Psychiatric Nursing Part 2 (Pdf) Flashcards
regulates the internal organs and responsible for vital
functions such as regulation of blood gases and the maintenance of BP
BRAINSTEM
hunger, thirst and sex.
- thought & emotions
Hypothalamus
allows human to sleep and carry out conscious mental activity
RAS reticular Activating System
crucial role in emotional status and psychological
function (norepinephrine, serotonin, dopamine
Limbic system –
CEREBELLUM
Coordinated muscle energy & activity
🞂 Maintenance of equilibrium
🞂 Coordinates contraction
responsible for mental activities and a conscious sense
of being. Also responsible for language and the ability to communicate
CEREBRUM
responsible for conscious sensation and the
initiation of movement
Cerebral cortex
Parietal cortex
touch
Temporal
Sound
Occipital
Vision
Frontal
Initiation of Skeletal muscle contraction
responsible for thoughts, goal-oriented
oriented behavior & inhibition
- Seat of Personality
Prefrontal cortex
– regulation of movements
Basal ganglia
emotions, learning, memory
and basic drives
Amygdala and hippocampus
is present at the postsynaptic membrane and
destroys acetylcholine shortly after it attaches to nicotinic or muscarinic
receptors on the postsynaptic cell.
Acetylcholinesterase
monoamine transmitters norepinephrine, dopamine, and serotonin are all
inactivated in this manner by the enzyme,
monoamine oxidase.
involved fine muscle movements,
Decision making
Stimulate hypothalamus and release hormone
Dopamine
Decrease Dopamine
Parkinsons
Depression
Increase dopamine
Schizo
Mania
Decrease norephi
Depression
Increase norepi
Schizo
Anxiety
Mania
Role in sleep regulation, hunger, mood, and pain perception
Aggression and sexual behavior
Serotonin
Decrease serotonin
Depression
Increase serotonin
Anxiety
reduces aggression, excitation and anxiety
y-aminobutyric acid (GABA)
Decrease GABA
Anxiety
Schizo
Huntingtons
Inc - Anxiety
Excitatory, role in learning and memory
Glutamate
Decrease glutamate
Psychomimetic state resembles schizo
Increase glutamte
Improved cognitive performance in behavioral task
Decrease acteylcholine
Azheimer
Huntingtons
Parkinsons
Inc - Depression
Antidepressant and anti anxiety
Reinforces memory
Substance P
a specific channel for transmitting and
receiving messages
The use of silence
– self-awareness of one’s feelings
Genuineness
one understands the ideas expressed
Empathy
5 concepts of empathy
Human trait
◦ Professional state
◦ communication process
◦ caring process
◦ special relationship
ability to view another person as being
worthy of caring about & as someone who has strength & achievement
potential
Positive regard
consistently encourage
client to use their resources helps minimize the client’s feeling of
helplessness & dependency & also validates their potential for change
Helping client develop resources –
– the process whereby a person unconsciously
& inappropriately displaces onto individuals in his/her current life t
Transference
the tendency of the nurse to displace
onto the client feelings related to people in the nurse’s past
Countertransference
Common countertransference reaction
Boredom (indifference)
2. Rescue
to establish a client database & assess own feelings
regarding the client
PREORIENTATION PHASE
develop mutual trust, establish role of the nurse as
significant other to the client
ORIENTATION PHASE
Goal: identify & address client’s problem
WORKING PHASE
◦ Goal: identify & address cl
intervention designed to prevent clients from
harming themselves or others
Limit setting
Goal: assist client to review what was learned and to transfer
learning interaction with others
TERMINATION PHASE
Interaction with client behaviors
🞂 Violent behavior
Stay out of striking distance
Hallucinations
Provide reality but acknowledge behavior
◦ Assess the hallucination based on content of the messages
Delusions
Clarify the meaning of the delusions then ignore
Conflicting values
Help client examine the effects or outcomes of their beliefs on
their lives, relationship, and happiness
Severe anxiety & incoherent speech
Spend frequent, brief time with patients, offer support, and
build trust
Provide limit setting
◦ Help client express their needs directly to others
Manipulation
Crying
Unless a form of manipulation, allow client to cry
◦ Provide privacy
◦ Be quiet and unobtrusive
Sexual innuendos or inappropriate touch
◦ Remind client these actions are inappropriate
Denial & lack of cooperation
Reality testing & supportive confrontation with denial
Depressed affect, apathy, & psychomotor retardation
Patience, frequent contact, and empathy
◦ Encourage hygiene, proper nutrition and gradual increase in
activities
◦ Postponed major decisions until emotions have subsided
Suspiciousness
Communicate clearly, simply, and congruently.
◦ Clarify misinterpretation
◦ Provide simple rationale or explanations for rules, activities,
occurrences, noises and requests
Hyperactivity
Patient should be in a quiet area, with minimal auditory &
visual stimulation
◦ Remain calm, speak slowly and softly & respect patient’s
personal space
Nurses must be open and clear
◦ State action that they cannot meet patient’s need
◦ Limit setting
Transference & countertransference
Consists of treatment by means of control modification of the
client’s environment to promote positive experiences
Milieu Management
Friendly, warm, trusting, secure, supportive, comforting
atmosphere throughout the uni
Characteristics of milieu therapy
Elements of Milieu therapy
SSNLB
Safety
Structure
Norms
Limit settings
Balance
should be set on acting-out behavior
◦ Reinforces the norms of making rules & expectations clear &
encourage the milieu therapy concept—responsibility to self
Limit settings –
Group of conditions in which the affected person experiences
persistent anxiety that the person cannot dismiss and that interferes with
daily activities
ANXIETY DISORDERS
Characterized by excessive chronic anxiety or worry & might concern everyday events
GENERAL ANXIETY DISORDER
restlessness. Fatigue, poor concentration, irritability, muscle tension, sleep disturbance, physical symptoms (dry mouth, upset stomach)
GENERAL ANXIETY DISORDER
Milieu mgt: for GAD
Recreational activities
● Relaxation exercises, meditation & biofeedback
● CBT
● Therapeutic touch & acupressure
recurrent panic attack & are worried about having more attacks
PANIC DISORDERS
eelings of terror that function is suspended, perceptual field is severely limited & misinterpretation of reality
Panic disorder with agoraphobia
intense, excessive anxiety or fear about being in places or situations from which escape might be difficult or embarrassing or in which help might not be available if panic attack occurs
Agoraphobia
Psychotherapeutic mgt: Reduce immediate anxiety
Stay physically close to patient use simple sentences, firm voice, remove to smaller quiet room to minimize stimuli
Psychopharmacology Panic disorder without agoraphobia
SSRI
● Benzodiazepine (clonazepam, lorazepam) – immediate effect
persistent thoughts, impulses, images or desires that maybe trivial or morbid
Obsession
repetitive stereotyped behavior that are performed in a particular manner in response to an obsession
Compulsion
Etiology OCD
genetic, increase brain activity in the frontal lobe & basal ganglia, serotonin dysregulation
NPR for OCD
Accept rituals permissively
Avoid criticism or punishment, making demands, showing
Psychopharmacology OCD
Antidepressant:
o Clomipromine (anafranil)
● SSRI – fluoxetine (Prozac), setraline (Zoloft), fluovoxamine (Luvox) & paroxetine (Plaxil)
Milieu mgt for OCD
Relaxation exercises & stress mgt.
● Recreational or social skills
● CBT, problem-solving & communication or assertive training groups
Intense, irrational, persistent fear responses to an external object activity or situation
PHOBIC DISORDERS
response to experience anxiety & is characterized by a persistent fear of specific places or things
Phobia
fear of being in public or open spaces places or situations in which escape might be difficult or help might not be available
Agoraphobia with history of panic disorders
fear of being humiliated, scnrutinized, or embarrassed in public
Social phobia
fear of a specific object or situation that is not either of the above
Specific phobia
NPR for Phobias
Accept patient & their fears with a non-critical attitude
● Provide & involve patient in activities that do not increase anxiety but increase involvement, rather that promote avoidance
● Help client with physical safety and comfort
● Help patient recognize that their behavior is a method of avoiding anxiety
Psychoparma for SSRI for Phobia
to reduce anxiety & depression & block panic attacks, if present
Milieu mgt for Phobia
Assertive training & goal-setting groups
● Social skills group to help redevelop social skills and decrease avoidance
● Behavior therapy – systemic desensitization, flooding, exposure, and self-exposure
Develop after exposure to a clearly identifiable traumatic event that threatens the self, others, resources, and/or sense of control or hope
ACUTE STRESS DISORDER & POST TRAUMATIC STRESS DISORDERS
symptoms occur within 1 month of extreme stressor; includes dissociative symptoms (depersonalization, emotional detachment., dazed appearance, amnesia
ACUTE STRESS SYNDROME
severe traumatic event that is not an ordinary occurrence e.g.. Rape, fire, flood, earthquake, tornado, bombing, plane crash, war, torture, kidnapping
POST STRESS DISORDER
4 diagnostic criteria for PTSD
- Dissociative symptoms & numbing
- Reexperiencing the trauma & intrusive memories – hallucinations
- Arousal symptoms
- Other symptoms
● Anxiety or panic attack
grief, depression, suicidal ideation or attempts, impulsive self-destructive behavior, anxiety-relate disorders & substance abuse
PTSD
Psychotherapeutic mgt: prevent or minimize the symptoms
1. NPR: for PTSD
DEVELOP TRUST
Nurse needs to be non-judgmental honest, emphatic, and supportive
● Teach dynamics of ASD & PTSD
● Exposure therapy & systematic desensitization
● Expressive therapy (art, music, poetry) – facilitate externalizing painful emotions that are difficult to verbalize
● Crisis counselling –
Psychopharma for PTSD
● Benzodiazepine (clonazepam, lorazepam) – to reduce level of anxiety and fear. Help with sleep disturbance
● Clonidine & propanolol – diminish the peripheral autonomic response associated with fear, anxiety & nightmare
● Lithium carbonate – prescribed to patients experiencing explosive outburst
● SSRI (paroxetine, setraline, fluoxetine) – decrease repetitive behaviors, disturbing images & somatic states
● TCA – depression, adehonia & sleep disturbances ● Antipsychotic (respirodone) – psychotic thinking
Milieu mgt for PTSD
Social activities
● Recreational & exercise program ● Group therapy
Characterized by the presence of physiologic complaints or symptoms, ● which are not under voluntary control & no demonstrable organic finding ● and physiologic bases
F. SOMATOFORM DISORDERS 1. NPR:
Conversion of mental states or experiences into bodily symptoms associated with anxiety
◦ Recurrent, frequent & multiple somatic complaints for several years without physiologic cause
Types: 1. Somatization disorder
Associated with psychological factors like severe pain in one or more of anatomical sites that causes significant distress or impairment in functioning
◦ Pain is exaggerated or out of proportion
Pain disorder
Worried & belief that they have serious disorders base on the misinterpretation of bodily signs & sensation for at least 6 months
◦ Preoccupation persists despite appropriate medical tests & reassurances
Hypochrondiasis
Individual is preoccupied with an imagined defect in appearance which are usually facial flaws.
◦ Dermatologist & plastic surgeon is often consulted
◦ May also exhibit obsessive compulsive traits & depressive syndrome
- Body dysmorphic disorder
NPR for Somatoforms
Use matter-of-fact caring approach
Encourage patient to verbalize & describe feeling
Use positive reinforcement & set limits
Do not push awareness of or insight into conflicts or problems
Milieu for Somatoform
Relaxation exercises meditation and CBT
● Family therapy
disturbances in the normally well-integrated continuum of consciousness, memory, identity, and perception
G. DISSOCIATIVE DISORDER
the removal from conscious awareness of painful feelings, memories, thoughts, or aspects of identity
Dissociation
Defense mechanism of Dissociative
repression
Cause of Dissociative
Inability to recall important personal information usually of a traumatic or stressful nature
● The disorder is often associated with exposure to traumatic event common during disaster and wartim
Types of dissociative disorders
- Dissociative amnesia
- Dissocialise fugue – sudden, unexpected travel away from
- Depersonalization disorder – involves an altered sense of
- Dissociative identity disorder – existence of 2 or more
Sudden inability recall important information of one or more episodes not associated with organic disorders usually of a traumatic or stressful nature
- Dissociative amnesia
sudden, unexpected travel away from home or some other location with the assumption of a new identity or a confusion about one’s identity
Dissocialise fugue
involves an altered sense of self, so that the individual feel unreal or strange or believe that danger is not happening to then or to someone else
Depersonalization disorder
existence of 2 or more identities or personalities that take control of the person’s behavior with its own patterns of relating, perceiving, and thinking
Dissociative identity disorder
The person or host us unaware of the other personalities, but the other alters might be aware of each other to varying degrees
◦ Defense mechanism:?
- Dissociative identity disorder –
Repression
NPR for Dissociative
Ensure client safety
Provide nondemanding, simple routine
Confirm identity of client and orientation to time & place
Milieu for Dissociativew
Individual therapy
● Task-oriented group activities
● OT and art therapy ● Cognitive therapy ● Self-help groups
Childhood & Adolescent psychiatric disorders
Social
◦ Social & environment – severe marital discord, low socioeconomic status, large family & overcrowding, parental criminality maternal psychiatric disorder, traumatic life event, sexual/physical abuse
alterations of neurotransmitters (decrease in norephhinephrine & serotonin
Biochemical in children
Characterized by impairment in social interaction, communication and restricted repertoire of activity & interest c. Usually first observed before 3 years of age
a. Autistic disorder
- Pervasive development disorders
a. Autistic disorder
a. Asperger’s disorders –
Attention deficit/hyperactivity disorder
Characterized by impairment in social interaction, communication and restricted repertoire of activity & interest c. Usually first observed before 3 years of age
a. Autistic disorder
Symptoms of Autism
Impairment in communication & imaginative activity ● Impairment in social interaction
● Markedly restricted, stereotypical patterns of behavior, interest and activities
a severe developmental disorder
characterized by major difficulties in social interaction & restricts & unusual interest & behavior
Aspergers Disorder
Symptoms of Aspergers
Use monotone speech and rigid language
● They cannot understand jokes and are taken advantage easily ● Inability to show empathy to others but want to meet people & make friends
characterized by inattention, impulsiveness, and overactivity in school 9before 7 years
b. Attention deficit/hyperactivity disorder – characterized by
Characteristics of ADHD
Inattention
❖ Difficulty paying attention in tasks or play
❖ Does not seem to listen, follow through or finish tasks
Nursing Diagnoses for ADHD
Risk for injury
● Impaired social interaction
● Ineffective individual
● Risk for violence for self-directed or directed to others
ADHD intervention
Talk to client about safe & unsafe behavior – use clear, honest straightforward communication
● Assess the frequency & severity of accidents
● Provide supervision for potentially dangerous
nduring pattern of disobedience, argumentative, explosive angry outburst, low frustration tolerance, and a tendency to blame others for quarrels or accidents
Oppositional defiant disorder
Recurrent pattern of negativistic, disobedient, hostile , defiant behavior towards authority figures with serious violation of basic rights of others
Oppositional defiant disorder
characterized by persistent pattern of behavior in which the rights of opthers and age-appropriate societal norms or rules are violated
Conduct disorder
Predisposing in Conduct Dx
ADHD, oppositional child behaviors, parental rejection, inconsistent parenting with harsh discipline, early institutional living, frequent shifting of parental figures,
excessively anxious when
separated from or anticipating a separation from their home or parental figures
Separation anxiety disorders
Characteristics Separation anxiety disorders
Excessive distress
Excessive worries
Fear of being home alone
Refusal to sleep unless near a parental figure
Refusal to attend school
Nursing interventions for sepanx
Assess the quality of the relationship between child & parents
Accept regression but give emotional support
Psychopharma for sepanx
antihistamines, anxiolytics and antidepressants
sum total of the person’s distinctive character, behavior, attitudes, the way one carries himself , the way one communicate
Personality
enduring pattern of inner experience & behavior that deviates markedly from the expectation of the individual’s culture, is pervasive & inflexible, has an onset in adolescence or early adulthood, is stable over time, & lead to distress or impairment “ (APA, 2000)
Personality disorder
(ODD, ECCENTRIC)
CLUSTER A DISORDERS
CLUSTER A DISORDERS (ODD, ECCENTRIC)
a. Paranoid personality disorder
b. Schizoid personality disorder
b. Schizotypal personality disorder
Individuals with this disorder lacks personal & social relationship. They are detached from others & withdraws from interaction – hypersensitive
● Introverted since childhood, rarely have close friends
Schizoid personality disorder
Defense mechanism Schizoid personality disorder
INTELLECTUALIZATION
Avoid in Schizoid
Avoid being too “nice” or “friendly” 2. Do not try to increase socialization
Individuals with this disorder may have behavior similar to those of someone with schizophrenia, however psychotic episode are infrequent & less severe
Schizotypal personality disorder
Has __________ appearance and shows evidence of magical thinking or perceptual distortion that are not clear delusions or hallucination
Schizotypal personality disorder : Eccentric
Symptoms of schizoid
Ideas of reference
2. With magical thinking/odd beliefs leading to interpersonal difficulties
3. Problems in thinking, communicating and perceiving
4. Has eccentric appearance and shows evidence of magical thinking or perceptual distortion that are not clear delusions or
CLUSTER B CRITERIA (DRAMATIC, EMOTIONAL, ERRATIC)
a. Antisocial personality disorder
c. Borderline personality disorders
c. Narcissistic personal disorder
Histrionic personality disorder
Has consistent disregard for others with exploitation & repeated unlawful actions.
a. Antisocial personality disorder
Charming, intellectual and smooth talkers
● They repeatedly neglect responsibilities, tell lies and perform destructive or illegal acts, without developing any insight into predictable consequences
● Hostile, unable to follow rules
● Diagnose before age 15 as conduct disorder
a. Antisocial personality disorder
Criteria for Antisocial PD
LIAR
Lack of Guilt
Irresponsible
Aggressive behavior
Recklessness
Be firm, steadfast and consistent in dealing with patient’s
behavior and reinforcing rules & policies
Nx int for Antisocial PD
Characterized by impulsiveness, unpredictable, unstable moods
● Desperately seek relationship to avoid feeling abandoned
● Chronic sense of boredom
● Overspending, promiscuity, overeating
● Problems with identity & self-image
Borderline personality disorders
Defense mech of Borderline
Projection
Inadequate regulation of serotonin & dopamine & other transmitters
● Parents may cling to the child and prevent autonomy, individual or parent withdraws support & attention making the child confuse
Etiology of Borderline PD
Nursing int for Borderline
Set realistic goals, use clear action word
● Be aware of manipulative behaviors
● Provide clear & consistent boundaries & limits
Individuals with this disorder display grandiosity about his performance and achievement
● Arrogant, extrovert
c. Narcissistic personal disorder
Defense mech of c. Narcissistic personal disorder
Rationalization
Individual with this disorder are characterized by excessive emotional attention seeking behavior and are dramatic and ego-centric ● Seductive, flamboyant and shallow – use speech to impress others
Histrionic personality disorder
Nursing int for Histrionic personality disorder
Understand seductive behavior as a response to distress
● Keep communication & interaction professional, despite temptation to collude with the client in a flirtatious & misleading manner ● Encourage & model the use of concrete & descriptive rather that vague & impressionistic language
- CLUSTER C DISORDERS (ANXIOUS, FEARFUL)
a. Dependent personality disorder
b. Avoidant personality disorder
c. Obsessive-compulsive personality disorder
1. MAJOR DEPRESSIVE DISORDER (MDD)
For Dependent PD
Increase responsibility for self in daily livings ● Be assertive
● Encourage client to verbalize feeling
● Be aware of countertranference
These clients are timid, socially uncomfortable, with self care and withdrawn
● Social inhibition and avoidance of all situation that require interpersonal contact
b. Avoidant personality disorder
Nx int for Avoidant PD
Be friendly, gentle, reassuring approach
● Help client to confront fears gradually
● Support & direct client in accomplishing short-term goals ● Relaxation techniques
Perfectionist and inflexible
● Overly strict & often set standards for themselves that are too high
● Preoccupied with details, rules, trivial and procedures
● Difficult to express emotions or warmth
c. Obsessive-compulsive personality disorder
Defense mechanism: c. Obsessive-compulsive personality disorder
intellectualization, rationalization, reaction-formation
extreme change in mood that presents problems in daily functioning
Mood disorders
Characterized by 1 or more major depressive episodes, which are defined as at least 2 weeks by depressive mood or less of interest accompanied by at least 4 additional symptoms of depression
- MAJOR DEPRESSIVE DISORDER (MDD)
Signs of MDD
Depressed mood most of the day
b. Anhedonia
c. Significant weight loss or gain (5% wt. in month)
d. Insomia or hypersomia (2 hrs in 1 month)
MOOD DISORDERS ◦ Characteristics
Disregards grooming, cleanliness & personal appearance
b. Stooped posture & dejected facial expression
c. Dishevelled, downcast, lacking eye contact & tearful
d. Agitated
occurs in younger population
● Increase appetite or wt. gain, hypersomnia, leaden paralysis &
extreme sensitivity to interpersonal rejection
Atypical depression –
older adults
Anhedonia
Depression worse in AM
Wt loss anorexia
Melancholic depression
psychomotor attraction including immobility, excessive motor activities, mutism, echolalia or echopraxia inappropriate posturing
Catatonic features
mood disturbance that occurs during the first ___ days post partum
Postpartum depression 30 days
Delusion of guilt, delusions of deserved punishment, somatic delusions, nihilistic delusion, & delusion of poverty
Psychotic depression – delusions & hallucination
occur in conjunction with a seasonal change
Seasonal affective disorder (SAD
Establish trust
● Nonjudgmental & friendly approach
● Use silence & stay with patient
● Avoid challenging or testing the client
● Do not argue
● Divert patient’s attention
Nx guideline for SAD
Patient is depressive mood for at least 2 years ▪ With poor appetite or over-eating
▪ Insomia or hypersomia
▪ Low energy or fatigue
DYSTHMIC DISORDER
Difference betweeen MDD and DD
Duration and Severity
Behavior – always on the go, increase sexual drive
Thought – flight of ideas, inflated self-esteem
Affect – feeling of happiness, confidence
Mild elation or hypomaniac (4 days)
Intensified symptoms
Mood disturbance & lability
Enthusiastic & intrusive
Hyperactivity
◦ Flight of ideas ●
Acute manic episodes
state of extreme excitement
◦ Disorientation, incoherence
◦ Visual or olfactory hallucination
◦ Exhaustion, dehydration, injury even death
Delirium
elevated, expansive or irritable mood
Manic episodes
less, severe level of impairment
Hypomanic episodes
hypersomia, hyperphagia, wt. gain, leaden paralysis, little energy
Depressive episodes
🞂 Basic syndromes of bipolar disorders
MHD
Manic
Hypomanic
Depressive
experiences swings between manic episodes and major depression
Bipolar I disorder
characterized by 1 or more depressive episodes accompanied by at least one hypomanic episodes
Bipolar I disorder
a swing between a hypomanic and depressive symptoms
Cyclothymic disorders
Disturbance of speech, social, interpersonal & occupational relationship, activity & appearance
● Speech – rapid, pressured, loud, easily distracted
● Altered social, interpersonal & occupational relationship
● Objective behavior
NX for Manic disorders
Limit – setting
Reinforcement of reality
Respond to legitimate complaints
Redirect patient into more healthy activities Provide for can be eaten easily
Assess amount of sleep & rest
Milieu mgt. Manic
Safety
Consistency among staff
Reduction of environmental stimuli
Limit their intake or refuse to eat but do not lose their appetite
◦ Perfectionist & introvert with self-esteem & peer relationship problems
◦ Clinical manifestation/behaviors
Restricters Vomiters-purgers
🞂 ANOREXIA NERVOSA
Amenorrhea
◦ Hypotension, bradycardia, hyponatremia
◦ Dry skin with lanugo
◦ Delayed gastric emptying
◦ Slow peristalsis—-constipation
◦ Dehaydration
🞂 ANOREXIA NERVOSA
Etiology of 🞂 ANOREXIA NERVOSA
A culture of thinness, relational orientation of women
● Genetic component
● Family environment
● Odd eating habits & emphasis on appearance
● Rejection of food & wt. loss as a positive reinforcement
● Childhood sexual abuse
● Regression to a prepubertal state
Intermittent binge period and periods of restrictive eating
◦ Loss of control over eating
◦ Anxious & feeling of weakness – before eating while binging
◦ Angry & agitated or depressed
BULIMIA NERVOSA
Bulimia Nervosa charac
Secretive about behavior ● Binge eating
● F/E abnormalities
● Use of laxatives
● Use of ipecac syrup
● Menstrual irregularities
● Dental carries
● Russel’s sign
● Loss of control over eating
EATING DISORDERS
◦ Psychotherapeutic mgt
Medical stabilization
● Wt. restoration –
● Help patient reestablish appropriate eating behavior
● Elevate self-esteem
● Medical treatment – IV lines & feeding tubes
◦ Nursing guidelines
● Convey warmth & sincerity
● Listen emphatically
● Be honest
Psychopharmacology for eating dx
Anxiolytics
● Atypical antipsychotics
● Antidepressants - SSRI
mental disorder characterized by disturdance in thought & sensory perception & deterioration in psychosocial functioning
Schizophrenia
delusions, any prominent hallucinations, disorganized speech or disorganized catatonic behavior
Psychotic
SCHIZOPHRENIA
🞂 Precipitating factors
1. Emotional - marital problem
2. Somatic – pregnancy, physical illness 3. May be none
🞂
4 A’s (Eugene Bleuler)
Affect
Associative looseness
Autism
Ambivalence
outward manifestation of a person’s feelings & emotion – flat, blunted, inappropriate bizarre affect
Affect
haphazard & confused thinking manifested in jumbled & illogical speech & reasoning
Associative looseness
hinking that is not bound to reality but reflects the private perceptual world of the individual – delusions, hallucination, neologism
Autism
simultaneously holding 2 opposing emotions, attitudes, ideas, or wishes towards the same person situation or object
Ambivalence
🞂 Phases of schizophrenia Acute
period of florid positive symptoms as well as negative symptoms
Phases of Schizo: Maintenance
period when acute symptoms decrease in severity
patient is might still experience hallucination & delusions but not as severe nor as disabling as they were during the acute phase
Stabilization phase in Schizio
Common symptoms of schizophrenia
Delusions
Hallucinations
Illusions
Depersonalization
Affective flattening
Ambivalenve
false fixed beliefs that cannot be corrected by reasoning
Delusions
sensory perception for which no external stimulus exist
Hallucinations
feeling of the individual that the self has been changed or altered
Depersonalization
🞂 Common delusions in schizophrenia
Delusions of Reference
Somatic delusions
Grandiose
Nihilistic delusions
Delusions of Influence
everything that is occurring in the environment has significance to oneself
Delusions of reference
false belief that one is being singles
out for harm by others – someone is platting against him/her
Delusion of persecution
appearance or functioning of one’s body
is altered
Somatic delusion –
false belief that one is a very powerful ◦ & important person
Grandiose delusion
I am dead”
Nihilistic delusion
one is controlled by others or outside
force
Delusions of influence
alse belief that one’s mate in unfaithful; may have so-called proof
Jealousy
🞂 Symptoms of loose association
Neologism
2. Echolalia
3. Word salad
4. Clang association
3 broad clinical symptoms
Positive
Negative
Disorganized symps
Reflects the presence of overt psychotic or distorted behavior
- Positive symptoms
reflect a dimunition or loss of normal function
Negative symptoms
presence of confused thinking, incoherent or disorganized speech & disorganized behavior
Disorganized symptoms
Onset of positive symptoms is generally acute
🞂 Sx: delusions, excitement, feelings of persecution, grandiosity, hallucination, hostility, ideas of reference, illusions, insomia
Type I schizophrenia
Type II schizophrenia
Slow onset of negative symptoms aused by viral infxn & abnormalities in cholecystokinin
🞂 Sx: dimunition or loss og normal function, anergia, anhedonia, alogia, avolition, blunted affect or affective flattening,
Experience persecutory or grandiose delusion & auditory hallucination
SCHIZOPHRENIA SUBTYPES
1. PARANOID TYPE
psychomotor disturbances
◦ Motoric immobility, waxy flexibility or stupor
◦ Excitement (excessive motor activity)
CATATONIC TYPE
most severe prognosis, disintegration of personality & is withdrawn, disorganized speech, disorganized behavior, flat or inappropriate affect
DISORGANIZED TYPE
characterized by atypical symptoms that do not meet the criteria for other subtypes
UNDIFFERENTIATED TYPE
Continuing evidence of negative symptoms without characteristic symptoms of schizophrenia
🞂 SCHIZOPHRENIA
- RESIDUAL TYPE
Psychopharmacology of Schiz
Stabilize acute symptoms
◦ Maintain therapeutic plasma levels ◦ Typical antipsycotics
● Haloperidol (Haldol)
● Chlorpromazine (Thorazine)
● Thiothixene (Navane)
◦ Atypical antipsychotics
● Clozapine (Clozaril)
● Respirodone (Respiradol)
● Olanzopine (Zyprexa)
🞂 Milieu mgt.
For disruptive patients:
● Set limits
● Frequently observe escalating patients to intervene
● Modify the environment to minimize objects that can be used as weapons
● Be careful in stating what the staff will do if a patient acts out
● When using restraints, provide for safety by evaluating the patient’s status of hydration, nutrition, elimination, & circulation
SCHIZOPHRENIA For withdrawn patients:
unless patient can hear what is being said
● Do not touch suspicious patients without warning ● Be consistent in activities
● Maintain eye contact
◦ For patient with impaired communication:
● Be patient & do not pressure patient to make sense
● Do not place patient in group activities that would frustrate them, damage self-esteem, or over-tax their abilities
◦ For disorganized patients:
Remove disorganized patient to a less stimulating environment
● Provide a calm environment
● Provide safe & relatively simple activities for these patients
🞂 Nursing guidelines for Schizo
Build a therapeutic alliance with patient
◦ Be calm
◦ Accept patient
◦ Keep promises
◦ Be honest
◦ Do not reinforce hallucinations or delusions ◦ Do not touch patient without warning
◦ Reinforce positive behaviors
◦ Avoid competitive activities
Uninterruptive period of illness during which at some point the patient experiences a MDD, manic or mixed episodes along with the negative symptoms of schizophrenia
Schizoaffective Disorder
Patient exhibits features of schizopohrenia for more than 1 month but fewer that 6 months
- Schizophreniform disorder
Onset of at least 1 or more positive symptoms of psychosis
◦ Occur at least 1 day to less that an month then full recovery
Brief psychotic disorder
due to a general medical condition
◦ Presence of prominent hallucination or delusion determined as resulting from the direct physiologic effect of a specific medical condition
Psychotic disorder
It is an overwhelming reaction to a threatening situation in which an individual’s usual problem-solving skills and coping responses are inadequate for maintaining psychological equilibrium
CRISIS
Crisis is time limited and is usually resolve one way or another in a brief period
4-6 weeks
occurs from transition from one stage of maturation to another in the life cycle
Developmental crisi
occurs to a sudden, unexpected event in an individual life. These events is all about experiences of loss.
Situational crisis
occurs in response to severe trauma or natural disaster. These crisis can affect individuals, communities and even nation
Adventitious crisis
individual has emotional equilibrium
Pre-Crisis period
ndividual has the subjective experience of being upset, failure of usual coping mechanism, symptoms are expereinced
Crisis period –
resolution of crisis
Post-Crisis period
confusion, difficulty concentrating,
racing thoughts, inability to make decisions
Cognitive symptoms
disorganization, impulsive, angry
outburst, withdrawal from social interaction
Behavioral symptoms
anxiety, anger, guilt, sadness, depression, paranoia, suspicion, helplessness, powerlessness
Emotional symptoms
the goal of crisis intervention is to return the individual to pre-crisis level of functioning
🞂 Emphasis is on strengthening and supporting healthy aspects of individual’s functioning
Principles of crisis intervention
Establishes rapport and communities hope and optimism 🞂 Assumes an active, directive role if necessary
🞂 Make suggestions and offer alternatives
Role of crisis intervention worker includes:
