Download MH-PP9-3-12

26 Hours
Presented by:
Mrs. Mary Elizabeth Pacuska, M.S.N.




Attend Class
Read assigned text material
Participate in class projects and discussions
Complete assigned projects



Unit Examinations 50%
Article Critique (Required) -2 points from
final grade if not completed
Complete Practice Questions Chapters 62, 63,
64,and 66 in Silvestri’s Comprehensive
Review for NCLEX-PN Examination -5 points
from final grade if not completed

Self-awareness:
ability to recognize nature of one’s own
attitude, emotions, and behavior
Do you have any prejudices about patients
with psychiatric disorders?



“successful performance of mental function,
resulting in productive activities, fulfilling
relationships, and the ability to adapt to
change and cope with adversity”
State in which one is responsible, displays
self awareness, is self directive, reasonably
worry free, and can cope
Function in society, accepted in a group, and
generally satisfied with their lives.







Self-governance
Progress toward growth
Tolerance of uncertainty
Self-esteem
Reality Orientation
Mastery of environment
Stress Management



Inherited Characteristics (Biologic)
Nurturing during childhood (Psychological)
I.Q., self-concept, emotional development
Life Circumstances(Socio-cultural)
i.e. family stability, ethnicity and culture,
economic level, religion, values, beliefs,
abuse and poor parenting


Def: A clinically significant behavioral or
psychological syndrome experienced and
marked by distress, disability.
Not dealing with problems through rational
decisions.




All ages, races, gender and socioeconomic
levels
In US 48 Million/year (1in5), 20% of children
2nd leading cause of disability in US
15% have co-occurring substance abuse
or Dual diagnosis


Unknown
Complex set of interactions involving genetic
predisposition and environmental influences
Mental Health, the ability
to:
 be flexible
 be successful
 form close relationships
 make appropriate
judgements
 solve problems
 cope with daily stresses
 have a positive sense of
self
Mental illness:
 Impairment of ability to
think, feel, or make
sound judgements
 Difficulty or inability to
cope with reality or to
form strong personal
relationships
Stress
Anxiety



Condition that develops from a threat to
one’s well-being requiring one to adjust to
environment
May be acute (fight or flight) or chronic
Physical Response (stress reaction)- arousal
of autonomic nervous system




A feeling of apprehension, uneasiness, or
uncertainty in response to a real or perceived
threat.
Automatic and unconscious biologic response
to a stressor
Impossible to avoid, instinctive
May be present whether there is danger or
not
External
Physical environment (noise,
lights, weather, crowds)
Major life events ( death, divorce,
loss of job, marriage)
Work related (rules, deadlines,
production pressures, gossip)
Social (bossy or aggressive
individuals, strained
friendships, marital affairs)
Everyday life (schedules,
household duties, family
conflict)
Internal
Personality traits (perfectionist,
workaholic, worrier, loner)
Negative self talk (pessimism,
irrational thinking, selfcriticism)
Thinking snags (all or none
approach, unrealistic and
inflexible expectations)






Assess situation and see if it real is what it seems
to be
Adaptation- successful management of stress
Adaptive coping- using rational management of
stress and anxiety
Palliative coping- solution which temporarily
relieves anxiety, problem still exists
Maladaptive coping- unsuccessful attempts made
to decrease anxiety
Dysfunctional coping- not attempting to reduce
anxiety or solve problem






Positive self talk
Assertiveness
training
Problem solving
skills
Communication
skills
Relaxation
techniques
meditation





Support systems
Practical attitude
Sense of humor
Self-care
Faith in spiritual
power and in self





Differs from stress and anxietydisorganization and disarray occur as coping
strategies fail or unavailable
Inability to control situation or function
Seeks a way out
Panic- feels helpless and lost
Needs intervention




Threat or stressor increases anxiety and defenses
begin
Defense strategies fal and threat continues,
functioning becomes disorganized, autonomic
responses engage
Temporary resolution – allows daily functioning
Eventual- overwhelming anxiety causing serious
disorganization of mental defenses, fear,
confusion, violence, or suicidal behaviors.







Deals with present situation and resolution of
immediate issue
Early intervention vital
Decrease anxiety to tolerable level
Need to define problem
Determine available support
Set realistic goals
If suicidal- protective measures







Grief- emotional process of coping with loss
Feel empty, hopeless and detached from meaning
in life
Loss can be actual or perceived change in status of
one’s relationship to a valued object or person
(person, pet, home, job, etc..)
Grief- feeling of profound sadness and
despondency
Mourning is personal (family and cultural influence)
A Process- learning to accept, grow
Give right to right to grieve in whatever time frame
needed





Anticipatory
Conventional- bereavement (adapting to loss)
Dysfunctional – failure to complete process and
cope successfully
Life becomes meaningless, continued longing for
what is lost- chronic sorrow
Contributing factors: suicide, homicide, missing
persons, multiple losses, ambivalent feelings,
unresolved grief from previous loss, guilt with
regard to circumstances, survivor guilt, feelings of
worthlessness, marked decrease in functioning,
delusional thinking

Denial

Anger

Bargaining

Depression

Acceptance










If intense- clinical treatment
Need to face reality of our own death
Respect of clients way of grieving
Avoid reassuring clichés
Open ended statements
Determine patients support systems
Be open and honest with feelings
Reassure normalcy
Support groups
Journaling










Anger- emotion triggered in response to threats, insulting situations
or anything that seriously hampers the intended actions of
individual- instinctive
Violence- intense feeling toward an individual starts with verbal or
physical threats and assaults
Abuse- the destructive action
Often learned response
Managing anger- we have ability to control
Need to control and separate physical from emotional responsephysical activity
Learn appropriate assertion techniques
Use “I” statements- own our feelings and express without attacking
Talking to others
Forgiveness



“an enduring pattern of perceiving, relating
to, and thinking about oneself and the
environment that is demonstrated in our
social and interpersonal interrelationships.”
Personality traits- unique
Genetic transmission of personality traits
from both parents, family patterns, society
and environmental influences
Psyche made up of three components:



Conscious- present awareness
Preconscious- below current awareness,
easily retrieved
Unconscious- past experiences and related
emotions- contributes to emotional
discomfort and disturbances
Personality has three aspects:
 ID
 EGO
 SUPEREGO
MUST BE IN BALANCE FOR REASONABLE
MENTAL HEALTH
Pleasure principle:“I want what I want when I
want it.”
Present at birth
Functions in the irrational and emotional part
of mind.
Basic needs and feelings: hunger, aggression,
sex, protection, and warmth
ID too strong: self gratification and uncaring
to others





Rational part of mind, begins development
6-8 months, well developed by 2 years
Reality principle: Grows out of knowing
can’t always get what we want.
Ego strength refers to how well ego copes
with ID and Superego
Sensations, feelings, adjustments, solutions
and defenses formed here
Too strong: Extremely rational, cold,
boring, distant







Last part of mind to develop, starts at 3-4 years,
well developed by 10-11.
Controls, inhibits, and regulates impulses and
socially unacceptable instinctive urges
Moral part of mind; parental & societal values
Strives for perfection, causes anxiety
Conscience
Operates at conscious and unconscious level
Too Strong: guilty, insufferable saintly personality





Constant need for ego to reconcile conflicts between id and
superego causes anxiety. Anxiety cases need to preserve
sense of self.
For ego to remain in control automatic psychological
processes (ego defense mechanisms) are mobilized
“Unconscious, protective barriers used to manage instinct and
affect in stressful situations.” Sigmund Freud
Therapeutic used in relation to problem solving- short term
allowing us to work to realistic outcome or solution.
Maladaptive DM lead to distortion of reality and selfdeception regulating the response to protect oneself








Compensation
Conversion
Denial
Displacement
Dissociation
Fantasy
Humor
Introjection








Projection
Rationalization
Reaction-formation
Regression
Repression
Sublimation
Suppression
Undoing






History: “lunatics”, “the insane’, Locked in cells,
beaten, starved. Late 1700’s- psychiatry
19th century- beginning of change- recognized as
an illness and treatment questioned
20th century- psychiatric nursing added to all
curriculums
1946- National Mental Health Act- funding for
research
1956- 1st antipsychotic drugs- put end to
lobotmies



1950-1980 institutionalized dropped from
500,000 to less than 100,000
Improved, more compassionate care
Legislation for research, development of
patient rights



Stigma and lack of social awareness
Access to Care: cultural disparity, cultural
incompetence among mental health providers
Cost of care- managed care

Client rights: “Bill of Rights”, appropriate care,
Informed consent, confidentiality,

Use of Seclusion and restraints

Nurse Accountability





Inpatient: Voluntary and involuntary
Outpatient- private, community, support
groups, marriage and family counseling
Nonpsychiatric facilities- holistic
Dual diagnosis treatment facilities
Correctional Facilities- antisocial thoughts
and behaviors, loss of sense of self, denial
that situation is due to their own choices,
aggressive behaviors


Therapeutic Milieu
Treatment Team: psychiatrist, psychologist,
psychiatric nurse, mental health technician,
social worker, licensed professional
counselor, case manager, religious counselor,
recreation specialist, Occupational therapist,
dietician

Pharmacologic treatment







Provide holistic care
Set appropriate limits and boundaries
Trust
Professionalism
Mutual Respect
Caring, empathy, and genuineness
Therapeutic communication

Judgmental attitudes

Excessive Probing

Lack of Self Awareness







Active Listening
Goal directed
Appropriate
Flexibility and feedback
Assertiveness
Non-Confrontational
Self Disclosure








Clarifying and
validating
Focusing and
refocusing
Giving information
Presenting reality
Listening
Neutral responses
Silence
Providing
acknowledgement and
feedback






Providing nonverbal
encouragement
Reflecting
Restating
Sharing perceptions
Summarizing
Using broad and openended questions







Asking “Why?”
Being defensive
Changing the subject
Giving advice, disapproval or approval
Stereotypical comments
Making value judgments
Giving false reassurance




1. “Have you shared your feelings with your
family?”
2. “I think we should talk more about your anger
with your family.”
3. “You’re feeling angry that your family continues
to hope for you to be cured.”
4. “Well it sounds like you’re pretty pessimistic.
After all, years ago people died of pneumonia.”

1. “I don’t see you as a failure.”

2. “You have everything to live for.”

3. “Feeling like this is all part of being ill.”

4 “You’ve been feeling like a failure for a
while?”




1. “I hate being asked these kinds of
questions too.”
2. “I am a nurse and as such I’ll have you
know that all information is kept
confidential.”
3. “I know that some of these questions are
difficult for you, but as a nurse, I must legally
respect your confidentiality.”
“This is difficult for you to speak about, but I
am trying to perform a complete data
collection and I need this information.”




1.”If you didn’t want our care, why did you
come here?”
2. “ Why are you being so difficult? I only want
to help you.”
3. ”Sounds like you’re feeling pretty troubled
by all of us. Let’s work together so you can
do everything for yourself as you request.”
4. ”I will respect your feelings. I’ll just leave
this cup for you to collect your urine in. After
breakfast, I will take more blood from you.”





Axis I: clinical disorders and
delirium,dementia, mental disorders as
the result of a general medical condition
Axis II: personality disorders/mental
retardation
Axis III: General medical conditions
Axis IV: Psychosocial and environmental
problems
Axis V: global assessment of functioning
(GAF)


Coded from 0-100
Psychological, social, and occupational
functioning






Axis I: 300.4 Dysthymic Disorder
315.00 Reading Disorder
Axis II:
No Diagnosis
Axis III: 382.9 Otitis Media
Axis IV:
Victim of Child Neglect
Axis V: GAF= 53 (current)







Psychopharmacology
Spirituality
Complementary and Alternative Therapies
Milieu Therapy
Interpersonal Therapy
Behavior
Electroconvulsive Therapy



Antipsychotics
Antianxiety
Agents
Antidepressants




Stimulants
Mood Stabilizers
Anticonvulsants
Antiparkinson
Agents






Acupressure/acu
puncture
Aromatherapy
Homeopathy
Hypnotherapy
Imagery
Biofeedback







Herbs
Meditation
Reiki
Reflexology
Art/Music
Therapy
Pet Therapy
Yoga
Goals:
 Decrease patient’s emotional discomfort
 Increase patient’s social functioning
 Increase the ability of the patient to behave
or perform in a manner appropriate to the
situation.





Milieu- the physical and social environment
in which an individual is receiving treatment.
Safe environment
Treatment team
Community meetings, activity groups,
physical exercise
One-to-one relationship with staff




Establish a contract and role clarification
Supportive therapy- reinforce coping mech
Re-educative therapy:
learn new ways of perceiving and behaving
Explores alternatives, reality therapy, cognitive
restructuring and behavior modification and
development of coping skills
Reconstructive therapy
Making major life changes with psychotherapy,
may take years



Principle: how an individual feels and behaves
is determined by way in which they think
about the world and their place in it.
Based on attitudes and assumptions from
previous experiences
Correct dysfunctional beliefs






Decreased isolation
Opportunities to help others
Development of coping skills
Decreased transference to therapist
Open groups: no boundaries
Closed groups: set rules

Couple Therapy

Family Therapy





Procedure: uses electric current to induce
seizures
Side Effects: headache, disorientation,
memory disturbance
Effects are cumulative
Postictal Agitation
Informed Consent





Biologic
Psychological
Cultural
Spiritual
Social needs

Specific data regarding a particular problem

Used in crisis

Assess mood, affect and behavior

Brief Psychiatric Rating Scale (BPRS)

Drug Attitude Inventory (DAI-10)

Hamilton Rating Scale for Depression (HRSD)






Appearance
Affect, Emotional
State
Behavior,
Attitude, Coping
patterns
Communication
and Social Skills
Content of
Thought
Orientation







Memory
Intellectual ability
Insight
Spirituality
Sexuality
Neurovegitative
Changes
Medical Issues




Physical characteristics
Peculiarity of dress
Cleanliness
Use of cosmetics





Outward manifestation of one’s emotions
Blunted
Flat
Inappropriate
Labile





Strange, threatening, suicidal, abusive
Unusual mannerisms
Friendly, fearful, angry , aggressive
Overactive or underactive
Ask how they normally cope with problems








Impaired Communication:
Blocking – sudden stoppage
Circumstatiality- unnecessary detail
Flight of Ideas- ideas fragmented
Perseveration- same verbal response
Verbigeration- meaningless repetition of
specific words or phrases
Neologism- self invented
Mutism- refusal to speak





Delusions: fixed false beliefs
Hallucinations: sensory perceptions without
actual stimuli
Depersonalization: feeling of unreality, out of
body sensation
Obsessions: insistent thoughts
Compulsions: insistent, repetitive, intrusive,
and unwanted urges to perform acts



Person, place, time
Where they are, who they are, date?”
Levels of orientation



Ability to recall past experiences
Recent memory: recall immediate past-two
weeks
Long-term memory: recall remote past



Name past presidents
Simple math problems
Evaluate abstract and concrete thinking



Self-understanding
Do they consider themselves ill?
Do they understand what’s happening?


Clients beliefs, culture and religious culture
Are beliefs and values helping or hindering
client?


Concerns about sexual identity, activity and
function
Does client prefer male or female clinician to
discuss concerns?

Changes in psychophysiologic functions:
sleep patterns, eating patterns, energy levels,
sexual functioning, bowel functioning




Cardiovascular disease
Stroke
Parkinson’s
Can impede medical treatment

Nick Vujicic, No Arms, No Legs, No Worries!
Part 1





Stress produces anxiety
Anxiety: “the uncomfortable feeling of dread
that is a response to extreme or prolonged
periods of stress.”
Mild, moderate, severe, or panic
Free-floating anxiety
Signal anxiety





Generalized Anxiety Disorder (GAD)
Panic disorder
Phobia
Obsessive-Compulsive Disorder
Post-traumatic Stress Disorder (PTSD)



DSM: related to 2 or
more things and last 6
months
Symptoms:Most show 6
or more to be considered
anxious
Behaviors: restlessness,
fatigue, feeling on edge
Symptoms:










muscle aches
shakes
palpitations
dry mouth
nausea
vomiting
hot flashes
chills
polyuria
difficulty swallowing




A state of
extreme fear that
cannot be
controlled
With or without
agoraphobia
Episodes present
quickly
DSM: at least 4
symptoms









Symptoms:
Fear (usually of dying,
losing control, or going
crazy)
Dissociation (feeling that
it’s happening to
someone else)
Nausea
Diaphoresis
Chest pain
Increased pulse
Shaking
Unsteadiness



Most common
Phobia: irrational
fear
700 different
phobias




Subcategories:
agoraphobia
social phobia
simple phobia


Obsession: repetitive thought, urge or
emotion
Compulsion: repetitive act that may appear
purposeful







Ensure basic needs are met
Identify precipitating events
Show empathy
Allow compulsive behaviors as long as not a
danger to patient or others
Implement distracters of behaviors
Reinforce non-ritualistic behaviors
Establish written contract to decrease
frequency

http://www.usanetwork.com/series/monk/w
ebisodes/index.html


Response to an
unexpected
emotional or
physical trauma
that could not be
controlled.
DSM: must have
symptoms for at
least one month








Symptoms:
Flashbacks
Social withdrawal
feelings of low selfesteem
Changes in relationships
Irritability, anger,
outbursts
Depression
Chemical dependency






Recognize anxiety
Establish trust
Protect client
Avoid anxiety provoking situations
Provide activities and creative outlets
Promote relaxation




Psychopharmacol
ogy:
Anti-anxiety :
benzdiazepines,
or Atarax,
Catapres, Zoloft
Antidepressants:
MAOI’s or lithium
carbonate


Counseling
individualized:
individual therapy,
group, and
systematic
desensitization
Hypnosis, imagery
relaxation exercises,
biofeedback




Librium, valium, Serax, Tranxene, Ativan,
Xanax
tranquilizing, sedation, numb emotions
Adverse effects: ataxia, slurred speech,
rebound phenomenon, seizures
Lethal with alcohol
Overdose potential


Antianxiety (anxiolytics): treat daytime
anxiety
Hypnotics: treat insomnia





Maintain a calm milieu
Maintain open communication
Observe for signs of suicidal thoughts
Document any changes in behavior
Encourage activities




Disorders in which people experience
extreme changes in mood (emotions) and
affect (outward expression of mood).
Affects all ages, ethnic groups, and
socioeconomic groups
Twice as many woman as men
Sadness becomes depression when it lasts 2
years or more.












Symptoms:
Sad mood
Loss of pleasure in usually pleasurable things
No hallucinations or delusions and four of the following
for at least two consecutive weeks:
weight loss or gain
sleep pattern disturbance
increased fatigue
increased agitation
increase or decrease in normal activity
feelings of guilt or worthlessness
decreased ability to think, remember or concentrate
suicidal thoughts







Assess for suicidal ideations
Provide safety
Assist with ADL’s
Do not push decision making
Monitor sleep and nutrition
Focus on strengths
Respond to anger therapeutically




2 Million Americans
Condition in which both extreme mania
(extreme elation or agitation) and extreme
depression exist
Tend to cycle
Change from depression to manic phase
drastic and obvious





Persistent sad, anxious
or empty mood
Feelings of hopelessness
or pessimism
Feelings of guilt,
worthlessness, or
hopelessness
Loss of interest or
pleasure in ordinary
activities, including sex
Decreased energy, a
feeling of fatigue or
being slowed down






Difficulty concentrating,
remembering, making
decisions
Restlessness or
irritability
Sleep disturbances
Loss of appetite and
weight loss or weight
gain
Chronic pain or other
persistent bodily
symptoms that are not
caused by physical
disease
Thoughts of death or
suicide, suicide attempts





Excessive highs
Sustained period of
different than normal
behavior
Increased energy,
activity, restlessness,
racing thoughts, and
rapid talking.
Decreased need for
sleep
Unrealistic beliefs in
one’s abilities and
powers






Extreme irritability and
distractibility
Uncharacteristically poor
judgment
Increased sexual drive
Abuse of drugs
Obnoxious, provocative,
or intrusive behavior
Denial that anything is
wrong







Remove hazards
Assess client for
fatigue
Provide rest periods
Monitor sleep
patterns
Private room
Encourage client to
express feelings
Use calm, slow
interactions







Help client focus
Ignore or distract
from grandiose
thinking
Present reality to
client
Do not argue with
client
Reduce stimuli
Supervise clothing
Avoid competitive
games














President - Abraham LINCOLN
Musician - Adam ANT
Actor - Ben STILLER
Actor - Burgess MEREDITH
Astronaut - Buzz ALDRIN
Author - Charles DICKENS
Nurse - Florence NIGHTINGALE
Director - Francis Ford COPPOLA
Boxer - Frank BRUNO
Scientist - Isaac NEWTON
Actor - Jean Claude VAN DAMME
Musician - Jimi HENDRIX
Actor - Linda HAMILTON
Composer - Ludwig Van
BEETHOVEN
















Prime Minister - Winston
CHURCHILL
Music Producer - Phil SPECTOR
Director - Tim BURTON
Actor - Richard DREYFUSS
Musician - Ray DAVIES
Model - Sophie ANDERTON
Musician – STING
Musician - Kurt COBAIN
Actor - Ned BEATTY
Musician - Ozzy OSBOURNE
Actor - Jim CAREY
Actor - Robert DOWNEY JR
Actor - Robin WILLIAMS
Actor - Spike MILLIGAN
Actor - Stephen FRY
Artist - Vincent VAN GOGH



Similar to mania but not as severe
Hard to describe
Need to assess extreme of mood changes,
length of time in each mood, frequency of
cycling, and other symptoms.







Generally over 45 years
Women more than men
“Empty nest syndrome”
Symptoms more somatic
Anorexia and sleep disturbances commen
Hypochondriasis
No cure or relief of depression





Lithium- monitor levels
Valproate, Zyprexa, Tegretaol (acute manic
symptoms)
Antidepressants
Psychotherapy
Electroconvulsive therapy (ECT)




Patience,
patience,
patience!!!!
Monitor lithium
level
Honesty
Consistency




Activity
Nutrition
Communication
Monitor for
suicidal ideation
and implement
suicide
precautions






A maladaptive behavior that results from
ineffective personality development. Affects
the way one interprets and fits in the world
we live in.
Stress exacerbates manifestations
May deteriorate to psychotic state
Seldom seen for treatment
Originate in early childhood
Due to overuse of defense mechanisms








Poor impulse control
Feelings of abandonment and depression
Rage, guilt, fear and emptiness
Impaired judgment
Projects own feelings on to others
Rigid and inflexible
Distorted self-perception; self-hate or selfidealization
Concrete or diffuse thinking

Cluster A (odd-eccentric)
Schizoid
Schizotypal
Paranoid

Cluster B (overemotional, erratic types)
Histrionic
Narcissistic
Borderline
Antisocial

Cluster C (anxious, fearful types)
Obsessive-compulsive
Avoidant
Dependent







Don’t want involvement in interpersonal or
social relationships
Due to ineffective and unemotional
parenting
Described as“loners”
Very engrossed in books
Intellectual and successful in careers
Appear shy and introverted
Respond in very serious, factual manner
that is pleasant but not warm or inviting






Displays abnormal, highly unusual thoughts,
perceptions, speech and behavior
Suspicious
Paranoid
Magical thinking
Odd thinking and speech
Relationship deficits









Suspiciousness and mistrust
May seem “normal”, but feel treated unfairly
Prone to filing lawsuits
Difficulty maintaining eye contact
Take themselves very seriously
Cold and calculating in relationships
Take comments and events very seriously
Don’t confuse with Paranoid Schizophrenia: no
hallucinations or delusions
Familial




Pervasive and excessive emotionality and
attention seeking behavior
Behavior often inappropriate
Overly concerned with impressing people
Excessively upset with criticism

Histrionic





Almost opposite of schizoid
Exaggerated impression of themselves
self-centered and self-important
Friends chosen according to how good they
make narcissist feel
Seem to take criticism lightly; actually
repressing deep feelings of anger and
resentment

PAMan

http://wps.prenhall.com/chet_kneisl_contem
porary_1/0,7601,680172-,00.utf8.htm











Causes the greatest amount of trouble for society
Requires immediate self-gratification
Often in trouble with the law
Difficulty handling frustration and anger
Seldom feel affection, loyalty, remorse, or guilt
High risk for substance abuse
Family with few or inconsistent rules, no guidelines for
appropriate social behavior
Inability to feel or show affection
Usually gregarious, intelligent and likable
Very serious maladaptive behavior: serial killers
Manipulative in treatment








Common, more frequent in females
Behavioral responses are unpredictable
Moods unstable, uncertain of sexual preference or
self-concept
Substance abuse, suicidal tendencies
Anhedonia
Feel bored and empty
Etiology may be ineffective nurturing by parents
Conflicts between love/hate,
abandonment/domination,
dependency/detachment

Borderline






Difficulty expressing warm and tender
emotions
Perfectionist, stubborn and controlling
Inflexible with details and rules
Miserly
Hoarders
Ritualistic





Characterized by social withdrawal
Sensitive to potential rejection
Feelings of inadequacy
Hypersensitive to reactions of others
Lack of support system






DSM: A pervasive pattern of dependent and
submissive behavior.”
Want others to make decisions for them
Feel inferior, suggestible, feelings of selfdoubt
Avoid responsibility
Try to satisfy and please others
Inordinate amount of fear

Wizard of Oz






Often don’t perceive they have a problem,
rarely hospitalized
Often leave treatment when confronted with
problem
Psychotherapy, individual and group, or
cognitive
Therapy long; stop and start
Most will not improve
Medications; Prozac









Maintain safety
Allow client to make choices
Encourage to discuss feelings not act out
Discuss expectations
Assist with anger management
Trust
Limit setting
Communication
Role modeling





Group of disorders characterized by psychotic
Disturbances in affect, mood, behavior and
thought
Begins about 16-25 years of age
3 Million Americans
Thought disorder





Quietness
Withdrawal
Grades drop
Change in personality
Change in relationships





Chronic, intermittent, acute psychotic
episodes,progressive downhill course
Relapse rate as high as 60% in first 2 years
12 year follow-up: 78% deterioration in
functioning, 3% attempt suicide
Not curable
High incidence in Homeless







At least two of the following present for a
significant portion of time during a one
month period:
Delusions
Hallucinations
Disorganized speech
Grossly disorganized or catatonic
behavior
Negative symptoms
Social/Occupational dysfunction
Positive
Symptoms






Hallucinations
Delusions
Loose Associations
Combativeness
Hostility
Paranoia
Negative
Symptoms






Social & emotional
withdrawal
Apathy
Flat affect
Poor
insight/judgment
Amotivation
Mutism or
catatonia

Circumstaniality

Neologisms

Confabulation

Thought blocking

Flight of ideas

Word Salad

Looseness of
association
Delusions
 A false fixed belief


Types; Grandeur,
jealousy and
persecution
Hallucinations
 A sense perception
with no external
stimuli
 Types: auditory,
gustatory,
olfactory, tactile,
and visual







Clang association
Echolalia
Mutism
Neologism
Pressured speech
Verbigeration
Word salad





Unusual suspiciousness (main symptom) and
fear
Hostile and aggressive behavior
Also, catatonia, incongruent affect, and loose
associations in speech
Delusions of persecution and grandeur
Voices common






Unusual behavior and facial contortions
Speech bizarre and incoherent
“word salad”
Inappropriate emotions
Disorganized auditory hallucinations
Most severe, poor prognosis




Less frequent
Disturbed motor activity, vacillate between
extreme rigidity and agitation
Rigid (catatonic stupor) not move for hours
or days
Very suggestible
Echolalia
Echoprexia

http://www.youtube.com/watch?v=kvdw4b7t
C-8&feature=related






Establish nurse-patient relationship
Stress situational reality
Accept the patient as he or she is
Do not foster a dependency
relationship
Avoid stressful situations
Use only therapeutic communication
Hay Lo Soul,
Good To Too Two 2 here from you. I thought things got so good for you
that you just 4 GOT WHAT you could of remembered or could remember
what you don't forgit. Where is your mind—must you watch TV all day to
go to night school to be a D.A. JUST to forgit I didn't take your money
when I had ALL your credit cards locked up in [continued on second page]
my dreams—Rife with Con Va Lution due 2 subjewgashen. My spelling got
better—see when you go to school you learn to spell—oh well I'm just
playing clown words to say I didn't forgit Hellbilly—Bill we always had good
days + I'm glad your gonna be a D.A. Be one who works for justice + not
one who wants to win win + and don't care if people didn't do rong—
anyway be as good as you are when you git a job + don't let the job make
you bad you make the JOB good.
Easy Charles Manson
Letter Marginalia:
You even typing now—Cool. A HILLBILLY that can type—FAR OUT.
I know if you payed what you owe you would be brok brok in like broak
ones a panter brock + that they is a crook



Physical symptoms with no known organic
cause
Rooted in unconscious mechanisms that
develop to deny, repress, and displace
anxiety
Dependent, emotionally needy, and
frustrated, want to punish relatives





Conversion disorder
Hypochondriasis
Dysmorphophobia
Somatization disorder
Somatoform pain disorder





Due to overuse of conversion
reaction
Paralysis and blindness
Very real to the patient
Symptom allows person to avoid
unacceptable situation or extreme
anxiety; dysfunction is relieving the
anxiety (primary gain), (secondary
gain) extra benefits from staying ill.
Malingering: conscious effort to
avoid unpleasant situations, faking




“Professional patients”
Worried about getting “it”
Intense fear of becoming seriously ill
Concerned they are not being taken seriously




Onset generally on teens through 30’s
Excessive preoccupation with an imagined
defect in one’s physical appearance
Usually facial
Obsessive/compulsive behaviors




Onset about age 30
DSM: 35 symptoms
Must have 13 of the 35 symptoms
Frequent symptoms: free-floating anxiety,
emotional turmoil expressed in physical
symptoms, usually in loss of physical
function, pain that changes location
frequently, depression, suicidal ideation.





Any age, mostly in adolescence and early
adulthood
women more than men
Possible hormonal interaction with
neurochemicals
Level of pain not consistent with physical
problem, does not change location
Psychalgia: emotional pain that manifests
as physical pain







Assess for physical problems
Discourage discussion about physical symptoms by
not responding with positive reinforcement
Allow specific time period for client to discuss
physical complaints
Help client to relate feelings and conflicts with
physical symptoms
Assure client physical causes have been ruled out
Relaxation techniques
Diversional activities





Often medical unit not psychiatric unit
Individualized
Stress management
Behavior modification
Medications used sparingly

Communication skills: honesty and gaining
trust

Therapy

Support









Transsexualism
Exhibitionism
Fetishism
Pedophilia
Sexual masochism
Sexual sadism
Voyeurism
Zoophilia
Frotteurism

Anorexia Nervosa

Bulimia Nervosa

Morbid Obesity



“aversion to food”
Usually in
adolescent girls
Negative feelings
towards their
mothers
Symptoms:
Excessive weight loss
Refusal to maintain normal
weight
Intense fear of gaining
weight
Obsessive thoughts
Excessive exercise
Shy, introvert
Perfectionist
Distorted body image
Amenorrhea
Insomnia




“binge eating”
Followed by forced vomiting
Adolescence
Binge-Purge





Extreme dieting
Use and abuse of
laxatives
Diuretics
Obsession with
food and eating
Extreme
sensitivity to
body shape and
weight





Poor self-concept
Suicidal ideation
Impulsiveness
Depression, guilt,
worthlessness
Erosion of teeth
enamel



Obesity: body weight greater than 15% of
ideal body weight
Morbid obesity: More than 100 pounds over
ideal weight
Fixated at oral stage




Electrolyte imbalances
Cardiac irregularities
Edema and dehydration
Gastrointestinal problems
Act of killing oneself purposely.





39% of people over 65 attempt suicide
Third leading cause of death in adolescents
250,000 suicide attempts annually, 30,00
succeed
Depression major cause
Men more violent; guns, hangings, cars,
women; overdose




Noticeable improvement in mood
Giving away personal items
Talking about death or has preoccupation
Difficulty sleeping






Not a mental illness
Many homeless have threat to mental health
Mentally ill 50% of homeless
25-50% have a psychosis
33-50% are alcoholics
Schizophrenia major problem





Very rare
Ideas split off from personality and become
buried in unconscious
Severe result of overuse of DM
Anxiety or severe psychological trauma
Develop new personality to separate from
their severe emotional pain



Psychogenic amnesia: sudden inability to
remember personal information due to
physical or psychological trauma
Psychogenic Fugue: more dramatic, leave
town, new identity. Does not appear
confused or disoriented.
Depersonalization Disorder: Usually under
40. Oriented to person, place and time, but
perception of reality has changed. “Floating”
or “Out of body”


2 or more completely distinct personalities
Can be different






Monitor frequently
Safety
Medications
Communication
Contract
Crisis Intervention