PSYCHIATRIC NURSING

Overview:

A. Psychiatric Nursing

• Mental health
• Primary purpose is to promote mental health
• Not curable, only to reduce the symptoms

B. Main Tool : IPR (Interpersonal Relationship)

Client, individual, family, environment Nurse: self-awareness to

minimize weakness, maximize strength

C. Focus of Psyche : Human Behavior

- Leads to identification of feelings
- Responses to the environment, changes are
meaningful

D. Tool Used By The Nurse : Therapeutic use of self acquired thru self-
awareness

E. Levels Of Prevention:

3 Levels Of Prevention:

1.) Primary
•
Promote mental health (Healthy)
• Remove factors before they can cause illness
Ex. Stress reduction
Health Teachings/Community
Teachings/Community Demographics
Support System
Accident Prevention
2.) Secondary
• Lessen the duration of mental illness (ill)
Ex. Suicide Prevention
Crisis Intervention/ Treatment & Diagnosis
Providing Psychotherapy & Milieu Therapy
3.) Tertiary
• Function to become independent
Ex. Rehabilitation Centers/ Al anon
Relapse Avoidance

F. Stages Of Interaction

1st Stage: Orientation

Assessment 2nd Stage: Working
Establishment of Trust Problem Solving

Created by Niňa E. Tubio 1

 Tell Patient of Termination Discussion 3rd
Stage: Termination
Set contract Patient is mostly cooperative Summarize
Evaluation Say
Goodbye
Patient is resistant Grief-Anger (Focus
of RN)
Pt. violent/suicidal
I. MENTAL HEALTH ----- A state of mind

6 Concepts In Mental Health:

1. Self-Awareness

2. Self-Actualization
–Self-fulfillment or self-realization

3. Perception Of Reality

4. Autonomous Behavior:
– Independence, decision-making ability

5. Adaptation : Use of Adaptive Defense Mechanisms

 Compensation
 Rationalization
 Identification
 Fantasy
 Substitution
 Sublimation

6. Integrative Capacity
- Time to evaluate frustrations
- Ability to solve conflicts:

*Conflict—presence of 2 goals
resolved through

a. Double Approach = 2 + goals

b. Double Avoidance = 2 goals
c. Approach-Avoidance = (+) & (-) outcome
Ex. Developmental Task

II. PERSONALITY DEVELOPMENT:

*Our beliefs & thoughts influence our feelings & consequently

manifests as behavior.

BELIEFS FEELINGS
BEHAVIOR
Create the

Created by Niňa E. Tubio 2

 Different Inputs/Factors

* Per sonare ------- “to sound through”--- The sum total of traits w/c are
unique

III. THEORIES ON PERSONALITY DEVELOPMENT:

1. SIGMUND FREUD - Father of Psychoanalysis

Psychoanalysis – Uses the principle of free association

(Talk of anything that comes to mind & correlate w/ the
behavior)
- As the treatment for the unconscious mind
- The role of the unconscious w/c has conflicts-----results to
maladaptive behaviors
(Dr. Karen Horney- detractor of Freud’s’ Penis Envy

- “ALL BEHAVIOR HAS MEANING”

Different Theories Of Sigmund Freud:

A. 3 STRUCTURE OF THE PERSONALITY

I sex”
D
IMPULSIVE Part

WANT TO
Operates on “PLEASURE PRINCIPLE”
Instinctual drive: “Eat, urinate, have

Avoidance of pain, All “I”

Ex. Babies are all ID: “I want it, I want

S
it now”

UPEREGO “CONSCIENCE”
SHOULD NOT Higher self, ideal ego
MALL VOICE OF GOD Tells you what is right or wrong
The censoring part, the moral values
What makes you a perfectionist, rigid &
righteous
Ex. I should not eat yet…..
Function:
1. Inhibit the ID impulse

E
Operates on “REALITY PRINCIPLE”
GO In touch with reality
XECUTIVE The self, self-identity
Arbiter

Created by Niňa E. Tubio 3

 Develops 6 months
Functions:
1. Higher Functions: memory, orientation,
decision-maker

2. Integrator of Personality: mediator bet.

the Id & Superego
between self & environment

3. It will tolerate frustrations

4. Solve conflicts
Ex. “I can wait for what I want”

5. Uses Defense Mechanism---to maintain

balance (PRN only)

6. Directs motor skills

7. Evaluate the environment

8. Reduces anxiety
*The ability to tolerate frustration based on the balance of the 3 functions:
Imbalance -----Maladaptive Behavior

1. 2.
ID SUPEREGO

SUPEREGO ID
EGO EGO

ID is dominant; needs a superego (conscience) SUPEREGO is

dominant; needs an ID
Characteristic of: Characteristic of:
MANIC OBSESSIVE-
COMPULSIVE
ANTISOCIAL (Serial-killer) ANOREXIA
NERVOSA
NARCISSISTIC PERFECTIONIST,
RIGID

3.

ID SUPEREGO

EGO

If there’s Weakened EGO Impaired Reality Perception

Characteristic of: SCHIZOPHRENIA

B. THE THEORY OF LIBIDO

LIBIDO - Sexual energy for survival

• Man’s sexual desires & urges
• Personal-----libidal striving w/c focuses on gratification

Created by Niňa E. Tubio 4

C. THE THEORY OF DREAMS
• Resides in the unconscious

D. THE THEORY ON LEVELS OF AWARENESS

3 Levels of Awareness:
> Highest level of Awareness
CONSCIOUS > Contains all experiences that can be
recalled voluntarily

PRE-CONSCIOUS > “Tip Of The Tongue”; Deja Vu

(Sub-conscious) > Experiences that partly forgotten &
partly remembered

> Forgotten
> Experiences that cannot be recalled
UNCONSCIOUS
Ex. Dreams, accidents, anxieties
& phobias
> Where traumatic experiences are
stored (Repression)
Ex. Birth Trauma (the cause of 1st
anxiety)

*The ID, Ego & Superego -----all resides in the unconscious & operates on
different levels of the mind
Except the ego when dealing with reality----resides on the
---conscious

Repression – Unconscious Suppression – Conscious forgetting

forgetting of of an
an anxiety- anxiety-provoking
E. provoking event
THE PSYCHOSEXUAL THEORY event (voluntary)

STAGES OF PSYCHOSEXUAL DEVELOPMENT

1. ORAL STAGE 0 – 18 months

 “ Survival”
 All ID
 Cry, suck mouth
 Biting, Thumb sucking & Nail biting-----------------all normal in infancy
 Dependent, Helpless----------------needs to develop sense of trust, sense of
security

After 6 months, EGO develops------Development of Self-Concept

Maternal Deprivation results if there’s no feeding, not given milk/water,

not kept warm

 Residuals Developed : 3 Maladaptive

Behavior:

 Overeating Narcissisti Regressi Fixation

c on Stopping
Created by Niňa E. Tubio Stems Going to in a certain5
from being an earlier stage of
deprived & developme Developm
  Over-talkative
 Gossiping
 Chewing gums
 Smoking & Drinking alcohol

2. ANAL STAGE 18 months – 3 years old

 Focus on Elimination -----Bowel -------the 1st to developed

-----Bladder (Bedwetting)
 Toilet training
 Temper Tantrums---Normal---Ignore as long as no harm is present: If (+)
harm---set limits
 SUPEREGO is being formed(begins)---------------Mother as the superego

 Sense of Autonomy Develops------manifested through

Negativism (No) Stubbornness

 Concerns: Punishment
Cleanliness
Habit-training Stage

 Residuals Developed: Perfectionist, Rigid, Righteous, Collectors &

Hoarders

 Problems: Strict Toilet Training

Too much punishment w/ Toilet-training result to a child who is:
Good Bad mother
mother

Successful Clean Dirty

Organized Disorganized
SE Obedient Disobedient

SE SE
Anal Retentive Anal
Expulsive
(Obsessive-Compulsive)
(Antisocial)
3. PHALLIC STAGE 3 years – 6 years old

 Focus:
P HALLIC
ENIS
ARENT
RE - SCHOOLER

Genitals------Penis only
 Development of Gender Identity Sense of Being
Masculine/Feminine

Created by Niňa E. Tubio 6

  Sense of Initiative
 Genital Exhibitionism/Masturbation
 Imaginative With a friend
 Explorative “Why”
 Residuals Developed: Sexual Deviation
 Sibling Rivalry is normal

 Development of Complexes----child attachment to opposite sex

Oedipus Electra Complex

Complex (girl loves daddy) Both complexes
(boy loves
resolved thru
mommy)
Identification
Identification
(girl imitates To parent of the
same sex Identification mommy)
(boy imitates (Role Identification)
daddy) Girls-
“Penis Envy”

4. LATENCY STAGE 6 to 12 years old (School Age) (“Log tu” tulog

ang libido)

 Focus: School & Peer

 The Homosexual Stage-----------Identify with the same sex------Best friend
 Areas on school & social competition--------------form the sense of group
success
 Sense of Industry
 Fear: School Phobia-------------Separation-Anxiety

R
A
W
EADING
ITING
ITHMETIC
Sublimation – placing sexual energies
(feelings) toward
more productive endeavors

 Residuals Developed: School Dropout

5. GENITAL STAGE 12 years and above (Gising na ulit ang sexual

energy)

G
 Focus: Genitals
 Emergence of LUST ENITAL
 The Heterosexual Stage ISING
 Sense of Identity
 AMBIVALENCE: Child Adult

 Struggle for independence from parents

 Problems: Conflicts & Frustrations dominates

Residuals Developed: Drug Addiction, Promiscuity, Alcoholism

2. ERIK ERICKSON------- Psychosocial Theory Of Development

Created by Niňa E. Tubio 7

  Considered the “Social Factors”
 Man as a Social Being
 Person play different roles & as we play them, we achieve something

PSYCHOSOCIAL STAGES OF DEVELOPMENT

Freud Significa
Stage (+) (-) Factor nt
Person

0-18 Oral Trust Mistrust Mother

Feeding
months ( Friendly/ (Withdrawn/Susp
(Infancy) Affectionate) icious)
(Self-Confidence)
Shame &
Autonomy Toilet
18 months Anal Doubt Parents
(Self- Training
– 3 years (Overtly
Determination) “No,No”
(Toddler) Compliant)
(Independence) “My”

Phalli Initiative Family

3 – 6 years Guilt Independe
c (Responsible)
(Pre- (Denial, nce
(Role
Schooler) Restrictions) “Teach
Identification)
Anger To Self The Child”
Initiate the 1st
step

Laten School Teacher

t Industry Inferiority “Who Am Peer
6-12 years
(Competition) (Social Loner) I” based
(School)
(Cooperative) (School Drop- on beliefs,
“Sx of High Self- out) selects &
Esteem” become
who you
are along
w/ your
peers

12 – 20 Genit Opposite
Peers
years al Identity Role Confusion Sex
(Major
(Adolescen (Self-Actualized) (Identity Crisis)
factor in
ce) (Self-Direction)
the dev’t
of beliefs

20-25 Isolation Husband/

years Intimacy (Relationships/Jo Wife
Love
(Young (Commitment) bs on Children
Adult) Temporary
Basis)
25-45 Generativity Stagnation
years (Productivity) (Selfish, Self- Parenting Children
(Middle “Sharing” Centered) “Sharing Grandchil
Adult) “No Learning” beliefs w/ dren

Created by Niňa E. Tubio 8

 children”
45 &
Despair Husband/
Above Ego Integrity
(Hopeless, Reflection Wife
(Late (Worthiness)
Unworthy) Best
Adult) (Completeness)
(Fear of Death) friend

 Paranoia = Stems from the development of mistrust

Exercise: Newly admitted Patient:----Develop 1st ----Trust

----Develop/teach autonomy since pts. Are dependent
with self-care deficit
3. JEAN PIAGET-------Theory Of Cognitive Development

Four Stages Of Cognitive Development

1st Stage : Sensorimotor 0- 2 years old

• Preverbal
• Recognizing environment by the use of senses (baby can
see,perceive,hear)

Adapt through the use of reflexes &

motor skill
• Concept of Object Permanence
----even if they cannot see the object, they still
believed its existence

2nd Stage : Pre-Operational 2- 7 years old

• Egocentric----does not feel what adults feel
• Animistic Thinking -------cartoons are powerful
• Imitates other people
• Pre-Conceptual 2-4 y/o -----Use of language to talk
• Intuitive Stage 4 -7 y/o-----Unidimentional
classification/characteristics
(Child can fix toys according to size, color, height---
1 at a time only

3rd Stage : Concrete Operational 7 – 12 years old

• Logical
• Concept of Cause & Effect

4th Stage : Formal Operation 12 years old & above

• Idealistic
• Abstract Thinking

4. ABRAHAM MASLOW’S HIERARCHY OF NEEDS

SELF-ACTUALIZATION > Continuous

Improvement of Self
> Low self- esteem: Give
Task SELF- ESTEEM

LOVE & BELONGINGNESS

SAFETY & SECURITY
Created by Niňa E. Tubio 9
 BASIC PHYSIOLOGICAL NEEDS

5. OTTO RANK------Theory Of Birth Trauma

 Birth Trauma---------Manifested Through----------Separation
Anxiety
 Birth Trauma --------the 1st cause of Anxiety

6. CARL JUNG------Theory Of Libido

 Theory Of Libido-------derived from an energy level

7. ADOLF MEYER--------Psychobiology Theory

 Concept of the mind & body as one entity
8. ALFRED ADLER------Individual Psychology
 Unique
 Man born with a weakness but overcomes it
through

Compensation
 Inferiority Vs. Superiority Concept
9. HARRY STACK SULLIVAN-----Theory Of Interpersonal Relationships

 Theory of Interpersonal Relationships

Mother & Child developed IPR during infancy------if lacking------anxiety

Builder Of Self-Esteem

Motivation
Stages:
1. Infancy--------------- 0-18 months
 Mouth

2. Childhood------------18 months- 6 y/o

 Egocentric/Gender Identity

3. Juvenile----------------6-9 y/o
 Competitive

4. Pre-Adolescence------ 9-12 y/o

 Best Friend
 Depends on group success

5. Early Adolescence--- 12-18 y/o

 Emergence of Lust
 Attraction to opposite sex-----bases: physical
appearance

6. Late Adolescence------18-22 y/o

Created by Niňa E. Tubio 10

  Development of lasting relationship----based on
security

7. Adulthood-----------------22 y/o & above

 Achievements
 Focus on emotional & sexual maturity

10. BEHAVIORAL MODELS

A. IVAN PAVLOV ------------------CLASSICAL CONDITIONING MODEL

“All behavior is learned” through CLASSICAL CONDITIONING

Unconditioned stimulus Unconditioned Response

(food) (salivation)
Conditioned stimulus
(bell)

B. B.F. SKINNER ---------------------OPERANT CONDITIONING MODEL

 If all behavior is learned, then it can be unlearned

Good Behavior Reward Positive reinforcement

Repeated behavior

Bad Behavior Punishment Negative reinforcement

Extinguishes behavior / extinction

IV. PSYCHOPHARMACOLOGY

Anatomy: Frontal Lobe = Personality, Learning, Judgment, Language

Occipital Lobe = Vision
Temporal Lobe = Hearing, Smell
Parietal Lobe = Touch

How do you interact with your environment?

S ENSORY -----1st ------seeing

I NTEGRATION ------2nd------analyze

M OTOR ------3rd------action

Voluntary Movements Involuntary Movements

(SOMATIC)SNS (AUTONOMIC)
ANS

Created by Niňa E. Tubio 11

 Brain
(Alert) Sympathetic
Parasympathetic (Relax)

Spinal cord ♥ HR ↑ ↓

RR ↑ ↓
Motor Nerves
GI ↓ dry mouth ↑
moist mouth
constipation diarrhea
Ach GU ↓ retention ↑
frequency
Acetylcholine – “on” switch of muscle
(transmits message to the muscle) Neuro Epinephrine/
Acetylcholine
Transmitter Norepinephrine
Synapse Pupils Midriasis Myotic
Blood Vessel Vasoconstriction
Vasodilatation
BP Increased
Decreased
Muscle Fiber

 Anti-Cholinergic/ Anti-Parasympathetic Effect is

sympathetic

 Sympathetic Drug Classifications:

A- anxiety
P- psychotic
ANTI C-cholinergic
D- depressants

V. DEFENSE MECHANISMS

 Mental mechanisms
 Coping Mechanisms from stress
 Patterns of adjustment
 Affects/Interferes with ADL--------harm to self or others
 Operates on the unconscious level

Processes on the Ego---------to reduce anxiety--------maintain self-

esteem

Results to

> Adaptive/ Maladaptive

> Distort reality
> Self-deception

Created by Niňa E. Tubio 12

 DEFENSE MECHANISMS

Displacement Transfer of feelings to less threatening object/person

rather than the one who provoked it
• Unacceptable
Ex. “ Boss shouts at you, you shout to your
subordinate”

Denial Failure to acknowledge an unacceptable trait or situation

or reality
Ex. “I am not an alcoholic”

Regression Returning to an earlier developmental stage (earlier

pattern of behavior)
Ex. Acting like a child

Repression Unconscious forgetting of anxiety provoking concept

(Selective forgetting)

Rationalization Illogical reasoning for a socially unacceptable trait (Giving

rational reasons)
• Uses “because”
• Most common defense mechanism used
Ex. “I drink the beer in the ref rather than waste it”

Reaction-Formation Doing opposite of the intention (Hypocrites)

Undoing Doing opposite of what you have done (Action & then
amends)
Ex. Show true feeling then feels guilty after doing it

Identification Assuming trait, persona, social & occupational role

(Models a certain behavior)
 Unconsciously imitating another person

Projection Attribute to others one’s unacceptable trait (Scapegoat

Mechanism)
Ex. “Not me but them”

Introjection Assume another’s trait as your own (Taken into oneself)

Ex. “Not only you, Me too”

Suppression Conscious forgetting of an anxiety-provoking concept

(Voluntary forgetting)
 Intentional forgetting to an unpleasant
experience
Ex. “I don’t want to talk about it”

Sublimation Excessive energies put towards more productive

endeavors
 Redirect feelings (anger) to a socially
acceptable behavior
Substitution Replacing a difficult goal with an accessible one
Conversion Repression. Anger repressed & converted to physical
symptoms

Created by Niňa E. Tubio 13

 Ex. numbness & motor
paralysis
 Solve conflicts by manifesting physical
symptoms

Compensation Overachieving in one area to cover defective part or

weakness
 To overcome inferiority & excel in other
aspect of personality

Fantasy Use of imagination/daydreaming

Isolation Separating your feelings from the situation

Fixation Arrest of maturation/Persistence of one stage of

development

Symbolism Give meaning to objects

Dissociation Psychological flight from self

Ex. Amnesia, Rape or traumatic experiences
 Unconscious separation of certain parts or
functions of personality

Alteration in--------Memory
Identity
Consciousness

To reduce/avoid anxiety
Categories:
1. Psychogenic Amnesia------loss of
memory

2. Fugue --New identity in a

new place

3. Multiple Personality
 Dissociative identity
disorder
 2 or more personalities
4. Depersonalization
 Unreality to oneself
 With altered sense of self

5. Dissociation not otherwise

classified
 Sleep talking----
somniloquism
 Sleepwalking---
somnambulism
 Amok aggression

Created by Niňa E. Tubio 14

VI. CONCEPT OF NEUROSES & PSYCHOSES

Neuroses Psychoses

1. Maladaptive emotional state 1. Disturbance of the mind

2. Reality is present 2. No reality
3. Ego in the conscious 3. Ego in the unconscious
4. Behavior is socially acceptable 4. Behavior is
appropriate

Core Symptom: Anxiety Core Symptom: Hallucination,

Illusion, Delusion

Tx: Minor Tranquilizer Tx: Major Tranquilizer

Ex. Valium, Ativan Ex. Thorazine, Haldol
VII. THERAPEUTIC COMMUNICATION

THERAPEUTIC COMMUNICATION TECHNIQUES

THERAPEUTIC NON-THERAPEUTIC

• Offering Self
• Ignoring patient’s feelings or
emotions
“I’ll sit with you”
“Don’t worry be happy”
“I’ll stay with you”

• Silence • False Reassurance

(giving patient time to think) “Everything’s going to be fine”
• Making observations • Ignoring the client
“You seem sad”
• Active Listening
Nodding, establish eye • Changing the subject
contact,
leaning forward
• Exploring questions
• Asking “why?”
Who, what, where, when,
Putting client on the defensive
how
• Broad Opening • Making value-based judgments
“How are you today?” Prejudicial, use of adjectives
“How are things going “Nice weather today”
today?”
• General leads • Flattery
“Go on. I’m listening.” “You are the most beautiful …”
“ And then what else?”

• Restating • Advising
Client: “I’m sad.” “You should do this.”
Nurse: “You’re sad?” “In my opinion…”

• Refocusing
“ We were talking about the • Commanding client
exam….”

Created by Niňa E. Tubio 15

 • Focusing
• Arguing with the patient
“Tell me more about this…”

• Clarification
“What do you mean by • Do not impose your opinion
plooplank?”

CONCEPTS & DISORDERS

VIII. ANXIETY
- Vague sense of impending doom
- Afraid of the unknown
- Present is the anticipation of danger
- A feeling of uneasiness---------vague
apprehension------uncertainty

Different with Fear – afraid of what you know

- Presence of an external danger

A. ASSESSMENT:

Level of Anxiety

0 = Ataraxia------absence of anxiety----------uncommon---------present only in clients

on shabu/drug addicts
P
E
R
C
E
P
T
U Mild Moderate Severe Panic
A +1 +2 +3 +4
L

F
I
E
L
D

MILD MODERATE SEVERE

PANIC

Created by Niňa E. Tubio P D S 16

 Widened Perceptual Field acing on’t know what to do
uicide
Increased motivation RN meds on’t know what to say
afety
Restless irective
Enhance learning capacity Selective Inattention Free-floating
anxiety
Increased Hearing Presence of Physical Sx muscle tension
DON’T TOUCH client
Problem-Solving present Narrowing of attention
Respiratory alkalosis*
* Good: Client more aware
*Breathe into bag
* Bad: Contagious Disorganized
Level
* Normal anxiety r/t everyday tension
Terror/Threat
USE THERAPEUTIC COMM
Apathy
Ex. “You seem anxious” *An
emergency
Words are usually enough to SNS
Activation
Manage mild anxiety

NURSING DIAGNOSES: Ineffective Individual Coping

Powerlessness
Impaired Skin Integrity

PLANNING/ IMPLEMENTATION: ↓ level of anxiety

↓ level of environmental stimuli
Relaxation techniques (Psychophysiology)

EVALUATION: Effective individual coping

B. DISORDERS ASSOCIATED WITH ANXIETY

1.) GENERALIZED ANXIETY DISORDER

• 6 months excessive worrying

• Restless
• Concentration difficulty
• Sleep problems
• Palpitations
• Feeling of being at the edge of seat
• Easy fatigability
• Patient knows what the problem is

2.) PANIC DISORDER

• 15-30 minutes escalation of the SNS

• Sudden: Happens w/o warning
• With or W/O agoraphobia

2 Types:
Agoraphobia - Fear of open spaces > Outstanding
Sign of Panic Disorder

Created by Niňa E. Tubio 17

 Social Phobia - Fear of public

3.) POST TRAUMATIC STRESS DISORDER (PTSD)

Trauma
Disasters
Victims Survivors
Rape
War (not forever)
Others

Flashbacks : > 1
month
Nightmares
4.) MALINGERING
- Pretending to be sick (Conscious)
- No organic basis
- Intentional

*Primary gain – the result you get when you manifest certain behavior
that ↓ anxiety
(Ex. Escape from Teacher)

*Secondary gain = ↑ Attention ( Ex. from mother)

Physiology:
ANXIETY

“I am sick”

Malingering Somatoform Psychosomatic

(Pretending) (Unconscious) Disorders
(Real pain/ real Sx, )
5.) SOMATOFORM DISORDERS

Unconscious
Not pretending but no organic basis Major Sign:
DOCTOR
SOMATOFORM HOPPING
(unconscious) Favorite pastime of
people suffering
Affects the 3 system

Nervous System HYPOCHONDRIASIS BODY DYSMORPHIC

CONVERSION Minor discomfort DISORDER
La belle difference interpreted as major Illusion of structural
(Emotional illness defects
detachment) S &Sx not real
Loss of Sensory/Motor
Fx
S &Sx real
NURSING FOCUS: Client’s Feelings (↓anxiety leads to
↓symptoms)
Created by Niňa E. Tubio 18
 6.) PSYCHOSOMATIC DISORDERS

 Psycho physiologic
 Real illness, real Sx & pain with organic basis

Physiology: ↑ ANXIETY

SNS PNS

↑BP Vasoconstrictio Bronchoconstrictio

Hypertension n n

Cerebral Left Gastric Asthma

Artery Artery
Migraine
Decreased O2 supply----cells die
Breakdown of mucosal lining-----
ulceration

Stress ulcer

7.) OBSESSIVE-COMPULSIVE DISORDER (OCD)

Physiology:

Beliefs/Thoughts reflect into feelings

Factors: If disturbed thoughts Anxiety

Obsession (Persistent Thoughts) Anxiety

(Root of Anxiety)

Do something to relieve anxiety

Action : Compulsion
Persistent Behavior &
Action

Created by Niňa E. Tubio 19

 ↓ anxiety

Reasons when compulsion becomes negative:

1. Interferes with ADLs
2. Harms self & others

8.) PHOBIA
 Irrational fear

Etiology: Prior knowledge Ex. Tire will cause burning

Experience Ex. Trauma in past related to feared
object

Intervention: REMOVE stimulus (object of fear) to ↓ anxiety

(Immediate intervention)

Increased stimuli = ↑ anxiety

Decreased stimuli = ↓ anxiety

Ex. Belief Feelings Behavior

Object will hurt patient Scared
Avoidance: Interferes w/ ADL

Tx:
BEHAVIORAL THERAPY:

Systematic Desensitization - gradual exposure to

feared object

Individual Therapy

1.
Hypnosis--------------------Relaxed state
2.
Free Association----------Ideas shared to psychoanalyst
3.
Catharsis--------------------Free to express feelings
4.
Transference---------------Patient feels something for
psychoanalyst
5. Counter transference-----Rn feels something for patient
IX. EATING DISORDERS

ANOREXIA NERVOSA & BULIMIA NERVOSA

ANOREXIA BULIMIA
Diet, diet, diet Eating Pattern Eat, Eat…induce vomiting
Underweight, < 85% of
Weight Normal weight
body weight
3 months amenorrhea Menstruation Irregular menstruation
Failure To Recognize Knowledge Knows the Problem But

Created by Niňa E. Tubio 20

 Problem Ashamed & Embarrassed

NURSING CONSIDERATIONS
Bulimic induces vomiting & tends to
NURSING ALERT abuse laxatives
• Most fatal Assess for:
complication: Dental caries
ARRHYTHMIAS Wounded knuckles
Vomiting - Risk for metabolic
alkalosis
MANAGEMENT:

Priority: Restore fluid & electrolyte balance

Anorexic & bulimic clients are at risk for FLUID VOLUME
DEFICIT
• Collaborate with client re: menu through use of CONTRACT
to ensure cooperation

Priority: Target weight gain & Monitor eating pattern & weight

• Stay with client for 1 hour after meals to ensure client

eats food & does not induce vomiting.
• Accompany in the toilet

Nsg Dx: Body Image Disturbance

N.I. - Establish nutrition pattern

- Teach stress management, Journal keeping
- Anti-depressant

RELATED DISORDERS:

1. BINGE EATING DISORDER

- Recurrent episodes of binge eating
- No regular use of appropriate compensatory
behaviors

2. NIGHT EATING SYNDROME (NES)

- Characterized by morning anorexia
- Evening hyperphagia
(Consuming 50% of daily calories after last
evening meal)
- Nightime awakenings (at least once a night)

3. COMORBID PSYCHIATRIC DISORDERS COMMON IN CLIENTS WITH

EATING DISORDER

X. PERSONALITY DISORDERS

Cluster A

Created by Niňa E. Tubio 21

 SCHIZOID Avoids people, Do not care about people & believes he
can stand on his own
Detachment from social relationships
Avoids activities & group more concerned with things
No enjoyment: Limited range of emotional expression in
interpersonal settings

PARANOID Suspicious
Violent

SCHIZOTYPAL Acute discomfort in relationships

Eccentric behavior
Cluster B
ANTISOCIAL Breaks the law
Usually charming, witty
As kids, were usually cruel to animals, steals, lie
As Adults, drug addicts-drives fast-unsafe sex-thrill
seeker
Are slick talkers

BORDERLINE Loves to split groups “My life is an empty

Likes to keep spares glass”
Afraid of being alone (+) (-)
Manipulative fill suicidal
Self-mutilation friends
Superficial Relationships Splitting
Labile affect
(sudden change of mood)
HISTRIONIC Attention-Seeking
Excited, dramatic
Manipulative

NARCISSISTIC “I love myself”

Insensitive, Arrogant
Self-absorbed
Exaggerated
Cluster C

AVOIDANT Avoid people & groups

Fears criticism, ↓ Self-esteem
Have a talent but no confidence

DEPENDENT “Can’t live without you”

↓ Self-Esteem
Poor decision-making skills

OBSESSIVE-COMPULSIVE Organized
Constancy in Environment
Perfectionists------Provide time to do rituals
OTHER CATEGORIES:

PASSIVE-AGGRESSIVE Always says “yes” but resistance is hidden

DEPRESSIVE Pattern of depressive cognitions & behaviors
in a variety of context

NURSING INTERVENTION TO ALL: Improve Interpersonal Relationships

Created by Niňa E. Tubio 22

 Build Trust
XI. SCHIZOPHRENIA

 EGO Disintegration Impaired Reality Perception

 Famous example: John Forbes Nash, Jr.

THEORIES OF CAUSATION:
> Stress Diathesis Model - Stressful living pushes person to escape into
fantasy
“Far better to be king in your fantasy world” idea
> Genetic Vulnerability - Runs in families; genetic component
(biological)
> Unknown
> Physiological Finding: ↑Dopamine in schizophrenic clients

Physiology:
ACH “ON” switch D “OFF” switch

↑ACH
↑ACH ↑Dopamine
ACH D

↓ACH
D ↓Dopamine ACH
Parkinso Schizophr
n’s enia

Antipsychotic agents → ↓Dopamine

Client manifest Parkinson-like symptoms
known as
↓Dopamine
ACH EXTRA PYRAMIDAL SIDE
EFFECTS
(Voluntary mov’t of the skeletal
D muscles) (↓D & ↑ACH)
↑ACH A kathisia (restlessness, inability to stay
still)* Most common
A kinesia ( muscle rigidity)
D ystonia ----earliest sign (1-5 days)
Characteristic Features:
• Torticullis (wry neck)
Give ANTICHOLINERGICS to
treat EPS • Oculogyric crisis (fixed stare)
Except Tardive Dyskinesia • Opisthotonus ( arched back)

T ardive Dyskinesia (irreversible effects)

d/t ↑ Adenosine Triphosphate
• Lip smacking
Anti-Psychotic & Anti- • Tongue protrusion
Cholinergic Both given to • Cheek puffing
Schizophrenia
Created by Niňa E. Tubio to balance 23
N euroleptic Malignant Syndrome or NMS
• Hyperthermia,
 ACH D

ANTICHOLINER DOPAMINERGI
GICS CS
A Parlodel
kineton Larodop
A rtane a

OTHER SIDE EFFECTS OF ANTIPSYCHOTIC MEDICATIONS:

• Photosensitivity
Teach patient to use sunscreen, wide-brimmed hat when going out
• Agranulocytosis (↑ monocytes, ↑ lymphatic)
Teach client to report SORE THROAT (1st sign of Blood Dyscrasia)
Hypersensitive Reactions Ex. Allergy
↓ Epinephrine ------Hypotension
Endocrine-------------M = Gynecomastia F = Enlargement of breast & ↑ libido
Arrythmia
Blurring of vision, Opacity of the lens, retinitis
Pruritus, dermatosis, rashes, eczema, dermatitis & hyperpigmentation

A. THE NURSING PROCESS:

ASSESSMENT: 4 A’s Types Of Affect

A
1. Appropriate
FFECT External manifestation (feelings & 2. Inappropriate
emotion)
3. Flat (none)
4. Blunt
MBIVALENCE Pull between 2 opposing forces
(incomplete)
UTISM Self-absorbed, Trapped in own world
SSOCIATIVE LOOSENESS Unrelated ideas

Created by Niňa E. Tubio 24

 4 THINGS TO ASSESS IN SCHIZOPHRENIC PATIENTS

Assess Content of Thought Hallucinations/ Suspicious Suicidal

Illusions

Nsg Dx Disturbed Thought Disturbed Risk for Risk for

Processes Sensory Other- Self-
Perception Directed Directed
Violence Violence

Planning/ Present Reality Present Reality Present Present

Implement Provide Safety Provide Safety Reality Reality
ation Provide Provide
Safety Safety

Evaluation Improved Thought Improved Minimize/ Minimize/

Processes Sensory Eliminate risk Eliminate
Perception for other- risk for
directed self-
violence directed
violence

B. SYMPTOMS

S & Sx OF SCHIZOPHRENIA
2 Types

POSITIVE
NEGATIVE
Hyperactive
Hypoactive
Sociable
Withdrawn
Talkative
Quiet
Restless
Flat Affect
Queen of the World
Apathy
Flight of ideas PARANOID
Poverty of
(Hallucinattion,Illusion, • Uses Projection
words
Delusion)
Problems with:

• Mistrust-------Suspicious

N.I.
1. Develop Trust:
C. TYPES OF SCHIZOPHRENIA Orientation
2. One-to-one
interaction
SCHIZOPHRENIA 3. Short but frequent
visits
4. Foods in sealed
container
DISORGANIZED Meals wrapped
• Inappropriate affect CATATONIC
5. Consistent Approach
(sad but smiles) • Ambivalence
• Flat affect • Waxy
• Scared/Withdrawn/Viol
• Disorganized flexibility
ent
speech/manner • “No” (Rebel)
(flight of ideas) • Negativism N.I.
Created by Niňa E. Tubio 25
• Hebephrenic 1. Keep door open
(giggling) 2. Don’t touch patient
3. Establish Eye
 UNCLASSIFIED
or
UNDIFFERENTI
ATED
• Mixed
classification
s
RESIDUAL • Cannot be
• No more (+) or (-) classified
Sx
• Social Withdrawal
• Withdrawn

D. THOUGHT PROCESS DISTURBANCE

FLIGHT OF IDEAS LOOSE

Fragmented ASSOCIATIONS
thoughts; moving -Stringing together
one unconnected of unrelated topics
Vs.
topic to another with a vague
“The sun is shining. connection
The mouse is on the “I am going home.
mat. Here is the The home of the
bag.” brave. The brave
- New topics little Indian boy.

AMBIVALENCE Feeling of being pulled between 2 opposing

forces

ECHOLALIA I repeat what you say (Word Repetition)

ECHOPRAXIA I repeat what you do (Action Repetition)

WORD SALAD Just mixing of words, no rhyme

CLANG ASSOCIATION Rhyming words

Created by Niňa E. Tubio 26

 NEOLOGISM Newly created words-------- * NURSE
can use CLARIFICATION

DELUSIONS Fixed, false beliefs

Persecutory “The FBI is after me”

Grandeur “I am queen of the world”
Ideas of Reference “They are talking about me.”

CONCRETE THINKING Inability to conceptualize the meaning of

words & phrases
* Test by asking client to tell the meaning of a
proverb

P ilosopo
roverb

HALLUCINATIONS False sensory perceptions; without stimulus

(-) for visual, auditory, tactile

ILLUSIONS Misinterpretations of real external stimuli

(+) for stimuli, visual, tactile, auditory

MAGICAL THINKING Believes that he has magical power

MANAGEMENT TECHNIQUE

H
Auditory hallucinations are
ALLUCINATIONS common. IMPORTANT: Also
ask what the voices are
saying because 10% of

A
schizophrenic clients are
CKNOWLEDGMENT
“I know the voices are real to you…”

R EALITY ORIENTATION----------Present reality

“But I don’t hear them.”

D IVERSION
“Let’s go to the garden.”
IRECTIVE

Created by Niňa E. Tubio 27

XII. ALZHEIMER

A
nomia Don’t know name of object
gnosia Problem with senses (smell, taste , hear, touch)
phasia Can’t say it
praxia Can’t do it

D
issociative Fugue Takes a new personality from a far
away place.
New Place, New Identity
issociative Identity Disorder Multiple Personality
issociative Amnesia Don’t know who/where I am
epersonalization Believe that they are not persons
anymore
+ Perseveration “I want to talk about something,
this is what I want to do…."

Mngt: ECT Therapy

XIII. DISORDERS OF THE CHILD

1. AUTISM Trapped in own world/ live in a fantasy world

 Unresponsive to people
 Echolalia
 Poor eye contact
 Cannot express feelings verbally----root of self-directed
violence/self-mutilation
 Boys > Girls

Autistic-savant (gifted) - about 1% of all autistics

ASSESSMENT: ABC’s

APPEARANCE Flat affect

Created by Niňa E. Tubio 28

 Consistent movement
Neat, OC, Wants constancy

BEHAVIOR Repetitive
Ritualistic

COMMUNICATION Echolalia
Incomprehensible/Difficulty communicating
* Can’t cry for help; usually hurts self to get
attention
*Talk slowly to autistic child

Nsg Dx: Impaired Verbal Communication

Impaired Social Interaction ------cannot form IPR
Self-mutilation ------cannot express anger,
turned it inward
Risk for Injury

PLANNING/ IMPLEMENTATION:

Use Maslow’s Hierarchy of Needs

Promote constancy & safety
EXPRESSIVE THERAPY----uses art, music, literature, poetry
Purpose: ↓ risk for injury, improved social interaction,
able to express feelings

EVALUATION: Enhanced Communication

Improved Social Interaction
Safety

2. ATTENTION DEFICIT & HYPERACTIVITY DISORDER (ADHD)

 Cannot focus on anything

 Can progress to Conduct Disorder----to---Antisocial
Behavior---Future Criminal
 ID dominant: Mother & RN will act as SUPEREGO

ID dominant may grow up to be ANTISOCIAL

Residual ADHD may not be antisocial

Onset: 7 years old & below

Duration: 6 months & above
Settings: Must appear in 2 (home & school)

Created by Niňa E. Tubio 29

 ASSESSMENT:

APPEARANCE Usually dirty

BEHAVIOR Clumsy
Hyperactive
Impatient, Easily Distracted

COMMUNICATION Talkative, Blurts out in class

Nx Dx: Risk for Injury

Impaired Social Interaction

PLANNING/ IMPLEMENTATION

MILIEU THERAPY

S
Tructure ----Provide place to study,eat,play,bath
Chedule ----Time for everything
et limits
afety Medical Mgt:
RITALIN

EVALUATION: Minimize risk for injury ↓ Glucose

Improved social interaction ↑ Glucose
Safety
↓ Frontal lobe
↑ Frontal lobe

↓ judgment
↑ judgment

S/Sx of ADHD
3. MENTAL RETARDATION Ritalin ( a stimulant)

Levels Of Mental Retardation:

Profound Severe Moderate Mild Borderline

Normal
IQ 20 35 50 70 90
110

Created by Niňa E. Tubio 30

 Profound: <20 Thinks like an INFANT---Cannot be trained-----Stay with
the Client

Severe: 20-35

Moderate: 35-50 Can be trained. Mental age is 2-7 y/o------------Pre-

operational Stage

Mild: 50-70 Can go to school. Mental age is 7-12 y/o

XIV. CHILD ABUSE

B
Burns
Bruises
Bone Fractures (Bungi)
Body of Evidence should not be lost ( Don’t bathe child, Don’t brush
teeth)
BANTAY BATA 163

XV. MOOD DISORDERS

A. BIPOLAR
 2 poles------ Happy (dominant) & Sad
 Too self-actualize

Created by Niňa E. Tubio 31

 BIPOLAR I MANIC TYPE * Mania is not a Dx but
an episode
BIPOLAR II MANIC-DEPRESSIVE TYPE of bipolar disorder

BIPOLAR I USUAL PROFILE:

 Female
 Usually 20 years old & above
 Under stress
 Obese

DRUG OF CHOICE: Lithium ( for mania) ↓ NE ------Takes 2-4 weeks to

work

ASSESSMENT: Use Maslow’s Hierarchy of Needs

3 Or More Signs Confirms Disorder:

G grandiose, ↑ risk activities

F flight of ideas
S sleeplessness
P pressured speech
E exaggerated SE
E extraneous stimuli (easily distracted)
D distractibility

MANAGEMENT:

Manifested by Defensiveness & Compensation

↓ Self -Actualized ↑Self Esteem by giving TASK

Compensation: S/Sx: flamboyant, heavy make-up,

↓ Self -esteem loud voice
Caregiver Role: Train /
Safety
Impaired Social Interaction Impulsive so ensure safety
Lock doors & windows
Place in room with low
Risk For Injury/ Other-Directed stimulus
Violence Not with other manics or
Manic clients usually
↓ Eat ↓ Sleep Hyperactive
masturbate because of
↑ Sex worrying
Finger foods Private room ↓ anxiety
“Tell pt. it is not allowed”

What are appropriate tasks?

No competition or group games, sports e.g. basketball-------------↑ Anxiety
Gross motor skills e.g. watering plants, sweeping the floor to put energies
to productive endeavors
Avoid activities with fine motor skills e.g. sewing
Escort outdoors
Punching bag------“Displacement”
B. MANIA

Created by Niňa E. Tubio 32

  Needs a mood stabilizing agents------ LITHIUM & GROUP
THERAPY

↑ NE

LITHIUM - drug of choice

If level is near 2.5- 3
mEq/L
 Ataxia
L evel : 0.5 – 1.5
mEq/ dL  Mental Confusion

I ncrease urination

N
3 Signs of Lithium
Toxicity ausea, vomiting, diarrhea
a ( ↑ sodium intake to
correct FVD)
(Na: 135-145 mEq/L)
T remors, fine hand

H ydration
l/day
3

Kiidneys I ncrease
“PUPU”
Check first before
beginning therapy
(BUN, Creatinine) U
Only 90% absorb by
iidneys
kidneys M outh, dry *
* Lithium absorbs
water

Created by Niňa E. Tubio 33

 C. DEPRESSION
 ↓ Serotonin
 If unresponsive to drugs------- ECT Therapy

THE GRIEF PROCESS

Denial
Anger
Bargaining
Depression
2 wks or more is a sign of MAJOR CLINICAL
DEPRESSION
Acceptance

ASSESSMENT
↓ Self –
5 Actualization
↓ Self –esteem Give Simple TASK
4

3 Withdrawn

Stay with client

2 Risk for self-directed violence

↕ eat ↕ sleep hypoactive

1
↓ sex
Be sensitive to client’s
needs

MANAGEMENT OF DEPRESSED PATIENT:

1. Give Antidepressants

2. If Drugs not working----Electroconvulsive Therapy (ECT)

Pre-ECT:
N npo for 6 hrs.

A atropine sulfate------dry mouth

B barbiturates

S succinycholine Chloride-----To relax muscles

Post-ECT:

Side-lying position---Lateral

Created by Niňa E. Tubio 34

 S/E: Headache, Dizziness
Temporary Memory loss (distinct Sx) Rn reorient

LEAD TO: SUICIDE Verbal

“I won’t be a problem
anymore”
SUICIDAL CUES “This is my last day on
earth”
Non Verbal
Gives away valuables
Sudden change in mood

ALONE
SUICIDE TRIAD:

LOSS
OF

SPOUSE JOB

Who Will Commit Suicide?

s Ex--------Male (more successful) ------Female (hesitant)

A Ge-------15-24 y/o or above 45 y/o

D epression
P atient with previous attempts will try again

E thanol (ETOH) Alcoholics

R irrational
S lacks social support Suicide Area: Hospital
O rganized plan----greater risk Majority happens on a
weekend
N o family from 1-3 AM
Sunday
S ickness, Terminal Weekend----less
personnel

MANAGEMENT OF SUICIDAL PATIENT:

D irect Question/Approach
“Do you plan to commit suicide?”

rregular
I nterval Visit frequently but should not be
predictable
Created by Niňa E. Tubio 35
 Most suicides are done in the early morning &
E ndorsement
arly AM
during endorsement

Close Surveillance
XVI. SUBSTANCE ABUSE

Types of ADDICT:

1. Nervous 2. Depressed

• Tremors • Sits down on chair

• Give DOWNERS • Give UPPERS

DOW NERS UPPERS

EUPHORI
A
Asleep Awake
Bradypnea Psychological
Bradycardia sense
Pupils constrict of well-being
Hypotension Tachycardia
Coma Tachypnea
Asleep Pupils dilate
Weight Gain Dry mouth
*Constipation Hypertension
* GU Retention Seizures
Weight loss (Thin)
*Diarrhea

Alcohol
Cocaine

INE
Barbiturates
Opiates Morph Hallucinogen
Narcotic Code Amphetamines
Marijuana Hero

STOP UPPERS
Antidote: NARCAN (narcotic antagonists)

Alcohol Overdose Coma

Tremors
Fatigue
Morphine Overdose Bradypnea

Crash Syndrome

Created by Niňa E. Tubio 36

 Depressed

Suicide

OVERDOSE vs. WITHDRAWAL

OVERDOSE WITHDRAWAL
Alcohol
↓ HR ↑ HR
↓ BP ↑ BP Sx of WITHDRAWAL:
Sx Of OVERDOSE to 2
↓ RR ↑ RR Types:
LOC (coma) ↑seizures 1. Know if drug is Upper or
Cocaine Downer
1. Identify if drug is Upper or
↑ HR ↓ HR Downer 2. Check for opposite effect &
↑ BP ↓ BP 2. Check Effect
↑ RR ↓ RR 3. Sx of Withdrawal
↑seizures LOC (coma)
Narcotic Antagonist:
Narcan (Naloxone HCl) Drug of choice for Overdose

Valium (Diazepam) Drug of choice for

Narcotics Withdrawal
(for seizures)
Methadone Drug of choice for Narcotics
Detoxification

ALCOHOLISM

Alcohol Abuse - Awake, happy----socializing

- A way of escape from problems
- D/T peer pressure
Etiology: Theory of Intergenerational Transmission (child imitating parents)

Physiology: ALCOHOL

BLOCKOUT Awake but unaware

CONFABULATIO Inventing stories to increase self-

N esteem

D ENIAL
EPENDENCE
“I am not an alcoholic”
“I can’t live without you”

a. Physical – tremors, tachycardia,

restless
b. Psychological Carving

ENABLING or Significant other tolerates

CODEPENDECY abuser

Tolerance Increased Drinking

tolerated by the body

Created by Niňa E. Tubio 37

MANAGEMENT
Ask 1st the time of last

A
alcohol intake before
giving Anatabuse:
VOIDs ALCOHOL There should be a
VERSION THERAPY 12 – HOUR INTERVAL
LCOHOLICS ANONYMOUS NEVER take alcohol
NTABUSE (Disulfiram) with antabuse OR ELSE
Nausea & Vomiting

B
Problems of Alcoholics: 1 VIT. DEFICIENCY(Thiamine)

Monitor for:
WERNICKE’S
C OMPLICATIONS ENCELOPATHY
(motor problems)
KORSAKOFF’S
SNS stimulation
Within 24-72˚
of withdrawal
D ELIRIUM TREMORS
Tremors, Hallucinations, Provide well-lit room
Illusions to avoid
&

F ORMICATION

AMILY THERAPY
Feeling of “bugs crawling under
the skin”

THERAPY: 1. DETOXIFICATION - Withdrawal with MD Supervision

Role of the Nurse:

Alcohol

CHECK belongings for: Mouthwash

Elixir (alcohol-based)

ASK TIME of last alcohol intake to monitor delirium

SELF-HELP vs. GROUP THERAPY

Nurse as organizer Nurse as
facilitator
e.g. Alcoholics

Created by Niňa E. Tubio 38

XII.

P ANTI-ANXIETY AGENTS
H
V alium M iltown
A
L ibrium E quanil
R
A tivan V istaril
M
S erax A tarax
A
T ranxene I nderal
B uspar
M
O (Used also for Alcohol Withdrawal) “VLAST ME
M VAIB”
E
N
T
S THE AUTONOMIC NERVOUS SYSTEM

(2 Neurotransmitters) Epinephrine/ Norepinephrine

excite the SNS

Gamma aminobutyric acid (GABA) inhibits SNS

(Stops)

ANTI-ANXIETY AGENTS GABA

ANXIETY
ANTI If ABRUPT Withdrawal:
E/ NE
CHOLINERGIC Rebound phenomenon
Constipation Within 1 wk
Retention
Dry mouth
Blurred vision Seizures D
ANTI-ANXIETY WITHDRAWAL
AGENTS E
P
*Effects of E
↑ GABA Recommended:
GABA: N
Gradual
Drowsiness D
Withdrawal
Orthostatic E
Tapered dose
Hypotension N
C
*Contraindicati E
ons
No coffee
RELAXED No alcohol
Do not drive
To prevent Orthostatic
Hypotension:
S it
D angle
S tand gradually

Created by Niňa E. Tubio 39

 All Medications Taken On Full Stomach-------except Anti-Anxiety

ANTI-DEPRESSANTS

A sendin A ventyl
N orpramin V ivactil
T ofranil E lavil
S inequan P
rozac (ssri)
A nafranil P axil

↑ Serotonin ↓ Serotonin

Give

ANTIDEPRESSANTS ------------------taken on full

stomach

↑ Serotonin ↑ Serotonin & NE ↑ Serotonin, NE

& Dopamine
S afest T wo to 4 wks
S ide effects low wo M ono
R neurotransmitters A mine
I to 4 wks C O xidase
A I inhibitors
Selective * Higher
Serotonin incidence of *2-6 wks
Reuptake side effects effect
Inhibitors Tricyclic MAO destroys
serotonin;
↓MAO will
With MAOIs , AVOID TYRAMINE-RICH FOODS or else
HYPERTENSIVE CRISIS
Diaphoresis

Tyramine rich foods:

A vocado F ernented
foods
ged cheese P ickles
B eer reserved
foods

MONOAMINE OXIDASE INHIBITORS ( MAOIs)

Created by Niňa E. Tubio M PLAN Marplan 40

N DIL Nardil
P NATE
 AR
ANTI-PARKINSON AGENTS “CAPABLES”

C ogentin B enadryl
A rtane L arodopa
P arlodel E
ldedpryl
A kineton S
ymmetrel
2 CLASSIFICATION

ANTICHOLINERGICS DOPAMINERGICS
ABC PLSE
A kineton, Artane P arlodel
B enadryl L arodopa
C ogentin S ymmetrel
E ldepryl

ANTI-PSYCHOTICS

S tellazine C lozaril
S erentil M ellaril
T horazine H aldol
T rilafon P
rolixin

SNS Effect-------2-4 wks

TRANQUILIZERS

• Produces emotional relaxation/calmness

2 Types
Minor Major
Anxiolytics (ANTI-AXIETY) Neuroleptics (ANTI-
PSYCHOTIC)

Valium Thorazine
Anxionil Haldol
Ativan Serenace
Tranxene Mellaril
Xanax Trilafon
Serax Proloxin
Librium Modecate
Equanil Clozaril

Created by Niňa E. Tubio 41

 Miltown Risperdal

Action: ↓ Anxiety ↓ Dopamine

CNS Depressant Produces EPS

Acts on Limbic system Responsible for alertness

S/E: Habit-forming, Produces Drug Tolerance
VLASTMEVAIB SSTTCMHP
Always ON
EPS/E
ANXIETY SCHIZOPHREN Akathisia MANIA
Akinesia
E/NE D Dystonia
NE
Anticholinergic Tardive
S/E Dyskinesia
Constipation NMS
S/E
Dry mouth Ach L
ANTI-ANXIETY Blurred vision ANTI- N ausea
I Vomiting
PSYCHOTICS T Diarrhea
H
N a ↑
↑GABA Drowsy D K I
U
X alcohol ↓D M
X coffee
Anticholinergic
X drive ABC Dopaminergic
eqpmt Constipation PLSE
Orthostatic retention
Hypotension
Diarrhea
gradual Frequency

RELAXED

SSRI
PPZ
↑ Serotonin
only

Anticholinergic
S/E
Constipation
Retention
Male Erectile
↑ Serotonin ANTI-DEPRESSANTS Dysfuncion
TCA /NE
ANTSAVE

↑ all

Health Teaching To All: Drug

Compliance

NO to Tyramine ↓Serotonin
MAOIs or else
MNP HYPERTENSIVE
CRISIS
DEPRESSI

Created by Niňa E. Tubio 42

Table 1. Somatoform Disorder (DSM-IV)

Temporal Exclusions By
Somatoform
General & Other Other
Disorder Other Exclusions
Description Requireme Psychiatric
(DSM-IV)
nts Illness

Somatization History of many Onset <30 Not specified Not explained by

Disorder physical y of age general medical
complaints; 4 pain condition or substance
sites or functions: effect
2 nonpain GI, 1
sexual or
reproductive, 1
pseudoneurologic

Undifferentia One or more Duration >6 Not accounted Not explained by

ted physical mo for by another medical condition or
somatoform complaints mental disorder pathophysiologic
disorder mechanism

Conversion Symptoms Associated Not limited to Not intentionally

Disorder affecting voluntary psychologic pain or sexual produced or feigned;
motor and/or al factors dysfunction; not not explained by other
sensory function exclusively neurologic or medical
suggesting during course of condition, substance
neurologic and/or somatization effect, or culturally
medical condition disorder; not sanctioned behavior
better and/or experience
accounted for by
other mental
disorder

Pain Pain is Psychologic Not better Not specified

Disorder predominant al factors in accounted for by
focus; severe important mood, anxiety,
enough to warrant role or psychotic
clinical attention disorder; does
not meet criteria
for dyspareunia

Hypochondri Preoccupation Duration >6 Not exclusively Not of delusional

asis with fear of having mo during obsessive intensity; not restricted
or idea that one compulsive to circumscribed
has serious disorder (OCD), concern about
disease based on generalized appearance
misinterpretation anxiety, panic
of bodily disorder, major

Created by Niňa E. Tubio 43

 symptoms; depressive
persistent fear episode,
and idea despite separation
medical anxiety, or other
evaluation and somatoform
reassurance disorder

Body Preoccupation Not Not better Not specified

Dysmorphic with imagined applicable accounted for by
disorder defect in other mental
appearance or disorder
excessive concern
about slight
physical anomaly

Somatoform Somatoform Can be <6 Does not meet Not specified

disorder, not symptoms mo duration criteria for any
otherwise other
specified somatoform
disorder

Note.—To qualify for this category of diagnoses, the symptoms must cause clinically
significant distress or impairment in social, occupational, or other areas of functioning.

Created by Niňa E. Tubio 44