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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 reductionHealth Teachings/Community Teachings/Community DemographicsSupport SystemAccident Prevention
2.) Secondary Lessen the duration of mental illness (ill)
Ex. Suicide PreventionCrisis Intervention/ Treatment & DiagnosisProviding Psychotherapy & Milieu Therapy
3.) Tertiary Function to become independent
Ex. Rehabilitation Centers/ Al anonRelapse Avoidance
F. Stages Of Interaction
1st Stage: OrientationAssessment 2nd Stage: WorkingEstablishment of Trust Problem Solving Tell Patient of Termination Discussion 3rd Stage: Termination Set contract Patient is mostly cooperative SummarizeEvaluation Say Goodbye Patient is resistant Grief-Anger (Focus of RN)
Pt. violent/suicidalI. MENTAL HEALTH ----- A state of mind
6 Concepts In Mental Health:
Created by Niňa E. Tubio 1
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 goalsresolved through
a. Double Approach = 2 + goalsb. Double Avoidance = 2 goalsc. Approach-Avoidance = (+) & (-) outcome Ex. Developmental Task
II. PERSONALITY DEVELOPMENT:
*Our beliefs & thoughts influence our feelings & consequently manifests as behavior.
BELIEFS FEELINGS BEHAVIOR Create the
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
Created by Niňa E. Tubio 2
- 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
D Operates on “PLEASURE PRINCIPLE” IMPULSIVE Part Instinctual drive: “Eat, urinate, have sex”WANT TO Avoidance of pain, All “I”
Ex. Babies are all ID: “I want it, I want 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 valuesWhat makes you a perfectionist, rigid & righteous
Ex. I should not eat yet…..Function:
1. Inhibit the ID impulse
Operates on “REALITY PRINCIPLE”GO In touch with realityXECUTIVE The self, self-identityArbiter
Develops 6 monthsFunctions:
1. Higher Functions: memory, orientation, decision-maker
2. Integrator of Personality: mediator bet. the Id & Superegobetween self & environment
3. It will tolerate frustrations4. 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.
EGO EGO
ID is dominant; needs a superego (conscience) SUPEREGO is dominant; needs an IDCharacteristic of: Characteristic of:
MANIC OBSESSIVE-COMPULSIVEANTISOCIAL (Serial-killer) ANOREXIA NERVOSA
Created by Niňa E. Tubio 3
IS
E
ID
SUPEREGO
SUPEREGO
ID
NARCISSISTIC PERFECTIONIST, RIGID
3.
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
C. THE THEORY OF DREAMS Resides in the unconscious
D. THE THEORY ON LEVELS OF AWARENESS
3 Levels of Awareness:> Highest level of Awareness> Contains all experiences that can be recalled voluntarily
> “Tip Of The Tongue”; Deja Vu> Experiences that partly forgotten & partly remembered
> Forgotten> Experiences that cannot be recalled 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 mindExcept the ego when dealing with reality----resides on the ---conscious
E. THE PSYCHOSEXUAL THEORY
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:
Created by Niňa E. Tubio 4
ID SUPEREGO
CONSCIOUS
PRE-CONSCIOUS(Sub-conscious)
UNCONSCIOUS
Repression – Unconscious forgetting of an anxiety-provoking event
Suppression – Conscious forgetting of an anxiety-provoking event (voluntary)
- The only conscious defense mechanism
Successful CleanOrganizedObedient
P
Overeating 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: PunishmentCleanlinessHabit-training Stage
Residuals Developed: Perfectionist, Rigid, Righteous, Collectors & Hoarders
Problems: Strict Toilet TrainingToo much punishment w/ Toilet-training result to a child who is:
Anal Retentive Anal Expulsive(Obsessive-Compulsive) (Antisocial)
3. PHALLIC STAGE 3 years – 6 years old
HALLIC
ENIS ARENT RE - SCHOOLER
Focus: Genitals------Penis only Development of Gender Identity Sense of Being Masculine/Feminine 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
Both complexes resolved thru
Created by Niňa E. Tubio 5
NarcissisticStems from being deprived & neglected as a child
Regression Going to an earlier developmental stage
Good mother Bad mother
DirtyDisorganizedDisobedient
SE SE
SE
Oedipus Complex(boy loves mommy)
Identification(boy imitates daddy)
Boys-“Castration fears”
Electra Complex(girl loves daddy)
Identification(girl imitates mommy)
Girls-“Penis Envy”
Fixation Stopping in a certain stage of Development
R
Identification To parent of the same sex(Role Identification)
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
EADING W ITING
A ITHMETIC
Residuals Developed: School Dropout
5. GENITAL STAGE 12 years and above (Gising na ulit ang sexual energy)
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, Alcoholism2. ERIK ERICKSON------- Psychosocial Theory Of Development
Considered the “Social Factors” Man as a Social Being Person play different roles & as we play them, we achieve something
PSYCHOSOCIAL STAGES OF DEVELOPMENT
Stage Freud (+) (-) Factor Significant Person
0-18 months(Infancy)
Oral Trust( Friendly/ Affectionate)
(Self-Confidence)
Mistrust(Withdrawn/Suspicious)
Feeding Mother
18 months – 3 years
(Toddler)
Anal Autonomy (Self-Determination)
(Independence)
Shame & Doubt (Overtly Compliant)
Toilet Training“No,No”
“My”
Parents
3 – 6 years(Pre-Schooler)
Phallic Initiative(Responsible)
(Role Identification)Initiate the 1st step
Guilt(Denial, Restrictions)
Anger To Self
Independence“Teach The
Child”
Family
Created by Niňa E. Tubio 6
Sublimation – placing sexual energies (feelings) toward more productive endeavors
G
6-12 years(School)
Latent Industry(Competition) (Cooperative)
“Sx of High Self-Esteem”
Inferiority(Social Loner)
(School Drop-out)
School“Who Am I” based on
beliefs, selects & become who you are along w/ your peers
TeacherPeer
12 – 20 years(Adolescence)
Genital Identity(Self-Actualized)(Self-Direction)
Role Confusion(Identity Crisis)
Peers(Major factor in
the dev’t of beliefs
Opposite Sex
20-25 years(Young Adult)
Intimacy(Commitment)
Isolation(Relationships/Jobs on
Temporary Basis)
Love Husband/WifeChildren
25-45 years(Middle Adult)
Generativity(Productivity)
“Sharing”
Stagnation(Selfish, Self-Centered)
“No Learning”
Parenting“Sharing beliefs w/ children”
ChildrenGrandchildren
45 & Above(Late Adult)
Ego Integrity(Worthiness)
(Completeness)
Despair(Hopeless, Unworthy)
(Fear of Death)
Reflection Husband/WifeBest 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
Created by Niňa E. Tubio 7
> Continuous Improvement of Self> Low self- esteem: Give Task
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
MotivationStages:
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 Development of lasting relationship----based on security
7. Adulthood-----------------22 y/o & above Achievements
Created by Niňa E. Tubio 8
SELF-ACTUALIZATIONSELF- ESTEEM
LOVE & BELONGINGNESSSAFETY & SECURITY
BASIC PHYSIOLOGICAL NEEDS
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, LanguageOccipital Lobe = VisionTemporal Lobe = Hearing, SmellParietal 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
Brain (Alert) Sympathetic Parasympathetic (Relax)
Spinal cord ♥ HR ↑ ↓
RR ↑ ↓ Motor Nerves
GI ↓ dry mouth ↑ moist mouth constipation diarrhea
GU ↓ retention ↑ frequency Acetylcholine – “on” switch of muscle(transmits message to the muscle) Neuro Epinephrine/ Acetylcholine
Created by Niňa E. Tubio 9
Ach
Transmitter Norepinephrine Synapse Pupils Midriasis Myotic
Blood Vessel Vasoconstriction VasodilatationBP 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
DEFENSE MECHANISMS
Displacement Transfer of feelings to less threatening object/person rather than the one who provoked it
UnacceptableEx. “ Boss shouts at you, you shout to your subordinate”
Denial Failure to acknowledge an unacceptable trait or situation or realityEx. “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)
Created by Niňa E. Tubio 10
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 experienceEx. “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 oneConversion Repression. Anger repressed & converted to physical symptoms
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 selfEx. Amnesia, Rape or traumatic experiences Unconscious separation of certain parts or functions of personality
Alteration in--------MemoryIdentityConsciousness
To reduce/avoid anxietyCategories:
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
VI. CONCEPT OF NEUROSES & PSYCHOSES
Created by Niňa E. Tubio 11
Neuroses Psychoses
1. Maladaptive emotional state 1. Disturbance of the mind2. Reality is present 2. No reality3. Ego in the conscious 3. Ego in the unconscious4. Behavior is socially acceptable 4. Behavior is appropriate
Core Symptom: Anxiety Core Symptom: Hallucination, Illusion, Delusion
Tx: Minor Tranquilizer Tx: Major TranquilizerEx. Valium, Ativan Ex. Thorazine, Haldol
VII. THERAPEUTIC COMMUNICATION
THERAPEUTIC COMMUNICATION TECHNIQUES
THERAPEUTIC NON-THERAPEUTIC
Offering Self“I’ll sit with you”“I’ll stay with you”
Ignoring patient’s feelings or emotions“Don’t worry be happy”
Silence (giving patient time to think)
False Reassurance“Everything’s going to be fine”
Making observations“You seem sad”
Ignoring the client
Active Listening Nodding, establish eye contact, leaning forward
Changing the subject
Exploring questionsWho, what, where, when, how
Asking “why?”Putting client on the defensive
Broad Opening“How are you today?”“How are things going today?”
Making value-based judgmentsPrejudicial, use of adjectives“Nice weather today”
General leads“Go on. I’m listening.”“ And then what else?”
Flattery“You are the most beautiful …”
RestatingClient: “I’m sad.”Nurse: “You’re sad?”
Advising“You should do this.”“In my opinion…”
Refocusing“ We were talking about the exam….” Commanding client
Focusing“Tell me more about this…” Arguing with the patient
Clarification “What do you mean by plooplank?” Do not impose your opinion
Created by Niňa E. Tubio 12
P D S
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
MILD MODERATE SEVERE PANIC
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 CopingPowerlessnessImpaired Skin Integrity
Created by Niňa E. Tubio 13
PERCEPTUAL
FIELD
Mild+1
Moderate+2
Severe+3
Panic+4
PLANNING/ IMPLEMENTATION: ↓ level of anxiety↓ level of environmental stimuli
Relaxation techniques (Psychophysiology)
EVALUATION: Effective individual copingB. 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 DisorderSocial Phobia - Fear of public
3.) POST TRAUMATIC STRESS DISORDER (PTSD)
Trauma Disasters Rape War (not forever) Others
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:
Created by Niňa E. Tubio 14
Victims Survivors
Flashbacks : > 1 monthNightmares
ANXIETY
“I am sick”
Malingering(Pretending)
Somatoform(Unconscious)
Psychosomatic Disorders(Real pain/ real Sx, ) illness
5.) SOMATOFORM DISORDERS
Unconscious Not pretending but no organic basis Major
Sign:
Affects the 3 system
6.) PSYCHOSOMATIC DISORDERS
Psycho physiologic Real illness, real Sx & pain with organic basis
Physiology:
Decreased O2 supply----cells die
7.) OBSESSIVE-COMPULSIVE DISORDER (OCD)
Physiology:
Created by Niňa E. Tubio 15
SOMATOFORM(unconscious)
Nervous SystemCONVERSION
La belle difference(Emotional detachment)
Loss of Sensory/Motor FxS &Sx real
HYPOCHONDRIASISMinor discomfort interpreted
as major illness
BODY DYSMORPHIC DISORDER
Illusion of structural defectsS &Sx not real
DOCTOR HOPPINGFavorite pastime of people suffering from this disorder
↑ ANXIETY
SNS PNS
↑BPHypertension
Vasoconstriction Bronchoconstriction
Cerebral ArteryMigraine
Left Gastric Artery
Breakdown of mucosal lining-----ulceration
Asthma
Stress ulcer
NURSING FOCUS: Client’s Feelings (↓anxiety leads to ↓symptoms)
Beliefs/Thoughts reflect into feelings
Factors: If disturbed thoughts Anxiety
Obsession (Persistent Thoughts) Anxiety (Root of Anxiety)
Do something to relieve anxietyAction : Compulsion
Persistent Behavior & Action
↓ anxiety
Reasons when compulsion becomes negative:1. Interferes with ADLs2. Harms self & others
8.) PHOBIA Irrational fear
Etiology: Prior knowledge Ex. Tire will cause burningExperience Ex. Trauma in past related to feared object
Intervention: REMOVE stimulus (object of fear) to ↓ anxiety (Immediate intervention)
Increased stimuli = ↑ anxietyDecreased 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 state2. Free Association----------Ideas shared to psychoanalyst3. Catharsis--------------------Free to express feelings4. Transference---------------Patient feels something for psychoanalyst5. Counter transference-----Rn feels something for patient
IX. EATING DISORDERS
ANOREXIA NERVOSA & BULIMIA NERVOSA
ANOREXIA BULIMIA
Created by Niňa E. Tubio 16
Diet, diet, diet Eating Pattern Eat, Eat…induce vomiting
Underweight, < 85% of body weight Weight Normal weight
3 months amenorrhea Menstruation Irregular menstruation
Failure To Recognize Problem Knowledge Knows the Problem But Ashamed & Embarrassed
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
SCHIZOID Avoids people, Do not care about people & believes he can stand on his ownDetachment from social relationships Avoids activities & group more concerned with thingsNo enjoyment: Limited range of emotional expression in interpersonal settings
PARANOID Suspicious
Created by Niňa E. Tubio 17
NURSING CONSIDERATIONSBulimic induces vomiting & tends to abuse laxatives
Assess for:Dental caries
Wounded knucklesVomiting - Risk for metabolic alkalosisDiarrhea – risk for metabolic acidosis
NURSING ALERT Most fatal complication: ARRHYTHMIAS
Violent
SCHIZOTYPAL Acute discomfort in relationshipsEccentric behavior
Cluster BANTISOCIAL Breaks the law
Usually charming, wittyAs kids, were usually cruel to animals, steals, lieAs Adults, drug addicts-drives fast-unsafe sex-thrill seekerAre slick talkers
BORDERLINE Loves to split groupsLikes to keep sparesAfraid of being aloneManipulativeSelf-mutilationSuperficial Relationships
HISTRIONIC Attention-SeekingExcited, dramatic Manipulative
NARCISSISTIC “I love myself”Insensitive, ArrogantSelf-absorbedExaggerated
Cluster C
AVOIDANT Avoid people & groupsFears criticism, ↓ Self-esteemHave a talent but no confidence
DEPENDENT “Can’t live without you”↓ Self-EsteemPoor decision-making skills
OBSESSIVE-COMPULSIVE OrganizedConstancy in EnvironmentPerfectionists------Provide time to do rituals
OTHER CATEGORIES:
PASSIVE-AGGRESSIVE Always says “yes” but resistance is hiddenDEPRESSIVE Pattern of depressive cognitions & behaviors in a variety of context
NURSING INTERVENTION TO ALL: Improve Interpersonal RelationshipsBuild 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
Created by Niňa E. Tubio 18
“My life is an empty glass”
(+)fill
friends
( - )suicidal
SplittingLabile affect
(sudden change of mood)
Physiology: “ON” switch “OFF” switch
OTHER SIDE EFFECTS OF ANTIPSYCHOTIC MEDICATIONS:
PhotosensitivityTeach patient to use sunscreen, wide-brimmed hat when going out
Agranulocytosis (↑ monocytes, ↑ lymphatic)Teach client to report SORE THROAT (1st sign of Blood Dyscrasia)
Created by Niňa E. Tubio 19
↓Dopamine↓ACH
↑Dopamine
ACH D
ACH
D
↑ACH↑ACHD
ACHParkinson’s Schizophrenia
↓Dopamine
D
ACH
Antipsychotic agents → ↓DopamineClient manifest Parkinson-like symptoms known as
EXTRA PYRAMIDAL SIDE EFFECTS (Voluntary mov’t of the skeletal muscles) (↓D & ↑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) Oculogyric crisis (fixed stare) Opisthotonus ( arched back)
T ardive Dyskinesia (irreversible effects) d/t ↑ Adenosine Triphosphate
Lip smacking Tongue protrusion Cheek puffing
N euroleptic Malignant Syndrome or NMS Hyperthermia, Unstable BP, ↑ CPK, Diaphoresis, Pallor A medical emergency, discontinue drug
Give ANTICHOLINERGICS to treat EPS
Except Tardive Dyskinesia
↑ACH
DACH
ANTICHOLINERGICS A kineton A rtane Benadryl Cogentin
DOPAMINERGICS Parlodel Larodopa Symmetrel Eldepryl
Anti-Psychotic & Anti-Cholinergic Both given to Schizophrenia to
balance the effect
A
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
FFECT External manifestation (feelings & emotion) MBIVALENCE Pull between 2 opposing forces UTISM Self-absorbed, Trapped in own world SSOCIATIVE LOOSENESS Unrelated ideas
4 THINGS TO ASSESS IN SCHIZOPHRENIC PATIENTS
Assess Content of Thought Hallucinations/ Illusions Suspicious Suicidal
Nsg Dx Disturbed Thought Processes Disturbed Sensory Perception
Risk for Other-Directed Violence
Risk for Self-Directed Violence
Planning/ Implementation
Present RealityProvide Safety
Present RealityProvide Safety
Present RealityProvide Safety
Present RealityProvide Safety
Evaluation Improved Thought Processes Improved Sensory Perception
Minimize/ Eliminate risk for other-directed violence
Minimize/ Eliminate risk for self-directed violence
B. SYMPTOMS
S & Sx OF SCHIZOPHRENIA 2 Types
C. TYPES OF SCHIZOPHRENIA
Created by Niňa E. Tubio 20
Types Of Affect
1. Appropriate2. Inappropriate3. Flat (none)4. Blunt (incomplete)
POSITIVEHyperactive
SociableTalkativeRestless
Queen of the WorldFlight of ideas
(Hallucinattion,Illusion, Delusion)
NEGATIVEHypoactiveWithdrawn
QuietFlat Affect
ApathyPoverty of words
SCHIZOPHRENIA
D. THOUGHT PROCESS DISTURBANCE
Vs.
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 21
FLIGHT OF IDEASFragmented thoughts;
moving one unconnected topic to another
“The sun is shining. The mouse is on the mat. Here is the bag.”
- New topics- No connection
LOOSE ASSOCIATIONS-Stringing together of
unrelated topics with a vague connection
“I am going home. The home of the brave. The brave little Indian boy. Little boy blue…” - Use of same words to different sentence
DISORGANIZED Inappropriate affect
(sad but smiles) Flat affect Disorganized speech/manner (flight of ideas) Hebephrenic (giggling) (+) and (-) symptoms
CATATONIC Ambivalence Waxy flexibility “No” (Rebel) Negativism
PARANOID Uses Projection
Problems with:
Mistrust-------Suspicious
N.I.1. Develop Trust: Orientation2. One-to-one interaction3. Short but frequent visits4. Foods in sealed container Meals wrapped5. Consistent Approach
Scared/Withdrawn/Violent
N.I. 1. Keep door open 2. Don’t touch patient
3. Establish Eye contact4. Maintain 1 arm distance5. Have visibility: stand halfway6. Stay near door not window7. Call for reinforcement 8. Calm & Firm
RESIDUAL No more (+) or (-) Sx Social Withdrawal Withdrawn
UNCLASSIFIED or UNDIFFERENTIATED Mixed
classifications Cannot be
classified anymore
P
DA
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
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
ALLUCINATIONS
CKNOWLEDGMENT“I know the voices are real to you…”
EALITY ORIENTATION----------Present reality“But I don’t hear them.”
IVERSION“Let’s go to the garden.”
IRECTIVE
XII. ALZHEIMER
nomia Don’t know name of objectgnosia Problem with senses (smell, taste , hear, touch)
Created by Niňa E. Tubio 22
HAR
Auditory hallucinations are common. IMPORTANT: Also ask what the voices
are saying because 10% of schizophrenic clients are suicidal.
D
phasia Can’t say itpraxia Can’t do it
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 affectConsistent movementNeat, OC, Wants constancy
BEHAVIOR RepetitiveRitualistic
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
Created by Niňa E. Tubio 23
Impaired Social Interaction ------cannot form IPRSelf-mutilation ------cannot express anger, turned it inwardRisk for Injury
PLANNING/ IMPLEMENTATION:
Use Maslow’s Hierarchy of NeedsPromote constancy & safetyEXPRESSIVE THERAPY----uses art, music, literature, poetry
Purpose: ↓ risk for injury, improved social interaction, able to express feelings
EVALUATION: Enhanced CommunicationImproved Social InteractionSafety
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 ANTISOCIALResidual ADHD may not be antisocial
Onset: 7 years old & belowDuration: 6 months & aboveSettings: Must appear in 2 (home & school)
ASSESSMENT:
APPEARANCE Usually dirty
BEHAVIOR ClumsyHyperactive
Impatient, Easily Distracted
COMMUNICATION Talkative, Blurts out in class
Nx Dx: Risk for InjuryImpaired Social Interaction
PLANNING/ IMPLEMENTATION
MILIEU THERAPY
Created by Niňa E. Tubio 24
S
B
Tructure ----Provide place to study,eat,play,bathChedule ----Time for everythinget limitsafety
EVALUATION: Minimize risk for injuryImproved social interactionSafety
3. MENTAL RETARDATION
Levels Of Mental Retardation:
Profound Severe Moderate Mild Borderline Normal IQ 20 35 50 70 90 110
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
Burns Bruises Bone Fractures (Bungi) Body of Evidence should not be lost ( Don’t bathe child, Don’t brush teeth) BANTAY BATA 163
Created by Niňa E. Tubio 25
Medical Mgt: RITALIN
↓ Glucose ↑ Glucose
↓ Frontal lobe ↑ Frontal lobe
↓ judgment ↑ judgment
S/Sx of ADHD
Ritalin ( a stimulant) Given after meals to prevent loss of appetite Last dose given 6˚ hs Don’t give at bedtime ---- will cause insomnia
Compensation: S/Sx: flamboyant, heavy make-up, loud voice
XV. MOOD DISORDERS
A. BIPOLAR 2 poles------ Happy (dominant) & Sad Too self-actualize
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:
Created by Niňa E. Tubio 26
↓ Self -Actualized
Impaired Social Interaction
Risk For Injury/ Other-Directed Violence
↓ Eat ↓ Sleep Hyperactive ↑ Sex
Manifested by Defensiveness & Compensation↑Self Esteem by giving TASK
Caregiver Role: Train / Safety
Impulsive so ensure safetyLock doors & windowsPlace in room with low stimulusNot with other manics or depressives
Manic clients usually masturbate because of worrying
“Tell pt. it is not allowed”
↓ Self -esteem
iidneysK
N ausea, vomiting, diarrheaa ( ↑ sodium intake to correct FVD) (Na: 135-145 mEq/L)
iidneys
Finger foods Private room ↓ anxiety
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
Needs a mood stabilizing agents------ LITHIUM & GROUP THERAPY
↑ NE
LITHIUM - drug of choice
3 Signs of Lithium Toxicity
Created by Niňa E. Tubio 27
L
I
T
H
I
U
M
evel : 0.5 – 1.5 mEq/ dL
ncrease urination
remors, fine hand
ydration 3 l/day
ncrease “PUPU”
outh, dry *
* Lithium absorbs water
Check first before beginning therapy (BUN, Creatinine)
Only 90% absorb by kidneys
If level is near 2.5- 3 mEq/L Ataxia Mental Confusion
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
5
4
3
2
1
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
S/E: Headache, Dizziness
Created by Niňa E. Tubio 28
↓ Self –esteem
Withdrawn
Risk for self-directed violence
↕ eat ↕ sleep hypoactive ↓ sex
Be sensitive to client’s needs
Stay with client
Give Simple TASK
↓ Self –Actualization
s
Temporary Memory loss (distinct Sx) Rn reorient
LEAD TO: SUICIDE
SUICIDAL CUES
ALONESUICIDE TRIAD:
LOSS OF
SPOUSE JOB
Who Will Commit Suicide?
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
O rganized plan----greater risk
N o family
S ickness, Terminal
MANAGEMENT OF SUICIDAL PATIENT:
irect Question/Approach“Do you plan to commit suicide?”
rregular nterval
ndorsementarly AM
XVI. SUBSTANCE ABUSE
Created by Niňa E. Tubio 29
Verbal“I won’t be a problem anymore”“This is my last day on earth”“I’ll soon be gone.”
Non VerbalGives away valuablesSudden change in mood
D
I
E
Visit frequently but should not be predictable
Most suicides are done in the early morning & during endorsement
Close Surveillance
Suicide Area: Hospital Majority happens on a weekend from 1-3 AM Sunday Weekend----less personnel Early AM----everyone is asleep
INE
Types of ADDICT:
1. Nervous 2. Depressed
Tremors • Sits down on chair Give DOWNERS • Give UPPERS
AsleepBradypnea
BradycardiaPupils constrictHypotensionComaAsleepWeight Gain*Constipation* GU Retention
Morph Code Hero
STOP UPPERS Antidote: NARCAN (narcotic antagonists)
Alcohol Overdose Coma Tremors Fatigue
Morphine Overdose Bradypnea
Crash Syndrome
Depressed
Suicide
OVERDOSE vs. WITHDRAWAL
Created by Niňa E. Tubio 30
AlcoholBarbituratesOpiatesNarcoticMarijuana
DOW NERS UPPERS
CocaineHallucinogenAmphetamines
Awake Psychological sense of well-beingTachycardia TachypneaPupils dilateDry mouthHypertensionSeizuresWeight loss (Thin)*Diarrhea
EUPHORIA
Created by Niňa E. Tubio
OVERDOSE WITHDRAWAL
Alcohol↓ HR↓ BP↓ RR
LOC (coma)
↑ HR↑ BP↑ RR
↑seizures
Cocaine↑ HR↑ BP↑ RR
↑seizures
↓ HR↓ BP↓ RR
LOC (coma)
31
Sx Of OVERDOSE to 2 Types:
1. Identify if drug is Upper or Downer2. Check Effect3. Sx of Withdrawal
Sx of WITHDRAWAL:
1. Know if drug is Upper or Downer2. Check for opposite effect & Sx
D ELIRIUM TREMORS Tremors, Hallucinations, Illusions
AB1 VIT. DEFICIENCY(Thiamine)
SNS stimulationWithin 24-72˚ of withdrawal Provide well-lit room to avoid
hallucinations
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:
a. Physical – tremors, tachycardia, restless b. Psychological Carving
Tolerance Increased Drinking tolerated by the body
MANAGEMENT
VOIDs ALCOHOL VERSION THERAPYLCOHOLICS ANONYMOUSNTABUSE (Disulfiram)
Problems of Alcoholics:
Created by Niňa E. Tubio 32
ALCOHOL
BLOCKOUT
CONFABULATION
ENIAL EPENDENCE
ENABLING or CODEPENDECY
Awake but unaware
Inventing stories to increase self-esteem
“I am not an alcoholic”“I can’t live without you”
Significant other tolerates abuser
D
Ask 1st the time of last alcohol intake before giving Anatabuse:
There should be a12 – HOUR INTERVAL
NEVER take alcohol with antabuse OR ELSE Nausea &
VomitingHypotension
C OMPLICATIONS
Monitor for:WERNICKE’S ENCELOPATHY
(motor problems)KORSAKOFF’S PSYCHOSIS
(memory problems)
F &
ORMICATION
AMILY THERAPY
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
XII.
THE AUTONOMIC NERVOUS SYSTEM
(2 Neurotransmitters) Epinephrine/ Norepinephrine excite the SNS
Created by Niňa E. Tubio 33
PHARMA
MOMENTS
ANTI-ANXIETY AGENTS
V alium M iltown L ibrium E quanil A tivan V istaril S erax A tarax T ranxene I nderal B uspar
(Used also for Alcohol Withdrawal) “VLAST ME VAIB”
Feeling of “bugs crawling under the skin”
SELF-HELP vs. GROUP THERAPY Nurse as organizer Nurse as facilitator e.g. Alcoholics Anonymous
DEPENDENCE
Gamma aminobutyric acid (GABA) inhibits SNS (Stops)
ANTI-ANXIETY AGENTS GABA
E/ NE
All Medications Taken On Full Stomach-------except Anti-Anxiety
↑ Serotonin ↓ Serotonin
Give
ANTIDEPRESSANTS ------------------taken on full stomach
Created by Niňa E. Tubio 34
ANXIETY
RELAXED
ANTI-ANXIETY AGENTS
↑ GABA*Effects of GABA:
DrowsinessOrthostatic
Hypotension
*Contraindications No coffee
No alcoholDo not drive
ANTICHOLINERGIC
ConstipationRetentionDry mouth
Blurred vision WITHDRAWAL
If ABRUPT Withdrawal:Rebound phenomenon
Within 1 wk
Seizures
Recommended:Gradual WithdrawalTapered dose
To prevent Orthostatic Hypotension: S it D angle S tand gradually
↑ Serotonin
S afestS ide effects lowR I to 4 wks
Selective Serotonin Reuptake Inhibitors
“PPZ”
↑ Serotonin & NE
T wo to 4 wks wo neurotransmittersC A * Higher incidence of side effectsTricyclic Antidepressants
“AANTSAVE”
↑ Serotonin, NE & Dopamine
M onoA mineO xidase I inhibitors
*2-6 wks effectMAO destroys
serotonin; ↓MAO will ↑serotonin
ANTI-DEPRESSANTS
A sendin A ventyl N orpramin V ivactil T ofranil E lavil S inequan P rozac (ssri) A nafranil P axil (ssri)
Z oloft (ssri)
MONOAMINE OXIDASE INHIBITORS ( MAOIs) M PLAN Marplan N DIL Nardil P NATE Parnate
ANTI-PSYCHOTICS
S tellazine C lozaril S erentil M ellaril T horazine H aldol T rilafon P rolixin
SNS Effect-------2-4 wks
ANTI-PARKINSON AGENTS “CAPABLES” C ogentin B enadryl A rtane L arodopa P arlodel E ldedpryl A kineton S ymmetrel
AR
With MAOIs , AVOID TYRAMINE-RICH FOODS or else HYPERTENSIVE CRISIS Diaphoresis
2 CLASSIFICATION
ANTICHOLINERGICS DOPAMINERGICS ABC PLSE
A kineton, Artane P arlodel B enadryl L arodopa C ogentin S ymmetrel
E ldepryl
Created by Niňa E. Tubio 35
Tyramine rich foods:
A vocado F ernented foods ged cheese P icklesB eer reserved foodsC hocolate S oy sauce
TRANQUILIZERS
Produces emotional relaxation/calmness
2 TypesMinor Major
Anxiolytics (ANTI-AXIETY) Neuroleptics (ANTI- PSYCHOTIC)
Valium ThorazineAnxionil HaldolAtivan SerenaceTranxene MellarilXanax TrilafonSerax ProloxinLibrium ModecateEquanil ClozarilMiltown Risperdal
Action: ↓ Anxiety ↓ Dopamine
CNS Depressant Produces EPS
Acts on Limbic system Responsible for alertnessS/E: Habit-forming, Produces Drug Tolerance
Created by Niňa E. Tubio 36
L I T H I U M
Always ONEPS/E
AkathisiaAkinesiaDystoniaTardive
DyskinesiaNMS
Ach
NED
DrowsyX alcoholX coffeeX drive eqpmtOrthostatic Hypotension
Anticholinergic S/E
ConstipationDry mouthBlurred vision
E/NE
RELAXED
ANXIETY
VLASTMEVAIB
↑GABA
MANIASCHIZOPHRENIA
gradual
↓D
S/EN ausea
Vomiting Diarrhea N a ↑
KD
AnticholinergicABC
Constipationretention
DopaminergicPLSE
DiarrheaFrequency
SSTTCMHP
ANTI-DEPRESSANTS
Anticholinergic S/E
ConstipationRetentionMale Erectile Dysfuncion
↑ Serotonin only
↑ Serotonin /NE
SSRIPPZ
TCAANTSAVE
ANTI-PSYCHOTICSANTI-ANXIETY
Health Teaching To All: Drug Compliance
Table 1. Somatoform Disorder (DSM-IV)
Somatoform Disorder(DSM-IV)
General DescriptionTemporal &
Other Requirements
Exclusions By Other Psychiatric Illness Other Exclusions
Somatization Disorder
History of many physical complaints; 4 pain sites or functions: 2 nonpain GI, 1 sexual or reproductive, 1 pseudoneurologic
Onset <30 y of age
Not specified Not explained by general medical condition or substance effect
Undifferentiated somatoform disorder
One or more physical complaints
Duration >6 mo Not accounted for by another mental disorder
Not explained by medical condition or pathophysiologic mechanism
Conversion Disorder
Symptoms affecting voluntary motor and/or sensory function suggesting neurologic and/or medical condition
Associated psychological factors
Not limited to pain or sexual dysfunction; not exclusively during course of somatization disorder; not better accounted for by other mental disorder
Not intentionally produced or feigned; not explained by other neurologic or medical condition, substance effect, or culturally sanctioned behavior and/or experience
Pain Disorder Pain is predominant focus; severe enough to warrant clinical attention
Psychological factors in important role
Not better accounted for by mood, anxiety, or psychotic disorder; does not meet criteria for dyspareunia
Not specified
Hypochondriasis Preoccupation with fear of having or idea that one has serious disease based on misinterpretation of bodily symptoms;
Duration >6 mo Not exclusively during obsessive compulsive disorder (OCD), generalized anxiety, panic disorder, major depressive episode,
Not of delusional intensity; not restricted to circumscribed concern about appearance
Created by Niňa E. Tubio 37
DEPRESSION
↑ all
↓SerotoninMAOIsMNP
NO to Tyramineor else
HYPERTENSIVECRISIS
persistent fear and idea despite medical evaluation and reassurance
separation anxiety, or other somatoform disorder
Body Dysmorphic disorder
Preoccupation with imagined defect in appearance or excessive concern about slight physical anomaly
Not applicable Not better accounted for by other mental disorder
Not specified
Somatoform disorder, not otherwise specified
Somatoform symptoms Can be <6 mo duration
Does not meet criteria for any other somatoform disorder
Not specified
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 38
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