NON-THEARAPEUTIC BARRIERS

1. Why
 Entails a defensive explanation
 Never ask it directly
 Validate the feelings of the client to prevent the concept of rejection
2. False Hope
 Fake assurance
 Playing God
3. Cliché
 Form a false assurance
 Figurative state “there’s always a rainbow after the rain”
4. Crowding
 Too much Information
 Don’t ask offensive questions
 Unnecessary information
 Only ask important questions
 Firing questions (not giving the client the time to answer)
5. Ignoring/Rejection
 Concept of neglect
Ex.: Masturbation (ignore the behavior/provide privacy)
 Temper tantrum (manifestation of regression)
6. Touch
 Could be misinterpreted (sexual/physical)
 Never promote eye contact to the person
7. Belittling of feelings
 Invalidating the feelings of the client
8. Advising/Imposing
 Never advise and never impose
 Every individual has its own perspective
9. Exclamatory point (!!!)
 Never increase your voice to elderly individual
 Older (the higher the volume, the harder for them to hear.
o Should be in normal to moderate voice.
 Talk the client normally in eye level, face with adequate lightning.

Different Disorders
DSM5 – Global Assessment Functionality
1. Neurosis
 Intactness of reality
 Easily corrected
 S/Sx: Anxiety (fear of the unknown)

Stages of Anxiety Signs & Symptoms Management

Mild  Butterflies in the stomach  Stress management
 Excited/anxious  Relation technique
 Widening perception  Deep breathing
 Increase motivation - Normalizes
 ↑ learning production of
neurotransmitters
Moderate  Perception starts to decrease  Give specific
 Selective inattention information (short)
 Suppression (keeping  PRN meds:
yourself away from the - zepam/zolam
stress) (anxiolytic)
- highly addicting
- monitor RR
- WOF: drowsiness
- give during evening
Severe  Start of SNS manifestation  Don’t give health
(fight or flight) teachings
 Fight, fight & freeze (new)  Prompt safety
 Epi/Nore (Catecholamine)
 ↑ V/S
 Respiratory Alkalosis
(Hyperventilation)
 Tunnel vison (glaucoma)
Panic  Episodes of hallucinations  Safety is the priority
(auditory hallucination &  Always stay with the
command) client for 24hrs.
 Episodes of delusions  1:1 supervision
 Personality organization  Dim light and quiet
environment
(↓stimuli)
 Room should be ed
hallways, not near
the nurse station
 No group activity
 Suicide/homicide
precaution
- avoid sharps object
- avoid glasses
- avoid metals, cords

2. Psychosis
 Schizophrenia
 Reality is no longer intact
 Negative concept of reality
 Panic attack
 Poor prognosis

Disorders
 Starts on the concept of anxiety
1. Phobia – diagnosed in 6 months
2. PTSD – diagnosed in 2 months
3. Personality – diagnosed in 6 months
4. Generalized Anxiety Disorder – diagnosed in 6 months

Signs & symptoms:

1. Hallucination
- no stimuli involved
- senses involved
- has been removed by DSM5
2. Illusion
- has stimuli involved
3. Delusion
- fixed false belief (irreversible)
- altered thought process
- acknowledge & the present reality
- persecution

Psychosis:
Schizotypal Personality Disorder
 Fairness
 Has magical thinking (superstitious)
 Has peculiar ideas (horoscope)
o Become abnormal if there’s distraction in activities or delusion of
behavior.
 If not controlled, schizophrenia
 Schizotypal → Schizophreniform (dx in 2-6 months) → Schizophrenia
(thought process & dx 6 months) → Schizoaffective (thought & mood)
 Mood:
o Mania: grandiosity
o Major depression
 Hopeless
 Helplessness
 Worthless (reflects to suicidal behavior)
Schizophrenia
 Dx in 6 months
 Medical term:
o Dementia Praecox (Emil Kraepelin)
 Syndrome (collection of signs & symptoms)
o Thought: delusion
o Affect: Affect disturbances
o Motor: echopraxia
o Preceptor: hallucination
 Etiology: unknown (idiopathic)
 Predisposing factors: neurologic theory (↑dopamine)
 ↑ Dopamine
 Distortion of reality
 Diathesis model (constant exposure to stress)
 Double bind of communication: contradicting information
o Paradoxical information
o Gas lighting
 Disorders: Metabolic
o Thyroid Disorders
o Pernicious anemia (↓B12)
 Genes: DNA
o 1 parent:32%
o 2 parents: 65%
o Monozygotic twins: 10-15%

MANIFESTATIONS
 ↑ Dopamine (confirmatory)  ↓ Dopamine (non-confirmatory)
 Paranoid (suspicious)  Can lead to depression
 Agitation (hostile when  Alogia
provoke/stimuli involved  Poor thought process
 Delusional Behavior (fixed false  Anergia
belief)  No energy
 Persecution  Seen in major depression
 Grandiosity (schizo/manic)  Avolition
 Erotomania:  Absence of motivation
- inclined with idea that  No drive, no will
you are loved by all  Mutism
people  Asocial behavior
- excessive feeling of  Apathy
lovability  Absence of reaction
  Referential:  Anhedonia
- perceived that you’re  Absence of pleasure
the subject of the  Lack joy in life
topic/controversy  Depression
- paranoid people  Normal individual
 4As:
1. Autism
2. Ambivalence (opposing)
3. Association looseness\
4. Affect Disturbances
 Broad or exaggerated
Ex.: incongruence
 Opposite reaction
 Hallucination
 Speech disturbances
 Echolalia
- Repeating speech of
other people
 Verbigeration
- Repeating own
speech

 Circumstantially (+)
- Beating around the
bush but will arrive to
the desired
response/answer the
question
 Tangentiality
- Cannot answer the
question
- Never answer the
question appropriately

 Clang
- Rhyming
 Concrete
- “pilosopo”
- Answers literally could
have Autistic

Antipsychotic Medication:
1. Neuroleptic
2. Psychotropic
3. Ataractic
4. Major tranquilizer

→ can ↓ dopamine (therapeutic)

 Another neurotransmitter that will act in reverse
 ↑Acetylcholine
- Secondary effect (effect of medication)
- Triggers Extrapyramidal Tract
o Control motor (fine) – involuntary tremor
o Control tonicity – spasm of the muscle
 Lead to EPS
- Anticholinergic
1. Cogentin (Benztropine)
2. Benadryl (Diphenhydramine)
 We use the side effect
 Adjuvant effect (primary effect)
3. Artene
 Azin/Peridol meds
Mood/Affect
1. Major Depression
2. Mania (exaggerated)
3. Bipolar Disorders
o Bipolar Disorders I: with history of mania
o Bipolar Disorders II without history of mania

Mania -----------------------------------------------------------------------------

Hypomania -----------------------------------------------------------------------------
- milder version of mania & shorted duration 5 days but last 1-2 weeks

Normal -----------------------------------------------------------------------------

Dysthymia -----------------------------------------------------------------------------
- no suicidal behavior
- PDD (Prolong depressive Disorder) – 2yrs.

MD -----------------------------------------------------------------------------

Cyclothymia
- Alternating episode of hypomania & dysthymia
Mania
- Normal to mania
Bipolar I
- Normal to mania to major depression
Bipolar II
- Normal to major to normal to major to hypomania

Major Depression Mania

A- Appearanc  Poor grooming  Disorganized
e  Weight loss dressing
 Absence of appetite  Bright color clothing
 ↓ nutrition (neon)
 Medication (Tricyclic)  ↓ nutrition
 Weight loss
-give finger foods
B- Behavior  ↓ self-esteem (Integrity  ↑ self-esteem
Complex)  Superiority Complex
 Hopeless, Helplessness, (Grandiosity)
worthless  Boisterous
 Defense mechanism:  Monopolizer
 Hate towards other  Defense mechanism:
people -acting out behavior
 Introjection (self-
blaming)
C- pre-Caution  Suicidal Precaution  Homicidal Precaution
 Never leave the client -no intent of homicide
alone  Act out (verbalize
feelings)
 Sublimation
 No group activities
D- Drug of  Antidepressant  Mood stabilizers
Choice  Mood elevators:  Lithium
- SSRI (safest) (0.5-1.5mEq/L)
- TCA (most potent)  Therapeutic
o Many foods (0.6-1.2mEq/L)
contraindication  If no lithium, use
- MAOI anticonvulsant meds
 Stimuli: \
 ↑ active friendliness
 Group therapy
 ↑ bright light
 Noise stimuli
 No love songs
 Non-directing signs