PSYCHIATRIC NURSING Presented by: Dave Jay Sibi. Manriquez, RN

Introduction MENTAL HEALTH – balance in a persons internal life and adaptation to reality Mental ILL Health – state of imbalance characterized by a disturbance in a persons thoughts, feelings and behavior

MENTAL HEALTH – balance in a persons internal life and adaptation to reality

Mental ILL Health – state of imbalance characterized by a disturbance in a persons thoughts, feelings and behavior

Psychiatric nursing interpersonal process whereby the professional nurse practitioner ,through the therapeutic use of self (art) and nursing theories (science), assist clients to achieve psychosocial well being. Core : interpersonal process

interpersonal process whereby the professional nurse practitioner ,through the therapeutic use of self (art) and nursing theories (science), assist clients to achieve psychosocial well being.

Core : interpersonal process

Related Terms Mental hygiene measures to promote mental health , prevent mental illness and suffering and facilitate rehabilitation Main tool: therapeutic use of self It requires self-awareness Methods to increase self-awareness: Introspection Discussion Experience Role play

Mental hygiene

measures to promote mental health , prevent mental illness and suffering and facilitate rehabilitation

Main tool: therapeutic use of self

It requires self-awareness

Methods to increase self-awareness:

Introspection

Discussion

Experience

Role play

Assessment (psychosocial processes ) Appearance , behavior or mood Speech , thought content and thought process Sensorium Insight and judgment Family relationships and work habits Level of growth and development

Assessment (psychosocial processes )

Appearance , behavior or mood

Speech , thought content and thought process

Sensorium

Insight and judgment

Family relationships and work habits

Level of growth and development

Common Behavioral Signs and Symptoms

Disturbances in perception Illusion misinterpretation of an actual external stimuli Hallucinations false sensory perception in the absence of external stimuli PERCEPTION

Illusion

misinterpretation of an actual external stimuli

Hallucinations

false sensory perception in the absence of external stimuli

PERCEPTION

PERCEPTION

PERCEPTION

PERCEPTION

Disturbances in thinking and speech neologism – coining of words that people do not understand Circumstantiality – over inclusion of inappropriate thoughts and details Word salad – incoherent mixture of words and phrases with no logical sequence THINKING & SPEECH

neologism – coining of words that people do not understand

Circumstantiality – over inclusion of inappropriate thoughts and details

Word salad – incoherent mixture of words and phrases with no logical sequence

Verbigeration – meaningless repetition of words and phrases Perseveration – persistence of a response to a previous question Echolalia – pathological repetition of words of others Aphasia – speech difficulty and disturbance Expressive , receptive or global THINKING & SPEECH

Verbigeration – meaningless repetition of words and phrases

Perseveration – persistence of a response to a previous question

Echolalia – pathological repetition of words of others

Aphasia – speech difficulty and disturbance

Expressive , receptive or global

Flight of ideas- shifting of one topic from one subject to another in a somewhat related way Looseness of association-incoherent illogical flow of thoughts (unrelated way) Clang association – sound of word gives direction to the flow of thought THINKING & SPEECH

Flight of ideas- shifting of one topic from one subject to another in a somewhat related way

Looseness of association-incoherent illogical flow of thoughts (unrelated way)

Clang association – sound of word gives direction to the flow of thought

Delusion – persistent false belief, rigidly held Delusions of grandeur: special /important in a way Persecutory: threatened Ideas of reference: situation/events involve them Somatic: body reacting in a particular way THINKING & SPEECH

Delusion – persistent false belief, rigidly held

Delusions of grandeur: special /important in a way

Persecutory: threatened

Ideas of reference: situation/events involve them

Somatic: body reacting in a particular way

Jealous: thinking that their partner is unfaithful Erotomanic: person, usually of high status, is in love with the client Religious: illogical ideas about God and religion exhibited by extreme or extraneous behavior Mixed: combination of above without a predominant theme THINKING & SPEECH

Jealous: thinking that their partner is unfaithful

Erotomanic: person, usually of high status, is in love with the client

Religious: illogical ideas about God and religion exhibited by extreme or extraneous behavior

Mixed: combination of above without a predominant theme

Magical thinking – primitive thought process thoughts alone can change events Autistic thinking – regressive thought process; subjective interpretations not validated with objective reality Dereism – unorganized thinking THINKING & SPEECH

Magical thinking – primitive thought process thoughts alone can change events

Autistic thinking – regressive thought process; subjective interpretations not validated with objective reality

Dereism – unorganized thinking

Disturbances of affect Inappropriate – disharmony between the stimuli and the emotional reaction Blunted affect – severe reduction in emotional reaction Flat affect – absence or near absence of emotional reaction Apathy – dulled emotional tone AFFECT

Inappropriate – disharmony between the stimuli and the emotional reaction

Blunted affect – severe reduction in emotional reaction

Flat affect – absence or near absence of emotional reaction

Apathy – dulled emotional tone

Depersonalization – feeling of strangeness from one’s self Derealization – feeling of strangeness towards environment Agnosia – lack of sensory stimuli integration AFFECT

Depersonalization – feeling of strangeness from one’s self

Derealization – feeling of strangeness towards environment

Agnosia – lack of sensory stimuli integration

Disturbances in motor activity Echopraxia – imitation of posture of others Waxy flexibility – maintaining position for a long period of time Ataxia – loss of balance Akathesia – extreme restlessness MOTOR ACTIVITY

Echopraxia – imitation of posture of others

Waxy flexibility – maintaining position for a long period of time

Ataxia – loss of balance

Akathesia – extreme restlessness

Dystonia- uncoordinated spastic movements of the body Tardive dyskinesia – involuntary twitching or muscle movements Apraxia – involuntary unpurposeful movements MOTOR ACTIVITY

Dystonia- uncoordinated spastic movements of the body

Tardive dyskinesia – involuntary twitching or muscle movements

Apraxia – involuntary unpurposeful movements

Disturbances in memory Confabulation – filling of memory gaps Déjà vu – something unfamiliar seems familiar Jamais vu- something familiar seems unfamiliar Amnesia – memory loss (inability to recall past events) Retrograde-distant past Anterograde – immediate past Anomia – lack of memory of items MEMORY

Confabulation – filling of memory gaps

Déjà vu – something unfamiliar seems familiar

Jamais vu- something familiar seems unfamiliar

Amnesia – memory loss (inability to recall past events)

Retrograde-distant past

Anterograde – immediate past

Anomia – lack of memory of items

Dynamics of Human Behavior Behavior – the way an individual reacts to a certain stimulus Conflict – situation arising from the presence of two opposing drives Need - organismic condition that requires a certain activity

Behavior – the way an individual reacts to a certain stimulus

Conflict – situation arising from the presence of two opposing drives

Need - organismic condition that requires a certain activity

Dynamics of Human Behavior Personality totality of emotional and behavioral traits that characterize the person in day to day living under ordinary conditions; it is relatively stable and predictable.

Personality

totality of emotional and behavioral traits that characterize the person in day to day living under ordinary conditions; it is relatively stable and predictable.

FORMATION OF PERSONALITY TEMPERAMENT biological-genetic template that interacts with our environment. a set of in-built dispositions we are born with mostly unalterable our nature. CHARACTER the outcome of the process of socialization, the acts and imprints of our environment and nurture on our psyche during the formative years (0-6 years and in adolescence). the set of all acquired characteristics we posses, often judged in a cultural-social context. Sometimes the interplay of all these factors results in an abnormal personality

TEMPERAMENT

biological-genetic template that interacts with our environment.

a set of in-built dispositions we are born with

mostly unalterable

our nature.

CHARACTER

the outcome of the process of socialization, the acts and imprints of our environment and nurture on our psyche during the formative years (0-6 years and in adolescence).

the set of all acquired characteristics we posses, often judged in a cultural-social context.

Sometimes the interplay of all these factors results in an abnormal personality

THEORIES OF PERSONALITY DEVELOPMENT

Freud’s PSYCHOSEXUAL THEORY

Libido – inner drive Parts of body –focus of gratification Unsuccessful resolution - fixation Structures of personality Id: pleasure principle-instinct Ego: controls action and perception –reality principle Superego: moral behavior - conscience

Libido – inner drive

Parts of body –focus of gratification

Unsuccessful resolution - fixation

Structures of personality

Id: pleasure principle-instinct

Ego: controls action and perception –reality principle

Superego: moral behavior - conscience

0-18 m0s ;oral – mouth – trust and discriminating 18 mos. – 3 years ; anal – bowels – holding on or letting go Negativism and toilet training age 3 -6 years phallic ; genitals –exploration and discovery ( inc. sexual tension) Gender identification and genital awareness Oedipus and Electra complex Castration anxiety and penis envy

0-18 m0s ;oral – mouth – trust and discriminating

18 mos. – 3 years ; anal – bowels – holding on or letting go

Negativism and toilet training age

3 -6 years phallic ; genitals –exploration and discovery ( inc. sexual tension)

Gender identification and genital awareness

Oedipus and Electra complex

Castration anxiety and penis envy

6-12 years – latency (quiet stage) sexual energy diverted to play. Institution of superego: control of instinctual impulses 12 – young adult – genital ; reawakening of sexual drives –relationships Sexual maturation Sexual identity ,ability to love and work

6-12 years – latency (quiet stage) sexual energy diverted to play. Institution of superego: control of instinctual impulses

12 – young adult – genital ; reawakening of sexual drives –relationships

Sexual maturation

Sexual identity ,ability to love and work

Eric Erickson’s PSYCHOSOCIAL THEORY

0-12mos 1-3y 3-6 6-12 12-18 18-25 25-60 60 and above TRUST vs. MISTRUST AUTONOMY vs. SHAME & DOUBT INDUSTRY vs. INFERIORITY INITIATIVE vs. GUILT IDENTITY vs. IDENTITY CONFUSION INTIMACY vs. ISOLATION EGO INTEGRITY vs. STAGNATION GENERATIVITY vs. DESPAIR

0-12mos

1-3y

3-6

6-12

12-18

18-25

25-60

60 and above

TRUST vs. MISTRUST

AUTONOMY vs. SHAME & DOUBT

INDUSTRY vs. INFERIORITY

INITIATIVE vs. GUILT

IDENTITY vs. IDENTITY CONFUSION

INTIMACY vs. ISOLATION

EGO INTEGRITY vs. STAGNATION

GENERATIVITY vs. DESPAIR

INFANCY CONSISTENT MATERNAL –CHILD INTERACTION – TRUST INNER FEELING OF SELF WORTH HOPE

CONSISTENT MATERNAL –CHILD INTERACTION – TRUST

INNER FEELING OF SELF WORTH

HOPE

TODDLER ALLOW EXPLORATION PROVIDE FOR SAFETY “ NO, NO” – NEGATIVISM OFFER CHOICES / REVERSE PSYCHOLOGY TOILET TRAINING – 18 MOS.-BOWEL DAYTIME BLADDER: 2 yo NIGHTIME BLADDER: 3 yo REWARD W/ PRAISE AND AFFECTION INDEPENDENCE

ALLOW EXPLORATION

PROVIDE FOR SAFETY

“ NO, NO” – NEGATIVISM

OFFER CHOICES / REVERSE PSYCHOLOGY

TOILET TRAINING – 18 MOS.-BOWEL

DAYTIME BLADDER: 2 yo

NIGHTIME BLADDER: 3 yo

REWARD W/ PRAISE AND AFFECTION

INDEPENDENCE

PRE-SCHOOL PROVIDE PLAY MATERIALS SATISFY CURIOSITY TEACH AND REINFORCE(HYGIENE,SOCIAL BEHAVIOR) SIBLING RIVALRY WILLPOWER

PROVIDE PLAY MATERIALS

SATISFY CURIOSITY

TEACH AND REINFORCE(HYGIENE,SOCIAL BEHAVIOR)

SIBLING RIVALRY

WILLPOWER

SCHOOL AGE HOW TO DO THINGS WELL-SUPPORT EFFORTS CHUMS AND HOBBIES NEEDS TO EXCEL/ACCOMPLISH NEED FOR PRIVACY AND PEER INTERACTION COMPETENCE

HOW TO DO THINGS WELL-SUPPORT EFFORTS

CHUMS AND HOBBIES

NEEDS TO EXCEL/ACCOMPLISH

NEED FOR PRIVACY AND PEER INTERACTION

COMPETENCE

ADOLESCENCE MAKE DECISION,EMANCIPATION FROM PARENTS BODY IMAGE CHANGES NEED TO CONFORM BUT KEEP INDIVIDUALITY SELF - AWARENESS

MAKE DECISION,EMANCIPATION FROM PARENTS

BODY IMAGE CHANGES

NEED TO CONFORM BUT KEEP INDIVIDUALITY

SELF - AWARENESS

YOUNG ADULT COMMITMENT AND FIDELITY RESPONSIBILITY ACHIEVEMENT OF INDEPENDENCE

COMMITMENT AND FIDELITY

RESPONSIBILITY

ACHIEVEMENT OF INDEPENDENCE

MIDDLE ADULTHOOD SUPPORT-PERIOD OF ROLE TRANSITIONS MIDLIFE CRISIS ADJUSTMENT AND COMPROMISE MOST PRODUCTIVE AND CREATIVE ALTRUISM

SUPPORT-PERIOD OF ROLE TRANSITIONS

MIDLIFE CRISIS

ADJUSTMENT AND COMPROMISE

MOST PRODUCTIVE AND CREATIVE

ALTRUISM

LATE ADULTHOOD SELF ACCEPTANCE SELF WORTH WISDOM

SELF ACCEPTANCE

SELF WORTH

WISDOM

Jean Piaget’s COGNITIVE THEORY

0-2 SENSORIMOTOR REFLEXES IMITATIVE REPETITIVE BEHAVIOR SENSE OF OBJECT PERMANENCE AND SELF SEPARATE FROM ENVT. TRIAL AND ERROR RESULTS IN PROBLEM SOLVING

REFLEXES

IMITATIVE REPETITIVE BEHAVIOR

SENSE OF OBJECT PERMANENCE AND SELF SEPARATE FROM ENVT.

TRIAL AND ERROR RESULTS IN PROBLEM SOLVING

2-7Y PRE-OPERATIONAL SELF-CENTERED,EGOCENTRIC CANNOT CONCEPTUALIZE OTHER’S VIEW ANIMISTIC THINKING IMAGINARY PLAYMATE – SYMBOLIC MENTAL REPRESENTATION – CREATIVITY 2-4 PRE-CONCEPTUAL (PRE-LOGICAL) 4-7 INTUITIVE (UNDERSTANDING OF ROLES)

SELF-CENTERED,EGOCENTRIC

CANNOT CONCEPTUALIZE OTHER’S VIEW

ANIMISTIC THINKING

IMAGINARY PLAYMATE – SYMBOLIC MENTAL REPRESENTATION – CREATIVITY

2-4 PRE-CONCEPTUAL (PRE-LOGICAL)

4-7 INTUITIVE (UNDERSTANDING OF ROLES)

7-12Y CONCRETE OPERATIONAL LOGICAL CONCRETE THOUGHT INDUCTIVE REASONING (SPECIFIC TO GENERAL) CAN RELATE, PROBLEM SOLVING ABILITY REASONING AND SELF-REGULATION

LOGICAL CONCRETE THOUGHT

INDUCTIVE REASONING (SPECIFIC TO GENERAL)

CAN RELATE, PROBLEM SOLVING ABILITY

REASONING AND SELF-REGULATION

12-ABOVE: FORMAL OPERATIONAL THOUGHT Abstract thinking Separation of fantasy and fact Reality oriented Deductive reasoning Apply scientific method

Abstract thinking

Separation of fantasy and fact

Reality oriented

Deductive reasoning

Apply scientific method

Havighurst’s DEVELOPMENTAL TASKS

Baby to early childhood Right from wrong and Conscience Late childhood Physical skills, wholesome attitude, social roles Conscience morality and values Fundamental skills in academics Personal independence

Baby to early childhood

Right from wrong and Conscience

Late childhood

Physical skills, wholesome attitude, social roles

Conscience morality and values

Fundamental skills in academics

Personal independence

Adolescence Sexual social roles Relationships Independence and ideology Early adulthood Career Selecting a mate Finding Civic or social responsibility

Adolescence

Sexual social roles

Relationships

Independence and ideology

Early adulthood

Career

Selecting a mate

Finding Civic or social responsibility

Middle age Achieving Civic or social responsibility Adjusting to changes Satisfactory career performance Adjusting to aging parents Adjusting to parental roles Old age Adjusting to changes Establishing satisfactory living arrangements and affiliations

Middle age

Achieving Civic or social responsibility

Adjusting to changes

Satisfactory career performance

Adjusting to aging parents

Adjusting to parental roles

Old age

Adjusting to changes

Establishing satisfactory living arrangements and affiliations

Kohlberg’s MORAL DEVELOPMENT/ THINKING/ JUDGEMENT

PRE-CONVENTIONAL (0-6) PUNISHMENT AND OBEDIENCE OBEDIENCE TO RULES TO AVOID PUNISHMENT CONVENTIONAL ( 6-12 ) MUTUAL INTERPERSONAL EXPECTATIONS,RELATIONSHIPS AND CONFORMITY SOCIAL SYSTEM AND CONSCIENCE MAINTENANCE BEING GOOD IS IMPORTANT SELF RESPECT OR CONSCIENCE

PRE-CONVENTIONAL (0-6)

PUNISHMENT AND OBEDIENCE

OBEDIENCE TO RULES TO AVOID PUNISHMENT

CONVENTIONAL ( 6-12 )

MUTUAL INTERPERSONAL EXPECTATIONS,RELATIONSHIPS AND CONFORMITY

SOCIAL SYSTEM AND CONSCIENCE MAINTENANCE

BEING GOOD IS IMPORTANT SELF RESPECT OR CONSCIENCE

POST –CONVENTIONAL (12 – 18 Y) PRIOR RIGHT OR SOCIAL CONTRACT UNIVERSAL ETHICAL PRINCIPLE ABIDE FOR COMMON GOOD RATIONAL PERSON-VALIDITY OF PRINCIPLES-AND BECOME COMMITTED TO THEM INNER CONTROL OF BEHAVIOR UNDERSTANDING THE EQUALITY OF HUMAN RIGHTS AND DIGNITY OF HUMAN BEINGS AS INDIVIDUALS

POST –CONVENTIONAL (12 – 18 Y)

PRIOR RIGHT OR SOCIAL CONTRACT

UNIVERSAL ETHICAL PRINCIPLE

ABIDE FOR COMMON GOOD

RATIONAL PERSON-VALIDITY OF PRINCIPLES-AND BECOME COMMITTED TO THEM

INNER CONTROL OF BEHAVIOR UNDERSTANDING THE EQUALITY OF HUMAN RIGHTS AND DIGNITY OF HUMAN BEINGS AS INDIVIDUALS

Harry Stack Sullivan’s INTERPERSONAL THEORY

INFANCY NEED FOR SECURITY-INFANT LEARNS TO RELY ON OTHERS TO GRATIFY NEEDS AND SATISFY WISHES, DEVELOPS A SENSE OF BASIC TRUST, SECURITY AND SELF WORTH WHEN THIS OCCURS

NEED FOR SECURITY-INFANT LEARNS TO RELY ON OTHERS TO GRATIFY NEEDS AND SATISFY WISHES, DEVELOPS A SENSE OF BASIC TRUST, SECURITY AND SELF WORTH WHEN THIS OCCURS

TODDLERHOOD / EARLY CHILDHOOD CHILD LEARNS TO COMMUNICATE NEEDS THROUGH USE OF WORDS AND ACCEPTANCE OF DELAYED GRATIFICATION AND INTERFERENCE OF WISH FULFILLMENT

CHILD LEARNS TO COMMUNICATE NEEDS THROUGH USE OF WORDS AND ACCEPTANCE OF DELAYED GRATIFICATION AND INTERFERENCE OF WISH FULFILLMENT

PRE-SCHOOL DEVELOPMENT OF BODY IMAGE AND SELF-PERCEPTION ORGANIZES AND USES EXPERIENCES IN TERMS OF APPROVAL AND DISAPPROVAL RECEIVED BEGINS USING SELCTIVE INATTENTION AND DISASSOCIATES THOSE EXPERIENCES THAT CAUSE PHYSICAL OR EMOTIONAL DISCOMFORT AND PAIN

DEVELOPMENT OF BODY IMAGE AND SELF-PERCEPTION

ORGANIZES AND USES EXPERIENCES IN TERMS OF APPROVAL AND DISAPPROVAL RECEIVED

BEGINS USING SELCTIVE INATTENTION AND DISASSOCIATES THOSE EXPERIENCES THAT CAUSE PHYSICAL OR EMOTIONAL DISCOMFORT AND PAIN

SCHOOL AGE THE PERIOD OF LEARNING TO FORM SATISFYING RELATIONSHIPS WITH PEERS-USES COMPETITION,COMPROMISE AND COOPERATION THE PRE-ADOLESCENT LEARNS TO RELATE TO PEERS OF THE SAME SEX

THE PERIOD OF LEARNING TO FORM SATISFYING RELATIONSHIPS WITH PEERS-USES COMPETITION,COMPROMISE AND COOPERATION

THE PRE-ADOLESCENT LEARNS TO RELATE TO PEERS OF THE SAME SEX

ADOLESCENCE LEARNS INDEPENDENCE AND HOW TO ESTABLISH SATISFACTORY RELATIONSHIPS WITH MEMBERS OF THE OPPOSITE SEX

LEARNS INDEPENDENCE AND HOW TO ESTABLISH SATISFACTORY RELATIONSHIPS WITH MEMBERS OF THE OPPOSITE SEX

YOUNG ADULTHOOD BECOMES ECONOMICALLY, INTELLECTUALLY AND EMOTIONALLY SELF SUFICIENT

BECOMES ECONOMICALLY, INTELLECTUALLY AND EMOTIONALLY SELF SUFICIENT

LATER ADULTHOOD LEARNS TO BE INTERDEPENDENT AND ASSUMES RESPONSIBILITY FOR OTHERS

LEARNS TO BE INTERDEPENDENT AND ASSUMES RESPONSIBILITY FOR OTHERS

SENESCENCE DEVELOPS AN ACCEPTANCE OF RESPONSIBILITY FOR WHAT LIFE IS AND WAS AND OF ITS PLACE IN THE FLOW OF HISTORY

DEVELOPS AN ACCEPTANCE OF RESPONSIBILITY FOR WHAT LIFE IS AND WAS AND OF ITS PLACE IN THE FLOW OF HISTORY

TREATMENT MODALITIES

REMOTIVATION THERAPY TREATMENT MODALITY THAT PROMOTES EXPRESSION OF FEELINGS THROUGH INTERACTION FACILITATED BY DISCUSSION OF NEUTRAL TOPICS STEPS : climate of acceptance creating bridge to reality sharing the world we live in appreciation of works of the world climate of appreciation

TREATMENT MODALITY THAT PROMOTES EXPRESSION OF FEELINGS THROUGH INTERACTION FACILITATED BY DISCUSSION OF NEUTRAL TOPICS

STEPS :

climate of acceptance

creating bridge to reality

sharing the world we live in

appreciation of works of the world

climate of appreciation

MUSIC THERAPY Involves use of music to facilitate expression of feelings, relaxation and outlet of tension

Involves use of music to facilitate expression of feelings, relaxation and outlet of tension

PLAY THERAPY enables patient to experience intense emotion in a safe environment with the use of play children express themselves more easily in play. revealing as reflection of child’s situation in the family provide toys and materials – facilitate interaction – observe and help child resolve problems through play

enables patient to experience intense emotion in a safe environment with the use of play

children express themselves more easily in play. revealing as reflection of child’s situation in the family

provide toys and materials – facilitate interaction – observe and help child resolve problems through play

Group therapy Treatment modality involving three or more patients with a therapist to relieve emotional difficulties, increase self – esteem, develop insight , LEARN NEW ADAPTIVE WAYS TO COPE WITH STRESS and improve behavior with others IDEAL 8 – 10 MEMBERS

Treatment modality involving three or more patients with a therapist to relieve emotional difficulties, increase self – esteem, develop insight , LEARN NEW ADAPTIVE WAYS TO COPE WITH STRESS and improve behavior with others

IDEAL 8 – 10 MEMBERS

MILIEU THERAPY Consists of treatment by means of controlled modification of the patient’s environment to facilitate positive behavioral change Increase patient’s Awareness of feelings Sense of responsibility and Help return to community clients plan social and group interaction token programs , open wards and self medication are done

Consists of treatment by means of controlled modification of the patient’s environment to facilitate positive behavioral change

Increase patient’s

Awareness of feelings

Sense of responsibility and

Help return to community

clients plan social and group interaction

token programs , open wards and self medication are done

FAMILY THERAPY A METHOD OF PSYCHOTHERAPY WHICH FOCUSES ON THE TOTAL FAMILY AS AN INTERACTIONAL SYSTEM PROBLEM IS A FAMILY PROBLEM focus on sick members behavior as source of trouble / symptom serve a function for the family members develop sense of identity points out function of the sick member for the rest of the family

A METHOD OF PSYCHOTHERAPY WHICH FOCUSES ON THE TOTAL FAMILY AS AN INTERACTIONAL SYSTEM

PROBLEM IS A FAMILY PROBLEM

focus on sick members behavior as source of trouble / symptom serve a function for the family

members develop sense of identity

points out function of the sick member for the rest of the family

PSYCHOANALYTIC focuses on the exploration of the unconscious, to facilitate identification of the patients defenses ANXIETY RESULTS BETWEEN CONFLICTS OF ID AND EGO Becomes aware of unconscious thoughts and feelings to understand anxiety and defenses

focuses on the exploration of the unconscious, to facilitate identification of the patients defenses

ANXIETY RESULTS BETWEEN CONFLICTS OF ID AND EGO

Becomes aware of unconscious thoughts and feelings to understand anxiety and defenses

HYPNOTHERAPY Various methods and techniques to induce a trance state where patient becomes submissive to instructions

Various methods and techniques to induce a trance state where patient becomes submissive to instructions

BEHAVIOR MODIFICATION Application of learning principles in order to change maladaptive behavior Believes that psychological problems are a result of learning Everything learned can be unlearned

Application of learning principles in order to change maladaptive behavior

Believes that psychological problems are a result of learning

Everything learned can be unlearned

BEHAVIOR MODIFICATION OPERANT CONDITIONING Use of rewards to reinforce positive behavior Perceived and self-reinforcement becomes more important than external reinforcement DESENSITIZATION Slow adjustment or exposure to feared objects (phobias) Periodic exposure until undesirable behavior disappears or lessens

OPERANT CONDITIONING

Use of rewards to reinforce positive behavior

Perceived and self-reinforcement becomes more important than external reinforcement

DESENSITIZATION

Slow adjustment or exposure to feared objects (phobias)

Periodic exposure until undesirable behavior disappears or lessens

AVERSION THERAPY An example of behavior modification Painful stimulus is introduced to bring about an avoidance of another stimulus End view: behavioral change

An example of behavior modification

Painful stimulus is introduced to bring about an avoidance of another stimulus

End view: behavioral change

HUMOR THERAPY To facilitate expression and enhance interaction ACTIVITY THERAPY Group interaction while working on a task together OTHER THERAPIES

HUMOR THERAPY

To facilitate expression and enhance interaction

ACTIVITY THERAPY

Group interaction while working on a task together

BIOLOGICAL/ MEDICAL THEORY EMOTIONAL PROBLEM IS AN ILLNESS cause may be inherited or chemical in origin FOCUS OF TREATMENT IS MEDICATIONS AND ECT

EMOTIONAL PROBLEM IS AN ILLNESS

cause may be inherited or chemical in origin

FOCUS OF TREATMENT IS MEDICATIONS AND ECT

BIOLOGICAL THERAPY ELECTROCONVULSIVE THERAPY Artificial induction of a grand mal seizure by passing a controlled electrical current through electrodes applied to one or both temples mechanism of action – unclear voltage: 70 – 150 volts Duration: 0.5 – 2.0 seconds 6 to 12 treatments intervals of 48 hours indicators of effectiveness – occurrence of generalized tonic – clonic seizures

ELECTROCONVULSIVE THERAPY

Artificial induction of a grand mal seizure by passing a controlled electrical current through electrodes applied to one or both temples

mechanism of action – unclear

voltage: 70 – 150 volts

Duration: 0.5 – 2.0 seconds

6 to 12 treatments

intervals of 48 hours

indicators of effectiveness – occurrence of generalized tonic – clonic seizures

indications – depression , mania and catatonic schizophrenia s/e: confusion, disorientation, short -term memory loss, seizure (30-60 sec) NPO prior Contraindications Fever, pregnancy Inc ICP, fracture retinal detachment TB with hemoptysis cardiac d/o consent needed Reorient after, supportive care

indications – depression , mania and catatonic schizophrenia

s/e: confusion, disorientation, short -term memory loss, seizure (30-60 sec)

NPO prior

Contraindications

Fever, pregnancy

Inc ICP, fracture

retinal detachment

TB with hemoptysis

cardiac d/o

consent needed

Reorient after, supportive care

medications given : Atropine sulfate: decrease secretions Succinylcholine (Anectine): promote muscle relaxation Methohexital Sodium ( Brevital ): serves as an anesthetic agent common complications: loss of memory headache apnea fracture respiratory depression

medications given :

Atropine sulfate: decrease secretions

Succinylcholine (Anectine): promote muscle relaxation

Methohexital Sodium ( Brevital ): serves as an anesthetic agent

common complications:

loss of memory

headache

apnea

fracture

respiratory depression

Psychopharmacologic Therapy

Benzodiazepines Indications Anxiety Sedation/sleep Muscle spasm Seizure disorder Alcohol withdrawal syndromes Benzodiazepines

Indications

Anxiety

Sedation/sleep

Muscle spasm

Seizure disorder

Alcohol withdrawal syndromes

Anti-anxiety drugs Generic Trade name Alprazolam Xanax Chlordiazepoxide Librium Clorazepate Tranxene Diazepam Valium Lorazepam Ativan Oxazepam Serax Busipirone BuSpar Benzodiazepines

Generic Trade name

Alprazolam Xanax

Chlordiazepoxide Librium

Clorazepate Tranxene

Diazepam Valium

Lorazepam Ativan

Oxazepam Serax

Busipirone BuSpar

Side effects Drowsiness/ sedation Ataxia Feelings of detachment Increase irritability and hostility Anterograde amnesia Increased appetite & weight gain Nausea Headache, confusion Benzodiazepines

Drowsiness/ sedation

Ataxia

Feelings of detachment

Increase irritability and hostility

Anterograde amnesia

Increased appetite & weight gain

Nausea

Headache, confusion

Anti-depressants Indications Depression Bipolar depression Panic disorder Bulimia Obsessive-compulsive d/o Possibly Attention deficit/Hyperactivity d/o Post Traumatic Stress D/o Conduct d/o Anti-depressants

Indications

Depression

Bipolar depression

Panic disorder

Bulimia

Obsessive-compulsive d/o

Possibly

Attention deficit/Hyperactivity d/o

Post Traumatic Stress D/o

Conduct d/o

Tricyclic (TCA) Generic Trade name Amitriptyline Elavil Imipramine Tofranil Trimipramine Surmontil Nortriptyline Pamelor Trazodone Desyrel Bupropion Wellbutrin Anti-depressants

Generic Trade name

Amitriptyline Elavil

Imipramine Tofranil

Trimipramine Surmontil

Nortriptyline Pamelor

Trazodone Desyrel

Bupropion Wellbutrin

Side effects Orthostatic hypertension Anticholinergic effect Dry mouth, blurred vision, constipation, excessive sweating, urinary hesitancy/ retention, tachycardia, agitation, delirium, exacerbation of glaucoma Neurologic effects sedation, psychomotor slowing, poor concentration, fatigue, ataxia, tremors Decrease libido and sexual performance Anti-depressants

Orthostatic hypertension

Anticholinergic effect

Dry mouth, blurred vision, constipation, excessive sweating, urinary hesitancy/ retention, tachycardia, agitation, delirium, exacerbation of glaucoma

Neurologic effects

sedation, psychomotor slowing, poor concentration, fatigue, ataxia, tremors

Decrease libido and sexual performance

Monoamine Oxidase inhibitors Generic Trade name Isocarboxazid Marplan Phenelzine Nardil Tranylcypromine Parnate Anti-depressants

Generic Trade name

Isocarboxazid Marplan

Phenelzine Nardil

Tranylcypromine Parnate

Side effects Postural lightheadedness Constipation Delay ejaculation or orgasm Muscle twitching Drowsiness Dry mouth Anti-depressants

Postural lightheadedness

Constipation

Delay ejaculation or orgasm

Muscle twitching

Drowsiness

Dry mouth

Dietary restrictions Cheese, esp. aged and matured Fermented or aged protein Pickled or smoked fish Beer, red wine, sherry; liquor & cognac Yeast Fava or broad beans Beef or chicken liver Spoiled/ overripe fruits; banana peel yogurt Tyramine Hypertensive Crisis Anti-depressants

Cheese, esp. aged and matured

Fermented or aged protein

Pickled or smoked fish

Beer, red wine, sherry; liquor & cognac

Yeast

Fava or broad beans

Beef or chicken liver

Spoiled/ overripe fruits; banana peel

yogurt

Hypertensive Crisis Signs Sudden elevation of BP Explosive headache, occipital may radiate frontally Head & face flushed Palpitations, chest pain Sweating, fever Nausea, vomiting Dilated pupils, photophobia Intracranial bleeding Anti-depressants

Signs

Sudden elevation of BP

Explosive headache, occipital may radiate frontally

Head & face flushed

Palpitations, chest pain

Sweating, fever

Nausea, vomiting

Dilated pupils, photophobia

Intracranial bleeding

Treatment Hold next MAO dose Don’t let pt. lie down IM chlorpromazine 100 mg Fever: manage by external cooling techniques Anti-depressants

Treatment

Hold next MAO dose

Don’t let pt. lie down

IM chlorpromazine 100 mg

Fever: manage by external cooling techniques

Serotonin Reuptake Inhibitors Generic Trade name Fluoxetine Prozac Sertraline Zoloft Paroxetine Paxil Venlafaxine Effexor Anti-depressants

Generic Trade name

Fluoxetine Prozac

Sertraline Zoloft

Paroxetine Paxil

Venlafaxine Effexor

Side effects Nausea Diarrhea Insomnia Dry mouth Nervousness Headache Male sexual dysfunction Drowsiness Dizziness Sweating Anti-depressants

Nausea

Diarrhea

Insomnia

Dry mouth

Nervousness

Headache

Male sexual dysfunction

Drowsiness

Dizziness

Sweating

Mood stabilizing drugs Indications Acute mania Bipolar prophylaxis Possibly Bulimia Alcohol abuse Aggressive behavior schizoaffective Mood stabilizing

Indications

Acute mania

Bipolar prophylaxis

Possibly

Bulimia

Alcohol abuse

Aggressive behavior

schizoaffective

Mode of action Normalizes the reuptake of certain neurotransmitters such as serotonin, norepinephrine, acetylcholine and dopamine Reduces the release of norepinephrine thru competition with calcium Effects intracellularly Lag period: 7-10 to 14 days Mood stabilizing

Mode of action

Normalizes the reuptake of certain neurotransmitters such as serotonin, norepinephrine, acetylcholine and dopamine

Reduces the release of norepinephrine thru competition with calcium

Effects intracellularly

Lag period: 7-10 to 14 days

Lithium carbonate Trade names Eskalith Lithotabs Lithane Lithonate MOA: unclear; interfere with metabolism of neurotransmitters; alter Na transport in nerves and muscle cells Prelithium workup Urinalysis (BUN and creatinine) ECG, FBC, CBC Mood stabilizing Preparation: tab, cap, liq & SR form Dose: 900 to 3600 mg/day

Trade names

Eskalith

Lithotabs

Lithane

Lithonate

MOA: unclear; interfere with metabolism of neurotransmitters; alter Na transport in nerves and muscle cells

Prelithium workup

Urinalysis (BUN and creatinine)

ECG, FBC, CBC

Side effects Early Nausea and diarrhea Anorexia Fine hand tremor (propranolol) Thirst, Polydipsia (dec. crea, inc. albumin) Metallic taste Fatigue Lethargy Late Weight gain acne Mood stabilizing

Early

Nausea and diarrhea

Anorexia

Fine hand tremor (propranolol)

Thirst, Polydipsia (dec. crea, inc. albumin)

Metallic taste

Fatigue

Lethargy

Late

Weight gain

acne

Contraindications Brain damage/ CV disease Epilepsy Elderly/ debilitated Thyroid and renal disease Severe dehydration Pregnancy (1 st trimester) Can augment the effects of anti-depressants Mood stabilizing

Brain damage/ CV disease

Epilepsy

Elderly/ debilitated

Thyroid and renal disease

Severe dehydration

Pregnancy (1 st trimester)

Can augment the effects of anti-depressants

Nursing considerations Therapeutic serum level: 0.5 – 1.2 meq/L Maintenance level: 0.6 -1.2 meq/L Toxic Mild to moderate: 1.5 to 2 meq/L Moderate to severe: 2 – 2.5 meq/L Needs dialysis: 3 meq and above Early signs of toxicity Lethargy, mild nausea, vomiting, fine hand tremors, anorexia, polyuria, polydipsia, metallic taste, fatigue Late signs of toxicity Ataxia, giddiness, tinnitus, blurred vision, polyuria Mood stabilizing

Therapeutic serum level: 0.5 – 1.2 meq/L

Maintenance level: 0.6 -1.2 meq/L

Toxic

Mild to moderate: 1.5 to 2 meq/L

Moderate to severe: 2 – 2.5 meq/L

Needs dialysis: 3 meq and above

Early signs of toxicity

Lethargy, mild nausea, vomiting, fine hand tremors, anorexia, polyuria, polydipsia, metallic taste, fatigue

Late signs of toxicity

Ataxia, giddiness, tinnitus, blurred vision, polyuria

Nursing considerations Lithium levels should be checked q 2-3 mos Serum drawn in the AM, 12H after last dose Common causes of inc. levels Dec. Na intake Diuretic therapy Dec. renal functioning F&E loss Medical illness Overdose NSAIDS Mood stabilizing

Lithium levels should be checked q 2-3 mos

Serum drawn in the AM, 12H after last dose

Common causes of inc. levels

Dec. Na intake

Diuretic therapy

Dec. renal functioning

F&E loss

Medical illness

Overdose

NSAIDS

Nursing considerations Diet: adequate Na+ and fluid 3g NaCl/ day 6-8 glasses of H2O No caffeine No driving: wait for clinical effect Mood stabilizing

Diet: adequate Na+ and fluid

3g NaCl/ day

6-8 glasses of H2O

No caffeine

No driving: wait for clinical effect

Management Moderately severe toxicity Osmotic diuresis: urea/ mannitol Aminophylline & PLR IV Adequate NaCl Peritoneal/ hemodialysis Severe toxicity Assess hx quickly Hold next lithium dose Check BP, rectal T°, RR, LOC, support O2 Obtain labs ECG Emetic, NGT lavage Hydrate: 5-6L/day c PLR; FBC-CDU Mood stabilizing

Moderately severe toxicity

Osmotic diuresis: urea/ mannitol

Aminophylline & PLR IV

Adequate NaCl

Peritoneal/ hemodialysis

Severe toxicity

Assess hx quickly

Hold next lithium dose

Check BP, rectal T°, RR, LOC, support O2

Obtain labs

ECG

Emetic, NGT lavage

Hydrate: 5-6L/day c PLR; FBC-CDU

Other drugs Carbamazepine (Tegretol) Side effects Dizziness Ataxia Clumsiness Sedation Dysarthria Diplopia Nausea & GI upset Preparation: liq, tab, chewable tab Mood stabilizing 800 to 1200 mg/day

Carbamazepine (Tegretol)

Side effects

Dizziness

Ataxia

Clumsiness

Sedation

Dysarthria

Diplopia

Nausea & GI upset

Preparation: liq, tab, chewable tab

Nursing considerations Assess drug levels q 3-4 days Monitor salt and fluid intake Avoid alcohol and non-prescription drugs Refer dec. in UO Don’t stop abruptly C/I: pregnancy Take with meals Mood stabilizing

Assess drug levels q 3-4 days

Monitor salt and fluid intake

Avoid alcohol and non-prescription drugs

Refer dec. in UO

Don’t stop abruptly

C/I: pregnancy

Take with meals

Other drugs Valproic acid (Depakote, Depakene) Side effects Nausea Hepatoxicity Neurotoxicity Hematological toxicity Pancreatitis Prep: tab, cap, sprinkles MOA: inc. levels of GABA; inhibits the kindling process or “snoball”-like effect seen in mania & seizures Mood stabilizing

Valproic acid (Depakote, Depakene)

Side effects

Nausea

Hepatoxicity

Neurotoxicity

Hematological toxicity

Pancreatitis

Prep: tab, cap, sprinkles

MOA: inc. levels of GABA; inhibits the kindling process or “snoball”-like effect seen in mania & seizures

Nursing considerations Therapeutic level: 50 – 100 ug/mL Dose: 1, 000 – 1,500 mg/day Monitor serum levels 12H after last dose Toxic effects Severe diarrhea, vomiting, drowsiness, mm. weakness, lack of coordination Renal failure, coma, death Mood stabilizing

Therapeutic level: 50 – 100 ug/mL

Dose: 1, 000 – 1,500 mg/day

Monitor serum levels 12H after last dose

Toxic effects

Severe diarrhea, vomiting, drowsiness, mm. weakness, lack of coordination

Renal failure, coma, death

Anti-psychotic drugs Indications Psychotic symptoms of schizophrenia, acute mania and depression Gilles de Tourette disorder Treatment-resistant bipolar disorder Huntington’s disease and other movement disorder Possibly Paranoid Childhood psychoses Anti-psychotic

Indications

Psychotic symptoms of schizophrenia, acute mania and depression

Gilles de Tourette disorder

Treatment-resistant bipolar disorder

Huntington’s disease and other movement disorder

Possibly

Paranoid

Childhood psychoses

MOA: block receptors of dopamine (D2, D3, D4) If unresponsive after 6 weeks of therapy, another class is tried General considerations Calms without producing impairment of sleep High therapeutic index Non addicting, no tolerance Avoided in pregnancy Anti-psychotic

MOA: block receptors of dopamine (D2, D3, D4)

If unresponsive after 6 weeks of therapy, another class is tried

General considerations

Calms without producing impairment of sleep

High therapeutic index

Non addicting, no tolerance

Avoided in pregnancy

TYPICAL: High Potency Fluphenazine (Prolixin) Haloperidol (Haldol) Thiothexene (Navane) Trifluoperazine (Stelazine) Anti-psychotic

Fluphenazine (Prolixin)

Haloperidol (Haldol)

Thiothexene (Navane)

Trifluoperazine (Stelazine)

Moderate Potency Loxapine (Loxitane) Molindone (Moban) Perphenazine (Trilafon) Anti-psychotic

Loxapine (Loxitane)

Molindone (Moban)

Perphenazine (Trilafon)

Low Potency Chlopromazine (Thorazine) Chlorprothixene (Taractan) Mesoridazine (Serentil) Thioridazine (Mellaril) Anti-psychotic

Chlopromazine (Thorazine)

Chlorprothixene (Taractan)

Mesoridazine (Serentil)

Thioridazine (Mellaril)

ATYPICAL Clozapine (Clozaril) Resperidone (Risperdal) Olanzapine (Zyprexa) Quetiapine (Seroquel) Sertindole (Serlec’t) Ziprasidone (Zeldox) Anti-psychotic

Clozapine (Clozaril)

Resperidone (Risperdal)

Olanzapine (Zyprexa)

Quetiapine (Seroquel)

Sertindole (Serlec’t)

Ziprasidone (Zeldox)

Contraindications CNS depression: brain damage, excess alcohol/ narcotics Parkinson’s disease Allergy Blood dyscrasias Acute narrow angle glaucoma BPH Anti-psychotic

CNS depression: brain damage, excess alcohol/ narcotics

Parkinson’s disease

Allergy

Blood dyscrasias

Acute narrow angle glaucoma

BPH

Hypotension Sedation Dermal and ocular syndrome Neuroleptic malignant syndrome Anticholinergic syndrome Movement syndrome (Extrapyramidal Syndrome) Atropine psychosis Agranulocytosis Seizures Side effects New! Anti-psychotic

Hypotension

Sedation

Dermal and ocular syndrome

Neuroleptic malignant syndrome

Anticholinergic syndrome

Movement syndrome (Extrapyramidal Syndrome)

Atropine psychosis

Agranulocytosis

Seizures

Neuroleptic Malignant Syndrome A potentially fatal, idiosyncratic reaction to an antipsychotic drug 10-20% mortality rate Sx: rigidity, high fever, autonomic instability (BP, diaphoresis, pallor, delirium, elev. CPK), confused or mute, fluctuate from agitation to stupor Occurs in the first 2 weeks of therapy Risk: high dose of high-potency drugs; dehydration, poor nx, concurrent med illness Anti-psychotic TTT: dantrolene (Dantrium), Bromocriptine (Parlodel)

A potentially fatal, idiosyncratic reaction to an antipsychotic drug

10-20% mortality rate

Sx:

rigidity,

high fever,

autonomic instability (BP, diaphoresis, pallor, delirium, elev. CPK), confused or mute, fluctuate from agitation to stupor

Occurs in the first 2 weeks of therapy

Risk: high dose of high-potency drugs; dehydration, poor nx, concurrent med illness

Movement Syndromes Akathisia Dystonia Tardive dyskinesia Bradykinesia Parkinsonism Anti-psychotic

Akathisia

Dystonia

Tardive dyskinesia

Bradykinesia

Parkinsonism

Other s/e Atropine psychosis (geriatrics) Hyperactivity, agitation, confusion, flushed skin, sluggish reactive pupils TTT: IM physostigmine Agranulocytosis (Clozapine) Occurs 3-8 wks after Medical emergency s/s: fever, malaise, sore throat, leukopenia TTT: d/c, reverse iso, antibiotics Seizures (Clozapine) Occurs in 5% of patients; TTT: D/c drug Anti-psychotic New!

Atropine psychosis (geriatrics)

Hyperactivity, agitation, confusion, flushed skin, sluggish reactive pupils

TTT: IM physostigmine

Agranulocytosis (Clozapine)

Occurs 3-8 wks after

Medical emergency

s/s: fever, malaise, sore throat, leukopenia

TTT: d/c, reverse iso, antibiotics

Seizures (Clozapine)

Occurs in 5% of patients; TTT: D/c drug

Anticholinergics Benztropine (Cogentin) Trihexyphenidyl (Artane) Biperiden (Akineton) Procyclidine (Kemadrin) Not withdrawn abruptly Provide cool environment Anti-psychotic

Benztropine (Cogentin)

Trihexyphenidyl (Artane)

Biperiden (Akineton)

Procyclidine (Kemadrin)

Not withdrawn abruptly

Provide cool environment

ANTIPARKINSONIAN MEDICATIONS Adjunct to anti-psychotic agents to balance dopamine/ acetylcholine in the brain s/e: glaucoma, tachycardia, HPN, cardiac dx, asthma, duodenal ulcer A/e: blurred vision, photosensitivity, drowsiness, orthostatic hypotension, CHF, hallucinations

Adjunct to anti-psychotic agents to balance dopamine/ acetylcholine in the brain

s/e: glaucoma, tachycardia, HPN, cardiac dx, asthma, duodenal ulcer

A/e: blurred vision, photosensitivity, drowsiness, orthostatic hypotension, CHF, hallucinations

COMMON DRUGS: Trihexyphenidyl (Artane) benztropine (Cogentin) Biperiden (Cogentin) Selegiline (Eldepryl) Pergolide (Permax) ANTIHISTAMINE Diphenhydramine HCl (BENADRYL) DOPAMINE RELEASING AGENT Amantadine (SYMMETREL)

COMMON DRUGS:

Trihexyphenidyl (Artane)

benztropine (Cogentin)

Biperiden (Cogentin)

Selegiline (Eldepryl)

Pergolide (Permax)

ANTIHISTAMINE

Diphenhydramine HCl (BENADRYL)

DOPAMINE RELEASING AGENT

Amantadine (SYMMETREL)

Nursing considerations Best taken after meals Avoid driving Check BP Alcohol increases sedative effects Avoid sudden position change Drug is not withdrawn abruptly

Nursing considerations

Best taken after meals

Avoid driving

Check BP

Alcohol increases sedative effects

Avoid sudden position change

Drug is not withdrawn abruptly

PSYCHIATRIC DISORDERS

ANXIETY DISORDERS PANIC DISORDERS SPECIFIC PHOBIA SOCIAL PHOBIA OCD PTSD ACUTE STRESS DISORDER GENERALIZED ANXIETY DISORDER ANXIETY DISORDERS

PANIC DISORDERS

SPECIFIC PHOBIA

SOCIAL PHOBIA

OCD

PTSD

ACUTE STRESS DISORDER

GENERALIZED ANXIETY DISORDER

PANIC ATTACKS Discrete period of intense fear or discomfort in which at least 4 if the ff sx develop abruptly and peak within 10 mins: Palpitations, pounding heart, or accelerated HR Sweating Trembling or shaking Sensations of SOB and smothering Feeling of choking ANXIETY DISORDERS

Discrete period of intense fear or discomfort in which at least 4 if the ff sx develop abruptly and peak within 10 mins:

Palpitations, pounding heart, or accelerated HR

Sweating

Trembling or shaking

Sensations of SOB and smothering

Feeling of choking

Chest pain or discomfort Nausea or abd. Pain Feeling dizzy, unsteady, lightheaded or faint Derealization or depersonalization Fear of losing control or going crazy Fear of dying Paresthesias Chills or hot flashes ANXIETY DISORDERS

Chest pain or discomfort

Nausea or abd. Pain

Feeling dizzy, unsteady, lightheaded or faint

Derealization or depersonalization

Fear of losing control or going crazy

Fear of dying

Paresthesias

Chills or hot flashes

SPECIFIC-> PHOBIA ← SOCIAL Excessive and unreasonable cued by the presence or anticipation of a specific object or situation Defense mech commonly used include repression and displacement Fear of social performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others ANXIETY DISORDERS

Excessive and unreasonable cued by the presence or anticipation of a specific object or situation

Defense mech commonly used include repression and displacement

Fear of social performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others

OBSESSION COMPULSION Recurrent and persistent thoughts, impulses, or images are experienced during the disturbance as intrusive and inappropriate Cause anxiety or distress Px knows that these are just product of one’s own mind. Px feels driven to perform repetitive behaviors or mental acts in response to obsession or according to the rules that one deems must be applied rigidly. Aimed at reducing anxiety ANXIETY DISORDERS

Recurrent and persistent thoughts, impulses, or images are experienced during the disturbance as intrusive and inappropriate

Cause anxiety or distress

Px knows that these are just product of one’s own mind.

Px feels driven to perform repetitive behaviors or mental acts in response to obsession or according to the rules that one deems must be applied rigidly.

Aimed at reducing anxiety

OBSESSION COMPULSION Fear of dirt & germs Fear of burglary or robbery Worries about discarding something important Concerns about contracting a serious illness Worries that things must be symmetrical or matching Excessive hand washing Repeated checking of door and window locks Counting and recounting of objects in everyday life Hoarding of objects Excessive straightening, ordering, or of arranging things Repeating words or prayers silently ANXIETY DISORDERS

Fear of dirt & germs

Fear of burglary or robbery

Worries about discarding something important

Concerns about contracting a serious illness

Worries that things must be symmetrical or matching

Excessive hand washing

Repeated checking of door and window locks

Counting and recounting of objects in everyday life

Hoarding of objects

Excessive straightening, ordering, or of arranging things

Repeating words or prayers silently

POST TRAUMATIC STRESS SYNDROME Person has experienced, witnessed or been confronted with an event that involved actual or threatened death or serious injury, or a threat to physical integrity Person reexperiences these in the mind Involves intense fear, helplessness, or horror and numbing of general responsiveness (PSYCHIC NUMBING) ANXIETY DISORDERS

Person has experienced, witnessed or been confronted with an event that involved actual or threatened death or serious injury, or a threat to physical integrity

Person reexperiences these in the mind

Involves intense fear, helplessness, or horror and numbing of general responsiveness (PSYCHIC NUMBING)

ACUTE GENERALIZED STRESS ANXIETY Meets the criteria for exposure to a traumatic event and person experiences 3 of the ff sx: sense of detachment, reduced awareness of one’s surroundings, derealization, depersonalization, dissociated amnesia Excessive anxiety or worry, occurring in more days than not for at least 6 mos, about a number of events or activities Finds it difficult to control the worry ANXIETY DISORDERS

Meets the criteria for exposure to a traumatic event and person experiences 3 of the ff sx:

sense of detachment,

reduced awareness of one’s surroundings,

derealization,

depersonalization,

dissociated amnesia

Excessive anxiety or worry, occurring in more days than not for at least 6 mos, about a number of events or activities

Finds it difficult to control the worry

MOOD/ AFFECTIVE DISORDERS BIPOLAR D/O BIPOLAR I: current or past experience of manic episode, lasting at least a week, that is severe enough to cause extreme impairment in social or occupational functioning. MANIA: hyperactivity DEPRESSED: extreme sadness or withdrawal MIXED BIPOLAR II: hx of 1 or more mj depressive episodes & at least 1 hypomanic episode; no mania MOOD DISORDERS

BIPOLAR D/O

BIPOLAR I: current or past experience of manic episode, lasting at least a week, that is severe enough to cause extreme impairment in social or occupational functioning.

MANIA: hyperactivity

DEPRESSED: extreme sadness or withdrawal

MIXED

BIPOLAR II: hx of 1 or more mj depressive episodes & at least 1 hypomanic episode; no mania

MAJOR DEPRESSIVE D/O @ least 5 sx of same 2- wk period with one being either depressed mood or loss of interest or pleasure. Single episode or recurrent Other sx: wt loss, insomnia, fatigue, recurrent thoughts of death, diminished ability to think, psychomotor agitation or retardation, feelings of worthlessness. MOOD DISORDERS

MAJOR DEPRESSIVE D/O

@ least 5 sx of same 2- wk period with one being either depressed mood or loss of interest or pleasure.

Single episode or recurrent

Other sx: wt loss, insomnia, fatigue, recurrent thoughts of death, diminished ability to think, psychomotor agitation or retardation, feelings of worthlessness.

CYCLOTHYMIC D/O Hx of 2 yrs of hypomania with numerous periods of abnormally elevated, expansive or irritable moods. Does not meet the criteria of mania or depression. DYSTHYMIC D/O @ least 2 yrs of usually depressed mood and at least 1 of the sx of mj depression without meeting the criteria for it SEASONAL AFFECTIVE D/O Depression that comes with shortened daylight in fall and winter that disappears during spring and summer. MOOD DISORDERS

CYCLOTHYMIC D/O

Hx of 2 yrs of hypomania with numerous periods of abnormally elevated, expansive or irritable moods.

Does not meet the criteria of mania or depression.

DYSTHYMIC D/O

@ least 2 yrs of usually depressed mood and at least 1 of the sx of mj depression without meeting the criteria for it

SEASONAL AFFECTIVE D/O

Depression that comes with shortened daylight in fall and winter that disappears during spring and summer.

Dealing with Inappropriate Behaviors AGGRESSIVE BEHAVIOR Assist the client in identifying feelings of frustration and aggression Encourage the client to talk out instead of acting out feelings of frustration Assist the client in identifying precipitating events or situations that lead to aggressive behavior Describe the consequences of the behavior on self and others Assist in identifying previous coping mechanisms Assist the client in the problem-solving techniques to cope with frustration or aggression MOOD DISORDERS

AGGRESSIVE BEHAVIOR

Assist the client in identifying feelings of frustration and aggression

Encourage the client to talk out instead of acting out feelings of frustration

Assist the client in identifying precipitating events or situations that lead to aggressive behavior

Describe the consequences of the behavior on self and others

Assist in identifying previous coping mechanisms

Assist the client in the problem-solving techniques to cope with frustration or aggression

DEESCALATION TECHNIQUES Maintain safety Maintain large personal space and use nonaggressive posture Use calm approach and communicate with a calm, clear tone of voice (be assertive not aggressive Determine what the client considers to be his or her need Avoid verbal struggles Provide clear options that deal with behavior Assist with problem-solving and decision making regarding the options MOOD DISORDERS

DEESCALATION TECHNIQUES

Maintain safety

Maintain large personal space and use nonaggressive posture

Use calm approach and communicate with a calm, clear tone of voice (be assertive not aggressive

Determine what the client considers to be his or her need

Avoid verbal struggles

Provide clear options that deal with behavior

Assist with problem-solving and decision making regarding the options

MANIPULATIVE BEHAVIORS Set clear, consistent, realistic, and enforceable limits and communicate expected behaviors Be clear about consequences associated with exceeding set limits Discuss behavior in nonjudgmental and nonthreatening manner Avoid power struggles Assist in developing means of setting limits on own behavior MOOD DISORDERS

MANIPULATIVE BEHAVIORS

Set clear, consistent, realistic, and enforceable limits and communicate expected behaviors

Be clear about consequences associated with exceeding set limits

Discuss behavior in nonjudgmental and nonthreatening manner

Avoid power struggles

Assist in developing means of setting limits on own behavior

SCHIZOPHRENIA characterized by impairments in the perception or expression of reality and by significant social or occupational dysfunction. Once considered as a deadly disease There is lack of insight in behavior Dx: late adolescence and early adulthood 15-25 y.o. (men); 25-35 y.o. (women) Obsolete term: dementia praecox = “cognitive deterioration early in life” Eugene Bleuler: schiz “split”; phren “mind” SCHIZOPHRENIA

characterized by impairments in the perception or expression of reality and by significant social or occupational dysfunction.

Once considered as a deadly disease

There is lack of insight in behavior

Dx: late adolescence and early adulthood

15-25 y.o. (men); 25-35 y.o. (women)

Obsolete term: dementia praecox = “cognitive deterioration early in life”

Eugene Bleuler: schiz “split”; phren “mind”

Risk factors Genetics: identical twins 50%, 15% for fraternal twins Biochemical factors Dopamine hypothesis: overactive Serotonin imbalance Decreased brain volume, enlarged ventricles, deeper fissures, and loss or underdeveloped brain tissue Psychoanalytic lack of trust during the early stages Weak ego Defenses: REPRESSION, REGRESSION, PROJECTION Environment influences: poverty, lack of social support, hostile home environment, isolation, unsatisfactory housing, disruption in interpersonal relationships (divorce or death), job pressure or unemployment SCHIZOPHRENIA

Genetics: identical twins 50%, 15% for fraternal twins

Biochemical factors

Dopamine hypothesis: overactive

Serotonin imbalance

Decreased brain volume, enlarged ventricles, deeper fissures, and loss or underdeveloped brain tissue

Psychoanalytic

lack of trust during the early stages

Weak ego

Defenses: REPRESSION, REGRESSION, PROJECTION

Environment influences: poverty, lack of social support, hostile home environment, isolation, unsatisfactory housing, disruption in interpersonal relationships (divorce or death), job pressure or unemployment

Subtypes Catatonic type prominent psychomotor disturbances are evident. Symptoms can include catatonic stupor and waxy flexibility Disorganized type where thought disorder and flat affect are present together Paranoid type where delusions and hallucinations are present but thought disorder, disorganized behavior, and affective flattening are absent SCHIZOPHRENIA

Catatonic type

prominent psychomotor disturbances are evident. Symptoms can include catatonic stupor and waxy flexibility

Disorganized type

where thought disorder and flat affect are present together

Paranoid type

where delusions and hallucinations are present but thought disorder, disorganized behavior, and affective flattening are absent

Residual type where positive symptoms are present at a low intensity only Undifferentiated type psychotic symptoms are present but the criteria for paranoid, disorganized, or catatonic types has not been met SCHIZOPHRENIA

Residual type

where positive symptoms are present at a low intensity only

Undifferentiated type

psychotic symptoms are present but the criteria for paranoid, disorganized, or catatonic types has not been met

Symptoms According to Bleuler: 4 A’s Affect is inappropriate Associative looseness Autistic thinking Ambivalence SCHIZOPHRENIA

According to Bleuler: 4 A’s

Affect is inappropriate

Associative looseness

Autistic thinking

Ambivalence

Positive symptoms delusions, auditory hallucinations and thought disorder and are typically regarded as manifestations of psychosis. Negative symptoms considered to be the loss or absence of normal traits or abilities E.G. flat, blunted or constricted affect and emotion, poverty of speech and lack of motivation. Symptoms SCHIZOPHRENIA

Positive symptoms

delusions, auditory hallucinations and thought disorder and are typically regarded as manifestations of psychosis.

Negative symptoms

considered to be the loss or absence of normal traits or abilities

E.G. flat, blunted or constricted affect and emotion, poverty of speech and lack of motivation.

Symptoms S ocial isolation C atatonic behavior H allucinations I ncoherence (marked looseness of association) Z ero/ lack of interest, energy and initiative O bvious failure to attain expected level of dev’t P eculiar behavior H ygiene and grooming impaired R ecurrent illusions and unusual perception experiences E xacerbations and remissions are common N o organic factors accounts for the symptoms I nability to return to baseline functioning after relapse A ffect is inappropriate SCHIZOPHRENIA

S ocial isolation

C atatonic behavior

H allucinations

I ncoherence (marked looseness of association)

Z ero/ lack of interest, energy and initiative

O bvious failure to attain expected level of dev’t

P eculiar behavior

H ygiene and grooming impaired

R ecurrent illusions and unusual perception experiences

E xacerbations and remissions are common

N o organic factors accounts for the symptoms

I nability to return to baseline functioning after relapse

A ffect is inappropriate

Nsg Dx: Abnormal thought process BLOCKING: sudden cessation of a thought in the middle of a sentence, unable to continue the train of thought CIRCUMSTANTIALITY: before getting to the point of answering a question, the individual gets caught up in countless details and explanations CONFABULATION LOOSENESS OF ASSOCIATION NEOLOGISM WORD SALAD SCHIZOPHRENIA

BLOCKING: sudden cessation of a thought in the middle of a sentence, unable to continue the train of thought

CIRCUMSTANTIALITY: before getting to the point of answering a question, the individual gets caught up in countless details and explanations

CONFABULATION

LOOSENESS OF ASSOCIATION

NEOLOGISM

WORD SALAD

Interventions Assess physical needs Set limits Maintain safety Initiate one-on-one interaction & progress to small groups Spend time with clients Monitor for altered thought process Maintain ego boundaries, avoid touching Limit time of interaction Be neutral Do not make promises that can’t be kept SCHIZOPHRENIA

Assess physical needs

Set limits

Maintain safety

Initiate one-on-one interaction & progress to small groups

Spend time with clients

Monitor for altered thought process

Maintain ego boundaries, avoid touching

Limit time of interaction

Be neutral

Do not make promises that can’t be kept

Establish daily routines Do not “go along” with the client’s delusions or hallucinations Provide simple complete activities Reorient Speak to the client in simple direct and concise manner Set realistic goals Explain everything that is being done Decrease stimuli Monitor for suicide risk SCHIZOPHRENIA

Establish daily routines

Do not “go along” with the client’s delusions or hallucinations

Provide simple complete activities

Reorient

Speak to the client in simple direct and concise manner

Set realistic goals

Explain everything that is being done

Decrease stimuli

Monitor for suicide risk

Environment Provide safe environment Limit stimuli Psychological Ttt Behavior therapy Social skills training Self-monitoring Social ttt Milieu therapy Family therapy Group therapy (long-term ttt) SCHIZOPHRENIA

Environment

Provide safe environment

Limit stimuli

Psychological Ttt

Behavior therapy

Social skills training

Self-monitoring

Social ttt

Milieu therapy

Family therapy

Group therapy (long-term ttt)

Related psychotic disorders SCHIZOAFFECTIVE DISORDER schiz + mood disorder (mania/ depression) BRIEF PSYCHOTIC DISORDER sudden onset of psychotic symptoms, lasts less than 2 mos and client returns to premorbid level of functioning SCHIZOPHRENIFORM DISORDER schiz sx lasting between 1 month and <6mos DELUSIONAL DISORDER characterized by prominent, nonbizarre delusions SCHIZOPHRENIA

SCHIZOAFFECTIVE DISORDER schiz + mood disorder (mania/ depression)

BRIEF PSYCHOTIC DISORDER sudden onset of psychotic symptoms, lasts less than 2 mos and client returns to premorbid level of functioning

SCHIZOPHRENIFORM DISORDER schiz sx lasting between 1 month and <6mos

DELUSIONAL DISORDER characterized by prominent, nonbizarre delusions

PERSONALITY DISORDERS CLUSTER A (odd & eccentric) paranoid, schizoid, schizotypal CLUSTER B (bad, dramatic & erratic) antisocial, borderline, histrionic, narcissistic CLUSTER C (anxious & fearful) avoidant, dependent, OCD PERSONALITY D/O

CLUSTER A (odd & eccentric)

paranoid, schizoid, schizotypal

CLUSTER B (bad, dramatic & erratic)

antisocial, borderline, histrionic, narcissistic

CLUSTER C (anxious & fearful)

avoidant, dependent, OCD

CLUSTER A: ODD & ECCENTRIC PARANOID chronic hostility projected to others; suspicious and mistrusts people Seen mostly in men SCHIZOID social detachment = “loner” & “introvert” Restriction of emotions Attention fixed on objects rather than people Functions well in vocations SCHIZOTYPAL: interpersonal deficits Magical thinking, telepathy Apparent in childhood or adolescence PERSONALITY D/O

PARANOID

chronic hostility projected to others; suspicious and mistrusts people

Seen mostly in men

SCHIZOID

social detachment = “loner” & “introvert”

Restriction of emotions

Attention fixed on objects rather than people

Functions well in vocations

SCHIZOTYPAL: interpersonal deficits

Magical thinking, telepathy

Apparent in childhood or adolescence

Interventions for PARANOID D/O Asses for suicide risk Avoid direct eye contact Establish trusting relationship Promote increased self-esteem Remain calm, nonthreatening and nonjudgmental Provide continuity of care Respond honestly to the client PERSONALITY D/O

Asses for suicide risk

Avoid direct eye contact

Establish trusting relationship

Promote increased self-esteem

Remain calm, nonthreatening and nonjudgmental

Provide continuity of care

Respond honestly to the client

Follow thru on commitments Provide a daily schedule of activities Gradually introduce client to groups Do not argue with delusions Use concrete, specific words PERSONALITY D/O

Follow thru on commitments

Provide a daily schedule of activities

Gradually introduce client to groups

Do not argue with delusions

Use concrete, specific words

Do not be secretive with client Do not whisper in presence of client Assure that the client will be safe Provide opportunity to complete small tasks Monitor eating, drinking, sleeping and elimination patterns Limit physical contact Monitor for agitation and decrease stimuli as needed PERSONALITY D/O

Do not be secretive with client

Do not whisper in presence of client

Assure that the client will be safe

Provide opportunity to complete small tasks

Monitor eating, drinking, sleeping and elimination patterns

Limit physical contact

Monitor for agitation and decrease stimuli as needed

CLUSTER B: ERRATIC, DRAMATIC, OR EMOTIONAL ANTISOCIAL Syn: sociopath, psychopathic & semantic d/o Etiology: Genetics interfere in the dev’t of positive interpersonal relationships Brain damage or trauma Low socioeconomic status Faulty family relationships: neglect Secondary gains 15-40 y.o. PERSONALITY D/O

ANTISOCIAL

Syn: sociopath, psychopathic & semantic d/o

Etiology:

Genetics interfere in the dev’t of positive interpersonal relationships

Brain damage or trauma

Low socioeconomic status

Faulty family relationships: neglect

Secondary gains

15-40 y.o.

Signs Lack of remorse or indifference to persons hurt Immediate gratification Failure to accept social norms Impulsivity Consistent irresponsibility Aggressive behavior Reckless behavior that disregards the safety of others 80-90% of all crime is committed by antisocials (NIHM, 2000) ANTISOCIAL PERSONALITY D/O

Signs

Lack of remorse or indifference to persons hurt

Immediate gratification

Failure to accept social norms

Impulsivity

Consistent irresponsibility

Aggressive behavior

Reckless behavior that disregards the safety of others

80-90% of all crime is committed by antisocials (NIHM, 2000)

BORDERLINE Latent, ambulatory and abortive schizophrenics Between moderate neurosis and frank psychosis but quite stable Theories faulty separation from mother; parent and child are bound by guilt Trauma at 18 mos (weakening of ego) Unfulfilled need for intimacy BORDERLINE PERSONALITY D/O

BORDERLINE

Latent, ambulatory and abortive schizophrenics

Between moderate neurosis and frank psychosis but quite stable

Theories

faulty separation from mother; parent and child are bound by guilt

Trauma at 18 mos (weakening of ego)

Unfulfilled need for intimacy

Signs instability Impulsivity: unpredictable gambling, shoplifting, sex & substance abuse hypersensitivity, self-destructive, profound mood shifts unstable & intense relations Disturbance in self concept Common in women Defenses: denial, projection, splitting, projective identification BORDERLINE PERSONALITY D/O

Signs

instability

Impulsivity: unpredictable gambling, shoplifting, sex & substance abuse

hypersensitivity, self-destructive, profound mood shifts

unstable & intense relations

Disturbance in self concept

Common in women

Defenses: denial, projection, splitting, projective identification

HISTRIONIC Pattern of theatrical or overtly dramatic behavior Signs Discomfort when the client isn’t the center of attention Self-dramatization and exaggerated emotions uses physical appearance, sexually seductive and provocative behavior Excessively impressionistic speech lacking in detail (labile emotions) Problems in dependence & helplessness More frequent in women HISTRIONIC PERSONALITY D/O

HISTRIONIC

Pattern of theatrical or overtly dramatic behavior

Signs

Discomfort when the client isn’t the center of attention

Self-dramatization and exaggerated emotions

uses physical appearance, sexually seductive and provocative behavior

Excessively impressionistic speech lacking in detail (labile emotions)

Problems in dependence & helplessness

More frequent in women

NARCISSISTIC Exaggerated or grandiose sense of self-importance Develop early in childhood Preoccupied with fantasies of unlimited success, power and beauty Signs arrogance, need for admiration, lack of empathy, seductive, socially exploitative, manipulative Occurs more in men NARCISSISTIC PERSONALITY D/O

NARCISSISTIC

Exaggerated or grandiose sense of self-importance

Develop early in childhood

Preoccupied with fantasies of unlimited success, power and beauty

Signs

arrogance, need for admiration,

lack of empathy,

seductive, socially exploitative, manipulative

Occurs more in men

CLUSTER C: ANXIOUS OR FEARFUL AVOIDANT Sensitive to rejection, criticism, humiliation, disapproval, or shame Interferes with participation in occupational activities, dev’t of relationships, and take personal risks social inhibition, longs for relationships Anxiety, anger and depression are common Social phobia may occur Seen in 10% of clients in mental clinics AVOIDANT PERSONALITY D/O

AVOIDANT

Sensitive to rejection, criticism, humiliation, disapproval, or shame

Interferes with participation in occupational activities, dev’t of relationships, and take personal risks

social inhibition, longs for relationships

Anxiety, anger and depression are common

Social phobia may occur

Seen in 10% of clients in mental clinics

DEPENDENT Lacks confidence and unable to function in an independent role Allows other persons to be responsible of their lives Most frequent personality disorder in the mental health clinic submissive behavior, low self-esteem, inadequate, helpless DEPENDENT PERSONALITY D/O

DEPENDENT

Lacks confidence and unable to function in an independent role

Allows other persons to be responsible of their lives

Most frequent personality disorder in the mental health clinic

submissive behavior, low self-esteem, inadequate, helpless

OBSESSIVE-COMPULSIVE Preoccupied with rules & regulations, overly concerned about trivial detail, excessively devoted to their work Depression is common Men are more affected than women O-C PERSONALITY D/O

OBSESSIVE-COMPULSIVE

Preoccupied with rules & regulations, overly concerned about trivial detail, excessively devoted to their work

Depression is common

Men are more affected than women

UNDER STUDY PERSONALITY D/O PASSIVE-AGGRESSIVE: sullen and argumentative, resents others, resists fulfilling responsibilities, complains of being unappreciated DEPRESSIVE: gloomy, brooding pessimistic, guilt-prone, highly critical of self and others, cheerless. PERSONALITY D/O

PASSIVE-AGGRESSIVE: sullen and argumentative, resents others, resists fulfilling responsibilities, complains of being unappreciated

DEPRESSIVE: gloomy, brooding pessimistic, guilt-prone, highly critical of self and others, cheerless.

Interventions Maintain safety against self-destructive behaviors Allow the client to make choices and be as independent as possible Encourage the client to discuss feelings rather than act them out Provide consistency in response to the client’s acting out Discuss expectations and responsibilities with the client Inform the client that harm to self, others, and property is unacceptable PERSONALITY D/O

Maintain safety against self-destructive behaviors

Allow the client to make choices and be as independent as possible

Encourage the client to discuss feelings rather than act them out

Provide consistency in response to the client’s acting out

Discuss expectations and responsibilities with the client

Inform the client that harm to self, others, and property is unacceptable

Identify splitting behavior Assist the client to deal directly with anger Develop a written contract with the client Encourage the client to participate in group activities, and praise nonmanipulative behavior Set and maintain limits Remove the client from group situations in which attention-seeking behaviors occur Provide realistic praise for positive behaviors in social situations PERSONALITY D/O

Identify splitting behavior

Assist the client to deal directly with anger

Develop a written contract with the client

Encourage the client to participate in group activities, and praise nonmanipulative behavior

Set and maintain limits

Remove the client from group situations in which attention-seeking behaviors occur

Provide realistic praise for positive behaviors in social situations

Hypoactive sexual disorder (asexuality) Sexual aversion disorder (avoidance of or lack of desire for sexual intercourse) Female sexual arousal d/o (failure of normal lubricating arousal response) Male erectile d/o Female orgasmic disorder Male orgasmic disorder Premature ejaculation PSYCHOLOGICAL SEXUAL D/O SEXUAL DISORDERS

Hypoactive sexual disorder (asexuality)

Sexual aversion disorder (avoidance of or lack of desire for sexual intercourse)

Female sexual arousal d/o (failure of normal lubricating arousal response)

Male erectile d/o

Female orgasmic disorder

Male orgasmic disorder

Premature ejaculation

Vaginismus Secondary sexual dysfxn Paraphilias Gender identity d/o PTSD due to genital mutilation or childhood sexual abuse Other sexual problems Sexual dissatisfaction (non-specific) Lack of sexual desire anorgasmia Impotence STD SEXUAL DISORDERS

Vaginismus

Secondary sexual dysfxn

Paraphilias

Gender identity d/o

PTSD due to genital mutilation or childhood sexual abuse

Other sexual problems

Sexual dissatisfaction (non-specific)

Lack of sexual desire

anorgasmia

Impotence

STD

Infidelity Delay or absence of ejaculation, despite adequate stimulation Inability to control timing of ejaculation Inability to relax vaginal muscles enough to allow intercourse Inadequate vaginal lubrication preceding and during intercourse Burning pain on the vulva or in the vagina with contact to those areas SEXUAL DISORDERS

Infidelity

Delay or absence of ejaculation, despite adequate stimulation

Inability to control timing of ejaculation

Inability to relax vaginal muscles enough to allow intercourse

Inadequate vaginal lubrication preceding and during intercourse

Burning pain on the vulva or in the vagina with contact to those areas

Unhappiness or confusion related to sexual orientation Persistent sexual arousal syndrome Sexual addict hypersexuality Post Ejaculatory Guilt Syndrome, the feeling of guilt after the male orgasm SEXUAL DISORDERS

Unhappiness or confusion related to sexual orientation

Persistent sexual arousal syndrome

Sexual addict

hypersexuality

Post Ejaculatory Guilt Syndrome, the feeling of guilt after the male orgasm

SEXUAL EXPRESSION HETEROSEXUALITY HOMOSEXUALITY BISEXUALITY TRANSVESTISM SEXUAL DISORDERS

HETEROSEXUALITY

HOMOSEXUALITY

BISEXUALITY

TRANSVESTISM

PARAPHILIAS EXHIBITIONISM: the recurrent urge or behavior to expose one's genitals to an unsuspecting person. FETISHISM: the use of non-sexual or nonliving objects or part of a person's body to gain sexual excitement. Partialism refers to fetishes specifically involving nonsexual parts of the body. FROTTEURISM: the recurrent urges or behavior of touching or rubbing against a nonconsenting person. SEXUAL DISORDERS

EXHIBITIONISM: the recurrent urge or behavior to expose one's genitals to an unsuspecting person.

FETISHISM: the use of non-sexual or nonliving objects or part of a person's body to gain sexual excitement. Partialism refers to fetishes specifically involving nonsexual parts of the body.

FROTTEURISM: the recurrent urges or behavior of touching or rubbing against a nonconsenting person.

SEXUAL MASOCHISM: the recurrent urge or behavior of wanting to be humiliated, beaten, bound, or otherwise made to suffer. SEXUAL SADISM: the recurrent urge or behavior involving acts in which the pain or humiliation of the victim is sexually exciting. TRANSVESTIC FETISHISM: a sexual attraction towards the clothing of the opposite gender. SEXUAL DISORDERS

SEXUAL MASOCHISM: the recurrent urge or behavior of wanting to be humiliated, beaten, bound, or otherwise made to suffer.

SEXUAL SADISM: the recurrent urge or behavior involving acts in which the pain or humiliation of the victim is sexually exciting.

TRANSVESTIC FETISHISM: a sexual attraction towards the clothing of the opposite gender.

PEDOPHILIA: the sexual attraction to prepubescent or peripubescent children. VOYEURISM: the recurrent urge or behavior to observe an unsuspecting person who is naked, disrobing or engaging in sexual activities, or may not be sexual in nature at all. SEXUAL DISORDERS

PEDOPHILIA: the sexual attraction to prepubescent or peripubescent children.

VOYEURISM: the recurrent urge or behavior to observe an unsuspecting person who is naked, disrobing or engaging in sexual activities, or may not be sexual in nature at all.

Other paraphilias not otherwise specified (&quot;Sexual Disorder NOS&quot;) telephone scatalogia (obscene phone calls) necrophilia (corpses) partialism (exclusive focus on one part of the body) zoophilia(animals) coprophilia (feces) klismaphilia (enemas) urophilia (urine) SEXUAL DISORDERS

Other paraphilias not otherwise specified (&quot;Sexual Disorder NOS&quot;)

telephone scatalogia (obscene phone calls)

necrophilia (corpses)

partialism (exclusive focus on one part of the body)

zoophilia(animals)

coprophilia (feces)

klismaphilia (enemas)

urophilia (urine)

SOMATOFORM D/O SOMATIZATION D/O: hx of many physical complaints beginning before the age of 30 occurring over a pd of several yrs resulting in ttt being sought or significant occupational or social fxning. CONVERSION D/O: 1 or more sx of deficits affecting voluntary motor or sensory function suggesting a neurological or general medical condition; preceded by conflicts or stressors; can’t be explained and sanctioned by cultural behavior. Most common: blindness, deafness, paralysis, inability to talk “ La belle indifference”

SOMATIZATION D/O: hx of many physical complaints beginning before the age of 30 occurring over a pd of several yrs resulting in ttt being sought or significant occupational or social fxning.

CONVERSION D/O: 1 or more sx of deficits affecting voluntary motor or sensory function suggesting a neurological or general medical condition; preceded by conflicts or stressors; can’t be explained and sanctioned by cultural behavior.

Most common: blindness, deafness, paralysis, inability to talk

“ La belle indifference”

HYPOCHONDRIASIS: preoccupation with fears of having, or ideas that one has, a serious dse based on the person’s misinterpretation of bodily sx and persist despite appropriate medical eval and reassurance and has existed for @ least 6 mos. (e.g.:extensive use of home remedies) PAIN D/O: pain in 1 or more anatomical sites severe enough to warrant clinical attention and causes clinically significant distress or impairment in fxning.

HYPOCHONDRIASIS: preoccupation with fears of having, or ideas that one has, a serious dse based on the person’s misinterpretation of bodily sx and persist despite appropriate medical eval and reassurance and has existed for @ least 6 mos. (e.g.:extensive use of home remedies)

PAIN D/O: pain in 1 or more anatomical sites severe enough to warrant clinical attention and causes clinically significant distress or impairment in fxning.

Interventions Do not reinforce the sick role Discourage verbalization about physical symptoms by not responding with positive reinforcement Explore with the client the needs being met by the physical symptoms Convey understanding that the physical symptoms are real to the client Report and assess any new physical complaint next

Interventions

Do not reinforce the sick role

Discourage verbalization about physical symptoms by not responding with positive reinforcement

Explore with the client the needs being met by the physical symptoms

Convey understanding that the physical symptoms are real to the client

Report and assess any new physical complaint

next

EATING DISORDER BEHAVIORS BINGE: rapid consumption of large quantities of food in a discrete period of time. (A: hundrends of Cal; B: thousands of Cal at a sitting) PURGE: Maladaptive eating regulation response that includes excessive exercise, forced vomiting, OCD Rx diuretics, diet pills, laxatives and steroids. FAST/ RESTRICT: Includes vegetarian diet eliminating all meat without substituting nonanimal sources of protein, OC about food choices, and eating habits. EATING DISORDERS

BINGE: rapid consumption of large quantities of food in a discrete period of time. (A: hundrends of Cal; B: thousands of Cal at a sitting)

PURGE: Maladaptive eating regulation response that includes excessive exercise, forced vomiting, OCD Rx diuretics, diet pills, laxatives and steroids.

FAST/ RESTRICT: Includes vegetarian diet eliminating all meat without substituting nonanimal sources of protein, OC about food choices, and eating habits.

ANOREXIA BULIMIA Rare vomiting or diuretic/laxative abuse More severe wt loss Slightly younger More introverted Hunger denied Eating behavior may be considered normal and a source of esteem Sexually inactive Obsessional and perfectionist features dominate Frequent Less wt loss Slightly older More extroverted Hunger experienced Eating behavior considered foreign and source of distress More sexually active Avoidant, dependent, or borderline features as well as obsessional features EATING DISORDERS

Rare vomiting or diuretic/laxative abuse

More severe wt loss

Slightly younger

More introverted

Hunger denied

Eating behavior may be considered normal and a source of esteem

Sexually inactive

Obsessional and perfectionist features dominate

Frequent

Less wt loss

Slightly older

More extroverted

Hunger experienced

Eating behavior considered foreign and source of distress

More sexually active

Avoidant, dependent, or borderline features as well as obsessional features

ANOREXIA BULIMIA complications Death from starvation (or suicide, in chronically ill) Amenorrhea Fewer behavioral problems (these increase with level of severity) Death from hypokalemia or suicide Menses irregular or absent Drug and alcohol abuse, self-mutilation, and other behavioral problems EATING DISORDERS

Death from starvation (or suicide, in chronically ill)

Amenorrhea

Fewer behavioral problems (these increase with level of severity)

Death from hypokalemia or suicide

Menses irregular or absent

Drug and alcohol abuse, self-mutilation, and other behavioral problems

DELIRIUM The medical dx term that describes an organic mental disorder characterized by a cluster of cognitive impairments with an acute onset with a specific precipitating factor. Sx: diminished awareness of the environment, disturbances in psychomotor activity and sleep-wake cycle. COGNITIVE: the mental process characterized by knowing, thinking, and judging. COGNITIVE DISSONANCE: arises when 2 opposing beliefs exists at the same time. COGNITIVE DISTORTIONS: (+) or (-) distortions of reality that might include errors of logic, mistakes in reasoning, or individualized view of the world that do not reflect reality. Term: confusion = cognitive impairment See dementia COGNITIVE DISORDERS

The medical dx term that describes an organic mental disorder characterized by a cluster of cognitive impairments with an acute onset with a specific precipitating factor.

Sx: diminished awareness of the environment, disturbances in psychomotor activity and sleep-wake cycle.

COGNITIVE: the mental process characterized by knowing, thinking, and judging.

COGNITIVE DISSONANCE: arises when 2 opposing beliefs exists at the same time.

COGNITIVE DISTORTIONS: (+) or (-) distortions of reality that might include errors of logic, mistakes in reasoning, or individualized view of the world that do not reflect reality.

Term: confusion = cognitive impairment

See dementia

DEMENTIA The medical dx term that describes an organic mental d/o characterized by a cluster of cognitive impairments of generally gradual onset and irreversible without identifiable precipitating stressors. Types: VASCULAR or MULTI-INFARCT VASCULAR WITH ALZHEIMER’S DSE AD: most common DEMENTIA WITH LEWY BODIES: 2 nd most common; neurofilament material PARKINSONIAN DEMENTIA AIDS DEMENTIA COMPLEX COGNITIVE DISORDERS

The medical dx term that describes an organic mental d/o characterized by a cluster of cognitive impairments of generally gradual onset and irreversible without identifiable precipitating stressors.

Types:

VASCULAR or MULTI-INFARCT

VASCULAR WITH ALZHEIMER’S DSE

AD: most common

DEMENTIA WITH LEWY BODIES: 2 nd most common; neurofilament material

PARKINSONIAN DEMENTIA

AIDS DEMENTIA COMPLEX

FRONTAL LOBE DEMENTIA or PICK’S DSE: cytoplasmic collections; 3 rd most common; loss of expressive language & comprehension CREUTZFELDT-JAKOB DSE: prion ( proteinaceous infectious particles) = spongy brain; related to TSE & BSE in mad cow dse CORTICOBASAL DEGENERATION or HUNTINGTON’S DSE/CHOREA: jerky mov’ts SUPRANUCLEAR PALSY: clumping of protein tau = slow mov’t, weak eye mov’t (esp. downward), impaired walking &balance COGNITIVE DISORDERS

FRONTAL LOBE DEMENTIA or PICK’S DSE: cytoplasmic collections; 3 rd most common; loss of expressive language & comprehension

CREUTZFELDT-JAKOB DSE: prion ( proteinaceous infectious particles) = spongy brain; related to TSE & BSE in mad cow dse

CORTICOBASAL DEGENERATION or HUNTINGTON’S DSE/CHOREA: jerky mov’ts

SUPRANUCLEAR PALSY: clumping of protein tau = slow mov’t, weak eye mov’t (esp. downward), impaired walking &balance

Reversible Causes: Subdural hematoma Tumor (meningioma) Cerebral vasculitis Hydrocephalus Terms: disorientation, memory loss (sensory, primary, secondary, tertiary, working memory), confabulation, confusion Disturbing behaviors Aggressive psychomotor Nonaggressive psychomotor Verbally aggressive Passive Functionally impaired: loss of ability to do self-care COGNITIVE DISORDERS

Reversible Causes:

Subdural hematoma

Tumor (meningioma)

Cerebral vasculitis

Hydrocephalus

Terms: disorientation, memory loss (sensory, primary, secondary, tertiary, working memory), confabulation, confusion

Disturbing behaviors

Aggressive psychomotor

Nonaggressive psychomotor

Verbally aggressive

Passive

Functionally impaired: loss of ability to do self-care

DELIRIUM vs. DEMENTIA Rapid onset w/ wide fluctuations Hyperalert to difficult to arouse LOC Fluctuating affect Disoriented, confused Attention & sleep disturbed Memory impaired Disordered reasoning Gradual, chronic with continuous decline Normal LOC Labile affect Disoriented, confused Attention intact, sleep usually normal Memory impaired Disordered reasoning & calculation COGNITIVE DISORDERS

Rapid onset w/ wide fluctuations

Hyperalert to difficult to arouse LOC

Fluctuating affect

Disoriented, confused

Attention & sleep disturbed

Memory impaired

Disordered reasoning

Gradual, chronic with continuous decline

Normal LOC

Labile affect

Disoriented, confused Attention intact, sleep usually normal

Memory impaired

Disordered reasoning & calculation

DELIRIUM vs. DEMENTIA Incoherent, confused, delusional, stereotyped Illusions, hallucinations Poor judgment Insight may be present in lucid moment Poor but variable in MSE next Disorganized, rich in content, delusional, paranoid No change in perception Poor judgment No insight Consistently poor & progressively worsens in MSE COGNITIVE DISORDERS

Incoherent, confused, delusional, stereotyped

Illusions, hallucinations

Poor judgment

Insight may be present in lucid moment

Poor but variable in MSE

next

Disorganized, rich in content, delusional, paranoid

No change in perception

Poor judgment

No insight

Consistently poor & progressively worsens in MSE

ALZHEIMER’S DEMENTIA Most common type of dementia Stages: MILD: impaired memory, insidious loses in ADL, subtle personality changes, socially normal MODERATE: obvious memory loss, overt ADL impairment, prominent behavioral difficulties, variable social skills, supervision needed SEVERE: fragmented memory, no recognition of familiar people, assistance needed with basic ADL, fewer troublesome behaviors, reduced mobility (4 A’s) COGNITIVE DISORDERS

Most common type of dementia

Stages:

MILD: impaired memory, insidious loses in ADL, subtle personality changes, socially normal

MODERATE: obvious memory loss, overt ADL impairment, prominent behavioral difficulties, variable social skills, supervision needed

SEVERE: fragmented memory, no recognition of familiar people, assistance needed with basic ADL, fewer troublesome behaviors, reduced mobility (4 A’s)

Symptoms AGNOSIA: Difficulty recognizing well-known objects APHASIA: Difficulty in finding the right word APRAXIA: Inability or difficulty in performing a purposeful organized task or similar skilled activities AMNESIA: Significant memory impairment in the absence of clouded consciousness or other cognitive symptoms COGNITIVE DISORDERS

AGNOSIA: Difficulty recognizing well-known objects

APHASIA: Difficulty in finding the right word

APRAXIA: Inability or difficulty in performing a purposeful organized task or similar skilled activities

AMNESIA: Significant memory impairment in the absence of clouded consciousness or other cognitive symptoms

PSYCHIATRIC D/O IN CHILDREN MENTAL RETARDATION PERVASIVE DEV’TAL D/O AUTISM RETT’S D/O CHILDHOOD DISINTEGRATIVE D/O ASPERGER’S D/O PDD NOS LEARNING D/O READING MATHEMATICS WRITTEN EXPRESSION ACADEMIC PROBLEM LEARNING D/O NOS CHILDHOOD DISORDERS

MENTAL RETARDATION

PERVASIVE DEV’TAL D/O

AUTISM

RETT’S D/O

CHILDHOOD DISINTEGRATIVE D/O

ASPERGER’S D/O

PDD NOS

LEARNING D/O

READING

MATHEMATICS

WRITTEN EXPRESSION

ACADEMIC PROBLEM

LEARNING D/O NOS

MOTOR SKILLS D/O COMMUNICATION D/O EXPRESSIVE LANGUAGE MIXED RECEPTIVE/EXPRESSIVE PHONOLOGICAL STUTTERING SELECTIVE MUTISM COMMUNICATION D/O NOS MOV’T & TIC D/O DEV’TAL COORDINATION TRANSIENT TIC CHILDHOOD DISORDERS

MOTOR SKILLS D/O

COMMUNICATION D/O

EXPRESSIVE LANGUAGE

MIXED RECEPTIVE/EXPRESSIVE

PHONOLOGICAL

STUTTERING

SELECTIVE MUTISM

COMMUNICATION D/O NOS

MOV’T & TIC D/O

DEV’TAL COORDINATION

TRANSIENT TIC

CHRONIC MOTOR&VOCAL TIC TOURETTE’S D/O STEREOTYPIC MOV’T D/O TIC D/O NOS DISORDERS OF INTAKE & ELIMINATION PICA RUMINATION FEEDING D/O ENURESIS ENCOPRESIS OTHER: BULIMIA, ANOREXIA CHILDHOOD DISORDERS

CHRONIC MOTOR&VOCAL TIC

TOURETTE’S D/O

STEREOTYPIC MOV’T D/O

TIC D/O NOS

DISORDERS OF INTAKE & ELIMINATION

PICA

RUMINATION

FEEDING D/O

ENURESIS

ENCOPRESIS

OTHER: BULIMIA, ANOREXIA

ADHD & DISRUPTIVE BEHAVIOR D/O ADHD ADHD NOS CONDUCT D/O OPPOSITIONAL DEFIANT CHILD ANTISOCIAL DISRUPTIVE BEHAVIOR NOS MOOD D/O MJ DEPRESSIVE D/O BIPOLAR I OR II DYSTHYMIC MIXED EPISODE HYPOMANIC EPISODE MOOD D/O DUE TO MEDICAL CONDITION SUBSTANCE-INDUCED MOOD D/O CHILDHOOD DISORDERS

ADHD & DISRUPTIVE BEHAVIOR D/O

ADHD

ADHD NOS

CONDUCT D/O

OPPOSITIONAL DEFIANT

CHILD ANTISOCIAL

DISRUPTIVE BEHAVIOR NOS

MOOD D/O

MJ DEPRESSIVE D/O

BIPOLAR I OR II

DYSTHYMIC

MIXED EPISODE

HYPOMANIC EPISODE

MOOD D/O DUE TO MEDICAL CONDITION

SUBSTANCE-INDUCED MOOD D/O

ANXIETY D/O D/O OF RELATIONSHIP SEPARATION ANXIETY REACTIVE ATTACHMENT OF INFANCY OR EARLY CHILDHOOD PARENT-CHILD RELATIONAL PROBLEM SIBLING RELATIONAL PROBLEM PROBLEMS RELATED TO ABUSE OR NEGLECT CHILDHOOD DISORDERS

ANXIETY D/O

D/O OF RELATIONSHIP

SEPARATION ANXIETY

REACTIVE ATTACHMENT OF INFANCY OR EARLY CHILDHOOD

PARENT-CHILD RELATIONAL PROBLEM

SIBLING RELATIONAL PROBLEM

PROBLEMS RELATED TO ABUSE OR NEGLECT

MENTAL RETARDATION an IQ below 70, significant limitations in two or more areas of adaptive behavior (i.e., ability to function at age level in an ordinary environment), and evidence that the limitations became apparent in before 18 y.o. The following ranges, based on the Wechsler Adult Intelligence Scale (WAIS), are in standard use today: Class IQ Terms Profound Below 20 Idiot Severe 20–34 Imbecile Moderate 35–49 Moron Mild 50–69 Borderline 70–79 CHILDHOOD DISORDERS

an IQ below 70, significant limitations in two or more areas of adaptive behavior (i.e., ability to function at age level in an ordinary environment), and evidence that the limitations became apparent in before 18 y.o.

The following ranges, based on the Wechsler Adult Intelligence Scale (WAIS), are in standard use today:

Class IQ Terms

Profound Below 20 Idiot

Severe 20–34 Imbecile

Moderate 35–49 Moron

Mild 50–69

Borderline 70–79

RETT’S D/O Development is normal until 6-18 months, when language and motor milestones regress, purposeful hand use is lost Acquired deceleration in the rate of head growth (resulting in microcephaly in some) Hand stereotypes are typical and breathing irregularities such as hyperventilation, breath holding, or sighing are seen in many. Early on, autistic-like behavior may be seen Common in females CHILDHOOD DISORDERS

Development is normal until 6-18 months, when language and motor milestones regress,

purposeful hand use is lost

Acquired deceleration in the rate of head growth (resulting in microcephaly in some)

Hand stereotypes are typical and breathing irregularities such as hyperventilation, breath holding, or sighing are seen in many.

Early on, autistic-like behavior may be seen

Common in females

CHILDHOOD DISINTEGRATIVE D/O or HELLER’S SYNDROME CDD has some similarity to autism, but an apparent period of fairly normal development is often noted before a regression in skills or a series of regressions in skills. characterized by late onset (>3 years of age) of dev’tal delays in language, social function and motor skills; skills apparently attained are lost CHILDHOOD DISORDERS

CDD has some similarity to autism, but an apparent period of fairly normal development is often noted before a regression in skills or a series of regressions in skills.

characterized by late onset (>3 years of age) of dev’tal delays in language, social function and motor skills; skills apparently attained are lost

ASPERGER’S D/O characterized by difference in language and communication skills, as well as repetitive or restrictive patterns of thought and behavior. Signs: unable to interpret or understand the desires or intentions of others and thereby are unable to predict what to expect of others or what others may expect of them Narrow interests or preoccupation with a subject to the exclusion of other activities Repetitive behaviors or rituals Peculiarities in speech and language Extensive logical/technical patterns of thought Socially and emotionally inappropriate behavior and interpersonal interaction Problems with nonverbal communication Clumsy and uncoordinated motor mov’ts CHILDHOOD DISORDERS

characterized by difference in language and communication skills, as well as repetitive or restrictive patterns of thought and behavior.

Signs: unable to interpret or understand the desires or intentions of others and thereby are unable to predict what to expect of others or what others may expect of them

Narrow interests or preoccupation with a subject to the exclusion of other activities

Repetitive behaviors or rituals

Peculiarities in speech and language

Extensive logical/technical patterns of thought

Socially and emotionally inappropriate behavior and interpersonal interaction

Problems with nonverbal communication

Clumsy and uncoordinated motor mov’ts

CHRONIC MOTOR/ VOCAL TIC TIC is a sudden, repetitive, stereotyped, nonrhythmic, involuntary movement (motor tic) or sound (phonic tic) that involves discrete groups of muscles. can be invisible to the observer (e.g. abdominal tensing or toe crunching) CHILDHOOD DISORDERS

TIC is a sudden, repetitive, stereotyped, nonrhythmic, involuntary movement (motor tic) or sound (phonic tic) that involves discrete groups of muscles.

can be invisible to the observer (e.g. abdominal tensing or toe crunching)

TOURETTE’S D/O characterized by the presence of multiple physical (motor) tics and at least one vocal (phonic) tic; these tics characteristically wax and wane TTT: Neuroleptic medications haloperidol (Haldol) pimozide (Orap) CHILDHOOD DISORDERS

characterized by the presence of multiple physical (motor) tics and at least one vocal (phonic) tic; these tics characteristically wax and wane

TTT: Neuroleptic medications

haloperidol (Haldol)

pimozide (Orap)

ADHD Inattention: Failure to pay close attention to details or making careless mistakes when doing schoolwork or other activities Trouble keeping attention focused during play or tasks Appearing not to listen when spoken to Failure to follow instructions or finish tasks Avoiding tasks that require a high amount of mental effort and organization, such as school projects Frequently losing items required to facilitate tasks or activities, such as school supplies Excessive distractibility Forgetfulness Procrastination, inability to begin an activity Difficulties with household activities (cleaning, paying bills, etc.) Difficulty falling asleep, may be due to too many thoughts at night Frequent emotional outbursts Easily frustrated Easily distracted Hyperactivity-impulsive behaviour Fidgeting with hands or feet or squirming in seat Leaving seat often, even when inappropriate Running or climbing at inappropriate times Difficulty in quiet play Frequently feeling restless Excessive speech Answering a question before the speaker has finished Failure to await one's turn Interrupting the activities of others at inappropriate times Impulsive spending, leading to financial difficulties CHILDHOOD DISORDERS

Inattention:

Failure to pay close attention to details or making careless mistakes when doing schoolwork or other activities

Trouble keeping attention focused during play or tasks

Appearing not to listen when spoken to

Failure to follow instructions or finish tasks

Avoiding tasks that require a high amount of mental effort and organization, such as school projects

Frequently losing items required to facilitate tasks or activities, such as school supplies

Excessive distractibility

Forgetfulness

Procrastination, inability to begin an activity

Difficulties with household activities (cleaning, paying bills, etc.)

Difficulty falling asleep, may be due to too many thoughts at night

Frequent emotional outbursts

Easily frustrated

Easily distracted

Hyperactivity-impulsive behaviour

Fidgeting with hands or feet or squirming in seat

Leaving seat often, even when inappropriate

Running or climbing at inappropriate times

Difficulty in quiet play

Frequently feeling restless

Excessive speech

Answering a question before the speaker has finished

Failure to await one's turn

Interrupting the activities of others at inappropriate times

Impulsive spending, leading to financial difficulties

Frequently prescribed stimulants are methylphenidate (Ritalin and Concerta), amphetamines (Adderall) and dextroamphetamines (Dexedrine) Feingold diet which involves removing salicylates, artificial colors and flavors, and certain synthetic preservatives from children's diets. CHILDHOOD DISORDERS

Frequently prescribed stimulants are methylphenidate (Ritalin and Concerta), amphetamines (Adderall) and dextroamphetamines (Dexedrine)

Feingold diet which involves removing salicylates, artificial colors and flavors, and certain synthetic preservatives from children's diets.

CONDUCT D/O repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated, AGGRESSION TO PEOPLE & ANIMALS DESTRUCTION OF PROPERTY DECEITFULNESS OR THEFT SERIOUS VIOLATIONS OF RULES Beginning before age 13 CHILDHOOD DISORDERS

repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated,

AGGRESSION TO PEOPLE & ANIMALS

DESTRUCTION OF PROPERTY

DECEITFULNESS OR THEFT

SERIOUS VIOLATIONS OF RULES

Beginning before age 13

OPPOSITIONAL DEFIANT characterized by an ongoing pattern of disobedient, hostile, and defiant behavior toward authority figures that goes beyond the bounds of normal childhood behavior Signs Losing temper Arguing with adults Refusing to follow the rules Deliberately annoying people Blaming others Easily annoyed Angry and resentful Spiteful or even revengeful next CHILDHOOD DISORDERS

characterized by an ongoing pattern of disobedient, hostile, and defiant behavior toward authority figures that goes beyond the bounds of normal childhood behavior

Signs

Losing temper

Arguing with adults

Refusing to follow the rules

Deliberately annoying people

Blaming others

Easily annoyed

Angry and resentful

Spiteful or even revengeful

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SUBSTANCE ABUSE Excessive or unhealthy use of substances, such as alcohol, tobacco or drugs, or use of products such as food Terms: TOLERANCE: the declining effect of the same drug dose when it is taken repeatedly over time HABITUATION: a psychological dependence of the use of a drug ADDICTION: the biological and/ or psychological behaviors related to substance dependence WITHDRAWAL SYMPTOMS: result from a biological need that develops when the body becomes adapted to having an addictive drug in the system; occurs when serum levels decrease SUBSTANCE ABUSE

Excessive or unhealthy use of substances, such as alcohol, tobacco or drugs, or use of products such as food

Terms:

TOLERANCE: the declining effect of the same drug dose when it is taken repeatedly over time

HABITUATION: a psychological dependence of the use of a drug

ADDICTION: the biological and/ or psychological behaviors related to substance dependence

WITHDRAWAL SYMPTOMS: result from a biological need that develops when the body becomes adapted to having an addictive drug in the system; occurs when serum levels decrease

ADDICTION ALCOHOL: blood alcohol levels of 0.1% (100mg alcohol/dl of blood) or higher WITHDRAWAL Anorexia Anxiety Easily startled Hyperalertness HPN Insomnia Irritability Jerky mov’t Possibly: hallucinations, illusions or vivid nightmares Seizures (7-48 hrs after cessation) Tachycardia tremors SUBSTANCE ABUSE

ALCOHOL: blood alcohol levels of 0.1% (100mg alcohol/dl of blood) or higher

WITHDRAWAL

Anorexia

Anxiety

Easily startled

Hyperalertness

HPN

Insomnia

Irritability

Jerky mov’t

Possibly: hallucinations, illusions or vivid nightmares

Seizures (7-48 hrs after cessation)

Tachycardia

tremors

WITHDRAWAL DELIRIUM Agitation Anorexia Anxiety Delirium Diaphoresis Disorientation with fluctuating levels of consciousness Fever (100 to 103 F) Hallucinations and delusions Insomnia Tachycardia and HPN Disulfiram (Antabuse) therapy SUBSTANCE ABUSE

WITHDRAWAL DELIRIUM

Agitation

Anorexia

Anxiety

Delirium

Diaphoresis

Disorientation with fluctuating levels of consciousness

Fever (100 to 103 F)

Hallucinations and delusions

Insomnia

Tachycardia and HPN

Disulfiram (Antabuse) therapy

Nursing care Obtain info about drug type and amount consumed Assess v/s Remove unnecssary obj from environment Provide one-on-one supervision if necessary Provide a quiet, calm environment with minimal stimuli Maintain orientation Ensure safety Use restraints Provide physical needs Provide food and fluids as tolerated Administer medications Collect blood and urine samples for drug screening SUBSTANCE ABUSE

Obtain info about drug type and amount consumed

Assess v/s

Remove unnecssary obj from environment

Provide one-on-one supervision if necessary

Provide a quiet, calm environment with minimal stimuli

Maintain orientation

Ensure safety

Use restraints

Provide physical needs

Provide food and fluids as tolerated

Administer medications

Collect blood and urine samples for drug screening

SPOUSE ABUSE Battering precipitates 1:4 suicide attempts of all women Wives explain the injuries as being self-inflicted or accidental Phases Tension-building: series of small incidents that leads to beating Acute beating phase: wife becomes object of assault behavior Loving phase: batterer is remorseful and assures spouse that he will not harm her again. This leads to reconciliation. ABUSE

Battering precipitates 1:4 suicide attempts of all women

Wives explain the injuries as being self-inflicted or accidental

Phases

Tension-building: series of small incidents that leads to beating

Acute beating phase: wife becomes object of assault behavior

Loving phase: batterer is remorseful and assures spouse that he will not harm her again. This leads to reconciliation.

Myths They believe that if they try not to antagonize with their husband, he will change. Efforts to coerce the wife out of the victim role can be fruitful. Facts Women stay in relationships with men who batter because they feel guilty or responsible of the husband’s behavior Wife develops little sense of self-worth, immobilized and unable to remove self from the relationship. Assessment: injuries, other evidence Interventions: with consent ABUSE

Myths

They believe that if they try not to antagonize with their husband, he will change.

Efforts to coerce the wife out of the victim role can be fruitful.

Facts

Women stay in relationships with men who batter because they feel guilty or responsible of the husband’s behavior

Wife develops little sense of self-worth, immobilized and unable to remove self from the relationship.

Assessment: injuries, other evidence

Interventions: with consent

CHILD ABUSE PHYSICAL BATTERING EMOTIONAL SEXUAL NEGLECT ABUSE

PHYSICAL BATTERING

EMOTIONAL

SEXUAL

NEGLECT

ELDERLY ABUSE A variety of behaviors that threaten the health, comfort, and possibly the lives of the elderly, including physical and emotional neglect, emotional abuse, violation of personal rights, financial abuse, and direct physical abuse. Commonly committed by care givers. ABUSE

A variety of behaviors that threaten the health, comfort, and possibly the lives of the elderly, including physical and emotional neglect, emotional abuse, violation of personal rights, financial abuse, and direct physical abuse.

Commonly committed by care givers.

SEXUAL ABUSE Components Sexual Misuse: inappropriate sexual activity Rape: there is actual penetration Incest: refers to the relationship between the victim and abuser blood relative or step parent role Interventions Children: thru play or role playing with puppets Prevention of further sexual abuse next ABUSE

Components

Sexual Misuse: inappropriate sexual activity

Rape: there is actual penetration

Incest: refers to the relationship between the victim and abuser blood relative or step parent role

Interventions

Children: thru play or role playing with puppets

Prevention of further sexual abuse

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COMPLETED SUICIDE Self-inflicted death LEVELS OF SUICIDE Ideation: thought Attempt: acted upon but failed Completed SUICIDE

Self-inflicted death

LEVELS OF SUICIDE

Ideation: thought

Attempt: acted upon but failed

Completed

CHEMICAL RESTRAINT CHEMICAL RESTRAINTS: Medications used to restrict the patient’s freedom of movement or for emergency control of behavior but are not a standard treatment for the px’s medical or psychiatric condition. PHYSICAL RESTRAINTS: Are any manual method or physical or mechanical device attached to or adjacent to the px’s body that he or she cannot easily remove and that restricts freedom of movement or normal access to one’s body, material or equipment.

CHEMICAL RESTRAINTS: Medications used to restrict the patient’s freedom of movement or for emergency control of behavior but are not a standard treatment for the px’s medical or psychiatric condition.

PHYSICAL RESTRAINTS: Are any manual method or physical or mechanical device attached to or adjacent to the px’s body that he or she cannot easily remove and that restricts freedom of movement or normal access to one’s body, material or equipment.

SECLUTION AND RESTRAINTS SECLUTION: the involuntary confinement of a person alone in a room from which the person is physically prevented from leaving. No therapeutic evidence other than a last resort to ensure safety. Evidence suggest that it adds to further trauma and physical harm

SECLUTION: the involuntary confinement of a person alone in a room from which the person is physically prevented from leaving.

No therapeutic evidence other than a last resort to ensure safety.

Evidence suggest that it adds to further trauma and physical harm

GUIDELINES All hospital staff who have direct contact with the px should have ongoing education and training in the proper use of seclusion and restraints and other alternatives Physician or licensed practitioner should evaluate need within 1 hour after the initiation of this intervention. Max of 4 hours for adults, 2 hours for ages 9-17, and 1 hour for children under 9 yrs Orders may be renewed for 24 hrs before another face to face evaluation Continuous assessment, monitoring and evaluation; recorded Good nursing care For both restrained and secluded: constant monitoring face to face or by both audio and video equipment. Px should be released ASAP

GUIDELINES

All hospital staff who have direct contact with the px should have ongoing education and training in the proper use of seclusion and restraints and other alternatives

Physician or licensed practitioner should evaluate need within 1 hour after the initiation of this intervention.

Max of 4 hours for adults, 2 hours for ages 9-17, and 1 hour for children under 9 yrs

Orders may be renewed for 24 hrs before another face to face evaluation

Continuous assessment, monitoring and evaluation; recorded

Good nursing care

For both restrained and secluded: constant monitoring face to face or by both audio and video equipment.

Px should be released ASAP

OTHER GUIDELINES SECLUSION Room should allow observation and communication with px Remove all items that px might use to harm self Document: rationale, response to intervention, physical condition, nsg care, & rationale for termination RESTRAINTS Give support & reassurance Position in anatomical position Privacy is important v/s & Circulation check Should be released q 2hrs Avoid tying to the side rails of bed Assist in periodic change in body positions

SECLUSION

Room should allow observation and communication with px

Remove all items that px might use to harm self

Document: rationale, response to intervention, physical condition, nsg care, & rationale for termination

RESTRAINTS

Give support & reassurance

Position in anatomical position

Privacy is important

v/s & Circulation check

Should be released q 2hrs

Avoid tying to the side rails of bed

Assist in periodic change in body positions

TERMINATING THE INTERVENTION As soon as met the criteria for release Review with px the behavior that precipitated the intervention & px’s capacity to exercise control over behavior DEBRIEFING: reviewing the facts related to an event & processing the response to them; can be used after any stressful event next

As soon as met the criteria for release

Review with px the behavior that precipitated the intervention & px’s capacity to exercise control over behavior

DEBRIEFING: reviewing the facts related to an event & processing the response to them; can be used after any stressful event

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THERAPEUTIC IMPASSES Are blocks in the progress of the nurse-pt relationship Provokes intense feelings in both the nurse and patient RESISTANCE TRANSFERENCE COUNTERTRANSFERENCE BOUNDARY VIOLATIONS

Are blocks in the progress of the nurse-pt relationship

Provokes intense feelings in both the nurse and patient

RESISTANCE

TRANSFERENCE

COUNTERTRANSFERENCE

BOUNDARY VIOLATIONS

RESISTANCE Reluctance or avoidance of verbalizing or experiencing troubling aspects of oneself Eg: suppression or repression, intensification of sx, self-devaluation or hopelessness, intellectual inhibitions, acting out or irrational behavior, superficial talk, intellectual insight/ intellectualization, transference reactions.

Reluctance or avoidance of verbalizing or experiencing troubling aspects of oneself

Eg: suppression or repression, intensification of sx, self-devaluation or hopelessness, intellectual inhibitions, acting out or irrational behavior, superficial talk, intellectual insight/ intellectualization, transference reactions.

TRANSFERENCE Unconscious response in which the px experiences feelings and attitudes toward the nurse that were originally associatated with other significant figures in his or her life. HOSTILE TRANSFERENCE: anger and hostility, resistance DEPENDENT TRANSFERENCE: submissive, subordinate and regards the nurse as a god-like figure; views relationship as magical

Unconscious response in which the px experiences feelings and attitudes toward the nurse that were originally associatated with other significant figures in his or her life.

HOSTILE TRANSFERENCE: anger and hostility, resistance

DEPENDENT TRANSFERENCE: submissive, subordinate and regards the nurse as a god-like figure; views relationship as magical

What do you do? LISTEN CLARIFY REFLECT EXPLORE/ ANALYZE

LISTEN

CLARIFY

REFLECT

EXPLORE/ ANALYZE

COUNTERTRANSFERENCE Created by the nurse’s specific emotional response to the qualities of the patient; inappropriate in the context, content and intensity of emotion; nurses identify the px with individuals from their past, and personal needs Types: Reactions of INTENSE love or caring Disgust or hostility Anxiety, often in response to resistance by the px

Created by the nurse’s specific emotional response to the qualities of the patient; inappropriate in the context, content and intensity of emotion; nurses identify the px with individuals from their past, and personal needs

Types: Reactions of INTENSE

love or caring

Disgust or hostility

Anxiety, often in response to resistance by the px

Eg. Difficulty empathizing Feelings of depression before or after the session Carelessness about implementing the contract Drowsiness during the sessions Encouragement of the px’s dependency Arguments with the px Personal or social involvement with the px Sexual or aggressive fantasies toward the px Tendency to focus on only one aspect or way of looking at information presented by the px Attempts to help the px with matters not related to the identified nursing problems Feelings of anger or impatience because of the px’s unwillingness to change Dreams about or preoccupation with the px

Eg.

Difficulty empathizing

Feelings of depression before or after the session

Carelessness about implementing the contract

Drowsiness during the sessions

Encouragement of the px’s dependency

Arguments with the px

Personal or social involvement with the px

Sexual or aggressive fantasies toward the px

Tendency to focus on only one aspect or way of looking at information presented by the px

Attempts to help the px with matters not related to the identified nursing problems

Feelings of anger or impatience because of the px’s unwillingness to change

Dreams about or preoccupation with the px