Lecture, 2 psychiatric nursing……practical
Lecture objectives:- ( Summary )
At the end of this lecture the students will be aware of :
Sign and symptoms
I- Disturbances of consciousness, orientation, and attention
1- Disturbance of consciousness (Clouding of consciousness- Stupor- Coma)
2- Disturbance of orientation (Disorientation )
3- Attention (Distractibility - Hypervigilance )
of mental illness II- Disturbances of memory
1 Amnesia (Anterograde – Retrograde – Total – Localized )
2 Par amnesia (Falsification – Confabulation - DÉJÀ VU phenomenon - JAMAIS VU phenomena)
III – Disorders of affect and mood
(1) Inappropriate affect (incongruity)-Euphoria-Depression-Mood swings-Irritable mood-Anhedonia-
Ambivalence-Anxiety-Panic).
IV- Disturbance in perception
1- Hallucination (Auditory – Visual - Olfactory –Gustatory - Tactile)
2. Illusion
3. Depersonalization
Associate Prof.dr. Yosr elmasri,,,,, Psychiatric Mental Health Nursing
4. Derealization
I- Disturbances of 1.Disturbance of consciousness
consciousness, orientation, and Conscious is the state of awareness of the self and environment.
attention &concentration Disturbances of consciousness are most often associated with
organicmentaldisordersand include:-
Associate Prof.dr. Yosr elmasri,,,,, Psychiatric Mental Health Nursing Associate Prof.dr. Yosr elmasri,,,,, Psychiatric Mental Health Nursing
a. Clouding of consciousness
b. Stupor
Incomplete clear mindedness and the patient react incompletely to lack of reaction to internal or external stimulus and unawareness to
stimuli ….attention, concentration and memory are impaired and surroundings.
orientation is disturbed. The patient is mute and motionless but fully conscious and the eyes
may be open and follow external objects.
https://www.youtube.com/watch?v=_Sn1i9obIEo
Associate Prof.dr. Yosr elmasri,,,,, Psychiatric Mental Health Nursing Associate Prof.dr. Yosr elmasri,,,,, Psychiatric Mental Health Nursing
2- Disturbance of orientation
c. Coma a. Disorientation
Profound degree of unconsciousness, patient not respond Loss of awareness of one's relationship to time, place, and person (TPP).
even to strong stimulus
Associate Prof.dr. Yosr elmasri,,,,, Psychiatric Mental Health Nursing Associate Prof.dr. Yosr elmasri,,,,, Psychiatric Mental Health Nursing
3- Disturbance of attention
b. Hypervigilance: excessive attention
a. Distractibility inability to focus attention and focus on all external and internal
…. Attention drown into irrelevant external stimuli ( The
patient attends to every passing stimulus regardless of
stimuli, which is present in hypomanic and
its significance) obsessive persons.
Seen in mania and anxiety.
Associate Prof.dr. Yosr elmasri,,,,, Psychiatric Mental Health Nursing Associate Prof.dr. Yosr elmasri,,,,, Psychiatric Mental Health Nursing
1 Amnesia
Partial or total inability to recall past experience ,
may be organic or functional in origin and may take
II- Disturbances of memory the following forms:
a. Anterograde amnesia:
loss of memory of recent events e.g. occurs after
head trauma or organic brain disorder and drug
intake
Associate Prof.dr. Yosr elmasri,,,,, Psychiatric Mental Health Nursing
Associate Prof.dr. Yosr elmasri,,,,, Psychiatric Mental Health Nursing
b. Retrograde amnesia loss of memory d. Localized amnesia loss of memory
of remote events, which occurs in advanced for an isolated event (limited time ) with
dementia.
intact memory before and after.
c. Total amnesia
Seen in brain lesions, severe anxiety and
loss of memory for recent and remote events
fugue states.
Associate Prof.dr. Yosr elmasri,,,,, Psychiatric Mental Health Nursing
Associate Prof.dr. Yosr elmasri,,,,, Psychiatric Mental Health Nursing
2 Paramnesia c DÉJÀ VU phenomenon
a. Falsification…. Memory becomes unconsciously Is a French term meaning already seen or there is
distorted by adding some personal false details, seen nothing new in that. …..it is an illusion of visual
in hysteria, depression, and paranoid disorders.
recognition in which new situation is incorrectly
b.Confabulation……. Unconscious filling of gaps regarded as familiar to the patient, may be seen
in memory by imagined or untrue events . Most often in anxiety disorders and fatigue.
associated with organic mental disorders
Associate Prof.dr. Yosr elmasri,,,,, Psychiatric Mental Health Nursing
Associate Prof.dr. Yosr elmasri,,,,, Psychiatric Mental Health Nursing
Break 15 minutes
d JAMAIS VU phenomena
Meaning never seen : false feelings of
unfamiliarities with a real situation
one has experienced before e.g.
epilepsy.
Associate Prof.dr. Yosr elmasri,,,,, Psychiatric Mental Health Nursing
Emotion: is a complex feeling state related to affect
and mood
III – Disorders of affect Mood
Is the internal feeling tone as experienced by a person
and mood (subjective) and reported by him, and may be also observed by
others
Affect
Is the visible expressed part of emotion (objective)…. i.e.
observable feeling tone accompanies behavior and
Associate Prof.dr. Yosr elmasri,,,,, Psychiatric Mental Health Nursing communication.
Associate Prof.dr. Yosr elmasri,,,,, Psychiatric Mental Health Nursing
1.Inappropriate affect 2. Euphoria
(incongruity) Intense elation with feeling of
Disharmony between the emotional feeling
grandeur as seen in manic
tone and the idea or speech accompanying it patient and in drug abuser
Associate Prof.dr. Yosr elmasri,,,,, Psychiatric Mental Health Nursing Associate Prof.dr. Yosr elmasri,,,,, Psychiatric Mental Health Nursing
4. Labile mood Mood swings
3. Depression Oscillation between euphoria and depression or anxiety
A psychopathological feeling of https://www.youtube.com/watch?v=msd9nLLvj6w&t=77s
sadness, hopelessness, loneliness and
helplessness e.g. in major depression 5. Irritable mood
Easily annoyed and provoked anger, e.g. in mania
Associate Prof.dr. Yosr elmasri,,,,, Psychiatric Mental Health Nursing Associate Prof.dr. Yosr elmasri,,,,, Psychiatric Mental Health Nursing
6. Anhedonia
Inability to experience pleasure.
The patient is no longer able to enjoy activities that
7. Ambivalence
previously give him pleasure, such as playing games, or Having tow opposing feelings, attitude, idea or wishes
seeing family or friends, toward the same person, situation or object at the same
many patients described themselves as feeling emotionally
time, seen in schizophrenia.
empty.
Most commonly seen in depression, and sometimes in
schizophrenia as a negative symptoms
Associate Prof.dr. Yosr elmasri,,,,, Psychiatric Mental Health Nursing Associate Prof.dr. Yosr elmasri,,,,, Psychiatric Mental Health Nursing
8. Anxiety
Feeling of apprehension, tension, and uneasiness caused by 9.Panic
anticipation of danger which may be internal or external. Sudden, intense morbid fear attacks associated with intense anxiety
Seen in anxiety disorders and mood disorders. that produces terror and physiological changes, of short duration
(minutes).
Associate Prof.dr. Yosr elmasri,,,,, Psychiatric Mental Health Nursing
Associate Prof.dr. Yosr elmasri,,,,, Psychiatric Mental Health Nursing
Perception Is the process of giving a
meaning to sensory stimuli.
IV- Disturbance in perception It is disturbance include hallucinations,
illusions, depersonalization and
derealization.
Associate Prof.dr. Yosr elmasri,,,,, Psychiatric Mental Health Nursing Associate Prof.dr. Yosr elmasri,,,,, Psychiatric Mental Health Nursing
1. Hallucination Hallucination are not restricted to the mentally ill . A few
normal people experience them, especially when tired, also occur in healthy people
False sensory perceptions experienced without real external
during transition between sleep and waking: they are called hypnagogicwhile
stimulus . Patient are usually experienced as originated in the falling asleep or hypnapompicwhile awaking
outside world not within the mind as imagination
Associate Prof.dr. Yosr elmasri,,,,, Psychiatric Mental Health Nursing
Associate Prof.dr. Yosr elmasri,,,,, Psychiatric Mental Health Nursing
Types of hallucination: b- According to sensory modality
Auditory hallucination
a. According to complexity: Is the most common type of hallucinations in
- Unformed hallucination e.g. whistle, flashes of light.
psychiatric disorders ( are the most common
- Formed hallucination such as hearing voices or music or
seeing faces and colored objects …… seen in organic diagnostic criteria of schizophrenia ) . May be
mental disorders and hysteria noises or voices ……. this voices may be as give
commands, threaten, punishment or provide
reassurance .
Associate Prof.dr. Yosr elmasri,,,,, Psychiatric Mental Health Nursing Associate Prof.dr. Yosr elmasri,,,,, Psychiatric Mental Health Nursing
Visual hallucination Olfactory hallucination:
May be Formed hallucination e.g. peoples appearing smaller in size
e.g. unpleasant smell
than the corresponding real percept.
Are seen in dissociation and conversion disorders ,substance abuse and Gustatory hallucination:
schizophrenia. e.g. unpleasant taste
Associate Prof.dr. Yosr elmasri,,,,, Psychiatric Mental Health Nursing
Associate Prof.dr. Yosr elmasri,,,,, Psychiatric Mental Health Nursing
Tactile (haptic) hallucination: 2. Illusion
e.g. sensation of being touched, sensation of insects moving under
the skin ….. Occurs in cocaine abuse and occasionally in
Misinterpretation or false perception of real external
schizophrenia. stimulus.
Associate Prof.dr. Yosr elmasri,,,,, Psychiatric Mental Health Nursing Associate Prof.dr. Yosr elmasri,,,,, Psychiatric Mental Health Nursing
3. Depersonalization:
A subjective sense of being unreal , strange, unfamiliar to oneself.
4. Derealization:
A subjective sense that the environment is strange and unreal,
feeling of changed reality.
Thanks
...........SMRT objective
Associate Prof.dr. Yosr elmasri,,,,, Psychiatric Mental Health Nursing
