The document discusses personality disorders and schizophrenic disorders. It describes three clusters of personality disorders - cluster A includes disorders like schizotypal PD characterized by odd behavior and poor social skills; cluster B includes dramatic disorders like borderline PD with unstable relationships and self-image; cluster C includes anxious disorders like avoidant PD. Schizophrenia is then discussed, characterized by positive symptoms like hallucinations and negative symptoms like flat affect. Causes may include genetic and environmental factors. Treatment involves medications to reduce symptoms and therapies like family therapy.
This nursing care plan outlines the assessment data, expected outcomes, nursing diagnosis, and implementation strategies for a client experiencing depression. The client presents with symptoms including suicidal thoughts, slowed mental processes, disordered thoughts, feelings of despair and worthlessness, and sleep disturbances. The nursing diagnosis is ineffective coping. Expected immediate outcomes are for the client to be free from self-harm, engage in reality-based interactions, and be oriented. Stabilization outcomes include expressing feelings directly and being free from psychotic symptoms. Community outcomes are medication compliance if prescribed, increased ability to cope with stress, and identifying a support system. Nursing interventions include providing a safe environment, continually assessing suicide risk, closely observing the client during medication changes or behavioral changes,
One of my assignments in graduate school was to pick a topic about mental health. I chose to research Obsessive Compulsive Disorder (OCD) since so many have to endure this terrible illness. In addition, I was fascinated by how the brain works in people diagnosed with OCD and excited to share my findings with my colleagues. This project required me to implement evidence-based research by reviewing articles and books on the topic. I had to familiarize myself with the findings, create and present a comprehensive power point slide to my professors and fellow students.
OCPD and OCD share some similarities but have key differences in onset, course, and treatment. OCPD develops early in life as a personality trait, while OCD can develop at any age as a mental disorder. OCPD is stable over time, while OCD fluctuates in severity and can be persistent despite treatment. Perfectionism is pervasive in OCPD and justified as improving efficiency, whereas OCD involves non-productive time spent on compulsions to neutralize obsessions. Interpersonal problems are usually the reason OCPD patients seek treatment due to need for control, while OCD patients seek treatment due to distress from obsessions and compulsions. OCPD may receive anxiolytics or CBT,
This document provides guidance on delivering bad news to patients. It discusses that bad news can seriously affect a patient's view of the future. Delivering bad news properly is important for the patient's psychological adjustment and reduces stress for doctors. However, it can be challenging due to individual patient needs, time constraints, and a focus on biomedical training over communication skills. The document recommends the ABCDE/SPIKES approach for delivering bad news, which includes advance preparation, building rapport, communicating clearly, dealing with reactions, and validating emotions. Key steps involve preparing details, arranging private time, assessing the patient's understanding, offering hope and support, and documenting the discussion.
The document discusses generalized anxiety disorder, defining it as excessive and persistent anxiety that lasts for over 6 months. It affects around 2.5-8% of the population and is more common in women. Causes may include genetic factors as it often runs in families, biochemical imbalances of neurotransmitters like serotonin and GABA, and psychological factors related to difficulties with ego development. Symptoms include motor symptoms like tremors, psychological symptoms like worrying thoughts, and physiological symptoms like increased heart rate. Treatment involves anxiolytic medications like SSRIs, SNRIs, benzodiazepines and buspirone as well as cognitive behavioral therapy and relaxation techniques.
The document defines obsessive-compulsive disorder as an anxiety disorder characterized by recurrent unwanted thoughts (obsessions) that lead to repetitive behaviors or mental acts (compulsions) like cleaning. Genetics and abnormal serotonin levels may contribute to its development. Symptoms include intrusive thoughts, images, doubts, or impulses that cause distress. Compulsions like cleaning rituals provide temporary relief. Treatment involves medication like antidepressants and exposure therapy to help patients resist compulsions. Nurses should provide support and help patients develop coping skills to manage their symptoms.
Non schizophrenic Psychosis
Brief Psychotic Disorder
Schizophreniform Disorder
Substance-Induced Psychotic Disorder
Psychotic Disorder Due to a General Medical Condition
Schizoaffective Disorder
Shared Psychotic Disorder
Delusional Disorder
Dr. Mohammad Hussein
الذهان الغير فصامي
د.محمد حسين
استشاري الطب النفسي
1. Mood disorders are characterized by disturbances in mood that are not caused by other medical conditions. They include conditions like manic episodes, bipolar disorder, depressive episodes, and persistent mood disorders.
2. The document discusses the clinical features, classification, etiology, and nursing management of mood disorders with a focus on manic episodes and depressive episodes. Core features of mania include elevated mood, increased speech and activity, and decreased sleep while features of depression include depressed mood, loss of interest, and changes in appetite and sleep.
3. Nursing care for patients with mood disorders focuses on safety, meeting nutritional and social needs, administering prescribed treatments, and setting limits on manipulative behaviors.
This nursing care plan outlines the assessment data, expected outcomes, nursing diagnosis, and implementation strategies for a client experiencing depression. The client presents with symptoms including suicidal thoughts, slowed mental processes, disordered thoughts, feelings of despair and worthlessness, and sleep disturbances. The nursing diagnosis is ineffective coping. Expected immediate outcomes are for the client to be free from self-harm, engage in reality-based interactions, and be oriented. Stabilization outcomes include expressing feelings directly and being free from psychotic symptoms. Community outcomes are medication compliance if prescribed, increased ability to cope with stress, and identifying a support system. Nursing interventions include providing a safe environment, continually assessing suicide risk, closely observing the client during medication changes or behavioral changes,
One of my assignments in graduate school was to pick a topic about mental health. I chose to research Obsessive Compulsive Disorder (OCD) since so many have to endure this terrible illness. In addition, I was fascinated by how the brain works in people diagnosed with OCD and excited to share my findings with my colleagues. This project required me to implement evidence-based research by reviewing articles and books on the topic. I had to familiarize myself with the findings, create and present a comprehensive power point slide to my professors and fellow students.
OCPD and OCD share some similarities but have key differences in onset, course, and treatment. OCPD develops early in life as a personality trait, while OCD can develop at any age as a mental disorder. OCPD is stable over time, while OCD fluctuates in severity and can be persistent despite treatment. Perfectionism is pervasive in OCPD and justified as improving efficiency, whereas OCD involves non-productive time spent on compulsions to neutralize obsessions. Interpersonal problems are usually the reason OCPD patients seek treatment due to need for control, while OCD patients seek treatment due to distress from obsessions and compulsions. OCPD may receive anxiolytics or CBT,
This document provides guidance on delivering bad news to patients. It discusses that bad news can seriously affect a patient's view of the future. Delivering bad news properly is important for the patient's psychological adjustment and reduces stress for doctors. However, it can be challenging due to individual patient needs, time constraints, and a focus on biomedical training over communication skills. The document recommends the ABCDE/SPIKES approach for delivering bad news, which includes advance preparation, building rapport, communicating clearly, dealing with reactions, and validating emotions. Key steps involve preparing details, arranging private time, assessing the patient's understanding, offering hope and support, and documenting the discussion.
The document discusses generalized anxiety disorder, defining it as excessive and persistent anxiety that lasts for over 6 months. It affects around 2.5-8% of the population and is more common in women. Causes may include genetic factors as it often runs in families, biochemical imbalances of neurotransmitters like serotonin and GABA, and psychological factors related to difficulties with ego development. Symptoms include motor symptoms like tremors, psychological symptoms like worrying thoughts, and physiological symptoms like increased heart rate. Treatment involves anxiolytic medications like SSRIs, SNRIs, benzodiazepines and buspirone as well as cognitive behavioral therapy and relaxation techniques.
The document defines obsessive-compulsive disorder as an anxiety disorder characterized by recurrent unwanted thoughts (obsessions) that lead to repetitive behaviors or mental acts (compulsions) like cleaning. Genetics and abnormal serotonin levels may contribute to its development. Symptoms include intrusive thoughts, images, doubts, or impulses that cause distress. Compulsions like cleaning rituals provide temporary relief. Treatment involves medication like antidepressants and exposure therapy to help patients resist compulsions. Nurses should provide support and help patients develop coping skills to manage their symptoms.
Non schizophrenic Psychosis
Brief Psychotic Disorder
Schizophreniform Disorder
Substance-Induced Psychotic Disorder
Psychotic Disorder Due to a General Medical Condition
Schizoaffective Disorder
Shared Psychotic Disorder
Delusional Disorder
Dr. Mohammad Hussein
الذهان الغير فصامي
د.محمد حسين
استشاري الطب النفسي
1. Mood disorders are characterized by disturbances in mood that are not caused by other medical conditions. They include conditions like manic episodes, bipolar disorder, depressive episodes, and persistent mood disorders.
2. The document discusses the clinical features, classification, etiology, and nursing management of mood disorders with a focus on manic episodes and depressive episodes. Core features of mania include elevated mood, increased speech and activity, and decreased sleep while features of depression include depressed mood, loss of interest, and changes in appetite and sleep.
3. Nursing care for patients with mood disorders focuses on safety, meeting nutritional and social needs, administering prescribed treatments, and setting limits on manipulative behaviors.
A quick overview of best practice treatments for mental disorders. Great for personal study, as flashcards, for study for the NCMHCE or similar exams, or as a presentation.
One of my assignments in graduate school was to pick a topic about mental health. I chose to research Obsessive Compulsive Disorder (OCD) since so many have to endure this terrible illness. In addition, I was fascinated by how the brain works in people diagnosed with OCD and excited to share my findings with my colleagues. This project required me to implement evidence-based research by reviewing articles and books on the topic. I had to familiarize myself with the findings, create and present a comprehensive power point slide to my professors and fellow students.
This document provides information on obsessive-compulsive personality disorder (OCPD) in 4 parts:
1. Introduction - OCPD is characterized by perfectionism and inflexibility. It affects 1-2% of the population.
2. Prevalence - Men are more likely to be affected than women. Those with higher education are also more likely. Comorbidity with mood/anxiety disorders is common.
3. Diagnostic Criteria - To be diagnosed requires 4 of 7 criteria related to perfectionism, orderliness, mental/interpersonal control, rigidity, and reluctance to delegate.
4. Management - Cognitive-behavioral therapy may help reduce perfectionism. Psychodynamic psychotherapy
Obsessive-compulsive disorder (OCD) is characterized by distressing, intrusive thoughts and related compulsions that attempt to neutralize obsessions. Common obsessions include fears of contamination, harming others, mistakes, and social acceptance. Common compulsions include cleaning, checking, arranging, collecting, counting, and tapping. Cognitive behavioral therapy (CBT), specifically exposure and response prevention (ERP), is an effective treatment that aims to change maladaptive thoughts and behaviors by exposing patients to their fears while preventing compulsions.
REACTION TO STRESS DISORDER AND ADJUSTMENT DISORDERSdivya2709
This document discusses acute stress reaction disorders and post-traumatic stress disorder (PTSD). It defines acute stress reaction as being characterized by anxiety, despair and anger related to a clearly identifiable stressor. PTSD is defined as anxiety symptoms, trauma reexperiencing, and stimulus avoidance lasting over 4 weeks after a traumatic event. Adjustment disorders are also covered, including types like with anxiety or depressed mood. Treatment involves relieving symptoms associated with the stressor and enhancing coping skills.
Depression
Background
Pathophysiology
• The monoamine theory of depression is that it results from a central deficit in the monoamine neurotransmitters serotonin (5-HT) and norepinephrine.
• Other reported physiological features include ↑cortisol and a blunted TSH response.
• However, there is no widely accepted and definitively proven biological model of depression.
Epidemiology
• Time course: for most it is an episodic illness, but for other it follows a more chronic course.
• Incidence: 5% annual risk, 20% lifetime risk.
Presentation
DSM and NICE criteria
These are based on DSM-4, though DSM-5 does not significantly differ.
Major depressive disorder is ≥2 weeks of low mood and/or anhedonia, and at least 4 symptoms out of:
• ↓Energy or fatigue.
• ↓Concentration
• ↓Weight/appetite.
• Disturbed sleep, which commonly includes early waking. Diurnal pattern to symptoms also seen, with symptoms often worse in the morning.
• Slowing of thought and movements (psychomotor slowing) or agitation.
• Ideas of worthlessness or guilt.
• Recurrent thoughts of death or suicide.
• All but the last 2 are considered 'biological' symptoms.
Schizophrenia is a psychotic disorder characterized by disturbances in thinking, behavior, and emotions. It has biological, psychological, and social contributing factors. Biologically, it is linked to genetic predisposition, changes in brain activity like abnormal dopamine levels, and drug use in some cases. Psychologically, it involves impaired reasoning and memory. Socially, factors include social disadvantages, trauma, and psycho-social stress. Treatment involves both biological approaches like dopamine-blocking medication and psychological/social approaches like CBT, social support, and reducing stigma. A biopsychosocial model recognizes the interaction between biological, psychological, and social vulnerabilities in the development of schizophrenia.
This document discusses somatoform disorders and provides an overview of key topics including:
- Definitions and objectives of understanding somatoform disorders
- Examples of specific disorders like somatization disorder, hypochondriasis, and conversion disorder
- The case of "Ms. A" who has persistent medical complaints and seeks further diagnostic testing
- Distinguishing somatoform disorders from conditions like malingering and factitious disorders
- Management strategies like explaining the chronic nature of symptoms and exploring their impact on a patient's life
The document discusses mental health assessment in primary care. It introduces the Look, Listen, and Test (LLT) framework for psychiatric assessment. LLT utilizes existing observational and history taking skills in primary care. The physician looks at the patient, listens to what they say, and performs appropriate tests through questions or exams. It can help structure consultations and support a holistic view. The framework draws from the more extensive SCAN assessment but is briefer and more suitable for typical primary care consultations.
Quick review of the essential points— DSM5 diagnosis criteria, assessments, treatments—of these disorders to better prepare for the National Clinical Mental Health Counseling Exam. This was informed by several exam prep programs, and can be used like flashcards or as a presentation.
This document discusses psychological assessment skills for identifying and addressing psychological distress in patients with MS. It identifies several situations where distress may occur, such as at diagnosis, changes in disease progression, or losses of independence. It also outlines important skills for assessment like empathy, use of open questions, and listening for emotional content rather than providing reassurance. Screening tools and potential referral options are presented for patients showing signs of depression, anxiety, or needing additional support. The document emphasizes the importance of understanding what is a normal adjustment process versus something requiring further intervention.
1) OCD affects approximately 1% of children, with rituals persisting into adulthood if left untreated. Common symptoms include contamination fears, checking behaviors, and reassurance seeking.
2) Treatment involves psychoeducation, cognitive techniques, exposure therapy to confront fears, and prevention of compulsive rituals. The gold standard is combined cognitive behavioral therapy and selective serotonin reuptake inhibitors.
3) For severe pediatric OCD, treatment guidelines recommend starting with CBT for milder cases and adding an SSRI or using an SSRI alone for more severe presentations in adolescents. Exposure therapy involves gradually confronting feared stimuli while resisting compulsions to reduce anxiety.
OCD is an anxiety disorder characterized by recurrent obsessions and/or compulsions. It affects approximately 3% of the population worldwide and typically emerges between ages 20-24. While the exact cause is unknown, biological factors like abnormalities in brain circuits and serotonin levels are implicated. Treatment involves cognitive-behavioral therapy such as exposure response prevention and medication like SSRIs. Nursing management focuses on assessing coping abilities, role functioning, and providing psychoeducation on relationships between anxiety, thoughts, and behaviors.
A functional disorder causes physical discomfort which makes everyday life difficult. It can be seen as a disorder where the mind and the body for various reasons are not functioning properly
This document discusses different types of anxiety disorders including generalized anxiety disorder, social phobia, panic disorder, agoraphobia, specific phobias, post-traumatic stress disorder, and obsessive-compulsive disorder. It describes the symptoms, causes, and common treatments for each disorder which typically involve medication, cognitive behavioral therapy, and exposure therapy.
Quick review of the essential points— DSM5 diagnosis criteria, assessments, treatments—of these disorders to better prepare for the National Clinical Mental Health Counseling Exam. This can be used like flashcards or as a presentation.
This document provides an overview of conversion disorder in children. It discusses the history and conceptualization of conversion disorder. Key points include: conversion disorder involves physical symptoms that cannot be explained by medical factors and may represent underlying psychological issues; it is more common in children and adolescents experiencing stressors or family dysfunction; learning from models and gaining secondary benefits can perpetuate symptoms; accurate diagnosis is important to guide appropriate treatment focusing on the underlying psychological needs rather than the physical symptoms.
The document discusses anxiety in children and adolescents. It describes the differences between depressed mood versus a depressive episode, and lists the diagnostic criteria for a major depressive episode. It also discusses irritable mood and the various conditions it could indicate. The document provides information on generalized anxiety disorder, including prevalence, genetics, neurotransmitters involved, and treatment options. It covers specific phobias and social phobia, including diagnostic criteria, prevalence, etiology, and treatment.
The document provides information on obsessive-compulsive disorder (OCD), including its history, epidemiology, clinical features, diagnostic criteria, etiology, and treatment. Some key points include:
- OCD has been recognized since ancient times with beliefs that it was caused by demonic possession or religious issues.
- It has a prevalence of around 2% worldwide and was historically considered treatment-resistant.
- The discovery that the antidepressant clomipramine could effectively treat OCD was a major breakthrough.
- OCD is characterized by obsessions (unwanted thoughts, images or urges) and/or compulsions (repetitive behaviors or rituals).
- The cause is believed to involve abnormalities in serotonin
Personality Disoder by Jayesh Patidar.pptxJayesh Patidar
This document provides information on personality disorders according to the DSM-IV-TR. It discusses what personality and personality disorders are, and defines personality as predictable responses and behaviors to one's environment. Personality disorders are characterized by inflexible behaviors that differ from cultural expectations and cause impairment. The document outlines three clusters of personality disorders - A, B, and C - and provides details on paranoid, schizoid, schizotypal, antisocial, histrionic and narcissistic personality disorders, including key signs, symptoms, epidemiology, characteristics, etiology and classification.
This document provides information on several personality disorders, including definitions, classifications, symptoms, diagnosis, and treatment. It discusses paranoid, schizoid, and schizotypal personality disorders in Cluster A. Cluster B disorders covered are antisocial, borderline, histrionic, and narcissistic personality disorders. The document aims to inform readers about the characteristics and clinical approach to these conditions.
A quick overview of best practice treatments for mental disorders. Great for personal study, as flashcards, for study for the NCMHCE or similar exams, or as a presentation.
One of my assignments in graduate school was to pick a topic about mental health. I chose to research Obsessive Compulsive Disorder (OCD) since so many have to endure this terrible illness. In addition, I was fascinated by how the brain works in people diagnosed with OCD and excited to share my findings with my colleagues. This project required me to implement evidence-based research by reviewing articles and books on the topic. I had to familiarize myself with the findings, create and present a comprehensive power point slide to my professors and fellow students.
This document provides information on obsessive-compulsive personality disorder (OCPD) in 4 parts:
1. Introduction - OCPD is characterized by perfectionism and inflexibility. It affects 1-2% of the population.
2. Prevalence - Men are more likely to be affected than women. Those with higher education are also more likely. Comorbidity with mood/anxiety disorders is common.
3. Diagnostic Criteria - To be diagnosed requires 4 of 7 criteria related to perfectionism, orderliness, mental/interpersonal control, rigidity, and reluctance to delegate.
4. Management - Cognitive-behavioral therapy may help reduce perfectionism. Psychodynamic psychotherapy
Obsessive-compulsive disorder (OCD) is characterized by distressing, intrusive thoughts and related compulsions that attempt to neutralize obsessions. Common obsessions include fears of contamination, harming others, mistakes, and social acceptance. Common compulsions include cleaning, checking, arranging, collecting, counting, and tapping. Cognitive behavioral therapy (CBT), specifically exposure and response prevention (ERP), is an effective treatment that aims to change maladaptive thoughts and behaviors by exposing patients to their fears while preventing compulsions.
REACTION TO STRESS DISORDER AND ADJUSTMENT DISORDERSdivya2709
This document discusses acute stress reaction disorders and post-traumatic stress disorder (PTSD). It defines acute stress reaction as being characterized by anxiety, despair and anger related to a clearly identifiable stressor. PTSD is defined as anxiety symptoms, trauma reexperiencing, and stimulus avoidance lasting over 4 weeks after a traumatic event. Adjustment disorders are also covered, including types like with anxiety or depressed mood. Treatment involves relieving symptoms associated with the stressor and enhancing coping skills.
Depression
Background
Pathophysiology
• The monoamine theory of depression is that it results from a central deficit in the monoamine neurotransmitters serotonin (5-HT) and norepinephrine.
• Other reported physiological features include ↑cortisol and a blunted TSH response.
• However, there is no widely accepted and definitively proven biological model of depression.
Epidemiology
• Time course: for most it is an episodic illness, but for other it follows a more chronic course.
• Incidence: 5% annual risk, 20% lifetime risk.
Presentation
DSM and NICE criteria
These are based on DSM-4, though DSM-5 does not significantly differ.
Major depressive disorder is ≥2 weeks of low mood and/or anhedonia, and at least 4 symptoms out of:
• ↓Energy or fatigue.
• ↓Concentration
• ↓Weight/appetite.
• Disturbed sleep, which commonly includes early waking. Diurnal pattern to symptoms also seen, with symptoms often worse in the morning.
• Slowing of thought and movements (psychomotor slowing) or agitation.
• Ideas of worthlessness or guilt.
• Recurrent thoughts of death or suicide.
• All but the last 2 are considered 'biological' symptoms.
Schizophrenia is a psychotic disorder characterized by disturbances in thinking, behavior, and emotions. It has biological, psychological, and social contributing factors. Biologically, it is linked to genetic predisposition, changes in brain activity like abnormal dopamine levels, and drug use in some cases. Psychologically, it involves impaired reasoning and memory. Socially, factors include social disadvantages, trauma, and psycho-social stress. Treatment involves both biological approaches like dopamine-blocking medication and psychological/social approaches like CBT, social support, and reducing stigma. A biopsychosocial model recognizes the interaction between biological, psychological, and social vulnerabilities in the development of schizophrenia.
This document discusses somatoform disorders and provides an overview of key topics including:
- Definitions and objectives of understanding somatoform disorders
- Examples of specific disorders like somatization disorder, hypochondriasis, and conversion disorder
- The case of "Ms. A" who has persistent medical complaints and seeks further diagnostic testing
- Distinguishing somatoform disorders from conditions like malingering and factitious disorders
- Management strategies like explaining the chronic nature of symptoms and exploring their impact on a patient's life
The document discusses mental health assessment in primary care. It introduces the Look, Listen, and Test (LLT) framework for psychiatric assessment. LLT utilizes existing observational and history taking skills in primary care. The physician looks at the patient, listens to what they say, and performs appropriate tests through questions or exams. It can help structure consultations and support a holistic view. The framework draws from the more extensive SCAN assessment but is briefer and more suitable for typical primary care consultations.
Quick review of the essential points— DSM5 diagnosis criteria, assessments, treatments—of these disorders to better prepare for the National Clinical Mental Health Counseling Exam. This was informed by several exam prep programs, and can be used like flashcards or as a presentation.
This document discusses psychological assessment skills for identifying and addressing psychological distress in patients with MS. It identifies several situations where distress may occur, such as at diagnosis, changes in disease progression, or losses of independence. It also outlines important skills for assessment like empathy, use of open questions, and listening for emotional content rather than providing reassurance. Screening tools and potential referral options are presented for patients showing signs of depression, anxiety, or needing additional support. The document emphasizes the importance of understanding what is a normal adjustment process versus something requiring further intervention.
1) OCD affects approximately 1% of children, with rituals persisting into adulthood if left untreated. Common symptoms include contamination fears, checking behaviors, and reassurance seeking.
2) Treatment involves psychoeducation, cognitive techniques, exposure therapy to confront fears, and prevention of compulsive rituals. The gold standard is combined cognitive behavioral therapy and selective serotonin reuptake inhibitors.
3) For severe pediatric OCD, treatment guidelines recommend starting with CBT for milder cases and adding an SSRI or using an SSRI alone for more severe presentations in adolescents. Exposure therapy involves gradually confronting feared stimuli while resisting compulsions to reduce anxiety.
OCD is an anxiety disorder characterized by recurrent obsessions and/or compulsions. It affects approximately 3% of the population worldwide and typically emerges between ages 20-24. While the exact cause is unknown, biological factors like abnormalities in brain circuits and serotonin levels are implicated. Treatment involves cognitive-behavioral therapy such as exposure response prevention and medication like SSRIs. Nursing management focuses on assessing coping abilities, role functioning, and providing psychoeducation on relationships between anxiety, thoughts, and behaviors.
A functional disorder causes physical discomfort which makes everyday life difficult. It can be seen as a disorder where the mind and the body for various reasons are not functioning properly
This document discusses different types of anxiety disorders including generalized anxiety disorder, social phobia, panic disorder, agoraphobia, specific phobias, post-traumatic stress disorder, and obsessive-compulsive disorder. It describes the symptoms, causes, and common treatments for each disorder which typically involve medication, cognitive behavioral therapy, and exposure therapy.
Quick review of the essential points— DSM5 diagnosis criteria, assessments, treatments—of these disorders to better prepare for the National Clinical Mental Health Counseling Exam. This can be used like flashcards or as a presentation.
This document provides an overview of conversion disorder in children. It discusses the history and conceptualization of conversion disorder. Key points include: conversion disorder involves physical symptoms that cannot be explained by medical factors and may represent underlying psychological issues; it is more common in children and adolescents experiencing stressors or family dysfunction; learning from models and gaining secondary benefits can perpetuate symptoms; accurate diagnosis is important to guide appropriate treatment focusing on the underlying psychological needs rather than the physical symptoms.
The document discusses anxiety in children and adolescents. It describes the differences between depressed mood versus a depressive episode, and lists the diagnostic criteria for a major depressive episode. It also discusses irritable mood and the various conditions it could indicate. The document provides information on generalized anxiety disorder, including prevalence, genetics, neurotransmitters involved, and treatment options. It covers specific phobias and social phobia, including diagnostic criteria, prevalence, etiology, and treatment.
The document provides information on obsessive-compulsive disorder (OCD), including its history, epidemiology, clinical features, diagnostic criteria, etiology, and treatment. Some key points include:
- OCD has been recognized since ancient times with beliefs that it was caused by demonic possession or religious issues.
- It has a prevalence of around 2% worldwide and was historically considered treatment-resistant.
- The discovery that the antidepressant clomipramine could effectively treat OCD was a major breakthrough.
- OCD is characterized by obsessions (unwanted thoughts, images or urges) and/or compulsions (repetitive behaviors or rituals).
- The cause is believed to involve abnormalities in serotonin
Personality Disoder by Jayesh Patidar.pptxJayesh Patidar
This document provides information on personality disorders according to the DSM-IV-TR. It discusses what personality and personality disorders are, and defines personality as predictable responses and behaviors to one's environment. Personality disorders are characterized by inflexible behaviors that differ from cultural expectations and cause impairment. The document outlines three clusters of personality disorders - A, B, and C - and provides details on paranoid, schizoid, schizotypal, antisocial, histrionic and narcissistic personality disorders, including key signs, symptoms, epidemiology, characteristics, etiology and classification.
This document provides information on several personality disorders, including definitions, classifications, symptoms, diagnosis, and treatment. It discusses paranoid, schizoid, and schizotypal personality disorders in Cluster A. Cluster B disorders covered are antisocial, borderline, histrionic, and narcissistic personality disorders. The document aims to inform readers about the characteristics and clinical approach to these conditions.
The DSM-5 organizes 10 personality disorders into 3 groups, or clusters, based on shared key features. Cluster C Personality disorders includes 3 disorders sharing anxious and fearful features. Avoidant, Dependent, and Obsessive-Compulsive.
Personality disorder ppt MENTAL HEALTH NURSINGvihang tayde
Most definition of normal personality includes some or all of the following features,
Present since adolescence.
Stable overtime despite fluctuations in mood.
Manifest in different environment.
Recognizable to friends and acquaintance.
Personality disorders are long-term patterns of thoughts, behaviors, and moods that impair functioning and cause distress. They are characterized by inflexible and maladaptive traits. There are 10 recognized personality disorders grouped into 3 clusters based on symptoms. Treatment involves psychotherapy to help manage behaviors, gain insight, and modify maladaptive traits. Personality disorders affect around 6% of the population and usually emerge during teenage years or early adulthood. Genetics, childhood trauma, verbal abuse, and brain differences may contribute to their development.
Personality disorder and its managementlisamanlali
This document provides information on personality disorders, including:
- Personality disorders involve inflexible and unhealthy patterns of thinking, perceiving situations, and relating to others that cause problems in relationships, work, and social settings.
- They are diagnosed based on chronic patterns of behavior that deviate from cultural norms and cause distress or impairment.
- Personality disorders are grouped into three clusters based on characteristics and symptoms.
- Causes may include genetic, biological, psychological, social, and environmental factors interacting over a person's lifetime.
- Treatment involves psychotherapy and sometimes medication to help manage symptoms and improve coping strategies.
Personality disorders are patterns of perceiving, reacting, and relating to other people and events that are relatively inflexible and that impair a person's ability to function socially”.
This document discusses several personality disorders including paranoid, schizoid, schizotypal, and histrionic personality disorders. It defines personality disorders as enduring patterns of behavior that deviate from cultural norms and cause distress. Paranoid personality disorder involves irrational suspicions and mistrust. Schizoid personality disorder involves a lack of interest in social relationships and emotions. Schizotypal personality disorder involves odd thinking and behavior. Histrionic personality disorder involves exaggerated emotions and seeking attention. Genetics and environment may contribute to these disorders. Treatment involves psychotherapy and sometimes medication.
This document defines personality disorders and provides details on specific types. It begins by defining personality disorders as traits that consistently influence behavior. It then discusses diagnosis and clusters personality disorders into three groups: Cluster A (eccentric/odd), Cluster B (erratic/dramatic), and Cluster C (anxious/fearful). For each type, it lists clinical manifestations and describes features such as social detachment, impulsivity, narcissism, and perfectionism. The document concludes by covering signs and symptoms, nursing diagnoses, and nursing interventions for personality disorders.
The document discusses Cluster A personality disorders, which include paranoid, schizoid, and schizotypal personality disorders. It provides definitions and classifications of personality disorders according to the DSM-IV-TR. For each Cluster A disorder, it describes epidemiology, etiology, clinical features, diagnosis, differential diagnosis, and treatment approaches. The disorders are characterized by social detachment, suspiciousness, odd or eccentric behaviors, and peculiar thinking patterns. Treatment involves psychotherapy and in some cases pharmacotherapy to reduce symptoms and paranoid ideation.
Personality disorders are characterized by maladaptive patterns of behavior, cognition and inner experiences that deviate from cultural norms. They are classified in the DSM-5 into three clusters - A, B and C. Cluster A includes paranoid, schizoid and schizotypal personality disorders. Cluster B includes antisocial, borderline, histrionic and narcissistic personality disorders. Cluster C includes avoidant, dependent and obsessive-compulsive personality disorders. Etiology includes genetic, neurological, hormonal and environmental factors. Treatment involves psychotherapy and pharmacotherapy aimed at symptom management.
This document discusses personality disorders, including antisocial personality disorder and passive-aggressive personality disorder. It defines personality disorders as chronic psychological conditions beginning in childhood or early adulthood that negatively impact social and occupational functioning. The key characteristics of personality disorders are maladaptive and rigid behaviors, abnormal personality traits, and significant impairment. The causes are thought to involve genetic and environmental factors. Antisocial personality disorder is characterized by disregard for others and criminal behavior, while passive-aggressive personality disorder involves indirectly expressing negative feelings through procrastination and excuses.
Define Personality disorder
List The Causes of Personality disorders
Know General Personality Disorder Criteria
List Differential Diagnosis
List and define Clusters: A, B, and C criteria and treatment
The document provides information on personality disorders, including:
1. The definition of a personality disorder as an enduring pattern of inner experience and behavior that deviates from cultural expectations and causes impairment.
2. The main types of personality disorders are described, including antisocial, borderline, histrionic, narcissistic, avoidant, dependent, and obsessive-compulsive personality disorders.
3. Assessment of personality disorders involves clinical history, standardized measures, and examining areas like childhood experiences, relationships, employment, and criminal history. Treatments evaluated include psychotherapy, cognitive therapies, and intensive programs, but outcomes vary depending on the specific personality disorder.
This document provides an introduction to mental health nursing. It defines mental health and mental illness, outlines the characteristics of mentally healthy and ill individuals, and describes common signs and symptoms of mental illness. It also discusses misconceptions about mental illness and potential unfounded fears nursing students may have about working in psychiatric settings due to lack of knowledge or experience.
Borderline personality disorder (BPD) is characterized by difficulties regulating emotions which can lead to impulsivity, unstable relationships, and self-harm. About 1.4% of adults in the US have BPD, which is more common in women. Symptoms include fear of abandonment and unstable self-image. The causes are genetic, environmental like childhood abuse, and neurological differences in emotional regulation areas of the brain. Treatment focuses on psychotherapy.
- Recurrent unexpected panic attacks characterized by a sudden surge of intense fear or discomfort that reaches a peak within minutes and involves at least 4 of 13 physical or cognitive symptoms.
- At least one attack must be followed by 1 month or more of persistent concern about additional attacks or a significant change in behavior related to the attacks.
- Panic attacks are not better explained by another mental disorder and are not due to a medical condition or substance.
Disorganized schizophrenia is a severe subtype of schizophrenia characterized by incoherent and illogical thoughts and behaviors that prevent daily functioning. Signs include disorganized thinking and speech, inappropriate behavior, lack of emotion, and delusions or hallucinations. It is diagnosed using criteria from the DSM including evidence of disorganized speech, behavior, blunted emotions, and emotions inappropriate for situations. The causes are likely genetic and environmental factors combined with imbalances in neurotransmitters like dopamine.
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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Personality disorders
1. PERSONALITY DISORDERS
Personality disorders fall into three groups, or clusters, shown in this chart. Clients with cluster A personality
disorders are characteristically aloof and restrained in relationships; others may describe them as odd or strange.
Clients with cluster B disorders typically are dramatic, unrestrained, and unpredictable. Those with cluster C
disorders are overly apprehensive about the present and future and worry about failing.
PERSONALITY DISORDER CLIENT DESCRIPTION
Cluster A
Schizotypal personality disorder • Has some cognitive and perceptual distortion
• May be viewed as odd or eccentric in speech and behavior
• Has poorly developed social skills
• Has strained and uncomfortable relationships
• Is easily overwhelmed by too much social or interpersonal stimuli
Paranold personality disorder • Uses projection
• Is extremely suspicious of other’s motives
• Is very guarded in relationships and finds hidden meanings
• Is very private
• Expects to be exploited or harmed by others
• Questions others loyalty
• Reads hidden meaning into harmless remarks or events
• Doesn’t forgive slights, insults, or injuries
Schizold personality disorder • Is emotionally cold and detached
• Is withdrawn and controlled
• Can’t form warm, spontaneous relationships
• Usually lives alone or in parents’ home
• Has little need for friendships or intimacy
• Has a solitary lifestyle
• Seems indifferent to praise or criticism
Cluster B
Narcisstic personality disorder • Can’t empathize with others because of intense need for love and
admiration
• Demands much time and attention from others
• Feels entitled or special
• Is arrogant, haughty, and envious
Histrionic personality disorder • Controls anxiety through dramatic presentation of self
• Uses attention – seeking behaviors and flattery to get others to meet
needs
• Is overly concerned with physical attractiveness
• Can’t tolerate delayed gratification
• Has a seductive appearance or behavior
• Becomes anxious when limits are placed on attention – seeking
behaviors
Borderline personality disorder • Has a poorly developed sense of self and is easily influenced by
other people
2. • Struggles with overwhelming feelings of anger and anxiety
• Views situation in extremes (all good or all bad)
• Has intense fear of abandonment
• Feels empty and devoid of substance
• Needs others around to maintain a sense of self (you + me = self)
Paranoid personality disorder
PARANOID PERSONALITY DISORDER is characterized by extreme distrust of others. Paranoid people
avoid relationships in which they aren’t in control or have the potential of losing control.
Contributing factors
• Genetic predisposition
• Neurochemical alteration
• Parental antagonism
Assessment findings
• Feelings of being deceived
• Suspiciousness, mistrust of friends and relatives
• Refusal to confide in others
• Hostility
• Emotional reactions, including nervousness, jealousy, anger, or envy
• Self – righteousness
• Social isolation
• Sullen attitude
• Lack of social support systems
• Hyperactivity, especially in children
• Delusional thinking
• Hypervigilance
• Lack of humor
• Major distortions of reality
• Need to be in control
Diagnostic evaluation
There are no specific tests for paranoid personality disorder.
Nursing diagnoses
Anxiety
Ineffective individual coping
Chronic low self – esteem
Social isolation
SCHIZOPHRENIC AND DELUSIONAL DISORDERS
People with major distortions in ego functioning experience serious disturbance in all areas of their lives,
having impaired reality testing and a compromised ability to relate with others. Common signs of impairment in
reality testing include bizarre behaviors, inability to assume responsibility for oneself, and misinterpretation of
environmental stimuli.
3. Major disturbances in ego functioning can result from functional causes, such as acute psychosis, or
from underlying organic causes related to drug ingestion, high fever, an accumulation of toxins in the body, or
dementia.
SCHIZOPHRENIA is a brain disease characterized by nueurotransmitter imbalances and structural
changes within the brain. Distorted though processes make living with this disease a challenge. Symptoms from
schizophrenia may be characterized a positive or negative. Positive symptoms focus on a distortion of normal
functions; negative symptoms focus on a loss of normal functions.
Overview
A. Characterized by disordered thinking, delusions, hallucinations, depersonalization (feelings of being
strange, not oneself), impaired reality testing (psychosis), and impaired interpersonal relationships.
B. Regression to the earliest stages of development is often noted (e.g., incontinence, mutism)
C. Onset is usually in adolescence/early adulthood.
D. Client may be seriously impaired and unable to perform ADL.
E. Etiology is not known; theories include
1. Genetic: 1% of population; risk approximately 15% with one schizophrenic parent,
approximately 30% with two.
2. Family; double – bind communication; message sent in negated.
3. Biochemical; increased dopamine activation.
4. Interaction of predisposing risk and environmental stress.
5. Psychoanalytic; fragile ego resorts to dysfunctional use of defense mechanisms (e.g.,
identification, projection).
F. Prior to onset (premorbid) client may have been suspicious, eccentric, or withdrawn.
Classifications
A. Disorganized: incoherent; delusions are not organized; social withdrawal; affect blunted, silly or
inappropriate
B. Catatonic: psychomotor disturbances
1. Stupor: mute, little reaction or movement
2. Excitement: purposeless, excited motor activity
3. Posturing: voluntary, inappropriate, bizarre postures
C. Paranoid: delusions and hallucinations of persecution/grandeur
D. Undifferentiated: disorganized behaviors, delusions and hallucinations
Contributing factors
• A fragile ego, which can’t withstand the demands of external reality
• Brain abnormalities
• Developmental involvement
• Genetic factors
• Neurotransmitter abnormalities
• Social or environmental stress, interacting with the person’s inherited biological makeup.
Assessment
A. Four A’s
1. Affect: flat, blunted
2. Associative looseness: verbalizations are disorganized
4. 3. Ambivalence: cannot choose between conflicting emotions
4. Autistic thinking: thoughts on self, extreme withdrawal, unable to relate to outside world
B. Any changes in thought, speech, affect
C. Ability to perform self – care activities, nutritional deficits
D. Suicide potential
E. Aggression
F. Regression
G. Impaired communication
Analysis
Nursing diagnoses for clients with schizophrenic disorders may include
A. Anxiety
B. Impaired verbal communication
C. Ineffective individual/family coping
D. Potential for injury
E. Altered nutrition
F. Powerlessness
G. Self – care deficit
H. Self – esteem disturbance
I. Sensory perceptual alteration
J. Sleep pattern disturbance
K. Social isolation
L. Potential for violence
Planning and implementation
Goals
Client will
A. Develop a trusting/therapeutic relationship with nurse
B. Be oriented, able to test reality.
C. Be protected from injury
D. Be able to recognize impending loss of control.
E. Adhere to medication regimen.
F. Participate in activities.
G. Increase ability to care for self.
Interventions
A. Offer self in development of therapeutic relationship
B. Use silence.
C. Set time for interaction with client.
D. Encourage reality orientation but understand that delusions/hallucinations are real to client.
E. Assist with feeding/dressing as necessary
F. Check on client frequently, remove potentially harmful objects.
G. Contract with client to tell you when anxiety is becoming so high that loss of control is possible.
H. Administer antipsychotic medications as ordered.
1. Reduction of hallucinations, delusions, agitation
2. Postural hypotension
a. Obtain baseline blood pressure and monitor sitting/standing.
b. Client must lie prone for 1 hour following injection.
c. Teach client to sit up or stand up slowly.
d. Elevate client’s legs while seated.
5. e. Withhold drug if systolic pressure drops more than 20 – 30 mm Hg from previous
reading.
3. Photosensitivity
a. Advise use of sun screen.
b. Avoid exposure to sunlight.
4. Aganulocytosis
a. Instruct client to report sore throat or fever.
b. Institute reverse isolation if necessary.
5. Elimination
a. Measure I & O
b. Check bladder distention.
c. Keep bowel record.
6. Sedation
a. Avoid use of heavy machinery.
b. Do not drive.
7. Extrapyramidal symptoms
a. Dystonic ractions
1. sudden contractions of face, tongue extraocular muscles.
2. administer antiparkinson agents prn (e.g benztropine [Gogentin] 1 – 8 mg or
diphenhydramine [Bendryl] 10 – 50 mg). which can be given PO or IM for faster
relief; trihexyphenidyl [Artane] 3 – 15 mg PO only, can also be used prn).
3. remain with client; this is a frightening experience and
usually occurs when medication is started.
Evaluation
• The client experiences less confusion in thinking or thought processes.
• The client talks about situations and issues that reinforce reality.
• The client independently manages daily care
• The client doesn’t place self at risk for harm.
• The client interacts appropriately with staff, selected peers, and visitors.
Treatment
• Family therapy
• Group therapy
• Milieu therapy
• Psychoeducational programs
• Social skills training
• Stress management
• Supportive psychotherapy
Symptom classification of schizophrenia
Here are example of positive and negative symptoms of schizophrenia.
POSITIVE SYMPTOMS
6. • Bizarre, disorganized, or catatonic behavior
• Delusions
• Disorganized speech
• Hallucinations
• Loose associations
• Paranoia
NEGATIVE SYMPTOMS
• Disorganized thinking process
• Flat affect
• Inability to have pleasure (anhedonia)
• Lack of motivation
• Lack of self – initiated behaviors (avolition)
• Poverty of speech (alogia)
• Social withdrawal
Antipsychotic Medications
Dosages
Drug Acute Symptom Maintenance/
Day
Range/Day Profound Side
Effects
Cholorpomazine
(Thorazine)
25 – 100 mg IM q1
– 4 h prn
200 – 600 mg PO 25 – 2000 mg PO Sedation
Anticholinergic
effects: dry mouth,
blurred vision,
constipation, urinary
retention, postural
hypotension
Thioridazine
(mellaril)
Fluphenazine HCI
(Prolixin, Permitil)
200 – 600 MG PO
in divided doses
1.25 mg IM, max 10
mg IM, divided
doses
150 – 300 mg PO
1 – 5 mg PO
50 – 800 mg PO
1 – 30 mg PO
Sedation
Extrapyramidal
effects: dystonic
reactions (muscular
contractions of
tongue, face, throat;
opisthotonos);
tremors, rigid
posture; akathisia
(restlessness);
tardive dyskinesia
Fluphenazine
decanoate/enanthate
(prolixin, Permitil)
Triflueoperazine
(Stelazine)
--
1 – 2 mg IM q4h;
2 – 4 mg PO, max
10 mg qd
25 mg Im q2wk
2 – 4 mg PO
25 – 100 mg IM
2 – 80 mg PO
Extrapyramidal
Extrapyramidal
Triflupromazine
(Vesprin)
10 – 75 mg IM 50 – 150 mg PO/IM 50 – 150 mg PO/IM Sedation,
hypotension
Perphenazine
(Trilafon)
5 – 10 mg IM q6h,
max 30 mg IM qd
16 – 64 mg PO 4 – 64 mg PO Extrapyramidal
7. Haloperidol
(Haldol)
2 – 10 mg IM in
divided doses
2 – 8 mg PO 1 – 100 mg PO Extrapyramidal
Thiothixene
(Navane)
8 – 16 mg IM in
divided doses
6 – 10 mg PO 6 – 60 mg PO Extrapyramidal
Loxapine (Loxitane) -- 60 – 100 mg PO 30 – 250 mg PO Extrapyramidal
Clozapine (Clozaril) -- 300 – 450 mg PO 75 – 700 mg PO Agranulocytosis;
available only with
weekly blood
testing and client
monitoring
Helping the client cope with hallucinations
This table details the progression of behaviors and sensations that a schizophrenic client may experience just
before and during a hallucination and describes nursing interventions that may help the client cope with these
occurrences. After a hallucination, the client may be exhausted. Be sure to allow time for the client to rest or
sleep.
BEHAVIORS AND SENSATION TRUSTING INTERVENTIONS
The client feels anxious or lonely and attempts to cope
by daydreaming or seeking out a trusted person.
• Lack of structure and feelings of loneliness
may precipitate hallucinations. Therefore,
provide the client with a highly structured daily
routine and engage the client in a structured
activity to dissipate anxiety and feelings of
loneliness.
• Don’t allow the client hours of free time.
The client experiences increasing anxiety, which leads
to a state of alertness. The client becomes preoccupied
with internal sensations (such as voices and images)
and starts to respond to them. Aware that the
sensations are internal, the client attempts to control
them.
• Help the client compare internal sensations
with external reality.
• Engage the client in a structured activity.
• Teach the client to hum, whistle, or talk but
loud to “crowd out” internal sensations.
• Ask the client to identify concrete things in the
external environment.
As internal sensations become increasingly dominant,
the client has trouble controlling them and eventually
yields to them.
• Talk to the client about external reality.
• Ask the client to compare the hallucination
with external reality.
• Use self as a focal point to get the client’s
attention and the client to focus on what you’re
doing and saying.
• Instruct the client to firmly tell the
hallucination to go away.
• Engage the client in a large – muscle activity.
The client becomes immersed in internal sensations
and feels powerless over them. Depending on the
nature of the hallucination, the client may become
very frightened.
• Have the client focus on external reality.
• Do whatever is necessary to get the client’s
attention.
• Maintain a firm but kindly tone of voice.
8. Delusional disorder
A delusion is a false belief to which a person adheres despite contradictory evidence. Clients with
DELUSIONAL DISORDER hold firmly to false beliefs despite contradictory information. The client with
delusional disorder tends to be intelligent and can have a high level of competence but has impaired social and
personal relationships. One indication of delusional disorder is an absence of hallucination.
The most common types of delusions include:
• Delusions of grandeur – belief that one is highly important, famous, or powerful
• Delusions of persecution – belief that one is being persecuted or harmed by others.
• Delusions of reference – belief that one is connected to events unrelated to himself.
Planning and goals
• The client won’t harm self or others.
• The client will learn alternative coping strategies.
• The client will regain normal level of functioning.
Implementation
• Formulate realistic, modest goals with the client to help diminish suspicion while increasing the client’s
self – esteem and sense of control.
• Establish a therapeutic relationship to foster trust.
• Explore event that trigger delusions to help you understand the dynamics of the client’s delusional
system. Discuss anxiety associated with triggering events.
• Don’t directly attack the delusion to avoid increasing the client’s anxiety instead, be patient in
formulating a trusting relationship.
• Once the dynamics of the delusions are understood, discourage repetitious talk about delusions and
refocus the conversation on the client’s underlying feelings. As the client identifies and explores
feelings, he’ll decrease reliance on delusional thought.
• Recognize delusion as the client’s perception of the environment. Avoid getting into arguments with the
client regarding the content of delusions to foster trust.
• Teach the client alternative coping mechanisms to handle periods of increased anxiety and enhance the
client’s self – esteem and self – control.
• Review key teaching topics with the client and family members to ensure adequate knowledge about the
condition and treatment, including:
o Learning decision – making, problem – solving, and negotiating skills.
o Understanding potential adverse effects of medication.
Evaluation
• The client doesn’t harm self or others.
• The client demonstrates less suspicious behavior.
• The client can identify signs and symptoms of anxiety.
• The client identifies factors that precipitate delusions and alternative coping mechanism to handle
anxiety.
Cocaine – use disorder
9. Cocaine – use disorder results from the potent euphoric effects of the drug. Individuals exposed to cocaine
develop dependence after a very short time. Maladaptive behavior follows, resulting in social dysfunction.
Contributing factors
Genetic predisposition
History of abuse, depression, or anxiety
Personality disorder
Assessment findings
Assault or violent behavior
Elevated energy and mood
Grandiose thinking
Impaired judgment
Impaired social functioning
Diagnostic evaluation
Drug screening is positive for cocaine.
Nursing diagnoses
Risk for violence: Self – directed
Risk for violence: Directed at others
Ineffective health maintenance
Imbalanced nutrition: Less than body requirements.
Treatment
• Detoxification
• Rehabilitation (inpatient or out patient)
• Narcotics Anonymous
• Individual therapy
Drug therapy option
• Anxiolytic agent: alprazolam (Xanax),lorazepam (Ativan)
• Dopamine agent: bromocriptine(Pardonel)
• Seletive serotonin reuptake inhibator: fluoxetine (Prozac), Paroxetine (Paxil)
Planning and goals
• The client will learn the adverse effects of cocaine on the body.
• The client will have adequate nutritionalk intake.
• The client won’t harm self or others.
Implementation
• Establish a trusting relationship with the client to alleviate any anxiety or paranoia.
• Provide the client with well- balanced meals to compensate for nutritional deficits.
• Provide a safe environment. The client may pose a risk to self or others.
• Set limits on the client’s attempts to rationalize behavior to reduce inappropriate behavior
• Review key teaching topics with the client and family members to ensureb adequate knowledge about
the condition and treatment, including:
- contacting narcotics anonymous
- coping strategies
- managing stress
10. Evaluation
• The client relates the adverse effects of cocaine and verbalizes plans for lifestyle changes and follow –up
support
• The client has sufficient nutritional intake
• The client doesn’t harm self or others during hospitalization
Substance abuse disorder
Substance abuse disorder includes all patterns of abuse excluding alcohol and cocaine. Abuse disorders have a
great deal in common, although symptoms vary depending on the abused substance
Contributing factors
• Familial tendency
• Gender ( female have increased likelihood of abusing prescription drugs; males have generally increase
likelihood of addiction)
• History of abuse, depression. or anxiety
• Influence of nationality and ethnicity
• Personality disorders
Assessment findings
• Attempts to avoid anxiety and other emotions
• Attempts to avoid conscious feelings of guilt and anger
• Attempts to meet needs by influencing others
• Blaming others for problems
• Development of biological or psychological need for a substance
• Dysfunction anger
• Feelings of grandiosity
• Impulsiveness
• Manipulation and deceit
• Need for immediate gratification
• Pattern of negative interactions
• Possible malnutrition
• Symptoms of withdrawal
• Use of denial and rationalization to explain consequences of behavior
Diagnostic Evaluation
• Positive blood and urine drug screening results confirm the diagnosis
• Standard alcoholism screening tools, such as the CAGE questionnaire and the Michigan Alcoholism
Screening test, in adequate alcoholism
Nursing diagnoses
• Ineffective health maintenance
• Imbalanced nutrition: Less than body requirements
• Risk for violence: self directed
• Risk for violence: Directed at others
11. Drug Therapy option
• Clonidine (catapres) for opiate withdrawal symptoms
• Metyhadone maintenance for opiate addiction detoxification
Planning and Goals
• The client will learn the adverse effects of substance abuse on the body
• The client will have adequate nutritional intake
• The client won’t harm self or others
• The client will commit to a recovery program and get assistance to maintain abstinence and coping skills
Implementation
• Ensure a safe, quiet environment free from stimuli to provide a therapeutic setting and to alleviate
withdrawal symptoms
• Monitor for withdrawal symptoms, such as delirium, tremors, seizures, or anxiety, to provide the most
comfortable environment possible
• Assess the client for polysubstance abuse to plan appropriate interventions
• Help the client to understand the ultimate consequences of substance abuse to assist recovery
• Provide measures to induce sleep to help the client manage the discomfort of withdrawal.