PSYCHOTIC

ASPECT OF PSYCHIATRIC MEDICAL

CARE REHABILITATION REHABILITATION
FOCUS Wellness and Disease, illness,
DISORDERS health NOT
symptoms
and symptoms

BASIS Person’s abilities Person’s

MENTAL ILLNESS and functional disabilities and
 A state of imbalance characterized by a behavior intra-psychic
disturbance in a person’s thoughts, feelings and functioning
behavior SETTING Caregiving in Treatment in
 A mental disorder or condition manifested by natural setting institutional setting
disorganization and impairment of a function that RELATIONSIP Adult to Adult Expert to Patient
arises from various causes such as psychological, relationship relationship
neurobiological, genetic and organic factors. MEDICATION Medicate as Medicate until
appropriate and symptoms are
CRITERIA OF MENTAL ILLNESS tolerate some controlled
1) Dissatisfaction with one’s characteristics, illness
abilities, and accomplishments DECISION Case management Physician makes
2) Ineffective or unsatisfying interpersonal MAKING in partnership with decisions and
relationships client prescribes
3) Dissatisfaction with one’s place in the world treatment
4) Ineffective coping or adaptation EMPHASIS Strengths, Dependence and
Self-help, and Compliance
PERSONITY CHARACTERISTICS Interdependence
1) Unaccepting of self and dislikes self
2) Has unrealistic perception of strengths and SCHIZOPHRENIA
weaknesses  A group of psychotic reactions that affect multiple
3) Thoughts and perceptions may not be reality areas of an individual’s functioning that includes:
based a) Thinking and communicating
4) Unable to find meaning and purpose in life b) Perceiving and interpreting reality
5) Lacks direction and productivity in life c) Feeling and demonstrating emotions
6) Has difficulty in meeting own needs d) Behaving in a socially acceptable manner
7) Depends on others for thoughts and actions
BLEULER 4 A’S OF SCHIZOPHRENIA
MISCONCEPTIONS ABOUT MENTAL ILLNESS 1) ASSOCIATIVE LOOSENESS
1) Abnormal behavior is different or odd and easily  Lack of logical thought leading to chaotic and
recognized disorganized thinking
2) Abnormal behavior can be predicted and 2) AFFECTIVE DISTURBANCES
evaluated  Flat, blunted and socially inappropriate affect or
3) Internal forces are responsible for abnormal feeling tone
behavior 3) AMBIVALENCE
4) People who exhibit abnormal behavior are  Presence of strong conflicting feelings leading to
psychic immobility
dangerous
4) AUTISTIC BEHAVIOR
5) Maladaptive behavior is always inherited
 Extreme retreat from reality leading to psychotic
6) Mental illness is incurable though processes

POPULATION AT RISK FOR MENTAL ILLNESS ETIOLOGY OF SCHIZOPHRENIA:

1) Familial or Genetic predisposition to mental  UNKOWN
illness  No single etiologic factor
2) Poor access to health care  THEORIES OF CAUSATION
3) Disadvantaged (homeless and poor) 1) Genetic Theory
4) Misusing substances 2) Psychodynamic Theory
5) Undergoing lifestyle changes 3) Neurobiological Theory
6) Victims of violence 4) Organic Theory
7) Elderly poor
OTHER POSSIBLE REASONS WHY ONE DEVELOPS BASIC NURSING INTERVENTION FOR AGITATION
SCHIZOPHRENIA 1) Remove cause of stimulation
1) Persistent faulty reaction to the environment; use 2) Eliminate stimulants
of faulty coping mechanisms (A. Meyer) 3) Set limits
2) Ego is weak, unable to integrate (S. Freud) 4) Monitor physical discomforts
3) Poor mother-child relationship (H. Sullivan) 5) Administer drugs as ordered.
6) Do not display anger and frustration
PRE-PSYCHOTIC PERSONALITY 7) Do not discourage
 Schizoid Personality Disorder 8) Do not criticize
9) Do not argue
OBJECTIVE BEHAVIORAL DISORDERS IN
SHIZOPHRENIA BASIC NURSING INTERVENTION FOR DELUSIONS
1) Alterations in personal relationships 1) Explain all procedures
2) Alterations of activity 2) Provide personal space
3) Maintain eye contact
SUBJECTIVE BEHAVIORAL DISORDERS IN 4) Provide consistency (cornerstone of TRUST)
SHIZOPHRENIA 5) Set realistic goals
1) Alterations in perception 6) Do not touch without warning
2) Alteration of thought 7) Do not whisper or laugh in the presence of the
3) Alteration of consciousness client (e.g. Idea of Reference)
4) Alteration of affect 8) Do not argue, disprove delusions
9) DO not reinforce delusions
CLASSIFICATION 10) Present logical argument
1) CATATONIC
 Rigid or stupor posture BASIC NURSING INTERVENTION FOR
 Waxy flexibility HALLUCINATIONS
 Mute 1) Decrease environmental stimuli
 Echolalia 2) Identify contributory factors
2) DISORGANIZED (HEBEPHRENIA) 3) Monitor command hallucinations
 Chronic schizophrenia 4) Be alert to non-verbal stimulation
 Severely depressed 5) Present reality
3) PARANOID 6) Do not participate in the hallucination process
 Dangerous; cannot determine what the
person is thinking (-) NEGATIVE SYMPTOMS
 Delusions of persecution  Absence of those that normal people exhibit
 NURSING CONSIDERATION:  CHRONIC onset
a) Have passive friendliness  Prognosis is POOR
4) UNDIFFERENTIATED  Effective: ATYPICAL antipsychotics (e.g.
 Manifestations are combination of other Clozapine, Resperidone)
classifications of schizophrenia  MANIFESTATIONS:
1) Flat affect
(+) POSITIVE SYMPTOMS 2) Avolition (decreased motivation)
 Present symptoms that normal people do not 3) Anhedonia (lack of pleasure)
exhibit 4) Attention impairment
 ACUTE onset 5) Anergia (no energy)
 Prognosis is GOOD 6) Alogia (lack of spontaneity and flow of
 Effective on TYPICAL antipsychotics (e.g. conversation)
Haloperidol) 7) Poor eye contact
 MANIFESTATIONS:  MANAGEMENT
1) Delusion  GENERAL CONSIDERATIONS
2) Hallucination 1) Continuity of care is important
3) Pressured Speech 2) Level of care depends on the severity of
4) Disorganized Behavior symptoms, availability of family and
social support
 3) Case management approach is important NURSING PRIORITY: Alteration In Nutrition Less
because client care is generally long term. Than Body Requirements
4) Brief psychiatric hospitalization 1) Meet physiologic needs (#1 Priority)
(Management of acute symptoms) 2) High caloric, high vitamins diet
a) Pharmacologic treatment 3) Finger foods and fluids
b) Milieu Management a) Sandwich
c) Supportive therapy b) French fries
d) Psycho-education for client and 4) Non-stimulating environment
family 5) Non-competitive solitary activities
e) Discharge planning a) Hiking
5) LONG TERM psychiatric hospitalization b) Camping
a) Used for client with persistent c) Gardening
symptoms d) Outdoor yoga
b) May pose a danger to self or others e) Walking
6) Community-based treatment
a) Supportive housing NURSING PRIORITY: Impaired Social Interaction
b) Day treatment programs 1) Promote adaptive coping
c) Supportive therapy 2) Set limits
d) Psycho-education programs 3) Provide meaningful interaction
e) Outreach services 4) Avoid judgment

MOOD DISORDERS NURSING PRIORITY: Ineffective Coping

 Affects a person’s emotional state 1) Therapeutic nurse-client relationship by kind,
 A disorder in which a person experiences long firm consistent, honest approach
periods of extreme happiness, extreme sadness,
or both. SYMPTOMS OF MAJOR DEPRESSION
1) Feeling sad most of the time r nearly every day
DEPRESSION 2) Lack of energy or feeling sluggish
 Grief or sadness is a typical response 3) Feeling worthless or hopeless
 Death of a spouse or family member 4) Loss of appetite or overeating
 Loss of a job 5) Weight gain or weight loss
 Major Illness 6) Loss of interest in activities that formerly brought
enjoyment
DIAGNOSTIC CRITERIA FOR DEPRESSION 7) Hypersomnia or Insomnia
 Is an emotional state characterized by: 8) Frequent thoughts about death or suicide
a) Sadness 9) Difficulty of concentrating or focusing
b) Discouragement
c) Guilt OTHER FORMS OF DEPRESSION
d) Decreased Self-esteem 1) Post-Partum Depression
e) Helplessness 2) Seasonal Affective Disorder (common in winter
f) Hopelessness season)
3) Psychotic Depression
DIAGNOSTIC CRITERIA FOR MANIA 4) Depression related to medical condition,
 Is an emotional state characterized by: medication or substance abuse
a) Elation
b) High Optimism BIPOLAR DISORDER
c) Increased Energy  Defined by swings in mood from periods of
d) Exaggerated sense of importance and depression to mania
invincibility  Depressive episodes with manic episodes or
mania
IMPACT OF MOOD DISORDERS  During a manic episode, a person may feel elated
1) May become CHRONIC and INCAPACITATING or can also feel irritable or have increased levels
without appropriate intervention of activity.
2) Client may not seek treatment
BIPOLAR I DISORDER
 MOST SEVERE form MANAGEMENT FOR DYSTHYMIA:
 Manic episodes last at least 7 days or maybe 1) Antidepressants
severe enough to require hospitalization a) SSRIs
 Depressive episodes will also occur, often lasting b) TCAs
for at least 2 weeks. c) MAOIs
2) Mood Stabilizers
BIPOLAR II DISORDER a) Lithium
 Causes cycles of depression similar to those of 3) Antipsychotics
Bipolar I 4) Psychotherapy
 Experiences HYPOMANIA (less severe form of a) Talk Therapy
mania) b) Cognitive Behavioral Therapy
 Able to handle daily responsibilities and does not c) Interpersonal Therapy
require hospitalization d) Problem-Solving

SYMPTOMS OF BIPOLAR DISORDER

1) Feeling extremely energized or elated
2) Rapid speech or movement
3) Agitation, restlessness, or irritability
4) Risk-taking behavior, such as spending too much
money or driving recklessly
5) Unusual increase in activity or trying to do too
many things at once
6) Racing thoughts
7) Insomnia or Troubled sleeping
8) Feeling jumpy or on edge for no apparent reason

CYCLOTHYMIA
 A MILDER FORM of bipolar disorder
 Experience continuous irregular mood swings
 From mild to moderate emotional “highs” to mild
to moderate “lows”
 Changes is mood can occur quickly and at any
time
 Only short periods of normal mood
 For an adult to be diagnosed with cyclothymic,
symptoms have to be experienced for at least 2
years.
 For children and adolescents, symptoms must
be persisting for at least 1 year.

DYSTHYMIA
 PERSISTENT depressive disorder
 CHRONIC form of depression (can last for at
least 2 years)
 Symptoms may occasionally lessen in severity
during this time.
 RISK FACTORS:
1) Family history
2) Previous diagnosis of mood disorder
3) Trauma, stress or major life changes in the
case of depression
4) Physical illness or use of certain medications
5) Brain structure and function in the case of
bipolar disorder