Psychiatric Nursing , PSYCHIATRIC DISORDER

1. Presented by: Dave Jay S. Manriquez, RN.
PSYCHIATRIC NURSING
Introduction
0. MENTAL HEALTH – balance in a persons internal life and adaptation to
reality
1. Mental ILL Health – state of imbalance characterized by a disturbance in a
persons thoughts, feelings and behavior
Psychiatric nursing
0. 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.
1. Core : interpersonal process
Related Terms
2. Mental hygiene
0. measures to promote mental health , prevent mental illness and
suffering and facilitate rehabilitation
1. Main tool: therapeutic use of self
2. It requires self-awareness
3. Methods to increase self-awareness:
3. Introspection
4. Discussion
5. Experience
6. Role play
4. Assessment (psychosocial processes )
7. Appearance , behavior or mood
8. Speech , thought content and thought process
9. Sensorium
10. Insight and judgment
11. Family relationships and work habits
12. Level of growth and development
Common Behavioral Signs and Symptoms
Disturbances in perception
5. Illusion
13. misinterpretation of an actual external stimuli
6. Hallucinations
14. false sensory perception in the absence of external stimuli

2. Disturbances in thinking and speech
7. neologism – coining of words that people do not understand
8. Circumstantiality – over inclusion of inappropriate thoughts and details
9. Word salad – incoherent mixture of words and phrases with no logical
sequence
10. Verbigeration – meaningless repetition of words and phrases
11. Perseveration – persistence of a response to a previous question
12. Echolalia – pathological repetition of words of others
13. Aphasia – speech difficulty and disturbance
15. Expressive , receptive or global
14. Flight of ideas- shifting of one topic from one subject to another in a
somewhat related way
15. Looseness of association-incoherent illogical flow of thoughts (unrelated
way)
16. Clang association – sound of word gives direction to the flow of thought
17. Delusion – persistent false belief, rigidly held
16. Delusions of grandeur: special /important in a way
17. Persecutory: threatened
18. Ideas of reference: situation/events involve them
19. Somatic: body reacting in a particular way
20. Jealous: thinking that their partner is unfaithful
21. Erotomanic: person, usually of high status, is in love with the client
22. Religious: illogical ideas about God and religion exhibited by
extreme or extraneous behavior
23. Mixed: combination of above without a predominant theme
18. Magical thinking – primitive thought process thoughts alone can change
events
19. Autistic thinking – regressive thought process; subjective interpretations
not validated with objective reality
20. Dereism – unorganized thinking

3. Disturbances of affect
21. Inappropriate – disharmony between the stimuli and the emotional reaction
22. Blunted affect – severe reduction in emotional reaction
23. Flat affect – absence or near absence of emotional reaction
24. Apathy – dulled emotional tone
25. Depersonalization – feeling of strangeness from one’s self
26. Derealization – feeling of strangeness towards environment
27. Agnosia – lack of sensory stimuli integration
Disturbances in motor activity
28. Echopraxia – imitation of posture of others
29. Waxy flexibility – maintaining position for a long period of time
30. Ataxia – loss of balance
31. Akathesia – extreme restlessness
32. Dystonia- uncoordinated spastic movements of the body
33. Tardive dyskinesia – involuntary twitching or muscle movements
34. Apraxia – involuntary unpurposeful movements
Disturbances in memory
35. Confabulation – filling of memory gaps
36. Déjà vu – something unfamiliar seems familiar
37. Jamais vu- something familiar seems unfamiliar
38. Amnesia – memory loss (inability to recall past events)
24. Retrograde-distant past
25. Anterograde – immediate past
26. Anomia – lack of memory of items
Dynamics of Human Behavior
2. Behavior – the way an individual reacts to a certain stimulus
3. Conflict – situation arising from the presence of two opposing drives
4. Need - organismic condition that requires a certain activity
Dynamics of Human Behavior
39. Personality
27. 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
0. TEMPERAMENT
0. biological-genetic template that interacts with our environment.

4. 1. a set of in-built dispositions we are born with
2. mostly unalterable
3. our nature.
1. CHARACTER
4. 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).
5. the set of all acquired characteristics we posses, often judged in a
cultural-social context.
2. Sometimes the interplay of all these factors results in an abnormal
personality
THEORIES OF PERSONALITY DEVELOPMENT
Freud’s
PSYCHOSEXUAL THEORY
40. Libido – inner drive
41. Parts of body –focus of gratification
42. Unsuccessful resolution - fixation
43. Structures of personality
28. Id: pleasure principle-instinct
29. Ego: controls action and perception –reality principle
30. Superego: moral behavior - conscience
44. 0-18 m0s ;oral – mouth – trust and discriminating
45. 18 mos. – 3 years ; anal – bowels – holding on or letting go
0. Negativism and toilet training age
46. 3 -6 years phallic ; genitals –exploration and discovery ( inc. sexual
tension)
1. Gender identification and genital awareness
2. Oedipus and Electra complex
3. Castration anxiety and penis envy
47. 6-12 years – latency (quiet stage) sexual energy diverted to play. Institution
of superego: control of instinctual impulses
48. 12 – young adult – genital ; reawakening of sexual drives –relationships
31. Sexual maturation
32. Sexual identity ,ability to love and work
Eric Erickson’s
PSYCHOSOCIAL THEORY
3. 0-12mos
4. 1-3y

5. 5. 3-6
6. 6-12
7. 12-18
8. 18-25
9. 25-60
10. 60 and above
11. TRUST vs. MISTRUST
12. AUTONOMY vs. SHAME & DOUBT
13. INDUSTRY vs. INFERIORITY
14. INITIATIVE vs. GUILT
15. IDENTITY vs. IDENTITY CONFUSION
16. INTIMACY vs. ISOLATION
17. EGO INTEGRITY vs. STAGNATION
18. GENERATIVITY vs. DESPAIR
INFANCY
49. CONSISTENT MATERNAL –CHILD INTERACTION – TRUST
50. INNER FEELING OF SELF WORTH
51. HOPE
TODDLER
19. ALLOW EXPLORATION
20. PROVIDE FOR SAFETY
21. “NO, NO” – NEGATIVISM
22. OFFER CHOICES / REVERSE PSYCHOLOGY
23. TOILET TRAINING – 18 MOS.-BOWEL
33. DAYTIME BLADDER: 2 yo
34. NIGHTIME BLADDER: 3 yo
24. REWARD W/ PRAISE AND AFFECTION
25. INDEPENDENCE
PRE-SCHOOL
52. PROVIDE PLAY MATERIALS
53. SATISFY CURIOSITY
54. TEACH AND REINFORCE(HYGIENE,SOCIAL BEHAVIOR)
55. SIBLING RIVALRY
56. WILLPOWER
SCHOOL AGE
57. HOW TO DO THINGS WELL-SUPPORT EFFORTS
58. CHUMS AND HOBBIES
59. NEEDS TO EXCEL/ACCOMPLISH
60. NEED FOR PRIVACY AND PEER INTERACTION
61. COMPETENCE

6. ADOLESCENCE
62. MAKE DECISION,EMANCIPATION FROM PARENTS
63. BODY IMAGE CHANGES
64. NEED TO CONFORM BUT KEEP INDIVIDUALITY
65. SELF - AWARENESS
YOUNG ADULT
66. COMMITMENT AND FIDELITY
67. RESPONSIBILITY
68. ACHIEVEMENT OF INDEPENDENCE
MIDDLE ADULTHOOD
26. SUPPORT-PERIOD OF ROLE TRANSITIONS
27. MIDLIFE CRISIS
28. ADJUSTMENT AND COMPROMISE
29. MOST PRODUCTIVE AND CREATIVE
30. ALTRUISM
LATE ADULTHOOD
69. SELF ACCEPTANCE
70. SELF WORTH
71. WISDOM
Jean Piaget’s
COGNITIVE THEORY
0-2 SENSORIMOTOR
72. REFLEXES
73. IMITATIVE REPETITIVE BEHAVIOR
74. SENSE OF OBJECT PERMANENCE AND SELF SEPARATE FROM
ENVT.
75. TRIAL AND ERROR RESULTS IN PROBLEM SOLVING
2-7Y PRE-OPERATIONAL
31. SELF-CENTERED,EGOCENTRIC
32. CANNOT CONCEPTUALIZE OTHER’S VIEW
33. ANIMISTIC THINKING
34. IMAGINARY PLAYMATE – SYMBOLIC MENTAL
REPRESENTATION – CREATIVITY
35. 2-4 PRE-CONCEPTUAL (PRE-LOGICAL)
36. 4-7 INTUITIVE (UNDERSTANDING OF ROLES)
7-12Y CONCRETE OPERATIONAL
76. LOGICAL CONCRETE THOUGHT

7. 77. INDUCTIVE REASONING (SPECIFIC TO GENERAL)
78. CAN RELATE, PROBLEM SOLVING ABILITY
79. REASONING AND SELF-REGULATION
12-ABOVE: FORMAL OPERATIONAL THOUGHT
80. Abstract thinking
81. Separation of fantasy and fact
82. Reality oriented
83. Deductive reasoning
84. Apply scientific method
Havighurst’s
DEVELOPMENTAL TASKS
85. Baby to early childhood
35. Right from wrong and Conscience
86. Late childhood
36. Physical skills, wholesome attitude, social roles
37. Conscience morality and values
38. Fundamental skills in academics
39. Personal independence
87. Adolescence
40. Sexual social roles
41. Relationships
42. Independence and ideology
88. Early adulthood
43. Career
44. Selecting a mate
45. Finding Civic or social responsibility
89. Middle age
46. Achieving Civic or social responsibility
47. Adjusting to changes
48. Satisfactory career performance
49. Adjusting to aging parents
50. Adjusting to parental roles
90. Old age
51. Adjusting to changes
52. Establishing satisfactory living arrangements and affiliations

8. Kohlberg’s
MORAL DEVELOPMENT/ THINKING/ JUDGEMENT
91. PRE-CONVENTIONAL (0-6)
53. PUNISHMENT AND OBEDIENCE
54. OBEDIENCE TO RULES TO AVOID PUNISHMENT
92. CONVENTIONAL ( 6-12 )
55. MUTUAL INTERPERSONAL
EXPECTATIONS,RELATIONSHIPS AND CONFORMITY
56. SOCIAL SYSTEM AND CONSCIENCE MAINTENANCE
57. BEING GOOD IS IMPORTANT SELF RESPECT OR
CONSCIENCE
93. POST –CONVENTIONAL (12 – 18 Y)
58. PRIOR RIGHT OR SOCIAL CONTRACT
59. UNIVERSAL ETHICAL PRINCIPLE
60. ABIDE FOR COMMON GOOD
61. RATIONAL PERSON-VALIDITY OF PRINCIPLES-AND
BECOME COMMITTED TO THEM
62. INNER CONTROL OF BEHAVIOR UNDERSTANDING THE
EQUALITY OF HUMAN RIGHTS AND DIGNITY OF HUMAN
BEINGS AS INDIVIDUALS
Harry Stack Sullivan’s
INTERPERSONAL THEORY
INFANCY
94. 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
95. CHILD LEARNS TO COMMUNICATE NEEDS THROUGH USE OF
WORDS AND ACCEPTANCE OF DELAYED GRATIFICATION AND
INTERFERENCE OF WISH FULFILLMENT
PRE-SCHOOL
37. DEVELOPMENT OF BODY IMAGE AND SELF-PERCEPTION
38. ORGANIZES AND USES EXPERIENCES IN TERMS OF APPROVAL
AND DISAPPROVAL RECEIVED

9. 39. BEGINS USING SELCTIVE INATTENTION AND DISASSOCIATES
THOSE EXPERIENCES THAT CAUSE PHYSICAL OR EMOTIONAL
DISCOMFORT AND PAIN
SCHOOL AGE
96. THE PERIOD OF LEARNING TO FORM SATISFYING
RELATIONSHIPS WITH PEERS-USES
COMPETITION,COMPROMISE AND COOPERATION
97. THE PRE-ADOLESCENT LEARNS TO RELATE TO PEERS OF THE
SAME SEX
ADOLESCENCE
98. LEARNS INDEPENDENCE AND HOW TO ESTABLISH
SATISFACTORY RELATIONSHIPS WITH MEMBERS OF THE
OPPOSITE SEX
YOUNG ADULTHOOD
99. BECOMES ECONOMICALLY, INTELLECTUALLY AND
EMOTIONALLY SELF SUFICIENT
LATER ADULTHOOD
100. LEARNS TO BE INTERDEPENDENT AND ASSUMES
RESPONSIBILITY FOR OTHERS
SENESCENCE
101. DEVELOPS AN ACCEPTANCE OF RESPONSIBILITY FOR WHAT
LIFE IS AND WAS AND OF ITS PLACE IN THE FLOW OF HISTORY
TREATMENT MODALITIES
REMOTIVATION THERAPY
102. TREATMENT MODALITY THAT PROMOTES EXPRESSION OF
FEELINGS THROUGH INTERACTION FACILITATED BY
DISCUSSION OF NEUTRAL TOPICS
103. 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
104. Involves use of music to facilitate expression of feelings, relaxation and
outlet of tension
PLAY THERAPY
40. enables patient to experience intense emotion in a safe environment
with the use of play
41. children express themselves more easily in play. revealing as
reflection of child’s situation in the family
42. provide toys and materials – facilitate interaction – observe and help
child resolve problems through play
Group therapy

10. 43. 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
44. IDEAL 8 – 10 MEMBERS
MILIEU THERAPY
45. Consists of treatment by means of controlled modification of the patient’s
environment to facilitate positive behavioral change
46. Increase patient’s
6. Awareness of feelings
7. Sense of responsibility and
8. Help return to community
47. clients plan social and group interaction
48. token programs , open wards and self medication are done
FAMILY THERAPY
49. A METHOD OF PSYCHOTHERAPY WHICH FOCUSES ON THE
TOTAL FAMILY AS AN INTERACTIONAL SYSTEM
50. PROBLEM IS A FAMILY PROBLEM
51. focus on sick members behavior as source of trouble / symptom serve a
function for the family
52. members develop sense of identity
53. points out function of the sick member for the rest of the family
PSYCHOANALYTIC
54. focuses on the exploration of the unconscious, to facilitate identification of
the patients defenses
55. ANXIETY RESULTS BETWEEN CONFLICTS OF ID AND EGO
56. Becomes aware of unconscious thoughts and feelings to understand anxiety
and defenses
HYPNOTHERAPY
105. Various methods and techniques to induce a trance state where patient
becomes submissive to instructions
BEHAVIOR MODIFICATION
106. Application of learning principles in order to change maladaptive behavior
107. Believes that psychological problems are a result of learning
108. Everything learned can be unlearned
BEHAVIOR MODIFICATION
109. OPERANT CONDITIONING
63. Use of rewards to reinforce positive behavior
64. Perceived and self-reinforcement becomes more important than
external reinforcement
110. DESENSITIZATION
65. Slow adjustment or exposure to feared objects (phobias)
66. Periodic exposure until undesirable behavior disappears or lessens
AVERSION THERAPY

11. 111. An example of behavior modification
112. Painful stimulus is introduced to bring about an avoidance of another
stimulus
113. End view: behavioral change
OTHER THERAPIES
114. HUMOR THERAPY
67. To facilitate expression and enhance interaction
115. ACTIVITY THERAPY
68. Group interaction while working on a task together
BIOLOGICAL/ MEDICAL THEORY
116. EMOTIONAL PROBLEM IS AN ILLNESS
117. cause may be inherited or chemical in origin
118. FOCUS OF TREATMENT IS MEDICATIONS AND ECT
BIOLOGICAL THERAPY
57. ELECTROCONVULSIVE THERAPY
9. Artificial induction of a grand mal seizure by passing a controlled
electrical current through electrodes applied to one or both temples
10. mechanism of action – unclear
11. voltage: 70 – 150 volts
12. Duration: 0.5 – 2.0 seconds
13. 6 to 12 treatments
14. intervals of 48 hours
58. indicators of effectiveness – occurrence of generalized tonic – clonic
seizures
59. indications – depression , mania and catatonic schizophrenia
60. s/e: confusion, disorientation, short -term memory loss, seizure (30-60 sec)
61. NPO prior
62. Contraindications
15. Fever, pregnancy
16. Inc ICP, fracture
17. retinal detachment
18. TB with hemoptysis
19. cardiac d/o
63. consent needed
64. Reorient after, supportive care
119. medications given :
69. Atropine sulfate: decrease secretions
70. Succinylcholine (Anectine): promote muscle relaxation
71. Methohexital Sodium ( Brevital ): serves as an anesthetic agent
120. common complications:
72. loss of memory
73. headache

12. 74. apnea
75. fracture
76. respiratory depression
Psychopharmacologic Therapy
Benzodiazepines
121. Indications
77. Anxiety
78. Sedation/sleep
79. Muscle spasm
80. Seizure disorder
81. Alcohol withdrawal syndromes
Anti-anxiety drugs
Generic Trade name
Alprazolam Xanax
Chlordiazepoxide Librium
Clorazepate Tranxene
Diazepam Valium
Lorazepam Ativan
Oxazepam Serax
Busipirone BuSpar
Side effects
122. Drowsiness/ sedation
123. Ataxia
124. Feelings of detachment
125. Increase irritability and hostility
126. Anterograde amnesia
127. Increased appetite & weight gain
128. Nausea
129. Headache, confusion
Anti-depressants
130. Indications
82. Depression
83. Bipolar depression
84. Panic disorder
85. Bulimia
86. Obsessive-compulsive d/o
131. Possibly
87. Attention deficit/Hyperactivity d/o
88. Post Traumatic Stress D/o
89. Conduct d/o
Tricyclic (TCA)
Generic Trade name
Amitriptyline Elavil
Imipramine Tofranil

13. Trimipramine Surmontil
Nortriptyline Pamelor
Trazodone Desyrel
Bupropion Wellbutrin
Side effects
132. Orthostatic hypertension
133. Anticholinergic effect
90. Dry mouth, blurred vision, constipation, excessive sweating, urinary
hesitancy/ retention, tachycardia, agitation, delirium, exacerbation of
glaucoma
134. Neurologic effects
91. sedation, psychomotor slowing, poor concentration, fatigue, ataxia,
tremors
135. Decrease libido and sexual performance
Monoamine Oxidase inhibitors
Generic Trade name
Isocarboxazid Marplan
Phenelzine Nardil
Tranylcypromine Parnate
Side effects
136. Postural lightheadedness
137. Constipation
138. Delay ejaculation or orgasm
139. Muscle twitching
140. Drowsiness
141. Dry mouth
Dietary restrictions
142. Cheese, esp. aged and matured
143. Fermented or aged protein
144. Pickled or smoked fish
145. Beer, red wine, sherry; liquor & cognac
146. Yeast
147. Fava or broad beans
148. Beef or chicken liver
149. Spoiled/ overripe fruits; banana peel
150. yogurt
Hypertensive Crisis
151. Signs
92. Sudden elevation of BP
93. Explosive headache, occipital may radiate frontally
94. Head & face flushed
95. Palpitations, chest pain
96. Sweating, fever

14. 97. Nausea, vomiting
98. Dilated pupils, photophobia
99. Intracranial bleeding
152. Treatment
100. Hold next MAO dose
101. Don’t let pt. lie down
102. IM chlorpromazine 100 mg
103. Fever: manage by external cooling techniques
Serotonin Reuptake Inhibitors
Generic Trade name
Fluoxetine Prozac
Sertraline Zoloft
Paroxetine Paxil
Venlafaxine Effexor
Side effects
153. Nausea
154. Diarrhea
155. Insomnia
156. Dry mouth
157. Nervousness
158. Headache
159. Male sexual dysfunction
160. Drowsiness
161. Dizziness
162. Sweating
Mood stabilizing drugs
163. Indications
104. Acute mania
105. Bipolar prophylaxis
164. Possibly
106. Bulimia
107. Alcohol abuse
108. Aggressive behavior
109. schizoaffective
165. Mode of action
110. Normalizes the reuptake of certain neurotransmitters such as
serotonin, norepinephrine, acetylcholine and dopamine
111. Reduces the release of norepinephrine thru competition with
calcium
112. Effects intracellularly
166. Lag period: 7-10 to 14 days
Lithium carbonate

15. 167. Trade names
113. Eskalith
114. Lithotabs
115. Lithane
116. Lithonate
65. MOA: unclear; interfere with metabolism of neurotransmitters; alter Na
transport in nerves and muscle cells
168. Prelithium workup
117. Urinalysis (BUN and creatinine)
118. ECG, FBC, CBC
Side effects
169. Early
119. Nausea and diarrhea
120. Anorexia
121. Fine hand tremor (propranolol)
122. Thirst, Polydipsia (dec. crea, inc. albumin)
123. Metallic taste
124. Fatigue
125. Lethargy
170. Late
126. Weight gain
127. acne
Contraindications
171. Brain damage/ CV disease
172. Epilepsy
173. Elderly/ debilitated
174. Thyroid and renal disease
175. Severe dehydration
176. Pregnancy (1st trimester)
177. Can augment the effects of anti-depressants
Nursing considerations
66. Therapeutic serum level: 0.5 – 1.2 meq/L
67. Maintenance level: 0.6 -1.2 meq/L
68. Toxic
20. Mild to moderate: 1.5 to 2 meq/L
21. Moderate to severe: 2 – 2.5 meq/L
22. Needs dialysis: 3 meq and above
69. Early signs of toxicity
23. Lethargy, mild nausea, vomiting, fine hand tremors, anorexia,
polyuria, polydipsia, metallic taste, fatigue
70. Late signs of toxicity
24. Ataxia, giddiness, tinnitus, blurred vision, polyuria

16. Nursing considerations
71. Lithium levels should be checked q 2-3 mos
72. Serum drawn in the AM, 12H after last dose
73. Common causes of inc. levels
25. Dec. Na intake
26. Diuretic therapy
27. Dec. renal functioning
28. F&E loss
29. Medical illness
30. Overdose
31. NSAIDS
Nursing considerations
178. Diet: adequate Na+ and fluid
128. 3g NaCl/ day
129. 6-8 glasses of H2O
179. No caffeine
180. No driving: wait for clinical effect
Management
74. Moderately severe toxicity
32. Osmotic diuresis: urea/ mannitol
33. Aminophylline & PLR IV
34. Adequate NaCl
35. Peritoneal/ hemodialysis
75. Severe toxicity
36. Assess hx quickly
37. Hold next lithium dose
38. Check BP, rectal T°, RR, LOC, support O2
39. Obtain labs
40. ECG
41. Emetic, NGT lavage
42. Hydrate: 5-6L/day c PLR; FBC-CDU
Other drugs
181. Carbamazepine (Tegretol)
130. Side effects
0. Dizziness
1. Ataxia
2. Clumsiness
3. Sedation
4. Dysarthria
5. Diplopia
6. Nausea & GI upset
131. Preparation: liq, tab, chewable tab
Nursing considerations
182. Assess drug levels q 3-4 days

17. 183. Monitor salt and fluid intake
184. Avoid alcohol and non-prescription drugs
185. Refer dec. in UO
186. Don’t stop abruptly
187. C/I: pregnancy
188. Take with meals
Other drugs
189. Valproic acid (Depakote, Depakene)
132. Side effects
7. Nausea
8. Hepatoxicity
9. Neurotoxicity
10. Hematological toxicity
11. Pancreatitis
133. Prep: tab, cap, sprinkles
190. MOA: inc. levels of GABA; inhibits the kindling process or
“snoball”-like effect seen in mania & seizures
Nursing considerations
191. Therapeutic level: 50 – 100 ug/mL
192. Dose: 1, 000 – 1,500 mg/day
193. Monitor serum levels 12H after last dose
194. Toxic effects
134. Severe diarrhea, vomiting, drowsiness, mm. weakness, lack of
coordination
135. Renal failure, coma, death
Anti-psychotic drugs
195. Indications
136. Psychotic symptoms of schizophrenia, acute mania and depression
137. Gilles de Tourette disorder
138. Treatment-resistant bipolar disorder
139. Huntington’s disease and other movement disorder
196. Possibly
140. Paranoid
141. Childhood psychoses
197. MOA: block receptors of dopamine (D2, D3, D4)
198. If unresponsive after 6 weeks of therapy, another class is tried
199. General considerations
142. Calms without producing impairment of sleep
143. High therapeutic index
144. Non addicting, no tolerance
145. Avoided in pregnancy
TYPICAL: High Potency
Fluphenazine (Prolixin)

18. Haloperidol (Haldol)
Thiothexene (Navane)
Trifluoperazine (Stelazine)
Moderate Potency
Loxapine (Loxitane)
Molindone (Moban)
Perphenazine (Trilafon)
Low Potency
Chlopromazine (Thorazine)
Chlorprothixene (Taractan)
Mesoridazine (Serentil)
Thioridazine (Mellaril)
ATYPICAL
Clozapine (Clozaril)
Resperidone (Risperdal)
Olanzapine (Zyprexa)
Quetiapine (Seroquel)
Sertindole (Serlec’t)
Ziprasidone (Zeldox)
Contraindications
200. CNS depression: brain damage, excess alcohol/ narcotics
201. Parkinson’s disease
202. Allergy
203. Blood dyscrasias
204. Acute narrow angle glaucoma
205. BPH
Side effects
206. Hypotension
207. Sedation
208. Dermal and ocular syndrome
209. Neuroleptic malignant syndrome
210. Anticholinergic syndrome
211. Movement syndrome (Extrapyramidal Syndrome)
212. Atropine psychosis
213. Agranulocytosis
214. Seizures
Neuroleptic Malignant Syndrome
76. A potentially fatal, idiosyncratic reaction to an antipsychotic drug
77. 10-20% mortality rate
78. Sx:
43. rigidity,
44. high fever,
45. autonomic instability (BP, diaphoresis, pallor, delirium, elev. CPK),
confused or mute, fluctuate from agitation to stupor
79. Occurs in the first 2 weeks of therapy

19. 80. Risk: high dose of high-potency drugs; dehydration, poor nx, concurrent
med illness
Movement Syndromes
215. Akathisia
216. Dystonia
217. Tardive dyskinesia
218. Bradykinesia
219. Parkinsonism
Other s/e
220. Atropine psychosis (geriatrics)
146. Hyperactivity, agitation, confusion, flushed skin, sluggish reactive
pupils
147. TTT: IM physostigmine
221. Agranulocytosis (Clozapine)
148. Occurs 3-8 wks after
149. Medical emergency
150. s/s: fever, malaise, sore throat, leukopenia
151. TTT: d/c, reverse iso, antibiotics
222. Seizures (Clozapine)
152. Occurs in 5% of patients; TTT: D/c drug
Anticholinergics
Benztropine (Cogentin)
Trihexyphenidyl (Artane)
Biperiden (Akineton)
Procyclidine (Kemadrin)
223. Not withdrawn abruptly
224. Provide cool environment
ANTIPARKINSONIAN MEDICATIONS
81. Adjunct to anti-psychotic agents to balance dopamine/ acetylcholine in the
brain
82. s/e: glaucoma, tachycardia, HPN, cardiac dx, asthma, duodenal ulcer
83. A/e: blurred vision, photosensitivity, drowsiness, orthostatic hypotension,
CHF, hallucinations
225. COMMON DRUGS:
153. Trihexyphenidyl (Artane)
154. benztropine (Cogentin)
155. Biperiden (Cogentin)
156. Selegiline (Eldepryl)
157. Pergolide (Permax)
226. ANTIHISTAMINE

20. 158. Diphenhydramine HCl (BENADRYL)
227. DOPAMINE RELEASING AGENT
159. Amantadine (SYMMETREL)
228. Nursing considerations
160. Best taken after meals
161. Avoid driving
162. Check BP
163. Alcohol increases sedative effects
164. Avoid sudden position change
165. Drug is not withdrawn abruptly
PSYCHIATRIC DISORDERS
ANXIETY DISORDERS
5. PANIC DISORDERS
6. SPECIFIC PHOBIA
7. SOCIAL PHOBIA
8. OCD
9. PTSD
10. ACUTE STRESS DISORDER
11. GENERALIZED ANXIETY DISORDER
PANIC ATTACKS
229. Discrete period of intense fear or discomfort in which at least 4 if the ff sx
develop abruptly and peak within 10 mins:
166. Palpitations, pounding heart, or accelerated HR
167. Sweating
168. Trembling or shaking
169. Sensations of SOB and smothering
170. Feeling of choking
171. Chest pain or discomfort
172. Nausea or abd. Pain
173. Feeling dizzy, unsteady, lightheaded or faint
174. Derealization or depersonalization
175. Fear of losing control or going crazy
176. Fear of dying
177. Paresthesias
178. Chills or hot flashes
SPECIFICS ¨ PHOBIA ¨ © SOCIAL
84. Excessive and unreasonable cued by the presence or anticipation of a
specific object or situation
85. Defense mech commonly used include repression and displacement
86. Fear of social performance situations in which the person is exposed to
unfamiliar people or to possible scrutiny by others
OBSESSION COMPULSION

21. 87. Recurrent and persistent thoughts, impulses, or images are experienced
during the disturbance as intrusive and inappropriate
88. Cause anxiety or distress
89.Px knows that these are just product of one’s own mind.
90. 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.
91. Aimed at reducing anxiety
OBSESSION COMPULSION
12. Fear of dirt & germs
13. Fear of burglary or robbery
14. Worries about discarding something important
15. Concerns about contracting a serious illness
16. Worries that things must be symmetrical or matching
17. Excessive hand washing
18. Repeated checking of door and window locks
19. Counting and recounting of objects in everyday life
20. Hoarding of objects
21. Excessive straightening, ordering, or of arranging things
22. Repeating words or prayers silently
POST TRAUMATIC STRESS SYNDROME
230. 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
231. Person reexperiences these in the mind
232. Involves intense fear, helplessness, or horror and numbing of general
responsiveness (PSYCHIC NUMBING)
ACUTE GENERALIZED
STRESS ANXIETY
92. Meets the criteria for exposure to a traumatic event and person experiences
3 of the ff sx:
46. sense of detachment,
47. reduced awareness of one’s surroundings,
48. derealization,
49. depersonalization,
50. dissociated amnesia
93. Excessive anxiety or worry, occurring in more days than not for at least 6
mos, about a number of events or activities
94. Finds it difficult to control the worry
MOOD/ AFFECTIVE DISORDERS
95. BIPOLAR D/O

22. 179. 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.
23. MANIA: hyperactivity
24. DEPRESSED: extreme sadness or withdrawal
25. MIXED
180. BIPOLAR II: hx of 1 or more mj depressive episodes & at least 1
hypomanic episode; no mania
233. MAJOR DEPRESSIVE D/O
181. @ least 5 sx of same 2- wk period with one being either depressed
mood or loss of interest or pleasure.
182. Single episode or recurrent
183. Other sx: wt loss, insomnia, fatigue, recurrent thoughts of death,
diminished ability to think, psychomotor agitation or retardation,
feelings of worthlessness.
234. CYCLOTHYMIC D/O
184. Hx of 2 yrs of hypomania with numerous periods of abnormally
elevated, expansive or irritable moods.
185. Does not meet the criteria of mania or depression.
235. DYSTHYMIC D/O
186. @ least 2 yrs of usually depressed mood and at least 1 of the sx of
mj depression without meeting the criteria for it
236. SEASONAL AFFECTIVE D/O
187. Depression that comes with shortened daylight in fall and winter
that disappears during spring and summer.
Dealing with Inappropriate Behaviors
AGGRESSIVE BEHAVIOR
96. Assist the client in identifying feelings of frustration and aggression
97. Encourage the client to talk out instead of acting out feelings of frustration
98. Assist the client in identifying precipitating events or situations that lead to
aggressive behavior
99. Describe the consequences of the behavior on self and others
100. Assist in identifying previous coping mechanisms
101. Assist the client in the problem-solving techniques to cope with frustration
or aggression
DEESCALATION TECHNIQUES
102. Maintain safety
103. Maintain large personal space and use nonaggressive posture
104. Use calm approach and communicate with a calm, clear tone of voice (be
assertive not aggressive
105. Determine what the client considers to be his or her need
106. Avoid verbal struggles

23. 107. Provide clear options that deal with behavior
108. Assist with problem-solving and decision making regarding the options
MANIPULATIVE BEHAVIORS
237. Set clear, consistent, realistic, and enforceable limits and communicate
expected behaviors
238. Be clear about consequences associated with exceeding set limits
239. Discuss behavior in nonjudgmental and nonthreatening manner
240. Avoid power struggles
241. Assist in developing means of setting limits on own behavior
SCHIZOPHRENIA
109. characterized by impairments in the perception or expression of reality and
by significant social or occupational dysfunction.
110. Once considered as a deadly disease
111. There is lack of insight in behavior
112. Dx: late adolescence and early adulthood
51. 15-25 y.o. (men); 25-35 y.o. (women)
113. Obsolete term: dementia praecox = “cognitive deterioration early in life”
114. Eugene Bleuler: schiz “split”; phren “mind”
Risk factors
26. Genetics: identical twins 50%, 15% for fraternal twins
27. Biochemical factors
0. Dopamine hypothesis: overactive
1. Serotonin imbalance
2. Decreased brain volume, enlarged ventricles, deeper fissures, and loss or
underdeveloped brain tissue
28. Psychoanalytic
3. lack of trust during the early stages
4. Weak ego
5. Defenses: REPRESSION, REGRESSION, PROJECTION
29. 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
242. Catatonic type
188. prominent psychomotor disturbances are evident. Symptoms can
include catatonic stupor and waxy flexibility
243. Disorganized type
189. where thought disorder and flat affect are present together
244. Paranoid type
190. where delusions and hallucinations are present but thought
disorder, disorganized behavior, and affective flattening are absent
12.Residual type

24. 4. where positive symptoms are present at a low intensity only
13.Undifferentiated type
5. psychotic symptoms are present but the criteria for paranoid,
disorganized, or catatonic types has not been met
Symptoms
According to Bleuler: 4 A’s
191. Affect is inappropriate
192. Associative looseness
193. Autistic thinking
194. Ambivalence
Symptoms
245. Positive symptoms
195. delusions, auditory hallucinations and thought disorder and are
typically regarded as manifestations of psychosis.
246. Negative symptoms
196. considered to be the loss or absence of normal traits or abilities
197. E.G. flat, blunted or constricted affect and emotion, poverty of
speech and lack of motivation.
Symptoms
30.Social isolation
31.Catatonic behavior
32.Hallucinations
33.Incoherence (marked looseness of association)
34.Zero/ lack of interest, energy and initiative
35.Obvious failure to attain expected level of dev’t
36.Peculiar behavior
37.Hygiene and grooming impaired
38.Recurrent illusions and unusual perception experiences
39.Exacerbations and remissions are common
40.No organic factors accounts for the symptoms
41.Inability to return to baseline functioning after relapse
42.Affect is inappropriate
Nsg Dx: Abnormal thought process
115. BLOCKING: sudden cessation of a thought in the middle of a sentence,
unable to continue the train of thought

25. 116. CIRCUMSTANTIALITY: before getting to the point of answering a
question, the individual gets caught up in countless details and explanations
117. CONFABULATION
118. LOOSENESS OF ASSOCIATION
119. NEOLOGISM
120. WORD SALAD
Interventions
121. Assess physical needs
122. Set limits
123. Maintain safety
124. Initiate one-on-one interaction & progress to small groups
125. Spend time with clients
126. Monitor for altered thought process
127. Maintain ego boundaries, avoid touching
128. Limit time of interaction
129. Be neutral
130. Do not make promises that can’t be kept
247. Establish daily routines
248. Do not “go along” with the client’s delusions or hallucinations
249. Provide simple complete activities
250. Reorient
251. Speak to the client in simple direct and concise manner
252. Set realistic goals
253. Explain everything that is being done
254. Decrease stimuli
255. Monitor for suicide risk
256. Environment
198. Provide safe environment
199. Limit stimuli
257. Psychological Ttt
200. Behavior therapy
201. Social skills training
202. Self-monitoring
258. Social ttt
203. Milieu therapy
204. Family therapy
205. Group therapy (long-term ttt)
Related psychotic disorders
259. SCHIZOAFFECTIVE DISORDER schiz + mood disorder (mania/
depression)
260. BRIEF PSYCHOTIC DISORDER sudden onset of psychotic symptoms,
lasts less than 2 mos and client returns to premorbid level of functioning

26. 261. SCHIZOPHRENIFORM DISORDER schiz sx lasting between 1 month
and <6mos
262. DELUSIONAL DISORDER characterized by prominent, nonbizarre
delusions
PERSONALITY DISORDERS
0. CLUSTER A (odd & eccentric)
0. paranoid, schizoid, schizotypal
1. CLUSTER B (bad, dramatic & erratic)
1. antisocial, borderline, histrionic, narcissistic
2. CLUSTER C (anxious & fearful)
2. avoidant, dependent, OCD
CLUSTER A: ODD & ECCENTRIC
131. PARANOID
52. chronic hostility projected to others; suspicious and mistrusts people
53. Seen mostly in men
132. SCHIZOID
54. social detachment = “loner” & “introvert”
55. Restriction of emotions
56. Attention fixed on objects rather than people
57. Functions well in vocations
133. SCHIZOTYPAL: interpersonal deficits
58. Magical thinking, telepathy
59. Apparent in childhood or adolescence
Interventions for PARANOID D/O
14. Asses for suicide risk
15. Avoid direct eye contact
16. Establish trusting relationship
17. Promote increased self-esteem
18. Remain calm, nonthreatening and nonjudgmental
19. Provide continuity of care
20. Respond honestly to the client
21. Follow thru on commitments
22. Provide a daily schedule of activities
23. Gradually introduce client to groups
24. Do not argue with delusions
25. Use concrete, specific words
263. Do not be secretive with client
264. Do not whisper in presence of client
265. Assure that the client will be safe
266. Provide opportunity to complete small tasks
267. Monitor eating, drinking, sleeping and elimination patterns
268. Limit physical contact
269. Monitor for agitation and decrease stimuli as needed

27. CLUSTER B: ERRATIC, DRAMATIC, OR EMOTIONAL
270. ANTISOCIAL
206. Syn: sociopath, psychopathic & semantic d/o
207. Etiology:
43. Genetics interfere in the dev’t of positive interpersonal
relationships
44. Brain damage or trauma
45. Low socioeconomic status
46. Faulty family relationships: neglect
47. Secondary gains
208. 15-40 y.o.
271. Signs
209. Lack of remorse or indifference to persons hurt
210. Immediate gratification
211. Failure to accept social norms
212. Impulsivity
213. Consistent irresponsibility
214. Aggressive behavior
215. Reckless behavior that disregards the safety of others
272. 80-90% of all crime is committed by antisocials (NIHM, 2000)
26. BORDERLINE
6. Latent, ambulatory and abortive schizophrenics
7. Between moderate neurosis and frank psychosis but quite stable
8. Theories
134. faulty separation from mother; parent and child are bound
by guilt
135. Trauma at 18 mos (weakening of ego)
136. Unfulfilled need for intimacy
273. Signs
216. instability
217. Impulsivity: unpredictable gambling, shoplifting, sex & substance
abuse
218. hypersensitivity, self-destructive, profound mood shifts
219. unstable & intense relations
220. Disturbance in self concept
274. Common in women
275. Defenses: denial, projection, splitting, projective identification

28. 276. HISTRIONIC
221. Pattern of theatrical or overtly dramatic behavior
222. Signs
48. Discomfort when the client isn’t the center of attention
49. Self-dramatization and exaggerated emotions
50. uses physical appearance, sexually seductive and provocative
behavior
51. Excessively impressionistic speech lacking in detail (labile
emotions)
223. Problems in dependence & helplessness
224. More frequent in women
277. NARCISSISTIC
225. Exaggerated or grandiose sense of self-importance
226. Develop early in childhood
227. Preoccupied with fantasies of unlimited success, power and beauty
228. Signs
52. arrogance, need for admiration,
53. lack of empathy,
54. seductive, socially exploitative, manipulative
229. Occurs more in men
CLUSTER C: ANXIOUS OR FEARFUL
278. AVOIDANT
230. Sensitive to rejection, criticism, humiliation, disapproval, or shame
231. Interferes with participation in occupational activities, dev’t of
relationships, and take personal risks
232. social inhibition, longs for relationships
233. Anxiety, anger and depression are common
234. Social phobia may occur
235. Seen in 10% of clients in mental clinics
279. DEPENDENT
236. Lacks confidence and unable to function in an independent role
237. Allows other persons to be responsible of their lives
238. Most frequent personality disorder in the mental health clinic
239. submissive behavior, low self-esteem, inadequate, helpless
280. OBSESSIVE-COMPULSIVE
240. Preoccupied with rules & regulations, overly concerned about
trivial detail, excessively devoted to their work
241. Depression is common
242. Men are more affected than women
UNDER STUDY PERSONALITY D/O

29. 281. PASSIVE-AGGRESSIVE: sullen and argumentative, resents others,
resists fulfilling responsibilities, complains of being unappreciated
282. DEPRESSIVE: gloomy, brooding pessimistic, guilt-prone, highly critical
of self and others, cheerless.
Interventions
137. Maintain safety against self-destructive behaviors
138. Allow the client to make choices and be as independent as possible
139. Encourage the client to discuss feelings rather than act them out
140. Provide consistency in response to the client’s acting out
141. Discuss expectations and responsibilities with the client
142. Inform the client that harm to self, others, and property is unacceptable
283. Identify splitting behavior
284. Assist the client to deal directly with anger
285. Develop a written contract with the client
286. Encourage the client to participate in group activities, and praise
nonmanipulative behavior
287. Set and maintain limits
288. Remove the client from group situations in which attention-seeking
behaviors occur
289. Provide realistic praise for positive behaviors in social situations
PSYCHOLOGICAL SEXUAL D/O
290. Hypoactive sexual disorder (asexuality)
291. Sexual aversion disorder (avoidance of or lack of desire for sexual
intercourse)
292. Female sexual arousal d/o (failure of normal lubricating arousal response)
293. Male erectile d/o
294. Female orgasmic disorder
295. Male orgasmic disorder
296. Premature ejaculation
143. Vaginismus
144. Secondary sexual dysfxn
145. Paraphilias
146. Gender identity d/o
147. PTSD due to genital mutilation or childhood sexual abuse
Other sexual problems
148. Sexual dissatisfaction (non-specific)
149. Lack of sexual desire
150. anorgasmia
151. Impotence
152. STD

30. 297. Infidelity
298. Delay or absence of ejaculation, despite adequate stimulation
299. Inability to control timing of ejaculation
300. Inability to relax vaginal muscles enough to allow intercourse
301. Inadequate vaginal lubrication preceding and during intercourse
302. Burning pain on the vulva or in the vagina with contact to those areas
303. Unhappiness or confusion related to sexual orientation
304. Persistent sexual arousal syndrome
305. Sexual addict
306. hypersexuality
307. Post Ejaculatory Guilt Syndrome, the feeling of guilt after the male
orgasm
SEXUAL EXPRESSION
308. HETEROSEXUALITY
309. HOMOSEXUALITY
310. BISEXUALITY
311. TRANSVESTISM
PARAPHILIAS
312. EXHIBITIONISM: the recurrent urge or behavior to expose one's genitals
to an unsuspecting person.
313. 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.
314. FROTTEURISM: the recurrent urges or behavior of touching or rubbing
against a nonconsenting person.
315. SEXUAL MASOCHISM: the recurrent urge or behavior of wanting to be
humiliated, beaten, bound, or otherwise made to suffer.
316. SEXUAL SADISM: the recurrent urge or behavior involving acts in
which the pain or humiliation of the victim is sexually exciting.
317. TRANSVESTIC FETISHISM: a sexual attraction towards the clothing of
the opposite gender.
318. PEDOPHILIA: the sexual attraction to prepubescent or peripubescent
children.
319. 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.

31. 320. Other paraphilias not otherwise specified (quot;Sexual Disorder
NOSquot;)
243. telephone scatalogia (obscene phone calls)
244. necrophilia (corpses)
245. partialism (exclusive focus on one part of the body)
246. zoophilia(animals)
247. coprophilia (feces)
248. klismaphilia (enemas)
249. urophilia (urine)
SOMATOFORM D/O
153. 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.
154. 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.
60. Most common: blindness, deafness, paralysis, inability to talk
61. “La belle indifference”
321. 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)
322. 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
323. Do not reinforce the sick role
324. Discourage verbalization about physical symptoms by not responding with
positive reinforcement
325. Explore with the client the needs being met by the physical symptoms
326. Convey understanding that the physical symptoms are real to the client
327. Report and assess any new physical complaint
0. next
EATING DISORDER BEHAVIORS
155. 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)
156. PURGE: Maladaptive eating regulation response that includes excessive
exercise, forced vomiting, OCD Rx diuretics, diet pills, laxatives and
steroids.

32. 157. FAST/ RESTRICT: Includes vegetarian diet eliminating all meat without
substituting nonanimal sources of protein, OC about food choices, and
eating habits.
ANOREXIA BULIMIA
55. Rare vomiting or diuretic/laxative abuse
56. More severe wt loss
57. Slightly younger
58. More introverted
59. Hunger denied
60. Eating behavior may be considered normal and a source of esteem
61. Sexually inactive
62. Obsessional and perfectionist features dominate
63. Frequent
64. Less wt loss
65. Slightly older
66. More extroverted
67. Hunger experienced
68. Eating behavior considered foreign and source of distress
69. More sexually active
70. Avoidant, dependent, or borderline features as well as obsessional features
ANOREXIA BULIMIA
complications
158. Death from starvation (or suicide, in chronically ill)
159. Amenorrhea
160. Fewer behavioral problems (these increase with level of severity)
161. Death from hypokalemia or suicide
162. Menses irregular or absent
163. Drug and alcohol abuse, self-mutilation, and other behavioral problems
DELIRIUM
71. 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.
72. Sx: diminished awareness of the environment, disturbances in psychomotor
activity and sleep-wake cycle.
73. COGNITIVE: the mental process characterized by knowing, thinking, and
judging.
6. COGNITIVE DISSONANCE: arises when 2 opposing beliefs exists
at the same time.
7. 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.
8. Term: confusion = cognitive impairment
0. See dementia
DEMENTIA

33. 164. 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.
165. Types:
62. VASCULAR or MULTI-INFARCT
63. VASCULAR WITH ALZHEIMER’S DSE
64. AD: most common
65. DEMENTIA WITH LEWY BODIES: 2nd most common;
neurofilament material
66. PARKINSONIAN DEMENTIA
67. AIDS DEMENTIA COMPLEX
250. FRONTAL LOBE DEMENTIA or PICK’S DSE:
cytoplasmic collections; 3rd most common; loss of expressive
language & comprehension
251. CREUTZFELDT-JAKOB DSE: prion (proteinaceous
infectious particles) = spongy brain; related to TSE & BSE in mad
cow dse
252. CORTICOBASAL DEGENERATION or HUNTINGTON’S DSE/
CHOREA: jerky mov’ts
253. SUPRANUCLEAR PALSY: clumping of protein tau = slow
mov’t, weak eye mov’t (esp. downward), impaired walking
&balance
166. Reversible Causes:
68. Subdural hematoma
69. Tumor (meningioma)
70. Cerebral vasculitis
71. Hydrocephalus
167. Terms: disorientation, memory loss (sensory, primary, secondary, tertiary,
working memory), confabulation, confusion
168. Disturbing behaviors
72. Aggressive psychomotor
73. Nonaggressive psychomotor
74. Verbally aggressive
75. Passive
76. Functionally impaired: loss of ability to do self-care
DELIRIUM vs. DEMENTIA
169. Rapid onset w/ wide fluctuations
170. Hyperalert to difficult to arouse LOC
171. Fluctuating affect
172. Disoriented, confused
173. Attention & sleep disturbed
174. Memory impaired

34. 175. Disordered reasoning
176. Gradual, chronic with continuous decline
177. Normal LOC
178. Labile affect
179. Disoriented, confused Attention intact, sleep usually normal
180. Memory impaired
181. Disordered reasoning & calculation
DELIRIUM vs. DEMENTIA
182. Incoherent, confused, delusional, stereotyped
183. Illusions, hallucinations
184. Poor judgment
185. Insight may be present in lucid moment
186. Poor but variable in MSE
0. next
187. Disorganized, rich in content, delusional, paranoid
188. No change in perception
189. Poor judgment
190. No insight
191. Consistently poor & progressively worsens in MSE
ALZHEIMER’S DEMENTIA
27. Most common type of dementia
28. Stages:
0. MILD: impaired memory, insidious loses in ADL, subtle personality
changes, socially normal
1. MODERATE: obvious memory loss, overt ADL impairment,
prominent behavioral difficulties, variable social skills, supervision
needed
2. SEVERE: fragmented memory, no recognition of familiar people,
assistance needed with basic ADL, fewer troublesome behaviors,
reduced mobility (4 A’s)
Symptoms
328. AGNOSIA: Difficulty recognizing well-known objects
329. APHASIA: Difficulty in finding the right word
330. APRAXIA: Inability or difficulty in performing a purposeful organized
task or similar skilled activities
331. AMNESIA: Significant memory impairment in the absence of clouded
consciousness or other cognitive symptoms
PSYCHIATRIC D/O IN CHILDREN
192. MENTAL RETARDATION
193. PERVASIVE DEV’TAL D/O
77. AUTISM
78. RETT’S D/O

35. 79. CHILDHOOD DISINTEGRATIVE D/O
80. ASPERGER’S D/O
81. PDD NOS
194. LEARNING D/O
82. READING
83. MATHEMATICS
84. WRITTEN EXPRESSION
85. ACADEMIC PROBLEM
86. LEARNING D/O NOS
332. MOTOR SKILLS D/O
333. COMMUNICATION D/O
254. EXPRESSIVE LANGUAGE
255. MIXED RECEPTIVE/EXPRESSIVE
256. PHONOLOGICAL
257. STUTTERING
258. SELECTIVE MUTISM
259. COMMUNICATION D/O NOS
334. MOV’T & TIC D/O
260. DEV’TAL COORDINATION
261. TRANSIENT TIC
262. CHRONIC MOTOR&VOCAL TIC
263. TOURETTE’S D/O
264. STEREOTYPIC MOV’T D/O
265. TIC D/O NOS
335. DISORDERS OF INTAKE & ELIMINATION
266. PICA
267. RUMINATION
268. FEEDING D/O
269. ENURESIS
270. ENCOPRESIS
271. OTHER: BULIMIA, ANOREXIA
195. ADHD & DISRUPTIVE BEHAVIOR D/O
87. ADHD
88. ADHD NOS
89. CONDUCT D/O
90. OPPOSITIONAL DEFIANT
91. CHILD ANTISOCIAL
92. DISRUPTIVE BEHAVIOR NOS
196. MOOD D/O
93. MJ DEPRESSIVE D/O
94. BIPOLAR I OR II
95. DYSTHYMIC
96. MIXED EPISODE

36. 97. HYPOMANIC EPISODE
98. MOOD D/O DUE TO MEDICAL CONDITION
99. SUBSTANCE-INDUCED MOOD D/O
336. ANXIETY D/O
337. D/O OF RELATIONSHIP
272. SEPARATION ANXIETY
273. REACTIVE ATTACHMENT OF INFANCY OR EARLY
CHILDHOOD
274. PARENT-CHILD RELATIONAL PROBLEM
275. SIBLING RELATIONAL PROBLEM
276. PROBLEMS RELATED TO ABUSE OR NEGLECT
MENTAL RETARDATION
74. 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.
75.The following ranges, based on the Wechsler Adult Intelligence Scale
(WAIS), are in standard use today:
76. 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
197. Development is normal until 6-18 months, when language and motor
milestones regress,
198. purposeful hand use is lost
199. Acquired deceleration in the rate of head growth (resulting in
microcephaly in some)
200. Hand stereotypes are typical and breathing irregularities such as
hyperventilation, breath holding, or sighing are seen in many.
201. Early on, autistic-like behavior may be seen
202. Common in females
CHILDHOOD DISINTEGRATIVE D/O or HELLER’S SYNDROME
338. 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.
339. 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
77. characterized by difference in language and communication skills, as well
as repetitive or restrictive patterns of thought and behavior.
78. 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

37. 9. Narrow interests or preoccupation with a subject to the exclusion of
other activities
10. Repetitive behaviors or rituals
11. Peculiarities in speech and language
12. Extensive logical/technical patterns of thought
13. Socially and emotionally inappropriate behavior and interpersonal
interaction
14. Problems with nonverbal communication
15. Clumsy and uncoordinated motor mov’ts
CHRONIC MOTOR/ VOCAL TIC
340. TIC is a sudden, repetitive, stereotyped, nonrhythmic, involuntary
movement (motor tic) or sound (phonic tic) that involves discrete groups of
muscles.
341. can be invisible to the observer (e.g. abdominal tensing or toe crunching)
TOURETTE’S D/O
342. characterized by the presence of multiple physical (motor) tics and at least
one vocal (phonic) tic; these tics characteristically wax and wane
343. TTT: Neuroleptic medications
277. haloperidol (Haldol)
278. pimozide (Orap)
ADHD
Inattention:
0. Failure to pay close attention to details or making careless mistakes when
doing schoolwork or other activities
1. Trouble keeping attention focused during play or tasks
2. Appearing not to listen when spoken to
3. Failure to follow instructions or finish tasks
4. Avoiding tasks that require a high amount of mental effort and
organization, such as school projects
5. Frequently losing items required to facilitate tasks or activities, such as
school supplies
6. Excessive distractibility
7. Forgetfulness
8. Procrastination, inability to begin an activity
9. Difficulties with household activities (cleaning, paying bills, etc.)
10. Difficulty falling asleep, may be due to too many thoughts at night
11. Frequent emotional outbursts
12. Easily frustrated
13. Easily distracted
Hyperactivity-impulsive behaviour
0. Fidgeting with hands or feet or squirming in seat
1. Leaving seat often, even when inappropriate
2. Running or climbing at inappropriate times
3. Difficulty in quiet play
4. Frequently feeling restless

38. 5. Excessive speech
6. Answering a question before the speaker has finished
7. Failure to await one's turn
8. Interrupting the activities of others at inappropriate times
9. Impulsive spending, leading to financial difficulties
344. Frequently prescribed stimulants are methylphenidate (Ritalin and
Concerta), amphetamines (Adderall) and dextroamphetamines (Dexedrine)
345. Feingold diet which involves removing salicylates, artificial colors
and flavors, and certain synthetic preservatives from children's diets.
CONDUCT D/O
346. repetitive and persistent pattern of behavior in which the basic rights of
others or major age-appropriate societal norms or rules are violated,
279. AGGRESSION TO PEOPLE & ANIMALS
280. DESTRUCTION OF PROPERTY
281. DECEITFULNESS OR THEFT
282. SERIOUS VIOLATIONS OF RULES
79. Beginning before age 13
OPPOSITIONAL DEFIANT
80. characterized by an ongoing pattern of disobedient, hostile, and defiant
behavior toward authority figures that goes beyond the bounds of normal
childhood behavior
81. Signs
100. Losing temper
101. Arguing with adults
102. Refusing to follow the rules
103. Deliberately annoying people
104. Blaming others
105. Easily annoyed
106. Angry and resentful
107. Spiteful or even revengeful
1. next
SUBSTANCE ABUSE
203. Excessive or unhealthy use of substances, such as alcohol, tobacco or
drugs, or use of products such as food
204. Terms:
108. TOLERANCE: the declining effect of the same drug dose when it
is taken repeatedly over time
109. HABITUATION: a psychological dependence of the use of a drug
110. ADDICTION: the biological and/ or psychological behaviors
related to substance dependence

39. 111. 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
205. ALCOHOL: blood alcohol levels of 0.1% (100mg alcohol/dl of blood) or
higher
112. WITHDRAWAL
0. Anorexia
1. Anxiety
2. Easily startled
3. Hyperalertness
4. HPN
5. Insomnia
6. Irritability
7. Jerky mov’t
8. Possibly: hallucinations, illusions or vivid nightmares
9. Seizures (7-48 hrs after cessation)
10. Tachycardia
11. tremors
283. WITHDRAWAL DELIRIUM
82. Agitation
83. Anorexia
84. Anxiety
85. Delirium
86. Diaphoresis
87. Disorientation with fluctuating levels of consciousness
88. Fever (100 to 103 F)
89. Hallucinations and delusions
90. Insomnia
91. Tachycardia and HPN
284. Disulfiram (Antabuse) therapy
Nursing care
0. Obtain info about drug type and amount consumed
1. Assess v/s
2. Remove unnecssary obj from environment
3. Provide one-on-one supervision if necessary
4. Provide a quiet, calm environment with minimal stimuli
5. Maintain orientation
6. Ensure safety
7. Use restraints
8. Provide physical needs
9. Provide food and fluids as tolerated
10. Administer medications
11. Collect blood and urine samples for drug screening
SPOUSE ABUSE

40. 206. Battering precipitates 1:4 suicide attempts of all women
207. Wives explain the injuries as being self-inflicted or accidental
208. Phases
113. Tension-building: series of small incidents that leads to beating
114. Acute beating phase: wife becomes object of assault behavior
115. Loving phase: batterer is remorseful and assures spouse that he
will not harm her again. This leads to reconciliation.
209. Myths
116. They believe that if they try not to antagonize with their husband,
he will change.
117. Efforts to coerce the wife out of the victim role can be fruitful.
210. Facts
118. Women stay in relationships with men who batter because they
feel guilty or responsible of the husband’s behavior
119. Wife develops little sense of self-worth, immobilized and unable to
remove self from the relationship.
211. Assessment: injuries, other evidence
212. Interventions: with consent
CHILD ABUSE
0. PHYSICAL BATTERING
1. EMOTIONAL
2. SEXUAL
3. NEGLECT
ELDERLY ABUSE
347. 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.
348. Commonly committed by care givers.
SEXUAL ABUSE
349. Components
285. Sexual Misuse: inappropriate sexual activity
286. Rape: there is actual penetration
287. Incest: refers to the relationship between the victim and abuser
blood relative or step parent role
350. Interventions
288. Children: thru play or role playing with puppets
289. Prevention of further sexual abuse
1. next
COMPLETED SUICIDE
351. Self-inflicted death
352. LEVELS OF SUICIDE
290. Ideation: thought
291. Attempt: acted upon but failed

41. 292. Completed
CHEMICAL RESTRAINT
213. 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.
214. 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
353. SECLUTION: the involuntary confinement of a person alone in a room
from which the person is physically prevented from leaving.
293. No therapeutic evidence other than a last resort to ensure safety.
294. Evidence suggest that it adds to further trauma and physical harm
215. GUIDELINES
120. 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
121. Physician or licensed practitioner should evaluate need within 1
hour after the initiation of this intervention.
122. Max of 4 hours for adults, 2 hours for ages 9-17, and 1 hour for
children under 9 yrs
123. Orders may be renewed for 24 hrs before another face to face
evaluation
124. Continuous assessment, monitoring and evaluation; recorded
125. Good nursing care
126. For both restrained and secluded: constant monitoring face to face
or by both audio and video equipment.
127. Px should be released ASAP
OTHER GUIDELINES
216. SECLUSION
128. Room should allow observation and communication with px
129. Remove all items that px might use to harm self
130. Document: rationale, response to intervention, physical condition,
nsg care, & rationale for termination
217. RESTRAINTS
131. Give support & reassurance
132. Position in anatomical position
133. Privacy is important
134. v/s & Circulation check
135. Should be released q 2hrs
136. Avoid tying to the side rails of bed
137. Assist in periodic change in body positions

42. TERMINATING THE INTERVENTION
354. As soon as met the criteria for release
355. Review with px the behavior that precipitated the intervention & px’s
capacity to exercise control over behavior
356. DEBRIEFING: reviewing the facts related to an event & processing the
response to them; can be used after any stressful event
2. next
THERAPEUTIC IMPASSES
357. Are blocks in the progress of the nurse-pt relationship
358. Provokes intense feelings in both the nurse and patient
295. RESISTANCE
296. TRANSFERENCE
297. COUNTERTRANSFERENCE
298. BOUNDARY VIOLATIONS
RESISTANCE
359. Reluctance or avoidance of verbalizing or experiencing troubling aspects
of oneself
360. 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
361. 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.
299. HOSTILE TRANSFERENCE: anger and hostility, resistance
300. DEPENDENT TRANSFERENCE: submissive, subordinate and
regards the nurse as a god-like figure; views relationship as magical
What do you do?
0. LISTEN
1. CLARIFY
2. REFLECT
3. EXPLORE/ ANALYZE
COUNTERTRANSFERENCE
218. 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
219. Types: Reactions of INTENSE
301. love or caring
302. Disgust or hostility
303. Anxiety, often in response to resistance by the px
220. Eg.

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