PHOBIA Diagnostic Test There is no single test to determine whether someone is suffering from a

Specific rational fear. specific phobia; healthcare practitioners will form a diagnosis based on the
Defense Repression patient’s account of their experiences and sometimes the results of clinical
Mechanism Projection interviews with psychologists.
Anatomy Amygdala – more responsive ➡ more susceptible to fear evoking stimuli Ex: The individual suffers from a persistent fear that is either unreasonable
Patho Vulnerabilities, Genetic, Environmental (traumatic events) ➡ Direct or excessive, caused by the presence or anticipation of a specific object or
situation
experience, vicarious experience, information transmission ➡ Specific
Medical Mngt Antidepressants
Phobia
Exposure Therapy
S/sx Types:
Drug Study Antidepressants (selective serotonin reuptake inhibitors)
Acrophobia – height
Nursing Dx Fear related to learned irrational response to natural or innate origins
Androphobia – man
(phobic stimulus)
Astraphobia – storms
Impaired social interaction related to intense fear of encountering feared
Claustrophobia – enclosed places
object, activity, situation
Kakorrhaphobia – failure
Ineffective coping related to tension release strategies
Nyctophobia – nights/ dark places
Implementation Exposure therapy
Ochlophobia – crowds
a. systematic desensitization.
Photophobia – light
*Gradual exposure to the feared object.
Ailurophobia – cats
b. implosive therapy/ flooding technique.
Aligophobia – pain
*Abrupt exposure to the feared object. Positive self-talk.
Belonophobia – needles
Discharge Plan Follow up care is a key part of treatment and safety. Thus, attend follow up
Brontophobia – thunder
check-ups
Cynophobia – dogs
Get enough sleep
Entomophobia – insects
Stay active, try do things patient usually enjoy doing
Genophobia – dirt
Discuss cause of fears to trusted friends and family members. Talking about
Hematophobia – blood
fears would help relive anxiety..
Microphobia – germs
Mysophobia – contamination or germs
Opidiophobia – snakes SCHIZOPRENIA
Pathophobia – disease is a group of disorder characterized by altered thinking feeling perception and behavior. Men
Phonophobia – loud noises tend to have a poorer prognosis that women.
Photophobia – light Definition men tend to be diagnosed between 18 – 25.
Pyrophobia – fire women are diagnosed most frequently between 25 35.
Taphophobia – being buried alive
Topophobia – stage fright PARANOID SCHIZOPHRENIA
Xenophobia – fear of strangers Onset: late, usually 30 – 35 y/o and is sudden/ acute.
Zoophobia – animals Behavioral pattern: Suspicious
Defense mechanism: Projection
Good luck! – From Popcorn Gorls “O Lord grant us success.” – Psalm 118:25
 Diagnostic Test The DSM-5 states that “the diagnostic criteria include the persistence of two
CATATONIC SCHIZOPHRENIA or more of the following active-phase symptoms, each lasting for a
Onset: no specific age and usually acute & precipitated by emotionally significant portion of at least a one-month period: delusions, hallucinations,
disturbing experience. disorganized speech, grossly disorganized or catatonic behavior, and
Behavioral pattern: Withdrawn negative symptoms.” At least one of the qualifying symptoms must be
Defense mechanism: Repression delusions, hallucinations, or disorganized speech.
Types: Medical Mngt Meds: 1st and 2nd generation antipsychotic drugs
Catatonic stupor Cognitive behavior therapy
Catatonic excitement. Personal therapy
UNDIFFERNTIATED SCHIZOPHRENIA Compliance Therapy
Symptoms of more than one type of schizophrenia. Acceptance and Commitment Therapy
Does not meet the criteria of paranoid, disorganized or catatonic. Supportive Psychotherapy
Drug Study ANTI-PSYCHOTIC DRUGS
RESIDUAL SCHIZOPHRENIA 1st generation: Risperidone (Risperdal), Clozapine (Clozaril, Versacloz)
History of at least one psychotic episode but with limited overt psychotic 2nd generation: Chlorpromazine, Fluphenazine
behavior. Indication: Management of manifestations acute and chronic psychoses
Negative symptoms are present in attenuated form such as odd beliefs. Contra: hypersensitivity
Anatomy Prefrontal Cortex – frontal lobe dysfunction ex: blunted affect, difficulty SE: extrapyramidal effects, photosensitivity, neuroleptic malignant
with problem solving, impoverished thinking syndrome
Medial Temporal lobe: hippocampus- smaller; amygdala – emotional Mngt: avoid abrupt withdrawal of drug
deficits Nursing Dx Impaired verbal communication
Dopamine – overactive result to hallucinations and delusions Disturbed thought process
Glutamate - increased Risk for self-directed or other-directed violence
Psycho-Patho Genetics and environmental factors ➡ Changes in brain chemistry Implementation Promote self-care & independency.
(increased dopamine) ➡ Prodromal Symptoms (social withdrawal, trouble Promote socialization.
concentrating, temper flares, difficulty sleeping) ➡ Active phase: Positive Provide safe and simple activities.
Symptoms (delusions, hallucinations, disorganized speech, catatonic Involve in therapeutic activities (remotivation activities).
behavior) and Negative Symptoms (lack of pleasure, loss of interest, flat Use active friendliness.
Care of clients Hallucinating:
affect, struggle with daily living, avolition, trouble with speech) ➡
Maintain accepting attitude.
Recovery Phase (cognitive symptoms: trouble learning new things, low
Assess type of hallucination.
attention span, problems with memory)
Do not argue with patient about reality of hallucination.
S/sx PARANOID SCHIZOPHRENIA Point out reality if possible.
Extreme suspiciousness. Encourage discussions of reality-based interest.
Ideas of reference. Comment on feeling tone of hallucinations.
Delusion of persecution. Ex: “That must be frightening to you.”
Auditory hallucination.
Unpredictable violence.
Good luck! – From Popcorn Gorls “O Lord grant us success.” – Psalm 118:25
 Encourage diversional activities and activities which patient can gain sense • Get enough sleep to help his mood and reduce stress.
of mastery.
Ex: “playing cards, artwork.”
Care of clients with Delusions: BORDERLINE PERSONALITY DISORDER
Allow patient to verbalize the delusions. Cluster B: Dramatic or Emotional
Do not argue with patient. Pervasive pattern of unstable interpersonal relationships, self-image and affects.
Do not reinforce delusions by validating them. Definition Unstable relationships, Impulsivity, Self-Mutilation (Cry for help),
Focus on potential real concern of patient. Manipulative to self and others, Fear of Neglect
Provide activities to divert attention from delusions. DSM V Criteria A. exhibits behavior that deviates from cultural expectations manifested in
Provide solitary activities then may progress to noncompetitive games or two or more: (CIA) Cognition, Impulse Control, Affect
activities. B. pattern is inflexible and pervasive
Paranoid Clients C. pattern leads to clinically significant distress or social impairment
Give client ample personal space. Defense They use splitting (extreme idealization and devaluation) as their defense
a. to enhance his sense of security. Mechanism mechanism.
Use no demand attitude. Anatomy The scans revealed that in many people with BPD, 3 parts of the brain were
a. making demands and being authoritative increases the clients either smaller than expected or had unusual levels of activity. These parts
suspiciousness. were:
Use passive friendliness. • amygdala – which plays an important role in regulating emotions,
Develop trust. especially the more "negative" emotions, such as fear, aggression and
a. be reliable and consistent. anxiety
Provide safety for others and client. • hippocampus – which helps regulate behaviour and self-control
a. approach client in a non-threatening manner. • orbitofrontal cortex – which is involved in planning and decision
b. never whisper making
c. never holds complicated objects. Patho Biological and environmental factors -> alterations in neurobiological
d. provide solitary, safe and relatively simple activities. mechanism -> neurotransmitter imbalance (serotonin and acetylcholine
Focus on client’s nutrition. dysfunction) and abnormal neurocircuitry (reduction in amygdala,
Catatonic Clients hippocampus, and temporal lobe) -> bpd
Provide safety. S/sx Fear of abandonment, unstable relationships, unclear self-image, impulsive
Promote nutrition and hydration. and self-destructive behaviors, self-harm, extreme emotional swings, chronic
Prevent bowel & bladder problem. feelings of emptiness, explosive anger, feeling suspicious or out of touch w/
Minimize circulatory problems & loss of muscle tone. reality
Discharge Plan • Educate patient and the family about the first signs of relapse. Signs of a Diagnostic Test There is no conclusive medical test for BPD, and a diagnosis is not based on
relapse include not wanting to do things with others and having problems a single indication or symptom. A
concentrating. Have a plan to deal with relapse and get help right away. mental health professional best diagnoses BPD after a thorough clinical
• Recommend a balanced diet including whole grains, dairy products, fruits, interview that may involve speaking with past
vegetables, and protein as this will help the body to deal with tension and therapists, examining previous medical examinations, and, if necessary,
stress. interviews with friends and family

Good luck! – From Popcorn Gorls “O Lord grant us success.” – Psalm 118:25
 Medical Mngt PSYCHOTHERAPY
• Dialectical therapy - group and individual therapy designed
specifically to treat borderline personality disorder. Skills-based
approach to teach how to manage emotions, tolerate distress and
improve relationships.
• Attitude therapy: MATTER OF FACT
Drug Study MEDICAL MANAGEMENT
• Anti-depressants: SSRI’s and TCA’s
Fluoxetine (Prozac) SSRI, 20-80 mg/d, Mild improvements in affective
symptoms, anger, impulsive aggression.
• Typical Antipsychotics
Haloperidol Classical neuroleptics, Mean doses 3-7.8 mg/d, Improvements
in paranoia, anger, possibly anxiety/affective symptoms.
• Anticonvulsants
Carbamazepine Mood Stabilizer, Therapeutic blood level dosage, Potential
improvement in impulsivity, but also possible worsening in melancholic
depression.
• Opiate-receptor antagonist (Naltrexone)
Caution Anxiolytics - benzodiazepines may worsen the symptoms of
impulsivity and suicidality in people with BPD
Nursing Dx Risk for self-mutilation related to irresistible urge for self- directed violence
Chronic low self-esteem related to persistent lack of integrated self-view
Impaired social interaction related to disturbed thought process
Implementation Closely supervised the client’s use of sharp or other potentially dangerous
objects – client may use these items for self-destructive acts.
Encouraged client to enter a no-self-harm contract – to take responsibility for
healthier behavior
Maintained a neutral, calm, and respectful manner – to help client see
themselves as a respected person
Discouraged client from making repetitive self-blaming and negative
remarks – Unacceptable behavior does not make the client a bad person, it
means that the client made some poor choices in the past.
Motivated the patient to express feelings and perceptions of problems – to
identify and clarify the possible reasons for impairment in interacting with
others.
Intervened in manipulative behavior – to reinforce adaptive behavior through
positive feedback and realistic praise.
Good luck! – From Popcorn Gorls
Discharge Plan M – Instruct the patient to take the medications prescribed by the doctor
BusPar (Buspirone), used to treat anxiety. Prozac (Fluoxetine), used to treat
depression, panic attacks, and obsessive-compulsive disorder
E – Instruct the patient on the necessity of keeping the surroundings free of
things that cause anxiety.
T – Discuss with the patient the need of sticking to the medication routine in
order to assure the patient's recovery from the current predicament.
Encourage patient to drink plenty of fluids to stay hydrated.
H – Encourage the patient to talk to friends and family for emotional support.
Instruct the patient to get enough sleep, eat healthy foods, get regular
exercise, and avoid alcohol and drugs.
O – Instruct the client to have a follow up checkup.
D – Instruct patient to eat healthy foods. Eating a balance of protective,
nutrient-dense foods. Instruct patient to avoid misusing alcohol or caffeine,
as these also can intensify mood instability.
S - Provide emotional and spiritual support to the client and the family.
BULIMIA NERVOSA
Eating disorder characterized by recurrent episodes of binge eating at least twice a week for 3
months. Normal weight to overweight (BMI: 18.5 – 30)
Definition Bulimia nervosa usually begins in late adolescence or early adulthood; 18 or
19 years is the typical age of onset. Binge eating frequently begins during or
after dieting.
DSM V Recurrent episodes of binge eating. An episode of binge eating is
CRITERIA characterized by both of the following:
Eating, in a discrete period of time (e.g., within a two hour period), an amount
of food that is definitely larger than what most people would eat during a
similar period of time and under similar circumstances.
Lack of control over eating during the episode (e.g., a feeling that you cannot
stop eating, or control what or how much you are eating).
Defense For people struggling with binge eating, eating often feels like “an escape,”
Mechanism comforting, calming, or a way to numb out.
Anatomy The MRI brain scans of the women with bulimia showed that as they viewed
the food cues shown to them after the stress task, there was a decrease in
blood flow through the precuneus, which is a brain region associated with
thinking about the self.
“O Lord grant us success.” – Psalm 118:25
 Patho Stress -> Decrease in blood flow through precuneus -> uses food to avoid
negative thoughts about self -> overeating -> body shape dissatisfaction ->
purging thru self-induced vomiting, excessive exercise, use of laxatives
S/sx B – Binge eating
U – Under strict dieting or vigorous exercise
L – Lack control over eating
I – Induced vomiting
M – Moth-eaten appearance teeth
I – Increase and persistent concern of body
A – Abuse of diuretics and laxatives
Diagnostic Test Physical Exam. This may include measuring your height and weight;
checking your vital signs, such as heart rate, blood pressure and temperature;
checking your skin and nails; listening to your heart and lungs, and
examining your abdomen.
Lab Tests. These may include a complete blood count and more specialized
tests to check electrolytes and protein, as well as liver, kidney and thyroid
functions. A urinalysis may also be performed.
Psychological Evaluation. A therapist or mental health provider will likely
inquire about your thoughts, feelings and eating habits. You may also be
asked to complete a psychological self-assessment questionnaire.
Other Studies. X-rays may be taken to measure your bone density, check for
stress fractures or broken bones, or evaluate you for pneumonia or heart
problems.
Medical Mngt COGNITIVE-BEHAVIORAL THERAPY - strategies designed to change
the client’s thinking (cognition) and action (behavior) about food focus on
interrupting the cycle of dieting, binging, and purging
Drusg Study PSYCHOPHARMACOLOGY
a. TCA
Desipramine (Norpramin), Antidepressant, selectively blocks reuptake of
norepinephrine (noradrenaline) from the neuronal synapse. Used as off-label
treatment of bulimia nervosa
SE: stomach upset, constipation, dry mouth, blurred vision, and
drowsiness
b. SSRI
Fluoxetine (Prozac), Antidepressant, regulate brain chemicals that control
mood. Guilt, anxiety, and depression about binging usually lead to purging.
SE: nausea, loss of appetite, diarrhea, anxiety, irritability
Good luck! – From Popcorn Gorls
Nursing Dx Imbalance Nutrition: less than body requirements related to self-induced
vomiting
Disturbed Body Image related to continual negative evaluation of self
Risk for Deficient Fluid Volume related to consistent self-induced vomiting
Implementation Monitor client during and after meals for acts of purging
Use a consistent approach. Sit with patient while eating; present and remove
food without persuasion and/or comment. - Patient detects urgency and may
react to pressure. Any comment that might be seen as coercion provides focus
on food
Make selective menu available, and allow patient to control choices as much
as possible. - Patient who gains confidence in self and feels in control of
environment is more likely to eat preferred foods.
Promote self-concept without moral judgment - Patient sees self as weak-
willed, even though part of a person may feel a sense of power and control
Encourage patient to take charge of own life in a more healthful way by
making own decisions - Patient often does not know what she or he may want
for self.
Discuss strategies to stop vomiting and laxative and diuretic use – to prevent
continued fluid loss
Identify actions necessary to regain or maintain optimal fluid balance - to
correct fluid imbalances
Discharge Plan M – You may need any of the following: Antidepressants called SSRIs are
usually used to treat bulimia. You may need this medicine even if you are
not depressed. Anticonvulsants may help control your mood swings and
decrease aggression or irritability.
E – Manage stress - Stress may increase your risk for a relapse.
T – Go to counseling sessions - Counseling is an important part of treatment
for bulimia. Be patient - Recovery from bulimia is a process that takes time.
H – Care for your mouth - Brush your teeth or rinse with fluoride mouthwash
or baking soda after vomiting.
O – Follow-up care is a key part of treatment and safety. Be sure to make and
go to all appointments, and call doctor or nurse call line if having problems.
D – Work on healthy eating habits. Listen to what counsellors and nutrition
experts say about healthy eating. Learn about what makes a healthy and
balanced diet, and then make a plan for your own healthy eating.
S - Provide emotional and spiritual support to the client and the family.
“O Lord grant us success.” – Psalm 118:25
 ALZHEIMERS o Difficulty with language and problems with reading,
Alzheimer's disease is a brain disorder that slowly destroys memory and thinking skills and, writing, and working with numbers
eventually, the ability to carry out the simplest tasks. In most people with the disease — those o Difficulty organizing thoughts and thinking logically
with the late-onset type symptoms first appear in their mid-60s. o Shortened attention span
o Problems coping with new situations
At first, Alzheimer’s typically destroys neurons and their connections in
o Difficulty carrying out multistep tasks, such as getting
parts of the brain involved in memory including:
dressed
- ENTORHINAL CORTEX o Problems recognizing family and friends
- HIPPOCAMPUS o Hallucinations, delusions, and paranoia
Anatomy And later affects the:
SEVERE ALZHEIMER’S DISEASE
- CEREBRAL CORTEX (responsible for language, reasoning, and
social behavior) o Inability to communicate
Eventually, many other areas of the brain are damaged. Over o Weight loss
time, a person with Alzheimer’s gradually loses his or her ability o Seizures
to live and function independently. Ultimately, the disease is fatal. o Skin infections
o Difficulty swallowing
Aging – Increased neurodegeneration – Increased neuroinflammatory and o Groaning, moaning, or grunting
increased apoptosis – Increased Caspase – 3 expression – Decreased o Increased sleeping
Short
synaptic plasticity and decreased memory process – Alzheimer’s disease o Loss of bowel and bladder control
Pathophysiology
– memory loss, repeating questions, wandering and getting lost, losing - 4As – amnesia, aphasia, apraxia, and agnosia
things, loss of spontaneity, etc. - Death when develops aspiration pneumonia. This type of
pneumonia develops when a person cannot swallow properly and
MILD ALZHEIMER’S DISEASE takes food or liquids into the lungs instead of air.
o Memory loss
o Poor judgment leading to bad decisions - Laboratory tests can be performed to rule out other conditions that
o Loss of spontaneity and sense of initiative may cause cognitive impairment:
o Taking longer to complete normal daily tasks o CBC to rule out hematologic disease
o Repeating questions o Liver enzyme levels to rule out hepatic disease
o Trouble handling money and paying bills o Thyroid-stimulating hormones (TSH) levels – to rule out
s/s thyroid disease
o Wandering and getting lost Diagnostic tests
o Losing things or misplacing them in odd places o Rapid plasma reagent to rule out syphilis
o Mood and personality changes o HIV serology to rule out HIV/ AIDS
o Increased anxiety and/or aggression o Paraneoplastic antibodies to rule out autoimmune
encephalitis
MODERATE ALZHEIMER’S DISEASE o CSF proteins to rule out Cretzfeldt-Jakob disease
o Increased memory loss and confusion - Computed Tomography (CT) scan
o Inability to learn new things - Magnetic Resonance Imaging (MRI)

Good luck! – From Popcorn Gorls “O Lord grant us success.” – Psalm 118:25
 - Positron Emission Tomography (PET) - Enforce with positive feedback when thinking and behavior are
appropriate
- EXPERIMENTAL THERAPIES - Use simple explanations and face-to-face interactions. Avoid
o these include anti-amyloid therapy, reversal of excess tau shouting and talking fast.
phosphorylation, estrogen therapy, vitamin E therapy, and - Discourage suspiciousness of others. Discuss with the client the
free radical scavenger therapy potential personal negative effects of continued suspiciousness of
- DIETARY MEASURES others
o caprylidene (Axona) is a prescription medical food that is - Avoid cultivation of false ideas
Medical
Management
metabolized into ketone bodies, and the brain can use - Observe client closely
these ketone bodies for energy when its ability to process
glucose is impaired. - Instruct family to give medications as scheduled
- PHYSICAL ACTIVITY - Encourage family to give and feed client with balanced diet
o Routine physical activity and exercise may have an impact - Encourage light aerobic exercises and mind exercise such as
on dementia progression and may perhaps have a reading and working on crossword puzzles
protective effect on brain health - Instruct the family and pt not to sleep during the day, and
encourage drinking a glass of warm milk or caffeine free herbal
Drugs include: Discharge Plan tea before going to bed
- ADUCANUMAB (early stage) - Encourage family and pt to go in some support groups and other
- CHOLINESTERASE INHIBITORS (mild to moderate cases) resources in their area
o Galantamine - Instruct family to be patient.
o Rivastigmine - Develop routine of medicines, appointments and tasks in a
Drug Study calendar, put sticky notes around the house, and schedule
o Donezepil
- MEDICAL FOOD activities and tasks for times of the day.
o Caprylidene
- N-METHYL-D-ASPARTATE ANTAGONISTS
o Memantine BIPOLAR 1
Bipolar disorder is a mental disorder that causes changes in a person’s temper, energy, and
- Chronic confusion r/t alteration in structure/ function of brain capacity to function. People with bipolar disorder experience excessive emotional states that
tissue normally arise all through intervals of days to weeks, known as temper episodes.
- Self-care deficit r/t cognitive impairment A patient with bipolar I illness that has a substance use issue such as alcohol, drugs, and
Nursing Dx - Risk for trauma r/t disorientation or confusion medication; the risk of suicide is significantly higher.
- Risk for self-directed or other-directed violence r/t delusional - NERVOUS SYSTEM
thinking o Central Nervous System
- Risk for falls r/t cognitive impairment ▪ Amygdala
Anatomy
▪ Hippocampus
Nursing - Orient client with reality and surroundings
Implementations ▪ Cortex
- Encourage caregivers about patient reorientation
o Peripheral Nervous System
Good luck! – From Popcorn Gorls “O Lord grant us success.” – Psalm 118:25
 ▪ Neurotransmitters
- PSYCHOTHERAPY
- ELECTROCONVULSIVE THERAPY (useful in a number of
Use of methamphetamine and cannabis, lack of support system,
instances in patients with bipolar disorder, such as when rapid,
experienced traumatic event, etc. – BIPOLAR DISORDER + 1 manic or
“mixed” episodes. +/- depressive episode – Decreased inhibitory control definitive medical/psychiatric treatment is needed)
of frontal and limbic emotional circuitry – Neuroanatomical Medical - NUTRITION THERAPY (Patients should be advised not to
Management make significant changes in their salt intake, because increased
abnormalities (shrinkage of hippocampus, over-performance of
amygdala, and decreased fronto-temporal gray matter – Disruption of salt intake may lead to reduced serum lithium levels and reduced
emotional homeostasis – Imbalance in the brain’s neurotransmitters: efficacy, and reduced intake may lead to increased levels and
Short toxicity.)
MANIC Mood (racing thoughts, impulsive, decreased need for sleep,
Pathophysiology - EXERCISE
grandiose ideas, and euphoria) OR DEPRESSIVEN Episode (Paranoia,
Anxious, Unable to focus) – Cognitive impairment and poor
Drugs include:
psychosocial adjustment
o Anxiolytics, benzodiazepines
o Mood stabilizer (Lithium)
Euthymic mood: Definite periods of normal mood and the goal is to Drug Study o Anticonvulsants
maintain this state o Antipsychotic, 2nd generation
o Antipsychotics, phenothiazine
- MANIC Mood o Antiparkinsons agents, dopamine agonists
o racing thoughts, impulsive, decreased need for sleep,
grandiose ideas, and euphoria - Risk for other-directed violence related to manic excitement,
- DEPRESSIVE Episode suspicion of others, paranoid ideation.
s/s
o Paranoia, Anxious, Unable to focus - Risk for injury related to extreme hyperactivity, destructive
- Suicidal ideation behaviors.
- Pressured speech Nursing Dx - Imbalanced nutrition: less than body requirements related to
- Auditory hallucination refusal or inability to sit still long enough to eat meals.
- Disturbed thought processes related to psychotic process.
- To get a diagnosis of bipolar disorder, you must have had at least - Disturbed sensory perception related to sleep deprivation,
one manic or hypomanic experience. psychotic process.
- PHYSICAL EXAM
- PSYCHIATRIC ASESSMENT - Provide a safe environment
Diagnostic tests - MOOD CHARTING - Decreasing environmental stimulation (may assist client to relax)
Nursing
- CRITERIA FOR BIPOLAR DISORDER (using the Diagnostic - Provide therapeutic communication
Implementations
and Statistical Manual of Mental Disorders (DSM-5) - Promote appropriate behavior
- Magnetic Resonance Imaging (MRI) - Manage medications

Discharge Plan - Instruct patient and family to be safe when administering or

giving take-home medicines
Good luck! – From Popcorn Gorls “O Lord grant us success.” – Psalm 118:25
 - Follow schedule of medicines to avoid relapse Inattentiveness
- Encourage pt to go to counselling sessions Distractibility and impulsiveness.
- Encourage client to get at least 30 minutes of activity on most
days of the week Common among boys.
- Instruct client to get enough sleep. Keep the room dark and quiet. Usually identified and diagnosed when the child
- Encourage client to eat a healthy diet
- Encourage client to lower stress begins pre-school.
- Instruct client to avoid alcohol drinking and smoking or using Academic performance is poor.
illegal drugs
- Teach client the early signs of mood changes Disruptive and intrusive behavior.
- Encourage and advise client to ask help from friends and family Hyperactivity and impulsive behavior.
when needed
*inability to sit still
ATTENTION DEFICIT HYPERACTIVE DISORDER *fidgets
(ADHD)
A condition that causes both kids and adults to be easily distracted, fidgety, and impulsive *run or climbs excessively
3 Keys areas of the brain are implicated in ADHD: *often on the go
Cortical regions *talks excessively
- Prefrontal cortex *blurts out answer/ interrupts conversation.
- Anterior Cingulate Cortex *can’t wait for turns is markedly affected.
Anatomy
Subcortical Regions Difficulty sustaining attention and concentration
- Limbic System (including Amygdala)
- Basal ganglia Although there is no single medical, physical, or genetic test for ADHD,
a diagnostic evaluation can be provided by a qualified mental health care
The Cerebellum professional or physician who gathers information from multiple
sources.
Brain disorder that affects both the structure and function of the brain. Diagnostic tests
- PHYSICAL EXAM (including vision and hearing test)
Brains of people with ADHD are smaller in certain areas- especially in - PSYCHIATRIC ASESSMENT
Short frontal lobe, affecting impulse, concentration, and inhibition. The neural
Pathophysiology - Neuropsychiatric EEG-Based Assessment Aid (NEBA) System
pathways do not connect and mature at the same time, making it harder - Noninvasive scan that measures theta and beta brain waves.
to pay attention and focus. There is also trouble processing dopamine
that impacts the brain chemistry. - Behavioral therapy (may use play therapy or talk therapy)- to
Medical communicate their experiences and feelings through play. Talk
Characterized by:
s/s Management therapy uses verbal communication between the client and a
Hyperactivity therapist to treat mental and emotional disorders.
- Psychosocial Interventions
Good luck! – From Popcorn Gorls “O Lord grant us success.” – Psalm 118:25
 - Cognitive Therapy for adults - Altered thought processes related to personality disorders.
- Exercise & Concentration and Focus Building Techniques - Risk for parental role conflict related to children with attention
(Activities, e.g., picture puzzle, mazes) deficit hyperactivity disorder.
- Medication - Risk for injury related to psychological (orientation ineffective).
- Risk for delay in growth and development related to mental
Drugs include: illness (hyperactivity), lack of concentration.
PSYCHOPHARMACOLOGY
- Ensure safety of client and that of other.
- Use to reduce hyperactivity, inattentiveness, - Improved role performance.
- impulsivity and liability of mood. - Simplifying instructions/ directions.
Nursing
CYLERT (pemoline) - Structured daily routine
Implementations
*Establish a daily schedule.
- Last drug to be prescribed due to its hepatotoxicity *Minimize changes.
- (liver damage). - Client/ family education and support
ADDERAL (Amphetamine)
- Instruct patient and family to be safe when administering or
RITALIN (Methylphenidine) giving take-home medicines
DEXEDRINE (Dextroamphetamine) - Follow schedule of medicines
- Encourage pt to go to counselling sessions
Drug Study - Side effects: loss of appetite, weight loss, irritability & Increase - Encourage client to perform concentration and focus building
self-injury during the highest dose wk. techniques
STRATTERA (Atomaxetine) - Avoid Multitasking. Staying focused and on task is necessary in
Discharge Plan
order to get work completed
- Non-stimulant drug approved in 2002.
- Encourage client to eat a healthy diet
- An antidepressant (SSRI).
- Encourage client to lower stress
- Side effects: loss of appetite, n/v, fatigability,
- Instruct client to avoid alcohol drinking and smoking or using
- abdominal distress.
illegal drugs
OTHER DRUGS: - Encourage and advise client to ask help from friends and family
- TCA when needed
- Alpha 2 agonists (clonidine & guanfacine)
- Traditional antipsychotic drugs – severe
ALCOHOLISM
impulsiveness. Alcoholism is an addiction to drinking alcohol.
Alcoholism is defined by alcohol dependence, which is the body's physical inability to stop
- Defensive coping related to feelings of inadequacy and need for
drinking and the presence of alcohol cravings.
Nursing Dx acceptance from others.
- Impaired social interaction related to developmental disabilities Anatomy Central Nervous System
(hyperactivity).
Good luck! – From Popcorn Gorls “O Lord grant us success.” – Psalm 118:25
 Alcohol interacts with the brain receptors, interfering with the
communication between nerve cells, and suppressing excitatory nerve
Short
pathway activity. Neuro-cognitive deficits, neuronal injury, and
Pathophysiology
neurodegeneration are well documented in alcoholics, yet the underlying
mechanisms remain elusive.
With intoxication, there is slurred speech, unsteady gait, lack of
coordination, and impaired attention, concentration, memory, and
judgment. Some people become aggressive or display inappropriate
sexual behavior when intoxicated.
s/s
Overdose of alcohol:
- Decreased Respiration and blood pressure
- Vomiting that may cause respiration
- Unconscious
A diagnostic evaluation can be provided by a qualified mental health
care professional or physician who gathers information from multiple
sources.
- PHYSICAL EXAM
- PSYCHOILOGICAL EVALUATION
Diagnostic tests - DSM-5 CRITERIA
- LABORATORY AND IMAGING TEST- there are no specific
tests to diagnose alcohol use disorder, certain patterns of lab test
abnormalities may strongly suggest it. And you may need tests to
identify health problems that may be linked to your alcohol use.
Damage to your organs may be seen on tests.
- Withdrawal and Detoxification- marked reduction of alcohol
intake; Because alcohol withdrawal can be life-threatening,
detoxification needs to be accomplished under medical
supervision.
Medical
- Psychological Counseling
Management
- Continuing Support- Aftercare programs and support groups help
people recovering from alcohol use disorder to stop drinking,
manage relapses and cope with necessary lifestyle changes.
- Medications
Good luck! – From Popcorn Gorls
Drugs include:
Drug Study o Lorazepam (Ativan) and Chlordiazepoxide (Librium) - use for
alcohol withdrawal
o Disulfiram (Antabuse)- Maintains abstinence for alcohol
- Ineffective Denial: Unsuccessful attempt to ignore or minimize
reality of events or situations that are unpleasant to confront
- Ineffective individual coping (negative role modeling;
inadequate support systems)
- Powerlessness (related to substance addiction, lifestyle of
Nursing Dx helplessness)
- Imbalanced nutrition: less than body requirements (related to
Insufficient dietary intake to meet metabolic needs for
psychological, physiological, or economic reasons)
- Sexual Dysfunction (Altered body function: Neurological
damage and debilitating effects of drug use (particularly alcohol
and opiates)
- Give the client and significant others information about
alcoholism in a matter-of-fact manner. Do not argue but dispel
myths.
- Avoid the client’s attempts to focus only on external problems
(such as marital or employment problems) without relating them
to the problem of alcoholism.
- Encourage the client to identify behaviors that have caused
Nursing
problems in his or her life
Implementations
- Positively reinforce the client when he or she identifies or
expresses feelings or shows any insight into his or her behaviors
or consequences
- Consistently redirect the client’s focus to his or her own
problems and to what he or she can do about them.
- Encourage other clients in the program to provide feedback for
each other
- Encourage pt to go to counselling sessions
Discharge Plan - Encourage client to do exercises
- Encourage client to eat a healthy diet
“O Lord grant us success.” – Psalm 118:25
 - Encourage client to lower stress increases urge to perform compulsion again, and a vicious
- Instruct client to avoid and stop alcohol drinking circle is thus maintained
- Encourage and advise client to ask help from friends and family - May function as means of avoiding discomfort
when needed Avoidance: not part of definition of OCD, its consider integral part
- Follow the medication regimen as ordered of disorder and seen in fears of contamination
S/sx - Fear of germs or contamination
- Unwanted forbidden or taboo thoughts involving sex,
OBSESSIVE COMPULSIVE DISORDER religion, and harm
Characterized by pervasive pattern of preoccupation with perfectionism, mental and - Aggressive thoughts towards others or self
interpersonal control, and orderliness at the expense of flexibility, openness, and - Religious obsessions such as having things symmetrical or
efficiency in a perfect order
Anatomy Frontal lobe- responsible for working memory and goal-oriented Diagnostic Test - Toxicology screen
behavior, sends a signal through striatum - CT scanning
Striatum- passes the signal on or acts like a brake and inhibits it - Radiography
Thalamus- which in part control subconscious movements, Treatment - Psychotherapy- aims to improve perceptions of and
receives the signal from the striatum and sends it back to frontal responses to social and environmental stressors
lobe. If signal is too “loud”, it can disrupt activity there - Inpatient care
Psycho patho Obsessions: unwanted intrusive thought, image, or urge that - Transfers- generally shorter than 2 weeks, may require
repeatedly enters one’s mind, core appraisals in OCD is over- transfer to psychiatric hospitals that can provide long-
inflated sense of responsibility for harm or its prevention. term care
Appraisal that harm might occur to the person, a loved one, or Drug Study - No drug is usually prescribed
another vulnerable person through what person might do or fail - Anxiolytics-
to do - benzodiazepine
- Antidepressants: SSRI’s and TCA’s- Clomipramine,
- Emotional consequences of an obsession are difficult for fluoxetine, fluvoxamine, and paroxetine
some patients to articulate and often described as
“discomfort” or distress, people with OCD believe they Nursing Dx Risk for suicide related to low frustration tolerance
might be responsible for preventing harm or catastrophe Risk for self-mutilation related to impulsive behavior
in future, and main emotion is anxiety Ineffective coping related to failure to learn or change behavior
based on past experience
Compulsions: repetitive behaviors or mental acts that the person Implementation - Promote client’s safety
feels driven to perform, can be overt and observed by others or - Promoting therapeutic relationship
covert mental act that cannot be observed - Establishing boundaries in relationship
- An early experimental study of Rachman and Hodgson - Teaching effective communication skills
established that compulsions are reinforcing because they - Helping clients to cope and to control emotions
seem to work and reduce discomfort in short term, it - Reshaping thinking patterns
- Structuring the client’s daily activities
Good luck! – From Popcorn Gorls “O Lord grant us success.” – Psalm 118:25
 Discharge Plan - Assist client in planning the rest periods between planned Implementation - Provide for pt’s physical needs
activities and rituals - Plan activities for times when pt’s energy peaks
- Support system available, specific referrals made, and - Assume active role in initiating communication
who is responsible for actions to be taken - Educate patient about depression
- Ask patient whether they think about death or suicide
- Stress the need for medication compliance
MAJOR DEPRESSIVE DISORDER Discharge Plan - Support system available, specific referrals made, and
Classified under mood disorder which are characterized by disturbances in who is responsible for actions to be taken
regulation of mood, behavior, and affect that go beyond normal fluctuations
Anatomy Amygdala- very active when someone is sad/depressed, high
activity continues
Thalamus- relays info from senses to other parts of the brain
than direct behavior and thinking.
Hypothalamus- “fight or flight”, releasing and controlling levels of
stress hormones, such as adrenaline and cortisol
Psycho patho - Genetic causes: family history is a potential cause that
may increase risk of developing condition
S/sx - Depressed mood
- A hedonism
- Weight changes, changes in sleep pattern, agitation or
psychomotor retardation
- Tiredness, worthlessness or guilt, difficulty thinking, and
hopelessness
Diagnostic Test - Beck depression inventory
- Dexamethasone suppression test
- Toxicology screening
- Diagnosis is confirmed if DSM-V-TR criteria is met
Treatment - Psychotherapy
- Electroconvulsive therapy
- Simulation techniques
Drug Study - Citalopram, paroxetine, and sertraline (first-line
treatment for patient’s w/ depression)
- Atypical depressants- bupropion and mirtazapine
Nursing Dx - Ineffective coping related to situational or malnutritional
crisis
- Hopelessness related to long-term stress
- Fatigue related to stress and anxiety
Good luck! – From Popcorn Gorls “O Lord grant us success.” – Psalm 118:25