PSYCHIATRIC AND

MENTAL HEALTH NURSING  INITIAL EFFECTS OF MENTAL ILLNESS

(BEHAVIORAL CHANGES):
1st symptom – irritability and restlessness, inability
PSYCHIATRIC NURSING
to sleep, lack of appetite
An interpersonal process whereby the nurse
assists and individual, family or community, to
 TWO GENERAL TYPES OF MENTAL ILLNESS:
promote mental health, to prevent or cope with the
experience of mental illness and suffering and if
 NEUROSIS - is a psychogenic reaction which
necessary, to find meaning in these experiences
arises because of an individual inability to cope
MENTAL HEALTH
Personality origin: intact
A state of emotional, psychological and social
Etiology: psychological factors like
wellness as evidenced by satisfying interpersonal
conflicts
relationships, effective behavior and coping, a positive
General Behavior: inconformity with society
self-concept and emotional stability
Insight: with insight
Self-Management: can manage self - treatment
 POSITIVE MENTAL HEALTH (WHO)
psychotherapy
 Attitude towards the individual self, Growth
development and self-actualization
 PSYCHOSIS - is a psychogenic reaction which is
 Integrative capacity
changed by severe personality organization
 Autonomous behavior
 Perception of reality
Personality Origin: absent
 Mastery of one’s environment
Etiology: both psychological and
structural – deterioration of
 BEHAVIOR
brain cells
 Reflex action
General Behavior: at odds with society
 Goal-directed behavior
Insight: without insight
 Behavior as a response to frustration
Self – Management: hospitalization is needed,
biologic methods like drugs
 NEEDS
and ECT
 Physiologic
Prognosis: deterioration is expected,
 Safety and security
bad prognosis
 Love and affection
 Self esteem
 COMMON PSYCHOTHERAPEUTIC
 Self actualization
INTERVENTIONS
MENTAL HEALTH vs. MENTAL ILLNESS 1. REMOTIVATION THERAPY
 reality orientation
 MENTAL HEALTH
 5 DIFFERENT STEPS:
 Is the balance in the person’s internal life and
1. Climate of Acceptance
adaptation to reality
2. Creating of bridge to reality – prevent
topic
 CRITERIA FOR MENTAL HEALTH:
3. Sharing the world we live in – discuss
 Attitude toward the individual self, self-
4. Appreciation of the works of the
acceptance
world – reflect
 Growth, development and self-actualization
5. Climate appreciation – finish
 Integration capacity – balance between the id,
ego and superego
2. MUSIC THERAPY
 Autonomous behavior ability to stand by the
 should be congruent to the patient
decision
 Manic – fast music
 Environmental mastery – ability to adapt and
 Depression – slow music
adjust to the environment
3. PLAY MATERIAL
MENTAL ILLNESS
 age-appropriateness and it should be
An illness with psychologic / behavioral
appropriate
manifestation which may be due to a physical,
psychological, social, genetic/biological or chemical  Infant - Solitary
imbalance  Toddler – Parallel
 Preschooler – Competitive
 CRITERIA FOR MENTAL ILLNESS:
 Presence of characteristic fixation 4. GROUP THERAPY
 Loss of existing functioning  8-10 patients, minimum of three
 Distention of affect
 Presence of regressive characteristic 5. PSYCHODRAMA
 Appearance of symptom  patient is to play the role

6. MILIEU THERAPY
 scientific manipulation of the environment
 nurse acts as a facilitator

7. FAMILY THERAPY
  indicated for abusive parents and abused  systemic desensitization
children  reward punishment
 indicated for phobia
8. PSYCHOANALYSIS
 exploration of the unconscious identity and 13. AVERSION THERAPY
defenses  covert sensitization, overt
sensitization
9. HYPNOTHERAPY
 indicated for anxiety, sexual disorder and 14. TOKEN ECONOMY
obesity  reward and punishment
 Toilet training
10. HUMOR THERAPY
 therapeutic laugh 15. GESTALT THERAPY
 forces are the here and now
11. TRANSACTIONAL ANALYSIS
 focus is effective communication

12. BEHAVIOR MODIFICATION

 Ego ideal – perfection to which person
PERSONALITY DEVELOPMENT /SELF AWARENESS aspires; corresponds to what parents taught was
SELF ACCEPTANCE good

PERSONALITY  Conscience – responsible for guilt

 Latin word persona meaning mask feelings; corresponds to those things parents
 Dynamic not static taught were bad
 An integration and interaction of traits
 Not determined by just one trait but by a number  STAGES OF DEVELOPMENT
of traits taken together  PSYCHOSEXUAL STAGE
 Considered to be the social stimulus value of
individuals 1. INFANCY
 Sum total of all the traits and characteristics of a  birth to 12 months
person that distinguishes him from one another.  ORAL

 PERSONALITY DEVELOPMENT/PERSONALITY  ORAL STAGE

THEORY:
 FREUD’S PSYCHOSEXUAL THEORY
1. Oral stage
2. Anal stage
3. Phallic stage
4. Latency stage
5. Genital stage
 THREE PARTS OF PERSONALITY
 ID
 Consists of all our primitive, innate desires,
which include bodily needs, sexual urges and
aggressive impulses.
 Totally unconscious and drives the person
toward immediate, total gratification
 Operates on pleasure principle (seeking of
immediate gratification and avoidance of
discomfort)
 EGO
 Establishes relations with environment through
conscious perception, feeling, action
 Controls impulses from id and demands from
superego
 Operates on reality principle (external conditions
considered and immediate gratification delayed
for future gains that can be realistically achieved.
 SUPEREGO
 Represents internalized moral code based on
perceived social rules and norms
 Active and concrete in directing person’s
thoughts, feelings and actions
 TWO SYSTEMS:
o Satisfaction is obtained primarily through the
erogenous zone of the mouth
o Security is the greatest need
o Narcissistic pleasure – seeking is through eating
and sucking (pleasure principle)
o Aggressive instincts are shown by biting and
chewing
o Weaning is a crucial conflict in this period
o FIXATION:
o Arrested development in which the person retains
means of gratification characteristic of an earlier
phase
o Develop dependent relationship in adulthood,
recreating dependency and immaturity of the
oral stage
o Optimistic, gullible and will swallow anything
o Individual uses oral approaches to hurt; biting
sarcasm
o Oral pleasures: eating, drinking and smoking
2. TODDLERHOOD
 1 year to 3 years old
 ANAL
 ANAL STAGE
o Anus is the site of tension and sensual
gratification
o Excretory processes, retentive and expulsive are
experienced as pleasurable
o The child uses these new skills to please or to
annoy parenting adults.
o Child exhibits motor self – control and
independence through negativistic behavior
o FIXATION:
o Anal – retentive personality shows traits of
obstinacy, parsimony and orderliness.
 o Anal – expulsive personality shows traits of
generosity, and outgoing nature and may highly
creative, expressive and artistically inclined.
3. PRE – SCHOOLER
 3 years to 6 years old
 PHALLIC
 PHALLIC STAGE
o Libido is centered in the genital region
o LIBIDO
o Sexual or psychic energy arising from hidden
drives or impulses involved in conflict
o Desire for pleasure, sexual gratification
o Masturbation, fantasy, play activities,
experimentation with peers and questioning of To develop Trust:
adults about sexual topics are indicative
behaviors
o Labeled phallic because the penis is presumed
to be the object of main interest. For little girls
who are envious or to the little boy who is
constantly fearing castration for unconscious
desires to experience sexual gratification with
mother.
o Major conflict is:
o Oedipal Complex or Electra Complex
o Child develops sexual interest toward the
parent of the opposite sex
4. SCHOOL AGE
 6 years to 12 years old
 LATENCY
 LATENCY STAGE
o Sexual urges are dormant until their  AUTONOMY
reawakening at puberty
o During this period, libido is channeled to school,
home and organizational activities, hobbies and
relationship with peers.
o The time foe increased intellectual activity,
identification with teachers and peers To develop Autonomy:
weakening of home ties
5. ADOLESCENT
 12 years to 18 years old
 GENITAL
 GENITAL STAGE
o Adolescent becomes sexually mature and libido
is centered again on the genital area.
o Person strives for independence, gains
intellectual maturity, selects a love object of the
opposite sex and settles into adult roles.
 SOCIAL LEARNING THEORY OF PERSONALITY
o Explains personality almost entirely in terms of
experience rather than biological factors
o Personality is learned just as learning to play
tennis, eat with a fork or speak a language
o Values play an important role in determining
behavior To develop Initiative:
o Values and expectancies determine personality.
o Explains why we are all different and when we
are exposed to similar environments, our ways
 GUILT
of expressing our motives and values differ.
 PSYCHOSOCIAL THEORY (Erik Erickson)
 Said that the child faces a wider range of human
relations as he grows up and has specific
problems to be faced with each stage
 STAGES OF DEVELOPMENT
 PSYCHOSOCIAL CRISES
1. INFANCY
 birth to 12 months
 TRUST vs. MISTRUST
 TRUST
 Caregiver’s satisfaction of infant’s basic
needs for food and sucking; warmth and
comfort and love and security in consistent
and sensitive manner
 Somebody must respond to the needs of an infant
 Infant must be given a gentle, caring and loving
attention
 Care must be given by one person only
(primary care giver). Whoever she/he is as long
as they can build the trust.
 Infants have to expect what will happen next. Life
of an infant is a routine.
 MISTRUST
 Basic needs of infants are not met or are met
inadequately, infant becomes suspicious,
fearful and mistrusting as evidenced by poor
eating, sleeping and elimination
2. TODDLERHOOD
 1 year to 3 years old
 AUTONOMY vs. SHAME AND DOUBT
 Child develops beginning independence while
gaining control over bodily functions of
undressing and dressing, walking, talking,
feeding self and toileting. Self control begins
 Learn how to wear his/her clothes by himself
 Let them eat by themselves
 Give them something that they can manipulate
 SHAME / DOUBT
 If toddlers developing independence is
discouraged by parents, child may doubt
personal abilities
 If child is made to feel bad when attempts to be
autonomous fail, child develops shame
3. PRE – SCHOOLER
 3 years to 6 years old
 INITIATIVE vs. GUILT
 INITIATIVE
 Developed when planning and trying out new
things. Child behavior is vigorous, imaginative
and intrusive.
 Conscience and identification with same-sex
parent develop
 Let a child play with a clay, sand, mud
 Let them go to the zoo.
 Parental restrictiveness may prevent child from
developing initiative
  Guilt may arise when child undertakes activities  IDENTITY vs. ROLE CONFUSION
in conflict with those of parents.
 Child must learn to initiate activities without  IDENTITY
infringing on right of others  Individual develops integrated sense of self
 Peers have major influence over behavior
 Major decision is to determine vocational goal
4. SCHOOL AGE
 6 years to 12 years old  ROLE CONFUSION
 INDUSTRY vs. INFERIORITY  Failure to develop sense of personal identity may
lead to role confusion, which often results in
 INDUSTRY feelings of inadequacy, isolation and
 Child wins recognition by demonstration of skill indecisiveness
and production of things and develops self-
esteem through achievements. 6. EARLY ADULTHOOD
 Child is greatly influenced by teachers and  18 years to 25 – 40 years old
school  INTIMACY vs. ISOLATION

 INFERIORITY
 Feelings of inferiority may occur when adults
perceive child’s attempt to learn how things
work through manipulation to be silly or
troublesome
 Lack of success in school, development of  ISOLATION
physical skills and making of friends also
contribute to inferiority
5. ADOLESCENT
 12 years to 18 years old
7. MIDDLE ADULTHOOD
 40 years to 65 years old
 GENERATIVITY VS. STAGNATION
 GENERATIVITY
 Mature adult is concerned with establishing and
guiding next generation
 Adult looks beyond self and expresses concerns
for future of world in general
 STAGNATION
 Self-absorbed adult will be preoccupied with  Maslow’s humanistic conceptions of personality
personal well-being and material gains
 Pre-occupation with self leads to stagnation of
life
 INTIMACY
 Task is to develop close and sharing
relationships with others, which may include
sexual partner
 Individual unsure of self-identity will have
difficulty developing intimacy
 Person unwilling or unable to share self will be
lonely
 Believed that to understand one’s personality,
you must know how he or she perceives the
world
 ABRAHAM MASLOW
 leader in Humanistic Psychology
 Heavily influenced by existential philosophy
 Existentialists believed that each person carves
out his own destiny – life is what you make it.
 Postulated that a person is never static, he is
always in the process of becoming different
focused primarily on two areas.
(1) Hierarchy of needs
(2) Concept of self actualization

8. LATE ADULTHOOD
 65 years old and above
 EGO INTEGRITY vs.. DESPAIR  MASLOW’S HIERARCHY OF NEEDS
SELF
 EGO-INTEGRITY ACTUALIZATION
 Older adult can look back with sense of SELF-ESTEEM
satisfaction and acceptance of life and death
LOVE AND BELONGINGNESS
 DESPAIR
 Unsuccessful resolution of this crisis may result
in sense of despair in which individual views life SAFETY NEEDS
as series of misfortunes, disappointments and
failures PHYSIOLOGICAL NEEDS

 HUMANISTIC THEORY
 Central focus is the concept of self

 SELF
 refers to the individual’s own personal internal
experiences and subjective evaluation
 This theory rejects the psychoanalyst’s notion of
unconscious motivation as an important force in
personality development.
 Rejects the idea that environmental forces are
the major determinants of personality
 Believed that human beings are endowed with
free will and free choice
 PHYSIOLOGICAL NEEDS
 Include the need for oxygen, water, food,
temperature control, elimination, shelter, exercise,
sleep, sensory stimulation and sexual activity
 This needs cease to exist as active means of
determining behavior when satisfied, reemerging
only when they are blocked or frustrated.
 SAFETY NEEDS
  Security, consistency, stability, fairness, structure,  tends toward a long, stringy, skinny body
order and limits; protection from immediate or
future danger; freedom from fear, anxiety and Ernest Kretschmer
chaos; a certain amount of routine and structured  was a German psycho-artist, who described four
environment types of techniques and their related
characteristics
 LOVE AND BELONGINGNESS
 Derived from societal factors and include a need Pyknic
to be cherished, a need for identification with  rounded full face, short neck, stocky build, short
significant others, affection from and affiliation limbs, mood fluctuations and a tendency to
with others, recognition and approval, extroversion and manic-depression
companionship and group interactions
 Not synonymous with sexual needs, but sexual Asthenic
needs maybe motivated by a need for love and  thin and angular, introverted and a tendency to
affection schizophrenia

 SELF – ESTEEM Athletic

 Concerned with the concept of self as a  strong, solid muscular build and comparable
worthwhile person and an awareness of introverted tendencies
individuality and uniqueness
 Included are needs for self – respect; respect Dysplastic
from others; sense of confidence, dignity,  characterized by bodily disharmony and
competence, independence, prestige, status and temperamentally introverted
success; recognition from others for
accomplishments; and desire to attain certain  BEHAVIOR (Carl Jung)
standards of excellence  Swiss Psychoanalyst and Founder of Analytical
Psychology
 SELF – ACTUALIZATION
 Self – fulfillment; ongoing emotional and spiritual  CLASSIFIED PERSONALITY TYPES ACCORDING TO:
development; ability to make decisions and be  ATTITUDE TYPES
autonomous; reaching individual’s potentialities; Extrovert
using talents; being productive and having peak  A tendency to direct the personality outward
experiences rather than inward toward the self
 Involves always becoming, it involves  Social, a man of action, whose motives are
spontaneity conditioned by external events
 Is negligent of ailments, not taking care of the self;
 PERSONALITY THEORY (George Kelly) accommodates readily to new situations, directly
 An individual is primarily a scientist whose life is oriented by objective data
an attempt to control and predict experience
 An individual is motivated by the necessity of Introvert
knowing reality.  Orientation inward toward the self
 Person classifies and categorizes perceptions,  Preoccupied with his own thoughts
events circumstances and situations, and when  Avoids social contacts and tends to run away from
this activity is complete experience results reality
 Personality is the continuous construction,  Conduct is governed by absolute standards and
rejection or acceptance of these personally principles and lacks of flexibility and adaptability
significant hypothesis about oneself
 PHYSIOLOGY OR BODY CHEMISTRY
 TYPE THEORIES  Hippocrates
 Constitutional Types  laid the foundation for the doctrine of
 These theories postulate that human temperaments based on the humors (fluids)
subjects can profitably be classified into a of the body.
smaller number of classes or types, each
class or type having characteristics in  GALEN (GREEK PHYSICIAN)
common which set its members apart from  An exact balance of these four humors resulted in
other classes or types a correctly constituted personality

 PHYSIQUE (Body Types) TEMPERAMENTS HUMORS

William Sheldon Quick-Strong (choleric) Yellow Bile

 bases his theory on the three layers of tissue in the  Easily angered, quick to react
human embryo – the endoderm, mesoderm and Quick-weak (sanguine) Blood
ectoderm  Generally warm-hearted,
pleasant, had a prominence of blood
Endomorphy Slow-strong (melancholic) Black Bile
 tends towards a roundness, heaviness and a  Suffers from depression and sadness
preponderance of visceral development Slow-weak (phlegmatic) Phlegm
 Listless and slow
Mesomorphy
 tends towards stockiness and good muscular  WAYS OF IMPROVING PERSONALITY
development  Self-appraisal
 Listing down and evaluating your physical,
Ectomorphy intellectual, social and emotional traits in
 terms of effectiveness, ineffectiveness or
partial effectiveness
 Effective Regulation Of Emotional Life
 One must develop a high degree of control over
one’s emotions and not allowing one’s emotion to
control you
 Negative or unpleasant emotions like fear, envy,
pride should be checked or sublimated
 Positive emotions like joy, love, reverence, etc.
should be developed
 Social relations
 One should be capable of social intimacy –
forming friendships and participating in social
relations that are deeper than mere
acquaintances
 Work
 One must be committed to some form of work
that is satisfying as well as economically good.
 Keep busy and indulge in worthwhile hobbies
 Love and Sex
 One must be able to forego personal gratification,
even sexual gratification, to satisfy the loved one.
Love consists or thinking more of other people
rather than one’s own self
 Self
 One must have a positive regard of one’s self as
distinguished part of the world he lives
 One must have a well-developed ego identity and
should know who he is, where he is going and
should have an inner assurance that he will be
recognized and accepted by those who count
 Philosophy of Life
 One should live by philosophy of life that should
give direction to one’s actuations
 SULLIVAN’S INTERPERSONAL THEORY
1. Infancy
2. Childhood
3. Juvenile
4. Preadolescence
5. Early adolescence
6. Late adolescence
 PIAGET’S COGNITVE THEORY
1. Sensorimotor
2. Preoperational
3. Concrete operational
4. Formal operations
 KOHLBERG’S MORAL DEVELOPMENT
 pre-conventional - punishment &
obedience
 conventional - social system &
conscience
 post-conventional - universal ethical
principle
 ECCLECTIC APPROACH
1. Development is a continuum
2. Behavior has meaning and is not determined
by chance
3. All behaviors should be goal-directed
4. The unconscious plays an active role in
determining behavior
5. The early years of life are extremely
important for personality development
 SELF – AWARENESS
 Involves noticing how the self feels, thinks,
behaves and senses at any given time.
 It is only through awareness of how the self blocks
messages and uses mental mechanisms that
people can achieve self-understanding
 AWARENESS
 Awareness is a way of focusing attention on the
present, thereby strengthening the impact of life
experiences.
 Always available and, with practice, can be used
successfully to enrich life
 Is not only the key to self understanding, it is also
the key to fullness of living
 First step in coping with stress.
The more aware one is, the deeper one can
experience feelings such as joy and pleasure
 IMPROVING SELF-AWARENESS
 Improving self-awareness requires concentration
and practice. The following suggested guidelines
could be used to develop self-awareness.
Awareness should never be forced; it should
simply be allowed to flow. Instant results should
not be expected, as growth requires time.
 Periodically stop and concentrate on what your
body is feeling at the moment. At first,
concentrate only on what the body senses. Later,
include environmental awareness as well. Tell
yourself what you are aware of.
 Ask yourself, “What am I aware of when I am
anxious, happy, joyous, frustrated?”
Concentrating on the bodily sensations that
accompany these feelings will make them more
concrete and, therefore, manageable.
 Listen to what you say and how you speak.
Persons often phrase sentences to avoid
awareness, particularly awareness of
responsibility. When responsibility for behavior
is excluded from awareness, a person loses
control over that behavior and is unable to
change it.
 A sentence such as “It is scary” is an attempt to
give up ownership of an emotion. Changing the
ownership from “it” to “I” helps to increase
awareness that it is really “I” who is scared, not
“it” that is scary. Ownership is accepted and the
emotion becomes controllable.
 “You make me angry” is another example of giving
up ownership of an emotion. Changing ownership
from “you” to “I” increases awareness of who is
responsible for the anger. E.g. “I am angry at you.”
When an individual accepts responsibility for her
own anger, she becomes aware that no one else
can cause it. Only she has control. Only she owns
the emotion and only she can accept it or change
it.
 People often explain their own feelings by using
the second or third (you or they). E.g., A person
may say, “You feel as if you’re all alone and no one
really cares. This is again giving up ownership.
  Saying, “can’t” is another way of eliminating  DISTURBANCES OF ATTENTION
responsibility for an action. There are some
legitimate “can’ts” but the majority are really
“won’ts”. Saying “I won’t” helps the individual
become aware of the fact that she also has rights.
 Clarify vague feelings of dislike by a process called
exaggeration. If you do not like something and do
not really know why, you may be able to  DISTURBANCES IN SUGGESTIBILITY
determine what it is you do not like through
exaggeration. Pretend the disliked object
(whether it be a dress, a classmate or a piece of
furniture) is directly in front of you. Tell it how
you feel as if it were really there. Each time you
repeat the statement, exaggerate. Allow yourself
to say whatever comes to mind. At the same time,
try to concentrate on the feelings.
 Another way of increasing awareness is to handle
disturbing experiences of the past by bringing
them into the present. Relate the experience as if  DISTURBANCES IN AFFECT
it were happening in the present. At the same
time, try to sense the experiences continue to
disturb you and you do not know why.
 SELF – ACCEPTANCE
 Self-acceptance is a regard for oneself with a
realistic concept of strengths and weaknesses.
 Behaviors of the self-accepting person include
the following.
 Persevering
 Minimizing weaknesses
 Seeing reality
 Trusting and accepting others
 Continuing growth toward self-actualization
 Recognizing and accepting one’s own
behavior
 Reaching out to others
 Increasing strengths
 Learning from mistakes
 TYPICAL SIGNS AND SYMPTOMS OF PSYCHIATRIC
 OTHER AFFECTS
ILLNESS
 CONSCIOUSNESS
 State of awareness; sensorium is intact and
apprehension of external stimuli presented is
unimpaired.
 DISTURBANCES IN CONSCIOUSNESS
 Confusion – disturbance of orientation as to
time, place and person
 Clouding of Consciousness – Incomplete clear
mindedness with disturbance in perception and
attitudes.
 Delirium – bewildered, restless, confused,
disoriented reaction associated with fear,
hallucinations and illusions
 Stupor – lack of reaction to and awareness of
surroundings
 Coma – profound degree of
unconsciousness
 Coma Vigil – coma in eyes remain open
 Dreamy State (Twilight) – disturbed
consciousness with hallucinations (visual and
auditory)
 The amount of effort exerted in focusing on
certain portions of an experience
 Distractability – inability to concentrate
attention
 Selective Inattention – blocking out of things
that generate anxiety
 Complaint and uncritical response to an idea:
 Folie a Deux (Folie a trois) – communicated
emotional illness between two or three persons
 Hypnosis – artificially induced modification of
consciousness
 AFFECT
 Visible manifestation of emotional feelings or
tone
 Inappropriate Affect – disharmony of affect and
ideation
 Pleasurable Affects
 Euphoria – heightened feeling of psychological
well being inappropriate to apparent event.
 Elation – air of confidence and enjoyment
associated with increased or exaggerated motor
activity; often labile and readily shifts to
irritability.
 Exaltation – intense elation with feelings of
grandeur
 Ecstasy – feeling of intense rapture
 UNPLEASURABLE AFFECTS
 Depression – psychopathologic feeling of
sadness
 Grief – sadness appropriate to a real loss of a
loved one
 Despair – sadness due to a loss of an
object
 Anxiety – feeling of apprehension due to
unconscious conflict
 Fear – anxiety due to consciously recognized and
realistic danger
 Agitation – anxiety associated with severe motor
restlessness
 Panic – acute intense attack of anxiety associated
with personality disorganization
 Free floating anxiety – pervasive fear not
attached to any idea
 Apathy – dulled emotional tone associated with
detachment or indifference
 Ambivalence – co existence of two opposing
impulses toward the same thing in the same
person at the same time
 Depersonalization – feeling of unreality
concerning one self or one’s environment
 Derealization – distortion of apatial
relationships so that environment becomes
unfamiliar
 Aggression – forceful, goal-directed action that
maybe verbal or physical and that is the motor
counterpart of the affect rage, anger or hostility
 Mood Swings – oscillations between periods of
euphoria and depression or anxiety
 MOTOR BEHAVIOR / CONATION
 The capacity to initiate action or son as
expressed through his behaviors
 DISTURBANCES OF CONATION
 Echolalia – psychopathological repeating of
words of one person by another
 Echopraxia – pathological imitation of
movements of one person by another
 Cerea Flexibility (Waxy Flexibility) – state in
which patient maintains body position into which
he is placed
 Catalepsy or Catatonia – immobile position is
constantly and unconsciously maintained.
 Command Automatism – automatic following of
suggestions
 Automatism – automatic performance of acts
representative of unconscious symbolic activity
 Cataplexy – temporary loss of muscle tone and
weakness precipitated by a variety of emotional
states
 Stereotype – continuous repetition of speech or
physical activities
 Negativitism – frequent opposition to
suggestions
 Mannerism – stereotyped involuntary
movements
 Verbigeration – meaningless repetitions of
speech
 OVERACTIVITY
 Hyperactivity – restless, aggressive, destructive
activity, maybe purposeful but simple and non-
productive
 Tic – spasmodic, repetitive motor
movements
 Sleepwalking (Somnambulism) – motor 
activity during sleep
 Compulsion – uncontrollable impulse to
perform an act repetitively
 OBSESSIVE IN ACTION
 Dipsomania – compulsion to drink
alcohol
 Egomania – pathological self pre –
occupation
 Erotomania – pathological pre occupation with
sex
 Kleptomania – compulsion to steal
 Megalomania – pathological sense of
power
 Monomania – pre occupation with a single
subject
 Nymphomania – excessive need for coitus in
female
 Satiriasis – excessive need for coitus in
male
 Trichotilomania – compulsion to pull
one’s hair
 Ritual – automatic activity, compulsive
in nature
 EMOTIONAL IN ORIGIN
 Volubility (Logorrhea) – copious, coherent, logical
 Hypoactivity – decrease activity or retardation,
as in psychomotor retardation, allowing of
 Looseness of Association – frequent speech
psychological and physical functioning
 Mimicry – simple, imitative motion activity of
childhood
 Violence – acting out of destructive aggression
by assaulting persons or objects in the  DISTURBANCES IN TYPE OF ASSOCIATION
environment
 Suicide – destructive aggression turned inward;
taking one’s own life.
 THINKING
 Goal – directed flow of ideas, symbols and
associations initiated by a problem or task and
leading toward a reality-oriented conclusion;
when a logical sequence occurs, thinking is
normal.
 DISTURBANCES IN THE FORM OF THINKING
1. Dereism – mental activity not concordant with logic
or experience
2. Autistic Thinking – thinking that gratifies unfulfilled
desires but has no regard for reality; somewhat
synonymous with deresim (dereistic thinking)
 Daydreaming – thinking is guided by egocentive
wishes and instinctual needs.
 DISTURBANCES IN THE STRUCTURE OF
ASSOCIATION
1. Neologism – new words created or invented by the
patient for psychological reasons
2. Word Salad – incoherent mixture of words and
phrases
 Circumstantiality – excessive associated ideas come
to consciousness because selective suppression is
reduced every detail about the topic discussed but
patient eventually gets from starting point to desired
goal.
Tangentiality – inability to have goal-directed
associations of thought; patient never gets from
starting point to desired goal
 Incoherence – running together of thoughts with no
logical connection, resulting in disorganization
 Perserveration – involuntary repetition of the
answer to a previous question when answering a new
question; can also be as endless repetition of activity;
patient is unable to shift from one task to another.
 Condensation – fusion of various concepts into one
 Irrelevant Answer – answer that is not in harmony
with question asked
 DISTURBANCES IN SPEED OF ASSOCIATIONS
1. Flight of ideas – rapid, continuous verbalization so
that there is a shifting from one idea to another
2. Clang Associations – words similar in sound but not
in meaning call up new thoughts
 Blocking – interruption in train of thinking;
unconscious in origin
 Pressure of Speech – voluble speech, difficult to
understand
speech
characteristic in which the point of the client’s
conversation shifts abruptly without any apparent
connection
 1. Motor Aphasia – disturbance of speech due to 1. Disturbances associated with organic brain
organic brain disorder in which understanding disease
remains but ability to speak is lost.  Agnosia – inability to recognize and interpret the
2. Sensory Aphasia – loss of ability to comprehend significance of sensory impressions
the meaning of words or use of objects

3. Nominal Aphasia – difficulty in finding right name 2. Disturbances associated with HYSTERIA
for an object
4. Synctactial Aphasia – inability to arrange words in
proper sequence
 DISTURBANCES IN CONTENT OF THOUGHT
1. Delusion – false belief, not consistent with patient’s
intelligence and cultural background that cannot be
corrected by reasoning or logic.
 Delusion of Grandeur – exaggerated conception
of one’s importance
 Delusion of Persecution – false belief that one is
being persecuted; often found in litigious clients
 Delusion of Reference / Ideas of Reference –
false belief that the behavior others portray refer
or relate directly to the client.
 Delusion of Influence / Ideas of Influence –
distorted thoughts about an event that occurred
because of the client’s influence
 Delusion of Self Accusation – False feeling of
remorse
 Delusion of Control – false feeling that one is
being controlled by others
 Delusion of Infidelity – false belief derived from
pathological jealousy that one’s lover is unfaithful
 Paranoid Delusion – over suspiciousness
leading to persecutory delusions
2. Trend or Preoccupation of Thought – centering of
thought content around a particular idea, associated
with a strong affective tone
3. Hypochondria – exaggerated concern over one’s
health that is not based on real organic pathology
4. Obsession – pathological persistence of an irresistible
thought, feeling or impulse that cannot be eliminated
from consciousness by logical effort; closely related  ILLUSION
to compulsion
Illnesses characterized by emotional conflict, the use
of defense mechanism of conversion and the
development of physical symptoms involving the
voluntary muscles or special sense organs
a. Hysterial Anesthesia – loss of sensory modalities
resulting from emotional conflicts
b. Macropsia – state in which objects appear larger
than they are
c. Micropsia – state in which objects appear smaller
than they are
2. Hallucinations – false sensory perceptions not
associated with the real external stimuli
 Hypnagogic Hallucination – false sensory
perception occurring midway between falling
asleep and being awake
 Auditory Hallucination – false auditory
perception
 Visual Hallucination – false visual perception
 Gustatory Hallucination – false perception of
taste
 Olfactory Hallucination – false perception of
smell
 Tactile Haptic Hallucination – false perception
of touch, such as the feeling of worms under the
skin
 Kinesthetic Hallucination – false perception of
movement of sensation, as from an amputated
limb (phantom limb)
 Lilliputian Hallucination – perception of objects
as reduced in size
 wrong perception of real external sensory stimuli

 Phobia – exaggerated and invariably pathological  MEMORY

dread of some specific type of stimulus or situation
 Acrophobia – dread of high places
 Agoraphobia – dread of open spaces
 Astraphobia – dread of storms, thunder,
lightning
 Algophobia – dread of pain
 Claustrophobia – dread of closed spaces
 Hematophobia – dread of blood
 Monophobia – dread of being alone
 Mysophobia – dread of germs and
contaminations
 Nyctophobia – dread of darkness
 Ochlophobia – dread of crowds
 Pathophobia – dread of diseases
 Pyrophobia – dread of fire
 Xenophobia – dread of strangers
 Zoophobia – dread of animals or a particular
animal
 Treskardekephobia – dread of number 13
 PERCEPTION
 Awareness of objects and relations that follows
stimulation of peripheral sense organs
 Function by which information stored in the
brain is later recalled to consciousness
 DISTURBANCE IN MEMORY
 Amnesia – partial or total inability to recall past
experiences
 Anterograde Amnesia – one that extends
forward to cover a period following the apparent
regaining of environmental contact
 Retrograde Amnesia – loss of memory extending
back over a period prior to the time when the
onset occurred; recovery is chronological –
those memories nearest the injury being the last
to return
 Paramnesia – falsification of memory by
distortion of recall
 Fausse Reconnaisance – false recognition
 Retrospective Falsification – recollection of a
true memory to which the patient adds false
details
 Confabulation – unconscious filling of gaps in
memory by imagined or untrue experiences that
patient believes but that have no basis in fact.
  De Ja Vu – illusion of visual recognition in which a M aternal infection
new situation is incorrectly regarded as a E exact gestational age is not reached
repetition of a previous memory N utritional deficiency
 Jamais Vu – false feeling of unfamiliarity with a T oxoplasmosis
real situation one has experienced A noxia
 Hypermnesia – exaggerated degree of retention L ead poisoning
and recall
R ecent infection (Measles)
 INTELLIGENCE E nvironmental factors
 The ability to understand, recall, mobilize and T hyroid deficiency
integrate constructively previous learning in A lcoholic mother
meeting new situations R H incompatibility
D amage to brain from various cause
 DISTURBANCES IN INTELLIGENCE A IDS
T oxemia
 Mental Retardation – organically caused by lack I nherited factor
of intelligence to such a degree that there is O piate intoxication
interference with social and vocational N eurological / neurodevelopmental impairment
performance
 NURSING DIAGNOSIS: Impaired intellectual
 Categories of Mental Retardation according to functioning
WHO
 PRINCIPLES OF NURSING CARE:
 Normal Intelligence Quotient (IQ) : 81 and  Repetition – they don’t learn in single session
above  Role modeling – they learn by examples
 Restructuring the environment
MILD 60 to 80 subnormal /
Borderline  FOCUS OF EDUCATION: Reading, Writing and
MODERATE 40 to 60 imbecile / Basic Arithmetic
Educable
SEVERE 20 to 40 moron /
Trainable  AUTISTIC DISORDER
PROFOUND 20 and below idiot / delayed socialization and communication
Custodial Care stereotypical behaviors
peculiar preoccupations
MENTAL RETARDATION early age of onset (before 30 months)
Mild - IQ level 50-55 to approximately 70
Moderate - IQ level 35-40 to 50-55 II. PERVASIVE DEVELOPMENTAL DISORDER
Severe - IQ level 20-25 to 35-40
Profound - IQ below 20 or 25 AUTISTIC DISORDER

 Etiology Infantile Autism

Chromosomal abnormalities Treatable but not curable
genetic factors More common among boys
prenatal factors Usually diagnosed at age 2 y/o
prenatal substance exposure MAIN PROBLEM: Interpersonal functioning
complications of pregnancy Most acceptable cause: Biological factors – brain anoxia,
perinatal factors intake of drugs
acquired childhood disorders Most commonly manifests itself in infancy but may begin
Disorders Usually First Diagnosed as late as 36 months of age. The autistic person is
During Infancy, Childhood or Adolescence markedly dysfunctional in most realms of human
MENTAL HEALTH AND REHABILITATION functioning. The aspects of impaired functioning are as
follows:

 MENTAL RETARDATION: 1. Interpersonal relations

a. lack of awareness of the presence of other people; lack
IQ less than 70 of awareness of other’s emotions or their need for privacy
Not a form of mental illness b. no comfort-seeking when distressed
c. limited or no imitation, social play or capacity to form
 MAIN PROBLEM: Inadequate mental peer friendships
functioning
 AGE OF ONSET: 18 years old 2. Verbal and non-verbal communication
abnormal eye-to-eye contact
 CAUSES: abnormal speech patterns
abnormal conversational ability
familial or genetic
damage to the embryo’s developing nervous system while 3. Activity level and interests
in the uterus a. repetitive body movements
injuries from the stress of birth b. preoccupation with objects
anoxia which occur prenatally, perinatally or postnatally c. very low range of interests
childhood diseases with high fever and toxicity adherence to nonfunctional routines or rituals
accidents and falls
SIGNS AND SYMPTOMS:
 TREATMENT: Remedial education
resist normal teaching method
silly laughing or giggling 2. DISORDER OF WRITTEN EXPRESSION
echolalia
acts as deaf Characterized by writing skills that are significantly
no fear of danger below the expected level for a person’s age, intellectual
insensitive to pain capacity and education as measured by a standardized
crying tantrums test.
loves to spin objects Components include
resists change in the routine
not cuddly Poor spelling
sustained odd play Errors in grammar and punctuations
difficulty interacting with others Poor handwriting
no eye contact
wants block not ball TERMS USED:
points to anything
attachment to inanimate objects Spelling disorder
Spelling dyslexia
MANAGEMENT OF PRIORITY PROBLEMS:
ETIOLOGY: Unknown
Tantrums – involves headbanging (place a helmet on the
head) DIAGNOSIS: History of child’s early poor
Routines – provides consistency motor behavior
Communication – all vowels Below normal in intelligent test and above normal in
verbal subtest
NURSING CARE:
CLINICAL FEATURES:
24-hour monitoring
Assistance with normal ADLs depending on the level of Child markedly impaired performance in motor
impairment coordination
Ensure safety of the environment
TREATMENT:
NURSING DIAGNOSIS: Potential for injury
Perceptual motor training
III. LEARNING DISORDERS Neurophysiological techniques of exercise for motor
dysfunctions
These disorders include educational areas in which Modified physical education
children may have problems:

3. READING DISORDER
1. MATHEMATICS DISORDER
Characterized By:
Impairment in 4 group of skill
Impaired ability to recognize words
Linguistic Skill – those related to understanding Slow inaccurate reading
mathematical terms and converting written problems Poor comprehension
into mathematical symbols
Perceptual Skills – the ability to recognize and ETIOLOGY:
understand symbols and to clusters of numbers
Mathematical Skills – basic addition, subtraction, Theories / Studies
multiplication and division and following sequences of Dyslexia and birth during winter months
basic operations Abnormal symmetries in the temporal or parietal lobes of
Attentional Skills – copying figures correctly and persons with reading disorders
observing operational symbols correctly Association to nutritional deficiency
Association to psychiatric disorders – cause and effect
EPIDIMIOLOGY: 6% of school age children who are not
MR DIAGNOSTIC CRITERIA:

ETIOLOGY: Multifactoral Reading achievement is substantially below the expected

chronological age, measured intelligence and age-
Maturational appropriate education
Cognitive It interferes with academic achievement or activities of
Emotional daily living
Socio-economic If a sensory deficit is present, the reading difficulties are
in excess of those usually associated with it.
DIAGNOSIS: History of difficulties with
arithmetic subjects CLINICAL FEATURES;
Standardized arithmetic test
Omissions, additions and distortions of words
CLINICAL FEATURES: Poor performance in handling Errors in oral reading
basic number concepts such as counting and adding even Speed is slow with minimal comprehension
one digit. Can copy but poor spellers
TREATMENT: Includes many disorders in which developmentally
expected speech sounds for the patients and intelligence
Remedial Education are incorrect or delayed.
Psychotherapy Errors in sound production
Substitution of one sound for another
IV. COMMUNICATION DISORDERS Omission of such sounds as final consonants

EXPRESSIVE LANGUAGE DISORDER ETIOLOGY: Unknown but can be related to:

Perinatal problems
This category includes the criterion of lack of correlation Hearing impairment
between a standardized test of expressive language and Structural abnormalities
the person’s nonverbal IQ, determined by an individually
administered test. The expressive language score is DIAGNOSTIC CRITERIA:
substantially lower than the IQ score. In addition, the
disturbance significantly interferes with academic A. Disturbances in the normal fluency and time patterning
achievement or ADLs. of speech (inappropriate for the individual age)
characterized by frequent occurrences of one or more of
ETIOLOGY: Not known the following:

DIAGNOSIS: Sound and syllable repetition

Presence of makedly below-age-level verbal or Sound prolongation
sign language, accompanied by a low score on Interjections
standardized expressive verbal tests. Broken words
Audible or silent blocking (filled or unfilled pauses in
CLINICAL FEATURES: speech)
Circumlocutions (words substitution to avoid
18 months – child fail to echo even single sounds problematic words)
like “mama” Words produced with an excess of physical tension
Age 4 – can speak short phrases but forget old words as Monosyllabic whole-word repetitions
they learn new ones
B. The disturbance in fluency interferes with academic or
COMPLICATIONS: occupational achievement or with social communication

Emotional problems of poor self-image, frustration and C. If a speech-motor or sensory deficit is present, the
depression. In contrast to patient with pervasive speech difficulties are in excess of those usually
disorders. associated with those problems.

TREATMENT: Language Therapy PHASE 1: - occurs preschool period

- episodic
MIXED RECEPTIVE – EXPRESSIVE LANGUAGE DISORDER
PHASE 2: - elementary school
This category includes the criterion that the score years
received on a standardized test of receptive language - chronic
does not correlate with standardized, individually
administered IQ tests. The deficit also interferes PHASE 3: - 8 yrs old and above
significantly with academic achievement or ADLs. - comes and goes
largely in response to specific situations
ETIOLOGY: Not known
PHASE 4: - late adolescence and
DIAGNOSIS: adulthood

Presence of a markedly below-age-appropriate level of TREATMENT:

comprehension of verbal sign language with intact age-
appropriate nonverbal intellectual capacity. Distraction
Language difficulties by standardized receptive language Suggestion
test Relaxation
The absence of pervasive developmental disorders
confirms the diagnosis. 4. STUTTERING

CLINICAL FEATURES: This category includes the criterion that speech

patterning is inappropriate for the person’s age and is
Significant impairment in both language comprehension characterized by frequent repetitions, sound
and language expression prolongations, broken words, or words produced with an
excess of tension. The disturbance interferes with
TREATMENT: academic achievement or ADLs.

Speech and language therapy V. MOTOR SKILLS DISORDER

Psychotherapy
The disorder in this category is DEVELOPMENTAL
3. PHONOLOGICAL DISORDERS COORDINATION DISORDER. In this condition, the person
is significantly unable to perform academic functions or
The criterion that determines this category is a consistent ADLs requiring motor coordination at level similar to
failure to use developmentally expected speech sounds. other children or adults of the same age. This condition is
not caused by a physical disorder, such as cerebral palsy, given after meals / 6 hours before bedtime
hemiplegia or muscular dystrophy growth suppression

ETIOLOGY: Unknown SIDE EFFECTS: insomnia and growth retardation

DIAGNOSIS: 2. CONDUCT DISORDER

history of child’s early poor motor behavior A child with this disorder shows a repeated,
below-normal in intelligent test and above-normal in persistent pattern of behavior that demonstrates little
verbal subtest. recognition or consideration of other people’s basic rights
or that violates social norms expected of a child of his or
CLINICAL FEATURES: her age. The diagnostic criteria for conduct disorder
require that at least three of the following symptoms be
child’s markedly impaired performance in motor present
coordination
Often bullies, threatens or intimidates others
TREATMENT: Often initiates physical fights
Has used weapon in more than one fight
Perceptual motor training Has been physically cruel to animals or people
Neurophysiological techniques of exercise for motr Has stolen with confrontation of a victim
dysfunctions Has forced someone into sexual activity
Modified physical education Has deliberately destroyed other’s property
Has deliberately set fires
VI. ATTENTION DEFICIT AND DISRUPTIVE BEHAVIOR Has broken into someone else house, building or
DISORDERS car
Has stolen items or forged without confrontation
ATTENTION DEFICIT / HYPERACTIVITY DISORDER of a victim
(ADD) Has run away from house at least twice
The child with this disorder displays a majority of the Often stays out all night despite parental
following behaviors: prohibitions
Is frequently truant
MAIN PROBLEM: Inattention, Hyperactivity and
Impulsivity
ETIOLOGY: Biopsychosocial factors

CAUSES: Parental factor – faulty child rearing practices

- chaotic home conditions
Neurologic impairment Sociocultural factors – socioeconomic deprived children
Prenatal trauma Psychological factors – brought up in chaotic and
Early malnutrition negligent condition
Frontal lobe hypoperfusion Neurobiological factors – decreases noradrenergic
Use of drug functioning
Child abuse and maltreatment
SIGN AND SYMPTOMS:
TREATMENT:
D ifficulty remaining sitted
E easily stimulated by extraneous stimuli Environmental structure with consistent rules
F idgetting Individual psychotherapy
I nterrupt / intrudes on others Medication
C hild exhibits hyperactivity
I ndulges in destructive behavior 3. OPPOSITIONAL DEFIANT DISORDER
T alks excessively
This is a disturbance that has been present for at
Distractability least 6 months. The symptoms should be present more
Difficulty waiting turn, following instructions, sustaining frequently than they are in other children of the same age.
attention, remaining task-focused and playing quietly The disturbance in behavior significantly impairs
Blurting out answers prematurely functioning in school, At home and social settings. The
Inattention symptoms include:
Excessively losing things
Engaging in dangerous activities Frequent episodes of loss of temper
Arguing with adults
These behaviors begin to manifest themselves before age Defying or refusing adult’s requests or rules
7, and they are not related to a pervasive personality Deliberately annoying others
disorder Blaming others for own mistakes
Becoming easily aggravated
NURSING DIAGNOSIS: Potential for injury Becoming resentful or angry
Swearing
PRINCIPLE OF NURSING CARE: Being spiteful or vindictive
Nutrition and safety – foods on the run (eg sandwich)
VII. FEEDING AND EATING DISORDERS
DRUG OF CHOICE:
Methylphenidate (Ritalin) PICA
to increase attention span
An eating disorder seen most frequently in toddlers displeasure regarding the appearance or behavior of the
between 12 and 24 months of age. The youngster client
persistently eats non-nutritive substances such as paint, Observe for signs of suicidal risk
sand, plaster and so on. It usually disappears Encourage discussion of the client’s feelings
spontaneously.
5. BULIMIA NERVOSA
RUMINATION DISORDER
Occurs predominantly in adolescent
Condition in which an infant, usually between 3 and 12
females. The person indulges in eating binges of high
months of age, repeatedly regurgitates partially digested
calorie food. She is aware of the abnormal eating patterns.
food without nausea or other GI illness. In order to meet
The binge eating may be pleasurable, but it is followed by
the criteria for this diagnosis, the condition must follow a
a depressed mood. The binge-eating episode ends
period of normal functioning and occur for 1 month. The
abruptly with abdominal pain, self-induced vomiting or
infant experience weight loss or fails to gain weight at a
sleep. The young woman repeatedly attempts to reduce
normal rate for his age. weight by self-induced vomiting, laxatives or diuretics or
severely restricted diets. She is fearful that she will not be
FEEDING DISORDER OF INFANCY OR EARLY CHILDHOOD able to stop eating voluntarily.

Category for eating disorder that do not meet the criteria B inge eating
for the above disorders. E.g. If a child experiences severe U nder strict dieting
emotional trauma that involves some aspect of eating. L acks control of binge eating
Such as being unreasonably disciplined for not I nduced vomiting
completely eating all the food on the plate, he may M inimum of 2 binge eating
demonstrate some aberration of normal eating behavior episode a week for 3 months
at the time or during a later stage of development I ncrease / persistent concern of
body size / shape
4. ANOREXIA NERVOSA A buse of diuretics and laxatives

A condition seen primarily in females between 12 and 18

years of age. The young woman develops a strong fear of VIII. TIC DISORDERS
becoming obese, that she limits food intake and does not
decrease as weight loss occurs The disorders included in this category
all include an abnormality of gross motor movement
MOST COMMON CAUSE: called tics. A tic is a rapid, involuntary movement of a
related group of muscles or the involuntary production of
Psychological Factors: words or noises.
- Individual factors (conflict about
growing up) A. TOURETTE’S DISORDER
- Parental factors (domineering parents)
- Sociocultural Occurs before the age of 18 and usually
has a chronic lifelong course. The person experiences
MAIN SIGN: Fear of gaining weight multiple vocal and motor (body) tics in many muscle
groups. The condition must be present over 1 year in
A menorrhea order to be diagnosed as Tourette’s disorder.
N o organic factor account for
weight loss ETIOLOGY:
O bviously thin but feels fat
R efusal to maintain normal body Genetic
weight Neurochemical and neuroantomical factors
E pigastric discomfort is common Dopamine system involvement
X symptom (peculiar symptom0 –
loves to hide foods TREATMENT: Pharmacologic Agents
I ntense fear of gaining weight Dopamine Antagonist
A lways thinking of foods Haloperidol .25 and .5 mg.

NURSING DIAGNOSES: Body image disturbance B. CHRONIC MOTOR OR VOCAL DISORDER

Self esteem
disturbance Includes the presence of either motor or
Ineffective vocal tics, but not both, in someone under the age 18.
individual coping They occur very frequently for a period of over a year.
There is no other neurologic condition causing the tics
PRINCIPLES OF NURSING CARE:
IX. ELIMINATION DISORDERS
Monitor patient’s weight
Stay with the patient 30 minutes – 1 hour after meals A. ENCOPRESIS
Public place
Encourage oral hygiene A disorder in which a child over 4 years of age passes
Behavior modification feces voluntarily or involuntarily in socially acceptable
places at least once a month.
NURSING CARE OF CLIENTS WITH EATING DISORDERS
B. ENURESIS
Supportive nursing attitudes and behaviors, including an
emphatic approach that avoids nurse’s disbelief or
A condition in which a child at least 5 years voids into B. SELECTIVE MUTISM
clothing or bed during the daytime or nighttime. The child
has at least two events per week for at least three A condition in which a person has the ability to speak and
consecutive months. understand language but consistently fails to talk in one
or more major social situations
X. OTHER DISORDERS OF INFANCY AND CHILDHOOD
ETIOLOGY:
A. SEPARATION ANXIETY DISORDER History of delayed onset of speech or speech
abnormalities that may be contributory.
The youngster experiences anxiety at or near panic level
when separated from a major attachment figure. The DIAGNOSTIC CRITERIA FOR SELECTIVE MUTISM
reaction exceeds what would be expected of a child of his
age. The child demonstrates clinging behavior. Physical Consistent failure to speak in specific social situations
signs of anxiety appear i.e. stomachaches, nausea, despite speaking in other situations
vomiting, diarrhea, headaches, dizziness and palpitations. The disturbance interferes with educational or
Their separation form significant others may cause occupational achievement or with social communication
morbid fears about death or accidents that might happen The duration of the disturbance is at least 1 month (not
to themselves of their parents. limited to the first month of school)
The failure to speak is not due to a lack of knowledge of,
ETIOLOGY: or comfort with the spoken language required in the
social situation.
Psychosocial factors The disturbance is not better accounted for by a
Learning factors communication disorder (eg stuttering) and does not
Genetic factors occur exclusively during the course of a pervasive
developmental disorder, schizophrenia, or other
DIAGNOSTIC CRITERIA FOR SEPARATION ANXIETY psychotic disorder.
DISORDER:
TREATMENT:
A. Developmentally inappropriate and excessive anxiety
concerning separation from home or from those to whom Multimodal Approach
the individual is attached, as evidenced by three (or Individual
more) of the following: Behavioral
Family interventions
Recurrent excessive distress when separation from whom Individual Psychotherapy
or major attachment figures occurs or is anticipated
Persistent and excessive worry about losing, or about C. REACTIVE ATTACHMENT DISORDER OF
possible harm befalling, major attachment figures INFANCY OR EARLY CHILDHOOD
Persistent and excessive worry that an untoward event
will lead to separation from a major attachment figure This condition affects the child’s ability to bond with or
Persistent reluctance or refusal to go to school or attach to others in a trusting manner. The child either is
elsewhere because of fear of separation aloof and uninterested in social relations or is
Persistently and excessively fearful or reluctant to be inappropriately familiar with unknown people.
alone or without major attachment figures at home or
without significant adults in other settings ETIOLOGY: grossly pathogenic care of the infant
Persistent reluctance or refusal to go to sleep without
being near a major attachment figure to sleep away from DIAGNOSIS AND CLINICAL FEATURES:
home
Repeated nightmares involving the theme of separation Non-organic failure to thrive
Repeated complaints of physical symptoms (such as Infants look sad, unhappy, joyless and miserable
headaches, stomachaches, nausea or vomiting) when Infants appear frightened and watchful, with a radarlike
separation from major attachment figures occurs or is gaze
anticipated
CRITERIA:
B. The duration of the disturbances is at least 4 weeks
C. The onset is before age 18 A. Markedly disturbed and developmentally
D. The disturbance causes clinically significant distress or inappropriate social relatedness in most contexts,
impairment in social, academic or other important areas beginning before age 5 years as evidenced by either (1) or
of functioning (2):
E. The disturbance does not occur exclusively during the
course of pervasive developmental disorder, Persistent failure to initiate or respond in a
schizophrenia or other psychotic disorder and in, developmentally appropriate fashion to most social
adolescents and adults, is not better accounted for by interactions as manifested by excessively inhibited,
panic disorder with agoraphobia. hypervigilant, or highly ambivalent and contradictory
responses.
TREATMENT: Multimodal Treatment Approach Diffuse attachments as manifested by indiscriminate
sociability with marked inability to exhibit appropriate
Individual psychotherapy selective attachments
Family education
Family Therapy B. The disturbance in criterion A is not accounted for
solely by developmental delay (as in mental retardation)
PHARMACOTHERAPY: Tryclic and Tetracyclic - and does not meet a criteria for a pervasive
antidepressants developmental disorder
C. Pathogenic care as evidenced by at least one of the Mixed
following: the onset is not later than 7 years of age
Persistent disregard of the child’s basic emotional needs treatment is through
for comfort, stimulation and affection psychostimulants, Methylphenidate (Ritalin), Pemoline
Persistent disregard of the child’s basic physical needs (Cylert)
Repeated changes of primary caregiver that prevent the Feingold diet
formation of stable attachments
OTHER CHILDHOOD DISORDERS
D. There is a presumption that the care in criterion C is Pervasive developmental disorders
responsible for the disturbed behavior in A. Disruptive disorders
Learning disorders
TREATMENT: Communication disorders
Tic disorders ; Tourette’s Syndrome
Psychosocial support services Elimination disorders
Hiring a homemaker
Adequate housing The Nurse’s Role in Childhood Mental Disorders
Improve financial status Help the parents accept a diagnosis and plan a realistic
approach to the situation
Psychotherapeutic interventions help shape family members and other people’s attitudes
Individual psychotherapy towards them and accept them
Psychotropic medications help in activities of daily living
Family or marital therapy standards of acceptable behavior within the ability of the
child should be provided
Educational – counseling services he should be taught to seek help when in difficulty to
Close monitoring of emotional and physical well-being resist frustration and achieve emotional control
create a therapeutic environment
D. STEREOTYPIC MOVEMENT DISORDER
VICTIMS OF ABUSE AND VIOLENCE
Involves repetitive intentional behaviors such as head Crime
banging, body weaving, self-biting and hand shaking or Phases Of Recovery From Trauma
waving. The activity either causes or risks physical injury Impact phase
or interferes with ADLs. Recoil Phase
Reorganization
ETIOLOGY:
Rape and sexual assault
Associated with normal development
Maternal neglect or abuse RAPE TRAUMA SYNDROME
Associated with dopamine activity. Sleep disturbances, nightmares
loss of appetite
DIAGNOSTIC CRITERIA: fear, anxieties, phobias and suspicions
decreased activities and motivation
1. Repetitive, seemingly driven and nonfunctional motor disturbance in relationships
behavior self-blame, guilt and shame
Behavior markedly interferes with normal activities or lowered self-esteem, worthlessness
results in self-inflicted bodily injury that requires medical somatic symptoms
treatment Nursing Interventions:
If Mental retardation is present, the stereotypic or self- Reaffirm that they are worthwhile persons with dignity
injurious behavior is so of sufficient severity to become a and rights, who id not cause and deserve the rape
focus of treatment convey to them that their anger is natural
The behavior is not better accounted for by compulsion, a move at the victim’s pace and be supportive
tic, a stereotypy that is a part of a pervasive always give rationales and descriptions for any
developmental disorder, or hair pulling procedures
The behavior is not due to the direct physiological of a protect the patient’s rights
substance or a general medical condition
The behavior persists for 4 weeks or longer. CARE OF THE CAREGIVER
Caregivers
TREATMENT: Role Strain
constant fatigue unrelieved by rest
Provide a well balanced psychosocial environment use of alcohol/ other substances
Psychotherapy social isolation
Psychopharmacology inattention to personal needs

Nursing Interventions:
Refer caregivers to knowledgeable health professional
who can provide information, support and assistance
ATTENTION-DEFICIT/HYPERACTIVITY DISORDER provide outlets for dealing with caregiver’s feelings
(ADHD) help them seek and accept assistance from other people
Inattention or agency and not wait until they are exhausted
Hyperactivity-impulsivity provide support for a personal
  Personality trait – inherent and habitual
mode of responding
 DEMENTIA  Emotional disorder – free floating,
 organic loss of mental functions causing nonsituational, generalized, and nonspecific
progressive loss of cognitive and other higher distress, diagnosed as anxiety disorders,
intellectual functions; slow and insidious anxiety neurosis or anxiety reaction
onset
 MANIFESTATIONS OF ANXIETY
 Physiologic
 Psychological
 Intellectual/ Cognitive
 ANXIETY
 A feeling of severe discomfort or dread that  LEVELS OF ANXIETY
arises from within the individual in response to  Mild (+1)
a threat, which is less visible and definable  Attentive, alert, perceptive to variety of
than fear, which has a visible object or trigger. stimuli

 Is a ubiquitous emotional state that is  Moderate (+2)

experienced when the self-identity or essential
values are threatened but has no specific
object. The feeling state is characterized by a
subjective sense of dread, apprehension,
threat, failure, helplessness or impending
disaster; by a sense of losing control, becoming
disoriented, or committing a destructive act; or
by a fear of sudden death.
 In contrast, fear is a feeling of apprehension or
disaster in response to a specific object.
 Well and ill people experience both feelings
 Normal Anxiety
 The degree of arousal appropriate to a
situation, as validated bu others familiar
with the situation
 State Anxiety
 Refers to the temporary state the person is
in when the anxiety episode occurs and
sympathetic arousal results.
 Impatient, Irritable, forgetful, demanding,
crying, angry
 Severe (+3)
 Alarm stage changes intensify and stage of
resistance may progress to stage of
exhaustion
 Sense of helplessness
 Mood changes
 Disorientation, confusion, hallucination
and delusions may be present
 Panic (+4)
 Behavior focused on finding relief: may
scream, cry, pray, trash limbs, run, hit
others, hurt self
 Often easily distracted, cannot attend or
concentrate
 No learning, problem solving, decision
making or realistic judgements
 COPING RESPONSES/COPING MECHANISMS
DEFENSE MECHANISMS

 Trait Anxiety  SPECIFIC DEFENSE MECHANISMS

 Refers to habitual or chronic anxiety or 1. Repression 11. Conversion
arousal 2. Suppression 12. Substitution
 Prone to attacks of acute, severe 3. Denial 13. Sublimation
anxiety 4. Rationalization 14. Displacement
5. Intellectualization 15. Reaction formation
 Psychic Anxiety 6. Isolation 16. Undoing
 Refers to an emotional state and includes 7. Symbolization 17. Projection
muscular tension and worry 8. Compensation 18. Regression
9. Identification 19. Fixation
 Somatic Anxiety 10. Introjection 20. Fantasy
 Refers to use of somatic or physical
complaints to discharge feelings and  DEFENSE MECHANISMS
mental distress  Defense Mechanisms are unconscious and
automatic mental maneuvers that decrease
 Morbid Anxiety the unpleasant feelings and anxiety. They
 Severe anxiety or panic that is function to protect the ego from
incapacitating, causing the person to be overwhelming anxiety. Mostly, they operate
unable to function effectively on an unconscious level and occur in everyday
life. Its formation begins in infancy.
 Anxiety is a word that has many meanings:
 Everyone uses defense mechanisms at one or
 Affect - vague, uncomfortable feeling another. When overused, they become
 Etiology – cause of behavior: for example, ineffective or ego defeating.
overeating or withdrawal
 Motivator – drive or reason for behavior: for  COMPENSATION
example, anxious or eager to participate in an  Making up for a perceived deficiency by
activity strongly emphasizing a feature that he
 Personality state or response – specific regards as an asset.
response to specific situational stimuli: for
example, a job or school
  A businessman perceives his small stature
negatively. He tries to overcome this by being
aggressive, forceful and controlling in business
dealings.
 DENIAL
 Avoidance of disagreeable realities by
ignoring or refusing to recognize them,
probably simplest and most primitive of all
defense mechanisms.
 A woman who was diagnosed to have breast
cancer tells her husband that no one has discussed
the laboratory results with her.
 DISPLACEMENT
 Shift of emotion from a person or object to
another usually neutral or less dangerous
person or object.
 A boy who has just been punished by his mother
for drawing on his bedroom walls shouts at his
younger brother.
 IDENTIFICATION
 Trying to become like someone admired by
taking on thoughts, mannerisms or tastes of
that individual.
 Sally has her styled like similarity to her young
English teacher whom she admires.
 INTELLECTUALIZATION
 Excessive reasoning or logic is used to avoid
experiencing disturbing feelings.
 A woman avoids dealing with her anxiety in
shopping malls by explaining that she is saving the
frivolous waste of time and money by not going
into them.
 INTROJECTION
 Intense type of identification in which a
person incorporates qualities or values of
another person or group into his own ego
structure. It is one of the earliest mechanisms
of the child; important information of
conscience.
 Eight-year-old Jimmy tells his 3-year old sister,
“Don’t scribble in your book of nursery rhymes.
Just look at the pretty pictures” thus expressing
his parents’ values to his little sister.
 ISOLATION
 Splitting off of emotional components of a
thought which maybe temporary or long term.
 A second year medical student dissects a cadaver
for her anatomy course without being disturbed
by thoughts of death.
 PROJECTION
 Attributing one’s thoughts or impulses to
another person
 A young woman who denies she has sexual
feelings about a co -worker accuses him without
basis of being a flirt and says he is trying to seduce
her.
 RATIONALIZATION
 Offering a socially acceptable or apparently,
logical explanation to justify or make
acceptable otherwise unacceptable impulses,
feelings, behaviors and motives.
 John fails an examination and complains that the
lectures were not well organized or clearly
presented.
 REACTION FORMATION
 Development of conscious attitudes and
behavior patterns that are opposite to what
one really feels or would like to do.
 A married woman who feels attracted to one of
her husband’s friends treats him rudely
 REGRESSION
 Retreat in face of stress to behavior
characteristics of any earlier level of
development.
 Four-year-old Nicole, who has been toilet-trained
for over a year, begins to wet her pants again
when her new baby brother is brought home from
the hospital.
 REPRESSION
 Involuntary exclusion of a painful or
conflictual thought, impulse or memory from
awareness.
 Mr. R does not recall hitting his wife when she
was pregnant
 SUBLIMATION
 Acceptance of a socially approved substitute
goal for a drive whose normal channel of
expression is blocked.
 Ed has an impulsive and physically aggressive
nature. He tries out for the football team and
becomes a star tackle.
 SUPPRESSION
 Conscious counterpart of repression,
intentional exclusion of material from
consciousness.
 A young man at work finds he is thinking so much
about his date that evening that it is interfering
with his work. He decides to put out his mind until
he leaves the office for the day.
 UNDOING
 Act or communication that partially negates a
previous one.
 Larry makes a passionate declaration of love to
Sue on a date. On their next meeting, he treats her
formally and distant.
CRISIS
 Maturational/ Developmental Crisis
Situational Crisis/Crisis Intervention
 COPING WITH LOSS, GRIEVING AND DEATH
 Developmental Concept of Death
 Stages of Grieving (Kubler-Ross)
1. Denial
2. Anger
 3. Bargaining  Medical-Biological Model
4. Depression  Psychoanalytical Model
5. Acceptance  Interpersonal Model
 Behavioral-Cognitive Model
 THERAPEUTIC USE OF THE SELF  Social Model
 Self-Awareness
1. Introspection  PSYCHOPHARMACOLOGY
2. Discussion  PRINCIPLES OF PSYCHOPHARMACOLOGY
3. Self-disclosure  A medication is selected based on the
client’s target symptoms
 THERAPEUTIC NURSE-CLIENT RELATIONSHIP  many psychotropic drugs must be given
 Nurse-Client Relationship in adequate dosages for a period of time
before their full effect is realized
 Phases of the Nurse-Client Relationship  the dosage of medication is often adjusted
1. Initial or Orientation Phase to the lowest dose effective for clients
2. Working Phase  elderly persons require lower dosages of
3. Termination or Resolution medication to produce therapeutic effects
and it may take longer for a drug to
achieve its full therapeutic effect
 psychotropic drugs are often decreased
gradually rather than abruptly discontinued
 THERAPEUTIC COMMUNICATION  follow-up care is essential to ensure
 Modes of Communication compliance with the medication regimen, to
1. Verbal make needed adjustments in dose and manage
2. Non-verbal side effects
3. Meta-communication
 ANTI-PSYCHOTICS
 THERAPEUTIC COMMUNICATION  PHENOTHIAZINES like
 GENERAL GUIDELINES: chlorpromazine(thorazine),
 Here and now rather than the past thioridazine(mellaril),
 ‘what’ rather than ‘why’ fluphenazine(prolixin),
 orientation and presentation of reality trifluoperazine(stelazine), perphenazine
 description rather than judging with actual (trilafon) haloperidol (serenace), loxapine
client behaviors and nursing observations
rather than giving inferences  clozapine(Clozaril),risperidone(Risperdal),
 maintenance of biologic integrity olanzapine(Zyprexa),quetiapine(Seroquel),
 nursing interventions rather than roles sertindole(Serlect), ziprasidone(Zeldox)
designated to other health team members
 SIDE EFFECTS :
 sharing information and exploring alternatives
1. Extrapyramidal Symptoms (EPS)
rather than giving actual solutions
 acute dystonia
 THERAPEUTIC COMMUNICATION TECHNIQUES  pseudoparkinsonism
 Giving Information  akathisia
 Giving Broad Openings 2. Neuroleptic Malignant Syndrome (NMS)
3. Tardive Dyskinesia
 Reflecting
4. Anticholinergic effects
 General Leads
5. Endocrine changes
 Verbalizing observations
6. Agranulocytosis
 Clarifying
 Validating  ANTIPARKINSON DRUGS
 Paraphrasing Dopaminergic drugs include :
 Summarizing carbidopa-levodopa (Sinemet), Amantadine
 Requesting descriptions/comparisons (Symmetrel), bromocriptine (Parlodel), pergolide
 Suggesting collaboration (permax), selegiline(Eldepryl)
 Offering Self
 Presenting Reality  ANTICHOLINERGICS USED ARE :
 Silence benztropine (Cogentin), biperiden (Akineton),
Trihexyphenidyl (Artane), diphenhydramine
 NON-THERAPEUTIC COMMUNICATION (Benadryl)
TECHNIQUES
 Giving advice  ANTI-DEPRESSANTS
 Rejection 1. Tricyclic antidepresants (TCAs) includes:
 Directly agreeing or disagreeing with the client  imipramine (Tofranil), Amitriptyline
 Directly expressing either approval or (Elavil), desipramine(Norpramin),
disapproval amoxapine (Asendin), Bupropion
 Belittling the client’s feelings (Wellbutrin), Doxepin (Sinequan),
 Giving false reassurance Nefazodone(Serzone), Trazodone (Desyrel),
 Requesting or even demanding an explanation trimipramine (Surmontil), Venlafaxine
 Defending (Effexor)
 Stereotypical responses
 Changing the topic 2. Monoamine oxidase inhibitors (MAOIs)
 Isocarboxacid (Marplan),
 THEORETICAL FRAMEWORK OF CARE Phenelzine(Nardil),
 tranylcypromine(parnate) moclobemide  Intense anxiety and anger
(Manerix)  Diurnal variation
 Rumination
3. Selective serotonin reuptake inhibitors  Suicidal thoughts
(SSRIs)Includes:  Anorexia
 Paroxetine(Seroxat,Paxil), Sertraline  Somatic complaints
(Zoloft), Fluvoxamine(Luvox), Fluoxetine  Increase abuse of substance
(Prozac)
 Severe depression
 ANTIMANIC  Intense
 standard drug of choice is Lithium Carbonate  Guilt and worthlessness
(Quilonium, Eskalith)  Flat affect
 Decreased speech
 Valproic acid (Depakote) or carbamazepine  Self destructive thoughts
(Tegretol)  Poor concentration
 Delusions and hallucinations
 ANTIANXIETY AGENTS
 diazepam(Valium), Clonazepam(Klonopin),  MANIFESTATIONS:
Lorazepam(Ativan), Triazolam(Halcion),  depressed mood
chlordiazepoxide(Librium)  anhedonia
clorazepate(Tranxene)  appetite disturbance with significant change in
weight
 psychomotor disturbance
 sleep disturbance
 ELECTROCONVULSIVE THERAPY  fatigue or energy loss (anergia)
 Induction of grand mal seizures through the  feelings of worthlessness or excessive or
application of electrical current to the brain to inappropriate guilt
effect behavioral changes  diminished concentration and indecisiveness
 the side effects are confusion and temporary  recurrent thoughts of death and suicidal
memory loss thoughts

 PSYCHOTHERAPY  ETIOLOGY:
 BEHAVIORAL MODIFICATION  biological theories of depression
 systematic desensitization; ignoring the  psychological theories
behavior; time out; token economy;
aversion  NURSING INTERVENTIONS:
 offer sincere concern and empathy
 MILIEU THERAPY  bolster self-esteem
 EVALUATING MENTAL FUNCTIONING  involve patients in activities in which they can
 Psychiatric History experience success
 recognize dependence
 MENTAL STATUS EXAMINATION  respond to anger therapeutically
 ABC’s of assessment (appearance, behavior,  spend time with withdrawn patients
communication pattern)  never reinforce delusions or hallucinations

 PSYCHOLOGICAL TESTING  BIPOLAR DISORDERS (MANIC-DEPRESSIVE)

 Diagnostic Statistical Manual Fourth Edition  MANIC EPISODES
(DSM IV)  Inflated self-esteem or grandiosity
 decreased need for sleep
 MOOD DISORDERS  very talkative (pressured speech)
 flight of ideas or subjective feeling that
 DEPRESSION thoughts are racing
 A functional disorder of mood that is not  reduced ability to filter out external
linked to with aging. The depression maybe stimuli ; easily distractible
precipitated by losses related to aging. Can  increased number of activities with
be manifested by cognitive impairment or increased energy and psychomotor
may be the cause of a decline in mental agitation
status. Can be identified by feelings of
sadness, hopelessness and worthlessness  ETIOLOGY:
and a decreased interest in activities.  Psychodynamic theories
 Biological theories
 TYPES OF DEPRESSION
 Mild depression  NURSING INTERVENTIONS:
 Lasts less than 2 weeks  Provide for patient’s physical safety and safety
 Feeling sad of those around him
 Alterations in sleep pattern  use short simple sentences to communicate
 Disinterest  provide the client with a list of daily activities
 Substance abuse  ensure that nutritional and fluid balance meals
are met
 Moderate depression  channel client’s need for movement into
 Persist overtime socially acceptable motor activities
 Sense of change
 Low sel-esteem  SPECIFIC PROBLEMS:
  Altered thought process  Nervous stomach
 Risk for self harm
 Activity intolerance  SUBTYPES:
 Altered nutrition  PHOBIC DISORDER
 Sleep pattern disturbance
 Maladaptive Behaviors  PHOBIA
 Abnormal excessive fear of a specific situation
 MALADAPTIVE BEHAVIOR or object
 Inability to act or react to a particular
condition or situation in an appropriate PHOBIA FEAR OF
manner Androphobia man
 Very complex Cynophobia dogs
 Can develop at any time from infancy through Gamophobia marriage
old age Hodophobia travel
 Stress and problems in any area can contribute Kainophobia change
to maladaptive behavior Kakorrhaphiophobia failure
 Reaction of an individual to stress Laliophobia speaking
Necrophobia death
 NORMAL Olfactophobia odor
 Has social, clinical, moral and statistical Ophidiophobia snakes
aspect Pharmacophobia medicine
 Includes a wide range of acceptable Phasmophobia ghosts
behaviors Ponophobia work
 Concerned with actions that fit the social Traumatophobia injury
rules Vaccinophobia vaccination

 ABNORMAL
 To many people, weird or bizarre
 PSYCHOLOGICAL DISORDERS
 Emotional disturbances characterized by
maladaptive behavior aimed at avoiding
anxiety
 Formerly classified as PSYCHONEUROSES OR
NEUROSES
 Represents a poor adaptation to stress, there is
a crippling of personality growth
 May occur at any time during the life cycle
 A person with psychological disorder has
contact with his environment
 Has the same view of reality as does the
normal person
 However, lacks awareness and so lacks control
over his behavior
 ANXIETY DISORDER
 Characterized by anxiety that is proportionate
to the stresses of daily living
 May occur periodically or it may be constant
 Anxiety attacks may be brought on by even
mild stress, or they may occur for no apparent
reason
 The person cannot relax
 Becomes restless and irritable and continually
over-reacts to stressful situations.
 May experience loss of appetite, heart
palpitations, and increased respirations
 If anxiety is severe or prolonged, symptoms
intensify and the person may need to be
hospitalized
 Anxiety attacks may be caused by repressed
feelings of anger and frustration
 SYMPTOMS:
 Nausea
 Anorexia
 Dry mouth
 Diarrhea
 Tachycardia
 Difficulty in swallowing
 OBSESSIVE – COMPULSIVE DISORDER
 Often caused by repressed thoughts and
feelings
 An attempt to relieve anxiety and is another
example of converting anxiety into other
symptoms
 OBSESSION
 Persistent, recurring thought or feeling that is
overpowering
 COMPULSION
 Irresistible urge to engage in a behavior
 Maybe in the form of frequent handwashing or
shoplifting
 The behavior is engaged in because it lowers
anxiety, when anxiety level builds up, the
obsessive-compulsive act is performed again.
 This process is cyclic and may occupy the
person’s entire life
 SOMATOFORM DISORDERS
 MAJOR CHARACTERISTICS:
 Patients have physical symptoms for
which there is no known organic cause or
physiologic mechanism
 Symptoms are very real to the patient;
serve to prevent or relieve anxiety.
Patients are not in control of their
symptoms which are unconscious and
involuntary
 Patients repeatedly seek medical
diagnosis and treatment, even though
they have been told that there is no
known physiological or organic evidence
to explain their symptoms or disability
 Persons with somatoform disorders often
appear to be needy and dependent on
others
 Defense mechanisms used: repression,
denial displacement
 CLASSIFICATION:
 1. SOMATIZATION DISORDER
SOMATIZATION DISORDER
 Is the expression of an emotional turmoil
or conflict through a physical symptom
with a loss or alteration of physical
functioning which is not under voluntary
control and is not otherwise explained by a
known physical disorder
 Refers to the persisting abnormal
autonomic discharge caused by anxiety
that is experienced as a physical symptom
 CHARACTERISTICS:
 Usually begins before the age of 30;
characterized by multiple somatic complaints
involving various body systems.
 Patients see many physicians through the
years and may even have exploratory and
unnecessary surgical procedures
 (+) Impairment of social and occupational
functioning
 Complaints or impairment are in excess of
what is expected
 Symptoms / complaints tend to be vague and
reported in exaggerated or histrionic manner
 Patients maybe anxious or depressed, feel
nervous, have sleep disturbances and
experience suicidal ideation because they
experience hopelessness about ever getting
better
 4 pain symptoms in 4 different bodily sites
(e.g. head, chest, pain during coitus or
urination)
 2 GI symptoms occur other than pain (nausea,
diarrhea, intolerance to different foods)
 1 sexual or reproductive symptom other than
pain (erectile or ejaculatory problem, irregular
menses, excessive menstrual bleeding)
 Other pseudoneurological symptom or deficit
that suggest a neurological disorder (blindness,
deafness, paralysis, seizures, difficulty in
swallowing or breathing and dissociative
symptom such as amnesia)
 MANAGEMENT:
 No definite therapy
 Pay attention to the prevention of unnecessary
treatment and diagnostic procedures
2. PAIN DISORDER PAIN DISORDER
 CHARACTERISTICS:
 Preoccupation with pain for at least 6
months is the sole symptom
 Pain in one or more areas of the body that
is severe enough to seek treatment causes
impairment in functioning or significant
distress
 Location or complaint of pain does not
change, unlike the complaints voiced in
somatization disorder
 Sometimes there is a physiological
disorder but the amount of pain or
impairment is greatly exaggerated or out
of proportion
 Doctor shoppers; may use analgesics
excessively without experiencing any relief
from their pain
3. HYPOCHONDRIASIS (HYPOCHONDRIAC
NEUROSIS)
 HYPOCHONDRIASIS
 Is the expression of excessive anxiety
about physical concerns and fears of
deteriorating health
 As feelings of isolation, loneliness, and
lack of gratification with other people
increase, the hypochondriachal person
begins to turn all of his / her energy
inward. The person regresses to an early
narcissistic level of development
4. CONVERION DISORDER (HYSTERICAL
NEUROSIS, CONVERSION TYPE)
 CONVERSION
 Defined as the unconscious process
through which anxiety is converted or
transmuted into a physical, physiological
or psychological symptoms
 CHARACTERISTICS:
 Conversion symptoms are expressed
through motor and sensory symptoms and
relate to increased stress, repressed or
disowned ideas and feelings and
maladaptive coping methods
 In conversion, the person invests a large
amount of energy and interest in the
illness so that the illness is the main
preoccupation. The person becomes the
illness
 The client will complain to you bitterly
about the symptoms.
 Commonly encountered manifestations are
dyskinesias, ataxia, contractures, paralysis,
blindness, deafness, numbness, tingling, itching
and vomiting
 The client will be invested in or preoccupied
with the symptoms, spending time and effort to
describe complain, and go over in detail every
change in symptoms. Yet the significance that
the illness plays in the person’s life is of no
great concerns
 LA BELLE INDIFFERENCE: the significance
implications or incapacity of the symptoms
is not given the importance if would be
ordinarily
 EXAMPLE: The blind person is not
concerned about blindness when he or she
is describing the loss of sight
 NURSING DIAGNOSIS: Somatization
through conversive symptoms related to
chronic anxiety and unresolved conflicts
 GOAL: Expresses anxiety and conflicts
verbally rather than physically
 INTERVENTION: Help the person see the
significance and connection between needs
and conflicts and the symptoms in terms of
his/her life
5. BODY DYSMORPHIC DISORDER
(DYSMORPHOPHOBIA OBSESSION DELA
HONTU DE CORPS)
 Nursing Interventions:
 Avoid reinforcing the symptoms
 increase self esteem by involving clients in
activities in which they can be successful
  encourage to identify and explore feelings  evaluate the patient’s access to a means of
suicide
 FACTITIOUS DISORDER  develop a formal “no suicide” contract with
 A person uses physical or mental symptoms patients
to receive treatment and become a patient  support patient’s reason to live
 Putting blood in a stool sample
 Putting oral thermometer in hot water  MANAGEMENT:
 Suicide precautions
 MALINGERING  Develop a contract
 If there is a recognizable motive and the  Encourage verbalization of feelings
behavior is evident of a voluntary act
 SCHIZOPHRENIA (WITHDRAWN
 CHARACTERISTICS: BEHAVIOR)
 Orderliness, stinginess, obstinacy
 Egocentric, miserly, very reliable,  FOUR A’S OF SCHIZOPHRENIA
conscientious in performing petty duties, 1. Affective disturbances
irascible, distrustful 2. Autism
 This characteristics are similar to those of 3. Associative looseness
the obsessive compulsive personality with 4. Ambivalence
one major difference, the hypochondriac has
an unusual concern about body image and  CRITERIA OF SCHIZOPHRENIA
size  At least two characteristic symptoms
 Delusions
 NURSING DIAGNOSIS: Somatization through  Hallucinations
hypochondriasis related to chronic anxiety and  disorganized speech
inability to cope with life situations and others  grossly disorganized or catatonic
behavior
 GOAL: Demonstrate less concern with body  negative symptoms
functions and symptoms and direct attention to  social and occupational dysfunction and
other people and events deterioration
 continuous sign of the disturbance for at
 INTERVENTION: least 6 months
1. Listen to the person’s complaints  schizoaffective and mood disorders are
2. Listen to the life story not present and is not responsible for
3. Try to develop a relationship symptoms
 not caused by substance abuse or a
 SUICIDAL CLIENTS general medical condition
 SUICIDAL BEHAVIOR
 Clients characteristically have feelings of
worthlessness, guilt, and hopelessness
that are so overwhelming that they feel
unable to go on with life and unfit to live.  OTHER PSYCHOTIC DISORDERS:
 Schizophreniform
 SUICIDE  Brief Psychotic disorder
 Levels Of Suicidal Behavior  Schizoaffective disorder
 Suicidal gestures
 suicidal ideations  SUBTYPES:
 suicidal threats  Paranoid Schizophrenia
 suicidal attempt  Disorganized Schizophrenia
 completed suicide  Catatonic schizophrenia
 Undifferentiated schizophrenia
 ETIOLOGY:  Residual schizophrenia
 Psychodynamic theories
 Sociological theories  ETIOLOGY:
 Biological theory  Biological theories
 Developmental theories
 CLUES:  Family theories
 Giving away personal, special, and prized  Vulnerability-Stress Model
possessions
 canceling social engagements  NURSING INTERVENTIONS:
 making out or changing a will  do not reinforce delusions nor hallucinations
 taking out or changing insurance policies  orient the patients to time and place if
 sudden calmness or improvement in a indicated
depressed client  do not touch the patients without warning
them
 ASSESSMENT:  avoid whispering or laughing when patients
 look for the plan are unable to heal all of a conversation
 client history of attempts  reinforce positive behaviors
 Psychosocial  do not embarrass patients

 NURSING INTERVENTION:  ANXIETY DISORDERS

 Evaluate patients for suicidal risks  creates a significant impairment in socio
occupational functioning
  Primary gain
 Secondary gain
 GENERALIZED ANXIETY DISORDER
 Panic Disorders
 Obsessive-Compulsive disorder
 Phobic disorders
 Acute Stress disorder
 Post Traumatic Stress disorder
 NURSING INTERVENTIONS:
 To Reduce Anxiety:
 provide a calm and quiet environment
 ask patients to identify what and how they
feel
 help patients identify possible causes of their
feelings
 listen carefully for patient’s expressions of
helplessness and hopelessness
 plan and involve patients in activities such as
walking or playing recreational games
 For Obsessive-Compulsive:
 provide patients with time to perform their
rituals ; never take away the ritual
 assist patient in connecting behaviors and
feelings
 structure simple activities, games or tasks for
patients
 recognize and reinforce positive non
ritualistic behaviors
 For ASD and PTSD:
 acknowledge any unfairness or injustice
related to trauma
 assure them that their feelings and reactions
are typical reactions to serious trauma
 help establish connections between trauma
and feelings, behaviors and problems
 encourage safe verbalizations of feelings
especially anger
 encourage adaptive coping strategies,
exercise, relaxation techniques and sleep-
promoting strategies
 facilitate progressive review of the trauma
and its consequences
 encourage the patients to establish or re-
establish relationships
 DISSOCIATIVE DISORDERS
 Dissociative amnesia
 Dissociative fugue
 Dissociative Identity disorder
 Depersonalization
 ROLES OF A NURSE :
 Uncovering and linking feelings with
conflicts and managing feelings are
important aspects of recovery of these
patients
 assist patients in establishing supportive
relationships because social interaction
reduces the tendency for dissociation
 AGGRESSIVE BEHAVIORS
 Anger
 Hostility
 Physical aggression
 Passive-aggressive
 ETIOLOGY:
 Biologic theories
 Psychosocial theories
 PHASES OF THE AGGRESSIVE CYCLE
1. Triggering phase
2. Escalation phase
3. Crisis phase
4. Recovery phase
5. Post crisis phase
 NURSING INTERVENTIONS:
 nurse should approach the client in a non-
threatening way
 provide directions for the client in calm firm
voice
 advice the client to take time-out for cooling
 ‘show of force’
 planned team approach is best
 restraints may be used or applied if needed
 encourage the client to explore alternatives
to aggressive behaviors
 encourage continued verbalizations of
feelings
 PERSONALITY DISORDERS
 COMMON CHARACTERISTICS:
 These clients are often in conflict with
their families and even society as a whole
 A particular personality trait or behavioral
pattern is used almost exclusively
 The behavior is usually troubling to others
 Extremely difficult to change
 It is difficult to form and maintain
satisfying interpersonal relationships
 CLUSTERS OF PERSONALITY DISORDER
A
Paranoid personality disorder
Schizoid personality disorder
Schizotypal personality disorder
B
Borderline personality disorder
Antisocial personality disorder
Histrionic personality disorder
Narcissistic personality disorder
C
Obsessive-compulsive personality disorder
Avoidant personality disorder
Dependent personality disorder
 Nursing Interventions :
 Encourage the clients to express both negative
and positive feelings
 increase the client’s ego strength through
positive reinforcement and feedback
 help the client expand his repertoire of coping
behaviors
 Implement strategies for reducing anxieties
 set firm, rational limits making sure that the
client is aware of expectations
 encourage client to identify the effects of
his/her behaviors on others
 assist clients in becoming assertive rather than
passive or aggressive
SUBSTANCE ABUSE
TERMINOLOGY:
  Causes slurred speech, incoordination and
 SUBSTANCE memory
 Refers to alcohol, drugs and food that are  Chronic uses causes multisystem dysfunction
ingested for reasons unrelated to health
 WITHDRAWAL SYMPTOMS RELATED TO CNS
 SUBSTANCE ABUSE EXCITATION
 Excessive or unhealthy use of harmful  Early Phase
substances such as alcohol, tobacco or drugs,  6-12 hours after last drink
or use of products such as food, that becomes  Anxiety, agitation, tremors, tachycardia,
unhealthy when excessive amounts are hypertension, diaphoresis, nausea and
ingested. vomiting

 DRUG USE  Delirium Tremens

 Ingesting in any manner a chemical substance
that has an effect on the body.
 This definition applies to all drugs taken legally
and illegally, both for medical and non-medical
usage.
 DRUG ABUSE
 Persistent or sporadic excessive drug use
inconsistent with or unrelated to acceptable
medical practice.
 This definition includes all drug intakes that is
not prescribed for medical use or is not within
the generally accepted context of taking non-
prescription medications for a specific health
problem, such as a headache or
gastrointestinal upset.
Increased temperature, diaphoresis, hypertension and
tachycardia, seizures, perceptual disturbances such as
illusions and hallucinations
 Fetal Alcohol Syndrome
Can occur in infants born to alcoholic mothers
Causes intellectual deficits, physical abnormalities
Requires infant withdrawal from alcohol
 STAGES OF ALCOHOLISM
I. PREALCOHOLIC
Occasional drinking
Constant relief drinking
Increase in alcoholic tolerance

 TOLERANCE II. PRODROMAL

 The declining effect of the same drug dose
when it is taken repeatedly overtime Onset of memory blackouts
Secretive drinking
Preoccupation with alcohol
 ADDICTION Gulping first drink
 Physical dependence on a substance causing an Inability to discuss problems
altered physiological state because of repeated Increase memory blackouts
use of a substance
 The drug must be continued to avoid physical III. CRUCIAL
symptoms of withdrawal, which vary from
moderate, such as muscular pain or increased Loss of control
perspiration, to life threatening, such as Rationalization of drinking behavior
convulsions Failure in efforts to control drinking
Grandiose and aggressive behavior
 HABITUATION Trouble with family and employer
 A psychological dependence on the use of a Self-pity
drug Loss of outside interest
Unreasonable treatment
 CHEMICAL DEPENDENCE Neglect of food
 A state of psychic and or physical dependence Tremors
on a substance following its administration on Morning drinking
a periodic or continuing basis
IV. CHRONIC
6. ALCOHOLISM
 Any use of alcoholic beverage that causes damage Prolonged intoxication
to the individual, society or both Physical and moral deterioration
 Illness characterized by significant impairment Impaired drinking
that is directly associated with persistent and Indefinable anxieties
excessive use of alcohol Obsession with drinking
Constant alibis given
 REASONS:
 Relieving tension  AN ALCOHOLIC TYPICALLY PORTRAYS THE
 Helping unwind FOLLOWING CHARACTERISTICS
 Drowning sorrow
 Making one feel free Angry overdependency
 Coping with stress Inability to express emotions adequately
 Helping one be sociable High anxiety in interpersonal relationships
Emotional immaturity
 EFFECTS OF ALCOHOL Ambivalence toward authority
 CNS Depressant Low frustration tolerance
 Immediate effects due to action on brain (acute Grandiosity
intoxication) Low self-esteem
Feelings of isolation  A MULTI APPROACH IN TREATING
Perfectionism and compulsiveness ALCOHOLISM

 COMMON BEHAVIORAL PROBLEMS OF THE  Alcoholic anonymous

ALCOHOLIC PATIENT  An organization run by former alcoholics
Denial whose personal experiences with alcohol
Dependency enable them to understand the alcoholic
Demanding problem
Destructive  Goal: to abstain from drinking one day at a
Domineering time
 Al-Anon (family groups) and Alateen
 ALCOHOL WITHDRAWAL SYNDROME (teenagers) focus on effects of alcoholism on
family and children.
 TREMULOUSNESS  These self-help groups meet regularly
Most common manifestation of alcohol withdrawal.  The personal contact with relatives of alcoholic
Tremors, also known as shakes or the jitters occur is therapeutic and provides emotional support
within the first 24 to 48 hours and can range from
mild to severe  RATIONAL EMOTIVE THERAPY
 Goal: to help alcoholic learn to tolerate
 HALLUCINOSIS stressors that come with living and use coping
Refers to symptoms of disordered perception and mechanism that are less defeating
hallucinations that occur in about one-fourth of those
suffering withdrawal from alcohol  TRANSACTIONAL ANALYSIS
 Goal: to help alcoholic stop playing games and
 CONVULSIVE SEIZURES to rewrite his life script.
May occur within 7 to 48 hours or longer after alcohol Patient is then able to cope with his problems more
intake is markedly lowered or discontinued directly

 DELIRIUM TREMENS  PSYCHOANALYSIS

Characterized by profound confusion, delusions, vivid
hallucinations, tremors, agitation, sleeplessness,
dilated pupils, hypertension, fever, tachycardia and
profuse perspiration
 WERNICKE-KORSAKOFF SYNDROME
Nutritional disease of the nervous system found in
alcoholics, caused primarily by the deficiency of
thiamine and niacin as a result of alcohol intake
 NURSING CARE
 Monitor vital signs, daily weight and I and O
 Encourage increase fluids and adequate
nutrition
 Decrease environmental stimuli during initial
withdrawal period
 Keep the room lighted to lessen the fear and
facilitate observation
 Stay with patient and keep in touch with reality
 Maintain seizure precaution as indicated by
individual client response
 Goal: to gain insight into behavior through
talking
 GROUP THERAPY
 Goal: to examine each member his impact on
others through increased understanding of his
own behavior and relationship
 ANTABUSE
 An optional drug therapy that reinforces
abstinence
 MEDICATIONS:
 Antabuse (Disulfiram)
Interferes with the metabolism of alcohol and produce
toxic reaction when combined with it.
 Tranquilizers
To facilitate psychotherapy and lessen the anxiety
 ANXIOLITICS
Given over 5-7 days in gradually decreasing doses
Chordiazepoxide (Librium) and Oxazepam (Serax)

 Maintain attitude acceptance avoiding  TREATMENT FACILITIES

judgmental behavior
Detoxification Centers
 Teach the client and significant others about Half-way house
substance abuse Hot meal programs

 Biopsychosocial symptoms and consequence  DRUG ABUSE / DEPENDENCE

of abuse
 Progressive course of dependence  NURSING CARE
 Phenomenon of relapse
 Effects of chronic abuse  ASSESSMENT

 Encourage the client to use self-help groups  Vital signs particularly respiratory function
such as AA  Level of consciousness (Orientation and
 Assist the client to identify strengths and alertness)
utilize these by abstinence  Reaction to pupil to light
 Patent airway
 Signs of withdrawal
  Nutritional needs  Sociological
 Fluid intake  Biochemical
 Urinary output
 Common Drugs of Abuse
 PLAN AND INTERVENTION  Sedatives/depressants
benzodiazepines and barbiturates
 The nurse should familiarize herself with the
streetnames of psychoactive drugs  Psychostimulants
 Ability to feel confident and comfortable with amphetamines, cocaine, and metamphetamine HCl
the drug dependent person
 Personal attitudes and value system  Cannabinoids
 Develops sensitivity to the feelings and Cannabis sativa (marijuana, hashish) is the common
reactions of others drug
 Understanding of the influences that led to the
problem  Inhalants
 Skill in assessing the mood and attitude of the ether, cleaning fluids, adhesives/ glue vapors
patient is necessary gasoline/ kerosene, and aerosols are
 drug addict is very persuasive and tends to be
manipulative  psychedelics/ hallucinogens
 The nurse needs to deal with addicts in phencyclidine (PCP, angel dust) and Lysergic Acid
straightforward, honest manner Diethylamide (LSD)
 The nurse must watch for and report the
danger signals of drug abuse  Opiates
 Opium and Heroin
 NURSING INTERVENTION
 Nursing Interventions:
1. HEROIN
 muscle flaccidity, respiratory depression and  Encourage participation in a treatment
coma program
 Intervention:  support the client through the detoxification
 Assess for needle marks and constricted pupil or withdrawal
 Maintenance of patent airway  detoxification may take 2-3 weeks and should
 Mouth-to-mouth resuscitation or mechanical take place in an in-patient setting
ventilator  paced gradual withdrawal is best
 phenothiazines maybe used as ordered
2. BARBITURATES  remain with highly anxious or panicky clients
 Intervention: and provide reassurance
abrupt withdrawal is dangerous and fatal  monitor vital signs, nutrition and hydration
status of clients
3. AMPHETAMINES  Assist clients to identify life stresses and
 irritable, hyperactive and suspicious conflicts and encourage exploration of
 Intervention: alternative coping strategies
 Kept in quiet environment and not touched  assist the client to identify social support
 Watch out for violent reaction network
 Anticipate that judgment is impaired due to  provide health teachings to clients
delusional state
 No injection of drugs should be attempted  SEXUAL DISORDERS
 Sexual dysfunctions
4. LSD  the sexual response cycle
 Intervention:  Sexual desire disorders
 Provision of quiet environment and calm  hypoactive
reassurance  sexual aversion disorder
 The patient needs to be talked down  Sexual arousal disorder
 Talking down to complete the trip  Orgasmic disorder
 premature ejaculation
 TREATMENT APPROACHES  anorgasmia
 Sexual pain disorders
 Group Therapies  Dyspareunia
 Methadone maintenance program  vaginismus
 Narcotic Anonymous
 Self-help program  PARAPHILIAS (SEXUAL PERVERSIONS)
 Psychotherapy  Exhibitionism * bestiality
 frotteurism * necrophilia
 SUBSTANCE RELATED DISORDERS  pedophilia * telephonic
 Substance Dependence scatologia
1. Tolerance  incest * coprophilia
2. Withdrawal  sexual masochism * pyromania
 sexual sadism * nymphomania
 Pattern of Pathologic Use
 fetishism * satyriasis
 Impairment in socio-occupational functioning
 voyeurism
 Etiology:
 GENDER IDENTITY DISORDER
 Psychoanalytic/Psychodynamic
 Homosexuality  Parasomnias
 Bisexuality  sleep terrors
 Transexualism (gender dysphoric disorder)  nightmares
 somnambulism
 EATING DISORDERS  breathing related sleep disorders
 Anorexia Nervosa  sleep-wake cycle disorder
 refusal to maintain body weight at a normal
BMI or it is less than 85% of the DBW  Nursing Interventions:
 intense fear of gaining weight or becoming fat  physical and psychosocial assessment
 disturbance in the way in which one’s body  coordinate sleep studies
weight or shape is experienced  attend to activities of daily living
 self evaluation is based on body weight but is  monitor nutritional pattern and activity level
always in denial  establish environment conducive to sleep
 amenorrhea (at least 3 consecutive cycles)  teach relaxation techniques
 record sleep patterns
 Types
 Restricting type  MENTAL ILLNESS IN THE ELDERLY
 binge eating/ purging type  Barriers to the Care of the Elderly
o Ageism
 Etiology o Attitudes
 Biological
 Socio-cultural  Psychiatric Disorders In The Elderly
 Psychological  Depression
 Bipolar disorders
 Physiologic Symptoms  Psychotic disorders
 Hypothermia  Anxiety disorders
 Edema  Substance Abuse
 Bradycardia
 Hypersensitivity  Nursing Interventions:
 Hypotension  Assess and meet physical needs
 lanugo  maximize independence
 promote sense of control
 Nursing Interventions:  provide consistency
 Monitor caloric intake  encourage open awareness
 watch out for signs of purging  increase self-esteem
 weigh daily  acknowledge individual feelings
 monitor activities  appreciate individual’s uniqueness
 plan for a realistic and healthy diet  reinforce genuine hopes
 monitor nutritional and electrolyte status  consider family and caregivers

 BULIMIA NERVOSA  COGNITIVE DISORDERS

 recurrent episodes of binge eating and a
sense of lack of control over eating  DELIRIUM
 recurrent compensatory behaviors
 at least 2x a week for the past 3 months  Nursing Interventions:
 self-evaluation is unduly influenced by body  Determine the degree of cognitive impairment
weight and shape  create a structured and safe environment
 disturbance does not occur exclusively during  institute measures to help patient relax and
episodes of anorexia fall asleep
 keep the room lit to allay fears and prevent
 Etiology: visual hallucinations
 Biological  monitor effects of medications
 Psychological
 DEMENTIA
 Types:  Multiple Cognitive Deficits
 Purging  Amnesia
 Non-purging  Aphasia
 Apraxia
 Nursing Interventions:  Agnosia
 For Binge Eating  Disturbance in executive functioning
 create an atmosphere of trust
 identify feelings associated with  ALZHEIMER’S DISEASE
binging/purging behavior  Stage I Early stage
 improve self-esteem  Stage II Middle stage
 teach about eating disorders  Stage III Terminal stage
 explore interpersonal relationships
 Drug therapy
 SLEEP DISORDERS  Anti cholinesterase agents - tacrine
 Dysomnias (Cognex), donazepil (Aricept)
 primary insomnia (Initial, middle and  antipsychotic agents
terminal)  benzodiazepines
 primary hypersomnia
  Nursing Interventions:  promote physical activity and sensory
 Remove any hazardous items or potential stimulation
obstacles from the patient’s environment to
provide and maintain safety  VASCULAR DEMENTIA
 monitor food and fluid intake  MENTAL DISEASES IN CHILDREN
 provide verbal and non-verbal o risk factors for childhood psychiatric
communication that is consistent and disorders are
structured  genetic and biological factors
 state expectations simply and completely  adverse environmental influences
 Increase social interaction to provide stimulus  family and socio-cultural factors
for the patients  stress experiences
 encourage the use of community resources  Resilience

Therapeutic Communication

COMMUNICATION

The means by which people make their needs known

The way they obtain understanding, reinforcement and assistance from others.
SOCIAL CONVERSATION – usually superficial and meets the needs of both parties. Its goal is usually
enjoyment.
THERAPEUTIC COMMUNICATION - less superficial, it is effective and purposeful. Its main goal is to develop or
maintain a healthy personality. Done by relieving stress and assisting the patient in developing better coping
mechanisms.

PRINCIPLES OF THERAPEUTIC COMMUNICATION:

Keep your voice calm.
Do not ignore the patient by talking as if he was not there.
Reassure the patient that you will help him regain control and will not let him hurt himself or others.
Stress that you know patient can maintain control of himself if he chooses
Never offer the patient something you cannot deliver
Do not threaten the patient
Avoid lengthy negotiation
Offer simple and brief choices

GOALS OF THERAPEUTIC COMMUNICATION:

Obtain useful information
Show caring
Help the patient understand himself
Relieve stress
Provide information
Teach problem-solving skills
Encourage acceptance of responsibility
Encourage activities of daily living

CHARACTERISTICS OF A THERAPEUTIC RELATIONSHIP

LISTENING
Perceiving the patient’s message in the cognitive and affective domains
WARMTH
Feeling of cordiality and affection

GENUINENESS
Being oneself and not acting out a role; being open and truthful

ATTENTIVENESS
Demonstrating a concentration of time and / or attention on the patient

EMPATHY
Understanding the patient’s feelings; viewing the world as the patient does.

POSITIVE REAGARD
Accepting the patient as he is.

THERAPEUTIC TECHNIQUES EXAMPLES

Using Silence Uh humm…
Nodding

2. Accepting Yes

3. Giving Recognition Good Morning, Mrs. X

I noticed that you combed your hair

4. Offering Self I’ll sit with you a while

I’ll stay here with you
I’m interested in your comfort

5. Giving broad openings Is there something you’d like to talk about?

What are you thinking about?
Where would you like to begin?

6. Offering general leads Go on…

And then…
Tell me about it…

7. Placing events in time or What seemed to lead up to…?

in sequence Was this before or after?
When did this happen?

8. Making observation You appear tense

Are you comfortable when you…

9. Encouraging description Tell me when you fell anxious

of perceptions What is happening?
What does the voice seems to be saying?

10. Encouraging comparisonWas this something like…?

Have you had similar experiences?
11. Restating P: I can’t sleep. I stayed awake the whole night
N: You have difficulty in sleeping?

P: The fellow that is my mate died at war and is pending yet to marry
N: You were going to marry him, but he died during the war?

12. Reflecting P: Do you think I should tell the doctor?

N: Do you think you should?

13. Focusing P: My brother spends all my money and then the nerve to ask for more.
N: This causes you to feel angry?

14. Exploring Tell me more about it…

Would you describe it more fully?
What kind of work?

15. Giving Information My name is…

Visiting hours are…
My purpose of being here is…
I’m taking you to the…

16. Seeking Clarification

17. Presenting reality I see no one in this room

 That sound is a car backfiring
Your mother is not here. I’m a nurse

18. Voicing doubt Isn’t that unusual?

Really?
That’s hard to believe

19. Seeking consensual validation Tell me whether my understanding of it agrees with yours

20. Verbalizing the implied P: It’s a waste of time

N: It is your feeling that no one understand
P: My wife pushes me around just like my mother and sister did
N: It is your impression that women are dominating?

21. Encouraging evaluation What are you feeling with regards to…
Does this contribute to your discomfort?

22. Attempting to translate P: I’m dead…

into feelings N: Are you suggesting that you feel lifeless?
P: I was out in the ocean
N: You must be lonely or you seem to feel deserted

23. Suggesting collaboration Perhaps you and I can discuss and discover what produces your anxiety.

24. Summarizing Have I got this straight?

You’ve said that…
During the past hours, you and I have discussed…

25. Encouraging formulation What could you do to let your anger out
of a plan of action harmlessly?
Next time this come up, what might you do to handle it?

NON - THERAPEUTIC TECHNIQUES EXAMPLES

Reassuring Don’t worry about it, everything will be alright
You’re coming along fine
Giving Approval That’s good…
I’m glad that you…
Rejecting Let’s not discuss…
I don’t want to hear that…
Agreeing That’s right!
I agree!
Disapproving That’s bad…
I’d rather…
You shouldn’t…
Disagreeing Its wrong…
I definitely disagree with…
I don’t believe that…
Advising I think you should…
Why don’t you…
Probing Now, tell me about…
Tell me your life history
Generic name Trade name Range of daily Comments
Oral dosage (mg)

PHENOTHIAZINE DERIVATIVES: ALIPHATIC SUBGROUP

Chloropromazine Thorazine 200-1000

PHENTOTHIAZINE DERIVATIVES: PIPERIDINE SUBGROUP

Thioridazine Mellaril 200-800
Piperacetazine Quide 20-160
Mesoridazine Serentil 100-400 Schizophrenia,
Organic mental disorders, and alcolohisms are odften treated with srentil

PHENOTHIAZINE DERIVATIVES: PIPERAZINE SUBGROUP

Fluphenazine Prolixin 2.5-40 Prolixin decanoate often
Given intramuscularly,
initially at 12.5-25 mg and repeated every 2-4 weeks for maintenance
Perphenazine Trilafon 8-64
Trifluoperazine Stelazine 15-20

BUTYROPHENONE DERIVATIVES
Haloperidol Haldol 1-100 Optimum dosage highly
Variable

THIOXANTHENE DERIVATIVES
Chlorprothixene Taractan 75-600 Specific for moderate to
severe agitation, anxiety, and tension related to schizophrenia
Thiothixene Navane 20-30

DIHYDROINDOLONE DERIVATIVES

Molidone Moban 40-225 Specific for use in

Schizophrenia

DIBENZOXAPEPINE DERIVATIVES
Loxapine succinate Loxitane 20-250

Table 15-3 Side Effects of antipsychotic drugs

Side effects Comments

Dry mouth, blurred vision, These effects result from the drug’s interference
constipation, urinary hesi- with acetylcholine. The first three should be
tance, paralytic ileus treated symptomatically and client reassured. In
instances of urinary hesitance and paralytic ileus
medication should be withheld until medical
evaluation is obtained.

Orthostatic hypotension Drug used with great caution if cardiovascular

disease is present and with the elderly. Individual should be warned about possible occurrences and taught to rise
slowly and dangle legs before standing.

Photosentisivity Protect client from ultraviolet light. Use sunscreen.

Occurs most frequently with chlorpromazine. Examine skin frequently.

Endocrine changes Weight gain, edema, lactation, and menstrual

irregularities. Treat symptomatically. Reassure client.

Extrapyramidal reactions Dose and duration related. Managed by adjusting

dose of drug or adding antiparkinsonism drug.

Pseudoparkinsonism Typical shuffling gait, masklike facies, tremor,

muscular rigidity, slowing of movements, and other symptoms mimicking those seen in Parkinson’s disease.

Akathisia, dystonia Continuous restlessness, fidgeting, and pacing occur

Spasm of neck muscles, extensor rigidity of back muscles, carpopedal spasm, eyes rolled back, swallowing difficulties
occur. There is acute onset, but condition is reversible with appropriate medication. Reassurance should be provided
until symptoms subside.

Akinesia Lethargy, feelings of fatigue and muscle weakness.

Must be differentiated form withdrawal.

Table 15-4 Possible adverse effects of antipsychotic drugs

Adverse effects Comments

Skin reactions Urticarial, maculopapolar, edematous, or petechial

responses may occur 1 to 5 weeks after initiation of treatment. Withhold drug until after medical evaluation.
Jaundice Develops in about 4 % of the clients and is a
dangerous complication; drug should be discontinued.
Agranulocycotisis and leukopeniaChlorpromazine depresses production of
leukocyte. Initial symptoms of sore throat, high temperature, and lesions in mouth indicate that drug should be
stopped immediately. Outcome may be lethal, but this is rare.
Ocular changes Corneal and lenticular changes and pigmentary
` retinopathy may occur with high dosages over long periods of time. Periodic ocular examinations are
recommended.
Convulsions Antipsychotic agents lower seizure threshold,
making seizure-prone persons more likely to have seizures. Persons with a history seizures or organic associated with
seizures require an increased dosage of anticonvulsant medication if antipsychotic are used.
Tardive dyskinesia Insidious onset of fine vermicular movements of
tongue occur, which is reversible if drug is discontinued at this time. Can progress to rhythmical involuntary
movements of the tongue, face, mouth, or jaw with protrusion of tongue, puffing of cheeks, and chewing movements.
No known treatment; often irreversible. Prevention is imperative. Female over 50 years on prolonged doses are
particularly at risk. Do no withhold drug until after medical evaluation symptoms will increase.

HISTORY, TRENDS AND STANDARDS / STRESS AND MENTAL HEALTH / ANXIETY

MENTAL HEALTH AND REHABILITATION
HISTORY, TRENDS AND STANDARDS

CONCEPTS OF MENTAL ILLNESS

TIME PERIOD CONCEPTS OF MENTAL ILLNESS

PRIMITIVE TIMES - Evil spirits possessed the body and must be driven
from the body.

ANCIENT CIVILIZATION - Thought to be natural phenomenon; humanistic

approach
 MIDDLE AGES - Superstition, witchcraft and torture

RENAISSANCE - Decline in belief of possession by evil spirits

- Mental problems irreversible
- Scientific inquiry; humanism

EIGHTEENTH CENTURY - Reform movement; chains removed

- Need for medical care recognized
- First mentally ill patient treated in hospital

NINETEENTH CENTURY - Research began

- Legislation concerning mental health enacted
- Hospitals for mentally ill established with long term
custodial care
- First psychiatric training school in United States
established

TWENTIETH CENTURY - Start of mental health movement

- Large state hospitals built
- Psychoanalysis
- More legislation concerning mental health enacted
- Community health care centers established
- Holistic concept of care and short-term care
introduced
- Goal to return patient to society
- Human services programs established
- Focus on prevention

CURRENT TRENDS fourteen standards of psychiatric – mental health

- In the early 1970s, care of the mentally ill shifted from nursing practice.
hospital to the community.
STANDARD I
Community mental health services included: : Data are collected through pertinent clinical
Foster Homes observations based on knowledge of the arts and
Crisis centers sciences, with particular emphasis upon psychosocial
Hotlines and biophysical sciences
Counseling centers
Therapeutic communities STANDARD II
Halfway houses : Clients are involved in the assessment, planning,
Day care centers implementation, and evaluation of their nursing care
program to the fullest extent of their capabilities
Services offered by comprehensive community
mental health centers: STANDARD III
Inpatient services : The problem solving approach is utilized in developing
Diagnosis nursing care plans
Pre and Post hospitalization
Professional and Paraprofessional Training STANDARD IV
Partial Hospitalization : Individuals, families, and community groups are
Emergency Services assisted to achieve satisfying and productive patterns of
Rehabilitation Services living through health teaching
Research and Evaluation
Emergency Services STANDARD V
Education and Consultation : The activities of daily living are utilized in a goal
directed way in work with clients
STANDARDS OF CARE
Nurses’ responsibilities are determined by legislation, STANDARD VI
agency policy, and standards set by the profession. : Knowledge of somatic therapies and related clinical
Legislation is enacted to provide safe practitioners skills are utilized in working with clients
Standards focus on practice and fulfill the profession’s
obligation to provide a means of determining the quality STANDARD VII
of nursing which the patient receives, whether such : The environment is structured to establish and
services are provided by the professional nurse, the maintain a therapeutic milieu
practical nurse, or the nursing assistant.
The nurse, working in a mental health care setting, is STANDARD VIII
responsible for providing high quality care as identified : Nursing participates with interdisciplinary teams in
by the standards of psychiatric nursing within the assessing, planning, implementing and evaluating
nurse’s legal role. programs and other mental health activities
The American Nurses’ Association’s booklet Standards of
Psychiatric – Mental Health Nursing Practices lists STANDARD IX
: Psychotherapeutic interventions are used to assist
clients to achieve their maximum development
STANDARD X
: The practice of individual, group or family
psychotherapy requires appropriate preparation and
recognition of accountability for the practice
STANDARD XI
: Nursing participates with other members of the
community in planning and implementing mental health
services that include the broad continuum of promotion
of mental health, prevention of mental illness, treatment
and rehabilitation
STANDARD XII
: Learning experiences are provided for other nursing
care personnel through leadership, supervision, and
teaching
STANDARD XIII
: Responsibility is assumed for continuing educational
and professional development and contributes are made
to the professional growth of others
STANDARD XIV
: Contributions to nursing and the mental health field are
made through innovations in theory and practice and
participation in research.
LEGAL RIGHTS OF PATIENTS
Patients have the right to refuse treatment
Patients must be provided with information which will
enable him to make a valid decision concerning any
proposed treatment
Patients have a right to humane treatment
Patients have the right to be treated as individuals
STRESS AND MENTAL HEALTH
PHYSIOLOGICAL EFFECTS OF GAS
Stressor
Crisis Stage
ACTH Secreted
Adaptation Stage Adrenal Medulla Stimulated
STRESS THEORY
According to Hans Selye, STRESS is a nonspecific
response to any demand made on the body.
Demands may range from a disappointment to a
severe illness. Some stress is necessary, but too
much stress may send the body into a state of
exhaustion. Coping with stress requires a great deal
of energy; the supply of this energy is limited.
A person’s response to stress is only one theory used
to explain mental illness. However, it provides a
useful framework for the study and practice of
mental health nursing.
PHYSIOLOGICAL EFFECTS OF STRESS
ADAPTIVE ENERGY
Was coined by Selye to indicate a force that the
individual uses to adapt to stress
STRESSORS
The demands which cause chemical and structural
changes that are manifestations of the body’s
attempt to maintain homeostasis
GENERAL ADAPTATION SYNDROME (GAS)
CRISIS OR ALARM STAGE
An instantaneous, short-term, life preserving and
total sympathetic nervous system response that
occurs when the person consciously or
unconsciously perceives a stressor and feels
helpless, insecure or biologically uncomfortable.
Fight or flight reaction
The body mobilizes its forces to handle the stressors.
The sympathetic nervous system is stimulated
STAGE OF RESISTANCE
Body’s way of adapting through an adrenocortical
response to the disequilibrium caused by the
stressors of life
STAGE OF EXHAUSTION
Occurs when the person is unable to continue to adapt to
internal and external environmental demands or when
adaptive mechanisms are inadequate
Sympathetic Nervous System
Stimulated
Epinephrine and Norepinephrine
Secreted
 Respiratory Blood Digestive Heart Rate
Muscles Vessels System Increases
Relaxed Constrict Slows

 O2 intake Maintain BP Conserve Carry more O2

Energy to cells and
help maintain
Adrenal Cortex BP
Stimulated
Mineralocorticoids
Secreted
Glucocorticoids
Secreted
Retains fluid

Glucogenesis
Supresses
Inflammation
 Energy