Ace Lennon N.

Babasa

Fundamentals of Psychiatric Nursing

BRANCH of NURSING - focuses on the care of client FIELD of Nursing Practice - plan of care emphasizes mental health INTEGRAL PART of the Nursing Curriculum - teaches management of mental disorder and maintaining mental health

Fundamentals of Psychiatric Nursing HISTORY OF PSYCHIATRIC NURSING Era of Magico Religious Explanations
In primitive cultures mental and physical suffering were not differentiated No distinction was made between magic, medicine and religion Primitive healers dealt with spirits Mental illness was due to loss of vital substance and introduction of foreign substance

Fundamentals of Psychiatric Nursing HISTORY OF PSYCHIATRIC NURSING Era of Organic Explanation Hippocrates proposed a different explanation to mental illness Loss of body humors

Fundamentals of Psychiatric Nursing HISTORY OF PSYCHIATRIC NURSING Era of Alienation Troubled minds were believed to be due to the moon hence the concept of lunacy was created.

Fundamentals of Psychiatric Nursing HISTORY OF PSYCHIATRIC NURSING

Era of Confinement patients here were confined Era of Moral Treatment the medical treatment consisted of torture with special parphernalia Era of Psychoanalysis insanity was linked to faulty life habits and treated with new forms of physical treatment. Contemporary Period psychiatric thinking was expanding and moving toward social dimensions with the inclusion of drugs

Fundamentals of Psychiatric Nursing

PERSONALITIES IN PSYCHIATRIC NURSING 1. Florence Nightingale 2. Linda Richards 3. Hildegard Peplau 4. Harriet Bailey 5. Frances Sleeper

CONTINUUM OF CARE
No SUSPECTED MENTAL HEALTH PROBLEM

PROBLEM CONFIRMATION
Leave the SYSTEM Yes
RISK ASSESSMENT Dangerous to self and others Gravely Disabled Acutely Psychotic Suicidal or homicidal

No

Yes

COMMUNITY BASED CARE Severity of the illness Amount of supervision

HOSPITAL BASED CARE DISCHARGE PLANNING

Outpatient Services Residential Services Self-Help Groups

Fundamentals of Psychiatric Nursing

Fundamentals of Psychiatric Nursing MENTAL STATUS EXAMINATION A. APPEARANCE 1. Personal Identification 2. Behavior and Psychomotor Activity 3. General Description

Fundamentals of Psychiatric Nursing MENTAL STATUS EXAMINATION B. SPEECH C. MOOD AND AFFECT Mood a pervasive and sustained emotion that colors the persons perception Affect the outward expression

Fundamentals of Psychiatric Nursing MENTAL STATUS EXAMINATION D. THINKING Form of thinking Content of thinking Thought disturbance Perceptual disturbance Dreams and fantasies

1. 2. 3. 4. 5.

Fundamentals of Psychiatric Nursing

MENTAL STATUS EXAMINATION E. SENSORIUM Alertness Orientation Concentration and Calculation Memory Fund of knowledge Abstract thinking Insight Judgement

1. 2. 3. 4. 5. 6. 7. 8.

Fundamentals of Psychiatric Nursing

DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL HEALTH DISORDERS, TEXT REVISION, FOURTH EDITION

Diagnostic Criteria Lists diagnostic criteria for each disorder If a sufficient number of signs and symptoms are elicited from the patient in the history and mental status Specific diagnostic criteria increase reliability

Fundamentals of Psychiatric Nursing

DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL HEALTH DISORDERS, TEXT REVISION, FOURTH EDITION

Descriptive Criteria Only describes mental disorders. Atheoretical with regard to cause Etiology and treatment are not covered in DSM The descritptive approach increases the validity

Fundamentals of Psychiatric Nursing

DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL HEALTH DISORDERS

Axis I Clinical Disorders Axis II Personality Disorders and Mental Retardation Axis III General Medical Conditions Axis IV Psychosocial and Enviormantal Diagnosis Axis V Global Assessment of Functioning

Fundamentals of Psychiatric Nursing

RATING SCALES USED IN DSM IV TR
1. Global Assessment of Functioning (GAF) used to report a clinicians judgment of a patients illness 2. Social and Occupational Functioning Assessment (SOFAS) can be used to track a patients process in social and occupational stress 3. Global Assessment of Related Functioning (GARF) measured the overall functioning of a family or other ongoing relationship 4. Defensive Functioning (DFS) covers the defense mechanism used by an individual

Fundamentals of Psychiatric Nursing

HOSPITALIZATION PROCEDURES

Temporary Admission cannot be hospitalized against will for more than 15 days usually done for patients who are senile, confused or unable to make decisions

Fundamentals of Psychiatric Nursing HOSPITALIZATION PROCEDURES Informal Admission operates under the general hospital model in which the patient is admitted to the unit in such a way that a MS patient is admitted

Fundamentals of Psychiatric Nursing

HOSPITALIZATION PROCEDURES Voluntary Admission do not undergo the advice of a physician or they seek treatment on their own BUT such patient applies in writing for admission to the psyche unit free to LEAVE against medical advice

Fundamentals of Psychiatric Nursing HOSPITALIZATION PROCEDURES Involuntary Admission if patients are dangerous to themselves after a fried or relative applies fro admission and 2 physicians confirm the need for hospitalization

Fundamentals of Psychiatric Nursing HOSPITALIZATION PROCEDURES Seclusion placing and keeping an inpatient in a special room for the purpose of containing a clinical situation Restraint measures designed to confine a patients bodly movements such as leather cuffs, leather jackets and anklets

Fundamentals of Psychiatric Nursing

HOSPITALIZATION PROCEDURES Informed Consent written document outlining a patients consent to a proposed procedure or treatment plan
1. 2. 3. 4. 5. identification of procedures or treatment plan discomfort and risks to be expected disclosure of alternative procedures offer to answer any queries instructions that the patient is free to withdraw

Fundamentals of Psychiatric Nursing MEMBERS OF THE HEALTH TEAM

1. Psychiatric Nurse 2. Psychiatrist 3. Psychologist 4. Psychiatric Social worker 5. Occupational Therapist 6. Recreational Art Therapist 7. Rehabilitation Worker

Fundamentals of Psychiatric Nursing

MENTAL HEALTH
state of of mental functions resulting in the productive activities, fulfilling relationships with other people and the ability to and

Fundamentals of Psychiatric Nursing

A utonomy and independence T olerance of lifes complexities M astery of the environment O outook that is positive S self esteem P otentials realized and maximized H happy with self and can laugh at mistakes E motionally flexible and resilient R reality testing is intact E volving reinventing self

CRITERIA OF MENTAL HEALTH

BEST (Board Exam Sample Tanong) Which among the criteria listed is the most crucial in maintaining mental health ? a. Positive outlook b. Self esteem c. Reality Testing d. Tolerance of lifes uncertainties Answer: B

BEST (Board Exam Sample Tanong)

Psychiatric nursing education has been characterized by the three firsts. Which of the following is an Exception?
A. Linda Richards, the first American psychiatric nurse B. Nursing mental diseases: the first psychiatric nursing book C. Hildegard Peplau, the first psychiatric nursing theorist D. Florence Nightingale, the first nurse researcher who focused on nursing Answer: D

Fundamentals of Psychiatric Nursing MENTAL HEALTH (From WHO)

State of well being in which the individual can , can and fruitfully and able to make

Fundamentals of Psychiatric Nursing

MENTAL ILLNESS (S.B. 3509)
Refers to mental psychiatric disorder characterized by existence of recognizable changes in the thoughts, feelings and general behavior of an individual brought about by neurological causes manifested by genetic or biochemical abnormalities and associated medical conditions which include distress personality disorder, substance use dependence and mental retardation

Theoretical Basis of Psychiatric Nursing

EVERY human behavior is caused and can be explained Freud believes that repressed sexual urges, desires, impulses or drives motivated much human behavior

Theoretical Basis of Psychiatric Nursing

Components of Personality 1. ID- part of a person that reflects BASIC or innate DESIRES, INSTINCT and SURVIVAL impulses 2. EGO- represents the REALITY aspect 3. SUPER-EGO- part that reflects MORALITY and ethical concepts, and values

Theoretical Basis of Psychiatric Nursing

Personality Stages and Functional Awareness 1. Conscious perceptions, thoughts and emotion that exist in the persons awareness 2. Pre-conscious/Subconscious- Thoughts and emotions not currently in awareness but can be recalled with effort 3. Unconscious- thoughts, drives and emotions totally a person is Unaware

Theoretical Basis of Psychiatric Nursing

FREUDS PSYCHOSEXUAL STAGES OF DEVELOPMENT

RAL (birth-18months) A L (18months-36months) LLIC/OEDIPAL (3 years-5years) TENT (5years-11years) NITAL (11years-13years)

Theoretical Basis of Psychiatric Nursing HARRY STACK SULLIVAN

Infancy (birth-onset of language): primary need for bodily contact & tenderness Childhood (language to 5years): parentssource of praise & acceptance; gratificationself-esteem; mod anxietyuncertainty & insecurity Juvenile (5-8years): shift to syntaxic mode begins; learn to negotiate own needs; opportunities for approval & acceptance of others Pre-adolescence (8-12years): genuine intimacy w/ friend of same sex; attachment & love; source of satisfaction isnt family anymore Adolescent (puberty to adulthood): lust; relationship with opposite sex; self-esteem or self-ridicule

Theoretical Basis of Psychiatric Nursing

CARL ROGERS humanistic approach; focused on Therapeutic Relationship; Client-Centered Therapy: role of client rather than the therapist (client does work of healing) Therapists role: Unconditional + regard: non-judgmental Genuineness: congruent between what therapist feels Empathic

Theoretical Basis of Psychiatric Nursing

ERIK ERIKSON PSYCHOSOCIAL Trust vs. Mistrust Autonomy vs. Shame and Doubt I NItiative vs. Guilt DUstry vs. inferiority DEntity vs RC MAcy vs. Isolation GENerativity vs. Stagnation TEgrity vs. Despair

Theoretical Basis of Psychiatric Nursing

ERIK ERIKSON VIRTUES Trust vs. Mistrust - H Autonomy vs. Shame and Doubt - W I NItiative vs. Guilt - P DUstry vs. inferiority - C DEntity vs RC - F MAcy vs. Isolation - L GENerativity vs. Stagnation - C TEgrity vs. Despair - Wis

Nurse Patient Relationship

Maintain genuineness, respect, an empathic understanding, and concreteness with the client. Care a holistic manner. Assess religious and spiritual practices Assess cultural beliefs and values including emotionproducing situations, how emotions are expressed, and what the appropriate social response to expressed emotions may be. Maintain appropriate limits. Maintain honest and open communication. Encourage expression of the clients feelings. Assist the client to develop resources.

Nurse Patient Relationship

FOCUS OF THERAPEUTIC RELATIONSHIP

Reinforced self-worth Enhanced self-concept & confidence Learn coping strategies Examine relationships Achieve self-growth Solve problems Extinguish unwanted behavior

Nurse Patient Relationship

ROLES OF THE NURSE
one who identifies learning needs and provides

information source person is one who provides specific needed information

unselor is one who listens as the client reviews feelings ader is one who directs the nurseclient interaction

chnical expert is one who understands various professional devices urrogate is one who serves as a substitute figure

Nurse Patient Relationship

PRE ORIENTATION I ntrospection N amed after spicere look T allying strengths and weaknesses R un the list identify your SKA A sk philosophically about biases and prejudices

Nurse Patient Relationship

ORIENTATION A ssessment and analysis of the patient ) B Boundary setting setting the limits C ontract development D eveloping trust and rapport E stablishing goals and problem identification F ormulation of the nursing diagnosis (product of the orientation phase)

Nurse Patient Relationship

GUIDELINES IN SETTING LIMIT
S haping up is the goal of setting limits - form of disciplining E ncourage positive or constructive behavior take time to notice positive behaviors T ell to stories of accomplishment L ogical, reasonable, realistic and appropriate PROCESS of setting limits I nconsistency be AVOIDED M inimize criticism and derogatory remarks I gnoring an error of behavior is not helpful T each what id right and sensible

Nurse Patient Relationship

WORKING D ecision making about the clients problem, conflicts and trauma E exploration of the clients feelings, problems and behavior C hange promotion (conflict resolution) I insight and learning activities S kills building I nventory of changes O n progress and off-progress evaluation N otes on Journal

Nurse Patient Relationship CHALLENGES IN THE NPR

W rath problems: anger, rage, violent behavior A ltered thought processes, suspiciousness, delusions and hallucinations T ransference and Counter-transference C ontrolling behavior, manipulative and sexual ideations H yperactively manic O bviously depressed U ncooperative T alking or speech problems

Nurse Patient Relationship

Guidelines for Wrath Problems

C alming medication (PRN) A assistance at hand: co-staff and security L eave when necessary M aintain safety for yourself D oors for escape should be available O bserve for distance: Stay out of striking distance with patient W andering from the subject means changing the topic temporarily N never touch the patient

Nurse Patient Relationship

TERMINATION L etting GO of resistance and embracing change E vidence of independence and long-lasting progress and learning T riumph over problems, conflicts, feelings G uarantee of compliance, support, and follow series O bvious positive changes in cognition and behavior

Communication PRINCIPLES OF COMMUNICATION

Acceptance: communicate a favorable reception by saying you have the right to live & exist Permission: its ok to try new things Protection: anticipate trouble spots with new behavior Interest: expressing desire to know another person Respect: communicating willingness to work w/ client Concreteness: arrive to the direct idea Honesty: consistent, open & frank Assistance: present & available at times; tangible aid

Communication
SPEECH PATTERNS ASSOCIATED WITH PSYCHIATRIC PROBLEMS

Blocking: looses train of thoughts, stops talking Circumstantiality: describing too much detail Echolalia: repeating last word heard Flight of ideas: shifting to unrelated topic Loose associations: speaks constantly loosely-related topics Mutism: inability to speak Neologism: coining new term Perseveration: answering new question w/ previous questions answer Pressured speech: speak rapidly w/ urgency Verbigeration: repeat words, phrases, sentences several times over

Communication Communication includes verbal and nonverbal expression. Successful communication includes appropriateness, efficiency, flexibility, and feedback. Anxiety in the nurse or client impedes communication Communication needs to be goal directed within a professional framework.

Communication
THERAPEUTIC COMMUNICATION TECHNIQUES FOSTERING DESCRIPTION OFFERING SELF Ill sit with you ACTIVE LISTENING direct eye contact, distance SILENCE EMPATHY I can hear how painful it is to you GENERAL LEADS Go on CLARIFICATION What do you mean? Example nga. RESTATING repeating the exact words of the client VERBALIZING THE IMPLIED rephrasing the patients words QUESTIONING Who? What?

Communication
THERAPEUTIC COMMUNICATION TECHNIQUES FOSTERING ANALYSIS AND CONCLUSIONS MAKING OBSERVATIONS commenting what is seen PRESENTING REALITY I know that the voices are real to you but I dont hear them DESCRIPTION OF PERCEPTION What do you think? What is your opinion? VOICING DOUBT Expressing uncertainty / What other conclusions could there be? PLACING AN EVENT IN TIME OR SEQUENCE When did you do this? Then COMPARISON How do you compare this from last time?

Communication
THERAPEUTIC COMMUNICATION TECHNIQUES FOSTERING INTERPRETATION OF MEANING/IMPORTANCE FOCUSING pursuing a topic until meaning is clear/ Explain more about INTERPRETING provide a view of the meaning / It sound as if. ENCOURAGING EVALUATION So what does this all mean to you?

Communication
THERAPEUTIC COMMUNICATION TECHNIQUES FOSTERING PROBLEM SOLVING AND DECISIONS SUGGESTING COLLABORATION I can help you understand this better GOAL SETTING What do you think needs to change? GIVING INFORMATION I can tell you more about your medicines

Communication
THERAPEUTIC COMMUNICATION TECHNIQUES FOSTERING COMPLETION OF PLANS (testing out new behaviors and evaluating outcomes) REHEARSING tell me exactly the things you wanted to tell you family on Friday ROLE PLAYING Ill play your wife, what will you tell me? SUPPORTIVE CONFRONTATION - I know this is not easy for you to do but I think you can do it.

Communication
NON-THERAPEUTIC COMMUNICATION TECHNIQUES

Models of Care MILLIEU THERAPY

Milieu is physical and social environment in which an individual lives. Milieu therapy provides a safe environment that is adapted to the individual clients needs and also provides greater comfort and freedom of expression than the client has experienced in the past.

Models of Care MILLIEU THERAPY

Milieu therapy is staffed by persons trained to provide support and understanding and individual attention All members contribute to the planning and functioning of the setting The power hierarchy is diminished because all members are viewed as significant and valuable members of the community.

Models of Care MILLIEU THERAPY

FOCUS A. positive environmental manipulation, physical and social, to effect a positive change. B. clients rights through involvement in setting goals, freedom of movement, and informal relationships with staff. C. group and social interaction D. community meetings, activity groups, social skills groups, and physical exercise programs.

Models of Care

BEHAVIOR THERAPY Behavior therapy is an approach to bring about behavioral change Behavior therapy includes a group of diversified approaches for dealing with maladaptive behavior. The belief is that most behaviors are learned. Maladaptive behavior is a way of dealing with stress, and the therapy is an approach to bring about a change in the behavior.

Models of Care

Models of Care

Models of Care

PSYCHOTHERAPY
basic concept INVOLVES UNDERSTANDING focus is on ISSUES OF IMPORTANCE to the client, purpose of the interaction, identification of the roles of the therapist and client, and the use of primarily verbal means of communication. Nonverbal techniques include silence, body language, facial expression, and respect for personal space.

Models of Care

PSYCHOTHERAPY 3 Levels of Psychotherapy 1. Supportive 2. Reeducative 3. Reconstructive

Models of Care

PSYCHOTHERAPY
3 Levels of Psychotherapy Supportive allows the client to express feelings, explore alternatives, and make decisions in a safe, caring environment. needed briefly or over a period of years. No plan exists to introduce new methods of coping; instead the therapist reinforces the clients existing coping mechanisms.

Models of Care

PSYCHOTHERAPY
3 Levels of Psychotherapy Reeducative involves NEW WAYS of perceiving and behaving client explores alternatives in a planned, systematic way and requires a longer period than supportive therapy client enters into a CONTRACT that specifies desired changes of behavior. includes short-term psychotherapy, reality therapy, cognitive restructuring, and behavior modification.

Models of Care

PSYCHOTHERAPY
3 Levels of Psychotherapy Reconstructive involves deep psychotherapy of psychoanalysis. may require 2 to 5 years of therapy or more and focuses on all aspects of the clients life. Emotional and cognitive restructuring of self takes place. Positive outcomes include a greater understanding of self and others, more emotional freedom, and the development of potential abilities.

Models of Care

SELF CONTROL THERAPY

Self-control therapy is a combination of cognitive and behavioral approaches A basic theme is that talking to oneself can direct and control actions more effectively. Self-control therapy is useful to deal with stress.

Models of Care DESENSITIZATION

Desensitization is the reduction of intense reactions to a stimulus by repeated exposure to the stimulus in a weaker and milder form. Gradually over a period of time, exposure is increased until the fear of the object or situation has ceased.

Models of Care

GROUP THERAPY
Functions of a Group

Models of Care

1. 2. 3. 4.

TYPES OF GROUP sk Group aching Group pportive/ Therapeutic Group lf-help Group

Models of Care

TYPES OF GROUP
1. Task Group
function is to accomplish a specific outcome or task. focus is on solving problems and making decisions to achieve this outcome. Often a deadline is placed on completion of the task, and such importance is placed on a satisfactory outcome that conflict within the group may be smoothed over or ignored in order to focus on the priority at hand.

Models of Care

TYPES OF GROUP 2. Teaching Group

Teaching, or educational, groups exist to convey knowledge and information to a number of individuals. These groups usually have a set time frame or a set number of meetings. Members learn from each other as well as from the designated instructor.

Models of Care

TYPES OF GROUP 3. Supportive/ Therapeutic Group

The primary concern of support groups is to prevent future upsets by teaching participants effective ways of dealing with emotional stress arising from situational or developmental crises.

Models of Care

TYPES OF GROUP 4. Self-help Group

They allow clients to talk about their fears and relieve feelings of isolation while receiving comfort and advice from others undergoing similar experiences These groups may or may not have a professional leader or consultant. They are run by members of the group, and leadership often rotates from member to member.

Models of Care STAGES OF GROUP DEVELPOMENT

INITIAL
Group development involves superficial rather that open and trusting communication. Members become acquainted with each other and search for similarity between themselves and other group members. Members may be unclear about the purpose or goals of the group A certain amount of structuring of group norms, roles, and responsibilities take place.

Models of Care STAGES OF GROUP DEVELPOMENT

WORKING During this stage, the real work of the group is accomplished Members are familiar with each other, the group leader, and the group roles, and they feel free to approach their problems and to attempt solve their problems. Conflict and cooperation surface during the groups work.

Models of Care STAGES OF GROUP DEVELPOMENT

TERMINATION The group evaluates the experience and explores members feelings about it and the impending separation. The termination stage provides an opportunity for members who have difficulty with termination to learn to deal more realistically and comfortably with this normal part of human experience.

Models of Care FAMILY THERAPY

based on the premise that the members, with the presenting symptoms, signal the presence of pain in the entire family. therapist works to assist the family members to identify and express their thoughts and feelings; define family roles and rules; try new, more productive styles of relating; and restore strength to the family.

Electroconvulsive Therapy

An effective treatment for depression that consists of inducing a grand mal (tonic-clonic) seizure by passing an electrical current through electrodes that are attached to the temples

Electroconvulsive Therapy
Usual course is 6 - 12 treatments given 2-3 times per week Maintenance ECT once a month may help to decrease the relapse rate for the client with recurrent depression

Electroconvulsive Therapy
At-risk clients include: 1. with recent myocardial infarction 2. cerebral vascular accident 3. cerebral vascular malformation 4. clients with intracranial mass lesions

Electroconvulsive Therapy
Contraindications: 1. Angina pectoris 2. Congestive heart failure 3. Severe pulmonary disease 4. Fractures 5. Glaucoma 6. PREGNANCY 7. Use of MAOIs and clozapine

Electroconvulsive Therapy
Uses Manic clients whose conditions are resistant to lithium and antipsychotic medications and clients who are rapid cyclers (a client with a bipolar disorder who has many episodes of mood swings close together) Clients with schizophrenia (especially catatonia), those with schizoaffective syndromes, and psychotic clients.

Electroconvulsive Therapy
Indications for use When antidepressant medications have no effect When there is a need for a rapid definitive response, such as when a client is suicidal or homicidal The client is in extreme agitation or stupor

Electroconvulsive Therapy

PRE-PROCEDURE Explain the procedure to the client Encourage the client to discuss feelings, including myths regarding ECT Teach the client and family what to expect Informed consent must be obtained when voluntary clients are being treated

Electroconvulsive Therapy
PRE-PROCEDURE For involuntary clients, when informed consent cannot be obtained, permission may be obtained from the next of kin, although in some states the permission for ECT must be obtained from the court NPO after midnight or at least 4-8 hours prior to treatment

Electroconvulsive Therapy

PRE PROCEDURE Baseline vital signs are taken The client is requested to void Hairpins, contact lenses, and dentures are removed Administer preoperative medication if prescribed; atropine sulfate may be prescribed to prevent aspiration

Electroconvulsive Therapy
Intra-procedure The nurse must obtain an IV line BP and Vitals taken ECG and EEG electrodes are attached to the body SHORT acting anesthetics are administered: Methohexital, Thiopental Muscle relaxant is administered_ Succinylcholine

Electroconvulsive Therapy
Intra-procedure Oxygen is given by mask Tongue guard may be placed on the mouth 110-150 volts of electricity is delivered for 0.5 to 2 seconds to initiate a tonic clonic seizure, usually lasting for 1-minute

Electroconvulsive Therapy
Intra-procedure Oxygen is given by mask Tongue guard may be placed on the mouth 110-150 volts of electricity is delivered for 0.5 to 2 seconds to initiate a tonic clonic seizure, usually lasting for 1-minute

Electroconvulsive Therapy
INTRA-PROCEDURE Oxygen is given by mask Tongue guard may be placed on the mouth 110-150 volts of electricity is delivered for 0.5 to 2 seconds to initiate a tonic clonic seizure, usually lasting for 1-minute

Electroconvulsive Therapy
POST procedure Continue monitoring of vital signs Patient is usually brought to the recovery room where emergency drugs and equipments are available RE-ORIENT the client when he is awake Provide reassurance that the amnesia is ONLY temporary

Electroconvulsive Therapy
POST procedure The patient is returned to the room after all vitals are stable Mental status examination NPO temporarily and introduce foods once GAG reflex will return

Electroconvulsive Therapy
POTENTIAL SIDE EFFECTS Confusion Disorientation Short term memory loss- which may last up to 6 months Fractures Arrhythmias

Anxiety
DESCRIPTION
is a subjective, individual experience. is normal response to stress. is a feeling of apprehension, uneasiness, uncertainty, or dread. occurs as a result of threats that may be misperceived or misinterpreted. occurs as a result of a threat to identify or selfesteem may result when values are threatened may precede new experiences.

Anxiety
This is the most universal of all emotions that cannot be observed directly BUT must be inferred from behavior This is defined as a Sense of impending doom, an apprehension of dread that seemingly has no basis in reality

Anxiety vs Fear
ANXIETY FEAR
State of mental Emotion of apprehension uneasiness Source may not be Source is identifiable identifiable Related to the future Related to the present Vague Definite

Result of psychological or emotional conflict

Result of discrete physical or psychological entity, definite and concrete events

Anxiety

The PSYCHOSEXUAL theory believes that anxiety is a response to the emergence of the ID impulses that are NOT acceptable to SUPEREGO The EGO detects a real or potential conflict between the ID and the SUPEREGO resulting to the development of ANXIETY

Anxiety

BIRTH is the prototypical separation anxiety- the threat to life and the separation from the mother. In subsequent developmental changes, unconscious conflicts are perceived as life threatening associated with separation

Anxiety

TYPES OF ANXIETY Normal: a healthy type of anxiety Acute: precipitated by imminent loss or change that threatens the sense of security Chronic: anxiety that the individual has lived with for a long time.

Levels of Anxiety
MILD
Mild anxiety is associated with the tension of everyday life. The individual is alert. The perceptual field is increased. Mild anxiety can be motivating, produce growth and creativity, and increase learning.

MODERATE
The focus is on immediate concerns. Moderate anxiety narrows the perceptual field. Selective inattentiveness occurs. Learning and problem-solving still take place.

Levels of Anxiety
SEVERE Severe anxiety is a feeling that something bad is about to happen. A significant occurs reduction in perceptual field occurs. Focus is on specific details or scattered details. All behaviors is directed at relieving the anxiety. Learning and problem-solving are not possible. The individual needs direction to focus.

Anxiety
PANIC associated with dread and terror and a sense of impending doom. The personality is disorganized. The individual is unable to communicate or function effectively. Increased motor activity occurs. Loss of rational thoughts with distorted perception occurs. Inability to concentrate occurs. If prolonged, can lead to exhaustion and death.

Anxiety
GENERAL NURSING MEASURES
Recognize the anxiety and Establish trust. Protect the client Do not attack coping mechanisms Do not force the client into situations that provoke anxiety. Decrease stimulation in the environment. Modify the environment by setting limits or limiting the interaction with others. creative outlets. Promote relaxation techniques. Administer antianxiety medications as prescribed.

Anxiety

INTERVENTIONS: MILD TO MODERATE LEVELS Help the client identify the anxiety. Encourage the client to talk about feelings and concerns. Help the client identify thoughts and feelings that occurred before the onset of anxiety. Encourage problem solving. Encourage gross motor exercise.

Anxiety
INTERVENTIONS: SEVERE TO PANIC LEVELS
Reduce the anxiety quickly. Use a calm manner. Always remain with the client Minimize environmental stimuli. Provide clear, simple statements. Use a low-pitched voice. Attend to the physical needs of the client. Provide gross motor activity. Administer antianxiety medications as prescribed.

Defense Mechanisms A coping mechanism (protective defense) of the ego that attempts to protect the individual from feelings of adequacy and worthlessness and to prevent awareness of anxiety. When anxiety is too painful, the individual copes by using defense mechanisms to protect the ego and decrease anxiety.

Defense Mechanisms

An unconscious process in which the client blocks undesirable and unacceptable thoughts from conscious expression.

Defense Mechanisms

Engaging in behavior that is considered to be opposite of a previous unacceptable behavior, thought or feeling.

Defense Mechanisms

Putting forth extra effort to achieve in areas where one has a real or imagined deficiency.

Defense Mechanisms

The expression of emotional conflicts through physical symptoms.

Defense Mechanisms

An attempt to make unacceptable feelings and behavior acceptable by justifying the behavior.

Defense Mechanisms

Developing conscious attitudes and behaviors and acting out behaviors opposite to what one really feels.

Defense Mechanisms

Disowning consciously intolerable thoughts and impulses.

Defense Mechanisms

Transferring ones internal feelings, thoughts, and unacceptable ideas and traits to someone else.

Defense Mechanisms

Returning to an earlier developmental stage to express an impulse to deal with reality

Defense Mechanisms

The unconscious attempt to change oneself to resemble an admired person.

Defense Mechanisms

A type of identification in which the individual incorporates the traits or values of another into self.

Crisis
Crisis is a temporary state of severe emotional disorganization caused by failure of coping mechanisms and lack of support. Decision making and problem solving are inadequate. Treatment is immediate, supportive, and directly responsive to the immediate crisis to assist the client and the family through the stressful situation.

Crisis
PHASES OF A CRISIS (DIDA) PHASE 1: External precipitating event PHASE 2:
Perception of threat Increase in anxiety Client may cope or resolve crisis

Crisis
PHASE 3:
Failure of coping Increasing disorganization Emergence of physical symptoms Relationship problems

PHASE 4:
Mobilization of internal and external resources Resolutions related to precrisis functioning that include functioning at a higher level, at the same level, or at a lower level.

Crisis
TYPES OF CRISES Maturationalrelates to developmental stages and associated role changes Situationalarises from an external source and is associated with a life event that upsets an individual or a groups psychological equilibrium. Adventitiousrelates to a crisis of disaster or an event that is not a part of everyday life and is unplanned and accidental.

Crisis Intervention A technique of helping the person go through the crisis To mobilize his resources To help him deal with the here and now A five step problem solving technique designed to promote a more adaptive outcome including improved abilities to cope with future crises

Crisis Intervention
Treatment is immediate, supportive, and directly responsive to the immediate crisis. Interventions are goal directed. Feelings of the client are acknowledged. Intervention provides opportunities for expression and validation of feelings. Connections are made between the meaning of the event and the crisis. Client explores alternative coping mechanisms and tries out new behaviors.

Crisis Intervention
GOAL: HELP THE PATIENT GO BACK TO HIS STATE OF OPTIMUM LEVEL OF FUNCTIONING IDENTIFY the problem LIST alternatives- all possible solutions to the problem need to be listed. CHOOSE from among the alternativesIMPLEMENT the planEVALUATE the outcome-

Psychosis
POOR contact with reality PRESENCE of delusions, hallucinations, severe thought disturbances, alteration of mood, poverty of thought and abnormal behavior (schizophrenia , major disorder of affect (mania depression), major paranoid states and organic mental disorder Benefits fr: PSYCHOANALYSIS and antiPSYCHOTICS

Neurosis
any long term mental or behavioral d/o in which contact with reality is retained the condition is recognized by the patient as abnormal. features anxiety or behavior exaggerated designed to avoid anxiety (anxiety d/o ; hysteria to conversion d/o, amnesia, fugue,multiple personality and depersonalization- dissociative d/o ;oc d/o) Benefits from Behavior Therapy

Anxiety Related Disorders

GENERALIZED ANXIETY DISORDER
an unrealistic anxiety in which the cause usually can be identified. Assessment Restlessness/ inability to relax / Inability to concentrate Episodes of trembling and shakiness Chronic muscular tension and Dizziness Chronic fatigue and sleep problems Inability to recognize the connection between the anxiety and physical symptoms Focused on the physical discomfort

Anxiety Related Disorders

PANIC DISORDER The cause usually cannot be identified. Panic disorder produces a sudden onset with feelings of intense apprehension and dread. Severe, recurrent, intermittent anxiety attacks lasting 5 to 30 minutes occur.

Anxiety Related Disorders

Assessment of Panic Disorder
Choking sensation Labored breathing Pounding heart Chest pain Dizziness Nausea Blurred vision Numbness of tingling of the extremities A sense of unreality and helplessness A fear of being trapped A fear of dying

Anxiety Related Disorders

POSTTRAUMATIC STRESS DISORDER After experiencing a psychologically traumatic event, outside the range of usual experience, the individual reexperiences the event via recurrent and intrusive dreams of flashbacks. Stressors A natural disaster A terrorist attack Combat experiences

Anxiety Related Disorders

Victim of rape Accidents Victim of crime or violence Victim of sexual, physical, and emotional abuse Reexpriencing the event as flashbacks

Anxiety Related Disorders

Interventions Promote desensitization through gradual exposure to the event or situations similar to the event. Instruct the client in relaxation techniques. Provide individual therapy that addresses loss of control issues or anger. Encourage use of support groups. Encourage use of hypnotherapy.

Anxiety Related Disorders

PHOBIAS

A phobia is an irrational fear of an object or situation that persists although the personal may recognize it as unreasonable. A phobia is associated with panic level anxiety if the object, situation, or activity cannot be avoided.

Anxiety Related Disorders

Interventions Stay with the client when the anxiety Identify the basis of the anxiety. Allow the client to verbalize feelings about the anxietyproducing object or situation; frequently talking about the feared object is the first step in the desensitization process. Promote desensitization by gradually introducing the individual to the feared object or situation in small doses. Teach relaxation techniques such as breathing exercises, muscle relaxation exercises, and visualization of pleasant situations. Do not force the client to have contact with the phobic object

or situation.

Anxiety Related Disorders

OBSESSIVE-COMPULSIVE DISORDER Obsessions: preoccupation with persistent intrusive thoughts and ideas. Compulsions repeated performance of rituals or purposeless behaviors designed to prevent some event, diver unacceptable thoughts, and decrease anxiety. Obsessions and compulsions often occur together and can disrupt normal activities.

Anxiety Related Disorders Anxiety occurs when one resists obsessions or compulsions and from being powerless to resist the thoughts or rituals. Obsessive thoughts can involve issues of violence, aggression, sexual behavior, orderliness, or religion and uncontrollably can interrupt conscious thoughts and the ability to function.

Anxiety Related Disorders

Interventions
Identify the situations that precipitate the behavior. Don not interrupt the compulsive behaviors Allow time for the client to perform the compulsive rituals. Provide for client safety related to the behaviors. Implement a schedule for the client that distracts from the behaviors. Set limits on the rituals that may interfere with the clients physical well-being to protect the client from physical harm. Encourage the client to verbalize concerns.

Somatoform
Somatoform disorders are characterized by persistent worry of complaints regarding physical illness without supporting physical findings. The client focuses on the physical signs and symptoms and is unable to control the signs and symptoms. The physical signs and symptoms increase with psychosocial stressors. The anxiety is redirected into a somatic concern.

Somatoform
SOMATIZATION DISORDER: verbalize recurrent frequent and multiple somatic complaint for several years without physiologic cause Formula of pain: 2 gastro + 1 sexual + pseudoneurologic = usually begins before 30 years old = chronic emotional abuse = etiology =mx : long term = requires hospital setting; Treat physical sx conservatively, antidepressants

Somatoform
HYPOCHONDRIASIS: unrealistic fear of having a serious illness; the clients interpretation of body symptoms is without organic basis Belief of the disease is not of delusional intensity Ambiguous, vague physical feelings Nagpe-persist = despite appropriate medical evaluation and reassurance Grabe ang interpretation ng minor physical problems

Somatoform
these pts displace anxiety onto their bodies and misinterpret bodily sx that persist for 6 months = check again and again for reassurance from friends and MDs = amplifies + augment somatic sensations = have low threshold and tolerance to discomfort = 4-6% gen pop Etiology: Faulty cognitive scheme Sx = admission for a sick role (form of escape to avoid obligations = secondary gain) Variant for anxiety and depression Aggression + hostile wishes = towards others transferred into physical complaints (Originates from the past: repressed, disappointment, failure, rejection, losses)

Somatoform
PAIN DISORDER: presence of and focus on pain in one or more body sites and is sufficiently severe to come to clinical situation = also known as somatoform pain disorder/ psychogenic pain disorder/ idiopathic pain disorder/ post traumatic, neuropathic, neurological, iatrogenic = diagnosed with hypochondriasis, conversion and malingering = client experiences pain for which there is no physiologic basis and often have accompanying psychological factors = pt is convinced that somewhere there is a health

Somatoform
CONVERSION DISORDER: An illness of sx of deficits that affects voluntary motor or sensory function that suggest a neurological or other medical condition = unconscious and unintentional = originally combined with somatization: hysteria = Paul Briquet and Jean Matin Charcot: contributed to the development of conversion d/o = Freud coined the term conversion based on his work with Anna O. = sx of CD reflect unconscious conflicts

Somatoform
Epidemiology: 2:1 (WOMEN TO MEN) onset is late childhood to early adulthood Etiology: psychoanalytic (caused by repression of unconscious intrapsychic conflicts and conversion of anxiety into a physical sx), learning theory (piece of learned behavior), biological factors of classically conditioned (excessive decrease in cortical arousal)

Somatoform
ASSOCIATED FEATURES: Primary gain: keeping internal conflicts outside their awareness Secondary gain: accrue tangible advantages and benefits as a result of being sick La belle indifference: abnormal lack of concern Identification: pt may unconsciously model their sx on those someone important to them MALINGERING: occurs when a person deliberately fakes symptoms in order to benefit = conscious and intentional

Somatoform
MALINGERING: occurs when a person deliberately fakes symptoms in order to benefit = conscious and intentional = not considered a psychiatric disorder: involves falsification of illness = consciously motivated = result of secondary gain (extra attention, relief from responsibility or financial rewards) = occurs in young adulthood

Somatoform
FACTITIOUS DISORDER: clients intentionally produce a feign physical or psychological symptom = malingering + somatoform mistakenly confused with factitious = difference: malingering has external incentives for the behavior present; factitious has psychological need to assume a sick role (external incentives are absent) = highly knowledgeable about medicines: allows them to convincingly fake = constellation of symptoms = self induction of a disease is conscious but the underlying motivation is unconscious = Uncontrollable lying is the hallmark characteristic

Dissociative Disorders
DSM IV-TR: disruption in the usually integrated function of consciousness, memory, identity or perception of the environment Dissociative disorder is associated with exposure to an extremely traumatic event.

Dissociative Disorders
DISSOCIATIVE AMNESIA: inability to recall important personal info (usually traumatic in nature) classic presentation: freq found in intrapsychic conflict or emo stress non-classic: amnesia also occur for flashbacks or behavioral re-experiencing episodes etiology: extreme intra-psychic conflict; betrayal trauma tx: Cognitive Therapy, hypnosis, somatic, Group Psychotherapy

Dissociative Disorders
Dissociative amnesia Memory impairment may be partial or almost complete Assessment Localized. The client blocks out all memories about specified period. Selective. The client recalls some but not all memory about past life.

Dissociative Disorders
DEPERSONALIZATION DISORDERS: as if the individual is living in a dream/movie; individual reports feelings of automation derealization: feeling of the external world is unreal = persistent recurrent feeling of detachment or estrangement from ones self = epidemiology: third most commonly reported psychiatric symptom = etiology: psychodynamic (disintegration of the ego); traumatic stress;

Dissociative Disorders
= clinical features: patients have difficulty in expressing what they are feeling Bodily s; Duality of self as observer and actor Being cut from others; Being cut off from ones emotions = treatment: SSRI (fluoxetine) = helpful

Dissociative Disorders
DISSOCIATIVE FUGUE: sudden, unexpected travel away from home or ones customary place of daily activities with inability to recall some or all of ones past
= confusion about personal identity or assumption of a new identity = wandering = to escape from stress; travel may last from hours to days (months onwards: very rare) = during the period: clients completely forget their past life and associations, but unlike with amnesia, they are unaware of having forgotten anything = return to consciousness: Do Not Remember the Period of Fugue

Dissociative Disorders
DISSOCIATIVE IDENTITIES D/O: multiple personalities: different influences and have power over one another; represent diff ages & gender; diff physio responses & disorders; communicate with w/ one another = executive alter, personalities 2-100; aware w/ each other co-consciousness, host personality; switching = process; loses = when alternate personality is present for a period of time

Dissociative Disorders
DISSOCIATIVE IDENTITY D/O: previously MPD, characterized by the presence of 2 or more distinct identities or personality states that recurrently take control of the individuals behavior; accompanied by inability to recall important personal info. = etiology: strongly linked to severe experiences of early childhood trauma, usually maltreatment. = tx: psychotherapy, cognitive therapy, hypnosis, ECT (electroconvulsive therapy)

Dissociative Disorders
DISSOCIATIVE D/O NOT OTHERWISE SPECIFIED: covers all of the conditions characterized by a primary dissociative response that do not meet the dx criteria a. dissociative trance d/o: single or episodic disturbances in the state of consciousness that are indigenous to particular locations and cultures. b. brainwashing: prolonged and coercive persuasion

Personality Disorders
Personality disorders include various inflexible maladaptive behavior patterns or traits that may impair functioning and relationships. The individual usually remains in touch with reality and typically has a lack of insight into his or her behavior. Stress exacerbates manifestations of the personality disorder. In severe cases the personality disorder may deteriorate to a psychotic state.

Personality Disorders
Poor impulse control Moods that include rage, guilt, fear and emptiness Difficulty with problem solving Inability to perceive the consequences of behavior Impaired reality testing: distortion of reality and often projection of own feelings onto others.

Personality Disorders
Schizotypal personality disorder

Description: exhibition of abnormal or highly unusual thought, perceptions, speech and behavior patterns Assessment
Suspicious Paranoia Magical thinking Odd thinking and speech Relationship deficits

Personality Disorders
Schizoid personality disorder Description: characterized by an inability to form warm, close social relationships Assessment Social detachment and lack of close relationships Interest in solitary activities Aloof and indifferent Restricted expression of emotions Lack of interest in others

Personality Disorders
Paranoid personality disorder
Description: characterized by suspiciousness and mistrust of others Assessment Suspicious and distrusting Argumentative Hostile aloofness Rigid, critical, and controlling of others

Personality Disorders
Histrionic personality disorder Description
Characterized by overly dramatic and intensely expressive behavior Client is lively and dramatic and enjoys being the center of attention Interpersonal relations may be poor

Personality Disorders
Assessment Attention seeking Need to be the center of attention Sexually seductive or provocative Self-dramatizing and theatrical Overly concerned with appearance

Personality Disorders
Narcissistic personality disorder
Characterized by an increased sense of self-importance Client is preoccupied with fantasies and unlimited success and has a constant need for attention and admiration

Assessment
Grandiosity Need for admiration and inflation of accomplishments Overestimation of abilities and underestimation of contributions of others Lack of empathy and sensitivity to need of others

Personality Disorders
Avoidant personality disorder
Description: characterized by social withdrawal and extreme sensitivity to potential rejection Assessment
Feelings of inadequacy Hypersensitive to reactions of others and poor reaction to criticism Social inhibition Lack of support

Personality Disorders
Dependent personality disorder
The individual lacks self-confidence and the ability to function independently Person passively allows others to make decision and assume responsibility for major areas in the persons life.

Assessment
Person has difficulty making decisions. Person lacks autonomy Person cannot tolerate being alone and always must have a close relationship. Person needs others to assume responsibility and make decisions.

Personality Disorders
Obsessive-Compulsive personality disorder
The client has difficulty expressing warm and tender emotions and reflects perfectionism, stubbornness, the need to control others, and a devotion to work

Assessment Orderliness and perfectionism Overly conscientious Inflexible and preoccupied with details and rules Devoted to work and lacks leisure

Personality Disorders
Antisocial personality disorder A pattern of irresponsible and antisocial behavior Characterized by selfishness, inability to maintain lasting relationships, poor sexual adjustment, failure to accept social norms, irritability, and

aggressiveness.
Assessment Perception of the world as hostile Superficial charm and hostility No shame or guilt Self-centered

Personality Disorders
Borderline personality disorder Characterized by instability in interpersonal relationships, mood and self-image Behavior may be impulsive and unpredictable Assessment Unclear identity Unstable and intense Extreme shifts in mood Easily angered Easily bored

Personality Disorders
IMPULSE CONTROL DISORDERS -irresistible impulsivity - Inability to resist a temptation to complete an activity that is considered harmful to others

Personality Disorders
INTERMITTENT EXPLOSIVE DISORDER - Episodes of aggresiveness that result in assault destruction of property - The aggressiveness is out of proportion to the provocation

Personality Disorders
KLEPTOMANIA - Individual cannot resist the urge to steal PYROMANIA - Irresistible impulse to start fire PATHOLOGICAL GAMBLING - Disrupts family, personal or vocational pursuits - Xp and aroused euphoric state during betting

Personality Disorders
TRICHOTILLOMANIA - Chronic destructive hair pulling

SCHIZOPHRENIA
S ocial and occupational dysfunction P erceptual and thought distortion L ink or relationship to a pervasive developmental disorder I ingestion of drugs or alcohol (substance abuse) T ime (symptoms persist for at least 6 months)

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ETIOLOGY OF SCHIZOPHRENIA
NATURE - risk factors inlclude the following
genetic chromosomal mutation Hereditary faulty transmission Perinatal trauma

Percentage of incidence
10 among relatives 40 for a child with both parents

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ETIOLOGY OF SCHIZOPHRENIA
NURTURE - Environmental risk factors are evident in that malnutrition and viral infection in women during their gestational period MOST POTENT THEORY Dopamine Dysregulation Increased lead to hypedopaminergic activity of the mesolimbic system causing POSITIVE signs of the disorder

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BLEULER 4 As Schizophrenia
Associative Looseness lack of logical thought
leading to chaotic and disorganized thinking Affective Disturbances flat, blunted, and socially inappropriate affect of feeling tone Ambivalence presence of strong conflicting feelings leading to psychic immobility and confusion Autism extreme retreat from reality, preoccupation with self, leading to psychotic thought processes

POSITIVE SIGNS
Also called symptoms reflect an excess or distortion of npsychotic or active ormal functioning and include: Delusions Hallucinations Disorganized thinking and behavior Catatonic behavior Loose associations Suspiciousness Bizaare behavior
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NEGATIVE SIGNS
Also called deficit reflect a loss of normal functioning

Withdrawal Ambivalence Loss of motivation (avolition) Loss of pleasure (anhedonia) Poverty of speech (alogia) Blunted or flat affect
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CLINICAL SUBTYPES Un-Di-Ca-Pa- Res UN exhibits psychotic symptoms in more than one category DI called hebephrenic/ typically regressive and primitive CA - stupor/waxy/mutism PA persecutory pre-oc with one or more delusions + extreme suspiciousness RES presents with eccentric beh but psyche sx if present at all, are not prominent
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CLINICAL SUBTYPES Phren, Affective ang Brief SchizoPHRENiform essential features identical with schizo but duration is at least one month but less than six months Schizo AFFECTIVE behaviors characteristics of schiz in addition to those indicative of mood d/o BRIEF psychotic include a sudden onset of psychotic symptoms that last for at least one day but less than one month
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ANTIPSYCHOTICS

HA NA STELA PRO

MODERTE

TRI LOXI MOBA

THORA SEREN TARAC MELLA

HIGH

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LOW

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NURSING INTERVENTIONS
1. Ensuring the clients safety PRIORITY. 2. Health Teaching importance of meds 3. Identify a support group - to provide info, care and support to the client 4. Intersectoral collaboration is important refer to occupational therapist for social training skills 5. Continually remind the importance of medication
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NURSING INTERVENTIONS
6. Health teaching on the management of stress that include relaxation techniques 7. Identify symptoms that may harm the patient 8. Communicate accordingly. Listen for themes in the conversation 9. Promote the clients self-esteem by focusing on positive qualities. 10. Psychoeducation on the family enlightens about the illness.
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MOOD DISORDERS
MAJOR DEPRESSIVE DISORDER
Unipolar; persistent sad mood lasting 2wks or longer Melancholic feat.; Atypical feat.(mood reactivity)Psychotic feat.Postpartum onset; Seasonal SX:AT LEAST 5 Low Interest/ pleasure Wt loss or gai Appetite Insomnia/hypersomnia Psychomotor agitation or retardation Fatigue/loss of energy Feels worthless Inapp/ excessive guilt Indecisiveness Suicidal

MOOD DISORDERS
DYSTHYMIA CHRONICALLY DEPRESSED mood most of the day, more days than not for at least 2 yrs. Never had a manic d/o, hypomanic or mixed episodes s/sx: at least 2 poor appetite/overeating insomnia/hypersomni low energy/fatigue low self-esteem indecisiveness feeling hopeless

MOOD DISORDERS
CLYCLOTHYMIA Mild depression+ hypomanic; walang major dep, mania or mixed= at least 2 years. Numerous periods w/ hypomanic sx as well as numerous peroids with depressive sx that dont meet the criteria for MD

MOOD DISORDERS
BIPOLAR 1 MANIC-DEPRESSIVE Dapat may manic episode(lasts at least 1 wk, at least 3 of these sx) and no past MD episodes Excessive talking, less sleep, inflated self-esteem/ grandiosity, subj feeling that thoughts are racing, inc goal-directed activity, distractibility, excessive involvement in pleasurable activities 1 or more manic + major depression

MOOD DISORDERS

BIPOLAR 2 Hypomanic+one or more major depression Has or has HX of One or more major depressive episodes, at least 1 hypomanic episode Never had a manic or mixed episode** Higher incidence in women 5-15%= full manic episode

 <1.5 Fine hand tremors, dry mouth; polydypsia, polyuria 1.5-2.0 Vomiting & diarrhea, muscle weakness, ataxia, dizziness, confusion 2.0-2.5 Persistent NV, blurred vision, muscle twitching, inc DTR 2.5-3.0 Myoclonic twitches, urinary + fecal incontinence >3.0 Seizures; cardiac arrhythmias; HoPN, peripheral vascular collapse, death

SUICIDE
The ultimate deed of self-destruction that signifies the demise of desire and longing to die. REMEMBER it is not a disorder or diagnosis but a BEHAVIOR

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PROFILE OF A SUICIDAL PERSON

S ex A ge D epression P revious attempt E thanol abuse R ational thinking impaired S social support impaired O rganized plan N no spaouse/ nagging spouse S sickness, chronic or terminal
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THEORIES OF SUICIDE
L oss of something or someone as the valuable foundation of depression (the loss and deficit factor) O verwhelming and unusual stressful situation (the curse and doomed factor) S ubstance alteration (the pychobiological factor) S hame and rejection (socio-biological factor)
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LEVEL OF RISK
0 (none) NO suicidal ideation 1+ (Mild) some ideation but no plan 2+ (Moderate) SOME ideation, but plan is vague low in lethality, and the individual most probably wont do it 3+ (Severe) frequent ideation, plan is specific and lethal, the individual still probably WONT DO IT 4+ (Extreme) frequent ideation, plan is specific and lethal andthe and individual WILL DO IT

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SUMMARY OF NURSING ASSESSMENT

D ocument the details of the suicidal plan main goal is to keep the client safe from self-harm assess the suicide plan ask directly about the suicide intent and the actual plan assess the lethality regardless of the lethality patient must be taken SERIOUSLY D esperately cry for help (CIRCUMSTANTIAL ANALYIS) identify evidence of desperation D ecrypting and decoding the mask (CONVERSATIONAL ANALYSIS) the nurse must be skillful in making the unknown known
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NURSING INTERVENTIONS

C ategorize or classify the case on the basis of seriousness of intent, lethality of means and gravity of depression C lose watching and monitoring C ounting on collaborative referral and support C ut the motivation to die C aring and empathy in this time of crisis C onsolidating a contract
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COGNITIVE DISORDERS
The conditions traditionally labeled as ORGANIC BRAIN DISORDERS are classified into three groups: 1. Delirium, dementia, amnesia and other cognitive disorders 2. Mental disorders due to a general medical condition 3. Substance related disorders cognitive disorders they feature impairment in memory, language or attention as cardinal symptom Dementia is NOT a disease rather a group of symptom
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SEXUAL DISORDERS
The Three Criteria of Sexual Disorders 1. SD related to dysfunctional, INCOMPLETE or faulty sexual cycle (completion problems) 2. SD related to dysfunctional INTENTION (paraphilia 3. SD related to dyfunctional IDENTIFICATION (transexual)

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SEXUAL DISORDERS
SEXUAL DYSFUNCTIONS: characterized by a disturbance in the sexual response cycle or by pain associated with sexual intercourse inhibition of sexual appetite that compromise sexual response cycle

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SEXUAL DISORDERS
SEXUAL DESIRE DISORDER Little or no sexual desire or an aversion causes of aversion: 1. Protection: unconscious fear of having sex 2. inhibition of phallic psychosexual phase and unresolved oedipal conflict = freud 3. fear of the vagina = castration (fear of) = vagina dentata
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SEXUAL DISORDERS
SEXUAL AROUSAL DISORDER Cant maintain the physiologic requirements: female = without lubrication) male = without erection = impotence Viagra one type of impotence accdg to feud: Inability to reconcile feelings of affection towards a woman with feeling of desire = conflicting for her = can only function to women he doesnt desire = MADONNAPUTANA COMPLEX
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ORGASMIC DISORDER Cant compete response d/t inability to achieve orgasm (anorgasm; retired) Female orgasmic disorder: fear of impregnation; rejection by partner damage to the vagina hostility to men Male orgasmic disorde Rigid/puritanical backgroundSex: sinful Vagina: dirty

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SEXUAL DISORDERS
Sexual pain disorder Genital pain (dyspareunia) vaginismus vag lock: involuntary spasms of the outer 3rd of the vagina, where the contractions cause an interference of penile insertion Causes: 1. strict religious upbringing 2. anticipation at first sexual experience 3. sexual trauma = rape = weapon 4. lust murder 5. problematic dyadic relationship nonverbal fashion = sign of protest

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SEXUAL DISORDERS
PARAPHILIA NOT OTHERWISE SPECIFIED Telephone and computer scatalogia: obscene phone calling Necrophilia: obtaining sexual gratification from cadavers Partialism: concentrate their sexual activity on one part of the body to the excusion of all others (e.g mouth-genital contact): cunnilingus, anilingus, fellatio Points to consider: mouth-genital contact is associated with foreplay; but when a person uses these activities as SOLE SOURCE OF GRATIFICATION = paraphilia exists = refuses to proceed to coitus

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SEXUAL DISORDERS
SEXUAL DISORDER NOT OTHERWISE SPECIFIED: rare, poorly documented not specifically described Marked feelings of inadequacy concerning sexual performance or other traits related to self-imposed standards of masculinity or femininity Distress about a pattern of repeated sexual relationships involving a succession of lovers who are experienced by the individual Persistent and marked distress about sexual orientation

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SEXUAL DISORDERS
OTHERS (with pus) Post-coital Dysphoria occurs during the resolution phase of sexual activity, when a person does not achieve satisfaction Unconsummated marriage have never had coitus Causes: lack of sex education, sexual prohibitions, immaturity Sex addiction compulsively seeks out sexual experiences Don Juanism men are hypersexual = not interested after sex Nymphomania womans excessive desire for coitus

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SLEEP DISORDERS
DYSSOMNIAS: d/o of quantity or timing; difficulty initiating or maintaining sleep or excessive sleepiness 1.Primary Insomnia: (1 month) diff maintaining or initiating sleep; non restorative 2.Primary Hypersomnia: (1 month) excessive slepiness; prolonged sleep episodes or daytime sleep episodes that occur almost daily 3.Breathing Related D/O:Common form is sleep apnea; common type: obstructive

SLEEP DISORDERS
4. Narcolepsy: almost irresistible urge to sleep followed by brief episodes of deep sleep followed by sense or refreshment 5.Circadian Rhythm Sleep Disorders: sleep-wake disturbance through internal cues

SLEEP DISORDERS
PARASOMNIAS: unusual or sudden phenomenon that appears suddenly during sleep 1.Nightmare d/o: frightening dreams (often in women) 2.Sleep terror d/o: night terrors/pavor nocturnes: screaming, fear and panic = clinical distress = potential for injury (may last 1 -10 mins), common in children 5-7yrs 3.Sleep walking d/o: arousal disorder: somnambulism: mild (confusional arousal) = sitting and mumbling on bed; complex: getting out of bed

 Parasomnia NOS Bruxism (teeth-grinding = dental bite plate) Somniloquy (sleep talking) Jactatio capitis nocturna (headbanging) Sleep paralysis (inability to execute voluntary movements)

SLEEP DISORDERS

EATING DISORDERS
THE FOUR Ts OF ANOREXIA (TaTTiTi)
Tanggi = Timbang Refusal to maintain body weight 85% EBW; 15% BMI Takot = Taba Intense fear to inc weight or become fat Timang Body image disturbance Undue Denial Tigil: Amenorrhea for 3 cycles

EATING DISORDERS
Binge-eating Eating a large amount Lack of control over eating Behavior (inappropriate compensatoy) Vomiting, laxatives, diuretics Both: binge-eating and behaviors occur 2x a week for 3 months Body shape + weight Influences self-evaluation Beeeh! (akala meron para wala) The disturbance doesnt occur during Anorexia Nervosa

CHILD PSYCHIATRY
DEVELOPMENTAL DISORDERS Mental retardation: IQ below 70 before age of 18 Specific development d/o: dysfunctions r/t genetics, organic damage, delayed maturation Learning Motor skills: first noticed as clumsiness Communication: problems in language expression, understanding language, symptom of phonological d/o, stuttering (genetic etiology; word substitution = avoid problematic words)

CHILD PSYCHIATRY
AUTISM SPECTRUM DISORDERS: Autism: life-long condition that involves difficulty in the quality of both social interaction and communication w/ onset prior to age 3 years Aspergers: has some but not all of the features of autism; no delay in language, cognitive development is later = preschool Retts: accumulation of multiple developmental deficits by a child following normal development during the first five months of life Childhood disintegrative disorder: quite similar to retts except that its period of normal development is much longer with symptoms not appearing until ages 2 through 10. NO head growth deceleration or loss of hand skills

CHILD PSYCHIATRY
ATTENTION DEFICIT AND DISRUPTIVE BEHAVIOR DISORDER ADHD: inattention, hyperactive, impulsive: 6months prior to age 7; commonly diagnosed in early school years Conduct d/o: boys show an incidence 3-5x greater than girls; clinical feature is repetitive and persistent behavior in w/c the basic rights of others or major age-appropriate societal norms are violated. Oppositional defiant d/o: usually present in CD; it is recurrent and hostile pattern of behavior toward authority figure; doesnt involve physical aggression, destructive behavior, deceitfulness, theft or serious violation shown in CD.

CHILD PSYCHIATRY
FEEDING AND EATING DISORDERS Pica: child persistently eats non-nutritive substances; seen in preschool Rumination: repeated regurgitation & chewing of food; common in male infants bet 3-12mos Feeding d/o of infancy or early childhood: Persistent failure to eat adequately, accompanied by either failure to gain weight or significant weight loss.

CHILD PSYCHIATRY
ELIMINATION DISORDER

Enuresis: nocturnal (most common and typically occurs first part of the night); diurnal (waking of the night hours; early pm of school days) Encopresis: usually involuntary; w/ constipation and continuous leakage (day and during sleep), w/o constipation (feces is normal and soiling is intermittent)

CHILD PSYCHIATRY
TIC DISORDER Tourettes: involves multiple motor tics and one or more vocal tics, w/c can occur simultaneously or at different periods during illness (may begin as early as 2); dx: never a tic-free period = 3 months Chronic motor or vocal: differs from tourettes in that it involves either motor or vocal, but not both Transient tic: differs from the other 2 because of its duration. Others require that the problem have occurred for at least a year; it doesnt last longer than 12months

COGNITIVE DISORDERS DELIRIUM

Delirium is an acute alteration of consciousness. It tends to fluctuate over the course of the day and attention span is impaired. Clinical Features: presents with an acute onset (hours or days) and a fluctuating course, inattention or distraction and disorganized thinking or an altered LOC

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GENERAL NURSING INTERVENTIONS DELIRIUM R cording and monitoring neurological and VS E liminating the causative agent/ factor C alling client by name O ffering an explanation of whats to be done first before doing anything L imit setting if the client exhibits physically abusive behavior L ighting the clients room well to avoid wandering E xplaining ideas by using short, simple and concrete phrases C clarifying reality if perceptual distortion happens T alking face-to-face with the client I gnoring insults made by the client O rientation cues should be provided (clocks, photos) N nearby personnel continuity of care S upplying eyeglasses or hearing aid if needed
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COGNITIVE DISORDERS DEMENTIA

Characterized by the following patterns: 1. Progressive pattern memory impairment (remote or recent) and at least one of the ff problems aphasia, apraxia, agnosia 2. Obvious impairment in occupational and social functioning (decline from previous higher level of functioning) 3. Irreversibility of the course most cases dementia is irreversible 4. Cognitive decline 5. Alzheimers prototype dementia disorder most common cause of dementia 50-70% of cses

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COGNITIVE DISORDERS DEMENTIA

GENERAL NURSING INTERVENTIONS

1. Encourage social activities. 2. Provide adequate sleep. 3. Make and adhere to a strict schedule. 4. Maintain a proper stimulation level. 5. Provide adequate hydration. 6. Reformat tasks (occupational therapy) 7. Support caregivers.
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COGNITIVE DISORDERS DEMENTIA

GENERAL NURSING INTERVENTIONS

1. Encourage social activities. 2. Provide adequate sleep. 3. Make and adhere to a strict schedule. 4. Maintain a proper stimulation level. 5. Provide adequate hydration. 6. Reformat tasks (occupational therapy) 7. Support caregivers.
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PSYCHOPHARMACOLOGY DEMENTIA
Cholinestarse Inhibitors sterase (TaDo Penezil at GaRi Astig) TACRINE first cholinesterase inhibitor DONEPEZIL long half life and can be taken with or without food GALANTAMINE RIVASTAGMINE HCL NMDA ( N-methyl d-aspartate receptor) NAMENDA (Memantine) blocks NMDA

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COGNITIVE DISORDERS ALZHEIMERS

The exact cause is unknown. Researchers believe that the beta amyloid protein (present the plaques in the brain), the pathologic hallmark of AD. RISK FACTORS: S ex: Female H ereditary predisposition E lderly (older than 65) L ifestyle patterns T rauma E nvironmental neurotoxic substances R educed mental activity or challenge
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COGNITIVE DISORDERS ALZHEIMERS

Assessment: the stages of AD
Stage 1 (Mild)
Stage 2 (Moderate) Stage 3 (Severe)

FORGETFULNESS: usually not diagnosable CONFUSION: Short-term memory impairment, decline in ADLs
AMBULATORY DEMENTIA: losses in ADL, reasoning and verbal communication poor

Stage 4 (Late)

END STAGE: no recognition of family and self. Forgets how to eat. Must be institutionalized
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COGNITIVE DISORDERS ALZHEIMERS CLINICAL MANIFESTATIONS R ecalling, retrieving, and relearning difficulties O rientation and confusion problems N urofibrillary tangles A DL difficulty L ogical reasoning impairment D ementia
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COGNITIVE DISORDERS ALZHEIMERS

GENERAL PROBLEMS TO ADDRESS DA ily living issues such as eating and self care which may become extremely difficult DE cline of memory and language proficiency the ability to learn is impaired. Patient may also have poor communication DE pendency issues the need for physical help is necessary because of the clients inability to take care of himself DI sorientation this may lead to falls, injuries or accidents DI fficult behavior due to apathy and uncontrolled emotions
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SUBSTANCE ABUSE
Psychoactive (psychotropic) substance is any substance which after absorption has influence on mental processes both cognitive and affective.
1. stimulative 2. suppressive 3. hallucinogenic

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SUBSTANCE ABUSE
MENTAL AND BEHAVIORAL DISORDERS DUE TO PSYCHOACTIVE SUBSTANCE USE ACUTE INTOXICATION A transient condition following the administration of psychoactive substance resulting in disturbances in level of consciousness, cognition, perception, affect or behaviour, or other psychophysiological functions and responses Closely related to dose levels
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SUBSTANCE ABUSE
HARMFUL USE The damage may be physical and/or mental. Socially negative consequences are not evidence (neither acute intoxication or hangover).

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SUBSTANCE ABUSE
a) DEPENDENCE SYNDROME (ADDICTION) A strong desire or sense of compulsion to take the substance (craving) Difficulties in controlling substance-taking Withdrawal symptoms characteristic for the substance Evidence of tolerance Progressive neglect of pleasures and interests Persisting with substance use despite clear evidence of overtly harmful consequences Physical dependence Psychic (psychological) dependence
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b) c)
d) e) f)

SUBSTANCE DISORDER
According to the DSM IV-TR: 1. Side effects of a medication 2. Consequence of abusing a drug 3. Related to exposure to a toxin

SUBSTANCE DEPENDENCE: maladaptive pattern of use leading to a clinically significant impairment. Manifested by 3 or more With duration of 12 months

SUBSTANCE DISORDER
Hallmarks of this pattern: 1. tolerance = needing an increased amount 2. withdrawal = uncomfy and maladaptive physiologic 3. compulsive use = despite persistent desire to cut-down 4. taken in larger amounts or longer period than was intended 5. great deal of time = spent in activities to obtain the substance 6. gives up or reduced = important social or occupational or recreational activities 7. continued use despite = knowledge of having a problem

SUBSTANCE DISORDERS
SUBSTANCE ABUSE: Pattern of repeated abuse of substance that is maladaptive in that significant adverse consequence occur = occurring within a 12-month period manifested by one more 1. recurrent substance abuse 2. recurrent substance use in situations 3. recurrent substance-related legal problems 4. continued use despite

SUBSTANCE DISORDER
SUBSTANCE WITHDRAWAL: the development of maladaptive physiologic, behavioral and cognitive changes that are the result of reducing or stopping the heavy and regular use of substance >syndrome includes clinically significant DISTRESS or IMPAIRMENT in social, occupational or other IMPORTANT AREAS of functioning

SUBSTANCE DISORDERS
SUBSTANCE INTOXICATION: reversible syndrome of maladaptive physiologic and behavioral changes that are d/t the effects of substance to persons CNS

MOOD DISORDERS