PSYCHIATRIC NURSING

Prof. Kenneth Arzadon, RN, UKRN

What is Mental Health Disorder?

Alteration in…. SILENCE

OFFERING SELF
“I’ll sit with for a while”

That affects ones…

BROAD OPENING
“How are you feeling today?”
“Is there something you’d like to talk about?”
INTROSPECTION “Where would you like to begin?”

EXPLORING
“Tell me more about that.”
“Tell me what happened.”
“Will you describe it more fully.”
Therapeutic Use of Self Active Listening “Go on, I’m listening.”

Components of Active Listening: S RESTATING

O CLIENT: “I can’t sleep. I stay awake all night.”
L NURSE: “You have difficulty sleeping.”
E
R VERBALIZING THE IMPLIED
CLIENT: “It’s a waste of time talking to anyone.“
Non-verbal Communication: Proxemics NURSE: “Do you feel that no one understands?”
Paralanguage NURSE: “Do you feel like you’re being ignored,
Kinesics that no one is really listening?”

Verbal Communication: SEEKING CLARIFICATION

“I feel sorry for you.”
“I see you are sad.”
“It must have been very difficult for you to los
you sister when you needed her most.”
Client: “I feel invisible.”
Nurse: “Can you explain that to me?”
Client: “I’m feeling sick inside ”
Nurse: “What do you mean by ‘feeling sick
inside?”

“I know what it felt like to loss a sister, I lost mine

when I was six.”
Client: “I feel so lost.”
========================================
Nurse: “give me an example of feeling lost.”
Therapeutic Communication ENCOURAGING DESCRIPTION
“What are your feelings in regard to…”
NURSING*RADTECH*DENTISTRY*CRIMINOLOGY*MIDWI
FERY*MEDTECH LET*PSYCHOMET*RESPIRATORY
THERAPY*CIVIL SERVICE*NAPOLCOM
NCLEX*DHA*HAAD* PROMETRIC* UK-CBT
“During the past hour, you and I have
discussed…” “You’ve said that…”
can do it.“
“It would be difficult at first, but you’ll get
through it.”
SUMMARIZING
“What would help you do even better next
time.” “If things didn’t go well, what do
you want to differently this time?”

REINFORCEMENT
“This new approached worked for you, keep it Non – therapeutic
up!” communication Agreeing /
"What do you think is happening to you right Disagreeing:
now? “ “I agree….” / “I disagree….”
"How serious is this for you?"
"How important is it to change this behavior?" Advising:
“I think you should…” / “Why don’t you…”
IDENTIFYING THEMES
“What comes into your mind each time Belittling: “Everybody gets down in the
you….?” “What happens when you feel dump..” Stereotyping: “Just have a
this way?” “What do you do each time positive attitude.” Reassuring:
you argue with your wife?” “Everything will be alright.” Requesting
an explanation: “Why”
CONSENSUAL VALIDATION Probing: “What made you say that?”
Client: “My mind is like mashed Testing: “Do you still remember what
potatoes.” Nurse: “You find it happened?”
difficult to put thoughts together.”
Discounting and Patronizing
Client: “I’m way out in the ocean.” statements • “AT LEAST…”
Nurse: “You seem to feel lonely” • “YOU CAN STILL…”
• “It was for the best.”
REFLECTING • “Life must go on.”
CLIENT: “Do you think I should tell my • “I know how you feel.”
dad?” NURSE: “Do you think you • “God needed another angel in heaven.” •
should?” “God won’t put you in a situation more
“What do you think would work best?” than you can bear.”

ENCOURAGING COMPARISON
“What is different about your feelings NURSE-PATIENT RELATIONSHIP
today?” “How does this compare with Most Important Element:
the last time?” Approach:
Purpose:
FORMULATING A PLAN
GOAL SETTING Professional Relationship
“What could you do to let your Elements of a contract:
anger out harmlessly?”
-
“What do you want to do differently?”
-
“What is the best alternative for you?”
-
SUPPORTIVE CONFRONTATION
''I know this isn't easy to do, but I think you
 CRISIS and CRISIS INTERVENTION
What is Crisis?
PHASES OF NPR
Types of Crisis
Situational
PRE – ORIENTATION
Goal: Adventitious
Problem:
Maturational
ORIENTATION
Goal:
Problem: Priority Assessment:
1.
2.
3.
WORKING
Goal: Duration of Crisis:
Problem: Goal:
Transference Focus:
Countertransference Approach:
Cross transference Medium used:

========================================
TERMINATION
Goal: Diagnostic and statistical Manual of Mental
Problem: Disorder (DSM ____)

WHODAS 2.0 (World Health Organization

STRESS and STRESS ADAPTATION Disability Assessment Scale)

Selye’s Stress Adaptation Model Alarm 6 main domains of Functioning

1.
Resistance 2.
3.
Exhaustion 4.
5.
Lazarus’ Interaction Model 6.
Primary Appraisal
Secondary Appraisal Etiology of Mental Disorders
Reappraisal
Diathesis Stress Model
Precipitating factor
Coping Mechanisms
Adaptive
Palliative
Maladaptive
Dysfunctional
Predisposing factor
Protective factor

Aristotle’s Tabula Rasa Disturbances in THOUGHT

• DELUSION
Freud’s Structural Theory of Personality Grandiose
Persecutory
ID Somatic
EGO Nihilistic
SUPEREGO Erotomanic

EGO DEFENSE MECHANISMS Ideas of Reference

Denial Circumstantiality
Regression Tangential Thinking
Introjection

Projection Associative Looseness

Displacement Flight Of Ideas

Reaction Formation UNUSUAL SPEECH PATTERNS

Undoing Neologisms

Suppression Schizophasia
Repression Clang associations

Rationalization SYMPTOMATOLOGIES OF MENTAL DISORDER

Intellectualization
Disturbances in PERCEPTION
Splitting • Illusion
• Hallucination
Substitution Visual
Compensation
Sublimation
Echolalia
Identification Verbigeration
Dissociation
Stilted language
Perseveration

Tactile
Auditory Disturbances in Memory

Amnesia

Gustatory Retrograde
Olfactory
• Synesthesia Anterograde

Confabulation
 A
R
BEHAVIORAL MANAGEMENT M

WITHDRAWN CLIENT
MANIC CLIENT
• Active Friendliness
Behavior:
Activity
Room:
Accompany
Activity:
Appraise
Diet:

DEPRESSED CLIENT
MANIPULATIVE CLIENT
• Kind Firmness
Matter of Fact
Silence
Calm and non-threatening approach
Offering Self
Motivate
Consistently
Engage in _________________
___________________ Directive
SUICIDAL CLIENT
AGGRESSIVE CLIENT
G
C
Decrease Stimulation
A
Deescalate
S
Directive approach
H
SHOW OF FORCE
Gender:

Age: ASSAULTIVE PATIENT

Civil Status: Assault Cycle

Triggering
Consider! –
Escalation

Crisis
Most Common Time:
Recovery
• Direct Confrontational
Post crisis depression

PARANOID CLIENT
SECLUSION
• Passive Friendliness Room:
Purpose:
D Goal:
I Monitoring:
S Environment:
RESTRAINT ANXIETY RELATED DISORDERS
Doctor’s order (Application): Informed consent:
Proper Application: OBSESSIVE COMPULSIVE DISORDER
Obsession –
Compulsion –

Defense Mechanism:
Doctor’s order (removal): Proper Removal:
Management:
1st step:

ANXIETY SOMATIC SYMPTOM ILLNESSES • Illness

Characteristic: Anxiety Disorder
Initial Nursing Action: Disease Conviction
Disease Phobia
• Priority
• Conversion Disorder
Drug of choice:
Primary Gain:
Nursing education:
Secondary Gain:
Nursing Diagnosis:
Antidote:

Psychotherapy:
Levels of Anxiety

Mild

Moderate

Medical Management:
Severe

Panic FACTITIOUS DISORDER:

Munchausen’s Syndrome
Munchausen’s by proxy

Interventions for anxiety CYBERCHONDRIA:

R
E TRAUMA RELATED DISORDERS Cause:
P Survivor’s guilt –
E
A Manifestations:
T
Management:
• Defusing
• Debriefing
NURSING DIAGNOSIS: A
INTERVENTIONS: H
- N
-
- Cluster C
A
PSYCHOTHERAPEUTIC Management: D
EVALUATION: O
MEDICAL TREATMENT:
Management:
Goal of Management:

PERSONALITY DISORDERS: Sexual Deviation Disorders

Age of diagnosis: (Paraphilia) Frotteurism
Age of Improvement: Voyeurism
Bestiality
Cluster A Telephone Scatalohia
P Sadism
S Masochism
• Adaptive closure therapy (empty
chair technique)
• Catharsis
Medical Management:
Medical Management

DISSOCIATIVE DISORDERS SUBSTANCE ABUSE

Dissociative Amnesia
Neurotransmitter:
Dissociative Fugue
Psychodynamics:
Dissociative Identity Disorder
Remnants:
Depersonalization Personality type:
Derealization Reason:
Behaviour:
Approach:
EATING DISORDERS
Therapy:
Psychodynamics:
Purpose:
Sociocultural factor:
Laboratory Test:
Neurotransmitter:
Priority:
Age group:
Anorexia Nervosa Bulimia Nervosa NARCOTICS
Purpose:
Commonly abused narcotics: Worst complication:
Signs of Abuse:
Detoxification:

S Antidote:

Cluster B Early signs of withdrawal: Late signs of

B
withdrawal: Early Withdrawal Symptoms:

Late Withdrawal Symptoms:

BARBITURATE
Most important element
Purpose:
Commonly abused barbiturates: Sign of abuse:
Tool: CAGE
Detoxification:
Signs of Withdrawal:
GROUP THERAPY
No. of participants
STIMULANT Stages
Purpose: Formation
Commonly abused stimulants: Signs of abuse: Leader
Decision Maker
AMPHETAMINE Prime
Rehabilitator

Sign of withdrawal
COCAINE ⮚ What if codependency?
Sign of withdrawal

Medical Management: WERNICKE – KORSAKOFF’s

HALLUCINOGENS SYNDROME Cause:

Purpose: Wernicke’s Korsakoff’s

Most commonly abused hallucinogens:
Cannabis Sativa (Marijuana)
Lysergic Acid Diethylamide (LSD)
Phenylcyclidine (PCP)
Ecstasy

Transient Hallucinations:
Management:

ALCOHOLISM
Effects of Alcohol:
Defense Mechanism:
GLOBAL COGNITIVE DISORDER
DELIRIUM DEMENTIA
AVERSION THERAPY
Purpose Cause
Drug used
Onset
Assessment
Example

Prognosis
Contraindication
Disorientation SCHIZOPHRENIA
CRITERIA IN THE DIAGNOSIS OF
Duration SCHIZOPHRENIA

Level of
1st generation 1st generation
consciousness

Attention

2 or more of the following for at least

_________. -
- 3rd generation DEPOT INJECTION
-
-
-

BIOLOGIC THEORY
Genetics:
Neuroanatomy:
Neurochemistry: SIDE EFFECTS:
Immunovirology: P
S
SOCIAL CAUSATION HYPOTHESIS
C
Other Related Disorders:
A
Brief Psychotic Disorder
T
Schizophreniform
Shared Psychotic Disorder D
Schizotypal O
G

Abnormal Affect
4As of Schizophrenia
Catatonia

Treatment Modality
POSITIVE SIGNS
EPS
NEGATIVE SIGNS

Asociality
Avolition
Anhedonia

Alogia
 MONOAMINE OXIDASE INHIBITOR
NMS
(MAOI) •
•
•

Nursing considerations

TD
TRICYCLIC ANTIDEPRESSANTS (TCA) •
•
•

Nursing Considerations

Missed dose? SELECTIVE SEROTONIN REUPTAKE

Prevention: INHIBITORS (SSRI)
SCHIZOPHRENIA AND SUICIDE:

MAJOR DEPRESSIVE
DISORDER Mild depression:
Major Depression: BIPOLAR DISORDER
Criteria for diagnosis: Neurotransmitter:
D Psychosocial Factors:
I Sociocultural Factors:
W
A Defense Mechanism:
G
Bipolar Mixed type
Exogenous: Bipolar I
Endogenous: Bipolar II
Defense Mechanism:
Initial Sign: Manic

Hallmark sign: Hypomanic

TREAMENT MODALITY CYCLOTHYMIA

Dosage DYSTHYMIA
Effectivity SEROTONIN NOREPINEPHRINE REUPTAKE
INHIBITORS (SNRI)
Combination

Shifting
SEROTONIN SYNDROME
C
H
A
R
D
Electroconvulsive Therapy
Indication:
Contraindications:
Mechanism of Action:
Frequency:
Pre-Meds:

Voltage:
Effect:
Side effect:
Nursing Responsibility:

TREATMENT MODALITY
DRUG OF CHOICE:
Mechanism:
Onset:
Peak:
Therapeutic Level:
Common side effect:
Signs of toxicity:
Must be at bedside:
Monitor:

Diet

Instruction

Anti-convulsant Medication:

What is Dual Diagnosis?