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Chapter 13
Care of the Psychiatric Patient
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Psychiatric Care Settings
• Outpatient mental health clinics
• Long-term psychiatric care facilities
• Acute psychiatric care facilities
• Psychiatric rehabilitation facilities
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Nursing Assistant’s Duties in a Psychiatric
Care Setting
• Psycho-educational groups—Responsible for
making sure patients attend group meetings and
supervision during the meetings.
• ADL groups—Plays an important role in planning
and leading these groups.
• Social skill–building groups—Responsible for
helping patients to practice the skills they have
learned.
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Nursing Assistant’s Duties in a Psychiatric
Care Setting (cont)
• Recreational groups—Gives patients the
opportunity to engage in enjoyable activities and
socialize with others.
• Day trips—Responsible for helping to plan
activities, encouraging patients to attend, and
participating in the activities.
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Therapeutic Environment
• Promotes interaction between patients and staff
members
• Encourages participation in group activities
• Conveys a positive, accepting attitude
• Protects the patient from physical and emotional harm
• Protects the patient’s dignity and self-esteem
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Therapeutic Environment
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Therapeutic Communication
• Communication between a health care worker and a
patient that is directed at helping the patient express
concerns and resolve problems
• Listening is very important
• Clear, honest communication is essential for maintaining
a therapeutic environment
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Common Therapeutic Communication
Techniques
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Workplace Safety
• Follow the facility’s or unit’s policies
• Develop trusting relationships with the people you care
for
• Some conditions require:
– Restraints
– Seclusion
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Psychiatric Treatment
• Medication
• Psychotherapy
• Electroconvulsive therapy
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Four Main Categories of Medications
• Antidepressants
• Anxiolytics
• Mood stabilizers
• Antipsychotics
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Antidepressants
• Used to treat clinical depression
• Fall into several main categories:
– Tricyclic antidepressants
– Selective serotonin reuptake inhibitors (SSRIs)
– Monoamine oxidase inhibitors (MAOIs)
– Other antidepressants work by affecting
norepinephrine and epinephrine levels
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Anxiolytics
• Used to treat anxiety disorders (such as obsessivecompulsive disorder, panic attacks, phobias, and PTSD)
• Commonly used anxiolytic medications
– Benzodiazepines
– Buspirone
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Mood Stabilizers
• Used in the treatment of bipolar disorder (manic
depression)
• Lithium is a commonly used mood stabilizer
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Antipsychotics
• Used to treat psychotic disorders (such as schizophrenia)
• Can also be used to treat the manic phase of bipolar
disorder
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Observations That Should Be Reported
• Extrapyramidal side effects
– Dystonia
– Akathisia
– Drug-induced parkinsonism
– Tardive dyskinesia
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Psychotherapy
• “Talk therapy”
• A licensed therapist helps the patient explore feelings,
attitudes, thinking, and behavior
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Electroconvulsive Therapy (ECT)
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Common Psychiatric Disorders
• Anxiety disorders
• Clinical depression
• Psychotic depression
• Bipolar disorder (manic depression)
• Schizophrenia
• Personality disorder
• Substance abuse disorders
• Eating disorders
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JIGSAW ACTIVITY
• STUDENTS WILL BE ASSIGNED TO A GROUP USING NUMBERS
IN RANDOM ORDER. EACH GROUP WILL BE GIVEN A “PUZZLE
PIECE” AND A MENTAL HEALTH DISORDER THAT IS IN THE
TEXT. DURING THE TIME GIVEN EACH GROUP WILL GATHER
INFORMATION ABOUT THE DISORDER EITHER FROM THE
TEXT, PERSONAL EXPERIENCE, MOVIES, OR OTHER SOURCES
AND WRITE THE INFORMATION ON THE PUZZLE PIECE.
• AT THE END OF THIS TIME, GROUPS WILL EXCHANGE
INFORMATION WITH THE PUZZLE PIECE THAT MATCHES WITH
THEIR GROUP AND WRITE ANY NEW INFORMATION ON THE
PUZZLE PIECE.UNTIL ALL GROUPS HAVE MATCHED THE
PIECES TOGETHER TO FORM A “PICTURE” (COMPLETED
PUZZLE) OF THE PSYCHIATRIC DISORDERS PAITENTS SUFFER.
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Anxiety Disorders
• Most common form of mental illness
• Common anxiety disorders:
– Panic disorder
– Obsessive-compulsive disorder
– Phobia
– Post-traumatic stress disorder (PTSD)
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Clinical Depression
• Characterized by intense feelings of sadness and
hopelessness
• Psychotic depression is severe clinical depression
• A person may have suicidal ideation
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Bipolar Disorder (Manic Depression)
• Causes a person to have mood swings
• Manic phase of the disorder may cause reckless or
impulsive behavior
• Lithium is most commonly used to balance a person’s
moods
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Lithium Toxicity
Observations to report to the nurse immediately:
• The person has diarrhea or vomiting
• The person is having trouble moving in a coordinated
way
• The person complains of ringing in the ears
• The person has urinary frequency
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Schizophrenia
• Very disabling form of mental illness
• A person with schizophrenia:
– May have trouble distinguishing real from imaginary
– May have hallucinations and delusions
– May hear voices
– May have disordered thinking and speech
– May become unresponsive to others
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Behavioral Effects of Schizophrenia
• Affect: a person’s facial expression
– Flat affect
– Inappropriate affect
• Polydipsia
• Paranoia
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Personality Disorders
• Divided into three main categories
– Cluster A: defined by odd or eccentric behavior
– Cluster B: defined by dramatic, unpredictable, and
emotional behavior
– Cluster C: defined by fearful or shy behavior
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Common Traits of Personality Disorders
• They engage in socially unacceptable behaviors.
• They tend to be very self-centered.
• They tend to manipulate or exploit others.
• They do not handle stress well.
• They tend to blame others for their problems.
• They often lack insight (in other words, they do not
recognize that they have a problem).
• People with personality disorders are at increased risk for
developing other psychiatric disorders, such as eating
disorders, substance abuse disorders, anxiety disorders,
and depression.
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Substance Abuse Disorders
• Involve excessive or inappropriate use of drugs (legal or
illegal)
• Can go through withdrawal when receiving treatment for
substance abuse
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Eating Disorders
• Anorexia nervosa
• Bulimia nervosa
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Question
Who is involved in therapeutic communication?
A. Doctor and licensed nurse
B. Health care worker and patient
C. Licensed nurse and nursing assistant
D. Doctor and patient
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Answer
B. Health care worker and patient
Therapeutic communication is directed at helping the
patient express concerns and resolve problems.
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Question
Tell whether the following statement is true or false.
Suddenly stopping therapy with benzodiazepines can be
fatal.
A. True
B. False
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Answer
A. True
Abruptly stopping benzodiazepines can cause death. It is
important for the patient to take her medication as
ordered.
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Question
How many different types of personality disorders are
there?
A. 2
B. 10
C. 3
D. 20
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Answer
C. 3
• Cluster A personality disorders are those defined by odd
or eccentric behavior.
• Cluster B personality disorders are those defined by
dramatic, unpredictable, and emotional behavior.
• Cluster C personality disorders are those defined by
fearful or shy behavior.
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