NCM 217 MIDTERMS

● B.F. Skinner - Operant Conditioning

INTERPERSONAL THEORY
● Harry Stack Sullivan - Interpersonal Development
MALADAPTIVE PATTERNS Theory
● Hildegard Peplau
NCM 217
COGNITIVE FRAMEWORK
TOPIC OUTLINE
● Albert Ellis- Rational Emotive Therapy
I. Conceptual Framework Of Psychiatric
HUMANISTIC FRAMEWORK
Nursing Practice
● Abraham Maslow - Human needs
II. Psychosocial Development Theory
● Carl Rogers - Client - Centered Therapy
III. Personality Dynamics
IV. Psychosexual Development Theory
PSYCHOBIOLOGICAL THEORIES (ANATOMY)
V. Behavioral Framework
● Theories that explain how the food that we eat
VI. Intrapersonal Theory
affect how we behave
VII. Interpersonal Theory Of Nursing
● Theory behind medications; how does the erikson
VIII. Cognitive Behavioral Framework
medication affect the behavior of the human being
IX. Cognitive Stages Of Development
X. Humanistic Framework
PSYCHOSOCIAL DEVELOPMENT THEORY
ERIK ERIKSON
LECTURE DATE: 02/28/2023 and 03/01/2023
VIDEO LECTURE
● 1902-1994
● Famous psychologist
CONCEPTUAL FRAMEWORK OF PSYCHIATRIC ● Contemporary of sigmund freud and anna freud
NURSING PRACTICE ● “At a very beginning of life we have that
CONCEPTUAL MODELS IN PSYCHIATRIC developmental phase and that this result to the ego
NURSING PROCESS development through social interaction,and the
developmental task are sequential and dependent
DEFINITION on the prior successful master”
● Methods of organizing knowledge that provide a ● 8 developmental phases
basis for understanding human behavior and the ● Ego dev’t results from social interaction
relationship of biologic factors, developmental ● Developmental tasks are squential and dependent
processes and environmental influences. on prior successful mastery
- Every behavior has meaning
PURPOSES/FUNCTIONS - Symptoms of mental illness are caused by
● Allow the systematic organization of knowledge unconscious internal conflicts arising from
● Guide data collection unresolved issues in early childhood
● Provide explanations for assessed behaviors
● Guide care plan development
● Provide rationales for selecting interventions KEY POINTS
● Determine evaluation criteria for outcome ● This speaks about the human development or
measurement the development of the persons
● Guide research by providing assumptions to be well-being/personality is greatly influenced by the
tested social interaction that the persons had
● Every behaviour has meaning
● Symptoms of mental illness are caused by
NOTE unconscious internal conflict arising from
● the conceptual models will help understand unresolved issues in early childhood
human behavior, however you call that behavior ● Informant- the one who supply as the information
(e.g. ill behavior, appropriate behavior, irrelevant
behavior)\
● It is safe to call them conceptual models because
most of the theorists base their ideas and LIFE STAGE ADULT BEHAVIORS
propositions on their own experiences rather ADULT BEHAVIOR REFLECTING
than experimentation. REFLECTING DEVELOPMENT
● Psychologist trying to dig deep why they are in MASTERY AL PROBLEMS
rehab
TRUST VS. - Realistic trust - Suspiciousness
SELECTED FRAMEWORKS MISTRUST of self and / testing of
(Infant) 0 - 18 others others
PSYCHODYNAMIC THEORIES mos. - Confidence in - Fear of criticism
● Sigmund Freud - Psychosexual others and affection
Development/Psychoanalytic Theory - Optimism and - Dissatisfaction
● Erik Erikson - Psychosocial Development hope & hostility
● Carl Gustav Jung - Personality Dynamics - Shares openly - Projection of
● Jean Piaget - Intelligence And Cognitive with others blame &
- Relates to feelings
BEHAVIORAL THEORIES others - Withdrawal
● Ivan Pavlov - Classical Conditioning effectively from others OR

3G
 - Copes to - Overly trusting efforts and - Inadequate
develop of others effectiveness problem-solving
- Viewing the - Naïve and - Ability to skills
world as safe gullible cooperate and - Manipulation of
and reliable - Shares to compromise others
relationship as quickly and - Identification - Lack of friends
nurturing easily with admired of same sex
- Stable and others
dependable - Balance of OR
work and play
AUTONOMY VS. - Self control and - Self doubt / self - Joy of - Overly high
SHAME & willpower consciousness involvement in achieving /
DOUBT - Realistic self - Dependence on the world perfectionist
(Toddler) 18 concept and others for - Feeling - Fear of failing
most – 3/5 y.o. self esteem approval unworthy and - Feeling unable
- Pride and - Sense of being inadequate to gain love or
sense of out of control of - Poor work affection unless
goodwill the self and history totally
- Simple one’s life - Inadequate successful
cooperativenes - Obsessive – problem-solving - Being a
s compulsive skills workaholic
- Delated behaviors - Manipulation of
gratification others
when OR - Lack of friends
necessary - Excessive of same sex
independence
of defiance, OR
grandiosity
- Unwillingness - Overly high
to ask for help achieving
- Impulsiveness /perfectionist
and inability to - Fear of failing
wait - Feeling unable
- Reckless to gain love or
disregard for affection unless
safety of self totally
and others successful
- Being a
INITIATIVE VS. - Adequate - Excessive guilt/ workaholic
GUILT conscience embarrassment
(Preschool) 3/4 - - Initiative - Passivity and IDENTITY VS. Confident - Lack of giving up
5/6 y.o balance with apathy ROLE Emotional of goals, beliefs,
restraint - Avoidance of CONFUSION stability - values - Feelings
- Appropriate activities/ (Adolescence) Commitment to of confusion,
social pleasures 12 – 18/20 y.o. career planning indecision -
behaviors - Self-pity - and realistic Superficial, short
- Curiosity and Reluctance to long term goals term
exploration show emotions - Sense of relationships with
- Healthy - Underachievem having a place opposite sex OR
competitivenes ent of potential in the society - - Dramatic
s Establishing overconfidence -
- Sense of OR relationship Acting – out
direction with opposite behaviors
- Original and - through on sex - Fidelity to (alcohol, drug
purposeful plans friends - use)
activities - Little sense of Development of
guilt for actions personal values
- Excessive
expressions of INTIMACY VS. Ability to give Persistent
emotion ISOLATION and receive isolation -
- Labile emotion (Young Adult) love - Emotional
- Excessive 18 – 40 y.o. Commitments distance in all
competitivenes and mutuality relationships -
s with others - Prejudices
Collaboration in against others -
INDUSTRY VS. - Sense of - Feeling work and Many career
INFERIORITY competence - unworthy and affiliations - changes -
(School age) 6- Completion of inadequate Sacrificing for Seeking intimacy
12 y.o. projects - Poor work others - through casual
- Pleasure in history Responsible sex encounters
sexual OR -
3G
 ● Swiss psychiatrist who formed the psychoanalytic
behaviors Possessiveness school known as analytic psychology
and jealousy ● Viewed external factors as playing an important role
Dependency of in people’s growth & adaptation
parents and or ● Each person has a mixture of each component
partner -
abusiveness
2 TYPES OF PERSONALITY ORGANIZATION
toward loved
ones
1. Introversion / Introverts - focus on their inner
world of thoughts, intuitions, emotions & sensations
GENERATIVITY Productive, Self-centerednes
2. Extroversion / Extroverts - more oriented toward
VS. constructive, s - Exaggerated
the outer world, other people & material goods
STAGNATION creative - concern for
(Middle Adult) Personal and appearance and
PERSONA
40 – 65 y.o. professional possessions -
● the mask converting the personality, is the force a
growth - Lack of interest
person presents to the outside world
Parenteral and in the welfare of
● A part in our life or personality that we are either
societal others - Lack of
introverts or extroverts
responsibilities civic and
professional
ULTIMATE GOAL
activities - Loss
● To achieve INDIVIDUATION, a process continuing
of interest in
throughout life whereby people develop a unique
marriage and/or
sense of their identity
extramarital
○ Either introvert or extrovert man yung
affairs OR - Too
magiging fixed to you as a person the most
many
important thing here is to achieve
professional or
individuation, it means you recognize your
community
own individuality.
activities to
ANIMA
detriment of
● female component of a male personality
family / self
● Ex. Men are moody, strong intuition which is usually
common in women
INTEGRITY VS. Feelings of self Suicidal ideas or
DESPAIR acceptance - apathy OR - ANIMUS
(Maturity or Sense of Inability to ● male component of a female personality
Older Adult) 65 dignity, worth reduce activities - ● Ex. great basketball players na mga babae which is
y.o. to death and importance Overtaxing usually a part of a character of men
- Adapation to strength and
life according to abilities - Denial
PSYCHOSEXUAL DEVELOPMENT THEORY;
limitations - of death as
Valuing one’s inevitable
STRUCTURE OF PERSONALITY;
life - Sharing of LEVELS OF AWARENESS
wisdom - SIGMUND FREUD
Exploration of
philosophy of ● 1856-1939
life and death ● Austrian psychiatrist
● Founder of psychoanalysis
● Theory focuses on intrapsychic processes and
APPLICATION TO NURSING psychosexual development

ERIK ERIKSON INTRAPSYCHIC PROCESSES

● The nurse assess a client’s psychosocial
development according to expected norms for
specific age
● The nurse can use knowledge of development tasks
in selecting appropriate interventions for the client
○ Ex. Client developed mistrust
- To deal with client who are not
trusting, you need to base all the
interventions and all actions on a
matter of fact attitude
- It must have basis kasi kung hindi
mag dududa at mag dududa ang
client
● The nurse fosters healthy behaviors & encourages
hope that relearning is possible
PERSONALITY DYNAMICS
CARL GUSTAVE JUNG
● 1875 - 1961
● DRIVES/INSTINCTS
○ “We as human beings are driven by our
instincts: instincts to live, instinct for
hunger..”
3 LEVELS OF AWARENESS
1. CONSCIOUS
○ Represents the ego or us in the present
2. SUBCONSCIOUS
○ Represents something that has been
hidden from the consciousness
○ Stored in the memory and needs a little
effort for us to remember
○ EX.: If someone asks “what did you do
Saturday last week?” and it's currently
Monday. You try to remember with little
effort, “Ah I watched a concert, etc.”

3G
 3. UNCONSCIOUS
○ Memories, experiences stored in the part
of the consciousness
○ The largest part of the level of awareness
of which you need more time and effort
to remember them
○ Experiences that we’ve forgotten; we need
people, psychoanalysis, and hypnosis (an
external tool) to remember these
experiences
○ We cannot remember these experiences
with our own capacity alone
PERSONALITY STRUCTURE
● ID
- The primitive one
● EGO
- The present, represent the conscious
● SUPEREGO
- Represents the command of the society
NOTE:
Ma’ams example in explaining ID, Ego and Superego:
- You ask your parents for 2 months of allowance
in advance to be able to buy an iPhone 14 Pro
Max kahit wala kang kakainin for 2 months.
EGO
- Since Ego is based on the PRESENT; “dito na
allowance ko, kailangan ko ba talaga ibili or
bilhin ko ba talaga ang iPhone Pro Max kahit
wala akong kakainin for the next 2 months?”
SUPER EGO
- The parents gave you your allowance for the
next 2 months in order for you to live normally at
makapag aral ka kasi nay kakainin ka. Di mo
dapat bili ang iPhone 14 Pro Max.
DEFENSE MECHANISM
● When your ID, Ego, and SuperEgo needs are NOT
met, then it creates anxiety on the person, creating
an emotional imbalance on the person, in which the
person displays different behavior. For the person to
ACHIEVE that balance, they go for a defense
mechanism
SIGMUND FREUD
● Theories on dreams
○ Freud speaks about people and scenarios
that appear in our dreams that are actually
desires not met when we are conscious
and awake
● Personality are shaped by one's own childhood
● Personality is fueled by sexual and aggressive
urges
○ Freud speaks about drives and instincts
that makes a person move
● Personality is shaped by reward and punishment
● Personality is shaped based on someones need
has been met
○ If the need has not been met, there is
anxiety
PSYCHOSEXUAL THEORY
SIGMUND FREUD
● INFANCY - ORAL (0-1 Age)
○ The person/human being/infant or the child
needs to satisfy the oral needs during
this time
○ 0-1 (breastfeeding age or bottle feed)
■ There’s a need for the baby to
suck the teats of the bottle or the
breast of the mom to help them
satisfy their oral needs
○ At a certain age the child needs to be
weaned from being hooked to sucking
■ Note: the bottle milk is a source
of comfort for the infants
■ To wean the child, some parents
put spicy things on the bottle so
the child will repel from the
bottled milk. This experience
causes anxiety and may lead to
oral fixation.
○ If the oral need is not met, this creates a
death threat on this balance experience
and so there is anxiety. The child may
think this bottle is my source of comfort,
how come it’s giving me pain this time?
■ There is a need to teach mothers
how to wean a child properly, and
it have to be in stages
○ How to wean properly?
■ Example: The mother will say
“may prize ka sa akin if hindi ka
na nag drink ng milk mo doon sa
bottled milk”. Itabi ng mother ang
bottled milk and ang glass of milk.
Prizes can be an hour additional
for watching television, or using
cellphone.
■ Mother should not easily put spicy
things on the teats of the bottle or
show the child na gi chop ang
teats ng bottle or gipakain sa dog
● TODDLER - ANAL
○ The child control his/her poop or urine as a
manner of manipulating the environment
● PRESCHOOL - PHALLIC
○ Developmental task is establishing
sexual identity and the beginning of
socialization
■ Example: the females wear the
sandal of their mothers to mimic
■ Children mirror their parents of
the same gender
○ Tendency to develop the electra complex
and the oedipus complex
■ The son mirrors the father but
develop fondness to the mother
■ Anak na lalaki close sa mama,
anak na babae close sa papa -
● SCHOOL AGE - LATENCY
○ Critical experience here is the
development of peer group experiences
○ Group identification
○ Very moment the child channels the sexual
drive into cool activities
● ADOLESCENCE - GENITAL
○ Critical experience is experiencing
heterosexual relationship and sexual
maturity
3G
 ○ Any disbalance or needs unmet will create
or lead to different experience of a person
such creating anxiety
APPLICATION TO NURSING
● Nurses should assess the client’s anxiety levels and
use of defense mechanism
○ On the different structures of personality
(id, ego, supergo) - any needs unmet will
lead to anxiety. For the persons to get
back to balance, the person needs to use
defense mechanism
○ Ex: the story of a daughter who lost her
father during the pandemic and still
provides plate or space for the deceased
father on the table when they eat
■ We may think that the daughter is
using denial as a defense
mechanism because the person
is not capable of dealing the
anxiety brought about by the lost
of the father
● Psychodynamic theory can be used to understand a
client’s behavior and provide developmental
perspective of behavior
○ During case study you can use theories of
sigmund freud or erik erikson
BEHAVIORAL FRAMEWORK
IVAN PAVLOV
● 1849-1936
● Famous for the Classical Conditioning
● Awarded Nobel Prize in Physiology or Medicine
1904
● Russian physiologist
GENERAL CONSIDERATIONS
● “People learn to be who they are by environmental
shaping”
● Behavior:
○ Can be observed, described, & recorded
(common in therapies handling children
with autism or ADHD. Other therapies
record journaling)
○ Is subject to reward or punishment
○ Can be modified by changing one’s
environment
CLASSICAL CONDITIONING
● Established that learning or conditioning can occur
when a stimulus is paired with an unconditioned
response.
OPERANT CONDITIONING
● Burrhus Frederic Skinner (1904-1990)
● “The consequences of behavior determine the
probability that the behavior will occur again” -
repetition of good behavior
● Positive and Negative reinforcement
● Behavior developed depending on the
reinforcement used. Positive or Negative
● If a person done good things, we respond with
positive reinforcement. Thus, the tendency of the
person will repeat the good behavior. While in
negative reinforcement, the person will not repeat it.
BEHAVIORAL MODIFICATION TECHNIQUES
● MODELING
○ Learned by imitating the behavior of
another person.
○ Applicable with our clients who already
forgot to take good care of themselves.
Forgot to do hygiene - nurse will offer a
comb for the client to imitate the combing
of hair.
○ Applicable for the growing up children.
“Ang paggawa ng mali ay nagiging tama
sa mata ng bata kapag ginagawa ito ng
matanda” - the children has the tendency
to mimic what the adult are doing. Adults
have better maturity and thinking.
● TOKEN ECONOMY
○ Done though giving prizes.
● SYSTEMATIC DESENSITIZATION
○ Done to people who are having phobias.
○ Slowly exposing the person to the feared
object.
○ Up until the person deals with their fears.
● AVERSIVE THERAPY
○ Flooding
○ Allowing the person to shout, cry, etc,
while facing your greatest fear.
● RELAXATION TECHNIQUE
○ You wanted to develop behavior, start with
relaxation
○ Meditation
APPLICATION TO NURSING
● The nurse assesses both adaptive & maladaptive
behaviors
○ Adaptive - when the person is setting
reality and is trying to move from the denial
or from maladaptive to the adaptive
behavior
● The nurse & client collaborate in identifying
behaviors that need to change
○ Nurses identity what are the ill behaviour
or maladaptive behavior of the client and
tell them
● The nurse uses various behavioral modification
techniques
● The nurse uses principles of behavioral theory
when teaching the client
○ Such as positive reinforcement, negative
reinforcement or condition response of the
client
PRINCIPLES OF OPERANT CONDITIONING
● All behavior is learned
○ It is learned because we are not born with
that attitude and behavior
● Consequence result from behavior = REWARD or
PUNISHMENT
● Behavior that is rewarded with reinforcers tend to
recur
● Positive reinforcers that follow a behavior increase
the likelihood that behavior will occur
● Negative reinforcers that are removed after a
behavior, increase the likelihood that behavior will
recur
● Continuous reinforcement is the fastest way to
increase behavior, but the behavior will not last long
after the reward ceases
3G
● Random intermittent reinforcement is slower to
produce an increase in behavior, but behavior will
continue after the reward ceases
INTRAPERSONAL THEORY
HARRY STACK SULLIVAN
● 1952
● Focus on interaction between an individual & his
environment
● Personality is shaped through interaction with
significant others
○ Child internalizes approval or disapproval
from the parents & therefore the SELF is
shaped by the parental view of the child
SELF-SYSTEM (3 COMPONENTS OF
PERSONALITY)
● “GOOD-ME”
○ Developed in response to a behavior
receiving an approval from parents or
significant other.
○ Appreciation we do following a good act
● “BAD-ME”
○ Developed in response to a behavior
receiving disapproval from parents or
significant other.
○ Rejection and disapproval creates anxiety
● ”NOT-ME”
○ Developed in response to a behavior
generating extreme anxiety from parents
or significant others
○ You cannot identify yourself due to severe
rejection
● ANXIETY
○ an interpersonal phenomenon when there
is conflict or problems with significant
others
● BASIC NEEDS of an individual
○ Satisfaction (biological)
○ Security (emotional % social)
● OTHER CONTRIBUTIONS
○ Concept of Therapeutic Community
STAGE OF HEALTHY
INTERPERSONAL DEVELOPMENT
● INFANCY (Birth-onset of language)
○ Experiences maternal tenderness
○ Intuits maternal anxieties
○ Struggles to achieve sense of security &
avoid anxiety
○ Solitary play
● CHILDHOOD (Language - 5 years)
○ Modifies actions to suit demands in
sex-role training
○ Peer day / parallel play, socialization thru
family events
○ Uses movement & language to avoid
anxiety
● JUVENILE (5-8 years)
○ Learns to accept subordinate to authority
figures outside the family
○ More concept of self-status & role
○ Associational, cooperative play,
competitive play
● PREADOLESCENCE (8-12 years)
○ Capable of participating in genuine love
relationships
○ Develops consideration & concern outside
himself
○ Chum relationships
● EARLY ADOLESCENCE (12-18 years)
○ Heterosexual contacts enter into personal
relationships
○ Attempts to integrate sex with other
personal relationships
○ Development of lust
● LATE ADOLESCENCE (20-40 years)
○ Masters expressions of sexual impulses
○ Forms satisfying & responsible
associations
○ Uses communication skills to protect self
from conflicts with others
○ Intimacy & lust
HIDEGARD PEPLAU (1952)
● Renowned nurse theorist
● Developed interpersonal theory of nursing
● Nurse-client relationship can be therapeutic
● Nurse uses the nurse-client relationship as a
corrective interpersonal experience for client
● Nursing intervention often focuses on “here & now”
interpersonal concerns
● Anxiety intervention is an important nursing function
INTERPERSONAL THEORY OF NURSING
HILDEGARD PEPLAU
● 1952
● Renowned nurse theorist
● Developed interpersonal theory of nursing
● Nurse-client relationship can be therapeutic
● Nurse uses the nurse-client relationship as a
corrective interpersonal experience for client
● Nursing intervention often focuses on “here & now”
interpersonal concerns
● Anxiety intervention is an important nursing function
COGNITIVE BEHAVIORAL FRAMEWORK
ALBERT ELLIS
RATIONAL-EMOTIVE THERAPY
● Confrontation of irrational beliefs that prevent the
individual from accepting responsibility for self and
behavior (belief na tayo lang gumagawa sa utak
natin)
● Teaches the individual to stop blaming themselves
and to accept themselves as they are, with flaws
and imperfections.
FORMULATED THE ABC THEORY OF PERSONALITY
A - Activating event
B - Belief or perception about the event
C - Consequence
D - Dispute irrational belief through RET
COMMON MISPERCEPTIONS OF THOUGHT
PATTERNS
3G
 ○ the client is taught consciously to say
MISPERCEPTION DEFINITION CLINICAL “’stop" to maladaptive thoughts
EXAMPLE
APPLICATION TO NURSING
ARBITRARY Holding beliefs in “I don’t care what
INFERENCE absence of things you do to ● The nurse assesses client's thought patterns &
supporting help me. I know identifies misperceptions
evidence you dislike me.” ● The nurse encourages client's assumption of
responsibility for one's own behaviours & fosters
SELECTIVE Concentrating on “Look at how fat awareness of the effect of negative thinking on
ABSTRACTION a single detail my thighs are.” feelings about self-image
while ignoring (said by an ● The nurse uses cognitive techniques in intervention
others underweight) strategies

OVERGENERALI Making global “People who are COGNITIVE STAGES OF DEVELOPMENT

ZATION assumptions in authority are JEAN PIAGET
based on an like my
isolated incident boss–unfair & ● 1896-1980
critical.” ● Swiss child psychologist
● Explored how intelligence & cognitive functioning
MAGNIFICATION Greatly “I don’t ● develop in children
exaggerating a understand this
situation one paragraph–I’ll
never be able to FOUR STAGES OF COGNITIVE DEVELOPMENT
read this book.”
● SENSORIMOTOR (0-2 years)
MINIMIZATION Belittling “I’m a person who ● PRE-OPERATIONAL (2-7 years)
personal ability, has no abilities or ○ Pre-conceptual (2-4 yrs)
action, or good qualities.” ○ Intuitive (4 to 7 years)
response ● CONCRETE OPERATION (7-12 yrs)
● FORMAL OPERATION (12 years onwards)
DICHOTOMOUS “All or nothing: “If you don’t agree
THINKING patterns of with me on this HUMANISTIC FRAMEWORK
thought issue, then you’re ABRAHAM MASLOW
not my friend.”
● 1921-1970
OTHER COMMON IRRATIONAL BELIEFS/ ● American psychologist
INAPPROPRIATE RULES FOR LIVING (ALBERT ● Formulated hierarchy of needs in 1954
● Maslow’s theory individual differences
ELLIS)

● That one should feel loved & approved by everyone

- Irrational belief
● That one must be totally competent in order to be
considered worthwhile
● That people have little to change or to control
feelings
● That influence of the past should definitely
determine feelings of the present
● That rejection or unfair treatment has catastrophic
consequences
● That it is terrible to be mediocre and unpopular
● That one is disliked when there is disagreement
with another
● That one should never make mistakes
● That people who are obnoxious should be judged
as rotten or bad
● That it is easier to be passive in life than confront
difficulties & responsibilities
● That life is awful if problems are not solved with the NOTE:
right or precise decisions - We can apply Maslow’s theory on our patient by
attaining first the basic needs of the client before
COGNITIVE BEHAVIORAL FRAMEWORK proceeding to other levels of needs. Basic needs
include: Shelter, Water, Air, Sleep or Humanistic
COGNITIVE TECHNIQUES
Needs.
● COGNITIVE RESTRUCTURING
○ teaching the client to change maladaptive GENERAL CONSIDERATIONS
beliefs through positive self- statements &
refuting irrational beliefs ● Theory focuses on ‘here & now’ current behaviors,
issues & problems: spiritual values & meanings
● THOUGHT STOPPING

3G
● Human nature is positive & growth oriented;
existence involves search for meaning &
authenticity
● Maslow’s theory
VIEW OF MENTAL ILLNESS IN HUMANISTIC
CONTEXT
● Failure to develop one’s full potential leads to poor
coping
● Lack of self- awareness & unmet needs interfere
with feelings of security (self-esteem) as well as
relationships
● Fundamental human anxiety= fear of death leading
to existential anxiety
HUMANISTIC FRAMEWORK
CARL ROGERS
● 1902-2987
● Client-Centered Therapy
3 CENTRAL CONCEPTS TO PROMOTE
SELF-ESTEEM
● UNCONDITIONAL POSITIVE REGARD
○ a the client that is not dependent on the
client’s behavior
○ Non judgemental care.
● GENUINENESS
○ realness or congruence between what the
therapist feels and what he or she says to
the client
○ be genuine to the clients, as if you don’t
patient will repel from you.
● EMPATHIC UNDERSTANDING
○ therapist senses the feeling and personal
meaning from the client and
communicated this understanding to the
client
○ Be sensitive to what your client is feeling.
APPLICATION TO NURSING
● Nurse-client relationship is based on positive
regard, respect and empathy
● It is essential for the nurse to analyze herself when
working with the psychiatric client
○ The nurse should have self-awareness as
if you don't, this may result in developing
counter transference.
● Nurse assess spiritual aspects of the client
○ Some clients have develop delusions
based on their spirituality
● Nurse helps client gain self understanding through
reflective listening and empathic responses
● Nurses advocate clients' freedom to choose
alternatives of behaviors in congruence with beliefs
about the meaning and value of one’s life.
○ Our interventions are guided with this
theory and principle. To help us
understand our client and help us nurses
develop our nursing process and sets of
interventions to be effective and healthy for
our patients.
LECTURE DATE: 03/07/23 (F2F)
NOTE:
- SCHIZ: the icon of psychosis (detachment of
reality) problem with neurotransmitter dopamine,
when the person is sad, serotonin is low, given
antidepressants
- MDD: Major Depressive Disorder
(psychobiological theory speaks about serotonin
being high)
Depression Screening Mnemonic (Have to experience
2 weeks or more)
S Sleep disturbance
I interest decreased (anhedonia)
G Guilt or feelings of worthlessness
- (excessive guilt; lahat nalang sorry; no
value on self)
E Energy decreased
C Concentration problems
A Appetite/weight changes
P Psychomotor agitation or retardation (very slow)
S Suicidal ideation
Easier to Understand Criteria for Schizophrenia
A. 2 or more positive symptoms
B. Disruption in functioning
C. 6 months duration (Below 6 months
Schizophreniform, 1 month and less: Brief
Psychotic Disorder)
D. Affective Disorder (-): There has to be NO
HISTORY of MDD because it will turn into
schizoaffective disorder
E. Physiologic Reasons (-): Ex. Pt. Got malaria and it
went to the brain, kaya nag hallucinate siya
- Drug-use, alcohol and nicotine is included
under physiologic reasons
- Drug-induced psychosis: the longest time
the drug can stay in the body is 1 month
F. ASD (-)
- there are those with autism that
experience hallucinations so it needs to be
ruled out
ALCOHOLICS
● Take disulfiram; they cannot be exposed to anything
with alcohol at all because they will develop
physiological changes such as difficulty of breathing
3G
 NCM 217 ● Retinal detachment
● Myocardial infarction
TOPIC OUTLINE
● NURSING RESPONSIBILITIES
I. Treatment Modalities Pre-ECT
● Obtain consent
LECTURE DATE:PRELIMS VIDEO LECTURE ● Place client on NPO (8 hours prior)
SOMATIC THERAPIES ● Remove anything metallic in the body
including dentures
● PSYCHOTROPIC (PSYCHOACTIVE) ● Empty client’s bladder
MEDICATIONS exert their effect in the brain, ● Check VS
altering emotions and affecting behaviors by: ● Meds:
1. Altering amounts of neurotransmitters at a. Atropine SO4 - decrease
the synapse salivation, to decrease risk of
2. Binding to specific receptor sites at aspiration
presynaptic and postsynaptic neurons b. Succinylcholine (Anectine) -
muscle relaxant
c. Methohexital (Brevital) -
NOTE: anesthetic
- Somatic Therapies speaks about involvement of
the physical bodies. Such as taking medicines to Intra-ECT
change the condition of the mind thus leading to ● Ensure patent airway
a change in behaviors. ● Insert bite-block so that they won't bite
their tongue
● ELECTROCONVULSIVE THERAPY (ECT)
- Used primarily for client with depression Post-ECT
- Short-acting anesthesia is used to induce ● Side lying position - promote drainage of
unconsciousness fluids, such as saliva.
- CLient’s VS, oxygenation, cardiac ● VS q15
functioning are carefully monitored before, ● Reorient client (time, place, person) -
during and following ECT (post-op usually they have short term memory loss.
protocols) ● Resumption of eating will be as soon as
- Electric current = 70-150 volts applied gag reflex is present.
- for 0.5-2 seconds to procedure seizure for
30-60 seconds, administered 2-3 times per ● INSULIN SHOCK THERAPY
week for a total of 6-12 treatments. - The administration of sufficient insulin to
induce convulsions and coma.
a. Insulin injections - seizure then
come
b. Introduction of glucose after 30 to
60 mins through gastric gavage

THE NERVE TISSUE

NOTE:
- Not often used nowadays, as it is invasive.
Electric current is induced to a specific body part
in hopes that it will lower or increase or
normalize neurotransmitters thus changing the NEUROTRANSMITTERS
behavior.
- ECT usually take 6 months ● Are chemical substances in the nervous system that
facilitate the transmission of nerve impulses across
synapses between neurons.
● ECT INDICATIONS Note:
● Major depression ○ Synaptic Junction - space between axons
● Prophylaxis for recurrent depression and the dendrite.
(maintenance ECT) ○ Axons - send aways impulses
● Severe mania - not controlled by meds ○ Dendrite - receives impulses
● post -partum psychosis unresponsive to
antidepressants RECEPTOR SITES
● Catatonic schizophrenia unresponsive to
meds ● Channels or specially tailored protein molecules
located on presynaptic and postsynaptic cell
● CONTRAINDICATIONS membranes.
● Clients with fractures
● Increased ICP
3G
 ○ Tryptophan is a precursor of your very own ● It can tell the neuron to fire off a signal or not.
serotonin, a neurotransmitter that is often ● ↑ level competitiveness, aggression and impulse
associated with depression and anxiety. control (euphoria, aggression and intense sexual
Foods that are rich in tryptophan feelings), hypersensitive (psychosis)
○ Chicken ● ⬇ level Parkinsonian Disease and and depression
○ Egg LSD and other hallucinogenic drugs are thought to
○ Cheese work on the dopamine system.
○ Milk
○ Peanuts SEROTONIN

● known as the 'feel-good' chemical.

● It has a profound effect on mood and anxiety - high
levels of it, or sensitivity to it, are associated with
serenity and optimism.
○ ↑ levels - we can think of the good things
that is happening in our lives
● Too little leads to depression, problems with anger
control, obsessive-compulsive disorder, and suicide.
● Too little leads to an increased appetite for
carbohydrates (starchy foods) and trouble sleeping,
which are also associated with depression and
other emotional disorders

GLUTAMATE

● The brain's major excitatory NT

● neurons that are implicated in learning and
long-term memory.
● Responsible for sending signals between nerve
cells

EPINEPHRINE/NOREPINEPHRINE

● Regulate attention, mental focus, cognition, fight or

flight response, and is also essential in metabolism
● Its release affects the body= thus called stress
hormone
● Plays a role in fight or flight response
● Implicated in anxiety disorders

ACETYLCHOLINE

● Controls activity in brain areas connected with

Synaptic Junctions
DOPAMINE
● Controls arousal levels in many parts of the brain
and is vital for giving physical motivation.
attention, learning and memory.
● Low levels of Ach in cerebral cortex :Alzheimer's
disease
● Drugs that boost its action may improve memory in
such patients.
● Anticholinergic - blocks the acetylcholine
● Increase level of dopamine may present a low level
of acetylcholine
● Dopamine and acetylcholine are irreversible
proportional
● Mataas ang level ng dopamine may lead to
schizophrenia, hallucinations, agitation,
aggressiveness
● Anti- Psychotic aims to lower the level to of
dopamine in synapse
● Aakyat si acetylcholine pag bumaba si dopamine,
pag mataas level ni acetylcholine this will mimic
parkinsonian like syndrome.
● That’s why there is pseudo parkinsonism as a side
effect of antipsychotic
● Prolonged use of antipsychotic this will lead to client
to experiencing parkinson's symptom
● Pag increase acetylcholine maaffect ang motor
function of the body.
● Increase acetylcholine this may lead to
pseudo parkinsonism or other symptoms such as:
- Oculogyric
- Limping

3G
 - Hardening of the neck ● Maternal exposure to virus during the critical fetal
development Fetal development experience
GAMMA-AMINOBUTYRIC ACID- (GABA)
NEUROPLASTICITY
● most prevalent inhibitory NT
● Plays role in relaxing and calming a person
● Decrease level in seizures
HELLO PO
Note: PSYCHOPHARMACOLOGY
● Cognition is how our brain works 1. ANXIOLYTICS
● People who is anxious high GABA
● ANTIANXIETY AGENTS (anxiolytics) and
SEDATIVE-HYPNOTICS
Neurotransmitter Function Effect ● Anxiolytic benzodiazepines benzodiazepines
● Sedative-hypnotic Antihistamines
Dopamine Excitatory Fine movement, ● Other - Buspirone
emotional behavior ● Given to patient who are having generalized anxiety
Inc.- schizophrenia or anxiety that cannot control
Dec -parkinsonism, ● Given also to the client who have insomnia
depression ● Anxiolytics is addicting

Serotonin Inhibitory Sleep, mood, eating NURSING INTERVENTIONS

behavior, 1. Should be taken only in short-term basis
Inc-mania ● It is highly addicting
Dec- depression 2. Avoid alcohol and other CNS depressants
3. Avold activities requiring mental alertness
Norepinephrine Excitatory Arousal, wakefulness, ● Response is slowed
learning, 4. Discontinuation of benzodiazepines causes
Inc- mania withdrawal symptoms
Dec-depression ● Monitored and tapered by psychiatrist
● Pag biglang istop ang pag take patient can
Gamma-aminobuty Inhibitory Slows down body feel withdrawal symptoms
ric acid activity
Dec- anxiety 2. ANTIPSYCHOTIC

Acetylcholine Excitatory Arousal, attention, TYPICAL

movement Side effects: extrapyramidal syndrome
Inc- spasms - First generation medication that was first to
Dec- paralysis, discover for psychosis such as
Alzheimer’s dse, chlorpromazine
Parkinsonism ATYPICAL
Side effects: fatal, neuromalignant syndrome
- More Expensive compared with typical
NEUROBIOLOGIC CAUSES OF MI - Lower extrapyramidal syndrome
GENETICS AND HEREDITY - Less S/S

● The study is still in progress. NURSING INTERVENTIONS

● Several Mental disorders maybe linked to a specific ● Check CBC & BP may cause leukopenia and
gene or a combination but its not solely genetic • orthostatic hypotension
● Nature Vs. Nurture ● report elevated temp,,muscle rigidity and sore
● Nature - genes; own genetic predisposition throat, avoid sunlight exposure
● Nurture- behaviors, traits, shaped by - Pt should not be exposed to sunlight for
environments,culture they are easily burn due to antipsychotic
○ How we grew up drugs they’re taking
● may require several weeks of therapy to obtain
STRESS AND THE IMMUNE SYSTEM desired effects
PSYCHOIMMUNOLOGY ● take with food or milk to reduce stomach irritation
● watch out for s and sx of adverse rxns (EPS -
● Effect of psychosocial stressors on the body's extrapyramidal syndrome, NMS - neuroleptic
immune system. malignant syndrome)
● No link between specific stressor with specific ● teach the importance of follow up and compliance to
disease medications
● Immune system and brain can influence ● no activity that requires alertness for 2 weeks from
neurotransmitters start of therapy
- Full blown effect of the medication is can
INFECTION be seen by minimum after 2-3 weeks of
taking the meds
THEORIES: - Pag walang nakitang improvement in the
● Viral affinity to brain tissues first week of taking the meds make sure
○ Rabies - infection that directly affects the the client will take the medication pag mag
brain. It has a strong affinity to the brain. stop sila mag start ulit magbilang ng
weeks.
3G
 ● Tardive Dyskinesia - a late symptoms
● Decrease dopamine increase acetylcholine
parkinsonian symptoms
3. ANTIPARKINSONISM
NURSING INTERVENTIONS
● Best taken after meals
● Avoid driving blurring of vision
● Check bp-hypotension
● Alcohol increases sedative effects
● Avoid sudden position change
● Drugs is not withdrawn abruptly
4. ANTIDEPRESSANTS
- Targeting the serotonin
A. TCA - Tricyclic antidepressants
B. MAOIs - Monoamine Oxidase Inhibitors
C. SSRIs - Selective Serotonin reuptake inhibitors
- Pili lang ang serotonin na i-absorb or
intake ni dendrites
○ Lithium toxicity -
= ● Avoid activities that increase perspiration
● Takes 2-3 weeks before therapeutic effect becomes
evident
● Antipsychotic given during the first two weeks to
manage the acute symptoms of mania, until lithium
takes effect
● Normal- .5-1.5mEq/L
● Monitor serum levels 2-3 times weekly when started
and monthly while on maintenance
ANTIPSYCHOTICS DRUGS
● Usually ending in a “zine” in the last word
● Haloperidol is also antipsychotic drug
● Biperiden is an anticholinergic drug, given if the
client is experiencing EPS.

A. TCA FOR ANTIDEPRESSANTS

NURSING CONSIDERATION
● Suicide risk in 10-14 days
- Heightened monitoring is needed
● Sunblock required
- vulnerable in getting burns
● Increase Fluid Intake
● Take dose at bedtime, best given after meals
● Sugarless candy/gum
MOOD STABILIZERS
- If have dry mouth
● Delay of 2-6 weeks (2-3wks) before noticeable
1. LITHIUM
effects
a. Conventional Mood Stabilizing Agent
● Check BP- hypotension
b. Mechanism of Action: Lithium modulates
● Check heart rate- causes cardiac arrhythmias
or normalizes reuptake of certain
neurotransmitters such as serotonin,
B. MAOI norepinephrine, acetylcholine and
dopamine. It balances fluctuating
NURSING CONSIDERATIONS emotions, lowers violent tendencies during
● Avoid tyramine rich the manic period and prevents relapse
● Foods: Avocado, Banana, Cheddar, and aged
cheese, soy sauce and preserved foods Indications:
● Takes 3-4 wks to work, 2-3 weeks before initial 1. Treatment of symptoms of Mood Disorders such as
therapeutic effects become noticeable mood swings, elation, flight of ideas, aggressive,
● Avoid stimulants violent, and self- destructive behavior.
- Coffee, coke, chocolate 2. Manic episodes of the Bipolar Disorder
● Avoid tricyclics until 3 weeks after stopping maoi 3. Long term maintenance for Bipolar Disorder
● Use sunblock 4. Adjunct treatment for schizoaffective disorder,
● Best taken after meals impulse control disorders, conduct disorders and
● Report headache indicative of hypertensive crisis PDD.

C. SSRI Side effects

● Take in am to avoid insomnia
● Takes at least 4 weeks to work
● Can potentiate effects of digoxin, coumadin and
valium
● Used for anorexia, both nervosa and bulimia
○ Anorexic patient not want to gain weight
1. Nausea, polyuria and polydipsia, weight gain, dry
mouth and fine hand tremor.
2. Maintenance therapy can cause hypothyroidism
leukocytosis (reversible once tx is d/c), acne,
psoriasis and kidney damage.
Toxic Side Effects

5. MOOD STABILIZERS
Plasma Lithium Level Common Side Effect
NURSING CONSIDERATIONS
● Lithium and Carbamazepine < 1.5 Fine Hand Tremor, Mild
● Increase fluid intake 3L per day and normal amount Thirst, Nausea, muscle
sodium intake 3Gm/Day weakness, restlessness
● Best taken after meals
● Monitor for toxicity 1.5 - 2.0 (1.5 - Toxic level) Coarse hand tremors

3G
 Contraindications:
diarrhea vomiting, 1. Pregnancy
drowsiness, lack of 2. Benadryl & Cogentin - Obstruction of bladder,
coordination (early signs of pylorus-duodenum
toxicity) 3. Cogentin- patients with glaucoma, myasthenia
gravis
2.0- 3.0 Blurred vision, vertigo, 4. Symmetrel- history of seizure, liver disease,
tinnitus, slurred speech, eczema like rash CHF, renal disease
twitching, hyperreflexia,
confusion IMPORTANT HEALTH TEACHINGS
1. Use with caution, especially when working with
> 3.0 Seizures, Arrhythmias, machineries
peripheral vascular 2. Report swelling, difficulty, urination, shortness of
collapse, COMA breath, difficulty walking, tremors or slurred speech
immediately
Contraindications 3. Some of the drugs can be abused- monitoring is
1. Patients with renal disease, cardiac problems, required
severe dehydration, Na depletion.
- Na deletion or Hyponatremia can lead to Commonly used Antiparlkinsonian Agents
marked Lithium retention and possible 1. Anticholinergics / Antimuscarinics
toxicity a. Benztropine (Cogentin)
2. Use with caution in elderly patients with diabetes, b. Trihexyphenidyl (Artane)*
thyroid disorders urinary retention and seizure c. Biperiden Hcl (Akineton)*
disorders d. Procyclidine (Kemadrin)
2. Antihistamine
Other Health Teachings a. Diphenhydramine Hcl (Benadryl)
1. BloodLevels should be monitored regularly once a 3. Dopamine Agonist / Antiparkinson
month a. Amantadine (Symmetrel) eps
2. If toxic side effects occur, discontinue the drug and b. Ropinirole (Requip)
inform health care provider
3. Increase oral fluid intake to at least 2.3 Liday and
eat a balanced diet with normal Na intake
4. Effects of Lithium can.be felt 2-3 weeks after initial
dose Do not discontinue medications without
doctor's advise
5. Lithium should be taken with food
Commonly used
- Lithium CO4
- Lithobid
- Priadel
- Lithonate
- Quilonum-R
- Eskalith
- Lithotabs

ANTIPARKINSONIAN DRUGS

3 Types of AntiParkinsonian drugs used in Psychiatry :

1. Antihistamines-Blocks effects of Histamine resulting
to Anticholinergic effects
2. Anticholinergics-Normalize the imbalance of
cholinergic Dopaminergic transmission in the basal
ganglia
3. AntiParkinsonism- Increase Dopamine release

Indications:
1. Decreased EPS (in patients receiving
Phenothiazines)
2. Reverse acute dystonia by reducing severity of
rigidity
3. Suppression of drooling and other signs of
Parkinson's

Side effects:
1. Dry mouth, blurred vision, drowsiness nausea
2. Orthostatic hypotension tachycardia palpitations
3. Confusion, memory loss
4. Urinary retention
5. Psychiatric s/s : depression & hallucinations
6. Cardiac armythmia if taken with Erythromycin

3G
 . High potency = lower dose is needed (commonly given once
a day)
a. Low potency - higher dose is needed (commonly given 3x a
NOTE:
day) ● regardless of your country, if you have mental condition, you
2. Half-life - amount of time for half of the drug to be removed can still marry even if the partner also has mental condition as
from the bloodstream it is a CIVIL RIGHT
. Short half-life = higher dose is needed
a. High half-life = lower doses INDICATION:
PRINCIPLES T HAT GUIDE PHARMACOLOGIC TX ● Schizophrenia
● Medication is selected base on its effect on the client’s target sx. o Psychotic episodes are forever (cardinal sign)
o Ex: delusional thinking, hallucination → target sx in ● Psychotic episodes of acute mania
schizo; since these are psychotic sx, then antipsychotics o Transient hallucination or delusion only in Bipolar
are given. If pt is depressed, antidepressants are given Mania episode
o Efficacy of the medication is evaluated by its ability to o Antimanic medications can be given DURING
minimize the target symptoms. mania
● Psychotropic drugs must be given in adequate dosages for a period ● Psychotic depression (due to serotonin blocking effect)
of time before their full effect is realized o Depression also have Transient psychotic episode
o Example: Antidepressant reaches therapeutic effects for ● Drug-induced psychosis use to tx symptoms of psychosis i.e.
4-6 weeks = Some stops taking it. Hence, it is important delusions & hallucinations
to educated patient to take drug in adequate dosages
o Drug-induced aka substance abuse
● Dosages of the medications are often adjusted to the lowest
dosage effective for the client
o psychosis- hallucinations brought about by drug
o substance abuse- behavioral therapy
TWO TYPES OF RESTRAINT
1. Physical -
● can be given to patient with dementia who are having
psychotic episodes
2. Chemical - gives high doses for faster efficacy
● Elderly requires lower dosage to produce therapeutic effects, and ● patients with Personality Disorder specifically BORDERLINE
it may take longer for a drug to achieve efficacy??? Personality Disorder
o Elderly are prone to hepatotoxicity.
● Psychotropic medications are often gradually tapered rather than CLASSIFICATION
abruptly D/C
o Rebound symptoms - temporary return or recurrence of PHENOTHIAZINES
the original symptoms; aka withdrawal. 3 SUBDIVISIONS
● Follow up care is essential to ensure compliance with the
1. Aliphatic- strong sedatives, may cause EPS
medication regimen, to make needed adjustments in dosage, and
2. Piperazine - moderate Sedatives; cause more EPS;
to manage S/E
antiemetic
● Compliance with medication regimen is often enhanced when the
3. Piperidine - strong sedative, few EPS, no antiemetic
regimen is as simple as possible in terms of both the number of
medications prescribed and the number of daily doses ●

ANTIPSYCHOTICS OR NEUROLEPTICS
● Known before as MAJOR TRANQUILIZERS/SEDATIVES
● Number one antipsychotic drug side effect is
SEDATION/DROWSINESS
● Term “Major Tranquilizer” was used in 1950s - THORAZINE ,
changed to ANTIPSYCHOTICS and now called as
NEUROLEPTICS
● It blocks receptors of the DOPAMINE
● In psychosis/schizo, dopamine is high therefore medications
taken should BLOCK the receptor to decrease it.

NOTE: (MEDICATIONS AND THEIR NT IMPLICATION)

● ANTIPSYCHOTIC (dopamine decrease)
● ANTIDEPRESSANT (serotonin)
● MANIA/ANTIMANIC (serotonin and acetylcholine)
● ANXIOLYTICS (GABA)
● ANTIPARKINSONIAN (Dopamine increase and ●
acetylcholine) ● Ali - chlorpro ang common
● Piperazine - prochlor ang common
GENERAL CONSIDERATIONS ● Piperidine - thioridazine ang common

● It calms the excited client w/o producing impairment of motor

function ALIPHATIC PIPERAZINE PIPERIDINE
● Has a high therapeutic index (can be given in high doses while
not increasing the risk)
● Usually not addicting (even if taken for a lifetime, compared to
PPAs [cough syrups, decongestants have addicting effect])
● Use in pregnancy is NOT recommended (if pt is pregnant
regardless of the mental disorder or taking medication, STOP
the drug)

ONE DAY, ALL YOUR HARD WORK WILL PAY OFF. 理異種 2
 Ex. Ex: ex:
● Chlorprom ● Fluophena ● mesoridaz INDICATIONS
azine hcI zine ine ● relieve positive (+) symptoms
(thorazine (Prolixin) besylate ● Ex:schizophrenia, bipolar, cognitive impairment
) - most ● Perphena (serentil) (dementia, parkinson’s)
common zine ● thioridazin
● Promazin (Trilafon) e hcl ● clients with severe agitation, rage, or combativeness and
hyperactive states
e HCI ● Prochlorp (mellaril)-
(sparine) erazine used for ● treatment of tics (motor control disability), intractable hiccups,
(Compazi short term vomiting and vertigo
ne) - most depressio ● i.e. Louie Cabalde
common n ● vocal tics - saying obscene words (stereotypical)
● Thiothixen accompan ● motor tics - movements (blinking of the eyes,
e ied with repeating movement of the head, etc)
(Navane) anxiety,
● Triflouper agitation, ● Tourette’s syndrome - combination of vocal and
motor tics
azine sleep
(Stelazine disturbanc
) es, OTHER INDICATIONS OF TYPICAL OR OLD
combative GENERATION ANTIPSYCHOTIC
children,
with a ● Drug induced nausea (Prochlorperazine)
maximum ● Intractable hiccups (Chlorpromazine)
limit of ● Pruritus (itchiness)
800mg/da
y
● Dementia who have psychotic sx (in low dosage)
● Tranquilizer for agitated and disruptive behavior
● HIGH ● Fluphenazine (Prolixin)
POTENCY ● Haloperidol (Haldol)
● Thiothixene (Navane)
BUTYROPHENONES ● Trifluoperazine (Stelazine)
. Droperidol (Inapsine)
. prescribed as a pre-operative drug ● MODERATE ● Loxapine (Loxitane)
a. Can be given alone or as a conjunction/ in combination with POTENCY ● Molindone (Moban)
narcotics (i.e. morphine, demerol - used during operation) ● Perphenazine (Trilafon)
b. Given for vomiting - has an antiemetic effect
c. Has an effect in the BP (decreases), but increases HR
● LOW ● Chlorpromazine (thorazine) -
A. Haloperidol (haldol)
POTENCY very 1st antipsychotic
. Use for acute psychosis
discovered in 1950s
a. given those with severe behavioral problems (i.e. combative
patients) ● Thioridazine (mellaril) -
b. Use to suppress narcotic withdrawal syndrome phenothiazine
c. Given to schizo ● Chlorprothixene (Taractan)
●
DIBENZOXAZEPINE SIDE EFFECTS
● are used for acute psychosis and schizophrenia SEDATION/ DROWSINESS
● common drugs:
. Loxapine (Loxitane) ● always choose sedation as number one side effect
THIOXANTHENES ORTHOSTATIC HYPOTENSION
● Are use for acute psychosis and schizophrenia ● Rationale: this is why VS is taken first during PSA
● Common drugs: DEPRESSED HYPOTHALAMIC FUNCTION
. Thiothixene (Navene)
DIHYDROINDOLONE ● Increased appetite - reason why some patients asked for
extra food even after eating [ie. Catalunan Grande]
● Are used for acute psychosis and schizophrenia
● Weight gain
● common drugs:
● Amenorrhea (absence of menstruation
● chlorprothixene (Cloxan, Taractan, Truxal) ● Gynecomastia (in men)
● molindone (Moban) ● False (+) pregnancy test
● Sexual dysfunction - common (male: erectile dysfunction,
2 TYPES OF ANTIPSYCHOTICS male and female: orgasmic dysfunction; diminished
libido/sexual response)
TYPICAL/CONVENTIONAL (OLD GENERATION DRUGS) ● Increased risk of breast CA
. block specific dopamine receptor sites (D2)- limbic areas of
the brain, hypothalamus and cerebral cortex (cerebrum), an action
● Functions of the hypothalamus:
believed to reduce psychotic symptoms ● Regulate temperature
● D1,2,3,4,5- Dopamine 2-4 are associated with mental ● Homeostasis
disorders ● Water content
b. blocks the dopamine receptor in the basal ganglia causing the ● Appetite
EPS & other S/E ● Sexual drive
.Basal ganglia - responsible for motor control
i.EPS = motor control disorder or disturbances
● Feeding

ONE DAY, ALL YOUR HARD WORK WILL PAY OFF. 理異種 3
 NURSING MANAGEMENT ● Torticollis (spasm and stiffness of head
● Discuss with the physician the option of administering bedtime and neck muscles; can result to laryngeal
dose to avoid daytime sedation. spasm w/c leads to respiratory
depression)
● Monitor BP prior to administration
● Instruct pt to avoid sudden change in movement, to rise slowly
● Oculogyric crisis (eyes roll back – only
white part can be seen)
and dangle feet while sitting (sudden change may cause
orthostatic hpn) ● Pseudoparkinsonism/ Parkinsonian Syndrome
● Make sure pt is not pregnant (false positive pregnancy test ● pin rolling
● Instruct pt dietary regimen for weight loss ● tremors
● discuss gynecomastia effect- normal effect ● Akathisia
● encourage pt to discuss body image issues ● motor restlessness described by people
having “ants in the pants”, always pacing,
● encourage client to verbalize problems about sexual
fidgeting, shifting
functioning- medications may be decreased or changed (i.e.
A Beautiful Mind) ● No cure
ANTICHOLINERGIC SIDE EFFECTS ● Tardive Dyskinesia
● long term irreversible effect of
. Blurring of vision antipsychotic drug
a. Dry eyes - may lead to mydriasis (excessive dilatation of the
pupil) → IOP → narrow angle glaucoma) ● manifested by a bizarre involuntary
b. Constipation stereotyped facial movements from the
c. Urinary retention or hesitancy eyebrows to the eyes to the mouth and
d. Nasal congestion neck and jaw
● No cure
GI S/E ● goal: prevent the occurence of TD
● This can be done by:
● nausea
● keeping the maintenance
● diarrhea dosages as low as possible
● increased appetite = weight gain ● changing medications
● NURSING MANAGEMENT
● assess for EPS
● Offer sugarless candy or gun ● Recognize dystonic reaction
as an emergency (esp.
● Rinse mouth frequently oculogyric crisis, laryngeal
● Provide high fiber diet spasm)
● Increase oral fluid intake to at least 6-8 glasses per day ● Reassure the patient
● Assess sensation for bladder distention. Teach pt to ● Advise patient to rest - EPS
● Instruct client to take medication with meals ● administer antidote:
● Small frequent feeding anticholinergic
● Maintain normal fluid intake ● Neuroleptic Malignant Syndrome (NMS)
● Report persistence of diarrhea ● occurs in the first 2 weeks of
● the treatment
DERMATOLOGIC EFFECT ● Hyperthermia of 40 C/ 102 F
● Altered consciousness
● Systemic dermatoses (general term used to describe any (mute/stupor)
skin defect or lesions in the skin that is systemic) may occur
2-8 weeks after treatment
● Diaphoresis, tachycardia
● Contact dermatitis (redness and itchiness of the skin after
● EPS reactions
coming in contact to a substance ; allergic reaction) may ● Elevated CPK
occur ● Elevated BP, arrhythmias
● Ex. allergy to laundry detergent ● Seizure
● Photosensitivity - occurrence of rashes after exposure to ● Death
sun ● Respi: depression
● ● nsg mgt
● nursing mgt ● stop the drug stat!
● Instruct pt to use sunscreen and wear clothing over exposed ● administer dopamine
area enhancer medications such as
● Avoid scratching to avoid infection Bromocriptine (Parlodel)
● ● Supportive /asymptomatic
treatment

CNS EFFECT CONTRAINDICATIONS

● Extrapyramidal Syndrome (PS)
● Acute dystonia (movement disorder in which a
person’s muscle contract uncontrollably) (i.e.
expect rigidity, tremors, gait and balance)
● Opisthotonus (uncontrollable twisting of
the arch/back, tightness in the entire
body where back and head almost
meets)
● any known allergic reaction to antipsychotics
● pts with severe CNS depression d/t excessive ROH or
narcotic use, brain damage or trauma, elderly and debilitated
pts
● Pts. w/ blood dyscrasias (esp. Agranulocytosis- decrease in
WBC)
● Pts. w/ narrow angle glaucoma
● Pts w/ BPH (because of urinary retention)

ONE DAY, ALL YOUR HARD WORK WILL PAY OFF. 理異種 4
 ● Pts. with Parkinson’s disease- Dopamine is low
● OTHER INFORMATION
● The most common S/E of antipsychotics is DROWSINESS
ATYPICAL (NEW GENERATION DRUGS) ● Phenothiazines and Thioxanthenes also block norepinephrine
● block dopamine receptor in the limbic system and affect causing sedative effects and hypotension
serotonin receptors in the cortical areas of the brain ● Butyrophenones block only the ——
● Advantages over typical: ● Haloperidol
1. Reduce (+) and (-) symptoms ● increased incidence of EPS d/t blockage of
2. decreased (or no) EPS effects dopamine receptors
3. does not cause Tardive Dyskinesia
● increased incidence of glaucoma
● common atypical antipsychotics
● atropine counteracts EPS and potentiates effect of
● clozapine (Clozaril) antipsychotic
● Risperidone (Risperdal) ● usually if one antipsychotic medication is ineffective, another
● Olanzapine (Zyprexa) is prescribed
● Quetiapine (Seroquel) ● drugs should not be discontinued abruptly
● Sertindole (Serlect) ● aggravate symptoms or cause acute psychotic
● Ziprasidone (Zeldox) symptoms
● Aripiprazole (Abilify) ● stop only during NMS and AGRANULOCYTOSIS
● Solian (Amisulpride)
● 4 NEW ATYPICAL (2007 Janssen) ANTIDEPRESSANTS
● Paliperidone (Invega)
● Iloperidone (Fanapt) MONOAMINE OXIDASE INHIBITORS (MAOIS)
● Asenapine (Saphris) ● Most effective in treatment of ATYPICAL DEPRESSION
● Lurasidone(Latuda) o s/sx: overeating and oversleeping
● TOXIC S/E: o Weight gain
● Seizures (Grand mal seizure - appears without warning, o Highly reactive emotions
whole body is shaking) o Marked anxiety
● monitor for pt seizure o At times sleeplessness
● ensure pt safety during seizure ● Toxic side effects
● Hematologic Effects- Agranulocytosis (decrease WBC A/N o HEPATIC TOXICITY
VALUE: 2000/3000 but follow 2000 in quiz, occurs at 3-8 ▪ Blood counts and LFT should be
weeks, most common in CLOZAPINE) obtained prior to therapy
● weekly monitoring of WBC
▪ Stop the drug STAT!
● D/C Drug STAT!
● Place pt in reverse isolation (r/f infection) ▪ Supportive or asymptomatic treatment –
● Agranulocytosis (d/t Clozapine) bedrest, good nutrition and adequate
fluids
● flu-like symptoms
● fever, malaise o Hypertensive crisis
● sore throat ▪ D/C MAOIs and contact physician
● mouth sores ▪ Monitor BP
● leukopenia ▪ Treatment is palliative – lower the BP
● CLIENT TEACHING with antihypertensives (Nifedipine SL or
● drink sugar free liquids and eat sugar free hard Phentolamine IV), monitor for
candy arrhythmias
● Avoid calorie laden beverages and candy
● prevent constipation by increasing intake of water ▪ Manage fever by external cooling
and bulk-forming foods in the diet and by ▪ Institute supportive nursing care as
exercising indicated
● Stool softeners are permissible but laxative should ● Contraindications
be avoided.
o Cardiovascular disease or history of stroke
● Use sunscreen. Avoid long periods in the sun, wear o Hyperthyroidism
protective clothing o Patient’s for surgical procedure – MAOIs should
● rise slowly from lying or sitting. wait to walk until any be discontinued 2 weeks prior to surgery
dizziness has subside o Pheochromocytoma – a tumor that secretes
● inform pt that it can cause sleepiness or pressor substances
drowsiness. avoid activities that require alertness ● Patient teaching
● if a dose of antipsychotic or antipsychotic o Therapeutic effect achieved within 10 days - 4
medication is missed, take if the dose is only 3-4 weeks
hours late. If the missed dosage is more than 4 o Avoid driving if drowsy
hours late or the next dose is due, omit the forgotten o Certain over-the counter drugs should be avoided
dose. (e.g. Ritalin, ephedrine)
● kulang o All of the pt’s Hx care providers should be aware
● If patients have difficulty remembering medication, that pt is taking MAOI
use a chart to record doses when taken, or use a o Avoid high tyramine foods
pill box labeled with dosage, times, and or days of o h/a, palpitations and stiff neck should be reported
the week to help them remember when to take this immediately
medication.

ONE DAY, ALL YOUR HARD WORK WILL PAY OFF. 理異種 5
 o FOODS CONTAINING TYRAMINE TO AVOID
WHEN TAKING MAOIs o Other S/E
▪ Mature or aged cheeses or dishes made ▪ Tremors
with cheese (ie lasagna or pizza) ▪ Nervousness
▪ No aged meats (ie pepperoni, salami, ▪ Nausea
mortadella, summer sausage, beef logs,
● OTHER INFORMATION
and similar products)
o Important health teaching
▪ No italian broad beans (fava) pods or ▪ Effects of the drug usually take place 3
banana peel weeks to 1 month after initial dose
▪ Avoid all top beers and microbrewery ▪ Do not D/C drug prematurely
beer o For health care providers
▪ No saturated, soy sauce or soybean ▪ May alleviate depression, but suicidal
condiments, or marmite (concentrated thoughts and ideation will still persist
yeast)
▪ Maintain suicide precaution
● MAOI drug interactions – the following drugs can cause
potentially fatal drug interaction when taken with MAOI
antidepressants ANTIDEPRESSANT PHARMACOTHERAPY
o Other MAOI antidepressants
o SSRI antidepressants
o Meperidine or Demerol MONOAMINE Phenelzine,
o Buspirone or Buspar OXIDASE tranylcypromine,
o Dextromethorphan INHIBITORS (MAOIs) selegiline
o General anesthetics

TRICYCLIC AND Amitriptyline,

SELECTIVE SEROTONIN REUPTAKE INHIBITORS TETRACYCLIC clomipramine, doxepin,
(SSRIS) ANTIDEPRESSANTS imipramine,
(TCAs) trimipramine,
amoxapine,
desipramine,
nortriptyline,
protriptyline,
maprotiline

SELECTIVE Citalopram, fluoxetine,

SEROTONIN fluvoxamine,
REUPTAKE paroxetine, sertraline,
INHIBITORS (SSRIs) escitalopram

SEROTONIN/NOREPI Venlafaxine, duloxetine

● Side effects and management NEPHRINE
o Insomnia REUPTAKE
▪ Take the dose early in the day, eliminate INHIBITORS (SNRIs)
caffeine, use relaxation measures before
going to bed
o Headache
ATYPICAL nefazodone ,
▪ May use analgesics as prescribed, if
ANTIDEPRESSANTS mirtazapine, bupropion,
headache becomes severe, then may trazodone
require the discontinuance of they
medication
o Weight loss
▪ Encourage adequate caloric intake
▪ Use with caution in patients with eating
disorders (anorexia, bulimia nervosa)
o Sexual dysfunction
▪ Anorgasmia in women and ejaculatory
dysfunction in men
▪ Teach clients to report any sexual
function problems with the health care
provider. If problem persists, another
antidepressant may be recommended

ONE DAY, ALL YOUR HARD WORK WILL PAY OFF. 理異種 6
 ANXIOLYTICS / ANTI-ANXIETY AGENTS o LITHIUM LEVELS N: .6-1.2 mEq/L
o antipsychotic/mood stabilizers produced a serum
level of: 1-1.5 mEq/L (normal)
● DOSAGE (mood stabilizing)
o Lithium
▪ Effective dosage is determined by
monitoring serum lithium levels and
assessing the client’s clinical response to
the drug
▪ Daily dosage range from 900-3600 mg;
▪ Serum lithium level = 1.0 mEq/L < .5
mEq/L are rarely therapeutic; levels (>
1.5 mEq/L are usually considered toxic)
o Carbamazepine
▪ Dosages from 800-1200 mg/day;
extreme dosage is 200-2000 mg/day
▪ Anticonvulsant (Tegretol)
● MECHANISM OF ACTION: ANXIOLYTICS o Valproic acid
o Benzodiazepines
▪ Dosages from 1000-1500 mg/day;
▪ Mediates the action of amino acid extreme dosage is 750-3000 mg/day
GABA< the major inhibitory
neurotransmitter in the brain ▪ Prevent manic episodes
o Buspirone ▪ GABA (inhibitory)
▪ Believed to exert its anxiolytic effects by ● MOOD STABILIZING DRUGS SIDE EFFECTS
acting as a partial agonist at serotonin o LITHIUM
receptors, decreasing serotonin turnover ▪ Mild nausea or diarrhea
● PHARMACOKINETICS ▪ Anorexia
o Readily absorbed after oral ingestion
o IM administration causes slow and inconsistent ▪ Fine hand tremor
absorption (except Lorazepam – Ativan) ▪ Polydipsia
o Metabolized by the liver ▪ Polyuria
o Very lipid soluble - readily cross blood brain barrier
o Active metabolites can exert an effect for up to 10 ▪ Metabolic taste in the mouth
days ▪ Fatigue or lethargy
o Excreted in the urine
● PATIENT TEACHING
▪ Weight gain or acne
o Not for minor stresses in life ▪ TOXIC S/E
o Over the counter drugs may potentiate action ● Severe diarrhea
o Avoid driving until tolerance develops ● Persistent nausea and
o ROH and other CNS depressants potentiate effect vomiting
of benzodiazepine ● Drowsiness
o Hypersensitivity to the drug ● Muscle weakness
o Should not be stopped abruptly ● Lack of coordination (ataxia)
● COMMON DRUGS
● Tinnitus - ringing of the ears
o Diazepam (Valium)
o Chlordiazepoxide (Librium) ▪ Untreated, these symptoms worsen and
o Clorazepate dipotassium (Tranxene) can lead to renal failure, coma, death
o Oxazepam (Serax) ▪ When toxic signs occur, the drug should
o Lorazepam (Ativan) be d/c immediately
o Alprazolam (Xanax)
o Prazepam (Centrax) ▪ If lithium levels exceed 3.0 mEq/L -
o Halazepam dialysis may be indicated
o Flurazepam (Dalmane) o CARBAMAZEPINE & VALPROIC ACID
o Temazepam (Restoril) ▪ Drowsiness
o Triazolam (Halcion) ▪ Sedation

MOOD STABILIZERS ▪ Dry mouth

● PHARMACOKINETICS ▪ Blurred vision
o Well absorbed from the GI tract ▪ Rashes
o Peak levels are reached within 1-3 hours
o Takes 7-10 days to achieve a clinical response ▪ Orthostatic hypotension
o 600 mg TID o VALPROIC ACID
o .6-1.2 mEq/L ▪ Weight gain
o Lithium levels should be monitored every 2-3 days
→ after 2-3 days of monitoring we can go to weekly
▪ Alopecia
monitoring of lithium levels ▪ Tremor

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 ● NURSING INTERVENTIONS FOR PTS TAKING LITHIUM
Selegiline Depression
o Suggest taking lithium levels with meals
o Suggest drinking 240 mL of water/day Sinemet Agitation, Anxiety, Euphoria
o Advise to elevate feet - ankle edema
o Advise pt to maintain a consistent sodium intake Drug Interactions
(causes Na depletion) ● Pyridoxine (Vit. B12)
o Increase sodium intake if there is a major increase ○ Increases dopa decarboxylase which metabolized
in perspiration (diaphoresis) levodopa in the peripheral NS to dopamine=
o Watch out for lithium toxicity decrease dopamine in the synapse
○ Do not eat LIMA foods (rich in Vit b12)
● Antipsychotic Drugs
ANTI-PARKINSONIAN DRUGS
○ It blocks the dopamine receptors
Understanding AP Drugs ● MAOI antidepressant
● Schizophrenia → Increase Dopamine → Give Antipsychotic ○ If taken with levodopa = HYPERTENSIVE CRISIS
→ Blocks Dopamine → Parkinsonism develops → Give
Anticholinergic Drug → Block the activity of Acetylcholine → ANTICHOLINERGIC AGENTS
ANTI PARKINSONIAN DRUGS (to restore ● Drugs of choice for drug induced parkinsonism
acetylcholine/dopamine balance) ● Useful in early stages of Parkinson’s disease but more
effective when combined w/other dopaminergic agents
Drugs uses in Parkinson’s Health teachings
DOPAMINERGIC AGENTS ● Advise to avoid alcohol, cigarette smoking caffeine & aspirin
● Agents that increase dopamine to decrease gastric acidity
● Encourage to ingest foods that are high in fiber & to increase
1. DOPAMINE PRECURSOR (LEVODOPA - DOPAR &
fluid intake
LARODOPA, CARBIDOPA - SINEMET)
● Hard candy, ice chips or sugarless chewing gum for dry
● Increase dopamine by increasing the bioavailability (the rate mouth
at which your substance is absorbed) ● Sunglasses in direct sun because of possible
● Increase Levodopa = Increase Dopamine photosensitivity
● Sineme t= treat parkinson symptom such as muscle stiffness, Common Drugs
tremors, spasm, and poor muscle control or ATAXIA 1. Benztropine (Cogentin)
2. DOPAMINE RELEASER (AMANTADINE - 2. Biperiden (Akineton)
SYMMETREL) 3. Diphenhydramine (Benadryl)
● Remaining dopamine in the system will be efficiently or better 4. Ethopropazine (Parsidol)
utilized 5. Procycl;idine (Kemadrin)
6. Trihexyphenidyl (Artane)
3. DOPAMINE AGONIST (BROMOCRIPTINE - PARLODEL ,
PERGOLIDE - PERMAX)
● Mimics neurotransmitter dopamine
4. DOPAMINE INHIBITOR
● Blocks the metabolism of the dopamine by inhibiting the MOA
B
Less Serious Side Effects
● Mild nausea, dry mouth, loss of appetite, heartburn,
diarrhea, constipation;
● Headache, dizziness, drowsiness, blurred vision;
● Sneezing, stuffy nose, cough, or other cold symptoms;
● Sleep problems (insomnia), strange dreams;
● Muscle pain, numbness or tingly feeling.
Serious Side Effects
● Greatly increase eye blinking/twitching,
● Fainting
● mental/mood changes
● Unusual strong urges
● Worsening of involuntary movement or spasms
Psychiatric Side Effects

DRUGS SIDE EFFECTS

Amantadine Confusion

Bromocriptine Hallucinations

Levodopa Delusions

Pergolide Paranoid Ideation

ONE DAY, ALL YOUR HARD WORK WILL PAY OFF. 理異種 8
 TREATMENT MODALITIES

PSYCHOTHERAPY 1. Psychotherapy groups

● Therapeutic interaction between a qualified provider and a 2. Therapy groups
client or group ● Support groups
● Designed to benefit persons experiencing emotional distress, ● Activity groups (art, music, dance
impairment or illness groups, play, psychodrama)
● Education groups
INDIVIDUAL PSYCHOTHERAPY ● Socialization groups
● A method of bringing about change in a person by exploring
● Reality-orientation groups
his or her feelings, attitudes, thinking and behavior
● Community meeting groups
GROUP THERAPY 3. Self-Help Groups
● Psychotherapeutic process that occur in formally organized NURSE’S ROLE IN GROUPS
groups designed to change maladaptive or undesirable ● Resource person
behavior
● Role model
● Clients participate in sessions with a group of people
● Determines structures, format and goals
TYPES OF GROUPS ● Establishes psychological climate of the group
● Open group ● Works toward achievement of goal
● Closed group
● Facilitates group possess
● Structured
● Unstructured ○ Promotes smooth flow communication
○ Encourages silent members to participate
GOAL OF GROUP THERAPY
○ Exert leadership and degree of control when group
● Alteration of the behavioral patterns of group members
flounders
through the development of new and more effective ways of
○ Interprets rules and sets limits for the group
coping with stress
FAMILY THERAPY
ADVANTAGES OF GROUP THERAPY
● Goals:
● Advantages of group therapy
○ Understanding how family dynamics contribute to
○ Economical
the client’s psychopathology
○ Increase feelings of closeness
○ Mobilizing the family’s inherent strengths and
○ Feedback from group
functional resources
○ Opportunities for practicing alternative behaviors
○ Restructuring maladaptive family behavioral styles
○ Provides attention to reality and development of
● Roles of the Nurse
insight
1. Assess interactions among family members
PRINCIPLES OF GROUP THERAPY 2. Encourage expression of feelings
● Verbalization 3. Assist family in resolving problems
● Activity ACTIVITIES OF DAILY LIVING (ADL)
● Support
● Set of activities performed by individual, necessary for the
● Change
promotion of personal hygiene, which can be fone with or
STAGES OF GROUP DEVELOPMENT without assistance/supervision
1. Orientation stage ● Goal:
2. Working stage ○ Promote and improve personal hygiene
3. Termination stage ○ Promote self independence
4. Examples of group therapy ○ Encourage participation
EXAMPLES OF GROUP THERAPY
● Poetry therapy INTERACTIVE THERAPIES
● Art therapy REMOTIVATION THERAPY
● Music therapy ● Consist of 10-22 (ideal: 4-8) patients, 30-45 mins
● Dance therapy ● Re-experience reality oriented activities
● Psychodrama ● Goal:
● Play therapy 1. Stimulate patients to think about
RECREATIONAL OR ACTIVITY THERAPY something and talk about himself
2. Develop the ability to communicate and
● Sing-along
share idea and experience with others
● Dancing
3. Develop feelings of acceptance and
● Drawing
recognition
● 5 steps:
TYPES OF THERAPY GROUPS ○ Climate of acceptance

ONE DAY, ALL YOUR HARD WORK WILL PAY OFF. 理異種 1
 ○ Bridge to reality
○ Sharing the world we love in
○ Appreciation of the works of the world
○ Climate of appreciation
● Objectives of Remotivation Therapy
○ To stimulate patient to her fellow explorer of ther
eal world
○ To develop the ability to communicate and share
experience with others
○ To develop feelings of acceptance and recognition
○ To promote group harmony and identification
● Topics to be covered
○ Literature
○ Hobbies
○ Science & Health
○ Sports
○ Geography
○ Nature
○ Entertainment
● Topics NOT to be covered
○ Love
○ Sex
○ Religion
○ Family problems
○ Politics
○ Violence
PSYCHODRAMA
● A method which the client is helped to overcome
maladaptive behaviors and develop new perspectives
though reenactment of emotionally difficult situations
● Goal:
○ To gain understanding of the behavior of oneself or
the other person involved in the actual situation
● Persons involved in psychodrama
1. The patient as the protagonist
2. The group members act as the auxiliary egos
3. The director coordinates the process before the
therapy starts
● Techniques
○ Setting the scene- protagonist chooses and set
the scene by describing what is happening
○ Role reversal- protagonist should take the role of
significant persons so that distortions may be
controlled and reintegrated
○ Soliloquy- the actor or actress speaks about the
thoughts and feelings that usually go unspoken
○ Doubling- the double mimics the protagonist
posture and gestures and puts into words the
feelings suggested in the protagonist’s description
○ Mirroring- this is similar to the role of the double,
except that in the scene and mirrors observed
behavior
○ Self-counseling- it requires the protagonist to
take the role of the counselor to the individual
playing his/her auxiliary eg
EXPRESSIVE THERAPIES
DANCE THERAPY
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● expression of feelings through rhythmic body movements,
which enhances emotional and physical integration of the
individual
○ Dance activities
■ Travel
■ Mirror
■ Mirroring
■ Life’s Journey
■ Simon Says
■ Movement Metaphors
MUSIC THERAPY
● an activity for socialization and self expression and
sometimes realization through musical activities
TYPES OF MUSIC THERAPY
CREATIVE MUSIC
● ranges from simple clapping to using simple instruments
establishing a band, orchestra or choir
MUSIC APPRECIATION
● consist of playing carefully selected pieces of music followed
by a discussion of memories and assocs. Evoked
MUSIC DISCUSSION
● focuses on communication of emotion stimulated by
particular passages of music carefully chosen for their mood
content
OCCUPATIONAL THERAPY
● it's a rehabilitative procedure that diverts patient attention
and this develops their creative abilities for purposeful living
and lead to to the mystery of self and environment
○ Mental or physical
○ Given to recover from a handicap
○ Awareness and making them creative
○ Can be used as a source of income
○ Since social taboo is present- they can’t get a job
easily once discharged
○ In presenting occupational therapy, lay down
expenses and possible profit
● Goals:
○ To arouse interest
○ To exercise mind and body in healthy activity
○ To overcome disability
● Purpose:
○ Gives sense of achievement
○ Restores self-confidence
○ Diverts patient’ attention
○ Helps build up and maintain contact with reality
○ Develop his creative abilities
○ Orients patients toward future self-support by
practical means
ART THERAPY
● (Criteria: Content, colour, size, organisation)
● tool for stimulating self- expression in client
● As a diagnostic tool from which modifications in treatment
can be made
○ Can assess what’s in their mind
2
 ● Provide opportunities for increased self-esteem and for ● Severe depression; acute suicidal; unwilling to eat and
promoting sublimation and personal growth cannot tolerate medications
● Facilitate group process ● Manic clients whose conditions are resistant to lithium and
● As a cathartic experience antipsychotic drugs.
CRITERIA USED IN ART THERAPY
● Content- reflects what concerns the patient NURSING INTERVENTION: BEFORE ECT:
o Haggard-looking figure: body image distortion ● NPO
Man falling from a bridge: support suicidal ideation ● Check consent
● Color- represents the patient’s emotions ● Vital signs
o Eg. Red and orange: anger and frustration ● Empty bladder
Blue and green: coldness; probable alienation ● Remove denture, lenses, hair pins etc.
Dark brown and bleach: depression ● Meds are prescribed
● Size- indicates the patient’s feelings to others and his
environment DURING ECT:
o Eg. Minute figure in w/c the pt identifies suggest small
and unimportant ● VS every 15 mins
● Organization- reflects degree of cohesiveness of the ● Position at the side to prevent aspiration
individual or the group ● Orient the time
● Reassure that memory loss is transient
● Offer fluid and flood when gag and swallow resume
OTHER THERAPIES
BIBLIOTHERAPY SPECIAL INTERVENTION:
● An expressive therapy that uses an individual’s relationship
● Clients VS, oxygenation, cardiac fx are carefully monitored
to the content of books and poetry and other written words
before, during and following ECT
as therapy.
● Assess client’s medical status (CV and Pulmo)
● Objectives of Bibliography
● Be sure that consent was signed
o Stimulate psychological, social, and aesthetic values
● Address the families concern regarding effects/side effects of
from books
the procedure
o Provide stimulus for the memory
o Increase level of understanding of the information
COMPLEMENTARY AND ALTERNATIVE THERAPIES
PLAY THERAPY
● Technique that makes it possible for a patient to express
COMPLEMENTARY MEDICINE
● Includes therapies used with conventional medicine
himself freely.
practices
● Enables the individual a unique opportunity to discharge
ALTERNATIVE MEDICINE
strong emotions in a secure atmosphere.
● Includes therapies used in place of conventional treatments.

TREATMENT MODALITIES
SOMATIC THERAPIES
● Psychotropic (psychoactive) medications exert their effect in
the brain, altering emotions and affecting behaviors by:
o Altering amounts of neurotransmitters at the synapse
o Binding to specific receptor sites at presynaptic and
postsynaptic neurons
ELECTROCONVULSIVE THERAPIES
● Used primarily for client with depression
● Short-acting anesthesia is used to induce unconsciousness
● Electric current = 70-150 volts applied through the brain for
0.5-2 seconds to produce seizure for 30-60 seconds,
administered 2-3 times per week for a total of 6-12
treatments.
VARIETY OF COMPLEMENTARY AND ALTERNATIVE THERAPIES
● Alternative medical system
● Mind-body interventions
● Biologically based therapies
● Manipulative and body-based therapies
● Energy therapies
o Biofield therapies
o Bio-electric based therapies
ALTERNATIVE THERAPIES
● Medicinal herbs in the treatment of mental illness
● St. John’s wort - for mild depression
● Gingko Biloba - improves memory

INDICATIONS OF ECT:

ONE DAY, ALL YOUR HARD WORK WILL PAY OFF. 理異種 3
 CRISIS INTERVENTION
● Goal: for the individual to return to the precrisis level of
TREATMENT MODALITIES functioning.
● Crisis - a temporary state of high anxiety in which an
individual’s problem solving mechanisms fail.
4 LEVELS OF NURSING INTERVENTIONS
1. Manipulation
2. General support
CATEGORIES OR TYPES: 3. Generic approach
MATURATIONAL OR DEVELOPMENTAL CRISES 4. Individual approach
● predictable events in the normal course of life.
SITUATIONAL CRISES TECHNIQUES:
● are unanticipated or sudden events that threatened the 1. Catharsis
individual’s 2. Clarification
ADVENTITIOUS OR SOCIAL CRISES 3. Suggestion
● are unanticipated or sudden events that threatened the 4. Reinforcement of behavior
individual’s 5. Support of defenses
● NOTE: not all events that result in crises are “negative” in 6. Raising self esteem
nature. Events like:
7. Exploration of solution
o Marriage
o Retirement
o Childbirth INTERVENTION CATEGORIES
GENERAL CONSIDERATIONS 1. Authoritative
o Offering the person new information, knowledge,
1. Can occur to anybody at one time or another
or meaning
2. Not necessarily pathological
2. Raising the person’s self-awareness by providing
3. Can provide stimulus for growth and learning
feedback about behavior
4. It is time limited; usually resolved within 4-6 weeks
o Directing the person’s behavior by offering
5. Person’s perception of the problem determines the crisis so
suggestions or courses of actions
it is different from one person to another.
1. Facilitative
o Encouraging the person to identify and discuss
AGULERA (1998):
feelings
3 FACTORS THAT INFLUENCE INDIVIDUAL EXPERIENCE OF A CRISIS o Serving as a sounding board for the person
● Individual’s perception of the event affirming the person’s self-worth
● Availability of emotional support
● Availability of adequate coping mechanisms

CRISIS INTERVENTION
● Method of providing assistance to those affected by a crisis,
in which the immediate problem is resolved and
psychological equilibrium is restored.

ONE DAY, ALL YOUR HARD WORK WILL PAY OFF. 理異種 2
• Primary nurse for specific clients
-

• was the first to recognize nursing’s responsibility for creating and

•
-

Therapist with individual groups and families controlling a patient's milieu.

SUBROLES: -

• Author of Power of Environmental Adaptation (Environmental

Theory)
MOTHER SUBSTITUTE
-

Harry Stack Sullivan

•
-

Provide the opportunity establish relationships and communicate

with patients
- • developed the theory of the “therapeutic community or therapeutic
milieu”;
TECHNICIAN
-

• Father of Milieu Therapy

•
-

Requires attention to accuracy, economy of effort and material HILDEGARD PEPLAU

supplies as well as to efficient performance.
-

•
-

Insuring safety to the patient • Mother of Psychiatric Nursing; developed the concept of the
therapeutic nurse-patient relationship
TEACHER
-

o NPR - nurse-patient relationship

•
-

Every nurse becomes a teacher while performing nursing tasks, o NPI - nurse-patient interaction
regardless of the clinical service she works in
-

MAXWELL JONES (1953)

SOCIAL AGENT
-

• Published the book The Therapeutic Community

•
-

Social activities serve as an energy and anxiety-releasing outlets. FACTS

(help decrease negative thoughts and hallucinations)
MILIEU MANAGEMENT
-

COUNSELOR
-

• Is the purposeful manipulation of the environment to promote a

•
-

Counseling in nursing is concerned with helping the patient to therapeutic atmosphere.

remember and understand fully what is happening to him in the
-

o Manipulate the environment with an intended purpose or plan;

present situation.
-

the environment is deliberately manipulated to serve a

o
-

Develop sympathetic listening by being positive, dynamic, purpose, which is to promote a therapeutic environment and
avoid giving suggestions or opinions
-

help the patients recover.

o
-

The nurse should be skillful in reflecting first themselves o Manipulation - influencing, handling, managing the
before the patient.
-

environment in a SKILLFUL manner.

o Give reassurance, make the patient feel someone they can
THERAPEUTIC MILIEU
-

depend on.
-

o
-

Do not give “FALSE REASSURANCE”, ex. Saying the pt will • Is the treatment environment managed in such a way that the
be cured; or promising them something.
-

environment itself is therapeutic

WARD MANAGER
-

• Managers of the milieu management are the nurses.

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This involves manipulation of the patient’s environment to the

degree that it favors the patient’s recovery
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PURPOSE AND GOAL
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Develop a warm, home-like, and accepting atmosphere; PURPOSE OF A THERAPEUTIC ENVIRONMENT

calming, therapeutic, welcoming
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• To help patients recognize & recover from psychiatric problems

ESSENTIAL QUALITIES OF THE PSYCHIATRIC that led to their currency situation
NURSE GOAL OF MILIEU MANAGEMENT
• Therapeutic use of self
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To organize all interpersonal and environmental forces to develop

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Genuineness and warmth - break down our defenses for our an atmosphere that facilitates patient’s growth, rehabilitation, and
patients
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restoration of health.
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Empathy • Establishment of satisfying interpersonal relationships.

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Putting or walking a miles with our patient o Transference: is the feeling of the patient towards the nurse,
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Acceptance it is considered normal.

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Accept the patient as a person, but not the behavior o Countertransference- the feeling of the nurse towards the
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Maturity and self-awareness patient

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Major role in the nurse’s ability to tolerate ROLES OF THE NURSE

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Leadership • Has the responsibility of shaping the therapeutic environment

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All of you are born to be leader, have the ability to empower, based on the essential features and elements of an effective
direct, manage, lead the client care
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MILIEU MANAGEMENT
• Milieu = environment
PSYCHIATRIC WARD
• An ideal psychiatric hospital is not merely an asylum or cotton-
padded environment but it should emphasize the fragility,
weakness, and incompetence of the patients. It should reflect a
sane/normal society or environment by permitting the optimal use
of capacity.
• Promote optimal use of capacity through social organizations,
programs, PSA, social support, and community values.
• In the ward, address the clients as “residents”, not “patients”.
• Social Hall - where activities are done (eg. watching tv, etc)
HISTORICAL OVERVIEW OF MILIEU MANAGEMENT
Florence Nightingale (1854, during the Crimean war)
therapeutic milieu
• Must be available, flexible, & willing to help patients to develop
problem-solving skills & coping mechanisms to deal with problems
• Teaching role
• Colleague, team leader, supervisor and trainer, & consultant
o Nurse has a 24-hour responsibility to patient care since we
have more contact with the patient.
ELEMENTS OF EFFECTIVE MILIEU
1. SAFETY
• freedom from danger or harm (psychological and physical)
• Psychological: Nurse will not give any activity that will lessen or
harm the patients’ ability to use their mental functions.
• Physical: Nurse will not allow patients to engage in confrontations
or any activities that may cause physical harm (eg. activities that
involve blowing which may exacerbate an asthma attack, etc.)
o What to do to avoid confrontations: use diversional tactics,
create comments that will cut off their conversation that may
lead to confrontation, which may even lead to their hostility.
▪ Ex. PT. “Yabag mani siya uy”. Nurse “Sir di man
importante gwapo kag tingog, importante nakashare
siya”.

ONE DAY, ALL YOUR HARD WORK WILL PAY OFF. 理異種 2
 o If pt is showing signs of auditory hallucinations, re-orient the
patient; reality check.
▪ Ex. pt “ana siya kabit man daw ka”; nurse “wala man koy
nakita nga laing tao diri para mag ingon ana saimo,
maam, kita lang man duha diri”.
• Confinement
o Keeping something harmful under control or within limits.
• Use of “time-out” rooms (isolation rooms)
o Commonly used when the patient starts pacing, murmuring or
hallucinating.
CONSIDERATIONS:
• Making rounds regularly to check on patient s
• Taking V/S to assess for adverse medications reactions, orthostatic
hypotension or unsuspected problems
• Checking patient’s belongings upon admission and removing
dangerous objects, meds, etc.
• Observing precautions against fall for at-risk populations
• Coping with agitated patients before they escalate to violent
behavior (agitated behavior example: pacing)
• Keeping sharp objects locked away
• Checking pt’s belongings upon admission & removing dangerous
objects, medications, etc.
• Observing visitors for objects or substances (drugs) that would be
deleterious to a pt’s health.
2. UNIT STRUCTURE
• GOAL: to make a perfect environment, but to develop a nurturing
setting that can contain and soothe aggression, frustration,
deprivation, disappointment, and loss.
• STRUCTURE: Design of the unit
o Physical structure of the facility
o The unit regulations that is part of the structure, daily
schedule, physical exercise of the institution (at least 10-15
minutes exercise)
3. UNIT NORMS
• Unit expectations or unit climate
• Expected behavior for a given therapeutic setting; expectations or
climate
• NON VIOLENCE
o Rules are regulations that we have to follow to keep the norm.
o Norms: violent behaviors are NOT ALLOWED. Must have a
NON-VIOLENT ENVIRONMENT; provide physical and
emotional security to the patients.
4. LIMIT SETTING
• Set on behaviors that are not conducive to mental health or that
might hurt the pt. or the others.
• “Contracting” –
o Basis of the limit setting; “gisabotan” (‘You are only allowed to
raise hands when you have questions.”)
o Providing instructions on things that are allowed and not
allowed.
o Giving awareness of the schedule
o We will be here from Mon-Saturday, etc
• “Self defining”
o Limit should be set on acting up behaviors (“Sir, *this or that*
is not allowed.”) (“Sir, violent behavior is not allowed”) (“Sir,
alcohol is not allowed”) (“Sir, masturbating is not allowed”)
5. BALANCE
• The process of gradually allowing independent behaviors in a
dependent environment.
o Represents the Art of Psychiatric Nursing
o Allow the patients to help
6. UNIT OR ENVIRONMENTAL MODIFICATIONS
ONE DAY, ALL YOUR HARD WORK WILL PAY OFF. 理異種
• Development of the unit environment.: Decorating, equipping, and
designing the environment. So that it will produce the most
therapeutic yield
o Creating an environment where the patient is able to
maximize their strength; purposeful arrangement of the
environment where the patient can make use of their optimal
ability; promote maximum use of the patient's ability.
7. SUPPORT
• Unconditional acceptance of the patient to reduce anxiety and
enhance self-esteem.
• Communicated through empathy, being available, appropriately
offering encouragement and reassurance
o Great Pretenders - patients may create excuses (headache,
etc) to not join or participate in the said activities, so as a
student nurse, it is your job to support and encourage them.
(by cheering, etc)
8. STRUCTURE
• Providing a predictable organization of time, place & activity
• The patient learns to delay impulsive and inappropriate responses
though consistent expectations and behavioral responses.
o Done through meetings, recreational, music therapies, social
skills; basically the program on how to teach patient about
basic skills (grooming, etc)
▪ Unit structure - building; physical construction of the
facility
▪ Structure - curriculum, daily programs, activities
9. INVOLVEMENT
• A process that helps patients actively attend to their own
responsibility in treatment participation
• Promotes self-efficacy - self presumed expectations that one can
cope with and master situations (ex. ADLs)
10. VALIDATION
• Act of affirming a person’s worldview through empathy and
nonjudgmental acceptance of the patients’ thoughts and feelings
and perspective
o Understanding and appreciation of the client’s uniqueness
(ex. “your concerns and feelings is validated”)
o Heaviest element of the milieu management.
o Act of affirmation of the feelings of the client.
o We cannot deny the fact that some of us have prejudices.
GENERAL PRINCIPLES FOR DEVELOPING A
THERAPEUTIC NURSE-PATIENT RELATIONSHIP IN
MILIEU MANAGEMENT
• Be calm when talking to patients (pts can sense fear or
nervousness)
• Accept patients as they are, but do not accept all behaviors
• Keep Promises
• Be consistent. (No is a no. Yes is a yes. Stick with the rules
created.)
• Be honest
BASIC INTERVENTIONS STRATEGIES FOR
DEVELOPING A THERAPEUTIC NURSE-PATIENT
RELATIONSHIP
• Do not reinforce hallucinations or delusions
o assess the hallucinations;Anong itsura ng tao, anong sinasabi
ng tao. After asking the patient.
o REORIENT. REALITY CHECK. DO NOT LEAVE IT LIKE
THAT.
• Orient patients to time, person, and place if indicated
• Do not touch patients without warning them
o Do not touch them unless you inform them (Ex: BP and Temp
Taking)
• Avoid whispering or laughing
3
 o Not unless there is something funny, they have the tendency
to become PARANOID
o No sign language
• Reinforce positive behaviors
o by clapping, thanking, or complementing
o Avoid competitive activities with some patients
o Especially patients that are bipolar
• Do not embarrass patient
• For withdrawn patients, start with one-to-one interactions
• Allow and encourage verbalization of feelings
o Ultimate goal in NPI

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 PSYCHOLOGICAL BASES OF BEHAVIOR
○ ADHD
PSYCHOBIOLOGY ○ Dementia
● Scientific study of the relationships among the structure and PARIETAL LOBE
function of the brain, biochemical, hormonal process, genetics,
● Taste and touch (interprets sensation)
experiences, and behavior
● Spatial orientation (body position information)
● Sensory-association areas (sensory function)
CENTRAL NERVOUS SYSTEM
● Brain Anterior Portion- specialized in somatic sensation and perception
o Cerebrum Posterior Portion - integrate visual and auditory
o Cerebellum ● Abnormalities
o Diencephalon ○ Imbalanced spatial activity
o Brainstem ○ Body image impaired
○ Self-care deficits
CENTRAL NERVOUS SYSTEM
CEREBRUM TEMPORAL LOBE
● Center for coordination and integration of all formation needed to ● Sense of smell
interpret and respond to the environment ● Long- term memory
● Seat of Intelligence ● Hearing/Auditory Processing (understanding sound)
A. HEMISPHERES ● Emotional Expressions
I. LEFT HEMISPHERE ● Divisions:
● Logical Functioning ○ Primary Auditory Receptive Area - receiving
● Analytic Functions i.e. reading, writing, and mathematical tasks auditory
○ Secondary Auditory Association - receives input
II.
RIGHT HEMISPHERE
from primary auditory receptive area;
● Creative thinking, intuition interpretation; association of sounds
● Artistic abilities ○ Visual Association Area - process visual
Decussation- cross over from medulla oblongata and spinal cord information
Corpus Callosum ○ Olfactory - smell
● pathway connecting the two hemispheres and coordinating ● Wernicke’s Area
their function ○ Responsible for recognition and interpretation of
● Major communication pathway words and letters for speech
● Split Brain Syndrome ○ Involved in the comprehension of speech
B. LOBES ● Abnormalities
FRONTAL LOBE
○ Aggressive and violent behaviors
● Organization of thought ○ Olfactory and auditory hallucinations
● Highest Intellectual Function (High Order Thinking) ○ Language abnormalities
● Body Movement ○ Aphasia (both visual and auditory)
● Speech
OCCIPITAL LOBE
● Memory
● Visual function and interpretation
● Emotions
● Perception, recall and optically induced reflexes
● Moral Behavior
● Coordinating language generation
● Inhibition of Emotional Impulses
● Abnormalities
● Division:
○ Visual Illusion
○ Motor Cortex - separation of frontal and parietal
○ Visual Hallucinations
lobes; controls voluntary muscle activities
○ Pre-Motor Cortex - program movement patterns CENTRAL NERVOUS SYSTEM
○ Pre-Frontal Areas - responsible for thoughts; CEREBELLUM
goal-oriented behaviors; mood inhibition ● Coordination for movement and balance
○ Frontal Pole - seat of personality ● Functions
● Integration of all this information helps regulates arousal, ○ Coordinating muscle synergy
focuses attention and allows problem solving and decision ● Cerebellar Disorder
making ○ Ataxia - muscle incoordination
● Broca’s Area - left pre-frontal lobe; speech articulation; motor ○ Decreased tendon reflexes on the affected side
production of speech ○ Asthenia - muscle tire easily
● Abnormalities ○ Intention Tremor - occurs when doing something
○ Schizophrenia ○ Nystagmus - repetitive eye uncontrolled
movements

ONE DAY, ALL YOUR HARD WORK WILL PAY OFF. 理異種 1
 CENTRAL NERVOUS SYSTEM CENTRAL NERVOUS SYSTEM
DIENCEPHALON BRAINSTEM
● Embedded in the cerebrum and is superior to the brainstem ● Collective name for:
THALAMUS 1. Midbrain
● “Relay switching center of the brain” 2. Pons
● Sensation - receives & relay sensory information (except 3. Medulla Oblongata
smell) ● Contains centers that control environment and respiratory
● Emotions, memory, regulating mood functions, sleep, consciousness and impulses
● Filter to avoid overloading ● Contains nuclei - secrete neurotransmitters
● If damage = behavioral abnormalities MIDBRAIN
HYPOTHALAMUS ● Structure
● Temperature regulating/ Homeostasis ○ Substantia nigra- synthesis of dopamine
● Sleep & Rest pattern (important for movement and memory)
● Appetite control ○ Red Nuclei - controls the gait
● Endocrine function (hormonal output to the anterior pituitary) ○ Tectum - mediates whole body movements in
● Visceral control (gag reflex, control of bladder) response to visual and auditory stimuli
● Sexual drive ○ Tegmentum - origin of network of fiber known as
● Impulsive behavior association w/ feeling mesolimbic dopaminergic pathway; motor center
● Regulates autonomic Nervous System of the midbrain; and prevent unwanted movements
HIPPOCAMPUS A. RAS (reticular activating system)
● Memory (emotions attach to memory) ● Influences motor activity, sleep, consciousness,
● Emotional arousal and awareness
● If damaged = Difficulty to recall ● If in a coma= RAB is turned off
B. EPS (Extrapyramidal System)
● Relays information about movement and
CENTRAL NERVOUS SYSTEM
coordination to the spinal nerves
AMYGDALA ● Modulates movement, maintains appropriate
● Provides an emotional component to memory muscle tone, adjust posture
● Modulates aggression and sexuality (ohh sexy)
● Emotional arousal PONS
● If damaged = violence, impulsive, aggression ● Bridges the gap both structurally and functionally (primary
LIMBIC SYSTEM motor pathway)
● Controls the 4’s: Feeding, fighting, fleeing, fornicating ● Noradrenergic (norepinephrine) pathways
● Memory MEDULLA OBLONGATA
● Pleasure center (Ugh) ● Origin of adrenergic (adrenaline) pathways
FUNCTIONS: ● Contains vital centers for RR, Regulation of BP, Partial
LIMBIC OLFACTORY regulation of HR, vomiting, swallowing and CU Functions
● Olfactory pathway: odor detection, feeding, and feeling
pleasure BASAL GANGLIA
● Smell is significant to emotion ● Connect to the cortex and thalamus and organize muscle
PLEASURE OR FEEDING FUNCTIONS driven “motor” movements of the body.
● Receives, integrates and transmit motor information
● Reward pathway: feeling of pleasure
MAJOR DIVISIONS:
FIGHT OR FLIGHT FUNCTION
CAUDATE NUCLEUS
● Elicits rage behavior or flight
● Organize and filter info. That is sent to frontal lobe
MEMORY LIMBIC FUNCTION
● Assist Frontal lobe to prioritize the transfer of info.
● Transfer information from short term to long term memory
● If damaged:
● Papez circuit
➢ Behavioral changes
○ Process memories ➢ Inability to control emotions
○ Where memories are made and stored ➢ Inability to control impulse
➢ Inability to control thought process
● Disturbances in Limbic System
➢ Inability to experience intense feeling of
○ Memory loss seen in dementia
guilt, shame, and embarrassment
○ Poorly controlled emotions (common to MURDERERS)
○ Impulses seen in psychotic or manic behavior ➢ Movement
➢ Stuck (cannot move on)
*** The way in which emotions & motivates are generated in the limbic PUTAMEN
system is still unclear.*** ● Controls voluntary movement
*** Each emotion is likely diffusely linked to different limbic and non ● If damaged= showing of motor slowness
limbic areas.*** ● Overstimulation of Putamen= Chorea (sudden, unintended,
*** NO SPECIFIC AREA RESPONSIBLE FOR YOUR FEELINGS OF and uncontrollable jerky movements of the arms/ dance like
LOVE, LIKE, AND HATE*** arms, wrists, hands)
GLOBUS PALLIDUS
● Controls muscle tone

ONE DAY, ALL YOUR HARD WORK WILL PAY OFF. 理異種 2
 ● If damaged: rigidity
SUBSTANTIA NIGRA
● Same with midbrain

● Disorders of the Basal Ganglia

○ Parkinsonism - an umbrella term that refers to
brain conditions that cause slowed movements,
rigidity (stiffness) and tremors.
○ Chorea - dance like hand movement
○ Atherosis - slow snake like movements of the
wrist
○ Hemiballismus - flailing – sudden

NEUROTRANSMITTERS

NEUROTRANSMITTER IMPLICATION FOR MENTAL

DISORDER
Dopamine • Increase = mania,
schizophrenia
• Decrease - parkinson’s
disease (movement
disorder)
• Antipsychotics → blocks
dopamine

Histamine • Increase = mania

• Decrease = depressed
(depressive symptoms)
• Psychotropics → blocks
histamine, increases
weight, voracious
appetite

Norepinephrine • Increase = mania,

anxiety, schizophrenia
• Decrease = depression
(depressive episode
under bipolar disorder),
social withdrawal,
memory loss

Serotonin • Increase =
schizophrenia (delusion,
hallucination, withdrawal
behavior), anxiety, mood
disorder
• Decrease = depression

Acetylcholine • Increase = depression

• Decrease = alzheimer’s
huntington’s chorea,
parkinson’s, myasthenia
gravis

GABA • Increase = apathy,

delayed reaction
• Decrease = anxiety,
epilepsy

Glutamate • Increase = parkinson’s

• Decrease = psychotic
behaviors
• High levels of glutamate
→ neurotoxic effects

ONE DAY, ALL YOUR HARD WORK WILL PAY OFF. 理異種 3