MENTAL HEALTH Historical View of Mental Illness

⊗ "A state of well-being where a person can realize his or ⊗ In the past, mental illness has been viewed as:
her own  Demonic possession
abilities to cope with the normal stresses of life and work  Influence of ancestral spirits
productively." (WHO)  Result of violating taboo or neglecting cultural, ritual, and
⊗ Balance in person’s internal life and adaptation to spiritual condemnation
reality. ⊗ Period of Enlightenment (1745-1886)
⊗ State of well-being in which a person is able to realize  Lunatics were restrained in iron menacles
his potentials.  Mentally ill were exhibited as diversion and entertainment
for the public
Criteria for Mental Health:  Establishment of asylums
⊗ Self-awareness  Opening of state hospitals for mentally ill.
♦ Ability to: ⊗ Period of Scientific Study
 recognize one’s thoughts feelings, asset potentials and  Psychoanalysis by Sigmund Freud
weakness. ⊗ Psychotropic Drugs (1950)
 experience genuine feelings as anger, happiness,  Use of chlorpromazine and imipramine
resentment  Mental illness is caused by chemical imbalance in the brain.
 leads to self-acceptance, self-understanding in order to ⊗ The Decade of the Brain (1990)
understand others  Focused on the connections between mental illness and
biological malfunction in the brain and the neuroendocrine-
⊗ Autonomy: ability to function independently and immune system.
function with
others  Biological views holds that biological defects are
⊗ Perceptive ability responsible for certain serious mental illness.
 Awareness of stimuli, reality orientation.
 Orientation to: Time, Place, Person Diagnosis of Mental Illness
⊗ Integral capacity: Ability to harmonize psychic forces
(id, ego, ⊗ Use of the Diagnostic and Statistical Manual of Mental
super ego). Illness (DSM-
⊗ Self-actuation IV)
 Ability to adopt to life changes, happy to work with ⊗ Provides diagnostic criteria for each mental disorder and a
others system
 Satisfaction in every endeavor of 5 axes to give a comprehensive view of the client’s mental
 Genuine cooperation illness.
⊗ Mastery of one’s environment: Awareness of the  Axis I: The clinical disorder that is the focus of treatment
changes  Axis II: Personality disorders and mental retardation
around him  Axis III: Medical conditions
 Axis IV: Psychosocial and environmental problems
MENTAL HYGIENE  Axis V: Global assessment of functioning (GAF)
⊗ a science that deals with: Promotive, Preventive,
Curative, PSYCHIATRIC NURSING
Rehabilitative aspects of care. Importance:
⊗ An interpersonal process
MENTAL DISORDER ⊗ Concerned with all the aspects of care
⊗ A medically diagnosable illness which results in ⊗ Both a Science and an Art
significant  Science – uses different theories
impairment of one's cognitive, affective or relational  Art - therapeutic use of self
abilities and is ⊗ Clientele:
equivalent to mental illness.  Individual, family and the community
Criteria for Mental Disorder:  Both mentally healthy and mentally ill
⊗ Dissatisfaction with: Main tool of the nurse: Therapeutic use of Self
 one’s characteristics, abilities and accomplishments Characteristics of a Good Psychiatric Nurse:
 one’s place in the world ⊗ Empathy
⊗ Ineffective: ⊗ Genuineness
 interpersonal relationship ⊗ Congruence
 coping or adaptation to the events in one’s life ⊗ Unconditional positive regard
MENTAL ILLNESS
⊗ A state in which an individual shows deficit in Roles of the Nurse in Psychiatric Setting:
functioning and is unable to maintain personal  Clinician
relationship.  Collaborator
⊗ State of imbalance characterized by a disturbance in a  Counselor
person’s thoughts, feelings and behavior  Healthy role model
⊗ Factors that increase the risk are: Crises, Abuses,  Parent surrogate
Poverty  Patient advocate
 Reality based neutral fact finder
 Researcher - Must be released at end of statutory time or put on
 Socializing agent voluntary status or have a hearing
 Teacher
 Technician 2.) Judicial Precedents
 Therapist -Unless incompetent, client maintains all previous rights
 Ward manager Insanity as a Defense
-⊗ Insanity : determined in court; legal terminology
Levels of Interventions in Psychiatric Nursing McNaughten Rule
 “At the time of the crime, the individual didn’t know the
LEVEL DESCRIPTION EXAMPLE nature and quality of the act or didn’t know right from
PRIMARY Aimed at altering -Health wrong.”
the stressors education
through: - Information COMMON BEHAVIORAL SIGNS AND SYMPTOMS
- promotion of dissemination
mental health - Counseling 1. Disturbance in Perception
 -lowering the ⊗ Illusion - misperception of an actual external stimuli
rate of cases ⊗ Hallucination - false sensory perception in the absence of
SECONDARY Interventions -crisis external stimuli
that limits the intervention Management:
severity of the -drug ⊗ Acknowledge the feelings
disorder through: administration ⊗ Reorient to reality
-case finding Provide distractions
-prompt ⊗ Neologism - pathological coining of new words
treatment ⊗ Circumstantiality - over inclusion of details
TERTIARY Aimed at -Alcoholics ⊗ Word salad - incoherent mixture of words and phrases
reducing the anonymous ⊗ Flight of ideas - shifting of one topic from one subject to
disability after a - Occupational another in a completely unrelated way
disorder therapy ⊗ Looseness of Association - shifting of a topic from one
through: subject to another in a somewhat related way
- Prevention of ⊗ Verbigeration - meaningless repetition of word or phrases
complication ⊗ Perseveration - persistence of a response to a previous
-Active program question
of ⊗ Echolalia - pathological repetition of words of others
rehabilitation ⊗ Clang association - the sound of the word gives direction to
the flow of thought
⊗ Delusion - false belief which is inconsistent with one's
THE PSYCHIATRIC SETTING knowledge and culture
 Grandeur - is an exaggerated belief of identity
Admitting a Client in the Psychiatric Setting  Nihilistic - the client denies the existence of self or part of
self
Areas to be assessed:  Persecution - belief that he or she is the object of
⊗ Health perception environmental attention and being singled out for
⊗ Orientation harassment
⊗ Metabolic pattern - Self-depreciation - worthlessness or hopelessness
⊗ Elimination pattern - Somatic - false belief to body function.
⊗ Cognitive pattern: Judgment, Insight, Memory
⊗ Activity and exercise pattern 2. Disturbances of Affect
⊗ Thought process
⊗ Sleep-rest pattern ⊗ Inappropriate affect - disharmony between the stimuli and
the emotional reaction
LEGAL ASPECTS OF PSYCHIATRIC NURSING ⊗ Blunted affect - severe reduction in emotional reaction
Types of Admissions: ⊗ Flat affect - absence or near absence of emotional reaction
⊗ Voluntary ⊗ Apathy - dulled emotional tone
 Persons admit themselves
 Client consents to all treatment Disturbances in Motor Activity
 Client can refuse treatment, including drugs, unless ⊗ Echopraxia - the pathological imitation of posture/action of
danger to self or others others
⊗ Involuntary ⊗ Waxy flexibility - maintaining the desired position for long
 1.) Judicial process periods of time without discomfort
- Initiated when someone files a petition ⊗ Akinesia - loss of movement
 -Certification of the likelihood of serious harm to self or ⊗ Bradykinesia - slowness of all voluntary movement
others, or unable to care for self including speech.
- Under 18, parents can confine with confirmation by a ⊗ Ataxia - loss of coordinated movement
 Essentials for a Therapeutic Communication:
Disturbances in Memory ⊗ Genuineness
⊗ Confabulation - filling in of memory gaps ⊗ Respect
⊗ Amnesia - inability to recall past events ⊗ Empathy
• Anterograde - immediate past ⊗ Attentive listening
• Retrograde - distant past ⊗ Trust (rapport)
⊗ Deja vu - feeling of having been to place which one has Barriers to a Therapeutic Communication
not yet visited ⊗ Belittling
⊗ Jamais vu - feeling of not having been to a place which ⊗ Interrupting / ignoring
one has visited ⊗ Giving advice
⊗ Dementia ⊗ Social response
• gradual deterioration of intellectual functioning ⊗ Changing the subject
• results in the decreased of capacity to perform ADL ⊗ Approving / disapproving
Other behavioral signs & symptoms ⊗ Moralizing
⊗ Agitation - severe anxiety associated with motor Examples: Therapeutic Technique
restlessness. Technique Example
⊗ Agnosia - inability to recognize and interpret sensory
stimuli. technique example
⊗ Akathisia - subjective feeling of muscular tension, accepting
restlessness and pacing repeated sitting and standing. acknowledging
⊗ Ambivalence - presence of two opposing feelings at the
same time.
⊗ Aphasia - inability or difficulty to speak or recall words
⊗ Apraxia - inability to carry out specific task or activity.
⊗ Delirium- refers to acute change or disturbance in a
person's: LOC, cognition, emotion , perception
⊗ Depression - feeling of sadness
⊗ Derealization - feeling of strangeness towards the
environment.
⊗ Dysthymia - persistent state of sadness
⊗ Elation (euphoria)- a feeling of high degree of
confidence, boastfulness and joy with increase motor
activity.
⊗ Narcolepsy - sleep disorder characterized by frequent
irresistible urge to sleep with episodes of cataplexy
(sudden loss of muscle power)

USE OF APPROPRIATE COMMUNICATION TECHNIQUES

Communication: reciprocal exchange of ideas between or
among NURSE – PATIENT RELATIONSHIP
persons Hildegard Peplau
Modes:
⊗ Verbal - written/spoken Phases:
⊗ Non-verbal - posture, tone of voice, facial expression Pre-Interaction Phase
⊗ begins when the nurse is assigned/chooses a patient
Types of Non-verbal communication: ⊗ patient is excluded as an active participant
⊗ Kinesis ⊗ nurse feels certain degree of anxiety
• body movement ⊗ includes all of what the nurse thinks and does before
• eye contact interacting
• gestures with the patient
⊗ Paralanguage ⊗ develop self-awareness
• voice quality data gathering, planning for first interaction
• non-language vocalization (crying, sobbing, moaning) Orientation phase
⊗ Proxemics – law of space relationship ⊗ when the nurse-patient interacts for the first time
⊗ Touch – physical act ⊗ establish of contract with the patient
⊗ Cultural artifacts ⊗ establish of trust and rapport
⊗ Meta communication ⊗ learn about the patient and his initial concerns and needs
• based on role expectations ⊗ encourage the patient to feel comfortable with the
• hidden meaning of words meeting
Therapeutic Communication: a way of interacting in a ⊗ conduct initial interview
purposeful manner to promote the client’s ability to ⊗ manage present emotion of the patient
express his thoughts and feelings openly. ⊗ provide support and empathy of the patient’s feelings
⊗ assure of confidentiality
Working / Therapeutic Phase: Nursing Implication: Help children achieve bowel and bladder
⊗ it is highly individualized control
⊗ identification and resolution of the patient's problems without undue emphasis on its importance.
⊗ more structured than the orientation phase Phallic Stage (4-6 years)
⊗ the longest and most productive phase ⊗ Pleasure: genital region.
⊗ limit setting must be employed  activities associated with stroking and manipulating their
⊗ planning and implementation sex
organs.
Problems: ⊗ Oedipus complex
⊗ Transference ⊗ Electra complex
- the development of an emotional attitude towards the ⊗ Concepts
nurse  Onset of “normal homosexuality”
-positive or negative Nursing implications:
⊗ Counter transference – experienced by the nurse /
therapist ⊗ Accept child's sexual interest
⊗ Help the parents answer child's questions about birth or
Termination Phase sexual
⊗ Evaluate the summary of progress differences.
⊗ Reinforce change and strength of patient Latency Stage (6 to 12 years)
⊗ Give rewards for the cooperation during interaction ⊗ Period of calmness / stable period.
⊗ Encourage expression of feelings about termination of ⊗ Many of the disturbing behaviors are buried in the
the relationship subconscious
⊗ Terminate the relationship without giving promises mind.
⊗ Their energies are absorbed by the concerns in school,
THEORIES OF HUMAN DYNAMICS peers, sports
Psychosexual Development : Sigmund Freud and other recreational activities
Nursing Implication: Help the child have positive experiences.
Levels of Consciousness Genital Stage (12 years & up)
3 Psychic Energies ⊗ Oedipal feelings are reactivated toward opposite sex
⊗ The person is on his way in establishing a satisfying life of
⊗ Libido - are the instinctual drives his own
⊗ Regression and fixation are common terms in this Nursing Implication:
theory. ⊗ Provide appropriate opportunities for the child to relate
with
⊗ Gave prominence to sexual feelings: defined "sex" as opposite sex.
anything that ⊗ Allow child to verbalize feelings about new relationships.
gives gratification Psychosocial Development Theory: Erik Erikson
Stages: ⊗ Childhood is very important in personality development.
Oral Stage (0-2 years) ⊗ Rejected Freud's attempt to describe personality solely on
⊗ The area of gratification is the mouth the basis
⊗ Pleasures: sucking activities like fingers, toes or nipples of sexuality,
⊗ Dissatisfaction: resurface at a later  believed that social factors greatly affect
 overeating, smoking, nail-biting  felt that personality continued to develop beyond five years
Nursing Implication: of
⊗ Provide oral stimulation by giving pacifiers age.
 Breastfeeding may provide more stimulation.
⊗ Do not discourage thumb sucking Identified 8 developmental stages throughout the whole life
Anal Stage (2-4 years) cycle.
⊗ Children's attention is focused on the anal region. ⊗ Stages 1-5 - childhood and adolescent
⊗ Pleasure: elimination. ⊗ Stages 6-8 - Adulthood
⊗ Covers the ideal age for "toilet training" (2 1/2 years)
⊗ 2 concepts: Stages:
 Holding on
 Letting go Stage 1:
Possible problems: Period of Life Infant, 0-18 months, (Hope)
⊗ Compulsive need to be clean and orderly. Psychosocial
⊗ Frugality and stinginess Crisis
⊗ Greed
⊗ Insistence on doing things at one's own rate at the Trust vs. Mistrust
expense of Relationship with Maternal person
others
⊗ Rigid training Positive
⊗ Excessive messiness and disorderly habits. Resolution
o Reliance on the caregiver Industry vs. Inferiority
o Development of trust in the environment Relationship with Neighbors/School
Positive
Negative Resolution
Resolution
o Learning the value of work
o Fear, anxiety and suspicion o Acquiring skills and tools of technology
o Lack of care, both physical & o Competence helps to order life and make
psychological by caretaker leads to things work
mistrust of environment
Negative
Stage 2: Resolution
Period of Life Toddler, 18 mos. to 3 years
Repeated frustrations and failures lead to
(Willpower) feelings of inadequacy and inferiority that
may affect their view of life
Psychosocial
Crisis Stage 5:

Autonomy vs. Shame/doubt Period of Life Adolescent, 12 to 18 yrs, (Fidelity)

Psychosocial
Relationship with Paternal person Crisis
Positive
Resolution Identity vs. Role confusion

o Sense of self-worth Relationship with Peer group

o Assertion of choice and will Positive
o Environment encourages independence, Resolution
leading to sense of pride
Experiments with various roles in
Negative developing mature individuality
Resolution
Negative
o Loss of self-esteem Resolution
o Sense of external control may produce
self-doubt in others Pressures and demands may lead to
confusion about self
Stage 3:
Period of Life Preschool, 3 to 6 years (Purpose) Stage 6:
Psychosocial Period of Life Young Adult, 18 to 54 yrs., (Love)
Crisis Psychosocial
Crisis
Initiative vs. Guilt
Intimacy vs. Isolation
Relationship with Family Relationship with Partners in friendship
Positive Positive
Resolution Resolution

The ability to learn to initiate activities, to o A commitment to others

enjoy achievement and competence o Close heterosexual relationship and
procreation
Negative
Resolution Negative
Resolution
o The inability to control newly developed
power Withdrawal from such intimacy, isolation,
o Realization of potential failure leads to self-absorption and alienation from others
fear of punishment and guilt
Stage 7:
Stage 4 Period of Life Middle Adult, 24 to 54 yrs., (Care)
Period of Life Schooler, 6 to 12 yrs. (Competence) Psychosocial
Psychosocial Crisis
Crisis
Generativity vs. Self-absorption
 o mathematical and scientific reasoning
Relationship with Partner ⊗ Combinatorial thinking - multidimensional approach
Positive o hypothetic or hypothetico-deductive reasoning
Resolution Moral Development Theory: Laurence Kohlberg
Level One
o The care and concern for the next (Preconventional
generation Morality)
o Widening interest in work and ideas • Children’s
judgments are
Negative based on external
Resolution criteria.
• Standards of
Self-indulgence and resulting psychological
impoverishment Stage 1
• Behavior is based on the desire to
Stage 8: avoid severe physical punishment
Period of Life Late Adult, 54 yrs. to death, (Wisdom) by a superior power.
Psychosocial • Right or wrong is based on
Crisis consequences to him.
• Punishment = wrong act
Integrity vs. Despair
right and wrong are
Relationship with Mankind absolute and laid
Positive down by authority.
Resolution Level Two
(Conventional
o Acceptance of one’s life Morality)
o Realization of the inevitability of death • Children’s
o Feeling of dignity and meaning of judgments are
existence based on the norms
and expectations of
Negative the group.
Resolution
Stage 2
Disappointment of one’s life and desperate • Actions are based largely on
fear of death satisfying one’s own personal
needs.
Cognitive Development Theory: Jean Piaget Stage 3
• Good behavior is that which pleases
Stages: others and judgments are based on
Sensorimotor (0-2 years) intentions.
⊗ Reflex to complex • Children conform to rules to win the
⊗ Begins to organize visual images and control motor approval of others and to maintain
responses. good relationships.
⊗ Coordinates sensory impressions. Stage 4
⊗ Pre-verbal stage • What is right is what is
Preoperational Stage (2-7 years) accepted.
⊗ Transitional period If the social accepts rules as
⊗ Egocentric and irreversible thinking appropriate for all group members,
⊗ Words become symbols for objects – symbolic thinking children will conform to them to avoid
⊗ Formation of ideas of categorization. social disapproval and censure
⊗ Lack of ability to go back and rethink a process or
concept. Level Three
⊗ Mental image – the symbolic process which are evident (Post Conventional
in plays Morality)
⊗ Construction of verbal schemas – preconcepts • The individual
Concrete Operations (7 – 11 years) recognizes the
⊗ Thinking appears to be stabilized arbitrariness of
o ability to think of the possible consequences of actions social and legal
⊗ Logical implications conventions.
Formal Operations • The individual
(11 years to adulthood) attempts to define
⊗ Full patterns of thinking moral values that
⊗ Ability to use logic and symbolic processes are separate from
group norms. ⊗ Catecholamines (norepinephrine and epinephrine)
⊗ Norepinephrine
Stage 5  Attention, learning and memory, sleep and wakefulness
• Behavior recognizes the laws as  Excess of this is associated with anxiety, memory loss, social
arbitrary and changeable. withdrawal and depression.
• For aspects of life not governed
by laws, right and wrong are ⊗ Epinephrine – responsible in the fight or flight mechanism
personal decisions based on ⊗ Serotonin
agreement and contracts.  An inhibitory neurotransmitter
Stage 6  Derived from tryptophan
• Morality is based on respect for  Involved in control of food intake, sleep and wakefulness,
others rather than on personal pain
desires. control, sexual behavior and emotions
• The individual conforms to both
social standards and to  Involved in anxiety and mood disorders, schizophrenia and
its
internalized ideals to avoid self- symptoms
condemnation rather than to ⊗ Histamine
 Primarily involved in immunity and allergic reactions
avoid social censure.  Some psychotropic drugs are block by histamine
Other Theories ⊗ Acetylcholine
 Affects sleep-wake cycle
Behavioral Model (Ivan Pavlov, John Watson, B. F.  Associated with Alzheimer’s disease
Skinner) ⊗ Glutamate
⊗ Behavior is:  An excitatory neurotransmitter
• a response to a stimulus from the environment  At high levels, it can cause neurotoxicity.
• learned and retained by positive reinforcement  Associated with Alzheimer’s and Huntington’s disease
⊗ Gama-Aminobutyric Acid
Interpersonal Model (Harry Stack Sullivan)  An inhibitory neurotransmitter
⊗ Focused on the role of the environment and  Associated to treat anxiety and induce sleep.
interpersonal relations as
the most significant influences on a individual’s PSYCHOTHERAPY
development.
⊗ Anxiety is communicated interpersonally. ⊗ Is a process in which a person enters into a contract to
Human Motivational Need Model. (Abraham Maslow) interact with
⊗ Hierarchy of needs in order of importance a therapist to relieve symptoms, resolve problems in living,
⊗ Primary needs (physiologic) need to be met prior to seek
dealing with personal growth
higher level needs.
Psychobiologic Model INDIVIDUAL THERAPY: Is a confidential relationship between
⊗ Focus is in mental illness as a biophysical impairment. client
⊗ Human behavior is influenced by genetics, biochemical and therapist.
alterations ⊗ Hypnotherapy: Involves various methods and techniques
and function of brain and CNS. to
⊗ The stress response is a neuroendoctine response. induce a trance state where the patient becomes submissive
Important structure (limbic system): to
⊗ Thalamus – regulates activity, sensation, emotion instructions
⊗ Hypothalamus – themoregulation, appetite control, ⊗ Humor therapy: Use of humor to facilitate expression of
endocrine feelings
function, appetite control, impulsive behavior associated and to enhance interaction
with ⊗ Psychoanalysis: Focuses on the exploration of the
feelings of anger, rage or excitement. unconscious, to
⊗ Hippocampus and amygdale – emotional arousal and facilitate identification of the patient's defenses
memory GROUP THERAPY
⊗ Neurons – basic functioning unit of the CNS • minimum number : 3
⊗ Neurotransmitters • Ideal number :8-10
 Chemical substances manufactured in the neuron • Advantages:
 Aid transmission of information throughout the body o decreases isolation
⊗ Dopamine o decreases dependence
 An excitatory neurotransmitter o develops coping skills
 Located primarily at the brain stem o develops interpersonal learning
 Involved in control of complex movements, motivation, o develops opportunities for helping others
cognition and regulation of emotional responses o develops ability to listen to other members
 Associated with pyschosis and Parkinson’s disease
⊗ Remotivation Therapy: Promotes expression of feeling o The consequences should occur immediately after the client
through has exceeded the limit
interaction facilitated by discussion of neutral topics o Consistency must occur with all personnel.
⊗ Family therapy: A method in which family members o Purposes:
gain: o Minimizes manipulation and splitting of the staff.
o insight into the problems o Provide a framework for the client to function in and
o improve communication enable a client to learn to make requests.
o improve functioning of individual members as well as
the • Systematic Desensitization
family as a whole. o Clients are exposed slowly to a feared object or a thing that
o It focuses on the total family as an interactional system inhibits anxious responses and taught ways to relax.
⊗ Milieu Therapy o Effective in treating phobias.
• A therapeutic environment is organized to: • Implosive therapy
o The clients are exposed abruptly to intense forms of anxiety
o encourage and assist the client to control producers, either in imagination or in real life
problematic behavior
o function within the range of social norms • Cognitive Behavior therapy
o Uses confrontation as a means of helping the clients
⊗ Play therapy restructure or rearrange irrational beliefs, maladaptive
• Effective for children suffering from maladjustment or thinking, perception-, and behaviors.
behavior o Used for depression and adjustment difficulties.
disorder. • Biofeedback
• The child is usually placed in a play room o Teaches the client to control or change aspects of their
• Purpose - to discover the causes of the child's conflict internal environment.
through • Aversion therapy
observation of his play and to interpret it to the child. o Uses unpleasant or noxious stimuli to change inappropriate
⊗ Recreational therapy behavior.
• Uses activities which vitalize the patient's interest and o Examples
help him o Antabuse to treat alcoholics
or her to relax and feel refreshed. o Showing films to drivers who are arrested for speeding or
• Example: Playing baseball may be prescribed for as a driving while under the influence of alcohol or drugs.
means of
expressing hostility in a group. • Assertiveness Training
⊗ Occupational therapy: Uses any mental or physical o Clients are encouraged and taught how to appropriately
activity relate
prescribed or guided to aid an individual's recovery from a to others
disease o Teaches the individual to ask for what is beneficial to both
or injury. mentally ill and mentally healthy persons.
⊗ Musical therapy • Token-economy: Utilizes the principle of rewarding desired
• Involving the music which allows the child or adolescent behavior to facilitate change.
to ELECTROCONVULSIVE THERAPY (ECT)
express herself or himself. • Exact mechanism is unknown
• Also effective with those who have difficulty
communicating. • Requires a consent
⊗ Art therapy: Clients are encouraged to express their • Usually given at 70-150 volts for about .5-2 seconds
feelings or Effectivity: 6-12 treatments with at least 48 hour interval
emotions by painting, drawing or sculpture. • Indicator of effectiveness: tonic-clonic seizure
⊗ Psychodrama therapy: Patients dramatizes their Indications of use:
emotional • Depression
problems in a group setting. • Mania
⊗ Behavior Therapy • Catatonic schizophrenia
• Is a mode of treatment that focuses on modifying Contraindications (not absolute)
observable • Fever
(overt) and quantifiable behavior • Increased ICP
• Systematic manipulation of the environment and • Cardiac conditions
variables • TB with history of
thought to be functionally related to the behaviors. hemorrhage
• Limit Setting
• Unhealed fracture
o Therapist gives an advanced warning of the limit and • Retinal detachment
the • Pregnancy
consequences will follow if the client does not adhere to
the Before the procedure:
limit. • Diagnostic procedures
o X-ray o Assess for:
o ECG  Fever
o EEG  Sore throat
• Drugs given  Lab data: WBC count
o Atrophine sulfate (decrease secretions)
o Anectine (Succinylcholine) – relax muscles • Hepatotoxicity
o Methohexital Na (Brevital) - anesthetic o Assess for ALT & AST
MINOR TRANQUILIZERS/ ANXIOLYTICS
During the procedure: ⊗ Common indication: Anxiety disorders
• Observe for tonic-clonic seizure ⊗ Desired Effect: Decreased anxiety, adequate sleep
After the procedure: Examples:
• Position • Diazepam (Valium)
• Check vital signs • Oxazepam (Serax)
• Reorient the client • Chlordiazepoxide
• Watch out for complications: (Librium)
o Memory loss
o Headache • Chlorazepate Dipotassium
o Apnea (Tranxene)
o Respiratory depression • Alprazolam (Xanax)
o Fracture
BASIC CONCEPTS ON PSYCHOPHARMACOLOGY Nursing Implications:
MAJOR TRANQUILIZERS/ ANTIPSYCHOTICS • Best taken before meals
⊗ Indication: Schizophrenia and Other Psychosis • Advise to avoid driving
⊗ Desired effect: control of symptoms • Avoid alcohol and caffeine-containing foods
⊗ Best taken after meals • Administer it separately with any drug
Examples:
ANTIDEPRESSANTS
• Haloperidol (Haldol) Desired effects: increased appetite, adequate sleep
• Prochlorperazine
(Compazine) Tricyclic Antidepressants
Examples:
• Fluphenazine (Prolixin) • Imipramine (Tofranil) • Amitriptyline (Elavil)
• Chlorpromazine Nursing Implications:
(Thorazine) ⊗ Best given after meals
Side effects: Nursing Action ⊗ Effectivity: after 2-3 weeks
Blurred vision Avoid driving ⊗ Check the BP, it causes hypotension
Dry mouth Give sugarless gum ⊗ Check the heart rate, it causes cardiac arrythmias
Tachycardia, palpitation, ⊗ Monitor I & O
constipation, urinary retention ⊗ Monitor for signs of increased IOP

Monitor & report MAO INHIBITORS

Indication: refractory depression
Photosensitivity Don’t expose skin to sunlight Examples:
Orthostatic hypotension Monitor BP • Tranylcypromine (Parnate)
• Phenelzine (Nardil)
Advise gradual change in • Isocarboxazid (Marplan)
position Nursing Implications:
⊗ Best taken after meals
Extra Pyramidal Symptoms ⊗ Report headache; it indicates hypertensive crisis
o Pseudoparkinsonism ⊗ Avoid tyramine containing foods like:
o pill-rolling tremors • Avocado
mask-like face • Banana
o cog-wheel rigidity • Cheddar and aged cheese
o propulsive gait • Soysauce
o Akathisia - restless leg • Preserved foods
syndrome ⊗ Effectivity: 2-3 weeks
o Dystonia - defect in muscle
tone ⊗ Monitor the BP
⊗ There should be at least a two-week interval when shifting
Report at once from one
anti-depressant to another
Adverse effect: report promptly Selective Serotonin Reuptake Inhibitors
• Tardive dyskinesia - lip smacking Examples:
• Agranulocytosis • Fluoxetine (Prozac)
• Celatopram (Celexa) body tissues.
• Sertraline (Zoloft) Phases:
• Alarm
• Paroxetine (Paxil) o Acute phase of the syndrome
• Fluvoxamine (Luvox) o Characterized as the “flight and fight” reaction
o Defensive by nature but self-limiting
Nursing Implications: o If stress is intense, it may lead to death.
⊗ Avoid the use of: • Resistance
• diazepam o Characterized as the state of adaptation
• Alcohol o Person moves back to homeostasis
• Tryptophan • Exhaustion
• Monitor PTT, PT o Result of a prolonged exposure to stress and adaptive
⊗ Never give to pregnant / lactating mothers. mechanisms can no longer persist.
ANTI-MANIC AGENT Local Adaptation Syndrome
Examples: • Refers to inflammatory response and repair
• Lithium Citrate processes that occur at the local site of tissue injury.
(Cibalith – S) Eustress - positive stress
Distress
• Lithium Carbonate • Negative stress
(Eskalith, Lithane, Lithobid)
• Damaging stressors which may result in various physical
Nursing implications: and
⊗ Best taken after meals emotional disorders such as: anxiety, frustration, insecurity,
⊗ Increase intake of: aimlessness
• fluids (3 L /day) CRISIS AND CRISIS INTERVENTION
• sodium (3 gm/day) • A situation that occurs when an individual's habitual coping
⊗ Avoid activities that increase perspiration ability
⊗ Never give to pregnant mothers becomes ineffective to meet the demands of a situation.
⊗ Effectivity: 10-14 days • As a serious interruption and disturbance of one's
⊗ Antipsychotic is administered during the first 2 weeks equilibrium or
⊗ Therapeutic level:.5-1.5 meq/L homeostasis
⊗ If ineffective: Tegretol • Leads to potentially dangerous, self-destructive or socially
⊗ Signs of toxicity: unacceptable behavior.
o Vomiting Characteristics
o Anorexia • Highly individualized
o Nausea • Self-limiting: 4-6 weeks
o Diarrhea • Person affected becomes passive and submissive
o Abdominal cramps • Affects a person’s support system
o Lightheadedness (late)
Type Description Example
⊗ Antidote: Mannitol
Maturational/developme
STRESS ntal crisis

• A nonspecific response of the body to any demand expected,

made upon it. predictable and
(Hans Selye, 1936) internally
• A state produced by a change in the environment that is motivated
perceived
as challenging, threatening or damaging to the person’s Puberty,
dynamic adolescence,
equilibrium. (Smeltzer, 1992) young adulthood,
Adaptation marriage, or the
• A constant ongoing process that occurs along time aging process.
continuum,
beginning with birth and ending with death. (Smeltzer, Situational/accidental Unexpected,
1992) unpredictable
• A continuous process of seeking harmony in an and externally
environment. motivated
Types of Adaptation:
General Adaptation Syndrome (GAS) Economic
• Involves the whole body in response to stress. difficulty, illness,
• Compared to life process as it focuses on the “wear and accident, rape,
tear of the divorce or death
 • Child neglect - lack of provision of those things which are
Social crisis Due to acts of necessary
nature for the child's growth and development
Types of Commission:
Natural Physical Abuse
calamities • Is an intentional physical harm inflicted on a child by a
parent or
Phases other person.
• Denial Emotional abuse - insult and undermining one's confidence
• Increased Tension Sexual abuse - abuse in the form of sexual contact
• Disorganization Characteristics of Abusive Parents:
• Attempts to reorganize • They come from violent families
• Stage for full reorganization • They were also abused by their parents
CRISIS INTERVENTION • They have inadequate parenting skills
• Major Goal: • They are socially isolated because they don't trust anyone
o Restore the maximum level of functioning (pre-crisis • They are emotionally immature
state) • They have negative attitude towards the management of
the
o It is an active but temporary entry into the life situation abused
of an Warning signs of Child Abuse / Neglect:
individual or a family during a period of stress. • Child’s excessive knowledge on sex and abusive words
o A way of entering into the situation to help them • Hair growth in various lengths
mobilize their • Inconsistent stories from the child and parent/s
resources and to decrease the effect of stress. • Low self-esteem
Domestic Violence Requiring Crisis Intervention: • Depression
RAPE • Apathy
• Nonconsensual sexual penetration of an individual, • Bruised or swollen genitalia; tears or bruising of rectum or
obtained by vagina
force or threat, or in cases in which the victim is not • Unusual injuries for the child’s age and development
capable of • Serious injuries (fractures, burns, lacerations)
consent. • Evidence of old injuries not reported
Kinds of Rape Republic Act 7610
• Power – to prove masculinity (Anti Child Abuse Law)
• Anger – means of retaliation • Required reporting of suspected cases
• Sadistic – to express erotic feelings • Report cases to the nearest authorities within 48 hours
Silent Rape Syndrome Assessment, Planning and Nursing Actions for Crisis
• Is a maladaptive reaction to rape • Primary concerns:
• The victim:
• fails to disclose information about the rape o Physical injuries
• is unable to resolve feelings about the sexual assault o Alleviation of psychological trauma
• Results to increase anxiety and may develop a sudden • Nurse should display:
phobic o Sensitivity
reaction. o Attitude (Nonjudgmental)
Rape Trauma Syndrome (RTS) o Confidentiality
• Refers to a group of signs and symptoms experienced by o Respect
a victim in o Empathy
reaction to rape o Dignity
Phases: • Evidences are important:
• Acute Phase – shock, numbness, disbelief o stained clothing
• Denial – refusal to discuss the event o fingernail scrapings
• Heightened Anxiety – fear, tension, nightmares o mouth or anal smears containing semen
• Stage of Reorganization • Intervention focuses family as a unit.
• If the victim is a child: Play and art therapy
Battered Wife Syndrome (BWS) DEFENSE MECHANISM
• A form of cyclic domestic violence
• Men: low self-esteem • These are automatic and usually unconscious processes or
• Women: Dependent personality disorder act by
Child Abuse the individuals to:
• Is an act of omission of responsibility or commission in o reduce or cope anxiety or fear
which o resolve emotional or mental conflict
intentional harm is inflicted on a child. o protect one's self-esteem
o protect one's sense of security
Components of Omission: • Becomes pathologic when overused.
• Child abandonment – leaving the child physically • Used by both mentally healthy and mentally ill individuals
Common Defense Mechanisms Used: o Literally, this means to "throw off.
• Compensation o A student who failed a subject blames his failure on poor
o An attempt to overcome a real or imagined short teaching.
coming, • Reaction – Formation
inferiority, inabilities and weaknesses. o Expression of feeling that is the direct opposite of one's real
o A blind woman becomes proficient in playing piano. feeling.
• Conversion o Also referred to as overcompensation.
o Emotional problems are converted to physical o A student who dislikes one of her classmates may act or
symptoms show
o A student unprepared for a report suffered headache concern toward her.
the day she • Rationalization
is supposed to deliver her report. o An individual finds a justifiable cause and acceptable
• Denial reasons just
o Failure to acknowledge an intolerable thought, feeling, to be saved from an embarrassing and anxiety producing
experience or reality thoughts or situations.
o A middle-aged man after being admitted to the CCU o A basketball player claims that he missed the shot and lost
because of the
game because of the distractions made by the audience.
an AMI, insists that he is in the hospital for just a
diagnostic work- • Regression
up. o Is the turning back to earlier patterns of behavior in solving
personal conflicts.
• Displacement o Commonly seen to schizophrenic patients
o A person who becomes ill in the face of disappointment has
o the redirection of feelings to a less threatening object regressed to a form of childish behavior.
o An adolescent boy, after an argument with his father, • Repression
goes to the o It is the involuntary or unconscious forgetting of an
room and kicked his room’s door. unpleasant
• Fantasy ideas or impulses.
o Conscious distortion of unconscious feelings or wishes o During the nurse-patient relationships, patients often
o A boy who is being bullied by his friends wished he had unconsciously avoid discussing those experiences producing
the anxiety which are emotionally difficult to verbalize.
power of Wolverine. • Suppression
• Fixation o Permits the individual to store away or consciously forget
o An unhealthy mechanism which is an arrest of the
maturation at unpleasant, painful and unacceptable thoughts, desires,
certain stages of development. experiences and impulses.
o A boy never overcame being fully reliant from his o "I'll think it about tomorrow", "I'd rather go now", "Can we
mother. change the topic?"
• Introjection o A boy walked out from the group and said "I have to go
o Symbolic assimilation or taking into oneself a now",
love/hatred object. when he was asked what was happened to their relationship
Derived from the word "introject" which literally means to with
take his girlfriend.
into or ingest. • Substitution
o Common to depressed clients. o Replacing the desired unattainable goal with one that is
• Identification attainable
o An individual integrates certain aspects of someone o A woman who failed the nursing board exam 3 times,
else's worked as
personality into one's own. a nursing aide just to be in the hospital.
o A young school teacher adopts his former mentor's • Sublimation
teaching o The redirection of unacceptable instinctual drive with one
style when conducting class sessions. that is
• Intellectualization socially acceptable
o An overuse of intellectual concepts by an individual to o Instead of harming his mother, a man expressed his anger
avoid by
expression of feelings composing a song.
o A man who was asked to share a memorable experience • Symbolization
about o Less threatening object is used to represent another
his grandmother who died discussed the stages of death o A woman, missing her husband finds comfort in hugging her
and son
dying by Elizabeth Kubler Ross. who looks like his father.
• Projection • Undoing
o Attributing to others one's unconscious wishes/fear. o An attempt to erase an act, thought, feeling, guilt or desire
o A man gives her wife a bunch of roses after their night.
argument last