PSYCHIATRIC

NURSING
PREPARED BY: JOEL C. PASCUA, BSN, RN
MENTAL HEALTH
state of emotional,
psychological, and social
wellness evidenced by satisfying
personal relationships, effective
behavior and coping, a positive
self concept, and emotional
stability.
COMPONENTS OF MENTAL HEALTH
(Johnson, 1997)
 Autonomy and Independence
 Maximizing One’s Potential
 Tolerating Life’s Uncertainties
 Self-esteem
 Mastering the Environment.
 Reality Orientation
 Stress Management
THERAPEUTIC USE OF SELF
Main tool used by the nurse in
Psychiatric Nursing.
Hildegard Peplau (1952) “Clear
understanding of once self”.
Therapeutic use of self requires SELF-
AWARENESS!!!
SELF-AWARENESS

Process by which the nurse

gains recognition of his or her
own feelings, beliefs, and
attitudes.
METHODS USED TO INCREASE SELF-
AWARENESS
ROLE PLAY
INTROSPECTION
DISCUSSION
ENLARGING ONE’S EXPERIENCE
DISTURBANCE IN COMMUNICATION
CIRCUMSTANTIALITY
Over inclusion of details.

WORD SALAD
this is a mixture of words and
phrases that has no meaning.
DISTURBANCE IN COMMUNICATION
VERBIGERATION
Meaningless repetition of words and
phrases.

PERSEVERATION
Persistence of a response to a
previous question.
DISTURBANCE IN COMMUNICATION
ECHOLALIA
 Pathological repetition of words of others.

FLIGHT OF IDEAS
 Excessive amount and rate of speech
composed of fragmented or unrelated
ideas.
DISTURBANCE IN COMMUNICATION
LOOSENESS OF ASSOCIATION
 Shifting of a topic from one subject to
another in a completely unrelated way.

CLANG ASSOCIATION
 - The sound of the word gives direction to
the flow of thought.
DISTURBANCE IN COMMUNICATION

DELUSION
False belief which is
inconsistent with one’s
knowledge and culture
DISTURBANCES IN AFFECT
INAPPROPRIATE AFFECT
- Disharmony between the stimulus
and the emotional reaction.

BLUNTED AFFECT
- Severe reduction in emotional
reaction.
DISTURBANCES IN AFFECT
FLAT AFFECT
 Absence or near absence of emotional /
facial reaction that would indicate
emotions or mood

APATHY (Dulled emotional tone)

 Feelings of indifference toward people,
activities, and events
DISTURBANCES IN AFFECT
AMBIVALENCE
Holding seemingly contradictory beliefs
or feelings about the same person,
event or situation

DEPERSONALIZATION
Feeling of strangeness towards oneself
DISTURBANCES IN AFFECT

DEREALIZATION
Feeling of strangeness
towards the environment
DISTURBANCES IN MOTOR ACTIVITY
ECHOPRAXIA
 The pathological imitation of posture or
action of others.

WAXY FLEXIBILITY
 Maintaining desired position for long
periods of time without discomfort.
DISTURBANCES IN MEMORY
CONFABULATION
 Filling a memory gap with detailed fantasy
believed by the teller.

AMNESIA
 to recall past events.

ANTEROGRADE AMNESIA
 Loss of memory of the immediate past.
DISTURBANCES IN MEMORY
RETROGRADE AMNESIA
 Loss of memory of the distant past.

DÉJÀ VU
 Feeling of having been to a place which one has not
yet visited.

JAMAIS VU
 Feeling of NOT having been to a place which one HAS
VISITED.
CORE CONCEPTS ON THERAPEUTIC
COMMUNICATION
COMMUNICATION

Interchange of information,
ideas or thoughts.
ELEMENTS OF COMMUNICATION
Sender - Originator of the information
Message - Information being transmitted
Receiver - Recipient of information
Channel - Mode of communication
Feedback - Return response
Context - The setting of the
communication
VARIABLES THAT INFLUENCE
COMMUNICATION
Perception
Values
Culture
LEVELS OF COMMUNICATION
Intrapersonal - a person
communicates within himself
Interpersonal- within dyads (group of
two persons) and in small groups.
Public - between a person and
several other people.
MODES OF COMMUNICATION

VERBAL COMMUNICATION: THE SPOKEN

WORD

NON-VERBAL MESSAGES
 Proxemics
Intimate Distance – actual contact to 1.5
feet
Personal Distance – 1.5 to 4 feet or 3 to 4
feet for interviews
Social Distance – 4 to 12 feet
Public Distance – 12 feet and beyond
CHARACTERISTICS OF SUCCESSFUL
COMMUNICATION
1. Feedback (return response)
2. Appropriateness
3. Efficiency
4. Flexibility
THERAPEUTIC COMMUNICATION

An interpersonal interaction

between the nurse and client.
GOALS OF THERAPEUTIC
COMMUNICATION
 Establish a therapeutic nurse-client
relationship
 Identify the most important client concern at
the moment (the client-centered goal)
 Assess client’s perception of the problem as it
unfolded.
 Facilitate client’s expression of emotions
GOALS OF THERAPEUTIC
COMMUNICATION
 Teachclient and family necessary self-care
techniques
 Recognize client’s needs
 Implement interventions designed to address
client’s needs
 Guide client toward identifying a plan of action to
a satisfying and socially acceptable resolution.
THERAPEUTIC COMMUNICATION
TECHNIQUES
ACCEPTING
Indicating reception
Examples: “Yes”; “I follow what
you said”; Nodding
THERAPEUTIC COMMUNICATION
TECHNIQUES
BROAD OPENINGS
Allowing client to take the initiative in
introducing the topic
Example: “Where would you like me to
begin?”
THERAPEUTIC COMMUNICATION
TECHNIQUES
CONSENSUAL VALIDATION
Searching for mutual understanding,
for accord in the meaning of the
words.
Example: “Tell me whether my
understanding of it agrees with yours.”
THERAPEUTIC COMMUNICATION
TECHNIQUES
ENCOURAGING COMPARISON
Helping the client to understand by
looking at similarities and
differences.
Example: “Have you had similar
experiences?”
THERAPEUTIC COMMUNICATION
TECHNIQUES
ENCOURAGING DESCRIPTION OF
PERCEPTIONS
Asking client to verbalize what he or she
perceives.
Examples: “Tell me when you feel
anxious”; “What is happening?”; “What
does the voice seem to be saying?”
THERAPEUTIC COMMUNICATION
TECHNIQUES
ENCOURAGING EXPRESSION
Asking client to appraise the quality
of his or her experience.
Example: “What are your feelings in
regard to. . ?”
THERAPEUTIC COMMUNICATION
TECHNIQUES
EXPLORING
Delving further into a subject or
idea.
Examples; “Tell me more about
that.”; “Would you describe it
more fully?”; “What kind of work?”
THERAPEUTIC COMMUNICATION
TECHNIQUES
FOCUSING
Concentrating on a single point.
Examples: “This point seems looking
at more closely.”; “Of all the
concerns you have mentioned,
which is most troublesome?”
THERAPEUTIC COMMUNICATION
TECHNIQUES
FORMULATING A PLAN OF ACTION
Asking client to consider kinds of behavior
likely to be appropriate in future situations.
Examples: “What could you do to let your
anger out harmlessly?”; “Next time this
comes up, what might you do to handle
it?”
THERAPEUTIC COMMUNICATION
TECHNIQUES
GENERAL LEADS
Giving encouragement to
continue.
Examples: “Go on.”; “And
then?”; “Tell me about it.”
THERAPEUTIC COMMUNICATION
TECHNIQUES
GIVING INFORMATION
Making available the facts that the
client needs.
Examples: “My name is. . .”; “Visiting
hours are. . .”; “My purpose in being
here is. . .”
THERAPEUTIC COMMUNICATION
TECHNIQUES
GIVING RECOGNITION
Acknowledging, indicating
awareness.
Examples: “Good Morning Ms. A. .
.”;“You’ve finished your list of things to
do.”; “I notice that you’ve combed
your hair.”
THERAPEUTIC COMMUNICATION
TECHNIQUES
MAKING OBSERVATIONS
Verbalizing what the nurse
perceives.
Examples: “You appear tense.”;
“Are you uncomfortable when . .
?”; “I notice that you are biting
your lip.”
THERAPEUTIC COMMUNICATION
TECHNIQUES
OFFERING SELF
Making oneself available.
Examples: “I will sit with you awhile.”;
“I will stay here with you.”; “I am
interested in what you think.”
THERAPEUTIC COMMUNICATION
TECHNIQUES
PLACING EVENT IN TIIME SEQUENCE
Clarifying the relationship of events in
time.
Examples: “What seemed to lead up to.
. ?”; “Was this before or after?”; “When
did this happen?”
THERAPEUTIC COMMUNICATION
TECHNIQUES
PRESENTING REALITY
 Offering for consideration that which is
real.
Examples: “I see no one else in the
room.”; “That sound was a car
backfiring.”; “Your mother is not here. I
am a nurse.”
THERAPEUTIC COMMUNICATION
TECHNIQUES
REFLECTING
 - Directing client actions, thoughts, and
feelings back to the client.
Examples
 Client: “Do you think I should tell the
doctor?”
 Nurse: “Do you think you should?”
THERAPEUTIC COMMUNICATION
TECHNIQUES
RESTATING
Repeating the main idea expressed.
Examples
Client: “I can’t sleep. I stay awake all
night.”
Nurse: “You have difficulty sleeping.”
THERAPEUTIC COMMUNICATION
TECHNIQUES
SEEKING INFORMATION
Seeking to make clear that which is not
meaningful or that which is vague.
Examples: “I am not sure that I follow.”;
“Have I heard you correctly?”
THERAPEUTIC COMMUNICATION
TECHNIQUES
SILENCE
Absence of verbal communication,
which provides time for the client to put
thoughts or feelings into words, regain
composure, or continue talking.
Examples: Nurse says nothing but
continues to maintain eye contact and
conveys interest
THERAPEUTIC COMMUNICATION
TECHNIQUES
SUGGESTING COLLABORATION
 Offering to share, to strive, to work with the
client for his or her benefit.
 Examples: “Perhaps you and I can discuss
and discover the triggers for your anxiety.”;
“Let’s go to your room and I will help you find
what you are looking for.”
THERAPEUTIC COMMUNICATION
TECHNIQUES
SUMMARIZING
Organizing and summing up that
which has gone before.
Examples: “Have I got this straight?”;
“You’ve said that. .”; “During the past
hour, you and I have discussed..”
THERAPEUTIC COMMUNICATION
TECHNIQUES
TRANSLATING INTO FEELINGS
- Seeking to verbalize client’s feelings
that he or she expresses only indirectly.
Examples: Client: “I am dead.”, Nurse:
“Are you suggesting that you feel
lifeless?”
THERAPEUTIC COMMUNICATION
TECHNIQUES
VERBALIZING THE IMPLIED
 Voicing what the client has hinted at or
suggested.
 Examples
Client:“I can’t talk to you or anyone. It is a
waste of time.”
Nurse: “Do you feel that no one understands?”
THERAPEUTIC COMMUNICATION
TECHNIQUES
VOICING DOUBT
Expressing uncertainty about the
reality of the client’s perceptions.
Examples: “Isn’t that unusual?”;
“Really?”; “That is hard to believe.”
NON-THERAPEUTIC
COMMUNICATION TECHNIQUES
ADVISING
-Telling the client what to do.
Examples: “I think you should.”;
“Why don’t you?”
NON-THERAPEUTIC
COMMUNICATION TECHNIQUES
AGREEING
Indicating accord with the
client.
Examples: “That is right.”; “I
agree.”
NON-THERAPEUTIC COMMUNICATION
TECHNIQUES
BELITTLING FEELINGS EXPRESSED
 Misjudging the degree of the client’s discomfort.
 Examples
Client: “I have nothing to live for. . . I wish I was
dead”
Nurse: “Everybody gets down in the dumps.” OR “I
have felt that way myself.”
NON-THERAPEUTIC
COMMUNICATION TECHNIQUES
CHALLENGING
Demanding proof from the client.
Examples:
“But how can you be the President of the
United States?”
“If you are dead, why is your heart
beating?”
 NON-THERAPEUTIC
COMMUNICATION TECHNIQUES
DEFENDING
Attempting to protect someone or
something from verbal attack.
Examples: “This hospital has a fine
reputation.”; “I am sure your doctor has
your best interests in mind.”
NON-THERAPEUTIC
COMMUNICATION TECHNIQUES
DISAGREEING
Opposing the client’s ideas.
Examples:
“That is wrong.”;
“I definitely disagree with. . .”;
“I do not believe that. . .”
NON-THERAPEUTIC
COMMUNICATION TECHNIQUES
GIVING APPROVAL
Sanctioning the client’s behavior or
ideas.
Examples: “That is good.”; “I am
glad that. . ”
NON-THERAPEUTIC
COMMUNICATION TECHNIQUES
GIVING LITERAL RESPONSES
 Responding to a figurative comment as though it
were a statement of fact.
Examples
 Client: “They are looking in my head with a
television camera.”
 Nurse: “Try not to watch television.” OR “What
channel?”
NON-THERAPEUTIC
COMMUNICATION TECHNIQUES
INDICATING THE EXISTENCE OF AN EXTERNAL
SOURCE
 Attributing the source of thoughts, feelings, and
behavior to others or to outside influences.
 Examples: “What makes you say that?”; “What
made you do that?”; “Who told you that you
were a prophet?”
NON-THERAPEUTIC
COMMUNICATION TECHNIQUES
INTERPRETING
 Asking to make conscious that which is
unconscious; telling the client the meaning
of his or her experience.
 Examples: “What you really mean is. . .”;
“Unconsciously you are saying. . .”
NON-THERAPEUTIC COMMUNICATION
TECHNIQUES
INTRODUCING AN UNRELATED TOPIC
Changing the subject.
Examples
Client: “I would like to die.”
Nurse “Did you have visitors last night?”
NON-THERAPEUTIC
COMMUNICATION TECHNIQUES
MAKING STEREOTYPED COMMENTS
 Offering meaningless clichés or trite
comments.
 Examples: “It is for your own good.”; “Just
keep your chin up”; “Just have a positive
attitude and you will be better in no
time.”
NON-THERAPEUTIC COMMUNICATION
TECHNIQUES
PROBING
Persistent questioning of the client.
Examples: “Now tell me about this
problem. You know I have to find
out.”; “Tell me your psychiatric history.”
NON-THERAPEUTIC
COMMUNICATION TECHNIQUES
REASSURING
Indicating there is no reason for
anxiety or other feelings of discomfort.
Examples: “I would not worry about
that.”; “Everything would be alright.”;
“You are coming along just fine.”
NON-THERAPEUTIC
COMMUNICATION TECHNIQUES
REJECTING
- Refusing to consider or showing
contempt for the client’s ideas or
behaviors.
Examples: “Let us not discuss. . .”;
“I do not want to hear about. . .”
NON-THERAPEUTIC COMMUNICATION
TECHNIQUES
REQUESTING AN EXPLANATION
Asking the client to provide reasons for
thoughts, feelings, behaviors, events.
Examples: “Why do you think that?”;
“Why do you feel that way?”
NON-THERAPEUTIC
COMMUNICATION TECHNIQUES
TESTING
Appraising the client’s degree
of insight.
Examples: “Do you know what
kind of hospital this is?”; “Do
you still have the idea that . ?”
NON-THERAPEUTIC
COMMUNICATION TECHNIQUES
USING DENIAL
Refusing to admit that a
problem exists.
Examples; Client: “I am dead.”
Nurse: “Do not be silly.”
GUIDELINES FOR IDENTIFYING THERAPEUTIC
RESPONSES IN THE BOARD EXAM

LOOK FOR THERAPEUTIC PHRASES

 - The following are therapeutic phrases
utilized by the nurse:
 “It seems…”; “It sounds…”; “I will sit with
you…”; “I will stay with you…”; “I will
check…”; “Tell me…”
GUIDELINES FOR IDENTIFYING THERAPEUTIC
RESPONSES IN THE BOARD EXAM
LOOK FOR NON-THERAPEUTIC PHRASES
- The use of ‘labels’ is non-therapeutic
“That’s good!”; “That’s bad!”; “You’re
the best!”; “You’re the worst!”
- The use of ‘absolutes’ is non-
therapeutic
GUIDELINES FOR IDENTIFYING THERAPEUTIC
RESPONSES IN THE BOARD EXAM
LOOK FOR NON-THERAPEUTIC PHRASES

 “Always…”; “Never…”; “None…”; “All….”

 - The use of ‘commands’ is non-therapeutic
 “You need to…”; “You must…”; “You
should…”
GUIDELINES FOR IDENTIFYING THERAPEUTIC
RESPONSES IN THE BOARD EXAM

USE OF OPEN-ENDED QUESTIONS

“Tell me, how do you feel,” then
follow it up with “I understand how
you feel. I will stay with you for
awhile.’
GUIDELINES FOR IDENTIFYING THERAPEUTIC
RESPONSES IN THE BOARD EXAM
USE OF CLOSED-ENDED QUESTIONS
 Use of Closed-ended questions is therapeutic
when dealing with:
 Manic patients - This would discourage them
from over-control of the conversation
 Rape or Crisis Victims- With their unstable
condition, they may misconstrue use of open-
ended questions as ‘prying’.
GUIDELINES FOR IDENTIFYING THERAPEUTIC
RESPONSES IN THE BOARD EXAM

USE OF ‘WHY’ QUESTIONS

The use of the question ‘why’ is non-
therapeutic
Example:
Client: “I was speeding along the street
and did not stop at the sign”
Nurse: “Why were you speeding?”
GUIDELINES FOR IDENTIFYING THERAPEUTIC
RESPONSES IN THE BOARD EXAM

USE OF ‘WHAT’ QUESTIONS

The use of the question ‘what’ is
therapeutic
“What is happening?”; “What does
the voice seem to be saying?”; “What
transpired after that?”
GUIDELINES FOR IDENTIFYING THERAPEUTIC
RESPONSES IN THE BOARD EXAM

AVOID FALSE REASSURANCES

Examples: “I would not worry about
that.”; “Everything would be
alright.”; “You are coming along just
fine.”
GUIDELINES FOR IDENTIFYING THERAPEUTIC
RESPONSES IN THE BOARD EXAM

USE OF THE WORD ‘I’

Example:
Client: “Should I move from my home to
a nursing home?”
Nurse: “If I were you, I’d go to a nursing
home, where you’ll get your meals
cooked for you”
GUIDELINES FOR IDENTIFYING THERAPEUTIC
RESPONSES IN THE BOARD EXAM

USE OF THE WORD ‘YOU’

 Examples
Client: “I am dead.”
Nurse: “Are you suggesting that you feel
lifeless?”
Client: “I am way out in the ocean.”
Nurse: “You seem to feel lonely or deserted.”
GUIDELINES FOR IDENTIFYING THERAPEUTIC
RESPONSES IN THE BOARD EXAM

USE OF DIRECT QUESTIONS FOR SUICIDAL

PATIENTS
 Nurse: “Do you have any plans of killing
yourself?”

AVOID THE ‘AUTHORITARIAN ANSWER’

 Avoid statements like “I think you should. . I
should know, I am the nurse”
WHAT TO REMEMBER IN
THERAPEUTIC COMMUNICATION
 Be empathetic and not just sympathetic!
EMPATHY
 ability of the nurse to perceive the meanings and
feelings of the client and to communicate that
understanding to the client.
SYMPATHY
 Feelings of concern or compassion one shows for
another.
NURSE – PATIENT RELATIONSHIP

Seriesof interactions between

the nurse and the patient in
which the nurse assists the
patient to attain positive
behavioral change
CHARACTERISTICS OF THE
NURSE-PATIENT RELATIONSHIP
Goal-directed
Focused on the needs of the
patient
Planned
Time-limited
Professional
BASIC ELEMENTS OF THE
NURSE-PATIENT RELATIONSHIP
Trust
Rapport
Unconditional positive regard
Setting
limits
Therapeutic communication
PHASES OF THE
NURSE-PATIENT RELATIONSHIP
PRE-ORIENTATION PHASE
Begins when the nurse is assigned to a
patient

ORIENTATION PHASE
Begins when the nurse and the patient
interacts for the first time
PHASES OF THE
NURSE-PATIENT RELATIONSHIP
WORKING PHASE
 highly individualized
 longestand most productive phase of the nurse-
patient relationship; Limit-setting is employed

TERMINATION PHASE
 gradual weaning process; mutual agreement
 PROBLEMS AFFECTING THE NURSE-
PATIENT RELATIONSHIP
TRANSFERENCE
 client displaces onto the nurse attitudes and feelings
that the client originally experience in other relationships
COUNTERTRANFERENCE
 nurse displaces onto the client attitudes or feelings from
his or her past.
RESISTANCE
 Development of ambivalent feelings toward self-
exploration
LEVELS OF INTERVENTIONS IN
PSYCHIATRIC NURSING
PRIMARY

SECONDARY

TERTIARY
 MAJOR TYPES OF NEUROTRANSMITTERS
TYPES ACTION PHYSIOLOGIC EFFECTS

DOPAMINE Excitatory Controls complex movements,

motivation, cognition;
regulates emotional response.

NORE- Excitatory Changes in attention, learning

PINEPHRINE and memory, sleep and
(NORADRE-NALINE) wakefulness, mood

EPINEPHRINE Excitatory Fight-or-flight response

(ADRENALINE)
 MAJOR TYPES OF NEUROTRANSMITTERS
TYPES ACTION PHYSIOLOGIC EFFECTS

SEROTONIN Inhibitory Control of food intake, sleep and

wakefulness, temperature
regulation, pain control, sexual
behaviors, regulation of emotion.
HISTAMINE Neuromodulator Alertness, control of gastric
secretions, cardiac stimulation,
peripheral allergic responses

ACETYLCHOLI Excitatory or Sleep and wakefulness cycle;

NE Inhibitory signals muscles to become alert
 MAJOR TYPES OF NEUROTRANSMITTERS
TYPES ACTION PHYSIOLOGIC EFFECTS

NEUROPEP-TIDES Neuromodulators Enhance, prolong,

inhibit, or limit the
effects of principal
neurotransmitters
GLUTA-MATE Excitatory Neurotoxicity results if
levels are too high
GAMMA- Modulates other
AMINOBU-TYRIC neurotransmitters
ACID (GABA)
PSYCHOTROPIC DRUG
CATEGORIES
ANTI-PSYCHOTIC DRUGS

used to treat symptoms of psychosis,

such as delusions and hallucinations.

work by blocking the receptors of the

neurotransmitter Dopamine.
2 TYPES OF ANTI-PSYCHOTIC DRUGS
TYPICAL:

ATYPICAL:
SIDE EFFECTS OF ATYPICAL - ANTIPSYCHOTIC
DRUGS – CLOZAPINE (Clozaril)
Agranulocytosis
suddenly and is characterized by fever, malaise,
ulcerative sore throat, and leukopenia.
TREATMENT
 Blood samples should be taken weekly to
monitor the WBC count of patients with
agranulocytosis.
 discontinued immediately if the white blood cell
count drops by 50% or to less than 3,000.
EXTRA PYRAMIDAL EFFECTS
ACUTE DYSTONIA
 Spasms or stiffness in muscle groups can produce
torticollis, Opisthotunos and Oculogyric crisis.
PSEUDOPARKINSONISM
 A stiff, stooped posture; Masklike facies;
Decreased arm swing; shuffling, festinating gait,
Cogwheel rigidity, Drooling; Tremor; Bradycardia
 Coarse pill-rolling movements of the thumb and
fingers while at rest
EXTRA PYRAMIDAL EFFECTS

AKATHISIA
intense need to move about
client appears restless or anxious and
agitated, often with a rigid posture or
gait and a lack of spontaneous
gestures.
EXTRA PYRAMIDAL EFFECTS
TARDIVE DYSKINESIA (TD)
 Tongue-thrusting and protrusion, lip-smacking,
blinking, grimacing and other excessive,
unnecessary facial movements
NEUROLEPTIC MALIGNANT SYNDROME (NMS)
 - potentially fatal, idiosyncratic reaction to an
antipsychotic drug with the following
symptoms:
ANTICHOLINERGIC DRUGS
Used to treat Extra-pyramidal
Effects.
Examples: Akineton, Cogentin,
Artane, Benadryl.
ANTI DEPRESSANT DRUGS
primarily used in the treatment of:

a. Major depressive illness

b. Panic disorder
c. Bipolar / Psychotic depression
TRICYCLIC ANTI DEPRESSANT DRUGS
The cyclic antidepressants became
available in the 1950s and for years were
the first choice of drugs to treat
depression.
MONOAMINE OXIDASE INHIBITOR (MAOI)
ANTIDEPRESSANT DRUGS
also discovered in the 1950s and
were found to have a positive
effect on depressed persons.

low incidence of sedation and

anticholinergic effects
 SELECTIVE SEROTONIN REUPTAKE INHIBITOR
(SSRI) ANTIDEPRESSANT DRUGS
 firstavailable in 1987 with the release of
fluoxetine (Prozac).
 replaced the cyclic drugs as the first choice in
treating depression, because they equal in
efficacy and produce fewer troublesome side
effects.
 effective in the treatment of Obsessive-
Compulsive Disorder as well.
ANTIANXIETY DRUGS
Anxiety and anxiety disorders; Insomnia;
Obsessive-Compulsive disorder;
Depression; Post-traumatic Stress
disorder; Alcohol withdrawal
Benzodiazepines have proved to be the
most effective in treating anxiety.
Examples of Anxiolytics
 Alprazolam (Xanax) Lorazepam
 Chlordiazepoxide (Ativan)
(Librium)
Oxazepam (Serax)
 Clonazepam (Klonopin)
 Chlorazepate Temazepam
(Tranxene) (Restoril)
 Diazepam (Valium) Triazolam (Halcion)
 Flurazepam (Dalmane)
Buspirone (BuSpar)
MOOD STABILIZING DRUGS
To treat bipolar affective disorder
by stabilizing the client’s mood
To avoid or minimize the highs and
lows that characterizes bipolar
illness
To treat the acute phases of mania
SIDE FEFECTS OF MOOD STABILIZING
DRUGS - LITHIUM
Mild nausea (take medication with food) or
diarrhea
Anorexia
Finehand tremors (use propranolol – a beta
blocker)
Polydipsia; Polyuria; Metallic taste in the mouth
Fatigue or lethargy
TOXIC EFFECTS OF MOOD
STABILIZING DRUGS - LITHIUM
Severe diarrhea; Vomiting;
Drowsiness; Muscle weakness; Lack of
coordination
Untreated, these symptoms worsen
and can lead to renal failure, coma
and death.
DRUG ALERT!!!
When toxic signs occur, the drug
should be discontinued immediately.
Informed Physician and prepare
mannitol.
If Lithium levels exceed 3.0 mEq/day,
dialysis may be indicated.
OTHER DRUGS USED
 STIMULANTS: Amphetamines, –
methylphenidate (Ritalin), pemoline
(Cylert), dextroamphetamine (Dexedrine)
- Avoid Stimulant food and beverages.
 SENSITIZING DRUGS: Antabuse
- Avoid Alcohol
 ELECTROCONVULSIVE THERAPY
 believed that the shock stimulates brain
chemistry to correct the chemical imbalance
of depression.
 Voltage: 70-150
 Length: 0.5-2 seconds.
 Frequency: 6-12 treatments with 48 hours
apart.
 Indication: Depression, Mania, Catatonic
Schizophrenia
ELECTROCONVULSIVE THERAPY
 Contraindications: Fever; Increased intracranial tumor;
TB with history of Hemorrhage; Cardiac condition;
recent fracture; Retinal Detachment; Pregnancy
 consent is needed
 Premeds: Atropine sulphate, Anectine
(Succinylcholine), Methohexital Sodium (Brevital)
 Complications: Loss of memory; Headache; Apnea;
Fracture; Respiratory depression
COMMON PSYCHOTHERAPEUTIC
INTERVENTIONS
 HYPNOTHERAPY
 REMOTIVATION
THERAPY  HUMOR THERAPY
 MUSIC THERAPY  BEHAVIOR
 PLAY THERAPY MODIFICATION
 GROUP THERAPY  AVERSION THERAPY
 MILIEU THERAPY  DESENSITIZATION
 FAMILY THERAPY
 COGNITIVE THERAPY
 PSYCHOANALYSIS
 DIVISIONS OF THE MIND OR LEVELS
OF AWARENESS
CONSCIOUS
 part of the mind focused on awareness
PRECONSCIOUS
 part of the mind that contains information that can
be recalled at will
UNCONSCIOUS
 It
is the largest part of the mind; contains materials
and information that can never be recalled
PERSONALITY STRUCTURE
ID
- Pleasure-seeking behavior; Aggression;
Sexual impulses
EGO
- Reality Principle
SUPEREGO
- Morality Principle
CRISIS AND CRISIS INTERVENTION
CRISIS
 turning point in an individual’s life that produces
an overwhelming emotional response
 CHARACTERISTICS OF A CRISIS STATE
• Highly individualized
• Lasts for 4 – 6 weeks
• Person affected becomes passive and
submissive
• Affects a person’s support system
TYPES OF CRISES

MATURATIONAL OR
DEVELOPMENTAL CRISIS
SITUATIONAL OR ACCIDENTAL CRISIS
SOCIAL OR ADVENTITIOUS CRISIS
PHASES OF A CRISIS
1) Denial - Initial reaction
2) Increased Tension
- person recognizes the presence of a crisis and
continues to do activities of daily living
3) Disorganization
- person is pre-occupied with the crisis and is unable
to do activities of daily living
4) Attempts to Reorganize
- individual mobilizes previous coping mechanisms
CRISIS INTERVENTION
GOAL OF CRISIS INTERVENTION
- To enable the patient to attain an optimum level of
functioning
TYPES OF CRISIS INTERVENTION
• AUTHORITATIVE CRISIS INTERVENTION
• FACILITATIVE CRISIS INTERVENTION
PRIMARY ROLE OF THE NURSE IN CRISIS
- Active and directive, the nurse has to assist the patient
CRISIS: RAPE
Isa crime of violence and humiliation of
the victim expressed through sexual
means
Rape is the penetration of an act of
sexual intercourse with a female against
her will and without her consent,
whether her will is overcome by force,
fear of force, drugs, or intoxicants
ESSENTIAL ELEMENTS NECESSARY TO DEFINE AN
ACT OF RAPE

Use of threat / force

Lack of consent of the victim
Actual penetration of the penis
into the vagina
DIFFERENT KINDS OF RAPE
1.ANGER RAPE
 - Rapist believes he is the victim of an unjust society
and takes revenge on others by raping
2. POWER RAPE
 - The intent of the rapist is not to injure the victim but
to command and master another person sexually
3. SADISTIC RAPE
 - Involves brutality
 - This is done to express erotic feelings
RAPE TRAUMA SYNDROME
- group of signs and symptoms experienced by a victim
in reaction to a rape
PHASES OF THE RAPE TRAUMA SYNDROME

1) Acute Phase - shock, numbness and disbelief

2) Denial Phase - victim’s refusal to talk about the event
3) Heightened Anxiety - fear, tension, and nightmares
4) Stage of Reorganization - victim’s life normalizes
NURSING CARE FOR RAPE VICTIMS
 In the emergency setting, provide immediate
emotional support
 The nurse should allow the woman to proceed at
her own pace and not rush her through any
interview or examination
 Give as much control back to the victim as
possible by allowing her to make decisions, when
possible, about whom to call, what to do next,
what she would like done, etc.
 NURSING CARE FOR RAPE VICTIMS
 It is the victim’s decision about whether or not to file charges
and testify against the perpetrator and the victim must sign
consent forms before any photographs of hair and nail
samples are taken for future evidence
 The priority in the care of a rape victim is the preservation of
evidence
 Prophylactic treatment for STDs is offered
 Prophylaxis can be offered to prevent pregnancy
 In some areas, HIV testing is strongly encouraged
 Referrals to rape crisis centers are encouraged
ANXIETY

“stage of uneasiness or discomfort

experienced to varying degrees
frequently coupled with doubts,
fears, obsessions.”
LEVELS OF ANXIETY

I. Mild (alert and awake)

• Heightened awareness, Increase perceptual
field, Sharpening of the mind
• Widens perceptual field, Focused and
motivated
• MANAGEMENT: Encourage Verbalization of
feelings
 LEVELS OF ANXIETY
II. Moderate
 Purposeless pacing, Narrowed/decrease perceptual
field, Selective attention
 S/sx: Sudden changes in V/S, Diaphoretic, Muscle
stiffness, GI Disturbances- Butterfly in the stomach
(both Mild and Moderate)
 Needs assistance in verbalizing feelings.
 MANAGEMENT: PRN (medical intervention), Anti-
anxiety drugs, Encourage to verbalize feelings.
 LEVELS OF ANXIETY
III. Severe Anxiety
• Increased/continuous pacing periods, Does not know
what to do/say, Limited perceptual field, With vision
disturbance (Tunnel vision)
• Nauseated and vomiting, Chest pain,
• Fight and flight response.
• Will not verbalize feelings, With directive approach.
• MANAGEMENT: Be directive in a calm manner. Use
clean and simple instructions. Decrease
environmental stimuli. Promote safety.
 LEVELS OF ANXIETY
IV. PANIC
 Loss of rational thought/delusional and Hysterical stage,
Completely blocked mental process
 Muteness and personality disintegration,
Shock/Hyperventilation/Physiologic exhaustion.
 May commit suicide with no idea of what he is doing.
 MANAGEMENT: Protect patient from physiologic exhaustion,
Provide brown bag when hyperventilating.
 PRIORITY: SAFETY and STAY with the patient.,
 DOC: SSRI
PRIORITY NURSING DIAGNOSES FOR ANXIETY
 Ineffective individual coping
 Anxiety

PRINCIPLES OF NURSING CARE IN ANXIETY

 Calm
 Administer medications
 Listen to the patient’s concerns
 Minimize environmental stimuli
EGO DEFENSE MECHANISMS
 COMPENSATION  RATIONALIZATION
 CONVERSION  REACTION
 DENIAL FORMATION
 DISPLACEMENT  REGRESSION
 DISSOCIATION  REPRESSION
 FIXATION  RESISTANCE
 IDENTIFICATION  SUBLIMATION
 INTELLECTUALIZATION  SUBSTITUTION
 INTROJECTION  SUPPRESSION
 PROJECTION
 UNDOING
ANXIETY DISORDERS

 emotional illnesses
characterized by fear,
autonomic nervous system
symptoms and avoidance
behavior
1. PHOBIAS
 Agoraphobia
 Monophobia
 Aerophobia
 Claustrophobia
 Xenophobia
 Arachnophobia
 Social Phobia
MANAGEMENT OF PATIENT WITH
PHOBIA
Anti anxiety drugs
Systematic Desensitization
Flooding approach
 2. PANIC DISORDER
SYMPTOMS
A discrete episode of panic lasting 15 to 30 minutes with four
or more of the following:
 Palpitations;
Sweating; Trembling or shaking; Shortness of
breath; Choking or smothering sensation; Chest pain or
discomfort; Nausea
 Derealization
(sensing that things are not real) or
depersonalization (feelings of being disconnected from
oneself
 Fear of dying or going crazy; Paraesthesia's
MANAGEMENTS OF PANIC
DISORDER
 Anti-anxiety medications
 Relaxation exercises
 Deep breathing
 Cognitive behavioral techniques
• POSITIVE REFRAMING
• DECATASTROPHIZING
• ASSERTIVENESS TRAINING
3. OBSESSIVE-COMPULSIVE
DISORDER
OBSESSIONS COMPULSIONS
FEAR OF DIRT AND GERMS EXCESSIVE HAND WASHING

FEAR OF BURGLARY REPEATED CHECKING OF DOOR

OR ROBBERY AND WINDOW LOCKS

WORRIES ABOUT DISCARDING COUNTING AND RECOUNTING OF

SOMETHING IMPORTANT OBJECTS IN EVERYDAY LIFE

WORRIES THAT THINGS MUST BE EXCESSIVE STRAIGHTENING,

SYMMETRICAL OR MATCHING ORDERING, OR ARRANGING OF
THINGS
MANAGEMENTS OF OBSESSIVE-
COMPULSIVE DISORDER
• Anti-anxiety medications
• Response prevention (delaying or
avoiding performance of the rituals)
• Thought Stopping
4.GENERALIZED ANXIETY DISORDER
SYMPTOMS
 Apprehensiveexpectations more days than not for
6 months or more about several events or activities
 Uncontrollable worrying
 Significant
distress or impaired social or
occupational functioning
 Threeof the following symptoms: Restlessness; Easily
fatigued; Difficulty concentrating or mood going
blank; Irritability; Muscle tension; Sleep disturbance
MANAGEMENT OF GENERALIZE
ANXIETY DISORDER
Anti-anxietymedications
Anti-depressants
Psychotherapy
5. ACUTE STRESS DISORDER
SYMPTOMS
 Exposureto traumatic event causing intense fear,
helplessness, or horror
 Marked anxiety symptoms or increased arousal
 Significant distress or impaired functioning
 Persistent re-experiencing of the event
 Three of the following symptoms: Sense of emotional
numbing or detachment; Dissociative amnesia
(inability to recall important aspect of the event);
Feeling dazed; Derealization; Depersonalization
MANAGEMENT OF ACUTE STRESS
DISORDER
Anti-anxietymedications
Anti-depressant medications
Group therapy
6. POST-TRAUMATIC STRESS
DISORDER
SYMPTOMS
 Exposure to traumatic event involving intense
fear, helplessness or horror
 Re-experiencing (intrusive recollections or
dreams, flashbacks, physical and
psychological distress over reminders of the
event)
 Avoidance of memory-provoking stimuli
MANAGEMENTS OF POST
TRAUMATIC DISORDER
 Anti-anxiety medications
 Anti-depressant medications
 Group therapy

PRIORITY NURSING DIAGNOSIS FOR ANXIETY

DISORDERS
• Ineffective individual coping
SOMATOFORM DISORDER
A. Hypochondriasis
 Simple signs and symptoms are interpreted as
severe illnesses with no organic cause.
B. Body Dysmorphic Disorder
 Psychological conflicts which is manifested by
facial and/or body structural deficits with no
organic cause.
C. Psychosomatic Disorder
 Sudden anxiety attack with positive organic
cause. Ex. Asthma
POSSIBLE NURSING DIAGNOSIS
Anxiety
IneffectiveIndividual coping
Body Image Disturbance
Altered Role Performance
DISSOCIATIVE DISORDER
A. Dissociative Amnesia
 Person does not know his identity where he lives and who
he is.
B. Dissociative Fugue
 An attempt to form a new identity in a distant place or
far place.
C. Depersonalization
 Feeling of strangeness and unrealness of one self.
D. Dissociative Identity Disorder
 Presence of existing 2 or more identity other than the real
personality.
NURSING RESPONSIBILITY
Be honest at all times
Be non-judgmental
Provide safety
Anti anxiety and Anti Psychotic
medications.
PERSONALITY DISORDERS

ingrained, enduring pattern of

behaving and relating to self,
others, and the environment;
personality includes
perceptions, attitudes, and
emotions
 CLUSTER A
1. PARANOID PERSONALITY DISORDER
 Symptoms / Characteristics
• Mistrust and suspicion of others
• Uses the defense mechanism of projection, which is
blaming other people, institutions or events for their own
difficulties
 Nursing Interventions
• approach these clients in a formal, business-like manner
and refrain from chit-chat and jokes (serious and
straightforward approach)
• Involve the client in treatment planning
 CLUSTER A
2. SCHIZOID PERSONALITY DISORDER
 Symptoms / Characteristics
• Detached from social relationships
• Report no leisure or pleasurable activities because they
rarely experience enjoyment
• Involve themselves more with things than people
 Nursing Interventions
• Focus on improved functioning of the client in the
community
• Assist the client to find a case manager – one who can help
the client obtain services and health care, manage
finances, etc.
CLUSTER A
3. SCHIZOTYPAL PERSONALITY DISORDER
 Symptoms / Characteristics
• Clothes are ill fitting, do not match, and may be stained or dirty
• Cognitive distortions include ideas of reference (events have
special meaning for him), magical thinking that he has special
powers, unfounded beliefs
 Nursing Interventions
• Development of self-care skills
• Nurse encourages client to establish a daily routine for hygiene
and grooming
• Improve community functioning and provide social skills training
CLUSTER B
1. ANTISOCIAL PERSONALITY DISORDER
 Symptoms / Characteristics: Violation of the rights of others,
Lying, Rationalization of own behaviour, Thrill-seeking behaviors,
Exploitation of people in relationships, Poor work history;
Consistent irresponsibility
 Nursing Interventions
• Promote responsible behavior
• Limit setting
• Consistent adherence to rules and treatment plan
• Confrontation - technique designed to manage
manipulative or deceptive behavior.
CLUSTER B
2. BORDERLINE PERSONALITY DISORDER
 Symptoms / Characteristics
• Fear of abandonment, real or perceived
• Unstable and intense relationships
• Recurrent self-mutilating behavior or suicidal threats or gestures
• Transient psychotic symptoms such as hallucinations demanding
self-harm
 Nursing Interventions:
• Promote client’s safety
• Helping clients to cope and control emotions
• Cognitive Restructuring Techniques
CLUSTER B
3. HISTRIONIC PERSONALITY DISORDER
 Symptoms / Characteristics
• With a pervasive pattern of excessive emotionality and attention-
seeking
• Clients are overly concerned with impressing others with their
appearance
• Dress and flirtatious behavior are not limited to social situations or
relationships but also occur in occupational and professional settings
 Nursing Intervention
• It would be more acceptable to stand at least 2 feet away from
them and to shake hands.”
• Teaching social skills and role-playing those skills in a safe, non-
threatening environment can help clients to gain confidence in their
ability to interact socially
 CLUSTER B
4. NARCISSISTIC PERSONALITY DISORDER
 Symptoms / Characteristics
• Has a pervasive pattern of grandiosity (in fantasy or
behavior), need for admiration, and lack of empathy for
others
• They believe that they are superior, special and they
demand special attention
• Underlying self-esteem is almost always fragile and
vulnerable
• They are hypersensitive to criticism and need constant
attention, admiration
Nursing Intervention
 The nurse must use self-awareness skills to avoid
the anger and frustration that their behavior
and attitude can engender
 The nurse must not internalize such criticism or
take it personally
 She sets limits to rude or verbally abusive
behavior and explains his or her expectations
from the clients.
CLUSTER C
1. AVOIDANT PERSONALITY DISORDER
 Symptoms / Characteristics
• Has a pervasive pattern of social discomfort and reticence,
low self-esteem and hypersensitivity to negative evaluation
• They fear rejection, criticism, shame or disapproval
• They remain aloof in their relationships and feel inferior to
others
 Nursing Interventions:
• require much support and reassurance from the nurse
• The nurse can help them to explore positive self-aspects,
positive responses from others, and possible reasons for self-
criticism
CLUSTER C
2. DEPENDENT PERSONALITY DISORDER
 Symptoms /Characteristics
• Has a pervasive and excessive need to be taken
care of which leads to submissive and clinging
behavior and fears of separation
 Nursing Interventions:
• help the clients to express feelings of grief and loss
over the end of a relationship while fostering
autonomy and self reliance
CLUSTER C
3. OBSESSIVE-COMPULSIVE PERSONALITY
DISORDER
 Symptoms / Characteristics
• Has a pervasive pattern of preoccupation
with perfectionism, mental and
interpersonal control and orderliness at the
expense of flexibility, openness and
efficiency
AUTISM
disorder characterized by impairment
in communication skills, or the presence
of stereotyped behavior, interests and
activities with associated impairment in
social interactions
CONCEPTS
MAIN PROBLEM: Impaired
interpersonal functioning

MOST ACCEPTABLE CAUSE OF AUTISM

• Biological Factors: Brain anoxia
and Intake of drugs
 MOST COMMON SIGNS AND SYMPTOMS
 Resist normal teaching method
 Silly laughing or giggling
 Echolalia
 Acts as deaf
 No fear of danger
 Insensitive to pain
 Crying tantrums
 Loves to spin objects
CONCEPTS
COMMON PROBLEMS AND APPROPRIATE MANAGEMENT
 Tantrums
• Involves head-banging
• INT: Place a helmet on the head
 Communication
• All vowels
• Use of short sentences when talking to the child
 Routines
• Provide consistency
 PRIORITY NURSING DIAGNOSIS
• Risk for injury
OTHER MANAGEMENTS
 NUTRITION
• Small Frequent Feedings
• Assist in Eating
• Well-Balanced Diet
 SAFETY
• Padded Walls
• Helmet
• Monitor Behavior
OTHER MANAGEMENTS
CONSISTENT ENVIRONMENT
• To avoid confusion, gradually
introduce new activities.
LOVE AND BELONGINGNESS
• Family Therapy
DOC: Low dose of Antipsychotic
ATTENTION DEFICIT HYPERACTIVITY
DISORDER (ADHD)
COMMON ETIOLOGICAL FACTORS
Neurologic impairment; Pre-natal trauma
Early malnutrition
Frontal lobe hypoperfusion
Use of drugs by the mother during
pregnancy
SIGNS AND SYMPTOMS HYPERACTIVE / IMPULSIVE
INATTENTIVE BEHAVIORS BEHAVIOURS
 Misses details; Makes careless
mistakes  Fidgets; Often leaves a
 Has difficulty sustaining attention seat, (e.g., during a meal)
 Does not seem to listen  Runs or climbs excessively;
 Does not follow-through on chores Can not play quietly
or homework  Is always on the go; driven
 Has difficulty with organization  Talks excessively; Blurts out
 Avoids tasks requiring mental answers
effort  Interrupts; Can’t wait for
 Often loses necessary things turn
 Is easily distracted by other stimuli
MANAGEMENTS
 NUTRITION
• Finger foods
• High in calories, CHON and CHO
• AVOID: FOODS with seeds

 RISK FOR INJURY (OTHERS)

• Remove sharps/metallic/glass wares
• Avoid C sports
MANAGEMENTS
 SLEEP DEPRIVATION MANAGEMENTS
• Give warm milk and warm bath.
• Decrease environmental stimuli
• Avoid taking afternoon NAPS
 CONSISTENT LIMIT SETTINGS/STRUCTURED DAILY ROUTINE
 LOVE AND BELONGINGNESS
 IMPROVED ROLE PERFORMANCE
 PHARMACOLOGIC TREATMENT: Methylphenidate (Ritalin),
Dextroamphetamine (Dexedrine), Amphetamine (Adderall)
MENTAL RETARDATION
LEVEL OF MENTAL INTELLIGENCE WHAT CAN BE
RETARDATION QUOTIENT (IQ) DONE
MILD / MORON 50 / 55 TO 70 EDUCABLE
MODERATE / 35 / 40 TO 50 / 55 TRAINABLE
IMBECILE
SEVERE / IDIOT 20 / 25 TO 35 / 40 NEEDS CLOSE
SUPERVISION
PROFOUND BELOW 20 / 25 NEEDS CUSTODIAL
CARE
MANAGEMENT OF MENTAL RETARDATION
NURSING CARE
 help parents accept a diagnosis of mental
retardation
 Consider the developmental or functional
age and not the chronological age
PRINCIPLES OF NURSING CARE
 Repetition
 Role Modeling
 Restructuring the Environment
FOCUS OF EDUCATION FOR
MENTALLY RETARDED PATIENTS
Reading
Writing
Basic Arithmetic
EATING DISORDERS
 1. ANOREXIA NERVOSA
Life-threatening eating disorder characterized by:
 the client’s refusal or, inability to maintain a
minimally normal body weight
 intense fear of gaining weight or becoming fat
 significantly disturbed perception of the shape
or size of the body
 steadfast inability or refusal to acknowledge the
seriousness of the problem or even that one
exists
Clientswith anorexia nervosa have:
A body weight that is 85% less than
expected for their age and height
Experienced amenorrhea for at least 3
consecutive cycles
A preoccupation with food and food-
related activities
SIGNS AND SYMPTOMS
 Fearof gaining weight or becoming fat even when
severely underweight (Main Sign)
 Body image disturbance
 Amenorrhea
 Emaciation;
Hypotension, hypothermia and
bradycardia
 Hypertrophy of salivary glands
 Elevated
BUN; Electrolyte imbalances; Leukopenia and
mild anemia; Elevated liver function studies
2. BULIMIA NERVOSA
Is an eating disorder characterized by:
 Recurrent episodes (at least twice a week for 3
months) of binge eating (consuming a large
amount of food, far greater than most people
eat at a time, in a discrete period of usually 2
hours or less)
 Bingeeating followed by inappropriate
compensatory behaviors to avoid weight
gain such as:
 Purging (compensatory behavior
designed to eliminate food by means of
self-induced vomiting, misuse of laxatives,
enemas, and diuretics)
 Fasting
 Excessively exercising
SIGNS AND SYMPTOMS
 Recurrent episodes of binge eating
 Compensatory behavior such as self-induced
vomiting, misuse of laxatives, diuretics, enema
or other medications, or excessive exercise
 Usually within normal weight range,
possible underweight or overweight
 Chipped, ragged, or moth eaten
appearance of the teeth
 Metabolic alkalosis (from vomiting) or
metabolic acidosis (from diarrhea)
COMMON NURSING DIAGNOSES
RELATED TO EATING DISORDERS
Body image disturbance
Self-esteem disturbance
Ineffective individual coping
MANAGEMENTS
 NUTRITION: LESS
• Well balanced diet
• Monitor Food Intake
• Weigh Daily Upon rising up in Bed
• Stay 1-2 hours
• WOF: Purge and Binge Eating and Laxative use
MANAGEMENTS
SELF-ESTEEM: LOW
 Enrol in Assertiveness skills class.
 Cognitive Therapy: Removal of Irrational
Thoughts, Explain “Matter of fact answers”
 Behavioral Therapy: “Reward and
Punishment” and it should be success
focused.
MANAGEMENTS
 ELECTROLYTE IMBALANCE: Hypokalemia
 ACID-BASE IMBALANCE:
• Metabolic Alkalosis due to Vomiting = provide
acid ASH diet. (Prunes, Plums, Cranberries)
• Metabolic Acidosis due to Diarrhea = give
NaHCO3.
 RUSSELS SIGNS: Provide skin care
 SUICIDAL-Depressed: Anti-depressants
SEXUAL DISORDERS
PARAPHILIAS
A group of psychosexual disorders
characterized by unconventional sexual
behaviors
 These are abnormal expressions of sexuality
 They are not, by definition, pathologic
 They only become so when severe, insistent,
coercive and harmful to the self or others
PARAPHILIAS
SEXUAL MASOCHISM
- Erotic interest in receiving
psychological or physical pain, real or
fantasized
TRANSVESTITISM
- Using the apparel of the opposite sex
PARAPHILIAS
FETISHISM
- Sexual arousal elicited by inanimate
objects (shoes, leather, and rubber) or
specific body parts (feet, hair)
AUTOEROTIC ASPHYXIA
- Constriction of the neck to enhance
masturbation experience; often leads to
accidental death
PARAPHILIAS
EXHIBITIONISM
 Intentional
exposure of the genitals to a stranger or
unsuspecting person
 May be accompanied by arousal and masturbation
either during or after the exposure
VOYEURISM
 Secret observation of an unsuspecting person (usually
a woman) engaged in a private act, e.g., undressing
or having sex.The voyeur often masturbates during or
after the viewing.
PARAPHILIAS
FROTTEURISM
 Intense sexual arousal elicited by rubbing the
genitals against a non-consenting person

OBSCENE PHONE CALLERS

 Calling a non-consenting person and making: sexual
noises; using profanity; attempting to seduce;
describing sexual activity.
 The caller often masturbates during or after the call
 PARAPHILIAS
PEDOPHILIA
 Sexual interest in a child
 Behavior ranges from: Exposure; Voyeurism;
Explicit talk to touching; Oral sex; Intercourse
UROPHILIA: Urinating on the sexual partner
COPROPHILIA: Smearing feces on the partner
SADISM: Erotic interest in inflicting physical pain
OTHER FORMS OF PARAPHILIA
ANNILINGUS - Tongue brushing of the anus
CUNNILLINGUS - Tongue brushing of the
vulva
FELLATIO - Inserting the penis into the mouth
PARTIALISM - Inserting the penis into the
other parts of the body
TYPE OF THERAPY PERFORMED ON
PATIENTS WITH PARAPHILIAS
BEHAVIORAL MODIFICATION
AVERSION THERAPY
TOKEN THERAPY
PSYCHOSIS
SCHIZOPHRENIA
 (splitmind) was coined by Bleuler to describe
a lack of integration of the patient’s functions
 disharmony between the patient’s thinking,
feeling and acting.
 distorted and bizarre thoughts, perceptions,
emotions, movements and behavior.
 The main problem in schizophrenia is Altered
Thought Process
CHARACTERISTICS OF PATIENTS
 asthenic or slender, lightly muscled body type
 self conscious, retiring, moody and sensitive
 disorganized and disturbed; or disassociated from
the content of thought
 failure in adapting to objective reality
 utilizethe mechanism of denial and withdraw from
reality
 Delusions and hallucinations
TYPES OF SCHIZOPHRENIA
PARANOID TYPE

 Characterized by persecutory (feeling

victimized or spied on) grandiose delusions,
hallucinations, and occasionally, excessive
religiosity (delusional religious focus) or hostile
and aggressive behavior.
TYPES OF SCHIZOPHRENIA
CATATONIC TYPE

mutism,and peculiarities of voluntary

movement, echolalia, and
echopraxia
CATATONIC TYPE
 Catatonic Stupor: Marked decrease in reactivity to the
environment and/or reduction in spontaneous movement
and activity or mutism
 Catatonic Negativism: Apparently motive-less resistance
to all instruction or attempts to be moved
 Catatonic Rigidity: Maintenance of a rigid posture against
efforts to be moved
 Catatonic Excitement: Excited motor activity, apparently
purposeless and not influenced by external stimuli
 Catatonic Posturing: Voluntary assumption of
inappropriate posture.
TYPES OF SCHIZOPHRENIA
DISORGANIZED TYPE
 Incoherence, marked loosening of
associations, or grossly disorganized
behavior
 Flat or grossly inappropriate affect
 Does not meet the criteria for the
catatonic type
TYPES OF SCHIZOPHRENIA
RESIDUAL TYPE
 Absence of prominent delusions, hallucinations,
incoherence or grossly disorganized behavior
 Continuing evidence of the disturbance, as
indicated by 2 or more of these residual symptoms:
o Marked social isolation or withdrawal
o Marked impairment in role functioning as wage-
earner, student or homemaker
o Marked peculiar behaviors
TYPES OF SCHIZOPHRENIA
UNDIFFERENTIATED TYPE
 Characterized by mixed schizophrenic
symptoms (of other types) along with
disturbances of thought, affect and
behavior
 Prominent delusions, hallucinations,
incoherence or grossly disorganized
behavior
 manifestations cannot be fitted into one
or the other types
THEORIES OF CAUSATION OF
SCHIZOPHRENIA

Biologic (Genetic Theories)

Brain Structure
Psychological Theories
Family Theories
FUNDAMENTAL SIGNS AND SYMPTOMS OF
SCHIZOPHRENIA AS IDENTIFIED BY BLEULER

 Associative Looseness
 Autism
 Apathy
 Ambivalence
SIGNS AND SYMPTOMS
POSITIVE OR HARD SYMPTOMS OF
SCHIZOPHRENIA
 AMBIVALENCE
 ASSOCIATIVE LOOSENESS
• Nurse: "Do you have enough money to buy that candy bar?”
• Patient: “I have a real yen for chocolate. The Japanese have
all the yen and have taken all of our money and marked
it. You know, you have to be careful of the Marxists
because they are friends with the Swiss and they have
all the cheese and all the watches and that means
they have taken all the time. The worst thing about
Swiss cheese is all the holes. People have to be careful
about falling into holes.”
POSITIVE OR HARD SYMPTOMS OF
SCHIZOPHRENIA
 DELUSIONS
 ECHOPRAXIA
 FLIGHT OF IDEAS
• Example: Patient: “The sun is shining. Where is
my sun? I love Lucy. Let us play ball.”
 IDEAS OF REFERENCE
 PERSEVERATION
NEGATIVE OR SOFT SYMPTOMS OF
SCHIZOPHRENIA
 ALOGIA
 Nurse: “How have you been sleeping lately?”
 Client: “Well, I guess, I do not know, hard to tell.”
 ANHEDONIA
 APATHY
 BLUNTED AFFECT
 CATATONIA
 FLAT AFFECT
 LACK OF VOLITION
GENERAL SIGNS AND SYMPTOMS
1) Perceptual changes
• A. Illusions- Client’s misperceives or exaggerates
stimuli in the external environment
• B. Hallucinations
2) Disturbances in thought
• thoughts are disconnected or disjointed
• A. CLANG ASSOCIATIONS - ideas that are
related to one another based on sound or
rhyming rather than meaning.
• Example: “I will take a pill if I go up to the hill but
not if my name is Jill, I don’t want to kill.”
B. DELUSIONS- Disturbances in the
content rather than the form of thought
Examples: The client may think that
food has been poisoned or that rooms
are bugged with listening devices
Types of Delusions:
 1. PERSECUTORY / PARANOID DELUSIONS
 2. GRANDIOSE DELUSIONS
• Example: The client may claim to be engaged to a
famous movie star or related to some public figure such
as claiming to be the daughter of the President of the
Philippines
 3. RELIGIOUS DELUSIONS
• Examples: Client claims to be the Messiah or some
prophet sent from God
• Believes that God communicated directly to him or her
Types of Delusions:
4. SOMATIC DELUSIONS
• Examples; A male client may say that he is
pregnant; A client may report decaying
intestines or worms in the brain
5. REFERENTIAL DELUSIONS / IDEAS OF REFERENCE
• Examples: The client may report that the
president was speaking directly to him on a
news broadcast or that special messages
are sent through newspaper articles
GENERAL SIGNS AND SYMPTOMS
3) Changes in communication
Thought Disorganization
Thought Blocking
Tangential Communication
Circumstantial Communication
Alogia
GENERAL SIGNS AND SYMPTOMS
4) Disruptions in emotional responses
• Restricted or inappropriate expression or emotion
5) Motor Behavior Changes
• Disorganized behavior and catatonia
(manifested by unusual body movement or lack
of movement)
• Examples: Catatonic Excitement, Catatonic
Posturing, Stupor
GENERAL SIGNS AND SYMPTOMS
6) Self care deficits
- They neglect to bathe, change clothes or attend to
minor grooming tasks
- Some show little awareness of current fashion styles
- Wearing clothing that makes them look out of place is
also seen
7.) Activity Intolerance
- brought about by ambivalence about where to sit or
what to eat
MEDICATIONS USED IN SCHIZOPHRENIA
Drug Classification: Antipsychotics or
neuroleptics
 Conventional antipsychotics
• These are dopamine antagonists
 Atypical antipsychotics
• Newer schizophrenic drugs which are
both dopamine and serotonin antagonists
CONVENTIONAL ANTIPSYCHOTICS
 Chlorpromazine  Haloperidol (Haldol)
(Thorazine)
 Loxapine (Loxitane)
 Trifluoperazine
(Trilafon)  Molindone (Moban)
 Fluphenazin (Prolixin)  Perphenazine (Etrafon)
 Thioridazine (Mellaril)  Trifluoperazine
 Mesoridazine (Serentil) (Stelazine)
 Thiothixene (Navane)
ATYPICAL ANTIPSYCHOTICS
• Clozapine (Clozaril)
• Risperidone (Risperdol)
• Olanzapine (Zyprexa)
• Quetiapine (Seroquel)
• Ziprasidone (Geodon)
EFFECTS OF ANTIPSYCHOTICS
- Prescribed primarily for efficacy in
decreasing psychotic symptoms like
delusions, hallucinations and
looseness of association
- They do not cure schizophrenia;
they only manage the symptoms of
the disease
WHEN TO ADMINISTER
ANTIPSYCHOTIC MEDICATIONS:

Best taken after meals

SIDE EFFECTS OF ANTIPSYCHOTIC
MEDICATIONS
 1) Extrapyramidal Side Effects or EPS
 DYSTONIC REACTIONS
 ACUTE DYSTONIA
 PSEUDOPARKINSONISM
 AKATHISIA
 2)TARDIVE DYSKINESIA
 3) Neuroleptic Malignant Syndrome
 4) Agranulocytosis
NURSING CARE FOR
SCHIZOPHRENIA
- Promote adequate
communication
- Promote compliance with
medical regime
- Assist with grooming and hygiene
- Promote organized behavior
NURSING CARE FOR
SCHIZOPHRENIA
- Promote social interaction and activity
- Social skills training
-Promote reality-based perceptions as
hallucinations and illusions often frighten clients
- Intervene with delusions
- Promote congruent emotional responses
- Promote family understanding and involvement