▪ Exponent of the unconscious portion of the mind and

MENTAL HEALTH – PSYCHIATRIC Psychosocial development of man

❖ 20th Century
NURSING PRACTICE ✓ Dr. Adolf Meyer
▪ Psychobiologic Theory
HISTORICAL BACKGROUND ✓ Clifford Beers
▪ A former mentally ill person
❖ Prehistoric Times
▪ Wrote “A mind that found itself “revealed how the
✓ Tribal Rites
mental institution treat the patients.
❖ Early Greek and Roman Era
▪ Mental hygiene advocator
✓ Temples
✓ Dr. Harry Stack Sullivan (1892-1949)
❖ Middle Ages
▪ Interpersonal theory
✓ Believed that patients are possessed by evil spirits. They
❖ The first world-wide Mental Health Year was inaugurated in
bring the patients to the priests.
1960 with the following objectives:
❖ 16th Century
1. Consideration of the needs of children and family in a
✓ Jails, Dungeons, Lunatic Asylums
changing world;
✓ King Henry VIII – called the “Mad King”. Have 6 wives and
2. The teaching of the mental health;
killed his 2 wives.
3. The teaching of principles of mental health;
❖ 17 Century
th
4. Mental Health and the sociological aspects of industrial
✓ Anatomy of Melancholy by Robert Burton
change;
❖ 18th Century
5. The psychological problems of migration
✓ Philippe Pinel
❖ Dr. Franz Kallman
▪ Father of modern clinical psychiatry
✓ Study of identical twins
▪ Liberator of the insane → freed the patients
✓ Schizophrenia – 86% of the cases
▪ A committed pioneer and advocate of humanitarian
✓ Bipolar Disorder – 96% of all cases
methods in the treatment of the mentally ill.
❖ Eugene Bleuler
✓ Esquirol – student of Pinel, also an advocate of
✓ 1857 – 1939
humanitarian treatment.
✓ Swiss Psychiatrist
✓ Benjamin Franklin
✓ Named Schizophrenia in 1911
▪ Founded Pennsylvania Hospital together with Dr.
❖ Dr. Manfred Sakel
Thomas Bond. “To care for the sick-poor and insane
✓ 1900 – 1957
who were wandering the streets of Philadelphia”
✓ Developed insulin shock therapy
✓ Benjamin Rush
❖ Ladilas J. Meduna
▪ Father of American Psychiatry
✓ 1896 – 1964
▪ “Mental illness is a disease of the mind and not a
✓ Pentylenetetrazol (Metrazol) – convulsion producing drug
possession of demons”
❖ Cerletti and Binni
✓ Dr. Edward S. Cowles
✓ 1938 – Electroconvulsive Therapy (ETC)
▪ Superintendent of Mclean Hospital in Massachusetts.
❖ Other Significant Persons in Psychiatric Nursing
▪ Advocate of Hospital Functions that encompassed
✓ St. Dymphna
patient treatment, research, and teaching
▪ Patron Saint of the insane (Nervous Disorder)
❖ 19th Century
▪ Victim of her insane father
✓ The 1st authentic textbook on psychiatric disorders was
✓ Rank
published in 1845
▪ Author of Birth Trauma and Separation Anxiety
✓ Establishment of Eastern Psychiatric Hospital
Theory
✓ Dorothea Lyndie Dix
✓ Simon and Binet
▪ Social Reformer
▪ Founder of IQ testing
▪ Campaigned to build hospitals
✓ Alfred Adler
✓ Jean Martin Charcot (1825-1893)
▪ Will Power Theory
▪ Morbid or pathogenic idea
▪ Striving for superiority is only compensatory for
▪ Hysterical manifestations
feelings of inferiority
✓ Emil Kraepelin
✓ John Watson
▪ Classification of mental disorder
▪ Father of Behaviorism
▪ Dementia praecox – aka schizophrenia
✓ Victor Frankl
✓ Sigmund Freud
▪ Wrote “Man’s search for meaning”
▪ Psychoanalytic Theory
▪ Spiritual theory
▪ Father of Psychoanalysis

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Marybeth G. Marcial RN, PhD
 ✓ Carl Rogers ❖ 1917
▪ Person-centered therapy ✓ All patients paid for by the government were transferred to
✓ Carl Jung San Lazaro Hospital
▪ Collective unconscious: Extrovert, Introvert, Ambivert ❖ 1918
✓ Asclepiades ✓ The City of Manila erected its own hospital, the City
▪ Father of Psychiatry Sanitorium for manila residents
▪ Pioneer physician of psychotherapy, physical therapy, ❖ 1925
and molecular medicine ✓ 64-hectare site was acquired at Barrio San Felipe Neri,
✓ Sisa Mandaluyong, Rizal.
▪ Considered the epitome of a Filipino Woman’s ✓ Only 46.5 hectare remain because of bless housing
suffering, a statue was created in her honor at the ❖ December 17, 1928
entrance of the NCMH compound ✓ Insular Psychopathic Hospital
✓ Hans Berger ✓ Later renamed the National Psychopathic Hospital, with a
▪ Electroencephalography (EEG) capacity of 400 beds, was formerly opened for service for
✓ Egas Moniz the care and treatment of the mentally ill.
▪ Lobotomy of psychosurgery ❖ 1935
▪ Developer of cerebral angiography ✓ The City Sanatorium was closed and all its patients
✓ Franz Anton Mesmer transferred to the National Psychopathic Hospital. The war
▪ Hypnotism; Mesmerism stopped the expansion program in 1941.
✓ Dorothy H. Smith ❖ At the start of the World War II in January 1942, there were
▪ Remotivation Technique (she used rhythm and poetry 3,156 patients
to engage clients who are mute) ✓ 2,062 – admitted during war
✓ M. Jones ✓ 5,228 – total
▪ Therapeutic Community/Therapeutic Milieu ✓ 307 – patients remained in 1945
✓ Joseph Pratt ✓ 2,191 – discharged
▪ Group Psychotherapy ✓ 2,642 - died
✓ Joseph Wolpe ❖ Some portions of the hospital were used as emergency wards for
▪ Desensitization (behavior therapy for phobia patients) sick and dying Filipino soldiers released by the Japanese from
✓ Fritz Pearls concentration camps during the period of Japanese occupation
▪ Gestalt Therapy (from technique-oriented therapy) of the Philippines.
✓ Ivan Pavlov ❖ After World War II, admission increased at a rapid rate.
▪ Classical conditioning ✓ Patient’s population reached 2,030 in 1950
✓ Linda Richards ✓ 5,896 in 1960
▪ The first American Psychiatric Nurse was a graduate ✓ 7,435 in 1970
of the New England Hospital for Women. ✓ 8,700 in 1975
▪ Directed at Psychiatric Nursing at the Mclean ❖ National Psychopathic Hospital was renamed the National
Psychiatric Asylum in Waverly, Massachusetts, in Mental Hospital and later the National Center for Mental Health.
1890.
✓ Harriet Bailey
OBJECTIVES OF THE NATIONAL CENTER FOR MENTAL
▪ Author of the first psychiatric nursing textbook,
HEALTH
“Nursing Mental Diseases” (1920)
✓ Skinner – Operant Conditioning 1. Care, treatment, and rehabilitation of the mentally ill
✓ Bettelheim – “Infantile autism is due to parental rejection” 2. Prevention of mental disorders, and promotion of mental health
✓ Asherman – Family Therapy consciousness
3. Training and education of medical and paramedical personnel,
HISTORY OF THE NATIONAL CENTER FOR MENTAL including student affiliates.
4. Researches in Psychiatry, neurology, neuropathology, and
HEALTH (NCMH)
related discipline.
❖ 19th Century
✓ A sailor of the Spanish Navy became mentally ill METHODS OF TREATMENT IN THE NCMH
✓ Most patients are Spanish Sailors
✓ Treatment was in Hospicio de San Jose, in Manila. ➢ Somatic Therapy – Primarily ECT
✓ Medical Doctors and nuns ➢ Chemotherapy – Primarily tranquilizers and anti-depressant
❖ 1904 drugs
✓ “Insane Department” was opened in San Lazaro Hospital ➢ Ergotherapy – Use of occupational and recreational therapy
✓ Dr. Elias Domingo – 1st trained doctor in psychiatry
NCM 117: Care of Clients with Maladaptive Patterns of Behavior
Marybeth G. Marcial RN, PhD
➢ Logotherapy – Use of religion. The patients are encouraged to 4. Community based care – prevent mental health problems and
attend church services and group sessions with the chaplain. treat existing disorders
➢ Psychotherapy – Individual and group psychotherapy are utilized 5. Develop a continuum of care that coordinated the activities of
diverse treatment sources and facilities
HISTORICAL DEVELOPMENT OF PSYCHIATRY IN THE
PHILIPPINES DYNAMICS OF BEHAVIOUR
➢ Belief in native healers performing healing process that can be
spiritual, magical and interpersonal
PATTERNS & SYMPTOMS
(CLINICAL MANIFESTATIONS OF PSYCHIATRIC
➢ Pre-Spanish Regime
DISORDERS)
• Believed in a world that is squally material and spiritual
• Healers are called babaylan (shaman) and sorcerer healing
• If they disobeyed the spiritual world, they would be punished DISTURBANCES OF THINKING
in the material world • Normal Thought
➢ Spanish Rule - Thought or the cognitive, includes processes of judgment,
• Mental Illness caused by an act of sorcery comprehension, memory and reasoning. Normal rational
thinking consists of a goal-directed flow of ideas &
• Belief in mangkukulam and manggagaway
associations initiated by a problem or task and leading to a
• Treatment is done by herbolarios reality-oriented conclusion.
• Used bamboo sticks and herbs
• Hysteric patients are thrown in the river • Disturbances of Thought or Association
➢ Japanese Time - The flow of thought may become seemingly haphazard,
• National Psychopathic Hospital purposeless, Illogical, confused, incorrect, abrupt, and
bizarre. This phenomenon is most conspicuous in
• Electroshock Therapy
schizophrenia. In fact, Bleuler regarded disturbances in
association as one of the fundamental symptoms of the
LIBERATION PERIOD AND ERA OF THE REPUBLIC diseases.

• National Psychopathic Hospital renamed to National Mental

DISTURBANCES IN FORM OF THINKING
Hospital
• 1946 – V. Luna General Hospital established psychiatric service Under this category are included all deviations from rational, logical,
goal-directed thinking
• ECT mode of treatment
• Hypnosis and group therapy were treatment modalities • Dereism
• 1947 – UST opened Neuropsychiatry Section - Dereistic thinking, emphasizes the disconnections that have
• 1949 – Philippine Mental Health Association was founded taken place between the patient's mental processes and his
• 1956 – University of the East Ramon Magsaysay Memorial ongoing actual experiences. The mental processes do not
follow reality, logic or experience.
Medical Center established psychiatry department
• 1958 – Philippine General Hospital opened it’s own • Autism
neuropsychiatry section - Can occur as a character trait, referring to individuals who
• 1973 – first textbook – An outline of Psychiatric Nursing by are bashful, shy, retiring, shut in, inaccessible, or introverted.
Jesusa Bagan Lara
• Nenita Yasay Davadilla – 1st psychiatric nurse sent abroad to DISTURBANCES IN STREAM OF THOUGHT
obtain masters degree
Certain abnormalities may be observed in the manner and rate of
• Magda Carolina Go Vera Llamanzares – 1st Child Psychiatric associative processes
Nurse
• UP College of Nursing – 1968 – 1st graduate program • Neologism
• Sotera Capella – 1st Chief Nurse - Refers to the coinage of new words that have symbolic
• The National Center for Mental Health meaning, or the conferring of new meanings upon words
that are commonly.
• 4,200 bed capacity
• Word Salad
SYSTEMATIC CHANGES IN MENTAL HEALTH CARE - A disconnected flow of communication made up of a mixture
of words, phrases and sentences which sound meaningless
1. Away from symptom stabilization toward recovery and and as if the product of dissociations and the pressure of
reintegration invading thoughts.
2. Away from view that professionals have all the answers, moving
toward more involvement of consumers and family members • Intellectualization
3. Away from medication management toward holistic thinking - a state of anxious pondering about abstract, theoretical or
philosophical issues. It is a flight into intellectual concepts
NCM 117: Care of Clients with Maladaptive Patterns of Behavior
Marybeth G. Marcial RN, PhD
 and words that are emotionally neutral in order to avoid deficiency Aphasia results in an inability to pronounce words
objectionable feelings or impulses. and names and to indicate the use of common objects

• Circumstantiality • Motor Aphasia

- is a disorder of association in which too many associated - Disturbance of speech due to organic brain disorder in which
ideas come into consciousness because of too little selective understanding remains but ability to speak is lost.
suppression. The inclusion in conversation by a highly
anxious individual of many unnecessary details, scattered • Sensory Aphasia
thoughts and explanations. The pressure of invading thought - Loss of ability to comprehend the meaning of words or use
and feelings tends to organize the communications and of objects.
delays the reaching of the goal point of the conversation.
• Nominal
• Stereotype - Difficulty in finding right name for an object
- Is the constant repetition of any speech or action.
• Syntactical Aphasia
• Verbigeration - Inability to arrange words in proper sequence
- the continuous reiteration of a specific phrase. It may also
occur in the form of writing a given word or phrase over and • Semantic Aphasia
over again, and it is most often seen in schizophrenia. - Is the ability to recognize the full significance of words. It is
related to a loss in the capacity for abstract thinking.
• Perseveration
- psychopathological repetition of the same word or idea in • Jargon Aphasia
response to different questions. - Speech is reduced to a limited group of unintelligible
- *When a patient gives an answer that is in harmony with and neologisms, which the subject uses in a stereotyped fashion.
appropriate to the questions, his answer is said to be
relevant. If it is out of harmony, it is said to be irrelevant.
DISTURBANCES IN CONTENT OF THOUGHT
• Incoherence • Fantasy
- is the result of disorderly thinking; thoughts do not follow in - Is a mental representation of a scene or occurrence that is
logical sequence. Under such circumstances the patient’s recognized as unreal but is either expected or hoped for
verbalizations cannot be understood by the listener. A milder
manifestation of incoherence is known as scattering. ➢ Creative Fantasy - Which prepares for some later action

• Volubility or logorrhea ➢ Day-dreaming Fantasy - Which is the refuge for wishes that
- is copious speech that may occur more or less within limits cannot be fulfilled
of normal and that coherent and logical.
• Pseudologica Fantastica
• Pressure of speech - False logic of a fantastic nature that is motivated by a low
- is voluble speech that is difficult for the listener to interrupt. self- esteem and weak superego impersonation of
celebrities, pathological lying and the writing of false
• Flight of ideas signatures are abnormal uses of the mechanism of
- a continuous stream of conversation with rapid shifts in identification, it differs from normal day–dreaming uses of
topics owing to pressure of thoughts, sometimes the mechanism of identification. It differs from normal day-
characterized as topic jumping. An alert listener can detect dreaming in that the subject believes in the reality of his
connections to the fundamental topic of conversation. Often fantasies intermittently and for long enough intervals of time
the shifts can be traced to stimulation of preceding to act on them.
statements as in the following: “Three ships sailed out of the
harbor of Beirut. We are three brothers. I liked my older • Imposter
brother best. The best man in the service. Not a wedding - Is a type of pathological liar who seeks to gain some
service in the ship’s sail. Three ships. He was stationed in advantage by imposing on others various lies about his
Beirut.” attainments, social position on worldly possessions.

• Clang association • Phobia

- a linkage of similar word sounds, such as seven, heaven, - An exaggerated and invariably pathological dread of some
eleven, to compensate for defects in memory and type of stimulate or situation.
communication which may be psychic or organic origin. ✓ Acrophobia - Dread of high places
✓ Agoraphobia - Dread of open places
• Aphasia ✓ Algophobia - Dread of PAIN
- Is a general term for all disturbances of language and ✓ Astra(po)phobia - Dread of dead bodies
communication due to brain lesions but not as the result ✓ Claustrophobia - Dread of closed or confined places
faulty innervations of the speech muscles, involvement of ✓ Coprophobia - Dread of excreta
the organs of articulation, or general mental or intellectual ✓ Hematophobia - Dread of sight of blood
✓ Hydrophobia - Dread of water
✓ Lalophobia or Glossophobia - Dread of speaking
NCM 117: Care of Clients with Maladaptive Patterns of Behavior
Marybeth G. Marcial RN, PhD
 ✓ Mysophobia - Dread of dirt or contamination II. DISORDERS OF CONSCIOUSNESS
✓ Necrophobia - Dread of dead bodies
✓ Nyctophobia - Dread of darkness, night - Consciousness is a faculty of perception that draws on
✓ Pathophobia or Nosophobia - Dread of disease, suffering information from the outer world directly through the sense
✓ Peccatophobia - Dread of sinning organs and indirectly through stored memory traces.
✓ Phonophobia - Dread of speaking loud
✓ Photophobia - Dread of strong light
✓ Sitophobia - Dread of eating Levels of Consciousness
✓ Taphobia - Dread of being buried alive - Consciousness exists on a continuum, with maximum alertness at
✓ Toxophobia - Dread of being poisoned one extreme and absolute unconsciousness or coma on the other,
✓ Xenophobia - Dread of strangers In between are confusion, clouding of consciousness, delirium
✓ Zoophobia - Dread of animals and stupor.

• Obsession 1. Confusion
- There is disorientation as to time, place and person and a
- Is the pathological presence of a persistent and irresistible
feeling of bewilderment, it is often accompanied by an
thought, feeling or impulse that cannot be eliminated from impairment of consciousness and is encountered both in
consciousness by any logical effort. organic states functional disorders

• Trend or Preoccupation of Thought 2. Clouding of consciousness

- When thought, content centers around a particular idea and - There is a disturbance in perception, attention and thought
is associated with a strong affective tone. and a subsequent amnesia.

• Delusion 3. Delirium
- False belief, not consistent with patient’s intelligence and - Is a psychic state characterized by disorientation in all
cultural background that cannot be corrected by reasoning spheres, confusion clouding of consciousness and
bewilderment in association with anxiety, fear, illusions and
➢ Delusion of grandeur hallucinations. It is a result of an infection, tumor,
- Exaggerated perception of one’s importance hemorrhage or toxic metabolic disorder and is classically
➢ Delusion of persecution associated with acute brain syndromes.
- False belief that one is being prosecuted, often found in
litigious patients. 4. Stupor
- (Litigious - is a pathological tendency to take legal action - Is a state of relative nonresponsiveness to the environment
because of suspected and imagined persecution.)
➢ Delusion of reference 5. Coma
- False belief that the behavior of others refers to oneself - Is the term describing the most profound degree of
derived from ideas of reference in which patient falsely unconsciousness, in which there is no detectable evidence of
feels he is being talked about by others. responsiveness.
➢ Delusional of self-accusation
- False feeling or remorse. • Coma vigil
➢ Delusional of Control - Is a coma in which the eyes remain open. This condition may
- False feeling that one is being controlled by others. occur in a variety of acute organic brain disorders,
➢ Delusion of Infidelity particularly when the diencephalon is affected
- False belief from pathological jealousy that one lover is
unfaithful. • Attention
- (Pathological Jealousy - May occur in marital setting in - Is an aspect of consciousness that is related to the amount of
which a spouse has unconscious extramarital sexual effort exerted in focusing on a certain portion of an
impulses either heterosexual or homosexual) experience so that they become relatively more vivid.
➢ Paranoid delusion
- Oversuspiciousness leading to persecutory delusions. • Distractibility
- An aspect or attention is too easily drawn from a given
content by extraneous or distracting stimuli.
DISTURBANCES IN JUDGEMENT

- Judgment from a psychiatric point of view, Is the mental act of • Selective Inattention
comparing or evaluating alternatives within the framework of a - An aspect of attentiveness that generates anxiety, guilt, and
given set for the purpose of deciding on a course of action. The other unpleasant feelings
comparison may be in terms of magnitude, rightness, goodness,
beauty, or economic worth.
• Blunting of attention
- Is an extreme form of inattention in which responses to
noxious stimuli are reduced

NCM 117: Care of Clients with Maladaptive Patterns of Behavior

Marybeth G. Marcial RN, PhD
• Apperception III. DISTURBANCES OF ORIENTATION
- or Comprehension, implies the correct and clear recognition
- Orientation may be defined as the ability to recognize one’s
of the meaning of the data of perception. When a mental
surroundings and their temporal and spatial relationships to
image is clearly perceived but is falsely interpreted or oneself or to appreciate one’s relations to the social environment.
understood, one speaks of abnormal appreciation. This may - Disorientation for time, place, and person.
occur in psychoneurosis in relation to severe anxiety, in
psychotic states as a result of delusions and in organic brain
disease with sensory aphasia. IV. DISTURBANCES IN MEMORY
• Amnesia
• Suggestibility - Is the partial or total inability to recall past experience.
- Exists when a particular responds compliantly with unusual
readiness • Retrograde amnesia
- There is amnesia for a period prior to the traumatic event.
➢ Negative suggestibility
- In which the patient does the opposite of what is • Hysterical amnesia
suggested, is seen normally in children and in catatonic - Is a loss of memory for a particular period of past life or for
schizophrenia as negativism. Which means the certain situations associated with great fear, rage or
perverse resistance to suggestion or advice. shameful humiliation.

➢ Folie or Deux • Hysterical fugue state

- A psychotic reaction in which two closely related and - A form of amnesia that sets in following a severe emotional
associated individual’s simultaneously show the same trauma.
symptoms and one member seems to have influenced
the other. • Paramnesia
➢ Folie a trios - Is a distortion of recall usually associated with the inclusion
- Also a communicated insanity, this time it affects three of false details or wrong temporal relationships.
members of the family
● Fausse reconnaissance
• Hypnosis - Or False recognition, is the feeling of certainty the one is
- This is an artificially induced disturbance of consciousness recalling accurately something that is patently inaccurate
that may superficially resemble sleep but is physiologically
distinct from it. It is characterized by heightened ● Retrospective falsification
suggestibility. As a result, a variety of sensory motor, and - A type of paramnesia, sometimes called illusions of memory,
memory abnormalities may be induced by the hypnotist false details, meaning, and recollections of real memory are
created in response to emotional needs. A patient may recall
• Sleep a past true event but distort it in accordance with a present
- Is a complex state of altered consciousness consisting of at need to support a symptom.
least four separate stages of varying depth, sensory and
motor activity and responsibility. ● Confabulation
- There is an unconscious filling in of gaps in memory by
● Insomnia imagined experience that the patient believes, although they
- Is a pathological inability to sleep have no basis in fact.

● Hypersomnia • Pseudo Reminiscence

- Is often seen in depressive reactions occurring in - Incorporate both confabulation and retrospective
psychoneurotics. In those instances, sleep is a retreat from falsification
painful encounters with the real world.
• Deja vu
● Reversal of sleep habit - An illusion of recognition in which a new situation is
- Is a common accompaniment of hypersomnia. In these incorrectly regarded as repetition of a previous memory.
instances the patient tends to sleep soundly through the
early morning hours, wakes up gradually in the early • Jamais vu
afternoon and achieves full wakefulness at a time when most - There is a false feeling of unfamiliarity with a real situation
people are going to bed. that one has experienced.

● Drowsiness • Deja entendu

- Is a state of consciousness that intervenes normally between - In which a comment never heard before is incorrectly
sleep and waking and is characterized by a general slowing regarded as a repetition or previous conversation.
up of the thought processes with a tendency to concreteness
in thinking, diminished perception and clumsiness in motor • Deja pense
responses - In which a thought never heard entertained before is
incorrectly regarded as repetition of a previous thought.

NCM 117: Care of Clients with Maladaptive Patterns of Behavior

Marybeth G. Marcial RN, PhD
• Hypermnesia • Shallow or Inadequate affect
- Is an exaggerated degree of retention and recall. It can be - Emotional flatness
elicited at times in a hypnotic trance. It is seen in certain
prodigies, obsessive neurosis, paranoia, and mania. • Inappropriate affect
- When the emotion does not correlate with the stimulus

V . DISTURBANCES IN PERCEPTION • Labile – Changeable

• Macropsia
• Attitude
- Is a condition characteristic of hysteria in which objects
- Refers to the effective state with which a person habitually
appear larger that they really are. They may assume a
confronts his environment
terrifying proportion.

• Micropsia LEVELS OF PLEASURABLE EFFECTS:

- Is a condition in which objects appear smaller. It may
1. Euphoria
alternate with macropsia in hysteria, but it has also been
- Refers to the first, moderate level in the scale of
described as an aura in some cases epilepsy.
pleasurable affects. It is a feeling of emotional and physical
• Hypochondriasis well-being. When it occurs in a manifestly inappropriate
- Is the unshakable belief that physical disease is present, In setting, it is indicative of mental disorder.
the face of all evidence to the contrary.
2. Elation
• Illusions - May be thought of as a second level in the scale of
- There is perceptual misinterpretation of a real external pleasurable affects. It is characterized by a definite affect of
sensory experience. gladness in which there is an air of enjoyment and self-
confidence, and motor activity is increased. This affect
• Hallucinations belongs within the limits of normal life experience. Yet, it
- Is the apparent perception of an external object with no may be indicative of mental disorder when it occurs in a
corresponding rest object exists. manifestly inappropriate setting.

➢ Hypnagogic Hallucination 3. Exaltation

- False memory perception occurring midway between - Extreme elation and is usually associated with delusions of
falling asleep and being awakes. grandeur

➢ Auditory Hallucination 4. Ecstasy

- False auditory perception - Feeling of intense rapture

➢ Visual Hallucination 5. Mood swings

- False visual perception - Refer to the oscillations between periods of euphoria and
feelings of depression and anxiety.
➢ Olfactory Hallucination
- False perception of smell 6. Ambivalence
- Refers to the co-existence of antithetical emotion, attitudes
➢ Gustatory Hallucination and ideas or wishes towards given object or situation at the
- False perception of taste same time.

➢ Tactile Haptic Hallucination 7. Depersonalization

- False perception of touch, such as feeling of worms - A mental phenomenon characterized by a feeling of unreality
under the skin. and strangeness about oneself. The patient says, In effect,
“This experience does not hurt me because I am not me”
➢ Kinesthetic Hallucination
- False perception of movement or sensation, as 8. Derealization
amputated limb (phantom limb). - a mental phenomenon characterized by the loss of the sense
of reality concerning one’s environment/surroundings. The
➢ Lilliputian Hallucination patient says in effect, “This environment is not dangerous to
- The hallucination objects, usually people, appear gently me because this environment does not really exist.”
reduced in size.

VII. DISTURBANCES IN MOTOR ASPECT OF BEHAVIOUR

VI. DISTURBANCES IN AFFECT • Conation
- Or the conative aspect of mental functioning, refers to the
- Affect is the feeling tone, pleasurable or unpleasurable, that capacity to initiate action or motor discharge and concerns
accompanies an idea.

NCM 117: Care of Clients with Maladaptive Patterns of Behavior

Marybeth G. Marcial RN, PhD
 the basic strivings of an individual as expressed through his
behavior • Tension
- Increased motor and psychological activity that is unpleasant
• Echolalia
- Is the pathological repetition by imitation of the speech of • Panic
another person - Acute intense attack of anxiety associated with personality
disorientation.
• Echopraxia
• Free-floating anxiety
- Is the pathological repetition by imitation of the movements - Pervasive fear not attached to any idea
of another person
• Apathy
- Dulled emotional tone associated with detachment or
• Waxy Flexibility (cerea flexibilities)
indifference
- Is the maintenance by the patient of imposed postures with
increased muscle tone, as when a limb remain passively in
the position in which it is placed, however long and • Aggression
uncomfortable - Forceful goal-directed action that may be verbal, physical
and that is motor counterpart of the affect of rage, anger or
hostility
• Agitation
- Is a state of chronic restless motor activity that is a
manifestation of emotional tension • Pathological limb rigidity
- State of unconsciousness in which immobile position is
constantly maintained
• Sleep Walking (somnambulism)
- Is a motor disturbance that occurs primarily during childhood
and tends to occur more often in individuals prone to • Command automatism
hysterical symptom formation, it is also commonly - Automatic following of suggestion
associated with enuresis.
• Automatism
➢ Compulsion - uncontrollable impulse to perform an act - Automatic performance of act representative of unconscious
repetitively. symbolic activity
➢ Dipsomania - the compulsion to drink alcohol excessively
➢ Egomania - the pathological preoccupation with self • Negativism
➢ Kleptomania - compulsive stealing - Frequent opposition to suggestions
➢ Megalomania- preoccupation with delusions of great
power • Mannerism
➢ Monomania - the preoccupation with a single idea - Stereotyped involuntary movements
➢ Nymphomania - excessive sexual desire in female
➢ Satyriasis - excessive sexual desire in male • Hyperactivity (hyperkenesis)
➢ Pyromania - the morbid compulsion to set fire - Restless, aggressive, destructive activity
➢ Trichotillomania - the compulsion pulling out of one’s hair.
• Erothamania
• Tic - Pathological preoccupation with sex
- An intermittent spasmodic twitching of the face or other
part, repeated at frequent intervals and without external • Ritual
stimulus. Tics occur automatically and are not under - Automatic activity compulsive in nature emotional in origin
conscious control.
• Hypoactivity
- Decreased activity or retardation, as in psychomotor
VIII. OTHER BEHAVIOR PATTERNS retardation, slowing or psychological and physical
functioning
• Dreamy state (twilight)
- Disturbed consciousness with hallucination
• Mimicry
- Simple, imitative motion activity of childhood
• Depression
- Psychopathological feeling of sadness
• Tangentiality
- Inability to have a goal-directed association of thought. Goal
• Grief or mourning
is never reached
- Sadness appropriate to real loss
• Condensation
• Anxiety
- Fusion of various concepts into one
- Feeling of apprehension due to unconscious conflict
• Punning
• Fear
- Injecting witty remarks
- Anxiety due to consciously recognized and realistic danger.
NCM 117: Care of Clients with Maladaptive Patterns of Behavior
Marybeth G. Marcial RN, PhD
 • Incest Victims
• Hysterical anesthesia • Runaways
- Loss of sensory modalities resulting from emotional conflicts
REPRESENTATION
• Cosmic identification Young lady holding a book and a sword in
- Expressing the delusion that one has abilities which may be her hand.
likened to the powers of a supreme being
DEATH AND MARTYRDOM
• Lability
✓ DEATH: May 15 (between 620 and 640)
- Sometimes characterized as emotional instability. Patient
15 Years old
manifests quick shifts in his emotional responses, as if gliding
✓ FEAST DAY: May 15
from one into another affect
✓ Church of Gheel in Belgium
✓ Bishop Guy I of Cambrai (Author of her life)
• Insight
- Being able to recognize and accept the fact that one is ill even
though the dynamics of the illness are not understood EARLY LIFE: HAPPY CHILDHOO D
• Paragon of beauty like her mother
• Alien Control • Filled with love for Jesus Christ
- A belief held that one is under the stronger influence of • Bright and eager pupil
another person or force • “JEWEL” of her home
• Under the care of her Christian mother
• La belle indifference • Baptized by Father GEREBRAN secretly
- A relative lack of concern regarding the severity of symptoms
(e.g., person is suddenly blind but show no anxiety over the
LIFE AFTER HER MOTHER ’S DEATH
situation)
• Fourteen years old
• Concrete thinking ✓ Shed tears and bereavement
- The psychotic person has difficulty thinking on the abstract ✓ Found comfort in divine faith
level and may use literal translations concerning aspects of
the environment ❖ Damon was under bereavement and grief
❖ Caused Damon’s insanity
• Religiosity ❖ Counselors suggested King Damon for a second marriage
- The psychotic person becomes preoccupied with religious ❖ Asked followers to seek out a lady who is similar to his wife
ideas, a defense mechanism thought to be used in an ❖ Messengers searched for the King’s request to other countries but
attempt to stabilize and provide structure to disorganized found no one
thought and behaviors ❖ Counselors suggested King Damon to choose Dymphna
❖ Dymphna became horrified
❖ Fr. Gerebran advised Dymphna to take refuge
ST. DYMPHNA ❖ Fr. Gerebran, Dymphna, Court Jester and his wife took refuge
❖ Went to Antwerp, Ireland and took a short rest
Patroness of Nervous Disorders ❖ Went to the village of Gheel, Belgium at the Chapel of St. Martin
❖ Messengers knew where Dymphna took refuge
PERSONAL PROFILE ❖ King Damon commanded his servants to kill Fr. Gerebran while he
✓ Bornin 7th Century, AD himself will strike the head of Dymphna
❖ King Damon and his followers successfully reached Gheel,
✓ Birthplace: Ireland
Belgium
✓ Parents: Father → King Damon, Mother → Unnamed
❖ King Damon pleaded Dymphna to come back but Fr. Gerebran
✓ Princess
rebuked him
✓ Virgin and Martyr
✓ St. Dympna, St. Dimpna ❖ Without delay, the king’s followers struck the priest on the neck
with a sword
✓ In Irish: St. Davnet, St. Damhnait
❖ Fr. Gerebran died
❖ Dymphna refused the King’s Offer
PATRONAGE ❖ And the king struck a sword on the head of Dymphna
• Insanity ❖ Dymphna fell down on the feet of her insane father
• Mental illness ❖ Dymphna died
• Nervous System Disorders
• Epileptics
BURIAL
• Mental Health Professionals
• Happy Families • Remains of Dymphna and Gerebran to remain to the ground after
their death
• Inhabitants of Gheel transferred them to a cave (customary)
• Inhabitants of Gheel reminisced their holy death
• Inhabitants went to the cave to find more suitable burial for them

NCM 117: Care of Clients with Maladaptive Patterns of Behavior

Marybeth G. Marcial RN, PhD
• To their surprise, they had seen two most beautiful tombs
(whiter than a snow) with a carved name “Dympna”
• The coffin was opened and they found a red tile which stated
“Here lies the holy virgin and martyr Dymphna”
• Church of St. Dymphna

MIRACLES AND CURES

❖ More mentally afflicted persons where brought to the Shrine of
St. Dymphna
❖ There had been remarkable cures to the mentally afflicted
persons
❖ Mentally ill individuals started to be placed at Gheel, Belgium and
there they were cared for
❖ “Infirmary of St. Elizabeth” was built by the Sisters of St.
Augustine
❖ The infirmary was later on converted into a hospital that took care
for the mentally ill individuals

INSTITUTIONS BUILT IN HER HONOR

• CHURCH OF ST. DYMPHNA was built in the place where her
remains was found
• “Infirmary of St. Elizabeth” was built by the Sisters of St.
Augustine

National Shrine of St. Dymphna

- The first church in America dedicated

in her honor

NCM 117: Care of Clients with Maladaptive Patterns of Behavior

Marybeth G. Marcial RN, PhD
NCM 117- PSYCHIATRIC NURSING | MALADAPTIVE PATTERNS OF BEHAVIOR
R.M. FERNANDO, RN, MAN
MIDTERMS
LESSON 1: LEGAL ASPECT OF • Individual State
PSYCHIATRIC NURSING • Precedent-setting legal cases
• The Joint Commission on Accreditation of Healthcare
SOURCES OF LAWS Organizations (JCAHO)
STATUTORY LAW • Health Insurance
- laws of country
- ex. Constitution (whatever our right is/are stated in PHILIPPINE MENTAL HEALTH LAW- RA 11036
this) Establishing a National Mental Health Policy for the purpose
COMMON LAW of Enhancing the Delivery of Integrated Mental Health
- legal principles/cases Services, Promoting and Protecting the Rights of Person
- arises from common court cases w/ regards to psych Utilizing Psychosocial Health Services, Appropriating Funds
nursing Therefore and other Purposes
ADMINISTRATIVE LAW SEC. 2 Objectives
- from administration • Strengthen effective leadership and governance for
- ex. Board of Nursing; Insurance- Medicare mental health by, among others, formulating,
developing and implementing national policies,
MAJOR COURT DECISIONS strategies, programs and regulations relating to mental
COGNITIVE STANDARD health
M’ Naghten Rule • Develop and establish a comprehensive, integrated
- based on the 1843 case of Daniel M'Naghten in England. effective and efficient national mental health care
M'Naghten was attempting to kill the prime minister system responsive to the psychiatric, neurologic and
when he instead killed Secretary Edward Drummond. psychosocial needs of the Filipino people
- delusion of persecution; “the ruling political party is • Protect the rights and freedom of person with
going to kill me” psychiatric, neurologic and psychosocial needs
- a verdict of not guilty by reason of insanity; his insanity
• Strengthen information system, evidence and research
is not going to be liable for the murderous act
for mental health
RIGHT TO TREATMENT
• Integrated mental health care in the basic health
Wyatt v. Stickney
services
- Tuscaloosa, Alabama
• Integrate strategies promoting mental health in
- Abused by manual labor (cleaning, least restricted);
educational institution, the workplace and in the
right to treatment even if they are mentally ill; pts are
communities
not labor force & must be given proper medications
PATIENT’S BILL OF RIGHTS
- Patients have a ”constitutional right to receive such
The 1987 Constitution of the Republic of the Philippines-
individual treatment as will give each of them a realistic
Article X
opportunity to be cured or to improve his or her mental
Published: February 11, 1987
condition.”
• People with mental health condition have the right to
RIGHT TO REFUSE TREATMENT
make decision about their lives including their
Rogers v. Okin
treatment
- Massachusetts
• Have the right to be free from all abuses including the
- Forced to participate in research, after long time, they
practice of seclusion and restraints
won as they are seen as guinea pigs on coercion; due to
• Have the right to live and fully participate in their
force they won
communities of choice
- Committed mental patient assumed competent to make
treatment decisions in non-emergencies • Have the right to receive the services they want, how
- If pt. is delusional, guardian, conservators & significant and where they want them with full explanation of
others must sign IC insurance benefits, treatment options and side effects
DUTY TO WARN • Have the right to privacy and to manage who can see
Tarasoff v. Regents of University of California their healthcare information
- Tashana was declared dead after 2 days, d/t no warning MAGNA CARTA OF WOMEN- RA 9710
from the school that she is not safe; also with one’s self • Eliminate discrimination through recognition,
not just with others protection, fulfillment and promotion of the right of
- when a mental health professional learns of potential Filipino women especially those belonging to the
violence against another, that mental health marginalized sector of society
professional incurs an obligation to exercise a • Leave benefits of 2 mos with full pay for those who
reasonable duty of care to protect the intended victim. undergo surgery
SOURCES OF LAW AFFECTING PSYCHIATRIC NURSING • Non discrimination in employment in the field of
• The Constitution military, police and similar services

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NCM 117- PSYCHIATRIC NURSING | MALADAPTIVE PATTERNS OF BEHAVIOR
R.M. FERNANDO, RN, MAN
MIDTERMS
• Provision for equal access and elimination of 3. Wrongfully committing a patient to a psychiatric
discrimination in education, scholarship and training facility
• Non-discriminatory and non-derogatory portrayal of
COMMITMENT ISSUES
women in media and film, recognize dignity of women
• Voluntary patients
and the role and contribution of women in family,
• Involuntary patients
community or society
➢ Emergency care-48-72 hrs
MAGNA CARTA OF DISABLED PERSON- RA 7277
➢ Short-term observation and treatment
• Disabled person are those suffering from restrictions or
different abilities as a result of mental, physical, or ➢ Long-term commitment-90 days
sensory impairment to perform an activity in the • Incapacitated persons
manner or within the range considered normal for a ➢ Conservators and guardians
human being
• Disabled person have the same rights as other people to MENTAL HEALTH
take their proper place in society • a state of well-being in which every individual realizes
• Disabled person are part of the Philippine society thus his/her own potential, can cope with the normal
the state shall give full support to the well-being of the stresses of life, can work productively and fruitfully and
disabled person is able to make a contribution to her/his community
• Rehabilitation of the disabled person shall be the
concern of the government, to foster their capacity to MENTAL HEALTH CRISIS
attain a more meaningful, productive and satisfying life • any non-life-threatening situation in which people
• Facilitate integration of disabled person into the experience an intensive behavioral, emotional or
mainstream of society psychiatric response triggered by a precipitating event
MAGNA CARTA OF HEALTH WORKERS- RA 7305 and whose behavior puts them at risk of hurting
• Health workers are all persons who are engaged in themselves or others and prevent them from being able
health and health related work, and all persons to care for themselves or function effectively in the
employed in all hospital, sanitaria, health infirmaries, community
Rural and Barangay Health Stations, clinic and other
related establishment GLOBAL AND REGIONAL PERSPECTIVE ON MENTAL
• The act aims to promote and improve the social, HEALTH
economic well-being of the health workers, their living MENTAL HEALTH PROGRAM
and working conditions and terms of employment VISION:
• Develop their skills and capabilities in order that they ➢ A society that promotes the well-being of all
will be more responsive and better equipped to deliver Filipinos, supported by transformative multi-
health projects and programs
sectoral partnerships, comprehensive mental
• To encourage those with proper qualifications and
health policies and programs, and a responsive
excellent abilities to join and remain in government
service service delivery network
MISSION:
UNINTENTIONAL TORTS ➢ To promote over-all wellness of all Filipinos,
▪ Negligence- failure to do or not to do prevent mental, psychosocial, and neurologic
▪ Duty to Warn others- duty to warn of threatened disorders, substance abuse and other forms of
suicide or harm addiction, and reduce burden of disease by
▪ Malpractice- professional negligence improving access to quality care and recovery in
→ Elements order to attain the highest possible level of health
1. Duty to Care- legally recognized relationship to participate fully in society.
2. Breach of Duty- failed to conform to standards Objectives:
of care 1. To promote participatory governance and leadership
3. Injury or Damage- loss in mental health
4. Causation- direct cause of damage or injury 2. To strengthen coverage of mental health services
through multi-sectoral partnership to provide high
INTENTIONAL TORS quality service aiming at best patient experience in a
▪ Assault-deliberate threat coupled with apparent ability responsive service delivery network
to do physical harm 3. To harness capacities of LGUs and organized groups to
▪ Battery-intentional touching implement promotive and preventive interventions
▪ False imprisonment-unlawful restraint on mental health
1. Excessive force to restrain a patient 4. To leverage quality data and research evidence for
2. Preventing patient from leaving a health care mental health
facility 5. To set standards for compliance in different aspects of
services
LORRAINE ANNE SABLA-ON,SN CSAB 2
NCM 117- PSYCHIATRIC NURSING | MALADAPTIVE PATTERNS OF BEHAVIOR
R.M. FERNANDO, RN, MAN
MIDTERMS
PROGRAM COMPONENTS D. If the eating behavior occurs in the context of another
1. Wellness of Daily Living mental disorder (e.g., intellectual disability [intellectual
- Promotion of Healthy Lifestyle, Prevention and Control developmental disorder], autism spectrum disorder,
of Diseases, Family wellness programs, etc schizophrenia) or medical condition (including
- School and workplace health and wellness programs pregnancy), it is sufficiently severe to warrant additional
2. Extreme Life Experience clinical attention
- Provision of mental health and psychosocial support ▪ Onset –childhood, adolescent or adult
(MHPSS) during personal and community wide disasters ▪ Can occur with co morbidity such as autism spectrum
3. Mental Disorder disorder, schizophrenia and OCD
4. Neurologic Disorders ▪ Can be associated with trichotillomania
5. Substance Abuse and other Forms of Addiction
ANOREXIA NERVOSA
mhGAP Mental Health Gap Action Programme DIAGNOSTIC CRITERIA
▪ Scaling up care for mental, neurological, and substance A. Restriction of energy intake relative to requirements,
use disorders leading to a significantly low body weigh fit in the ff
▪ WHO aims to provide health planners, policy-makers, context of age, sex, developmental trajectory, and
and donors with a set of clear and coherent activities physical health. Significantly low weight is defined as a
and programme for scaling up care for mental, weight that is less than minimally normal or, for
neurological and substance use disorders through the children and adolescents, less than that minimally
Mental Health Gap Action Programmes expected.
OBJECTIVES B. Intense fear of gaining weight or of becoming fat, or
▪ To reinforce the commitment of governments, persistent behavior that interferes with weight gain,
international organizations, and other stakeholders to even though at a significantly low weight.
increase the allocation of financial and human resources C. Disturbance in the way in which one’s body weight or
for care of MNS disorders. shape is experienced, undue influence of body weight
▪ To achieve much higher coverage with key interventions or shape on self-evaluation, or persistent lack of
in the countries with low and lower middle incomes that recognition of the seriousness of the current low body
have a large proportion of the global burden of MNS weight
disorders
STRATEGIES (F50.01) Restricting type: During the last 3 months, the
▪ This programme is grounded on the best available individual has not engaged in recurrent episodes of binge
scientific and epidemiological evidence on priority eating or purging behavior (i.e., self-induced vomiting or the
conditions. It attempts to deliver an integrated package misuse of laxatives, diuretics, or enemas). This subtype
of interventions, and takes into account existing and describes presentations in which weight loss is accomplished
possible barriers to scaling up care. primarily through dieting, fasting, and/or excessive exercise.

LESSON 2: EATING DISORDERS (F50.02) Binge-eating/purging type: During the last 3

months, the individual has engaged in recurrent episodes of
▪ Mostly affect women aging 45-65 years old and children binge eating or purging behavior (i.e., self-induced vomiting
12 years old or the misuse of laxatives, diuretics, or enemas)
▪ Characterized by a persistent disturbance of eating or
eating related behavior that results in the altered 3 ESSENTIAL FEATURES
consumption or absorption of food and that significantly ➢ Persistent energy intake restriction
impairs physical health or psychosocial function ➢ Intense fear of gaining weight or of becoming fat
2 Most Common Eating Disorder: ➢ Disturbance in self-perceived weight or shape
▪ Anorexia Nervosa
▪ Bulimia Nervosa ▪ Although anorectics limit their intake or refuse to eat,
they do not generally loose their appetite
PICA ▪ They suppress their appetite to remain thin
DIAGNOSTIC CRITERIA ▪ Menstrual cycle may cease or might be irregular and
A. Persistent eating of nonnutritive, nonfood substances spotty
over a period of at least 1 month.
B. The eating of nonnutritive, nonfood substances is ▪ Anorectic patients become preoccupied with food and
inappropriate to the developmental level of the eating
individual. ▪ They believe they are nutrition experts
C. The eating behavior is not part of a culturally supported
or socially normative practice.

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NCM 117- PSYCHIATRIC NURSING | MALADAPTIVE PATTERNS OF BEHAVIOR
R.M. FERNANDO, RN, MAN
MIDTERMS
▪ Engage in bizarre behaviors such as hoarding, preparing larger than what most individuals would eat in a
elaborate meals for others but not eating the food they similar period of time under similar circumstances.
prepare 2. A sense of lack of control over eating during the
episode (e.g., a feeling that one cannot stop eating
BEHAVIOR or control what or how much one is eating).
▪ Onset is often subtle B. Recurrent inappropriate compensatory behaviors in
▪ Common premorbid profile is that of a perfectionistic order to prevent weight gain, such as self-induced
and introverted girl with self-esteem and peer vomiting; misuse of laxatives, diuretics, or other
relationship problems medications; fasting; or excessive exercise.
▪ They can also be accomplished and active in school C. The binge eating and inappropriate compensatory
activities behaviors both occur, on average, at least once a week
for 3 months.
OBJECTIVE SIGN
D. Self-evaluation is unduly influenced by body shape and
Restricters
weight.
→ normal or slightly above normal weight range for
E. The disturbance does not occur exclusively during
height and build
episodes of anorexia nervosa.
→ Simply eat less and avoid situations in which they
are expected to eat
▪ Usually begins in adolescence or early adult life
→ Often withdraw to their rooms and avoid family and
▪ More cases in women than in men
friends
▪ Binge periods alternate with periods of restrictive eating
→ Participate in rigid exercise program
→ Hyperactive to lose weight
BEHAVIOR
Vomiters-purgers
▪ Bulimia means to have insatiable appetite
→ more often overweight before eating disorder, ▪ Massive overeating
weight tends to fluctuate
▪ Onset is 15-24 years old
→ Induction of vomiting or excessive use of laxatives
▪ Binge eating large amount of food for a short period of
or diuretics
time
→ Deny concerns about weight
→ Typically eat normal in social situations OBJECTIVE SIGNS
→ After a meal they retreat to the nearest bathroom ▪ Secretive about their behavior
and purge themselves ▪ Binge on high-calorie, high-carbohydrate “snack food”
→ Hypotension, bradycardia, hypothermic ▪ Occurs during the evening or at night
▪ Physically exhausted
SUBJECTIVE SIGNS
▪ Painful abdominal distention
▪ Concerned about being obese, losing weight
▪ Fluid and electrolyte abnormalities
▪ Often say that they would rather die than be fat
▪ Erosion of dental enamel
ETIOLOGY ▪ Russell’s sign ( callusing of the knuckles of the fingers)
Biologic factor: increased serotonin ▪ Pancreatitis
Sociocultural : unrealistically thin beauty ideal for women
SUBJECTIVE SIGN
- American culture stresses the importance of physical
▪ Express a fear of becoming fat
attractiveness in obtaining approval
▪ Feeling anxious, lonely and bored or uncontrollably
Family factor: emotional restraint
craving food before the binge
- rigid organization in the family
▪ Guilt feeling after a binge
- Tight control of the child behavior by parents and
▪ Depressed
avoidance of conflict
Psychodynamics factor: it might be related to an early ETIOLOGY
history of sexual abuse Biologic –lowered serotonin level
- Regression to a prepubertal state, so that adolescent Sociocultural –same with anorexia nervosa
does not mature physically and emotionally Family Factors –having conflict, disorganized, lacking in
- Fear of being out of control because of lack of well- nurturance
defined self - Chaotic family
Cognitive and Behavioral Factor –cycle of low self-esteem,
BULIMIA NERVOSA
extreme concerns about body shape and weight, strict
DIAGNOSTIC CRITERIA 307.51 (F50.2)
dieting, binge eating and compensatory behavior
A. Recurrent episodes of binge eating. An episode of binge
Psychodynamic –ambivalent feelings of self-esteem
eating is characterized by both of the following:
1. Eating, in a discrete period of time (e.g., within any
2-hour period), an amount of food that is definitely
LORRAINE ANNE SABLA-ON,SN CSAB 4
NCM 117- PSYCHIATRIC NURSING | MALADAPTIVE PATTERNS OF BEHAVIOR
R.M. FERNANDO, RN, MAN
MIDTERMS
DIFFERENTIATION IN BEHAVIORS TRANSVESTISM
- Wearing clothes of the opposite sex to achieve sexual
pleasure
- Begins late childhood
- Heterosexual males who wears dress in womens’
clothing
EXHIBITIONISM
- Derives sexual pleasure from repetitive act of exposing
one’s genital to an unsuspecting stranger
- Begins mid 20s
PEDOPHILIA
PSYCHOTHERAPEUTIC MANAGEMENT - Prefers and achieve sexual arousal and satisfaction
Anorexia –3 objectives: when sexual activity is performed with prepubertal
1. Increasing weight to at least 90% of the average body children
weight - Prefers 13 years old and below
2. Helping patients reestablish appropriate eating INCEST
behaviors - Is pedophilia with child and adolescent relatives and
3. Increasing self-esteem so that they do not need the involves relationship by blood, marriage or live-in
perfection that they believe thinness provides partners
• Intravenous lines VOYEURISM
• Refeeding and weight restoration slowly - Derives sexual gratification by observing unsuspecting
• Bulimic Patient –medical stabilization person who are naked, disrobing or engaging in sexual
• Cognitive-behavioral therapy activity
• Family therapy - Masturbation may be done while peeping
SADISM
• Pharmaco-therapy
- Sexual satisfaction is obtained by inflicting pain on the
Key Intervention for Eating Disorders partner
• Monitor daily caloric intake and electrolyte status MASOCHISM
• Observe for signs of purging and other compensation for - Needs to be humiliated or suffer as accompaniment to
food consumption sex act in order to have sexual excitement
• Plan for a dietitian to meet with patient and family to (1) FROTTEURISM
provide accurate information on nutrition (2) discuss - Sexual pleasure is derived from rubbing or touching
realistic and healthy diet (3) assist the nurses in against a non-consenting person
monitoring the nutritional intake ZOOPHILIA
• Convey warmth and sincerity - Involves sexual arousal or desire for sexual contact with
• Be honest animals
BESTIALITY
• Set appropriate behavioral limits
- Sexual contact with animals
• Teach patient about their disorder
• Model and teach appropriate social skills
SEXUAL DYSFUNCTION
• Initiate behavior modification program that rewards
LIFELONG- no satisfying sexual experienced was ever felt
weight gain
ACQUIRED- develop after a period of normal functioning
- Could be limited to certain partners or situations
LESSON 3: SEXUAL DISORDERS
DELAYED EJACULATION
PARAPHILIA DIAGNOSTIC CRITERIA
• is a condition in which sexual instinct is express in ways A. Either of the following symptoms must be experienced
that are socially prohibited or unacceptable. on almost all or all occasions (approximately 75%-100%)
Characterized by:
of partnered sexual activity (in identified situational
• long standing sexual urges, fantasies or
contexts or if generalized, in all contexts) and without
behaviors(nonhuman objects).
the individual desiring delay:
• Infliction of pain or humiliation to self, partner or
nonconsenting individual. 1. Marked delay in ejaculation
• Has lasted for 6 months 2. Marked infrequency or absence of ejaculation
• Resulted in severe distress and impairment in normal B. The symptoms in Criterion A have persisted for a
functioning minimum duration of approximately 6 months
TYPES OF PARAPAPHILIA C. The symptoms in Criterion A cause clinically significant
FETISHISM distress in the individual
- Inanimate objects are used to achieve sexual D. The sexual dysfunction is not better explained by a
excitement and gratification nonsexual mental disorder or as a consequence of
- May be a requirement for erotic arousal severe relationship distress or other significant stressors

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NCM 117- PSYCHIATRIC NURSING | MALADAPTIVE PATTERNS OF BEHAVIOR
R.M. FERNANDO, RN, MAN
MIDTERMS
and is not attributable to the effects of a FEMALE ORGASMIC DISORDER
substance/medication or another medical condition DIAGNOSTIC CRITERIA
Specify whether: A. Presence of either of the following symptoms and
Lifelong: The disturbance has been present since the experienced on almost all or all (approximately 75%-
individual became sexually active 100%) occasions of sexual activity (in identified
Acquired: The disturbance began after a period of relatively situational contexts or, if generalized, in all contexts):
normal sexual function 1. Marked delay in, marked infrequency of, or absence
of orgasm.
Specify whether:
2. Markedly reduced intensity of orgasmic sensations.
Generalized: Not limited to certain types of stimulation,
B. The symptoms in Criterion A have persisted for a
situations, or partners
minimum duration of approximately 6 months.
Situational: Only occurs with certain types of stimulation,
C. The symptoms in Criterion A cause clinically significant
situations, or partners
distress in the individual.
Specify current severity: D. The sexual dysfunction is not better explained by a
Mild: Evidence of mild distress over the symptoms in nonsexual mental disorder or as a consequence of
Criterion A severe relationship distress (e.g., partner violence) or
Moderate: Evidence of moderate distress over the other significant stressors and is not attributable to the
symptoms in Criterion A effects of a substance/medication or another medical
Severe: Evidence of severe or extreme distress over the condition.
symptoms in Criterion A
DIAGNOSTIC FEATURE
DIAGNOSTIC FEATURE • difficulty experiencing orgasm and/or markedly reduced
• A marked delay in or inability to achieve ejaculation intensity of orgasmic sensations
(Criterion A) • symptoms must be experienced on almost all or all
• The man reports difficulty or inability to ejaculate occasions of sexual activity
despite the presence of adequate sexual stimulation
and the desire to ejaculate GENITO-PELVIC PAIN/PENETRATION DISORDER
DIAGNOSTIC CRITERIA
A. Persistent or recurrent difficulties with one (or more) of
ERECTILE DISORDER the following:
DIAGNOSTIC CRITERIA 1. Vaginal penetration during intercourse.
A. At least one of the three following symptoms must be 2. Marked vulvovaginal or pelvic pain during vaginal
experienced on almost all or all (approximately 75%- intercourse or penetration attempts
100%) occasions of sexual activity (in identified 3. Marked fear or anxiety about vulvovaginal or pelvic
situational contexts or, if generalized, in all contexts): pain in anticipation of, during, or as a result of
1. Marked difficulty in obtaining an erection during vaginal penetration.
sexual activity. 4. Marked tensing or tightening of the pelvic floor
2. Marked difficulty in maintaining an erection until muscles during attempted vaginal penetration.
the completion of sexual activity B. The symptoms in Criterion A have persisted for a
3. Marked decrease in erectile rigidity minimum duration of approximately 6 months.
B. The symptoms in Criterion A have persisted for a C. The symptoms in Criterion A cause clinically significant
minimum duration of approximately 6 months. distress in the individual.
C. The symptoms in Criterion A cause clinically significant D. The sexual dysfunction is not better explained by a
distress in the individual. nonsexual mental disorder or as a consequence of a
D. The sexual dysfunction is not better explained by a severe relationship distress (e.g., partner violence) or
nonsexual mental disorder or as a consequence of other significant stressors and is not attributable to the
severe relationship distress or other significant stressors effects of a substance/medication or another medical
and is not attributable to the effects of a condition
substance/medication or another medical condition. DIAGNOSTIC FEATURES
DIAGNOSTIC FEATURES • difficulty having intercourse
• repeated failure to obtain or maintain erections during • genito-pelvic pain
partnered sexual activities • fear of pain or vaginal penetration
• occurs on the majority of sexual occasions • tension of the pelvic floor muscles
• Symptoms may occur only in specific situations involving
certain types of stimulation or partners

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NCM 117- PSYCHIATRIC NURSING | MALADAPTIVE PATTERNS OF BEHAVIOR
R.M. FERNANDO, RN, MAN
MIDTERMS
MALE HYPOACTIVE SEXUAL DESIRE DISORDER GENDER DYSPHORIA
DIAGNOSTIC CRITERIA DIAGNOSTIC CRITERIA
A. Persistently or recurrently deficient (or absent) Gender Dysphoria in Children
sexual/erotic thoughts or fantasies and desire for sexual A. A marked incongruence between one’s
activity. The judgment of deficiency is made by the experienced/expressed gender and assigned gender, of
clinician, taking into account factors that affect sexual at least 6 months’ duration, as manifested by at least six
functioning, such as age and general and sociocultural of the following (one of which must be Criterion A1):
contexts of the individual’s life. 1. A strong desire to be of the other gender or an
B. The symptoms in Criterion A have persisted for a insistence that one is the other gender (or some
minimum duration of approximately 6 months. alternative gender different from one’s assigned
C. The symptoms in Criterion A cause clinically significant gender).
distress in the individual. 2. In boys (assigned gender), a strong preference for
D. The sexual dysfunction is not better explained by a cross-dressing or simulating female attire: or in girls
(assigned gender), a strong preference for wearing
nonsexual mental disorder or as a consequence of
only typical masculine clothing and a strong
severe relationship distress or other significant stressors
resistance to the wearing of typical feminine
and is not attributable to these effects of a clothing.
substance/medication or another medical condition 3. A strong preference for cross-gender roles in make-
believe play or fantasy play.
DIAGNOSTIC FEATURE
4. A strong preference for the toys, games, or
• low/absent desire for sex and deficient/absent sexual
activities stereotypically used or engaged in by the
thoughts or fantasies are required for a diagnosis of the other gender.
disorder 5. A strong preference for playmates of the other
gender.
6. In boys (assigned gender), a strong rejection of
PREMATURE (EARLY) EJACULATION typically masculine toys, games, and activities and
DIAGNOSTIC CRITERIA a strong avoidance of rough-and-tumble play; or in
A. persistent or recurrent pattern of ejaculation occurring girls (assigned gender), a strong rejection of
typically feminine toys, games, and activities.
during partnered sexual activity within approximately 1
7. A strong dislike of one’s sexual anatomy.
minute following vaginal penetration and before the
8. A strong desire for the primary and/or secondary
individual wishes it. sex characteristics that match one’s experienced
Note: Although the diagnosis of premature (early) gender.
ejaculation may be applied to individuals engaged in B. The condition is associated with clinically significant
nonvaginal sexual activities, specific duration criteria have distress or impairment in social, school, or other
not been established for these activities. important areas of functioning
B. The symptom in Criterion A must have been present for
at least 6 months and must be experienced on almost all
or all (approximately 75%-100%) occasions of sexual Gender Dysphoria in Adolescents and Adults
activity (in identified situational contexts or, if A. A marked incongruence between one’s
generalized, in all contexts). experienced/expressed gender and assigned gender, of
C. The symptom in Criterion A causes clinically significant at least 6 months’ duration, as manifested by at least
distress in the individual. two of the following:
D. The sexual dysfunction is not better explained by a 1. A marked incongruence between one’s
nonsexual mental disorder or as a consequence of experienced/expressed gender and primary and/or
severe relationship distress or other significant stressors secondary sex characteristics (or in young
and is not attributable to the effects of a adolescents, the anticipated secondary sex
substance/medication or another medical condition. characteristics).
2. A strong desire to be rid of one’s primary and/or
DIAGNOSTIC FEATURES secondary sex characteristics because of a marked
• Premature (early) ejaculation is manifested by incongruence with one’s experienced/expressed
ejaculation that occurs prior to or shortly after vaginal gender (or in young adolescents, a desire to prevent
penetration, operationalized by an individual's estimate the development of the anticipated secondary sex
of ejaculatory latency (i.e., elapsed time before characteristics).
ejaculation) after vaginal penetration. 3. A strong desire for the primary and/or secondary
sex characteristics of the other gender.
4. A strong desire to be of the other gender (or some
alternative gender different from one’s assigned
gender)

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NCM 117- PSYCHIATRIC NURSING | MALADAPTIVE PATTERNS OF BEHAVIOR
R.M. FERNANDO, RN, MAN
MIDTERMS
5. A strong desire to be treated as the other gender 5. Aversive stimulation- olfactory aversions, the
(or some alternative gender different from one’s pairing of noxious odors with the individual’s
assigned gender). deviant fantasy, interrupts the fantasy and suppress
6. A strong conviction that one has the typical feelings behavior.
and reactions of the other gender (or some
alternative gender different from one’s assigned
gender).
LESSON 4: COGNITIVE DISORDERS
GENDER IDENTITY DISORDER COGNITIVE DISORDERS
DSM-IV-TR Criteria
• Revolves around learning and memory
A. Strong and persistent cross-gender identification
• Divided into reversible and irreversible
1. In children:
a. Stated desire or insistence that he or she is the NON DEMENTIA
other sex. 1. Mild Cognitive Impairment
b. In boys, dressing in female attire; in girls - is a regression in cognition that is not a result of
wearing only masculine setting normal aging
c. Make believe play or fantasies of being the - It results in confusion, changes in the persons way
other sex of knowing and understanding
d. Desire to participate in games and pastimes of No treatment but they can have a variety of activities:
the other sex • Improve sleep habits
e. Prefers playmates of the other sex • Treat underlying psychiatric disorder
2. In adolescents and adults: • Eat well, reduce alcohol
a. Stated desire to be the other sex • Increase socialization and do stimulating activities
b. Frequently passes as the other sex • Challenge the brain with mental exercises
c. Desires to be treated as the other sex • Compare and contrast things
d. Conviction that he or she has typical feelings
and reactions of the other sex 2. Delirium
B. Feelings of discomfort with own sex or - refers to dramatic behavioral changes that a person
inappropriateness in gender role of own sex may experience
- Desire for hormones and surgery to become the Hallmark Signs:
opposite sex. - Fluctuating level of consciousness
- Sexual reassignment surgery. - Slurred speech
- Day-night sleep reversal
INTERVENTIONS
- Hallucinations (visual, tactile)
• Referral to therapy groups.
• Self-help groups such as Sex Addicts Anonymous 3. Pseudodementia
• Sex education and stress management - cognitive deficits or depression but not enough
• Antiandrogen medications-diminishes sexual desire and symptoms to make a dementia diagnosis
fantasy - If depressed treat with medications,
• Selective serotonin reuptake inhibitors can also be psychotherapy, occupational and exercise therapy
given. DSM IV-TR Criteria for Delirium
Cognitive-Behavioral Therapies 1. disturbances of consciousness( reduced clarity of
1. Imaginal desensitization- sexual situations are awareness of the environment) with reduced ability to
described in detail and the individual uses focus, sustain or shift attention.
relaxation techniques to tolerate discomfort and to 2. 2.changes in cognition ( memory deficit, disorientation,
suppress sexual urges. language disturbance, perceptual disturbance)
2. Covert sensitization- individual verbalizes and 3. 3. Develops over a short period of time ( usually hours
associates negative consequences such as to days) and with a tendency to fluctuate during the
imprisonment for their behavior. course of the day
3. Cognitive restructuring- the individual’s irrational
belief and rationalizations about their behavior are DEMENTIA
challenged by group members or therapist. • A progressively deteriorating course that ultimately
4. Victim empathy training-becoming sensitive to affects cognition, perception, language, behavior and
victim’s feelings by watching videotapes of victim motor abilities.
experiences or listening to tape of victims
experiences.

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NCM 117- PSYCHIATRIC NURSING | MALADAPTIVE PATTERNS OF BEHAVIOR
R.M. FERNANDO, RN, MAN
MIDTERMS
Potentially Reversible Dementias 2. Moderate (MMSE score 10-19)
1. Normal Pressure Hydrocephalus Duration: 3-4 years
• triad symptoms: Changes:
- unsteady gait or apraxia Apraxia, agnosia
- urinary urgency or incontinence Aphasia with poor comprehension
- dementia Disorientation,
Blunting of affect
• Brain imaging shows- enlarged lateral and third
Misidentification
ventricles
Sleep disturbance
• Impaired return of cerebrospinal fluid to the Delusions,
subarachnoid space and to the venous system Needs assistance in activities of daily living
• Tx- neurosurgery- ventricular shunt is placed in one Redirectable, extreme emotional lability
of the lateral ventricles in the brain Self-absorption
Supervision with meals
2. Vit. B 12 Deficiency
Wandering
• demyelinination of the cerebrum occurred Urinary incontinence
• peripheral neuropathy is the common physical
symptom 3. Severe (MMSE score 0-9)
• delirium, depression and psychosis Duration: 5-10 years
• Tx: Vit. B 12 replacement Changes:
Gait disturbance
Irreversible Dementias Unable to fed self
DSM IV-TR Criteria for Dementia Double incontinence
A. The development of multiple cognitive deficits Bowel impaction
manifested by both: Bed bound
1. Memory impairment ( impaired ability to learn new Difficulty swallowing
information or to recall previously learned Fetal position
information) Requires 24 hrs supervision, close observation
2. One or more of the following cognitive disturbances
a. Aphasia
b. Apraxia Stages according to cognitive decline (Reisberg Scale)
c. Agnosia • Stage 1- No Cognitive decline, experiences no
d. Disturbance of executive functioning problem in daily living
B. The cognitive deficits in criteria A1 and A2 each cause • Stage 2 – Very Mild Cognitive decline, forgets name
significant impairment in social and occupational and location of objects, may have trouble finding
words
functioning and represent a significant decline from
• Stage 3 – Mild Cognitive decline, has difficulty
previous level of functioning.
travelling to new locations, has difficulty handling
C. The course is characterized by a gradual onset and
problems at work
continuing cognitive decline.
• Stage 4 – Moderate Cognitive decline, has difficulty
with complex task
1. Alzheimer’s Disease
• Stage 5 – Moderately Severe Cognitive decline, needs
• Alois Alzheimer- 1907
help to choose clothing, needs prompting to bathe
• Hallmark sign- neurofibrillary tangle
• Stage 6 – Severe Cognitive decline, needs help in
• Protein plaques (Beta amyloid)
putting on clothing, requires assistance in bathing,
may have a fear of bathing, has difficulty to use toilet,
Stages of Alzheimer's
or is incontinent
1. Mild (MMSE score 20-30)
• Stage 7 – Very Severe Cognitive decline
Duration: 2-3 years
Changes: - Vocabulary becomes limited, eventually
Decreased short term memory, declining in single words, loses ability to walk and
Word name finding difficulty sit, becomes unable to smile
Decision making, concentration, reasoning and
judgment problems CAUSES:
Difficulty performing visual activities • Neural Loss
Denial • Beta amyloid Plaques
Getting lost • Brain atrophy
Repetitive questioning • Genetics
• Hormones

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NCM 117- PSYCHIATRIC NURSING | MALADAPTIVE PATTERNS OF BEHAVIOR
R.M. FERNANDO, RN, MAN
MIDTERMS
CLASSIC BEHAVIORS OF ALZHEIMER’S 2. Vascular Dementia
• Memory loss • 2nd most prevalent dementia
• Word finding difficulty • Brain has multiple vascular lesions in the cortex and
• Difficulty concentrating subcortical areas
• Misinterpreting the environment • Maintain ability to speak with word finding
• Delusions difficulty
• Illusions • Dementia is related to location of lesion
• Somatic Preoccupations RISK FACTORS
• Misidentification • Hypertension
• Sundowning • Diabetes mellitus
• Cardiac arrhythmias
Four (4) A’s of Alzheimer's and Adaptive Factors • Previous stroke
1. Agnosia- impaired ability to recognize or identify • Tobacco use
familiar objects and people in the absence of visual and • Alcohol use and substance abuse
hearing impairement TREATMENT
• Assess and adapt to visual impairment • Treat the medical problem and health issues
• Do not expect patient to remember you, introduce • Improve physical health
yourself Psychotherapeutic Management for Dementia
• Cover mirrors or pictures Communication strategies-be pleasant, kind and use good
• Name objects and demonstrate their use eye contact
• Keep area free of ingestible hazards Scheduling strategies- develop a schedule that provides
2. Aphasia- language disturbances are exhibited in both structure
expressing and understanding spoken words. - develop singular activities
Expressive aphasia- inability to express thoughts in words - provide group experience with one subject at a time
Receptive aphasia- inability to understand what is said Nutritional strategies
• Assess and adapt for hearing loss - serve smaller meals several times a day
• Observe and use gestures, tone and facial - -finger foods
expression Toileting Strategies
• Provide help for word finding - provide attention to personal hygiene & toileting
• Restate your understanding of behaviors and word needs
fragments - take the patient to the bathroom every 2 hrs
• Acknowledge feelings expressed verbally and
nonverbally
• Use simple words and phrases for concise and LESSON 5: ANXIETY RELATED DISORDERS
organized
• Allow time to responses
• Use pictures, symbols and signs
3. Amnesia- inability to learn new information or to recall
previously learned information
• Do not expect patient to remember you, introduce
yourself
• Do not test patients memory unnecessarily
• Operate on the here and now
• Provide orientation cues
• Remember you must adopt when the patient
cannot change
• Compensate for the patients lost judgment or ANXIETY
reasoning • Apprehension, tension, uneasiness from anticipation of
4. Apraxia- inability to carry out motor activities despite danger, the source of which is largely unknown or
intact motor function unrecognized.
• Assess and adopt for motor weakness and • May be regarded as pathological when it interferes with
swallowing difficulties effectiveness in living, achievement of desired goals or
• Simplify task, give step by step instructions and satisfaction, or reasonable emotional comfort.
time for response (Shahrokh & Hales, 2003)
• Initiate motion for patient with gentle guidance or
touch

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NCM 117- PSYCHIATRIC NURSING | MALADAPTIVE PATTERNS OF BEHAVIOR
R.M. FERNANDO, RN, MAN
MIDTERMS
4. LEVELS OF ANXIETY of fear of another panic attack or significant maladaptive
• Mild behavior related to the attacks
→ Alertness
→ Awareness of surrounding NURSING INTERVENTIONS
→ Attentiveness • Stay with patient and acknowledge the patient’s
• Moderate discomfort.
→ Difficulty in concentrating • Maintain a calm style and demeanor
→ Easily distracted, can focus with assistance • Speak in short, simple sentences and give one direction
→ Misperception of stimuli at a time in a calm tone of voice
• Severe • If the patient is hyperventilating, provide a brown paper
→ Disorientation bag and focus on breathing with the patient
→ Delusions and hallucinations • Allow the patient to pace or cry, which enable the
→ Flight of ideas release of tension and energy
→ Panic-Disorganized perception • Communicate to the patient that you are in control and
→ Disorganized or irrational reasoning and problem will not let anything happen to them
solving • Move or direct patient to a quieter less stimulating
→ Out of contact with reality environment
• Ask the patient to express their perception or fears
ANXIETY DISORDERS about what is happening to them.
• Anxiety Disorder goes beyond the regular nervousness
and slight fear a person may feel from time to time. GENERALIZED ANXIETY DISORDER (GAD)
An anxiety disorder happens when: • Characterized by chronic, unrealistic, and excessive
→ Anxiety interferes with person’s ability to function. anxiety and worry.
→ Often overreact when something triggers one’s • The symptoms have existed for 6 months or longer and
emotions. cannot be attributed to specific organic factors, such as:
→ Can’t control responses to situations caffeine intoxication or hyperthyroidism
• Anxiety and worry are associated with muscle tension,
Types of Anxiety Related Disorder: restlessness, or feeling keyed up or on edge
PANIC DISORDER • Individual avoids activities or events that may result in
• characterized by Recurrent Panic Attacks, the onset of negative outcomes or spends considerable time and
which is unpredictable and manifested by intense effort preparing for such activities.
apprehension, fear, or terror, often associated with
feelings of impending doom and accompanied by
intense physical discomfort.
• Fear, Worry and Behavioral Change related to another
attack
Characterized by four or more of the following:
• Palpitations, pounding heart, or accelerated heart
rate
• Sweating
• Trembling or shaking
• Sensations of shortness of breath or smothering
DSM 5 TR Criteria for GAD
• Feelings of unreality (derealization) or being
1. The presence of excessive anxiety and worry about a
detached from oneself (depersonalization)
variety of topics, events, or activities. Worry occurs
• Fear of losing control or going crazy
more often than not for at least six months and is clearly
• A feeling of choking
excessive.
• Chest pain or discomfort
2. The worry is experienced as very challenging to control.
• Nausea or abdominal distress
The worry in both adults and children may easily shift
• Feeling dizzy, unsteady, lightheaded, or faint
from one topic to another
• Fear of dying
3. The anxiety and worry are accompanied by at least
• Numbness or tingling sensations (paresthesias)
three of the following physical or cognitive symptoms
• Chills or hot flush
(In children, only one of these symptoms is necessary
DSM 5 TR Criteria for Panic Disorder
for a diagnosis of GAD):
Panic Disorder include the experiencing of recurrent panic
- Edginess or restlessness
attacks, with 1 or more attacks followed by at least 1 month
- Tiring easily; more fatigued than usual

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NCM 117- PSYCHIATRIC NURSING | MALADAPTIVE PATTERNS OF BEHAVIOR
R.M. FERNANDO, RN, MAN
MIDTERMS
- Impaired concentration or feeling as though the • Flooding is a form of rapid desensitization in which a
mind goes blank behavioral therapist confronts the client with the phobic
- Irritability (which may or may not be observable to object (either a picture or the actual object) until it no
others) longer produces anxiety
- Increased muscle aches or soreness
- Difficulty sleeping (due to trouble falling asleep or NURSING INTERVENTIONS
staying asleep, restlessness at night or unsatisfying • Accept patients and their fears with non critical attitude
sleep • Provide and involve patients in activities that do not
NURSING INTERVENTIONS TO REDUCE ANXIETY: increase anxiety
• Provide calm and quiet environment • Help patient with physical safety and comfort needs
• Ask patients to identify what and how they feel • Help patients recognize that their behavior is a method
• Help patients identify possible causes of their feelings of avoiding anxiety.
• Encourage patient to describe and discuss their feelings • CBT (Cognitive Behavioral Therapy), SSRI are used to
with you reduce anxiety
• Listen carefully for patient’s expressions of helplessness
and hopelessness ACUTE STRESS DISORDER AND PTSD
• Ask patient whether they feel suicidal or have a plan to • Disorders that can develop after exposure to a clearly
hurt himself identifiable traumatic event that threatens the self,
• Plan and involve patient in activities such as going for others, resources, and/or sense of control or hope.
walk or playing recreational games
CHARACTERISTICS OF ASD AND PTSD
PHOBIA • Avoidance – persistent attempt to avoid situations,
activities and sometimes even people.
• Fear cued by the presence or anticipation of a specific
object or situation, exposure to which almost invariably • Reexperiencing the trauma and intrusive memories
provokes an immediate anxiety response or panic • Hyperarousal symptoms (anxiety, restlessness,
attack, even though the subject recognizes that the fear irritability, disturbances in sleep and impairment in
is excessive or unreasonable. The phobic stimulus is memory and concentration)
avoided or endured with marked distress (Shahrokh &
Hales, 2003) NURSING INTERVENTIONS
PHOBIC DISORDERS • Be nonjudgmental
Agoraphobia - fear of being in places or situations • Assure patients that their feelings and behaviors are
from which escape might be difficult, or in which typical reactions to serious trauma
help might not be available if a limited symptom • Help patients recognize the connections between the
attack or panic-like symptoms (rather than full trauma experience and their current feelings, behaviors,
panic attacks) should occur. and problems.
Social Phobia- is an excessive fear of situations in • Help patients evaluate past behaviors in the context of
which a person might do something embarrassing the trauma not in the context of current values and
or be evaluated negatively by others standards
Specific Phobias- Identified by fear of specific • Encourage safe verbalization of feelings, especially
objects or situations that could conceivably cause anger.
harm (e.g. spiders, heights, etc.) but the person’s • Encourage adaptive coping strategies, exercise,
reaction to them is excessive, unreasonable, and relaxation techniques
inappropriate • Facilitate progressive review of the trauma and its
Claustrophobia – fear of being in constricted, confined consequences
spaces • Encourage patients establish or reestablish relationship
Aerophobia – Fear of flying
Arachnophobia – fear of spiders OBSESSIVE- COMPULSIVE DISORDER
Hypochondria – fear of becoming ill • involves obsessions (thoughts, impulses, or images) that
Zoophobia – fear of animals cause marked anxiety and/or compulsions (repetitive
Acrophobia – fear of heights behaviors or mental acts) that attempt to neutralize
anxiety
TREATMENT • Recurrent, persistent, unwanted, intrusive thoughts,
• Systematic Desensitization, in which the therapist impulses, or images beyond worrying about realistic life
progressively exposes the client to the threatening problems;
object in a safe setting until the client’s anxiety • Attempts to ignore, suppress, or neutralize obsessions
decreases. with compulsions that are mostly ineffective;

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NCM 117- PSYCHIATRIC NURSING | MALADAPTIVE PATTERNS OF BEHAVIOR
R.M. FERNANDO, RN, MAN
MIDTERMS
• Adults and adolescents recognize that obsessions and
compulsions are excessive and unreasonable

NURSING INTERVENTIONS
• Offer encouragement, support, and compassion.
• Be clear with the client that you believe he or she can
change.
• Encourage the client to talk about feelings, obsessions,
and rituals in detail
• Gradually decrease time for the client to carry out
ritualistic behaviors.
• Assist client to use exposure and response prevention
behavioral techniques
• Encourage client to use techniques to manage and
tolerate anxiety responses.
• Assist client to complete daily routine and activities
within agreed-on time limits.
• Encourage the client to develop and follow a written
schedule with specified times and activities

RELATED DISORDERS
• Anxiety disorder due to a general medical condition is
diagnosed when the prominent symptoms of anxiety
are judged to result directly from a physiologic condition
• Substance-induced anxiety disorder is anxiety directly
caused by drug abuse, a medication, or exposure to a
toxin. Symptoms include prominent anxiety, panic
attacks, phobias, obsessions, or compulsions
• Separation anxiety disorder is excessive anxiety
concerning separation from home or from persons,
parents, or caregivers to whom the client is attached. It
occurs when it is no longer developmentally appropriate
and before 18 years of age
• Adjustment disorder is an emotional response to a
stressful event, such as one involving financial issues,
medical illness, or a relationship problem, that results in
clinically significant symptoms such as marked distress
or impaired functioning

LORRAINE ANNE SABLA-ON,SN CSAB 13

 PERSONALITY DISORDERS 5. Persistently bears grudges (i.e., is unforgiving of
insults, injuries, or slights).
 As defined in DSM-5 are enduring pattern of inner 6. Perceives attacks on his or her character or
experience and behavior that: reputation that are not apparent to others and is
 Differs markedly from the expectations of the quick to react angrily or to counterattack.
individual’s culture, 7. Has recurrent suspicions, without justifications,
regarding fidelity of spouse or sexual partners.
 Is pervasive and inflexible,
SCHIZOID PERSONALITY DISORDER
 Has an onset in adolescence or early adulthood,
A pervasive pattern of detachment from social relationships
 Is stable over time,
and a restricted range of expression of emotions in
 And leads to distress or impairment.
interpersonal settings, beginning by early adulthood and
 Formerly referred to as character disorders – are a class present in a variety of contexts, as indicated by four (or
of personality types which deviate from the more) of the following:
contemporary expectations of a society. 1. Neither desires nor enjoys close relationships,
 Personality Disorders (American Psychiatric Association including being part of a family.
– APA) – and enduring pattern of inner experience and 2. Almost always chooses solitary activities.
behavior that deviates markedly from the expectations 3. Has little, if any, interest in having sexual
of the culture of the individual who exhibits it. experiences with another person.
GENERAL CRITERIA PERSONALITY DISORDER 4. Takes pleasure in few, if any, activities.
A. Experience and behavior deviating markedly from the 5. Lacks close friends or confidants other than firs-
expectations of the individual’s culture. This pattern is degree relatives.
manifested in two (or more) of the following areas: 6. Appears indifferent to the praise or criticism of
1. Cognition others.
2. Affect 7. Shows emotional coldness, detachment, or flattened
3. Interpersonal functioning affect.
4. Impulse control  Does not occur exclusively during the course of
B. The enduring pattern is inflexible and pervasive across a schizophrenia, a mood disorder with psychotic features,
broad range of personal and social situations. another psychotic disorder, or a pervasive
C. The enduring patterns leads to clinically significant developmental disorder and is not due to the direct
distress or impairment in social, occupational, or other physiological effects of a general medical condition.
important areas of functioning. GUNTRIP CRITERIA (HARRY GUNTRIP)
D. The pattern is stable of long duration, and its onset can 1. Introversion
be traced back at least to adolescence or early 2. Withdrawnness
adulthood. 3. Narcissism
E. The enduring pattern is not better accounted for as a 4. Self-sufficiency
manifestation or consequence of another mental 5. A sense of superiority
disorder. 6. Loss of affect
F. The enduring pattern is not due to the direct 7. Loneliness
physiological effects of a substance (e.g., a drug abuse, a 8. Depersonalization
medication) or a general medical condition (e.g., head 9. Regression
trauma). SCHIZOTYPAL PERSONALITY DISORDER
PERSONALITY DISORDERS A pervasive pattern of social and interpersonal deficits
Cluster A – “Weird” Odd, Eccentric Behaviors marked by acute discomfort with, and reduced capacity for,
 Paranoid Personality Disorder close relationships as well as by cognitive or perceptual
 Schizoid Personality Disorder distortions and eccentricities of behaviors, beginning by
 Schizotypal Personality Disorder early adulthood and present in a variety of contexts, as
Cluster B – “Wired” Dramatic, Emotional, Erratic Behavior indicated by five (or more) of the following:
 Antisocial Personality Disorder 1. Ideas of reference (excluding delusions of reference).
 Borderline Personality Disorder 2. Odd beliefs or magical thinking that influences
 Histrionic Personality Disorder behavior and is inconsistent with subcultural norms
 Narcissistic Personality Disorder (e.g., superstitious, belief in clairvoyance, telepathy,
Cluster C – “Wimpy” Anxious, Fearful Behavior or “sixth sense”; in children and adolescents, bizarre
 Avoidant Personality Disorder fantasies or preoccupations).
 Dependent Personality Disorder 3. Unusual perceptual experiences, including bodily
 Obsessive-Compulsive Personality Disorder illusions.
PARANOID PERSONALITY DISORDER 4. Odd thinking and speech (e.g., vague, circumstantial,
This disorder is characterized by a pervasive distrust and metaphorical, overelaborate, or stereotyped)
suspicion of others such that their motives are interpreted 5. Suspiciousness or paranoid ideation.
as malevolent, beginning by early adulthood and present in a 6. Inappropriate or constricted affect.
variety of contexts, as indicated by four (or more) of the 7. Behavior or appearance that is odd, eccentric, or
following: peculiar.
1. Suspects, without sufficient basis, that others are 8. Lack of close friends or confidants other than first-
exploiting, harming, or deceiving him or her. degree relatives.
2. Is preoccupied with unjustified doubts about the 9. Does not occur exclusively during the course of
loyalty or trustworthiness of friends or associates. Schizophrenia, a Mood Disorder with Psychotic
3. Is reluctant to confide in others because of Features, another Psychotic Disorder, or a Pervasive
unwarranted fear that the information will be used Developmental Disorder.
maliciously against him or her.  If criteria are met prior to the onset of Schizophrenia,
4. Reads benign remarks or events as threatening or add “Premorbid”, e.g., “Schizotypal Personality Disorder
demeaning. (Premorbid)

NCM 117 – CARE OF PATIENTS WITH MALADAPTIVE PATTERNS OF BEHAVIOR SUBERE, PATRICIA LORRAINE T. | BSN 3G
 ANTISOCIAL PERSONALITY DISORDER 7. Lacks empathy: is unwilling to recognize or identify
A. There is a pervasive pattern of disregard for and with the feelings and needs of others.
violation of the rights of other occurring since age 15 8. Is often envious of others or believes that others are
years, as indicated by three (or more) of the following: envious of him or her.
1. Failure to conform to social norms with respect to 9. Shows arrogant, haughty behaviors or attitudes.
lawful behaviors as indicated by repeatedly HISTRIONIC PERSONALITY DISORDER
performing acts that are grounds for arrest. Diagnosis criteria for histrionic personality disorder require
2. Deceitfulness, as indicated by repeated lying, use of meeting five (or more) of the following persistent behaviors:
aliases, or conning others for personal profit or 1. Uncomfortable when not the center of attraction.
pleasure. 2. Seductive or provocative behavior.
3. Impulsivity or failure to plan ahead. 3. Shifting and shallow emotions.
4. Irritability and aggressiveness, as indicate by 4. Uses appearance to draw attention.
repeated physical fights or assaults. 5. Impressionistic and vague emotions.
5. Reckless disregard for safety of self or others. 6. Dramatic or exaggerated emotions.
6. Consistent irresponsibility, as indicated by repeated 7. Suggestible (easily influenced by others).
failure to sustain consistent work behavior or honor 8. Considers relationships more intimate than they are.
financial obligations. PRAISE ME (Mneumonic)
7. Lack of remorse, as indicated by being indifferent to P – provocative (or seductive) behavior
or rationalizing. R – relationships, considered more intimate than they are
B. The individual is at least age 18 years. A – attention, must be at center of
C. There is evidence of Conduct Behavior with onset before I – Influenced easily
age 15 years. S – speech (style) – wants to impress, lacks details
D. The occurrence of antisocial behavior is not exclusively E – emotional lability, shallowness
during the course of Schizophrenia or Manic Episode. M – make up – physical appearance used to draw attention
BORDERLINE PERSONALITY DISORDER to self
A pervasive pattern of instability of interpersonal E – exaggerated emotions – theatrical
relationships, self-image, and affects, and marked DEPENDENT PERSONALITY DISORDER
beginning by early adulthood and present in a variety of Beginning by early adulthood and present in a variety of
contexts, as indicated by five (or more) of the following: contexts as indicated by five (or more) of the following:
1. Frantic efforts to avoid real or imagined 1. Has difficulty making everyday decisions without an
abandonment. excessive amount of advice and reassurance from
2. A pattern of unstable and intense interpersonal others.
relationships characterized by alternating between 2. Needs others to assume responsibility for most
extremes of idealization and devaluation. major areas of his or her life.
3. Identity disturbance: markedly and persistently 3. Has difficulty expressing disagreement with others
unstable self-image or sense of self. because of fear of loss of support or approval (this
4. Impulsivity in at least two areas that are potentially does not include realistic fears or retribution).
self-damaging (e.g., spending, sex, substance abuse, 4. Has difficulty initiating projects or doing things on his
reckless driving, binge eating). or her own (because of a lack of self-confidence in
5. Recurrent suicidal behavior, gestures, or threats, or judgment or abilities rather than a lack of motivation
self-mutilating behaviors. or energy).
6. Affective instability due to a marked reactivity of 5. Goes to excessive lengths to obtain nurturance and
mood (e.g., intense episodic dysphoria, irritability, or support from others, to the point of volunteering to
anxiety usually lasting a few hours and only rarely do things that are unpleasant.
more than a few days). 6. Feels uncomfortable or helpless when alone because
7. Chronic feelings of emptiness. of exaggerated fears of being unable to care for
8. Inappropriate, intense anger or difficulty controlling himself or herself.
anger (e.g., frequent displays or temper, constant 7. Urgently seeks another relationship as a source of
anger, recurrent physical fights). care and support when a close relationship ends.
9. Transient, stress-related paranoid ideation or severe 8. Is unrealistically preoccupied with fears of being left
dissociative symptoms. to take care of himself or herself.
NARCISSISTIC PERSONALITY DISORDER AVOIDANT PERSONALITY DISORDER
A pervasive pattern of grandiosity (in fantasy or behavior), A pervasive pattern of social inhibition, feelings of
need for admiration, and lack of empathy, beginning by early inadequacy, and hypersensitivity to negative evaluation,
adulthood and present in a variety of contexts, as indicated beginning by early adulthood and present in a variety of
by five (or more) of the following: contexts, as indicated by four (or more) of the following:
1. Has a grandiose sense of self-importance (e.g., 1. Avoids occupational activities that involve significant
exaggerates achievements and talents, expects to be u=interpersonal contact, because of fears if criticism,
recognized as superior without commensurate disapproval, or rejection.
achievements). 2. Is unwilling to get involved with people unless
2. Is preoccupied with fantasies of unlimited success, certain of being liked.
power, brilliance, beauty, or ideal love. 3. Shows restraint within intimate relationships
3. Believes that he or she is “special” and unique and because of the fear of being shamed or ridiculed.
can be understood by, or should associate with, 4. Is preoccupied with being criticized or rejected inn
other special or high-status people (or institutions). social situations.
4. Requires excessive admiration. 5. Is inhibited in new interpersonal situations because
5. Has a sense of entitlement (i.e., unreasonable of feelings of inadequacy.
expectations of especially favorable treatment or 6. Views self as socially inept, personally unappealing,
automatic compliance with his or her expectations). or inferior to others.
6. Is interpersonally exploitative (i.e., takes advantage
of others to achieve his or her own ends).
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 7. Is unusually reluctant to take personal risks or to  A slowing down of thought and a reduction of physical
engage in any new activities because they may prove movement (observable by others, not merely subjective
embarrassing. feelings of restlessness or being slowed down).
OBSESSIVE-COMPULSIVE PERSONALITY DISORDER  Fatigue or loss of energy nearly every day.
A pervasive pattern of preoccupation with orderliness,  Feelings of worthlessness or excessive or inappropriate
perfectionism, and mental and interpersonal control, at the guilt nearly every day.
expense of flexibility, openness, and efficiency, beginning  Diminished ability to think or concentrate, or
by early adulthood and present in a variety of contexts, as indecisiveness, nearly every day.
indicated by four (or more) of the following:  Recurrent thoughts of death, recurrent suicidal without a
1. Is preoccupied with details, rules, lists, order, specific plan, or a suicide attempt or a specific plan for
organization, or schedules to the extent that the committing suicide.
major point of the activity is lost. EPIDEMIOLOGY
2. Shows perfectionism that interferes with task  Age and Gender – higher in women than it is in men by
completion (e.g., is unable to complete a project almost 2 to 1.
because his or her own overly strict standards are  Women experience more depression than men
not met). beginning at about age 10 and continuing through
3. Is excessively devoted to work and productivity to midlife.
the exclusion of leisure activities and friendships (not  Social Class – both depression and personality disorders
accounted to by obvious economic necessity). have most commonly been found to be outcomes of low
4. Is overconscientious, scrupulous, and inflexible socioeconomic status. (Hudson, 2005)
about matters of morality, ethics, or values (not  Race and Culture – socioeconomic class of the race being
accounted for by cultural or religious identification). investigated.
5. Is unable to discard worn-out or worthless objects
 Clinicians tend to underdiagnose mood disorders
even when they have no sentimental value.
and to over diagnose schizophrenia.
6. Is reluctant to delegate tasks or to work with others
 Depression is more prevalent in whites that it is in
unless they submit to exactly his or her way of doing
blacks, but that depression tends to be more sever,
things.
persistent, and disabling in blacks, and they are less
7. Adopts a miserly spending style toward both self and
likely to be treated.
others; money is viewed as something to be hoarded
 Marital Status – being single was a significant predictor
for future catastrophes.
of depression in the 37- to 49-year old age group, but
8. Shows rigidity and stubbornness.
was not a significant predictor of depression in any of
the other age groups (18-25, 26-36, 50+). (LaPierre,
DEPRESSION 2004)
 Married had a protective effect against major
Mood – is a pervasive and sustained emotion that may have depression. (George, 1992)
a major influence on a person’s perception of the world (e.g.,  Seasonality – suicide  Spring (March-May); Fall
depression, joy, elation, anger, and anxiety). (September to November). (Davidson, 2005)
Affect – is described as the emotional reaction associated TYPES OF DEPRESSIVE DISORDERS
with an experience (Taber’s, 2005). MAJOR DEPRESSIVE DISORDER (MDD)
 Otherwise known as major depressive disorder or Is characterized by depressed mood or loss of interest or
clinical depression, is a common and serious mood pleasure in usual activities.
disorder.  Impaired social and occupational functioning that has
 Those who suffer from depression experience persistent existed for at least 2 weeks, no history of manic
feelings of sadness and hopelessness and lose interest in behavior.
activities they once enjoyed.  Symptoms that cannot be attributed to use of
 Aside from the emotional problems caused by substances or a general medical condition.
depression, individuals can also present with a physical  The diagnosis of MDD is specified according to whether
symptom such as chronic pain or digestive issues. it is a single (the individual’s first encounter) or recurrent
 To be diagnosed with depression, symptoms must be episodes (the individual has a history of previous
present for at least two (2) weeks. episodes).
CRITERIA PERSISTENT DEPRESSIVE DISORDER (Dysthymia)
 The DMS-5 outlines the following criterion to make a Similar to, if somewhat milder than, those ascribed to MDD.
diagnosis of depression. The individual must be Individuals with this mood disturbance describe their mood
experiencing five or more symptoms during the same 2- as sad or “down in the dumps” (American Psychiatric
week period and at least one of the symptoms should Association [APA], 2000).
be either (1) depressed moor or (2) loss of interest or  There is no evidence of psychotic symptoms. The
pleasure. essential feature is a chronically depressed mood (or
 To receive a diagnosis of depression, these symptoms possibly an irritable mood in children or adolescents) for
must cause the individual clinically significant distress most of the day, more days that not, for at least 2 years
or impairment in social, occupational, or other (1 year for children and adolescents).
important areas of functioning. The symptoms must also  The diagnosis is identified as early onset (occurring
not be a result of substance abuse or another medical before age 21 years) or late onset (occurring at age 21
condition. years or older).
 Depressed mood most of the day, nearly every day. PREMENSTRUAL DYSPHORIC DISORDER
 Markedly diminished interest or pleasure in all, or almost Depressed mood, excessive anxiety, mood swings, and
all, activities most of the day, nearly every day. decreased interest in activities during the week prior to
 Significant weight loss when not dieting or weight gain, menses, improving shortly after the onset of menstruation
or decrease or increase in appetite nearly every day. and becoming minimal or absent in the week post-menses
(APA, 2013).

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SUBSTANCE/MEDICATION – INDUCED DEPRESSIVE PSYCHOSOCIAL THEORIES
DISORDER 1. Psychoanalytical Theory – Freud observed that
Direct result of physiologic effects of substance (drug abuse, melancholia occurs after the loss of a loved object, either
medication or toxin exposure). The depressed mood is actually by death or emotionally by rejection, or the loss
associated with intoxication or withdrawal from substances of some other abstraction of value to the individual.
such as alcohol. Amphetamines, cocaine, etc. 2. Learning Theory – Seligman theorized that learned
DEPRESSIVE DISORDER DUE TO ANOTHER MEDICAL helplessness predisposes individuals to depression by
CONDITION imposing a feeling of lack of control over their life
Characterized by symptoms associated with major situation. They become depressed because they feel
depressive episodes that are direct physiological helpless; they have learned that whatever they do is
consequence of another medical condition (APA, 2013). futile.
PREDISPOSING FACTORS 3. Object Loss Theory – The theory of object loss suggests
BIOLOGICAL THEORIES that depressive illness occurs as a result of having been
1. Genetics abandoned by or otherwise separated from a significant
 Twin studies – monozygotic twins indicate that other during the first 6 months of life.
heritability of recurrent major depression is 4. Cognitive Theory – Beck and colleagues (1979) proposed
approximately 37%. a theory suggesting that the primary disturbance in
 Family studies – major depression is 1.5 to 3 times depression is cognitive rather than affective.
more common among first-degree biological SIGNS AND SYMPTOMS
relatives of people with the disorder than among S – sleep (insomnia or hypersomnia)
the general population (APA, 2000). I – interest (diminished interest or pleasure from activities)
 Adoption studies – biological children of parents G – guilt (excessive or inappropriate; feelings of
with mood disorders are at increased risk of worthlessness)
developing a mood disorder, even when they are E – energy (loss of energy or fatigue)
reared by adoptive parents who do not have the C – concentration (diminished or indecisiveness)
disorder (Dubovsky, Davies, & Dubovsky, 2003). A – appetite (decrease or increase; weight loss, weight gain)
2. Biochemical Influences P – psychomotor retardation/ agitation
 Biogenic Amines – deficiency of the S – suicide (recurrent: thoughts of death, suicidal ideation,
neurotransmitters norepinephrine, serotonin, and suicide attempt)
dopamine ate functionally important receptor sites TREATMENT MODALITIES FOR DEPRESSION
in the brain.  Individual Psychotherapy
3. Neuroendocrine Disturbances  Group Therapy
 Hypothalamic-Pituitary-Adrenocortical Axis –  Family Therapy
hypersecretion of cortisol. This elevated serum  Cognitive Therapy
cortisol is the basis for the dexamethasone  Electroconvulsive Therapy
suppression test that is sometimes used to  Light Therapy
determine if an individual has somatically treatable  Transcranial Magnetic Stimulation
depression.  Psychopharmacology
4. Physiological Influences ELECTROCONVULSIVE THERAPY (ECT)
 Medication Side Effects – drugs with direct to CNS  Is the induction of a grand mal (generalized) seizure
(anxiolytics, antipsychotics, sedatives). through the application of electrical current to the brain.
 Neurological Disorders – CVA, Brain Tumors,  Action: Application of Electric Current (70-110 volts) 
Alzheimer’s disease, Parkinson’s disease, and alteration (temporary) of brain’s electrochemical
Huntington’s disease. processes  decreased depression.
 Electrolyte Disturbances - Excessive levels of sodium Note: Action of ECT is not well understood
bicarbonate or calcium can produce symptoms of  Indications:
depression, as can deficits in magnesium and  Primarily used with clients with depression.
sodium. Potassium is also implicated in the  Used as adjunct therapy for patients no longer
syndrome of depression. Symptoms have been responding to antidepressants.
observed with excesses of potassium in the body, as  Contraindications:
well as in instances of potassium depletion.  Brain tumor
 Hormonal Disturbances - Depression is associated  Respiratory diseases (PTB, etc)
with dysfunction of the adrenal cortex and is  Pregnant women (specially with PIH)
commonly observed in both Addison’s disease and Always Remember!!
Cushing’s syndrome. Other endocrine conditions  Duration of administration: 0.5 to 1 second.
include hypoparathyroidism, hyperparathyroidism,  Frequency of treatment: 2 – 3 times weekly.
hypothyroidism, and hyperthyroidism.  Total number of treatments: 6-12 therapies.
 Nutritional Deficiencies - Deficiencies in vitamin B1  Side effect: Seizure (tonic-clonic seizure).
(thiamine), vitamin B6 (pyridoxine), vitamin B12,  Nursing Management
niacin, vitamin C, iron, folic acid, zinc, calcium, and  Informed consent
potassium may produce symptoms of depression  Pre-ECT Medications:
(Schimelpfening, 2009).  Anectine (muscle relaxant)
 Other Physiological Conditions – SLE,  Atropine sulfate (anticholinergic)
cardiomyopathy, congestive heart failure,  Brevital (anesthetic agent)
myocardial infarction, and cerebrovascular accident  NPO
(stroke); infections, such as encephalitis, hepatitis, ECT
mononucleosis, pneumonia, and syphilis; and  Priority: SAFETY
metabolic disorders, such as diabetes mellitus.  Position: post ECT
 Assess V/S, LOC (s/E), presence of gag reflex

NCM 117 – CARE OF PATIENTS WITH MALADAPTIVE PATTERNS OF BEHAVIOR SUBERE, PATRICIA LORRAINE T. | BSN 3G
 ATTITUDE THERAPIES
The main aim of Attitude therapy is to convert a person’s
negative attitude to a positive attitude through a change of
behavior and beliefs by different techniques.
 Types:
 Solid Attitude Therapy/Kind Firmness
 Not Demanding Attitude Therapy
 Passive Friendliness Therapy
 Active friendliness Therapy
 Matter-Of-Fact

MOOD DISORDERS (Depressive and Bipolar Disorders)

 Mood Disorders or Affective Disorders are described by

marked disruptions in emotions (severe lows called
depression or highs called hypomania or mania).
 According to DSM-5 mood disorders have been broadly
categorized as bipolar disorders and depressive
disorders.
 Bipolar is a group of brain disorders that cause extreme
fluctuation in a person’s mood, energy, and ability to
function.
 Bipolar disorders are further categorized as:
 Bipolar I
 Bipolar II
 Cyclothymic Disorder SIGNS AND SYMPTOMS
 Bipolar and related disorder to another medical D – distractibility
condition I – indiscretion
 Substance/medication-induced bipolar and related G – grandiosity
disorder F – flight of ideas
CATEGORIES OF BIPOLAR A – activity increase
 Bipolar I disorder is a manic-depressive disorder that can S – sleep deficit
exist both with and without psychotic episodes. T – talkativeness
 Bipolar II disorder consists of depressive and manic DRUGS
episodes which alternate and are typically less severe  Anti-manic: Lithium Carbonate
and do not inhibit function.  Action: Inhibits the release of norepinephrine and
 Cyclothymic Disorder is a cyclic that causes brief dopamine but not serotonin from stimulated neurons.
episodes of hypomania and depression.  Normalize reuptake of neurotransmitters.
COMPARISON  Nursing Management:
DEPRESSION 1. Obtain baseline: renal, cardiac, thyroid.
Subtypes 2. Monitor WBC for Leukocytopenia and
1. Major Depression/MDD (severe) Agranulocytosis.
- Last for at least 2 weeks. 3. Increase fluid intake.
2. Dysthymic (less severe) 4. Avoid excessive exercises and warm environment.
- Chronic depression for at least 2 year period. 5. Assess for signs of lithium toxicity.
3. Depression Not Otherwise Classified 6. Crosses placenta and enters breast milk and has
- 2 days to 2 weeks. been associated with congenital abnormalities.
BIPOLAR  TERATOGENIC
Subtypes  Therapeutic level of Lithium: 0.5 to 1.5 meq/L
1. Manic  Maintenance dose: 0.6 to 1.2 meq/L
- Last from 1 to 2 weeks.  Elderly: 0.5 to 1.0 meq/L
2. Hypomanic (less severe) ANTIDEPRESSANT: SELECTIVE SEROTONIN REUPTAKE
- Lasts for at least 4 days. INHIBITORS (SSRIs)
3. Bipolar I SSRIs are the most commonly prescribed class of anti-
- Manic + depressive episode (with history of mania). depressants.
4. Bipolar II  An imbalance of serotonin may play a role in
- Depressive episode + hypomania (no history of depression.
mania).  These drugs fight depression symptoms by
5. Cyclothymia decreasing serotonin reuptake in the brain. This
- Hypomania + depress mood that lasts for at least 2 effect leaves more serotonin available to work in the
years. brain.
WHAT’S THE DIFFERENCE?  Sertraline (Zoloft)
Bipolar I – characterized by severe mood shifts or a mix of  Fluoxetine (Prozac, Sarafem)
depression and high-energy phases known as manic  Citalopram (Celexa)
episodes.  Escitalopram (Lexapro)
Bipolar II – known as hypomania. A milder form of bipolar  Paroxetine (Paxil, Pexeva, Brisdelle)
disorder with less-intense mood elevations.  Fluvoxamine (Luvox)

NCM 117 – CARE OF PATIENTS WITH MALADAPTIVE PATTERNS OF BEHAVIOR SUBERE, PATRICIA LORRAINE T. | BSN 3G
 SIDE EFFECTS OF SSRIs ADVERSE EFFECTS
 Nausea 1. TCA Overdose – S/S: Agitation, Stupor, Sedation
 Trouble sleeping Nursing Management
 Nervousness  V/S monitoring and ECG
 Tremors  Maintain patent airway
 Sexual problems  Catharsis or gastric lavage with activated charcoal
SSRIs CAN ALSO BE INDICATED TO 2. Serotonin Syndrome – S/S: Hyperthermia, Hyperreflexia,
 Obsessive-compulsive disorder (OCD) Hypertension
 Panic disorder Nursing Management
 Bulimia  Give Cyproheptadine as antidote or any cholinergic
 Post-traumatic stress disorder (PTSD) stimulants
 Premenstrual dysphoric disorder (PMDD)  Supportive symptomatic care
 Notify physician immediately
 Hot flashes caused by menopause
3. Agranulocytosis
 Anxiety
Nursing Management
ANTIDEPRESSANT: TRICYCLIC ANTIDEPRESSANTS
 Check CBC
(TCAs)  Isolation precaution if necessary
TCAs are often prescribed when SSRIs or other 4. Seizure
antidepressants don’t work. It isn’t fully understood Nursing Management
how these drugs work to treat depression.  Safety and patent airway
 amitriptyline  Side lying position and reorient patient after the
 amoxapine atack
 clomipramine (Anafranil) COMMON SIDE EFFECTS OF ANTIDEPRESSANT
 desipramine (Norpramin)
 doxepin
 imipramine (Tofranil)
SIDE EFFECTS OF TCAs
Common side effects of TCAs can include:
 Constipation
 Dry mouth
 Fatigue
The more serious side effects of these drugs include:
 Low blood pressure
 Irregular heart rate
 Seizures
INTERACTIONS OF TCAs
 Alcohol – decreases effectiveness, increases
sedation effects.
 Tricyclic antidepressants can increase the effects of
Epinephrine in the heart. This can lead to high
blood pressure and problems with heart rhythm.
ANTIDEPRESSANTS: MONOAMINE OXIDASE
INHIBITORS (MAOIs)
MAOIs are older drug that treat depression. They work
by stopping the breakdown of norepinephrine,
dopamine, and serotonin.
 Isocarboxazid (Marplan)
 Phenelzine (Nardil)
 Selegiline (Emsam), which comes as a transdermal patch
 Tranylcypromine (Parnate)
SIDE EFFECTS OF MAOIs
 Nausea
 Dizziness
 Drowsiness
 Trouble sleeping
 Restlessness
INTERACTIONS
 Foods – avoid Tyramine rich foods and beverages(aged
cheese, soy sauce, tofu, draft beer)
 Other Antidepressant drugs
 It can dangerously cause high levels of serotonin
(serotonin syndrome)
Always Remember
 Never give antidepressants at the same time.
 Wait for 2 to 3 weeks before shifting to other drugs

NCM 117 – CARE OF PATIENTS WITH MALADAPTIVE PATTERNS OF BEHAVIOR SUBERE, PATRICIA LORRAINE T. | BSN 3G
 SUBSTANCE RELATED  Moderate Substance Use Disorder four to five
criteria.
DISORDERS  Severe Substance Use Disorder six or more criteria

 Substance abuse can be defined as using a drug in a way

that is inconsistent with medical or social norms and
despite negative consequences.
 Two Groups of Substance-Related Disorders
1. Substance Abuse Disorder (SAD) are common
chronic relapsing illness that are characterized by
drug-seeking and drug-taking behaviors that persist
negative consequences.
2. Substance-Induced Disorders, including intoxication,
withdrawal, and other substance/medication-
induced mental disorders, are caused by the effects
of subdtances. CAUSES
 DSM-5 combines substance abuse and substance  The exact causes of drug abuse, dependence, and
dependence into one called “substance use disorder”. Ti addiction are not known, but various factors are thought
recognized substance-related disorders resulting from to contribute to the development of substance-related
the use of: disorders.
 10 Separate Classes of Drugs  Biological Factors. Children of alcoholic parents are
 Alcohol at a higher risk for developing alcoholism and drug
 Caffeine dependence than are children of non-alcoholic
 Cannabis parents.
 Hallucinogens  Physiological Factor. Children of alcoholics are four
 Inhalants times as likely to develop alcoholism compared with
the general population.
 Opioids
- Some theorists believe that inconsistency in
 Sedatives, hypnotics, or anxiolytics
parent’s behaviour, poor role modelling, and lack of
 Stimulants (including amphetamine-type
nurturing pave the way for the child to adopt a
substances, cocaine, and other stimulants)
similar style of maladaptive coping, stormy
 Tobacco
relationships, and substance abuse.
 Other or unknown substances
 Social and Environmental Factor. Cultural factors,
CRITERIA
social attitudes, peer behaviors, laws, cost, and
 Substance use disorders span a wide variety of problems availability all influence initial and continued use of
arising from substance use, and cover 11 different substances.
criteria. TYPES AND SYMPTOMS
 The 11 DSM-5 Criteria for a Substance Use Disorder  Each substance use disorder is classified as its own
1. Took more extensive amounts/extended time. disorder.
Using the substance in larger amounts of for longer
 The most common Substance Use Disorders
than it’s meant to be.
1. Alcohol. Alcohol is a central nervous system
2. Repeated efforts to control use or quit. Wanting to
depressant that is absorbed rapidly into the
cut down or stop using the substance but nor
bloodstream; initially the effects are relaxation and
succeeding.
loss off inhibition; with intoxication, there is slurred
3. Full time spent using. Consuming a lot of time
speech, unsteady gait, lack of coordination. And
getting, using, or recovering from use of the
impaired attention, concentration, memory, and
substance.
judgement.
4. Craving. Desires and urges to use the substance.
EFFECTS OF ALCOHOL
5. Disregard major roles. Not accomplishing what is
 Blood alcohol concentration (BAC) is the level of alcohol
need to be done at work, home, or school because
in blood.
of substance use.
 A BAC of 0.01 means there is 0.01g of alcohol in 100ml
6. Social or interpersonal dilemmas. Resuming to use
of your blood.
when it causes problems in relationships.
 In an average, healthy person, one standard drink:
7. Missed activities. Giving up significant social,
increases BAC by about 0.02.
occupational or recreational activities because of
substance use.  Takes about one hour to break down but this can be
8. Hazardous use. Using substances again and again different for everyone.
when it places the person in danger.
9. Physical or psychological problems. Extending the
use even if physical or psychological problems arise.
10. Tolerance. Requiring more of the substance to get
the effect the person desires.
11. Withdrawal. Development of withdrawal symptoms,
which can be alleviated by taking more of the HOW LONG ALCOHOL STAYS IN THE BLOOD
substance.  Drinking more than one standard drink per hour will
 In order to be diagnosed with a substance use disorder: increase BAC. The faster the person drinks, the higher his
 Substance Use Disorder the person must meet two BAC.
or more of these criteria within a 12-month period.  When he stops drinking, his BAC will keep rising as the
 Mild Substance Use Disorder possesses two or alcohol in his stomach goes into your blood.
three of the criteria.  The only way to lower his BAC is time. The more drinks he
had, the more times he needs.
NCM 117 – CARE OF PATIENTS WITH MALADAPTIVE PATTERNS OF BEHAVIOR SUBERE, PATRICIA LORRAINE T. | BSN 3G
 Alcohol cannot be removed from the blood by vomiting, psychological pain and induce a sense of euphoria
having a cold shower, or drinking coffee. and well-being.
SHORT-TERM EFFECTS  Opioid intoxication develops soon after the
A healthy person is likely to experience the following: initial euphoric feeling. Symptoms include
 BAC of up to 0.05 apathy, lethargy, listlessnesss, impaired
 Feeling of wellbeing judgement, psychomotor retardation or
 Talkative, relaxed, and more confident agitation, constricted pupils, drowsiness, slurred
 BAC of up to 0.05 to 0.08 speech, and impaired attention and memory.
 Impaired judgement and movement 6. Hallucinogen. Are substances that distort the user’s
 Reduced inhibitions perception of reality and produce symptoms similar
 BAC of up to 0.08 to 0.15 to psychosis, including hallucinations and
 Slurred speech depersonalization.
 Impaired balance, coordination, vision, and reflexes  Hallucinogen intoxication is marked by several
 Unstable emotions maladaptive behavioural or psychological
changes; anxiety, depression, paranoid ideation,
 Nausea and vomiting
ideas of reference, fear of losing one’s mind,
 BAC of up to 0.15 to 0.30
and potentially dangerous behaviour such as
 Unable to walk without help
jumping out the window in the belief that one
 Sleepy
could fly.
 Difficulty breathing 7. Inhalants. Are a diverse group of drugs that includes
 Memory loss anesthetics, nitrates, and organic solvents that are
 Loss of bladder control inhaled for their effects.
 Possible loss of consciousness  The most common substances in this category
 BAC of over 0.30 are Alphatic and Aromatic Hydrocarbons found
 Coma in gasoline, glue, paint thinner, and spray paints.
 Death  Inhalant intoxication involves dizziness,
nystagmus, lack of coordination, slurred speech,
unsteady gait, tremor, muscle weakness, and
blurred vision.
MEDICAL MANAGEMENT
Pharmacologic Management
 Two main purposes
1. To permit safe withdrawal from alcohol, sedative-
hypnotics, and benzodiazepines.
2. To prevent relapse.
BENZODIAZEPINES
Alcohol withdrawal is usually managed with a
benzodiazepine-anxiolytic agent, which is used to suppress
the symptoms of abstinence.
DISULFIRAM (Antabuse)
May be prescribed to help deter clients from drinking.
- SCAM
ACAMPROSATE (Campral)
2. Sedatives, Hypnotics, and Anxiolytics. This class of May be prescribed for clients recovering from alcohol abuse
drugs includes all central nervous system or dependence to help reduce cravings for alcohol and
depressants, barbiturates, non-barbiturates decrease the physical and emotional discomfort that occurs
hypnotics, and anxiolytics, particularly especially in the first few months of recovery.
benzodiazepines. METHADONE
 The effects of the drugs, symptoms of A potent synthetic opiate, is used as a substitute for heroin
intoxication, and withdrawal symptoms are in some maintenance programs.
similar to those of alcohol. LEVOMETHADYL
3. Stimulants (amphetamines, cocaine). Stimulants are Is a narcotic analgesic whose only purpose is the treatment
drugs that stimulate or excite the central nervous of opiate dependence.
system; intoxication from stimulants develops NALTREXONE (ReVia)
rapidly. Is an opioid antagonist often used to treat an overdose. It
 Effects include the high or euphoric feeling, can also be used to treat alcohol abuse.
hyperactivity, hypervigilance, talkativeness, ALCOHOL ANONYMOUS (AA)
anxiety, grandiosity, hallucinations, stereotypic  Was founded in the 1930s by alcoholics; this self-help
or repetitive behaviour, anger, fighting, and ground developed the 12-step program model for
impaired judgement. recovery, which is based on the philosophy that total
4. Cannabis (marijuana). Cannabis is the most widely abstinence is essential and that alcoholics need the
used illicit substance in the United States. help and support of others to maintain sobriety.
 Research has shown that cannabis has short- NURSING ASSESSMENT
term effects of lowering intraocular pressure. Assessment of a client with substance abuse disorder
 Symptoms of intoxication include impaired include:
motor coordination, inappropriate laughter, 1. History. Client with a parent or other family members
impaired judgement, short-term memory, and with substance abuse problems may report a chaotic
distortions of time and perception. family life, although this is not always the case.
5. Opioids. Are popular drugs of abuse because they 2. Thought process and content. During the assessment of
desensitize the user to both physiologic and thought process and content, clients are likely to

NCM 117 – CARE OF PATIENTS WITH MALADAPTIVE PATTERNS OF BEHAVIOR SUBERE, PATRICIA LORRAINE T. | BSN 3G
 minimize their substance abuse, blame others for their  Plan of care.
problems, and rationalize their behaviour.  Teaching plan.
3. Sensorium and intellectual process. Clients generally are  Responses to interventions, teaching, and actions
oriented and alert unless they are experiencing lingering performed.
effects of withdrawal.  Attainment or progress toward the desired
4. General appearance and motor behaviour. Assessment outcome.
of general appearance and behaviour usually reveals WERNICKE-KORSAKOFF SYNDROME
appearance and speech to be normal.  Wernicke-Korsakoff Syndrome is a neurological disorder
5. Self-concept. Clients generally have low self-esteem, caused by the lack of thiamine (vitamin B1).
which they may express directly or cover with grandiose  The disorder includes Wernicke Encephalopathy and
behaviour. Korsakoff Amnesic Syndrome which are not different
NURSING DIAGNOSIS conditions but different stages of the same disease
Based on the assessment data, the major nursing diagnosis (Wernicke-Korsakoff syndrome).
for substance abuse are:  Wernicke's Encephalopathy represents the "acute"
 Risk for injury: related to substance intoxication or phase of the disorder and Korsakoff's amnesic syndrome
withdrawal. represents the disorder progressing to a "chronic" or
 Ineffective denial: related to underlying fears and long-lasting stage.
anxieties.  The disorder's main features are problems in acquiring
 Ineffective coping: related to inadequate support system new information or establishing new memories, and in
or coping skills. retrieving previous memories.
 Imbalance nutrition: less than body requirements WERNICKE’S ENCEPHALOPATHY
related to drinking alcohol instead of eating nourishing  Is a degenerative brain disorder caused by the lack of
food. vitamin B1. It may result from:
 Chronic low self-esteem: related to retarded ego  Alcohol abuse
development.  Dietary deficiencies
PLANNING  Prolonged vomiting
 Treatment outcomes for clients with substance use may  Eating disorders
include the following:  Effects of chemotherapy
 The client will abstain from alcohol and drug use.
 B1 deficiency causes damage to the brain's
 The client will express feelings openly and directly.
thalamus and hypothalamus. Symptoms include:
 The client will verbalize acceptance of responsibility
 Mental confusion
for his or her own behaviour.
 Vision problems
 The client sill practice nonchemical alternatives to
 Coma
deal with stress or difficult situations.
 Hypothermia
 The client will establish an effective after-care plan.
 Low blood pressure
NURSING INTERVENTIONS
 Lack of muscle coordination (ataxia)
 Nursing interventions for a client with substance abuse
KORSAKOFF SYNDROME (Korsakoff’s Amnesic Syndrome)
include:
Is a memory disorder that results from vitamin B1 deficiency
 Providing health teaching for client and family.
and is associated with alcoholism. Korsakoff's syndrome
Clients and family members need facts about the
damages nerve cells and supporting cells in the brain and
substance, its effects, and recovery.
spinal cord, as well as the part of the brain involved with
 Addressing family issues. Without support and help
memory.
to understand and cope, many family members may
 Symptoms include:
develop substance abuse problems of their own,
 Amnesia
thus perpetuating the dysfunctional circle;
treatment and support groups are available to  Tremor
address issues of family members.  Coma
 Promoting coping skills. Nurses can encourage  Disorientation
clients to identify problem areas in their lives and to  Vision problems
explore the ways that substance use may have TREATMENT
intensified those problems.  Treatment involves replacement of thiamine and
EVALUATION providing proper nutrition and hydration. In individuals
 Goals are met as evidenced by: with Wernicke's encephalopathy, it is very important to
 The client was able to abstain from alcohol and drug start thiamine replacement before beginning nutritional
use. replenishment.
 The client was able to express feelings openly and  In some cases, drug therapy is also recommended.
directly.  Stopping alcohol use may prevent further nerve and
 The client was able to verbalize acceptance of brain damage.
responsibility for his or her own behavior.  Most symptoms of Wernicke's encephalopathy can be
 The client was able to practice nonchemical reversed if detected and treated promptly and
alternatives to deal with stress or difficult situations. completely. However, improvement in memory function
 The client was able to establish an effective after- is slow and, usually, incomplete. Without treatment,
care plan. these disorders can be disabling and life-threatening.
DOCUMENTATION GUIDELINES
 Documentation in a client with substance abuse
disorders include:
 Individual findings, including factors affecting,
interactions, nature of social exchanges, specifics of
individual behavior.
 Cultural and religious beliefs, and expectations.
NCM 117 – CARE OF PATIENTS WITH MALADAPTIVE PATTERNS OF BEHAVIOR SUBERE, PATRICIA LORRAINE T. | BSN 3G
  Stabilizing Phase – the patient is getting better.
 Stable Phase – the patient might still experience
hallucinations and delusions but not as severe or
disabling as they were during the acute phase.
DSM-5 TR CRITERIA
A. Characteristics Symptoms (at least 2 of the following)
 Delusions
 Hallucination
 Disorganized speech
 Grossly disorganized or catatonic behavior
 Negative Symptoms
TYPES OF DELUSIONS

SCHIZOPHRENIA AND OTHER 
Erotomatic
Grandiose
PSYCHOSES  Jealous
 Persecutory
SCHIZOPHRENIA  Somatic
 The word schizophrenia comes from the Greek words  Mixed or Unspecified
schizo meaning split, and phrene meaning mind, to  Religious
describe fragmented thinking.  Nihilistic
 Is a diagnostic term used to describe a major psychotic  Delusion of Influence
disorder characterized by disturbances of the following:  Delusion of Reference
 Perception (hallucinations) B. Social – occupational dysfunction: work,
 Thought processes (thought derailment) interpersonal, and self-care functioning below the
 Reality testing (delusions) level achieved before onset
 Feeling (flat or inappropriate affect) C. Duration: continuous signs of the disturbance for at least
 Behavior (social withdrawal) 6 months
 Attention (inability to concentrate) D. Schizoaffective and mood disorders not present and not
 Motivation (cannot initiate or persist in goal- responsible for the signs and symptoms
directed activities) E. Not caused by substance abuse or a general medical
 Formerly known as Dementia Pracox (Emil Kraeplin) disorder.
 Age of onset in men is typically 4 to 6 years earlier than it POSITIVE VS. NEGATIVE SCHIZOPHRENIA
is in women TYPE 1: POSITIVE SYMPTOMS
 Men have a more severe course  Hallucination
 Women have more positive symptoms  Delusion
 Estrogen modulates dopamine function  Incoherence
 Women are more compliant with medications TYPE 2: NEGATIVE SYMPTOMS
 Women tend to have lower blood levels and longer half-  Alogia
lives of medications  Anergia
THREE INESCAPABLE “FACTS” ABOUT SCHIZOPHRENIA  Asocial behavior
 Age at onset: late adolescent and early adulthood  Attention deficits
 Role of stress: Onset and relapse always related to stress  Avolition
 Efficacy of Dopamine Antagonist: Drugs that block  Blunted affect
dopamine receptors are therapeutic  Communication difficulties
Psychosis – is a disruptive mental state in which an individual  Difficulty with abstraction
struggles to distinguish the external world from internally  Passive social withdrawal
generated perception.  Poor grooming and hygiene
DIFFERENTIATE NEUROSIS FROM PSYCHOSIS AS TO:  Poor rapport
 Personality  Poverty of speech
 Reality Testing ETIOLOGY
 Insight  Biochemical Theories
 Delusion  Neurostructural Theories (Brain Atrophy, Cerebral
 Causes/Genetic Factor Blood Flow)
EPIDEMIOLOGY OF SCHIZOPHRENIA  Genetic Theories
 1% of the population develops schizophrenia  Perinatal Risk Factors
 95% suffer lifetime  Family Theories
 50% experience serious side effects from medications  Vulnerability – Stress Model – biologic and
 10% kill themselves psychodynamic predispositions coupled with stress.
FOUR A’s OF SCHIZOPHRENIA (Blueler)  Developmental Theories of Schizophrenia (Erickson)
 A  affective disturbance – inappropriate, or flattened  Sigmund Freud – poor ego boundaries, superego
affect dominance.
 A  autism – preoccupation with the self, with little  Erikson I trust vs. mistrust
concern for external reality  Sullivan – absence of warm, nurturing attention can
 A  associative looseness – the stringing together of result disordered social interactions.
unrelated topics PARANOID
 A  ambivalence – simultaneous opposite feelings  Used to be the most common form of schizophrenia. In
COURSE OF ILLNESS (Overlapping Phases) 2013, the American Psychiatric Association determined
 Acute Phase – the patient experience severe psychotic that paranoia was a positive symptom of the disorder,
symptoms.
NCM 117 – CARE OF PATIENTS WITH MALADAPTIVE PATTERNS OF BEHAVIOR SUBERE, PATRICIA LORRAINE T. | BSN 3G
 so paranoid schizophrenia wasn’t a separate condition.  The biological nature of the disorder and the drugs used
Hence, it was then just changed to schizophrenia. to treat it.
 The subtype description is still used though, because of PSYCHOTHERAPEUTIC PRINCIPLES
how common it is. Symptoms include: 1. NPR (Nurse-Patient Relationship) PRINCIPLES
- Delusions  Focus on behaviour
- Hallucinations  A long term relationship is most therapeutic
- Disorganized speech (word salad, echolalia)  Accept patient but not all behaviors
- Trouble concentrating  Be consistent
- Behavioural impairment (impulse control, emotional  Do not reinforce hallucinations and delusions
lability)  Avoid whispering or laughing if patient cannot hear all of
- Flat affect conversation.
CATATONIC 2. PSYCHOTROPIC DRUGS
 Rare severe mental disorder characterized by striking A. Traditional Antipsychotics
motor behaviour, typically involving either significant  Haloperidol (Haldol)
reductions in voluntary movement or hyperactivity and  Fluphenazine Decanoate (Fluxim)
agitation.  Chlorpromazine (Thorazine)
 In some cases, the patient may remain in a state of B. Atypical Antipsychotics
almost complete immobility, often assuming  Clozapine (Leponex)
statuesque positions. Patients may remain motionless  Risperedone (Risperdal)
in a rigid posture for hours or even days.
 Olanzapine (Zyprexa)
HEBEPHRENIC/DISORGANIZED SCHIZOPHRENIA
 Quetiapine (Seroquel)
 The individual doesn’t have hallucinations or delusions.
 Aripiprazole (Abilify)
Instead they experience disorganized behaviour and
MECHANISM OF ACTION
speech. This can include:
- Flat affect
- Speech disturbances
- Disorganized thinking
- Inappropriate emotions or facial reactions
- Trouble with daily activities
UNDIFFERENTIATED SCHIZOPHRENIA
 The term used to describe when an individual displayed
behaviors that were applicable to more than one type
of schizophrenia. For instance, an individual who had
catatonic behaviour but also had delusions or MAJOR SIDE EFFECTS OF ANTIPSYCHOTIC DRUGS
hallucinations, with word salad, might have been EPS
diagnosed with undifferentiated schizophrenia.
RESIDUAL
 When a person has a previous diagnosis of
schizophrenia but no longer has any prominent
symptoms of the disorder. The symptoms have
generally lessened in intensity.
 Residual schizophrenia usually includes more
“negative” symptoms, such as:
- Flattened affect ANTICHOLINERGIC EFFECTS
- Psychomotor difficulties  Dry mouth
- Slowed speech  Blurred vision
- Poor hygiene  Constipation
TYPES (DSM-5)  Urinary hesitation
1. Paranoid (HIDS)
 Tachycardia
 Hallucinations – auditory EPS - APAT
 Ideas of reference  Elevated prolactin (ammenorhea, galactorrhea,
 Delusions of persecution impotency, decreased libido)
 Suspicion  Sedation
2. Disorganized or Hebephrenic (SIM)  Orthostatic Hypotension
 Silly (behaviour)  Medical Management: ABCD
 Incoherence PISA SYNDROME
 Mannerism A reversible lateral bending of the trunk with a tendency to
3. Catatonic (WAN) lean to one side.
 Woxy (flexibility 3. MILIEU MANAGEMENT PRINCIPLES
 Acute stupor – not moving  Milieu – therapeutic manipulation of the environment
 Negativism  Modify environment to decrease stimulation and for
 Should use ECT safety
 Considered as emergency  Staff consistency is crucial
4. Undifferentiated  Arrange environment to reduce withdrawn behavior
5. Residual  Monitor television watching
 No manifestations but there are remnants
 Protect patient’s self esteem
 Dormant
DEPRESSION AND SUICIDE IN SCHIZOPHRENIA
 Depression is a natural part of schizophrenia.
 Depression is a reaction to schizophrenia
NCM 117 – CARE OF PATIENTS WITH MALADAPTIVE PATTERNS OF BEHAVIOR SUBERE, PATRICIA LORRAINE T. | BSN 3G
 OTHER PSYCHOTIC DISORDERS
SCHIZOAFFECTIVE DISORDER
 Is a psychosis characterized by both affective (mood
disorder) and schizophrenic (thought disorder)
symptoms with substantial loss of occupational and
social functioning.
 Schizophrenic symptoms are dominant but are
accompanied by major depressive or manic symptoms.
 Prognosis is better than schizophrenia.
DELUSIONAL DISORDER
 Display symptoms similar to those seen in patients with
schizophrenia. The following symptoms differentiate
delusional disorders from schizophrenic disorders:
 Delusions have basis in reality.
 One or more delusion for at least a month. Behavior
except delusion doesn’t appear “odd”.
 The patients have not met the criteria for schizophrenia.
 The behavior is relatively normal except in relation to
their delusions.
 If mood episodes have occurred concurrently with
delusions, their total durations has been relatively brief.
 The symptoms are NOT the direct result of a substance-
induced or medical condition.
BRIEF PSYCHOTIC DISORDER
 Includes all psychotic disturbances that last less than
one month and are not related to mood disorder, a
general medical condition, or a substance induced
disorder.
 At least one of the following disturbances must be
present: delusions, hallucinations, disorganized speech,
or grossly disorganized or catatonic behaviour.
SCHIZOPHRENIFORM DISORDER
 Displays symptoms that are typical of schizophrenia and
last at least one month but no longer than six months.
 This cautious approach spares the individual the lifelong
diagnosis of schizophrenia until professionals are
absolutely sure of the diagnosis.
SHCIZOPHRENIA SPECTRUM (DSM-5)

OTHER PSYCHOTIC DISORDERS (DSM-5)

NCM 117 – CARE OF PATIENTS WITH MALADAPTIVE PATTERNS OF BEHAVIOR SUBERE, PATRICIA LORRAINE T. | BSN 3G