schedules to the extent that the major point of the activity is lost, (2) shows perfectionism that interferes with task completion, (3) is excessively devoted to work and productivity to the exclusion of leisure activities and friendships, (4) is overconscientious scrupulous, and inflexible about matters if morality, ethics, or values, (5) is unable to discard worn-out or worthless objects even when they have no sentimental value, (6) is reluctant to delegate tasks or to work with others unless they submit to exactly his or her way of doing things, (7) adopts a miserly spending style toward both self and others; money is viewed as something to be hoarded for future catastrophes, (8) shows rigidity and stubbornness

y PERVASIVE DEVELOPMENTAL DISORDERS (PDD)

o AUTISTIC DISORDER o ASPERGER s DISORDER o RETT s DISORDER

y DISRUPTIVE BEHAVIOR DISORDERS

o ATTENTION DEFICIT/HYPERACTIVITY DISORDER o CONDUCT DISORDER o OPPOSITIONAL DEFIANT DISORDER

y EATING DISORDERS
o ANOREXIA NERVOSA o BULEMIA NERVOSA

y COGNITIVE/ORGANIC
o ANOREXIA NERVOSA o BULEMIA NERVOSA

y ASSOCIATIVE/SOMATOFORM DISORDERS
o SOMATIZATION DISORDER o UNDIFFERENTIATED SOMATOFORM DISORDER o CONVERSION DISORDER o PAIN DISORDER o HYPOCHONDRIASIS o BODY DYSMORPHIC DISORDER

 HYPERSOMNIA  NARCOLEPSY o PARASOMNIAS  NIGHTMARE DISORDER  SLEEP TERROR DISORDER  SLEEPWALKING DISORDER

y PSYCHOSOMATIC DISORDERS y DISSOCIATIVE DISORDERS

o DISSOCIATIVE AMNESIA o DISSOCIATIVE FUGUE o MULTIPLE PERSONALITY DISORDER o DEPERSONALIZATION DISORDER

y FACTITIOUS DISORDER y IMPULSE-CONTROL DISORDER

o INTERMITTENT EXPLOSIVE DISORDER o KLEPTOMANIA o PYROMANIA o PATHOLOGICAL GAMBLING o TRICHOTILLOMANIA

y AFFECTIVE DISORDER
o MAJOR DEPRESSIVE DISORDER o DYSTHYMIC DISORDER o BIPOLAR DISORDER o CYCLOTHYMIC DISORDER

y ABUSIVE DISORDER
o BATTERED WIFE SYNDROME o DOMESTIC VIOLENCE

y SEXUAL FUNCTION DISORDERS

o PARAPHILIAS  EXHIBITIONISM  FETISHISM  FROTTEURISM  PEDOPHILIA  SEXUAL MASOCHISM  SEXUAL SADISM  TRANSVESTIC FETISHISM  VOYEURISM o GENDER IDENTITY DISORDERS

y SLEEP DISORDERS
o DYSSOMNIAS  PRIMARY INSOMNIA