psych disorders

1. ANXIETY DISORDER
Anxietybecomesadisorderwhen
a personisunable to cope with
stressorsandtheyinterfere with
the person’sactivitiesof daily
living.Central toanxietydisorder
isthe person’smisinterpretation
of stressorsandtheirexaggerated
response tothe stressors.A
stressorisa situationthattriggers
a stressresponse.

2. Alcohol withdrawal

5. Bipolar Disorder
Extreme mood swings exhibited by
manic or hypomanic mood and
depressive mood.
Will have periods of exacerbations and
stable moods and may rapidly cycle.
Bipolar I: 1 manic episodealternating
with major depression
Bipolar II: at least 1 hypomanic episode
with at least 1 depressive episode
Manic Episode
Intense irritation or agitation with
psychotic features.
*Symptomatic for at least 1-week
Experiences at least 3 of the following:
• Impulsiveness • Decreased appetite
• Flight of ideas • Impaired judgment
• Delusions • Highly irritable • Agitation
• Decreased sleep • Paranoid • Grandiosity
Hypomanic Episode
Noticeable change in mood
No impairment of ADLs
No psychotic features
*Symptomatic for at least 4 days
At least 3 of the following:
• Flight of ideas • Easily distracted
• Excessive talkativeness • Grandiosity
• Decreased sleep • Psychomotor agitation
• Excessive pleasurable and has a high-
risk activity for poor outcomes.
Depressive Episode
Depressive mood is when the
patient shows signs of clinical
depression.
• Isolation • Hopelessness
• Insomnia • Weight loss
• Sluggish • Sexual dysfunction
• Overwhelmed • Low self-esteem

6. Treatment Administer:
Lithium, Depakote(valproic acid), Tegretol
(carbamazepine)
NursingAlert /Assessment
Lithium: Renal labs, LFT, Electrolytes.
Diet: normal salt intake. No diuretics
excretion decrease effect.
Lithium toxicity;
 muscle weakness, uncoordinated
voluntary muscle movement (ataxia)
 tremors,
 diarrhea, vomiting.
 If occurs: Call Dr. and Hold next dose.
Nursing Diagnoses
• Risk for self-injury related to manic
and depressive behaviors • Risk for
low self-esteem related to depressive
behavior • Risk for impaired social
interaction related to manic and
depressive behaviors
Nursing Interventions
Manic Episode
• Calm quiet environment away from
others if necessary.
• Ensure patient’s safe and others.
• Watch for escalating behaviors and
call for support immediately.
• Reinforce appropriate behavior and
discourage inappropriate behavior
while setting limits.
• Do not argue or engage in power
struggles. • Help the patient set
realistic goals.• Give high-protein
finger-food that the patient can eat
while walking around.

7. Borderline PersonalityDisorder
Borderline personalitydisorder
occurs whena patienthas
significantemotionalinstability
expressedbyfrequentmood
swingsandperiodsof
impulsivenessthatcanleadto
violentbehaviorinreactionto
criticism.
distortedsense of self andfeels
mistreated,misunderstood,and
empty,whichcanleadto self-
destructive behaviors.The patient
usessplittingasa defense
mechanismwheneverthey
perceive dangerousanxiety.
Splittingiswhere the patientsees
anotherpersonas eitherall good
or all bad, andthisview alternates
swiftly.A patientdiagnosedwitha
borderline personalitydisorder
presentswithimpulsive behavior
withdisregardtoconsequencesof
the behavior.Fearof
abandonmentcanleadto
substance abuse andsuicide
attempts.
Symptomsof borderline
personalitydisordermanifest
betweenearlychildhoodandthe
early20s. Althoughthisperiodis
challengingforthe patient,family,

8. and friends,the patientislikelyto
stabilize intheir30s
HallmarkSignsandSymptoms•
Feelingof emptiness•Paranoid
ideation•Fear of abandonment•
Unstable interpersonal
relationships•Self-destructive
behavior• Violentbehaviorwith
others• Avoidsbeingalone •
Swiftmoodswings•Outburstsof
anger• Seeingothersaseitherall
goodor all bad• Clingingbehavior
• Low self-esteem•Impulsivity
withoutregardto consequences
borderline personalitydisorder
requiresthe followingcriteria.
From earlychildhood,the patient
has experiencedfive ormore of
the following:•Impulsivityintwo
areas thatleadsto self-damage•
Attemptstoavoidperceivedor
real abandonment•Self-
mutilatingbehaviorsuchas
suicidal gesturesorideations•
Unable to control intense anger,
leadingtophysical fights•
Paranoidideationorsymptomsof
dissociativedisorder•Feeling
emptyor bored• Short periodsof
intense irritabilityTreatment•
Psychotherapy:Individual

9. psychotherapywithfocuson
providingastructuredtherapeutic
settingwithinwhichlimitsare set
and enforced•Dialectical
behaviortherapy(DBT):
Dialectical behaviortherapy
includesindividual therapyand
grouptherapyduringwhich
participantsworkonskills
training.Skillstrainingfocuseson
copingtechniques.The patientis
able to consultwiththe therapist
inpersonor by phone.• Partial
hospital programs:Partial hospital
programsare day programs
duringwhichthe patientis
assignedtoone groupduringthe
course of treatment.The group
has five sessionsdaily.Each
sessionfocusesoncopingskillsor
psychotherapy.Eachpatient
receivesone-on-one counseling.•
Administer:Depakote (valproate),
Eskalith(lithium),Zyprexa
(olanzapine),Risperdal
(risperidone),BuSpar(buspirone),
ReVia(naltrexone)
NursingDiagnoses•Riskfor self-
mutilationrelatedtoself-
destructive behavior•Defensive
copingrelatedtofearof
abandonment•Hopelessness
relatedtolow self-esteemNursing

10. Interventions•Askthe patientto
signa behavioral contractthat
containsexpectationsand
consequences.•Rewardpositive
behaviors.•Ensure that the
patientexperiencesthe
consequencesforthe patient’s
actions.• Helpthe patientthink
throughproblems,butletthem
solve theirownproblems.•Avoid
nurturing.• The patientmusttake
responsibilityfortheiractions.•
Limitinteractionwiththe patient
to reduce the opportunityfor
themto splitandmanipulate
staff.• Be alertfor self-
destructive behaviors,suchas
cheekingmedicationinan
attemptto gatherenough
medicationtooverdose.•Keep
the patientsafe.Watchfor signs
of suicidal ideationorsuicide
attempt.

11. Major depressive disorder(MDD)
occurs whenthe patienthas
persistentdepressivesymptoms
for 2 or more weeks.The patient
isunlikelyaware thatthe patient
has MDD andtherefore doesnot
seektreatment. Majordepressive
disorderisdifferentfrom
situational depression.In
situational depression,the person
isable to returnto a normal mood
withouttreatment.Major
depressivedisorderhasperiodsof
remission.Occurrencesof MDD
increase withage.
HallmarkSignsandSymptoms•
Sexual dysfunction•Changesin
eating(increasedordecreased) •
Insomnia• Sluggish•Suicidal
ideation•Low self-esteem•
Hopelessness•Apathy
The initial stepistorule out
physiologicandothermental
disorderscausingthe symptoms
before reachingapsychiatric
diagnosis.The psychiatric
diagnosisof MDD requiresthe
following:Five of the followingare
presentdailyfor2 weeks:•
Fatigue • Insomniaor
hypersomnia•Worthlessness•
Depressedmood•Weightlossor
gain• Uninterestedindaily

12. activities•Agitatedtoretardation
movement•Unable to
concentrate
NursINGAlertMedical disorders
and medicationscancause
symptomsthatresemble MDD.
Treatment• Administer:•
SelectiveSerotoninReuptake
Inhibitors(SSRIs):Celexa
(citalopram),Prozac(fluoxetine),
Luvox (fluvoxamine),Paxil
(paroxetine),Zoloft(sertraline),
Effexor(venlafaxine)•Atypical
Antidepressants:Remeron
(mirtazapine),Desyrel
(trazodone),Wellbutrin
(bupropion),Serzone
(nefazodone) •Tricyclic
Antidepressants:Tofranil
(imipramine),Elavil
(amitriptyline),Sinequan
(doxepin) •Monoamine Oxidase
Inhibitors(MAOI):Nardil
(phenelzine),Parnate
(tranylcypromine) •
Electroconvulsive Therapy(ECT):
ECT applieselectricalcurrent
throughelectrodesintothe
patient’sbrain,resultingin30- to
60-secondseizures.Treatmentis
giventhree timesaweekfor6
weeksandisan alternative to
medicationswhenthe patient
doesnotreact positivelyto

13. medication.•Psychotherapy:
Focusis on helpingthe patient
cope withsymptomsof MDD and
performactivitiesof dailyliving.
Psychotherapyisusedin
conjunctionwithmedication.
NursingDiagnoses•Riskfor low
self-esteemrelatedtodepressive
behavior• Riskforimbalanced
nutritionrelatedtochangesin
eating• Disturbedsleeppattern
relatedtoinsomniaor
oversleepingNursing
Interventions•Assessforsuicidal
ideationsandsignsof suicide
attempts.• Provide patientsafety
and remove all objectsthatcan be
usedforself-injury.•Place the
patientonsuicide protocol,if
appropriate.•Encourage the
patienttoexpresstheirfeelings
• Provide positivereinforcement.
• Engage the patientfrequently
throughoutthe dayto preventthe
patientfrombecominganxious.•
Provide supportforhygiene;
however,letthe patientperform
as many hygienictasksas
possible.•Setrealistic
expectationsforthe patient.•
Create activitieswhere the patient
will succeedanddevelopasense

14. of accomplishment.•Helpthe
patientmake appropriate
decisions.•Review how the
patientisto take medicationand
describe the side effectsand
adverse effects.Tell the patient
whatto do if theyexperience side
effectsoradverse effects.•Be
alertto identifymedicationside
effectsandadverse effects.•
Make sure that the patientis
compliantwithtreatment.

15. Psychosis

16. Schizophrenia:
Schizophreniaisamental illness
characterizedbya person’s
abnormal misinterpretationof
realityreferredtoaspsychosis.
The person’sbehaviorseems
bizarre to othersbecause the
behaviorisinappropriateto
reality.However,the behavioris
appropriate tothe personbased
on the person’smisperceptionof
reality.
In addition,some schizophrenic
patientsmaybe unable to
distinguishbetweenfantasyand
reality.Forexample,a
schizophrenicmightobsessively
watch oldwesternmoviesand
thenput ona full western
costume complete withtwotoy
gunsand a badge and walkthe
streetsthinkinghe isthe sheriff
protectingeveryoneintownfrom
the “bad guys.”It is important
that the nurse understandthat
the schizophrenicbehavioris
usuallyappropriate in the
patient’sperceivedreality.The
inappropriatenessof the patient’s
behaviorisa resultof the
misperceptionof realitybythe
patient.

17. Hallucinations
A persondiagnosedwith
schizophreniamayhave
hallucinations.
A hallucinationisaperceptionof
somethingreal inthe absence of
reality.Thatis,the person
experiencessomethingthatisreal
but isnot real.There are several
typesof hallucinations.
These are:• Visual:Seeing
somethingthatisnotthere •
Auditory:Hearingvoicesbutno
one issayinganything.A voice
may tell the patienttodo
something.Thisisreferredtoasa
commandvoice or command
hallucination.•Olfactory:
Smellinganodorthatdoesnot
exist• Tactile:Feelingsomething
that doesnotexist• Gustatory:
Tastingsomethingwithout
anythingbeinginthe patient’s
mouth
Delusion
A delusionisthe appropriate
interpretationof astimulusbythe
patient;howeverthe patientgives
a bizarre significance tothe
stimulus.Forexample,the patient
may realize thatthe familiarmail
carrier droppedmail inthe mail

18. box,butthe patientbelievesthat
the mail carrier stoppedbrieflyto
readthe patient’smind.Positive
and Negative Symptoms
A positive symptomof
schizophreniadisorderisa
symptomthatappearswhenthe
patienthasan episode of
schizophreniadisorder.For
example, hallucinationsand
delusionsare positive symptoms
of schizophreniadisorderbecause
there isoutwardmanifestationof
the symptoms.Twootherpositive
symptomsare classifiedas
disorganizedsymptoms. These
are: • Bizarre behavior:Bizarre
behavioriswhere the patient
displaysstrange andunusual
behaviorduringanepisode of
schizophreniadisorder.•
Confusion:The patient
experiencesthoughtdisorderthat
leadstodisorganizedspeechand
isunable to converse withothers.

19. A negative symptomof
schizophreniadisorderisa normal
behaviorthatisabsent.That is,a
personwhoisnot experiencingan
episode of schizophreniadisorder
shoulddisplayspecificbehavior.
However,apersonhavingan
episode of schizophreniadisorder
doesnotdisplaythatbehavior.
Here are commonnegative
symptomsof schizophrenia
disorder:• Anhedonia:Anhedonia
isthe inabilitytoexperience
pleasure.•Apathy:Apathyisthe
decreasedinterestinactivities,
people,andthings.•Asociality:
Asocialityiswhenthe patient
avoidsrelationshipsand
withdrawsfromsociety.•Blunted
affect:Bluntedaffectiswhenthe
patientisunable toshow
emotions,althoughtheycontinue
to feel emotions.•Lack of
motivation:The patientisunable
to beginactivities.•Povertyof
Speech:The patientprovides
terse replieswhensomeone tries
to converse withthem.

20. Phasesof SchizophreniaDisorder
There are three phasesof
schizophreniadisorderthatfollow
ina progression.Patients
diagnosedwithschizophrenia
disorderrarelyexperience full
remission.Theseare:•
Prodromal:The patientshows
decreasedfunctionalitysuchas
poor hygiene, lackof motivation,
and beginningtowithdraw from
society.The patientisable to
work,althoughthere isa marked
decrease inperformance.This
stage occurs about a yearbefore
the patientishospitalized•
Active:The patientdemonstrates
positive ornegative signsof
schizophreniadisorder.Thismay
occur continuouslyorepisodically
(i.e.,withperiodsof exacerbation
and remission).Two-thirdsof
patientsdiagnosedwith
schizophreniadisorderhave
multiple active phasesintheir
lifetime.
• Residual:The patient
demonstratesmore negative signs
of schizophreniadisorderthan
positive signs.Positive signsdo
not have a material effectonthe
patient’sbehavior.The patient’s
baseline functionalitystabilizes.

21. Degreesof Schizophrenia
Disorder
The degree of schizophrenia
disorderisthe variationof
symptomsof schizophreniaduring
the patient’slife.Symptomsare
controlledbyantipsychotic
medication.Patientswhoare
compliantwithtreatmentwill
typicallyexperience fewer
symptomsthanpatientswhoare
noncompliantwithmedication.
Symptomscan alsoincrease if the
prescribedantipsychotic
medicationisnolongereffective.
The degreesof schizophrenia
disorderare:• Mild: Lessthan
tworelapsesbythe age of 45. The
patientisstable withfew
symptoms. • Moderate:Multiple
relapsesbythe age of 45. Stress
increasessymptomsthatcontinue
betweenrelapses.•Severe:
Multiple relapsesbythe age of 45
withfew stable periods.The
patientisunable toperform
activitiesof dailyliving.
AntipsychoticMedicationAdverse
Side EffectsAntipsychotic
medicationaffects
neurotransmitterstocontrol
symptomsof schizophrenia
disorder.There are twocategories

22. of antipsychoticmedication.
These are typical and atypical.
Typical antipsychoticmedications
are oldmedicationsthataffecta
broad numberof
neurotransmitters.Atypical
antipsychoticmedicationsare
new medicationsthataffecta
narrow numberof
neurotransmitters.Typical
antipsychoticmedicationsaffect
neurotransmittersthatcause
symptomsof schizophrenia
disorderandalsoaffect
neurotransmittersthathave no
relationtothose symptoms.Asa
result,typical antipsychotic
medicationscanhave adverse
side effects.The mostcommon
adverse side effectsare:•
Akathisia:Akathisiaisasensation
of restlessnessandinabilityto
remainstill.•Dystonia:Dystonia
isuncontrolledsustainedmuscle
contractions.• Neuroleptic
malignantsyndrome:Neuroleptic
malignantsyndrome adversely
affectstemperature regulation,
leadingthe patienttohave a
dangerouslyhightemperature
that cannot be treatedby
antipyreticmedication.•Sexual
dysfunction:A patientmay
experience problemswitharousal.

23. Thisis a majorreasonwhy some
patientsdiagnosedwith
schizophreniadisorderstoptaking
medication.•Tardive dyskinesia:
Tardive dyskinesiaisinvoluntary
repetitivebodymovements.
NursingAlertImmediately
withholdthe nextdose of
antipsychoticmedicationandcall
the practitioneratthe firstsignof
an adverse side effectfrom
antipsychoticmedication.

24. Schizoaffective disorder is a
chronic mental health
condition characterized
primarily by symptoms of
schizophrenia, such as
hallucinations or delusions,
and symptoms of a mood
disorder, such as mania and
depression.
Many people with
schizoaffective disorder are
often incorrectly diagnosed
at first with bipolar disorder
or schizophrenia. Because
schizoaffective disorder is
less well-studied than the
other two conditions, many
interventions are borrowed
from their treatment
approaches.
Schizoaffective is relatively
rare, with a lifetime
prevalence of only 0.3%.
Men and women experience
schizoaffective disorder at
the same rate, but men often
develop the illness at an
earlier age. Schizoaffective
disorder can be managed

25. effectively with medication
and therapy. Co-occurring
substance use disorders are
a serious risk and require
integrated treatment.
Symptoms
The symptoms of
schizoaffective disorder can
be severe and need to be
monitored closely.
Depending on the type of
mood disorder diagnosed,
depression or bipolar
disorder, people
will experience
different symptoms:
 Hallucinations, which
are seeing or hearing
things that aren’t
there.
 Delusions, which are
false, fixed beliefs that
are held regardless of
contradictory evidenc
e.
 Disorganized thinking.
A person may switch
very quickly from one

26. topic to another or
provide answers that
are completely
unrelated.
 Depressed mood. If a
person has been
diagnosed with
schizoaffective
disorder depressive
type they will
experience feelings of
sadness, emptiness,
feelings of
worthlessness or
other symptoms of
depression.
 Manic behavior. If a
person has been
diagnosed with
schizoaffective
disorder: bipolar type
they will experience
feelings of euphoria,
racing thoughts,
increased risky
behavior and other
symptoms of mania.
Causes

27. The exact cause of
schizoaffective disorder is
unknown. A combination of
causes may contribute to the
development of
schizoaffective disorder.
 Genetics. Schizoaffe
ctive disorder tends to
run in families. This
does not mean that if
a relative has an
illness, you will
absolutely get it. But it
does mean that there
is a greater chance of
you developing the
illness.
 Brain chemistry and
structure. Brain
function and structure
may be different in
ways that science is
only beginning to
understand. Brain
scans are helping to
advance research in
this area.
 Stress. Stressful
events such as a
death in the family,
end of a marriage or

28. loss of a job can
trigger symptoms or
an onset of the
illness.
 Drug
use. Psychoactive
drugs such as LSD
have been linked to
the development of
schizoaffective
disorder.
Diagnosis
Schizoaffective disorder can
be difficult to diagnose
because it has symptoms of
both schizophrenia and
either depression or bipolar
disorder. There are two
major types of
schizoaffective disorder:
bipolar type and depressive
type. To be diagnosed with
schizoaffective disorder a
person must have the
following symptoms.
 A period during which
there is a major mood

29. disorder, either
depression or mania,
that occurs at the
same time that
symptoms of
schizophrenia are
present.
 Delusions or
hallucinations for two
or more weeks in the
absence of a major
mood episode.
 Symptoms that meet
criteria for a major
mood episode are
present for the
majority of the total
duration of the illness.
 The abuse of drugs or
a medication are not
responsible for the
symptoms.
Treatment
Schizoaffective disorder is
treated and managed in
several ways:
 Medications,
including mood

30. stabilizers,
antipsychotic
medications and
antidepressants
 Psychotherapy, such
as cognitive
behavioral therapy or
family-focused
therapy