Don Remedios Trinidad Romualdez Medical Foundation

Calanipawan Road, Tacloban City, Leyte 6500

College of Nursing

BRIEF
PSYCHOTIC
DISORDER
GROUP I
Sawa-an, Jazzel C.

Sevilla, Andrea Marie B.

Subito, Jenna P.

Siat, Maria Angelica

Tabuyan, Athena E.

Tirona, Ma. Theressa E.

Torregosa, Alvin T.

Torrejos, Trisha Moreiny O.

Trinidad, Servell Steven Leonard C.

Ursua, Jancis A.

Velasquez, Esther Angeli M.

 I. ABOUT THE DISEASE

OVERVIEW OF THE DISEASE

Brief psychotic disorder occurs when a client experiences the sudden onset of at least
one psychotic symptom, such as delusions, hallucinations, or disorganized speech or behavior,
which lasts from 1 day to 1 month, and there is an eventual full return to the premorbid level of
functioning. Evidence of impaired reality testing may include incoherent speech, delusions,
hallucinations, bizarre behavior, and disorientation. The episode may or may not have an
identifiable stressor or may follow childbirth.

There are three basic forms of brief psychotic disorders:

1. Brief psychotic disorder with obvious stressor (also called brief reactive
psychosis):
➢ This type happens shortly after a trauma or major stress, such as the death of a
loved one, an accident, assault, or a natural disaster. It's usually a reaction to a
very disturbing event.
2. Brief psychotic disorder without obvious stressor
➢ With this type, there is no apparent trauma or stress that triggers it.
3. Brief psychotic disorder with postpartum onset
➢ This type only happens in women, usually within 4 weeks of having a baby.

EARLY WARNING SIGNS

Typically, a person will show changes in his or her behaviors before brief psychotic disorder
develops. The list below includes several early warning signs

● Worrisome drop in grades or job performance

● New trouble thinking clearly or concentrating
● Suspiciousness, paranoid ideas or uneasiness with others
● Withdrawing socially, spending a lot more time alone than usual
● Unusual, overly intense new ideas, strange feelings or having no feelings at all
● Decline in self-care or personal hygiene
● Difficulty telling reality from fantasy
● Confused speech or trouble communicating

SIGNS AND SYMPTOMS

The most obvious ones include:

● Hallucinations: Someone might hear voices, see things that aren't there, or feel
sensations on their skin even though nothing is touching their body.
● Delusions: These are false beliefs that someone refuses to give up, even in the face of
facts.

Other signs and symptoms are:

● Disorganized thinking
● Speech or language that doesn't make sense
● Unusual behavior
● Problems with memory
● Disorientation or confusion
● Changes in eating or sleeping habits, energy level, or weight
● Not being able to make decisions

NURSING MANAGEMENT:
Because of the short duration of brief psychotic disorder, treatment is brief and focused on
being as nonrestrictive as possible. However, it remains clinically imperative to prevent patients
from harming themselves or others. Accordingly, patients experiencing an acute psychotic
attack may have to be hospitalized briefly so that they can be evaluated and their safety
ensured. If a patient becomes aggressive and combative, brief seclusion or restraint may be
necessary.

Psychotherapeutic management of BPD would involve medically informing the patient and
his/her family about the condition and treatment modalities employed for the particular patient.
Along with emphasizing reintegration into the societal milieu, it is essential to focus on
managing comorbid disorders or stressors and improving overall coping skills.

During the treatment process, the patient should be monitored on a long-term basis to assess
for relapse or the presence of residual symptoms that may necessitate referral to a specialist. It
is essential to support the patient to maintain medication adherence as a lack of adherence may
facilitate symptom relapse.

CAUSATIVE FACTOR

Experts don’t know what causes brief psychotic disorder. It is possible there is a genetic
link since the condition is more common in people who have a family history of psychotic or
mood disorders, such as depression or bipolar disorder.

Another theory suggests that poor coping skills could trigger the disorder as a defense
against or escape from a very frightening or stressful situation.

In most cases, the disorder is triggered by a major stress or traumatic event. For some
women, childbirth can be a trigger.

RISK FACTORS:

● Certain personality traits and disorders (most commonly histrionic, narcissistic, paranoid,
schizotypal, and borderline personality disorders)
● Gender (women are slightly more likely than men to develop brief psychotic disorder)
● Dysfunctional coping skills
● Family history of brief psychotic disorder and other mental health disorders

COMMON MEDICATION

Antipsychotics, especially second-generation, are the first-line treatment for brief psychotic
disorder.

1. Second-generation or atypical antipsychotics: Quetiapine, paliperidone, olanzapine,

risperidone, aripiprazole, ziprasidone, and clozapine
2. First-generation or typical antipsychotics: Trifluoperazine, fluphenazine, haloperidol,
chlorpromazine, and thioridazine
3. Benzodiazepines

STATISTICS

Reliable data on the frequency of brief psychotic disorder are not available, mostly
because of its low incidence and variation based on the population under study. However,
increased frequency of the disorder generally occurs in populations known to be under high
stress such as immigrants, refugees, earthquake victims, etc. A study researching the Finnish
population found the prevalence of brief psychotic disorder to be 0.05%. Another study in rural
Ireland found 10 cases of BPD among 196 first-admission psychosis cases.

Compared to developed countries, reports show a higher incidence of brief psychotic

disorder in developing countries. Data drawn from the World Health Organization Determinants
of Outcome Study also found that the incidence of BPD in developing countries was ten times
as much as that in industrialized countries. BPD is also thought to be more common in women
and those with a personality disorder.

SURVIVAL RATE AND PROGNOSIS

Given the nature of this condition, the prognosis is considerably well with complete remission of
symptoms within a month per definition based on DSM-5 criteria. However, prognosis is notably
worse for individuals diagnosed with BPD who have then been able to meet criteria for other
disorders characterized by psychosis.

DIAGNOSIS

A diagnosis of brief psychotic disorder can only be made retrospectively after the symptoms
have remitted within one month of presentation, as the symptoms of psychosis may otherwise
be an early manifestation of another disorder with a psychotic component.

DSM-5 : Brief Psychotic Disorder

A. Presence of one (or more) of the following symptoms. At least one of these must be (1), (2),
or (3):

1. delusions
2. hallucinations
3. disorganized speech (e.g., frequent derailment or incoherence)
4. grossly disorganized or catatonic behavior

Note: Do not include a symptom if it is a culturally sanctioned response pattern.

B. Duration of an episode of the disturbance is at least 1 day but less than 1 month, with
eventual full return to premorbid level of functioning.

C. The disturbance is not better explained by major depressive or bipolar disorder with
psychotic features or another psychotic disorder such as schizophrenia or catatonia, and is not
attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or
another medical condition.

ANATOMY AND PHYSIOLOGY

The pathophysiology of BPD is not known, especially given the extremely low incidence
of the disorder. Its higher prevalence among patients with personality or mood disorders may
suggest underlying biological or psychological susceptibility which may have some genetic
influence. The dopamine hypothesis is believed to be related to different disorders of psychosis.
Scientists have conducted a lot of research into the effects of psychosis on the brain and the
brain changes that may trigger psychotic episodes. They believe that the neurotransmitter
dopamine plays a key role.

A neurotransmitter is a chemical agent that nerve cells use to transmit information to

other nerve cells or muscle or gland cells. Dopamine modulates many brain functions, with
dopamine pathways regulating motor control, motivation, interest, reward and activities such as
walking and talking. Impairment of such brain functions may underlie the symptoms of
psychosis. Evidence that has led researchers to posit “the dopamine hypothesis” in conditions
such as schizophrenia, bipolar disorder, and other psychosis disorder is based on several
sources, including studies of brain scans and drugs that affect dopamine levels in the brain.
DEMOGRAPHIC DATA

Patient’s Name : J.S.

Sex : Female
Age : 17 years old
Time and Date of Admission : 08/09/22 at 9:00 P.M
Attending Physician : May Bernadette Egloso-Alas
Birthplace : IOS, Davao Del Norte
Permanent Address : SOS Village, Brgy. 94 (Tigbao), Tacloban City, Leyte
Nationality : Filipino
Religion : Roman Catholic
Marital Status : Single
Educational Attainment : Senior High School
Occupation : Student
Mother : Merlie N. Sangalang
Father : Joel N. Sangalang
Health Care Financing : PhilHealth
Classification : Sponsored - POS - Financially Incapable
Source of Medical Care : EVMC
Hospital Number : 00340587
Chief Complaint:
 “Kay bangin mayda ako kato” - patient
 “Naging agresibo hiya, diri hiya mapakali, nagtitinuok ngan nag yiyinakan hiya na hiya la
nausa, gusto na patyon an iya SOS mother” - SOS social worker
Admitting Diagnosis : Brief Psychotic Disorder

IDENTIFYING DATA

J.S, 17 year old Filipino, female, single, born September 15, 2004, Iglesia ng
Makapanyarihang Diyos, right handed, originally from Davao and currently residing at Brgy. 94
Tigbao, Children’s SOS Village, Tacloban City. Patient came in for the first time for a psychiatric
consult on August 6, 2022.
HISTORY OF PRESENT ILLNESS

1 WEEK PTA: Aggressive behaviors started to be evident when the patient’s older sister left for
Davao del Sur to join their religion, which was unusual for them to see from the patient. When
her sister was still in the city, they would lock themselves in the bathroom, and refused to eat
and drink.

5 DAYS PTA: Patient mentioned “Maul-ol iya lawas”. Her house mother offered OTC
medications but she refused in taking them because she believed that God will heal her.

4 DAYS PTA: Patient would always read the bible. When the bible is being taken away from
her, she would get angry and irritated. She once kicked the house mother in the genital 3 times.
She did not want to talk to her house mother, and patient gets easily irritated and does not want
to be lectured. But she apologized in the end. She once saw her deceased brother in the
bathroom, saying that he will always be with her.

3 DAYS PTA: Her social worker decided for a check-up at EVMC and was assessed by the
pediatrician. They were waiting for their laboratory results. No medications were given.

2 DAYS PTA: Patient asked permission for dressmaking training but according to the other
participants she was not seen during the activity. She was seen under the stage crying, reading
the bible, and was talking to herself. She also once told her SOS sibling that it’s going to be the
end of the world, and the Lord will come soon.

1 DAY PTA: Patient was eager to go outside of the house. She wanted to go back to Davao
where her older sister was. “Nadiri ako kan nanay” was verbalized because she wanted their
previous house mother who already retired. She also told her siblings in the evening that
wanted to kill nanay.

PAST FEW DAYS: Patient refused to eat nor drink in their house because she thinks their
house mother poisons their food, showing a sign of persecutory delusion, which is also the
reason why she wants to leave the house. She also shows signs of referential delusion, like
when a person in the radio said “mayda niya TB”, she responded “hino nayakan na mayda ko
TB?” and she wanted to seek consultation for TB. Their village director was also willing to bring
the patient to Davao if she will behave.

PAST PERSONAL HISTORY

Patient did not have any problems at birth. No known childhood illnesses. No previous
surgeries, and accidents. No known allergies.

FAMILY HISTORY

Currently her mother, is unable to manage her children because she is mentally incapacitated.
While her father, is deceased. Cause of death was not mentioned. Patient have 4 other older
siblings. The eldest, 24 years old apparently well. The second, who died at the age of 21 due to
kidney disease. The third is, 20 years old, and the fourth, , 18 years old who are both apparently
well.

None of the family members have a chronic illness or diseases like, blood related disorders,
heart diseases, liver disease, etc.

DEVELOPMENTAL AND SOCIAL HISTORY

Birth and infancy: Patient was the youngest child among the 5 Sangalang siblings. She was
delivered normally by her mother through the supervision of a midwife.

Childhood: She was admitted at SOS Children’s Village at the age of 3 years old because her
biological father and mother were unable to provide her and her other siblings with their basic
needs and education. Her mother has been mentally incapacitated since then. When Julie was
brought to Tacloban City, she was a happy child and all her basic needs were given and
provided.

Adolescence: Patient is a senior high school student. She is observed to be an average learner
in school. She is one of the achievers in her section. As she enters adolescence, her SOS
mother starts to orient her for basic teenage changes. She had a close relationship with her
sister. They spent free time reading the bible and worshipping God.

PHYSICAL EXAMINATION

A. GENERAL
Patient is a 17 year old female who is awake and coherent, who looks physically
healthy. She is well-groomed and dressed with clean clothes. She is able to move
independently, but moves in a slow motion. Patient responds in a soft volume in a
soft tone. Tie marks and wound seen on both wrists.
B. VITAL SIGNS
Vital signs taken and are as follows:
TEMPERATURE: 37.1 (degrees Celsius)
O2 SATURATION: 96%
HEART RATE: 131 bpm
RESPIRATORY RATE: 20 cpm
BLOOD PRESSURE: 110/80
C. SKIN, HAIR, AND NAILS
Skin is brown, soft, and intact. Scratches and wound marks found on both wrists.
Client has no odor of perspiration. Hair is fixed, black, smooth, and firm. Fingernails
 are thin and pinkish in color. Capillary nail beds in both hands refills less than 3
seconds.
D. HEAD AND NECK
Head is symmetric, hard, smooth, and oval in shape. No masses or depression on
the head noted. Temporal artery is elastic and non-tender. Neck is symmetric with
head centered. Trachea is midline.
E. EENT
Eyeballs are symmetrically aligned without protruding or sinking. Sclera is white.
Upper and lower eyelids close easily and meet completely when closed. Skin on both
eyelids is without redness, swelling, or lesions. Anicteric sclera. No drainage noted
on nasolacrimal duct
Nose and nasal passages are not inflamed. No presence of discharges, tenderness,
and no active lesions.
Lips are pink to pale and moist. No cracks, active lesions, and dryness noted.
F. CHEST AND LUNGS
Above normal breathing pattern at 20 cpm. Accessory muscles not used in support
for breathing. Sternum is positioned midline and straight.
G. HEART
Heart rate is at a quicker pace at 131 bpm, as the client stated she felt anxious at the
time of the interview and examination. No cyanosis noted.
H. BREAST
Was not able to assess nor to observe.
I. ABDOMEN
No tenderness nor pain reported.
J. MUSCULOSKELETAL
Shoulder levels are symmetrical. Muscles are fully developed. Elbows and knees are
symmetric, without any deformities, redness, or swelling. Lower leg is in alignment
with the upper leg. Toes point forward and lies flat.
K. GENITOURINARY
No difficulty upon urination is noted.
 GORDON’S TYPOLOGY OF 11 FUNCTIONAL HEALTH PATTERNS

1. HEALTH PERCEPTION & HEALTH MANAGEMENT PATTERNS

When patient was asked if she feels like she’s healthy, she answered yes and when she
was asked to describe how healthy she is, she did not answer. When patient feels sick, she
does not do anything other than praying to God.
2. NUTRITION AND METABOLIC PATTERNS
Prior to admission, patient refused to eat food and drink water and when she was
admitted, she gets to eat food thrice a day and drink at least 8 glasses of water every day.
Prior to admission, her meals would usually be cooked by her house mother and when she
was admitted, she was given ration meals. Meals would usually consist of rice, vegetables,
and fish or meat. Her appetite has increased ever since she was admitted. There were no
reports of difficulty in swallowing.
3. ELIMINATION PATTERN
Prior to admission, patient urinates at least 4 times a day and defecates once a day.
There were no reports of difficulty in urinating as well as defecating. There have been no
changes in her elimination pattern ever since she was admitted.
4. ACTIVITY – EXERCISE PATTERN
Prior to admission, patient would always read the bible and gets angry when it gets
taken away while during admission, patient would roam around or socialize with other
patients in the ward. She would sometimes sing and play games with other ward patients.
Patient does not exercise prior and during admission.
5. SLEEP AND REST PATTERN
Prior to admission, patient has difficulty in sleeping and keeps on waking up at night.
During admission, she wanders during the night and experiences hallucinations.
6. COGNITIVE AND PERCEPTUAL PATTERN
Patient was able to mention her name correctly, and other personal details. She was not
able to answer where she currently is but was able to answer the current month and year
correctly.
7. SELF-PERCEPTION SELF-CONCEPT PATTERN
Patient sees herself as a creation of God and that she was given the task to spread
God’s word and to take care of God’s creation.
8. ROLE – RELATIONSHIP PATTERN
Patient has 4 siblings and is the closest with her sister, the fourth child. The patient no
longer has any contact with her biological parents ever since she arrived at SOS Children’s
Village. She was sent to the village because both of her parents failed to provide her needs
and her mother also is mentally incapacitated. She was then cared for by their house mother
whom she calls Nanay. Patient has verbalized that she does not like their current house
mother and wanted their former house mother who was already retired.
9. SEXUALITY – REPRODUCTIVE PATTERN
Client does not engage in any sexual activity prior and during admission.
10. COPING STRESS TOLERANCE PATTERN
Patient does not understand the idea of stress and when she feels overwhelmed, she
tries to talk to God.
11. VALUE – BELIEF PATTERN
Client is a roman catholic and considers religion as important. She likes reading the
bible. She also has this belief that the Lord will come soon.
 MENTAL STATUS EXAMINATION

A. APPEARANCE
Client is well-groomed, dressed with clean clothes. Client has a good gait, but appears
to move in a slow motion and slightly slouches.
B. BEHAVIOR
Patient cannot look straight in the eyes when conversing. Was seen fidgeting with
fingers when being interviewed, as verbalized by the patient she was anxious at the
time. She was also able to follow commands, and is able to do things and can manage
herself on her own.
C. ATTITUDE
Client was quite anxious in the beginning of the interview, and was cooperative
throughout the assessment. She even let the interviewers sit in a comfortable position
and feel welcomed. She was focused as well. She keeps up and answers the questions
being asked accordingly.
D. LEVEL OF CONSCIOUSNESS
Client was awake and coherent.
E. ORIENTATION
Client was able to mention her name correctly, and other personal details such as her
birthdate, age, address, and etc. however in the midst of the interview she interrupted
and said she was asked the same question by the previous team, and decided to
proceed to the next questions. When asked as to where she currently is, she was not
able to answer. She was not also certain as what the current date was, but she was able
to answer the month and year correctly.
F. SPEECH AND LANGUAGE
a. Quantity: Patient responds only when being asked. She was at a right amount of
speech.
b. Rate: She speaks at a normal rate
c. Volume: She speaks with a soft tone and volume
d. Fluency and rhythm: Patient has a clear delivery of words with appropriately placed
inflections. She also was somewhat hesitant, because she said she was
embarrassed when talking about religion to other people.
G. MOOD
When patient was asked if she was happy or sad, she answered that she feels both. She
felt happy that she have other people to talk with in the facility. And at the same time sad
because she thinks that there are people who wants to hurt her.
H. AFFECT
Client can show different moods when being conversed with, however with a restricted
affect. She can react or show moods accordingly to the situation but not as wide and
showy.
I. THOUGHT PROCESS OR THOUGHT FORM
When being asked, the patient answers directly.
J. THOUGHT CONTENT
The reason why the patient was anxious when she saw the interviewers bringing a tray
with a green linen was because she is scared being tied up again. Because before she
was admitted to EVMC, both of her hands were tied with a green rope. She also have a
strong belief in God, wherein she trusts everything to God. When she was in the SOS
village, she said that she was bullied or teased by children her age. She also thinks that
our world changed because of “Tiktok” and “Mobile Legends”, thinking that it has a
positive and negative effect. She doesn’t also trust the radio unlike before, as verbalized,
“Yana kay iba na it gin yayakan. Bagat gin iimbestiga ako about hit akon kinabuhi”,
which presents a positive sign for ideas of reference.

K. SUICIDALITY AND HOMICIDALITY

a. Suicidality: patient did not respond
b. Homicidality: She mentioned that she sometimes had a thought of hurting her
house mother because she thinks that she puts poison in their food, and the way she
treats the patient. But she also feels sorry in the end because knows it is wrong and
would disappoint God.
L. INSIGHT AND JUDGEMENT
When asked if she knows why she is in the facility she responded that she doesn’t know.
But when asked what happened in their home before she was admitted, she responded
that she was tied due to her destructive behavior, which caused her to think that maybe
 that was the cause as to why she was admitted. When she commits such acts, she
would talk to God, and ask for guidance.
M. ATTENTION
a. Digit span: Client was able to recite the numbers 1, 7 and 10. And was able to recite
these numbers backwards
b. Spelling backwards: Client was able to spell her name and in backwards correctly.
c. Calculations: Client was able to answer basic calculations such as 5x5, 7-4, 3+4,
25/5, etc. correctly.
N. MEMORY
a. Recent memory: She easily remembered the first interviewer’s name. Then she got
confused with the other 2 female interviewers’ names
b. Remote memory: She remembers as to who the current president is. She only
remembers that date of her grade 6 graduation.
c. Immediate memory: She missed a number on the number sequence the examiner
gave her. (0, 3, 2, 5, 8)
O. INTELLECTUAL
a. Information and vocabulary: Client was given the words “blue, table, and horse”.
She was able to recite these words after 5 minutes.
b. Vocabulary: Client is fluent in waray-waray, and is able to speak and understand
Tagalog.
c. Abstraction
i. Similarities: Patient did not answer.
ii. Proverbs: She preferred not to answer.
 Urinalysis

Si Reference Conentional Reference

Parameters Result Result Implication
Unit Range Unit Range
Light
Color Normal
Yellow
Clarity Clear Normal
pH 6.0 4.6-8.0 Normal
Specific
1.015 Normal
Gravity
Leukocyte Negative <trace 0.00 Normal
Blood Negative <trace 0.00 Normal
Glucose Negative <trace 0.00 Normal
Nitrite Negative <trace 0.00 Normal
Protein Negative <trace 0.00 Normal
Ketone Negative <trace 0.00 Normal
Bilirubin Negative <trace 0.00 Normal
PUS Cells 9 /uL 0-17 1.64 /HPF 0-3 Normal
Red Cells 5 /uL 0-11 0.91 /HPF 0-2 Normal
Squamous
Epithelial 3 /uL 0-17 0.55 /HPF 0-3 Normal
Cells
Bacteria 1 /uL 0-278 0.18 /HPF 0-50 Normal
Amorphous 0.94 Normal
Pregnancy
Negative Normal
Test

Complete Blood Count

Examination Result Unit Reference range Implication

Hemogoblin 138 g/l 120-160 Normal
Hematocrit 0.41 l/l 0.36-0.46 Normal
RBC 4.92 X10^12 4.2-5.4 Normal
WBC 9.83 X10^9/L 4.8-10.8 Normal
Neutrophils 0.63 0.43-0.65 Normal
Lymphocytes 0.23 0.20-0.45 Normal
Monocytes 0.06 0.5-0.12 Normal
Eosinophils 0.01 0.01-0.03 Normal
Basophol 0.00 0-0.01 Normal
MCV 82.30 fL 80-94 Normal
MCH 28.0 pg 27-31 Normal
MCHC 341 g/L 320-360 Normal
Platelet 370 X10^9/L 150-400 Normal
 PATHOPHYSIOLOGY OF BRIEF PSYCHOTIC DISORDER

Psychosis is characterized as disruptions to a person’s thoughts and perception resulting in a loss of

contact with reality. It is a common feature of many psychiatric, neuropsychiatric, neurologic,
neurodevelopmental, and medical conditions. It is the hallmark feature of schizophrenia spectrum and
other psychotic disorders, a co-occuring aspect to many mood and substance-use disorders, as well as a
challenging symptom to many neurologic and medical conditions.

Psychosis may result from a primary psychiatric illness, substance-use, or another neurologic or medical
condition, which includes prenatal and perinatal complications, injuries and child/drug abuse, extreme
stress, sleep deprivation, living alone and lack of support, traumatic experience, family conflict, death of
loved one. Other risk factors may include male patients with ages ranging from 30-45 years old; patients
with a family history of psychotic disorder, commonly a first degree relative; personality disorder, and
inadequate coping mechanism which may lead extreme stress.

Dopamine, a neurotransmitter that controls mental/emotional responses and motor reactions, is most
strongly linked to the pathophysiology of psychotic disorders. The positive symptoms of psychotic
disorders are believed to be caused by excess dopamine in the mesolimbic tract. This increase in
mesolimbic activity results in delusions, hallucinations, and other psychotic symptoms. Decrease in
dopamine transmission in mesocortical projection leads to dopaminergic neuron project into the
cerebral cortex thought to cause negative symptoms.

Primary psychotic disorders such as brief psychotic disorder, schizophreniform disorder, schizoaffective
disorder, delusional disorder or shared delusional disorder are considered neurodevelopmental
abnormalities and believed to develop in utero, although many times the manifestation of psychotic
symptoms and full-blown illness correlate with epigenetic or environmental factors (subtance-abuse,
stress, immigration, infection, postpartum period, or other medical causes).

Secondary psychotic disorders such as Substance-Induced Disorder, is likely when the psychosis begins
following the onset of a medical condition, such as metabolic disorders, head injuries, dementia,
intracranial tumors, or drug and alcohol intoxication or withdrawal, varies in severity of the medical
condition and resolves when the medical condition improves.

In Brief Psychotic Disorder, there is a sudden onset of psychotic symptoms, which lasts from 1 day to 1
month. The episode may or may not have an identifiable stressor or may follow childbirth. The
Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), classifies brief psychotic
disorder as belonging to the category of schizophrenia spectrum and other psychotic disorders.These
disorders are characterized by delusions, hallucinations, disorganized thinking, motor behavior
abnormalities (including catatonia), and negative symptoms.

The disorder is characterized by the abrupt onset of 1 or more of the following symptoms; Delusions,
Hallucinations, Bizarre behavior and posture, and Disorganized speech. Associated symptoms may
include Affective symptoms, Disorientation, Impaired attention, and Catatonic behavior. The specific
DSM-5 criteria must have at least 1 or more of the following symptoms mentioned previously. The
duration of an episode of the disturbance is at least 1 day but less than 1 month, with eventual full
return to premorbid level of functioning. The disturbance cannot be better explained by major
depressive or bipolar disorder with psychotic features or by another psychotic disorder (eg,
schizophrenia or catatonia), nor can it be attributed to the physiologic effects of a substance or
medication or another medical condition.

Management usually involves commonly used antipsychotic medications such as Olanzapine and
Risperidone, which work by blocking dopamine and are considered the first-line treatment for the
disorder. Cognitive Behavioral Therapy is also effective in people with psychotic disorders. Disorganized
and irrational thought processes are common in these conditions and CBT targets the presenting
symptoms.
References:

● https://emedicine.medscape.com/article/294416-overview

● https://www.medicalnewstoday.com/articles/248159#treatment

● https://www.ncbi.nlm.nih.gov/books/NBK546579/#:~:text=Pathophysiology,excitatory

%20neurotransmitter%2C%20is%20also%20implicated.

● https://www.sciencedaily.com/releases/2016/08/160831085320.htm

● https://www.verywellmind.com/the-relationship-between-schizophrenia-and-dopamin

e-5219904#:~:text=The%20most%20common%20theory%20about,hallucinations%2

C%20and%20other%20psychotic%20symptoms.

● https://www.therecoveryvillage.com/mental-health/psychosis/treatment/

● https://www.ncbi.nlm.nih.gov/books/NBK539912/
PHARMACOLOGICAL STUDY
MECHANISM OF
DRUG NAME INDICATIONS CONTRAINDICATIONS
ACTION
Olanzapine Antagonizes  Bipolar Mania Contraindications:
10mg/tab alpha1-adrenergic,  Schizophrenia None known.
(Oral- dopamine,  Agitation
OD@HS) histamine,  Depression Cautions:
muscarinic, Associated with  Pts with benign prostatic
serotonin receptors. Bipolar Disorder hyperplasia, suicidal pts,
Produces decrease GI motility,
anticholinergic, paralytic ileus, urinary
histaminic, CNS retention, glaucoma,
depressant effects. myasthenia gravis, breast
cancer or history of breast
cancer, hepatic impairment,
elderly, concurrent use of
potentially hepatotoxic drugs,
dose escalation, known
cardiovascular disease
(history of MI, ischemia,
heart failure, conduction
abnormalities),
cerebrovascular disease,
conditions predisposing pts
to hypotension (dehydration,
hypovolemia, hypertensive
medications), history of
seizures, conditions lowering
seizure threshold (e.g.,
Alzheimer’s dementia), those
at risk for aspiration
pneumonia.
SIDE/ADVERSE EFFECTS
Side Effects
Frequent: Drowsiness (26%),
agitation
(23%), insomnia (20%),
headache
(17%), nervousness (16%),
hostility
(15%), dizziness (11%), rhinitis
(10%).
Occasional: Anxiety,
constipation (9%);
Nonaggressive atypical
behavior (8%); dry mouth
(7%); weight gain (6%);
orthostatic hypotension, fever,
arthralgia, restlessness, cough,
pharyngitis, visual changes
(dim vision) (5%).
Rare: Tachycardia; back,
chest, abdominal, or extremity
pain; tremor.
Adverse Effects/
Toxic Reactions
Rare reactions include
seizures, neuroleptic malignant
syndrome, a potentially
fatal syndrome characterized
by hyperpyrexia, muscle
rigidity, irregular pulse or
B/P, tachycardia, diaphoresis,
NURSING RESPONSIBILITIES
Before:
 Observe rights of drug administration:
right patient, right drug, right dosage,
right route, right time
 Educate client about the drug, its
purpose and importance
 Assess for possible contraindications
and cautions: history of allergy to reduce
the risk of hypersensitivity reaction
 Perform a physical examination to
establish baseline data before beginning
therapy to determine the effectiveness
of the therapy and to evaluate for the
occurrence of any adverse effects
associated with drug therapy
During:
 Avoid dehydration, particularly during
exercise, exposure to extreme heat,
concurrent use of medication causing
dry mouth, other drying effects.
 Sugarless gum, sips of tepid water may
relieve dry mouth.
 Notify physician if pregnancy occurs or if
there is intention to become pregnant
during olanzapine therapy.
 Take medication as ordered; do not stop
taking or increase dosage.
 Rise slowly from sitting/lying position.
 Avoid alcohol.
 Avoid tasks that require alertness, motor
skills until response to drug is
 cardiac arrhythmias.
Extrapyramidal symptoms
(EPS), dysphagia may occur.
Overdose
(300 mg) produces
drowsiness, slurred speech.
established.
 Monitor diet, exercise program to
prevent weight gain.
After:
 Monitor behavior, appearance,
emotional status, response to
environment, speech pattern, thought
content.
 Monitor B/P, glucose, lipids, hepatic
function tests.
 Assess for tremors, changes in gait,
abnormal muscular movements,
behavior.
 Supervise suicidal-risk pt closely during
early therapy (as depression lessens,
energy level improves, increasing
suicide potential).
 Assess for therapeutic response
(interest in surroundings, improvement
in self-care, increased ability to
concentrate, relaxed facial expression).
 Assist with ambulation if dizziness
occurs.
 Assess sleep pattern.

Notify physician if extrapyramidal symptoms

(EPS) occurs.
Risperidone May antagonize Contraindications: Frequent (26%–13%): Before:
 Psychotic Disorders
2 mg dopamine, None known. Agitation, anxiety, insomnia,  Serum renal function, LFT should be
(Oral- OD) serotonin receptors  Bipolar Mania headache, and constipation. performed before therapy begins.
 Autism
in both CNS and Cautions: Renal/hepatic  Assess behavior, appearance,
periphery. impairment, seizure disorders, Occasional (10%–4%): emotional status, response to
cardiac disease, recent MI, Dyspepsia, rhinitis, environment, speech pattern,
Therapeutic Effect: breast cancer or other prolactin- drowsiness, dizziness, nausea, thought content, baseline weight.
Suppresses dependent tumors, suicidal pts, vomiting, rash, abdominal pain,  Obtain fasting serum glucose.
 psychotic behavior pts at risk for aspiration
pneumonia. Parkinson’s disease,
pts at risk for orthostatic
hypotension, elderly, diabetes,
decreased GI motility, urinary
retention, BPH, xerostomia,
visual problems, pts exposed to
temperature extremes,
preexisting myelosuppression,
narrow-angle glaucoma; pts with
high risk of suicide.
Na Valproate Directly increases Contraindications:
 Seizures
+ Valproic concentration of  Active hepatic disease,
Acid inhibitory  Manic episodes urea cycle disorders,
dry skin, tachycardia.
Rare (3%–2%): Visual
disturbances, fever, back pain,
pharyngitis, cough, arthralgia,
angina, aggressive behavior,
orthostatic hypotension, breast
swelling.
Side effects:
 Abdominal pain,
diarrhea, transient
During:
 Monitor B/P, heart rate, weight, LFT,
EKG.
 Monitor for fine tongue movement
(may be first sign of tardive
dyskinesia, which may be
irreversible).
 Monitor for suicidal ideation. Assess
for therapeutic response (greater
interest in surroundings, improved
self-care, increased ability to
concentrate, relaxed facial
expression).
 Monitor for potential neuroleptic
malignant syndrome: fever, muscle
rigidity, irregular B/P or pulse,
altered mental status.
 Monitor fasting serum glucose
periodically during therapy.
After:
• Avoid tasks that may require alertness,
motor skills until response to drug is
established (may cause dizziness/
drowsiness).
• Avoid alcohol.
• Go from lying to standing slowly.
• Report trembling in fingers, altered gait,
unusual muscular/skeletal movements,
palpitations, severe dizziness/fainting,
swelling/pain in breasts, visual changes,
rash, difficulty breathing.
Before:
 Assess behavior, appearance,
500 mg/tab neurotransmitter  Migraine known mitocondrial alopecia, indigestion, emotional status, response to
(Oral- OD) GABA Headaches disorders nausea, vomiting, environment, speech pattern,
Cautions: tremors, fluctuations in thought content
Therapeutic History of hepatic impairment, body weight  Ensure that you have the right drug,
effect: Produces bleeding abnormalities, pts at Adverse effects: right patient, that the drug was
anticonvulsant high risk for suicide  Hepatotoxicity stored properly, is not expired, and
effect, stabilizes Blood dyscrasias is prepared properly at the right dose
mood, prevents  Explain to the patient as to why he is
migraine headache receiving the drug and how it is
associated with his illness

During:
 May give without regard to food
 Do not mix oral solution with
carbonated beverages
 Make sure that the drug is given at
the right time, at the right frequency,
and at the right route
After:
 Monitor serum LFT, ammonia, CBC
 Question for suicidal ideation
 Asses for therapeutic response
 Avoid tasks that require alertness,
motor skills until response to drug is
established
 Document administration properly
and promptly

Therapeutic serum level: 50-100 mcg/ml

Toxic serum level: >100 mcg/ml
BIPERIDEN It is a tertiary amine For use as an adjunct Contraindications: CNS: confusion, depression, Before:
2mg/tab antimuscarinic with in the therapy of all dizziness, hallucinations,  Assess patient’s diagnosis.
(PRN) central and forms of parkinsonism Hypersensitivity; Angle closure headache, sedation,  Assess patient’s mental status.
peripheral actions. It
and control of
glaucoma; Bowel obstruction; weakness.  Assess patient’s visual acuity.
stimulates and then Megacolon; Tardive dyskinesia. EENT: blurred vision, dry eyes,  Confirm medication from doctor’s
depresses the CNS, extrapyramidal and mydriasis. orders.
 it also has disorders secondary to Cautions: CV: arrhythmias, hypotension,  Assess blood pressure.
antispasmodic neuroleptic drug palpitations, tachycardia.  Confirm patient’s identity.
actions on smooth therapy. Seizure disorders; Cardiac GI: constipation, dry mouth,  Administer medication at the right
muscle and reduces arrhythmias; ileus, nausea. prescribed route.
secretions, esp GU: hesitancy, urinary  Must administer medication with food.
salivary and retention.  Practice aseptic technique.
bronchial secretions. Misc: decreased sweating.  Administer medication at the prescribed
A muscarinic time
receptor antagonist During:
Biperiden targets the  Observe proper documentation of
M1 receptor subtype administered medication.
with a high degree of
 Ensure that patient has fully swallowed
selectivity. It also
oral form of medication.
inhibits the N-
After:
methyl-D-aspartate
 Observe patient’s behavior closely for at
(NMDA) receptor
least 15-30 minutes after administration.
 Instruct patient to move slowly to
prevent dizziness.
 Encourage patient to increase fluid
intake to prevent drying of mouth.

DIPHENHYD Competes with  Nausea Contraindications: None  Occasional: Drowsiness, Before:

RAMINE histamine for  Vomiting known. restlessness, dry mouth,  Assess behavior, appearance,
25 MG/0.5 receptor sites on Cautions: peptic ulcer, bladder hypotension, insomnia emotional status, response to
 Motion Sickness
ML IM effector cells of GI neck obstruction, asthma, (esp. in children), environment, speech pattern,
 treat life-
tract, blood vessels, COPD excitation, lassitude. thought content
threatening allergic
and respiratory Sedation, dizziness,
tract. Depressant reactions hypotension more likely  Ensure that you have the right drug,
(anaphylaxis) right patient, that the drug was
action on noted in elderly.
labyrinthine stored properly, is not expired, and
 Rare: Visual disturbances,
function. is prepared properly at the right
hearing disturbances,
Diminishes paresthesia. dose
vestibular
stimulation.  Explain to the patient as to why he is
receiving the drug and how it is
associated with his illness

During:

 Obtain baseline B/P, pulse rate. Assess

for dehydration if excessive vomiting
has occurred (poor skin turgor, dry
mucous membranes, longitudinal
furrows in tongue).
 Monitor children closely for paradoxical
reaction.
 Monitor serum electrolytes in pts with
severe vomiting. Assess hydration
status.
After:
 Instructed to avoid tasks that require
alertness, motor skills until response to
drug is established.
 Instructed to avoid alcohol.
Sugarless gum, sips of water may relieve
dry mouth.
 Course in the Ward

Date Treatment Medication IVF Diet Diagnostics Special Endorsement Significance

August 9,  Olanzapine 10 mg/tab, 1 tab OD DAT (diet  CBC and PC  Admit to Psychiatry Patient was admitted for being a
2022 HS as  Urinalysis; Ward under the harm to others. Olanzapine and
9:00 A.M.  Sodium Valproate + Valproic tolerated) Pregnancy test service of Drs. Sodium Valproate + Valproic Acid
Acid 500 mg/tab, 1 tab A.M. with SAP  Serum Na, K, Cl, Egloso/Arcamo/Hor were ordered to reduce or prevent
Reason (strict ionized Ca, Mg ca manic episodes. The patient’s diet
for aspiration  AST, ALT  Secure consent for was DAT with SAP because the
admission: precaution)  CXRPA admission and patient was restrained. Laboratory
Harm to  AFB sputum management and diagnostic exams were ordered
others  BUN, Creatinine  Psychoeducation to monitor the general health of the
and supportive patient and to rule out other
 TSH
psychotherapy conditions that may have been
initiated responsible for their symptoms.
 Monitor I&O and Monitoring of I&O and vital signs
vital signs every were ordered. 24 hours responsible
shift adult watcher, strict precautions of
 Strict suicide, suicide, homicide, escape and
homicide, escape, assault, and also restraining were
assault precautions ordered in case the patient does
 Ensure 24 hours harm to self and others.
responsible adult
watcher at all times.
 Will refer to Dra.
Caingnug (Child
Psychiatry
Consultant)

Add:
 May restrain on
deemed necessary
area with consent
 For psychological
testing once
maintained stable
August 10, Continue other
2022 management.
7:30 A.M.
August 11,  Increase Olanzapine 10mg/tab, Follow-up laboratory Refer accordingly. Olanzapine was increased from 1 tab
2022 1 ½ tablet in A.M. results. HS to 1 ½ tablet in A.M. The dosage
7:28 A.M.  Start Risperidone 2mg, 1 tablet and frequency were changed to have
in A.M. a better medication adherence.
 Biperiden 2mg, 1 tablet in A.M. Risperidone was ordered to treat
PRN irritability associated with the
 Continue Divalproex Na 500 disorder. Biperiden was ordered PRN
mg, 1 tab in A.M. to treat extrapyramidal symptoms
such as stiffness, tremors, spasms,
and poor muscle control. Divalproex
was still ordered with the same dose
and frequency.
August 12, Continue medications Follow-up pending Refer accordingly.
2022 lab results.
7:30 A.M.
August 13, Continue medications Refer accordingly.
2022
8:00 A.M.
August 14, Continue medications Refer accordingly.
2022
8:00 A.M.
August 15, Increase Olanzapine 10mg/tab, 2  Continue other Olanzapine was increased from 1 ½
2022 tabs OD HS management. tablet in A.M. to 2 tabs OD HS. The
8:40 A.M.  Refer. dosage and frequency were changed
to have a better medication
adherence. Olanzapine was ordered
to be given at bedtime because one
of its side effects is drowsiness and it
increases the amount of slow-wave
sleep.
August 16, Continue medications Follow-up pending Refer accordingly.
2022 lab results.
7:40 A.M.
August 17, Continue medications  Follow-up Refer accordingly Psychological exam was ordered to
2022 pending lab assess the patient’s psychological
7:45 A.M. results. condition.
 For
psychological
exam today
August 18, Continue medications Refer accordingly
2022
7:05 A.M.
August 19, Continue medications Refer accordingly
2022
8:20 A.M.
August 20,  Increase Risperidone 2mg/tab Risperidone was from 2mg OD to
2022 BID 2mg BID. The dosage and frequency
8:00 A.M.  Continue other medications were changed to have a better
medication adherence.
August 21,  Continue medications Refer.
2022
7:30 A.M.
August 22,  May give Fluphenazine 25mg Refer. Fluphenazine is a long-acting
2022 0.5 ml IM today parenteral antipsychotic drug
7:45 A.M.  Diphenhydramine 50mg/ml IM intended for use in the management
together with Fluphenazine x 1 of patients requiring prolonged
dose parenteral neuroleptic therapy.
 Continue other meds Diphenhydramine is an antihistamine
that relieves the symptoms of
allergies with the prior medication
given.
August 23,  Home meds: Follow-up on The patient was discharged and was
2022 - Olanzapine 10 mg, 2 tabs September 5, 2022 at instructed to take home medications
8:00 A.M. HS OPD. as prescribed by the physician and to
- Risperidone 2mg, 1 tab BID have a follow-up check-up after 2
- Divalproex Na 500 mg/tab weeks at the OPD.
BID
- Biperiden 2 mg, 1 tab in
A.M.
PRIORITIZED PSYCHIATRIC NURSING DIAGNOSES

Cues Diagnosis Scientific Rationale Objectives Nursing Interventions Rationale Evaluation

Subjective Cues: Disturbed thought Delusional disorder is After 4 hrs of nursing Independent: After 4 hrs of nursing
“Mayda man Processes related relatively rare, has a later interventions client will be 1. Be sincere and honest Delusional clients interventions client
kamo higot, hihtan to Disruption in age of onset as compared able to: when communicating are extremely was able to:
ako niyo?” as cognitive to schizophrenia, and with the client avoid sensitive about
verbalized by operations and does not show a gender  Demonstrate vague or evasive others and can  Demonstrate
patient activities as predominance. The decreased anxiety remarks recognize insincerity. decreased
evidence by patients are also relatively  Sustain attention Evasive comments anxiety
Objective Cues: perscutory stable. The exact cause of and concentration to hesitation reinforces  Sustain
 Feelings of delusions the delusional disorder is complete tasks or 2. Be consistent in mistrust or delusions. attention and
discomfort unknown. Many biological activities setting expectations, concentration
noted conditions like substance  Be in a relaxed state enforcing rules and so Clear, consistent to complete
 Reduced use, medical conditions,  Be free from forth limits provide a tasks or
Attention Span neurological conditions delusions or secure structure for activities
 Inability to can cause delusions. The demonstrate ability 3. Do not make promises the client  Be in a relaxed
maintain eye delusional disorder to function without that you cannot keep. state
contact involves the limbic system responding to  Be free from
observed and basal ganglia in those delusions 4. Encourage the client to delusions or
 Blunted Affect with intact cortical talk with you, but do Broken promises demonstrate
 Guarding functioning.Hypersensitive not pry for information. reinforce the client's ability to
Behavior persons and ego defense mistrust of others. function without
 Wringing mechanisms like reaction 5. Explain procedures responding to
hands formation, projection, and and try to be sure the Probing increases delusions
 Persecutory denial are some client understands the the client's suspicion
Delusion psychodynamic theories procedures before and interferes with
noted for delusional disorder. carrying them out. the therapeutic
Social isolation, envy, relationship.
 Tensed/anxiou
distrust, suspicion, and 6. Give positive feedback
s state to
low self-esteem are some for the client's When the client has
social contact
of the factors which when successes. full knowledge of
 Ideas of
becoming intolerable leads procedures, he or
reference
to a person seeking an she is less likely to
noted
explanation and thus feel tricked by the
 Asociality forming a delusion as a staff.
 Alogia
solution.

7. Recognize the client's Positive feedback for

Reference: delusions as the genuine success
Joseph S. (2022). client's perception of enhances the client's
Delusional Disorder. the environment. sense of well-being
Retrieved from: and helps make
https://www.ncbi.nlm.nih.g nondelu sional reality
ov/books/NBK539855/ 8. Initially, do not argue a more positive
with the client or try to situation for the
convinct the client that client.
the delusions are false
or unreal. Recognizing the
client's perceptions
9. Interact with the client can help you
on the basis of real understand the
things; do not dwell on feelings he or she is
the delusional experiencing.
material.
Logical argument
10. Engage the client in does not dispel
one-to-one activities at delusional ideas and
first, then activities in can interfere with the
small groups, and development of trust.
gradually activities in
Larger groups.
Interacting about
11. Do not be judgmental reality is healthy for
or belittle or joke about the client.
the cli ent's beliefs

12. Directly interject doubt

regarding delusions as A distrustful client
soon as the client can best deal with
seems s ready to one person t tially.
accept this (e.g., "I find Gradual introduction
that hard to believe."). of others as the
Do not argue but client to erates is
present a factual less threatening
account of the
situation.
The client's
delusions can be
distressing, Empathy
conveys your caring,
interest, and
acceptance of the
client.

As the client begins

to trust you, her or
she mahy be willing
to doubt the delusion
if you express your
doubt

Reference:
Videbeck, Shiela L.
(2020). Mood
disorders and
Suicide. In
Psychiatric-Mental
Health Nursing (8th
ed.). Wolters Kluwer
 CUES NURSING SCIENTIFIC GOAL NURSING RATIONALE EVALUATION
DIAGNOSIS OBJECTIVES INTERVENTIONS
“waray ako Disturbed Sensory-perceptual SHORT TERM:  Keep an eye out  The patient may After 1 week of nursing
makaturog hin Sensory alteration can be defined for increased experience interventions the
maupay kagab-e Perception as when there is a change After 1 week of nursing worry, anxiety, or hallucinogenic patient:
kay nababatian ko (Auditory) in the pattern of sensory interventions the patient: irritability activity, which  Was able to
an boses tak related to stimuli followed by an  Will continue can be very continue
bugto” as inability to focus abnormal response to performing his or disturbing and performing his
verbalized by the such stimuli. Such her role the patient may or her role
patient. perceptions could be  Patient will act on  Patient
increased, decreased, or sustain his or her command sustained his or
“nabati ka hito ate? distorted with the patient’s social hallucinations her social
Akon ito brother ha hearing, vision, touch, relationships and harm relationships
simbahan, gusto ko sensation, smell or  Will recognize himself or  Recognized
hiya buligan” as kinesthetic responses to several stressful  Investigate how others. several
verbalized by the stimuli. Such changes in issues that trigger patient perceives stressful issues
patient. the pattern of responses to hallucinations and the psychotic  Examining the that trigger
stimuli lead to changes in delusions symptoms, such hallucinations hallucinations
a patient’s behavior,  Will demonstrate as hallucinations and sharing and delusions
sensory acuity, decision- techniques for and delusions experiences can  Demonstrated
 Anxious making process and distracting herself provide the techniques for
 (+) Auditory problem-solving abilities. from the voices individual with distracting
hallucinatio This can lead to irritability, confidence that herself from the
ns restlessness, poor he may be able voices
 (+) concentration, fluctuating  Assist the patient to handle the
Delusions mental status, changes in in identifying times auditory Goals were met.
communication due to when auditory or hallucinations.
inattention, and lack of visual
focus. Furthermore, hallucinations are  This intervention
sensory deprivation in most prominent assists both the
isolated patients can lead and disturbing. nurse and the
to anxiety, depression, patient identify
aggression, hallucinations situations and
and psychotic reactions. instances that
 Stay with the may be most
patient when they stressful and
 begin to lose touch provoking to the
with reality and patient.
instruct them to tell  When given
“voices they hear” repetitive
to leave them directions, the
alone. Repeat patient can
several times in sometimes learn
matter-of-fact tone. to push voices
aside
 When applicable particularly in
minimize the the context of a
environmental trusting
stimuli such as relationship.
reduced noise and
minimal activity.
 This intervention
reduces the
possibility of
anxiety causing
hallucinations
and aids in the
patient’s
relaxation.
 NURSING
CUES SCIENTIFIC RATIONALE GOAL INTERVENTION RATIONALE EVALUATION
DIAGNOSIS
SUBJECTIVE: Impaired Verbal People with schizophrenia SHORT TERM: INDEPENDENT: After 1 week of nursing
“An radyo dati Communication exhibit wide ranging Within 1 week of nursing intervention, the client
nagpipinatukar la related to altered deficits in most cognitive intervention, the client 1. Assess whether 1. Establishing a was able to:
hin mga kanta ni perception domains, such as goal will be able to: incoherence in speech baseline facilitates  Spend three 5-
Sarah Geronimo maintenance, working  Spend three 5-minute is chronic or more the establishment of minute periods with
yana bagan memory, and processing periods with nurse, sudden, as in an realistic goals, the nurse, sharing
giniimbistigahan na speed. In particular, sharing observations exacerbation of cornerstone for observations in the
ako han radyo parte disorganized speech in the environment symptoms. environment
planning effective
tak kinabuhi” as symptoms, such as  Spend time with one  Spend time with
verbalized communication care.
or two other people in one or two other
“Hain na an lalaki impairment (i.e., a structured activity people in a
didi na kwarto? communication involving neutral 2. Identify how long structured activity
Nawara man hiya” impairment is defined as topics patient has been on involving neutral
as verbalized communication failures in 2. Therapeutic levels topics
antipsychotic
speech, that is, a phrase LONG TERM: of an antipsychotic
medication.
OBJECTIVE: or passage of speech in medication can help LONG TERM:
 Delusion of which the meaning is Within 1 month of clear thinking and
reference sufficiently unclear to nursing intervention, the diminish looseness After 1 month of
noted impair the overall meaning client will be able to: of association. nursing intervention,
3. Plan short, frequent
 Looseness of of the speech passage.  With the aid of periods with patient 3. Short periods are the client was able to:
associations medication and throughout the day. less stressful, and  With the aid of
 Inability to attentive listening, be periodic meetings medication and
distinguish Merrill AM, Karcher NR,
Cicero DC, Becker TM, able to speak in a give the patient a attentive listening,
internally
Docherty AR, Kerns JG. manner that can be chance to develop be able to speak in
stimulated
thoughts from Evidence that understood by others 4. Use simple words, and familiarity and a manner that can
actual communication keep directions simple. safety be understood by
 Use two diversionary
environmental impairment in 4. Patient might have others
tactics that work for
events schizophrenia is difficulty processing
him or her to lower Use two diversionary
associated with even simple
anxiety, thus tactics that work for him
generalized poor task 5. Keep voice low, and sentences.
enhancing ability to speak slowly. or her to lower anxiety,
performance. Psychiatry 5. High-pitched/loud
think clearly and thus enhancing ability
Res. 2017 Mar;249:172-
tone of voice can to think clearly and
179. doi:
10.1016/j.psychres.2016.1 speak more logically raise anxiety levels; speak more logically
2.051. Epub 2017 Jan 6. slow speaking aids
PMID: 28104564; PMCID: 6. Look for themes in understanding.
PMC5452682. what is said, even 6. Often patient’s
though spoken words choice of words is
appear incoherent symbolic of
(e.g., anxiety, fear,
feelings.
sadness).
7. Use therapeutic
techniques to try to
understand the 7. Even if the words
patient’s concerns are hard to
8. Focus on and direct understand, try
patient’s attention to getting to the
concrete things in the feelings behind
environment. them
9. Keep environment 8. Helps draw focus
quiet and as free of away from
stimuli as possible delusions and focus
on reality-based
things.
9. Keeps anxiety from
escalating and
10. Use simple, concrete, increasing
and literal confusion and
explanations. hallucinations/delusi
ons.
10. Minimizes
misunderstanding
and/ or
incorporating those
misunderstandings
into delusional
systems
 CUES NURSING SCIENTIFIC OBJECTIVES NURSING RATIONALE EVALUATION
DIAGNOSIS RATIONALE INTERVENTIONS
Subjective cues: Impaired social Patients with a After 4 hours of nursing 1. Assess if 1. Many of the After 4 hours of
- “Diri man ako interaction related progressive form of intervention, the patient the medication has positive symptoms nursing intervention,
niyo hihigton to feeling the disease are will reached therapeutic of schizophrenia the patient has
ano? Bangin threatened in increasingly socially levels. (hallucinations,
ako niyo social situations isolated. Individuals - engage in one delusions, racing - engaged in one
activity with a nurse activity with
higton” as with this disease find thoughts) will
by the end of the a nurse by the
verbalized by themselves day. subside with end of the day.
the pt. seriously medications, which
- “nahahadlok disadvantaged in the will facilitate
ako ha mga social arena, unable After 2 days of nursing interactions. After 2 days of nursing
nurse tas to correctly read and intervention, the patient 2. Identify with client 2. Increased anxiety intervention, the
doctor” as respond to social will symptoms he can intensify patient has
verbalized by signals, and - maintain an experiences when he agitation, - maintained an
the pt. vulnerable to the interaction with or she begins to feel aggressiveness, interaction with
- “Nadiri ako it stresses of their another client while anxious around and another client
iba na mga complex social doing an activity others. suspiciousness. while doing an
tawo didi kay environments. (e.g., simple board 3. Keep client in an 3. Client might activity (e.g.,
diri ako nira game, drawing). environment as free of respond to noises simple board
- demonstrate interest game, drawing).
naiintidihan” stimuli (loud noises, and crowding with
to start coping skills - Demonstrated
as verbalized. training when ready crowding) as possible. agitation, anxiety, interest to start
Objective cues: for learning. and increased coping skills
- Patient - engage in one or inability to training when
appeared shy, two activities with concentrate on ready for
unable to minimal outside events. learning.
make eye encouragement from 4. Avoid touching the 4. Touch by an - engaged in one
nurse. or two activities
contact, - state that he or she client. unknown person with minimal
hands is comfortable in at can be encouragement
fidgeting least three misinterpreted as a from nurse.
- Patient structured activities sexual or - Stated that he or
appeared that are goal threatening she is
anxious directed. gesture. This comfortable in at
during social particularly true for least three
contact a paranoid client. structured
After 1 to 2 weeks of activities that are
5. Ensure that the goals 5. Avoids pressure on
nursing intervention, the goal directed.
set are realistic; the client and
patient will
whether in the hospital sense of failure on
- use appropriate or community. part of After 1 to 2 weeks of
skills to initiate and nurse/family. This nursing intervention,
maintain an sense of failure can the patient has
interaction. lead to mutual
- attend one 6. Structure activities that withdrawal - used appropriate
structured group skills to initiate
work at the client’s 6. Client can lose
activity. and maintain an
- seek out supportive pace and activity. interest in activities interaction.
social contacts. that are too - attended one
- improve social ambitious, which structured group
interaction with can increase a activity.
family. 7. Structure times each sense of failure. - seeked out
day to include planned 7. Helps client to supportive social
contacts.
times for brief develop a sense of
- improved social
interactions and safety in a non-
interaction with
activities with the threatening
family and other
client on one-on-one environment.
people.
basis
8. If client is unable to
respond verbally or in 8. An interested
a coherent manner, presence can
spend frequent, short provide a sense of
period with clients. being worthwhile.

9. If client is found to be
very paranoid, solitary
or one-on-one 9. Client is free to
 activities that require
concentration are
appropriate.
10. If client is
delusional/hallucinatin
g or is having trouble
concentrating at this 10. Even simple
time, provide very
simple concrete
activities with client
(e.g., looking at a
picture or do a
painting).
choose his level of
interaction;
however, the
concentration can
help minimize
distressing
paranoid thoughts
or voice.
activities help draw
client away from
delusional thinking
into reality in the
environment.

11. If client is very

withdrawn, one-on-
one activities with a
“safe” person initially 11. Learn to feel safe
should be planned. with one person,
then gradually
12. Try to incorporate the might participate in
strengths and interests a structured group
the client had when activity.
not as impaired into 12. Increase likelihood
the activities planned. of client’s
participation and
13. Teach client to remove enjoyment.
himself briefly when
feeling agitated and
work on some anxiety 13. Teach client skills
 relief exercise (e.g., in dealing with
meditations, rhythmic anxiety and
exercise, deep increasing a sense
breathing exercise). of control.
14. Useful coping skills
that client will need
include conversational
and assertiveness 14. These are
skills. fundamental skills
for dealing with the
world, which
15. Remember to give everyone uses
acknowledgment and daily with more or
recognition for positive less skill.
steps client takes in 15. Recognition and
increasing social skills appreciation go a
and appropriate long way to
interactions with sustaining and
others. increasing a
16. Provide opportunities specific behavior.
for the client to learn
adaptive social skills in
a non-threatening
environment. Initial
social skills training 16. Social skills training
could include basic helps the client
social behaviors (e.g., adapt and function
appropriate distance, at a higher level in
maintain good eye society, and
contact, calm increases the
manner/behavior, client’s quality of
moderate voice tone). life.
17. Eventually engage
other clients and
significant others in
social interactions and
activities with the
client (card games, 17. Client continues to
ping pong, sing-a- feel safe and
songs, group sharing competent in a
activities) at the graduated
client’s level. hierarchy of
interactions.
 NURSING SCIENTIFIC
CUES GOAL INTERVENTION RATIONALE EVALUATION
DIAGNOSIS RATIONALE
SUBJECTIVE: Defensive coping Defensive coping a SHORT TERM: INDEPENDENT: After the interventions,
“Nadiri ako kan related to apparent nursing diagnosis Within 4 hours of nursing 1. Before carrying out 11. This intervention the client was able to:
nanay kay gin weakness, and accepted by the intervention, the client certain procedures, the prepares the patient  Suitably engage
bubutangan niya hin doubts about North American will be able to: nurse should explain ahead of time and with others
hilo tam pagkaon…” others’ intentions Nursing Diagnosis  Suitably engage with them to the patient. reduces the  Continue to follow
as verbalized by the Association, defined others possibility of medical advice
patient as the state in which  Continue to follow completely  Demonstrate newly
an individual has a medical advice misunderstanding learned coping
“Nagyinakan adto repeated projection  Demonstrate newly the nurses' purpose strategies for
hiya ha una na gusto of falsely positive learned coping 2. Approach the patient in as unfriendly or anxiety and
niya patyon an iya self-evaluation strategies for anxiety a nonjudgmental, confrontational. helplessness
house mother kay based on a self- and helplessness courteous, and neutral
tungod hito na protective pattern way. 12. A skeptical patient
hihiloan it ira that defends against is less likely to
pagkaon” as underlying perceived mistake intention or
verbalized by the threats to positive meaning if the
watcher. self-regard. 3. Patients should be content is unbiased
Defensive coping, as assessed and observed and the attitude is
OBJECTIVE: introduced by S. regularly for rising polite and
 Patient Freud, represents a anxiousness and nonjudgmental.
appeared distortion of aggression indicators.
anxious unwelcome reality: it 13. The nurse or other
 Increased alters the way a 4. When talking with a healthcare
heart rate of stressful situation is patient with psychosis, practitioner must
131 bpm perceived, by use plain and primary intervene before the
expelling disturbing language. patient loses
thoughts or control.
emotions from
conscious 14. This intervention
awareness. Its reduces the
functions resemble 5. Be honest and possibility of
the ones of medical transparent with the misunderstanding
defense patient when setting and
mechanisms but in objectives and enforcing misinterpretation of
standards.
regard to mental the statement's
health. Thus, the meaning.
role of psychological
defense is to guard 15. Patients who have
individuals against psychosis are
disease-related extremely aware of
information that deception. Honesty
induces distress and and consistency
threatens foster an
psychological environment in
equilibrium. which trust can
flourish.
REFERENCE:
https://www.ncbi.nl
m.nih.gov/pmc/arti
cles/PMC3141643/
 NURSE PATIENT
ANALYSIS ANALYSIS
VERBAL NONVEBAL VERBAL NONVERBAL

SN1: Good Morning! Kami tim Greets client in a Giving information Okay la Anxious facial expression. Patient seemed to be anxious
student nurses yana nga oras friendly tone to Faintly smiles
kutob alas dos, Ako hi Kuya establish rapport
Alvin.

SN2: Ako liwat hi Ate Trisha

SN3: Ako liwat hi Ate Esther,

okay la maginterview kami ha
imo yana?

SN2: Kamusta ka man yana Speaks in a gentle Exploring Okay la liwat Looks down and plays with Patient seemed nervous and
nga adlaw? manner using soft and fingers does not meet eye contact
audible voice

SN2: Sige ok la magtikang na Smiles and spoke with Exploring Julie Sangalanag Patient glances tot he nurses Patient looks more neatly
kita ha interview? Ano pa adto a gentle voice and quietly sits looks down groomed and appears more
an imo ngaran? again relaxed

SN2: Pira na nim edad? Gently speaks in a soft Exploring 17 Patient remained sitting with Patient confidently answers
and audible voice hands on lap questions regarding
demographic data

SN2: Nakakahinumdom ka pa Gently speaks in a soft Exploring September 15, 2004 Patient closed eyes as she Patient seems to have difficulty
nim birthday? and audible voice answered the question remembering

SN2:Maaram ka kun diin ka Gently speaks in a soft Exploring Ha Davao. Patient remained sitting with Patient can clearly remember
ginanak? and audible voice hands on lap her birthplace

SN2: Maaram ka kun hain kita Gently speaks in a soft Exploring Ha hospital Patient scanned the whole Patient is oriented
yana? and audible voice room and remained back to

SN2: Maaram ka kun anot
petsa yana?
SN1: August 18, 2022 na yana
SN1: Okay la kuhaon namon
tim vital signs?
SN1: Diri ini hiya masakit,
madaliay la ini hiya
SN3: Diri ini maulol uho diri
ako nasasakitan. Mahuram
ako tim tudlo
SN2: Waray man ini hiya
higot. Nakasugad la ini hiya
SN3: Ginkukulba ka yana
Ma’am Julie?
SN2: Diri ini hiya higot, tela la
ini hiya
sitting with hands on lap
Gently speaks in a soft Exploring Diri ako maaram an Patient pauses and closes Patient seems to have difficulty
and audible voice adlaw pero august 2022 eyes before answering the remembering the date of the day
na question
Gently speaks in a soft Presenting reality “....” Nods while looking down Client appeared attentive and
and audible voice serious
“....” Stared for a short while Patient displayed tensed
behavior. Anxious state seemed
to increase
Speaks in a more Presenting reality Sige Patient starts to take a look on Patient seemed to examine if
gentle manner assuring the tray there are any harmful objects in
safety while showing the tray
equipment for vital
signs to the patient
Nurse demonstrate how Presentng reality Waray ini higot? Points at the pulse oximeter Patient still seemed to be
pulse oximeter is used anxious
and Gently places
finger on the pulse
oximeter
Explains in a gentle Presenting reality Adi man hiya diri ini Suddenly points out the green Patient’s anxious state
manner higot? lining increased
Speaks genlty while Making Diri man ako niyo Displays guarding behaviour Pulse oximeter revealed patient
while reading the observations hihigton ano? Bangin ako to be tachypnic indicating that
results of pulse niyo higton patient is anxious and scared.
oximeter Patient displays persecutory
delusion
Speaks gently while Presenting reality Looks at the green lining Anxious state starts to subside
showing the green cloth
to patient
SN1: Waray kami higot, mga
sangkay mo kami didi tanan
diri ka namon papasakitan
Gently reassures safety Presenting reality Gintarayan mo ngani ako Looks at S1 Patient displays paranoid
using gentle kanina delusion as evidence by ideas of
voice while attempting Offering self reference
to calm the patient
down

SN1: Sorry kun huna mo Speaks in a gentle Presenting Reality Ayaw nala hito Shyly smiles Patient seems to be more
gintarayan ko ikaw kanina manner. relaxed
pero waray ko ikaw adto
gintarayan kanina. Diri ko ikaw Defending
tatarayan kay diri kita
magkaaway.

SN3:Maaram ka it rason kun Speaks in a gentle Exploring Diri. Patient’s smile faded and Patient appeared serious
kayano aadi ka yana ha manner looked down
EVMC?

SN3:Hino nagkadi ha imo? Speaks in a gentle Placing event in Hi Jessica. Looks at a distance and looks Patient maintained serious
manner time back down expression

SN3:Han ano man adto na Speaks in a gentle Placing event in Han ginhigot ako nira. Patient frowned with voice Patient showed a look of
adlaw na iyo pagkanhi? manner time turned softer sadness

SN3:Kayano ka man nira Speaks in a gentle Placing event in May ginhimo ako na Patient looked down, avoiding Patient showed a look of guilt
ginhigot? manner time maraot ha SOS eye contact

SN3:Ano na maraot nim Speaks in a gentle Exploring Nagyakan ako na “Amo Patient remained looking down Expression of guilt was more
ginhimo? manner talaga ini it SOS waray evident
mga gamit”

SN3:Tas an imo pagkanhi Speaks in a gentle Placing event in Ginhigtan ako dinhi Patient frowned again Patient seems to dislike being
ginano ka man? manner time tied and is hurt with the
experience
SN3:Aw ginhigtan ka na dati Speaks in a gentle Summarizing “....” Nods Patient seems scared
tas ginhigtan ka utro? manner

SN1:Pwede kumita tim kamot? Leans over to the Seeking “....” Lends arms to the nurse Presence of scars were noted.
patient to take a closer information
look on the scar

SN1: Ano ini na mga samad? Points over the scars Seeking Oo Patient displayed guarding Client seemd to be really scared
An kanan paghigot ini nira observed Clarification behavior of the experience
haimo?

SN3:May ginkaaway ka didto Speaks in a gentle Exploring Hi Nanay Mary Anne Patient looked up and thinked Cleint showed an expression of
ha SOS bago ka nahinganhi? manner before answering bitterness and sadness

SN3:Kayano kamo nagaway ni Speaks in a gentle Exploring Kay ginhihiluan niya tam Patient looked back down and Patient seems to have previous
Nanay Mary Anne? manner mga pagkaon, played with her fingers while episode of persecutory delusion
ginhihikaatay ako niya answering

SN2:Anot imo giniinisip yana Speaks in a gentle Exploring Nagiba na an kalibutan Client sighed and continued Client appeared serious
nga adlaw? manner answering

SN2:Ano pa man an iba na Speaks in a gentle Focusing An radyo iba na an Looked down, serious, and Client remained serious
imo na obserbaran manner ginyiyinakan shook her head slightly

SN2:Kay ano an ginyayakan
han radyo dati?
Speaks in a gentle Exploring An radyo dati Still looking down and is sitting Client also had previous episode
manner nagpipinatukar la hin straight of delusion of reference
mga kanta ni Sarah
Geronimo yana bagan
giniimbistigahan na ako
han radyo parte tak
Indicating the
kinabuhi
presence of an
external source
SN2: Pwede mo igdescribe tim Spoke with a smile and Mahusay Smiles and giggles but Cleint showed a slight hind of
kalugaringon? a gentle tone immediately returns to sitting joy in facial expression
straight

SN2:Ano tim mga ginhihimo Spoke with a smile and Exploring Nakaon la tas katurog Stops to think before Provided direct response
ha usa ka adlaw? a gentle tone answering

SN2:Anot tim mga hilig Looked at the patient, Exploring Magkinanta Smiled shyly Client seemed happy when
himuon? focused talking about her likes

SN2:Ano pat iba na imo mga Spoke with a smile and Exploring Sumayaw, Magdrawing Faces the nurse while stiing Explained and answered directly
hilig himuon? a gentle tone tapos magworship kan straight
God

SN1:Anot mga bagay na Speaked in a gentle Exploring Mga tawo. Client looked down again Client diplayed an expresson of
nakakadulot hin stress ha manner sadness
imo?

SN1:Mga tawo? Looked at the patient to Seeking Mga tawo na masasama Client maintained looking down Explained and answered directly
seek clarification Clarification na diri ako ginsasangkay

SN1:Anot mga bagay na Speaked gently Exploring Mga tawo liwat na Client looked back at the Answered directly
nakakapagpsaya haim? buotan nurses

SN1:So ano man happy ka Spoke with a smile and Encouraging Naduha, happy ak kay Client remianed sitting straight Answered and explained directly
yana or sad? a gentle tone Expression may mga tawo na gusto
makipagsangkay haak
yana pero sad kay may
mga tawo liwat nga gusto
ako ipahamak

SN1:An- - - Paused and listened to Silence Pwede kumaturog la Touched her head and loked at Client looked tired and sleepy
the patient anay ako? Malipong na the nurses
tak ulo hit mga pakiana
All nurses: Sige thank you po Smiled to the patient Giving recognition “...” Smiles and proceeds to her
han imo time. Ma’am Julie and waved goodbye room