REVIEW NOTES FOR

PSYCHIATRIC
NURSING
 OVERVIEW OF PSYCHIATRIC
NURSING
Theoretical Models for
Understanding Behavior
SITUATIONS
EXPERIENCES
MAN

SITUATION
PERSISTS
ANXIETY
Therapeutic use of self
Mental
-therapeutic communication
Mechanisms/Defense
Mechanisms Crises Intervention

Schizophrenic
Anxiety Disorders Disorders

Somatization Disorders Paranoid Disorders

Dissociative DisordersDYSFUNCTIONALIT Organic Mental

Disorders
Personality Disorders Y
Eating Disorders
Substance Use Disorders
Abuse & Violence
Mood Disorders Application of the Nursing Process:
Sexual Disorders
Assessment: Classical signs &
symptoms
Interventions/TTT: Therapies
Pharmacology
CAM

Legal Issues
Future Trends and Concerns
Community-based Mental Health Programs
 THEORIES OF PERSONALITY DEVELOPMENT

A. Psychoanalytic Model: (Freud’s Theory)

• Personality Components:
ID: “the demanding child”
: ruled by the Pleasure Principle –
reflects basic or innate desires such
as pleasure seeking behavior,
aggression and sexual impulse
: seeks instant gratification, causes
impulsive unthinking behavior, and has
no regard for rules or social convention

SUPEREGO: “the judge”, “an

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

THEREFORE, ANXIETY RESULTS FROM

THE EGO’S ATTEMPTS TO BALANCE
THE IMPULSIVE INSTINCTS OF THE ID
WITH THE STRINGENT RULES OF THE
SUPEREGO.
•3 LEVELS OF AWARENESS:
CONCIOUS: Everything we are
aware of at a given moment: thoughts,
perceptions, feelings and memories

PRECONCIOUS: thoughts and

emotions not currently in the person’s
awareness, but which can be recalled
with some effort ( remembering a time
when you were rejected as a child )

UNCONSCIOUS: Beyond
awareness; contains repressed memories
and emotions plus the instinctual drives
of the ID; the realm of thoughts and
feelings that motivate a person even
though he/she is totally unaware of them;
usually memories of traumatic events
that are too painful to remember
Much of what we do and say is motivated
by our “subconscious” thoughts or
feelings ( those in the preconscious or
unconscious level of awareness ). E.g.
Freudian slips or slips of the tongue

The subconscious theory is the basis for

Dream Analysis and the method of Free
Association.
OTHER IMPORTANT CONSTRUCTS OF
THE PSYCHOANALYTIC MODEL:

•ALL HUMAN BEHAVIOR HAS MEANING

•ANXIETY IS A RESPONSE TO AN
UNCONSCIOUS CONFLICT OR THREAT
TO THE EGO
•MENTAL MECHANISMS/DEFENSE
MECHANISMS ARE LARGELY
UNCONSCIOUS IN NATURE AND
OPERATE TO PROTECT THE EGO FROM
ANXIETY
•SYMPTOMS OF MENTAL ILLNESS ARE
CAUSED BY INTERNAL CONFLICTS
•DEFENSES ARE FIXED AT AN EARLY
DEVELOPMENTAL STAGE
•UNRESOLVED CONFLICTS FROM EARLY
CHILDHOOD CAUSE VULNERABILITY TO
SIMILAR ADULT SITUATIONS
EGO DEFENSE MECHANISMS

:Methods of attempting to
protect the self and cope
with the basic drives or
emotionally painful
thoughts, feelings or events

: Most of these defense

mechanisms operate at the
unconscious level of
awareness
1. COMPENSATION: overachievement in one area to
offset real or perceived deficiencies in another area.
E.g. Napoleon Complex – diminutive man becoming
emperor; nurse with low self esteem works double
shifts so her supervisor will like her
2. CONVERSION: expression of an emotional conflict
through the development of a physical symptom,
usually sensorimotor in nature. E.g. A teenager
forbidden to see x-rated movies is tempted to do so
by friends and develops blindness, and the
teenager is unconcerened about the loss of sight.
3. DENIAL: failure to acknowledge an unbearable
condition; failure to admit the reality of a situation or
how one enables the problem to continue. E.g. a
diabetic eating chocolate candy; spending money
freely when broke; waiting three days to seek help
for severe abdominal pain
4. Displacement: ventilation of intense feelings
towards persons less threatening than the one who
aroused those feelings. E.g. Person mad at his
boss, yells at his spouse
5. Dissociation: dealing with emotional conflict by a
temporary alteration in consciousness or identity.
E.g. amnesia that prevents recall of yesterday’s
auto accident; adult remembers nothing of
childhood sexual abuse
6. FIXATION: immobilization of a certain portion of the
personality resulting from unsuccessful completion of
tasks in a developmental stage. E.g. Never learning to
delay gratification; Lack of a clear sense of identity as
an adult
7. IDENTIFICATION: modeling actions and opinions of
influential others while searching for identity, or
aspiring to reach a personal, social,or occupational
goal. E.g. A nursing student becoming a CCU nurse
because this is the specialty of an instructor she
admires
8. INTELLECTUALIZATION: separation of the
emotions of a painful event or situation from the facts
involved; acknowledging the facts but not the
emotions. E.g. Person shows no emotional reaction/
expression when discussing a serious car accident
9. INTROJECTION: accepting another person’s
attitude, beliefs, and values as one’s own. E.g. A
person who dislikes guns becomes an avid hunter, just
like his best friend
10. PROJECTION: unconscious blaming of
unacceptable inclination or thoughts on an external
object. E.g. Man who has thought about same-gender
sexual relationships, but never had one, beats a man
who is gay; A person with many prejudices loudly
identifies others as bigots
11. RATIONALIZATION: excusing own behavior to
avoid guilt, responsibility, conflict, anxiety, or loss of
self-respect. E.g. A student blames failure on teacher
being mean; Man says he beats his wife because she
doesn’t listen to him.
12. REACTION FORMATION: Acting the opposite of
what one thinks or feels. E.g. woman who never
wanted children becomes a “super mom”; Person who
despises the boss tells everyone what a great boss he
is.
13. REGRESSION: Moving back to a previous
developmental stage to feel safe or have needs met.
E.g. 5 year old asks for a bottle when baby brother is
being fed; Man pouts like a 4 year old when he is not
the center of his girlfriend’s attention.
14. REPRESSION: Excluding emotionally painful or
anxiety-provoking thoughts and feelings from
conscious awareness. E.g. Woman has no memory of
the mugging she suffered yesterday; Woman has no
memory before age 7, when she was removed from
abusive parents.
15. RESISTANCE: Overt or covert antagonism toward
remembering or processing anxiety - producing
information. E.g. Nurse is too busy with other technical
tasks to spend time talking to a dying patient; Person
attends court-ordered ttt for alcoholism but refuses to
participate
16.SUBLIMATION: Exhibiting acceptable behavior to
make up for or negate unacceptable behavior. E.g.
Person who cheats on a spouse brings the spouse a
bouquet of roses. Man who is ruthless in business
donates large amounts of money to charity.
17. SUBSTITUTION: Substituting a socially
acceptable activity for an impulse that is
unacceptable. E.g. Person who has quit smoking
sucks on hard candy when the urge to smoke arises.
Person goes for a 15-minute walk when tempted to
eat junk food
18. SUPPRESSION: Replacing the desired
gratification with one that is more readily available.
E.g. Woman who would like to have her own children
opens a day care center
19. UNDOING: Ritualistically negating or undoing
intolerable feelings or thoughts. E.g. A man who has
thoughts that his father will die must step on sidewalk
cracks to prevent this and cannot miss a crack. A
woman has a sudden death wish of her mother as she
is leaving her house; she retraces her steps and
passes by the door in a backward fashion to remove
her guilt.
 OTHER DEFENSE MECHANISMS

ACTING OUT: The individual copes with

stress by engaging in actions rather than
reflecting upon internal beliefs
AFFILIATION: Involves turning to other
people for support
AIM INHIBITION: The individual accepts a
modified form of their original goal
ALTRUISM: Satisfying internal needs
through helping others
AVOIDANCE: Refusing to deal with or
encounter unpleasant objects or situations
HUMOR: Pointing out the funny or ironic
aspects of a situation
PASSIVE-AGGRESSION: Indirectly
expressing anger
 4 LEVELS/ LINES OF DEFENSE

• 1st level: considered normal and involves conscious

efforts at maintaining control over anxiety by
changing the environment or one’s perspective:
suppression, substitution, rationalization,
fantasy
• 2nd level: involves character changes and
manipulation of relationships with others. May lead
to personality disorders if prolonged or
exaggerated and to difficulties in the interpersonal
areas of work, marriage and parenting:
identification, introjection /internalization,
restitution
• 3rd level: comprises the repressive defenses which
involve changes in the intrapsychic process:
compensation, reaction-formation, sublimation,
displacement, projection, symbolization,
conversion, repression, undoing
• 4th level: seen in the use of the regressive defenses
and involves a return to a state of helplessness
and withdrawal from reality: denial, dissociation,
regression
B. BEHAVIORAL MODEL : Pavlov’s Theory
( Classical Conditioning); Skinner’s Theory
( Operant Conditioning)
CONCEPTS:
- Maladaptive behaviors are learned through
conditioning and continue because they are
rewarding to the person
- Maladaptive behaviors can change/ be changed
without developing insight into underlying causes
by altering the environment
C. Interpersonal Model: Sullivan’s Theory
CONCEPTS
-Personality develops thru interaction with
significant others: approval or disapproval of
others
-Self-concept / Self-system: “good me”, “ bad me
“, and “ not me “
-When relationships are uncomfortable
ANXIETY
- Mental Illness: inappropriate interpersonal
relationship and the cause related to past
relationships, inappropriate communication and
current crisis
D. COGNITIVE MODEL:
CONCEPTS:
-Learned thoughts become the basis for
emotions and behavior
- The amount of perceived control over situations
affects behavior
- Mental Illness is a product of distorted thinking

E. HUMANISTIC MODEL:
CONCEPTS:
-Focus ia on the “Here and Now”
-The self is unique and is in search of meaning
and authenticity
- Human needs are organized in heirarchy of
relative order; e.g. Maslow’s
-Mental Illness is a failure to fully develop one’s
potential
-Lack of self-awareness and unmet needs
interfere with relationships and feelings of
security
-The fundamental human anxiety is fear of death,
which leads to existential anxiety (concern over
the meaning of one’s life)
F. PSYCHOBIOLOGIC MODEL:
CONCEPTS:
-Mental Illness is a biophysical impairment
influenced by genetics, biochemical alterations,
nervous system function
-Mental Illness can be predisposed however not
only by physiologic factors but by social and
environmental factors as well.
 FREUD ERIKSON

0-18 MOS
ORAL STAGE TRUST vs.
-“I am what I will” MISTRUST
-Focus of energy: mouth -consistency: trust
-inconsistency:
mistrust

Behavior Problems: Listlessness, lethargy, disturbed

feeding (failure to thrive), abnormal crying, social
unresponsiveness
Pathology: Infantile Autism ( Pervasive Developmental
Disorder

AUTONOMY vs.
18MOS- 3 ANAL STAGE SHAME & DOUBT
YRS
-Focus of energy :elimination -successful choices:
control (autonomy)
-superego development begins
-unsuccessful
choices: shame &
doubt
Behavior Problems: Constipation, diarrhea, enuresis,
encopresis, excessive rebellion, excessive conformity
Pathology: Autism, separation anxiety
 FREUD ERIKSON
3-6 yrs PHALLIC STAGE INITIATIVE vs. GUILT

-”I am what I imagine” -Exploring &

successful
-Focus of energy: relationships with
Genitals parents: initiative
-Unsuccessful
relationships with
parents: guilt

BEHAVIOR PROBLEMS: Excessive masturbation,

excessive fears
PATHOLOGY: attention deficit disorder, psychophysiological
disorders, anxiety disorders, avoidant disorder, overanxious
disorder, childhood onset pervasive disorder

LATENCY STAGE INDUSTRY vs.

6-12 yrs
INFERIORITY
-”I am what I am”
-Work with competency:
-Focus of energy: same Industry
sex friends
-Unable to satisfy family
expectations: Inferiority

BEHAVIOR PROBLEMS: withdrawal from peers, low

self-esteem, aggression, short attention span, learning
difficulties
PATHOLOGY: Childhood onset pervasive
developmental disorder, anxiety disorders, attention deficit
disorder
 GENITAL STAGE IDENTITY VS ROLE
12-20 yrs CONFUSION
-Focus of energy:
Opposite sex -Integrate past with
present roles: roles:
Identity

BEHAVIORAL PROBLEMS: Rebelliousness ( lying, stealing,

promiscuity, running away), drug/ alcohol abuse
PATHOLOGY: Conduct disorders, eating disorders, affective
disorders, suicide, substance abuse disorders

INTIMACY vs.
ISOLATION
18-25 yrs
-Capacity for love,
commitment to work &
relationships: Intimacy
BEHAVIOR PROBLEMS: Isolation, Impersonal Relationships,
Inconsistent Work History
PATHOLOGY: Affective Disorders, Suicide, Schizophrenia,
Drug/Alcohol Addiction, Personality disorder

GENERATIVITY vs.
STAGNATION
25-65 yrs
-Creative, Productive
concern for others:
Generativity
BEHAVIOR PROBLEMS: Self Indulgence; Low Self-esteem
PATHOLOGY: Affective Disorders, Neurosis, Psychosis,
Psychophysiologic Disororders
 PIAGET

AGE STAGE NORMAL FINDINGS

DEVELOPMENT

Birth- 18 moths • • Recognizes and attaches to

Sensorimotor primary caretaker, develops
simple motor skills, moves
from instant gratification to
coping with anxiety;
• Learns about self through
the environment

18 months – 3 years • • Learns to manipulate

Preoperational environment, after
negativism learns self-control
in toilet training, parallel play
• Develops expressive
language and symbolic play
3 – 6 years • Preoperational intuitive • Learns symbols
and concepts,
assertiveness
against
environment;
learns sex role
identity

6 12 year • Concrete operational • Sees cause and

effect and draws
conclusions,
develops
allegiance to
friends, uses
energy to
industriously to
create and perform
tasks, shows
competency in
school and with
friends
12 – 18 years • Formal operational •Thinks abstractly,
uses logic and
scientific reason,
masters
independence
through rebellion,
develops firm
sense of self, is
strongly influenced
by peers, develops
sexual maturity,
explores sexual
relationships
18 – 25 • Develops lasting intimate relationships and
years good work relationships

24 – 45 • Establishes a family and oversees next

years generation, is productive, shows concern for
others

45 years – • Sees own life as meaningful, is productive,

death accepts physical changes
 •
CRISIS AND CRISIS
INTERVENTION
• CRISIS = An internal disturbance that results
from a stressful event or perceived threat to
self; are self-limiting
• TYPES
- MATURATIONAL – follows
developmental stages
- SITUATIONAL – random occurrences
• PHASES OF DEVELOPMENT OF A CRISIS:
- increase anxiety and tension
- normal coping ineffective; seeks
assistance
- panic state
- personality changes
•3INTERRELATED BALANCING
FACTORS CONTRIBUTING TO THE
PRODUCTION AND OUTCOME OF A
CRISIS:
- perception of the problem
- situational supports
- coping skills

• GOAL OF THERAPY
To help client resolve the problem
and return to his pre-crisis level of
functioning or to a higher level of
functioning in a short period of time (4-6
weeks)

• ROLE OF THE NURSE:

to assess the situation quickly and
accurately and to assist the client in a
tentative formulation of his problem.
 COMMUNICATION
• DEFINITION: the act of imparting and
exchanging ideas, facts and feelings with
others
• FORMS: verbal and non-verbal
• THERAPEUTIC COMMUNICATION
TECHNIQUES:
 ACKNOWLEDGE THE PATIENT
 COMMUNICATE ACCEPTANCE TO THE
CLIENT
 ENCOURAGE THE CLIENT TO EXPRESS
FEELINGS, CONCERNS, ETC
 INCLUDE OPEN-ENDED STATEMENTS
AND ENCOURAGE DISCUSSION
 DEAL WITH PATIENT NEED, “HERE AND
NOW”
 OFTEN REFLECT COMMON SENSE,
BASED UPON NURSES’S EDUCATION
 ARE “DOWN-TO-EARTH CHOICES” NOT
“HIGH SOUNDING” EDUCATED
STATEMENTS
 SPECIFIC THERAPEUTIC
COMMUNICATION TECHNIQUES
• CONVEYING WARMTH: establish climate
where client feels cared for and
comfortable
• SHOWING EMPATHY: sensitivity to
clients’ current feelings and communicating
this to the client
• DISPLAYING GENUINENESS: nurse’s
response is sincere and an expression of
real feelings
• CONVEYING RESPECT: a point of view
that says the client counts and has dignity
• LISTENING ACTIVELY: assume attitudes
of wanting to hear what client says
• DEFINING BOUNDARIES: social, physical
and emotional limits the nurse creates
• STRUCTURING TIME: client having
accurate information about how much time
nurse can offer
•PACING: recognizing verbal and non-
verbal patterns of clients’ immediate
behavior and tension
•EFFECTIVELY USING QUESTIONS: no
“why” questions
•RESTATING: repeat what client says with
purpose of increasing client’s awareness of
what he is saying
•VALIDATING: checking accuracy of
communication with each other
•BACKTRACKING: going over what has
been talked about in order to regain focus
•ASKING FOR DEMONSTRATIONS AND
ILLUSTRATIONS: giving example/s
•PROVIDING INFORMATION: teaching
•EMPHASIZING RELATIONSHIPS
BETWEEN PARTS AND WHOLES: helps
client understand his/ner pattern of thinking
about problems
•OFFERING HOPE: understanding conveyed
by nurse of client’s despair or pain
•SUMMARIZING: way to reinforce important
ideas or points as to check out nurses’
perceptions

COMMUNICATION BLOCKERS:
•CLOSED DISCUSSION
•BELITTLING OR “TALKING DOWN” TO THE CLIENT
•SHIFTING RESPONSIBILITY, UNNECESSARILY, TO
OTHERS, SUCH AS THE DOCTOR, HEADNURSE,
ETC.
•INTELLECTUALIZING IN ABSTRACT LANGUAGE
ABOUT ABSTRACT CONCEPTS TO A CLIENT WITH
VERY CONCRETE NEEDS

NOTE: IN CHOOSING THE BEST THERAPEUTIC

RESPONSE, CHOOSE THE ONE THAT REFLECTS
FEELINGS AND PROVIDES INFORMATION
SPECIFIC EXAMPLES OF THERAPEUTIC TECHNIQUES:
•USING SILENCE
•ACCEPTING: yes; uh-hmm; I follow what you said; nodding
•GIVING RECOGNITION: Good morning, Mr. Santos. I see
you’ve combed your hair
•OFFERING SELF: I’ll sit with you awhile; I’ll stay here with
you; I’m interested in your comfort
•GIVING BROAD OPENINGS: Is there something you’d like
to talk about? What are you thinking about? Where would
you like to begin?
•OFFERING GENERAL LEADS: Go on; And then; Tell me
about it
•PLACING THE EVENT IN TIME OR IN SEQUENCE: What
seemed to lead up to…? Was this before or after…?; When
did this happen?
•MAKING OBSERVATIONS: You appear tense; Are you
uncomfortable
•ENCOURAGING DESCRIPTION OF PERCEPTIONS: Tell
me when you feel anxious., What is happening?, What does
the voice seem to be saying?
•ENCOURAGING COMPARISON: Was this something
like…? Have you had similar experiences?
•RESTATING: Client: I can’t sleep. I stay awake all night.
Nurse: You have difficulty sleeping?
•REFLECTING: Client: Do you think I should tell the doctor?
Nurse: Do you think you should?
Client: My brother spends all my money and
then has the nerve to ask for
more
Nurse: This causes you to feel angry?
•FOCUSING: This point seems worth looking at more
closely.; Tell me more about that.; Would you
describe it more fully.; What kind of work…
•GIVING INFORMATION: My name is…; Visiting hours
are…; My purpose in being here is…
•SEEKING CLARIFICATION: I’m not sure that I follow; What
would you say is the main point of what
you said?
•PRESENTING REALITY: I see no one else in the room;
The sound was a car backfiring.; Your mother
is not here, I’m a nurse.
•VOICING DOUBT: Isn’t that unusual?; Really?; That’s hard
to believe.
•SEEKING CONSENSUAL VALIDATION: Tell me whether
my understanding of it agrees with yours; Are
you using this word to convey the idea…?
•VERBALIZING THE IMPLIED: Client: I can’t talk to you or
to anyone. It’s a waste of time.
Nurse: Is it your feeling that no one
understands?
•ENCOURAGING EVALUATION: What are your
feelings in regard to…?; Does this
contribute to your discomfort?
•ATTEMPTING TO TRANSLATE:
Client: I’m dead.
Nurse: Are you suggesting that you
feel lifeless? Or is it that life seems without
meaning?
•SUGGESTING COLLABORATION:: Perhaps
you and I can…
•SUMMARIZING: Have I gotten this straight?;
You’ve said…
•ENCOURAGING FORMULATION OF A PLAN
OF ACTION: What could you do to let your anger
out harmlessly?; Next time this comes
up, what might you do to handle it?
NONTHERAPEUTIC TECHNIQUES
• REASSURING: Everything will be alright
• GIVING APPROVAL: That’s good
• REJECTING: Lets not discuss that
• DISAPPROVING: That’s bad
• AGREEING: That’s right
• DISAGREEING: I definitely disagree with that
• ADVISING: I think you should
• PROBING: Now tell me about…
• CHALLENGING: But how can you be President of the
Philippines?
• TESTING: What day is this?
• DEFENDING; No one here would lie to you
• REQUESTING AN EXPLANATION: Why do you feel this way
• INDICATING THE EXISTENCE OF AN EXTERNAL
SOURCE: Who told you that?; What makes you say that?
• BELITTLING FEELINGS EXPRESSED: Everybody feels low
at times
• MAKING STEREOTYPED COMMENTS: Nice weather we’re
having
• GIVING LITERAL RESPONSES: Client: I’m an easter egg
Nurse: What design?
• USING DENIAL: Client: I am nothing
Nurse: Of course you’re something. Everybody is somebody.
• INTERPRETING: What you really mean is…; Unconsciously
you are saying…
• INTRODUCING AN UNRELATED TOPIC: Client: I’d like to
die
Nurse: Did you get any visitors this weekend?
 ANXIETY DISORDERS
Anxiety is an apprehensive anticipation of an
unknown danger. Anxiety is a reaction to an
unconscious internal conflict, in contrast to
fear, which is an emotional response to a
consciously recognized external threat. Both
anxiety and fear cause a similar physiological
reaction, including elevated vital signs, dry
mouth, increased perspiration,
gastrointestinal discomfort, restlessness,
impaired sleep, difficulty concentrating,
dizziness, frequency of urination, and
muscular tension.
A small amount of anxiety is constructive, but too
much can be disabling and overwhelming.
Severity of anxiety is rated as mild, moderate,
severe, or panic. Responses to anxiety can be
behavioral, cognitive, and affective, as well as
physical. Observe the anxious client for
irritability; feelings of dread, guilt, or
helplessness; change in communication level
(increased or decreased); acting out
behaviors; or withdrawal from others. Again,
 Specific anxiety disorders :
•Panic disorder/panic attacks with or
without agoraphobia
• Phobias with simple, specific
subtypes
• Social phobia/social anxiety disorder
• Obsessive-compulsive disorder
(O.C.D.)
• Posttraumatic stress disorder
(P.T.S.D.)
• Acute stress disorder
• Generalized anxiety disorder
(includes overanxious
disorder of childhood)
• Anxiety disorder due to a medical
condition
• Substance-induced anxiety disorder
In general, the body’s reaction to
anxiety is the same whether the stress
is a positive or negative emotion or
occurrence. First, the fight or flight
mechanism is activated, causing
biochemical changes in the body.
Then, there’s a stage of resistance,
when physical and psychosocial
adaptation is in operation. Finally,
there’s a stage of exhaustion when the
body gives up its struggle against the
stressor. Panic and crisis can result.
Initially, while the client’s anxiety is
very high, the nurse must remain calm;
stay with the client; speak firmly,
clearly, and simply; and provide a safe,
protective environment. After this
period of high anxiety, the client will
likely be more receptive to the nurse
and be ready for exploratory work and
General nursing interventions
for the client with an anxiety
disorder include:
* reducing environmental stimuli
(lights, noise, activity),
*administering medications as
ordered and observing effects,
*using therapeutic communication
skills to encourage the client to
talk and express feelings,
*recommending physical activities
as outlets for nervous energy and
as distractions from anxiety,
*teaching the client about
diagnoses and treatments.
 TABLE 3
ANXIETY DISORDERS

TYPE CHARACTERISTICS MANAGEMENT

Phobia • Apprehension, • Avoid confrontation

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

Anorexia • Most common in • Monitor clinical status

nervosa females 12-18 years (e.g., weight, intake,
old; characterized by vital signs)
fear of obesity, • Behavior modification
dramatic weight loss, may help in acute phase
distorted body image, • Family therapy
anemia amenorrhea.
• Support efforts to take
Cathartics and enemas
may be used. responsibility for self
• Characterized by • Explore issues around
Bulemia sexuality
binge eating and
purging with induced • May be managed with
antidepressants
 TYPE CHARACTERISTICS MANAGEMENT

Obsessive – • Obsession – • Accept ritualistic

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

Assess level of • Look at body language, speech

anxiety patterns, facial expressions, defense
mechanisms and behavior used
• Distinguish levels of anxiety

Keep • Brief orientation to unit of procedures

environmental • Written information to read later,
stresses/stimulati when anxiety is lower
on low when • Pleasant, attractive, uncluttered
anxiety is high environment
• Provide privacy, if presence of other
patients is overstimulating
• Provide physical care if necessary
• Avoid offering many alternatives or
decisions when anxiety is high
 GENERAL EXAMPLES
PRINCIPLES

Assist patient to • Acknowledge anxious behavior

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

Maintain • Use an unhurried approach

accepting and • Acknowledge patient’s distress and his
helpful attitude concerns about problem
toward patient • Encourage clarification of feelings and
thoughts
• Evaluate and manage own anxiety while
working with patient
• Recognize the value of defense mechanisms
and realize that patient is attempting to make
the anxiety tolerable in the best way possible
- Do not attempt to remove a defense
mechanism at any time
 SOMATIZATION DISORDERS
• Essential features are physical symptoms
suggestive of physical disorder for w/c there is no
organic basis. The symptoms are not under
voluntary control.
• TYPES:
1. CONVERSION DISORDER: Anxiety created by
conflict is converted into a specific and usually
symbolic physical symptom
2. PSYCHOGENIC PAIN DISORDER: Severe and
prolonged pain with absence of any physical reason
3. HYPOCHONDRIASIS: An unrealistic interpretation
of physical signs or symptoms as abnormal
• NURSING DIAGNOSIS: Ineffective
coping( increased somatic complaints) related
to anxiety about unresolved conflict
• NURSING GOAL: Client will exhibit decrease in
somatic complaints and an increase in
verbalizations about feelings
• NURSING IMPLEMENTATION:
1. Respond to physical complaints matter-of-factly
2. Note relationship bet. Complaint & event in the
client’s life
3. Educate client about his/her disorder
4. Positively reinforce client when he/she
verbalizes his/her feelings
5. Provide redirection with constructive
activities

• ADJUNCT THERAPY:
1. Antianxiety medications
2. Rule out organic basis
3. Intensive supportive psychotherapy
 DISSOCIATIVE DISORDERS
• ESSENTIAL FEATURE: Temporary
alteration in the normally integrated functions
of consciousness identity or motor
behavior, so that part of one or more of these
functions is lost. The dissociation produces
considerable changes in the person’s behavior,
feelings and thoughts.
• TYPES:
1. PSYCHOGENIC AMNESIA: Partial or total
disability of a client to recall or identify past
experiences
2. PSYCHOGENIC FUGUE: Client retreats even
further into his mind and wanders away from
home
3. MULTIPLE PERSONALITY: Existence within
the individual of two or more distinct
personalities, each of whom is dominant at a
particular time
4. DEPERSONALIZATION: A loss of sense-of-
self
• NURSING DIAGNOSIS: Flight from self related
to anxiety
• NURSING GOAL: Client will express anxiety
verbally and develop appropriate coping
• IMPLEMENTATION:
1. Monitor environmental stimulation
2. Teach client how to reduce anxiety
3. Provide medication
• ADJUNCT THERAPY:
1. Hypnosis
2. Intensive psychotherapy
• SPECIAL TYPE OF DISSOCIATIVE
BEHAVIOR: POST-TRAUMATIC
STRESS DISORDER (PTSD): complex of
symptoms developed following
psychologically traumatic experience
• NURSING DIAGNOSIS: Prolonged
reaction to terror related to failure of ego to
integrate traumatic experience
• NURSING GOAL: Client will work through
the traumatic event and gain mastery over
coping
• IMPLEMENTATION:
1. Educate client about disorder
2. Provide supportive and protective
relationship
3. Help client discuss feelings
4. Limits
• ANTIANXIETY MEDICATIONS:
1. Benzodiazepines, i.e., Diazepam
(Valium)
2. Chlordiazepoxide (Librium)
3. Meprobamate (Equanil, Miltown)
4. Antihistamines (Vistaril, Atarax)
• Induce relaxation and decrease
muscle tension
• Side effects: dizziness and
drowsiness
• Nursing implication: high potential for
abuse- short term usage only
 PERSONALITY DISORDERS

• ESSENTIAL FEATURE: Deeply

ingrained, inflexible maladaptive
patterns of relating to, perceiving
and thinking about the environment
and oneself that are of sufficient
severity to cause either significant
impairment in inadaptive functioning
or subjective distress
• CHARACTERISTICS:
1. Poor self-esteem
2. Poor relationship skills
3. Low tolerance for anxiety
4. Manipulative
• ETIOLOGICAL FACTORS:
1. Childhood experiences
2. Parents
• TYPES:
1. Paranoid: Pervasive and long standing
suspiciousness
2. Schizoid: absence of warmth, tender
feelings for others; indifference to praise,
criticism or feelings
3. Histrionic: Behavior that is really overly
reactive and intensely expressed; a very
dramatic person
4. Narcissistic: Grandiose sense of self-
importance and a lack of empathy for
others
5. Antisocial: History of continuous and
chronic violation of rights of others
6. Borderline: Interpersonal relationships
which are intense and unstable. There is a
great dael of impulsiveness and
unpredictable behavior that is self-
damaging
7. Avoidant: Great deal of social withdrawal
and a lot of low self-esteem; yearns for
acceptance and affection
8. Dependent: A lack of self-confidence
and the person subordinates his own
needs for the needs of others because he
is so afraid of losing them
9. Compulsive: A great deal of
perfectionism, preoccupation with rules,
regulations and trivial details
• NURSING DIAGNOSIS: Unstable
interpersonal relationships related to
conflict between
dependency/independency.
• NURSING GOAL: Client will develop
meaningful, stable relationships
• IMPLEMENTATION:
1. Provide clear expectations and limits
2. Point out manipulation and offer
appropriate alternative behavior
3. Help client control impulses; learn to
think thru a situation
4. Support others when client devalues
them
 MANIPULATION: Clear, concise end rules;
consistency, set limits, confront
 LOW SELF-ESTEEM: successful activities,
approach when not seeking attention,
confront own anger, reinforce strengths
 IMPULSIVE OR SUICIDAL BEHAVIOR:
Precautions, therapeutic relationship,role
model relaxation
 SUICIDE
• THE ACT OF KILLING ONESELF
USUALLY BECAUSE OF A STRESS
PERCEIVED AS OVERWHELMING
• INDICATIVE SIGNS:
1. Changes from outgoing to introspected
2. Once easy to get along with, now sullen
and angry
3. Gives away important, personal items
4. Gets affairs in order, wills, insurances,
finances
5. Direct verbalization of “I’m no good;
“I’m better off dead”
• NURSING DIAGNOSIS: Potential for
injury to self related to poor impulse
control
• NURSING GOAL: Client will not harm
self
• IMPLEMENTATION:
1. Determine lethality potential
ask: “Have you thought of suicide/”
ask: “How would you do it?”
2. Determine if the client has the means
to carry it out
3. Determine how in touch with reality the
client is
4. Determine if the client is still
communicating
5. Determine the client’s support system
6. Provide suicide precautions:
@ one-to-one 24-hour precautions
@ contract
@hospitalization
7. Offer support, safety, esteem
 SUBSTANCE USE DISORDERS
• Essential feature: Maladaptive
behavioral changes as a result of
misusing drugs that affect the CNS
• Substance Abuse Diagnostic
Criteria:
- Abuse of at least one month’s duration
- Social complications of use
- Psychological dependence
- Pathological pattern
• Substance Dependence
- Tolerance-tissue adaptation: changes
occur in cells at the nervous system so
that more of the drug is required to
achieve the desired effect
- Withdrawal symptoms: substance
specific syndrome that follows cessation
of or reduction in intake of a substance
that was previously regularly used by an
individual to produce a physiological state
of intoxication. (Assess for restlessness,
sweating, tachycardia, N&V, illusions,
hallucinations, convulsions, hyperflexia,
coma, death)
•Classes of Substances:
- Alcohol = CNS depressant
- Barbiturates or other sedatives or hypnotics = CNS
depressant
- Cocaine = stimulant psychological dependence
- Amphetamine = stimulant
- Cannabis, Marijuana – CNS depressant
- Phencyclidine – PCP, LSD – hallucinogen –
psychologically addictive

•Assessment specific to Alcohol

Abuse:
-Clients in all health care settings should be
monitored for alcohol withdrawal – 1/3 all hospital
admissions involve some type of ETOH use

•Assessment specific to Cocaine

Abuse:
- Consider cocaine use if clients present with
symptoms of weight loss, skin problems,
tachyarrhythmias, seizures or spitting up black
phlegm. Also monitor for cellulitis as a result of
needle use.
•Consider Possible Alcohol Use:
- If history reveals an incidence of blackouts, insomnia, tremors
– seizures, G-I changes, fluctuant hypertension, seizures or
feelings of low self-esteem / suicide potential
• Nursing Diagnosis: Alternation in coping (Substance
Abuse) related to excessive dependency needs
• Nursing Goal: Client will abstain from drugs and develop
more appropriate coping
• Implementation:
- Assist client physiological and psychologically to withdraw
- Teach client about his disease
- Provide nutritional supplement as needed
- Support family getting into therapy
- Treat underlying personality disorder
- Psychotherapy
- Self – help groups
- Rehabilitation programs
- Antabuse other alternate therapies
- Focus nursing care on:
• Physical monitor for withdrawal, especially DTs, a medical
emergency
• Manipulate behaviors
• Impulsiveness
• Relationship
• Lack of Commitment
 Mania
• Essential features:
- Flights of ideas – stream of thought characterized
by rapid association of ideas
- Elated, grandiose mood – self-satisfied, confident,
aggressive
- Psychomotor Excitement – Continuous Activity
• Nursing Diagnosis: Excessive activity
related to denial of depression
• Nursing Goal: Client will acknowledge
depression and resume moderate level of activity
• Implementation:
- Physical care – sleeping, eating, rest, etc
- Thought processes
- Inflated self-esteem
- Painful consequences
• Adjunct Therapy:
- May be treated as an outpatient if mania is mild
- Hospitalization for acute and delirious
- MEDS: Lithium TTT, Tricyclics, MAO Inhibitors
• Lithium
- Take thorough nursing history - used on a long-term
basis
- Is a salt therefore report if client has history of
cardiovascular or kidney disease
- Therapeutic blood levels: .6 – 1.2 mEg/L
- Signs of toxicity (Blood level>2.0 mEg/L)
• Blurred vision, increased urination, diarrhea
• Irregularity, hypotension, slurred speech, syncope,
vomiting, confusion
• Blackouts, seizures, hyperactive movements,
arrhythmia, circulatory failure
• Tricyclics
- Doxepin (Sinequan) Amitryptyline (Elavil)
Imiprmine (Tofranil)
- Interferes with re-uptake of neurotransmitters
(MAO)
- Side effects: Anticholinergic, weight gain,
orthostatic hypotension
- Nursing Implementations: Give late afternoon or
early evening
• MonoAmine Oxidase Inhibitors (MAOI)
-Antidepressants
-Isocarboxazid(Marplan); Phenelzine(Nardil)
MAO-block destruction of neurotransmitters
-Most fatal side effect: Hypertensive crisis: occurs if
mixed with foods containing tyramine
-Nursing Implications: Avoid beer, wine, cheese,
yogurt, sour cream, citrus fruits, bananas,
avocadoes, soy sauce, dried or aged foods.
 Affective Disorders
• ESSENTIAL FEATURE: Characterized by
depressive behavior or elated (Manic) Behavior or
Fluctuations from one mood to the other.
 Depressive disorder : Disorder of mood; no
signs of manic behavior
 Bipolar Disorder : One or more manic episodes
with or without a history of a major depressive
episode
• Major Depression
- Psychologically depressed mood
- Appetite disturbances – Anorexia or ↑ food intake
- Sleep disturbances – difficulty going to sleep at
night or awakening after 4 -6 hours with inability
to return to sleep
- Psychomotor retardation or excitation
- Anxiety
- ↓ self-esteem
- Somatic complaints
- ↓ interest in sexual activity
- Suicidal thoughts
• Nursing Diagnosis: Alteration in mood and
rate performance related to depression
• Nursing goal: Client will exhibit more
appropriate affect and report some pleasure in life
• Implementation:
- Physical: Monitor I & O, diet, small meals, fluids,
sleep, exercise
- Thought Processes: Blocking, restate, limit
choices, calm, matter-of-fact, non-judgemental
- Guilt worthlessness: Warm, supportive, repeated
attention, here and now, guilt processes, activities
- Suicide precautions
• Adjunct Therapy: Antidepressants, etc,
psychotherapy hospitalization, clinical treatment,
long-term follow up
 Mood / Affective Disorders

Differences Between Mania and Depression

Mania Depression

Characterized by psychomotor Characterized by psychomotor

activity (↑ emotional support retardation (decreased
and physical activity) emotional and physical activity)

Associated with the following Associated with the following

signs and symptoms:
• Restlessness
• Flight of ideas
• inability to eat and sleep
because of involvement in
more important things
signs and symptoms:
•Constipation
•Slowed gait and activity
•Inability to make decisions
quickly
•Sleep disturbance

Extroverted personality Introverted personality

Initiation of activity Lack of initiative

 MANIA DEPRESSION

Delusional self-confidence Lack of self confidence

(feelings of worthlessness,
inadequacy, and inferiority

Directing hostility onto Internalizing hostility; feeling

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

Tendency to dress in bright, Loss of interest in

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

Apparent unlimited energy Lack of energy; easily

fatigued

Involved in groups; enjoys Withdrawn from groups

being the center of activity
 MANIA DEPRESSION
Higher muscle tonus; Low muscle tonus; possibly
possibly appearing younger appearing older than age
than age

Possible increase in sexual Possible lack in sexual

interest interest

ELECTROCONVULSIVE THERAPY
•Treatment for mood disorders, primarily used for
depression but can also be used for mania
•Nurse’s role: educative and supportive:
•Informed consent for ECT
•NPO from midnight the evening before
•Ask client to void immediately before TTT
DURING ECT:
•Assist the psychiatrist and anesthesiologist
•Monitor VS including ECG,BP and Oxygen
Saturation
Role Functions of the Health Team:
•Psychiatrist: administers the electric shock that
induces Grand Mal Seizure
•Anesthesiologist: responsible for administering
all IV medications and oxygen

•TTT PERIOD: 6-12 treatments can be given

through the entire course
•EXPECTED POST-ECT REACTIONS:
•Restlessness
•Agitation
•Confusion
•Disorientation
•Mild symptoms of tiredness, nausea and
headache (postanesthesia)
•Short-term memory loss
Nurse provides pallative and symptomatic
support and reassurance that the memory
loss is temporary.
 SCHIZOPHRENIC DISORDERS
• ESSENTIAL FEATURE: Disintegrative life
pattern characterized by a thought disorder,
withdrawal from reality, regressive behavior,
poor communication and impaired
interpersonal relationship
• Etiology may be biological ( insufficiency of
norepinephrine) or sociocultural

• FOUR PRIMARY SYMPTOMS:

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

NURSING DIAGNOSIS: ALTERATION IN

THOUGHT PROCESS RELATED TO
INABILITY TO TEST REALITY
Nursing goal: client will learn how to
validate whether or not his thoughts are
reality based

Implementation:
- Physical: Monitor weight, I & O, monitor
position & possible edema, teach basic
hygiene
- Thought disorders: Clarify pronouns; use
of here and now; visual activities; distraction;
repeated reality orientation
- Delusions (Fixed belief) Hallucinations
(False perception): Eye contact; orient; do
not reinforce or agree with client; use of
concrete language; distraction
- Blunted affect: Role model & teach
recognition of emotions
- Lack of Ego boundaries: Point out; role
model
- Activities: Concrete (Limit choice) teach
problem solving
- Lack of relationship skills: Trust,
attention, respect, caring, successful
activities
Pharmacologic Interventions:
Antipsychotic drugs (Chlorpromazine-
Thorazine; Haloperidol-Haldol)
Action: Modify thought disturbances;
decrease agitated; aggressive behavior;
antiemetics, antipyretics
Side effects: Anticholinergic: orthostatic
hypotension, tachycardia, dry mouth, weight
gain
Extrapyramidal effects: Restlessness;
Pseudo-parkinsonism, Tardive Dyskinesia
 Paranoid Disorders
•ESSENTIAL FEATURES: Psychotic
disorders in which the predominant symptoms
are delusions, generally persecutory, jealous
or grandiose.
-Characterized by projection, but no active
hallucinations
Nursing diagnosis: Impaired social
interactions related to feelings of mistrust and
suspicions of others.
-Ineffective individual coping related to accept
own feelings and responsibility for actions
secondary to low self-esteem.

Implementation:
-Milieu therapy = Present reality
-Psycho therapy
-Pharmacologic TTT = Major tranquilizers
 Organic Mental Disorders
• ESSENTIAL FEATURES: Psychological or behavior
abnormally associated with transient (reversible) or
permanent dysfunction of the brain. Sometimes referred to
as organic brain syndrome (OBS) and includes Alzheimer’s
disease
• Potential causes (Etiology):
- Endocrine dysfunctions
- Nutritional & Deficiency states
- Toxic conditions
- post-traumatic reactions
- Vascular disorders
- Metabolic & Electrolyte abnormalities
- Drugs & Medications
- Infections
- Degenerative & “Slow Virus” disease
- Neoplastic disorders

Nursing Diagnosis: Alteration in orientation

(Permanent/Temporary) related in structure and/or function
of brain

Nursing Goal: Client will remain oriented to

environment as long as possible
Implementation:
- Clarification of level of deficit & client’s ability to learn
- Empathy for client & family
- Prevent further deterioration as much as possible
- Facilitate client’s acceptance of disability
- Utilize problem – solving skills on individual basis
Common terms related to the assessment
of thought process and content:
• Circumstantial thinking: a client eventually answers a
question but only after giving excessive unnecessary detail.
• Delusion: a fixed false belief not based in reality
• Flight of ideas: excessive amount and rate of speech
composed to fragmented or unrelated ideas
• Ideas of reference: client’s inaccurate interpretation that
general events are personally directed to him or her, such as
hearing a speech on the news and believing the message
had personal meaning
• Loose associations: disorganized thinking that jumps
from one idea to another with little or no evident relation
between the thoughts
• Tangential thinking: wandering off the topic and never
providing the information requested
• Thought blocking: stopping abruptly in the middle of
sentence or train of thought; sometimes unable to continue
the idea
• Thought broadcasting: a delusional belief that others can
hear or know what the client is thinking
• Thought insertion: a delusional belief that others are
putting ideas or thoughts into the client’s head – that is, the
ideas are not those of the client
• Thought withdrawal: a delusional belief that others are
taking the client’s thoughts away and the client is powerless
to stop it
• word salad: flow of unconnected words that convey no
meaning to the listener

UNUSUAL SPEECH PATTERNS OF CLIENTS

WITH SCHIZOPHRENIA:
•Clang associations: ideas that are related to one
another based on sound or rhyming rather than
meaning: “ I will join the fun and swallow a coin but I
cannot see the sun, I think its my loin”
•Neologisms: words invented by the client: “I’m
scared of ‘wiggies’! Are you a ‘wiggy’?
•Verbigeration: stereotyped repetition of words or
phrases that may or may not have meaning to the
listener: “I am sick, so are you; so are you; so are
you”
•Echolalia: Client’s imitation or repetition of what the
nurse says : Nurse: “Did you sleep well?” Patient:
“Did you sleep well, sleep well…”
•Stilted Language:Use of words or phrases that are
flowery, excessive, or pompous:” Now isn’t it
immensely astonishing that a representative of
Florence Nightingale, a creature of planet earth woud
serve me a glass of sparkling water”
Perseveration: persistent adherence to a single
idea or topic and verbal repetition of a sentence,
phrase or word even when another person attempts
to change the topic: Nurse “How have you been
sleeping lately?” Patient: “I think I know who is out to
get me” Nurse: “Where did you put your things?’
Patient: “Even at home they’re out to get me” Nurse:
“Did you take your medicines this morning?” Patient:
“No matter where I go I know they’re out to get me.”
Word Salad: a combination of jumbled words and
phrases that are disconnected or incoherent and
make no sense to the listener: “jitter, rude, rice and
sugar, pretty, dance away, bulls eye”
DELUSION, ILLUSION, HALLUCINATION
DELUSIONS: False ideas or beliefs accepted as real
by the patient– external contradictory information or
facts cannot alter them
TYPES:
•Persecutory/paranoid Delusions: belief that others
are out to harm
•Grandiose Delusions: Claim to association with
famous people or celebrities, or the belief that he /she
is famous or capable of feats
•Religious Delusions: often center around the second
coming of Christ or another significant religious figure
or prophet. Unrelated to his/her religious faith but
comes as part of his/her psychosis
•Somatic Delusions: generally vague and unrealistic
beliefs about the client’s health or bodily functions.
Factual information or lab data does not change the
belief. Ex: having worms in the head
•Referential Delusions: ideas of reference involve the
client’s beliefs that television broadcasts, music or
newspaper articles have special meaning for him/ her.
HALLUCINATIONS: False sensory perceptions, or
perceptual experiences that do not exist in reality.
Can involve the senses and bodily sensations.( may
be perceived initially as real but later as
hallucinations)
ILLUSIONS: Misperceptions of actual environmental
stimuli ( may be corrected by factual information or
reality)
TYPES OF HALLUCINATIONS:
•Auditory- most common and may turn into
command hallucinations
•Visual- second most common
•Olfactory- often occurs with dementia, seizures or
cardiovascular accidents
•Tactile- most often found in patients undergoing
alcohol withdrawal; rarely occurs in schizophrenic
clients (electricity or bugs crawling along the body)
•Gustatory
•Cenesthetic: feels bodily functions that are
undetectable like formation of urine by the kidneys or
impulses transmitted by the brain
•Kinesthetic: patient is motionless but reports the
sensation of bodily movement like floating above the
ground