DISSOCIATIVE IDENTITY DISORDER

Group 13
 Jomari Jimenez
 Dominga Manabat
 Shaira Mae Millado
 Chrishelle Genesis Miranda
 Yzah Lordy Ann Navarro
 Aprille Nelie Pillos
 Russel James Passion
 Carla Mae Pimentel
 Nelfa Poloac
PSYCHIATRIC
HISTORY
 PSYCHIATRIC HISTORY
DEMOGRAPHIC DATA
Ms. Marieta a 28-year-old female currently living in barangay
Baligatan City of Ilagan, Isabela with no job or any other source
of income and lives alone. According to her, she never had
been in a relationship.
CHIEF COMPLAINTS
Ms. Marieta came to the clinic at 10:00am 22nd of June, and
reported herself about losing time and having no memory of
some part in her past activities or such a blank note in her
mind. She also added that sometimes there is a gap in her
memory. According to her, she finds herself coming-to a strange
place that seems unfamiliar and not even know how she got
thereand asking herseff out of nowhere why such things
happened to her.
 PSYCHIATRIC HISTORY
HISTORY OF PRESENT ILLNESS
Marieta is twenty-eight years old and currently lives alone in barangay Baligatan City of
Ilagan, Isabela. Marieta lived with her mother and stepfather until she was fourteen
when she ran away from home to escape sexual abuse by her stepfather and her
uncle. At five years old Marieta was molested by her stepfather. In addition, her mother
is an alcoholic and often got angry and violent with Marieta when drunk. The sexual
abuse and violence had gone on for as long as Marieta can remember. Her biological
father left the marital home when Marieta was two and had been out of contact since.
Marieta had never got on well with her mother but the relationship broke down
completely after she had told her about her stepfather’s abuse and her mum had not
believed her.
 PSYCHIATRIC HISTORY
At school, teachers reported that Marieta seemed a very bright and able pupil
who had achieved some high grades on occasion but lacked concentration
and consistently good results. She was also branded a troublemaker after
apparently being the ringleader in a binge-drinking episode in the school. At
twelve, she was found passed out in the school toilets, after she had cut both
wrists having been raped by her stepfather the previous day. She was seen by
a psychiatrist who asked about her family but she felt unable to tell anyone.
She returned home after treatment having nowhere else to go and went back
to school but from the age of thirteen missed more days than she attended.
 PSYCHIATRIC HISTORY
Currently Marieta is not working. She would like to go to college but states that there is
too much getting in the way. She reports losing time and having no memory of what has
gone on during these blank spells. She says she finds herself coming-to in strange
places, not knowing how she got there, or why she is there. This frightens her because
she was found wandering the streets in her nightdress one night at three in the morning
and had to be taken home by the police. Her arms are filled with scars from cutting but
she says that she does not cut herself. She states that she comes-to afterwards and it is
like someone else has done it. When I ask if she has ever found anything that she does
not recognise in her belongings she pulls out a small book with handwriting and
pictures. She says that she does not know the artist or the one with the frilly
handwriting. Neither, she says, are hers.
 PSYCHIATRIC HISTORY
PAST PSYCHIATRIC HISTORY
In previous month, Ms. Marieta was working in Mall as counter and this was the time
when her manager Mr. Jake present Marieta to request for treatment. The manager
who told Marieta would not be able to attend his work for the next month if she did not
attend therapy regular to treat her condition. Marieta had been through many bouts of
therapy to manage her multiple problem and later diagnose with different diagnosis
such as, Major depressive disorder, PTSD, and borderline personality disorder. It is
noteworthy to mention her long history of inconsistent diagnosis, and unsuccessful past
treatment episodes. At that time of first admission, Mr. Jake reported that Marieta had
been emotionally abusive to her co-worker and client over the past six months.
 PSYCHIATRIC HISTORY
According to the manager, Marieta rotated between three personalities,
sometimes Marieta is good like little girl, or she may be angry like a man, and
also sometimes she was abusive. Mr. Jake is bachelor graduate of nursing this
explain why he was familiar with the clinical signs and terminology regarding
Marieta’s condition. During the initial visit, Marieta revealed that she
experienced sexual abuse in her childhood, her stepfather and uncle raped her
more than he remembers. She was found in the bathroom pass out and have
cuts in her both wrist when she was 12 year old, she done this to herself after
her stepfather and uncle raped her.
 PSYCHIATRIC HISTORY
FAMILY HISTORY
Currently, the 28 year old female client lives alone in her apartment.
Her father left the client when she was only 2 year old and no other
medical history available. Her mother a 59 year old which suffers
from substance abuse and living with her stepfather. In the other
hand, family history was negative for psychotic disorder, medical
disease, dementia, addiction, and suicide attempts.
 PSYCHIATRIC HISTORY
MEDICAL HISTORY

The patient suffered from major depression at the age of

twelve. To treat depression at end of life, The physician
administered an antidepressant drug. For these symptoms, a
20-mg tablet of fluoxetine (Prozac) was taken orally every
morning.
 PSYCHIATRIC HISTORY
PERSONAL HISTORY
The client grew up in the small town of Delfin Albano, her
biological father left her in their marital home when she was two
and had been out of contact since. Teachers reported Marieta’s
as a bright pupil who achieved some high grades but lacks of
concentration and consistency. In the proceeding years, she was
notice for her troublemaker attitude and afterwards become
ringleader in a binge drinking episode.
 PSYCHIATRIC HISTORY
At twelve, she was found passed out in the school toilets, after
she had cut both wrists having been raped by her stepfather the
previous day. She was seen by a psychiatrist who asked about her
family but she felt unable to tell anyone. The client ran away from
home to escape sexual abuse by her stepfather and uncle when
she was fourteen. Now, the client is 28 year old and currently lives
alone in her apartment at barangay Baligatan City of Ilagan
Isabela.
WHAT IS DISSOCIATIVE
IDENTITY DISORDER?
 DISSOCIATIVE IDENTITY DISORDER

Dissociative Identity Disorder also Known as Multiple Personality

Disorder is a rare mental health condition, It is characterized by multiple
distinct personality/identity called “alters” present on one individual.
Globally, 1.5% of the population has been diagnosed of DID. Although
patients may spend an average of 6-12 years on treatment before being
diagnose because of large number of alters in these individuals, it can be
difficult to detect and diagnose. They acquire innumerable permutations of
symptoms present differently on different occasions resulting from
multiple diagnosis of 80% of patients with this disorder
 DISSOCIATIVE IDENTITY DISORDER

Moreover, Schizophrenia and Bipolar Disorder can also cause dramatic

mood swings mimicking Dissociative Identity Disorder but these
depressive or euphoric moods can last for at least a week, the change in
personality in DID only last for minutes to hours each time.
Symptoms of DID can be inability to remember large parts of childhood,
unexplained events, like finding yourself somewhere you don’t
remember walking to, hallucinations, out of body experiences, difference
in handwriting and some symptoms of DID can be attributed to a
person’s cultural background where possessions may be part of cultural
beliefs.
PSYCHIATRIC
MANAGEMENT
PSYCHIATRIC MANAGEMENT
PHASE ORIENTED TREATMENT
Phase 1: Establishing safety,stabilization, and symptom reduction
Phase 2: Confronting,working through, and integrating traumatic
memories
Phase 3: Identity integration and rehabilitation
Patients with dissociative disorders need to be educated about their
illness and given ongoing instruction about coping skills and stress
management. Normalizing experiences by explaining to the patient that
his or her symptoms are adaptive responses to past overwhelming
events is important.
PSYCHIATRIC MANAGEMENT
PSYCHOTHERAPY

INPATIENT CARE

TRANSFERS
PSYCHIATRIC MANAGEMENT
 PSYCHIATRIC MANAGEMENT
Family Therapy
-Direct communication with the family members will also reduce the
opportunities for manipulation and misunderstanding.

Group therapy
- Participation in group setting may diminish the patient sense of loneliness,
make available a secure place to discuss traumatic matter that patient
without dissociative disorder may not be able to tolerate, to study
interpersonal relationships, to develop more functional interaction, and
learn more about coping mechanism.
DIAGNOSTIC AND LABORATORY
TEST
DIAGNOSTIC AND LABORATORY TEST

 Physical Assessment
 Electroencephalography
 Imaging Studies
 Specific Questions to Identify Dissociative symptoms like for example:
 Dissociative Experience Scale (DES) from Bernstein and Putnam, 1986
 Dissociative Disorder Interview Schedule (DDIS) from Ross et a., 1989
 Somatoform Dissociation Questionnaire (SDQ) from Nijenhuis et al., 2012
DIAGNOSTIC AND LABORATORY TEST
 Criteria A
Disruption of identity characterized by two or more distinct personality states, which
may be described in some cultures as an experience of possession. The disruption
in identity involves marked discontinuity in sense of self and sense of agency,
accompanied by related alterations in affect, behavior, consciousness, memory,
perception, cognition, and/or sensory-motor functioning. These signs and symptoms
may be observed by others or reported by the individual.
 Criteria B
Recurrent gaps in the recall of everyday events, important personal information,
and/ or traumatic events that are inconsistent with ordinary forgetting.
DIAGNOSTIC
 Criteria C
AND LABORATORY TEST
The symptoms cause clinically significant distress or impairment in social,
occupational, or other important areas of functioning.
 Criteria D
The disturbance is not a normal part of a broadly accepted cultural or religious
practice. Note: In children, the symptoms are not better explained by imaginary
playmates or other fantasy play.
 Criteria E
The symptoms are not attributable to the physiological effects of a substance (e.g.,
blackouts or chaotic behavior during alcohol intoxication) or another medical
condition (e.g., complex partial seizures).
DIAGNOSTIC AND LABORATORY TEST
ASSOCIATED FEATURES SUPPORTING DIAGNOSIS
 Individuals with dissociative identity disorder typically present with comorbid
• Depression
• Anxiety
• substance abuse
• self-injury
• non-epileptic seizures
 They often conceal, or are not fully aware of, disruptions in consciousness,
amnesia, or other dissociative symptoms.
 Individuals with the disorder typically report multiple types of interpersonal
maltreatment during childhood and adulthood.
DIAGNOSTIC AND LABORATORY TEST
 Non maltreatment forms of overwhelming early life events,
such as multiple long, painful, early-life medical procedures,
also may be reported.
 Several brain regions have been implicated in the
pathophysiology of dissociative identity disorder, including the
orbitofrontal cortex, hippocampus, parahippocampal gyrus,
and amygdala.
DIAGNOSTIC AND LABORATORY TEST
Common Diagnosis Associated with Multiple Personality Disorder
• Major depressive disorder
• Bipolar disorder
• Posttraumatic Stress Disorder
• Psychotic Disorder
• Personality Disorder
• Conversion Disorder
• Seizure Disorder
• Factitious and Malingering
PHYSICAL ASSESSMENT
 PHYSICAL ASSESSMENT
Patient: Marieta
Age: 28 years old /Female
Date of assessment: August 16, 2022
Diagnosis: Dissociative Identity disorder

General Survey:
Initial vital signs:
BP: 120/80mmHg
T: 36.5 °C
PR: 80bpm
RR: 20cpm
taken August 16, 2022 @10:00am prior to interview
 PHYSICAL ASSESSMENT
BODY PART NORMAL FINDING ACTUAL FINDING INTERPRETATION

Head • Evenly distributed in • Evenly distributed, Thick Normal

• Hair the scalp. Thick and and silky black hair
silky hair • No lesions, infection and
• Free from infestation infestation noted
and flakes upon • Not well combed hair
parting
• Skull • Normocephalic and • Normocephalic and Normal
symmetrical symmetrical
• No tenderness noted
upon palpation
• Face • Symmetrical • Symmetrical facial Normal
and Fair color features
Eyes • Eyebrows and lashes • Evenly distributed Normal
• -External eye structure are well distributed • Symmetrically
• Eyelids skin intact, no
discharge, no
discoloration and lids
close symmetrically
• Internal Eye structure • Pupils are equally • White sclera in color Normal
round

• Black in color; equal

 PHYSICAL ASSESSMENT
BODY PART NORMAL FINDING ACTUAL FINDING INTERPRETATION

• Ears • Color same as facial skin • Color same as the facial Normal
• Symmetrical skin and symmetrically
• No redness or
tenderness
• External ear canal:
• Can hear whisper both
ears.
• Nose • Symmetric and straight • Symmetric and straight Normal
• No presence of • No discharge or bleeding
discharge or bleeding • Uniform in color
• Uniform color
• Mouth • Tongue is pink in color • Tongue are pink and no Normal
and moist lesion noted
• No swelling or bleeding • No swelling or bleeding
in the gums
• Neck • Muscles equal in size; • Neck muscles equal Normal
head centered
• Not palpable lymph
nodes
• Thorax and lungs • Chest wall symmetric • Normal chest shape Normal
• No visible deformities • No deformities
• Full symmetric chest • Vesicular breath sound
expansion vesicular when auscultated with
20cpm
 PHYSICAL ASSESSMENT
BODY PART NORMAL FINDING ACTUAL FINDING INTERPRETATION

• Heart • No presence of lifts or • No lifts or heave Normal

heave in the apical area • S1 and S2 normally
• S1 and S2 heard at all heard all sites
sites

• Abdomen • Uniform in color • Uniform in color Normal

• Audible bowel sounds

• Extremities • Upper extremities: Patient shows signs of scar

• Skin generally uniform • Skin complexion is in her both wrist when she's
uniform with all body only 12 years old
parts skin is intact.
• Scar in both wrist are
noted

• Lower extremities: • Skin turgor uniform in

•  Skin turgor color both right and left Normal
legs

• No tenderness or • No tenderness or
deformity deformity
GORDON’S FUNCTIONAL
HEALTH PATTERN
DEVELOPMENTAL TASK
 DEVELOPMENTAL TASK
Erickson’s Psychological Theory
The 6th stage : Intimacy vs Isolation
-This stage between approximately 19-40 years old.
-This stage was applied the patient because she is 28 years old.
According to her, she never been in relationship and no job. She
had sexual abused from her stepfather and to her uncle.
 DEVELOPMENTAL TASK
Major Development Task:
INTIMACY VS ISOLATION
• Develop relationship with others Avoidance of choice in relationship, work/lifestyle.
• Develop intimate relationship with another
commitment to career.

It results happy relationship and a sense of

commitment, safety & care with a relationship.

The goal of this stage is the patient must develop relationship to others,
so it is obvious that the patient which is diagnosed with DID have memory
loss/dementia and is unresponsive has difficulty at this stage because the
patient is never had been in a relationship and no job.
REVIEW OF ANATOMY AND
PHYSIOLOGY
REVIEW OF ANATOMY AND PHYSIOLOGY
BRAIN CHANGES IN DID

The quantitative evidence supporting changes in the brain of a person with DID is limited.
However, some studies have clearly reflected the possibility of changes in the structural
components of the brain, including the limbic system, the cerebral cortex and the blood flow
to the Cerebral Cortex. In 2003, Brunson et al., suggested that stress is one of the leading
factors affecting the volume of the hippocampus (Hippocampus is a complex brain
structure embedded deep into temporal lobe. It has a major role in learning and memory. It
is a plastic and vulnerable structure that gets damaged by a variety of stimuli.) This notion
emphasizes the association of stress with DID and early exposure to stress and changes in
the volume of stress specific regulatory structures of the brain.
REVIEW OF ANATOMY AND PHYSIOLOGY
REVIEW OF ANATOMY AND PHYSIOLOGY
LIMBIC SYSTEM
The limbic system is the part of the brain involved in our behavioral and
emotional responses, especially when it comes to behaviors we need for
survival: feeding, reproduction and caring for our young, and fight or flight
responses. You can find the structures of the limbic system buried deep within
the brain, underneath the cerebral cortex and above the brainstem. The
thalamus, hypothalamus (production of important hormones and regulation of
thirst, hunger, mood etc) and basal ganglia (reward processing, habit
formation, movement and learning) are also involved in the actions of the
limbic system, but two of the major structures are the hippocampus and the
amygdala.
PSYCHOPATHOLOGY
,
NURSING CARE
PLAN &
DRUG STUDY
PSYCHOPATHOLOGY
NURSING CARE PLAN
 ASSESSSMENT NURSING PLANNING INTERVENTION RATIONALE EVALUATION
DIAGNOSIS

SUBJECTIVE Ineffective coping Short-term Goal 1.Reassure client of 1.Presence of a 1.Client is able to
related to trauma as 1.Client will verbalize safety and security trusted individual demonstrate
As stated by the evidenced by understanding that by your presence. provides feeling of techniques that may
patient's teacher she Dissociating self she is employing Dissociative security be used in
has lacked of from painful situation dissociative behaviors may be and assurance of response to stress to
concentration by experiencing behaviors in times of frightening to the freedom from harm. prevent dissociation.
Memory loss psychosocial stress. client. 2. Client verbalizes
OBJECTIVE 2. Client will an understanding of
Physical abused and verbalize more 2. Identify stressor 2.This information is the relationship
sexual abuse adaptive ways of that precipitated necessary to the between severe
coping in stressful severe anxiety development of an anxiety and the
situations than effective plan of dissociative
resorting to client care and response.

NURSING CARE PLAN dissociation.

Long-term Goal
Client will
demonstrate ability
3. Explore feelings
that client
problem resolution.

3.Client’s self-
esteem is preserved
to cope with stress experienced in by the knowl
(employing means response to the edge that others may
other than stressor. Help client experience these
dissociation). understand that the behaviors in similar
disequilibrium circumstances.
felt is acceptable
indeed, even
expected in times of
severe stress.

4. to encourage
4. As anxiety level client to identify
decreases (and repressed traumatic
memory returns), experiences
use explo that contribute to
ration and an chronic anxiety.
accepting,
nonthreatening
environment
ASSESSSMENT NURSING PLANNING INTERVENTION RATIONALE EVALUATION
DIAGNOSIS

5. Have client 5.In times of extreme

identify methods of anxiety, client is
coping with stress in unable
the past and to evaluate
determine whether appropriateness of
the response was response. This
adaptive or information is
maladaptive. necessary for client
to develop a plan of
action for the
future.

NURSING CARE PLAN

6.Depending on
6. Help client define current level of
more adaptive anxiety, client
coping strategies. may require
Make assistance with
suggestions of problem-solving and
alternatives that decision making.
might be tried.
Examine
benefits and
consequences of
each alternative.
Assist client in the
selection of those
that are most 7.Positive
appropriate for her. reinforcement
enhances self-
7. Provide positive esteem and
reinforcement for encourages
client’s attempts to repetition of desired
change. behaviors
 ASSESSSMENT NURSING PLANNING INTERVENTION RATIONALE EVALUATION
DIAGNOSIS

SUBJECTIVE: Disturbbed thought Short-term Goal 1.Obtain as much 1.A baseline 1.Client is able to
processes related to Client will verbalize information as assessment is recall all events of
Patient's reports of: childhood trauma as understanding that possible about client important for the past life.
evidenced by loss of memory is from development of an 2. Client is able to
-losing time and Memory loss— related family and significant effective plan of care. demonstrate adaptive
having no memory of inability to recall to stressful situation others (likes, dislikes, coping strategies that
what has gone on selected events and begin discussing important people, may be used in
during blank spells. related to a stressful stressful situation activities, music, response to severe
-she finds herself situation with pets). anxiety to avert
coming-to in strange nurse or therapist. 2.Individuals who are amnestic behaviors.
places, not knowing Long-term Goal 2. Do not flood client exposed to painful
how she got there, or Client will recover with data regarding information from
why she is there. deficits in memory her past life. Instead, which the amnesia is
-she comes-to
afterwards and it is
like someone else
has done it
NURSING CARE PLAN and develop more
adaptive coping
mechanisms to deal
with stressful
expose client to
stimuli that represent
pleasant expe
riences from the past,
providing protection
may decompensate
even further into a
psychotic state.
-she does not know situations. such as smells
the artist or the one associated with
with the frilly enjoyable
handwriting. Neither, activities, beloved
she says, are hers. pets, and music
known to have been
OBJECTIVE: pleasurable to client
Childhood traumas:
(+) sexual abused
(+ physical abused
(+) loss of
concentration
(+)trouble maker

Present:
(+) loss of memory
ASSESSSMENT NURSING PLANNING INTERVENTION RATIONALE EVALUATION
DIAGNOSIS

3.As memory begins 3.Recall may occur

to return, engage during activities that
client in activities that simulate life
may provide experiences.
additional
stimulation.
4.Verbalization of
4.Encourage client to feelings in a
discuss situations nonthreatening
that have been environment may
especially stressful help client come to
and to explore the terms with

NURSING CARE PLAN

feelings associated unresolved issues
with those times. that may be
contributing to the
5.. Identify specific dissociative process.
conflicts that remain
unresolved, and 5.Unless these
assist underlying
client to identify conflicts are
possible solutions. resolved, any
improvement in
coping behaviors
must be viewed as
only temporary.

6.Provide instruction 6.so that dissociative

regarding more behaviors are no
adaptive ways to longer
respond to anxiety needed.
DRUG STUDY
 DRUG NAME ACTION DOSAGE/ INDICATION/ CONTRAINDICA ADVERSE NURSING
ROUTE USES TION & REACTION MANAGEMENT
CAUTION

FLUoxetine (Rx)
(floo-ox9uh-teen)
PROzac, PROzac
Inhibits CNS
neuron uptake of
serotonin but not
DRUG STUDY
Depression/OCD
Adult: PO 20
mg/day am; after
Major depressive
disorder,
obsessive
Hypersensitivity
Precautions:
Pregnancy C,
CNS: Headache,
nervousness,
insomnia,
Assessment
• Monitor B/P
(lying, standing),
Weekly, Sarafem of norepinephrine 4 wk if no compulsive breastfeed drowsiness, pulse q4hr; if
Func. class.: ​ clinical disorder (OCD), ing, geriatric, anxiety, tremor, systolic B/P drops
Antidepressant, improvement is bulimia nervosa; diabetes mellitus, dizziness, 20 mm hg, hold
selective noted, dosage Sarafem: narrow-angle fatigue, sedation, product and
serotonin may be premenstrual glaucoma, poor notify prescriber;
reuptake inhibitor increased to 20 dysphoric cardiac concentration, take VS q4hr in
Pregnancy mg bid in am, disorder malformations in abnormal dreams, patients with
category C afternoon; max 80 (PMDD), panic infants agitation, CV disease
mg/day; PO 90 disorder, (exposed to seizures, apathy, • Monitor blood
mg weekly generalized FLUoxetine in euphoria, studies: CBC,
Geriatric: PO 5-10 anxiety utero) hallucinations, leukocytes, dif
mg/day, increase disorder, social delusions, ferential, cardiac
as needed phobia psychosis, enzymes if patient
Child 5-18 yr: PO Unlabeled uses: suicidal ideation, is receiving
5-10 mg/day, max Alcoholism, neuroleptic malig long-term therapy;
20 mg/day anorexia ner nant syndrome– check platelets,
Alcoholism vosa, borderline like reactions, bleeding can
(unlabeled) personality serotonin occur; thyroid
Adult: PO 20-80 disorder, obesity, syndrome CV: growth rate
mg/day posttraumatic Hot flashes, (children)
Anorexia nervosa stress disorder palpitations, • Monitor hepatic
(unlabeled) angina pectoris, studies: AST, ALT,
Adult: PO 10 mg hemorrhage, bilirubin
every other day- hypertension, • Monitor hepatic
20 mg/day tachycardia, studies: AST, ALT,
Borderline 1st-degree AV bilirubin
personality block, • Check weight
disorder bradycardia, MI, qwk; appetite may
(unlabeled) thrombophlebitis, increase with
Adult: PO 20 generalized product
mg/day, max 80 edema
mg/day
DRUG NAME ACTION DOSAGE/ROUTE INDICATION/ CONTRAINDICA ADVERSE NURSING
USES TION & REACTION MANAGEMENT
CAUTION

DRUG STUDY
Kleptomania
(unlabeled)
Adult: PO 60-80
EENT: Visual
changes, ear/eye
pain, photo
• Assess ECG for
flattening of T-
wave, bundle
mg/day phobia, tinnitus, branch block, AV
Posttraumatic increased block,
stress disorder intraocular dysrhythmias in
(unlabeled) pressure cardiac
Adult: PO 10-80 GI: Nausea, patients
mg/day diarrhea, dry BLACK BOX
Premenstrual mouth, anorexia, WARNING:
dysphoric dyspepsia, Assess mental
disorder constipation, taste status:
(Sarafem) changes, flatu mood, sensorium,
Adult: PO 20 lence, decreased affect, suicidal
mg/day, may be appetite tendencies;
taken daily 14 GU: increase in
days before Dysmenorrhea, psychiatric
menses decreased libido, symptoms:
Available forms: urinary frequency, depression,
Caps 10, 20, 40 urinary tract panic; monitor for
mg; tabs infection, seizures; seizure
10, 20 mg; oral amenorrhea, potential
sol 20 mg/5 ml; cystitis, is increased;
del rel caps impotence, urine Sarafem is not
(PROzac Weekly) retention approved for
90 mg; tab 10, 15, INTEG: Sweating, children
20 mg rash, pruritus, • Monitor urinary
Implementation acne, retention,
• Give without alopecia, urticaria; constipation;
regard to meals angioedema, constipation is
• Give dose at exfoliative more likely to
bedtime if dermatitis, occur in children
oversedation Stevens-Johnson or geriatric
occurs syndrome,
during day; may toxic epidermal
take entire dose necrolysis
at bedtime; ge
DRUG NAME ACTION DOSAGE/ INDICATION/ CONTRAINDICA ADVERSE NURSING
ROUTE USES TION & REACTION MANAGEMENT

DRUG STUDY
CAUTION

riatric may not MS: Pain, Identify patient’s

tolerate once/day arthritis, twitching alcohol
dosing, crush if RESP: consumption; if
patient unable to Pharyngitis, alcohol is
swallow whole cough, dyspnea, consumed, hold
(tabs only) bron dose until am
• PROzac chitis, asthma, • Assess appetite
Weekly: Give on hyperventilation, in bulimia
same day each pneumonia nervosa,
week, swallow SYST: Asthenia, monitor weight
whole, do not serotonin daily, increase
crush, cut, chew syndrome, nutritious foods
• Store at room flulike symptoms, in diet, watch for
temperature; do neonatal bingeing and
not freeze abstinence vomiting
syndrome • Serious skin
reactions:
angioedema,
exfoliative
dermatitis,
Stevens-Johnson
syn
drome, toxic
epidermal
necrolysis
• Assess allergic
reactions: itching,
rash,
urticaria, product
should be
discontinued;
may
need to give
antihistamine
Patient/family
education
DRUG NAME ACTION DOSAGE/ INDICATION/ CONTRAINDICA ADVERSE NURSING
ROUTE USES TION & REACTION MANAGEMENT

DRUG STUDY
CAUTION

Teach patient
that therapeutic
effects may take
1-4 wk, not to
discontinue
abruptly
• Instruct patient
to use caution in
driving or
other activities
requiring
alertness
because of
drowsiness,
dizziness, blurred
vision; to avoid
rising quickly from
sitting to
standing,
especially
geriatric; to use
sunscreen to
prevent photosen
sitivity
• Caution patient
to avoid alcohol
ingestion,
other CNS
depressants
• Advise patient
not to discontinue
medication
quickly after long-
term use: may
cause nausea,
headache,
malaise
DRUG NAME ACTION DOSAGE/ INDICATION/ CONTRAINDICA ADVERSE NURSING
ROUTE USES TION & REACTION MANAGEMENT

DRUG STUDY
CAUTION

• Instruct patient
to increase fluids,
bulk in
diet if
constipation,
urinary retention
occur,
especially
geriatric
• Advise patient
to take gum, hard
sugarless
candy, or frequent
sips of water for
dry mouth
• Teach patient to
avoid all OTC
products unless
approved by
prescriber
• Advise patient
to change
positions slowly,
orthostatic
hypotension may
occur
DRUG NAME ACTION DOSAGE/ INDICATION/ CONTRAINDICA ADVERSE NURSING
ROUTE USES TION & REACTION MANAGEMENT

DRUG STUDY
CAUTION

• Teach that
suicidal thoughts,
behavior may
occur in young
adults, children
Evaluation
Positive
therapeutic
outcome
• Decrease in
depression
• Absence of
suicidal thoughts
• Decreased
symptoms of
OCD
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CONDUCTION
DISCHARGE PLAN/ HOME CONDUCTION
MEDICATION
Although there are no medications that specifically treat dissociative
disorders, the doctor may prescribe
- Antidepressants
- Anti-anxiety medications
to help control the mental health symptoms associated with dissociative
disorders
Types of counselling/ psychotherapy include:
Cognitive behaviour therapy (CBT);
Dialectical behaviour therapy (DBT);
Eye movement desensitization and reprocessing (EMDR).
Hypnosis.
 DISCHARGE PLAN/ HOME CONDUCTION
OUT- PATIENT CARE
The guardian or parent must learn how to deal with the child during expression of multiple
personalities or amnestic episodes.
A mental health professional with special experience in this area should provide follow-up
care for these patients.

EXERCISE
Can help DID because it helps DID's common comorbid conditions. Aerobic exercises such
as jogging, dancing and cycling, have been proven to reduce anxiety and depression. This
is thought to be because exercise increases blood circulation to the brain, ultimately
improving mood and cognitive function
DIET
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 Limit caffeine, as caffeine is a stimulant and can directly stimulate your

body’s alarm.
 Limit recreational drugs. Even if substances such as cannabis, nicotine and
alcohol seem to help with anxiety in the short-term, they usually worsen
anxiety over the long run.
 Limit processed foods as many artificial ingredients (e.g. artificial
sweeteners, coloring or preservatives) can worsen anxiety.
 Eat more a Mediterranean style diet which is high in whole grains,
vegetables and fruit
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HEALTH TEACHING
 Do reduce stress in your life.
 Do limit recreational screen time.
 Do get enough sleep.
 Do get time outdoors in nature.
 Self-help strategies -
(i) Talking to a trusted friend openly about any issues or problems.
(ii) Seeking professional help.
(iii) Joining a support group.
THANK YOU
FOR
LISTENING