PSYCHIATRIC – MENTAL

HEALTH NURSING

PREPARED BY:
MA. CARYL H. TADY, RN, MAN
ANGER, HOSTILITY, AND AGGRESSION :

ANGER : A NORMAL HUMAN EMOTION, WHEN EXPESSED

PROPERLY CAN BE A POSITIVE RESPONSE
- IT MAY BECOME A NEGATIVE EMOTION
CATHARSIS : VENTING ANGER THROUGH ENGAGING IN
AGGESSIVE BUT SAFE ACTIVITIES
NON-AGGRESSIVE ACTIVITIES : SUCH AS WALKING OR
TALKING TO A FRIEND IS MORE PREFERRED
HOSTILITY : VERBAL ABUSE, THREATENING BAHAVIOR,
AND VIOLATION OF RULES AND NORMS
AGGRESSION : FORM OF BEHAVIOR THAT INTENDS TO
ATTACK OR CAUSE INJURY TO AN INDIVIDUAL OR
PROPERTY
- SUICIDAL BEHAVIOR IS TERMED SELF-DIRECTED
AGGESSION

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 ANGER SUPPRESSION – COMMON IN WOMEN

PHYSICAL SYMPTOMS/PROBLEMS:
 MIGRAINE HEADACHES
 HYPERTENSION
 PAIN SYMPTOMS

INTERMITTENT EXPLOSIVE DIS.

TIME OUT – GOING TO A NEUTRAL PLACE

ACTING OUT – IMMATURE BEHAVIOR

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WHO ARE POTENTIAL FOR THESE BEHAVIOR?
PEOPLE WITH :
- PARANOID DELUSIONS - DEMENTIA
- AUDITORY HALLUCINATIONS - DELIRIUM
- HEAD INJURIES - ANTISOCIAL
- BORDERLINE PERSONALITY DIS.
PERSONALITY DIS. - MAJOR DEPRESSION
- INTOXICATION OF PROHIBITED DRUGS OR ALCOHOL

TREATMENT OF AGGRESSIVE BEHAVIOR:

1. MOOD STABILIZER
2. ANTIPSYCHOTIC MEDS
CHASER – LORAZEPAM THEN HALDOL
COCKTAIL – HALDOL AND LORAZEPAM TOGETHER
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SOCIAL AND EMOTIONAL CONCERN
GRIEF AND LOSS
GRIEF : SUBJECTIVE EMOTIONS AND AFFECT THAT ARE
NORMAL RESPONSE TO THE EXPERIENCE OF LOSS
EX. Behavioral, physiologic, cognitive responses
GRIEVING : PROCESS OF EXPERIENCING GRIEF
MOURNING : OUTWARD SIGN OF GRIEF ; A WAY OF
INTEGRATING LOSS AND GRIEF
TYPES OF LOSSES
1. PHYSIOLOGIC LOSS - paralysis
2. SAFETY LOSS – public violence
3. LOSS OF SECURITY & SENSE OF BELONGING
4. LOSS OF SELF-ESTEEM – challenge self-worth
5. LOSS RELATED TO SELF-ACTUALIZATION – inhibits
striving toward fulfillment

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THEORIST/ PHASE I PHASE II PHASE III PHASE IV
CLINICIAN

KUBLER- STAGE I : STAGE II: STAGE IV: STAGE V:

ROSS DENIAL ANGER DEPRESSION ACCEPTANCE
(1969) STAGE III:
BARGAINING
BOWLBY NUMBNESS, PHASE OF PHASE OF PHASE OF
(1980) DENIAL YEARNING & DISORGANI- REORGANI-
SEARCHING ZATION AND ZATION
DESPAIR

HARVEY SHOCK; INTRUSION OF CONFIDING

(1998) OUTCRY; THOUGHTS; TO OTHERS
DENIAL DISTRAC- TO EMOTE
TIONS

RODEBAUGH, REELING: FEELING: DEALING: HEALING:

SCHWINDT, & SHOCK, ANGUISH, ADAPTING TO INTEGRATION
VALENTINE DISBELIEF, GUILT, THE LOSS OF LOSS,
(1999) DENIAL SADNESS, LOSS MAY OR
08/02/21 ANGER MAY NOT 6BE
FORGOTTEN
DISENFRANCHISED GRIEF – GRIEF OVER A LOSS THAT IS
NOT OR CANNOT BE ACKNOWLEDGED OPENLY
ANTICIPATORY GRIEVING – IS WHEN PEOPLE FACING AN
IMMENENT LOSS BEGIN TO GRAPPLE WITH THE
VERY REAL POSSIBILITY OF THE LOSS OR DEATH IN
THE NEAR FUTURE
COMPLICATED GRIEF - REPONSE OUTSIDE THE NORM,
OCCURING WHEN PERSON IS VOID OF EMOTION,
GRIEVES FOR PROLONGED PERIODS, OR HAS
EXPRESSIONS OF GRIEF THAT SEEM DISPROPOR-
TIONATE TO THE EVENT
ACCULTURATION – ALTERING CULTURAL VALUES OR
BEHAVIORS AS A WAY TO ADAPT TO ANOTHER
CULTURE
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CRISIS INTERVENTION
CRISIS: IS A TURNING POINT IN AN INDIVIDUAL’S LIFE
THAT PRODUCES AN OVERWHELMING RESPONSE.
CATEGORIES:
1. MATURATIONAL CRISES (DEVELOPMENTAL CRISES)
- PREDICTABLE EVENTS IN THE NORMAL COURSE OF
LIFE, SUCH AS GETTING MARRIED, HAVING A BABY
2. SITUATIONAL CRISES – UNANTICIPATED OR SUDDEN
EVENTS THAT THREATEN THE PERSON’S INTEGRITY,
SUCH AS DEATH, ILLNESS, LOSS OF A JOB
3. ADVENTITIOUS CRISES (SOCIAL CRISES) – NATURAL
DISASTERS LIKE FLOODS, EARTHQUAKE, HURICANE,
WAR, VIOLENT CRIMES SUCH AS RAPE OR MURDER
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INTERVENTIONS:

1. DIRECTIVE INTERVENTIONS – TO ASSESSTHE

PERSON’S HEALTH STATUS AND PROMOTE
PROBLEM SOLVING
2. SUPPORTIVE INTERVENTIONS – ENCOURAGING
THE PERSON TO DISCUSS FEELINGS, AND
AFFIRMING THE PERSON’S SELF WORTH

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PROBLEMS RELATED TO ABUSE AND VIOLENCE

ABUSE :TO PHYSICALLY OR VERBALLY ATTACK OR INJURE

CHARACTERISTICS OF VIOLENT FAMILIES

- SOCIAL ISOLATION
- ABUSE OF POWER/CONTROL
- ALCOHOL OR OTHER DRUG ABUSE
- INTERGENERATIONAL TRANSMISSION PROCESS

1. CHILD ABUSE : HARMFUL PHYSICAL, EMOTONAL, AND

SEXUAL ACTS INFLICTED ON A CHILD
- PHYSICAL ABUSE - PSYCHOLOGICAL (EMOTIONAL
- SEXUAL ABUSE ABUSE)
- NEGLECT

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TREATMENT AND INTERVENTION
- ENSURE CHILDS SAFETY & WELL BEING
- DEVELOP TRUST IN CHILD

2. SPOUSE ABUSE : MISTREATMENT OR MISUSE OF ONE

PERSON BY ANOTHER IN THE CONTEXT OF AN INIMATE
RELATIONSHIP
- EMOTIONAL (PSYCHOLOGICAL ABUSE)
- PHYSICAL ABUSE
- SEXUAL ABUSE OR COMBINATION OF ALL TYPES

3. ELDERLY ABUSE : ACT OR OMISSION THAT RESULTS IN

HARM OR THREATENED HARM TO THE HEALTH OR
WELFARE OF AN ELDERLY

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CYCLE OF ABUSE AND VIOLENCE

VIOLENT BEHAVIOR
(ABUSIVE ATTACK)

PERIOD OF REMORSE
TENSION BUILDING OR CONTRITION
(ACCUSATIONS,ARGUMENTS, “HONEYMOON PERIOD”
COMPLAINTS, SILENT TX) ( ABUSER APOLOGIZES)

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 - PHYSICAL / SEXUAL ABUSE
- PSYCHOLOGICAL ABUSE
- NEGLECT & SELF- NEGLECT
- FINANCIAL EXPLOITATION
- DENIAL OF ADEQUATE MEDICAL TREATMENT
TREATMENT AND INTERVENTION :
PROVIDE :
- LEGAL SERVICES
- HOUSING
- MEDICAL & PSYCHIATRIC SERVICES
- SOCIAL SERVICES

RAPE : PERPETRATION OF AN ACT OF SEXUAL

INTERCOURSE WITH A MAN OR WOMAN AGAINST HIS
OR HER WILL WHETHER OVERCOME BY FORCE OR BY
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DRUGS OR INTOXICANTS OR INCAPABLE OF EXERCISING
RATIONAL JUDGMENT BECAUSE OF MENTAL DEFICIENCY,
OR WHEN BELOW THE AGE OF CONSENT (14 – 18 Y.O.)
MAY EXPERIENCE :
 MEMORY GAPS
 FALSE MEMORY SYNDROME

NSG. INTERVENTION
 PROMOTE CLIENT’S SAFETY AND SELF-ESTEEM
 HELP CLIENT COPE W/ STRESS AND EMOTIONS
 HELP BOOST THE CIENT’S SELF-ESTEEM
 GROUNDING TECHNIQUES
DATE RAPE (ACQUAINTANCE RAPE) MAY OCCUR ON A FIRST
DATE, ON A RIDE HOME FROM A PARTY.

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CARE OF CLIENTS W/ ANXIETY AND
STRESS RELATED ILLNESS :

ANXIETY
- A VAGUE FEELING OF DREAD AND APPREHENSION
- CAN SERVE MANY POSSIBLE FUNCTIONS SUCH AS
MOTIVATING A PERSON TO SOLVE A PROBLEM OR
TO RESOLVE A CRISIS

ANXIETY DISORDERS
- COMPRISE A GROUP OF CONDITIONS THAT SHARE
A KEY FEATURE OF EXCESSIVE ANXIETY W/
ENSURING BEHAVIORAL, EMOTIONAL, COGNITIVE,
AND PHYSIOLOGIC RESPONSES
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GENERAL ADAPTATION SYNDROME (HANS
SELYE) :

1. ALARM REACTION STAGE

- stress stimulates the body’s physiologic defense
to prepare for potential defense needs
2. RESISTANCE STAGE
- w/ continued stress, the lungs take in more air,
heart beats faster, and bld. shunted to muscles to
defend the body by fight, flight, or freeze
behaviors.
3. EXHAUSTION STAGE
- occurs when person has responded nega-tively to
stress. body stores depleted or the emotional
components are not resolved
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LEVELS OF ANXIETY:

1. MILD – wide perceptual field.

2. MODERATE – perceptual field narrowed
to immediate task.
3. SEVERE – perceptual field reduced to
one or scattered details.
4. PANIC – tunnel-vision perception

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INTERVENTIONS :

1. MILD ANXIETY – no direct intervention

2. MODERATE ANXIETY – speak in short, simple,
and easy-to-understand sentences
3. SEVERE ANXIETY – remain w/ the person;speak
in a low, calm, and soothing voice. instruct to take
deep breaths
4. PANIC ANXIETY – safety of the client is the
primary concern. keep talking to the person in a
confronting manner. go to a non stimulating
environment
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ANXIETY DISORDERS :

GENERALIZED ANXIETY DISORDER

- EXCESSIVE WORRYING AND ANXIETY FOR AT LEAST HALF OF
THE TIME FOR A PERIOD OF 6 MONTHS
- S/S : UNEASINESS, IRRITABILITY, MUSCLE TENSION, FATIGUE,
DIFFICULTY THINKING, & SLEEP ALTERATIONS

PHOBIC DISORDERS
- INTENSE, ILLOGICAL, PERSISTENT FEAR THAT CAUSES
EXTREME DISTRESS AND INTERFERES W/ FUNCTIONING
1. AGORAPHOBIA – ANXIETY ABOUT OR AVOIDANCE OF
PLACES OR SITUATIONS FROM W/C ESCAPE MIGHT BE
DIFFICULT OR HELP MIGHT BE UNAVAILABLE
2. SPECIFIC PHOBIA – AN IRRATIONAL FEAR OF AN OBJECT OR
SITUATION
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 CATEGORIES OF SPECIFIC PHOBIA :

> NATURAL ENVIRONMENTAL PHOBIAS – fear of

storms, water, heights, natural phenomena
> BLOOD-INJECTION PHOBIAS – fear of seeing one’s
own or others blood, traumatic injury
> SITUATIONAL PHOBIAS – fear of being in a specific
situation such as on a bridge, in a tunnel, elevator, or
small room
> ANIMAL PHOBIAS – fear of animals or insects
3. SOCIAL PHOBIA – fear of appearing stupid or shameful
in social situations

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TREATMENT (BEHAVIORAL THERAPY) :

1. SYSTEMATIC DESENSITIZATION – the

therapist progressively exposes the client to the
threatening object until anxiety decreases

2. FLOODING – rapid desensitization

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PANIC DISORDER :

- discrete episodes of panic attacks, 15 – 30 min. of

rapid, intense, escalating anxiety with physiologic
discomfort
- can lead to avoidance behavior

CONCEPTS OF BEHAVIOR PATTERN

1. PRIMARY GAIN – relief of anxiety achieved by
anxiety-driven behavior such as staying in the house
2. SECONDARY GAIN – attention received from others
as a result of these behaviors

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THERAPY:

1. COGNITIVE-BEHAVIORAL TECHNIQUES
- POSITIVE REFRAMING
- DECATASTROPHIZING
2. DEEP BREATHING AND RELAXATION

NURSING DX:
1. RISK FOR INJURY
2. ANXIETY
3. SITUATIONAL LOW SELF-ESTEEM
4. INEFFECTIVE COPING
5. POWERLESSNESS
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OBSESSIVE-COMPULSIVE DISORDER :

OBSESSIONS : recurrent , uncontrollable, persistent,

unwanted thoughts, images that cause marked anxiety
COMPULSIONS : repetitive, ritualistic behaviors or mental
acts that a person carries out to neutralize anxiety

COMMON COMPULSIONS :
1. CHECKING RITUALS 7. ORDERING
2. COUNTING RITUALS 8. RIGID PERFORMANCE
3. WASHING & SCRUBBING 9. AGGRESSIVE URGES
4. PRAYING & CHANTING
5. TOUCHING, RUBBING, OR TAPPING
6. HOARDING ITEMS

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ONSET AND CLINICAL COURSE :
- MALES : can start in childhood
- FEMALES : begins in the twenties
- exacerbation of symp. may be related to stress

THERAPY:
1. BEHAVIORAL THERAPY
- EXPOSURE – client deliberately confronts the situations or
stimuli he usually avoids
- RESPONSE PREVENTION – focuses of delaying or
avoiding performance of rituals
 HELP THE CLIENT COMPLETE THE DAILY ROUTINE
 NSG. DIAGNOSES SAME WITH PANIC DIS. W/
IMPARED SKIN INTEGRITY (FOR SCRUBBING RITUALS) 25
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POSTTAUMATIC STRESS DISORDER (PTSD)
- demonstrated by someone who has experienced
a traumatic event……
- symptoms occur after three months or more after the
trauma

ACUTE STRESS DISORDER

- symptoms appear within the first month after the trauma
and do not persist longer than 4 weeks

THREE CLUSTERS OF SYPTOMS:

1. RELIVING THE EVENTS
2. AVOIDING REMINDERS OF THE EVENT
3. BEING ON GUARD (HYPERAROUSAL)

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SOMATOFORM DISORDERS
- char. as a presence of pysical symptoms that suggest a
medical condition w/o a demonstrable organic basis

1. SOMATIZATION DIS – multiple physical symp. char. by a

combination of pain and GI, sexual, and
pseudoneurologic symptoms

2. CONVERSION (CONVERSION REACTION) – unexplained,

sudden deficits in sensory and motor function that
suggest neurologic disorder linked w/ psychological
factors
 KEY FEATURE – LA BELLE INDIFFERENCE, A SEEMING
LACK OF CONCERN OR DISTRESS

08/02/21 27
3. HYPOCHONDRIASIS – preoccupation w/ the fear
that one has a serious disease (disease conviction) or
will get a serious disease ( disease phobia)

4. PAIN DISORDER – char. by pain which is unrelieved

by analgesics

5. BODY DYSMORPHIC DISORDER – preoccupation

with an imagined or exaggerated defect in physical
appearance

RELATED DISORDERS
1. MALINGERING – intentional production of false or
grossly exaggerated symptoms motivated by external
incentives
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2. FACTITIOUS DISORDER – symptoms are intentionally
produced or feigned to gain attention

3. MUNCHAUSEN’S SYMDROME – persistent attempt to

obtain hospital tx. for a nonexistent illness

4. MUNCHAUSEN BY PROXY – inflicts illness or injury on

someone else to gain attention

NSG. INTERVENTION
- symp. management & improving quality of life
- assess self-image & encourage to talk
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DISSOCIATIVE DISORDERS
DISSOCIATION : allowing the mind to forget or remove itself
from painful situation or memory
1. DISSOCIATIVE AMNESIA – unable to remember important
personal information particularly of a traumatic accidents
and stressful events
2. DISOCCIATIVE FUGUE – patients physically tra- vel away
from their home or work situation and forget to remember
their previous identity; client may assume new identity
3. DEPERSONALIZATION – feeling of being detached from
self
4. DISSOCIATIVE IDENTITY DISORDER – assumes two or
more identity.

PSYCHOTHERAPY : HYPNOSIS
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ANTIANXIETY DRUGS (ANXIOLYTICS) :
- used to treat anxiety and anxiety dis., insomnia,
OCD, depression, PTSD, and alcohol withdrawal
1. BENZODIAZEPINE
- most effective in relieving anxiety
- drug with longer half-life accumulate in the
body and produce “next-day sedation”
- SIDE EFFECTS : physical dependence –
symptoms which resemble the original symptoms
when the drug is stopped

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- PSYCHOLOGICAL DEPENDENCE – fear the return of
anxiety symptoms or believe they are incapable

of handling anxiety without the drugs

- BENZODIAZEPINES
BENZODIAZEPINE : + ALCOHOL = POTENTIATION
DIAZEPAM (VALIUM) LORAZEPAM (ATIVAN)
OXAZEPAM (SERAX CLONAZEPAM
(KLONOPIN)
TRIAZOLAM (HALCION) ALPRAZOLAM (XANAX)

TEMAZEPAM (RESTORIL) FLURAZEPAM (DALMANE)

NONBENZODIAZEPINE:
BUSPIRONE (BUSPAR)
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 SCHIZOPHRENIA AND
PSYCHOTIC DISORDERS

08/02/21 33
CARE OF CLIENTS WITH SCHIZOPHRENIA AND
PSYCHOTIC DISORDERS

SCHIZOPHRENIA
- A SYNDROME OR DISEASE PROCESS WITH MANY DIFF.
VARIETIES AND SYMPTOMS
- CAUSES DISTORTED AND BIZARRE THOUGHTS, PER-
CEPTIONS, EMOTIONS, MOVEMENTS, & BEHAVIORS

ETIOLOGY
- BIOCHEMICAL : EXCESSIVE DOPAMINE RELEASE IN
THE CORTICAL REGION OF THE BRAIN
- GENETIC : 50% CHANCE IN IDENTICAL TWINS, 15% RISK
IF ONE BIOLOGIC PARENT HAS SCHIZOPHRENIA

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- BIOLOGICAL : ANATOMICAL AND PHYSIOLOGICAL
ABNORMALITIES
- NEUROSTRUCTURAL : VENTRICULAR ENLARGEMENT,
BRAIN ATROPHY, AND DECREASED CEREBRAL BLD.
POSITIVE OR HARD SYMPTOMS :
1.HALLUCINATIONS – FALSE SENSORY PERCEPTIONS
2. PERSEVERATION – EDHERENCE TO A SINGLE TOPIC
3.FLIGHT OF IDEAS – JUMPING FROM ONE IDEA TO
ANOTHER
4.AMBIVALENCE – CONTRADICTORY BELIEFS/FEELINGS
5.IDEAS OF REFERENCE – FALSE IMPRESSION THAT
EXTERNAL EVENTS HAVE MEANING TO THE PERSON
6.LOOSE ASSOCIATIONS – FRAGMENTED THOUGHTS
7.ECHOPRAXIA – IMITATION OF MOVEMENTS
8.DELUSIONS – FIXED FALSE BELIEF

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NEGATIVE OR SOFT SYMPTOMS

1. BLUNTED AFFECT – VERY LITTLE OR SLOW TO

RESPOND FACIAL EXPRESSION
2. ALOGIA – SPEAKING VERY LITTLE (POVERTY OF
CONTENT)
3. ANHEDONIA – FEELING NO JOY OR PLEASURE
4. CATATONIA – IMMOBILITY OR PERIODS OF AGITATION
5. APATHY – FEELINGS OF INDIFFERENCE
6. FLAT AFFECT – ABSENCE OF FACIAL EXPRESSION
7. AVOLITION – ABSENCE OF WILL & AMBITION

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TYPES OF SCHIZOPHRENIA
1. CATATONIC TYPE – MARKED PSYCHOMOTOR
DISTUR- BANCE, NEGATIVISM, MUTISM, ECHOLALIA,
ECHO- PRAXIA, AND WAXY FLEXIBILITY
2. DISORGANIZED TYPE – LOOSE ASSOCIATIONS,
DISORGANIZED BEHAVIOR, AND INAPPROPRIATE OR
FLAT AFFECT
3. PARANOID TYPE – EXTREME SUSPICIOUSNESS,
PERSECUTORY OR HOSTILE, AND AGGRESSIVE
BEHAVIOR
4. UNDIFFERENTIATED TYPE – MIXED SCHIZOPRHENIC
SYMPTOMS AND PRESENCE OF DISTURBANCES IN
THOUGHT, AFFECT, AND BEHAVIOR
5. RESIDUAL TYPE – ONE PREVIOUS EPISODE, SOCIAL
WITHDRAWAL, FLAT AFFECT, AND LOOSE
ASSOCIATIONS

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RELATED DISORDERS
1. SCHIZOPHRENIFORM DIS. – EXHIBITS SYMPTOMS OF
SCHIZO BUT FOR LESS THAN 6 MOS TO MEET THE
DIAGNOSTIC CRITERIA FOR SCHIZO
2. SCHIZOAFFECTIVE DIS. – W/ SYMPTOMS OF PSYCHO-
SIS AND FEATURES OF MOOD DISORDER
3. DELUSIONAL DIS. – HAS ONE OR MORE NON- BIZARRE
DELUSIONS THAT IS THE FOCUS IS BELIEVABLE
4. BRIEF PSYCHOTIC DIS. – SUDDEN ONSET OF AT LEAST
ONE PSYCHOTIC SYMPTOMSSUCH AS DELUSIONS,
HALLUCINATIONS , AND DISORGANIZED BEHAVIOR EX.
POSTPARTUM PSYCHOSIS
5. SHARED PSYCHOTIC DISORDER (FOLIE A DEUX) – TWO
PEOPLE SHARE A SIMILAR DELUSION

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* DELUSION : A FIXED FALSE BELIEF NOT BASED IN
> PERSECUTORY / PARANOID - BELIEF THAT OTHERS
ARE PLANNING TO HARM OR KILL HER
> GRANDIOSE : BELIEF THAT HE IS FAMOUS / CLAIM
TO ASSOCIATION WITH FAMOUS PEOPLE
> RELIGIOUS : CLIENT CLAIMS TO BE A MESSIAH
> SOMATIC : CLIENT’S HEALTH OR BODILY FUNCTIONS
> REFERENTIAL : ARTICLES HAVE SPECIAL MEANING
TO HER

08/02/21 39
* HALLUCINATION : FALSE SENSORY PERCEPTIONS,
OR PERCEPTUAL EXPERIENCES THAT DO NOT EXIST
IN REALITY
> AUDITORY – HEARING SOUNDS OR VOICES; MOST
COMMON TYPE
COMMAND HALLUCINATION – HEARING VOICES
DEMANDING THE CLIENT TO TAKE ACTION OR TO
HARM SELF OR OTHERS
> VISUAL – SEEING IMAGES THAT DO NOT EXIST, SUCH
AS LIGHTS OR A DEAD PERSON, DISTORTIONS AND
MONSTERS; SECOND MOST COMMON TYPE
> OLFACTORY – SMELLS OR ODORS, SUCH AS URINE
OR FECES

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> TACTILE : REFERS TO SENSATION SUCH AS BUGS
CRAWLING OR ELECTRICITY RUNNING THROUGH
THE BODY; COMMON TO CLIENT’S UNDERGOING
ALCOHOL WITHDRAWAL
> GUSTATORY :TASTE LINGERING IN THE MOUTH
> CENESTHETIC : FEELINGS OF BODILY FUNCTIONS
THAT ARE USUALLY UNDETECTABLE
> KINESTHETIC : SENSATION OF BODILY MOVEMENT
EVEN WHEN MOTIONLESS

- DEPERSONALIZATION – MOST SEVERE FORM OF

DISORIENTATION; CLIENT FEELS AS IF HER BODY
BELONGS TO SOMEONE ELSE OR HIS SPIRIT IS
DETACHED FROM THE BODY

08/02/21 41
TREATMENT MODALITIES
 PROMOTE SAFETY AND RIGHT TO PRIVACY AND
DIGNITY
 DO NOT OPENLY CONFRONT THE DELUSION OR ARGUE

 ESTABLISH AND MAINTAIN REALITY; IGNORE

DELUSIONS
 DISTRACTING TECHNIQUES

 TEACH POSITIVE SELF-TALK AND THINKING

PSYCHOPHARMACOLOGY
1. TYPICAL ANTIPSYCHOTICS

2. ATYPICAL ANTIPSYCHOTICS

08/02/21 42
UNUSUAL SPEECH PATTERNS
1. CLANG ASSOCIATIONS – RHYMING “I WILL TAKE A PILL
IF I GO UP THE HILL, BUT NOT IF MY NAME IS JILL, I
DON’T WANT TO KILL.”
2. NEOLOGISM – ARE NEW WORDS INVENTED BY THE
CLIENT “ I’M GRITTIZ. IF THERE ARE GRITTIZ HERE, I
WILL HAVE TO LEAVE. ARE YOU A GRITTIZ?’
3. VERBIGERATION – IS THE STEREOTYPED REPETI- TION
OF WORDS OR PHRASES. ECHOING “ I WANT TO GO
HOME, GO HOME, GO HOME, GO HOME.”
4. ECHOLALIA – REPETITION OF WHAT THE OTHER
PERSON SAYS
5. STILTED LANGUAGE – FLOWERY, EXCESSIVE WORDS

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6. PERSEVERATION – STUCK TO A SINGLE TOPIC / IDEA
7. WORD SALAD – FLOW OF UNCONNECTED WORDS
“GIRL, GRASS, SOMEHOW, BAD, MINK, LOVE, DRY.”
- LATENCY OF RESPONSE : REFERS TO HESITATION
BEFORE THE CLIENT RESPONDS TO QUESTIONS

NSG. DIAGNOSES
1. RISK FOR OTHER-DIRECTED VIOLENCE
2. RISK FOR SUICIDE
3. DISTURBED THOUGHT PROCESS
4. DISTURBED SENSORY PERCEPTION
5. SELF-CARE DEFICIT
6. IMPAIRED VERBAL COMMUNICATION

08/02/21 44
PSYCHOPHARMACOLOGY
PRINCIPLES :
1. A MEDICATION IS SELECTED BASED ON ITS EFFECT
ON THE CLIENT’S TARGET SYMPTOMS AND EFFEC-
TIVENESS IS EVALUATED BY ITS ABILITY TO DIMINISH
OR ELIMINATE THE TARGET SYMPTOMS
2. MANY PSYCHOTIC DUGS MUST BE GIVEN IN ADEQUATE
DOSAGES FOR SOME TIME BEFORE THEIR FULL
EFFECT IS REALIZED
3. THE DOSAGE OF THE MEDICATION IS OFTEN ADJUSTED
TO THE LOWEST EFFECTIVE DOSAGE FOR THE CLIENT.
HIGHER DOSAGES TO STABILIZE TARGET SYMPTOMS
AND LOWER DOSAGES TO SUSTAIN THOSE EFFECTS
OVERTIME

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 4. AS A RULE, OLDER ADULTS REQUIRE LOWER DOSAGES
OF MEDICATION THAN DO YOUNGER ONES TO EXPE-
RIENCE THERAPEUTIC EFFECTS. IT ALSO MAY TAKE
LONGER FOR A DRUG TO ACHIEVE ITS FULL EFFECT
5. PSYCHOTROPIC MEDICATIONS OFTEN ARE
DECREASED
GRADUALLY (TAPERING) BECAUSE OF WITHDRAWAL
(NEW SYMPTOMS APPEAR) AND REBOUND
( TEMPORARY
RETURN OF THE SYMPTOMS)

PSYCHOTROPIC DRUGS : ANTIPSYCHOTICS, ANTIDEP-

RESSANTS, MOOD STABILIZERS, ANXIOLYTICS, AND
STIMULANTS

08/02/21 46
TERMS :
1. EFFICACY
2. POTENCY
3. HALF-LIFE
4. OFF-LABEL USE
5. BLACK BOX WARNING

ANTIPSYCHOTIC DRUGS (NEUROLEPTICS) :

- USED TO TREAT SYMPTOMS OF PSYCHOSIS, SUCH AS
HALLUCINATIONS AND DELUSIONS SEEN IN
SCHIZOPHRENIA
- (OFF-LABEL USES) TX. OF ANXIETY, INSOMNIA, AGGRES-
SIVE BEHAVIOR AND OTHER DISRUPTIVE BEHAVIORS
THAT SOMETIMES ACCOMPANY ALZHEIMER’S DISEASE
- MISSED DOSE CAN BE TAKEN AFTER 3 – 4 HRS LATE

08/02/21 47
* MECHANISM OF ACTION
- IT BLOCKS THE DOPAMINE RECEPTORS (D1,D2,D3,D4,D5)
AND D2,D3, AND D4 HAVE BEEN ASSOCIATED WITH
MENTAL ILLNESS
- CONVENTIONAL OR TYPICAL STRONG BLOCKERS
OF D2 RECEPTORS EPS
- ATYPICAL WEAK BLOCKERS NO EPS
- DOPAMINE SYSTEM STABILIZERS ENHANCED A
TRANSMISSION WHERE IT IS TOO LOW AND REDUCE IT
WHERE IT IS TOO HIGH
> DEPOT INJECTION – TIME-RELEASE FORM OF MEDICATION
FOR MAINTENANCE THERAPY
* PROLIXIN ( DECANOATE FLUPHENAZINE) 7-28 DAYS
* HALDOL (DECANOATE HALOPERIDOL) 4 WEEKS
* RISPERDAL CONSTA (RISPERIDONE 25 MG) 2 WEEKS

08/02/21 48
EXTRAPYRAMIDAL SIDE EFFECTS
- SERIOUS NEUROLOGIC SYMPTOMS
1. ACUTE DYSTONIA – INCLUDES MUSCULAR RIGIDITY AND
CRAMPING, A STIFF THICK TONGUE WITH DIFFICULTY
SWALLOWING (SEVERE) LARYNGOSPASM AND
RESPIRATORY DIFFICULTIES
- OCCURS IN THE FIRST WK. OF TX, IN CLIENTS YOUNGER
THAN 40 YRS. IN MALES
- CAUSED BY HIGH POTENCY DRUGS SUCH AS
HALOPERIDOL AND THIOTHIXENE
* TORTICOLLIS – TWISTED HEAD AND NECK
* OPISTHOTONUS – TIGHTNESS IN THE ENTIRE BODY WITH
THE HEAD BACK AND AN ARCHED NECK
* OCULOGYRIC CRISIS – EYES ROLLED BACK IN A LOCKED
POSITION

08/02/21 49
TREATMENT :
- (ANTICHOLINERGIC DRUGS)
IM BENZTROPINE MESYLATE (COGENTIN)
IM OR IV DIPHENHYDRAMINE (BENADRYL)

2. PSEUDOPARKINSONISM – DRUG-INDUCED, GENERIC

LABEL OF EPS
- STIFF, OR STOOPED POSTURE; MASK-LIKE FACIES;
DECREASED ARM SWING; A SHUFFLING GAIT, FESTINA-
TING GAIT (WITH SMALL STEPS); COGWHEEL RIGIDITY
(RATCHET-LIKE MOVEMENTS OF JOINTS); COARSE PILL
ROLLING OF MOVEMENTS OF THE THUMB AND FINGERS
WHILE AT REST

TREATMENT :
- ADDING ANTICHOLINERGIC AGENT OR AMANTADINE

08/02/21 50
3. AKATHISIA – INTENSE NEED TO MOVE ABOUT “ANTS IN
PANTS.”CLIENT APPEARS RESTLESS OR ANXIOUS,
AGITATED OFTEN WITH A RIGID POSTURE OR GAIT AND A
LACK OF SPONTANEOUS GESTURES

TREATMENT :
- CHANGE IN ANTIPSYCHOTIC MED OR BY ADDING ORAL
AGENT SUCH AS A BETA BLOCKER, ANTICHOLINERGIC,
OR BENZODIAZEPINE

4. NEUROLEPTIC MALIGNANT SYNDROME – POTENTIALLY

FATAL IDIOSYNCRATIC REACTION TO ANTIPSYCHOTIC
(NEUROLEPTIC)
- S/S HIGH FEVER, AUTONOMIC INSTABILITY, ELEVATED
CPK (CREATININE PHOSPHOKINASE)

08/02/21 51
- CLIENTS ARE OFTEN MUTE AND CONFUSED, MAY
FLUCTUATE FROM AGITATION TO STUPOR
TREATMENT :
- IMMEDIATE DISCONTINUANCE OF ALL ANTIPSYCHOTIC
MEDS
- SUPPORTIVE MEDICAL CARE TO TREAT DEHYDRATION
AND HYPERTHERMIA

5. TARDIVE DYSKINESIA (TD) – A SYMDROME OF PERMA-

NENT INVOLUNTARY MOVEMENTS CAUSED BY THE
LONG-TERM USE OF CONVENTIONAL ANTIPSYCHOTICS
- INVOUNTARY MOVEMENTS OF THE TONGUE, FACIAL AND
NECK MUSCLES, UPPER AND LOWER EXTREMITIES, AND
TRUNCAL MUSCULATURE
- TONGUE THRUSTING AND PROTRUDING, LIP SMACKING

08/02/21 52
 - BLINKING, GRIMACING, AND OTHER FACIAL MOVEMENTS
- MONITOR THE CLIENT FOR INITIAL SIGNS OF TD USING
ABNORMAL INVOLUNTARY MOVEMENT SCALE

TREATMENT:
- KEEPING MAINTENANCE DOSAGES AS LOW AS POS-
SIBLE, CHANGING MED

ANTICHOLINERGIC SIDE EFFECTS:

- BUCO P(AN)DAN

OTHER SIDE EFFECTS :

- BLOOD PROLACTIN LEVEL BREAST ENLARGE-
MENT IN MEN & WOMEN, DIMINISHED LIBIDO, ERECTILE
AND ORGASMIC DYSFUNCTION, & MENSTRUAL
IRREGULARITIES, RISK FOR BREAST CANCER & WT. GAIN
08/02/21 53
 - WT. GAIN CAN ACCOMPANY MOST ANTIPSYCHOTICS ESP.
ATYPICAL, IT FURTHER INCREASES THE RISK FOR TYPE 2
DM WITH ZIPRASIDONE (GEODON) BEING THE EXCEPTION
MIS – (MELLARIL) THIORIDAZINE, (INAPSINE)DROPERIDOL,
(SERENTIL) MESORIDAZINE LENGTHENS THE QT
INTERVAL LEADING TO LIFE-THREATENING CARDIAC
DYSHYTHMIAS OR CARDIAC ARREST

CONVENTIONAL ATYPICAL NEW

ANTIPSYCHOTICS ANTIPSYCHOTICS GENERATION

CHLORPROMAZINE CLOZAPINE ARIPIPRAZOLE

(THORAZINE) (CLOZARIL) (ABILIFY)-DSS
FLUPHENAZINE RISPERIDONE
(PROLIXIN) (RISPERDAL)
TRIFLOUPERAZINE OLANZAPINE
(STELAZINE) (ZYPREXA)
HALOPERIDOL QUETIAPINE
(HALDOL) (SEROQUEL)
08/02/21 54
DROPERIDOL ZIPRASIDONE
CARE OF CLIENTS W/ MOOD DISORDERS

CATEGORIES
1. UNIPOLAR – EXHIBITS ONLY ONE MOOD
DEPRESSIVE
- MAJOR DEPRESSIVE DIS.
- DYSTHYMIC DIS.
- PREMENSTRUAL DYSPHORIC DIS.
2. BIPOLAR – MOOD SWINGS FROM PROFOUND
DEPRESSION TO EXTREME EUPHORIA
DEPRESSION – FEELINGS OF SADNESS, HOPELESS-
NESS, WORTHLESSNESS W/ LITTLE OR NO INTEREST IN
ACTIVITIES.
ENDOGENOUS DEPRESSION – DEPRESSION WITH NO
APPARENT CAUSE OR EXTERNAL PRECIPITATING
FACTOR.

08/02/21 55
EPIDEMIOLOGY
 GENDER – DEPRESSION HIGHER IN WOMEN THAN IN
MEN 2 TO 1. BIPOLAR 1.2 TO 1
 AGE – HIGHER IN YOUNG WOMEN AND DECREASE W/
AGE. LOWER IN YOUNG MEN & INCREASE W/ AGE
 SOCIAL CLASS – BIPOLAR OCCURS AMONG HIGHER
SOCIAL CLASSES
 MARITAL STATUS – INDIVIDUALS W/O CLOSE
INTERPERSONAL RELATIONSHIP ARE MORE
DEPRESSED
 SEASONALITY – MOOD DIS. SPRING (MAM) AND FALL
(SON)
 SUICIDE – PEAKS IN SPRING & SMALLER IN OCT.

08/02/21 56
MAJOR DEPRESSIVE DIS. – DEPRESSED MOOD MOST OF
THE DAY, NEARLY EVERYDAY FOR AT LEAST 2 WKS.
- LOSS OF INTEREST IN USUAL ACTIVITIES
- IMPAIRED SOCIAL, OCCUPATIONAL FUNCTIONING
- W/ NO MANIC EPISODE & CANNOT BE ATTRIBUTED TO
USE OF SUBSTANCES OR GEN. MEDICAL CONDITION

CLASSIFICATION
l. SINGLE OR RECURRENT
2. MILD, MODERATE, SEVERE
3. W/ PSYCHOTIC FEATURES
4. W/ CATATONIC FEATURES
5. W/ MELANCHOLIC FEATURES – DARK MOOD OF
DEPRESSION
08/02/21 57
6. CHRONIC
7. W/ SEASONAL PATTERN
8. W/ POSTPARTUM ONSET

DYSTHYMIC DIS. – “DOWN IN THE DUMPS.” DEPRESSED

MOOD MOST OF THE DAY, MORE DAYS THAN NOT, FOR
AT LEAST 2 YRS. ( 1 YR IN CHILDREN & ADOLESCENT) .
MILDER THAN MAJOR DEPRESSION

CLASSIFICATION
l. EARLY ONSET
2. LATE ONSET

PREMENSTRUAL DYSPHORIC DIS. – S/S OF DEPRESSION

DURING THE WK BEFORE MENSES & SUBSIDES AFTER
THE ONSET OF MENSTRUATION
08/02/21 58
MANIA – ABNORMAL ELEVATION OF MOOD; MOTOR ACTIVITY
IS EXCESSIVE, FRENZIED; PSYCHOTIC FEATURES MAY BE
PRESENT
- HOSPITALIZATION IS REQUIRED TO PREVENT HARM TO SELF
OR OTHERS
HYPOMANIA – MILDER REPRESENTATION; DOES NOT
REQUIRE HOSPITALIZATION; NOT SEVERE TO CAUSE
IMPAIRMENT
MANIFESTATIONS OF MANIA:
1. LACK OF SLEEP
2. INCREASED LIBIDO
3. INFLATED SELF-ESTEEM
4. EXPANDED SOCIALIZATION
5. GRANDIOSITY
6. EASILY DISTRACTED > POOR JUDGMENT
08/02/21 59
BIPOLAR MIXED – RAPID ALTERNATING MOODS ACCOM-
PANIED BY SYMPTOMS OF DEPRESSION & MANIA

BIPOLAR I – ONE OR MORE MANIC OR MIXED EPISODES

USUALLY ACCOMPANIED BY MAJOR DEPRESSION

BIPOLAR II – ONE OR MORE MAJOR DEP. EPISODES

ACCOMPANIED BY AT LEAST ONE HYPOMANIC EPISODE
M ____________ ______________ ____________
H_____________ ______________ ____________
NM _____________ ______________ ____________

D _____________ ______________ ____________

BM BI B II

08/02/21 60
CYCLOTHYMIC DIS. – CHRONIC MOOD DISTURBANCE
OF AT LEAST 2 –YR. DURATION INVOLVING NUMEROUS
HYPOMANIA AND DEPRESSED MOOD
RELATED DISORDERS
l. MOOD DISORDER DUE TO A GENERAL MEDICAL
CONDITION
2. DRUG - INDUCED MOOD DISORDER

TREATMENT
1. ANTIDEPRESSANTS
2. MOOD STABILIZERS (LITHIUM & ANTICONVULSANTS)
3. ECT (ELECTROCONVULSIVE THERAPY)
- FOR CLIENTS WHO DO NOT RESPOND TO
ANTIDEPRESSANTS

08/02/21 61
- SAFE FOR PREGNANT WOMEN
- IT IS AN APPLICATION OF ELECTRODES TO THE HEAD
OF THE CLIENT TO DELIVER ELECTRICAL IMPULSES TO
THE BRAIN
- GIVEN A SERIES OF 6 TO 15 TEATMENTS
- 12 TO 15 FOR MAXIMUM BENEFIT

PREPARATION
- NPO POST MIDNIGHT - REMOVE JEWELRY,POLISH
- VOID BEFORE THE PROCEDURE
- IV LINE FOR MEDICATIONS
> THIOPENTAL NA (PENTHOTAL) OR METHOHEXITAL
(BREVITAL) – SHORT-ACTING ANESTHETIC
> SUCCINYLCHOLINE CHLORIDE (ANECTINE) – MUSCLE
RELAXANT
> ATSO4 – DECREASED SALIVATION, INCREASED HR

08/02/21 62
TYPES
1. UNILATERAL – ELECTRODES ARE PLACED BOTH ON
ONE SIDE OF THE HEAD
- LESS MEMORY LOSS, MORE TREATMENTS NEEDED
2. BILATERAL/BITEMPORAL – ELECTRODES ARE PLACED
ONE ON EITHER SIDE OF THE HEAD
- RAPID IMPROVEMENT, INCREASED SHORT TERM
MEMORY LOSS

POSTICTAL AGITATION – HYPERACTIVE DELIRIUM MAY

OCCUR AS CLIENT EMERGES FROM ANESTHESIA
( RESTLESSNESS, INCOHERENCE, DISORIENTATION,
FLUCTUATION OF CONSCIOUSNESS) MAY LAST FEW
MIN. TO 1 HOUR
- IV DIAZEPAM (VALIUM) : TO STABILIZE THE SYMP.

08/02/21 63
 V/S ARE MONITORED
 ASSESS GAG REFLEX
 RECEIVES OXYGEN, ASSISTED TO BREATH W/ AMBU
 DURING THE PROCEDURE, EEG IS USED TO MONITOR
SEIZURE ACTIVITY IN THE BRAIN

 VAGUS NERVE STIMULATION (VNS) :

VAGUS NERVE STIMULATION (VNS) CAN HELP
PATIENTS WITH TREATMENT-RESISTANT DEPRESSION
THAT DO NOT IMPROVE WITH MEDICATION. VNS IS LIKE
A PACEMAKER FOR THE BRAIN. THE SURGICALLY
IMPLANTED DEVICE SENDS ELECTRICAL PULSES TO
THE BRAIN THROUGH THE VAGUS NERVE IN THE NECK.
THESE PULSES ARE BELIEVED TO EASE DEPRESSION
BY CHANGING THE BALANCE OF BRAIN CHEMICALS.

08/02/21 64
 TRANSCRANIAL MAGNETIC STIMULATION:
(ABBREVIATED TMS) A NON-INVASIVE TECHNIQUE THAT
CONSISTS OF A MAGNETIC FIELD EMANATING FROM A WIRE
COIL HELD OUTSIDE THE HEAD. THE MAGNETIC FIELD
INDUCES AN ELECTRICAL CURRENT IN NEARBY REGIONS OF
THE BRAIN. TMS WAS ORIGINALLY DEVELOPED AS A
DIAGNOSTIC TOOL FOR MAPPING BRAIN FUNCTION. IT
APPEARS PROMISING AS A TREATMENT FOR SOME
NEUROPSYCHIATRIC CONDITIONS, PARTICULARLY MAJOR
DEPRESSION.

08/02/21 65
NSG. MANAGEMENT
- OFFER FINGER FOODS
- PLAY THERAPY (TETHERBALL)
- PROVIDE QUIET ENIRONMENT W/ FEW STIMULI
- ALLOW CLIENT TO EXPRESS ANGER

SUICIDE – INTENTIONAL ACT OF KILLING ONESELF

 SUICIDAL IDEATION
 SUICIDE ATTEMPT
 SUICIDE GESTURE
 INITIATE A NO-SUICIDE CONTRACT

08/02/21 66
ANTIDEPRESSANTS
- USED IN THE TREATMENT OF MAJOR DEP., ANXIETY DIS.,
DEPRESSED PHASE OF BIPOLAR, AND PSYCHOTIC
DEPRESSION
- (OFF-LABEL USES) TX. OF CHRONIC PAIN, MIGRAINE,
PERIPHERAL AND DIABETIC NEUROPATHIES, SLEEP
APNEA, PANIC DISORDER, EATING DISORDERS

FOUR GROUPS:
1. TRICYCLIC AND RELATED CYCLIC COUMPOUNDS (TCAs)
- OLDEST DRUG TO TREAT DEPRESSION
- ANTICHOLINERGIC SIDE EFFECTS & SEXUAL DYSFXN.
- BLOCK THE REUPTAKE OF NOREPINEPHRINE & SERO-
TONIN
- 4 – 6 WKS. TO BE EFFECTIVE
- MISSED DOSE CAN BE TAKEN AFTER 3 HRS. LATE

08/02/21 67
2. SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIs)
- FIRST AVAILABLE IN 1987 AND PRODUCE FEWER
TROUBLESOME SIDE EFFECTS
- SIDE EFFECTS : ANXIETY, AGITATION, AKATHISIA,
NAUSEA, INSOMNIA AND SEXUAL DYSFXN.
- PROZAC WEEKLY 1ST AND ONLY MED THAT CAN BE GIVEN
ONCE A WK. AS MAINTENANCE THERAPY FOR DEP-
RESSION (90 MG. OF FLOUXETINE EC)
- BLOCK THE REUPTAKE OF SEROTONIN AND MAY BE
EFFECTIVE IN 2 – 3 WKS. & CAN TAKE AFTER 8 HRS. OF A
MISSED DOSE

3. MONOAMINE OXIDASE INHIBITORS (MAOIs)

- IT INTERFERES WITH ENZYME METABOLISM & CANNOT
BE GIVEN IN COMBINATION WITH OTHER MEDS LIKE
MAOIs, TCA, MEPERIDINE, CNS DEPRESSANTS, SSRIs

08/02/21 68
 - 2 – 4 WKS. TO BE EFFECTIVE
- SIDE EFFECTS : DAYTIME SEDATION, INSOMNIA, WT.

GAIN, DRY MOUTH, ORTHOSTATIC HYPOTENSION, AND

SEXUAL DYSFUNCTION
- CAN BE TAKEN IN THE MORNING
- FATAL WHEN TAKEN OVERDOSE

4. NOVEL ANTIDEPRESSANTS
- NEFAZODONE & TRAZODONE CAUSE HEADACHE
- NEFAZODONE CAN CAUSE DRY MOUTH & NAUSEA
- BUPROPION & VENLAFLAXINE CAN CAUSE LOSS OF
APPETITE, NAUSEA, AGITATION, AND INSOMNIA
- TRAZODONE CAN CAUSE PRIAPISM (A SUSTAINED AND
PAINFUL ERECTION IMPOTENCE)

08/02/21 69
THINGS TO REMEMBER :

- MAOI + TYRAMINE = HYPERTENSIVE CRISIS

- MAOI + SSRI = SEROTINISM (AGITATION, FEVER, RIGIDITY,
SWEATING, COMA, AND DEATH)
- NEFAZODONE MAY CAUSE RARE BUT POTENTIALLY LIFE
THREATENING LIVER DAMAGE
- BUPROPION CAN CAUSE SEIZURES
- IF MED CAUSES SEDATION, TAKE IT IN PM
IF IT CAUSES NERVOUSNESS, TAKE IT IN AM
- MAOI AND TCA ARE POTENTIALLY LETHAL IN AVERDOSE
AND POSE A RISK FOR CLIENTS WITH DEPRESSION WHO
MAY BE CONSIDERING SUICIDE

08/02/21 70
MOOD-STABILIZING DRUGS

- USED TO TREAT BIPOLAR DISORDER BY STABILIZING THE

CLIENT’S MOOD ESP. ACUTE EPISODES OF MANIA

1. LITHIUM – NORMALIZES THE REUPTAKE OF SEROTONIN,

NOREPINEPHRINE, ACETYLCHOLINE, AND DOPAMINE
- DAILY DOSAGES GENERALLY RANGE FROM 900-3,600 MG
- WATCH OUT FOR TOXICITY 1.5 MEQ/L
- 1.0 – 1.5 MEQ/L – FOR ACUTE MANIA
- 0.6 – 1.2 MEQ/L – FOR MAINTENANCE THERAPY
- CHECK FOR Na LEVEL BEFORE THE INITIAL DOSE
- MONITOR LITHIUM LEVEL EVERY 2 – 3 DAYS WHILE
DETERMINING THE THERAPEUTIC DOSAGE THEN EVERY
WK., WHEN STABLE ONCE A MONTH OR LESS FREQUENTLY

08/02/21 71
- SIDE EFFECTS: N/V, DIARRHEA, ANOREXIA, FINE HAND
TREMOR, POLYDIPSIA, POLYURIA, METALLIC TASTE IN
THE MOUTH, FATIGUE AND LEHTARGY
- TAKE MED WITH FOOD MAY HELP WITH GI PROBLEM
- PROPANOLOL FOR FINE TREMOR
- DIALYSIS IF LITHIUM LEVELS EXCEED 3.0 MEQ/L

2. VALPROIC ACID (DEPAKOTE, DEPAKENE)

CARBAMAZEPINE (TEGRETOL)
- ANTICONVULSANTS, STABILIZE THE MOOD BY INHIBITING
THE KINDLING PROCESS (SNOWBALL LIKE EFFECT SEEN
WHEN MINOR SEIZURE BUILD UP INTO MORE FREQUENT
AND SEVERE SEIZURES)
- VALPROIC ACID CAN CAUSE HEPATIC FAILURE
- CARBAMAZEPINE CAN CAUSE AA & AGRANULOCYTOSIS

08/02/21 72
OTHER ANTICONVULSANTS
- TOPIRAMATE (TOPAMAX), GABAPENTIN (NEURONTIN),
OXCARBAZEPINE (TRILEPTAL), LAMOTRIGINE
(LAMICTAL) – CAN CAUSE STEVENS-JOHNSON SYNDROME

08/02/21 73
 CARE OF CLIENTS WITH
PSYCHOLOGICAL DISORDERS

08/02/21 74
PERSONALITY DISORDERS – ARE DIAGNOSED WHEN
PERSONALITY TRAITS BECOME INFLEXIBLE AND MAL
ADAPTIVE AND INTERFERES WITH HOW THE PERSON
FUNCTIONS
DIAGNOSIS IS MADE ONLY WHEN THE PERSON EXHIBITS
ENDURING BEHAVIORAL PATTERN THAT DEVIATE
FROM CULTURAL EXPECTATIONS
1. COGNITION – WAYS OF PERCEIVING AND INTER-
PRETING SELF, OTHERS, AND EVENTS
2. AFFECT – APPROPRIATENESS OF EMOTIONAL
RESPONSE
3. INTEPERSONAL FUNCTIONING
4. IMPULSE CONTROL – ABILITY TO CONTROL BEHAVIOR
AT THE APPROPRIATE TIME AND PLACE
08/02/21 75
CLASSIFICATION

1. CLUSTER A – BEHAVIOR APPEARS ODD, AND

ECCENTRIC. PARANOID, SCHIZOID, SCHIZOTYPAL
2. CLUSTER B – EMOTIONAL, ERRATIC, AND DRAMATIC.
BORDERLINE, ANTISOCIAL, HISTRIONIC, NARCISSISTIC
3. CLUSTER C – ANXIOUS, FEARFUL. AVOIDANT, DEPEN-
DENT, OC

- TREATMENT RESISTANT
- TREATED ACCDG. TO SYMPTOMS
- COMBINATION OF THERAPY AND MEDICATION IS
HELPFUL
- COGNITIVE-BEHAVIORAL THERAPY (THOUGHT
STOPPING, AND POSITIVE SELF-TALK)

08/02/21 76
ETIOLOGY

1. TEMPERAMENT (BIOLOGIC) : INHERITED DISPOSITIONS

TRAITS:
> HARM AVOIDANCE
> NOVELTY SEEKING
> REWARD DEPENDENCE
> HIGHLY PERSISTENT

2. CHARACTER (PSYCHODYNAMIC) : ENVIRONMENTAL

INFLUENCES
TRAITS :
> SELF – DIRECTEDNESS
> COOPERATIVENESS
> SELF – TRANSCENDENCE

08/02/21 77
CLUSTER A PERSONALITY DISORDERS

PARANOID
- EXTREME SUSPICIOUSNESS AND MISTRUST OF
OTHERS; VIEWED BY OTHERS AS HOSTILE, STUBBORN,
AND DEFENSIVE

ASSESSMENT :
> SUSPICIOUS AND MISTRUST FUL
> EMOTIONALLY DISTANT, RESTRICTED AFFECT
> GUARDED OR HYPERVIGILANT
> LOW SELF-ESTEEM AND RIGID
- USE DEFENSE MECHANISM PROJECTION
NSG. INTERVENTIONS
- SERIOUS, STRAIGHTFORWARD APPROACH, FORMAL,
BUSINESS-LIKE MANNER
- INVOLVE CLIENT IN TREATMENT PLANNING
08/02/21 78
SCHIZOID
- INABILITY TO FORM A CLOSE RELATIONSHIP WITH
OTHERS
ASSESSMENT :
> LACK OF CLOSE RELATIONSHIP
> INTEREST IN SOLITARY ACTIVITIES
> ALOOF AND INDIFFERENT ; WITHDRAWN
> RESTRICTED EXPRESSION OF EMOTIONS

NGS. INTERVENTIONS
> IMPROVE THE CLIENT’S FUNCTIONING IN THE
COMMUNITY
> ASSIST THE CLIENT TO FIND A CASE MANAGER

08/02/21 79
SCHIZOTYPAL
- SOCIAL AND INTERPERSONAL DEFICITS AS WELL AS BY
COGNITIVE OR PERCEPTUAL DISTORTIONS
ASSESSMENT :
> ODD THINKING, SPEECH, AND APPEARANCE
> MAGICAL THINKING
> RELATIONSHIP DEFICITS
> UNKEMPT & DISHEVELED

NSG. INTERVENTIONS :
> DEVELOP SELF-CARE SKILLS
> IMPROVE COMMUNITY FUNCTIONING
> SOCIAL SKILLS TRAINING

08/02/21 80
CLUSTER B PERSONALITY DISORDERS

HISTRIONIC
- OVERLY DRAMATIC AND INTENSIVELY EXPRESSIVE
BEHAVIOR, ENJOYS BEING THE CENTER OF ATTENTION
ASSESSMENT :
> ATTENTION DEFICIT
> SEXUALLY SEDUCTIVE AND PROVOCATIVE
> OVERLY CONCERNED WITH APPEARANCE
> EXAGGERATE EMOTIONS INAPPROPRIATELY

NSG. INTERVENTIONS :
> TEACH APPROPRIATE SOCIAL SKILLS
> PROVIDE FACTUAL FEEDBACK

08/02/21 81
NARCISSISTIC
- INCREASED FEELING OF SELF – IMPORTANCE,
PREOCCUPIED WITH FANTASIES
ASSESSMENT :
> GRANDIOSITY
> NEED FOR ADMIRATION
> ARROGANT
> LACK OF EMPATHY WITH THE FEELING OF OTHERS

NSG. INTERVENTIONS :
> MATTER-OF-FACT APPROACH
> SET LIMITS ON RUDE AND ABUSIVE BEHAVIOR
> TEACH CLIENT SELF-CARE SKILLS

08/02/21 82
BORDERLINE
- UNSTABLE PERSONAL RELATIONSHIPS, MOOD AND
SELF – IMAGE; IMPULSIVE AND UNPREDICTABLE
ASSESSMENT :
> DYSPHORIC
> FEAR OF ABANDONMENT
> IMPAIRED JUDGMENT
> SPLITTING
> SELF – DESTRUCTIVE BEHAVIOR
NSG. INTEERVENTIONS :
> PROMOTE CLIENT’ S SAFETY (NO SELF-HARM)
>HELP COPE AND CONTROL EMOTIONS
> COGNITIVE RESTRUCTURING TECHNIQUE
> TEACH COMMUNICATION SKILLS (ASSERTIVE COM)

08/02/21 83
ANTISOCIAL
- DISREGARD FOR AND VIOLATION OF THE RIGHTS OF
OTHERS – AND WITH THE CENTRAL CHAR. OF DECEIT
AND MANIPULATION
ASSESSMENT :
> SELF-CENTERED > UNRELIABLE
> NO SHAME OR GUILT > SUPERFICIAL CHARM
> POOR JUDGMENT > IMPULSIVE
> IRRESPONSIBLE

NSG. INTERVENTIONS :
> LIMIT SETTING / CONFRONTATION / TIME OUT
> TEACH CLIENT PROBLEM SKILLS
> MANAGE FRUSTRATIONS AND ANGER

08/02/21 84
CLUSTER C PERSONALITY DISORDERS

AVOIDANT
- FEAR OF POTENTIAL REJECTION AND SOCIALLY
WITHDRAWN; LO SEL- ESTEEM

ASSESSMENT :
> POOR REACTION TO CRITICISM
> HYPERSENSITIVE TO REACTION OF OTHERS
> SOCIAL WITHDRAWAL
> FEELINGS OF INADEQUACY
> LACK OF SUPPORT SYSTEM

NSG. INTERVENTIONS :
> SUPPORT AND REASSURANCE
> COGNITIVE RESTRUCTURING TECHNIQUES
> PROMOTE SELF - ESTEEM

08/02/21 85
DEPENDENT
- LACK OF SELF CONFIDENCE, SUBMISSIVE AND
CLINGING BEHAVIOR
ASSESSMENT :
> CANNOT LIVE ALONE
> EXCESSIVE NEED TO BE TAKEN CARE OF
> LACK OF AUTONOMY

NSG. INTERVENTIONS :
> FOSTER SELF RELIANCE AND AUTONOMY
> TEACH PROBLEM SOLVING TECHNIQUE AND
DECISION MAKING SKILLS
> COGNITIVE RESTRUCTURING TECHNIQUES
08/02/21 86
OBSESSIVE – COMPULSIVE
- PREOCCUPATION WITH ORDERLINESS, PERFECTIONISM AND
CONTROL
ASSESSMENT :
> PERFECTIONISM, ORDERLINESS
> DEVOTION TO WORK
> INFLEXIBLE AND PREOCCUPIED WITH DETAILS AND RULES

NSG. INTERVENTIONS :
> ENCOURAGE NEGOTIATION W/ OTHERS
> ENCOURAGE CLIENT TO COMPLETE WORK ON SCHEDULE
> COGNITIVE RESTRUCTURING TECH/ BEHAVIORAL THERAPY

08/02/21 87
RELATED DISORDERS

DEPRESSIVE
- PERVASIVE PATTERN OF DEPRESSIVE COGNTION
AND BEHAVIOR
ASSESSMENT :
> WORTHLESSNESS, CHEERLESSNESS
> PESSIMISTIC
> LOW SELF- ESTEEM

NSG. INTERVENTIONS :
> ASSESS SELF- HARM RISK
> PROMOTE SELF- ESTEEM
> INCREASE INVOLVEMENT IN ACTIVITIES
08/02/21 88
PASSIVE –AGGRESSIVE
- PASSIVE EXPRESSION OF COVERT AGGRESSION;
NEGATIVE ATTITUDE
ASSESSMENT :
> STUBBORN
> FORGETFUL
> DEPENDENT
> FAULT FINDER, MATERIALISTIC

NSG. INTERVENTIONS :
> HELP CLIENT IDENTIFY FEELINGS AND EXPRESS THEM
> ASSIST CLIENT TO EXAMINE BEHAVIOR REALISTICALLY

08/02/21 89
 CARE OF CLIENTS WITH
COGNITIVE DISORDERS

08/02/21 90
DELIRIUM
- SYNDROME INVOLVING DISTURBANCES IN AWARENESS
ACCOMPANIED BY A CHANGE IN COGNITION
- POSTOP DELIRIUM, DRUG INDUCED, ALCOHOL INDUCED

SYMPTOMS :
> DIFFICULTY WITH ATTENTION, EASILY DISTRACTED
> DISORIENTED
> SENSORY DISTUBANCES (ILLUSIONS, HALLUCINATION
MISINTERPRETATIONS)
> CANGES IN PSYCHOMOTOR ACTIVITY
> ANXIOUS, FEARFUL, IRRITABLE

08/02/21 91
TREATMENT
- IDENTIFY AND TO TREAT THE UNDERLYING CAUSE
EITHER DUE TO SUBSTANCES OR A MEDICAL CONDITION

DEMENTIA
- ORGANIC SYNDROME WITH PROGRESSIVE DETERIORA-
TION IN PATIENT’S INTELLECTUAL FUNCTIONING,
MEMORY, PROBLEM SOLVING ABILITY, AND BEHAVIOR

STAGES OF DEMENTIA :
1. MILD – FORGETFULNESS W/C EXCEEDS THE NORMAL,
OCCASIONAL FORGETFULNESS
2. MODERATE – CONFUSION IS APPARENT
3. SEVERE – PERSONALITY AND EMOTIONAL CHANGES

08/02/21 92
HALLMARK SIGNS :
> AGNOSIA – INABILITY TO NAME OR RECOGNIZE
OBJECTS
> APHASIA – DETERIORATION OF LANGUAGE FUNCTION
> APRAXIA – IMPAIRED ABILITY TO EXECUTE MOTOR
FUNCTION
> AMNESIA – INABILITY TO REMEMBER
> DISTURBED EXECUTIVE FUNCTIONING

TYPES OF DEMENTIA:
ALZHEIMER’S DISEASE
> IRREVERSIBLE FORM OF DEMENTIA FROM NERVE CELL
DETERIORATION

08/02/21 93
ASSESSMENT :
> PROGRESSIVE DETERIORATION OF COGNITIVE
FUNCTIONING; INABILITY TO CARRY OUT ADL
- AVERAGE DURATION FROM ONSET OF SYMPTOMS TO
DEATH IS 8 TO 10 YRS.

VASCULAR DEMENTIA
> ONSET IS ABRUPT, FOLLOWED BY RAPID CHANGES IN
FUNCTIONING, A PLATEAU OR LEVELING-OFF PERIOD,
THEN MORE ABRUPT CHANGE AND ANOTHER PLATEAU

PICK’S DISEASE
> ONSET IS 50 TO 60 YRS.; DEATH OCCURS IN 2 TO 5 YRS.

08/02/21 94
CREUTZFELDT-JAKOB DISEASE
> A CNS DISORDER, DEVELOPS IN ADULTS 40 TO 60 YRS
> INVOLVES ALTERED VISION, LOSS OF COORDINATION OR
ABNORMAL MOVEMENTS AND DEMETIA
PAKINSON’S DISEASE
> SLOWLY PROGRESSIVE NEUROLOGIC CONDITION CHAR.
BY TREMOR, RIGIDITY, BRADYKINESIA, AND POSTURAL
INSTABILITY
HUNTINGTON’S DISEASE
> AN INHERITED, DOMINANT GENE DISEASE
> W/ CHOREIFORM MOVEMENTS THAT ARE CONTINUOUS
DURING WAKING HOURS AND INVOLVE FACIAL
CONTORTIONS, TWISTING, TURNING & TONGUE
MOVEMENTS; BEGINS IN THE LATE 30s & 10 TO 20 YRS
BEFORE DEATH
95
 SUBSTANCE ABUSE

08/02/21 96
- POLYSUBSTANCE ABUSE
- INTOXICATION
- WITHDRAWAL SYNDROME
- DETOXIFICATION
- SUBSTANCE ABUSE
- SUBSTANCE DEPENDENCE
- BLACKOUT
- TOLERANCE
- TOLERANCE BREAK
- ABSTINENCE
- SPONTANEOUS REMISSION OR NATURAL
RECOVERY
08/02/21 97
RISK FOR :
- MENTAL AND PHYSICAL DETERIORATION
- INFECTIOUS DISEASE SUCH AS HIV AND AIDS,
HEPATITIS, AND TUBERCULOSIS

RELATED DISORDERS :
- SUBSTANCE – INDUCED DISORDERS (ANXIETY, MOOD
DISORDERS AND DEMENTIA)

ETIOLOGY :
BIOLOGIC FACTORS – CHILDREN OF ALCOHOLIC
PARENTS ARE AT HIGHER RISK
PSYCHOLOGICAL FACTORS (FAMILY DYNAMICS) –
CHILDREN OF ALCOHOLIC PARENTS ARE 4X AS LIKELY
TO DEVELOP ALCOHOLISM

08/02/21 98
SOCIAL AND ENVIRONMENTAL FACTORS - CONSUMPTION
INCREASES IN AREAS WHERE AVAILABILITY INCREASES

CULTURAL CONSIDERATION – ATTITUDES TOWARD

SUBSTANCE USE, PATTERNS OF USE

TYPES OF SUBSTANCES :
ALCOHOL – A NERVOUS SYSTEM DEPRESSANT THAT IS
ABSORBED RAPIDLY INTO THE BLOODSTREAM

INTOXICATION : SLURRED SPEECH, UNSTEADY GAIT, LACK OF

COORDINATION, AND IMPAIRED ATTENTION, CON-
CENTRATION, MEMORY, AND JUDGMENT

OVERDOSE : VOMITING, UNCONSCIOUSNESS, AND

RESPIRATORY DEPRESSION (LAVAGE & DIALYSIS)

08/02/21 99
EFFECTS OF LONG-TERM USE: CARDIAC MYOPATHY,
WERNICKE’S ANF KORSAKOFF’S, PANCREATITIS,
ESOPHAGITIS, HEPATITIS, CIRRHOSIS, THROMBO-
CYTOPENIA, LEUKOPENIA, ASCITES

WITHDRAWAL : SYMPTOMS BEGIN 4-12 HRS. AFTER

CESSATION
- COARSE HAND TREMORS, SWEATING, ELEVATED
PULSE AND BP, INSOMNIA, ANXIETY AND N/V
- SEVERE OR UNTREATED : DELERIUM TREMENS –
TRANSIENT HALLUCINATIONS, SEIZURES, OR DELIRIUM
( WITHIN A WK. OF WITHDRAWAL )

DETOXIFICATION : UNDER MEDICAL SUPERVISION ( 3-5

DAYS ADMISSION )

08/02/21 100
SAFE WITHDRAWAL: ADMINISTRATION OF BENZO –
DIAZEPINES ( LORAZEPAM, CHLORDIAZEPOXIDE,
DIAZEPAM ) IT SUPRESSES THE WITHDRAWAL SYMP.
ACCOMPLISHED BY :
> FIXED-SCHEDULE DOSING OR TAPERING
> SYMPTOM-TRIGGERED DOSING – SEVERITY OF
SYMPTOMS DETERMINE THE AMOUNT OF MEDS. NEEDED

SEDATIVES, HYPNOTICS, AND ANXIOLOYTICS – A CENTRAL

NERVOUS SYSTEM DEPRESSANT
- BENZODIAZEPINES AND BARBITURATES MOST
FREQUENTLY ABUSED

INTOXICATION S/S : SAME WITH ALCOHOL, STUPOR, COMA

08/02/21 101
WITHDRAWAL : SYMPTOMS ARE OPPOSITE OF THE
ACUTE EFFECTS OF DRUGS ( AUTONOMIC HYPER –
ACTIVITY.
SEVERE : SEIZURE AND HALLUCINATIONS

DETOXIFICATION : TAPERING

STIMULANTS : STIMULATE OR EXCITE THE CENTRAL

NERVOUS SYSTEM ( AMPHETAMINES, COCAINE )
- “UPPERS” AMPHETAMINES
- COCAINE IS HIGHLY ADDICTIVE W/O CLINICAL USE
- METHAMPHETAMINE IS DANGEROUS, HIGHLY
ADDICTIVE, AND CAUSES PHYCHOTIC BEHAVIORS

08/02/21 102
INTOXICATION : ( BEHAVIORAL ) EUPHORIC FEELING,
HYPERACTIVITY, HYPERVIGILANCE, TALKATIVENESS,
GRANDIOSITY, HALLUCINATIONS, FIGHTING
(PHYSIOLOGIC) TACHYCARDIA, ELEVATED BLOOD
PRESSURE, DILATED PUPILS, PERSPIRATION AND
CHILLS, DILATED PUPILS

OVERDOSE : SEIZURES AND COMA, DEATHS ARE RARE

WITHDRAWAL : MARKED DYSPHORIA ACCOMPANIED BY

FATIGUE (“CRASHING”:DEPRESSIVE SYMPTOMS,
INCLUDING SUICIDAL IDEATION )
- WITHDRAWAL IS NOT TREATED PHARMACOLOGICALLY

08/02/21 103
CANNABIS : HEMP PLANT THAT IS WIDELY CULTIVATED.
- MARIJUANA REFERS TO THE UPPER LEAVES,
FLOWERING TOPS, AND STEM
- HASHISH IS THE DRIED RESINOUS EXUDATE FROM THE
LEAVES OF THE FEMALE PLANT

INTOXICATION : BEGINS LESS THAN 1 MINUTE AFTER

INHALATION. PEAKS 20 TO 30 MINS AND LAST AT LEAST
2 TO 3 HRS. (IMPAIRED MOTOR COORDINATION,
INAPPROPRIATE LAUGHTER IMPAIRED JUDGMENT AND
SHOT-TERM MEMORY AND DISTORTIONS OF TIME AND
PERCEPTION.

WITHDRAWAL SYMPTOMS : MUSCLES ACHES, SWEATING,

ANXIETY, AND TREMORS

08/02/21 104
OPIOIDS : DESENSITIZE THE USER TO BOTH PHYSIO
-LOGIC AND PSYCHOLOGICAL PAIN AND INDUCE A
SENSE OF EUPHORIA.
- POTENT PRESCRIPTION ANALGESICS : MORPHINE,
MEPERIDINE (DEMEROL), CODEINE, METHADONE
- ILLEGAL SUBSTANCES : HEROINE, NORMETHADONE

INTOXICATION : DEVELOPS SOON AFTER THE EUPHO-RIC

FEELING SUCH AS APATHY, LETHARGY, IMPAIRED
JUDGEMENT, CONSTRICTED PUPILS, DROWSINESS,
SLURRED SPEECH.
SEVERE OR OVERDOSE : COMA, RESPIRATORY
DEPPRESSION, PUPILLARY CONSTRICTION, UNCON-
SCIOUSNESS, AND DEATH
08/02/21 105
WITHDRAWAL : (INITIAL) ANXIETY, RESTLESSNESS,
ACHING LEGS AND BACK, CRAVING FOR MORE
OPIOIDS.
PROGRESSION : N/V, DYSPHORIA, LACRIMATION,
RHINORHEA, SWEATING, DIARRHEA, YAWNING, FEVER,
AND INSOMNIA

DETOXICATION : METHADONE

HALLUCINOGENS : SUBSTANCES THAT DISTORTS THE

USER’S PERCEPTION OF REALITY AND PRODUCES
SYMPTOMS SIMILAR TO PSYCHOSIS
- MESCALINE, PSILOCYBIN, LSD, ECSTACY AND PCP
- EFFECTS : AUTONOMIC HYPERACTIVITY, DILATION OF
PUPILS,
08/02/21 106
INTOXICATION :
- BEHAVIORAL/PSYCHOLOGICAL : ANXIETY, DEPRES-
SION, PARANOID IDEATION, IDEAS OF REFERENCE,
JUMPING OUT A WINDOW
- PHYSIOLOGIC : SWEATING, TACHYCARDIA, BLURRED
VISION, TREMORS, LACK OF COORDINATION
- PCP : BELLIGERENCE, AGGRESSION, IMPULSIVITY, AND
UNPREDICTABLE BEHAVIOR
- PCP TOXICITY : SEIZURES, HYPERTENSION,
HYPERTHERMIA, AND RESPIRATORY DEPRESSION

TX OF TOXIC REACTIONS IS SUPPORTIVE:

- MEDICATIONS THAT CONTROL SEIZURE AND BP
- COOLING DEVICES SUCH AS HYPETHERMIA BLANKETS

08/02/21 107
NO WIHDRAWAL SYMPTOMS, ONLY FLASHBACKS THAT
MAY PERSIST FOR FEW MONTHS UP TO 5 YRS.

INHALANTS : ANESTHETICS, NITRATES, AND ORGANIC

SOLVENT, ALIPHATIC AND AROMATIC HYDROCAR-BONS
(GASOLINE, LUE, PAINT THINNER, AND SPRAY PAINT.
- CAN CAUSE : SIGNIFICANT BRAIN DAMAGE, PERI-
PHERAL NERVOUS SYSTEM DAMAGE, LIVER DISEASE

INTOXICATION : DIZZINESS, NYSTAGMUS, LACK OF

COORDINATION, SLURRED SPEECH, UNSTEADY GAIT
- STUPOR AND COMA CAN OCCUR
- BEHAVIORAL SYMPTOMS : BELLIGERENCE, APATHY,
AGGRESSION, IMPAIRED JUDGMENT

08/02/21 108
ACUTE TOXICITY : ANOXIA, RESPIRATORY DEPRESSION,
VAGAL STIMULATION, AND DYSRHYTHMIAS.
- DEATH CAN OCCUR FROM BRONCHOSPASM, CARDIAC
ARREST, SUFFOCATION, OR ASPIRATION OF
COMPOUND OR VOMITUS

TX : SUPPORTING RESPIRATORY AND CARDIAC FUNC-

TIONING
- NO WITHDRAWAL SYMPTOMS AND DETOXICATION
PROCEDURES

DRUGS USED FOR SUBSTANCE ABUSE TREATMENT :

LORAZEPAM (ATIVAN) – ALCOHOL WITHDRAWAL
> 2 – 4 MG EVERY 2 – 4 HOURS PRN
> MONITOR V/S AND GLOBAL ASSESSMENTS FOR
EFFECTIVENESS, MAY CAUSE DROWSINESS
08/02/21 109
CHLORDIAZEPOXIDE (LIBRIUM) – ALCOHOL WITHDRAWAL
> 50 – 100 MG 2 – 4 HRS. PRN DO NOT EXCEED 300MG/D
> MONITOR V/S, MAY CAUSE DIZZINESS &
DROWSINESS

DISULFIRAM (ANTABUSE) – MAINTAIN ABSTINENCE FROM

ALCOHOL
> 500 MG/DAY FOR 1 – 2 WKS THAN 250 MG/DAY
> TEACH CLIENT TO READ LABELS TO AVOID
PRODUCTS WITH ALCOHOL

METHADONE (DOLOPHINE) – MAINTAIN ABSTINENCE

FROM HEROINE
> UP TO 120MG/DAY FOR MAINTENANCE
> MAY CAUSE NAUSEA AND VOMITING

08/02/21 110
LEVOMETHADYL (ORLAAM) – MAINTAIN ABSTINENCE FROM
OPIATE
> 60 – 90 MG 3X A WEEK FOR MAINTENANCE
> DO NOT TAKE THE DRUG ON CONSECUTIVE DAYS; TAKE
HOME DOSES ARE NOT PERMITTED

NALTREXONE (REVIA) – BLOCKS THE EFFECTS OF OPIATES,

REDUCES ALCOHOL CRAVINGS
> 350MG/WK, DIVIDED INTO 3 DOSES
> TAKE WITH FOOD OR MILK, MAY CAUSE HEADACHE

CLONIDINE (CATAPRES) – SUPRESSES OPIATE WITHDRAWAL

SYMPTOMS
> 0.1 MG EVERY 6 HRS PRN
> TAKE BP BEFORE EACH DOSE, WITHOLD IF HYPOTENSIVE

08/02/21 111
THIAMINE (B1) – WERNICKE AND KORSAKOFF
SYNDROME
> 100 MG/DAY >PROPER NUTRITION

FOLIC ACID ( FOLATE) – TREAT NUTRITIONAL DEFI-

CIENCES
> 1 – 2 MG/DAY
> URINE MAY BE DARK YELLOW

CYANOCOBALAMIN (VIT B12) – TREAT

NUTRITIONAL DEFICIENCIES
> 25 – 250 MCG/DAY
> TEACH PROPER NUTRITION

08/02/21 112
 EATING DISORDERS

08/02/21 113
ANOREXIA NERVOSA
: CHAR. BY CLIENT’S REFUSAL OR INABILITY TO
MAINTAIN A MINIMALLY NORMAL BODY WT.

TWO SUBGROUPS :

1. RESTRICTING SUBTYPE – LOSE WT. PRIMARILY

THROUGH DIETING OR EXCESSIVE EXERCISING.

2. BINGE EATING & PURGING SUBTYPE –

CONSUMING LARGE AMOUNT OF FOOD THEN
FOLLOWED BY COMPENSATORY BEHAVIORS
DESIGNED TO ELIMINATE FOOD.

08/02/21 114
BEHAVIORS :
> PREOCCUPIED WITH FOOD – RELATED
ACTIVITIES SUCH AS GROCERY
SHOPPING, COLLECTING RECIPES OR
COOKBOOKS, COUNTING CALORIES
> REFUSING TO EAT AROUND OTHERS
> EXCESSIVE EXERCISE IS COMMON, IT
MAY OCCUPY SEVERAL HRS. A DAY
BEGINS BETWEEN 14 AND 18 YRS.

08/02/21 115
BULIMIA NERVOSA

: CHAR. BY RECURRENT EPISODES (AT LEAST TWICE

A WEEK FOR THREE MONTHS) OF BINGE EATING
FOLLOWED BY COMPENSATORY BEHAVIORS TO
AVOID WT. GAIN

> THE AMOUNT OF FOOD DURING BINGING IS MUCH

LARGER THAN THE PERSON WOULD NORMALLY
EAT > WT. USUALLY IS IN NORMAL RANGE, SOME
ARE OVERWEIGHT AND UNDERWEIGHT
> 18 OR 19 IS THE TYPICAL AGE OF ONSET

08/02/21 116
BEHAVIORS :
> STORE FOOD IN THEIR CARS, DESKS, OR
SECRET LOCATIONS
> VISIT ONE FASTFOOD TO ANOTHER
ORDERING A NORMAL MEAL

S/S :
> RECURRENT EPISODES OF BINGE EATING
> COMPENSATORY BEHAVIORS
> CHIPPED, MOTH – EATEN TEETH
08/02/21 117
> INCREASED DENTAL CARRIES
> MENSTRUAL IRREGULARITIES
> ESOPHAGEAL TEARS
> FLUID ANG ELECTROLYTE IMBALANCE
> METABOLIC ALKALOSIS OR ACIDOSIS

RELATED DISORDERS :
1.BINGE EATING DISORDER – RECURRENT
EPISODES OF BINGE EATING W NO REGULAR
USE OF INAPPROPRIATE COMPENSATORY
BEHAVIORS
2. NIGHT EATING SYNDROME – CHAR. BY
MORNING ANOREXIA ANG EVENING
HYPERPHAGIA
3. COMORBID PSYCH. DISORDERS
08/02/21 118
BIOLOGIC FACTORS :
> GENETIC VULNERABILITY
> DISFUNCTION OF THE HYPOTHALAMUS
- LATERAL HYPOTHALAMUS ( DEFICITS RESULT IN
DECREASED EATING AND DECREASED RESPONSES TO
SENSORY STIMULI
- VENTROMEDIAL HYPOTHALAMUS (DISRUPTION LEADS
TO EXCESSIVE EATING AND DECREASED
RESPONSIVENESS TO SATIETY .

DEVELOPMENTAL FACTORS :
> ENMESHMENT (LACK OF CLEAR ROLE BOUNDARIES)
> SELF-PERCEPTIONS – BODY IMAGE DISTURBANCE

08/02/21 119
BULIMIA
> COGNITIVE-BEHAVIORAL THERAPY
> ANTIDEPRESSANTS – THEY IMPROVE THE MOOD

NSG. DIAGNOSES :
> IMBALANCED NUTRITION : LESS THAN/ MORE THAN
BODY REQUIREMENTS
> INEFFECTIVE COPING
> DISTURBED BODY IMAGE

COPING STRATEGIES:
> HELP CLIENT TO RECOGNIZE EMOTIONS FOR
ALEXITHYMIA
> SELF-MONITORING
08/02/21 120
 CHILD AND ADOLESCENT
DISORDERS

08/02/21 121
A. MENTAL RETARDATION – IS BELOW AVERAGE
INTELLECTUAL FUNCTIONING (INTELLIGENCE
QUOTIENT LESS THAN 70)
DEGREE OF RETARDATION :
1. MILD RETARDATION : IQ 50 – 70
2. MODERATE RETARDATION : 35 – 50
3. SEVERE RETARDATION : 20 – 35
4. PROFOUND RETARDATION : IQ LESS THAN 20
CAUSES :
1. TAY –SACH’S OR FRAGILE X CHROMOSOME
SYNDROME
2. TRISOMY 21 OR MATERNAL ALCOHOL INTAKE
3. FETAL MALNUTRITION, HYPOXIA, INFECTIONS
AND TRAUMA
08/02/21 122
TYPES :
1. PASSIVE AND DEPENDENT
2. AGGESSIVE AND IMPULSIVE

B. LEARNING DISORDER – DIAGNOSED WHEN CHILD’S

ACHIEVEMENT IN READING, MATH, OR WRITTEN
EXPRESSION IS BELOW EXPECTED FOR AGE, FORMAL
EDUCATION OR INTELLIGENCE.

> READING AND WRITTEN EXPRESSION DIS. USUALLY

IDENTIFIED IN THE FIRST GRADE.
> MATH DISORDER MAY GO UNDETECTED
> MAY DEVELOP SELF – ESTEEM AND DEVELOP POOR
SOCIAL SKILLS.
> WILL HAVE PROBLEMS WITH EMPLOYMENT OR SOCIAL
ADJUSTMENT.

08/02/21 123
C. MOTOR SKILLS DISORDER – THE ESSENTIAL FEATURE OF
DEVELOPMENTAL COORDINATION DIS.
- IMPAIRED COORDINATION SEVERE ENOUGH TO INTERFERE
W/ ACADEMICS AND ADL.
- DX IS NOT MADE DUE TO A GEN. MED. CONDITION
- EVIDENT AS A CHILD ATTEMPS TO CRAWL OR WALK, OR
TRIES TO DRESS INDEPENDENTLY OR MANIPULATE TOYS
SUCH AS BULDING BLOCKS
- COEXISTS W/ COMMUNICATION DIS.

TREATMENT :
- PHYSICAL EDUCATION: KICKING A FOOTBALL
- SENSORY INTEGRATION PROGRAMS: PHYSICAL THERAPIES
PRESCRIBED TO TARGET IMPROVEMENT IN AREAS WHERE A
CHILD HAS DIFFICULTIES.

08/02/21 124
D. COMMUNICATION DISORDERS – DX. WHEN COMMUNICATION
DEFICIT IS SEVERE ENOUGH TO HINDER DEVELOPMENT,
ACADEMIC, ADL, AND SOCIA- LIZATION.

> EXPRESSIVE LANGUAGE DIS. : IMPAIRED ABILITY O

COMMUNICATE THROUGH VERBAL & NON VERBAL

> MIXED RECEPTIVE-EXPRESSIVE LANGUAGE DIS. : PROBLEMS

W/ EXPRESSION AND UNDERSTANDING

> PHONOLOGIC DIS. : PROBS. W/ ARTICULATION

(STUTTERING – DISTURBANCE OF THE NORMAL FLUENCY
AND TIME PATTERNING OF SPEECH.

TREATMENT :
- SPEECH AND LANGUAGE THERAPY

08/02/21 125
E. PERVASIVE DEVELOPMENTAL DIS. – CHAR. BY
PERVASIVE AND USUALLY SEVERE IMPAIRMENT OF
RECIPROCAL SOCIAL INTERACTION SKILLS,
COMMUNICATION DEVIANCE, AND RESTRICTED
STEREOTYPICAL BEHAVIORAL PATTERNS. IT IS ALSO
CALLED AUTISM SPECTRUM DISORDERS .

AUTISTIC DIS.:
- PREVALENT IN BOYS THAN IN GIRLS
- IDENTIFIED NO LATER THAN 3 YEARS OF AGE
- DISPLAY LITTLE EYE CONTACT, MAKE FEW FACIAL
EXPRESSION TOWARD OTHERS, USE LIMITED GESTURES
TO COMMUNICATE
- LACK SPONTANEOUS ENJOYMENT, NO MOODS AND
AFFECT, & CANNOT ENGAGE IN PLAY

08/02/21 126
- LITTLE INTELLIGIBLE SPEECH
- ENGAGED IN STEREOTYPED MOTOR BEHAVIORS SUCH
AS HAND FLAPPING, BODY TWISTING AND HEAD
BANGING.
- DOES HAVE GENETIC LINK
- PERSIST INTO ADULTHOOD, REMAIN DEPENDENT

TREATMENT:
- HALOPERIDOL, RISPERIDONE : FOR TEMPER
TANTRUMS, AGGRESSIVENESS, STEREOTYPED
BEHAVIORS, HYPERACTIVITY
- “MAINSTREAMING”
- SPECIAL EDUCATION AND LANGUAGE THERAPY

08/02/21 127
RETT’S DIS.:
- MULTIPLE DEFICIT AFTER A PERIOD OF NORMAL
FUNCTIONING
- EXCLUSIVELY IN GIRLS, IS RARE, PERSISTS THROUGH-
OUT LIFE
- DEVELOPS BETWEEN BIRTH AND 5 MONTHS OF AGE
- LOSES INTEREST IN SOCIAL ENVIRONMENT, AND
SEVERE IMPAIRMENT OF EXPRESSIVE AND RECEP-TIVE
LANGUAGE BECOMES EVIDENT AS SHE GROWS OLDER

CHILDHOOD DISENTEGRATIVE DIS. (CDD):

- CHAR. BY MAKED REGRESSION IN THE MULTIPLE AREAS
OF FUNCTIONING AFTER 2 YRS. OF NORMAL GROWTH
AND DEVELOPMENT

08/02/21 128
- ONSET BET. 3 AND 4 YRS.
- SOCIAL AND COMMUNICATION DEFICITS
- SLIGHTLY MORE OFTEN IN BOYS THAN IN GIRLS

ASPERGER’S DIS.:
- WITH IMPAIRMENT OF SOCIAL INTERACTION AND
RESTRICTED STEREOTYPED BEHAVIORS BUT NO
LANGUAGE OR COGNITIVE DELAYS
- OFTEN IN BOYS THAN IN GIRLS
- EFFECTS ARE GENERALLY LIFELONG

08/02/21 129
 DISRUPTIVE BEHAVIOR DISORDERS

08/02/21 130
A. ATTENTION DEFICIT HYPERACTIVITY DIS.:
- CHAR. BY INATTENTIVENESS, OVERACTIVITY, AND
IMPULSIVENESS
- COMMON IN BOYS; FUSSY, TEMPERAMENTAL, POOR
SLEEPING PATTERNS
- “ALWAYS ON THE GO” AND “INTO EVERYTHING” AS
TODDLERS
- CANNOT TOLERATE SEDENTARY ACTIVITIES
- ACADEMIC PERFORMANCE SUFFERS

ETIOLOGY:
- ENVIRONMENTAL TOXINS, PRENATAL INFLUENCES,
HEREDITY, AND DAMAGE TO BRAIN STRUCTURE AND
FUNCTION

08/02/21 131
- PARENTAL EXPOSURE TO ALCOHOL, TOBACCO, AND LEAD,
AND SEVERE MALNUTRITION CAN INCREASE THE
LIKELIHOOD OF ADHD
- DECREASE METABOLISM IN THE FRONTAL LOBES
(ATTENTION, IMPULSE CONTROL, ORGANIZATION)
- RISK FACTORS INCLUDE FAMILY HX OF ADHD, ANTISOCIAL
PERSONALITY AND ALCOHOLISM AMONG RELATIVES

INTERVENTION/ PSYCHOPHARMACOLOGY/
- SIMULANTS (DAMP)
- SUGAR-CONTROLLED DIETS AND MEGAVITAMIN THERAPY
- ANTIDEPRESSANT ( 2ND CHOICE FOR TX)
- GOOD BREAKFAST AND NUTRITIOUS SNACKS

08/02/21 132
- THERAPEUTIC PLAY (DRAMATIC PLAY, CREATIVE PLAY)
- ENSURE CHILD’S SAFEY, SIMPLIFY INSTRUCTIONS,
STRUCTURE DAILY ROUTINE, FAMILY EDUCATION

ASSESSMENT:
- “OUT OF CONTROL”
- LABILE MOOD
- ATTENTION SPAN : SEVERE – 2-3 SEC., MILD 2-3 MIN.
- POOR JUDGMENT, LOW SELF-ESTEEM
NSG. DIAGNOSES:
- RISK FOR INJURY
- INEFFECTIVE ROLE PERFORMANCE
- IMPAIRED SOCIAL INTERACTION

08/02/21 133
B. CONDUCT DISORDER
1. MILD
2. MODERATE
3. SEVERE

C. OPPOSITIONAL DEFIANT DIS.:

- ENDURING PATTERN OF UNCOOPERATIVE, DEFIANT,
AND HOSTILE BEHAVIOR W/O MAJOR ANTISOCIAL
VIOLATIONS

08/02/21 134
FEEDING AND EATING DISORDERS

A. PICA : PERSISTENT INGESTION OF

NONNUTRITIVE SUBSTANCES
B. RUMINATION DIS.: REPEATED
REGURGITATION AND RECHEWING
OF FOOD
C. FEEDING DIS.: PERSISTENT FAILURE
TO EAT ADEQUATELY, W/C RESULTS
IN SIGNIFICANT WT. LOSS OR
FAILURE TO GAIN WT.

08/02/21 135
TIC DISORDERS

• SUDDEN, RAPID, RECCURENT, NONRHYTHMIC, STE-

REOTYPED MOTOR MOVEMENT OR VOCALIZATION.
TYPES:
1. SIMPLE MOTOR TICS : BLINKING, JERKING THE NECK,
SHRUGGING THE SHOULDERS, GRIMACING, AND
COUGHING
2. SIMPLE VOCAL TICS : CLEARING THE THROAT,
GRUNTING, SNIFFING, SNORTING, AND BARKING
3. COMPLEX VOCAL TICS : COPROLALIA, PALILALIA,
ECHOLALIA
4. COMPLEX MOTOR TICS : INCLUDE FACIAL GES-TURES,
JUMPING, OR TOUCHING OR SMELLING AN OBJECT

08/02/21 136
A. TOURETTE’S DIS.: INVOLVES MULTIPLE MOTOR
TICS AND ONE OR MORE VOCAL TICS, W/C MAY
OCCUR MANY TIMES A DAY FOR MORE THAN ONE
YEAR
- COMMON IN BOYS, IDENTIFIED BY 7 YEARS OF
AGE
- HAS SIGNIFICANT IMPAIRMENT IN ACADEMIC,
SOCIAL, AND OCCUPATIONAL AREAS AND FEELS
ASHAME OR SELF-CONSCIOUS

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ELIMINATION DISORDERS

A. ENURESIS
B. ENCOPRESIS

OTHER DISORDERS OF INFANCY, CHILDHOOD &

ADOLESCENCE
A. SEPARATION ANXIETY DIS.
B. SELECTIVE MUTISM
C. REACTIVE ATTACHMENT DIS.
D. STEREOYPIC MOVEMENT DIS.

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 THANK YOU AND

GOOD LUCK!!!

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