MENTAL HEALTH Regression- returning

According to the WHO (2020), mental into earlier

health is a state of well being in which an developmental stage
individual realizes his or her own abilities,
can cope with the normal stresses of life, Anal Stage Autonomy vs Shame
can work productively, and is able to make (18mon-3yrs) & Doubt (1-3 yrs)
a contribution to his or her community.
Gratification: control Autonomy develops
& elimination when the child’s toilet
Three Personality Components by
needs are met
Freud consistently
Good Mom “mom
ID - starts at birth “devil”
figure” balance
❖ I want what I want reward vs discipline Bad Mom
❖ Pleasure principle (happiness for Disorganized /
self gain) perfectionist (Palo)
❖ Unconscious desire Phallic/Oedipal Stage Initiative vs Guilt (3-6
❖ Sense of right & wrong diminished (3-5 yrs) yrs old)
(walang paki sa mali at tama)
❖ Innate/ Internal desires (eating, Curious of opposite Initiative develops
drinking & sex) sex (masturbation) when the child’s effort
at learning are
Oedipal Complex- supported
SUPEREGO- 3-6 yrs old “angel”
mama’s boy
❖ Conscience ❖ Talent
❖ Unconscious Electro Complex- ❖ Language
❖ Morality daddy’s girl development

EGO- 1-3 yrs old “self” Latency Stage Industry vs Inferiority

5-13 years old (6-12 years old)
❖ Partly unconscious and conscious
❖ Reality principle Sexual energy is Industry is achieved if
❖ Integrator of personality diverted to play the child learns how to
❖ D balancer od ID & Superego activity make things through
❖ Enables adaptive behavior working with others
School, Sports,
Freud’s Erikson’s Competition
Psychosexual Theory Psychosocial Theory
Genital Stage (12-21 Identity vs Role
Libido- sexual drives Social factors (paano years old) Confusion (12-18 yrs)
makitungo sa ibang
tao) Increase sexual Vocational choices are
activity to decrease supported
anxiety
Oral Stage (0-18 mon) Trust vs Mistrust (0-12
mon) Health Education:
Gratification: placing Sexual Education
things in the mouth Trust vs mistrust is
Intimacy vs Isolation
developed with mother
(18-25 yrs old)
 Intimacy is achieved if WORKING PHASE
the person is able to ❖ Most difficult & longest phase
establish satisfying ❖ Self concept increase
relationship ❖ Organized support system
❖ Lead to plan an intervention (pt &
Generativity vs
nurse)
Stagnation (25-65 yrs)
❖ Verbalization of feelings
The person is ❖ Encourage Independence
interested in guiding ❖ Realistic goal setting
next generation
TERMINATION PHASE
Integrity vs Despair 65
yrs old above ❖ Reinforcement & reward the
strength of the patient
The person evaluates ❖ Express feelings regarding
his/her life (reflection) termination
FOUR PHASES OF NURSE CLIENT ❖ Summarize & Evaluate
RELATIONSHIP ❖ Terminate without promises
S/s: regression: temper tantrums, thumb
PRE INTERACTION/ PRE sucking, apathy, fetal position when cry
ORIENTATION (for nurse)
❖ Stage of self awareness COMMUNICATION
❖ Awareness of self & your past and Exchange of information between 2 or
how it relates to the future more person
❖ To prevent transference (patient to ❖ Sender send message to receiver
nurse) ❖ Encoder- sender
❖ Countertransference (nurse to ❖ Decoder- receiver
patient) ❖ Feedback (w/o this no
❖ No personal biases communication)
❖ Two types of communication
ORIENTATION (initiation) ➢ Verbal
❖ Trust & rapport ➢ Nonverbal
❖ Reflect on words
❖ Use of contract, boundaries, & ELEMENTS OF COMMUNICATION
schedules Kinetics
❖ Strength & weakness (patient) ❖ Body language
❖ Therapeutic environment (safe & ❖ Facial expression, poise, posture,
comfortable for the patient) gait, movement, etc.
❖ Contractual ❖ Reflects mood
The start of termination phase: “Good
morning, full name, RN, shift, session, Proxemics
date start & end” ❖ space/distance between sender &
receiver
❖ Intimate distance- up to 18 inches
➢ Maintain professionalism
 ❖ Personal space- 18 inches to 4ft Exploring
➢ Health teaching, pt ❖ Tell me more about your job/
interview would you describe your
❖ Social Space- 9 to 12 ft responsibilities?
➢ Group therapy ❖ To know more details
❖ Public Space- beyond 12 ft Giving board openings or asking open
➢ General audience ended questions
Paralanguage ❖ Is there something you’d like to
❖ Vocal cues, vocal expression, voice do?
quality ❖ Pt to lead the conversation
Touch Accepting
❖ Shows attempt to connect or relate ❖ Yes, that must have been difficult
❖ Therapeutic touch (tapping back) for you.
❖ Battery unconsented touch Acknowledging or giving recognition
❖ I notice that you’ve fixed your bed
Silence ❖ Bawal pumuri pero pwede mag
❖ Encourages verbalization recognize
Asking direct question
NON THERAPEUTIC ❖ Are you going to kill yourself
COMMUNICATION TECHNIQUES ❖ Yes or No (close ended questions)
❖ False reassurance Offering self
➢ Don’t worry, everything ❖ I’ll sit with you in a while
will be alright Presenting reality
❖ Judging ❖ I see no one else in the room
➢ It’s your own mistake Voicing doubt
❖ Defending ❖ I find that hard to believe
➢ All doctors here are simply ➢ Illusion with stimulus
great ➢ Hallucination w/o stimulus
❖ Belittling ➢ Delusion false belief
➢ Don’t be concerned, Informing
everyone feels like that ❖ I’ll be your nurse for today, from
❖ Don’t ask WHY 7:00 until 3:00 this afternoon
❖ No advising & lecturing ❖ Health teaching
❖ Moralizing & disagree/ agree ➢ Avoid jargon/ medical term
❖ Ignoring the pt Making Observation
❖ Blaming the pt ❖ You appear tense
❖ No offering of praise Reflecting
❖ Avoid passing the back (referral) ❖ Client: I do not want those
medicines! Pout
THERAPEUTIC COMMUNICATION ❖ Nurse: you are unhappy of taking
TECHNIQUES the medication
Clarifying ❖ Reflecting feelings, ideas &
❖ I’m not sure I understand what you thoughts
are trying to say
Restating PANIC + 3
❖ Client: I can’t sleep, I stay awake ❖ Hallucination
all night ❖ Harming self & others
❖ Nurse: You can’t sleep at night ❖ Chest pain
❖ Don’t ask WHY ❖ Syncope
Supportive Confrontation: acknowledge Management:
client’s feelings ❖ do not touch the client.
❖ “I know it isn’t easy, but you can ❖ Just stay with the patient
do it” ❖ Safe environment
❖ “It would be difficult at first, but Antianxiety or anxiolytic medications
you’ll get through it” ❖ Potentiates GABA (Balancer)
❖ Minor tranquilizer (sedation)
ANXIETY DISORDER ❖ No abrupt STOP can cause
❖ A normal response to stress withdrawal symptoms
❖ A subjective experience that ❖ Downers
includes feelings of apprehension, Benzodiazepines (short acting)
uneasiness, uncertainty, or dread ❖ Valium (Diazepam)
❖ Fear of the unknown ❖ Xanax (alprazolam)
❖ Klonopin (clonazepam)
MILD + 1 ❖ Serax (oxazepam)
❖ Widened perception/ heighten ❖ Ativan (Lorazepam)
senses Nonbenzodiazepines (long term)
❖ Increase concentration ❖ Buspirone (buspar)
❖ Restless (stationary) ❖ No sedation
❖ Enhanced learning capacity ❖ No withdrawal symptoms (can
❖ Abdominal Butterflies STOP asap)
Management: no management ❖ 2-4 weeks onset & therapeutic
You seem restless effect
Side effects :
MODERATE +2 ❖ Anticholinergic
Pacing back & forth ❖ Avoid alcohol (downers) causes
❖ Nausea respiratory depression
❖ Anorexia ❖ Drying
❖ Vomiting ➢ Can’t See- blurred vision
❖ Diarrhea/ increase urination ➢ Can’t spit- dry mouth
❖ Abdominal Butterflies ➢ Can’t sweat- dry skin
Management: Safety, oral meds, problem ➢ Can’t pee- urinary retention
solving ➢ Can’t shit- constipation
ANTIDOTE: Flumazenil Romazicon
SEVERE +3 Precaution:
❖ Increase RR, BP, Dyspnea ❖ Bedtime before meals
❖ Confusion (don’t know what to do) ❖ Avoid coffee (uppers) & cigarette
/ Alogia (can’t speak) ➢ Decrease effect of drug
❖ Don’t know what to to do/say
 ❖ Avoid driving & operating ❖ Symptoms of a phobia are
machineries generally similar signs and
❖ Monitor kidney & liver symptoms to a panic attack
CRISIS Types of phobia
❖ When coping mechanism are Acrophobia- Fear of heights
ineffective that results to Agro
disequilibrium
❖ Temporary emotional disturbance PTSD & ACUTE STRESS DISORDER
Types of Crisis ➔ Fear of the traumatic past
❖ Maturational/Developmental ➢ Acute stress disorder ASD- is a
Crisis- expected/ predictable mental disorder that can occur
➢ Menarche, retirement, within the first month following a
Marriage traumatic event
❖ Situational/Accidental- often
unanticipated ➢ PTSD- Post traumatic stress
➢ Sudden loss of spouse/ job, disorder if symptoms persist for
divorce over 1 month
❖ Adventitious/Social- related to a S/sx:
crisis that is not a part of everyday ❖ same with server or panic attack
life and unplanned & accidental ❖ guilt/ anger (reassurance)
➢ disaster/ tragedy ❖ Insomnia & appetite loss
➢ Rape, tsunami, volcanic ❖ Nightmares
erruption ❖ Flashback
Duration of Crisis: 4-6 weeks (self Management:
limiting) ❖ Promote safety
❖ Goal: to help client return to pre ❖ Reassurance
crisis level ❖ Psychotherapy (talk therapy)
❖ Focus: here and Now (GESTALT ➢ Also called talk therapy
Therapy- focus in the present ➢ Help eliminate or control
problem not in past & future troubling symptoms
problem) ➢ Component: Mental Health
❖ Immediate problem, feelings, & Professional
solution
❖ Approach: PSYCHOTHERAPY
➢ Directive- promote problem
solving Defusing- providing education on stress
➢ Supportive- encourage and stress management
expression of feeling ❖ Inhale
PHOBIAS ❖ Exhale
❖ Fear of the known
❖ An illogical, intense, and persistent Debriefing- client is asked about their
fear of a specific object or social emotional reaction to an incident
situation
Exposure therapy- confronting trauma PARANOID PERSONALITY
associated thoughts rather than avoiding DISORDER
❖ Flooding - sudden exposure ❖ Easily Angered
❖ Systematic desensitization - ❖ Suspicious
gradual exposure ❖ Intense & controlling
❖ Lonely
Adaptive closure therapy (bibigyan ng ❖ Over-jealous
empty chair technique) ❖ Sensitive
❖ Closure ➢ Prone to violence
❖ For patient to verbalize feeling
HISTRIONIC PERSONALITY
Catharsis- releasing repressed emotions DISORDER
thru art & music ❖ Attention Seeker, seduction
❖ Gratification always needed
Guided Imagery - is a mind body ➢ Frequent gratification
intervention ❖ Hysterical & dramatic
❖ Hyperemotion
Group therapy
❖ 3-5 members (8-10) DEPENDENT PERSONALITY
❖ Open forum DISORDER
Goal: Reduce isolation communicate ❖ Wife battered syndrome
acceptance ➢ Binunugbog ng husband
Therapeutic Milieu: this provides a safe ❖ Indecisive and a good follower
& secure environment for clients that are ❖ Fears separation
in therapy ❖ Enabler & co-dependent
Autistic- private room (away to nurses
station)
ANTISOCIAL PERSONALITY
Personality Disorder DISORDER
Disorder is a way of thinking, feeling, and ❖ Good-talker & charming
acting that goes against what people in the ❖ Manipulates others for personal
culture expect, causes distress or makes it gain
hard to function, and lasts for a long time. ❖ Aggressive
❖ unaware ➢ Sexual
❖ Impulsive
NARCISSISTIC PERSONALITY ❖ Law/Rules breakers
DISORDER
❖ Me, myself & I BORDERLINE PERSONALITY
❖ Needs admiration DISORDER
❖ Arrogant & Grandiose ❖ Will use manipulation
❖ Really believe they are perfect ❖ Abandonment issues
(high self esteem) ❖ Gaslighting & Suicidal
❖ Constant need of praise
❖ Superiority complex
 AVOIDANT PERSONALITY CLUSTER A
DISORDER The ODD & ECCENTRIC Cluster
❖ Avoidnpeople ❖ Paranoid
❖ Timid ❖ Schizoid
❖ Inferiority Complex ❖ Schizotypal
❖ Sensitive to rejection/ criticism
➢ Shy to people CLUSTER B
The DRAMATIC & UNPREDICTABLE
SCHIZOID PERSONALITY ❖ Antisocial
DISORDER ❖ Borderline
❖ No best friend ❖ Histrionic
❖ Avoid people, attract to pets & ❖ Narcissistic
computer
❖ I don’t like people
❖ Loners CLUSTER C
❖ Stand on his own The ANXIOUS & FEARFUL Cluster
❖ Avoidant
SCHIZOTYPAL PERSONALITY ❖ Dependent
DISORDER ❖ OCPD
❖ Alone
❖ Has special powers Personality Disorder Management
❖ Withdrawn ❖ Improve community & client
❖ Often tells horrors/ magical stories functioning
❖ Overly detached ❖ Develop selfcare & safety
❖ Cognitive behavioral therapy
OBSESSIVE-COMPULSIVE ❖ Self awareness
DISORDER
❖ Aware IDENTITY DISORDER
❖ Obsession = Intrusive thoughts
❖ Compulsion = Repetitive Rituals DISSOCIATIVE IDENTITY
DISORDER
OBSESSIVE-COMPULSIVE Pathophysiology
PERSONALITY DISORDER ❖ Occurs when 2 or more identities
❖ Unaware (alters) rotate control over the
❖ Obsession = Intrusive thoughts client’s behavior
❖ Compulsion = Repetitive Rituals ❖ Multiple personalities
❖ Causes: PTSD (sexual trauma)
Nursing Management ❖ Host personality
❖ Divert/ redirect the ritual to a ❖ No awareness but reality is intact
productive activity
❖ Initially allow patient to continue DISSOCIATIVE AMNESIA
❖ Engage patient in social activities ❖ Unable to recall personal
❖ Set limits to patient’s ritual, but do information/ purchase
not stop/ interrupt a ritual
 DISSOCIATIVE FUGUE ❖ Uminom ng laxative
❖ Client assume new identity in new C. Factitious Disease by proxy
environment ❖ Cause illness to others

DEPERSONALIZATION DISORDER MUNCHAUSEN’S SYNDROME

❖ An altered self-perception in which
Nursing Management
Nursing Management ❖ Rule out any possible organic of
❖ Stay with patient physiologic cause
❖ Gather data about the patient ❖ Real for the patient
❖ Do not present all data, avoid ❖ Recognize manipulation
flooding ❖ Attend to physical complaints
❖ Explore stressors ❖ Consistent caregiver must be
❖ Ask the patient to relate the event provided
❖ Look for effective coping ❖ Encourage verbalization of feelings

SOMATIC SYSTEM DISORDER TREATMENT

❖ Psychological disorder where ➢ Antidepressant- SSRIs
clients have unexplained physical ❖ Prozac & Zoloft
symptoms like abdominal pain, ❖ Decrease symptoms
weakness, chest pain, SOB, & ➢ Chronic pain therapy- avoid
other narcotic analgesics
❖ Result normal (paracetamol/NSAIDS)
➢ Cognitive behavioral therapy
SOMATOFORM DISORDER
(imagined) EATING DISORDER
CONVERSION DISORDER ANOREXIA EATING BULIMIA
❖ Disability of an organ NERVOSA DISORDER
❖ La belle indifference
➢ Unconcerned w/ symptoms Diet, diet Eating pattern Eat, eat, vomit
BODY DYSMORPHIC DISORDER
<85 % of Weight Normal
❖ Defect in organ expected body weight
HYPOCHONDRIASIS
❖ Preoccupied with serious illness 3 months menstruation Irregular
❖ Doctor Shopping (123 opinion) amenorrhea menstruation
➢ Do not give placebo (give
only with consent) ANOREXIA NERVOSA
➢ Give pain medication ❖ Fear of obesity
With psychical symptoms, no organic ❖ Problem with hypothalamus
cause ● Emotion, Hunger, Thirst
A. Malingering ASSESSMENT
❖ Facking of illness ❖ Refusal to eat/ drink
B. Factitious ❖ Excessive exercise
❖ Cause an illness to self ❖ Perfectionist
 ❖ Underweight/ 15% or less than Bulimia
IBW ❖ Stay with client 1-2 hrs after
❖ Signs of malnutrition meals
Bony prominence ❖ Family therapy
Amenorrhea for 3 periods DRUGS:
Dry hair Antidepressants
Lanugo ➔ TCA- Toframil & Elavil
Imbalance F&E ➔ SSRI- Prozac & Zoloft
Poor skin turgor ➔ s/e decrease urge & purge
❖ Ensure Safety (suicidal)
NEUROTRANSMITTERS
BULIMIA NERVOSA/ BINGE & ❖ Dopamine/
PURGE SYNDROME Epinephrine/Norepinephrine
❖ Binge eating, followed by self- ❖ Serotonin- Excitatory/ inhibitory
induced vomiting ❖ GABA- gamma aminobutyric acid
➢ Balancer
ASSESSMENT:
❖ Hoarseness of voice NEURODEVELOPMENTAL
❖ Enlarged parotid glands DISORDERS
❖ Average weight
❖ Russel’s Sign- calluses on AUTISM SPECTRUM DISORDER
knuckles ❖ CAUSE: unknown
❖ Toothache- dental caries, halitosis ❖ Impairs child’s ability to
❖ Metabolic acidosis & alkalosis communicate and interact
❖ Enema’s, diuretics and diet pills Signs & symptoms
❖ Does not Maintain eye contact
Nursing Intervention: ❖ Does not Interact with gestures
❖ Encourage expression of feelings ❖ Like being cuddles & plays alone
❖ Always use the same scale ❖ Delay in language development
❖ To promote the feelings of control ❖ Echolalia & Rituals
❖ Include dietitian & psychiatrist ➢ OC & NEAT
❖ No signs of malnutrition ❖ Respond to question
❖ Goal ROUTINES & CONSISTENCY
❖ Safety
Anorexia ❖ Structure- provide place to study,
❖ Stay with pt during meals eat, play, bath, etc
❖ Family therapy ❖ Schedule- time for everything
DRUGS: ❖ Set limits
Antidepressants MANAGEMENT
➔ TCA- Toframil & Elavil ❖ Give a written schedule of daily
➔ SSRI- Prozac & Zoloft activities
➔ s/e wt gain ❖ Aggressive behavior; distract the
child & ask them to blow up a
balloon
 ❖ Increase risk for injury ❖ Iba reality
❖ TOC: haloperidol (haldol) - major ❖ Unknown cause
tranquilizers (pang pakalma)
Possible causes of Schizophrenia
ADD/ADHD ❖ Genetic
ADD- Attention Deficit Disorder ➢ 1 parents 15% chance
ADHD- Attention Deficit Hyperactivity ➢ 2 parents 35 % chance
Disorder ➢ Identical twin 50% chance
❖ Low dopamine & norepinephrine ❖ Neuroanatomic/ Neurochemical
❖ Low attention span ➢ Low CSF, brain tissue
Signs & symptoms ➢ Increase dopamine
❖ Impulsiveness “excessive talking” ❖ Immunovirologic
❖ Hyperactivity “restless” ➢ Meningitis & encephalitis
❖ Inattention “reduce ability to ❖ Substance abuse
focus” ➢ Long term use of drugs,
❖ Low self esteem & impaired social marijuana
skills Psychomotor Disturbances
Drug Names Positive symptoms
❖ Increase attention span ❖ Clear symptoms, visibly displayed
❖ Methylphenidate (brand: Adrenal) Negative Symptoms
❖ Amphetamine mixture (brand: ❖ Non-active symptoms, not visibly
Ritalin) displayed
❖ Dextroamphetamine stimulants ➢ Posturing- behavior that is
intended to impress or mislead
Residual ADHD grows up not antisocial ➢ Apraxia- no movement
❖ Meds: Ritalin, dexedrine, ➢ Automatism- repeated purposeless
pemoline, adderall behavior
❖ Appetite loss, insomnia ➢ Waxy flexibility- maintenance of
❖ Best time to give: once a day awkward posture
❖ Morning After meals: prevent loss ➢ Echopraxia- repetition of someone
of appetite else’s action
❖ Antidote: Alprazolam ➢ Rigidity- stiffness or inflexibility
❖ Don’t give at bedtime
❖ Stimulant- cause insomnia give 6
hrs prior bedtime if BID

PSYCHOTIC DISORDER
SCHIZOPHRENIA
A long-term mental disorder involving a
deteriorating breakdown in the relation
between thought, emotion, & behavior.

❖ The earlier the onset, the worse the

prognosis
 DISORGANIZED SPEECH & ❖ Hallucination: false sensory
THOUGHT perception in the absence of
❖ Loose associations: rapid shift of external stimuli.
thought with no logical connection ❖ Delusion: the false belief that is
❖ Flight of ideas: rapid shift of inconsistent with one’s knowledge
thought with logical connection and culture
❖ Neologisms: making up imaginary ❖ Delusions of Reference
words ➢ “This song has a secret
❖ Clang associations: listing message just for me”
rhyming words together that makes ➢ Main character/ anything
no sense that happens in this word is
❖ Word Salad: mixing words for me
together that have no meaning ❖ Delusions of Control
except to the client ➢ “I do not got online, that’s
❖ Concrete thinking: taking a how the NBI controls you”
statement literally ❖ Delusion of Grandeur
❖ Verbigeration- repeating phases ➢ “I have a very important
❖ Stilted language- use of flowery meeting with the president
words today”
❖ Perseveration- adherence to a ❖ Persecutory (paranoid) delusions
single topic ➢ “The hospital food is trying
❖ Echolalia: repetition of words to poison me”
❖ Religious Delusions- the central
DISORGANIZED THOUGHT theme often center to the second
Note: illusions & hallucination can be coming of christ or another
visual, tactile, auditory, gustatory, or significant religious figure or a
olfactory. prophet
❖ Ilusion- false perception of actual ❖ Capgras’ syndrome- the central
external stimuli theme is that a significant others
➢ Visual- taking psychedelics (usually family members) has been
(marijuana) replaced by and identical impostor
➢ Tactile - formication ❖ Dorian Gray- the central theme is
(alcohol withdrawal) that others are aging while the
➢ Olfactory- phantosmia client appears to remain the same
(PTSD) age (60 but believes she is 18)
➢ Gustatory- dysgeusia ❖ Jealous Delusions- the central
(schizo, epilepsy) theme of this is the unfaithfulness
➢ Auditory- commands of a spouse or lover. (gumawa ng
(Schizo) kwento sa utak niya na may iba
➢ Synesthesia- mixing of yung asawa tapos tinotoo)
senses (music naririnig pero ❖ Erotomanic delusion- belief that
gusto makita, lyrics the patient is loved intensely by the
nalalasahan) “loved object” who is usually
married, of a higher
 socio-economic status or otherwise Paranoid Schizo (hallu, illu, delu)
unattainable (naniniwala ka na ❖ Presenting signs in
love ka ng isang tao na hindi ka SUSPICIOUSNESS ideas of
kilala) persecution & delusion.
❖ Somatic delusion- the central ● Projection
theme involves bodily functions or ○ Sinisisi sa ibang tao
sensation. A false belief that there and delusion
is a physical ailment. ● Proxemics- social distance
Management ● Passive friendliness
❖ Hallucination must be recognized ○ Don’t smile
❖ Assess the content ● Persecutory delusion
➢ What are the voices telling Nursing Diagnosis: alteration in nutrition:
you? less than body requirements
❖ Reality presentation Nursing Goal: to meet the patient’s daily
❖ Divert the attention nutritional requirements
❖ Engage in reality- based activity Nursing Intervention:
❖ Reintegrate with the milieu ❖ Do not force patient to eat foods
❖ Talk back to the voices that he refuses
Delusion- false belief ❖ You may do any to following:
Management ➢ Allow client to buy food
❖ Clarification the meaning ➢ Allow client to prepare his
❖ Acknowledge the feeling own food
❖ Voice doubt ➢ Offer packaged food except
❖ Engage in reality based activities canned foods
Nursing Diagnosis: non compliance with
therapy/ medication
Nursing Intervention:
❖ Reinforce drug teaching
❖ Administer drugs in the same form
always
❖ Do not hide tablets
Board Exam Question: I will only eat
Classification of SCHIZOPHRENIA this when you taste it first. Hindi dapat
Disorganized- aka HEBEPHRENIC titikman
“taong grasa”
Essential features CATATONIC - movement disorder
❖ Characterized with inappropriate ❖ Essential features: psychomotor
behavior; silly crying, laughing, disturbance
regression, transient hallucination ❖ Waxy flexibility, (cerea
(auditory) flexibilitas), rigidity, posturing,
❖ Assist ADL negativism, mutism.
❖ Defense Mechanism: Autism &
Mutism
UNDIFFERENTIATED or MIXED Management: Shift to another generation
❖ Symptoms of more than one type drug
of schizophrenia
➢ Paranoid + catatonic NEUROLEPTIC MALIGNANT
RESIDUAL SYNDROME
❖ no longer exhibits overt symptoms, ❖ Crisis levels, result of deadly
no more delusional but still has adverse effect
negative symptoms ❖ Lead to seizure
SCHIZOAFFECTIVE ❖ Hyperthermia
❖ schizophrenia (+) mood disorder ❖ Hypertension
(e.g. depression) ❖ Muscle spasms
Nursing Action: Stop Meds
Medical Management: Supportive
management (baclofen) muscle relaxant
Prevention: increase fluids

TARDIVE DYSKINESIA
Antipsychotic- major tranquilizer ➔ lifetime
Typical Antipsychotic (1st gen/ ❖ Tongue protrusion
conventional) ❖ Teeth grinding
❖ “Zine or Dol” ❖ Lip Smacking
❖ Positive symptoms Nursing Action: notify HCP
❖ Risk: increase EPS Medical Management: Valbenazine
❖ Cheaper (ingrezza)
Atypical Antipsychotic (2nd gen) Prevention: start with lower dose
❖ “Done or pine”
❖ Negative symptoms Other Symptoms
❖ Aripiprazole (Abilify) New ➢ Constipation- increase fluid & fiber
❖ Risk: decrease EPS, risk for ➢ Agranulocytosis- monitor WBC
infection low WBC ➢ Tooth decay- sugarless hard candy/
(agranulocytosis) gum
❖ Expensive ➢ Dry mouth
➢ Adult: fever ➢ Orthostatic hypotension- change
➢ Elderly: Altered LOC position gradually
ExtraPyramidal Syndrome ➢ Galactorrhea - use cotton
❖ Acute Dystonia- facial grimace & underwear
opisthotonus ➢ Photosensitivity- avoid sunlight,
❖ Akathisia- restless/ agitation wear sunglasses, umbrella,
❖ Pseudoparkinsonism- shuffling sunscreen (SPF 25)
gait, pill rolling, mask like face ➢ Arrhythmias- report
➢ Temporary result of ➢ Weight gain- decrease sugar/
overdose calories in the diet
Nursing Action: notify the doctor, HCP & ➢ Sedation- avoid driving, operating
decrease dosage heavy machineries
DEFENSE MECHANISM ➢ Intellectualization-
➔ Protect ego & decrease anxiety acknowledging the facts but not the
➢ Displacement- transfer of feeling emotion
to less threatening object rather ○ Namatayan if normal iiyak
than the one who provoke it pero dito “anak kon patay
○ Transfer of anger to things na / flat affect”
➢ Denial- failure to acknowledge an ➢ Substitution- replacing a difficult
unacceptable trait or situation goal with a more accessible one
➢ Dissociation- psychological flight ○ Maging doctor dream di
from self, a type of amnesia kinaya kaya naging nurse
➢ Regression- return to an earlier ➢ Splitting- seeing someone as either
developmental stage good or bad idealized or devalued
➢ Repression- unconscious ➢ Idealization- the action of
forgetting of an anxiety provoking regarding or representing
concept something as perfect or better than
➢ Suppression- conscious forgetting in reality
of an anxiety provoking concept ○ Love is blind
➢ Sublimation- placing sexual Hypomania
energies toward a more productive ❖ Euphoria, hyperactivity, increase
endeavors (-) to (+) sex drive, restlessness
➢ Rationalization- illogical Mania
reasoning for a socially ❖ Hypomania, hallucination, illusion,
unacceptable trait delusion
➢ Reaction Formation- doing the Hypo Depression
opposite of your intention, plastic ❖ Excessive loneliness, hopelessness,
➢ Undoing- doing the opposite of anergia, worthlessness feeling
what you have done due to guilt Major Depression
➢ Identification- assume trait for ❖ Hypo dep, suicidal
personal, social, occupational role
○ Conscious copying Bipolar 1
➢ Projection- attributing to other ❖ Mania
one’s acceptable trait ❖ Hypomania
➢ Introjection - assume another ❖ Hypo dep
person’s trait as you own ❖ Major depression
○ Unconscious copying ➢ Antipsychotic drugs
➢ Conversion- repressed angers put Bipolar 2
towards physical symptoms ❖ Hypomania
affecting nervous system leading to ❖ Hypo dep
sensory numbness and motor ❖ Major depression
paralysis Manic disorder
➢ Compensation-overachievement ❖ Mania
in one are to cover a defective part ❖ Hypomania
○ Small but terrible Major depression
❖ Hypo dep
 ❖ Major depression ❖ Weekly weighing
Cyclothymia ❖ Continue one to one observation
❖ 2-3 years Bipolar like disorder ❖ Semi private room (near nurses’
❖ Hypomania station)
❖ Hypo depression ➢ Remove harmful objects
Dysthymia from the room
❖ Minor depression like ➢ Supervise during meals
❖ Last 2-3 years exp hypo depression ➢ Reassess: change of mood/
sudden improvement
DEPRESSION
Patho ANTIDEPRESSANT 4 rules
❖ Everything is low & slow, it is ❖ Increase risk of suicide (increase
thought to be from low levels of amount of serotonin)
neurotransmitters within the brain ❖ Slow Onset & slow taper off
❖ Neurotransmitters ➢ 2-4 weeks before stop meds
➢ Low, Excitatory serotonin, ➢ No abrupt stop =
dopamine, norepinephrine withdrawal
Signs & Symptoms ❖ Never mix
Diagnosis: 5 or more symptoms ➢ Can cause serotonin
❖ Depressed mood (hopeless, empty) syndrome- increase RR, BP,
❖ Anhedonia (loss of joy/ interest in HR, Temp, tremors will
life) lead to SEIZURE
❖ Weight loss (anorexia) or weight ❖ All antidepressant drugs
gain ➢ Uppers
❖ Psychomotor retardation or ➢ Decrease BP
agitation ➢ Cause weight gain
❖ Insomnia or hypersomnia (sleeping ■ Short term- wt loss
too much) ■ Long term- wt gain
❖ Fatigue (anergia) Insert antidepressant SS
❖ Feelings of worthlessness or Guilt ANTIDEPRESSANT DRUGS
❖ Difficulty in concentration ❖ TCA
❖ Suicidal thoughts (recurrent) ➢ ToSiEl
Depressed Client ❖ SSRI
Kind Firmness ➢ CeProZo
❖ Silent ❖ MAOI
❖ Offering self ➢ PaMaNa
❖ Motivate- remind client of time
when she or he felt better and was Selective Serotonin Reuptake Inhibitor
successful Action: Prevent reuptake of serotonin
❖ Engage in social activities increasing the availability of serotonin in
Diet the body
❖ Small frequent meals Increase serotonin- SAFEST drug
❖ High calories food & fluid ❖ Serotonin syndrome/ Sexual
❖ Staybwith client during meals dysfunction
 ❖ Side effect but suicide risk Pre- x ray
❖ Rigid muscle and restless ❖ Informed consent
❖ 1-4 weeks only ➢ Doctor, nurse witness
➢ Onset & taper off ➢ Voluntary
■ From patients
TRICYCLIC ANTIDEPRESSANT ➢ Involuntary
Action: prevent the reuptake of ■ Next of kin
norepinephrine and serotonin increase ❖ NPO 6-8 hrs prior
these neurotransmitter in the body ➢ Risk for aspiration
❖ 2-5 weeks- onset/ taper off Meds
❖ Check for the higher incidence of ❖ Atropine- dry mouth, decrease oral
side effect (anticholinergic) secretion
➢ 5 can’ts ❖ Barbiturates- Sedatives, anesthesia
❖ Assess for suicide- 1 prio ❖ Succinylcholine- muscle relaxant
DRUGS:ToSiEl, asendin, anafranil, to prevent seizure
aventyl, norpramin ❖ It is not a cure but a management
Post
MONOAMINE OXIDASE ❖ X ray
INHIBITORS ➢ Most common complication
Action:Increase availability of FRACTURE
norepinephrine, serotonin, & dopamine in ❖ Side Lying- lateral
brain ➢ Decrease salivation
❖ Most potent & powerful drugs ❖ S/E: most common: confusion &
❖ Avoid tyramine food temporary memory loss
➢ Alcohol, chocolate, aged ➢ Reorient patient (time, date
cheese, alcohol, soy sauce, & place)
avocado, fermented, Nursing Intervention
preserved & process foods 5 S in seizure
❖ Cause massive hypertension crisis ❖ Safety - 1st objective
❖ OTC drugs to avoid cause HTN ❖ Side lying- 1st position
crisis ❖ Side rails up
➢ Calcium, antacids, ❖ Stimulus down (no noise & bright
acetaminophen, NSAIDS lights)
➢ Decrease brain activity
ELECTROCONVULSIVE THERAPY ❖ Support the head with a pillow
(ECT) after seizure
❖ An effective treatment for ➢ For comfort
depression that consists of inducing
a (grand mal/ tonic-clonic) seizure POINTS TO REMEMBER
by passing an electrical current ❖ Electric current- 70-150 volts
through electrodes attached to ❖ Duration of Administration
temples ➢ 0.5 - 2 secs
❖ Treatment resistant disorder ❖ Frequency of Treatment
➢ Di na kaya ng meds ➢ 2-3 treatments weekly
 ❖ Total Number of Treatments ❖ Weekend less staff personnel
➢ 6-12 ECT therapy ❖ Early Am everyone is asleep
❖ Side Effect: Seizure (grand mal/ ➢ Endorsement
tonic-clonic) ➢ Irregular visitation
➢ Last 30 secs to 1 min or
slightly longer BIPOLAR DISORDER
What is bipolar disorder?
SUICIDE Mania:
❖ Intentional killing of self due to ➔ a mood disorder marked
loneliness in life and other factors hyperactive wildly optimistic state
VERBAL ➔ Mood that is elevated, expansive,
❖ I won’t be a problem anymore or irritable to mask depression
❖ This is my last day on earth Assessment
❖ I’ll soon be gone ❖ Mood elevated
NON VERBAL ❖ A grandiose delusion
❖ Take this ring, it's yours (giving of ❖ No need for sleep, eat
value) ❖ Inappropriate behavior
❖ Sudden change in mood ❖ Clanging vulgar
Risk factors: ❖ Depressed
❖ Sex: MALE ❖ Out of suicide
❖ Unsuccessful previous attempt ❖ Won’t sleep & eat
❖ Identification with someone who ❖ Negativistic
committed suicide Depression: The feeling of severe
❖ Chronic illness despondency and dejection
❖ Depression/ Dependent personality
❖ Age (18-25 and >40), alcoholism Nursing management:
❖ Lethality of previous ❖ Risk/ potential for injury directed
attempts/losses to others/ or to self
❖ Plan- Most outstanding ❖ Fluid & Electrolytes Imbalances
❖ Best approach for suicidal pt: ❖ Fluid Volume Deficit
Direct approach
Nursing management: Close surveillance Nursing Intervention:
Monitor behavior & location ❖ Accept client; reject behavior
❖ Assess directly and monitor for ❖ Provide consistent care
signs & plans ❖ Set limits of behavior/ external
➢ Dark jokes controls
❖ Safety, security, and supervision ❖ Distract & redirect energy:
➢ Suicide contract dancing/ walking with staff
➢ 24/7 constant supervision ❖ Meet nutritional needs: high
❖ Provide family therapy/ support calories finger foods and fluids to
and counseling be carried while moving (potato
Hospital area majority suicide will chips, bread, raisin, sandwich)
happens at
❖ Weekends 1-3 am sunday
 ➢ All high caloric & high Deescalate- encourage expression of
carbohydrate diet or all feelings, promote ASSERTIVE
bakery products COMMUNICATION
❖ We do not tolerate that attitude in
PSYCHOTROPIC MEDICATION the hospital, if you need help we
Antimanic and mood stabilizing agent can help you.
❖ Improves productivity by Direct approach- calm, non-threatening
decreasing psychomotor activity or Show force- visibility of 4-6 staff members
response to environmental stimuli Restraint
❖ Doctor’s order: secure within 24
LITHIUM PREPARATIONS hrs
❖ Lithium carbonate (Eskalith, ❖ Informed consent
Lithobid) ➢ involuntary
❖ Lithium citrate (Cibalith-s) ❖ Qualification
➢ Violent
BIPOLAR, MANIC ➢ Danger to self & others
❖ LITHIUM (salt): undergo the first ❖ Proper Application
kidney (BUN & CREA) test and ➢ 6-8 staff members required
check for blood levels ➢ Adequate circulation must
❖ Onset : 2-4 weeks be ensured
❖ Level: 0.6-1.2 meq/L ➢ Anchor in stable part of the
❖ Increase urination bed
❖ Toxicity watchout tremors, fine ■ Restrain on
hand bedframe
➢ Blurred vision, dry mouth, ❖ Doctor’s order: removal
& dry skin ❖ Proper removal
➢ Polyuria & diarrhea ➢ TEMPORARY- alternately
❖ Hydration should be within normal one at a time, for 10
limits minutes every 2 hrs
➢ Water 2-3 L per day ➢ Permanent- alternately one
➢ Salt 2-3g/ day at a time
➢ Normal water & salt SECLUSION ROOM
❖ Hypothyroidism- inhibits ❖ Inappropriate behavior, continuous
thyroidal iodine uptake thoughts & attempt of suicide
➢ Nakipag agawan si Lithium ❖ Informed consent
sa normal salt ng body ➢ Room: lockable &
❖ Avoid coffee, tea, alcoholic observable from the outside
beverages ➢ Purpose: restorative, not
punitive
AGGRESSIVE CLIENT (verbally ➢ Goal: to help client regain
abusive) self-control
Decrease stimulation- turn of television, ➢ Monitoring: one-on-one
let other clients leave the room monitoring on first hour
 ❖ Environment: less stimulated
environment (no visitors, phone
calls)
❖ Only bed and 4 walls of room

ALCOHOLISM
Nakuha sa family, genetics

Can cause disulfiram reaction

❖ Diarrhea
❖ Intense headache
❖ Nausea/Vomiting
❖ Abdominal Pain
ALCOHOL INTOXICATION
❖ Overdose of alcohol can cause STIMULANTS
COMA ❖ Purpose: to cause euphoria
❖ Decrease BP, RR, HR,Anxiety, ❖ Signs of abuse: HTP, Tachycardia,
tremors, Loc tachypnea, pupil dilation, appetite
loss, & insomnia
ALCOHOL WITHDRAWAL ➢ Cocaine
❖ Abrupt stop can cause seizures, ■ excoriated nostrils
delirium, tremens ■ Bipolar cycling-
❖ Occures 48-72 hrs euphoria
❖ Increase BP, RR, HR,Anxiety, ■ Depression
tremors, Loc ■ Bromocriptine
Treatment of choice: (parlodel)
❖ Diazepam ■ Decrease cravings
❖ Ativan ➢ Shaby (Methamphetamine)
❖ Librium (best) Poorman’s cocaine [oral]
■ Rotten & stained
teeth
NARCOTICS (downers)
❖ Purpose: to escape reality
❖ Commonly abused narcotics:
Ataxia- uncoordinated body movement codeine, tramadol, oxycodone,
Korsakoff- chronic & irreversible morphine, meperidine, fentanyl
Management: ➢ HypoBradyBrady, pupil
Thiamine- Rich Diet: nuts, green peas, constriction
pork, milk ➢ Route: IV (.5 mg)
Vitamin B complex ➢ Most common
complication:
HepA&B/HIV
Respiratory Depression
❖ Morphine Overdose/ Intoxication
❖ Downers
❖ Don’t abrupt stop
❖ Antidote: Naloxone Narcan
Detoxification
❖ Methadone- weak opioid
❖ Safety withdrawal
❖ Alcohol withdrawal
❖ No Abrupt stops
BARBITURATES (sedative hypnotics)
❖ Downers
➢ V/S: HypoBrady,Brady
➢ Pupil constriction
❖ Purpose; to cause sedation
❖ Commonly abused barbiturates -
barbitals
➢ Phenobarbitals,
methohexital, thiopental
❖ Management: activated charcoal
(sipsipin yung sobrang barbiturates
na pumasok sa katawan)
HALLUCINOGENS
❖ Purpose: to cause hallucination
❖ Most commonly abused
hallucinogens:
❖ Cannabis Sativa (Marijuana)-
bloodshot eyes (increase blood
flow to eyeballs)
❖ Is not Addictive, no nicotine
❖ Uppers- HALLUCINATION
❖ Downers- SEDATION
➢ Appetite stimulant
❖ Other drugs
➢ Lysergic Acid
Diethylamide- synesthesia
➢ PhencyClidine - violence
➢ Ecstasy- aggression (sex)
■ Parkinsons (less
tremors)
■ Glaucoma